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 signifi
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