Humanistic and economic burden associated with depression in the United States: a cross-sectional survey analysis

Abstract

Background: Depression (major depressive disorder [MDD]) affects the functioning of patients in many facets of life. Very few large-scale studies to date have compared health and economic related outcomes of those with versus without depression, and across various depression severity groups. We aimed to evaluate humanistic and economic burden in respondents with and without depression diagnosis, and across symptom severity groups.

Methods: Data from the 2017 US National Health and Wellness Survey (NHWS) were utilized. Of the adult respondents (N = 75,004), 59,786 were < 65 years old. Respondents not meeting eligibility criteria were excluded (e.g., those self-reporting bipolar disorder or experiencing depression in past 12 months but no depression diagnosis). Overall, data from 39,331 eligible respondents (aged 18-64 years) were analyzed; and comprised respondents 'with depression diagnosis' (n = 8853; self-reporting physician diagnosis of depression and experiencing depression in past 12 months) and respondents 'without depression diagnosis' (n = 30,478; no self-reported physician diagnosis of depression and not experiencing depression). Respondents with depression were further examined across depression severity based on Patient Health Questionnaire-9 (PHQ-9). Outcome measures included health-related quality-of-life (HRQoL; Medical Outcomes Study 36-item Short Form [SF-36v2]: mental and physical component summary [MCS and PCS]; Short-Form 6 Dimensions [SF-6D]; and EuroQol 5 Dimensions [EQ-5D]), work productivity and activity impairment (WPAI), and health resource utilization (HRU). Multivariate analysis was performed to examine group differences after adjusting covariates.

Results: Respondents with depression diagnosis reported significantly higher rates of diagnosed anxiety and sleep problems versus those without depression (for both; P < 0.001). Adjusted MCS, PCS, SF-6D, and EQ-5D scores were significantly lower in respondents with depression versus those without depression (all P < 0.001). Consistently, respondents with depression reported higher absenteeism, presenteeism, and overall WPAI, as well as greater number of provider visits, emergency room visits, and hospitalizations compared with those without depression (all P < 0.001). Further, burden of each outcome increased with an increase in disease severity.

Conclusions: Diagnosed depression was associated with lower health-related quality-of-life and work productivity, and higher healthcare utilization than those without depression, and burden increased with an increase in symptom severity. The results show the burden of depression remains high even among those experiencing minimal symptoms.

Keywords: Anxiety; Depression; Healthcare resource utilization; Quality of life; Sleep disorder; Work productivity.

Fig. 1

Eligible US NHWS sample for participants 18–64 years of age ^aPatients with depression diagnosis were stratified by PHQ-9 score at time of survey. MDQ, mood disorder questionnaire; NHWS, National Health and Wellness Survey; PHQ-9, the Patient Health Questionnaire 9; US, United States

Fig. 2

HRQoL outcomes among respondents with and without depression diagnosis and across severity groups – Multivariable results Results are based on generalized linear regression models controlling for demographics, health characteristics, and comorbidities as covariates. Respondents with depression diagnosis: those who self-reported physician diagnosis of depression and reported experiencing depression in the past 12 months. Respondents without depression diagnosis: those who had no self-reported physician diagnosis of depression, reported not experiencing depression in the past 12 months, and had PHQ-9 scores ≤ 4. In panels (b) and (d), the five groups are based on depression severity (PHQ-9 scores). *P-value < 0.001: comparison vs without depression diagnosis group in sub-figures a and c; comparison vs no/minimal symptoms severity group in sub-figures b and d. †P-value < 0.050 vs no/minimal symptoms severity group. Confidence bars represent standard error of the mean score. EQ-5D, EuroQol 5-Dimension; HRQoL, health-related quality of life; MCS, Mental Component Summary; PCS, Physical Component Summary; PHQ-9, the Patient Health Questionnaire 9; SF-36v2, the Medical Outcomes Study 36-Item Short Form Survey Instrument version 2; SF-6D, Short-Form 6 Dimensions

Fig. 3

WPAI scores among respondents with and without depression diagnosis and across severity groups – Multivariable results Results are based on generalized linear regression models controlling for demographics, health characteristics, and comorbidities as covariates. Respondents with depression diagnosis: those who self-reported physician diagnosis of depression and reported experiencing depression in the past 12 months. Respondents without depression diagnosis: those who had no self-reported physician diagnosis of depression, reported not experiencing depression in the past 12 months, and had PHQ-9 scores ≤ 4. In panel (b), the five groups are based on depression severity (PHQ-9 scores). *P-value < 0.001: comparison vs without depression diagnosis group in sub-figure a; comparison vs no/minimal symptoms severity group in sub-figure b. Confidence bars represent standard error of the mean score. PHQ-9, the Patient Health Questionnaire 9; WPAI, work productivity and activity impairment