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  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 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 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 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  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  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  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  Direct costs dropped from $1m to $400, – 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/

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

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

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 Initiative  ETAP  Two Screening Programs Available Depression and Manic-Depression Screening Alcohol Use

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 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 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 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 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 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 Initiative  MHMC ETAP Results for % 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 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 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  William McPeck, MSW Director, Employee Health and Safety Maine State Government 114 Sate House Station Augusta, ME (voice) (fax)