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Employers could improve employee productivity by 2.6 hours per week, or by more than two weeks per year.

The analysis of the study on return on investment and depression was part of a presentation by Azocar and Dr. David Whitehouse, the chief medical officer for OptumHealth, at the annual Behavioral Risk Management Conference of the Disability Management Employer Coalition.

The study suggested that the return on investment from depression treatment amounted to about $1,800. Treatment typically reduced depression, lowered absenteeism, improved on-the-job performance and increased employee retention.

"There is also a multiplier effect of depressed workers on co-workers," Whitehouse explained at the conference. So the impact of treating workers might be even greater that the initial calculations in the study.

"What's important about this study," Whitehouse emphasized, is that for the first time it shows that "it is possible to improve productivity if you invest in treating depression."

Azocar remarked, "Depression is the single most burdensome illness during a person's working years."

She said depression costs on in the United States are estimated to be $83.1 billion and that $51.1 billion of that cost comes from absenteeism and presenteeism.

In the study, employees with depression were identified using the World Health Organization Health and Work Performance Questionnaire. Those identified with moderate or severe depression received telephonic monitoring of psychotherapy and pharmacotherapy. The study found "substantial improvement" in those employees that received treatment after 6 and 12 months.

30 YEARS OF RESEARCH

In another session at the DMEC conference, Dr. Roy Sugarman, the director of behavioral solutions of the Brain Resource Co. in Australia, reported on a Web-based test of general and social cognition that can identify markers for different types of known behavioral conditions and mental illnesses.

The inexpensive, online test suggests appropriate treatment options based on an analysis of more than 30,000 datasets from a huge, international database. The tests can also be use to monitor the efficacy of treatment of a variety of mental illnesses.

For example, in its analysis of markers for depression, the test has found a high correlation between "negativity bias" and depression. A treatment option is associated with that marker. For a condition like posttraumatic stress disorder, the markers include higher "impulsivity-inhibition errors" in the testing process among what it calls general cognitive markers.

Sugarman said the test doesn't substitute for a medical diagnosis, but it helps take the typical "art of inference" out of the mental health diagnosis process.

And, with the diagnosis, the test suggests a "clinical pathway" for treatment.

Testing is relatively easy using the Internet and, in most cases, takes about 40 minutes. He said it separates those employees with behavioral conditions that need care from those that don't. It can also identify possible problems before the condition presents with obvious symptoms. He explained that it has taken 30 years of research and testing to develop the test.

GREATER AWARENESS

DMEC held its first Behavioral Risk Conference three years ago and had about 100 conference attendees. This year, the conference in Minneapolis attracted almost 260 attendees, and it is clear that interest in behavioral risk is clearly on the rise.

"We're at a tipping point," said Marcia Carruthers, president of DMEC. Although there still remains a stigma attached to mental illness, it seems to becoming less and less.

"There are effective treatments," she explained. With baby boomers approaching retirement, there will be "a human capital shortage" that will help motivate employers to seek treatment for employees with mental health problems. In addition, she called the efforts for mental health insurance parity in Congress heartening.

"There is increasing interest by employers in behavioral risk," she said, previewing the results of a DMEC sponsored survey of employers. All of the employers in the survey said behavioral risk was an "important areas" of concern for them.

"Employers are experimenting," she said, with the use of employee assistance programs and depression screening of employees for behavioral risk problems. And, she added, employers are continuing to look for appropriate metrics to document the return on investment in screening and treating employee mental health problems.

The next frontier, she said, will be a greater focus on "prevention and early intervention, not just loss control."

JACK ROBERTS is editor in chief of Risk & Insurance®.

April 7, 2008

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