New Approaches Needed to Manage Gaps in Treatment for Depression

Depression affects more than six percent of the working population. When people with bipolar disorder and other forms of depression are included, the true rate is even higher. But only half of workers suffering from depression receive any form of treatment, and less than half of these receive care consistent with current treatment guidelines according to new studies released by the American College of Occupational and Environmental Medicine (ACOEM) in its April Journal of Occupational and Environmental Medicine.

This special issue of JOEM, the official publication of ACOEM, presents an update on workplace depression, highlighting the need for an integrated, evidence-based approach to managing this common, chronic, and often recurrent disorder.

The 15 papers in the issue, prepared by experts in their fields, are presented as part of the ACOEM Depression in the Workplace Project, a joint venture of the ACOEM Occupational Mental Health Committee and the ACOEM Health and Productivity Section. Project co-directors Drs. Garson M. Caruso and T. Larry Myette will host a special session Wednesday, April 16on Depression in the Workplace during the American Occupational Health Conference, to be held in New York City April 13-16.

Having defined the scope of the problem, the new papers discuss some promising approaches to improving the management of workplace depression. For example, programs to improve coping and stress management skills, identify employees at risk, and promote early treatment may help to prevent or lessen the severity of depression.

New approaches will be needed to manage persistent gaps in treatment for depression. Although antidepressant medications are effective, they do not eliminate symptoms in all patients. Specific types of psychotherapy have proven beneficial, but appear to be underused.

Newer "collaborative care" approaches show promise in improving the outcomes of depression treatment. Although initial costs are higher, these intensive approaches make good business sense -- more effective treatment leads to better employee retention and increased hours worked. For employers, for whom depression is linked to increased unemployment, increased absenteeism, and decreased productivity -- not to mention disruptive effects on work organization and increased health care and disability costs -- such enhanced depression care programs should be viewed not as an added cost, but as a "human capital investment opportunity."

The authors call on the occupational medicine community to play a leadership role in improving the management of workplace depression. Caruso and Myette advocate the development of integrated approaches incorporating the best of clinical, community, and workplace programs. They concluded, "An expanded role for employers and occupational health professionals in the management of depression and other chronic diseases is seen as fundamental to maintaining a healthy and productive workforce."

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