Depression and the Employer

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 gt 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 Banks 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_at_state.me.us