It is widely known that depression is a serious illness, which is unfortunately very common. Symptoms of depression include overwhelming feelings of sadness and hopelessness and a loss of interest in enjoyable activities. Previous studies have demonstrated that depression is widespread in the United States. Additional studies have indicated that the cost of lost time from work because of depression is substantial.

Two studies in the June 18, 2003 issue of the Journal of the American Medical Association , a special issue on depression, took a closer look at the prevalence and costs of depression in the United States. The first study estimated that 6.6% of Americans experienced an episode of major depression in the past year and 16.2% will become depressed sometime in their lifetime. A second study projected that employers spend an excess of $31 billion per year due to depression-related lost production time.

About the Study

The National Comorbidity Survey Replication (NCS-R) study assessed the prevalence of depression among adults in the United States. Researchers screened a nationally representative sample of 9,090 people across the 48 contiguous United States for mental disorders. The participants also answered questions about their age, sex, marital status, socioeconomic status, and race. Clinical psychologists then interviewed 5,554 of the participants to determine if they were depressed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. The participants who met the diagnostic criteria for depression were further questioned about the severity of their depression and any treatment they had undergone.

The second study, called the Depressive Disorders Study (DDS), aimed to compare the lost production time (LPT) of depressed versus non-depressed workers, including days missed from work and reduced performance at work. The study went further and projected the cost of LPT to employers. Researchers interviewed 1,190 people to identify those who met diagnostic criteria for a depressive disorder, including major depression, dysthmia (moderately depressed mood for more than two years), or partial remission or recurrence of major depression. The participants were mostly white, formally educated beyond high school, working more than 30 hours per week, and making less than $40,000 per year. The researchers used data from the interviews to determine average health-related LPT among workers with and without depression. Lost labor costs were then calculated by multiplying lost hours by self-reported hourly wages.

The Findings

The results of the NCS-R suggested that over 13 million American adults were depressed within the last year and over 32 million will experience depression sometime during their lifetime. Over half of the participants who had been depressed in the last year received treatment, but only 21.6% reported receiving adequate treatment. Younger people, women, people who were divorced, separated, or widowed, and people living in the Midwest were more likely to experience depression. Blacks, retirees, and people with 0-11 years of education had a lower risk for depression.

This high prevalence of depression combined with the lack of adequate treatment is alarming, especially considering the high cost of depression in the workplace. The DDS found that on average, workers with depressive disorders reported 5.6 hours per week of health-related LPT, compared with 1.5 hours per week for workers without depression. Most (82.1%) of the LPT among depressed participants occurred at the workplace. In other words, the workers were showing up for work, but not being productive. The researchers calculated that American workers cost employers an estimated $44 billion per year in LPT, compared with $13 billion per year among workers without depression. LPT estimates could have been overestimated, however, since depressed people have the tendency to overstate work impairment. Also, the sample included only 219 workers with depression, which may not be enough to accurately estimate LPT for the entire United States population.

How Does This Affect You?

These two studies demonstrate that depression is a costly, widespread condition that is not, for the most part, being effectively treated. In the past decade, a number of campaigns have been launched to increase the public awareness of depression. Although the NCS-R study revealed that over half of depressed people are now seeking treatment—up from about one-third in 1993—only about one in five are receiving adequate treatment.

Both of these studies emphasize the importance of seeking treatment for depression. Almost one-third of the participants of the DDS who answered “yes” to at least one of the following questions were diagnosed with a depressive disorder: “In the past two weeks, did you feel sad, blue, or down in the dumps?” and “In the past two weeks, did you have little interest or pleasure in doing things?” Highly effective treatment is available for this condition. So, if you know or suspect that you are depressed, talk with your health care provider.