Telephone Counseling May Offer Needed Boost to Veterans With Depression

Adding a work-focused intervention to integrated depression care can lead to better employment and psychiatric outcomes in veterans, according to a study in JAMA Network Open.

Researchers tested a telephone-based work intervention called “Be Well at Work.” This counseling program, which teaches stress reduction and coping skills for work-related challenges, is relatively inexpensive and has been shown to reduce employee’s depression and absenteeism in traditional work settings. This study was the first to assess whether Be Well at Work could add value to an already proven model of depression care—the Veterans Health Administration (VHA) integrated care program.

The VHA’s multidisciplinary integrated care model includes comprehensive depression screening, regular assessments, brief behavioral therapy, medication, and referral to specialists if symptoms become severe. The VA system also offers vocational rehabilitation services, but this is geared toward placing veterans in jobs and not necessarily ensuring productivity and well-being while at work.

“There are so many younger veterans from today’s wars who are looking to assimilate back into society,” said lead study author Debra Lerner, Ph.D., a senior scientist and director of the Program on Health, Work, and Productivity at Tufts Medical Center. She co-developed Be Well at Work with David Adler, M.D., a senior psychiatrist at Tufts Medical Center. “The topic of employment is front and center at the VA.”

Lerner and colleagues enrolled 253 veterans (average age of 46) from the Philadelphia region who had been diagnosed with depression and reported at least a 5% drop in work productivity in the previous month. The participants were randomly assigned to receive either standard integrated care at the VHA or participate in the Be Well at Work program in addition to receiving integrated care. Participants in the Be Well at Work group received eight, biweekly 50-minute telephone calls for four months—led by trained counselors—as well as one follow-up session four months later.

After four months, the veterans who received the telephone intervention reported 17% greater improvements in work productivity and a 26% greater reduction in their depression symptom severity relative to veterans receiving only integrated care. These differences between the two study groups were still evident at the eight-month follow-up visit. The researchers estimated that the productivity increase saved employers about $1,800 per participant over one year, whereas the cost of the Be Well at Work intervention was $690 per participant—a 160% return on investment.

“The big question we have not answered yet is, What is the best strategy in the long run?” Lerner said. “Undoubtedly some people will want to sign up for this program a second time, so we have to find the best way to integrate new and returning patients.” That would be one of the key items that can be addressed in implementation trials—studies in which new programs are set up and run in other settings to test their viability.

The researchers just launched a small pilot program to implement Be Well at Work for employees at Tufts Medical Center and are looking for additional ways to expand the program. “If there are interested academic or community mental health centers, then reach out to us,” she said.

“We often don’t deal directly with work issues in depression care, but depression affects job security and quality of life for many workers, including veterans,” Lerner continued. “I hope this study encourages more veterans to seek care because programs like Be Well at Work can help.”

This study was supported by an award from the U.S. Department of Veterans Affairs, with additional support from researchers with the Corporal Michael J. Crescenz VA Medical Center in Philadelphia. ■

“Effect of Adding a Work-Focused Intervention to Integrated Care for Depression in the Veterans Health Administration: A Randomized Clinical Trial” is posted here.