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Depression and the Employer. William McPeck Maine State Government March 2002. Depression – Fast Facts. Estimated 11 – 17 million Americans Estimated 5 – 10 % of the population Women > Men 30,000 suicides/year Under Diagnosed and Under Treated. Depression in the Workplace.

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depression and the employer

Depression and the Employer

William McPeck

Maine State Government

March 2002

depression fast facts
Depression – Fast Facts
  • Estimated 11 – 17 million Americans
  • Estimated 5 – 10 % of the population
  • Women > Men
  • 30,000 suicides/year
  • Under Diagnosed and Under Treated
depression in the workplace
Depression in the Workplace
  • Greenberg, et al, 1993
    • Annual cost to corporate America = $44B
    • $12B from Lost Productivity
    • $12B from Lost Work Days
    • $12B from Direct Treatment Costs
    • $7.5B from Mortality Costs
depression in the workplace1
Depression in the Workplace
  • Druss, et al, 2000
    • Employees with depression incurred annual per capita health and disability costs of $5,415.
    • Employees with depression plus any other chronic illness cost 1.7 times more than employees with just the same medical condition alone.
depression in the workplace2
Depression in the Workplace
  • Druss, et al, 2000
    • Employees under age 40 with depression took 3.5 more annual sick days than those 40 years old or older without depression.
    • Workers with depression were absent from work at a rate of 1.5 times the average with a 20% reduction in productivity.
depression in the workplace3
Depression in the Workplace
  • Davidson, 1998
    • Depression alone accounts for lost workdays that total a $12 billion loss per year.
    • The cost of depression alone to employers is as high or higher than the cost of many other common illnesses.
hero study health enhancement research organization
HERO StudyHealth Enhancement Research Organization
  • Research database of 6 large employers representing 47,500 employees – Risk factors studied from 1990 – 1996 using HRAs
    • 70% suffered from depression
    • 46% suffered from high stress
    • 35% suffered from diabetes
    • 21% reported being overweight
    • 14% reported smoking
    • 12% had an elevated blood pressure
    • 10% reported a sedentary lifestyle
first chicago bank study
First Chicago Bank Study
  • Depression accounted for 52% of the mental health claims 1988 – 1991
  • 1991 claim cost for depression = $930,000
  • 62% of the total mental health treatment days were for depression
  • Depression was #1 in treatment days 40 treatment days per event
first chicago bank s response
First Chicago Bank’s Response
  • Increased EAP awareness and training
  • Managerial training
  • Increased corporate awareness
  • Focus on depression case management
  • Implemented screening program
  • Medical plan enhancements
first chicago bank results
First Chicago Bank Results
  • Direct costs dropped from $1m to $400,000 1992 – 1996
  • Depression as a percentage of mental health claims costs dropped from 62% - 45% 1992 – 1995
  • Direct treatment costs for depression dropped from $116 -$58 per member
  • Depression events went from 1.8/1000 employees to 4.8/1000 1989-1995
depression study maine state government employee som health plan 1997
Depression Study Maine State Government Employee (SOM) Health Plan 1997
  • 1,561 active members of plan had diagnosis of depression – 66% were employees – 6% of total active plan members
  • Depressed members were 2.5 times more likely to be female
  • Members with depression accounted for $6.7 million or 14% of total cost of medical plan
depression study som 1997
Depression Study – SOM - 1997
  • Members with depression
    • Cost of $308/pmpm; $206 for medical costs, $102 for mental health costs
    • 904 members with depression visited PCP
    • 1,908 visits to PCP for mental health treatment
depression study som 19971
Depression Study – SOM - 1997
  • Inpatient hospitalization rate for non-mental health conditions
    • 95.1/1,000 in depression group
    • 67.0/1,000 in non-mental health group
  • Members with depression had higher rates of non-mental health claims in virtually every medical diagnostic category studied
depression study som 19972
Depression Study – SOM - 1997
  • In 1997, SOM Plan spent $1,083,279 in anti-depressant medications
    • Average cost of $50.00/pmpm
  • Employees with depression averaged 16.2 prescriptions per year
  • 73% of active members with depression used anti-depressants
som update april 2000
SOM Update – April 2000
  • 1,672 (6.9%) of the active members had a depression claim;
    • 1,271 (76%) were employees
  • 1 in 12 employees had a depression claim during 1998
  • Members with depression experienced a total of 15,770 mental health visits during 1998
som update april 20001
SOM Update – April 2000
  • Depressed members had $1.3 million in mental health claim payments and $4.2 million in non-mental health claim payments in 1998
  • Depressed members, regardless of co-morbidity, averaged higher non-mental health utilization and payments than members without a mental health diagnosis.
som update april 20002
SOM Update – April 2000
  • Over $1.1 million in payments for antidepressants
  • Following AHCPR Depression Guidelines:
    • 50% of members with a new episode of depression, who received an antidepressant, did not receive the full 6 month course of treatment
    • 58% of new cases did not receive antidepressant treatment at all
mhmc depression initiative maine health management coalition
MHMC Depression InitiativeMaine Health Management Coalition
  • Employee Interactive Screening Program
    • Two versions available:
      • Telephone Screening (ETAP)
      • Online Screening
  • Nurse Call – Patient Follow-up
    • Pilot study with selected PCP practices
mhmc depression initiative
MHMC Depression Initiative
  • Employee Interactive Telephone Screening Program (ETAP)
    • SOM one of 19 MHMC employers participating
    • 96% of MHMC member employees covered
mhmc depression initiative1
MHMC Depression Initiative
  • Why an ETAP Program?
    • Prevalence of depression
    • Costs associated with depression
    • Depression and co-morbidity
mhmc depression initiative2
MHMC Depression Initiative
  • ETAP Program
  • Maintains a consumer orientation through:
    • Anonymity – No personal information recorded
    • Confidentiality – Employee responds to questions using telephone keypad; no conservation to be overheard
    • Only aggregate demographic and results data shared with employer
mhmc depression initiative3
MHMC Depression Initiative
  • ETAP
  • Two Screening Programs Available
    • Depression and Manic-Depression Screening
    • Alcohol Use
mhmc depression initiative4
MHMC Depression Initiative
  • Depression and Manic-Depression Screen
    • 10 question depression screening instrument developed and validated by Harvard University
    • 3 question manic depression screen also developed and validated by Harvard University
mhmc depression initiative5
MHMC Depression Initiative
  • Alcohol Use
    • 10 question Alcohol Use Disorder Identification developed in 1982 by the World Health Organization
      • Screens for alcohol behaviors and problems ranging from risky drinking to alcohol dependence
mhmc depression initiative6
MHMC Depression Initiative
  • ETAP
    • Dedicated 800 toll-free number for each organization
    • Immediate caller feedback
    • Weekly and quarterly reports
    • Educational and promotional materials
      • Special emphasis programs
        • Alcohol Awareness Day – April
        • Depression Screening Day – October
    • Automatic Transfer to EAP or MH insurance carrier
mhmc depression initiative7
MHMC Depression Initiative
  • ETAP National Results
    • Depression Screening
      • 73% of callers score positive for depression
      • 80% of positives score in the mild to moderate range
      • 90% not in treatment at time of call
      • 87% of callers are employees
      • 75% of the female callers score positive
      • 70% of the male callers score positive
mhmc depression initiative8
MHMC Depression Initiative
  • ETAP National Results
    • Alcohol Screening
      • 70 % of the callers score positive for an alcohol problem
      • 96% of those who score positive score in the harmful/hazardous or harmful/dependence range
      • 95.4% are not in treatment at the time of the call
      • 81% of the callers are employees
mhmc depression initiative9
MHMC Depression Initiative
  • ETAP National Results (continued)
    • 72% of the male callers score positive
      • 98% in the harmful or above range
    • 61% of the female callers score positive
      • 93% in the harmful range and above
mhmc depression initiative10
MHMC Depression Initiative
  • MHMC ETAP Results for 2001
    • 1.3% of the MHMC membership calling
      • Ranges from 0.3% - 7% per organization
    • Total of 730 calls
      • 505 for depression screening
      • 225 for alcohol screening
    • 71% of the callers female
    • 70% of the callers depicted depression symptoms
    • 85% of the callers with depression not in treatment at the time of the call
mhmc depression initiative11
MHMC Depression Initiative
  • MHMC Nurse Call Program
    • Nurse Case Management of Depression Treatment – costs approx. $150/patient
      • 6 month patient telephone follow-up
        • Patient education on depression management
        • Assess treatment progress
        • Screen for suicide
        • Help to develop an activity schedule
        • Keep the provider (PCP) informed of progress or complications
    • Psychiatric consultation and bi-weekly review
mhmc depression initiative12
MHMC Depression Initiative
  • Nurse Call results
    • 74% of patients still taking anti-depressant medications at 6 months
    • 57% of patients showed at least a 50% improvement in their baseline Hamilton Depression Severity Score
    • 18% self-reported an improvement in their baseline work role functioning
    • Improvements translate into a $2,600 savings/employee
for further information
For Further Information
  • William McPeck, MSW

Director, Employee Health and Safety

Maine State Government

114 Sate House Station

Augusta, ME 04333

207-287-6783 (voice)

207-287-6796 (fax)

william.c.mcpeck@state.me.us