Mental illness exacts "enormous toll" for U.S. businesses

Nov 10 2005

A study led by a Johns Hopkins University School of Medicine psychiatrist highlights the toll anxiety and depressive disorders exact on workplace performance and profits and points to employer-guaranteed specialized psychiatric care as both cost effective and humane.

According to the Hopkins report in the Nov. 10 issue of the Journal of Occupational and Environmental Medicine, employees with anxiety and depressive disorders work fewer hours, are more likely to end up on disability, and are less productive than their counterpart employees.

The study further shows that anxiety and/or depression complicate other medical conditions and seem to have a ripple effect in the work setting, creating low morale among coworkers and a higher turnover rate.

Lead author Alan Langlieb, M.D., M.P.H., an assistant professor of psychiatry, examined more than 100 published studies exploring how mental illness affects the workplace.

"After reviewing and analyzing the literature, it is clear that we have reached a tipping point," Langlieb said. "It is now pretty much indisputable that depression and anxiety in the workplace are an enormous expense to employers in terms of health care costs and productivity," he added.

Evidence shows that one in every 20 Americans will be depressed in a given year and that major depression will be the second leading cause of disability in the year 2020, according to Langlieb. Anxiety disorders will affect 29 percent of Americans in their lifetime, he added.

"Anxiety and depressive disorders, which often go hand in hand, create tremendous social and economic burdens on our society. They can be as debilitating as any major chronic illness," Langlieb said.

It is estimated that in 2000, the United States spent $83.1 billion for costs associated with depression and $63.1 billion in 1998 for costs associated with anxiety disorders. According to Langlieb's review, such costs include not only direct health care costs, but also "indirect" costs stemming from suicide, increased medical morbidity, reduced adherence to outpatient treatment leading to relapse and hospitalization, lost wages caused by missed work, and decreased workplace productivity.

Langlieb cited a 1998 study of more than 46,000 employees which estimated that each employee with depression generated $3,189 in annual health care costs compared with $1,679 annually for non-mental health illnesses. If depressed employees also were under high stress, the cost skyrocketed: 147 percent more was spent on health care for these individuals than on those with depression alone.

Langlieb said the best way to combat these costs is to guarantee that employees have access to quality, specialized psychiatric evaluations. "Studies are showing that if you start with a comprehensive psychiatric evaluation and create a treatment plan that might then involve psychologists, primary care and/or social work, employees will have less disability, greater work productivity and improved quality of life compared with those who received evaluation and treatment solely by a primary care provider."

Langlieb said quality treatment might be more expensive in the short term, but the long-term benefits clearly outweigh the initial treatment costs. "The old adage that you get what you pay for applies here," he said.

Jeffrey P. Kahn, M.D., of the Weill Medical College of Cornell University, contributed to the study. Langlieb and Kahn are co-editors of a book titled Mental Health and Productivity in the Workplace: A Handbook for Organizations and Clinicians.