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Cited by 380Mental Health Treatment and AccessWorkplace Health and Well-beingTreatment of Major Depression

Employer burden of mild, moderate, and severe major depressive disorder: mental health services utilization and costs, and work performance

Birnbaum, Howard G., Kessler, Ronald C., Kelley, David, Ben-Hamadi, Rym, Joish, Vijay N., Greenberg, Paul E.·2010·Depression and Anxiety
DOI 10.1002/da.20580
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Abstract

BACKGROUND: Treatment utilization/costs and work performance for persons with major depressive disorder (MDD) by severity of illness is not well documented. METHODS: Using National Comorbidity Survey-Replication (2001-2002) data, US workforce respondents (n=4,465) were classified by clinical severity (not clinically depressed, mild, moderate, severe) using a standard self-rating scale [Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR)]. Outcomes included 12-month prevalence of medical services/medications use/costs and workplace performance. Treatment costs (employer's perspective) were estimated by weighing utilization measures by unit costs obtained for similar services used by MDD patients in claims data. Descriptive analysis across three severity groups generated chi(2) results. RESULTS: Using a sample of 539 US workforce respondents with MDD, 13.8% were classified mild, 38.5% moderate, and 47.7% severe cases. Mental health services usage, including antidepressants, increased significantly with severity, with average treatment costs substantially higher for severe than for mild cases both regarding mental health services ($697 vs. $388, chi(2)=4.4, P=.019) and antidepressants ($256 vs. $88, chi(2)=9.0, P=.001). Prevalence rates of unemployment/disability increased significantly (chi(2)=11.7, P=.003) with MDD severity (15.7, 23.3, and 31.3% for mild, moderate, and severe cases). Severely and moderately depressed workers missed more work than nondepressed workers; the monthly salary-equivalent lost performance of $199 (severely depressed) and $188 (moderately depressed) was significantly higher than for nondepressed workers (chi(2)=10.3, P<.001). Projected to the US workforce, monthly depression-related worker productivity losses had human capital costs of nearly $2 billion. CONCLUSIONS: MDD severity is significantly associated with increased treatment usage/costs, treatment adequacy, unemployment, and disability and with reduced work performance.

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  • Only a minority of people with major depressive disorder receive treatment.

    “Although effectiveness trials show that expanded MDD treatment can reverse many of these adverse effects, only a minority of people with MDD receives treatment and the quality of treatment is unacceptably low among the majority of those in treatment.”

    From The Costs of Depression (2012) · cites this paper as [132]

  • The quality of treatment for major depressive disorder is low for most people who receive it.

    “Although effectiveness trials show that expanded MDD treatment can reverse many of these adverse effects, only a minority of people with MDD receives treatment and the quality of treatment is unacceptably low among the majority of those in treatment.”

    From The Costs of Depression (2012) · cites this paper as [132]

  • Stress, depression, and anxiety among working populations can result in reduced work performance and increased absenteeism.

    “Work-related stress, depression, and anxiety can result in reduced work performance and absenteeism [3-7]”

    From Improving Employee Well-Being and Effectiveness: Systematic Review and Meta-Analysis of Web-Based Psychological Interventions Delivered in the Workplace (2017) · cites this paper as [3]

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Authors
Birnbaum, H. G., Kessler, R. C., Kelley, D., Ben-Hamadi, R., Joish, V. N., & Greenberg, P. E.
Affiliations
  • Analysis Group (United States) (US)
  • Harvard University (US)
  • Sanofi (United States) (US)
Corresponding author
Birnbaum, Howard G.
ORCID
Venue
Depression and Anxiety
Publisher
Hindawi Limited
Published
2010-01
Volume
27
Issue
1
Pages
78-89
ISSN
  • 1091-4269 (ISSN-L)
  • 1520-6394
DOI
10.1002/da.20580
OpenAlex
W1971486864
Cited by
380
References
24
Citations by year
2026: 5 · 2025: 13 · 2024: 15 · 2023: 17 · 2022: 26 · 2021: 38 · 2020: 29 · 2019: 26 · 2018: 40 · 2017: 30 · 2016: 20 · 2015: 32 · 2014: 22 · 2013: 31 · 2012: 14
FWCI
14.80
Type
journal article
Language
en
Open access
closed
Licence
doi.wiley.com/10.1002/tdm_license_1.1 (tdm, 2069 d)
Locations
  • Depression and Anxiety (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Mental Health (U01-MH-60220, U01MH060220)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Health Professions › General Health Professions › Workplace Health and Well-being
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Keywords
major depressive disorder, depression severity, employer burden, mental health service utilization, treatment costs, antidepressants, employee performance, productivity loss, unemployment, disability, human capital costs, labor force
MeSH terms
Absenteeism, Adolescent, Adult, Costs and Cost Analysis, Cross-Sectional Studies, Depressive Disorder, Major, Major Depressive Disorder, Employee Performance Appraisal, Health Expenditures, Female, Health Surveys, Humans, Male, Mental Health Services, Middle Aged, Occupational Diseases, United States, Utilization Review, Cost of Illness, Young Adult

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