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Integrated Management of Depression: Improving System Quality and Creating Effective Interfaces

Myette, Thomas L. MD, MPH

Journal of Occupational and Environmental Medicine: April 2008 - Volume 50 - Issue 4 - p 482-491
doi: 10.1097/JOM.0b013e31816a9ea6
Original Articles
Learning Objectives 
  • Outline the components and efficacy of two strategies designed to enhance the quality of care for depression: the Chronic Care Model and the Chronic Disease Self-Management Program.
  • Compare the potential roles of the attending physician and case manager in providing integrated care to employees with chronic depressive illness.
  • List some of the more important functions that can be performed by insurers and contractors in furthering the delivery of integrated care to depressed employees.

Depression is a chronic recurrent condition and is a leading cause of work disability. Improving occupational outcomes for depression will require an integrated approach that incorporates best practices from the clinical, community, and workplace systems. This article briefly reviews recent quality improvement initiatives and promising practices in each system and then shifts to the importance of systems integration. An integrated chronic care model uses a sophisticated case management process to support essential relationships, facilitate key plans, and efficiently link the three systems to optimize clinical, economic, and occupational outcomes. An expanded role for employers and their agents in the management of depression and other chronic diseases is seen as fundamental to maintaining a healthy and productive workforce.

Objective: To improve occupational outcomes for depression by integrating best practices from the clinical, community, and workplace systems.

Methods: After a brief review of quality improvement initiatives and promising practices in each system, an integrated chronic care model is introduced.

Results: A case management process that links critical systems, supports essential relationships, and facilitates key plans is expected to result in improvements in clinical, economic, and occupational outcomes.

Conclusions: Employers should be more engaged with clinical and community partners in the prevention and control of depression in affected employees.

From the Strategic Workplace Health Department, Healthcare Benefit Trust, British Columbia, Canada; Department of Psychiatry, University of British Columbia, British Columbia, Canada.

Thomas Larry Myette, an employee of the Healthcare Benefit Trust, has no commercial interests related to this research.

Address correspondence to: T. L. Myette, MD, MPH, Strategic Workplace Health, Healthcare Benefit Trust, 405 – 3960 Quadra Street, Victoria, BC, Canada V8X 4A3; E-mail:

CME Available for this Article at

©2008The American College of Occupational and Environmental Medicine