This proposal seeks support for an effectiveness trial to evaluate the impact of depression outreach-treatment on work-related behaviors. The trial will differ from others in four ways: (1) We will screen in samples of employed people with Health Risk Appraisal (HRA) surveys rather than in primary care with depression screening scales. (2) Treatment will be provided by specialists working for United Behavioral Health (UBH) rather than by primary care doctors. (3) Detailed assessments of sickness absence, job-related accidents, quantity of work, quality of work, interpersonal relations at work and job turnover will be primary rather than secondary outcomes. (4) Cost-benefit analysis will be used to estimate the net benefit of the program to employers. The trial will be identical to others in outreach and care monitoring methods and in quality assurance. Five employers will collaborate: American Airlines, Delta airlines, the Massachusetts State Employees Association, Northeast Utilities, and Raytheon. There are two design changes: (1) The Group Health Cooperative (GHC) care manager outreach-monitoring model is now the core of the intervention rather than the hybrid GHC-UBH model proposed in the previous submission; (2) APA Evidence-Based Practice Guidelines will be used for quality assurance rather than the hybrid guidelines proposed in the previous submission. The study will be significant in answering a key question posed by employers: Will outreach and guideline-concordant treatment of depressed workers using realistic levels of quality assurance reduce the workplace costs of depression enough to be cost-effective to the employer? Also significant is our dissemination plan.(1) Regional Business Groups on Health and behavioral health management consultants will work with us to disseminate the results in order to create purchaser demand for enhanced depression outreach-treatment. The message to employers will be that depression outreach-monitoring care manager interventions are investment opportunities with positive returns on investment. (2) UBH will offer this outreach-monitoring intervention as a special add-on disease management program, which can be purchased for a premium over the standard plan. This is an extremely important opportunity for rapid and widespread dissemination in an area of research where dissemination of positive results has traditionally been a serious problem.
