Phillip Wang et al¹ published a report in JAMA demonstrating a real return on investment from simple mental health interventions. This study is important because it was well done. It was a randomized control trial involving 604 employees who had been identified as having depression from a larger pool of workers. The study was conducted by the National Institutes of Mental Health.

The employees were enrolled in United Behavioral Health. This is a large managed behavioral health care company. Initially 7978 workers were approached for screening of which 6456 completed the initial assessment. Of those 604 workers were identified as having possible depression and subsequently randomized to usual care or the intervention. Patients with lifetime bipolar disorder, substance disorder, recent mental health specialty care or suicidality were excluded. These are important disorders but would have made the study results more difficult to interpret.

Assessments were made for both groups at 6 and 12 months measuring depression and work performance. The group assignment was blinded from those making the assessments.

The intervention was simple telephone outreach and care management. The program encouraged workers to participate in available outpatient treatment, monitored treatment quality continuity, and attempted to improve treatment by giving recommendations to providers. Participants who were reluctant to enter treatment were offered structured telephone cognitive behavioral psychotherapy.

The intervention group had significantly improved depression scores, higher job retention, and worked more hours. The number of additional hours was an annualized effect of 2 weeks.

This study is important for employers because depression is so common. It affects 16% of adults in their lifetime². In addition there is a multiplier effect when depression is combined with other illness.

These types of interventions are readily available in the marketplace and should be considered by employers wishing to improve productivity and reduce cost.

Michael D. Rohwer MD.

¹. 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(12) 1401-1411

². Kessler RC, Berglund P, Demler O, et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS_R). JAMA 2003;289(23):3095-3105