The cost of depression

Depression is a common disorder. The Australian Bureau of Statistics (ABS) estimates that 5.8 per cent of the adult Australian population has depression each year and that depression is the leading contributor to the non-fatal disease burden in Australia.

Of those people in full-time employment the prevalence of depression has previously reported by the ABS to be 3.6 per cent. The societal cost of depression in Australia is largely unknown, but is potentially very significant. It not only includes the direct costs of treatment but also the indirect costs including lost productivity, both while at work and days absent from work.

Other societal results of depression include personal and financial costs to individuals, their families and their communities. Depression has one of the largest impacts on short-term absence from work, disability and work performance. Depression can have the first onset at any age however; highest prevalence for females is in the early to mid 20s while for males it is in mid-to-late 30s. This is when people are in the workforce. Many people with depression may not attribute their symptoms to depression, or may be reluctant to seek treatment.

The WORC (Work Outcomes Research Cost-Benefit) Project aims are to identify employees with symptoms of depression, who are not in treatment, by using cognitive behavioural therapy and motivational interviewing techniques to encourage them to seek advice from a mental health professional.

This project will not only identify the economic burden that depression has on employers and the nation but also determine the return on investment for early identification and treatment for depression.

Originating with Harvard University, Boston (USA), and modified to be relevant to Australian culture, the WORC Project is being conducted through the University of Queensland as the Australian component of the international study. Primary funding is provided by the Department of Health and Ageing, Mental Health Strategy branch, Queensland Health, beyondblue and the Australian Rotary Health Research Foundation.

The specific aim of this project is to test the hypothesis that the cost of proactive screening and treatment of depression in the labour force:

1. improves depressive symptoms; which in turn,
2. increases employee productivity resulting in a net benefit to employers and society.

It is expected proactive screening and treatment of depression in the workforce will reduce symptom severity, sickness absence, impairment in job performance, job-related accidents and job turnover.

The first phase of the project involved the recruitment of 58 large companies (representing over 350,000 employees) to consent to their employees being asked to participate.  Employees were invited to complete a confidential general health and emotional well-being questionnaire covering 28 physical health conditions and the Kessler 6 (K6), which is designed to screen employees for depressive symptoms.

Those employees who screened positive for depressive symptoms on the K6, and who had consented to further contact, were telephoned at home, and asked a further depression screening questionnaire, namely the Quick Inventory of Depressive Symptomatology - Self Report (QIDS-SR). Employees who were positive for depression symptoms on both the K6 and the QIDS-SR were called by trained psychologists. The  psychologists asked a series of further clinical questions, explained their answers, advised the worker of their confidentiality and ethical rights and gave a single counselling session. Employees were encouraged to visit a local mental health professional and sent  a referral letter.

Following this telephone contact with a psychologist, the employees are assigned into one of two intervention groups. The first group only receive the contact as described. The second group is provided with ongoing case management, encouragement to seek help and encouragement to adhere to prescribed therapies over a 12-month period. The  project's aim is to facilitate help-seeking behaviour, by encouraging them to talk to their general practitioner, a psychologist or an employee assistance provider.

A key aspect of the study is to use treatment services in their local community, which is economically practical and assists continuity.

Both groups are followed up after six weeks, thee, six, 12 and 18 months to track the clinical changes in depression symptoms and the employees’ performance at work. All contact with the employees is treated as highly confidential. It is very important that workers believe that they can speak freely with the psychologists without fear that their personal information will be accessible to their employer.

While the study is still in its early stages, it is already producing data from cross sectional analyses of the original health appraisal survey on depression prevalence rates, help-seeking behaviour and the economic burden of depression.

The WORC project has surveyed over 85,000 employees so far about physical and emotional health and work performance in terms of absenteeism and when present at work. The data from the K6 indicates a current depressive symptomatology prevalence rate of 6.7 per cent in full-time employees. Alarmingly, questionnaire data shows that 68 per cent of full-time employees with current depressive symptoms have not sought medical advice in the previous year. This equates to more than 303,000 employees in Australia who are struggling with a crippling illness who are not getting effective treatment.

Economic analyses shows that employees with depressive symptoms, not in treatment, are absent from work for 5.5 per cent of total working time which is 4.3 per cent more than their non-depressed counterparts. This equates to an annual wage loss of at least $1.5 billion due to absenteeism in Australia.

Moreover, employees with depressive symptoms have reduced ability to function at their usual level of capacity while at work. Project results suggest this represents a productivity decrement $2.8 billion a year. In total this is a staggering $4.3 billion in lost productivity each year due to undiagnosed depression.

When averaged across the nation’s workforce the annual cost of lost productivity per person with untreated depression symptoms is $9,665 per annum. Putting this in a context for employers’ consumption, it means that for each and every employee, depression is producing a loss of $647 per annum. Example, if you have 1,000 employees, estimated productivity loss would be approximately $647,000. It is important to note that these productivity losses are an “at least value”, they do not include additional losses due to WorkCover or insurance claims, part-time or casual employees, staff attrition or critical incidents.

Evidence to date suggests that undiagnosed depression is responsible for significant reductions in employee productivity; and this financial burden to organisations and corporate Australia may be alleviated by the early diagnosis and treatment of previously unidentified depressed individuals in the work force.