There has been increasing amounts of research showing the impact of depression on physical conditions—and vice versa—with more recognition about the rates of co-morbidity between depression and chronic medical conditions such as diabetes and heart disease.For example, according to a recent report from the Substance Abuse and Mental Health Services Administration (SAMHSA), adults experiencing major depressive episodes (MDE)—periods of depression lasting two weeks or more including significant problems with everyday aspects of life such as sleep, eating, feelings of self-worth, etc.—have higher rates of several physical illnesses, and hospitalizations and emergency department use, compared to those who are not experiencing MDE.
| Incidence of: | % with MDE | % without MDE |
| High Blood Pressure | 24.1% | 19.8% |
| Asthma | 17.0 | 11.4 |
| Diabetes | 8.9 | 7.1 |
| Heart Disease | 6.5 | 4.6 |
| Stroke | 2.5 | 1.1 |
| Any Emergency Room Use | 43.3 | 28.7 |
| Any Hospitalization | 18.1 | 10.8 |
| Source: 2008 and 2009 SAMHSA National Surveys on Drug Use and Health | ||
However, a recent article in the Wall Street Journal titled "New View of Depression: An Ailment of the Entire Body," brings the discussion to yet a new level. Citing current research in the area, the article states, "Scientists are finding that the same changes to chromosomes that happen as people age can also be found in people experiencing major stress and depression."
This is changing the focus from looking at stress and depression as just psychological conditions to systemic, body-wide illnesses. Indeed, research at the University of California, San Francisco, is showing that, as a result of these chromosomal changes, people who have suffered major bouts of depression are more at risk, at a younger age, of developing conditions associated with aging such as:
At a time when employees are reporting increased levels of stress, and depression is on the rise and yet still largely untreated, these findings do not bode well for the overall health of employees, now and in the future.
In our EAP practice in 2011, over a quarter of our cases had depression, stress or anxiety as primary presenting issues—understating their overall prevalence when considering how often they are also secondary presenting issues to other concerns such as financial/legal, marital and children/family. In our Return to Work Coaching program, these factors are commonly seen as adjuncts to medical conditions resulting in short and long term disability, FMLA, workers' comp and other extended leaves.
The implications of this are clear—increased depression, stress and anxiety, when unaddressed, not only can be costly in their own right due to medical costs, absenteeism and lower productivity through presenteeism, but are also a precursor to higher medical costs as "accelerated aging" takes its toll.
Thus, addressing mental health now not only has immediate pay-offs in reducing medical and employment-related costs, but can also prevent or reduce costly, chronic and debilitating medical expenses in the not-so-distant future.
In an excellent and thought-provoking article Ron Bachman, a former actuary who is now a senior fellow at the Center for Health Transformation, National Center for Policy Analysis and the Wye River Group on Health and an expert resource on mental health policy, posits, "It is now evident that one cannot successfully, or cost effectively, treat illnesses like hypertension, diabetes, asthma, congestive heart failure and other conditions without dealing with related (or co-morbid) stress and depression."
He goes on to talk about the ROI for addressing mental health for organizations. In a chart (see below) showing just the impact of the types of direct costs (vs. indirect costs) seen with increasing levels of medical intensity for the spectrum of mental illnesses and their associated medical conditions, it is clear that identifying and addressing mental conditions early is critical—and even more so when "age acceleration" is taken into account.
| The Corporate Costs of Mental Illness | ||||
| Medical Intensity | Type of Mental & Emotional Condition | Direct Health Plan Costs | Co-Morbid Conditions (Related Conditions) | Indirect Corporate Costs |
| Low | Frustration;
Anxiety; Low Stress; Minor Depression |
LOW | Tobacco Use;
Sleeplessness; Colds/Flu; Blood Pressure |
Moderate-HIGH Increased Errors; Presenteeism; Loss of Teaming |
| Medium | Moderate Stress;
Depression; Anger |
MEDIUM | Hypertension;
Musculoskeletal; Digestive; Gastrointestinal |
Moderate-HIGH Unscheduled Absences; Poor Morale; Relationships; Conflicts; Lost Productivity |
| High | High Stress;
Major Depression; Schizophrenia; Bipolar Disorder; Obsessive Compulsive; Panic Disorder; Anorexia-Bulimia |
HIGH | Cardiovascular;
Cancer; Diabetes; Asthma; Back Pain; Alcoholism |
HIGH-VERY HIGH Low Productivity; Divorce; Turnover; Early Retirement; Workers' Comp; Disability |
| Catastrophic | Violence;
Suicide |
VERY HIGH | Accidents;
Burns |
VERY HIGH Death; Work Violence; Disaster Recovery |
| Source: Ronald E. Bachman, employersweb.com | ||||
There are lots of reasons employees and their family members don't seek help, such as the real and perceived stigma around mental illness, cost, access and lack of awareness about how treatable most conditions are. As your EAP, we can be the ideal first point of contact in terms of:
As always, we want to be your partners in promoting the well being of your employees and their families. Helping them understand that depression and stress are conditions with broader impacts if not addressed is one of the best things we can do together to achieve that goal.
Pathways to Well Being Call VITAL WorkLife at 800.383.1908 or access resources through your VITAL WorkLife App