Prevalence and effects of mood disorders on work performance in a nationally representative sample of U.S. workers

Ronald C Kessler, Hagop S Akiskal, Minnie Ames, Howard Birnbaum, Paul Greenberg, Robert M A Hirschfeld, Robert Jin, Kathleen R Merikangas, Gregory E Simon, Philip S Wang, Ronald C Kessler, Hagop S Akiskal, Minnie Ames, Howard Birnbaum, Paul Greenberg, Robert M A Hirschfeld, Robert Jin, Kathleen R Merikangas, Gregory E Simon, Philip S Wang

Abstract

Objective: Research on the workplace costs of mood disorders has focused largely on major depressive episodes. Bipolar disorder has been overlooked both because of the failure to distinguish between major depressive disorder and bipolar disorder and by the failure to evaluate the workplace costs of mania/hypomania.

Method: The National Comorbidity Survey Replication assessed major depressive disorder and bipolar disorder with the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) and work impairment with the WHO Health and Work Performance Questionnaire. A regression analysis of major depressive disorder and bipolar disorder predicting Health and Work Performance Questionnaire scores among 3,378 workers was used to estimate the workplace costs of mood disorders.

Results: A total of 1.1% of the workers met CIDI criteria for 12-month bipolar disorder (I or II), and 6.4% meet criteria for 12-month major depressive disorder. Bipolar disorder was associated with 65.5 and major depressive disorder with 27.2 lost workdays per ill worker per year. Subgroup analysis showed that the higher work loss associated with bipolar disorder than with major depressive disorder was due to more severe and persistent depressive episodes in those with bipolar disorder than in those with major depressive disorder rather than to stronger effects of mania/hypomania than depression.

Conclusions: Employer interest in workplace costs of mood disorders should be broadened beyond major depressive disorder to include bipolar disorder. Effectiveness trials are needed to study the return on employer investment of coordinated programs for workplace screening and treatment of bipolar disorder and major depressive disorder.

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