Recovery from Depression, Work Productivity, and Health Care Costs among Primary Care Patients

ArticleinGeneral Hospital Psychiatry 22(3):153-62 · May 2000with12 Reads
DOI: 10.1016/S0163-8343(00)00072-4 · Source: PubMed
Abstract
We describe a secondary analysis of data from a randomized trial conducted at seven primary care clinics of a Seattle area HMO. Adults with major depression (n=290) beginning antidepressant treatment completed structured interviews at baseline, 1, 3, 6, 9, 12, 18, and 24 months. Interviews examined clinical outcomes (Hamilton Depression Rating Scale and depression module of the Structured Clinical Interview for DSM-IIIR), employment status, and work days missed due to illness. Medical comorbidity was assessed using computerized pharmacy data, and medical costs were assessed using the HMO's computerized accounting data. Using data from the 12-month assessment, patients were classified as remitted (41%), improved but not remitted (47%), and persistently depressed (12%). After adjustment for depression severity and medical comorbidity at baseline, patients with greater clinical improvement were more likely to maintain paid employment (P=.007) and reported fewer days missed from work due to illness (P<.001). Patients with better 12-month clinical outcomes had marginally lower health care costs during the second year of follow-up (P=.06). We conclude that recovery from depression is associated with significant reductions in work disability and possible reductions in health care costs. Although observational data cannot definitively prove any causal relationships, these longitudinal results strengthen previous findings regarding the economic burden of depression on employers and health insurers.
    • "Depression is the second leading cause of disability worldwide (Ferrari et al., 2013 ). In comparison to those with active depression , individuals in remission from depression are better able to maintain employment and may require fewer health care services (Simon et al., 2000 ). Of particular interest to clinicians and patients is the possibility of moving beyond mere remission of depressive symptoms to the attainment of complete mental health. "
    [Show abstract] [Hide abstract] ABSTRACT: This study investigated factors associated with complete mental health among a nationally representative sample of Canadians with a history of depression by conducting secondary analysis of the 2012 Canadian Community Health Survey- Mental Health (n=20,955). Complete mental health was defined as 1) the absence of mental illness, substance abuse, or suicidal ideation in the past year; 2) happiness or life satisfaction almost every day/past month, and 3) social and psychological well-being. The prevalence of complete mental health among those with and without a history of depression was determined. In a sample of formerly depressed respondents (n=2528), a series of logistic regressions were completed controlling for demographics, socioeconomic status, health and lifetime mental health conditions, health behaviours, social support, adverse childhood experiences, and religiosity. Two in five individuals (39%) with a history of depression had achieved complete mental health in comparison to 78% of those without a history of depression. In comparison to the formally depressed adults who were not in complete mental health, those in complete mental health were more likely to be female, White, older, affluent, married, with a confidant, free of disabling pain, insomnia, and childhood adversities and without a history of substance abuse. They were also more likely to exercise regularly and use spirituality to cope.
    Article · Apr 2016
    • "The lack of employment results in financial difficulties, and poverty results in reduced opportunity to obtain gainful employment. Unemployed persons and those who fail to obtain employment have more depressive symptoms than individuals who can get a job [2] . None of the participants has higher educational background (40% of the participants have the primary 4th grade, 6% have the primary 5th grade, 21% have the primary 6th grade, 15% have the primary 9th grade, 3% have the primary 11th grade and 15% have the primary 12th grade). "
    [Show abstract] [Hide abstract] ABSTRACT: Economic insufficiency causes stress and negative affects. Poverty is self-perpetuated, also due to a particular pattern of economic behaviors induced by negative affects and stress. Often, loneliness occurs together with economic insufficiency. For this study, it has been selected a sample of convenience. A positive correlation between anxiety/depression and negative affects is presented. Dispositional optimism and social support, factors which contribute to health, serve as buffers, in negative correlation, of the negative impact of negative affects, due to financial restraint , on health. Financial management is negatively correlated with the lack of cardiovascular health, and cardiovascular dysfunction correlates positively with loneliness, in this study. Positive affects correlate positively with resilience skills, which correlate negatively with depression. Within this context, psychobiological therapeutic interventions and psychotherapy, which also target psychological dysfunction related to economic behavior of persons in a situation of poverty , would be beneficial.
    Full-text · Article · Nov 2015
    • "Okazuje się, że poprawa funkcjonowania pacjentów z dużą depresją nie następuje równoczasowo z redukcją objawów chorobowych. Stwierdzono, że około 60% pacjentów z depresją po roku od zakończenia farmakoterapii nadal wykazuje co najmniej umiarkowane upośledzenie funkcjonowania zawodowego [44]. Dużą rolę w poprawie zawodowego funkcjonowania pacjentów dotkniętych zaburzeniami depresyjnymi odgrywają programy wsparcia. "
    [Show abstract] [Hide abstract] ABSTRACT: In Poland patients with psychiatric problems form a large group; in 2010 there were almost 1.5 million people for whom outpatient psychiatric care was provided, whereas approximately 200 thousand ill individuals were treated in 24-h psychiatric wards. Only 17% of the mentally disabled are professionally active. The results of many researches show that despite the detrimental influence of mental disorders on the employment (e.g., lower productivity, absenteeism, presenteism, increased risk of accidents at the workplace), professional activity can play a key role in the7stabilization of the mental state, it can also help in disease recovery. People with mental disorders are a social group that is at the higher risk of exclusion from the job market. The opinion prevailing among employers is that mentally ill individuals have decreased ability to conduct professional activity, and social attitudes towards them tend to be based on marking and stigmatizing. This review tackles the advantages of working during the illness, barriers which people with mental disorders face on the job market when they want to either start or continue work, and professional functioning of people with diagnosed depression (e.g., affective disorders) and schizophrenia (representing psychotic disorders). The analysis of existing data show that to improve the situation of mentally ill people present on the job market close cooperation between the representatives of various medical specializations is necessary, as well as their active participation in the process of social and professional rehabilitation of people affected by mental disorders.
    Full-text · Article · May 2015
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