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 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

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 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

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