|Bipolar Disorder Exacts Twice Depression’s Toll in Workplace
Productivity Lags Even After Mood Lifts
Bipolar disorder costs twice as much in lost productivity as major depressive
disorder, a study funded by the National Institutes of Health’s (NIH) National
Institute of Mental Health (NIMH) has found. Each U.S. worker with bipolar disorder
averaged 65.5 lost workdays in a year, compared to 27.2 for major depression.
Even though major depression is more than six times as prevalent, bipolar disorder
costs the U.S. workplace nearly half as much — a disproportionately high $14.1
billion annually. Researchers traced the higher toll mostly to bipolar disorder’s
more severe depressive episodes rather than to its agitated manic periods. The
study by Drs. Ronald Kessler, Philip Wang, Harvard University, and colleagues,
is among two on mood disorders in the workplace published in the September 2006
issue of the American Journal of Psychiatry.
Their study is the first to distinguish the impact of depressive episodes due
to bipolar disorder from those due to major depressive disorder on the workplace.
It is based on one-year data from 3378 employed respondents to the National Co-morbidity
Survey Replication, a nationally representative household survey of 9,282 U.S.
adults, conducted in 2001-2003.
The researchers measured the persistence of the disorders by asking respondents
how many days during the past year they experienced an episode of mood disorder.
They judged the severity based on symptoms during a worst month. Lost work days
due to absence or poor functioning on the job, combined with salary data, yielded
an estimate of lost productivity due to the disorders.
Poor functioning while at work accounted for more lost days than absenteeism.
Although only about 1 percent of workers have bipolar disorder in a year, compared
to 6.4 percent with major depression, the researchers projected that bipolar
disorder accounts for 96.2 million lost workdays and $14.1 billion in lost salary-equivalent
productivity, compared to 225 million workdays and $36.6 billion for major depression
annually in the United States.
About three-fourths of bipolar respondents had experienced depressive episodes
over the past year, with about 63 percent also having agitated manic or hypomanic
episodes. The bipolar-associated depressive episodes were much more persistent — affecting
134-164 days — compared to only 98 days for major depression. The bipolar-associated
depressive episodes were also more severe. All measures of lost work performance
were consistently higher among workers with bipolar disorder who had major depressive
episodes than those who reported only manic or hypomanic episodes. The latter
workers’ lost performance was on a par with workers who had major depressive
“Major depressive episodes due to bipolar disorder are sometimes incorrectly
treated as major depressive disorder,” noted Wang. “Since antidepressants can
trigger the onset of mania, workplace programs should first rule out the possibility
that a depressive episode may be due to bipolar disorder.”
Future effectiveness trials could gauge the return on investment for employers
offering coordinated evaluations and treatment for both mood disorders, he said.
Also participating in the study were: Dr. Kathleen Merikangas, NIMH; Dr. Minnie
Ames and Robert Jin, Harvard University; Dr. Howard Birnbaum, Paul Greenberg,
Analysis Group Inc.; Dr. Robert Hirschfeld, University of Texas; Dr. Hagop Akiskal,
University of California San Diego.
The National Institute on Drug Abuse (NIDA), Substance Abuse and Mental Health
Services Administration (SAMHSA), Robert Wood Johnson Foundation and John W.
Alden Trust provided supplemental funding.
In a related NIMH-funded study in the same issue of the American Journal of
Psychiatry, Drs. Debra Lerner, David Adler, and colleagues, Tufts University
School of Medicine and Tufts-New England Medical Center, found that many aspects
of job performance are impaired by depression and that the effects linger even
after symptoms have improved.
The researchers tracked the job performance and productivity of 286 employed
patients with depression and dysthymia, 93 with rheumatoid arthritis and 193
healthy controls recruited from primary care physician practices for 18 months.
While job performance improved as depression symptoms waned, even “clinically
improved” depressed patients performed worse than healthy controls on mental,
interpersonal, time management, output and physical tasks. The arthritis patients
showed greater impairment, compared to healthy controls, only for physical job
Noting that 44 percent of the depressed patients were already taking antidepressants
when they began the study and still met clinical criteria for depression — and
that job performance continued to suffer despite some clinical improvement — the
researchers recommended that the goal of depression treatment should be remission.
They also suggest that health professionals pay more attention to recovery of
work function and that workplace supports be developed, perhaps through employee
assistance programs and worksite occupational health clinics, to help depressed
patients better manage job demands.
Also participating in the study were: Dr. William Rogers, Dr. Hong Chang, Leueen
Lapitsky, Tufts-New England Medical Center; Dr. Thomas McLaughlin, University
of Massachusetts Medical School.
The Tufts-New England Medical Center General Clinical Research Center is funded
by the NIH’s National Center for Research Resources.
The National Institute of Mental Health (NIMH) mission is to reduce the
burden of mental and behavioral disorders through research on mind, brain,
and behavior. More information is available at the NIMH website, http://www.nimh.nih.gov.
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