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When physical and mental health problems co-occur and money gets tight, which prescriptions go unfilled?

April 08, 2009

A new study points to a troubling connection between out-of-pocket expenses for people contending with both physical illnesses and depression, affecting access to antidepressant treatment.

Dr. Carolyn Dewa, head of the Work and Well-being Research and Evaluation Program at the Centre of Addiction and Mental Health (CAMH), and her team explored whether the amount of money spent on medication before a disability episode impacts medication use among workers on depression-related disability. This study built on previous research that revealed workers on depression-related short-term disability improved with antidepressant treatment.

"The results raised concerns about the treatment choices people are making," Dr. Dewa said. "As an example, if a worker's prior out-of-pocket expenses for medication associated with heart disease were $500, the probability of filling an antidepressant prescription was only 40 percent."

The CAMH team analyzed administrative disability data for three large firms with approximately 63,000 employees nationwide. The analysis, published in Healthcare Policy revealed that workers on depression-related short-term disability are more likely to fill a prescription for antidepressant medication if they have previously purchased antidepressants. This suggests that the medication is viewed as necessary, which may point to increased adherence to antidepressants, an issue that is frequently of concern in depression treatment.

At the same time, a worker on depression-related short-term disability is less likely to fill a prescription for antidepressant medication if the worker already is paying high out-of-pocket costs for medications to treat physical disorders such as heart disease or asthma (about 50 percent of employees studied had a co-morbid chronic physical disorder).

This phenomenon may be a barrier to accessing antidepressant treatment, which could delay taking necessary medication, impacting not only a person's recovery, but also a company's bottom line. Approximately one third of work-related productivity losses can be attributed to an employee being either unproductive or unable to function at full capacity because of depression. While recommended use of anti-depressants is associated with increased productivity and decreased disability, depression treatment is often complicated by physical disorders (e.g. heart disease, ulcers, hypertension, and asthma) that also require prescription drug treatment.

According to Dr. Dewa, a delay in use could cost an average of $2,924 extra (based on the average hourly wage of $21.66) per worker on depression-related short-term disability.

As Dr. Dewa explains, these findings highlight the dilemma faced by many employers - the desire to control rising costs of prescription drug benefits must be balanced with the fact that it's important not to create barriers to treatment. More research is needed to evaluate if drug benefits should be changed for workers on depression-related disability leave, especially those with a chronic physical condition.

Centre for Addiction and Mental Health