The concepts and default values in this application are supported by peer-reviewed published literature on depression. Throughout the application, there are links to view both formal and informal abstracts on specific topics. The following list contains all articles which are used in the application.
Berger ML, Howell R, Nicholson S, Sharda C (2003). Investing in healthy human capital. Journal of Occupational and Environmental Medicine, 45(12), 1213-1225.
This recent paper highlights the importance of keeping a workforce healthy. Through a careful literature review and long-term thinking, the authors contend that investing in healthy human capital will pay off large dividends in the long run. This paper also cites many publications that are used in this model and are listed below.
Berndt ER, Finkelstein SN, Greenberg PE, Howland RH, Keith A, Rush AJ, Russell J, Keller MB (1998). Workplace performance effects from chronic depression and its treatment. Journal of Health Economics, 17, 511-35.
This study used data from a clinical trial to develop an econometric model showing the impact of a medical intervention on work loss. The first important finding was that a reduction in depressive severity rapidly improves a worker's perceived work performance. The largest effects were found in patients with low work performance and low depression severity.
Cantrell CR, Eaddy MT, Shah MB, Regan TS, Sokol MC. Methods for evaluating patient adherence to antidepressant therapy: a real-world comparison of adherence and economic outcomes. Med Care. 2006 Apr;44(4):300-3.
The authors conducted a retrospective study of 22,947 patients initiating selective serotonin reuptake inhibitor (SSRI) therapy for depression and/or anxiety between July 2001 and June 2002 in a large national managed care database. The authors examined clinical outcomes and medical costs across several cohorts.
Claxton AJ, Chawla AJ, Kennedy S (1999). Absenteeism among employees treated for depression. Journal of Occupational and Environmental Medicine, 41, 605-11.
Six hundred thirty workers who suffered from depression were treated with either SSRI or TCA antidepressant drugs. Their monthly absenteeism was measured for the six months prior to treatment and six months following the first treatment. For patients who received SSRI antidepressants, absenteeism was reduced from about 7.5 days per month during the first month of treatment to less than 4.0 days per month after the 6-month follow-up assessment. For patients who received TCA antidepressants, absenteeism was reduced from about 4.9 days per month to about 2.2 days per month.
Druss BG, Rosenheck RA, Sledge WH (2000). Health and disability costs of depressive illness in a major U.S. corporation. American Journal of Psychiatry, 157:8, 1274-1278.
Data from health and employee files of over 15,000 employees of a major U.S. manufacturing company were examined. The sample of employees were only those who had filed a medical claim in 1995. Depressive illness was associated with 9.86 annualized sick days. This estimate does not include lost productivity, only absenteeism.
Dunlop DD, Manheim LM, Song J, Lyons JS, Chang RW. Incidence of disability among preretirement adults: the impact of depression. Am J Public Health. 2005 Nov;95(11):2003-8.
The authors evaluated the effect of depression on risk, on the basis of standardized assessment, for developing activities of daily living (ADL) disability. The odds of ADL disability were 4.3 greater for depressed adults than their non-depressed peers.
Dunner DL, Kwong WJ, Houser TL, Richard NE, Donahue RMJ, Kahn ZM (2001). Improved health-related quality of life and reduced productivity loss after treatment with bupropion sustained release: A study in patients with major depression. Journal of Clinical Psychiatry, 3(1), 10-16.
Eight hundred sixteen patients who met DSM-IV criteria for major depression were given the antidepressant bupropion sustained release. Compared to baseline, patients working at a paid job reported missing 1.58 fewer hours of work per week because of depression at the eight-week follow-up assessment. They also reported being 14.6% more effective on the job, worked more hours overall, and incurred 6.37 fewer hours of lost productivity per week.
Giller E Jr, Bialos D, Riddle MA, Waldo MC (1998). MAOI treatment response: multiaxial assessment. Journal of Affective Disorders, 14, 171-5.
Forty-three outpatients (41 men) who met DSM-III criteria for major depression were given at least six weeks of treatment with isocarboxazid (ICZ), a type of monoamine oxidase inhibitor (MAOI). Patients who received 24 weeks of treatment were significantly improved in their work functioning, compared to their work functioning after only six weeks.
Greenberg PE, Kessler RC, Birnbaum HG, Leong SA, Lowe SW, Berglund PA, Corey-Lisle PK (2003). The economic burden of depression in the United States: How did it change between 1990 and 2000? Journal of Clinical Psychiatry, 64:12, 1465-1475.
This well-conducted study has been cited in the Wall Street Journal and USA Today. The authors found that $52 billion was incurred by employers as a result of depression. For every two depressed workers that are treated, there are three that are untreated. Direct medical costs accounted for half of the $52 billion, which was 19% lower per treated case compared to 1990. Five billion dollars was also lost due to depression-related suicides.
Greenberg PE, Kessler RC, Birnbaum HG et al. The economic burden of depression in the United States: how did it change between 1990 and 2000? J Clin Psychiatry 2003; 64(12):1465-1475.
This economic analysis estimated the average cost of treating a depressed person using national data. Published utilization data for individuals receiving medical treatment for depression included: the National Ambulatory Medical Care Survey, Mental Health, United States, 2000, the National Hospital Discharge Survey, and the National Nursing Home Survey. Average direct costs for the treated depressed were estimated to be $3,309 per case.
Kessler RC, Barber C, Birnbaum HG, Frank GR, Greenberg PE, Rose RM, Simon GE, Wang P (1999). Depression in the workplace: Effects on short-term disability. Health Affairs, Sept/Oct 1999, 163-171.
Data from two national surveys were analyzed to estimate the short-term disability associated with depression. The surveys were the National Comorbidity Survey (NCS) and the Midlife Development in the United States Survey (MIDUS). Depressed workers had between 1.5 and 3.2 more short-term work disability days in a thirty-day period than non-depressed workers. The productivity loss was estimated to be between $182 and $395 in the thirty day period.
Kessler RC, Greenberg PE, Mickelson KD, Meneades LM, Wang PS (2001). The effects of chronic medical conditions on work loss and work cutback. Journal of Occupational and Environmental Medicine, 43(3), 218-225.
The authors examined data from the MacArthur Foundation Midlife Development in the United States (MIDUS) survey. This was a nationally representative survey of 3,032 adults aged 25-74 years. Both work-loss and work-cutback days out of the past 30 were assessed. Data showed that individuals with major depression had 51.6 days per year of work loss.
Kouzis AC & Eaton WW (1994). Emotional disability days: Prevalence and predictors. American Journal of Public Health, 84: 1304-1307.
The authors examined a sample of adults who were assessed by the DSM-III diagnostic instrument. Respondents were asked to recall the number of days in the past three months they were kept from work, school, or usual activities for an entire day because of an emotional problem.
Lave JR, Frank RG, Schulberg HC, Kamlet MS. Cost-effectiveness of treatments for major depression in primary care practice. Arch Gen Psychiatry 1998; 55(7):645-651.
This randomized controlled trial of enhanced care pharmacotherapy or psychotherapy compared with usual care also measured treatment costs. Annual non-protocol treatment costs for the usual care group were $553.20, $308 for the psychotherapy group, and $294 for the pharmacotherapy group. Protocol and non-protocol treatment costs were $1,399 for the psychotherapy group and $1,291 for the pharmacotherapy group.
Lerner D, Adler DA, Chang H, Lapitsky L, Hood MY, Perissinotto C, Reed J, McLaughlin TJ, Berndt ER, Rogers WH (2004). Unemployment, Job Retention and Productivity Loss Among Employees With Depression. Psychiatric Services, 55:12, 1371-1378.
Baseline and 6-month follow-up data were collected from employees with major depression (n=75) and a control group (n=169), among other groups. Those with major depression had 1.9 days missed from work during a two-week span, compared to 0.7 days for the control group. This translates to approximately 60 and 18 days per year. Those with major depression reported lost productivity of 19.6%, compared to 6.6% in the control group.
Lim D, Sanderson K, Andrews G (2000). Lost productivity among full-time workers with mental disorders. The Journal of Mental Health Policy and Economics, 3: 139-146.
Data used in this study were taken from the Australian National Survey of Mental Health and Well-Being, a survey instrument modeled after the US National Comorbidity Survey (DSM-IV criteria). Respondents were asked to estimate the number of work-loss and work-cutback days they experienced in the past four weeks. Extrapolating the data provided in the published paper, depressed individuals experienced approximately 47.8 days missed per year.
Liu C-F, Hedrick SC, Chaney EF, Heagerty P, Felker B, Hasenberg N, Fihn S, Katon W. Cost-effectiveness of collaborative care for depression in a primary care veteran population. Psychiatr Serv 2003; 54: 698-704.
This study examined the incremental cost-effectiveness of a collaborative care intervention for depression compared with consult-liaison care. Collaborative care patients experienced received more prescriptions and experienced fewer depression-free days.
Mark TL. The costs of treating persons with depression and alcoholism compared with depression alone. Psychiatr Serv 2003; 54(8):1095-1097.
Using MedStat’s MarketScan database, the cost of treating people with depression was calculated based on claims data. People enrolled in HMOs were excluded from the population. The average cost of treating an individual with depression was $1,592 per year for the first two years following diagnosis.
Mintz J, Mintz LI, Arruda MJ, Hwang SS (1992). Treatments of depression and the functional capacity to work. Archives of General Psychiatry, 49, 761-8.
This study was a meta-analysis that examined 10 published depression treatment studies from the 1980s. Each study evaluated the effects of antidepressants and psychotherapy on work impairment. Work outcomes were generally good when treatment was effective, although the 10 studies differed in the extent to which the treatments were effective. Relapse was found to be an important predictor of long-term work impairment.
Pyne JM, Rost KM, Zhang M, Williams DK, Smith J, Fortney J. Cost-effectiveness of a primary care depression intervention. J Gen Intern Med 2003; 18(6):432-441.
This randomized study compared the cost-effectiveness of enhanced care with usual care in twelve practices. Outpatient costs were calculated based on patient self-report at six- and twelve-month interviews. The average cost per patient in the usual care group for mental health services and emergency room visits was $496 during a six-month period ($992 on an annual basis) and $713 ($1,426) for the enhanced care group.
Robinson RL, Birnbaum HG, Morley MA, Sisitsky T, Greenberg PE, Wolfe F (2004). Depression and Fibromyalgia: Treatment and Cost When Diagnosed Separately or Concurrently. The Journal of Rheumatology, 31:8, 1621-1629.
Claims data from a Fortune 100 company was analyzed. Findings from two groups are important to the depression calculator: the overall employer sample and MDD-only patients. MDD-only patients had $5,974 in 1998 in health care payments while the overall sample had $1,840. This difference is $4,134. The study also found that patients with MDD and Fibromyalgia had $8,686 in health care payments in 1998.
Robinson RL, Long SR, Chang S, Able S, Baser O, Obenchain RL, Swindle RW. Higher costs and therapeutic factors associated with adherence to NCQA HEDIS antidepressant medication management measures: analysis of administrative claims. J Manag Care Pharm. 2006 Jan-Feb;12(1):43-54.
The goal of this study was to determine if the type of antidepressant drug is related to adherence to National Committee for Quality Assurance (NCQA) Antidepressant Medication Management quality measures and to assess the six-month health care costs among newly diagnosed depressed patients. Receipt of mental health specialty care was the single factor most strongly associated with quality treatment by the HEDIS measures.
Rost K, Mingliang Z, Fortney J, Smith J, Smith Jr. GR (1998). Expenditures for the Treatment of Major Depression. Americal Journal of Psychiatry, 155:7, 883-888.
Charges for healthcare services were tracked for a community cohort of individuals with major depression (n=298). Total expenditures for inpatient and outpatient depression treatment were $631 per person for those who were treated (48% of the sample).
Rost K, Smith JL, Dickinson M (2004). The Effect of Improving Primary Care Depression Management on Employee Absenteeism and Productivity. Medical Care, 42:12, 1202-1210.
This study examined differences between usual and enhanced care of depression. Enhanced care clinicians provided improved depression management over 24 months. Growth curve modeling, which did not include an actual measure of productivity at baseline, showed that employed patients in enhanced care had 6.1% greater productivity and 22.8% less absenteeism over two years. For the consistently employed, productivity improved by 8.2% and absenteeism by 28.4% with enhanced care.
Rost K, Zhang M, Fortney J, Smith J, Smith GR, Jr. Expenditures for the treatment of major depression. Am J Psychiatry 1998; 155(7):883-888.
The intent of this study was to quantify the per capita expenditures for treating individuals with major depression living in the community. These individuals were part of a fee-for-service plan or were self-insured. Data on costs of depression treatment for 298 people came from self-report and were verified using medical and billing records. The average annual treatment costs were $631; median costs were only $152.
Rost K, Smith JL, Dickinson M. The effect of improving primary care depression management on employee absenteeism and productivity. A randomized trial. Med Care. 2004 Dec;42(12):1202-10.
This randomized trial demonstrated that improving the quality of care for depression has positive consequences for productivity and absenteeism.
Schoenbaum M, Unutzer J, Sherbourne C et al. Cost-effectiveness of practice-initiated quality improvement for depression: results of a randomized controlled trial. JAMA 2001 September 19;286(11):1325-30.
The objective of the study was to to determine the cost-effectiveness from a societal perspective of two quality improvement interventions to improve treatment of depression in primary care and their effects on patient employment. There were positive effects for those with enhanced care
Simon GE, Katon W, Rutter C, VonKorff M, Lin E, Robinson P, Bush T, Walker EA, Ludman E, Russo J (1998). Impact of improved depression treatment in primary care on daily functioning and disability. Psychological Medicine, 28, 693-701.
The authors assessed daily functioning and disability in a sample of depressed patients from a large primary care clinic between 1992 and 1994. All patients were involved with usual care treatment or one of two collaborative management programs. At baseline, patients in the intervention group missed 8.25 days of work or school out of the previous 90 days. At the seven-month follow-up assessment, intervention paitents missed 4.81 days of work or school out of the previous 90. This was an improvement of 41%. Patients in the usual care group did not change significantly.
Simon GE, Revicki D, Heiligenstein J, Grothaus L, VonKorff M, Katon WJ, Hylan TR, (2000). Recovery from depression, work productivity, and health care costs among primary care patients. General Hospital Psychiatry, 22, 153-62.
This study examined 290 adults with major depression who were beginning antidepressant treatment. Patients who had improved or remitted after 12 months reported fewer days missed from work due to illness (10.4 and 6.3 in two years) compared to patients who had not improved (16.8). Patients who were improved or remitted after 12 months had lower health care costs during the second year of follow-up ($2,345 and $2,236) compared to patients who had not improved ($6,365). The authors conclude that recovery from depression is related to significant reductions in work disability and possibly related to reductions in health care costs.
Simon GE, VonKorff M, Rutter C, Wagner E. Randomised trial of monitoring, feedback, and management of care by telephone to improve treatment of depression in primary care. BMJ 2000; 320(7234):550-554.
This randomized trial of three different depression treatment methods was conducted with 613 patients in Seattle primary care clinics. Economic analyses indicated total depression treatment costs over a six-month period were $388 in the usual care group and higher in the two intervention groups (feedback only = $414, care management $484). This is approximately $776, $828, and $968, respectively on an annual basis.
Simon GE. Cost-effectiveness of a collaborative care program for primary care patients with persistent depression. Am J Psychiatry. 2001; 158:1638-1644.
The authors evaluated the incremental cost-effectiveness of stepped collaborative care for patients with persistent depressive symptoms after usual primary care management. Consistent with other randomized trials, the stepped collaborative care program for depressed primary care patients led to substantial increases in treatment effectiveness and moderate increases in costs.
Stewart WF, Ricci JA, Chee E, Hahn SR, Morganstein D (2003). Cost of lost productive work time among US workers with depression. Journal of the American Medical Association, 289(23): 3135-3144.
Data were analyzed from employees who participated in the American Productivity Audit in 2001-2002. Workers with depression had 5.6 hours/week more lost productive time than those without depression. They found that 81% of the lost productive time was due to presenteeism.
Von KM, Katon W, Bush T et al. Treatment costs, cost offset, and cost-effectiveness of collaborative management of depression. Psychosom Med 1998; 60(2):143-149.
Using results from two randomized trials of collaborative care compared to usual care, the cost of depression treatment was estimated. For major depression, cost of usual care treatment was $850 in a year, while collaborative care cost $1,428.
Von Korff M, Ormel J, Katon W, Lin EH (1992). Disability and depression among high utilizers of health care. A longitudinal analysis. Archives of General Psychiatry, 49, 91-100.
This study examined 145 depressed adults who were high users of ambulatory health care. Patients with severe depression who had improved after 12 months experienced a 36% reduction in disability days per year (79 days to 51 days). Patients with moderate depression who had improved experienced a 72% reduction in disability days per year (62 days to 18 days). Those that did not improve after 12 months did not show a change in disability days.
Wang PS, Beck AL, Berglund P, Leutzinger JA, Pronk N, Richling D, Schenk TW, Simon G, Stang P, Ustun TB, Kessler RC (2003). Chronic Medical Conditions and Work Performance in the Health and Work Performance Questionnaire Calibration Surveys. Journal of Occupational and Environmental Medicine, 45:12, 1303-1311.
The Work Performance Questionnaire was used to assess absenteeism and presenteeism for reservation agents, customer service representatives, executives, and railroad engineers. Depression, independent of the other medical conditions examined, was associated with 15.1 excess days per year above normal absenteeism/presenteeism.
Wang PS, Beck AL, Berglund P, McKenas DK, Pronk NP, Simon GE, Kessler RC (2004). Effects of Major Depression on Moment-in-Time Work Performance. American Journal of Psychiatry, 161:10, 1885-1891.
Airline reservation agents (n=105) and telephone customer service representatives (n=181) filled out diaries at random time points, measuring work performance. Depression was associated with an excess 2.3 days per person per month of being depressed (27.6 days per year). Productivity was measured in this study while absenteeism was not.
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