Considering the costs of bipolar depression

Consumers increasingly are recognizing that depression is one of the most costly of all health problems. Employer-purchasers especially are concerned about depression because so much of the societal burden associated with this illness is related to adverse effects on workplace functioning. By the most recent estimates, based on year 2000 data, the total annual societal cost of depression in the United States is $83 billion, of which 62% is due to excess absenteeism and “presenteeism” (lower-than-average work performance). Many employers have responded to this situation by expanding depression outreach, treatment, and disease management programs. This has occurred at a time when many other factors have led to an increase in the proportion of workers with depression who have received treatment- (1)the introduction and aggressive promotion of direct-to-consumer advertising of new psychotropic medications with improved side-effect profiles; (2)the development of new community programs aimed at promoting awareness, screening, and help seeking for mental disorders; and (3)the expansion of primary care, managed care, and behavioral carve-out systems to deliver mental health services. These efforts collectively led to more than a tripling of the number of people who annually receive healthcare for depression in the United States in recent years compared with the late 1980s. The increased treatment of depression is encouraging in many ways. However, it also creates a major challenge for behavioral healthcare providers that must be recognized and met aggressively: that a much higher proportion of people with depression than previously realized suffer from an undetected and untreated bipolar spectrum disorder. (January 2007)