The interventions had approximately the same effect in improving outcomes, whether the added resources were for medication management or for psychotherapy. They also had similar outcome effects on sicker and on less sick patients. The programs significantly mitigated the detrimental effect of depression on employment. No other quality-improvement evaluation for any condition in primary care has shown that kind of positive employment boost. The RAND paper appears exactly one month after the surgeon-general of the United States issued his report underscoring the prevalence of mental disorders in the American population and the extent to which they go untreated.
Depression is one of the three leading causes of disability worldwide.
Previous studies have shown that about 20 percent of all primary medical care patients in the United States have significant depression symptoms, that about 5 percent are clinically depressed, and that only about a quarter of this latter group get treatment. Much of the care that is received is known to be poor. Although effective medication and psychotherapy treatments exist, depression is commonly not detected and not treated appropriately in primary care settings. It shows patients that they can hope to improve their lives. It shows providers, employers, managed care companies, and insurers that they can hope for good outcomes if they make reasonable efforts to organize treatment.