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Depression and the Employer

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Title: 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
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