Depression Linked to Chronic Conditions: Employers Absorb Majority of Costs

Health Enhancement Newsletter
Matria Healthcare
Published October 2004

While it is commonly known in the medical community that serious illnesses often trigger depression in patients, research suggests that a serious case of depression could lead to a chronic disease if left untreated for too long.

With chronic conditions on the rise, depression is fast becoming a serious issue for employers, who are losing $52 billion a year in absenteeism and lost productivity, which does not even include direct medical expenses from treatments and medications.[1]

A recent CIGNA study found that nearly 50 percent of treatment expenses for depression and other mental conditions come from patients with chronic conditions.[2] At the same time, results from a survey published in the Journal of Clinical Psychiatry showed that from 1990 to 2000, treatment rates for depression climbed by more than 50 percent, and employers bore the brunt of the costs, which amounted to $51.9 billion.[3] In the same survey, 88 percent of the 279 employee participants said that treatment improved their productivity in the workplace.

"The prevalence of depression among those with chronic conditions shows the importance of linking disability, disease management and behavioral health programs to ensure that individuals get the most appropriate care," said CIGNA medical officer David Whitehouse, MD, at a conference on depression and chronic illness.[4]

Chronic Conditions

The National Institute of Mental Health reports depression frequently co-occurs with a variety of other physical illnesses, including heart disease, stroke, cancer, and diabetes, and can also increase the risk for subsequent physical illness, disability and premature death. Here are a few findings from recent studies:

• Clinically depressed people have a 50 percent greater risk for experiencing sudden cardiac death, according to a National Institute of Health and Medical Research study.[5]

• A longitudinal study of 40 Johns Hopkins Medical School students found that those with a history of clinical depression were twice as likely to develop coronary artery disease.[6]

• Depression was diagnosed in 37 percent of patients with low back pain in another study published in Managed Healthcare Executive magazine.[7]

Employers and health plans have not been aggressive about implementing depression programs, partly because employees do not demand them, says Rand Corp. economist Michael Schoenbaum, PhD.

"Depressed people are poor advocates of themselves," he was quoted as saying in the May issue of Managed Care magazine. "The evidence is very strong that strategies to improve care for depression are effective," he also said, pointing out that care management functions such as regular telephone calls to check on the patient and consultations between physicians have proven to be effective.

Schoenbaum was suggesting that primary care physicians make those calls, as they are responsible for writing up to 80 percent of anti-depressant prescriptions. However, he even admits that PCPs would have to bill for phone calls or consultations with other physicians, which creates more issues for employers and health plans.

Many employers have been turning to depression disease management programs to provide those types of care functions. Matria's depression program, for instance, provides behavioral wellness specialists to educate employees about the condition, work with employees to make sure they are taking their medications properly and help them select the best intervention options for their specific needs.

Disease management programs are designed to improve the health and wellbeing of employees and their families, reduce costly doctor visits, hospital treatments and medications and increase employee productivity.

While more Americans are seeking help for mental health problems as the stigma fades, nearly 37 percent, or 24 million Americans, who needed mental health treatment in the past two years did not get it.[8] In the same survey, these people cited lack of insurance coverage and high expense as the major reasons they did not seek help. Other reasons included their perception that the problem was not serious enough or that treatment would not help the problem.

The good news is that out of the 59 million Americans who did receive treatment in the past two years, 80 percent claimed that the treatments, which included talk therapies and medications, were effective.

Officials from the nation's largest managed behavioral healthcare company announced recently that they see disease management as the wave of the future and plan to rely on disease management programs to assist in their primary goal of transforming physical health by focusing on behavioral health.

[1] Employee Benefit News, "Americans seek mental healthcare", June 15, 2004.

[2] PR Newswire, "Successful chronic disease and depression treatments", June 23, 2004.

[3] Managed Care, Depression programs might provide edge", May 2004.

[4] PR Newswire, "Successful chronic disease and depression treatments", June 23, 2004.

[5] Ob.Gyn. News, "Case-control study: depression a risk factor", May 1, 2004.

[6] PR Newswire, "Successful chronic disease and depression treatments", June 23, 2004.

[7] Obesity, Fitness & Wellness Week, "Link between depression and low back pain", July 10, 2004.

[8] Employee Benefit News, "Americans seek mental healthcare", June 15, 2004.