Study found significant improvement in symptoms and productivity
TUESDAY, Sept. 25 (HealthDay News) -- Employees struggling with depression who participated in a workplace program that used a care manager to guide them through treatment saw an improvement in their symptoms as well as greater productivity.
The authors of the study, which is published in the Sept. 26 issue of the Journal of the American Medical Association, are hoping the findings will spur employers to view health-care benefits in a different and more positive light.
"Usually, health-care benefits are viewed by the people who purchase them -- employers -- as just a cost. They assume that whatever cost they spend on workers' health, they won't see anything back," said Dr. Philip S. Wang, lead author of the study and director of the division of services and intervention research at the National Institute of Mental Health.
"One of the implications of our findings is that employers-purchasers would actually see a return on their investment and may be better able to conceive of benefits to workers, particularly vis-a-vis depression, as kind of an opportunity. You put something in, and you will get something back. This is a different model from how employers view mental-health care and health care in general."
Dr. Ewald Horwath, professor of psychiatry, epidemiology and public health at the University of Miami Miller School of Medicine, called the study finding "extremely significant, because it demonstrates that an intervention which improved access to care for depression not only improves outcome for depression but also work performance.
"What is not sometimes recognized is that depression is the second leading cause of disability throughout the world," Horwath said. "A study showing it can improve outcome in terms of work productivity and attendance is enormously important in terms of relieving people's suffering and potential productivity."
Personal suffering aside, depression costs the United States tens of billions of dollars a year, largely as a result of lost productivity. The malady is, according to background information in the study, one of the most costly health problems for employers.
And, while there are effective treatments, not everyone dealing with depression is treated or is treated well.
For this study, the first to be conducted exclusively among employed people, 604 employees with depression who were covered by a managed care behavioral health plan were randomly assigned to either to a care management program or to usual care. Employees with lifetime bipolar disorder, substance-abuse issues, suicidal tendencies, or recent mental health specialty care were excluded from the study.
The intervention effort consisted of telephone outreach and care management with a clinician who helped guide the employees through treatment.
"The care manager conducted outreach with workers who were identified as being depressed, tried to educate them about what depression was and tried to encourage them to get treatment if the symptoms were serious and not resolving," Wang explained. "When they got into treatment, the care manager tried to support them."
For example, if the patient was experiencing side effects from medication, the manager would encourage them to talk to their doctor and help them stay on the medication. If the patient was not interested in traditional, in-person treatments, the care manager would deliver psychotherapy via telephone. There were no restrictions on the type of treatment a patient could seek.
"By design, we wanted the intervention to be both feasible and very inexpensive," Wang said.
The "usual care" program consisted of screening as well as "nudging" the person toward treatment.
After six months and also one year, measurements of depression severity were significantly lower in the intervention group. Patients in the intervention group were more likely to recover (26.2 percent versus 17.7 percent) than people in the usual care group.
And people in the intervention group also worked an average of 2.6 more hours per week than workers in the usual care group, equivalent to about two more weeks a year. There was also higher job retention in the intervention group -- 92.6 percent versus 88 percent.
"The intervention was very practical," Horwath said. "They were augmenting what was already available with most managed care."
The National Institute of Mental Health has more on depression.
SOURCES: Philip S. Wang, M.D., Dr.P.H., director of division of services and intervention research, National Institute of Mental Health, Bethseda, Md.; Ewald Horwath, M.D., professor of psychiatry, epidemiology and public health and executive vice chair, department of psychiatry, University of Miami Miller School of Medicine; Sept. 26, 2007, Journal of the American Medical Association
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