More on Disease Management (Oct. 2006): Employers weigh in on depression

Depressive disorders stand out as a major occupational health issue, and employers are feeling the burden in reduced productivity and higher healthcare costs for their work forces.

Ron Finch, vice president, National Business Group on Health in Washington. D.C., puts a premium on productivity as the workforce ages, bringing more healthcare costs and issues along with it.

The challenge, he says, is keeping employees on the job although 90 million have chronic conditions-many with a behavioral health root. Those with depression consume double the amount of healthcare costs than those without it. Finch notes, however, that presenteeism is considered a soft number and is difficult to measure. He also recognizes the barrier of high copayments for accessing behavioral healthcare providers and the confusion surrounding the different levels of available providers.

Wayne Burton, MD, senior vice president and medical executive of JPMorgan Chase in New York City MD, finds his name synonymous with the exploration of the economic impact of depression in the workplace. He co-authored an article on the subject in 1994, having conducted a study using employees in his own company, formerly First Chicago Corp., where he served as vice president/medical director. The study offers an early glimpse at the astronomical costs of depression-$43 billion in total costs in 1990, with absenteeism contributing $12 billion. In addition, estimates suggested that 10% of short-term disability was attributable to depression.

The study also found that when comparing short-term disability data, medical plan costs and EAP referral data for depressive disorders with selected, common medical conditions, the average length of disability and disability relapse rate was greater for depressive disorders than for the medical conditions.

Dr. Burton pointed out that depressive disorders in 1994 clearly stood out as a major occupational health issue that demanded attention and caused the single highest mental health and disability cost. He recommended then and now that costs can be effectively managed by integrating rational benefit design, managerial training and provisions for early and appropriate intervention.

Dr. Burton also places an emphasis on coordinating care between PCPs and behavioral health professionals; educating employees and occupational health nurses about the signs and symptoms of depression and the need for nurses to quickly refer employees suffering from depression to an EAP; screenings for depression; and medication compliance.

He also co-authored another paper in a 2004 issue of the Journal of Occupational and Environmental Medicine, which builds a relationship between medical conditions, including depression, and presenteeism. In the study, 73,456 employees of a Midwestern financial institution, the majority of whom were female, received a health risk assessment that incorporated an eight-item version of the Work Limitations Questionnaire to assess health-related impacts on work performance.

Of the 17,685 respondents, nearly half reported suffering from at least one health condition for which they were being treated; of that group, 40.6% reported health-related limitations in mental/interpersonal activities. In addition, depression was associated with the highest odds of limitations in time-related components of work and the highest odds of problems with physical and mental tasks, as well as in overall output.

A more recent study by Dr. Burton is exploring the relationship between antidepressant medication compliance and short-term disability related to depression. "Our study is focusing on what happens to employees who stop taking antidepressant medications and their risk of being on a medical disability leave for depression," he explains.