Economic costs of minor depression: a population-based study
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Objective: Although the clinical relevance of minor depression has been demonstrated in many studies, the economic costs are not well explored. In this study, we examine the economic costs of minor depression. Method: In a large‐scale, population‐based study in the Netherlands (n = 5504) the costs of minor depression were compared with the costs of major depression and dysthymia. Excess costs, i.e. the costs of a disorder over and above the costs attributable to other illnesses, were estimated with help of regression analysis. The direct medical costs, the direct non‐medical costs and the indirect non‐medical costs were calculated. The year 2003 was used as the reference year. Results: The annual per capita excess costs of minor depression were US$ 2141 (95% CI = 753–3529) higher than the base rate costs of US$ 1023, while the costs of major depression were US$ 3313 (95% CI = 1234–5390) higher than the base rate. The costs of minor depression per 1 million inhabitants were 160 million dollars per year, which is somewhat less than the costs of major depression (192 million dollars per year). Conclusion: The economic costs associated with minor depression are considerable and approach those of major depression.
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The economic costs associated with mild to moderate depression are thought to approach those of major depression.
“The economic costs associated with mild to moderate depression are thought to approach those of major depression [9]”
From Feasibility and Preliminary Efficacy of Digital Interventions for Depressive Symptoms in Working Adults: Multiarm Randomized Controlled Trial (2023) · cites this paper as [9]
The Discussion (p. 7) says the population-level costs of minor depression approach those of major depression. The claim broadens this to “mild to moderate depression,” which the paper does not establish; the Discussion also notes that per-person costs were substantially lower for minor depression. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe estimated point prevalence of depression among both women and men was highest in North America (4·4 and 2·5% respectively) and lowest in the Western Pacific (2·3 and 1·3%); it was intermediate in other world regions both for women (2·8-3·6%) and men (1·9-2·0%).
“The estimated point prevalence among both women and men was highest in North America (4·4 and 2·5% respectively) and lowest in the Western Pacific (2·3 and 1·3%); it was intermediate in other world regions both for women (2·8-3·6%) and men (1·9-2·0%).”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [140]
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“The economic impact of depression is significant due to inability to work (Centre for Economic Performance, 2006; Cuijpers et al., 2007; Layard, 2006).”
BackgroundSelf-help strategies that are helpful for sub-threshold depression: A Delphi consensus study
Morgan, A. J., & Jorm, A. F. (2008) · Journal of Affective Disorders · doi:10.1016/j.jad.2008.08.004 · Cited by 91 · see citing works
“, 2004), increase the risk of developing major depressive disorder (Cuijpers and Smit, 2004), and have considerable economic costs (Cuijpers et al., 2007).”
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Brief self-rated screening for depression on the Internet
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“They cause serious disability (van Schaik et al., 2007), reduced quality of life (Cuijpers et al., 2004), and incur huge economic costs (Cuijpers et al. 2007b).”
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“In addition to the individual symptom burden imposed by untreated RDS, the economic costs are significant and closely approach those associated with major depressive disorder itself (Cuijpers et al., 2007).”
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Depression and Cardiovascular Health Care Costs Among Women With Suspected Myocardial Ischemia
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“Taken altogether, the cost of minor depression may be as high as 160 million US dollars per year per 1 million inhabitants, which is only marginally less than 192 million US dollars per year that is due to major depression [9].”
BackgroundKooistra, L. C., Wiersma, J. E., Ruwaard, J., van Oppen, P., Smit, F., Lokkerbol, J., Cuijpers, P., & Riper, H. (2014) · BMC Psychiatry · doi:10.1186/s12888-014-0290-z · Cited by 82 · see citing works
“As a result, depression is associated with considerable costs [4-6].”
BackgroundSelf-citationEmotion regulation and psychological and physical health during a nationwide COVID-19 lockdown.
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“Although the symptoms of StD were less severe than those of MDD, they may pose a significant burden on the work and study of the affected individuals, as well as have a significant social and economic impact.(5) Previous studies have suggested that StD is a highly prevalent condition worldwide correspondence: shida Qi…”
Stepped care treatment for depression and anxiety in primary care. a randomized controlled trial
Seekles, W., van Straten, A., Beekman, A. T. F., van Marwijk, H., & Cuijpers, P. J. (2011) · Trials · doi:10.1186/1745-6215-12-171 · Cited by 72 · see citing works
“These disorders are often associated with serious functional impairment, reduced quality of life [2,3], high levels of service use and rising economic costs [4,5].”
BackgroundSelf-citationSmits, N., Smit, F., Cuijpers, P. J., & de Graaf, R. (2007) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.230 · Cited by 64 · see citing works
“For example, the monetary costs of treating mental disorders such as major depression have been calculated (Berto et al., 2000; Greenberg and Birnbaum, 2005; Cuijpers et al., 2007).”
BackgroundSelf-citationWong, S. Y. S., Sun, Y. Y., Chan, A. T. Y., Leung, M. K. W., Chao, D. V. K., Li, C. C. K., Chan, K. K. H., Tang, W. K., Mazzucchelli, T., Au, A. M. L., et al. (2018) · The Annals of Family Medicine · doi:10.1370/afm.2206 · Cited by 60 · see citing works
“(5) A self-reported treatment evaluation was conducted immediately after the intervention to assess patient satisfaction.”
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“This is supported by data that show that as the severity and number of mental health symptoms increase, the days out of role and cost of treatment increase ( Cuijpers et al. 2007; Kessler et al. 1999; Wells et al. 2006).”
MethodBuntrock, C., Ebert, D. D., Lehr, D., Cuijpers, P. J., Riper, H. M., Smit, F., & Berking, M. (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-25 · Cited by 57 · see citing works
“First, subthreshold depression is a highly prevalent condition [21] and the burden posed on people affected and the community is considerable [22,23].”
BackgroundSelf-citationAngst, J., Gamma, A., Clarke, D. E., Ajdacic‐Gross, V., Wulf Rössler, A., & Regier, D. A. (2010) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2010.01580.x · Cited by 56 · see citing works
“(34) from an epidemiological study on minor depression, and to the subjective and objective burden borne by patients caregivers as described by Ostacher et al.”
BackgroundProblem-solving treatment and coping styles in primary care for minor depression.
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“negative impact on quality of life and yielding high economic costs [1].”
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“society [4, 5].”
The Economic Burden of Depression in Switzerland
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“[36], supporting this hypothesis, although using a different depression classification (minor vs.”
ResultSeekles, W., van Straten, A., Beekman, A. T. F., van Marwijk, H., & Cuijpers, P. J. (2009) · BMC Health Services Research · doi:10.1186/1472-6963-9-90 · Cited by 48 · see citing works
Self-citationde Graaf, L. E., Gerhards, S. A. H., Arntz, A. R., Riper, H. M., Metsemakers, J. F. M., Evers, S., Severens, J. L., Widdershoven, G. A. M., & Huibers, M. J. H. (2010) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2010.07.003 · Cited by 46 · see citing works
“It causes considerable suffering (Bijl & Ravelli, 2000; Kruijshaar, Hoeymans, Bijl, Spijker, & Essink-Bot, 2003) and the economic burden on society is substantial (Cuijpers et al., 2007; Luppa, Heinrich, Angermeyer, König, & Riedel-Heller, 2007; Slobbe et al., 2006).”
The long-term outcome of subthreshold depression in later life
Jeuring, H. W., Huisman, M. A., Comijs, H. C., Stek, M. L., & Beekman, A. T. F. (2016) · Psychological Medicine · doi:10.1017/s0033291716001549 · Cited by 46 · see citing works
“Recent studies have shown that SUBD represents a large burden of disease (Barry et al. 2009) both in individual patients and at the community level (Johnson et al. 1992; Cuijpers et al. 2007).”
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“Third, subthreshold depression itself is a considerable disease burden for people affected and for society [21, 22].”
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“These disorders are often associated with serious functional impairment, reduced quality of life(17,18) high levels of health care service use and rising costs borne by the patients.(19)”
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“Depressive symptoms lead to adverse health outcomes such as functional disability [5–7], decreased quality of life [8], mortality [6,9], and increased economic costs [10].”
BackgroundDepressive symptom severity is associated with increased cortical thickness in older adults
Szymkowicz, S. M., McLaren, M. E., Kirton, J. W., O’Shea, A. M., Woods, A. J., Manini, T. M., Anton, S. D., & Dotson, V. M. (2015) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.4324 · Cited by 41 · see citing works
“, 2013), increased economic costs (Cuijpers et al., 2007; Meeks et al., 2011), and increased risk for major depression and other psychiatric disorders (Laborde-Lahoz et al.”
BackgroundThe impact of clinical significance criteria on subthreshold depression prevalence rates
Baumeister, H., & Morar, V. (2008) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2008.01287.x · Cited by 40 · see citing works
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de Graaf, L. E., Gerhards, S. A. H., Evers, S., Arntz, A. R., Riper, H. M., Severens, J. L., Widdershoven, G. A. M., Metsemakers, J. F. M., & Huibers, M. J. H. (2008) · BMC Public Health · doi:10.1186/1471-2458-8-224 · Cited by 38 · see citing works
“Cost-of-illness studies reveal that the economic burden of depression is considerable [6-8].”
Furukawa, T. A., Tajika, A., Toyomoto, R., Sakata, M., Luo, Y., Horikoshi, M., Akechi, T., Kawakami, N., Nakayama, T., Kondo, N., et al. (2025) · Nature Medicine · doi:10.1038/s41591-025-03639-1 · Cited by 40 · see citing works
Self-citationPersonality and perceived need for mental health care among primary care patients
Seekles, W., Cuijpers, P. J., van de Ven, P. M., Penninx, B. W. J. H., Verhaak, P. F. M., Beekman, A. T. F., & van Straten, A. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.10.009 · Cited by 36 · see citing works
“Depression and anxiety also lead to huge economic costs due to health care utilization and productivity loss ( [Cuijpers et al., 2007a], [Lepine, 2002] and [Simon et al., 1995]).”
BackgroundSelf-citationTsutsumimoto, K., Makizako, H., Doi, T., Hotta, R., Nakakubo, S., Shimada, H., & Suzuki, T. (2016) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.4461 · Cited by 36 · see citing works
“It is associated with adverse health outcomes (Chachamovich et al., 2008; Cuijpers et al., 2013), increased economic costs (Cuijpers et al., 2007; Meeks et al., 2011), and increased risk for major depression and other psychiatric disorders (Laborde-Lahoz et al., 2015).”
BackgroundThe Association Between Mental Disorders and Productivity in Treated and Untreated Employees
Hilton, M. F., Scuffham, P., Sheridan, J. S., Cleary, C. M., Vecchio, N., & Whiteford, H. (2009) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0b013e3181b2ea30 · Cited by 35 · see citing works
Fractures in the framework: limitations of classification systems inpsychiatry
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The Societal Cost of Dementia in Singapore: Results from the WiSE Study
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“In addition, sub-threshold depression is associated with impaired functioning, reduced quality of life, and excess medical and nonmedical costs [9,10].”
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Using Staged Care to Provide “Right Care First Time” to People With Common Affective Disorders
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“Compared with diagnosed clinical depression, subthreshold forms of depression are more prevalent (Cuijpers, Huibers, Ebert, Koole, & Andersson, 2013), negatively impact subjective well-being and psychosocial function (Cuijpers & Smit, 2004), are related to increased use of health care services (Goldney, Fisher, Dal Gr…”
BackgroundA computer-assisted depression intervention in primary care
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“Combined, this sector of the adult population experiences decreases in well-being and in social and occupational role functioning that are comparable with patients with chronic medical illnesses (Hays, 1995 ; Spitzer et al. 1995; Wells & Sherbourne, 1999 ; Hirschfeld et al. 2000 ; Cuijpers et al. 2007).”
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“Depressive disorders are associated with substantial losses in quality of life in patients and their relatives [3], with increased mortality rates [4,5], with high levels of service use, and with huge economic costs [6,7].”
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“Cognitive impairment has societal and economical implications, both as a risk for decreased work participation (Cuijpers et al., 2007), and as a risk factor for developing major depression (Meeks et al.”
BackgroundUsage and reported helpfulness of self-help strategies by adults with sub-threshold depression
Morgan, A. J., Jorm, A. F., & Mackinnon, A. J. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.11.015 · Cited by 29 · see citing works
“, 2004), but its prevalence in the populationmeans it has a substantial burden through health service use and losses in productivity at work and home (Cuijpers et al., 2007).”
BackgroundVerbal Learning and Memory in Older Adults with Minor and Major Depression
Mesholam‐Gately, R. I., Giuliano, A. J., Zillmer, E. A., Barakat, L. P., Kumar, A., Gur, R. C., McAndrew, L. M., Bilker, W. B., Elderkin‐Thompson, V., & Moberg, P. J. (2011) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acr106 · Cited by 29 · see citing works
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Cost‐effectiveness of cognitive self‐therapy in patients with depression and anxiety disorders
Stant, A. D., Vergert, E. M. T., BOER, P. C. A. M. D., & Wiersma, D. (2007) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2007.01122.x · Cited by 28 · see citing works
“For policy makers, the potential cost savings associated with self-help strategies aimed at emotional disorders are particularly interesting, especially when also considering the substantial costs these disorders impose on society (5, 6).”
BackgroundSasaki, N., & Nishi, D. (2023) · BMC Research Notes · doi:10.1186/s13104-023-06512-x · Cited by 4 · see citing works
“A condition of having depressive symptoms that do not meet the criteria for a depressive disorder is associated with health problems [5], decreased quality of life [6], high economic cost [7], and prece-dented major depression [8, 9].”
Background
- Authors
- Cuijpers, P., Smit, F., Oostenbrink, J., De Graaf, R., Ten Have, M., & Beekman, A.
- Affiliations
- Trimbos Institute (NL)
- Erasmus University Rotterdam (NL)
- Corresponding author
- Cuijpers, P.
- Venue
- Acta Psychiatrica Scandinavica
- Publisher
- Wiley
- Published
- 2007-02-12
- Volume
- 115
- Issue
- 3
- Pages
- 229-236
- ISSN
- 0001-690X (ISSN-L)
- 1600-0447
- OpenAlex
- W2160468985
- Cited by
- 226
- References
- 38
- Citations by year
- 2026: 3 · 2025: 12 · 2024: 10 · 2023: 7 · 2022: 16 · 2021: 11 · 2020: 13 · 2019: 6 · 2018: 12 · 2017: 10 · 2016: 9 · 2015: 14 · 2014: 9 · 2013: 9 · 2012: 7
- FWCI
- 15.93
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Acta Psychiatrica Scandinavica (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- VU Research Portal (submittedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Topics
- 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
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- minor depression, economic costs, major depressive disorder, dysthymia, excess costs, direct medical costs, indirect costs, non-medical costs, cost comparison
- MeSH terms
- Adolescent, Adult, Depressive Disorder, Female, Humans, Male, Mental Health Services, Netherlands, Population Surveillance, Health Care Costs, Diagnostic and Statistical Manual of Mental Disorders
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