Depression Evaluation Measures
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
1. Valenstein M, Vijan S, Zeber JE, Boehm K, Buttar A. The cost-utility of screening for depression in primary care. Ann Intern Med 2001; 134: 345-360.
2. American Association of Geriatric Psychiatry (2008). Geriatrics and mental health—the facts.
3. Pratt LA, Brody DJ. Depression in the United States household population, 2005-2006. National Center for Health Statistics: NCHS Data Brief No. 7; 2008. Available from: https://www.cdc.gov/nchs/data/databriefs/db07.htm#ref08.
4. National Center for Health Statistics. Health, United States, 2007, with Chartbook on trends in the health of Americans. Hyattsville, MD: 2007.
5. Leopold RS. A Year in the Life of a Million American Workers. New York, New York: MetLife Disability Group; 2001.
6. Stewart WF, Ricci JA, Chee E, Hahn SR, Morganstein D. Cost of lost productive work time among US workers with depression. JAMA. 2003 Jun 18;289(23):3135-3144.
7. Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (October 11, 2007). The NSDUH Report: Depression among Adults Employed Full-Time, by Occupational Category. Rockville, MD.
8. Myette L, Garuso G, Stave G. Depression in the Working Population: Position Statement [Internet]. Elk Grove Village, Illinois: American College of Occupational and Environmental Medicine; 2009 [cited Feb 4, 2010]. Available from: http://www.acoem.org/guidelines.aspx?id=5613external icon
9. Weeks JL, Levy BS, Wagner GR, editors. Preventing occupational disease and injury. 2nd ed. Washington DC: American Public Health Association; 2005.
10. Campbell KP, Lanza A, Dixon R, Chattopadhyay S, Molinari N, Finch RA, editors. A Purchaser’s Guide to Clinical Preventive Services: Moving Science into Coverage. Washington, DC: National Business Group on Health; 2006.