Workers' comp costs are closely linked to depression

Depression screening is cost effective

Three factors: depression, stress and obesity, together account for about half of the variance in the average workers' compensation cost per case at PPG Industries. That is based on data from Health Risk Assessments completed by several thousand of the company's employees, and analysis of five years of workers' compensation claims at 35 worksites, according to Alberto M. Colombi, MD, MPH, medical director.

Single out high-risk workers for screening

Mental health screening should be part of your overall plan to assess risk, implement interventions, and establish outcomes measurement strategies, says Nancy W. Spangler, MS, OTR/L, a consultant to the Partnership for Workplace Mental Health and president of Leawood, KS-based Spangler Associates Inc. She suggests the following approaches:

1. Add questions about mental health and stress to health risk appraisals.

"This is a valuable and low-cost way to increase awareness," says Spangler. She advises using validated tools, including the World Health Organization Health and Work Performance Questionnaire or the Work Limitations Questionnaire.

2. Screen high-risk groups.

These include employees with other medical conditions, people who access employee assistance programs, those who are frequently absent from work, and employees in particularly high-stress positions.

Also screen any employee who has been off work for five days or more with an occupational injury or accident. For these cases, Spangler suggests using a nine-item depression scale, called the Patient Health Questionnaire.

"This tool may be helpful for both screening and monitoring progress," she says. Spangler points to one study that found a high prevalence of depressive symptoms at one month (43%) and six months (27%) post-workplace injury. In addition, the researchers found that few of the injured employees were receiving any treatment for depression(13% and 24%, respectively).1

3. Collaborate with others in your organization who may be able to influence mental health awareness.

Enlist the help of human resources, leadership, employee assistance, safety, and communications.

4. Communicate with referral clinicians.

Inform independent medical examiners, rehabilitation, and disability vendors that your organization values a comprehensive biopsychosocial approach to functional capacity examinations, work accommodations, and return-to-work strategies.


1. Franche RL, Carnide N, Hogg-Johnson S, et al. Course, diagnosis, and treatment of depressive symptomatology in workers following a workplace injury: a prospective cohort study. Can J Psychiatry 2009; 54(8):534-546.

"Depression screening is the most important tool that can be promoted in the realm of mental well-being," says Colombi. "It has direct bearings on occupational health and productivity. We found that the percentage of people that screen positive for depression, together with other factors, has an important impact on overall worker's compensation costs."

The findings indicate that depression is a contributing factor in a multi-factorial process, not the sole factor affecting worker's compensation. "Treating depression as a linear and isolated factor is a serious mistake, in my opinion," says Colombi.

When depression, obesity and stress are all set at their median level, the average payment for a worker's compensation case was found to be $4612. However, if obesity prevalence at that worksite increases from its median of 0.34 to .05, the cost increases 84% to $8519.

Conversely, if the proportion of workers reporting a neutral stress and satisfaction score improved from the median of .33 to .45, the average cost per case would decrease by 63%, to $2918. Finally, if all other factors remained unchanged, and the percentage of workers screened for depression at a worksite was increased from its medial level of 0.25 to 0.45, that would decrease the average payment to $2425, or 53%.

In order to determine your own return on investment from depression screening, Colombi says you need to understand three things. First, you need to know the relationship between depression and workers' compensation costs at your workplace. Secondly, you need to determine the investment required to prevent or treat depression. Lastly, compute the relationship between the financial investment and the benefits resulting from it.

"How much does it cost to increase depression screening from a quarter to half of the worksite population?" asks Colombi. "There are direct costs and indirect costs involved in this."

The direct costs are due to adding a Patient Health Questionnaire including depression to an online Health Risk Assessment, which Colombi says involved a one-time programming fee of $5,000. The indirect costs involved adding depression screening to the wellness programs already in place at each worksite. That cost, for PPG, was $25 per employee per year.

Thus, Colombi estimates that to reduce the average worker's compensation cost per employee by 50%, "you would need to invest $25 per employee to have a worker's compensation payment per employee saving of $500."


For more information on the benefits of mental health screening in the workplace, contact:

• Alberto Colombi, MD, MPH, Corporate Medical Director, PPG Industries, Inc., Pittsburgh, PA. Phone: (412) 434-3111. Fax: (412) 434-2014. E-mail:

• Nancy W. Spangler, MS, OTR/L, President, Spangler Associates Inc., Leawood, KS. Phone: (816) 820-1870. E-mail: Web: