Earnings changes for depressed individuals treated by mental health specialists.
OBJECTIVE
It is unclear whether the additional benefits of receiving depression treatment from mental health specialists in routine care pays for the additional costs, compared with treatment delivered by general medical providers. This study examines the difference in lost earnings and the difference in treatment costs experienced by depressed individuals treated in these two sectors.


METHODS
Representative community residents with depression were recruited and interviewed at baseline and at 6-month and 12-month follow-ups. Lost earnings were measured by lost workdays multiplied by subjects' wage rates. Treatment costs were approximated by charges abstracted from provider and insurance records.


RESULTS
After controlling for sociodemographic variables, baseline severity, and baseline comorbidity, the authors found a net mean annual economic savings of $877 associated with depression treatment delivered in the mental health sector compared with the general medical sector. Sensitivity analyses in alternative scenarios indicated similar savings.


CONCLUSIONS
Although it is the trend for primary care providers to provide mental health services, these analyses indicate a net economic savings if depression treatment is provided by mental health specialists, probably as a result of patients' greater functional improvement. As gatekeepers, especially in managed care, primary care providers have a unique responsibility to identify and detect patients with mental health problems. In the current structure, however, they may lack the necessary time to provide effective mental health services. Therefore, mental health specialists play a crucial role, with primary care providers' cooperation (i.e., detection, consultation, and referral), in providing the most cost-effective mental health services.
Zhang
M
M
VA Medical Center, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, USA. mingliang.zhang@merck.com
Rost
K M
KM
Fortney
J C
JC
D000328:Adult; D003156:Community Mental Health Services / Q000191:economics; D015897:Comorbidity; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000191:economics* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics; D012044:Regression Analysis; D012494:Sampling Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome