Depression is a common
disorder. The Australian
Bureau of Statistics
(ABS) estimates that 5.8 per
cent of the adult Australian
population has depression
each year and that
depression is the leading
contributor to the non-fatal
disease burden in Australia.
Of those people in full-time
employment the prevalence of
depression has previously
reported by the ABS to be
3.6 per cent. The societal
cost of depression in
Australia is largely
unknown, but is potentially
very significant. It not
only includes the direct
costs of treatment but also
the indirect costs including
lost productivity, both
while at work and days
absent from work.
Other societal results of
depression include personal
and financial costs to
individuals, their families
and their communities.
Depression has one of the
largest impacts on
short-term absence from
work, disability and work
performance. Depression can
have the first onset at any
age however; highest
prevalence for females is in
the early to mid 20s while
for males it is in
mid-to-late 30s. This is
when people are in the
workforce. Many people with
depression may not attribute
their symptoms to
depression, or may be
reluctant to seek treatment.
The
WORC (Work Outcomes
Research Cost-Benefit)
Project aims are to identify
employees with symptoms of
depression, who are not in
treatment, by using
cognitive behavioural
therapy and motivational
interviewing techniques to
encourage them to seek
advice from a mental health
professional.
This project will not
only identify the economic
burden that depression has
on employers and the nation
but also determine the
return on investment for
early identification and
treatment for depression.
Originating with Harvard
University, Boston (USA),
and modified to be relevant
to Australian culture, the
WORC
Project is being
conducted through the
University of Queensland as
the Australian component of
the international study.
Primary funding is provided
by the Department of Health
and Ageing, Mental Health
Strategy branch, Queensland
Health, beyondblue and the
Australian Rotary Health
Research Foundation.
The specific aim of this
project is to test the
hypothesis that the cost of
proactive screening and
treatment of depression in
the labour force:
-
improves depressive
symptoms; which in turn,
-
increases employee
productivity resulting
in a net benefit to
employers and society.
It is expected proactive
screening and treatment of
depression in the workforce
will reduce symptom
severity, sickness absence,
impairment in job
performance, job-related
accidents and job turnover.
The first phase of the
project involved the
recruitment of 58 large
companies (representing over
350,000 employees) to
consent to their employees
being asked to participate.
Employees were invited to
complete a confidential
general health and emotional
well-being questionnaire
covering 28 physical health
conditions and the Kessler 6
(K6), which is designed to
screen employees for
depressive symptoms.
Those employees who
screened positive for
depressive symptoms on the
K6, and who had consented to
further contact, were
telephoned at home, and
asked a further depression
screening questionnaire,
namely the Quick Inventory
of Depressive Symptomatology
- Self Report (QIDS-SR).
Employees who were positive
for depression symptoms on
both the K6 and the QIDS-SR
were called by trained
psychologists. The
psychologists asked a
series of further clinical
questions, explained their
answers, advised the worker
of their confidentiality and
ethical rights and gave a
single counselling session.
Employees were encouraged to
visit a local mental health
professional and sent a
referral letter.
Following this telephone
contact with a psychologist,
the employees are assigned
into one of two intervention
groups. The first group only
receive the contact as
described. The second group
is provided with ongoing
case management,
encouragement to seek help
and encouragement to adhere
to prescribed therapies over
a 12-month period. The
project's aim is to
facilitate help-seeking
behaviour, by encouraging
them to talk to their
general practitioner, a
psychologist or an employee
assistance provider.
A key aspect of the study
is to use treatment services
in their local community,
which is economically
practical and assists
continuity.
Both groups are followed
up after six weeks, thee,
six, 12 and 18 months to
track the clinical changes
in depression symptoms and
the employees’ performance
at work. All contact with
the employees is treated as
highly confidential. It is
very important that workers
believe that they can speak
freely with the
psychologists without fear
that their personal
information will be
accessible to their
employer.
While the study is still
in its early stages, it is
already producing data from
cross sectional analyses of
the original health
appraisal survey on
depression prevalence rates,
help-seeking behaviour and
the economic burden of
depression.
The
WORC
Project has
surveyed over 85,000
employees so far about
physical and emotional
health and work performance
in terms of absenteeism and
when present at work. The
data from the K6 indicates a
current depressive
symptomatology prevalence
rate of 6.7 per cent in
full-time employees.
Alarmingly, questionnaire
data shows that 68 per cent
of full-time employees with
current depressive symptoms
have not sought medical
advice in the previous year.
This equates to more than
303,000 employees in
Australia who are struggling
with a crippling illness who
are not getting effective
treatment.
Economic analyses shows
that employees with
depressive symptoms, not in
treatment, are absent from
work for 5.5 per cent of
total working time which is
4.3 per cent more than their
non-depressed counterparts.
This equates to an annual
wage loss of at least $1.5
billion due to Absenteeism
in Australia.
Moreover, employees with
depressive symptoms
have reduced ability to
function at their usual
level of capacity while at
work. Project results
suggest this represents a
productivity decrement $2.8
billion a year. In total
this is a staggering $4.3
billion in lost productivity
each year due to undiagnosed
depression.
When averaged across the
nation’s workforce the
annual cost of lost
productivity per person with
untreated depression
symptoms is $9,665 per
annum. Putting this in a
context for employers’
consumption, it means that
for each and every employee,
depression is producing a
loss of $647 per annum.
Example, if you have 1,000
employees, estimated
productivity loss would be
approximately $647,000. It
is important to note that
these productivity losses
are an “at least value”,
they do not include
additional losses due to
WorkCover or insurance
claims, part-time or casual
employees, staff attrition
or critical incidents.
Evidence to date suggests
that undiagnosed depression
is responsible for
significant reductions in
employee productivity; and
this financial burden to
organisations and corporate
Australia may be alleviated
by the early diagnosis and
treatment of previously
unidentified depressed
individuals in the work
force.