How employee depression affects the bottom line
As employers seek better ways to maximize workforce productivity and company-sponsored health benefits, considering the role of depression is critical.
The business case? Compelling.The economic burden of depression on American industry is incredibly high and growing. Research suggests that workplace depression costs a staggering $51.5 billion per year in the United States.
The largest component of these costs, an estimated $33 billion, is in lost work, productivity and absenteeism. Approximately 225 million workdays are lost annually due to productivity decline related to depression. This amounts to more days of work loss and work impairment than many other chronic conditions such as diabetes, asthma and arthritis.
Don’t think that depression is rare in your workforce, or that it will subside in time but without treatment. You’re wrong on both counts. In an organization of 400 employees, it’s likely that 20 of them will experience depression this year. Research shows that 15-20 percent of Americans have depression at some point during their lifetime and if left undiagnosed, untreated or undertreated, depression can be more difficult to arrest—and can lead to self-destructive thoughts, acts and potential for suicide.
Your best and brightest employees may be grappling with job stressors combined with personal issues that can include marital strife, parent/child discord, physical health concerns, financial burdens or death of a loved one. These problems can and do spill over into employees’ professional lives, with research showing that 90 percent of employees say their mental health and personal problems affect their job and directly impact their job performance. Struggling with these sorts of issues can bring about the onset of clinical depression, particularly in vulnerable individuals whose resiliency or coping skills are compromised by genetics, substance-use disorders or environmental stressors—personal or professional.
“Failure on the part of Wisconsin employers to fully recognize depression as a substantial drain on our state’s economy is short sighted,” notes Wis. Lt. Gov. Barbara Lawton. “Employers are de facto health policymakers by virtue of their role in providing health insurance benefits to the vast majority of workers and their families. The interests of these Wisconsin residents and their employers are best served only when the state’s business community aptly and cooperatively addresses depression in its workforce.”
Less now may mean more in the long run. Attempting to manage behavioral health costs with higher co-pays, visit limits and management of utilization can have an unforeseen and unfortunate effect: a surprising rise in employer health care costs. Rather than containing behavioral health costs, these constraining limits can create a contrary financial incentive for patients to access mental health care from primary care physician or other general medical provider instead of specialty mental health providers. This is because there are typically no limitations on PCP visits, and patient co-pays can be significantly less for primary care services.
In fact, one study found that limiting employer-sponsored specialty behavioral health services increased direct medical costs of beneficiaries who used behavioral services by as much as 37 percent; it also increased the number of sick days taken by employees with behavioral health problems. The study’s conclusion? Any savings attributed to limiting behavioral health benefits were fully offset by increased use of other medical services plus lost workdays.
Another problem with limiting employer-sponsored behavioral health care services centers on substandard treatment regimens. General medical practitioners will typically treat depressed patients with medications alone, and do so often with inadequate screening, monitoring and follow-up. While commonplace, this “medication only” protocol is inconsistent with current evidence-based best practices for depression treatment, which call for a combination of psychotherapy and medication to achieve the most successful patient outcomes.
“Numerous studies over the past two decades have found that the adequacy and quality of mental
health care delivered in the general medical setting is sub-optimal,” notes Ronald Finch, EdD, Vice President of the National Business Group on Health (NBGH) in Washington, D.C., a consortium of more than 260 large employers including 63 of the Fortune 100 companies. NBGH advocates for a quality health care delivery system based on scientific evidence of effectiveness.
“In fact, data show that only about 13 percent of individuals treated for behavioral health issues in the general medical sector received minimally adequate care, as compared to 44 percent of patients treated in the specialty mental health sector,” adds Finch.
One solution? Supporting these general medical providers with high-quality behavioral health care services, delivered through a collaborative care model, with primary care working hand-in-hand with specialty behavioral health providers.
Problem is, access to specialty mental health care services is constrained by benefit design with higher co-pays, visit limits and utilization management. So, is effective depression treatment a Catch-22, that is, best delivered by specialty mental health care providers but more likely delivered by the general medical sector? And is this dilemma sustained by employer- and insurance-imposed constraints that are short sighted and can be more costly in the end—to employers, employee patients and society?
It appears so, say experts, unless those carrying the bulk of the cost for these services—employers—recognize what the research suggests, and act on it to mandate “make-sense” approaches to the treatment of depression and other behavioral health conditions. Early, integrated, equalized treatment has payback. Intervening sooner rather than later can save costs associated with treatment of employees for depression.
A 2000 research study suggests more intense outreach to identify depression symptoms in employees earlier and to initiate treatment sooner can be more cost-effective than waiting until the condition and associated costs rose to a disability claim. The tangible benefits of this “sooner rather than later” approach to employee depression treatment? Many, according to Johns Hopkins University School of Medicine researcher Alan M. Langlieb, MD, MPH, MBA.
“The story exists. The data stands on its own,” Langlieb says of the financial benefits to employers of a strong behavioral health benefits, borne out in the research—and in real-world corporate stories. “Companies could feel they’re helpless,” adds Langlieb of the role that employers have in improving the quality, delivery and cost of health care, including that for behavioral and substance abuse. “But they’re in the driver’s seat. They can demand benchmarks from managed care. It’s not a mystery; it shouldn’t require that much legwork. These data have been building for some time and showing impressive results; the data keep building the same story—getting behavioral health assessments, managing the success, following patient outcomes. This is the bread and butter of good health care services.”
“Presenteeism is much more difficult to measure than absenteeism. Yet researchers have found that lost productivity due to presenteeism is, on average, 7.5 times greater than that lost to absenteeism.”