title: The impact on unemployment of an intervention to increase recognition of previously untreated anxiety among primary care physicians.
abstract: Anxiety is a common, though often unrecognized, problem in primary care settings. This study examines the effect on employment of an intervention designed to attune primary care physicians to previously unrecognized and untreated anxiety. Primary care physicians in a mixed-model health maintenance organization (HMO) were randomized by practice site to groups with (intervention) and without (usual care) intensive one-on-one education about anxiety and periodic feedback about their patients with anxiety. All persons 21-65 years of age presenting to the offices of these primary care providers were screened for anxiety with the SCL-90-R on two occasions. Those meeting the SCL-90-R cutpoints for anxiety and whose medical records provided no evidence of recognition or treatment for a mental health condition within the last 6 months were eligible for the study (n = 637). Of these, 573 (90%) completed two follow-up assessments. The present study evaluates the impact of the intervention aimed at the primary care physicians on the labor force participation rate of the persons with anxiety after 5 months of follow-up. The study also evaluates the impact of the intervention on hours of work and the presence of days spent in bed among the persons with anxiety working at the baseline interview and after 5 months. At baseline, the patients of intervention and usual care physicians with previously unrecognized and untreated anxiety did not differ in labor force participation rates. At the conclusion of the study, the patients of the intervention group physicians had significantly lower rates of labor force participation than those of the usual care group physicians. Among those working both at the beginning and conclusion of the study, the intervention had no impact on hours of work or the presence of days spent in bed. We conclude that attuning physicians may reduce labor force participation rates.
authors.affiliation: Medicine and Health Policy, University of California, San Francisco 94109, USA.
authors.forename: E
authors.initials: E
authors.lastname: Yelin
authors.forename: S D
authors.initials: SD
authors.lastname: Mathias
authors.forename: D P
authors.initials: DP
authors.lastname: Buesching
authors.forename: C
authors.initials: C
authors.lastname: Rowland
authors.forename: R Q
authors.initials: RQ
authors.lastname: Calucin
authors.forename: S
authors.initials: S
authors.lastname: Fifer
mesh_terms: D000041:Absenteeism; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D003120:Colorado; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010353:Patient Education as Topic; D011320:Primary Health Care; D012050:Rehabilitation, Vocational; D016896:Treatment Outcome