The Effects of Primary Care Depression Treatment on Patients' Clinical Status and Employment


  • Michael Schoenbaum,

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    • This work was funded by the Agency for Healthcare Research and Quality (R01-HS08349) and National Institute of Mental Health grants, Research Scientist Award (RSA) (MH01170-05) and the Research Center on Managed Care for Psychiatric Disorders (P50 MH54623), and the John D. and Catherine T. MacArthur Foundation (96-42901A-HE).

  • Jürgen Unützer,

  • Daniel McCaffrey,

  • Naihua Duan,

  • Cathy Sherbourne,

  • Kenneth B Wells

Address correspondence to Michael Schoenbaum, Ph.D., RAND, 1200 South Hayes Street, Arlington, VA, 22202. Jürgen Unützer, M.D., M.P.H., and Naihua Duan, Ph.D., are with the University of California, Los Angeles. Kenneth B. Wells, M.D., M.P.H., is with UCLA and RAND in Santa Monica. Daniel McCaffrey, Ph.D., is with RAND in Pittsburgh and Cathy Sherbourne, Ph.D., is with RAND in Santa Monica.


Objective. To evaluate the effects of depression treatment in primary care on patients' clinical status and employment, over six months.

Data Sources/Study Setting. Data are from a randomized controlled trial of quality improvement for depression that included 938 adults with depressive disorder in 46 managed primary care clinics in five states.

Study Design. Observational analysis of the effects of evidence-based depression care over six months on health outcomes and employment. Selection into treatment is accounted for using instrumental variables techniques, with randomized assignment to the quality improvement intervention as the identifying instrument.

Data Collection/Extraction Methods. Patient-reported clinical status, employment, health care use, and personal characteristics; health care use and costs from claims data.

Principal Findings. At six months, patients with appropriate care, compared to those without it, had lower rates of depressive disorder (24 percent versus 70 percent), better mental health-related quality of life, and higher rates of employment (72 percent versus 53 percent), each p<.05.

Conclusions. Appropriate treatment for depression provided in community-based primary care substantially improves clinical and quality of life outcomes and employment.