Wang Philip S, Simon Gregory E, Avorn Jerry, Azocar Francisca, Ludman Evette J, McCulloch Joyce, Petukhova Maria Z, Kessler Ronald C
Division of Services and Intervention Research, National Institute of Mental Health, Rockville, Maryland, USA.
JAMA. 2007 Sep 26;298(12):1401-11. doi: 10.1001/jama.298.12.1401.
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.
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.
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.
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).
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.
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.
clinicaltrials.gov Identifier: NCT00057590.
尽管遵循指南的抑郁症治疗显然有效，但治疗往往未达到循证医学推荐的标准。有组织的抑郁症护理项目能显著提高治疗质量，但雇主购买方基于从自身角度缺乏成本效益证据，迟迟未采用这些项目。
评估一项抑郁症外展治疗项目对工作场所相关结果的影响，这是雇主所关心的问题。
设计、地点和参与者：一项随机对照试验，通过两阶段筛选过程，从参加管理式行为健康计划的员工中确定604名患有严重抑郁症的员工。患者治疗分配情况保密，在第6个月和第12个月时对抑郁症严重程度和工作表现的评估采用盲法。排除有终生双相情感障碍、物质使用障碍、近期接受精神科专科护理或有自杀倾向的员工。
一个电话外展和护理管理项目鼓励员工接受门诊治疗（心理治疗和/或抗抑郁药物治疗），监测治疗质量的连续性，并通过向提供者提供建议来尝试改善治疗。对不愿接受治疗的参与者提供结构化电话认知行为心理治疗。
抑郁症严重程度（抑郁症状快速自评量表，QIDS）和工作表现（世界卫生组织健康与生产力问卷[HPQ]，一种经过验证的自我报告工具，用于评估工作保留率、缺勤时间、工作表现和关键工作场所事件）。
综合6个月和12个月评估的数据，干预组的QIDS自我报告得分显著更低（康复的相对比值为1.4；95%置信区间为1.1 - 2.0；P = 0.009），工作保留率显著更高（相对比值为1.7；95%置信区间为1.1 - 3.3；P = 0.02），并且与在职的常规护理组相比干预组的工作时长显著更多（β = 2.0；P = 0.02；相当于每年增加2周工作时长的效果）。
一个识别抑郁症并促进有效治疗的系统项目不仅能显著改善临床结局，还能改善工作场所相关结果。后者对雇主在恢复招聘、培训和薪资成本方面的经济价值表明，许多雇主通过对抑郁员工进行外展和强化治疗将获得正的投资回报。
clinicaltrials.gov标识符：NCT00057590。
