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The American Journal of Managed Care August 2014
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The Effect of Depression Treatment on Work Productivity
Arne Beck, PhD; A. Lauren Crain, PhD; Leif I. Solberg, MD; Jürgen Unützer, MD, MPH; Michael V. Maciosek, PhD; Robin R. Whitebird, PhD, MSW; and Rebecca C. Rossom, MD, MSCR
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The Effect of Depression Treatment on Work Productivity

Arne Beck, PhD; A. Lauren Crain, PhD; Leif I. Solberg, MD; Jürgen Unützer, MD, MPH; Michael V. Maciosek, PhD; Robin R. Whitebird, PhD, MSW; and Rebecca C. Rossom, MD, MSCR
This study demonstrated that reduction of depression symptoms following routine treatment in primary care is significantly associated with improvements in productivity at work.
One limitation of this study is the loss to follow-up of patients and therefore missing data at 6 months. We addressed this potential bias by using sets of stabilized inverse probability weights to adjust for variables known to differ between patients with complete and missing 6-month data. Results from our multivariate analysis did not change significantly when weighted or unweighted data were used, indicating that the relationship between depression symptom reduction and reduction in productivity loss was robust to the measured characteristics that differentiated the study-eligible sample from the analytic sample. Another study limitation is the lack of detailed data on other medical or psychiatric conditions that might be associated with work loss and productivity impairment, because we did not have access to comorbidity data across all health plans participating in the study. The inclusion of self-reported health status was used as a less precise proxy measure of disease burden.

In addition, this study examined the relationship between improvements in depression symptoms and work performance among employed patients to whom antidepressants were prescribed. The nature of this relationship may vary by the type of depression treatment received (psychotherapy vs antidepressants, or a combination), the treating clinician, and the type of job held by the patient (high vs low stress, physical demands, etc). Our data were not available or of sufficient detail to explore the impact of these factors on the relationship between depression and work performance, but they are important questions for further research.

Finally, the analyses for this study were restricted to those reporting at least some employment at baseline and at 6 months, and we excluded those either not in the labor force at either time period (e.g., retirees, etc) and those who lost employment, because our focus was on work function.


This study demonstrated the strong relationship between reductions in depression symptoms and increases in productivity over 6 months for patients initiated on antidepressant treatment across multiple primary care clinics. Findings from this study highlight the benefit to employers of investing in detection and effective treatment of depression to response or remission in order to maximize improvement in work outcomes for their employees.


We gratefully acknowledge the assistance of the ABQsHealthPartners diabetes education staff in New Mexico and HealthPartners Diabetes Program in Minnesota. We want to recognize Emily Parker, MPH, PhD, Maureen Busch, Colleen King, Dave Butani, and Jaime Sekenski, all of HealthPartners Institute for Education and Research; and Louise Hillen, College of the Holy Cross, for their contributions to the project. In addition, we want to thank Jeremy Gleeson, MD, from ABQsHealthPartners and Patrick O’Connor, MD, MPH, from HealthPartners Institute for Education and Research for their valuable consultative roles and support of the study. Finally, we are grateful to Mary VanBeusekom, HealthPartners Institute for Education and Research, and Morgan Seaborn, LCF Research, for their meticulous editing skills. This research would not have been possible without the active support of multiple payers (Blue Cross and Blue Shield of Minnesota, First Plan, HealthPartners, Medica, Minnesota Departmen. of Human Services, Preferred One, and U Care).

Author Affiliations: Kaiser Permanente Colorado, Denver (AB); HealthPartners Research Foundation, Minneapolis, MN (ALC, LIS, MVM, RRW, RCR); University of Washington, Seattle (JU).

Funding Source: This research was funded by the National Institute of Mental Health, grant #5R01MH080692.

Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (AB, LIS, RRW, RCS); acquisition of data (LIS, RRW, RCS); analysis and interpretation of data (AB, LIS, RRW, RCS); drafting of the manuscript (AB); critical revision of the manuscript for important intellectual content (AB, LIS, RRW, RCS); statistical analysis (AB); provision of study materials or patients (LIS, ACC); obtaining funding (LIS); administrative, technical, or logistic support (ALC, MVM); and supervision (AB, LIS, JU).

Address correspondence to: Arne Beck, PhD, Kaiser Permanente Colorado Institute for Health Research, Box 378066, Denver, CO 80237-8066. E-mail:

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