CoChat
Sign Up
Cited by 1,421Workplace Health and Well-beingMental Health Treatment and AccessHealth Systems, Economic Evaluations, Quality of Life

Cost of Lost Productive Work Time Among US Workers With Depression

Stewart, Walter F.·2003·JAMA
DOI 10.1001/jama.289.23.3135
Open this paper in CoChat — free account

Abstract

CONTEXT: Evidence consistently indicates that depression has adversely affected work productivity. Estimates of the cost impact in lost labor time in the US workforce, however, are scarce and dated. OBJECTIVE: To estimate the impact of depression on labor costs (ie, work absence and reduced performance while at work) in the US workforce. DESIGN, SETTING, AND PARTICIPANTS: All employed individuals who participated in the American Productivity Audit (conducted August 1, 2001-July 31, 2002) between May 20 and July 11, 2002, were eligible for the Depressive Disorders Study. Those who responded affirmatively to 2 depression-screening questions (n = 692), as well as a 1:4 stratified random sample of those responding in the negative (n = 435), were recruited for and completed a supplemental interview using the Primary Care Evaluation of Mental Disorders Mood Module for depression, the Somatic Symptom Inventory, and a medical and treatment history for depression. Excess lost productive time (LPT) costs from depression were derived as the difference in LPT among individuals with depression minus the expected LPT in the absence of depression projected to the US workforce. MAIN OUTCOME MEASURE: Estimated LPT and associated labor costs (work absence and reduced performance while at work) due to depression. RESULTS: Workers with depression reported significantly more total health-related LPT than those without depression (mean, 5.6 h/wk vs an expected 1.5 h/wk, respectively). Eighty-one percent of the LPT costs are explained by reduced performance while at work. Major depression accounts for 48% of the LPT among those with depression, again with a majority of the cost explained by reduced performance while at work. Self-reported use of antidepressants in the previous 12 months among those with depression was low (<33%) and the mean reported treatment effectiveness was only moderate. Extrapolation of these survey results and self-reported annual incomes to the population of US workers suggests that US workers with depression employed in the previous week cost employers an estimated 44 billion dollars per year in LPT, an excess of 31 billion dollars per year compared with peers without depression. This estimate does not include labor costs associated with short- and long-term disability. CONCLUSIONS: A majority of the LPT costs that employers face from employee depression is invisible and explained by reduced performance while at work. Use of treatments for depression appears to be relatively low. The combined LPT burden among those with depression and the low level of treatment suggests that there may be cost-effective opportunities for improving depression-related outcomes in the US workforce.

Integrity signals

Registry

Crossref · 10.1001/jama.289.23.3135

Cites

68 of 68 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Among people occupying social and productive roles, major depressive disorder predicts substantial declines in role functioning, including poorer marital quality, lower work performance, and lower earnings.

    “Among people with specific social and productive roles, MDD is found to predict significant decrements in role functioning (e.g., low marital quality, low work performance, low earnings).”

    From The Costs of Depression (2012) · cites this paper as [65]

  • Major depressive episode and major depressive disorder significantly predict overall lost work performance, with annual salary-equivalent human capital value estimates between $30.1 billion and $51.5 billion.

    “All these studies found that MDE and MDD significantly predict overall lost work performance. Several studies attempted to estimate the annual salary-equivalent human capital value of these losses. These estimates were in the range $30.1 billion66 to $51.5 billion.64”

    From The Costs of Depression (2012) · cites this paper as [65]

  • Suicide is ranked as the second leading cause of death among 15-29 year olds and as the 15th most common cause of death at all ages worldwide.

    “Suicide is ranked as the second leading cause of death among 15-29 year olds and as the 15thmost common cause of death at all ages worldwide. 201”

    From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [201]

Cites

Flagged first, then by citations

2 of the 70 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
Stewart, W. F.
Corresponding author
Stewart, Walter F.
ORCID
Stewart, Walter F.
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2003-06-18
Volume
289
Issue
23
Pages
3135
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.289.23.3135
OpenAlex
W2105346851
Cited by
1,421
References
70
Citations by year
2026: 22 · 2025: 20 · 2024: 37 · 2023: 55 · 2022: 48 · 2021: 85 · 2020: 61 · 2019: 48 · 2018: 71 · 2017: 61 · 2016: 113 · 2015: 71 · 2014: 78 · 2013: 81 · 2012: 61
FWCI
109.02
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Funders
Eli Lilly and Company
Topics
  • Health Sciences › Health Professions › General Health Professions › Workplace Health and Well-being
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
Keywords
depression, labor productivity, labor costs, absenteeism, employer costs, antidepressant use, treatment effectiveness, economic burden of depression, somatic symptoms, disability costs, mental health workforce planning, health care financing, health care delivery, health care utilization, health care costs
MeSH terms
Adult, Depression, Depressive Disorder, Efficiency, Employment, Factor Analysis, Statistical, Female, Humans, Male, Middle Aged, Population Surveillance, United States, Linear Models, Cost of Illness, Diagnostic and Statistical Manual of Mental Disorders

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review