Telephone treatment support improves outcomes for depressed employees

Publication Summary

ED FROM Wang PS, Simon GE, Avorn J, 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;298:1401–11. Correspondence to: Philip Wang, Division of Services and Intervention Research, National Institute of Mental Health, 6001 Executive Blvd, Room 7141, MSC 9629, Bethseda, MD 20892-9629, USA; [email protected] Source of funding: Grants from the National Institute of Mental Health and the Robert Wood Johnson Foundation. c Additional notes and a reference list are published online only at http://ebmh.bmj. com/content/vol11/issue2 C O M M EN TA R Y A lthough depression is associated with profound decrements in quality of life and functional capacity, the greatest societal cost is through lost productivity. Enhancements in the organisation and delivery of care for depression, such as collaborative care, are effective in treating depressive symptoms and have been shown to be cost effective. However care for depression is rarely delivered in the workplace or offered to depressed workers until they are absent from work. The potential for organisational interventions to improve work-related outcomes is substantial. It is perhaps surprising that trials and concurrent economic evaluations have not measured work-related productivity or the economic payback that might be achieved by reduced sickness rates. Wang and colleagues present an important USbased workplace trial, where they adapt collaborative care to an employee population experiencing significant depression. An important element of the intervention was the delivery of medication management and cognitive behavioural therapy (largely over the phone). Case managers were masters-level mental health workers who held caseloads of 50– 70 individuals at any one time. As anticipated, depression outcomes were improved at six and 12 months in line with existing research. However, the most important finding was that people in receipt of collaborative care were more able to stay in employment and experienced less sickness-related absence from work. Although a formal economic evaluation was not presented, it seems highly likely that the economic benefits of improved productivity would more than offset the minimal costs of this effective but low intensity intervention. The challenges to healthcare planners and to employers are to ensure that workplace interventions are prioritised and more widely implemented. This may mean reconsideration of where care is delivered (in the workplace rather than the clinic) and how it is delivered (over the phone rather than face-to-face). At present, mental health care is not generally seen as a priority by employers, and care is offered by heath services only when an individual has ceased to work (or lost their job) as a consequence of depression. Wang’s paper might help to reverse this logically indefensible position. Professor Simon Gilbody, DPhil, MRCPsych Professor of Psychological Medicine and Health Services Research, University of York, York, UK Competing interests: None declared. Therapeutics EBMH May 2008 Vol 11 No 2 47