Disease Management Update
Volume III, No. 30
November 9, 2006

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Table of Contents

  1. Depression Frequently Relieved with Carefully Monitored Treatment
  2. Disease Management Q&A: Fluidly Integrating Behavioral Health into DM Programs
  3. New! HealthSounds Podcast: Depression Disease Management: Healthcare's New Frontier
  4. Bipolar Disorder's Devastating Impact on Productivity
  5. Depression and Disease Management: Beyond the Stigma to Identification and Treatment

1. Depression Frequently Relieved with Carefully Monitored Treatment

Two-thirds of people who suffer from major depression can become symptom-free if they are willing to work with their doctors and try various treatments to determine which work best for them, according to a study led by UT Southwestern Medical Center. Treatments may involve taking different antidepressants or adding cognitive therapy to the mix.

Each year, about 21 million American adults — or 9.5 percent of the population — struggle with depression, often a recurring or chronic disorder. Depression frequently returns two or more times, with some episodes lasting two years or more. The study found that 67 percent of patients achieved a full remission of symptoms by the end of one to four treatment steps.

The six-year study on treatments for depression, designated STAR*D (Sequenced Treatment Alternatives to Relieve Depression), is the first benchmark study to implement specific step-by-step medication treatment guidelines based on patients' symptoms and medication side effects. This gives clinicians a "measurement-based care" approach to delivering high-quality treatment for depression.

To read more about this study, please visit:

2. Disease Management Q&A: Fluidly Integrating Behavioral Health into DM Programs

Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Dr. Sam Toney, president and chief medical officer of Health Integrated Inc.

Question: I struggle with teaching my DM staff that on-staff behavioral health nurses are not crisis counselors, but educational components of the program. Do you have any suggestions for dealing with this?

Response: It's a very valid issue, and many organizations have capacities they may not be fully realizing. If there are behavioral health clinicians and experts on staff within a care management institution, those professionals should be utilized as educational resources for further delineating the problem, and driving the interventions.

This is especially relevant in a healthcare organization dedicated to managing medical disease states that may have on-site resources in the behavioral health world. Those professionals can assist the managing nurses in identifying barriers to improvement, including anxiety and depression, as well as other characterological issues and problems facing the individual. They can help nurses effectively direct patients to appropriate interventions at the provider level. Also, they can utilize motivational and behavior change techniques that behavioral health clinicians typically use to move patients toward wellness.

For more details on depression disease management, including assessing staff-to-patient ratios, identifying comorbidities and addressing the indigent and uninsured, please visit:

We want to hear from you! Submit your question for Disease Management Q&A to info@hin.com.

3. New! HealthSounds Podcast: Depression Disease Management — Healthcare's New Frontier

In this week's Disease Management podcast, Dr. Sam Toney, president and chief medical officer of Health Integrated, describes how his organization's depression management program strives to include providers. You can also hear Mary Beth Chalk, chief operating officer of Resources for Living, describe how her program helped a member deal with her chronic condition.

To listen to this complimentary HIN podcast, please visit:

4. Bipolar Disorder's Devastating Impact on Productivity

Bipolar disorder costs twice as much in lost productivity as major depressive disorder, a study funded by the National Institutes of Health's (NIH) National Institute of Mental Health (NIMH) has found. Each U.S. worker with bipolar disorder averaged 65.5 lost workdays in a year, compared to 27.2 for major depression.

Even though major depression is more than six times as prevalent, bipolar disorder costs the U.S. workplace nearly half as much — a disproportionately high $14.1 billion annually. Researchers traced the higher toll mostly to bipolar disorder's more severe depressive episodes rather than to its agitated manic periods.

About three-fourths of bipolar respondents had experienced depressive episodes over the past year, with about 63 percent also having agitated manic or hypomanic episodes. The bipolar-associated depressive episodes were much more persistent — affecting 134-164 days — compared to only 98 days for major depression. The bipolar-associated depressive episodes were also more severe. All measures of lost work performance were consistently higher among workers with bipolar disorder who had major depressive episodes than those who reported only manic or hypomanic episodes. The latter workers' lost performance was on a par with workers who had major depressive disorder.

To see more results from this study, please visit:

5. Depression and Disease Management: Beyond the Stigma to Identification and Treatment

With the economic burden of depression and its comorbidities estimated at $83 billion annually – hitting employers hardest in the form of lost workdays, compromised productivity and workplace accidents – the healthcare industry is formalizing programs for early identification, adequate treatment and medical adherence of individuals with depressive disorder. This is no small task, given the challenges of screening depression severity, overcoming the stigma of mental illness, and educating primary care physicians on the value of this initiative. This free executive summary of responses to an HIN survey provides details on current and planned initiatives for depression and disease management.

To download this complimentary white paper, please visit:
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