Checking Vitals: Prevalence and Economic Impact of Cardiovascular Disease Co-Occurring with Depression
Volume 4, February 2010
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The leading cause of death in the United States, cardiovascular disease affects an estimated 81 million Americans each year. Compounding this enormous public health burden is the exceedingly high incidence of depression within this disease population.
In a 2009 study published in the Archives of General Psychiatry, data analysis reveals that patients who developed major depression after being hospitalized for a cardiac event — and remained depressed for at least six months — had more than three times the risk of dying from a cardiac event within the following fifteen months.
To address the complexities of this comorbidity, cardiologists have joined forces with behavioral health experts to explore more effective prevention and treatment strategies for depression within the context of cardiovascular disease. In particular, they are turning their focus to the mechanisms of depression that may compromise the body and lead to cardiovascular disease, such as the presence of irregular heart rhythms, increased blood pressure, arterial damage, and a weakened immune system.
Despite enormous advances in brain research in recent decades, depression often still goes undiagnosed and untreated. In 2008, the American Heart Association issued new recommendations that all heart disease patients be routinely screened for depression and referred to professionals for treatment, when necessary.
The American Heart Association (AHA) website contains a link to their first scientific statement on depression and coronary heart disease available at http://americanheart.mediaroom.com/index.php?s=43&item=523.
The AHA website goes on to say that, "The statement was prompted by the growing body of evidence that shows a link between depression in cardiac patients and a poorer long-term outlook," said Erika Froelicher, R.N., M.A., M.P.H., Ph.D., a professor at the University of California San Francisco, School of Nursing and Medicine and co-chair of the writing group.
Further studies show that the economic impact of cardiovascular disease on the US health care system is massive. According to the National Heart, Lung, and Blood Institute (NHLBI), the direct and indirect costs — in health expenditures and lost productivity — of cardiovascular disease and stroke in the United States was estimated to total $475 billion in 2009.
When prevalence rates of depression are added to cardiovascular disease, the total economic burden on our nation's health care system increases by tens of billions of dollars.
According to a 2009 Research Report, "Chronic Conditions and Comorbid Psychological Disorders," issued by Milliman, comorbid psychological disorders consistently drive up health care costs — with approximately 80 percent of these increased costs being medical costs, rather than behavioral service costs.
Also included in this report are findings from an academic study which show that depression significantly affects the self-care of members that have chronic medical conditions and the linkage between non-direct employer costs of comorbid psychological disorders such as disability and presenteeism, and the direct costs due to absenteeism. Results demonstrate that the average lost productive time per depressed worker, per week includes 1.0 hour due to absenteeism and 4.6 hours due to presenteeism, compared to 0.4 hours of absenteeism and 1.1 hours of presenteeism for non-depressed workers.
To address these issues, employers and health plans are turning their focus to safe, cost-effective, scalable, and confidential interventions, such as online Digital Health Coaching programs to help manage depression.
HealthMedia® Overcoming™ Depression — a sophisticated self-help intervention can help those with all levels of depression cope more effectively with moods and symptoms, decrease negative thinking, and become more active and engaged in life.
Additionally, it can help provide measurable benefits to health plans and employers through reduced health-related costs and ancillary medical costs, improved productivity, increased medication and treatment compliance, and reduced disability claims. Outcome data for HealthMedia® Overcoming™ Depression show:
- 41% of participants reported a decrease in average CES-D depression scores from 5.29 to 3.10
- 92% of participants reported a decrease in average number of Emergency Room (ER) visits from 0.52 to 0.04
- 29% of participants reported a decrease in physician visits over the past three months
- 16% of participants reported an increase in their confidence to manage depression
- $4,525 projected productivity savings per participant per year
Participant self-reported results at 6 months. Productivity savings data was calculated using the Work Productivity Activity Impairment (WPAI) questionnaire, which employs a validated algorithm to generate an estimate of productivity impairment. The WPAI consists of questions about absence from work, hours actually worked, the reduction in productivity at work, and the reduction in productivity while performing regular activities. Productivity savings is calculated using an average annual salary and benefits package of $50,000.