Depression is widespread and it is getting worse. Nineteen percent of Americans will suffer from depression at some time during their lives. Sadly, depression hits the young and old alike. Fifty percent of children and adolescents and 20 percent of adults report some symptoms of depression. Even though many kids don't "qualify" for the clinical diagnosis of depression, they have some of the problems that "truly depressed" people have--such as sadness, self-criticism, and the inability to enjoy their lives.
Many of these depressed kids eventually become depressed adults. And, it's getting worse in recent decades (Kessler and Walters, 1998; Ronald C. Kessler, Avenevoli, & Ries Merikangas, 2001). Kids born after 1960 were significantly more likely to suffer from depression in childhood or adolescence than kids born before 1960 (Klearman, G.L., Weissman,M.M.(1989)). Depression is on the rise--and the costs are escalating.
Depression has human costs that we all know of: sadness, sense of isolation, feeling like a burden, inability to enjoy life, and--for 35,000 people every year--suicide (Joiner, 2010). In fact, people who are depressed are 30 times more likely to kill themselves than people who are not depressed (Hawton, 1992). Depressed individuals are five times more likely to abuse drugs. These costs in the quality of life are enough to make us all concerned about depression. They are the human costs which are widespread and touch almost every family in America.
But there are also economic costs that are also significant--indeed, alarming.
Depression is the leading cause of medical disability for people aged 14 to 44 (Stewart, Ricci, Chee, Hahn, & Morganstein, 2003). Depressed people lose 5.6 hours of productive work every week when they are depressed (Stewart, 2003). Eighty percent of depressed people are impaired in their daily functioning (Pratt & Brody, 2008). Fifty percent of the loss of work productivity is due to absenteeism and short-term disability (R. C. Kessler, et al., 1999). In any 30 day period, depressed workers have 1.5 to 3.2 more short-term disability days (Druss, Schlesinger, & Allen, 2001).
People with symptoms of depression are 2.17 times more likely to take sick days (Adler, et al., 2006; Greener & Guest, 2007). And when they are at work their productivity is impaired--less ability to concentrate, lower efficiency, and less ability to organize work. In fact, absenteeism and work performance are directly related to how severe the depression is--the more severe the depression, the worse the outcome. In one study the costs of absenteeism were directly related to actually taking antidepressant medication (Birnbaum, et al., 2010; Dewa, Hoch, Lin, Paterson, & Goering, 2003). Those who took the prescribed medication had a 20 percent lower cost of absenteeism. Depressed people are seven times more likely to be unemployed (Lerner, et al., 2004).
In one of the largest studies of its nature ("The long-term effects of psychological problems during childhood"), children were followed for 40 years to determine the effects of illness and psychological problems on their life chances (Smith & Smith, 2010). Children or adults who suffer from depression have lower incomes, lower educational attainment and fewer days working each year. In fact, these psychological problems lead to seven fewer weeks of work per year, a loss of 20 percent in potential income, and a lifetime loss for each family who has a depressed family member of $300,000 (Smith & Smith, 2010).
People who suffer from depression end up with six-tenths of a year less schooling, an 11 percent decrease in the probability of getting married, and a loss (on average) of $10,400 per year in income by age 50 (Smith & Smith, 2010). In fact, there is a 35 percent decrease in lifetime income--due to depression. The cost for the total group--over one's lifetime--is estimated at 2.1 trillion dollars (Smith & Smith, 2010). And this does not include the increased cost of medical care that all of us must assume. Depression is a lifelong vulnerability for millions of people. And it's a national economic crisis.
The cost of depression (lost productivity and increased medical expenses) is $83 billion each year which exceeds the costs of the war in Afghanistan (Greenberg, et al., 2003). And depression is not a "limited engagement" with a fixed endpoint. These costs reoccur each year, every year, for the foreseeable future. Depression is an ongoing war that we may only recently recognize is a difficult one--but a potentially winnable war.
In the United Kingdom the National Health Service (NHS) has developed the largest mental health intervention program in history. The Improving Access to Psychological Treatments (IAPT) initiative mandates access to effective treatments for depression and other psychological problems. The argument behind this national initiative is largely economic--depressed people are less likely to work, have more disability days, and are less likely to be able to pay taxes. Simply from a practical point of view, effective treatment for depression makes economic sense. It's a good investment. If you effectively treat depression, people are more likely to work, require less disability coverage and--as cynical as it may sound--more likely to pay taxes. Treating depression pays. It's smart policy--and the right thing to do.
We may not be able to effectively overcome depression for everyone. Even though there are effective treatments for depression--such as medication or cognitive behavioral therapy--depressed people often wait over 10 years on average to seek treatment. This may sound depressing. But there is hope. If more people seek treatment earlier--and get effective treatment--the human cost and the economic costs can be reversed. It is hard to imagine what could be a higher priority if we care about the welfare of our people.
Robert L. Leahy, Ph.D.
American Institute for Cognitive Therapy
Author: "Beat the Blues Before they Beat You"
Adler, D. A., McLaughlin, T. J., Rogers, W. H., Chang, H., Lapitsky, L., & Lerner, D. (2006). Job performance deficits due to depression. American Journal of Psychiatry, 163, 1569-1576.
Birnbaum, H. G., Kessler, R. C., Kelley, D., Ben-Hamadi, R., Joish, V. N., & Greenberg, P. E. (2010). Employer burden of mild, moderate, and severe major depressive disorder: Mental health services utilization and costs, and work performance. Depression and Anxiety, 27(1), 78-89.
Dewa, C. S., Hoch, J. S., Lin, E., Paterson, M., & Goering, P. (2003). Pattern of antidepressant use and duration of depression-related absence from work. British Journal of Psychiatry, 183, 507-513.
Druss, B. G., Schlesinger, M., & Allen, H. M. (2001). Depressive symptoms, satisfaction, with health care, and 2-year work outcomes in an employed population. American Journal of Psychiatry, 158, 731-734.
Greenberg, P. E., Kessler, R. C., Birnbaum, H. G., Leong, S. A., Lowe, S. W., Berglund, P. A., et al. (2003). The economic burden of depression in the United States: How did it change between 1990 and 2000? Journal of Clinical Psychiatry, 64, 1465-1475.
Greener, M. J., & Guest, J. F. (2007). Do antidepressants reduce the burden imposed by depression on employers? CNS Drugs, 19, 253-264.
Hawton, K. (1992). Suicide and attempted suicide. Handbook of affective disorders. E. S. Paykel. New York, Guilford Press: 635-650
Joiner, Thomas Myths about suicide. Cambridge, MA, US: Harvard University Press. (2010). 288 pp.
Kessler, R. C., Avenevoli, S., & Ries Merikangas, K. (2001). Mood disorders in children and adolescents: An epidemiologic perspective. Biological Psychiatry, 49(12), 1002-1014.
Kessler, R. C., Barber, C., Birnbaum, H. G., Frank, R. G., Greenberg, P. E., Rose, R. M., et al. (1999). Depression in the workplace: Effects on short-term disability. Health Affairs, 18, 163-171.
Kessler, Ronald C. and E. E. Walters, "Epidemiology of DSM-III-R major depression and minor depression among adolescents and young adults in the National Comorbidity Survey," Depression and Anxiety 7 (1998): 3
Klearman, G.L.,&Weissman,M.M.(1989).Increasingratesofdepression. Journal of the AmericanMedicalAssociation,261(15),2229e2235
Lerner, D., Adler, D. A., Chang, H., Lapitsky, L., Hood, M. Y., Perissinotto, C., et al. (2004). Unemployment, job retention, and productivity loss among employees with depression. Psychiatric Services, 55(12), 1371-1378.
Pratt, L. A., & Brody, D. J. (2008). Depression in the United States household population, 2005-2006: NCHS Data Brief Number 7.
Smith, J. P., & Smith, G. C. (2010). Long-term economic costs of psychological problems during childhood. Social Science & Medicine, 71, 110-115.
Stewart, W. F., Ricci, J. A., Chee, E., Hahn, S. R., & Morganstein, D. (2003). Cost of lost productive work time among US workers with depression. Journal of the American Medical Association, 289, 3135-3144.