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

ArticleinGeneral Hospital Psychiatry 22(3):153-62 · May 2000with7 Reads
Impact Factor: 2.61 · 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.

    • "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 · Open Journal of Psychiatry
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    • "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 · Medycyna pracy
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    • "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: Streszczenie Osoby z zaburzeniami psychicznymi stanowią w Polsce liczną grupę. W 2010 r. psychiatryczną opieką ambulatoryjną obję-tych było prawie 1,5 mln osób, natomiast w całodobowych oddziałach psychiatrycznych leczono około 200 tys. chorych. Jedy-nie 17% osób niepełnosprawnych psychicznie jest aktywnych zawodowo. Badania dowodzą, że mimo niekorzystnego wpływu zaburzeń psychicznych na zatrudnienie (np. obniżona produktywność, absentyzm, prezentyzm, zwiększone ryzyko wypad-ków w pracy), praca może mieć kluczowe znaczenie dla stabilizacji stanu psychicznego, a także może pomóc w powrocie do zdrowia. Osoby z zaburzeniami psychicznymi są grupą społeczną najbardziej narażoną na wykluczenie z rynku pracy. Wśród pracodawców przeważa opinia, że osoby chorujące psychicznie mają ograniczoną zdolność do pracy zawodowej, a społecz-ne postawy wobec nich cechuje tendencja do naznaczania i piętnowania. W artykule omówiono korzyści dla zdrowia wyni-kające z podjęcia pracy w przebiegu choroby psychicznej, bariery napotykane przez chorych w podejmowaniu i kontynuowa-niu pracy oraz zawodowe funkcjonowanie osób z rozpoznaną depresją (będącą przykładem zaburzeń afektywnych) i schizo-frenią (będącą przykładem zaburzeń psychotycznych). Analiza dostępnych danych wskazuje, że w celu polepszenia sytuacji osób chorujących psychicznie na rynku pracy konieczna jest ścisła współpraca przedstawicieli różnych specjalności medycz-nych i ich aktywne zaangażowanie w proces rehabilitacji społeczno-zawodowej osób dotkniętych zaburzeniami psychicznymi. Med. Pr. 2015;66(1) Słowa kluczowe: zaburzenia psychiczne, schizofrenia, depresja, zatrudnienie, aktywność zawodowa, powrót do pracy 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 the stabilization 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 schizophre-nia (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. Med Pr 2015;66(1)
    Full-text · Article · Mar 2015 · Medycyna pracy
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