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Workplace Burden of Depression Magnified by Co-morbid Fatigue and Anxiety, New Study Shows
San Diego (ots/PRNewswire) -
Depression, well known to reduce workplace productivity, causes significantly greater productivity declines when accompanied by common co-occurring conditions such as fatigue, sleep problems or anxiety, according to a large new study presented today at the American Psychiatric Association's 160th Annual Meeting in San Diego.(1) The study also showed that co-occurring fatigue or sleep problems significantly increased depression-related healthcare costs.(1)
In the study, which used an integrated database of healthcare claims and surveys of almost 14,000 employees at two large U.S. firms, researchers analyzed data on healthcare spending and presenteeism (i.e., employees' estimates of their own productivity while at work) to assess the impact of depression and other chronic conditions.(1)
Overall, among the ten most prevalent physical and mental conditions measured, depression had the single largest negative effect on work productivity. That effect was magnified when fatigue, sleep problems and anxiety - conditions that often co-occur with depression - were also present. Further, while depression had significant adverse effects on productivity in the absence of other co-morbid conditions, effects of these other conditions in the absence of depression were not as pronounced.(1)
"While depression itself has a significant economic impact, the negative effect on both workplace productivity and healthcare costs can be considerably increased when employees who are depressed also suffer from other conditions," said Ronald C. Kessler, Ph.D., Professor of Health Care Policy, Harvard Medical School, Boston, Mass. "These findings suggest we should aim to identify and minimize multiple factors associated with depression early to reduce this burden."
About the Study(1)
Two large U.S. firms surveyed their employees about their productivity. The first sample, from a firm in the high-tech industry, consisted of 7,320 employees; the second, from a manufacturing company, included 6,490 employees. The companies then hired an independent data aggregation company to combine the survey data with medical and pharmacy claims data into a single database. The aggregation firm, in compliance with U.S. privacy laws, stripped out all information that could identify individual patients. This de-identified database was then used to compare and contrast the effects of depression and other conditions that often co-occur with depression, such as anxiety, chronic fatigue, and chronic sleep problems on absenteeism, work productivity and direct healthcare costs. Productivity was measured partly by reviewing absenteeism and partly by asking employees to rate their own "presenteeism" - their productivity on days when they were present but not performing at their usual standards - using the WHO Health and Work Performance Questionnaire (HPQ). Each worker's rating was compared with the average productivity score for all employees at the company. Statistical regression analysis was used to assess the effect of the target health problems on absenteeism and productivity while controlling for socio-demographics and claims-based measures of utilization in the six-month pre-survey period. Results were weighted to adjust for differential survey non-response.
Employee samples were geographically diverse, however study findings are not nationally representative of the U.S. employed population. Employee sample characteristics include:
Employer #1 Employer #2
Average age 40.3 37.0
Proportion female 24% 34%
Proportion paid hourly
(vs. salaried employees) 2% 26%
Proportion with covered spouse 77% 63%
Number of children (average) 1.3 1.1
Among the most prevalent physical and mental conditions, depression had the largest negative effect on overall work performance, followed by fatigue, anxiety, chronic sleeping problems, obesity. Painful conditions also had large effects. However, when the effect of each condition was examined while controlling for comorbid depression, the independent effect of the condition was diminished. This suggests that the other conditions examined in this study have their biggest impact on work performance when they occur with depression.
At one of the companies, depression in the absence of anxiety or fatigue/sleep disturbance was associated with a 3.5 percent reduction in the presenteeism score, equivalent to seven to eight full-time workdays per year. Depression with anxiety or fatigue/sleep disturbance was associated with larger negative effects (6-8 percent reduction in average presenteeism score), and having depression with both anxiety and fatigue/sleep problems was associated with a 13.2 percent reduction.
Employees experiencing depression had average annual costs in excess of both employer sample averages (US$4,132 and US$3,504 compared to US$3,286 and US$2,653, respectively). Employees who reported experiencing fatigue or sleep problems with depression had significantly higher average annual costs than those with depression alone (US$6,665 and US$5,306). (All results noted above statistically significant, p<0.05). Although having anxiety with depression was associated with lower rating of work performance, direct healthcare costs were not significantly different from costs of employees with depression alone.
Major Depressive Disorder (MDD) affects approximately 121 million people worldwide.(2) The World Health Organization estimates depression will be among the highest-ranking causes of disability in developed countries by 2020, second only to ischemic heart disease worldwide.(3) It can happen to anyone of any age, race or ethnicity; however, women are nearly twice as likely to experience depression as men.(4) Although it is one of the most frequently seen psychiatric disorders in the primary care setting(5,6), it often goes undiagnosed or is under-treated.(2,7) This may be because depressed people often present with physical symptoms rather than emotional complaints; in one large study, 69 percent of patients with MDD reported only physical symptoms as the reason for visiting their physician.(8)
Complete elimination of symptoms, or remission, is the primary goal of depression treatment. Treating the full spectrum of emotional and physical symptoms to remission significantly decreases a patient's risk of relapse.(9)
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1 Kessler R, White LA, Birnbaum H, et al. Impact of Depression and its
Pathways on Work Productivity. Presented at the American Psychiatric
Association 160th Annual Meeting, San Diego, 21 May 2007
2 World Health Organization. Factsheet - Depression, 2005. Available at:
Last visited 26 April 2007
3 Murray CJL, Lopez AD, eds. The Global Burden of Disease; 1996.
4 American Psychiatric Association. Diagnostic and Statistical Manual of
Mental Disorders. 4th ed., Text Revision. Washington DC: American
Psychiatric Association; 2000:345-428.
5 Ormel J, et al. Common mental disorders and disability across cultures:
results from the WHO Collaborative Study on Psychological Problems in
General Health Care. JAMA. 1994;272:1741-1748.
6 Spitzer RL, et al. Utility of a new procedure for diagnosing mental
disorders in primary care: the PRIME-MD 1000 study. JAMA.
7 Ormel J, Koeter MWJ, van den Brink W, van de Willige G. Recognition,
management, and course of anxiety and depression in general practice.
Arch Gen Psychiatry. 1991;48:700-706.
8 Simon GE et al. An International Study of the Relation Between Somatic
Symptoms and Depression. New Engl J Med. 1999;341(18):1329-35.
9 Paykel ES, et al. Psychol Med. 1995;25(6):1171-1180.@@end@@
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