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Bipolar Disorder Costs More Than Depression

September 2 2006 - Bipolar disorder costs twice as much in lost productivity as major depressive disorder. This is the finding of a study funded by the National Institute of Mental Health (NIMH) by Dr Ronald Kessler and Dr Philip Wang of Harvard University, and colleagues, one of two on mood disorders in the workplace published in the September 2006 issue of the American Journal of Psychiatry.

The study is based on data from 3378 adult employed respondents to the National Co-morbidity Survey Replication, a nationally representative household survey conducted in 2001-2003. It found that each American worker with bipolar disorder averaged 65.5 lost work days a year, compared to 27.2 for those with major depression. Major depression is more than six times as prevalent, but bipolar disorder costs nearly half as much. Projected totals are 96.2 million lost work days and U$14.1 billion lost to the economy through bipolar disorder, compared to 225 million work days and US$36.6 billion for major depression annually in the USA.

Respondents were asked on how many days during the past year they had experienced an episode of mood disorder. Researchers judged the severity of the disorder based on symptoms during the worst month. Lost work days due to absence or poor functioning on the job, combined with salary data, yielded an estimate of lost productivity. Poor functioning while at work accounted for more lost days than absenteeism.

About three-quarters of bipolar respondents had experienced depressive episodes over the past year, with about 63 per cent also having agitated manic or hypomanic episodes. The bipolar-associated depressive episodes were much more persistent and severe, affecting 134-164 days compared to 98 days for major depression. All measures of lost work performance were consistently higher among workers with bipolar disorder who had major depressive episodes than among those reporting only manic or hypomanic episodes. The latter group's lost performance was similar to workers with major depressive disorder.

Philip Wang commented:

"Major depressive episodes due to bipolar disorder are sometimes incorrectly treated as major depressive disorder. Since antidepressants can trigger the onset of mania, workplace programs should first rule out the possibility that a depressive episode may be due to bipolar disorder. Future effectiveness trials could gauge the return on investment for employers offering coordinated evaluations and treatment for both mood disorders."

In a related NIMH-funded study in the same issue of the American Journal of Psychiatry, Dr Debra Lerner and Dr David Adler, and colleagues of Tufts University School of Medicine and Tufts-New England Medical Center, found that many aspects of job performance are impaired by depression and that effects continue even after symptoms have improved.

The study recruited employed patients from primary care physician practices and tracked the job performance and productivity of 286 with depression and dysthymia, 93 with rheumatoid arthritis and 193 healthy controls for 18 months. Some 44 per cent of those with depression were taking antidepressant medication when the study began and still met clinical criteria for depression. Job performance improved as symptoms diminished, but even depressed patients deemed to be 'clinically improved' performed less well than healthy controls on mental, interpersonal, time management, output and physical tasks. Compared to healthy controls, arthritis patients showed greater impairment only in relation to physical job demands.

The report recommends that the goal of depression treatment should be remission. The authors suggest that health professionals should pay more attention to recovery of work function. Workplace supports should be developed, perhaps through employee assistance programmes and worksite occupational health clinics, to help depressed patients better manage job demands.

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