Prevalence and Effects of Mood Disorders on Work Performance in a Nationally Representative Sample of U.S. Workers

TLDR

Workplace cost studies of mood disorders have largely focused on major depressive episodes, while bipolar disorder has been overlooked due to conflation with depression and lack of evaluation of mania/hypomania costs. The study calls for effectiveness trials to assess the return on employer investment in coordinated screening and treatment programs for both bipolar disorder and major depressive disorder. Using the National Comorbidity Survey Replication, researchers diagnosed bipolar and major depressive disorders with the WHO CIDI and measured work impairment with the WHO Health and Work Performance Questionnaire, then applied regression analysis to estimate workplace costs among 3,378 workers. In this nationally representative sample, 1.1% of workers had bipolar disorder and 6.4% had major depressive disorder, with bipolar linked to 65.5 lost workdays per ill worker per year versus 27.2 for depression, largely due to more severe and persistent depressive episodes in bipolar, suggesting employers should broaden their focus beyond depression to include bipolar.

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.