The effects of primary care depression treatment on patients' clinical status and employment.
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.
Schoenbaum
Michael
M
RAND, Arlington, VA 22202, USA.
Unützer
Jürgen
J
McCaffrey
Daniel
D
Duan
Naihua
N
Sherbourne
Cathy
C
Wells
Kenneth B
KB
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