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The Depression Calculator for Employers

Evidence from Research

Productivity Loss

The studies included for analysis used data from employed adults diagnosed with MDD, PDD, or both and a healthy control group. They analyzed the effect of depression on employment, including excess lost productive time in the form of presenteeism and absenteeism. Excess lost productive time due to depression is measured by the difference in lost productive time among employed adults with depression minus the time among healthy control adults.

Authors/Year Journal Sample Absenteeism
(Days lost/
person/year)		 Presenteeism
(Days lost/
person/year)
Stewart et al. 2003 JAMA 692 6.5 29.9
Kessler et al. 2003 JAMA 514 35.6 NA
Lerner et al. 2004 J Occup Environ Med 389 41.6 27
Lam et al.
2009		 BMC Psychiatry 234 33.2 NA
Lerner et al. 2015 Psychiatry Serv 380 40.3 26.8
Reference:
  • Stewart WF, Ricci JA, Chee E, Hahn SR, Morganstein D. Cost of lost productive work time among US workers with depression. JAMA. 2003.
  • Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, Rush AJ, Walters EE, Wang PS. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003.
  • Lerner D, Adler DA, Chang H, Berndt ER, Irish JT, Lapitsky L, Hood MY, Reed J, Rogers WH. The clinical and occupational correlates of work productivity loss among employed patients with depression. J Occup Environ Med. 2004.
  • Lam RW, Michalak EE, Yatham LN. A new clinical rating scale for work absence and productivity: validation in patients with major depressive disorder. BMC Psychiatry. 2009.
  • Lerner D, Adler DA, Rogers WH, Chang H, Greenhill A, Cymerman E, Azocar F. A randomized clinical trial of a telephone depression intervention to reduce employee presenteeism and absenteeism. Psychiatry Serv. 2015.

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Basic Medical Care

Included studies used medical records from health maintenance organizations to identify adult patients diagnosed with depression (DSM-IV or V criteria) to find the absolute medical cost estimate to treat depression. The measurements include antidepressant pharmacotherapy initiated in primary care and psychiatric consultation. Annual medical cost and health care services utilization was assessed using health plan standardized claims to estimate annual medical spending and the excess economic burden due to depression to calculate the incremental cost.

Authors/Year Journal Sample Basic medical care
absolute medical
cost/person/year		 Basic medical care
incremental medical
cost/person/year
Greenberg et al. 1990 J Clin Psychiatry 10.4 million $4,072 N/A
Greenberg et al. 2000 J Clin Psychiatry 11.4 million $3,309 N/A
Simon et al. 2001 Arch Gen Psychiatry 1,295 $3,909 N/A
Greenberg et al. 2005 J Clin Psychiatry 13.8 million $9,648 $2,939
Katon et al. 2005 Arch Gen Psychiatry 1,801 $7,742 N/A
Wang et al. 2007 Arch Gen Psychiatry Review article $3,629 N/A
Greenberg et al. 2010 J Clin Psychiatry 15.4 million $10,379 $2,950
Egede et al. 2016 J Affect Disord 147,095 N/A $2,654
Reference:
  • Greenberg PE, Kessler RC, Birnbaum HG, Leong SA, Lowe SW, Berglund PA, Corey-Lisle PK. The economic burden of depression in the United States: how did it change between 1990 and 2000. J Clin Psychiatry. 2003.
  • Greenberg PE, Kessler RC, Birnbaum HG, Leong SA, Lowe SW, Berglund PA, Corey-Lisle PK. The economic burden of depression in the United States: how did it change between 1990 and 2000. J Clin Psychiatry. 2003.
  • Simon GE, Manning WG, Katzelnick DJ. Cost-effectiveness of systematic depression treatment for high utilizers of general medical care. Arch Gen Psychiatry, 2001.
  • Greenberg PE, Fournier AA, Sisitsky T, Pike CT, Kessler RC. The economic burden of adults with major depressive disorder in the United States (2005 and 2010). J Clin Psychiatry. 2015.
  • Katon WJ, Schoenbaum M, Fan MU, Callahan CM, Williams, Jr J, Hunkeler E, Harpole L, Zhou XHA, Langston D, Unützer J. Cost-effectiveness of improving primary care treatment of late-life depression. Arch Gen Psychiatry. 2005.
  • Wang PS, Patrick A, Avorn J, Azocar F, Ludman E, McCulloch J, Simon G, Kessler R. The costs and benefits of enhanced depression care to employers. Arch Gen Psychiatry. 2006;63(12):1345-1353. doi:10.1001/archpsyc.63.12.1345.
  • Greenberg PE, Fournier AA, Sisitsky T, Pike CT, Kessler RC. The economic burden of adults with major depressive disorder in the United States (2005 and 2010). J Clin Psychiatry. 2015.
  • Egede LE, Bishu KG, Walker RJ, Dismuke CE. Impact of diagnosed depression on healthcare costs in adults with and without diabetes: United States, 2004–2011.2016. J Affect Disord, Volume 195, 119–126.

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Enhanced Care
An extensive literature search was conducted to assess studies involving enhanced care for depression. Treatment was considered to be enhanced care if it met the majority of these criteria:
  • A collaborative care manager should be involved to provide structured and systematic interventions.
  • At least two professionals must be part of patient’s network.
  • The outcome is consistently monitored and changed if the improvement is insufficient.
  • Evidence-based treatment on the basis of clinical practice guidance must be provided.
To ensure comparability across studies, cost data were inflated to the year 2012 using country-specific gross domestic product inflation rates and were adjusted to US dollars using purchasing power parities.
Authors/Year Journal Sample Incremental
cost for
Intervention		 Cost-effectiveness
Von Korff et al. 1998 Psychosom Med 170 $582 $678
Von Korff et al. 1998 Psychosom Med 91 $593 $497
Simon, Manning et al. 2001 Arch Gen Psychiatry 407 $169 $2,472
Simon, Manning et al. 2001 Arch Gen Psychiatry 407 $169 $3,100
Simon, Katon et al. 2001 Am J Psychiatry 228 $230 $731
Schoenbaum et al. 2001 JAMA 1,356 $412 $557
Schoenbaum et al. 2001 JAMA 1,356 $588 $603
Liu et al. 2003 Psychiatr Serv 354 $233 $217
Katon et al. 2005 Arch Gen Psychiatry 1,801 $674 $788
Authors/Year: Von Korff et al. 1998
Journal: Psychosom Med
Sample: 170
Incremental
cost for
Intervention:		 $582
Cost-effectiveness: $678
Authors/Year: Von Korff et al. 1998
Journal: Psychosom Med
Sample: 91
Incremental
cost for
Intervention:		 $593
Cost-effectiveness: $497>
Authors/Year: Simon, Manning et al. 2001
Journal: Arch Gen Psychiatry
Sample: 407
Incremental
cost for
Intervention:		 $169
Cost-effectiveness: $2,472
Authors/Year: Simon, Manning et al. 2001
Journal: Arch Gen Psychiatry
Sample: 407
Incremental
cost for
Intervention:		 $169
Cost-effectiveness: $3,100
Authors/Year: Simon, Katon et al. 2001
Journal: Am J Psychiatry
Sample: 228
Incremental
cost for
Intervention:		 $230
Cost-effectiveness: $731
Authors/Year: Schoenbaum et al. 2001
Journal: JAMA
Sample: 1,356
Incremental
cost for
Intervention:		 $412
Cost-effectiveness: $557
Authors/Year: Schoenbaum et al. 2001
Journal: JAMA
Sample: 1,356
Incremental
cost for
Intervention:		 $588
Cost-effectiveness: $603
Authors/Year: Liu et al. 2003
Journal: Psychiatr Serv
Sample: 354
Incremental
cost for
Intervention:		 $233
Cost-effectiveness: $217
Authors/Year: Katon et al. 2005
Journal: Arch Gen Psychiatry
Sample: 1,801
Incremental
cost for
Intervention:		 $674
Cost-effectiveness: $788
Reference:
  • Von Korff M, Katon W, Bush T, Lin EHB, Simon GE, Saunders K, et al. Treatment costs, cost offset, and cost-effectiveness of collaborative management of depression. Psychosom Med 60:143–149. 1998.
  • Von Korff M, Katon W, Bush T, Lin EHB, Simon GE, Saunders K et al. Treatment costs, cost offset, and cost-effectiveness of collaborative management of depression. Psychosom Med 60:143–149. 1998.
  • Simon GE, Manning WG, Katzelnick DJ, Pearson SD, Henk HJ, Helstad CS. Cost-effectiveness of systematic depression treatment for high utilizers of general medical care. Arch Gen Psychiatry 58:181–187. 2001.
  • Simon GE, Manning WG, Katzelnick DJ, Pearson SD, Henk HJ, Helstad CS. Cost-effectiveness of systematic depression treatment for high utilizers of general medical care. Arch Gen Psychiatry 58:181–187. 2001.
  • Schoenbaum M, Unützer J, Sherbourne C, Duan N, Rubenstein LV, Miranda J, et al. (2001) Cost-effectiveness of Practice-Initiated Quality Improvement for Depression: Results of a Randomized Controlled Trial. JAMA 286: 1325–1330. Doi: 10.1001/jama.286.11.1325.
  • Schoenbaum M, Unützer J, Sherbourne C, Duan N, Rubenstein LV, Miranda J, et al. (2001) Cost-effectiveness of practice-initiated quality improvement for depression: results of a randomized controlled trial. JAMA 286: 1325–1330. Doi: 10.1001/jama.286.11.1325.
  • Liu C-F, Hedrick SC, Chaney EF, Heagerty P, Felker B, Hasenberg N, et al. Cost-effectiveness of collaborative care for depression in a primary care veteran population. Psychiatr Serv 54:698–704. 2003.
  • Katon WJ, Schoenbaum M, Fan M-Y, Callahan CM, Williams J Jr., Hunkeler E, et al. Cost-effectiveness of improving primary care treatment of late-life depression. Arch Gen Psychiatry 62:1313–1320. 2005.

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Improvement After Treatment

In the studies included, each patient enrolled in basic medical care was instructed to contact a health care provider like a primary care physician, psychiatrist, or behavioral health specialist. Patients enrolled in enhanced care had access to a depression care manager who provided education, behavioral activation, support of antidepressant medication management prescribed by their regular primary care provider, and problem-solving treatment in primary care along with counseling over the phone by EAP counselors.

Outcomes included presenteeism, absenteeism, and job retention. The change in depression-related presenteeism and absenteeism from baseline to follow-up was the endpoint. The other outcome included annual direct health care cost with and without treatment for depression to calculate the percent reduction in health care cost when they are treated for depression.

Authors/Year Journal Sample Treatment
type		 % Reduction
LPT Absenteeism
(% reduction/
person/year)		 % Improvement
LPT Presenteeism
(% improved/
person/year)
Lerner et al. 2004 Psychiatric Services 229 Basic medical care 29.41% 26.60%
Lerner et al. 2015 Psychiatric Services 1,227 Basic medical care 12.5% 13.46%
Lerner et al. 2012 J Occup Environ Med 193 Enhanced care 41.2% 33.98%
Lerner et al. 2015 Psychiatric Services 1,227 Enhanced care 46.7% 44.12%
Authors/Year: Lerner et al. 2004
Journal: Psychiatric Services
Sample: 229
Treatment type: Basic medical care
% Reduction
LPT Absenteeism
(% reduction/
person/year):		 29.41%
% Improvement
LPT Presenteeism
(% improved/
person/year):		 26.60%
Authors/Year: Lerner et al. 2015
Journal: Psychiatric Services
Sample: 1,227
Treatment type: Basic medical care
% Reduction
LPT Absenteeism
(% reduction/
person/year):		 12.5%
% Improvement
LPT Presenteeism
(% improved/
person/year):		 13.46%
Authors/Year: Lerner et al. 2012
Journal: J Occup Environ Med
Sample: 193
Treatment type: Enhanced care
% Reduction
LPT Absenteeism
(% reduction/
person/year):		 41.2%
% Improvement
LPT Presenteeism
(% improved/
person/year):		 33.98%
Authors/Year: Lerner et al. 2015
Journal: Psychiatric Services
Sample: 1,227
Treatment type: Enhanced care
% Reduction
LPT Absenteeism
(% reduction/
person/year):		 46.7%
% Improvement
LPT Presenteeism
(% improved/
person/year):		 44.12%
Authors/Year Journal Sample Treatment
type		 Total direct
health care
cost without
treatment
(cost/person/year)		 Total direct
health care
cost with
treatment
(cost/person/year)		 % Reduction
in health care
(cost/person/year)
Grypma et al. 2006 Gen Hosp Psychiatry 140 Basic medical care $8,588 $7,471 13.01%
Grypma et al. 2006 Gen Hosp Psychiatry 141 Enhanced care $7,949 $7,471 6.01%
Unützer et al. 2008 Am J Manag Care 279 Enhanced care $8,196 $7,356 10.26%
Authors/Year: Grypma et al. 2006
Journal: Gen Hosp Psychiatry
Sample: 140
Treatment type: Basic medical care
Total direct
health care
cost without
treatment
(cost/person/year):		 $8,588
Total direct
health care
cost with
treatment
(cost/person/year):		 $7,471
% Reduction
in health care
(cost/person/year):		 13.01%
Authors/Year: Grypma et al. 2006
Journal: Gen Hosp Psychiatry
Sample: 141
Treatment type: Enhanced care
Total direct
health care
cost without
treatment
(cost/person/year):		 $7,949
Total direct
health care
cost with
treatment
(cost/person/year):		 $7,471
% Reduction
in health care
(cost/person/year):		 6.01%
Authors/Year: Unützer et al. 2008
Journal: Am J Manag Care
Sample: 279
Treatment type: Enhanced care
Total direct
health care
cost without
treatment
(cost/person/year):		 $8,196
Total direct
health care
cost with
treatment
(cost/person/year):		 $7,356
% Reduction
in health care
(cost/person/year):		 10.26%
Reference:
  • Lerner D, Adler DA, Chang H, Lapitsky L, Hood MY, Perissinotto C, Reed J, McLaughlin TJ, Berndt ER, Rogers WH (2004). Unemployment, job retention and productivity loss among employees with depression. Psychiatr Serv, 55:12, 1371-1378.
  • Lerner D, Adler DA, Rogers WH, et al. A randomized clinical trial of a telephone depression intervention to reduce employee presenteeism and absenteeism. Psychiatr Serv. (Washington, DC). 2015;66(6):570-577. Doi:10.1176/appi.ps.201400350.
  • Lerner D, Adler D, Hermann RC, et al. Impact of a work-focused intervention on the productivity and symptoms of employees with depression. J Occup Environ Med. 2012;54(2):128-135. Doi:10.1097/JOM.0b013e31824409d8.
  • Lerner D, Adler DA, Rogers WH, et al. A randomized clinical trial of a telephone depression intervention to reduce employee presenteeism and absenteeism. Psychiatr Serv, (Washington, DC). 2015;66(6):570-577. Doi:10.1176/appi.ps.201400350.
  • Grypma l, Haverkamp R, Little S, Unützer J. Taking an evidence-based model of depression care from research to practice: making lemonade out of depression. Gen Hosp Psychiatry 2006;28:101-07.
  • Grypma l, Haverkamp R, Little S, Unützer J. Taking an evidence-based model of depression care from research to practice: making lemonade out of depression. Gen Hosp Psychiatry 2006;28:101-07.
  • Unützer J, Katon WJ, Fan MY, et al. Long-term cost effects of collaborative care for late-life depression. Am J Manag Care 2008;14:95-100.

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Diagnosis

The studies analyzed self-reports of health status assessment and depression symptoms and compared it with a physician diagnosis of depression (DSM-IV or V criteria) to assess misdiagnosis of depression.

The treatment compliance was considered inadequate when at least four outpatient visits with any physician for pharmacotherapy, or at least eight outpatient visits with any mental health specialty professional for psychotherapy, were not met during the 12-month treatment period.

Authors/Year Journal Sample Under diagnosis
/ Misdiagnosis %
(%/Year)		 Compliance/receiving
treatment/success
rate (%/Year)
Rioto et al., 2001 Benefits Q 6,215 63% 30% (compliance)
85% (treatment success rate)
Callahan et al., 2002 J Fam Pract 508 72% N/A
Kessler et al., 2003 JAMA 9,090 N/A 78%
Martin et al., 2005 The Clin Risk Manag Review article 60% 60%
Epstein et al., 2010 J Gen Intern Med 116 25% <50%
Dewa et al., 2015 J Occup Environ Med 2,219 N/A 55%
Authors/Year: Rioto et al., 2001
Journal: Benefits Q
Sample: 6,215
Under diagnosis
/ Misdiagnosis %
(%/Year):		 63%
Compliance / receiving
treatment / success
rate (%/Year):		 30% (compliance)
85% (treatment success rate)
Authors/Year: Callahan et al., 2002
Journal: J Fam Pract
Sample: 508
Under diagnosis
/ Misdiagnosis %
(%/Year):		 72%
Compliance / receiving
treatment / success
rate (%/Year):		 N/A
Authors/Year: Kessler et al., 2003
Journal: JAMA
Sample: 9,090
Under diagnosis
/ Misdiagnosis %
(%/Year):		 N/A
Compliance / receiving
treatment / success
rate (%/Year):		 78%
Authors/Year: Martin et al., 2005
Journal: The Clin Risk Manag
Sample: Review article
Under diagnosis
/ Misdiagnosis %
(%/Year):		 60%
Compliance / receiving
treatment / success
rate (%/Year):		 60%
Authors/Year: Epstein et al., 2010
Journal: J Gen Intern Med
Sample: 116
Under diagnosis
/ Misdiagnosis %
(%/Year):		 25%
Compliance / receiving
treatment / success
rate (%/Year):		 <50%
Authors/Year: Dewa et al., 2015
Journal: J Occup Environ Med
Sample: 2,219
Under diagnosis
/ Misdiagnosis %
(%/Year):		 N/A
Compliance / receiving
treatment / success
rate (%/Year):		 55%
Reference:
  • Martin LR, Williams SL, Haskard KB, DiMatteo MR. The challenge of patient adherence. Ther Clin Risk Manag. 2005;1(3):189–199.
  • Epstein RM, Duberstein PR, Feldman MD, Rochlen AB, Bell RA, Kravitz RL, Cipri C, Becker JD, Bamonti PM, Paterniti DA, “I didn’t know what was wrong:” how people with undiagnosed depression recognize, name and explain their distress. 2010. J Gen Intern Med 25(9):954–61.
  • Dewa CS, Hoch JS. Barriers to mental health service use among workers with depression and work productivity. 2015. J Occup Environ Med, 57 (7), 726-731.
  • Riotto M. Depression in the workplace: negative effects, perspective on drug costs and benefit solutions. Benefits Q. 2001; 2: 37–48.
  • Callahan EJ, Bertakis KD, Azari R, Robbins JA, Helms LJ, Leigh JP. Association of higher costs with symptoms and diagnosis of depression. J Fam Pract. 2002 Jun;51(6):540–4.
  • Kessler RC, Berglund P, Demler O, et al. The epidemiology of major depressive disorder: results from the National Co-morbidity Survey Replication (NCS-R). JAMA. 2003; 289:3095–3105.

Click here to see abstracts