Costs of Depression

Approximately one in five adults in the United States will suffer from depression at some time. Depression affects more than 17 million Americans each year. Mood disorders, including mania and various forms of depression, account for as many as 70 percent of psychiatric hospitalizations.

Sufferers of depression include some of the most creative and productive members of society, which means that the direct and indirect costs of this common illness are very high. The latest National Institutes of Health (U.S.) study on the cost of depression, reported for 1990, estimated the cost of depressive illness in the United States at between $33 billion and $44 billion annually (fig. 1.1), including direct treatment costs ($12.4 billion), absenteeism ($11.7 billion), lost productivity ($12.1 billion), and mortality costs ($7.5 billion). The number of lost work days due to depression may be as high as 200 million days per year.

On a more personal level, patients treated in psychiatric hospitals for serious depression may find themselves billed $1,000 to $1,500 a day or more for a hospitalization that may exceed five to seven days and occasionally last several weeks. Those charges may not even include the costs of physician visits, consultants, or special studies such as antidepressant medication blood levels or brain scans.

Most people, even solid middle-class individuals with good health insurance, will find themselves psychiatrically indigent if they require hospitalization for the treatment of depression. Health insurance policies, even good ones, commonly discriminate against psychiatric illness. Many policies have a poorer reimbursement rate for mental disorders, impose a lifetime maximum reimbursement limit (sometimes as little as $50,000), and require larger copayments for psychiatric treatment. The length-of-stay allowances for inpatient care of seriously depressed patients may also place the patient at significant risk. For example, a psychiatrist recently hospitalized a severely depressed woman on an emergency basis following her suicide attempt by overdose of prescribed medications. The insurance company ruled that the patient had to be discharged the day she no longer reported suicidal intent. The fragility of severely depressed patients in early recovery, including their increased risk for suicide, was apparently not a cost-efficient consideration.

Another problem is the stigma associated with mental illness, which can make treatment for depression and other brain disorders that are labeled as mental illnesses costly in personal ways. Traditionally, people with mental illnesses such as depression have been required to report their disorders on applications for a driver’s license, for employment, for security clearance, and for other routine purposes, while people with other medical conditions generally have not. Although the recent federal Americans with Disabilities Act attempted to correct that form of discrimination, the problem remains. When a physician recently changed her medical liability insurance policy, the application asked whether the applicant had ever been treated for mental illness. Nowhere on the policy was there another question about any other medical illness or treatment. Fearing discrimination in hiring, promotion, and other occupational and educational opportunities, many people who recognize their own depression will not seek treatment because of concerns that they may have to report it later.

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