NEW ORLEANS—When depression develops along with a chronic illness, it is necessary to treat both—not just the symptoms of the chronic illness. By recognizing this connection and designing health plans that treat both ailments effectively, employers will save money and employees’ health will improve.
“When you treat people for the co-existing depression and their chronic illnesses, you’ll get better outcomes,” said Andy Johnson, fund administrator of the Teamster Center Services Fund in New York, who spoke at the International Foundation of Employee Benefit Plans’ employee benefits conference here on Nov. 1, 2011. Johnson’s fund provides employee assistance and behavioral health management services to Teamsters union members.
The results of collaborative care—the treatment of chronic illness and depression together—can be striking. Johnson cited a study showing that the addition of psychological interventions for patients with serious medical disorders resulted in a:
• 77.9 percent reduction in their average stay in a hospital.
• 66.7 percent reduction in hospital visits.
• 48.6 percent decrease in physician office visits.
• 45.3 percent decrease in emergency room visits.
Chronic Conditions Are Costly
The Chronic Illness Alliance defines a chronic illness as “an illness that is permanent or lasts a long time,” affecting the patient’s quality of life. Common chronic illnesses include autoimmune diseases, cancer, cardiovascular diseases, osteoarthritis and epilepsy. The cost of care for a person with a chronic illness is four times greater than for someone without such an illness.
A chronic illness can lead to sadness, fear or anger. But a deeper depression can settle in, and that isn't uncommon. Depression is a problem for up to 25 percent of cancer patients, according to the Depression and Chronic Illness Fact Sheet from the National Alliance on Mental Illness (NAMI).
Depression might jeopardize a person’s recovery from a chronic disease because it often leads to negative behaviors, such as increased smoking and drinking or a failure to adhere to treatment plans. Fortunately, the road map for recognizing and treating chronic illnesses and depression is clear, according to Johnson.
Approximately 15 million American adults, or about 5 percent of the U.S. population, will experience major depression in a given year, according to NAMI. But just as many chronic illnesses can be managed, effective treatments are available for depression. “You really can significantly improve patient outcomes,” Johnson said.
Antidepressants are often very effective, Johnson emphasized. But common misperceptions about antidepressants must be overcome. For example, most people who take antidepressants need to take them continuously for only six to nine months, not a lifetime, Johnson noted. And when administered correctly, they do not alter an individual’s personality.
Psychotherapy is another important and effective treatment, Johnson said. Some patients do very well when they combine short-term antidepressant medication with six to 10 sessions of therapy.
Support groups offer benefits to those suffering from depression, including reduced feelings of loneliness, education on depression and treatments, and the chance to help others.
The IMPACT Model
Johnson had high praise for the IMPACT depression-treatment model. “It really does work with the whole spectrum of patients that come through the system.” The IMPACT model has five essential components:
1. Collaborative care. The patient's primary care physician works with a care manager to develop and implement a treatment plan.
2. Depression care manager. This might be a nurse, social worker or psychologist who educates, supports and monitors the patient.
3. Designated psychiatrist. This professional consults with the care manager and primary physician on the care of patients who do not respond to treatment.
4. Outcome measurements. The care manager measures the patient’s depressive symptoms regularly.
5. Stepped care. The treatment is adjusted based on clinical outcomes.
The IMPACT model is beneficial and cost-effective, Johnson indicated. IMPACT patients experienced more than 100 additional depression-free days over two years than those treated with usual care.
Patients who received IMPACT depression care had lower total health care costs than those that received usual depression care—$3,300 over four years. Yet, the cost of providing IMPACT care as a benefit to an insured population of older adults was less than $1 per member per month.
In the end though, the question is not what it will cost to treat depression along with chronic disease, Johnson said. The question is: What is the cost of doing nothing?
Common Signs of Depression
• Persistent sad, anxious or “empty” mood.
• Feelings of hopelessness or pessimism.
• Feeling of guilt, worthlessness or helplessness.
• Loss of interest or pleasure in hobbies and activities that were once enjoyed.
• Decreased energy or fatigue.
• Difficulty concentrating, remembering or making decisions.
• Insomnia, early-morning awakening or oversleeping.
• Appetite or weight changes.
• Thoughts of death or suicide, or suicide attempts.
• Restlessness or irritability.
John Scorza is associate editor of HR Magazine.
Depression Affects Women More than Men, SHRM Online Benefits Discipline, June 2008
Depression Care May Be Cost-Effective for Employers, SHRM Online Benefits Discipline, December 2006
Depression Leads to Absenteeism and Presenteeism, SHRM Online Benefits Discipline, September 2006
SHRM Online Benefits DisciplineSHRM Online Health Care Reform Resource Page