SAW/RTW Showcase: Impact of Treatment Quality

DMEC Staff@Work

Does the Quality of Depression Treatment Predict Future Disability Leave?

Depression Treatment and Future Disability LeaveBy Fraser Gaspar, PhD, MPH

ReedGroup MDGuidelines®

By Joshua Morrison, MPH (cand.)


Depression is the greatest contributor to worldwide disability.1 With a growing number of individuals being diagnosed with major depressive disorder (MDD), we became interested in preventing functional impairments following a depression diagnosis by investigating if the quality of depression treatment predicts a future work disability.

Pharmacotherapy and psychotherapy are the primary treatment modalities for individuals with MDD. However, patients with MDD frequently do not adhere to antidepressant treatment when it is initiated, and in those who were initially compliant, antidepressant adherence tends to decrease with time.2 This is significant because non-adherence to antidepressants has been shown to predict a future work disability and extended disability duration.3 However, to our knowledge, no study has investigated the broader question of how both antidepressant and psychotherapy treatments influence future work disability.


This retrospective study analyzed claims from two IBM Watson MarketScan databases: Commercial Claims and Encounters, and Health and Productivity Management. We identified 28,879 patients with an MDD diagnosis made between 2008 and 2015. Patients were only included if they had health and disability insurance coverage for one year before and after their diagnosis. As depression treatment for pregnant or breastfeeding women are outside traditional depression treatment guidelines, these women were also excluded. Patients were tracked in the data for two years for a work disability. This population could be described as a “typical” American corporate employee population.

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