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The Economic Burden of Depression in the United States: How Did It Change Between 1990 and 2000?

J Clin Psychiatry 2003;64(12):1465-1475

Background: The economic burden of depression was estimated to be $43.7 billion in 1990. A subsequent study reported a cost burden of $52.9 billion using revised prevalence data and a refined workplace cost estimation approach. The objective of the current report is to provide a 10-year update of these estimates using the same methodological framework.

Method: Using a human capital approach, we developed prevalence-based estimates of 3 major cost categories: (1) direct costs, (2) mortality costs arising from depression-related suicides, and (3) costs associated with depression in the workplace. Cost-of-illness estimates from 1990 were updated to reflect the experience in 2000 using current epidemiologic data and publicly available population, wage, and cost information.

Results: Whereas the treatment rate of depression increased by over 50%, its economic burden rose by only 7%, going from $77.4 billion in 1990 (inflation-adjusted dollars) to $83.1 billion in 2000. Of the 2000 total, $26.1 billion (31%) were direct medical costs, $5.4 billion (7%) were suicide-related mortality costs, and $51.5 billion (62%) were workplace costs.

Conclusion: The economic burden of depression remained relatively stable between 1990 and 2000, despite a dramatic increase in the proportion of depression sufferers who received treatment. Future research will incorporate additional costs associated with depression sufferers, including the excess costs of their coexisting psychiatric and medical conditions and attention to the role of painful conditions as a driver of these costs.

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