Depression and the Employer
William McPeckMaine State GovernmentMarch 2002
Depression – Fast Facts
Estimated 11 – 17 million Americans Estimated 5 – 10 % of the population Women > Men 30,000 suicides/year Under Diagnosed and Under Treated
Depression in the Workplace
Greenberg, et al, 1993 Annual cost to corporate America = $44B $12B from Lost Productivity $12B from Lost Work Days $12B from Direct Treatment Costs $7.5B from Mortality Costs
Depression in the Workplace
Druss, et al, 2000 Employees with depression incurred
annual per capita health and disability costs of $5,415.
Employees with depression plus any other chronic illness cost 1.7 times more than employees with just the same medical condition alone.
Depression in the Workplace
Druss, et al, 2000 Employees under age 40 with depression
took 3.5 more annual sick days than those 40 years old or older without depression.
Workers with depression were absent from work at a rate of 1.5 times the average with a 20% reduction in productivity.
Depression in the Workplace
Davidson, 1998 Depression alone accounts for lost
workdays that total a $12 billion loss per year.
The cost of depression alone to employers is as high or higher than the cost of many other common illnesses.
HERO StudyHealth Enhancement Research Organization
Research database of 6 large employers representing 47,500 employees – Risk factors studied from 1990 – 1996 using HRAs 70% suffered from depression 46% suffered from high stress 35% suffered from diabetes 21% reported being overweight 14% reported smoking 12% had an elevated blood pressure 10% reported a sedentary lifestyle
First Chicago Bank Study
Depression accounted for 52% of the mental health claims 1988 – 1991
1991 claim cost for depression = $930,000
62% of the total mental health treatment days were for depression
Depression was #1 in treatment days 40 treatment days per event
First Chicago Bank’s Response
Increased EAP awareness and training Managerial training Increased corporate awareness Focus on depression case
management Implemented screening program Medical plan enhancements
First Chicago Bank Results Direct costs dropped from $1m to $400,000
1992 – 1996 Depression as a percentage of mental
health claims costs dropped from 62% - 45% 1992 – 1995
Direct treatment costs for depression dropped from $116 -$58 per member
Depression events went from 1.8/1000 employees to 4.8/1000 1989-1995
Depression Study Maine State Government Employee (SOM)
Health Plan 1997
1,561 active members of plan had diagnosis of depression – 66% were employees – 6% of total active plan members
Depressed members were 2.5 times more likely to be female
Members with depression accounted for $6.7 million or 14% of total cost of medical plan
Depression Study – SOM - 1997
Members with depression Cost of $308/pmpm; $206 for medical
costs, $102 for mental health costs 904 members with depression visited
PCP 1,908 visits to PCP for mental health
treatment
Depression Study – SOM - 1997
Inpatient hospitalization rate for non-mental health conditions 95.1/1,000 in depression group 67.0/1,000 in non-mental health group
Members with depression had higher rates of non-mental health claims in virtually every medical diagnostic category studied
Depression Study – SOM - 1997
In 1997, SOM Plan spent $1,083,279 in anti-depressant medications Average cost of $50.00/pmpm
Employees with depression averaged 16.2 prescriptions per year
73% of active members with depression used anti-depressants
SOM Update – April 2000
1,672 (6.9%) of the active members had a depression claim; 1,271 (76%) were employees
1 in 12 employees had a depression claim during 1998
Members with depression experienced a total of 15,770 mental health visits during 1998
SOM Update – April 2000 Depressed members had $1.3 million
in mental health claim payments and $4.2 million in non-mental health claim payments in 1998
Depressed members, regardless of co-morbidity, averaged higher non-mental health utilization and payments than members without a mental health diagnosis.
SOM Update – April 2000 Over $1.1 million in payments for
antidepressants Following AHCPR Depression
Guidelines: 50% of members with a new episode of
depression, who received an antidepressant, did not receive the full 6 month course of treatment
58% of new cases did not receive antidepressant treatment at all
MHMC Depression InitiativeMaine Health Management Coalition
Employee Interactive Screening Program Two versions available:
Telephone Screening (ETAP) Online Screening
Nurse Call – Patient Follow-up Pilot study with selected PCP practices
MHMC Depression Initiative
Employee Interactive Telephone Screening Program (ETAP) SOM one of 19 MHMC employers
participating 96% of MHMC member employees
covered
MHMC Depression Initiative
Why an ETAP Program? Prevalence of depression Costs associated with depression Depression and co-morbidity
MHMC Depression Initiative ETAP Program Maintains a consumer orientation
through: Anonymity – No personal information
recorded Confidentiality – Employee responds to
questions using telephone keypad; no conservation to be overheard
Only aggregate demographic and results data shared with employer
MHMC Depression Initiative
ETAP Two Screening Programs Available
Depression and Manic-Depression Screening
Alcohol Use
MHMC Depression Initiative
Depression and Manic-Depression Screen 10 question depression screening
instrument developed and validated by Harvard University
3 question manic depression screen also developed and validated by Harvard University
MHMC Depression Initiative
Alcohol Use 10 question Alcohol Use Disorder
Identification developed in 1982 by the World Health Organization Screens for alcohol behaviors and problems
ranging from risky drinking to alcohol dependence
MHMC Depression Initiative ETAP
Dedicated 800 toll-free number for each organization
Immediate caller feedback Weekly and quarterly reports Educational and promotional materials
Special emphasis programs Alcohol Awareness Day – April Depression Screening Day – October
Automatic Transfer to EAP or MH insurance carrier
MHMC Depression Initiative
ETAP National Results Depression Screening
73% of callers score positive for depression 80% of positives score in the mild to
moderate range 90% not in treatment at time of call 87% of callers are employees 75% of the female callers score positive 70% of the male callers score positive
MHMC Depression Initiative
ETAP National Results Alcohol Screening
70 % of the callers score positive for an alcohol problem
96% of those who score positive score in the harmful/hazardous or harmful/dependence range
95.4% are not in treatment at the time of the call
81% of the callers are employees
MHMC Depression Initiative
ETAP National Results (continued) 72% of the male callers score positive
98% in the harmful or above range 61% of the female callers score positive
93% in the harmful range and above
MHMC Depression Initiative MHMC ETAP Results for 2001
1.3% of the MHMC membership calling Ranges from 0.3% - 7% per organization
Total of 730 calls 505 for depression screening 225 for alcohol screening
71% of the callers female 70% of the callers depicted depression
symptoms 85% of the callers with depression not in
treatment at the time of the call
MHMC Depression Initiative MHMC Nurse Call Program
Nurse Case Management of Depression Treatment – costs approx. $150/patient 6 month patient telephone follow-up
Patient education on depression management Assess treatment progress Screen for suicide Help to develop an activity schedule Keep the provider (PCP) informed of progress or
complications Psychiatric consultation and bi-weekly review
MHMC Depression Initiative Nurse Call results
74% of patients still taking anti-depressant medications at 6 months
57% of patients showed at least a 50% improvement in their baseline Hamilton Depression Severity Score
18% self-reported an improvement in their baseline work role functioning
Improvements translate into a $2,600 savings/employee
For Further Information William McPeck, MSW Director, Employee Health and Safety Maine State Government 114 Sate House Station Augusta, ME 04333 207-287-6783 (voice) 207-287-6796 (fax) [email protected]