Association of Psychotherapy with Disability Benefit Claim Closure among Patients Disabled Due to Depression

Abstract

BackgroundDepression is the most frequent reason for receiving disability benefits in North America, and treatment with psychotherapy is often funded by private insurers. No studies have explored the association between the provision of psychotherapy for depression and time to claim closure.MethodsUsing administrative data from a Canadian disability insurer, we evaluated the association between the provision of psychotherapy and short-term disability (STD) and long-term disability (LTD) claim closure by performing Cox proportional hazards regression.ResultsWe analyzed 10,508 STD and 10,338 LTD claims for depression. In our adjusted analyses, receipt of psychotherapy was associated with longer time to STD closure (HR [99% CI] = 0.81 [0.68 to 0.97]) and faster LTD claim closure (1.42 [1.33 to 1.52]). In both STD and LTD, older age (0.90 [0.88 to 0.92] and 0.83 [0.80 to 0.85]), per decade), a primary diagnosis of recurrent depression versus non-recurrent major depression (0.78 [0.69 to 0.87] and 0.80 [0.72 to 0.89]), a psychological secondary diagnosis (0.90 [0.84 to 0.97] and 0.66 [0.61 to 0.71]), or a non-psychological secondary diagnosis (0.81 [0.73 to 0.90] and 0.77 [0.71 to 0.83]) versus no secondary diagnosis, and an administrative services only policy ([0.94 [0.88 to 1.00] and 0.87 [0.75 to 0.996]) or refund policy (0.86 [0.80 to 0.92] and 0.73 [0.68 to 0.78]) compared to non-refund policy claims were independently associated with longer time to STD claim closure.ConclusionsWe found, paradoxically, that receipt of psychotherapy was independently associated with longer time to STD claim closure and faster LTD claim closure in patients with depression. We also found multiple factors that were predictive of time to both STD and LTD claim closure. Our study has limitations, and well-designed prospective studies are needed to establish the effect of psychotherapy on disabling depression.

Factors associated with the duration of disability benefits claims among Canadian workers: a retrospective cohort study

“…We previously found that residing in Quebec (v. Ontario) was associated with longer short-term disability claim duration, but shorter long-term disability claim duration. 4 Now, we report a similar association among SSQ claimants with psychological disorders who resided in Quebec compared with those residing elsewhere in Canada. Among claimants with musculoskeletal complaints and other illnesses, however, Quebec residency was associated with shorter short-term and longterm disability benefit duration.…”

“…Our findings are consistent with our previous study, which suggested older age, female sex (short-term disability claims only), higher salary and comorbidity were associated with longer claim duration among claimants with depression. 4 In our previous study, prolonged time to claim approval was only associated with longer long-term claim duration; in the current study, however, longer claim approval was associated with longer duration of both short-and long-term disability claims. Minimizing time to claim approval may be a promising target for reducing claim duration.…”

“…If a claimant received both shortand long-term benefits for the same disability, so long as each plan was only of 1 type (i.e., either standard or additional), that claimant contributed once in each short-and long-term disability model. Guided by our previous study 4 and content experts on our team, we selected, a priori, 10 variables that may be associated with claim duration and predicted the direction of anticipated effects (Appendix 1, available at www.cmajopen.ca/content/5/1/ E109/suppl/DC1). Claimants for whom SSQ manages both short-and long-term disability benefit plans do not undergo a separate approval process for long-term disability; rather, there is no delay between moving from short-term to long-term benefits as long as claimants qualify.…”

“…Furthermore, claim closure is a surrogate for patient-important outcomes, such as functional recovery and sustained return to work. 4 Most of the claims in our study sample were from a single province, which may threaten the external validity of our work. In addition, our results may not be generalizable to people who present with work-related disability, because those claims would be submitted to provincial compensation boards.…”

“…4 It remains uncertain, however, whether these associations are consistent among other private insurers and other clinical conditions. This question is important to address, because understanding of factors associated with claim duration -particularly those that are modifiablemay help insurers optimize case management policies and processes to facilitate faster recovery.…”