Recovery from Depression, Work Productivity, and Health Care Costs among Primary Care Patients

Department of Psychiatry and Behavioral Sciences, University of Washington Seattle, Seattle, Washington, United States
General Hospital Psychiatry (Impact Factor: 2.61). 05/2000; 22(3):153-62. DOI: 10.1016/S0163-8343(00)00072-4
Source: PubMed


We describe a secondary analysis of data from a randomized trial conducted at seven primary care clinics of a Seattle area HMO. Adults with major depression (n=290) beginning antidepressant treatment completed structured interviews at baseline, 1, 3, 6, 9, 12, 18, and 24 months. Interviews examined clinical outcomes (Hamilton Depression Rating Scale and depression module of the Structured Clinical Interview for DSM-IIIR), employment status, and work days missed due to illness. Medical comorbidity was assessed using computerized pharmacy data, and medical costs were assessed using the HMO's computerized accounting data. Using data from the 12-month assessment, patients were classified as remitted (41%), improved but not remitted (47%), and persistently depressed (12%). After adjustment for depression severity and medical comorbidity at baseline, patients with greater clinical improvement were more likely to maintain paid employment (P=.007) and reported fewer days missed from work due to illness (P<.001). Patients with better 12-month clinical outcomes had marginally lower health care costs during the second year of follow-up (P=.06). We conclude that recovery from depression is associated with significant reductions in work disability and possible reductions in health care costs. Although observational data cannot definitively prove any causal relationships, these longitudinal results strengthen previous findings regarding the economic burden of depression on employers and health insurers.

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    • "The lack of employment results in financial difficulties , and poverty results in reduced opportunity to obtain gainful employment. Unemployed persons and those who fail to obtain employment have more depressive symptoms than individuals who can get a job [2]. Limited resources, resulting in reduced opportunity for education, which prevent access to most skilled jobs, increase individual vulnerability and insecurity contributing to a persistently low social capital. "
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    ABSTRACT: Economic insufficiency causes stress and negative affects. Poverty is self-perpetuated, also due to a particular pattern of economic behaviors induced by negative affects and stress. Often, loneliness occurs together with economic insufficiency. For this study, it has been selected a sample of convenience. A positive correlation between anxiety/depression and negative affects is presented. Dispositional optimism and social support, factors which contribute to health, serve as buffers, in negative correlation, of the negative impact of negative affects, due to financial restraint , on health. Financial management is negatively correlated with the lack of cardiovascular health, and cardiovascular dysfunction correlates positively with loneliness, in this study. Positive affects correlate positively with resilience skills, which correlate negatively with depression. Within this context, psychobiological therapeutic interventions and psychotherapy, which also target psychological dysfunction related to economic behavior of persons in a situation of poverty , would be beneficial.
    Full-text · Article · Nov 2015 · Open Journal of Psychiatry
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    • "Occupation type was derived from the employment component of the NSMHWB, which was summarised according to the Australian and New Zealand Standard Classification of Occupation (ANZSCO) [16]. Data from published studies determined the probability [17] and cost [18] of depression-related job turnover, mean presenteeism days [19], and absenteeism and presenteeism-related lost productive time costs [2], [20]. "
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    ABSTRACT: Objective Working through a depressive illness can improve mental health but also carries risks and costs from reduced concentration, fatigue, and poor on-the-job performance. However, evidence-based recommendations for managing work attendance decisions, which benefit individuals and employers, are lacking. Therefore, this study has compared the costs and health outcomes of short-term absenteeism versus working while ill (“presenteeism”) amongst employed Australians reporting lifetime major depression. Methods Cohort simulation using state-transition Markov models simulated movement of a hypothetical cohort of workers, reporting lifetime major depression, between health states over one- and five-years according to probabilities derived from a quality epidemiological data source and existing clinical literature. Model outcomes were health service and employment-related costs, and quality-adjusted-life-years (QALYs), captured for absenteeism relative to presenteeism, and stratified by occupation (blue versus white-collar). Results Per employee with depression, absenteeism produced higher mean costs than presenteeism over one- and five-years ($42,573/5-years for absenteeism, $37,791/5-years for presenteeism). However, overlapping confidence intervals rendered differences non-significant. Employment-related costs (lost productive time, job turnover), and antidepressant medication and service use costs of absenteeism and presenteeism were significantly higher for white-collar workers. Health outcomes differed for absenteeism versus presenteeism amongst white-collar workers only. Conclusions Costs and health outcomes for absenteeism and presenteeism were not significantly different; service use costs excepted. Significant variation by occupation type was identified. These findings provide the first occupation-specific cost evidence which can be used by clinicians, employees, and employers to review their management of depression-related work attendance, and may suggest encouraging employees to continue working is warranted.
    Full-text · Article · Sep 2014 · PLoS ONE
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    • "The different morbidity burdens found in the two groups may have an impact on total costs of the disease. Beyond methodological differences, the results were similar to those of other reviewed studies, although other European investigators have also confirmed their impact by measuring quality of life in these patients [3,5,42,43]. In our study, direct and indirect costs represented 32.7% and 67.3% of total costs, respectively. "
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    ABSTRACT: The aim of the study was to determine the most common treatment strategies and their costs for patients with an inadequate response to first-line antidepressant treatment (AD) in primary care. A retrospective cohort study of medical records from six primary care centers was conducted. Adults with a major depressive disorder diagnosis, at least 8 weeks of AD treatment after the first prescription, and patient monitoring for 12 months were analyzed. Healthcare (direct cost) and non-healthcare costs (indirect costs; work productivity losses) were described. A total of 2,260 patients were studied. Forty-three percent of patients (N = 965) presented an inadequate response to treatment. Summarizing the different treatment approaches: 43.2% were switched to another AD, 15.5% were given an additional AD, AD dose was increased in 14.6%, and 26.7% remained with the same antidepressant agent. Healthcare/annual costs were 451.2 Euros for patients in remission vs. 826.1 Euros in those with inadequate response, and productivity losses were 991.4 versus 1,842.0 Euros, respectively (p < 0.001). Antidepressant switch was the most common therapeutic approach performed by general practitioners in naturalistic practice. A delay in treatment change when no remission occurs and a significant heterogeneity in management of these patients were also found.
    Full-text · Article · Aug 2012 · Annals of General Psychiatry
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