The proposed K08 Mentored Clinical Scientist Development Award outlines a program of training and health services research studying the impact of depressive disorders outside of the specialty mental health sector. The candidate is an Assistant Professor of Psychiatry and Public Health at Yale University with a clinical background in psychiatry and primary care internal medicine, as well as postdoctoral health services research training. The career award will allow the candidate to successfully conduct the proposed studies and develop a career as an independent researcher through classes in research design, statistics, economics, and organizational theory at Yale, and via off-site training with experts in the field. Yale University offers a rich source of resources and faculty and a growing breadth of experience in health services research. The career award mentor, Robert A. Rosenheck MD, is a nationally known health services researcher and director of the Health Services Research and Treatment Outcomes Division for the Yale Department of Psychiatry; the candidate and Dr. Rosenheck have developed a close collaborative relationship. The growing importance of purchasers and primary care providers in determining benefits and delivering care for depression has made it an increasing priority to understand the costs of depression in the workplace and general medical settings. The research program seeks to fill gaps in the previous literature studying the impact of depression in these two areas. The first project will seek to provide a better understanding of the causal mechanisms underlying the association between depression and increased use of general medical services. It will examine the role of health beliefs--a person's perception of his or her medical condition, and of the benefits and barriers to treatment--in mediating the relationship between depression and medical utilization. The second project will use a longitudinal database combining work and health claims data for employees of a major US corporation. This project will compare the impact of depression and three chronic medical illnesses on health costs, absenteeism and job performance ratings both cross-sectionally and over time.