Costs of Depression in the Workplace

Over the past two decades, together with my colleagues, I have undertaken many assessments of the costs of depression. One robust finding from this body of research, which is echoed in my latest study, is the enormity of the workplace burden of illness. A variety of reasons explain why this particular cost component is so large, with more than half of the costs of depression attributable to workplace productivity losses.

Depression is a highly prevalent, chronic illness that affects people especially in their prime working-age years. Furthermore, many of its symptoms can be highly impairing, particularly from a workplace perspective, whether the needed skills require strength, dexterity, concentration, or interpersonal capability. These symptoms include the following:

• cognitive impairments, due to reduced ability to focus
• behavioral impairments, due to social withdrawal or lack of motivation to accomplish even routine tasks
• physical impairments, due to bodily pain or fatigue
• emotional impairments, due to increased moodiness or irritability

In many cases, the symptoms of illness are not so severe that sufferers withdraw entirely from the labor force, resulting in a very sizable
pool of depressed workers at any given time. Because of this particularly problematic constellation of disease-specific factors, no employer is exempt from
the adverse consequences of depression in the workplace.

Employability for individuals with depression changes at different points in the business cycle. When the economy is growing, people with depression tend
to remain employable. But, in periods of economic decline, employees with depression bear a disproportionate burden compared with their nondepressed counterparts, especially among those aged 50 years and older. This is both because employees with depression are generally more likely to lose their jobs during economic downturns and because the buffer of part-time work is not as widely available to those with depression. Of course, distinguishing cause and effect in this context is difficult since the presence of depression is likely to diminish labor market attachment, even as unemployment itself could contribute to a more fragile state of emotional well-being.

All of these workplace findings highlight a tension that exists between societal interests and those of individual employers in the context of optimal patient management. On the one hand, society is better served when depressed workers are drawn into employment situations, as the opportunity cost of their
lost productive capacity is at least partially recaptured through their newfound labor market activity. In addition, for some depression sufferers, health care coverage is available only via employers. On the other hand, individual employers tend to incur added costs as the employment rate of depressed people rises.

Thus, the complex interplay of work status, depression symptoms, and depression treatment warrants continued study. Shining a bright light on the relative impact of these different contributors to direct cost changes and understanding how they have moved historically would offer insight into the available
levers that could be brought to bear in most effectively managing resource utilization in this context over time.

Financial disclosure:Dr Greenberg had no relevant personal financial relationships to report.

See the FOCUS COLLECTION of J Clin Psychiatry articles on healthcare economics.