Psychiatr News June 16, 2006
Volume 41, Number 12, page 19
© 2006 American Psychiatric Association
Treating Depression Expected To Reduce Disability Costs
Rich Daly
Insurance claims data should convince employers of the need to offer
coverage that encourages workers to be evaluated and treated for depression,
particularly when it is comorbid with other illnesses.
When workers were diagnosed with conditions such as chronic fatigue,
hypertension, back pain, obesity, or carpal tunnel syndrome, their time off
work was longer if they also suffered from depression.
This finding arose from an analysis conducted by Aetna of claims data from
36,747 short-term and long-term disability plan subscribers between 2002 and
2004. The analysis obtained similar results when depression occurred with
pregnancy and irritable bowel syndrome (IBS).
"We knew from industry data that depression and [physical] illness
were closely connected, but this was the first time we specifically looked at
our own data this way," said Caren Kittredge, product head for Aetna
Integrated Health Disability.
The Aetna analysis looked at short-term disability claims from January 1,
2002, to June 30, 2004, and long-term disability claims from January 1, 2002,
to June 30, 2003.
Disability plan beneficiaries diagnosed with IBS and depression, for
example, had 63 percent longer average disability durations than Aetna
enrollees with IBS but without a depression diagnosis. Back-pain claims
resulted in average disability durations 25 percent longer for claimants with
depression than for back-pain claimants without depression.
The results prompted Aetna to offer depression education resources for all
beneficiaries filing a disability claim and to refer certain claimants to
depression and other mental health programs.
The results are "very consistent" with other research that has
linked depression and severity of comorbid conditions, said psychiatrist Alan
Axelson, M.D., co-chair of the advisory committee of the National Partnership
for Workplace Mental Health, a partnership of APA, federal agencies, and
private industry.
Psychiatrists and mental health professionals have long seen a connection
between depression comorbidity and length of illness, having solid numbers to
illustrate the extent of the connection is helpful, he said. The partnership
aims to highlight such connections and the steps employers and physicians can
take to speed employees recovery from mental illness.
Sooner the Better
"The longer folks are away from work, the less confident and capable
they feel about going back," Axelson said. "We encourage
psychiatrists to get patients back to work at least part time or in some
limited capacity sooner to assist in their recovery."
The partnership is developing guidelines for insurers and physicians to
encourage early detection, diagnosis, and treatment of mental illness among
patients affected by other ailments or injuries.
Research suggests that only half of the millions of Americans who are
affected by depression each year seek help.
Untreated depression results in an estimated $44 billion a year in lost
productivity and work absences, according to another study. Major employers
have described depression as the greatest negative impact on productivity for
nonmanufacturing companies.
A 2005 study sponsored by the National Institute of Mental Health indicated
that the U.S. mental health system lagged behind the needs of consumers and
that improvements are needed to speed initiation of treatment and enhance the
quality and duration of treatment.
The National Comorbidity Survey Replication, a household survey of 9,282
English-speaking adult respondents, found that over a 12-month period, 60
percent of those with a mental disorder received no treatment at all
(Psychiatric News, July 15, 2005).
Insurer Develops New Programs
Aetna's response to the claims-data study includes continued development of
integrated programs to address depression among workers. Aetna Depression
Management, begun in October 2005, for example, provides clinical tools for
physicians, training for office staff, access to Aetna nurse case managers,
and support from Aetna's network of behavioral health specialists. The
Depression Management program stems from Aetna's decision to bring all
behavioral health business in-house, effective this past January 1, when it
ended its contract with Magellan Behavioral Healthcare. The change aimed to
integrate two data systems and care processes.
The company also increased reimbursement for physicians who screen and talk
with patients to evaluate the presence of depression (Psychiatric
News, January 20). Such patients include those at high risk for
depression such as those with diabetes, coronary artery disease, chronic back
pain, and other chronic conditions linked with depression.
Another Aetna response is that its disability case managers will make
disability claimants aware of an educational Web site,
<www.reawake.com>,
which Aetna developed to educate people at risk for depression and their
family members.
Although medical treatment has become a large part of mental health care,
the company does not plan changes to its drug formularies as a result of the
research, Kittredge told Psychiatric News.
Previous insurance industry research in this area generally looked at the
incidence of depression and not its duration among beneficiaries. The findings
on the length of the illness are particularly important for workers because
extended illness costs them financially, as well as physically.
"Our focus is to try to help people get back to work and back to firm
financial footing as quickly as possible after an illness, and depression can
slow that process down," Kittredge said.
Information on the Aetna study is posted at
<www.aetna.com/news/2006/pr_20060424a.htm>.
Information on the NIMH study is posted at
<www.nimh.nih.gov/press/mentalhealthstats.cfm>.
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