Depression in working adults: comparing the costs and health outcomes of working when ill

Fiona Cocker; Jan M Nicholson; Nicholas Graves; Brian Oldenburg; Andrew J Palmer; Angela Martin; Jenn Scott; Alison Venn; Kristy Sanderson

doi:10.1371/journal.pone.0105430

Depression in working adults: comparing the costs and health outcomes of working when ill

PLoS One. 2014 Sep 2;9(9):e105430. doi: 10.1371/journal.pone.0105430. eCollection 2014.

Authors

Fiona Cocker¹, Jan M Nicholson², Nicholas Graves³, Brian Oldenburg⁴, Andrew J Palmer⁵, Angela Martin⁶, Jenn Scott⁷, Alison Venn⁵, Kristy Sanderson⁵

Affiliations

¹ School of Population and Global Health, University of Melbourne, Melbourne, Australia; Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia.
² Judith Lumley Centre, La Trobe University, Melbourne, Australia.
³ School of Public Health, Queensland University of Technology, Queensland, Australia.
⁴ School of Population and Global Health, University of Melbourne, Melbourne, Australia.
⁵ Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia.
⁶ Tasmanian School of Business and Economics, University of Tasmania, Hobart, Australia.
⁷ School of Psychology, University of Tasmania, Hobart, Tasmania, Australia.

Abstract

Objective: Working through a depressive illness can improve mental health but also carries risks and costs from reduced concentration, fatigue, and poor on-the-job performance. However, evidence-based recommendations for managing work attendance decisions, which benefit individuals and employers, are lacking. Therefore, this study has compared the costs and health outcomes of short-term absenteeism versus working while ill ("presenteeism") amongst employed Australians reporting lifetime major depression.

Methods: Cohort simulation using state-transition Markov models simulated movement of a hypothetical cohort of workers, reporting lifetime major depression, between health states over one- and five-years according to probabilities derived from a quality epidemiological data source and existing clinical literature. Model outcomes were health service and employment-related costs, and quality-adjusted-life-years (QALYs), captured for absenteeism relative to presenteeism, and stratified by occupation (blue versus white-collar).

Results: Per employee with depression, absenteeism produced higher mean costs than presenteeism over one- and five-years ($42,573/5-years for absenteeism, $37,791/5-years for presenteeism). However, overlapping confidence intervals rendered differences non-significant. Employment-related costs (lost productive time, job turnover), and antidepressant medication and service use costs of absenteeism and presenteeism were significantly higher for white-collar workers. Health outcomes differed for absenteeism versus presenteeism amongst white-collar workers only.

Conclusions: Costs and health outcomes for absenteeism and presenteeism were not significantly different; service use costs excepted. Significant variation by occupation type was identified. These findings provide the first occupation-specific cost evidence which can be used by clinicians, employees, and employers to review their management of depression-related work attendance, and may suggest encouraging employees to continue working is warranted.

Publication types

Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Absenteeism
Adult
Australia
Depression / economics*
Health Care Costs*
Humans
Markov Chains
Models, Economic
Outcome Assessment, Health Care / economics*
Work / economics*

Grants and funding

Dr. Cocker completed this work whilst in receipt of a Pro Vice Chancellor (Research) Australian Research Council Strategic Research Scholarship (ARC Linkage Project LP0990010). This work was funded by a National Health and Medical Research Council (NHMRC) Project Grant (ID490018) awarded to Associate Professor Sanderson who was funded by an Australian Research Council Future Fellowship (FT991524). Professor Palmer has received advisory board payments in the area of diabetes from Jansen, Johnson and Johnson, sanofi Aventis, and Novo Nordisk. The listed funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.