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A new study by psychiatrists at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and Johns Hopkins University School of Medicine highlights the toll that anxiety and depressive disorders exact on workplace performance and profits, and suggests improved psychiatric evaluation as a cost-effective approach.

The article was published in the November 7 issue of the Journal of Occupational and Environmental Medicine.

Co-authors Dr. Jeffrey P. Kahn, associate attending psychiatrist at NewYork-Presbyterian/Weill Cornell and clinical associate professor of psychiatry at Weill Medical College of Cornell University in Manhattan, and Dr. Alan Langlieb, assistant professor of psychiatry at Johns Hopkins University School of Medicine, examined more than 100 published studies on how mental illness affects the workplace. They found that employees with anxiety and depressive disorders work fewer hours, are more likely to end up on disability, and are less productive than their counterpart employees.

They also found that anxiety and/or depression complicate physical medical conditions, and typically become more disabling than the physical conditions themselves. A depressed worker also has a ripple effect by creating low morale among co-workers and a higher turnover rate.

"There is no doubt that anxiety and depression are expensive for American employers," says Dr. Kahn. "But we are only now starting to see just how heavy the burden is to job performance and health-care costs."

In their work, Drs. Kahn and Langlieb examined a 1998 study of more than 46,000 employees. The study estimated that each employee with depression generated $3,189 annually in health-care costs compared with $1,679 annually for non-mental health illnesses. If the depressed employees were also under high stress, then the cost skyrocketed 147 percent more was spent on health-care costs for those with depression and stress than on those with depression alone.

Existing research shows that the indirect cost of depression to American business was $83.1 billion in 2000, and the indirect cost of anxiety was $63.1 billion in 1998. These numbers do not even include the enormously costly effects of reduced productivity and increased presenteeism (emotional distraction while at work). An estimated one in every 20 Americans will be depressed in a given year; major depression may soon become the leading cause of disability; and anxiety disorders will affect 29 percent of Americans in their lifetime.

"The most effective approach is to catch the problems early, and 'Doing It Right The First Time,' applies well to mental health," says Dr. Kahn. "While the cost of a more thorough initial evaluation may be higher, that cost is more than repaid by faster and more reliable improvement at the workplace, as well as at home." According to Dr. Kahn, quality specialized psychiatric evaluations are not readily available to most employees.

"Start with a comprehensive psychiatric evaluation, and create a treatment plan that might then involve psychologists, primary care, and/or social work," says Dr. Langlieb. "Employees will have less disability, greater work productivity, and improved quality of life compared with those who received evaluation and treatment solely by a primary-care provider. The old adage that 'you get what you pay for' applies here."

Drs. Kahn and Langlieb are co-editors of a book on mental health and the workplace, titled Mental Health and Productivity in the Workplace: A Handbook for Organizations and Clinicians (Jossey-Bass/Wiley 2003). Dr. Kahn is also CEO of WorkPsych Associates (WorkPsychCorp.com).

Drs. Kahn and Langlieb did not receive outside funding for this study.