How Depression Among Employees Leads to Increased Total Cost of Care

Mental health in America is in a steady decline. About one-third of adults in the United States report symptoms of depression.¹ This figure is 3x greater than in previous years. Depression is a mental health condition, but its impact goes far beyond mood and feelings.

People with depression are more likely to:

• Experience debilitating physical conditions like diabetes, chronic obstructive pulmonary disease, heart disease, and chronic pain.
• Suffer from worsening disability from associated physical illnesses.
• Be absent from work and less productive while at work.
• Make fewer decisions and/or poor decisions about their health and wellness.

Researchers from Highmark, with support from the Richard King Mellon Foundation, conducted a two-year retrospective analysis on depression among our members. The team looked at how depression directly and indirectly impacts wellness and quality of life — emotionally, physically, and socially.

In particular, the study focused on the relationship between depression severity and health care utilization costs. Researchers received regulatory approvals from an Institutional Review Board, ensuring the study met all data privacy standards. Study results appeared in the Journal of Affective Disorders in September 2024.²

Depression symptoms in our study

Approximately 745,000 members were identified as having some degree of depression during the study (2019 and 2020). About 369,000 of these members were included in the analysis for both years. This equates to 13.6 % of our 4+ million Highmark members diagnosed with depression in 2019 and 15.8 % in 2020. 

Member data was gathered across Highmark’s home markets of Pennsylvania, West Virginia and Delaware, as well as from national markets.Researchers classified members by the severity of their depression symptoms: minimal, mild, moderate, severe, and unknown.

The team used the standard Patient Health Questionnaires (PHQ-2 and PHQ-9) to gauge depressive symptoms. PHQ-9 is a nine-item questionnaire for assessing depression severity, while PHQ-2 only uses the first two questions on PHQ-9. The PHQ-2 questions are

• Over the last 2 weeks, how often have you felt little interest or pleasure in doing things?
• Over the last 2 weeks, how often have you felt down, depressed, or hopeless?

Health insurance implications for depression

Researchers also used ICD-10 medical codes associated with depressive disorders that appeared in member insurance claims. Data on mood stabilizers, anti-anxiety medications, and anti-psychotics were also included when measuring depressive disorders.

Together with the PHQ assessments, this information told researchers that:

• Two-thirds of members in the study had either mild or moderate depression.
• The majority (66%) of members diagnosed with depression were female, with a median age of 49+.
• About one-third of members in the study had at least one chronic physical condition.
• Diabetes was the most common condition experienced by 11% of members, followed closely by COPD.
• The majority (77%) of members stayed in the same depression classification, year over year.
  

Direct correlation between depression and total cost of care

Highmark researchers uncovered significant cost implications associated with depressive disorders of varying severity. Key findings include:

• Costs for severe depression were 117 % higher compared to minimal depression.
• Decreases in depression severity equated to an average cost savings of $41 per member per month.
• Members who had an increase in depression experienced from 25% to 48% higher health care costs.
• The average cost increase associated with a jump in depression symptom severity was $608.
• Members with unchanging severity levels saw a 3% ($52) to 8% ($79) increase in cost, year over year.
  

Reigning in future employee health benefit costs

Depression is projected to be a leading global health challenge by 2030, with an estimated cost of $300+ billion per year.^3,4 That figure includes direct expenses for outpatient care, prescriptions, lab services, and hospitalization. There are also indirect costs associated with absenteeism, lower productivity, and poor quality of life. 

All of this adds up to an increased total cost of care, especially when coupled with more expensive premiums and higher drug prices. Talk to your account manager about how Highmark can help your company alleviate depression among your staff. Highmark solutions minimize stigma around mental health care, while improving quality of life for our members