September 27 2007 - A study by Dr Philip S. Wang and colleagues from the National Institute of Mental Health (NIMH) published in the Journal of the American Medical Association found that employees with significant depression who participated in a program including a telephone outreach and care management service demonstrated fewer symptoms, improved work productivity and greater job retention than those receiving standard care.
Thomas R. Insel, NIMH director, said:
"This study provides compelling evidence of the importance of workplace depression screening, outreach, and enhanced treatment. It is in the interest of workers' health and the company's bottom line to ensure depressed employees are effectively treated."
The researchers point out that depression is one of the most costly health problems for employers. Many workers remain untreated or fail to access effective treatment programs. Employers purchasing corporate health benefits often do not invest in depression screening-treatment programs because of lack of confidence in their cost-effectiveness.
The team conducted a randomized controlled trial with 604 employees covered by a managed behavioral health plan diagnosed with significant depression during Web-based and telephone screening. Just over half (n=304) were offered a telephone outreach and care management program that encouraged them to enter outpatient treatment (psychotherapy and/or antidepressant medication), monitored their progress, and made recommendations to clinicians caring for them. Those reluctant to enter treatment were offered structured telephone cognitive behavioral psychotherapy. The remaining 300 hundred employees received standard care, including feedback about their results and advice to seek help from their usual health care provider.
The researchers found that the severity of depression was significantly lower in the intervention group measured at 6 and 12 months, and that these patients were 40 per cent more likely to have recovered (26.2 per cent compared to 17.7 per cent). Similarly, employees in the intervention group worked an average of two more hours per week and were 70 per cent more likely to stay in work (92.6 per cent compared to 88.0 per cent).
The researchers estimated that the value of the additional hours worked by an employee in the intervention group was approximately US$1800 per year, far exceeding the average program cost of US$100-US$400 per person.
"The results suggest that enhanced depression care of workers has benefits not only on clinical outcomes but also on workplace outcomes. The financial value of the latter to employers in terms of recovered hiring, training, and salary costs suggests that many employers would experience a positive return on investment from outreach and enhanced treatment of depressed workers."
Philip Wang, director of services and intervention research at NIMH added:
"For many people, a large chunk of their lives is devoted to work. Depression affects not only a person's health, but also his or her ability to work. Employers should consider a depression screening and intervention program as a healthy, win-win investment."
In an accompanying editorial, Kenneth B. Wells and Jeanne Miranda of the University of California, Los Angeles commented:
"Exactly how programs to improve depression care are implemented may affect the distribution of benefits - an important issue given evidence of disparities in quality of depression care and the potential for practice-based programs to overcome disparities in depression outcomes. Developers of interventions and policies should consider implications of their design for inclusion of underserved groups who may not seek behavioral health care. Despite the extensive efforts by Wang et al. to reach general employees, the majority of persons had already inquired about outpatient care. Learning how to optimize personal and societal gains by improving access to quality depression care across diverse communities through employer, practice, and community-based programs and policy changes is a next agenda for evidence-based action. As a community participant in the Witness for Wellness program recently stated: 'Depression is everybody's business.'"
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