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)

Methodology

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

Additional Results

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.

About Depression

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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    References:
    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:
      http://www.who.int/mental_health/management/depression/definition/en/.
      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.
      1994;272:1749-1756.
    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.

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