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Telephone Screening, Outreach, and Care Management for Depressed Workers and Impact on Clinical and Work Productivity Outcomes: A Randomized Controlled Trial
Open accessAbstract
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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“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]
In the citing paper
“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]
In the citing paper
“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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Metadata
- 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
- 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
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01MH061941, R01 MH61941)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Workplace Health and Well-being
- Health Sciences › Medicine › Psychiatry and Mental health › 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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