title: The effects of primary care depression treatment on patients' clinical status and employment.
abstract: OBJECTIVE
  To evaluate the effects of depression treatment in primary care on patients' clinical status and employment, over six months.
  
  
  METHODS
  Data are from a randomized controlled trial of quality improvement for depression that included 938 adults with depressive disorder in 46 managed primary care clinics in five states.
  
  
  METHODS
  Observational analysis of the effects of evidence-based depression care over six months on health outcomes and employment. Selection into treatment is accounted for using instrumental variables techniques, with randomized assignment to the quality improvement intervention as the identifying instrument.
  
  
  METHODS
  Patient-reported clinical status, employment, health care use, and personal characteristics; health care use and costs from claims data.
  
  
  RESULTS
  At six months, patients with appropriate care, compared to those without it, had lower rates of depressive disorder (24 percent versus 70 percent), better mental health-related quality of life, and higher rates of employment (72 percent versus 53 percent), each p<.05.
  
  
  CONCLUSIONS
  Appropriate treatment for depression provided in community-based primary care substantially improves clinical and quality of life outcomes and employment.
authors.affiliation: RAND, Arlington, VA 22202, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Schoenbaum
authors.forename: Jürgen
authors.initials: J
authors.lastname: Unützer
authors.forename: Daniel
authors.initials: D
authors.lastname: McCaffrey
authors.forename: Naihua
authors.initials: N
authors.lastname: Duan
authors.forename: Cathy
authors.initials: C
authors.lastname: Sherbourne
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Wells
mesh_terms: D003866:Depressive Disorder / Q000453:epidemiology / Q000628:therapy*; D004651:Employment / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D006302:Health Services Research; D006304:Health Status; D006801:Humans; D008329:Managed Care Programs / Q000592:standards; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D011785:Quality Assurance, Health Care; D011788:Quality of Life; D018434:Sickness Impact Profile; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology