Sunday, May 17, 2015

Depression is everywhere. Even your company.

There are extraordinary costs associated with depression. The human costs are that depression is the source of extreme human suffering, places our loved ones at risk for suicide, physical illness, and social disadvantage. The economic costs to the global economy and businesses are in the billions of dollars each year. If you are an employer, each depressed employee is contributing to 3 additional sick days each month, or a 10% reduction in productivity. Many people choose to ignore these costs by attaching stigma to people who may be depressed by calling them lazy, weak, and unstable, instead of acknowledging the fact that depression is an illness, and like other illnesses, can be effectively treated. This week, I want to share a study that demonstrates both the human and economic benefits caused by providing mental health services to treat depression. 

To do this, United Behavioral Health contacted almost 8,000 employees of large and diverse companies, including airlines, banks, and state governments. More than six thousand (6,456) of these employees completed an initial assessment, of which 604 were eligible for the study because they were: 1) currently depressed, 2) not receiving mental health care, and 3) not suffering from co-occurring and acute mental health problems that would impair their participation (e.g., current substance use disorders or evidence of bipolar disorder). All participants then completed questionnaires regarding their weekly work habits, such as their perceptions of productivity, hours worked, and performance.

Of these 604 depressed individuals, 304 were randomly assigned to a managed care intervention, while 300 were randomly assigned to “usual care.” The managed care intervention was that each patient was assigned a master’s level mental health case-manager who conducted a thorough phone assessment of the patient’s symptoms, provided them with referrals to psychotherapy and a psychiatrist. If the participant was unwilling to engage in in-person therapy, the case manager then completed a series of motivational phone appointments regarding their hesitation to seek treatment, while continuing to assess any changes in their symptoms via regular phone contact. In addition, participants were provided with a cognitive behavioral workbook to help them learn about strategies to reduce depression at home. After two months, patients who refused therapy and whose depression symptoms continued to worsen were offered a structured 8-session course of cognitive-behavioral therapy. In comparison, the patients in “usual care” were simply informed of their depression diagnosis at the end of the initial assessment, and referred to seek treatment from a mental health professional.

After 6 and 12 months, participants in the study again completed study questionnaires and interviews about their depression symptoms, work performance, and hours spent working. They found that after 6 months, 18% of participants who received the managed care intervention had recovered from their depression, while only 13% of participants in usual care had recovered. After 12 months, 26% of participants in the managed care intervention had recovered from depression, while only 18% in usual care had recovered. In other words, the managed care intervention achieved in 6 months, what usual care took a year to accomplish.

But what about work performance? At the end of 6 months, participants in the managed care intervention group were more likely to have kept their jobs and worked “effectively” for 2.9 more hours each week. At the end of 12 months, employees in the intervention reported working 3.5 more hours per week compared with the usual care participants.

These numbers may seem small to you. Believe me, for all the work that this intervention involved, you would hope that we wouldn’t be left with 75% of people still depressed, and only a 3.5 hour per week bump in productivity, but these numbers add up. 3.5 hours is nearly 10% of a full-time work week, multiplied by 10% of the company’s workforce. The authors of the article estimate that these extra productivity hours annualize to about $2,049* in added benefit to the employer, per employee, which far exceeds the additional cost of covering mental health visits in employee benefits.

Depression is characterized by persistent sad or irritable mood, loss of interest or pleasure in activities, difficulty concentrating, increased anxiety, changes in appetite, changes in sleep, and changes to physical mobility, such as moving very slowly or fidgeting. If a combination of these symptoms co-occur for two weeks or longer, they may indicate that a person is experiencing a depressive episode. The purpose of this article is not to encourage employers to diagnose their employees as depressed, but rather to consider what may underlie noted changes in an employee’s performance or mood and to invest in employee productivity via promoting mental health. If for no other reason, quite frankly, you can’t afford not to.

For other articles on depression and treatments, click here or here or here.

Wang, P. S., Simon, G. E., Avorn, J., Azocar, F., Ludman, E. J., McCulloch, J., ... & Kessler, R. C. (2007). Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: a randomized controlled trial. JAMA, 298(12), 1401-1411.

*This article was published in 2007. At the time, the authors estimated the additional benefit of 3.5 hours of increased productivity per employee to annualize to $1800. This figure has been adjusted based upon the rate of inflation in the United States and is subject to error.

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