title: Association of psychotherapy with disability benefit claim closure among patients disabled due to depression.
abstract: BACKGROUND
  Depression is the most frequent reason for receiving disability benefits in North America, and treatment with psychotherapy is often funded by private insurers. No studies have explored the association between the provision of psychotherapy for depression and time to claim closure.
  
  
  METHODS
  Using administrative data from a Canadian disability insurer, we evaluated the association between the provision of psychotherapy and short-term disability (STD) and long-term disability (LTD) claim closure by performing Cox proportional hazards regression.
  
  
  RESULTS
  We analyzed 10,508 STD and 10,338 LTD claims for depression. In our adjusted analyses, receipt of psychotherapy was associated with longer time to STD closure (HR [99% CI] = 0.81 [0.68 to 0.97]) and faster LTD claim closure (1.42 [1.33 to 1.52]). In both STD and LTD, older age (0.90 [0.88 to 0.92] and 0.83 [0.80 to 0.85]), per decade), a primary diagnosis of recurrent depression versus non-recurrent major depression (0.78 [0.69 to 0.87] and 0.80 [0.72 to 0.89]), a psychological secondary diagnosis (0.90 [0.84 to 0.97] and 0.66 [0.61 to 0.71]), or a non-psychological secondary diagnosis (0.81 [0.73 to 0.90] and 0.77 [0.71 to 0.83]) versus no secondary diagnosis, and an administrative services only policy ([0.94 [0.88 to 1.00] and 0.87 [0.75 to 0.996]) or refund policy (0.86 [0.80 to 0.92] and 0.73 [0.68 to 0.78]) compared to non-refund policy claims were independently associated with longer time to claim closure [corrected].
  
  
  CONCLUSIONS
  We found, paradoxically, that receipt of psychotherapy was independently associated with longer time to STD claim closure and faster LTD claim closure in patients with depression. We also found multiple factors that were predictive of time to both STD and LTD claim closure. Our study has limitations, and well-designed prospective studies are needed to establish the effect of psychotherapy on disabling depression.
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario Canada. shanil.ebrahim@utoronto.ca
authors.forename: Shanil
authors.initials: S
authors.lastname: Ebrahim
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Guyatt
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Walter
authors.forename: Diane
authors.initials: D
authors.lastname: Heels-Ansdell
authors.forename: Marg
authors.initials: M
authors.lastname: Bellman
authors.forename: Steven E
authors.initials: SE
authors.lastname: Hanna
authors.forename: Irene
authors.initials: I
authors.lastname: Patelis-Siotis
authors.forename: Jason W
authors.initials: JW
authors.lastname: Busse
mesh_terms: D000328:Adult; D002170:Canada / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D007342:Insurance Benefits / Q000706:statistics & numerical data; D018868:Insurance, Disability / Q000706:statistics & numerical data*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011613:Psychotherapy / Q000706:statistics & numerical data*; D062707:Return to Work / Q000706:statistics & numerical data; D016896:Treatment Outcome