Do you want to dramatically improve productivity? Offer depression outreach

(Editor's Note: This is part one of a two-part series on behavioral health issues. This month, we cover new research showing the link between depression interventions and productivity. Next month, we'll report on a growing trend toward integrating behavioral health and medical care.)

If an employee is depressed, that person may come to work every day, but how productive are they? Not very, says new research that shows a workplace program to identify depression and promote effective treatment significantly improves employee health and productivity.1

Still, few employers have implemented such programs, probably because they have decided it's unlikely to be cost-effective, says study co-author Ronald C. Kessler, PhD, a professor at Harvard Medical School's Department of Health Care Policy in Boston.

During Web-based or telephone screening, 604 employees from 16 large employers from a wide variety of industries were identified with clinically significant depression. Half were given an intervention with telephone support from a care manager and their choice of telephone psychotherapy, in-person psychotherapy, or antidepressant medication. The other half were given only feedback about their screening results and advised to seek care from their usual provider.

After one year, the employees in the intervention group were 40% more likely to have recovered from their depression, 70% more likely to stay employed, and worked an average of two hours more per week. The extra hours alone are worth $1,800 per employee per year, noted the researchers, which is much more than the $100 to $400 per person cost of the intervention.

"Our results show definitively something that we already suspected but never before rigorously documented: that high quality management of depressed workers can have a positive [return on investment] for employers," says Kessler. "Our hope is that employers will recognize the human capital investment opportunity in our findings and will respond by expanding their depression outreach-treatment programs."

These study results send a clear message to occupational health professionals that depression screening and intervention programs are a "win-win investment," says Philip Wang, MD, DrPH, the study's lead author and director of the National Institute of Mental Health's Division of Services and Intervention Research in Bethesda, MD. The results are important because depression takes a hefty toll on the U.S. workplace, affecting about 6% of employees each year and costing more than $30 billion annually in lost productivity, said Kessler.

"Not only is depression associated with poor health and suffering, but lost productivity as well," says Wang. "Our trial results suggest that enhancing the care of depression can effectively mitigate these negative outcomes."

Return to work sooner

The Hartford, a Simsbury, CT-based employer and disability insurer that participated in the above study, also did its own four-year prospective study from 2002 to 2006 involving 22 businesses in various industries with total of 94,000 employees.2 Eleven offered Employee Assistance Programs (EAP) services to their employees, and 11 did not.

The study found that EAPs decreased the duration of short-term disability claims by about two weeks. Carol A. Harnett, The Hartford's national practice leader for group disability and life practices, says, "We believe it is important to direct reSources toward assisting employees. Stress, depression and other behavioral health conditions are prevalent, costly, and treatable."

The Hartford's study found that mental health conditions often were hidden underneath physical complaints, says Harnett. "Researchers and industry experts alike often point to behavioral health issues accompanying physical diagnoses," she says. "Our study provided substantiation to this belief, showing that 71% of employees who sought EAP services filed disability claims for physical conditions."

Also, while 33% of employees with short-term disability claims who took advantage of EAP services returned to work, only 20% returned who didn't use the services, and only 16% returned who didn't have access to EAPs.

"When we looked at the direct costs associated with decreased short-term disability claim incidence and took the cost of the EAP program into account, we found an approximate 4:1 return," says Harnett.

Historically employers have seriously underestimated the financial impact of worker depression, not only on direct medical costs, but more importantly on productivity, says Joe Marlowe, senior vice president of the health and benefits practice at Aon Consulting, a Chicago-based consulting firm specializing in employee benefits.

"We still have a long way to go before employers really appreciate the impact of depression," says Marlowe. "We know that depressed workers are absent more, are far less efficient while at work, and consume more medical services including prescription drugs."

Depression tends to be underdiagnosed, and once diagnosed, tends to be undertreated, with treatment regimens often not consistent with evidence-based medicine, since the condition is often treated by primary care physicians instead of psychiatrists, says Marlowe. "With the high levels of stress that workers are under in this country trying to balance work and family life, what we are starting to see is younger employees, who you expect to be very productive and making major contributions, with particularly high rates of depression," says Marlowe.

Don't treat "in a vacuum"

Employers are starting to realize that they can't treat depression and mental illness "in a vacuum," says Marlowe, and they are beginning to integrate this with all their other medical programs. Various vendors should exchange information to make one another more effective, he advises. For example, every employee who surfaces as a potential disability claimant should be screened for depression because that will have an impact on how quickly they come back to work, he says.

If you only consider direct medical costs of depression, you are missing the bigger picture, says Marlowe. By asking employees to complete a brief survey about medical conditions in the previous 30 days, including depression, and asking them what they perceive is the impact on absence and presenteeism, you can unearth the hidden lost productivity of depression, he says. "Usually, the results of these kinds of surveys are an eye-opener for employers," he says. "You start to see a very different picture, because the medical and drug claim data don't demonstrate the impact of depression."

He points to an analysis of medical claims of 7,797 employees performed by Dow Chemical which showed that the average employee with depression incurred under $2,000 in medical claims, but those employees reported a substantial impact on their productivity that made the actual loss more than $18,000.3 Traditional EAP programs are "a mistake," because they are underutilized and many employees don't even know they exist, says Marlowe. Employers should be doing more outreach with individuals at risk and offering a wide range of services early, instead of waiting for employees to come to them, he says.

"We know that a depressed employee is less likely to be compliant with medical treatments and less compliant with taking their medication," says Marlowe. "By addressing the depression, you hope to improve the cooperation of the patient, which should speed recovery and reduce costs."

References

1. Wang PS, Simon GE, Avorn J, et al. Telephone screening, outreach and care management for depressed workers and impact on clinical and work productivity outcomes, a randomized controlled trial. JAMA 2007; 298:1,401-1,411.

2. Harnett CA. The real potential of employee assistance programs. Presented at the Disability Management Employer Coalition Annual International Conference. July 2007. Boston.

3. Collins JJ, Baase CM, Sharda CE, et al. The assessment of chronic health conditions on work performance, absence, and total economic impact for employees. J Occup Environ Med 2005; 47:547-557.

Sources

For more information on depression and work productivity, contact:

  • Carol A. Harnett, Vice President, National Practice Leader, Group Disability and Life Practices, The Hartford, 200 Hopmeadow St., Simsbury, CT 06089. Phone: (860) 843-7431. Fax: (860) 392-0871. E-mail: carol.harnett@hartfordlife.com.
  • Ronald C. Kessler, PhD, Professor, Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave., Suite 215, Boston, MA 02115. Phone: (617) 432-3587. Fax: (617) 432-3588. E-mail: kessler@hcp.med.harvard.edu.
  • Joe Marlowe, Senior Vice President, Health & Benefits, Aon Consulting, 555 E. Lancaster Ave., Suite 300, P.O. Box 7300, Radnor, PA 19087-7300. Phone: (610) 834-2137. Fax: (610) 834-3350. E-mail: joe_marlowe@aon.com.
  • Philip Wang, MD, DrPH, Director, Division of Services and Intervention Research, National Institute of Mental Health, 6001 Executive Blvd., Room 7151, MSC 9629, Bethesda, MD 20892-9663. Phone: (301) 443-6233. E-mail: wangphi@mail.nih.gov.