Addressing Depression in the WorkplacePaul Summergrad, M.D.

In this issue of Psychiatric Services, Lerner and colleaguesreport on an expansion of their previous work in applyingpopulation health and telephone care principles to the man-agement of depression in the workforce. The work-focusedintervention (WFI) is a suite of interventions based on estab-lished treatment modalities, such as cognitive-behavioraltherapy (CBT). In addition to lowering absenteeism amongdepressedworkers, a primary objective of theWFI is to reduceso-called presenteeism, which occurs when symptoms of ill-ness impair an individual’s ability to function effectively atwork. The WFI counselor uses a telephone-based protocolto develop a work-focused CBT strategy with the depressedworker. Counseling techniques derived from disability andrehabilitationmodels are also employed to helpworkers createstrategies to master the workplace and enhance their sense ofagency and purpose. Participants in the study by Lerner andcolleagues had screened positive on the PHQ-9 for major de-pressive disorder, persistent depressive disorder, or both. Theaverage PHQ-9 score indicated symptoms in the moderaterange; however, 21% of the entire sample had scores that placedthem in the severe range. Therefore, a secondary objective ofthe WFI was to reduce the severity of depression symptoms.

Lerner and colleagues found statistically significant im-provement among WFI participants, compared with a controlgroup, including improvements in workplace performance,attendance at work, and depression symptoms. Significantlyfor employers, the cost of the intervention was far lower thanthe demonstrable improvement in productivity. In addition,when outcomes of WFI participants were compared withthose of usual-care participants who received treatment froman employer-sponsored employee assistance program (EAP),the statistical significance of the improvements among WFIparticipants was maintained, although the separation betweenWFI participants and the EAP group was not as wide. A head-to-head comparison between the WFI and EAPs for selectedpopulations would help in determining which conditions andwhich outcomes are best targeted by each intervention.

Thefindings of this studymaybe important for other reasons.Given the shortage of psychiatrists and other, nonphysicianmental health clinicians, the ability of this telephone- and

Web-based intervention to provide effective care at thepopulation level has important implications for other settingswhere access to mental health services is limited. Amongthese are public schools, colleges and universities, and otherhealth care settings. Smaller primary care settings, wherecolocating mental health clinicians is often difficult, maystand to derive particular benefit from such interventions.

The burden of psychiatric illness is significant at both theindividual and population levels. Psychiatric disorders, in-cluding those associated with substance use, are the pre-eminent causes of years of life lost to disability among personsbetween the ages of 15 and 45 in the United States and inmanyother developed countries. Even in countries that are un-dergoing transformations from agrarian tomore industrializedeconomies, mental and substance use disorders are majorcauses of disability. It is estimated by the World EconomicForum that the impact of noncommunicable diseases, in-cluding mental disorders, on the direct and indirect costs ofhealth care will escalate markedly between now and 2030.Evenmore striking is the potential impact of mental disordersand cardiovascular illness on total world economic output.

If these burdens in disability, economic loss, and humansuffering were not enough, it is by now well known thatpatients with mental and substance use disorders are morelikely than age-matched peers to have other substantial generalmedical comorbidities and to die at younger ages. In a reportprepared for the American Psychiatric Association, Millimanfound dramatically higher medical costs for patients withmental disorders, primarily driven by the costs of hospital-basedmedical and surgical care. Many of the interventions in clinicalsettings for such patients depend on population screening andon team-based and collaborative care. Further targeted studiesfocusing on depressed populations in general medical settingsmay be worth undertaking to determine whether elements ofthe WFI can be of benefit outside the workplace.

Chairman, Department of Psychiatry, Tufts University School of Medi-cine, and Psychiatrist-in-Chief, Tufts Medical Center, Boston

The rights to the WFI are held by Tufts Medical Center.

Psychiatric Services 2015; 66:561; doi: 10.1176/appi.ps.660602

Psychiatric Services 66:6, June 2015 ps.psychiatryonline.org 561

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