title: Impact of primary care depression intervention on employment and workplace conflict outcomes: is value added?
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  Primary care interventions that enhance depression treatment and improve clinical outcomes can contribute meaningful added value to society by improving employment and workplace outcomes.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Family Medicine, University of Colorado Health Sciences Center, Colorado 80045-0508; USA. Jeff.Smith@uchsc.edu
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Smith
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Rost
authors.forename: Paul A
authors.initials: PA
authors.lastname: Nutting
authors.forename: Anne M
authors.initials: AM
authors.lastname: Libby
authors.forename: Carl E
authors.initials: CE
authors.lastname: Elliott
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Pyne
mesh_terms: D000328:Adult; D003220:Conflict, Psychological; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000175:diagnosis / Q000191:economics / Q000523:psychology / Q000534:rehabilitation*; D005260:Female; D006291:Health Policy / Q000191:economics; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009784:Occupational Diseases / Q000175:diagnosis / Q000191:economics / Q000523:psychology / Q000534:rehabilitation*; D010348:Patient Care Team / Q000191:economics; D011320:Primary Health Care / Q000191:economics; D016032:Randomized Controlled Trials as Topic; D012050:Rehabilitation, Vocational / Q000191:economics; D016896:Treatment Outcome; D017132:Workplace