Earnings changes for depressed individuals treated by mental health specialists

Objective: It is unclear whether the additional benefits of receiving depre ssion treatment from mental health specialists in routine care pays for the additional costs, compared with treatment delivered by general medical pro viders, This study examines the difference in lost earnings and the differe nce in treatment costs experienced by depressed individuals treated in thes e two sectors, Method: Representative community residents with depression w ere recruited and interviewed at baseline and at 6-month and 12-month follo w-ups, Lost earnings were measured by lost workdays multiplied by subjects' wage rates, Treatment costs were approximated by charges abstracted from p rovider and insurance records. Results: After controlling for sociodemograp hic variables, baseline severity, and baseline comorbidity, the authors fou nd a net mean annual economic savings of $877 associated with depression tr eatment delivered in the mental health sector compared with the general med ical sector. Sensitivity analyses in alternative scenarios indicated simila r savings. Conclusions: Although it is the trend for primary care providers to provide mental health services, these analyses indicate a net economic savings if depression treatment is provided by mental health specialists, p robably as a result of patients' greater functional improvement. As gatekee pers, especially in managed care, primary care providers have a unique resp onsibility to identify and detect patients with mental health problems. In the current structure, however, they may lack the necessary time to provide effective mental health services. Therefore, mental health specialists pla y a crucial role, with primary care providers' cooperation (i.e., detection , consultation, and referral), in providing the most cost-effective mental health services.