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Depression and the Employer

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

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  1. Depression and the Employer William McPeck Maine State Government March 2002

  2. 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

  3. 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

  4. 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.

  5. 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.

  6. 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.

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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.

  17. 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

  18. 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

  19. MHMC Depression Initiative • Employee Interactive Telephone Screening Program (ETAP) • SOM one of 19 MHMC employers participating • 96% of MHMC member employees covered

  20. MHMC Depression Initiative • Why an ETAP Program? • Prevalence of depression • Costs associated with depression • Depression and co-morbidity

  21. 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

  22. MHMC Depression Initiative • ETAP • Two Screening Programs Available • Depression and Manic-Depression Screening • Alcohol Use

  23. 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

  24. 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

  25. 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

  26. 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

  27. 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

  28. 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

  29. 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

  30. 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

  31. 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

  32. 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

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