1. Economic burden of depression in South Korea
Chang, Sung
Hong, Jin-Pyo
Cho, Maeng
Background: A recent national survey in South Korea indicated that the 12-month prevalence
rate of major depressive disorder was 2.5%. Depressive disorders may lead to disability,
premature death, and severe suffering of patients and their families. This study estimates the
economic burden of depression in Korea from a societal perspective. Methods: Annual direct
healthcare costs associated with depression were calculated based on the National Health
Insurance database. Annual direct non-healthcare costs were estimated for transport. Annual
indirect costs were estimated for the following components of productivity loss due to illness
such as morbidity (absenteeism and presenteeism) and premature mortality. Indirect costs were
estimated using the large national psychiatric epidemiological surveys in Korea. The human
capital approach was used to estimate indirect costs. Result: The total cost of depression was
estimated to be $4,049 million, of which $152.6 million represents a direct healthcare cost. Total
direct non-healthcare costs were estimated to be $15.9 million. Indirect costs were estimated at
$3,880.5 million. The morbidity cost was $2,958.9 million and the mortality cost was $921.6
million. The morbidity cost was identified as the largest component of overall cost. Conclusion:
Depression is a considerable burden on both society and the individual, especially in terms of
incapacity to work. The Korean society should increase the public health effort to prevent and
detect depression in order to ensure that appropriate treatment is provided. Such actions will
lead to a significant reduction in the total burden resulting from depression.
Social Psychiatry & Psychiatric Epidemiology, May2012, Vol. 47 Issue 5, p683-689, 7p
2. Employer burden of mild, moderate, and severe major depressive
disorder: mental health services utilization and costs, and work
performance.
Birnbaum, Howard G.
Kessler, Ronald C.
Kelley, David
Ben-Hamadi, Rym
Joish, Vijay N.
Greenberg, Paul E.
Background: Treatment utilization/costs and work performance for persons with major
depressive disorder (MDD) by severity of illness is not well documented. Methods: Using
National Comorbidity Survey-Replication (2001–2002) data, US workforce respondents
(n=4,465) were classified by clinical severity (not clinically depressed, mild, moderate, severe)
using a standard self-rating scale [Quick Inventory of Depressive Symptomatology Self-Report
1
(QIDS-SR)]. Outcomes included 12-month prevalence of medical services/medications use/costs
and workplace performance. Treatment costs (employer's perspective) were estimated by
weighing utilization measures by unit costs obtained for similar services used by MDD patients
in claims data. Descriptive analysis across three severity groups generated χ2 results. Results:
Using a sample of 539 US workforce respondents with MDD, 13.8% were classified mild, 38.5%
moderate, and 47.7% severe cases. Mental health services usage, including antidepressants,
increased significantly with severity, with average treatment costs substantially higher for severe
than for mild cases both regarding mental health services ($697 vs. $388, χ2=4.4, P=.019) and
antidepressants ($256 vs. $88, χ2=9.0, P=.001). Prevalence rates of unemployment/disability
increased significantly (χ2=11.7, P=.003) with MDD severity (15.7, 23.3, and 31.3% for mild,
moderate, and severe cases). Severely and moderately depressed workers missed more work than
nondepressed workers; the monthly salary-equivalent lost performance of $199 (severely
depressed) and $188 (moderately depressed) was significantly higher than for nondepressed
workers (χ2=10.3, P<.001). Projected to the US workforce, monthly depression-related worker
productivity losses had human capital costs of nearly $2 billion. Conclusions: MDD severity is
significantly associated with increased treatment usage/costs, treatment adequacy,
unemployment, and disability and with reduced work performance. Depression and Anxiety,
2010. © 2009 Wiley-Liss, Inc.
Depression & Anxiety (1091-4269), Jan2010, Vol. 27 Issue 1, p78-89, 12p, 6 Charts
3. Presenteeism and absenteeism: Differentiated understanding of
related phenomena.
Eric Gosselin
Louise Lemyre and Wayne Corneil
In the past it was assumed that work attendance equated to performance. It now appears that
health-related loss of productivity can be traced equally to workers showing up at work as well
as to workers choosing not to. Presenteeism in the workplace, showing up for work while sick,
seems now more prevalent than absenteeism. These findings are forcing organizations to
reconsider their approaches regarding regular work attendance. Given this, and echoing
recommendations in the literature, this study seeks to identify the main behavioral correlates of
presenteeism and absenteeism in the workplace. Comparative analysis of the data from a
representative sample of executives from the Public Service of Canada enables us to draw a
unique picture of presenteeism and absenteeism with regards not only to the impacts of health
disorders but also to the demographic, organizational, and individual factors involved. Results
provide a better understanding of the similarities and differences between these phenomena, and
more specifically, of the differentiated influence of certain variables. These findings provide
food for thought and may pave the way to the development of new organizational measures
designed to manage absenteeism without creating presenteeism.
Journal of Occupational Health Psychology, Vol 18(1), Jan, 2013. pp. 75-86
2
4. The Association of Treatment of Depressive Episodes and
Work Productivity
Dewa, Carolyn S
Thompson, Angus H
Jacobs, Phillip
Objective: About one-third of the annual $51 billion cost of mental illnesses is related
to productivity losses. However, few studies have examined the association of treatment
and productivity. The purpose of our research is to examine the association of depression and
its treatment and work productivity. Methods: Our analyses used data from 2737 adults aged
between 18 and 65 years who participated in a large-scale community survey of employed and
recently employed people in Alberta. Using the World Health Organization's Health and Work
Performance Questionnaire, a productivity variable was created to capture
high productivity (above the 75th percentile). We used regression methods to examine the
association of mental disorders and their treatment and productivity, controlling for
demographic factors and job characteristics. Results: In the sample, about 8.5% experienced a
depressive episode in the past year. The regression results indicated that people who had a severe
depressive episode were significantly less likely to be highly productive. Compared with people
who had a moderate or severe depressive episode who did not have treatment, those who did
have treatment were significantly more likely to be highly productive. However, about one-half
of workers with a moderate or severe depressive episode did not receive treatment. Conclusions:
Our results corroborate those in the literature that indicate mental disorders are significantly
associated with decreased work productivity. In addition, these findings indicate that treatment
for these disorders is significantly associated with productivity. Our results also highlight the
low proportion of workers with a mental disorder who receive treatment.
Canadian Journal of Psychiatry, Dec2011, Vol. 56 Issue 12, p743-750, 8p, 3 Charts
5. Using the interaction of mental health symptoms and treatment
status to estimate lost employee productivity.
Hilton, Michael F.
Scuffham, Paul A.
Vecchio, Nerina
Whiteford, Harvey A.
Objective: In Australia it has been estimated that mental health symptoms result in a loss of $
AU2.7 billion in employee productivity. To date, however, there has been only one study
quantifying employee productivity decrements due to mental disorders when treatment-seeking
behaviours are considered. The aim of the current paper was to estimate employee
work productivity by mental health symptoms while considering different treatment-seeking
behaviours. Method: A total of 60 556 full-time employees responded to the World Health
Organization Health and Work Performance Questionnaire. This questionnaire is designed to
monitor the work productivity of employees for chronic and acute physical and mental health
3
conditions. Contained within the questionnaire is the Kessler 6, a scale measuring psychological
distress along with an evaluation of employee treatment-seeking behaviours for depression,
anxiety and any other emotional problems. A univariate analysis of variance was performed for
employee productivity using the interaction between Kessler 6 severity categories and
treatment-seeking behaviours. Results: A total of 9.6% of employees have moderate
psychological distress and a further 4.5% have high psychological distress. Increasing
psychological distress from low to moderate then to high levels is associated with
increasing productivity decrements (6.4%, 9.4% and 20.9% decrements, respectively) for
employees in current treatment. Combining the prevalence of Kessler 6 categories with
treatment-seeking behaviours, mean 2009 salaries and number of Australian employees in 2009,
it is estimated that psychological distress produces an $ AU5.9 billion reduction in Australian
employee productivity per annum. Conclusions: The estimated loss of $ AU5.9 billion in
employee productivity due to mental health problems is substantially higher than previous
estimates. This finding is especially pertinent given the global economic crisis, when
psychological distress among employees is likely to be increasing. Effective treatment for mental
health problems yields substantial increases in employee productivity and would be a sound
economic investment for employers.
Australian & New Zealand Journal of Psychiatry, Feb2010, Vol. 44 Issue 2, p151-161
6. The excess cost of depression in South Australia: a populationbased study
Hawthorne, Graeme
Cheok, Frida
Goldney, Robert
Fisher, Laura
Objective: To establish excess costs associated with depression in South Australia, based on the
prevalence of depression (from the Primary Care Evaluation of Mental Disorders (PRIME-MD))
and associated excess burden of depression (BoD) costs. Method: Using data from the 1988
South Australian (SA) Health Omnibus Survey, a properly weighted cross-sectional survey of
SA adults, we calculated excess costs using two methods. First, we estimated the excess cost
based on health service provision and loss of productivity. Second, we estimated it from loss of
utility. Results: We found symptoms of major depression in 7% of the SA population, and 11%
for other depression. Those with major depression reported worse health status, took more time
off work, reported more work performance limitations, made greater use of health services and
reported poorer health-related quality-of-life. Using the service provision perspective excess
BoD costs were AUD$1921 million per annum. Importantly, this excluded non-health service
and other social costs (e.g. family breakdown, legal costs). With the utility approach, using the
Assessment of Quality of Life (AQoL) instrument and a very modest life-value (AUD$50 000),
the estimate was AUD$2800 million. This reflects a societal perspective of the value of illness,
hence there is no particular reason the two different methods should agree as they provide
different kinds of information. Both methods suggest estimating the excess BoD from the direct
service provision perspective is too restrictive, and that indirect and societal costs ought be taken
into account. Conclusions: Despite the high ranking of depression as a major health problem, it
is often unrecognized and undertreated. The findings mandate action to explore ways of reducing
4
the BoD borne by individuals, those affected by their illness, the health system and society
generally. Given the limited information on the cost-effectiveness of different treatments, it
would seem important that resources be allocated to evaluating
alternative depression treatments.
Australian & New Zealand Journal of Psychiatry, Jun2003, Vol. 37 Issue 3, p362-373, 12p
7. Severity of depression and magnitude of productivity loss.
Arne Beck,
A. Lauren Crain,
Leif I. Solberg,
Jürgen Unützer, MD,
Russell E. Glasgow,
Michael V. Maciosek,
Robin Whitebird, PhD,
Purpose: Depression is associated with lowered work functioning, including absences, impaired
productivity, and decreased job retention. Few studies have examined depression symptoms
across a continuum of severity in relationship to the magnitude of work impairment in a large
and heterogeneous patient population, however. We assessed the relationship
between depression symptom severity and productivity loss among patients initiating treatment
for depression. Methods: Data were obtained from patients participating in the DIAMOND
(Depression Improvement Across Minnesota: Offering a New Direction) initiative, a statewide
quality improvement collaborative to provide enhanced depression care. Patients newly started
on antidepressants were surveyed with the Patient Health Questionnaire 9-item screen (PHQ-9),
a measure of depression symptom severity; the Work Productivity and Activity Impairment
(WPAI) questionnaire, a measure of loss in productivity; and items on health status and
demographics. Results: We analyzed data from the 771 patients who reported being currently
employed. General linear models adjusting for demographics and health status showed a
significant linear, monotonic relationship between depression symptom severity
and productivity loss: with every 1-point increase in PHQ-9 score, patients experienced an
additional mean productivity loss of 1.65% (P < .001). Even minor levels
of depression symptoms were associated with decrements in work function. Full-time vs parttime employment status and self-reported fair or poor health vs excellent, very good, or good
health were also associated with a loss of productivity (P < .001 and P = .045, respectively).
Conclusions: This study shows a relationship between the severity of depression symptoms and
work function, and suggests that even minor levels of depression are associated with
a loss of productivity. Employers may find it beneficial to invest in effective treatments for
depressed employees across the continuum of depression severity.
Annals of Family Medicine, Vol 9(4), Jul-Aug, 2011. pp. 305-311.
8. Unemployment, Job Retention, and Productivity Loss Among
Employees With Depression.
Lerner, Derbra. Alder, David. Change, Hong
5
Objective: This study comprehensively assessed the work outcomes of employees
with depression. Methods: We collected baseline and six-month follow-up survey
data from 229 employees with depression and two employee comparison groups: a
group of healthy patients for the control group (N=173) and a group with
rheumatoid arthritis (N=87), a frequent source of work disability. Outcomes
included new unemployment and, within the employed subgroup, job retention
(versus job turnover), presenteeism (that is, diminished on-the-job performance
and productivity), and absenteeism. Results: At the six-month follow-up, persons
with depression had more new unemployment--14 percent for persons in the
dysthymia group, 12 percent for persons in the major depression group, and 15
percent for persons in the group with both dysthymia and major depression,
compared with 2 percent for persons in the control group and 3 percent for persons
in the rheumatoid arthritis group. Among participants who were still employed,
those with depression had significantly more job turnover, presenteeism, and
absenteeism. Conclusions: In addition to helping employees with
depression obtain high-quality depression treatment, new interventions may be
needed to help them to overcome the substantial job upheaval that this population
experiences.
Psychiatric Services, Vol 55(12), Dec, 2004. pp. 1371-1378.
9. Interactions between job stressors and social support: Some
counterintuitive results.
Kaufmann, Gary M.,
Beehr, Terry A.
Job stressors (underutilization of skills, quantitative workload, and job future ambiguity) and
social support (tangible and emotional support from supervisor, coworkers, and nonjob sources)
were used to predict psychological and physiological strains (job dissatisfaction, boredom,
workload dissatisfaction, depression, heart rate, and blood pressure) and organizational
consequences (absenteeism and job performance) among 102 hospital nurses (mean age 37.4
yrs). Based on previous theory and research, social support was expected to moderate the
relationship between stressors and strains so that stressors would be less strongly related to
strains in the presence of strong social support than under conditions of less social support.
Several interactions were found, but all were in the direction opposite from predictions (i.e.,
social support strengthened the positive relationship between stressors and strains). This result
contradicts most theories and models of job stress and social support.
Journal of Applied Psychology, Vol 71(3), Aug, 1986. pp. 522-526
6
10.
Increase in work productivity of depressed individuals with
improvement in depressive symptom severity.
Trivedi, Madhukar H.
Objective: The authors sought to identify baseline clinical and sociodemographic characteristics
associated with work productivity in depressed outpatients and to assess the effect of treatment
on work productivity. Method: Employed depressed outpatients 18–75 years old who completed
the Work Productivity and Activity Impairment scale (N = 1,928) were treated with citalopram
(20–40 mg/day) in the Sequenced Treatment Alternatives to Relieve Depression study. For
patients who did not remit after an initial adequate antidepressant trial (level 1), either a switch to
sertraline, sustained-release bupropion, or extended release venlafaxine or an augmentation with
sustained-release bupropion or buspirone was provided (level 2). Participants’ clinical and
demographic characteristics and treatment outcomes were analyzed for associations with
baseline work productivity and change in productivity over time. Results: Education,
baseline depression severity, and melancholic, atypical, and recurrent depression subtypes were
all independently associated with lower benefit to work productivity domains. During level 1
treatment, work productivity in several domains improved with reductions in depressive
symptom severity. However, these findings did not hold true for level 2 outcomes; there was no
significant association between treatment response and reduction in work impairment. Results
were largely confirmed when multiple imputations were employed to address missing data.
During this additional analysis, an association was also observed between greater impairment in
work productivity and higher levels of anxious depression. Conclusions: Patients with
clinically significant reductions in symptom severity during initial treatment were more likely
than non responders to experience significant improvements in work productivity. In contrast,
patients who achieved symptom remission in second-step treatment continued to have
impairment at work. Patients who have demonstrated some degree of treatment resistance are
more prone to persistent impairment in occupational productivity, implying a need for
additional, possibly novel, treatments.
The American Journal of Psychiatry, Vol 170(6), Jun 1, 2013. pp. 633-641.
11.
Productivity Losses Among Treated Depressed Patients
Relative to Healthy Controls
Suellen Curkendall, PhD, Kimberly M. Ruiz, EdM, Vijay Joish, PhD, and Tami L. Mark, PhD
Objectives: Estimate the productivity-related cost of depression in an
employed population.Methods:By using administrative data, annual shortterm disability (STD)
and absenteeism costs ($2005) were compared for
patients with depression and treated with antidepressants and for a matched
control group without depression. Results: Mean annual STD costs were
$1038 among treated depressed patients versus $325 among controls and
$1685 among a subgroup of severely depressed treated patients versus $340
among their controls. After controlling for demographic and employment
characteristics, treated patients with depression had STD costs that were
7
$356 higher per patient and those with severe depression had costs that were
$861 higher. The marginal impact of treated depression on absenteeism was
$377. Conclusions: Even when depressed patients are treated with antidepressants, there are
substantial productivity losses. Therapies that can better manage depression may provide
opportunities for savings to employers.
Journal of Occupational and Environmental Medicine, Vol 52(2), Feb, 2010. pp. 125-130.
12.
What does research tell us about depression, job
performance, and work productivity?
Lerner, Debra
Objective: To assess the work impact of depression. Methods: A review of research articles
published since 2002, reporting on the magnitude and/or nature of depression's impact on work.
Results: This research is characterized by the use of three outcome indicators (employment
status, absenteeism, and presenteeism metrics) and three research designs (population-based,
workplace, and clinical). The literature documents that, compared to non-depressed individuals,
those with depression have more unemployment, absences, and at-work performance deficits.
Methodological variation makes it difficult to determine the magnitude of these differences.
Additionally, the research suggests that the work impact of depression is related to symptom
severity and that symptom relief only partly reduces the adverse work outcomes of depression.
Conclusions: Research has contributed to knowledge of the multidimensional work impact
of depression. Further developing intervention research is an important next step.
Journal of Occupational and Environmental Medicine, Vol 50(4), Apr, 2008. pp. 401-410.
13.
The Effect of Improving Primary
Care Depression Management on Employee Absenteeism
and Productivity: A Randomized Trial.
Rost, Kathryn
Objective: To test whether an intervention to improve primary care depression management
significantly improves productivity at work and absenteeism over 2 years. Setting and Subjects:
Twelve community primary care practices recruiting depressed primary care patients identified
in a previsit screening. Research Design: Practices were stratified by depression treatment
patterns before randomization to enhanced or usual care. After delivering brief training,
enhanced care clinicians provided improved depression management over 24 months. The
research team evaluated productivity and absenteeism at baseline, 6, 12, 18, and 24 months in
326 patients who reported full-or part-time work at one or more completed waves. Results:
Employed patients in the enhanced care condition reported 6.1% greater productivity and 22.8%
less absenteeism over 2 years. Consistent with its impact on depression severity and emotional
role functioning, intervention effects were more observable in consistently employed subjects
where the intervention improved productivity by 8.2% over 2 years at an estimated annual value
of $1982 per depressed full-time equivalent and reduced absenteeism by 28.4% or 12.3 days over
8
2 years at an estimated annual value of $619 per depressed full-time equivalent. Conclusions:
This trial, which is the first to our knowledge to demonstrate that improving the quality of care
for any chronic disease has positive consequences for productivity and absenteeism, encourages
formal cost-benefit research to assess the potential return-on-investment employers of stable
workforces can realize from using their purchasing power to encourage
better depression treatment for their employees.
Medical Care, Vol 42(12), Dec, 2004. pp. 1202-1210.
14.
Health and Productivity as a Business Strategy:
A Multiemployer Study
Ronald Loeppke, MD, MPH
Michael Taitel, PhD
Vince Haufle, MPH
Thomas Parry, PhD
Ronald C. Kessler, PhD
Kimberly Jinnett, PhD
Objective: To explore methodological refinements in measuring
health-related lost productivity and to assess the business implications of
a full-cost approach to managing health. Methods: Health-related lost
productivity was measured among 10 employers with a total of 51,648
employee respondents using the Health and Work Performance Questionnaire combined with
1,134,281 medical and pharmacy claims.
Regression analyses were used to estimate the associations of health
conditions with absenteeism and presenteeism using a range of models.
Results: Health-related productivity costs are significantly greater than
medical and pharmacy costs alone (on average 2.3 to 1). Chronic
conditions such as depression/anxiety, obesity, arthritis, and back/neck
pain are especially important causes of productivity loss. Comorbidities
have significant non-additive effects on both absenteeism and presenteeism.
Executives/Managers experience as much or more monetized
productivity loss from depression and back pain as Laborers/Operators.
Testimonials are reported from participating companies on how the
study helped shape their corporate health strategies. Conclusions: A
strong link exists between health and productivity. Integrating productivity data with health data
can help employers develop effective
workplace health human capital investment strategies. More research is
needed to understand the impacts of comorbidity and to evaluate the cost
effectiveness of health and productivity interventions from an employer
perspective.
Journal of Occupational and Environmental Medicine, Vol 51(4), Apr, 2009. pp. 411-428.
15.
Course of depression, health services costs, and
work productivity in an International Primary Care Study
Simon, Gregory E.
9
The The Longitudinal Investigation of Depression Outcomes (LIDO) Study examined the
outcomes and economic correlates of previously untreated depression among primary care
patients in Barcelona, Spain; Be'er Sheva, Israel; Melbourne, Australia; Porto Alegre, Brazil, St.
Petersburg, Russia; and Seattle, USA. 968 patients (aged 18-75 yrs) with current depressive
disorder completed assessments of depression severity at baseline and 9 mo, and assessments of
health services utilization and work days missed at baseline, 9 mo, and 12 mo. Patients with
more favorable depression outcomes had fewer days missed from work; this relationship did not
reach the 5% level of statistical significance at any site, and reached the 10% significance level
only at Porto Alegre. Patients with more favorable depression outcomes also had lower health
services costs, but this relationship reached the 5% significance level only in St. Petersburg.
While the lack of statistical precision does not permit definitive conclusions, these findings are
consistent with recent studies showing that recovery from depressionis associated with lower
health services costs and less time missed from work due to illness.
General Hospital Psychiatry, Vol 24(5), Sep-Oct, 2002. pp. 328-335.
16.
Which presenteeism measures are more sensitive
to depression and anxiety?
Sanderson, Kristy
Background: Lost productivity from attending work when unwell, or "presenteeism", is a
largely hidden cost of mental disorders in the workplace. Sensitive measures are needed for
clinical and policy applications, however there is no consensus on the optimal self-report
measure to use. This paper examines the sensitivity of four alternative measures of presenteeism
to depression and anxiety in an Australian employed cohort. Methods: A prospective singlegroup study in ten call centres examined the association of presenteeism (presenteeism days,
inefficiency days, Work Limitations Questionnaire, Stanford Presenteeism Scale) with Patient
Health Questionnaire depression and anxiety syndromes. Results: At baseline, all presenteeism
measures were sensitive to differences between those with (N=69) and without
(N=363) depression/anxiety. Only the Work Limitations Questionnaire consistently showed
worse productivity as depression severity increased, and sensitivity to remission and onset
of depression/anxiety over the 6-month follow-up (N=231). There was some evidence of
individual depressive symptoms having a differential association with different types of job
demands. Limitations: The study findings may not generalise to other occupational settings with
different job demands. We were unable to compare responders with non-responders at baseline
due to anonymity. Conclusions: In this community sample the Work Limitations Questionnaire
offered additional sensitivity to depression severity, change over time, and individual symptoms.
The comprehensive assessment of work performance offers significant advantages in
demonstrating both the individual and economic burden of common mental disorders, and the
potential gains from early intervention and treatment.
Journal of Affective Disorders, Vol 101(1-3), Aug, 2007. pp. 65-74.
10
17.
Recovery from depression, work productivity, and health
care costs among primary care patients.
Simon, Gregory E.
Conducted a secondary analysis of data from a randomized trial conducted at 7 primary care
clinics of a Seattle area HMO. 290 adults with major depression beginning antidepressant
treatment completed structured interviews at baseline, 1, 3, 6, 9, 12, 18, and 24 mo. Interviews
examined clinical outcomes (Hamilton Depression Rating Scale and depression module of the
Structured Clinical Interview for DSM-III-R), employment status, and work days missed due to
illness. Medical comorbidity was assessed using computerized pharmacy data, and medical costs
were assessed using the HMO's computerized accounting data. Using data from the 12-mo
assessment, patients were classified as remitted (41%), improved but not remitted (47%), and
persistently depressed (12%). After adjustment fordepression severity and medical comorbidity
at baseline, patients with greater clinical improvement were more likely to maintain paid
employment and reported fewer days missed from work due to illness. Patients with better 12mo clinical outcomes had marginally lower health care costs during the second year of followup. Recovery from depression is associated with significant reductions in work disability and
possible reductions in health care costs.
General Hospital Psychiatry, Vol 22(3), May-Jun, 2000. pp. 153-162.
18.
Do Antidepressants Reduce the Burden Imposed
by Depression on Employers?
Greener, Mark J.
The ability to perform paid or unpaid work is integral to an individual's quality of life. Therefore,
we performed a systematic literature review to examine the impact of depression and its
treatment on occupational outcomes. This review found absenteeism from work to be markedly
higher among depressed employees and productivity to be dramatically undermined by some
symptoms of depression. Gaps in the published literature point to the need for future economic
and clinical analyses to include work-related outcomes. Published studies showed that
antidepressants can enhance work-related outcomes by alleviating affective symptoms. However,
the pharmacological properties of antidepressants may produce differential effects that influence
work-related outcomes in other ways. For example, TCAs, but not SSRIs, produce sedation and
impair cognitive function in ways that could undermine work-related outcomes. Formal analyses
are required to quantify whether the improved social functioning, motivation and vigilance that
may be associated with some newer antidepressants translate into improved work-related
outcomes. Although few published studies have directly quantified the cost benefit of
managing depression and associated lost productivity, existing studies that directly assessed
work-related outcomes have suggested that treating depression is cost effective. Gaps in the
published literature imply that the impact of depression and antidepressants on occupational
outcomes has been understudied. This reflects, in part, the fact that antidepressant studies lasting
11
4 or 6 weeks are unlikely to capture the impact of treatment on work-related measures. In
addition, the current evidence base is fraught with other methodological limitations. The effect of
depression on non-paid employment also requires further assessment. In conclusion, the efficacy
of antidepressants on work-related outcomes should be measured in clinical trials that have an
adequate design and a suitable follow-up period, and included in health technology assessments.
Until such studies are available, the evidence base supporting the use of antidepressants will
remain incomplete.
CNS Drugs, Vol 19(3), 2005. pp. 253-264.
19.
Depression in the workforce: The intermediary effect of
medical comorbidity.
McIntyre, Roger S.
Background: It is amply documented that mood disorders adversely affect job satisfaction,
workforceproductivity, and absenteeism/presenteeism. It is also well documented that mood
disorders are an independent risk factor for several chronic medical disorders (e.g., obesity,
diabetes mellitus, cardiovascular disease). Emerging evidence indicates that the workforce
dysfunction associated withdepression is partially mediated by medical comorbidity. Methods:
We conducted a PubMed search of all English-language articles published between 2005 and
July 2009 with the following search terms: major depressive disorder and depression, crossreferenced with work productivity, disability, economic cost, absenteeism, presenteeism, and
medical comorbidity. Articles selected for review were based on adequacy of sample size, the
use of standardized experimental procedures, validated assessment measures, and overall
manuscript quality. Results: Mood disorders are the most impairing condition amongst working
adults. It is estimated that approximately 35-50% of employees withdepression will take shortterm disability leave at some point during their job tenure. Moreover, 15-20% of the workforce
will receive short-term disability benefits during any given year; the annual income of
individuals affected by depression is reduced by approximately 10% when compared to
unaffected employees. Chronic stress-sensitive conditions independently contribute to workforce
maladjustment and associated disability. The mood disorder population is differentially affected
by several stress-related medical conditions resulting in greater impairment in the workforce.
Conclusion: Disability modelling in the depressed employee has emphasized the complex
interrelationship between depressive symptoms, workforce stress, and consequent disability. A
more refined model must include the effects of chronic medical conditions as a powerful
mediator and/or moderator of workforce impairment. Multidisciplinary interventions have been
demonstrated to reduce, but not eliminate workforce disability related to depression,
underscoring the need for elucidating other modifiable factors. Screening, treatment, and
prevention initiatives need to target chronic medical conditions in depressed employees in order
to reduce overall workforce disability.
Journal of Affective Disorders, Vol 128(Suppl 1), Jan, 2011. pp. S29-S36.
12
20.
Cost of Lost Productive Work Time Among US Workers
With Depression
Walter F. Stewart
Context Evidence consistently indicates that depression has adversely affected work
productivity. Estimates of the cost impact in lost labor time in the US workforce, however, are
scarce and dated.
Objective To estimate the impact of depression on labor costs (ie, work absence and reduced
performance while at work) in the US workforce.
Design, Setting, and Participants All employed individuals who participated in the American
Productivity Audit (conducted August 1, 2001–July 31, 2002) between May 20 and July 11,
2002, were eligible for the Depressive Disorders Study. Those who responded affirmatively to 2
depression-screening questions (n = 692), as well as a 1:4 stratified random sample of those
responding in the negative (n = 435), were recruited for and completed a supplemental interview
using the Primary Care Evaluation of Mental Disorders Mood Module for depression, the
Somatic Symptom Inventory, and a medical and treatment history for depression. Excess lost
productive time (LPT) costs from depression were derived as the difference in LPT among
individuals with depression minus the expected LPT in the absence of depression projected to the
US workforce.
Main Outcome Measure Estimated LPT and associated labor costs (work absence and reduced
performance while at work) due to depression.
Results Workers with depression reported significantly more total health-related LPT than those
without depression (mean, 5.6 h/wk vs an expected 1.5 h/wk, respectively). Eighty-one percent
of the LPT costs are explained by reduced performance while at work. Major depression
accounts for 48% of the LPT among those with depression, again with a majority of the cost
explained by reduced performance while at work. Self-reported use of antidepressants in the
previous 12 months among those with depression was low (<30%) and the mean reported
treatment effectiveness was only moderate. Extrapolation of these survey results and selfreported annual incomes to the population of US workers suggests that US workers with
depression employed in the previous week cost employers an estimated $44 billion per year in
LPT, an excess of $31 billion per year compared with peers without depression. This estimate
does not include labor costs associated with short- and long-term disability.
Conclusions A majority of the LPT costs that employers face from employee depression is
invisible and explained by reduced performance while at work. Use of treatments for depression
appears to be relatively low. The combined LPT burden among those with depression and the
low level of treatment suggests that there may be cost-effective opportunities for improving
depression-related outcomes in the US workforce.
JAMA. 2003;289(23):3135-3144. doi:10.1001/jama.289.23.3135.
21.
Effect of Major Depression on Moment-in-Time Work
Performance
Philip S. Wang
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OBJECTIVE: Although major depression is thought to have substantial negative effects on
work performance, the possibility of recall bias limits self-report studies of these effects. The
authors used the experience sampling method to address this problem by collecting comparative
data on moment-in-time work performance among service workers who were depressed and
those who were not depressed. METHOD: The group studied included 105 airline reservation
agents and 181 telephone customer service representatives selected from a larger baseline
sample; depressed workers were deliberately oversampled. Respondents were given pagers and
experience sampling method diaries for each day of the study. A computerized autodialer paged
respondents at random time points. When paged, respondents reported on their work
performance in the diary. Moment-in-time work performance was assessed at five random times
each day over a 7-day data collection period (35 data points for each
respondent). RESULTS: Seven conditions (allergies, arthritis, back pain, headaches, high blood
pressure, asthma, and major depression) occurred often enough in this group of respondents to be
studied. Major depression was the only condition significantly related to decrements in both of
the dimensions of work performance assessed in the diaries: task focus and productivity. These
effects were equivalent to approximately 2.3 days absent because of sickness per depressed
worker per month of being depressed. CONCLUSIONS: Previous studies based on days missed
from work significantly underestimate the adverse economic effects associated with depression.
Productivity losses related to depression appear to exceed the costs of effective treatment.
The American Journal of Psychiatry, VOL. 161, No. 10
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