March 2021 – Impact of Depression & Anxiety

As some of you may know, we are closely involved with the Council for Disability Awareness. This is a non-profit that does much in the US to promote disability insurance amongst consumers.  

Last year, my CDA colleagues Dr Fraser Gaspar and Fred Schott were co-authors of a research paper, along with Daniel Jolivet, Kerri Wizner, Carolyn Dewa, and published by the American College of Occupational and Environmental Medicine. The research used “pre-pandemic” data to examine the effect of depression and anxiety on Non-Occupational claims.

The key findings:

• The individuals with a history of depression or anxiety were more than 2x likely to file a disability claim than those with no depression or anxiety.
• Any individual who filed a claim was 4x more likely to be treated for depression or anxiety for first time within 12 months of that claim.

This paper is relevant now more than ever, and therefore we have provided the edited highlights, as well as a link to the document in its full glory.

I hope you find this interesting!

Ian Bridgman
Executive Director


The Paper
The following text is taken from the paper, to gain access to the full document, click here!

Introduction
To our knowledge, this is one of the first research studies to use a large administrative database to look at the timing of depression and/or anxiety disorders and incidence of Short Term Disability.

The relationship of depression and anxiety with recovery from medical conditions is complex, as mental disorders can serve as both a risk factor for and subsequent outcome of the return to work process.

Depression and Anxiety
Depression and anxiety can act as a risk factor for physical conditions through three pathways:

1. First, people with mental health conditions are more likely to make poor lifestyle choices including poor diet, decreased physical activity (both of which are correlated with obesity), and tobacco use. These factors are associated with poor physical health including musculoskeletal disorders.
2. Second, people with anxiety and depression are at elevated risk for accidental injuries, likely because of impaired focus and concentration, fatigue (particularly associated with sleep problems in depression), and slowed reaction times. 
3. Third, people dealing with depression and anxiety may ask their treatment provider to focus on their physical conditions as the cause of their disability leaves, rather than the mental conditions, due to the denial, shame, and stigma of their mental health condition.

There are at least two ways in which physical conditions contribute to anxiety and depressive conditions:

1. First, people with physical conditions frequently experience mental health issues as they deal with pain, loss of function and reduced quality of life. One identified pathway for this is the relationship between pain and poor sleep quality, which can contribute to depression. 
2. Second, people coping with pain tend to make lifestyle choices that increase their risk for anxiety and depression. For example, chronic pain is associated with poor quality diet and decreased physical activity, with resultant obesity, all of which are associated with anxiety and depression.

Data used in the Study
The study used Short Term Disability and Medical Records data, for the same individuals, from 2009 to 2016, and looked at just those claims with injuries or illnesses other than mental health. Also, maternity related claims were excluded.
The sample size was just under 500,000 claims.
The depression and anxiety diagnoses were identified from medical records from the same timeframe as each Short Term Disability claim. Claims where there was a first time occurrence of depression and anxiety were separated from those claims where there was previous history of depression and anxiety, as were claimants where there was no evidence of depression and anxiety at all.

Findings
There are two key findings reported in this study:

• The individuals with a history of depression or anxiety were more than 2x likely to file a disability claim than those with no depression or anxiety.
• Any individual who filed a claim was 4x more likely to be treated for depression or anxiety for first time within 12 months of that claim.

The paper analyses this in more detail by separating depression and anxiety, with depression showing greater impact. The paper also breaks this down by diagnosis category.

Conclusion
It’s hardly surprising that there is a complex relationship between depression and anxiety and our physical health.

There is a complex controlled chemical reaction going on inside our heads and we cannot begin to understand its subtlety.

Yet in this pandemic, depression and anxiety are now far more prevalent, presenting greater challenges for disability and workers compensation claims operations.

This paper highlights the quite dramatic linkage between the physical and mental wellbeing. For claims management we must develop more effective interventions to treat the whole person, not just manage the ICD code on the claim form.

For more information on how we can help your claims operation understand mental health severity, please email us at info@claimlab.org.