Skip directly to search Skip directly to A to Z list Skip directly to navigation Skip directly to site content Skip directly to page options
CDC Home

Depression

Once a company has conducted assessment and planning  for depression programs, and developed the specific tasks of implementation for these programs, it is time to develop the evaluation plan. This evaluation plan should be in place before any program implementation has begun.  

Metrics for worker productivity, health care costs, heath outcomes, and organizational change allow measurement of the beginning (baseline), middle (process), and results (outcome) of workplace health programs. It is not necessary to use all these metrics for evaluating programs. Some information may be difficult or costly to collect, or may not fit the operational structure of a company. These lists are only suggested approaches that may be useful in designing an evaluation plan.

These measures are designed for employee group assessment. They are not intended for examining an individual’s progress over time, which would raise concerns of employee confidentiality. For employer purposes, individual-level measures should be collected anonymously and only reported (typically by a third party administrator) in the aggregate, because the company’s major concerns are overall changes in productivity, health care costs, and employee satisfaction.

In general, data from the previous 12 months will provide sufficient baseline information and can be used in establishing the program goals and objectives in the planning phase, and in assessing progress toward goals in the evaluation phase. Ongoing measurements every 6 to 12 months after programs begin are usually appropriate measurement intervals, but measurement timing should be adapted to the expectations of the specific program. 

The mental health of workers is an area of increasing concern to organizations. Depression is a major cause of disability, absenteeism, presenteeism, and productivity loss among working-age adults. The ability to identify major depression in the workplace is complicated by a number of issues such as employees’ concerns about confidentiality or the impact it may have on their job that cause some people to avoid screening.

  • In a given year, 18.8 million American adults (9.5% of the adult population) will suffer from a depressive illness1
  • It is estimated that 20% of people aged 55 years or older experience some type of mental health issue. Depression is the most prevalent mental health problem among older adults2
  • Approximately 80% of persons with depression reported some level of functional impairment because of their depression, and 27% reported serious difficulties in work and home life3
  • Only 29% of all persons with depression reported contacting a mental health professional in the past year, and among the subset with severe depression, only 39% reported contact3
  • In a 3-month period, patients with depression miss an average of 4.8 workdays and suffer 11.5 days of reduced productivity1
  • In 2003, national health expenditures for mental health services were estimated to be over $100 million4
  • Depression is estimated to cause 200 million lost workdays each year at a cost to employers of $17 to $44 billion5,6
  • Research shows that rates of depression vary by occupation and industry type. Among full-time workers aged 18 to 64 years, the highest rates of workers experiencing a major depressive episode in the past year were found in the personal care and service occupations (10.8%) and the food preparation and serving related occupations (10.3%)7
  • Occupations with the lowest rates of workers experiencing a major depressive episode in the past year were engineering, architecture, and surveying (4.3%); life, physical, and social science (4.4%); and installation, maintenance, and repair (4.4%)7

Depression is a complex condition characterized by changes in thinking, mood, or behavior that can affect anyone. Depression is influenced by a number of factors such as genetics; physiology (e.g., neurotransmitters), psychology (e.g., personality and temperament), gender, and the environment (e.g., physical environment and social support). Depression in working populations is equally complex and the causes are not well understood. However, there is recognition that both work and non-work related risk factors play a role such as the effects of worksites that produce excessive job stress on employees and employees’ depression effect on the worksite.8

Evidence linking work organization with depression and other mental health problems, and with increased productivity losses, is beginning to accumulate. A number of studies of a diverse group of occupations have identified several job stressors (e.g., high job demands; low job control; lack of social support in the workplace) that may be associated with depression. Although the evidence is mounting of the links between job stress and depression, there is less evidence of effective interventions to prevent depression in the workplace. There is a need to better understand organizational practices to reduce job stress, and aspects of job design that contribute to poor mental health, so that interventions can be developed to interventions that effectively target these risk factors in the workplace.9

However, there are a number of strategies employers can pursue to support employees’ mental health such as holding depression recognition screenings; placing confidential self-rating sheets in cafeterias, break rooms, or bulletin boards; promoting greater awareness through employee assistance programs (EAP); training supervisors in depression recognition; and ensuring  workers' access to needed psychiatric services through health insurance benefits and benefit structures.

In addition to its direct medical and workplace costs, depression also increases health care costs and lost productivity indirectly by contributing to the severity of other costly conditions such as heart disease, diabetes, and stroke.  However, routine, systematic clinical screening can successfully identify patients who are depressed, allowing them to access care earlier in the course of their illnesses. Research suggests that 80% of patients with depression will improve with treatment.10

Top of Page

Worker productivity measures for depression11-18

Healthier employees are less likely to call in sick. Companies can sometimes assess sick day use to determine whether health programs are increasing worker productivity.

Baseline

  • Determine the average number of sick days per employee over the previous 12 months related to depression
    • This measure may be less useful if there has been a large increase or decrease in numbers of employees over the past 12 months
    • It may be difficult to measure when employees take sick leave directly related to depression, since employees may not report depression or even recognize they have depression. For example, they may have headaches, difficulty sleeping, or other symptoms of depression and report these problems as the cause of their absence. It may be more useful to measure sick leave related to formal counseling and treatment services
  • Determine the costs of worker absenteeism related to depression, including costs of replacement workers, costs in training replacement workers, and loss and delay in productivity. See note above regarding difficulty of measuring absenteeism related to depression
  • Determine time employees spend during working hours participating in worksite supported depression-related worksite programs
  • Additional validated surveys have been developed to provide employers with information about the indirect costs of untreated or undertreated employee health issues such as depression. Employers who use these health and productivity surveys on an ongoing basis can begin to evaluate the return on investment (ROI) of offering depression programs on employee absence or productivity. These surveys may be proprietary and may require a modest fee to use. Two examples are provided below:

Process

  • Re-assess the average number of sick days per employee at the first follow-up evaluation See note above regarding difficulty of measuring absenteeism related to depression
    • If employee education programs are successful, these measures may increase in the short term as screening and detection rates increase (This comment on education only applies to using sick leave or time off to obtain a clinical preventive service)
  • Periodic repeats of baseline measures

Outcome

  • Assess changes in the average number of sick days per employee in repeated follow-up evaluations. See note above regarding difficulty of measuring absenteeism related to depression
  • Assess changes in time employees spend during working hours participating in worksite supported depression-related worksite programs
  • Assess changes in costs from baseline

Top of Page

Health care costs measures for depression11-13

In contrast with the worker productivity costs described above, health care costs are measures of the direct expenses of providing employee health care and preventive health programs.

Baseline

  • Determine costs and use for health care, such as screening, disability, health care costs, counseling, and treatment (e.g., medications) for depression related illness and disability
  • Determine health care use and costs of employee participants before education and other programs are initiated with the same measures after operation of these programs

Process

  • Periodic repeats of baseline measures

Outcome

  • Assess changes in health care use and costs from baseline
  • Compare health care use and costs of employee participants before education and other programs are initiated with the same measures after operation of these programs
    • These measures may be affected by other circumstances, such as national education programs or changes in operation at the worksite, so they should be interpreted with caution

Top of Page

Health outcomes measures for depression11-13

The effectiveness of depression programs depends on the intensity of program effort and the use of multiple interventions. A rule of thumb is that the more programs implemented together as a package or campaign, the more successful the interventions will be.

Baseline

Process

  • Periodic repeats of baseline measures

Outcome

  • Assess changes in the percentage of employees who report depressive symptoms
  • Assess changes in levels of diagnostic and treatment procedures for depressive symptoms from health care and pharmaceutical claims data
  • Assess changes in compliance with disease management of other chronic conditions co-occurring with depression
  • Assess changes in employee knowledge, attitudes, and beliefs about depression and depressive symptoms
    • Measure changes in employee knowledge and beliefs about the symptoms, causes, and treatments for depression
    • Measure changes in employees’ knowledge of the risks of depression associated with other chronic conditions such as heart disease, cancer, and diabetes
    • Assess changes in employee awareness of existing workplace depression prevention and treatment programs, policies, and benefits

Top of Page

Organizational change measures for depression11-13

Depression prevention and treatment requires ongoing support from employers. New programs can be added over time and evaluated periodically for their effectiveness. For best results, recognition of the benefits of detecting and treating depression should become an inherent part of organizational change and corporate culture.

Measuring organization change is an assessment of company-initiated programs and policies that affect most employees regardless of their health status (e.g., establishing an Employee Assistance Program). These efforts need to be integrated for greatest effectiveness and will require time for full implementation. Regular measures of employee attitudes and program development are key in determining whether new programs are effective or require further adaptation to prevent continuing investment in ineffective efforts.

Baseline

  • Determine workplace barriers to employee’s awareness and use of depression-related workplace programs and benefits
  • Assess current workplace depression-related programs
    • List current depression prevention options for employees through worksite and identify number of employees (i.e., participation) using each option. Examples:
      • Number of depression-related programs (e.g., education seminars, individual education, EAP services) and participation in these programs
      • Number of training programs related to factors than may impact employee mental health such as conflict resolution, problem solving, effective communications, and job stressors and participation in these training programs
      • Availability of educational materials on depression prevention and recognition
      • Number of health-related policies (e.g., policies defining appropriate standards of conduct) and environmental strategies (e.g., reasonable accommodations) to create supportive mental health work environments
      • Number of organizational practices that address job stressors (e.g., high job demands; low job control) such as training or job modification
      • Number of workplace communications/media campaigns regarding depression prevention and treatment
      • Number of employee engagement/climate surveys to elicit information on trust and relationships between employees, coworkers, and supervisors
      • Number of partnerships with community resources such as local mental health services programs or extended EAP services
    • Determine costs of current company depression-related programs such as:
      • Staffing, equipment, and space
      • Employee time to participate in programs during work hours (e.g., education or counseling)
      • Costs of EAP services
    • Conduct survey of employee satisfaction with current workplace supported depression-related programs

Process

  • Reassess barriers to employee engagement in depression-related programs
  • Document steps taken and progress toward implementing each intervention selected
    • List numeric goals in each form of intervention within a designated time period (e.g., 12 months from startup):
      • Employee reach (e.g., number of educational pamphlets distributed)
      • Employee participation (e.g., number of employees using EAP services)
    • Describe timeline for implementation of each planned intervention (e.g., length of time and timing of tasks to develop, initiate, and conduct a mass campaign)
    • Create a baseline budget for new interventions including classes, instructors, classroom space, materials, etc
    • Identify opportunities for new partnerships with community groups who provide depression-related programs such as local mental health services programs or extended EAP services
  • Reassess employee satisfaction regarding workplace supported depression-related programs

Outcome

  • Measure reductions in the number and type of employee barriers for awareness and use of depression-related workplace programs and benefits
  • Assess changes in workplace depression-related programs including progress in achieving goals and in implementation of each intervention (e.g., length of time and timing of tasks to develop, initiate, and conduct a mass campaign)
    • Measure changes in the number of depression prevention options for employees through the worksite and changes in employee participation using each option before and after the depression-related program or campaign. Examples:
      • Number of new programs developed and offered to employees and participation in these programs (e.g., EAP services)
      • Number of new training programs developed and offered to employees and participation in these program (e.g., conflict resolution)
      • Number of new educational materials developed and made available to employees
      • Number new of health-related policies and environmental strategies to create supportive mental health work environments
      • Number of new organizational practices that address job stressors (e.g., high job demands; low job control) such as training or job modification
      • Number of new workplace communications/media campaigns including posters, brochures, employee success stories, organized buddy support systems, etc
      • Number of new employee engagement/climate surveys to elicit information on trust and relationships between employees, coworkers, and supervisors
      • Number of new partnerships with community groups to enhance access and opportunity for employee depression prevention and treatment such as local mental health services programs or extended EAP services
    • Assess changes in program costs from baseline
      • Increases in staffing or equipment needs due to new program offerings
      • Changes in employee time to participate in programs during work hours (e.g., education or counseling)
      • Changes in costs of EAP services
    • Assess changes in survey responses for employee satisfaction following implementation of a workplace supported depression-related program and compare to baseline

Depending on goal success, evaluate the need to adjust workplace programs.

Tools and Resources

Depression-related Baseline Measures

The assessment tools described in the assessment module include specific questions related to depression.

  Health-related Programs

  • Q11; Q12; Q13; Q20e,h; Q22; Q23; Q24a,b,d,e,h,i,j,k,l; Q26; Q27; Optional Questions A, B, C, I, K, L, M, OO

  Health-related Policies

  • Q28a

  Health Benefits

  • Q29; Q30; Q31; Q32; Q36; Optional Questions T, V, Z

  Environmental Support

  • Q39; Q40; Q41; Optional Questions CC, JJ

Additional Tools

  • CDC Health Scorecard [PDF – 3.5MB] developed by the Centers for Disease Control and Prevention (CDC), the Health Scorecard is a tool designed to help employers assess the extent to which they have implemented evidence-based health promotion interventions or strategies in their worksites to prevent heart disease, stroke, and related conditions such as hypertension, diabetes, and obesity.
  • The Substance Abuse and Mental Health Services Administration (SAMHSA) publishes regular reports from the National Survey on Drug Use and Health. State estimates on depression rates can be used for benchmarking
  • The Substance Abuse and Mental Health Services Administration (SAMHSA) Office of Applied Studies produces regular data and statistical reports on mental health and substance misuse including data on co-occurring disorders and workers
  • Health Risk Appraisals at the Worksite: Basics for HRA Decision Making [PDF - 2.3MB] is a guide developed by the National Business Coalition on Health in collaboration with the Centers for Disease Control and Prevention (CDC) in the selection and use of health risk appraisals in the workplace available for employers
  • The CDC Healthy Communities Program developed the Community Health Assessment and Group Evaluation (CHANGE) assessment tool to provide communities with a picture of the policy, systems, and environmental change strategies currently in place throughout the community, where gaps exists and facilitate action planning for making improvements. The CHANGE tool address five community sectors including worksites and health indicators related to physical activity, nutrition, tobacco use, chronic disease management, and leadership
  • Mental Health America’s Factsheet: Gaining a Competitive Edge Through Mental Health: The Business Case for Employers [http://www.mentalhealthamerica.net/go/gaining-a-competitive-edge-through-mental-health-the-business-case-for-employers] outlines several key reasons why addressing a workforce’s mental health makes good business sense
  • The Productivity Impact Model: Calculating the Impact of Depression in the Workplace and the Benefits of Treatment is a depression calculator developed by the National Partnership for Workplace Mental Health that provides employers with estimates of the costs, absenteeism, and incidence of depression among their employees as well as estimates of cost and productivity savings when employees receive treatment for depression

Top of Page

 

Contact Us:
  • Division of Population Health/Workplace Health Promotion
    Centers for Disease Control and Prevention
    4770 Buford Highway, Northeast, Mailstop K-45
    Atlanta, GA 30341
  • 800-CDC-INFO
    (800-232-4636)
    TTY: (888) 232-6348
  • Contact CDC-INFO
USA.gov: The U.S. Government's Official Web PortalDepartment of Health and Human Services
Centers for Disease Control and Prevention   1600 Clifton Road Atlanta, GA 30329-4027, USA
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348 - Contact CDC–INFO
A-Z Index
  1. A
  2. B
  3. C
  4. D
  5. E
  6. F
  7. G
  8. H
  9. I
  10. J
  11. K
  12. L
  13. M
  14. N
  15. O
  16. P
  17. Q
  18. R
  19. S
  20. T
  21. U
  22. V
  23. W
  24. X
  25. Y
  26. Z
  27. #