Severity of Major Depressive Disorder Influences Direct and Indirect Healthcare Costs

Investigators examined healthcare costs of adult patients with mild, moderate, moderately severe, and severe major depressive disorder and compare them with a control group representative of the general population.

The following article is a part of conference coverage from Psych Congress 2021 , held October 29th through November 1, 2021, in San Antonio, Texas. The team at Psychiatry Advisor will be reporting on the latest news and research conducted by leading experts in psychiatry. Check back for more from the Psych Congress 2021.


Major depressive disorder (MDD) has been found to lead to higher direct and indirect healthcare costs due to significantly greater losses in work productivity and healthcare resource utilization. These costs remain profoundly higher with severe MDD compared with mild MDD, according to research recently presented at Psych Congress 2021, held from October 29 through November 1, 2021, in San Antonio, Texas.

In 2018, the estimated economic burden of MDD was $326 billion (reflecting a 38% increase since 2010), with direct costs and costs due to loss of productivity contributing to 35% and 61%, respectively. Despite the prevalence of MDD and its profound associated costs, the incremental costs across severity levels are not well known. Study investigators therefore designed the current study to examine healthcare costs of adult patients with mild, moderate, moderately severe, and severe MDD and compare them with a control group representative of the general population.

Using data collected from the 2019 National Health and Wellness Survey, the researchers identified 10,710 adults who self-reported a diagnosis of depression. The patients were stratified according to disease severity using Patient Health Questionnaire (PHQ-9) scores. The general population cohort consisted of patients without MDD, bipolar I disorder, or schizophrenia within the last 12 months. Outcomes included direct costs resulting from the utilization of healthcare resources (eg, emergency department/provider visits and hospitalizations) and indirect costs from productivity loss estimated using the Work Productivity and Activity Impairment Questionnaire. Outcomes among the MDD severity cohorts and the general population cohort were compared using multivariate analysis and reported as mean estimates.

Among a total of 10,710 participants with MDD, 5905 were identified as having mild MDD, 2206 as having moderate MDD, 1565 as having moderately severe MDD, and 1034 as having severe MDD.  The general population cohort consisted of 52,687 participants. Significantly greater adjusted direct and indirect costs were identified in the total MDD cohort vs the general population (direct costs at $4407 vs $3036 and indirect costs at $5425 vs $3085, respectively; both P <.001). Within the MDD cohort, significantly greater indirect costs were seen for severe MDD ($8797), moderately severe MDD ($7438), and moderate MDD ($6537; all P <.001) compared with mild MDD ($4490), with a similar trend observed for direct costs (all P <.05 vs mild MDD).

The study investigators conclude, “These results highlight the considerable cost of MDD and the need for effective treatment regimens to minimize disease severity and decrease the associated economic burden.”

Disclosure: This clinical trial was supported by AbbVie. Please see the original reference for a complete list of authors’ disclosures.


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Culpepper L, Higa S, Martin A, Gillard P, Harrington A. Direct and indirect costs associated with major depressive disorder. Presented at: Psych Congress 2021; October 29-November 1, 2021; San Antonio, Texas.  Poster 149.