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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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Roby, Y. (2017) · Psychiatric Genetics · doi:10.1097/ypg.0000000000000186 · Cited by 23
“The illness is generally marked with a high rate of disability (Kessler et al., 2006) and accompanied by a lifetime suicide risk estimated at 10–20% (Goldberg and Harrow, 2004).”
BackgroundAdult ADHD: Prevalence and Clinical Correlates in a Sample of Italian Psychiatric Outpatients
Valsecchi, P., Nibbio, G., Rosa, J., Tamussi, E., Turrina, C., Sacchetti, E., & Vita, A. (2018) · Journal of Attention Disorders · doi:10.1177/1087054718819824 · Cited by 22
Thoma, P., Edel, M., Boris Suchan, A., & Bellebaum, C. (2014) · Psychiatry Research · doi:10.1016/j.psychres.2014.11.006 · Cited by 27
“Our patients were characterized by comorbid disorders, which is a typical finding given that the prevalence of comorbid diagnoses in ADHD has been estimated at 50–75% with mood disorders representing the most likely concurrent disorder (Kessler et al., 2006).”
BackgroundLau, M. A., Colley, L., Willett, B. R., & Lynd, L. D. (2012) · Mindfulness · doi:10.1007/s12671-012-0108-3 · Cited by 24
The Economic Burden of Acute Coronary Syndromes for Employees and Their Dependents
Page, R. L., II, Ghushchyan, V. H., Gifford, B., Read, R. A., Raut, M. K., Crivera, C., Naim, A. B., Damaraju, C. V., & Nair, K. V. (2013) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0b013e318297323a · Cited by 22
Depressive symptoms and web user experience
Thielsch, M. T., & Thielsch, C. (2018) · PeerJ · doi:10.7717/peerj.4439 · Cited by 21
“Kessler et al. (2006) estimate 27.2 annually lost workdays per ill worker with an associated annual capital loss of $4426.”
BackgroundInfluentialOccupational Psychiatric Disorders in Korea
Choi, K., & Kang, S. (2010) · Journal of Korean Medical Science · doi:10.3346/jkms.2010.25.s.s87 · Cited by 22
Sex differences in the mediators of functional disability in Major Depressive Disorder
Carmona, N. E., Subramaniapillai, M., Mansur, R. B., Cha, D. S., Lee, Y., Fus, D., & McIntyre, R. S. (2018) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2017.09.025 · Cited by 22
Yoshimasu, K., Barbaresi, W. J., Colligan, R. C., Voigt, R. G., Killian, J. M., Weaver, A. L., & Katusic, S. K. (2017) · Journal of Attention Disorders · doi:10.1177/1087054717718264 · Cited by 21
The impact of bipolar spectrum disorders on professional functioning: A systematic review
Dominiak, M., Jażdżyk, P., Antosik-Wójcińska, A. Z., Konopko, M., Bieńkowski, P., Święcicki, Ł., & Sienkiewicz‐Jarosz, H. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.951008 · Cited by 21
“(52) found less favorable outcomes related to more severe and persistent depressive episodes among BD individuals.”
BackgroundInfluentialImproving the Recognition of Borderline Personality Disorder in a Bipolar World
Zimmerman, M. A. (2015) · Journal of Personality Disorders · doi:10.1521/pedi_2015_29_195 · Cited by 21
“In largely separate literatures, both disorders have been associated with impaired occupational functioning (Ansell, Sanislow, McGlashan, & Grilo, 2007; Kessler et al., 2006; Morgan, Mitchell, & Jablensky, 2005; Skodol et al., 2002; Zanarini, Jacoby, Frankenburg, Reich, & Fitzmaurice, 2009; Zimmerman et al., 2010), im…”
BackgroundThe profile and familiality of personality traits in mood disorder families
Wu, P.-J., Chang, S., Lu, M.-K., Chen, W. J., Yang, Y. K., Tzung-LiehYeh, Liao, S.-C., Lu, R., & Kuo, P. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.01.015 · Cited by 21
Overdiagnosis of Bipolar Disorder and Disability Payments
Zimmerman, M. A., Galione, J. N., Ruggero, C. J., Chelminski, I., Dalrymple, K. L., & Young, D. (2010) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e3181e084e1 · Cited by 24
“, 1994) and profound disruptions in work and social functioning (Coryell et al., 1993; Dion et al., 1988; Kessler et al., 2006; Ruggero et al., 2007).”
BackgroundKiosses, D. N., & Alexopoulos, G. S. (2012) · Psychological Medicine · doi:10.1017/s0033291712000967 · Cited by 21
“Beyond suffering and compromised quality of life (Charney et al. 2003; Kessler et al. 2006), prolonged depression in late life increases medical burden and mortality both in medically ill and medically healthy persons (Bruce et al. 1994 ; Steffens et al. 2002).”
BackgroundSickness absence and mental health: evidence from a nationally representative longitudinal survey
Wooden, M., Bubonya, M., & Cobb‐Clark, D. A. (2016) · Scandinavian Journal of Work Environment & Health · doi:10.5271/sjweh.3553 · Cited by 21
Prevalence and correlates of depression with atypical symptoms in Hong Kong
Lee, S., Ng, K. L., & Tsang, A. (2009) · Australian & New Zealand Journal of Psychiatry · doi:10.3109/00048670903279895 · Cited by 19
Pankowski, D., & Wytrychiewicz‐Pankowska, K. (2023) · Journal of Religion and Health · doi:10.1007/s10943-022-01720-4 · Cited by 20
“More and more studies and analyses are indicating the negative impact of mental health issues on, inter alia, work (Kessler et al., 2006), relationships (Sharabi et al., 2016), and other areas of life (Lépine & Briley, 2011).”
BackgroundBipolar depression: clinically missed, pharmacologically mismanaged
Lloyd, L. C., Giaroli, G., Taylor, D. M., & Tracy, D. K. (2011) · Therapeutic Advances in Psychopharmacology · doi:10.1177/2045125311420752 · Cited by 20
“Kessler and colleagues highlighted the fact that work days lost per ill worker per year among patients with BPAD was greater than among those with unipolar major depression; the difference was driven primarily by recurrent depression, not mania [Kessler et al. 2006].”
BackgroundNiedhammer, I., & Chastang, J. (2014) · International Archives of Occupational and Environmental Health · doi:10.1007/s00420-014-1013-y · Cited by 20
“Mental health at work is a crucial issue in occupational health because of its high costs and its heavy impact on absenteeism, presenteeism, and other work-related outcomes such as reduced work performance and turnover (Birnbaum et al. 2010; Kessler et al. 2006).”
BackgroundResearch on Depression in the Workplace: Where Do We Go From Here?
Myette, T. L. (2008) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0b013e31816f855a · Cited by 20
“Epidemiologic and intervention research are needed to improve our understanding of the prevalence and workplace costs of both bipolar and non-bipolar mood disorders and to evaluate the ROI from the employer perspective of interventions aimed at enhancing detection and treatment for these disorders.(51) Mental and Phys…”
BackgroundHamm, R. M., Reiss, D. M., Paul, R. K., & Bursztajn, H. J. (2007) · International Journal of Law and Psychiatry · doi:10.1016/j.ijlp.2007.06.012 · Cited by 20
The effect of bipolar I disorder and major depressive disorder on workforce function
McIntyre, R. S., Wilkins, K., Gilmour, H., Soczynska, J. K., Konarksi, J. Z., Miranda, A., Woldeyohannes, H. O., Vagic, D., Alsuwaiden, M., & Kennedy, S. H. (2008) · Chronic diseases in Canada · doi:10.24095/hpcdp.28.3.01 · Cited by 20
“(4); A Miranda (3); HO Woldeyohannes, HBSc.”
BackgroundResultInfluentialValidity of Mind Monitoring System as a Mental Health Indicator using Voice
Hagiwara, N., Omiya, Y., Shinohara, S., Nakamura, M., Higuchi, M., Mitsuyoshi, S., Yasunaga, H., & Tokuno, S. (2017) · Advances in Science Technology and Engineering Systems Journal · doi:10.25046/aj020343 · Cited by 20
Ellard, K., Gosai, A., Bernstein, E. E., Kaur, N., Sylvia, L., Camprodon, J., Dougherty, D., Nierenberg, A., & Deckersbach, T. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.06.002 · Cited by 18
“Several researchers have identified a link between chronic emotion dysregulation in BD and impulsive and self-destructive behaviors, interpersonal problems, disruptions in work productivity, and increased suicidality (Kessler et al., 2006; Muhtadie et al., 2014; Phillips and Vieta, 2007; Samalin et al., 2016; Swann et…”
BackgroundChang, S.-S., & Chou, T. (2018) · Computational Psychiatry · doi:10.1162/cpsy_a_00021 · Cited by 20
“Bipolar disorder has a serious societal impact, with 65.5 workdays lost per year per patient (Kessler et al., 2006) and its early onset a major risk factor for suicide (Hawton, Sutton, Haw, Sinclair, & Harriss, 2005).”
BackgroundInfluentialDepression among ambulatory adult patients in a primary care clinic in southeastern Nigeria
Iloh, G. U. P., Aguocha, G. U., Amadi, A., & Chukwuonye, M. (2018) · Nigerian Postgraduate Medical Journal · doi:10.4103/npmj.npmj_107_18 · Cited by 20
Asplund, R. P., Jäderlind, A., Björk, I. H., Ljótsson, B., Carlbring, P., & Andersson, G. (2019) · Internet Interventions · doi:10.1016/j.invent.2019.100282 · Cited by 20
“In addition, it can result in impaired work functioning and problems in work participation, in the form of absenteeism and longterm sick leave (Joyce et al., 2016; Kessler et al., 2006; Sanderson and Andrews, 2006).”
BackgroundCorrelates of disability in depressed older adults with bipolar disorder.
Gildengers, A. G., Tatsuoka, C. M., Bialko, C. S., Cassidy, K. A., Dines, P. L., Emanuel, J. E., Jurdi, R. K. A., Gyulai, L., Mulsant, B. H., Young, R. C., et al. (2013) · PubMed · Cited by 20
Dorey, J., Beauchet, O., Thomas-Antérion, C., Rouch, I., Krolak‐Salmon, P., Gaucher, J., Gonthier, R., & Akiskal, H. S. (2008) · CNS Spectrums · doi:10.1017/s1092852900013924 · Cited by 20
“4%.(20) These three studies(1820) support and validate the clinical relevance of the”
ResultSelf-citationMacfadden, W., Adler, C. M., Turkoz, I., Haskins, J. T., Turner, N., & Alphs, L. D. (2011) · BMC Psychiatry · doi:10.1186/1471-244x-11-171 · Cited by 20
“Background Bipolar disorder is a serious, lifelong mental illness associated with marked psychosocial disability [1-5].”
BackgroundWoodward, T. C., Tafesse, E., Quon, P., & Lazarus, A. L. (2010) · PharmacoEconomics · doi:10.2165/11538350-000000000-00000 · Cited by 19
“,([23]) who used data from The National Comorbidity Survey Replication to estimate the workplace costs of mood disorders.”
MethodKok, A. A. L., Plaisier, I., Smit, J. H., & Penninx, B. W. J. H. (2017) · BMC Psychology · doi:10.1186/s40359-017-0179-y · Cited by 23
“4% of US workers with a Major Depressive Disorder [1]; in the Netherlands 9 and 7% of workers with an anxiety or depressive disorder respectively [2]).”
BackgroundInfluentialHobart, M., Zhang, P. G. Y., Weiss, C., Meehan, S. R., & Eriksson, H. (2018) · The International Journal of Neuropsychopharmacology · doi:10.1093/ijnp/pyy095 · Cited by 19
Yuan, Q., Liu, S., Tang, S. W., & Zhang, D. (2014) · BMC Public Health · doi:10.1186/1471-2458-14-685 · Cited by 19
Depression in the Workplace: The Role of the Corporate Medical Director
Burton, W. N., & Conti, D. J. (2008) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0b013e318169ccf8 · Cited by 19
“2 days, respectively.(4) Contributing to the overall negative impact that depressive disorders have on work life functioning is the fact that less than half of those who meet the criteria for diagnosis of the condition receive any treatment, and of those, only about one-third receive minimally adequate treatment.”
BackgroundSarris, J. J., Kavanagh, D. J., Adams, J., Bone, K. M., & Byrne, G. J. (2009) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2009.01.001 · Cited by 19
Persson Asplund, R., Asplund, S., von Buxhoeveden, H., Delby, H., Eriksson, K., Svenning Gerhardsson, M., Palm, J., Skyttberg, T., Torstensson, J., Ljótsson, B., et al. (2023) · Journal of Medical Internet Research · doi:10.2196/34446 · Cited by 18
Watanabe, K., Okusa, S., Sato, M., Miura, H., Morimoto, M., & Tsutsumi, A. (2023) · JMIR Formative Research · doi:10.2196/51334 · Cited by 19
“Given the widespread prevalence of both physical inactivity and depression or anxiety among employees [11,12], promoting physical activity is a central focus in preventive initiatives addressing mental health conditions among employees.”
BackgroundGermain, M. (2013) · Employee Relations · doi:10.1108/er-01-2013-0009 · Cited by 21
Cha, D., Michele, F., Soczynska, J., Woldeyohannes, H., Kaidanovich-Beilin, O., Carvalho, A., Malhi, G., Patel, H., Sim, K., Brietzke, E., et al. (2015) · CNS & Neurological Disorders - Drug Targets · doi:10.2174/1871527313666141130205024 · Cited by 18
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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