Depression exacts a heavy toll in the workplace, significantly affecting employee productivity. But new research suggests that early response to treatment of depression offers a significant return on investment.
In a new analysis of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, investigators from the University of Texas Southwestern Medical Center in Dallas found that work productivity improved in several domains when depressive symptoms remitted early in depression treatment.
In contrast, workers who did not achieve symptom remission until later stages of treatment continued to have impaired productivity.
"When people have depression and their work productivity suffers, it is mainly related to the fact that their symptoms are preventing them from accomplishing their best at work," principal investigator Madhukar Trivedi, MD, told Medscape Medical News.
"But if the recovery is incomplete, depression will continue to have a [negative] effect on interpersonal function and work productivity. We found that even if patients do go into remission with the second step of treatment, work productivity does not return to its previous functional status."
The study was published in the June issue of the American Journal of Psychiatry.
Cost of Lost Productivity
It is been estimated that the total cost of lost productivity to US employers is $225.8 billion annually and that, at 66%, depression is the single largest contributor.
The authors note that "depression in US workers cost employers an estimated $44 billion a year in lost productivity, compared with $31 billion a year for those without depression."
Compromised cognitive function and reduced social interaction as a result of depression have a negative impact on work and psychosocial functioning. However, the authors note that the sociodemographic and clinical factors associated with pretreatment impairment and treatment-related improvement in occupational functioning are unclear.
The objective of the study was to identify baseline clinical and sociodemographic characteristics associated with work productivity in depressed outpatients and to assess the effect of treatment on work productivity.
The study included 1928 employed depressed outpatients aged 18 to 75 years who were participants in the STAR*D study. All were treated with citalopram (20 - 40 mg/day).
Patients who did not remit after an initial adequate trial with citalopram (level 1 treatment) were either switched to sertraline, sustained-release bupropion, or extended-release venlafaxine. Alternatively, treatment with sustained-release bupropion or buspirone could be augmented (level 2 treatment).
The investigators then analyzed study participants' clinical and demographic characteristics and treatment outcomes for potential links to baseline work productivity and change in productivity over time.
Need for Additional Strategies
The self-reported Work Productivity and Activity Impairment scale was used to measure the number of work hours missed in the past 7 days; the number of hours worked in the past 7 days; and impairment resulting from health conditions while working or performing usual daily activities.
The authors report that during level 1 treatment, work productivity in several domains improved with reductions in the severity of depressive symptoms.
However, they add, these findings did not hold true for level 2 outcomes and showed no significant associations with treatment response or reductions in work impairment.
In an additional analysis of the data, the researchers found a link between more impaired productivity and higher levels of anxious depression.
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Dr. Madhukar Trivedi |
"The majority of studies focus on symptom improvement, not functional improvement, but a good outcome includes improvement in both symptoms and a return to previous levels of functioning.
"So what we recommend is that even for patients whose symptoms improve, you need to assess work productivity, and you may need additional strategies, such as exercise or cognitive behavioral therapy, in order to provide concrete improvements in function, including work productivity," said Dr. Trivedi.
Save Lives and Money
In an accompanying editorial, John Greden, MD, University of Michigan, Ann Arbor, points out that achieving early remission is critical to patients and employers alike.
"Individuals with treatment-resistant depressions generate the highest workplace costs," Dr. Greden writes. "Attaining early remission and preventing treatment-resistant depression among workers who develop depressive illnesses would save both lives and money."
Dr. Trivedi has declared receiving multiple research grants from and serving in various advisory capacities for a wide variety of pharmaceutical companies. Dr. Greden has reported no relevant financial relationships.
Am J Psychiatry. Published online June, 2013. Abstract, Editorial
