Telephone Screening, Outreach, and Care Management for Depressed Workers and Impact on Clinical and Work Productivity Outcomes

Abstract

EPRESSION IMPOSES ENORmous societal burdens, 1-3 with annual US economic costs of tens of billions of dollars due largely to productivity losses. 4,5 Indeed, comparative cost-of-illness studies show that depression is among the most costly of all health problems to employers. [6][7][8][9][10] Despite evidence that guidelineconcordant treatment can be effective, 11-21 many depressed workers are untreated or inadequately treated. [22][23][24][25][26] Effectiveness trials have demonstrated that organized depression screening and enhanced-care programs can significantly improve treatment and clinical outcomes. [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] Based on the magnitude of depression-related lost productivity, one might expect employer-purchasers (ie, those who purchase corporate health benefits) to invest in enhanced depression screening-treatment programs. However, widespread uptake has not occurred 42,43 due in part to employerpurchasers being unsure of the returnon-investment of such programs. 44,45 Few controlled trials have evaluated effects of such programs on work outcomes and those few focused on primary care samples rather than on the workplace samples that would be the focus of em-For editorial comment see p 1451.

Collaborative case management to aid return to work after long-term sickness absence: a pilot randomised controlled trial

“…Case management included brief interventions direct from the case manager for patients who refused to seek help elsewhere, including eight sessions of cognitive-behavioural therapy (CBT) for those with persistent symptoms. 31 The results showed improvements in depression as a result of case management interventions similar in magnitude to existing evidence on collaborative care (approximately one-third of a SD), and better rates of recovery (31% vs. 21%) at 12 months. Patients in case management also reported two additional hours of work per week (approximately 2 weeks of additional work over a 12-month period).…”

“…There have been a of number collaborative care interventions carried out in OH settings, although none in the UK 30,31,[49][50][51][52][53][54] (Table 3). Interventions were generally targeted at specific conditions, including mental health problems such as depression 30,31,49 or musculoskeletal disorders.…”

Individual and Societal Effects of Mental Disorders on Earnings in the United States: Results From the National Comorbidity Survey Replication

“…Experimental interventions are ultimately the only reliable way to resolve this uncertainty and document causal effects of mental disorders on earnings or other indicators of role performance (40). Such interventions are comparatively rare and almost always include only relatively shortterm follow-up.…”

Wishing Upon a STAR*D: The Promise of Ideal Depression Care by Primary Care Providers

“…However, most primary care practices consist of groups of three or fewer physicians (10), and sustaining a full-time care manager would be difficult for small practices. Telephone care management (11) could overcome this barrier if pooled across clinics. However, this requires systemic organization, such as a practice network (12), which is usually not in place in the current health care environment.…”