title: The work impact of dysthymia in a primary care population.
abstract: Physicians regard individuals with dysthymia as having relatively normal levels of functioning. This study examines in detail the work impact of dysthymia in a population of employed primary care patients. As part of an observational study conducted between 2001 and 2003 in clinics associated with three health plans in Massachusetts, we compared 69 patients diagnosed with DSM-IV dysthymia without concurrent major depressive disorder to 175 depression-free controls. Patients were employed at least 15 h per week, had no immediate plans to leave the labor market, and no major comorbid medical conditions. We assessed work absences and productivity loss due to on-the-job performance limitations ("presenteeism"). Patients with dysthymia, compared with controls, had less stable work histories and a greater frequency of significant problems at work. While absence rates were not significantly different (1.2 vs. 0.74 days, P<.09), individuals with dysthymia experienced significantly greater on-the-job productivity loss (6.3% vs. 2.8%, P<.0001). Dysthymia is an unrecognized cause of work impairment that has long-term negative consequences for individuals and their employers. The persistence of dysthymia with its serious impact on work functioning calls out for the development of new interventions.
authors.affiliation: The Health Institute, Institute of Clinical Research and Health Policy Studies, Tufts-New England Medical Center, 750 Washington Street, Box 345, Boston, MA 02111, USA. dadler@tufts-nemc.org
authors.forename: David A
authors.initials: DA
authors.lastname: Adler
authors.forename: Julie
authors.initials: J
authors.lastname: Irish
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: McLaughlin
authors.forename: Carla
authors.initials: C
authors.lastname: Perissinotto
authors.forename: Hong
authors.initials: H
authors.lastname: Chang
authors.forename: Maggie
authors.initials: M
authors.lastname: Hood
authors.forename: Leueen
authors.initials: L
authors.lastname: Lapitsky
authors.forename: William H
authors.initials: WH
authors.lastname: Rogers
authors.forename: Debra
authors.initials: D
authors.lastname: Lerner
mesh_terms: D000293:Adolescent; D000328:Adult; D039721:Diagnostic and Statistical Manual of Mental Disorders; D019263:Dysthymic Disorder / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D004526:Efficiency; D004650:Employee Performance Appraisal; D004651:Employment / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data