This is a revised application (original proposal, """"""""Pathways to Long-Term Outcomes in Depression""""""""). We propose to determine how remission from an initial depressive episode affects long-term (4-year follow-up) economic outcomes, including employment status and labor force participation outcomes, income, and wealth. If improving depressive illnesses also affects policy-relevant outcomes, then patients, practices, and providers may have increased incentives to commit to depression treatment and quality improvement programs. We also propose to estimate how short-term quality improvement programs affect these long-term economic outcomes and how appropriate treatment for depression, provided under naturalistic practice conditions, affects these outcomes. We propose to add four-year follow-up data collection (telephone interviews) for patients who participated in Partners in Care, an AHRQ/ MacArthur/ NIMH-funded Patient Outcomes Research Team (PORT-II). The parent study was a randomized trial of disseminating quality improvement interventions into diverse, nonacademic, community-based, managed, primary care practices in four geographic sites. The parent study evaluation included baseline and two-year follow-up data collector on patients who initially received care in primary care clinics randomized to usual care or one of two depression quality improvement interventions. The current study proposes to use the parent study's data and the new four-year follow-up data. The proposed analyses are a mix of experimental (intent-to- treat) and observational (instrumental variables, structural modeling, decision analysis) analyses. The interdisciplinary investigator team fielded the parent study.
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