Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: A randomized controlled trial | Knowledge Translation for Employment Research Center

Authors:	Wehman, P., Kregel, J., Keyser-Marcus, L., Sherron-Targett, P., Campell, L., West, M., & Cifu, D. X.
Year Published	2007
Publication	The Journal of the American Medical Association
Volume	298
Number	12
Pages	1401-1411
Publisher	American Medical Association
Background	Although guideline-concordant depression treatment is clearly effective, treatment often falls short of evidence-based recommendations. Organized depression care programs significantly improve treatment quality, but employer purchasers have been slow to adopt these programs based on lack of evidence for cost-effectiveness from their perspective.
Purpose	The purpose of this study was to evaluate the effects of a depression outreach-treatment program on workplace outcomes.
Setting	The study was conducted over the telephone with individuals all over the U.S. with behavioral health plan coverage.
Sample	A randomized controlled trial involving 604 employees covered by a managed behavioral health plan were identified in a 2-stage screening process as having significant depression. Patient treatment allocation was concealed and assessment of depression severity and work performance at months 6 and 12 was blinded. Employees with lifetime bipolar disorder, substance disorder, recent mental health specialty care, or suicidality were excluded.
Data Collection	Intervention effects on depression severity were estimated using multiple imputation multiple linear regression with simulated standard errors. QIDS-SR scores at 6 and 12 months were regressed on a dichotomous predictor for randomization status. Dichotomous measures of symptom improvement (?50% reduction in QIDS-SR scores) and complete remission (QIDS-SR scores of ?5) were also examined using multiple imputation multiple logistic regression. Comparable multiple imputation regression analyses were used to estimate intervention effects on work outcomes. The primary outcome was a composite measure of the number of effective hours worked in the prior 7 days, for which participants no longer working contributed no hours and numbers of hours worked by employed respondents were weighted by job performance.
Control	Those assigned to usual care were informed that their responses indicated possible depression and advised to consult with a clinician; they could receive any normally available insurance benefit or service (eg, psychotherapy or pharmacotherapy), just not the additional telephone care management components provided to those in the intervention group.
Findings	The results suggest that enhanced depression care of workers has benefits not only on clinical outcomes but also on workplace outcomes. Combining data across 6- and 12-month assessments, the intervention group had significantly lower QIDS self-report scores (relative odds of recovery, 1.4; 95% confidence interval, 1.1-2.0; P = .009), significantly higher job retention (relative odds, 1.7; 95% confidence interval, 1.1-3.3; P = .02), and significantly more hours worked among the intervention (?=2.0; P=.02; equivalent to an annualized effect of 2 weeks of work) than the usual care groups that were employed.
Conclusions	A systematic program to identify depression and promote effective treatment significantly improves not only clinical outcomes but also 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.
URL	http://www.ncbi.nlm.nih.gov/pubmed/17895456
Disabilities	Emotional disturbance
Populations	Male & Female
Outcomes	Increase in hours worked \| Wages
NIDILRR Funded	No
Research Design	Randomized Controlled Trials (RCTs)
Peer Reviewed	Yes

Year Published

2007

Publication

The Journal of the American Medical Association

Volume

298

Number

12

Pages

1401-1411

Publisher

American Medical Association

Background

Although guideline-concordant depression treatment is clearly effective, treatment often falls short of evidence-based recommendations. Organized depression care programs significantly improve treatment quality, but employer purchasers have been slow to adopt these programs based on lack of evidence for cost-effectiveness from their perspective.

Purpose

The purpose of this study was to evaluate the effects of a depression outreach-treatment program on workplace outcomes.

Setting

The study was conducted over the telephone with individuals all over the U.S. with behavioral health plan coverage.

Sample

A randomized controlled trial involving 604 employees covered by a managed behavioral health plan were identified in a 2-stage screening process as having significant depression. Patient treatment allocation was concealed and assessment of depression severity and work performance at months 6 and 12 was blinded. Employees with lifetime bipolar disorder, substance disorder, recent mental health specialty care, or suicidality were excluded.

Data Collection

Intervention effects on depression severity were estimated using multiple imputation multiple linear regression with simulated standard errors. QIDS-SR scores at 6 and 12 months were regressed on a dichotomous predictor for randomization status. Dichotomous measures of symptom improvement (?50% reduction in QIDS-SR scores) and complete remission (QIDS-SR scores of ?5) were also examined using multiple imputation multiple logistic regression. Comparable multiple imputation regression analyses were used to estimate intervention effects on work outcomes. The primary outcome was a composite measure of the number of effective hours worked in the prior 7 days, for which participants no longer working contributed no hours and numbers of hours worked by employed respondents were weighted by job performance.

Control

Those assigned to usual care were informed that their responses indicated possible depression and advised to consult with a clinician; they could receive any normally available insurance benefit or service (eg, psychotherapy or pharmacotherapy), just not the additional telephone care management components provided to those in the intervention group.

Findings

The results suggest that enhanced depression care of workers has benefits not only on clinical outcomes but also on workplace outcomes. Combining data across 6- and 12-month assessments, the intervention group had significantly lower QIDS self-report scores (relative odds of recovery, 1.4; 95% confidence interval, 1.1-2.0; P = .009), significantly higher job retention (relative odds, 1.7; 95% confidence interval, 1.1-3.3; P = .02), and significantly more hours worked among the intervention (?=2.0; P=.02; equivalent to an annualized effect of 2 weeks of work) than the usual care groups that were employed.

Conclusions

A systematic program to identify depression and promote effective treatment significantly improves not only clinical outcomes but also 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.

URL

http://www.ncbi.nlm.nih.gov/pubmed/17895456

Disabilities

Emotional disturbance

Populations

Male & Female

Outcomes

Increase in hours worked | Wages

NIDILRR Funded

No

Research Design

Randomized Controlled Trials (RCTs)

Peer Reviewed

Yes