Outreach and Treatment for Depression in the Labor Force

描述(由申请人提供)：本提案寻求支持一项有效性试验，以评估抑郁症外展治疗对工作相关行为的影响。这项试验将在四个方面与其他试验不同：(1)我们将使用健康风险评估(HRA)调查来筛选就业人员的样本，而不是使用抑郁症筛查量表来筛选初级保健。(2)治疗将由联合行为健康(UBH)的专家提供 而不是由初级保健医生。(3)对病假、与工作有关的事故、工作量、工作质量、工作中的人际关系和工作流动率的详细评估将是主要结果，而不是次要结果。(4)成本效益分析将用于估算该计划给雇主带来的净收益。该试验将在外联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。有两个设计上的变化：(1)团体卫生合作(GHC)护理管理者外展监测模式现在是干预的核心，而不是先前提交的GHC-UBH混合模式；(2)APA基于证据的实践指南将用于质量保证，而不是先前提交的建议的混合指南。这项研究将对回答以下关键问题具有重要意义 雇主：使用现实的质量保证水平对抑郁工人进行外展和符合指导方针的治疗是否足以降低工作场所抑郁症的成本，从而对雇主来说具有成本效益？同样重要的是我们的传播计划。(1)健康和行为健康管理顾问地区业务小组将与我们合作传播结果，以创造购买者对加强抑郁症外展治疗的需求。向雇主传达的信息将是抑郁症外展监测护理 经理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措施，作为一项特殊的附加疾病管理计划，可以比标准计划更高的价格购买。在一个积极成果的传播历来是一个严重问题的研究领域，这是一个迅速和广泛传播的极其重要的机会。

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.