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Cited by 409Workplace Health and Well-beingMental Health Treatment and AccessDigital Mental Health Interventions

Telephone Screening, Outreach, and Care Management for Depressed Workers and Impact on Clinical and Work Productivity Outcomes: A Randomized Controlled Trial

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Wang, Philip S., Simon, Gregory E., Avorn, Jerry, Azocar, Francisca, Ludman, Evette J., McCulloch, Joyce, Petukhova, Maria Z., Kessler, Ronald C.·2007·JAMA
DOI 10.1001/jama.298.12.1401PMC PMC2859667
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Abstract

CONTEXT: 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. OBJECTIVE: To evaluate the effects of a depression outreach-treatment program on workplace outcomes, a concern to employers. DESIGN, SETTING, AND PARTICIPANTS: 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. INTERVENTION: A telephonic outreach and care management program encouraged workers to enter outpatient treatment (psychotherapy and/or antidepressant medication), monitored treatment quality continuity, and attempted to improve treatment by giving recommendations to providers. Participants reluctant to enter treatment were offered a structured telephone cognitive behavioral psychotherapy. MAIN OUTCOME MEASURES: Depression severity (Quick Inventory of Depressive Symptomatology, QIDS) and work performance (World Health Organization Health and Productivity Questionnaire [HPQ], a validated self-report instrument assessing job retention, time missed from work, work performance, and critical workplace incidents). RESULTS: 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 (beta=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. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00057590.

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  • Expanded treatment for major depressive disorder can reverse many of its adverse effects.

    “Although effectiveness trials show that expanded MDD treatment can reverse many of these adverse effects, only a minority of people with MDD receives treatment and the quality of treatment is unacceptably low among the majority of those in treatment.”

    From The Costs of Depression (2012) · cites this paper as [129]

  • Two large-scale randomized workplace depression treatment effectiveness trials in the US evaluated cost-effectiveness from an employer perspective and both had positive returns-on-investment to employers; a substantial expansion of worksite depression care management programs occurred in the US after publication.

    “Two separate large-scale randomized workplace depression treatment effectiveness trials have been carried out in the US to evaluate the cost-effectiveness of expanded treatment from an employer perspective.129, 130 Both trials had positive returns-on-investment to employers. A substantial expansion of worksite depression care management programs has occurred in the US subsequent to the publication”

    From The Costs of Depression (2012) · cites this paper as [129]

  • Workers who receive treatment are more likely to be highly productive.

    “workers who receive treatment are more likely to be highly productive [10,11].”

    From Improving Employee Well-Being and Effectiveness: Systematic Review and Meta-Analysis of Web-Based Psychological Interventions Delivered in the Workplace (2017) · cites this paper as [11]

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Research works printed but not linked: 5

  1. [4]Greenberg PE, Kessler RC, Nells TL, Finkelstein SN, Berndt ER. Depression in the workplace: an economic perspective. In: Feighner JP, Boyer WF, editors. Selective serotonin re-uptake inhibitors: advances in basic research and clinical practice. 2 ed. John Wiley & Sons; New York, NY: 1996. pp. 327–363. [Google Scholar]
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  3. [58]Simon GE, Ludman EJ, Tutty S. Creating a Balance: A Step-by-Step Approach to Managing Stress and Lifting Your Mood. Trafford Press; Victoria, BC: 2006. [Google Scholar]
  4. [61]Beck A, Rush A, Shaw B, Emery G. Cognitive Therapy of Depression. Guilford Press; New York, NY: 1987. [Google Scholar]
  5. [83]Ryder R. Implementation strategies and applications for health risk appraisals. In: Hyner GC, Peterson KW, Travis JW, Dewey JE, Foerster JJ, Framer EM, editors. SPM Handbook of Health Assessment Tools. Society for Prospective Medicine and the Institute for Health and Productivity Management; Pittsburgh, PA: 1999. pp. 179–184. [Google Scholar]

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Authors
Wang, P. S., Simon, G. E., Avorn, J., Azocar, F., Ludman, E. J., McCulloch, J., Petukhova, M. Z., & Kessler, R. C.
Affiliations
National Institute of Mental Health (US)
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2007-09-26
Volume
298
Issue
12
Pages
1401
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.298.12.1401
PMC
PMC2859667
OpenAlex
W2047011180
Cited by
408
References
80
Citations by year
2026: 4 · 2025: 7 · 2024: 11 · 2023: 19 · 2022: 14 · 2021: 15 · 2020: 9 · 2019: 16 · 2018: 20 · 2017: 24 · 2016: 14 · 2015: 24 · 2014: 27 · 2013: 26 · 2012: 36
FWCI
69.50
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (R01MH061941, R01 MH61941)
Topics
  • Health Sciences › Health Professions › General Health Professions › Workplace Health and Well-being
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Keywords
telephone outreach, care management, labor productivity, job retention, employee performance, cognitive behavioral therapy, medication adherence, cost-effectiveness
MeSH terms
Absenteeism, Adult, Ambulatory Care, Antidepressive Agents, Community-Institutional Relations, Depression, Efficiency, Female, Humans, Male, Managed Care Programs, Mass Screening, Mental Health Services, Middle Aged, Outcome and Process Assessment, Health Care, Telephone, United States, Cognitive Behavioral Therapy, Occupational Health

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