Focus on Depression

Conclusion

In this edition of Quality Profiles, we have discussed the current variability of depression diagnosis and treatment and the barriers to effective management of depression. We have also presented quality improvement programs and case studies in depression care that have been developed by a variety of health care organizations.

Progress in the management of depression depends on the awareness and internalization of several concepts by health plans, employers, and practitioners:

• Depression is highly prevalent, affecting nearly 10% of the adult population.^[1]
• Depression is comorbid with a variety of behavioral and medical disorders, and its presence should be assessed in patients with serious and/or chronic conditions.^[2]
• Untreated depression is enormously costly to employers and health plans in terms of productivity losses and increased morbidity and mortality.^[3],[4]

Health care organizations are in a position to facilitate significant advances in the management of behavioral disorders. Specifically, health plans could strongly promote depression awareness among members and include advice about symptoms, risk factors, and when to seek treatment for oneself or loved ones. In their role as collaborators to the provider community, health plans should stress the need for coordination and continuity of care. In their role as shapers of resource utilization, they should play an active role in assessing cost-effectiveness and quality of therapeutic approaches.

All health care organizations can act as managers and expediters of change. A common attribute among the initiatives discussed in this edition of Quality Profiles is the involvement of multiple stakeholders in the inception, execution, and refinement of specific programs. A variety of exciting ideas have arisen from the provider community, advocacy groups, and health plans themselves, along with the passion and commitment to drive them to fruition. By providing the structural and financial support to ensure successful implementation of quality improvement initiatives, as well as the means for their continued evaluation and improvement, health care organizations will create an environment in which improved care of depression and related disorders can flourish.

The model QIA initiatives and case studies discussed here are presented in an effort to foster the creation of that environment. While intended primarily for health plan managers, all stakeholders can benefit by understanding the origins, development, and progress of specific quality improvement programs. These examples should be viewed as sources of inspiration, rather than step-by-step guides, to be shaped according to the specific needs of each organization’s members and community. By improving the care of behavioral disorders, health plans can save, extend, and improve the quality of members’ lives, and reduce the societal and economic burden of depression.

[1] - National Institute of Mental Health. National Institutes of Health. The numbers count: mental disorders in America. Available at: http://www.nimh.nih.gov/publicat/numbers.cfm#3 Accessed January 7, 2004.

[2] - Agency for Health Care Policy and Research (AHCPR). Depression in Primary Care: Volume 1. Detection and diagnosis. 1993. Available at: http://www.mentalhealth.com/bookah/p44-d1a.html#Head0 Accessed March 3, 2004.

[3] - Stewart WF, Ricci JA, Chee E, Hahn SR, Morganstein D. Cost of lost productive work time among US workers with depression. JAMA. 2003;289:3135-3144.

[4] - Greenberg PE, Kessler RC, Bimbaum HG, et al. The economic burden of depression in the United States: how did it change between 1990 and 2000? J Clin Psychiatry. 2003;64:1465-1475.