Depression in the Workplace: Treatment Program Can Improve Productivity Outcomes

An outreach treatment program for depression in the workplace can significantly lower depressive symptoms among employees, improve job retention, reduce absences, and increase work productivity, according to Philip S. Wang, MD, and colleagues. The researchers, who reported their findings in the September 26 JAMA, believe that employers would experience a positive return on investment from such a program.

Study participants were employees of 16 large companies who screened positive for possible depression on a health risk appraisal survey and were contacted via telephone and given a survey that included the Quick Inventory of Depressive Symptomatology–Self-Report (QIDS-SR); those with a score of 8 or higher had moderate or severe depression and were eligible for randomization. A total of 304 participants were randomized to receive a free-of-charge, structured telephone intervention program that systematically assessed the need for treatment and encouraged employees to enter outpatient treatment with psychotherapy and/or antidepressant medication. The program also provided support for treatment adherence, monitored treatment quality and continuity, and made recommendations to clinicians.

Another 300 participants were randomized to usual care, informed that they had possible depression, and advised to consult with a clinician. They were allowed to access any usual available insurance benefit or service, such as psychotherapy or pharmacotherapy.

ENHANCED INTERVENTION FOR DEPRESSION

“Workers in the intervention group worked an average of two more hours per week than workers in the usual care group, which is equivalent to an annualized effect of more than two weeks of work,” noted Dr. Wang, Director of the Division of Services and Intervention Research at the NIMH, and colleagues. This, coupled with increased job retention (at 12 months, 92.6% in the intervention group vs 88% in the usual care group; odds ratio [OR], 1.7), resulted in a significant 2.6-hour improvement per week in overall work function among intervention participants. At six months, QIDS-SR scores were significantly lower among those provided with the intervention than in those who received usual care, with mean scores of 10.2 and 11.2, respectively. Substantial depression symptom improvement (≥50% reduction in QIDS-SR score) occurred in a larger proportion of the intervention group than in the usual care group at six months; by 12 months, the difference was significant (30.9% of the intervention group and 21.6% of the usual care group). More than one-quarter of the intervention group experienced recovery at 12 months with a QIDS-SR score of 5 or less, significantly greater than those receiving usual care (17.7%).

Those assigned to the intervention group were also 1.6 times more likely to receive any mental health specialty treatment compared with those in usual care, but they were less likely to receive depression treatment in primary care or nonmedical settings (ORs, 0.7 and 0.6, respectively). Intervention patients also had more treatment contacts during the 12-month study, with a mean of 12.7, compared with a mean of 6.5 treatment contacts in the usual care group.

REDUCED DEPRESSION LEADS TO EMPLOYER COST SAVINGS

Although a formal evaluation of the intervention’s return on investment to employers is not yet possible, the investigators asserted that “the $1800 annualized value of higher mean hours worked among intervention participants retaining their jobs by itself far exceeds the $100 to $400 outreach and care management costs associated with low- to moderate-intensity interventions.” They proposed that companies view outreach and enhanced care for depressed employees as an investment in worker productivity rather than a workplace cost.

In an accompanying editorial, Kenneth B. Wells, MD, and Jeanne Miranda, PhD, of the Department of Psychiatry and Biobehavioral Services at the University of California, Los Angeles, noted that depression interventions offer advantages for employees with depression, their family and friends, their employers, and society. Drs. Wells and Miranda also pointed out that insurance policy changes need to avoid undermining the goals of such programs, for example, the exclusion of depression treatment from health care coverage when an employee changes jobs or insurance, based on a recent history of treatment in an employer-based depression program. “Under such an ill-advised policy, the risk of losing coverage would serve as a major deterrent to seeking care,” they asserted.

“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,” concluded the editorialists.