title: Depression in working adults: comparing the costs and health outcomes of working when ill.
abstract: OBJECTIVE
  Working through a depressive illness can improve mental health but also carries risks and costs from reduced concentration, fatigue, and poor on-the-job performance. However, evidence-based recommendations for managing work attendance decisions, which benefit individuals and employers, are lacking. Therefore, this study has compared the costs and health outcomes of short-term absenteeism versus working while ill ("presenteeism") amongst employed Australians reporting lifetime major depression.
  
  
  METHODS
  Cohort simulation using state-transition Markov models simulated movement of a hypothetical cohort of workers, reporting lifetime major depression, between health states over one- and five-years according to probabilities derived from a quality epidemiological data source and existing clinical literature. Model outcomes were health service and employment-related costs, and quality-adjusted-life-years (QALYs), captured for absenteeism relative to presenteeism, and stratified by occupation (blue versus white-collar).
  
  
  RESULTS
  Per employee with depression, absenteeism produced higher mean costs than presenteeism over one- and five-years ($42,573/5-years for absenteeism, $37,791/5-years for presenteeism). However, overlapping confidence intervals rendered differences non-significant. Employment-related costs (lost productive time, job turnover), and antidepressant medication and service use costs of absenteeism and presenteeism were significantly higher for white-collar workers. Health outcomes differed for absenteeism versus presenteeism amongst white-collar workers only.
  
  
  CONCLUSIONS
  Costs and health outcomes for absenteeism and presenteeism were not significantly different; service use costs excepted. Significant variation by occupation type was identified. These findings provide the first occupation-specific cost evidence which can be used by clinicians, employees, and employers to review their management of depression-related work attendance, and may suggest encouraging employees to continue working is warranted.
authors.affiliation: School of Population and Global Health, University of Melbourne, Melbourne, Australia; Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia.
authors.forename: Fiona
authors.initials: F
authors.lastname: Cocker
authors.affiliation: Judith Lumley Centre, La Trobe University, Melbourne, Australia.
authors.forename: Jan M
authors.initials: JM
authors.lastname: Nicholson
authors.affiliation: School of Public Health, Queensland University of Technology, Queensland, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Graves
authors.affiliation: School of Population and Global Health, University of Melbourne, Melbourne, Australia.
authors.forename: Brian
authors.initials: B
authors.lastname: Oldenburg
authors.affiliation: Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Palmer
authors.affiliation: Tasmanian School of Business and Economics, University of Tasmania, Hobart, Australia.
authors.forename: Angela
authors.initials: A
authors.lastname: Martin
authors.affiliation: School of Psychology, University of Tasmania, Hobart, Tasmania, Australia.
authors.forename: Jenn
authors.initials: J
authors.lastname: Scott
authors.affiliation: Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia.
authors.forename: Alison
authors.initials: A
authors.lastname: Venn
authors.affiliation: Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia.
authors.forename: Kristy
authors.initials: K
authors.lastname: Sanderson
mesh_terms: D000041:Absenteeism; D000328:Adult; D001315:Australia; D003863:Depression / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic; D017063:Outcome Assessment, Health Care / Q000191:economics*; D014937:Work / Q000191:economics*