depression and the employer william mcpeck maine state government march 2002

Depression and the Employer

William McPeckMaine State GovernmentMarch 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


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.


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.


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 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

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 $400,000

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

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 - 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


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


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 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

MHMC Depression Initiative

Employee Interactive Telephone Screening Program (ETAP) SOM one of 19 MHMC employers

participating 96% of MHMC member employees

covered


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


ETAP Two Screening Programs Available

Depression and Manic-Depression Screening

Alcohol Use


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


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


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


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


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 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

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 04333 207-287-6783 (voice) 207-287-6796 (fax) [email protected]

depression and the employer william mcpeck maine state government march 2002

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