Management of major depression in the workplace - Impact on employee work loss

Background and Objective: A growing body of literature on the economics of depression concludes that this illness has an enormous impact on workplace performance. In addition to work cutback and sporadic absenteeism, the symp toms of depression also result in elevated rates of chronic absenteeism tha t manifest in the form of workplace disability. Design and Setting: Using a unique data source that contains the medical, p harmaceutical and disability claims of a national US manufacturer, we measu red the extent of disability before and after initial treatment for major d epression. Participants: 1260 employees with at least one medical or disability claim for major depression based on International Classification of Diseases, 9th edition (ICD-9) codes in 1996 or 1997. Results: We estimate that the decreased disability payments in the first 30 days following initial treatment for major depression results in employer savings totalling $US93 per patient, which can exceed the cost of treatment for a similar period of time. These disability savings do not incorporate several additional sources of likely cost savings to the employer, and ther eby underestimate the workplace offsets associated with depression treatmen t. Additional benefits to the employer from the treatment of depression inc lude reduced work cutback and decreased sporadic absenteeism of treated emp loyees, reductions in some types of medical and prescription drug expenditu res following appropriate depression treatment, and productivity improvemen ts by employees serving as caregivers for treated spouses and children. Fur thermore, to the extent that new pharmaceutical products offer advantages i n the workplace over existing treatments for depression, the first month of such treatment will be associated with workplace savings that exceed per-p atient estimates reported here for current treatment modalities. Conclusions: The findings from this analysis imply that the workplace benef its from improved functioning are substantial and may in fact exceed the us ual costs of depression treatment. Thus, purely on economic rather than cli nical or quality-of-life grounds, this argues in favour of more aggressive outreach to employees with symptomatic disease that results in initiation o f treatment before their symptoms are allowed to persist and result in a di sability claim. In this light, detection and treatment of depression in the workplace can be seen as important components of community-based disease m anagement programmes.