Frequently Asked Questions

The incremental economic burden of adults with major depressive disorder increased 21.5%, from $173.2 billion in 2005 to $210.5 billion in 2010, in inflation-adjusted dollars. The cost mix was stable across both years, with about 45%-47% attributable to direct costs, 48%-50% to workplace costs, and 5% to suicide-related costs.

Only 38% of the total incremental costs were attributable to major depressive disorder itself, while the majority was associated with comorbid conditions. The authors concluded that comorbid conditions account for the largest portion of the growing economic burden of major depressive disorder.

Direct costs specifically attributable to major depressive disorder treatment accounted for only 12%-13% of the total incremental economic burden. These MDD-specific direct costs totaled $21.6 billion in 2005 and $27.7 billion in 2010, even though total direct costs incurred by individuals with MDD were much higher at $77.5 billion and $98.9 billion, respectively.

Workplace costs and direct medical costs were both major contributors, but workplace costs represented the largest share at 48%-50% of total incremental costs, compared with 45%-47% for direct costs. Suicide-related costs accounted for the remaining 5%.

Presenteeism was the larger workplace cost, accounting for approximately three quarters of workplace costs and 37% of the overall economic burden. Total presenteeism costs rose from $64.7 billion in 2005 to $78.7 billion in 2010, while absenteeism costs increased from $21.5 billion to $23.3 billion. In each study year, the average individual with major depressive disorder lost the equivalent of about 32 incremental workdays due to presenteeism.

Among employed and treated patients, incremental direct health care costs were $5,707 per patient in 2005 and $5,988 per patient in 2010. In both years, only 40% of these incremental direct costs were directly attributable to major depressive disorder, with 10%-11% due to other depression diagnoses and 48%-51% due to other conditions.

The excess direct costs beyond major depressive disorder treatment were largely associated with other mental health and medical conditions. The article specifically notes mental illnesses including anxiety, adjustment disorder, and posttraumatic stress disorder, as well as non-mental health services related to pain syndromes such as disc and back disorders, abdominal pain, chest pain, sleep disorders, and migraines.

Yes. The number of adults with major depressive disorder increased from 13.8 million in 2005 to 15.4 million in 2010. Over the same period, the adult US population grew from 216 million to 228 million, and the MDD prevalence rate increased from 6.4% to 6.8%.

Employment worsened for adults with major depressive disorder between 2005 and 2010. The full-time employment rate in the MDD group fell from 47.2% to 40.3%, and the gap in full-time employment versus adults without MDD widened from 8.7 percentage points to 10.3 percentage points. The article also reports 0.3 million fewer persons with MDD employed full-time, 0.3 million more employed part-time, and 1.6 million more not employed at all in 2010 than in 2005.

Yes, but treatment rates remained in the 50% range. The proportion of adults treated for major depressive disorder increased from 52.2% in 2005 to 56.2% in 2010, with 1.5 million more people treated in 2010. The largest increase was among full-time employed adults, whose treatment rate rose by 6.1 percentage points, compared with 1.2 percentage points in the part-time employed group and 0.8 percentage points in the not-employed group.

The article attributes the 27.5% increase in direct costs to both more cases of major depressive disorder and higher cost per case. Of that increase, 12.8 percentage points were due to growth in the number of MDD cases and 14.8 percentage points were due to higher cost per case. Within the case-growth component, 5.8 percentage points were due to growth in the adult US population and 7.0 percentage points were due to a higher MDD prevalence rate.

Suicide-related costs were estimated with the human capital method using a 3% discount rate and a conservative assumption that household services had no human capital value. The model used CDC suicide data by age and gender and attributed 50% of suicides to major depressive disorder. Based on this approach, suicide-related costs were estimated at $9.4 billion in 2005 and $9.7 billion in 2010.

The study combined national survey data and administrative claims data to estimate the incremental economic burden of adults with major depressive disorder in 2005 and 2010. Prevalence, employment, and treatment rates came from the National Survey on Drug Use and Health using DSM-IV criteria for past-year major depressive episode, while cost estimates came from the OptumHealth administrative claims database for adults aged 18-64 years with at least 2 ICD-9 claims for MDD on different dates. Patients with MDD were matched 1-to-1 with controls by direct characteristic matching and propensity score methods.

• The study relied on multiple data sources and some literature-based estimates rather than a single database.
• Presenteeism was estimated using an earlier published ratio between presenteeism and absenteeism, which may not fully reflect workplace changes over time.
• Costs for adults aged 65 years and older were not observed directly and were imputed from the 50-64 year age group.
• Some managed care beneficiaries could not be analyzed because payment data might be incomplete.
• The data did not include markers of depression severity, so the study could not assess economic burden by severity of illness.