working-late-office-featuredPhoto by Daniel Guimberteau (Flickr, CC-NC-SA-2.0)

Depression is a leading cause of disability worldwide. Previous research has shown that by far the greatest contributor to the overall economic impact of depression is loss in productivity; including both increased absenteeism and presenteeism-related costs in the workplace. However, there is very little research on the costs of depression outside of Western and high-income countries.

We used data from a survey of 8,000 employees across eight countries spanning diverse cultures and levels of economic development: Brazil, Canada, China, Japan, South Korea, Mexico, South Africa and the US. In these countries, workplace depression collectively costs almost US$ 250 billion. Analysing data, we found that between 0.1 per cent and 4.9 per cent of a country’s GDP was lost due to absenteeism and presenteeism in the workplace.

Attending work while dealing with depression — presenteeism — carries costs that are around five to ten times higher than absenteeism, when employees take time off to recover from depression.

Differences in absenteeism and presenteeism rates were associated with economic climate and per capita GDP.

In general, individuals who reported being more reluctant to disclose their depression to their employer due to fear of losing their jobs had lower levels of presenteeism.

However, national GDP levels play a role.

People living in countries with higher per capita GDP who feared losing their jobs (and therefore hid their depression from their employer) tended to stay home. In lower-GDP countries people tended to behave differently, going to work even when they were depressed, because they feared losing their jobs.

Thus, it seems that in higher-income countries, individuals with depression who experience additional stress due to the economic climate may cope through taking time off from work. The reason could be that this might be more acceptable when living in a country where the economy is stable, as there is likely to be a stronger social safety net.

On the other hand, individuals in lower-income countries who fear disclosing their depression because they may lose their job may not feel comfortable taking time off. As a result, they may remain at work, even though this may lead to lower levels of productivity,

There were some other interesting country differences. For example, the US and Brazil experienced the highest productivity losses due to presenteeism ($84.7 billion and $63.3 billion, respectively). Asian countries reported lower productivity losses due to depression, and this seemed to be attributable in part to a cultural reluctance to disclose mental health issues. Japan, however, had the highest aggregate costs associated with people taking time off from work for depression. Japanese employees reported longer periods of absenteeism, with 22 per cent (costing $14 billion) of people taking 21 or more days. This suggests that employees in Japan may have stayed at work longer until their depression became more severe.

Previous research which has examined the economic case associated with depression in the workplace has mainly been based in Western and high-income countries and so is not necessarily relevant for low- and middle-income or non-Western countries. Because we included nationally representative data from a diverse set of countries, in terms of both cultural factors and GDP, we were able to show that the impact of depression in the workplace is considerable across all countries and cultures, both in absolute monetary terms and as a proportion of a country’s GDP. Crucially, this means that depression is an issue deserving attention, regardless of a country’s economic development or culture.

Given the high prevalence and the significant economic consequences associated with depression, employers need to be proactive in supporting their employees who experience depression. Additionally, given the growth in non-communicable diseases globally — to which mental illnesses contribute substantially — the scale of the problem is likely to increase. However, many workplaces underestimate its impact.

There is evidence that workplace interventions focused on mental health promotion and treatment of depression can be cost-effective. Almost all of the evidence for these programmes, however, comes from high-income countries. And even in high-income countries, only a minority of companies participate in these initiatives. Further attention needs to be given to develop, adapt, implement and evaluate effective programmes across workplaces, particularly in low and middle income countries in order to mitigate the personal, societal and economic impacts of depression in the workplace. 



sara-evans-lackoSara Evans-Lacko is an Associate Professorial Research Fellow at the LSE’s Personal Social Services Research Unit (PSSRU). She is a mental health services researcher with a particular interest in the role of health services and social support in the prevention and treatment of mental illness. Her research focuses on developing innovative methods to improve access to and quality of mental health care for young people and cross-cultural applications of this in addition to the evaluation of public health interventions such as the Time to Change anti-stigma campaign which aim to improve important changes at the population level.


martin-knapp-photoMartin Knapp is Professor of Social Policy and Director of the Personal Social Services Research Unit at the LSE. He has also been Director of the NIHR School for Social Care Research since 2009. His current research emphases are primarily dementia, child and adult mental health, autism and long-term social care; much of his work has an economic focus, and in all of it he seeks to tease out the policy implications.