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Prevalence and Effects of Mood Disorders on Work Performance in a Nationally Representative Sample of U.S. Workers
Open accessAbstract
Objective: Research on the workplace costs of mood disorders has focused largely on major depressive episodes. Bipolar disorder has been overlooked both because of the failure to distinguish between major depressive disorder and bipolar disorder and by the failure to evaluate the workplace costs of mania/hypomania. Method: The National Comorbidity Survey Replication assessed major depressive disorder and bipolar disorder with the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) and work impairment with the WHO Health and Work Performance Questionnaire. A regression analysis of major depressive disorder and bipolar disorder predicting Health and Work Performance Questionnaire scores among 3,378 workers was used to estimate the workplace costs of mood disorders. Results: A total of 1.1% of the workers met CIDI criteria for 12-month bipolar disorder (I or II), and 6.4% meet criteria for 12-month major depressive disorder. Bipolar disorder was associated with 65.5 and major depressive disorder with 27.2 lost workdays per ill worker per year. Subgroup analysis showed that the higher work loss associated with bipolar disorder than with major depressive disorder was due to more severe and persistent depressive episodes in those with bipolar disorder than in those with major depressive disorder rather than to stronger effects of mania/hypomania than depression. Conclusions: Employer interest in workplace costs of mood disorders should be broadened beyond major depressive disorder to include bipolar disorder. Effectiveness trials are needed to study the return on employer investment of coordinated programs for workplace screening and treatment of bipolar disorder and major depressive disorder.
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“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 [64]
In the citing paper
“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 [64]
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“Impaired cognition is likely associated with difficulties in everyday tasks contributing to the high degree of psychosocial and functional impairments [6–8], reduced productivity [9], and disability associated with MDD [10, 11].”
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“A single episode of major depressive disorder is associated with an average of more than 5 weeks of lost productivity per worker, resulting in an annual capital loss of $36 billion to employers (Kessler et al., 2006).”
BackgroundThe increasing burden of depression
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“met the criteria of a major depressive episode during a 12-month period according to the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI).(3) The use of the Major Depression Inventory (MDI), a validated self-rating scale which assesses depressive episode according to the symptomatic…”
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What Does Research Tell Us About Depression, Job Performance, and Work Productivity?
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“With one exception,(47) studies measuring both absenteeism and presenteeism were consistent in finding that presenteeism created the higher cost burden.(7,20,41,46) This finding held true whether absenteeism was measured by self-report or using administrative data.”
ResultNovel Models for Delivering Mental Health Services and Reducing the Burdens of Mental Illness
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“A single episode of major depressive disorder is associated with an average of over 5 weeks of lost productivity per worker, resulting in an annual capital loss to employers of $36 billion (Kessler et al., 2006).”
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Treatment-resistant depression: Definitions, review of the evidence, and algorithmic approach
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BackgroundInfluentialThe genetics of bipolar disorder
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“The personal and societal costs of BPD are enormous: even among adequately-treated individuals, relapse is common and the disorder can be profoundly disabling, resulting in serious economic burden (Kessler et al., 2006) and a lifetime risk of suicide as high as 20%”
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“Our study provides higher estimates of work productivity costs compared with previous US studies [8, 23, 24]; however, these studies were based on samples collected more than a decade ago, and there were some methodological differences.”
ResultBirnbaum, H. G., Kessler, R. C., Kelley, D., Ben-Hamadi, R., Joish, V. N., & Greenberg, P. E. (2010) · Depression and Anxiety · doi:10.1002/da.20580 · Cited by 380
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“In recent years, functional outcome has become an issue of major concern not only in clinical settings but also because it represents a social and economic burden for society (5).”
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“2 | International Journal of Neuropsychopharmacology, 2016 Introduction Major depressive disorder (MDD) is a highly prevalent and disabling illness affecting greater than 350 million people worldwide (Kessler et al., 2006).”
BackgroundInterventions to improve return to work in depressed people
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“…disorder as revealed in empirical investigations (Goldberg and Harrow, 2005; Fagiolini et al., 2005; Altshuler et al., 2006; Shi et al., 2006; Kessler et al., 2006; Simon et al., 2007; Pope et al., 2007; Goetz et al., 2007; Morriss et al., 2007; Martinez-Aran et al., 2007; Michalak et al.,…”
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“Major depressive disorder is a highly prevalent, disabling disease with negative impact on medical health, life quality, and productivity (Kessler et al., 2006; Baune et al., 2007).”
BackgroundHeterogeneity of DSM-IV Major Depressive Disorder as a Consequence of Subthreshold Bipolarity
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“5 times higher than in DD (Kessler et al., 2006).”
Poverty, Material Hardship, and Depression *
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“While it is clear that depression results in lost income (Marcotte and Wilcox-Gok, 2001; Kessler et al., 2006; Greenberg et al., 2003), there is a growing consensus that socioeconomic disadvantage precedes poor mental health.”
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Interventions to improve return to work in depressed people
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“workers from the NCS-R (described above), BD patients with at least one prior-year major depressive episode had greater levels of absenteeism, presenteeism, and total lost workdays compared with BD patients with only manic/hypomanic episode(s) during the previous 12 months (Kessler et al., 2006).”
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“6 billion in the USA per annum.(12) The estimates presented here put the cost of psychological distress in the UK at £4.”
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“Individuals with depression lose 5.6 h of productive time at work per week compared to 1.6 h in non-depressed workers (Stewart et al. 2003), which results in 225 million lost workdays and $36.6 billion of salary-equivalent lost productivity per year associated with depression (Kessler et al. 2006).”
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“Including lost productivity, the total social cost of SMI is enormous (Drake et al. 2009; Hu 2006; Kessler et al. 2006; Knapp et al. 2004; Lim et al. 2001; Livermore et al. 2011; Salize et al. 2009; Wu et al. 2005).”
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“, 2008; Barkley, Murphy, O’Connell, & Connor, 2005) and (b) that the number of adults with ADHD in treatment is far lower than the actual number of adults with ADHD (Kessler et al., 2006).”
BackgroundWell-Being and the Risk of Depression under Stress
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“Depression is the leading cause of lost worker productivity and days lost to disability [1], [2] and accounts for an annual capital loss of $36 billion [3].”
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“Workers with MDD miss more days than their nondepressed counterparts, accounting for 225 million missed workdays each year and corresponding to an estimated $36.6 billion in annual lost productivity (Kessler et al., 2006).”
BackgroundInfluentialLeuchter, A. F., Cook, I. A., Marangell, L. B., Gilmer, W. S., Burgoyne, K. S., Howland, R. H., Trivedi, M. H., Zisook, S., Jain, R., McCracken, J. T., et al. (2009) · Psychiatry Research · doi:10.1016/j.psychres.2009.06.004 · Cited by 181
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“12 Indian Journal of Psychological Medicine | Volume 42 | Issue 1 | January-February 2020 economic and social consequences, such as decreased productivity and increased health care utilization costs.[5,6] Compounding the issue further, depression is associated with a high burden of nonresponse to conventional treatmen…”
BackgroundDistinguishing comorbidity and successful management of adult ADHD
Kooij, J. J. S., Huss, M., Asherson, P., Akehurst, R., Beusterien, K., French, A., Sasané, R., & Hodgkins, P. (2012) · Journal of Attention Disorders · doi:10.1177/1087054711435361 · Cited by 172
“According to data from the NCS-R, 38.3% of adult ADHD patients have a comorbid mood disorder, with a lifetime prevalence of 45% (Adler, Spencer, et al., 2008; Kessler et al., 2006).”
BackgroundMethodInfluentialAhola, K., Mika Kivimaki, B., Honkonen, T., Virtanen, M., Koskinen, S. V. P., Vahtera, J., & Lönnqvist, J. K. (2008) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2007.06.022 · Cited by 192
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Frank, E., Soreca, I., Swartz, H. A., Fagiolini, A. M., Mallinger, A. G., Thase, M. E., Grochocinski, V. J., Houck, P. R., & Kupfer, D. J. (2008) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2008.07121953 · Cited by 168
“In addition, patients with bipolar disorder who are employed have a higher number of annual missed work days than individuals without bipolar disorder (10) and tend to have more deficits in work performance when compared with persons with unipolar depression and with a nationally representative control group (11).”
Bipolar Disorder — A Focus on Depression
Frye, M. A. (2011) · New England Journal of Medicine · doi:10.1056/nejmcp1000402 · Cited by 170
Inflammatory mediators in major depression and bipolar disorder
Poletti, S., Mazza, M. G., & Benedetti, F. (2024) · Translational Psychiatry · doi:10.1038/s41398-024-02921-z · Cited by 195
“Mood disorders have been recognized by the World Health Organization as a major source of disability, morbidity, and mortality worldwide [1].”
BackgroundShockley, K. M., Ispas, D., Rossi, M. E., & Levine, E. L. (2012) · Human Performance · doi:10.1080/08959285.2012.721832 · Cited by 184
“Cumulative episodes of sadness may result in depression, which is linked to not only poor performance (Kessler et al., 2006) but also to absenteeism (Plaisier et al., 2010) and healthcare costs (Berto, D’Ilario, Ruffo, Di Virgilio, & Rizzio, 2000).”
BackgroundLee, C., Dickson, D. A., Conley, C. S., & Holmbeck, G. N. (2014) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.2014.33.6.560 · Cited by 163
“Depressive symptoms have been found to not only impact students during college, as observed in academics, interpersonal relationships, and overall quality of life (Rapaport, Clary, Fayyad, & Endicott, 2005), but also persist into adulthood (Kessler et al., 2006; Salmela-Aro, Aunola, & Nurmi, 2008).”
BackgroundWork Performance of Employees with Depression: The Impact of Work Stressors
Lerner, D., Adler, D. A., Rogers, W. H., Chang, G., Lapitsky, L., McLaughlin, T., & Reed, J. (2010) · American Journal of Health Promotion · doi:10.4278/ajhp.090313-quan-103 · Cited by 171
“Eligibility assessment involved the following steps: (1) research assistants (RAs) in primary care physician (PCP) offices invited patients, except those in obvious discomfort, to complete a brief self-report screening survey; (2) the PCP was informed of the result and asked to confirm medical eligibility; (3) confirm…”
Breast Cancer Survivors at Work
Hansen, J. A., Feuerstein, M. A., Calvio, L. C., & Olsen, C. H. (2008) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0b013e318165159e · Cited by 159
“Job stress and its emotional sequelae can impact an individual’s ability to perform optimally at work.(14,15) Although it is reasonable to assume symptom burden may impact job stress, research has not always supported this notion.”
BackgroundBarger, L. K., Rajaratnam, S. M. W., Wang, W., O’Brien, C. S., Sullivan, J. P., Qadri, S., Lockley, S. W., Czeisler, C. A., & for the Harvard Work Hours, H. A. S. G. (2015) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.4534 · Cited by 169
“56 59 Thus, screening should be an initial step in evaluation and treatment programs for sleep disorders.”
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Knekt, P., Lindfors, O., Laaksonen, M. A., Raitasalo, R., Haaramo, P., & Järvikoski, A. (2007) · Journal of Affective Disorders · doi:10.1016/j.jad.2007.08.005 · Cited by 147
“It has also been proposed that sickness presenteeism in the form of work cutback days is far more often an expression of reduced work capacity than actual absence from work (Kessler et al., 2006).”
BackgroundComparing the effects on work performance of mental and physical disorders
de Graaf, R., Tuithof, M., van Dorsselaer, S., & ten Have, M. (2012) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-012-0496-7 · Cited by 147
Ballenger, J. C. (2011) · Yearbook of Psychiatry and Applied Mental Health · doi:10.1016/j.ypsy.2010.10.088 · Cited by 146
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Sleep Disturbances in Mood Disorders
Rumble, M. E., White, K. H., & Benca, R. M. (2015) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2015.07.006 · Cited by 145
Ability of a 9-Item Well-Being Index to Identify Distress and Stratify Quality of Life in US Workers
Dyrbye, L. N., Satele, D., & Shanafelt, T. D. (2016) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0000000000000798 · Cited by 141
“Workers with mental health problems cost US employers $31 to $51 billion in lost productivity.(4,5) Mental health disorders are the leading cause for disability among workingaged US adults,(6) and among the most costly of all health conditions.”
BackgroundCognitive-behavioural interventions for attention deficit hyperactivity disorder (ADHD) in adults
Lopez, P. L., Torrente, F. M., Ciapponi, A., Lischinsky, A. G., Cetkovich-Bakmas, M., Rojas, J. I., Romano, M., & Manes, F. F. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010840.pub2 · Cited by 140
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“Although its effects are variable, MDD can cause impairment in cognitive functioning across multiple domains, including executive functioning and memory, with associated loss of productivity (Kessler et al. 2006).”
BackgroundWork Productivity in Brain Tumor Survivors
Feuerstein, M., Hansen, J. A., Calvio, L. C., Johnson, L. A., & Ronquillo, J. G. (2007) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0b013e318095a458 · Cited by 139
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Hing, B., Sathyaputri, L., & Potash, J. B. (2018) · American Journal of Medical Genetics Part B: Neuropsychiatric Genetics · doi:10.1002/ajmg.b.32616 · Cited by 137
“This disorder can severely affect social functioning of affected individuals, diminishing their quality of life, and increasing their risk of fatality through suicide (Bijl & Ravelli, 2000; Fredman,Weissman, Leaf, & Bruce, 1988; Kessler et al., 2006).”
BackgroundGodboldo-Brooks, A., Hagen, S. E., Sathyanarayanan, S., Schultz, A. B., & Edington, D. W. (2010) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0b013e3181f475cc · Cited by 140
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The WHO World Mental Health (WMH) Surveys
Aguilar‐Gaxiola, S., Alonso, J., Chatterji, S., Lee, S., Üstün, T. B., & Kessler, R. C. (2009) · Die Psychiatrie · doi:10.1055/s-0038-1671923 · Cited by 132
“4% of workers were found to have an episode of MDD in the year of the survey, resulting in an average of over five weeks of lost work productivity (10).”
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Ivanova, J. I., Birnbaum, H. G., Kidolezi, Y., Subramanian, G., Khan, S., & Stensland, M. D. (2010) · Current Medical Research and Opinion · doi:10.1185/03007995.2010.517716 · Cited by 133
“[0] Employees with disability data with at least 1 month eligibility from 2004–2007 2,232,365 [1] Employees identified as MDD 81,631 [2] Employees without psychoses, schizophrenia, bipolar/manic depression, or dementia 67,012 [3] Employees with at least one antidepressant claim starting 1/1/2004 39,059 [4] Eligible at…”
BackgroundSelf-citationClinical practice recommendations for bipolar disorder
Malhi, G. S., Adams, D., Lampe, L. A., Paton, M. B., O’Connor, N., Newton, L., Walter, G., Taylor, A., Porter, R., Mulder, R., et al. (2009) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2009.01383.x · Cited by 127
“In part, this occurs because bipolar disorder most often begins with a depressive episode that naturally leads to a diagnosis of depression (16, 17), and usually, several depressive episodes precede the first episode of mania or hypomania (18, 19).”
BackgroundInterventions to improve occupational health in depressed people
Nieuwenhuijsen, K., Bültmann, U., Neumeyer-Gromen, A., Verhoeven, A. C., Verbeek, J. H., & Feltz-Cornelis, C. M. (2008) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006237.pub2 · Cited by 129
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“4% have been reported to meet the criteria for major depressive disorder (MDD) [2], and 4.”
BackgroundMethodDepression and the workplace: A progress report
Bender, A., & Farvolden, P. (2008) · Current Psychiatry Reports · doi:10.1007/s11920-008-0013-6 · Cited by 126
Trivedi, M. H., Morris, D. W., Wisniewski, S. R., Lesser, I. M., Nierenberg, A. A., Daly, E., Kurian, B. T., Gaynes, B. N., Balasubramani, G. K., & Rush, A. J. (2013) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2012.12020250 · Cited by 123
“In addition, one study (5) found that major depression was associated with 8.”
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N-acetylcysteine for major depressive episodes in bipolar disorder
Magalhães, P. V. D. S., Dean, O. M., Bush, A. I., Copolov, D., Malhi, G. S., Kohlmann, K., Jeavons, S., Schapkaitz, I., Anderson‐Hunt, M., & Berk, M. (2011) · Brazilian Journal of Psychiatry · doi:10.1590/s1516-44462011000400011 · Cited by 113
Improving adherence in mood disorders: the struggle against relapse, recurrence and suicide risk
Pompili, M., Serafini, G., CASALE, A. D., Rigucci, S., Innamorati, M., Girardi, P., Tatarelli, R., & Lester, D. (2009) · Expert Review of Neurotherapeutics · doi:10.1586/ern.09.62 · Cited by 117
Metadata
- Authors
- Kessler, R. C., Akiskal, H. S., Ames, M., Birnbaum, H., Greenberg, P., .A, R. M., Jin, R., Merikangas, K. R., Simon, G. E., & Wang, P. S.
- Affiliations
- Harvard University (US)
- Venue
- American Journal of Psychiatry
- Published
- 2006-09
- Volume
- 163
- Issue
- 9
- Pages
- 1561-1568
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- PMC
- PMC1924724
- OpenAlex
- W2120839478
- Cited by
- 868
- References
- 47
- Citations by year
- 2026: 13 · 2025: 16 · 2024: 25 · 2023: 29 · 2022: 20 · 2021: 34 · 2020: 38 · 2019: 56 · 2018: 50 · 2017: 53 · 2016: 60 · 2015: 59 · 2014: 52 · 2013: 64 · 2012: 60
- FWCI
- 27.68
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- John D. and Catherine T. MacArthur Foundation (R01 DA016558)
- John W. Alden Trust
- Eli Lilly and Company
- Pfizer
- GlaxoSmithKline
- World Health Organization
- Harvard University
- Michigan State University
- Johns Hopkins University
- University of Pittsburgh
- National Institutes of Health (5r13mh066849-04, 5r01mh069864-04)
- Substance Abuse and Mental Health Services Administration
- College of Engineering, Michigan State University
- Pfizer Foundation (R01‐MH069864, R01-DA016558)
- Pan American Health Organization
- National Institute of Mental Health (R13-MH-066849, U01-MH-60220, MH60220, U13MH066849, U01MH060220, R01‐MH069864)
- National Institute on Drug Abuse (K05DA015799, R01DA016558)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Workplace Health and Well-being
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Keywords
- mood disorders, bipolar disorder, major depressive disorder, employee performance, work impairment, lost workdays, mania, hypomania, prevalence
- MeSH terms
- Absenteeism, Adolescent, Adult, Bipolar Disorder, Costs and Cost Analysis, Major Depressive Disorder, Depressive Disorder, Major, Efficiency, Female, Humans, Male, Middle Aged, Occupations, Psychiatric Status Rating Scales, Surveys and Questionnaires, Task Performance and Analysis, United States, Work, Comorbidity, Prevalence, Workplace, Mood Disorders
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