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Impact of Primary Care Depression Intervention on Employment and Workplace Conflict Outcomes: Is Value Added?
|Jeffrey L. Smith,1* Kathryn M. Rost,2 Paul A. Nutting,3 Anne M. Libby,4 Carl E. Elliott5 and Jeffrey M. Pyne6|
1B.S., Department of
Family Medicine, University of Colorado Health Sciences Center, Aurora,
CO, and Doctoral Program in Health & Behavioral Sciences, University
of Colorado at Denver, CO, USA
*Correspondence to: Jeffrey L. Smith, Department of Family Medicine,
University of Colorado Health Sciences Center; P.O. Box 6508, Mail Stop F496;
12474 E. 19th Avenue, Bldg. 402; Aurora, Colorado 80045-0508; USA
Tel.: + 1-303-724 9732
Fax: + 1-303-724 9746
Source of Funding: National Institute of Mental Health (R01 MH54444); and John D. and Catherine T. MacArthur Foundation. Dr. Rost is also supported by a National Institute of Mental Health Independent Scientist Award (K02 MH63651). Dr. Pyne is also supported by a Veterans Administration Career Development Award.
Background: Depression causes significant functional impairment in sufferers and often leads to adverse employment outcomes for working individuals. Recovery from depression has been associated with better employment outcomes at one year.
Aims of the Study: The study’s goals were to assess a primary care depression intervention’s impact on subsequent employment and workplace conflict outcomes in employed patients with depression.
Methods: In 1996-1997, the study enrolled 262 employed patients with depression from twelve primary care practices located across ten U.S. states; 219 (84%) of the patients were followed at one year. Intent-to-treat analyses assessing intervention effects on subsequent employment and workplace conflict were conducted using logistic regression models controlling for individual clinical and sociodemographic characteristics, job classification and local employment conditions. To meet criteria for subsequent employment, persons working full-time at baseline had to report they were working full-time at follow-up and persons working part-time at baseline had to report working part-/full-time at follow-up. Workplace conflict was measured by asking patients employed at follow-up whether, in the past year, they had ‘arguments or other difficulties with people at work’.
Results: Findings showed that 92.1% of intervention patients met criteria for subsequent employment at one year, versus 82.0% of usual care patients (c2=4.42, p=.04). Intervention patients were less likely than usual care patients to report workplace conflict in the year following baseline (8.1% vs. 18.9%, respectively; c2=4.11; p=.04). The intervention’s effect on subsequent employment was not mediated by its effect on workplace conflict.
Discussion: The intervention significantly improved employment outcomes and reduced workplace conflict in depressed, employed persons at one year. Economic implications for employers related to reduced turnover costs, for workers related to retained earnings, and for governments related to reduced unemployment expenditures and increased tax receipts may be considerable.
Limitations: Although similar primary care depression interventions have been shown to produce comparable effects on subsequent employment at one year, replications in larger samples of depressed, employed patients in different economic climates may be necessary to increase the generalizability and precision of estimates.
Implications for Health Care Provision and Use: Primary care interventions that enhance depression treatment and improve clinical outcomes can contribute meaningful added value to society by improving employment and workplace outcomes.
Implications for Health Policies: Federal/state governments may realize economic benefits from reduced unemployment expenditures and increased tax receipts should primary care depression interventions that improve employment outcomes be broadly disseminated. Policy initiatives to increase the dissemination of such interventions may be an innovative approach for improving labor force participation by depressed individuals.
Implications for Further Research: Formal cost-benefit analyses are needed to explore whether economic benefits to societal stakeholders from these and other labor outcomes equal or exceed the incremental costs of disseminating similar primary care interventions nationally. Researchers in other nations may wish to consider investigating the impact primary care depression interventions might have on employment and workplace outcomes in their countries.
Received 21 February 2002; accepted 20 June 2002
Copyright © 2002 ICMPE