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.
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.
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 (<30%) 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 per year in LPT, an excess of $31 billion per year
compared with peers without depression. This estimate does not include labor
costs associated with short- and long-term disability.
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.