Treating Depression Expected To Reduce Disability Costs

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>.▪