This project is an effectiveness trial aimed at evaluating the impact of aggressive outreach and treatment of depression on workplace productivity. We are concentrating on the cost of untreated depression to employers and the economic benefits of effective treatment.

The focus on work is a logical extension of the recent trend to expand the outcomes included in clinical trials beyond traditional symptom-improvement measures to broader quality-of-life indicators. Workplace performance has come to take on special importance in this set of expanded outcomes because the ability to work is a critical requirement for most working-age adults, and because employers play a critical role in paying for health insurance. This is especially important for depression, since comparative cost-of-illness studies show that depression is one of the health conditions that has the largest impact on sickness absence and other measures of productivity. The results of clinical studies in which patient self-reports of workplace performance have been included suggest that guideline-concordant depression treatment can have a dramatic effect on this outcome. When coupled with the observations that depression is a highly prevalent condition that has an early age of onset and that typically shows a chronic recurrent course, these results suggest that aggressive outreach and treatment of depression might represent a fairly unique health care investment opportunity for employers.

Despite this evidence, employer-sponsored health insurance programs have created substantially higher barriers for the treatment of mental disorders than physical disorders and continue to create new barriers despite the passage of parity legislation. Employers have serious doubts about the effectiveness of mental health treatments on outcomes that are of importance to the employers: sickness absence, productivity at work, interpersonal relationships at work that can affect the performance of other workers, and prevention of disability. The results of available clinical trials are not persuasive in arguing against these employer concerns because employers perceive these trials to be based on treatment strategies that are much more aggressive and carefully monitored than day-to-day treatment, and because the self-report outcome measures used in these trials are thought to be biased by the cognitive distortions associated with depression. The question for employers is whether real-life treatment delivered in an effectiveness trial framework can be shown to influence the objective measures of productivity that corporations use to monitor the performance of their workers.

This research is designed to answer that question. Our ultimate goal is to persuade employers that it is cost-effective to provide aggressive outreach and treatment of depression for their workers. In order to achieve this goal, the proposed research has the following specific aims:

• provide accurate descriptive data on the current prevalence, 12-month persistence, and occupation-industry-sociodemographic correlates of major depression and dysthymia in a large sample of working people drawn from five sites participating in the research;
• estimate the magnitude of productivity costs associated with untreated depression by linking the depression-prevalence data to three types of work-performance data;
• estimate the impact of aggressive outreach and treatment of depressed workers on the reduction in workplace-performance deficits;
• establish the cost-effectiveness of the intervention, from the perspective of employers, with regard to the balance between direct outreach and treatment costs and indirect savings in terms of workplace performance.

Innovative elements of the proposed research include:

• partnership with large employers during all phases of the research program;
• use of employer-collected work productivity data to evaluate the impact of depression and benefits of treatment;
• use of the Experience Sampling Method to reduce cognitive biases in self-report measures of daily functioning;
• extensive use of telephone treatment services to minimize productivity losses due to time spent in treatment.