Severity of Depression and Magnitude of Productivity Loss

Article Figures & Data

Table 1.

Patient Enrollment

Criteria	No. of Patients	% of Total	% of Remaining
Contact information from health plan	11,889	–	–
Contact made with member	7,155	60.2	60.2
Eligibility assessed	4,741	39.9	66.3
Study eligible	1,180	10.0	24.9
Consented	1,173	9.9	99.4
Baseline complete	1,168	9.8	99.6
Working for pay	771	6.5	66.0

Table 2.

Demographic Characteristics of Enrolled Patients Working for Pay (N = 771)

Characteristic	% or Mean (SD)
Female	74.8
Age, y	42.5 (12.4)
Ethnicity
Hispanic	3.0
Non-Hispanic white	90.2
Race
American Indian	0.5
Asian	0.8
Black, African American	3.8
Multiracial	1.4
Native Hawaiian, Alaska Native	0.4
Other	1.6
Unknown	0.3
White	91.3
Education, highest level
Grade 1–11	3.9
High school	21.4
Some college	39.3
College graduate	24.0
Graduate degree	11.4
Employment
Employed for wages	90.1
Self-employed	8.0
Student	1.0
On disability	0.8
Marital status
Married	52.8
Divorced	15.8
Separated	3.2
Unmarried couple	8.4
Widowed	1.7
Never married	18.0
Functional health status
Excellent	7.0
Very good	29.6
Good	40.6
Fair	18.5
Poor	4.3

Table 3.

WPAI Items and Related Measures

Item or Measure (No. of Patients Responding)	Mean (SD)
WPAI = Work Productivity and Activity Impairment questionnaire.
^a On a 10-point scale, where higher values indicate greater effect.
During the past 7 days, how many hours did you miss from work because of your health problems? (740)	3.1 (8.0)
During the past 7 days, how many hours did you actually work? (740)	33.8 (15.5)
During the past 7 days, how much did your health problems affect your productivity while you were working?^a (721)	3.5 (2.6)
Thinking of your regular job, how many days in the past 7 days were you limited in the amount of work you could do, accomplished less than you would like, or days you could not do your work as carefully as usual? (737)	2.2 (2.3)
Percent of work time missed due to health (absenteeism) (740)	8.2 (20.5)
Percent impairment at work due to health (presenteeism) (720)	35.2 (26.4)
Percent of work missed or work time impaired due to health (absenteeism or presenteeism) (719)	37.8 (27.5)
Hours of impairment at work due to health (720)	12.1 (11.0)
Hours of work missed or work impaired (productivity loss) due to health (719)	14.2 (12.6)

Table 4.

Relationship of Depression Severity (PHQ-9 Score), Demographics, and Health Status to Productivity Loss

Parameter	β Coefficient	Error	t Value	P Value
PHQ-9 = Patient Health Questionnaire 9-item screen.
Notes: The model had an estimated intercept of 36.50 and an error of 1.74. Positive estimates indicate loss of productivity; negative estimates indicate gain of productivity. Productivity loss is defined as the combination of absenteeism (percent of time missed in the past 7 days due to health) and presenteeism (percent impairment at work in the past 7 days due to health). These measures were obtained from the Work Productivity and Activity Impairment (WPAI) questionnaire.
^a The general linear model shows the relationship between PHQ-9 score and productivity loss adjusted for all other variables listed in the table.
^b Combination of Hispanic ethnicity and non-white race categories listed in Table 2.
^c Divorced, separated, widowed, or never married.
PHQ-9 score^a	1.65	0.24	6.98	<.001
Age	0.006	0.08	0.07	.94
Sex (male)	1.89	2.32	0.82	.41
Race/ethnicity (minority^b)	3.36	3.30	1.02	.31
Health (fair/poor)	4.80	2.39	2.01	.045
Education (high school or less)	−1.44	2.30	−0.62	.53
Employment status (part time)	−9.85	2.60	−3.79	<.001
Marital status (not coupled^c)	3.73	2.06	1.81	.07