Cost of lost productive work time among US workers with depression

JAMA. 2003 Jun 18;289(23):3135-44. doi: 10.1001/jama.289.23.3135.


Context: Evidence consistently indicates that depression has adversely affected work productivity. Estimates of the cost impact in lost labor time in the US workforce, however, are scarce and dated.

Objective: To estimate the impact of depression on labor costs (ie, work absence and reduced performance while at work) in the US workforce.

Design, setting, and participants: All employed individuals who participated in the American Productivity Audit (conducted August 1, 2001-July 31, 2002) between May 20 and July 11, 2002, were eligible for the Depressive Disorders Study. Those who responded affirmatively to 2 depression-screening questions (n = 692), as well as a 1:4 stratified random sample of those responding in the negative (n = 435), were recruited for and completed a supplemental interview using the Primary Care Evaluation of Mental Disorders Mood Module for depression, the Somatic Symptom Inventory, and a medical and treatment history for depression. Excess lost productive time (LPT) costs from depression were derived as the difference in LPT among individuals with depression minus the expected LPT in the absence of depression projected to the US workforce.

Main outcome measure: Estimated LPT and associated labor costs (work absence and reduced performance while at work) due to depression.

Results: Workers with depression reported significantly more total health-related LPT than those without depression (mean, 5.6 h/wk vs an expected 1.5 h/wk, respectively). Eighty-one percent of the LPT costs are explained by reduced performance while at work. Major depression accounts for 48% of the LPT among those with depression, again with a majority of the cost explained by reduced performance while at work. Self-reported use of antidepressants in the previous 12 months among those with depression was low (<33%) and the mean reported treatment effectiveness was only moderate. Extrapolation of these survey results and self-reported annual incomes to the population of US workers suggests that US workers with depression employed in the previous week cost employers an estimated 44 billion dollars per year in LPT, an excess of 31 billion dollars per year compared with peers without depression. This estimate does not include labor costs associated with short- and long-term disability.

Conclusions: A majority of the LPT costs that employers face from employee depression is invisible and explained by reduced performance while at work. Use of treatments for depression appears to be relatively low. The combined LPT burden among those with depression and the low level of treatment suggests that there may be cost-effective opportunities for improving depression-related outcomes in the US workforce.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cost of Illness*
  • Depression / epidemiology*
  • Depression / therapy
  • Depressive Disorder / epidemiology*
  • Depressive Disorder / therapy
  • Diagnostic and Statistical Manual of Mental Disorders
  • Efficiency*
  • Employment / statistics & numerical data*
  • Factor Analysis, Statistical
  • Female
  • Humans
  • Linear Models
  • Male
  • Middle Aged
  • Population Surveillance
  • United States / epidemiology