Consumer Health: The Next Generation of Managed Care

BENEFITS QUARTERLY, Second Quarter 2001 37 M ajor depressive disorder is a costly and debilitating disease that can have detrimental effects on quality of life, job productivity and family relationships, as well as pose a substantial risk for mortality. Depression is a relatively common disease, affecting almost 20% of adults in the United States at some point during their lives.[1] According to the National Institute of Mental Health, an estimated 17 million Americans experience serious depression each year. Research shows that at least one in ten men and one in five women will have a major depressive disorder during his or her lifetime. Despite its high prevalence, depression remains largely misunderstood, underrecognized and dramatically undertreated.[2] Patients with depression utilize significantly more health care services, leading to health care costs that can be twice as much as for those without depression. A 1995 study conducted at the Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington reported that the mean annual cost per patient with depression ($4,246) was significantly higher than for patients without depression ($2,371).[3] For employers, these findings point to a substantial impact on health care costs and workplace productivity. The negative effects of depression on functioning and well-being are greater than for many common chronic medical conditions.[4] According to a recent study, combined direct and indirect costs of depression in the United States totaled $43.7 billion in 1990.[5] Since then, the estimated total costs have soared to between $50 and $60 billion. Direct costs—those primarily related to the diagnosis and treatment of the condition, including hospitalization, primary care, outpatient care, pharmaceuticals and rehabilitation—account for only about one-fourth of total costs for depression. The rest is attributed to indirect costs, which are those associated with lost productivity, missed workdays, and lost lifetime earnings as a result of suicide. (See the figure.) One study showed annual costs for lost productivity and absenteeism to exceed $3,000 per employee with depression.[6] Based on sixmonth prevalence rates for major depression, the cost of depression in the United States in Depression in the Workplace: Negative Effects, Perspective on Drug Costs and Benefit Solutions