Depression has broad impact on disability, Aetna finds

Employee Benefit News, September 15, 2006
Chris Silva

There is a greater connection between depression and disability leave than was previously known, according to research from Aetna.

The health insurer examined short-term disability claims from Jan. 1, 2002 to June 30, 2004, and long-term disability claims from Jan. 1, 2002 to June 30, 2003. Researchers looked at a wide variety of ailments and conditions, from old standards like hypertension and pregnancy to less obvious candidates like irritable bowel syndrome and carpal tunnel.

What they found was that, in every instance, when depression is a comorbidity, the duration of the disability is longer. For example, claimants with chronic fatigue as the primary diagnosis and depression as a comorbidity were 100% more likely to miss additional days from work than claimants who just suffered from chronic fatigue. Other conditions scoring a high percentage include coronary atherosclerosis (80%), IBS (63%), pregnancy with normal delivery (39%), back pain (25%) and myalgia and myositis (23%).

“We looked at a wide range of primary diagnoses,” says Caren Kittredge, head of Aetna’s product management for disability and leave services. “If you look at some of these conditions, like IBS and chronic fatigue, you could see how depression might accompany some of these conditions because of what folks go through during these diagnoses. Some folks don’t know they have depression, or know that depression and disabilities are connected.”

Growing awareness

Aetna and other leading insurers are increasing their depression management services in an effort to help workers cope with the often-baffling illness.

“It’s a growing piece of our business,” Kittredge says of depression management. “It’s something we’re looking at very seriously and something we want to provide to our customers and consumers.”

The National Institute of Mental Health’s 2006 fact sheet on mental disorders states that major depressive disorder is the leading cause of disability in the United States for people aged 15-44, and that it affects approximately 14.8 million American adults, or roughly 6.7% of the U.S. population aged 18 or older.

Furthermore, the National Alliance on Mental Illness states that more than twice as many women as men (6.7 million to 3.2 million) suffer from major depressive disorder each year, and that about three-fourths of those who experience a first episode of depression will have at least one other episode in their lives.

Depressing the depression impact

With depression being a debilitating disorder to millions of Americans, Aetna wanted to offer more tools to its customers to understand and combat the disease. “In the disability world, employers and customers are coming to realize the impact of behavioral health on disabilities,” Kittredge observes.

Aetna reports increased participation in two of its behavioral health programs, Medical Psychiatric Case Management and Depression Disease Management, both of which were started in January 2005. MPCM screens members with medical conditions to determine if they also have behavioral health issues. Examples include a member with depression who is overwhelmed and is not responding to treatment regimens. Participants, who take six months on average to complete the program, reported a nearly 9% improvement in self-perception of physical health, a 45% improvement in self-perception of mental health and gained back nearly four days of work per month, according to Aetna records. Participants also demonstrated a reduction in emergency room utilization, inpatient length of stay for medical conditions, no change in outpatient visits and an increase in pharmacy costs.

DDM offers self-assessment for depression and comorbid disorders, as well as case management outreach for members and primary care physicians to coordinate care and access to services. Participants reported a nearly 30% improvement in self-perception of mental health, no change in self-perception of physical health and nearly two days gained per month at work, Aetna reports. Participants demonstrated a reduction in inpatient behavioral health cost, inpatient medical cost, reduced emergency room visits and improved adherence to antidepressants.

“If we can demonstrate that employees are much more productive at work, then that’s a good thing,” says Hyong Un, national director for Aetna Behavioral Health. “Depression is a very common disorder that affects 8% to 10% of the population. When someone is depressed and medically ill, their medical costs go up significantly. We know that there are good treatments for depression in terms of psychotherapy and antidepressants. This is a situation where you can improve the quality of lives and, at the same time, help reduce costs.”

Aetna doesn’t have accumulative data yet to report on for its depression management program, which it introduced in October 2005. In addition to offering increased reimbursement to physicians, the program includes a Web-based continuing medical education program for primary care physicians and provides access to on-call case planners and psychiatrists to answer questions and supply guidance.

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