Outreach and Treatment for Depression in the Labor Force

描述（由申请人提供）：本提案寻求对有效性试验的支持，以评估抑郁症外展治疗对工作相关行为的影响。该试验将在四个方面与其他试验不同：（1）我们将在就业人群中进行健康风险评估（HRA）调查，而不是在初级保健中使用抑郁症筛查量表进行筛查。(2)治疗将由联合行为健康（UBH）的专家提供 而不是初级保健医生。(3)对病假、工伤事故、工作量、工作质量、工作中的人际关系和工作更替的详细评估将是主要而不是次要的结果。(4)成本效益分析将用于估计该计划对雇主的净效益。该试验在外展和护理监测方法以及质量保证方面与其他试验相同。五家雇主将合作：美国航空公司、达美航空公司、马萨诸塞州雇员协会、东北公用事业公司和雷神公司。有两个设计变更：（1）团体健康合作社（GHC）护理经理外展监测模型现在是干预的核心，而不是之前提交的GHC-UBH混合模型;（2）阿帕循证实践指南将用于质量保证，而不是之前提交的混合指南。这项研究将对回答以下问题具有重要意义： 雇主：将推广和指导方针一致的治疗抑郁症的工人使用现实水平的质量保证减少抑郁症的工作场所成本足以成本效益的雇主？我们的传播计划也很重要。(1)区域健康商业团体和行为健康管理顾问将与我们合作，传播研究结果，以创造购买者对增强抑郁症外展治疗的需求。给雇主的信息将是抑郁症超出了监控护理 管理人员的干预是具有正投资回报的投资机会。(2)UBH将提供这种外展监测干预作为一个特殊的附加疾病管理计划，可以购买溢价超过标准计划。这是一个极其重要的机会，可以在一个传统上传播积极成果是一个严重问题的研究领域进行迅速和广泛的传播。

DESCRIPTION (provided by applicant): 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.