San Francisco VA Medical Center researchers find depression can cost jobs

By Camille Mojica Rey

Young people suffering from depression are more likely to lose their jobs or experience a decline in their incomes than those who are not depressed, according to a study by researchers at the San Francisco VA Medical Center (SFVAMC). “Our study shows that symptoms of depression are associated with subsequent unemployment and loss of family income among working young adults,” said Mary A. Whooley, MD, a physician in General Internal Medicine at the SFVAMC and assistant professor of medicine and epidemiology and biostatistics at UCSF.

According to results published in the December 9, 2002 issue of the Archives of Internal Medicine, 33 percent of participants with depressive symptoms in 1991 reported new unemployment or a loss of income during the subsequent five years, compared with 21 percent of those without depressive symptoms.

“When people have estimated the cost of depression they have not taken into account the cost to the individual in terms of employment and income,” said Whooley, lead author on the paper.

The study involved 2334 of 5115 adults between the ages of 18 and 30 taking part in the Coronary Artery Risk Development in Young Adults (CARDIA) study. The study included equal numbers of African Americans, whites, and men and women from four cities in the United States who completed an initial examination in 1990 and 1991.

The current analysis included only those participants who were working full-time or part-time and who reported an annual family income of $25,000 or more. “Previous studies have looked at this question, but the criticism has always been that unemployed and poor people are more likely to be depressed in the first place. It’s difficult to sort out, a sort of chicken-and-egg problem. The best you can do is exclude those people and follow the rest over time and that’s what we’ve done,” Whooley said.

The current findings provide strong evidence supporting a link between depression and subsequent unemployment or loss of income, Whooley said. In light of these results, physicians should be more watchful for signs of clinical depression and more aggressive in treating those with the disease, she said.

The study’s findings are also a wake-up call to those who resist treatment for their depression. “There’s a huge stigma associated with depression. People need to realize that depression is a disease just like diabetes and that there are plenty of treatments that offer relief from suffering and can also help you keep your job. People need to overcome the stigma and not be so embarrassed about saying: ‘I need help,’” Whooley said.

Additional authors on the study include Margaret A. Chesney, PhD, UCSF professor of medicine; Stephen B. Hulley, MD, MPH, UCSF chair and professor of epidemiology and biostatistics; Catarina I. Kiefe, MD, PhD and Jerome H. Markovitz, MD, University of Alabama at Birmingham and VAMC in Birmingham, Alabama; and Karen Matthews, PhD, University of Pittsburgh.

The CARDIA study was funded by grants from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD. Dr. Whooley was supported by an Advanced Research Career Development Award from the Department of Veterans Affairs Health Services Research an Development Service, and by the Robert Wood Johnson Foundation Generalist Physician Faculty Scholars Program, Princeton, NJ.