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The cost of depression

By Michael Hilton and Harvey Whiteford - posted Monday, 31 October 2005

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.

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About the Authors

Michael Hilton is the Project Director for the Work Outcomes Research Cost-Benefit (WORC) Project based at the Queensland Centre for Mental Health Research (QCMHR).

Harvey Whiteford is the Kratzmann Professor of Psychiatry and Population Health at The University of Queensland and Director of the Policy and Economics Group.

Creative Commons LicenseThis work is licensed under a Creative Commons License.

Photo of Michael HiltonMichael HiltonPhoto of Harvey WhitefordHarvey Whiteford
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