The addition of a work-focused intervention to integrated care (IC) has been shown to improve veterans’ occupational and psychiatric outcomes, thus decreasing obstacles to leading a productive civilian life, according to results published in JAMA Network Open. A randomized clinical trial (ClinicalTrials.gov identifier: NCT02111811) was conducted between October 21, 2014, and December 6, 2019, at a large Veterans Health Administration (VHA) medical center and 2 smaller satellite sites.

The investigators sought to examine whether a VHA IC program combined with telephonic work-focused counseling, called Be Well at Work (BWAW), could be superior to IC alone for the improvement of occupational functioning and severity of depression symptoms. They also investigated whether these effects would continue 4 months later, as well as the feasibility of the program.

A total of 253 participants ≥18 years of age were randomized to receive IC alone (n=114) or IC plus BWAW (n=139). Questionnaires were administered by blinded interviewers prior to the intervention, immediately after completion of the intervention at month 4 and at

month 8. To be eligible for the study, all participants needed to (1) be working for ≥15 hours per week in a job that they had had for ≥6 months; (2) be experiencing work limitations; and (3) have current major depressive disorder or persistent depressive disorder.


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IC was considered to be multidisciplinary care for depression that involves screening, clinical informatics, brief behavioral interventions, measurement-based care, and referral to specialty mental health care as necessary. BWAW counseling comprised 8 biweekly telephone sessions and 1 telephone booster visit after 4 months.

The primary outcome was the adjusted mean group difference in changes from before to after the intervention (ie, adjusted effect) in the percentage of at-work productivity, which was calculated via the Work Limitations Questionnaire (range, 0% to 25%). The secondary outcome was the adjusted effect in the Patient Health Questionnaire 9-item symptom severity score.

At the 4-month follow-up, patients in the IC-plus-BWAW group reported significantly greater reductions in at-work productivity (adjusted effect, –1.7; 95% CI, –3.1 to –0.4; P =.01) and severity of depression symptoms (adjusted effect, –2.1; 95% CI, –3.5 to –0.7; P =.003).

Improvements observed in the IC-plus-BWAW arm persisted 4 months following the intervention, with a mean difference in work productivity loss of –0.5 (95% CI, –1.9 to 0.9;

P =.46) and a mean difference in depression symptom severity of 0.6 (95% CI, –0.9 to 2.1;

P =.44). Among individuals who participated in BWAW, the cost per patient was $690.98, with a return on investment of 160%.

The study may be limited by the reliance on data from only 1 VHA medical center.

The investigators concluded that integrating telephonic work-focused care into IC provides a holistic, accessible, and efficient solution for the achievement of work success among veterans who are experiencing depression and difficulty functioning. The use of BWAW’s telephone-based counseling program renders high quality care more available to veterans.

Reference

Lerner D, Adler DA, Rogers WH, Ingram E, Oslin DW. Effect of adding a work-focused intervention to integrated care for depression in the Veterans Health Administration: a randomized clinical trial. JAMA Netw Open. 2020;3(2):e200075. doi:10.1001/jamanetworkopen.2020.0075.