May 16, 2014
by David McDaid, Derek King and Michael Parsonage
Substantial potential economic costs arise for employers from productivity losses due to depression and anxiety in the workforce. The main costs occur due to staff absenteeism and presenteeism (lost productivity while at work). From the perspective of the public purse, failure to intervene also risks higher future health and social care costs.
Labour Force Survey data suggest that 11.4 million working days were lost in Britain in 2008/09 due to work-related stress, depression or anxiety. This equates to 27.3 days lost per affected worker. It is estimated that the average annual cost of lost employment in England attributable to an employee with depression is £7,230, and £6,850 for anxiety (2005/06 prices). If these conditions are not treated, additional costs are also likely to arise from related physical health problems. In the longer term, wider costs may also be incurred, such as from acute care, the impact on family members and premature death. There may also be additional recruitment and training costs for employers if their employees permanently withdraw from the workforce.
In 2011 we were asked by the Department of Health to identify and analyse the costs and economic payoffs of a range of interventions in the area of mental health promotion, prevention and early intervention, and to present this information in a way that would most helpfully support NHS and other commissioners in assessing the case for investment. As part of this report, we looked at the case for workplace screening for depression and anxiety disorders.
Workplace-based enhanced depression care consists of completion by employees of a screening questionnaire, followed by care management for those found to be suffering from, or at risk of developing, depression and/or anxiety disorders. Those identified as being at risk of depression or anxiety disorders are offered a course of cognitive behavioural therapy (CBT) delivered in six sessions over 12 weeks. This intervention has been shown in a number of studies to be effective in tackling depression and reducing productivity losses in various workplaces. In a similar approach in Australia, productivity improvements outweighed the costs of the intervention.
It is estimated that £30.90 (at 2009 prices) covers the cost of facilitating the completion of the screening questionnaire, follow-up assessment to confirm depression, and care management costs. For those identified as being at risk, the cost of six sessions of face-to-face CBT is £240. Computerised CBT courses are cheaper, and may be less stigmatising to individual workers, but less is known about their longer-term effectiveness.
Our model assessed the cost-effectiveness of the above workplace-based intervention for depression and anxiety disorders, and whether it reduced sickness, absenteeism and presenteeism, compared with no intervention. The target population was a hypothetical cohort of working age individuals in a white collar enterprise with 500 full time equivalent employees, all of whom are screened. The cost/savings impact was addressed from the perspective of the health system (including personal social services) and business, with the enterprise paying the total costs of the intervention. The model assumed that only two-thirds of employees offered CBT as a result of screening would make use of this treatment. It is estimated that the reduction in presenteeism as a result of successful intervention is equivalent to an extra 2.6 hours of work per week. In year 1 the model assumed that this benefit would only be seen in the 36 weeks after the completion of the CBT course. If depression and anxiety orders were averted, then 27.3 days of absenteeism per annum associated with these disorders would be avoided. Conservatively, the model assumed that health and personal social services costs relating to depression and anxiety would only occur in year 2.
The results found that from a business perspective the intervention appeared cost-saving, despite the cost of screening all employees.
Benefits were gained through both a reduction in the level of absenteeism and improved levels of workplace productivity through a reduction in presenteeism. However, the impact may differ across industries; the case may be less strong where staff turnover is high and skill requirements low. From a health and personal social services perspective the model is cost-saving, assuming the costs of the programme are indeed borne by the enterprise.
- Workplace screening was cost-saving from the perspectives of both business and the health system, on the assumption that all costs were borne by business.
- The costs of the intervention were more than outweighed by gains to business due to a reduction in both presenteeism and levels of absenteeism.
- Public sector employers also have the potential to benefit from investing in universal workplace depression and anxiety screening interventions.
This post was first printed as a chapter in Knapp M, McDaid D, Parsonage M (eds) (2011) Mental Health Promotion and Mental Illness Prevention: The Economics Case, Department of Health, London.