For more than two decades, Boston economist Paul Greenberg has been calculating the costs of depression — the mood disorder, that is, not the economic downturn.
His latest study, now out in the Journal of Clinical Psychiatry, finds that major depression is costing the American economy $210.5 billion a year — boosted dramatically by the toll of the recent recession. And rates of depression particularly shot up among people over 50.
I asked Greenberg, head of the health care practice at the Boston economic consulting firm Analysis Group, to elaborate. Our conversation, lightly edited:
First, what would you most highlight from your latest findings?
There are many highlights but I’d focus on two. The first is that the costs of depression are large and growing. And the second is that costs of depression are borne in the workplace in a very dramatic way. There’s no employer that’s exempt from the costs of depression. And I think both the magnitude of costs generally, as well as the costs that are specific to the workplace, are worthy of further attention, further thought, further research.
What are a couple of the specific numbers that you find most striking?
Let’s start with the overall finding: We find the costs of depression to be approximately $210 billion per year. One of the interesting aspects is that only 40 percent of those costs are actually attributable to depression itself.
Could you explain that?
That means that 60 percent is attributable to elevated costs that, in the data, don’t show up as directly connected to depression, but they’re associated with depressed people to a greater extent than with non-depressed people.
To be more concrete, on the mental-illness side, there are an awful lot of co-morbid anxiety disorders, a lot of co-morbid PTSD-associated costs — those are examples where the same person who suffers from depression tends to have a higher likelihood of also incurring costs in these co-morbid categories.
But should those costs really count toward depression, when it’s technically another disorder that’s causing them?
Fair enough. That’s part of the age-old question of to what extent is this cause and what’s effect. Take the example of someone who suffers from cancer. It could be that in some instances, there’s an elevated cost of depression when you suffer from cancer. That’s one causal pathway where the depression likely follows the physical disorder. But in another instance, it could be that back pain or sleep disorders or migraines – those are examples of elevated physical disorder costs that accrue to depressed patients, likely as a result, at least in part, of the depression.
Here’s why it matters. If we’re more successful at treating the depression, there’s little or no hope it will alleviate any of the cancer costs. But if we’re more successful at treating depression, there’s a great opportunity to alleviate some or even a large part of those back pain, sleep disorder and migraine kinds of costs that are currently co-morbid with depression. Continue reading