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Although organized screening and care management programs improve depression outcomes in primary care, employers purchasing health benefits have not invested in these programs. Researchers used several methods to screen more than 65,000 workers in 16 large companies; they excluded subjects with recent treatment, suicidality, mania, or substance abuse and identified 604 workers who had the same mental health coverage and at least moderate depression. Subjects were randomized to receive usual care through the health plan or to enter a program using specially trained care managers who facilitated entry to specialty treatment, monitored treatment adherence and outcomes, shared this information with providers, and offered eight sessions of telephone cognitive-behavioral therapy to subjects who were not pursuing in-person treatment and were still symptomatic after 2 months.
Significantly more intervention patients than controls received specialty treatment over the year (44% vs. 33%); another 34% received telephone CBT. At 12 months, intervention subjects had significantly greater rates of 50% improvement (31% vs. 22%), remission (26% vs. 18%), and job retention (93% vs. 88%). Intervention recipients also averaged 2 more hours of work per week (annualized increase, 2 weeks). Job performance showed no between-group differences. Intervention recipients were dichotomized into mild and more-severe depression subgroups with no evident between-group differences in symptom and work effects.
Wang PS et al. Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: A randomized controlled trial. JAMA 2007 Sep 26; 298:1401.
Comment
According to the authors, these findings indicate that employers should view mental health treatment for workers not as a cost but as an investment to improve workforce productivity. They estimate that increased work hours achieve an average per-patient value of $1800, exceeding the $100 to $400 per-patient cost of care management and possibly approximating the costs of intervention subjects’ additional mental health visits.
As the authors also note, untreated depression imposes other costs, including those of hiring and training new employees and stress on co-workers. Societal benefits of treatment include decreased suffering, improved marital stability, and contributions to the community outside work. Similar analyses could help sway employers to facilitate treatment for depressed workers, thus reducing stigma and improving the overall mental health of the U.S. workforce.