Depression Leads in Top Risk Factors for Employer Health Spending

By Rebecca Vesely

Nov. 28, 2012

Depression ranks No. 1 of the 10 leading risk factors linked to more than one-fifth of employer and employee medical spending, according to a new study.

Annual medical spending for an employee with depression is $2,185 higher, or 48 percent more, than for a worker without depression, according to the study led by Ron Goetzel, research professor and director of Emory University’s Institute for Health and Productivity Studies and vice president of consulting and applied research for Truven Health Analytics. The study was published in the November issue of Health Affairs.

The study authors looked at health spending for 92,000 employees at seven organizations over three years. Some 22.4 percent of the $366 million spent annually by the seven employers could be attributed to 10 health risk factors.

A worker with high blood glucose cost $1,653 more than a worker without that risk factor; a worker with high blood pressure cost $1,378 more; and an obese worker cost $1,090 more. Physical inactivity, tobacco use and stress were also among the top risk factors, according to the study.

The message to employers is, they “better pay attention to the psychosocial aspect of employee health,” Goetzel said in an interview.

The study was a follow up to a landmark 1998 report by Goetzel and colleagues that first identified the economic effects of 10 modifiable health risk factors in the working population. This so-called HERO study, funded in part by employers through the Health Enhancement Research Organization, gave employers, for the first time, concrete information about the top risk factors for health spending.

“That study got a lot of attention,” Goetzel said. “Here we are in 2012 and we wanted to see, do these things hold up?”

For the most part, they do. In the new study, Goetzel and colleagues found that depression remained the most important predictor of health care costs. However, high stress was second in priority in 1998, but today had a smaller relationship to employer costs, according to the study.

The researchers used employee health risk assessments to identify the health risks. They chose to use the StayWell risk assessment—the same one as in the original study.

They wanted to know whether the health risks of workers had improved or worsened over the past 17 years and if the relationship between risks and costs had changed.

Risk prevalence rates for most risk factors were within five percentage points of one another between the two time periods. However, 32.3 percent of the employees today were obese, compared with 20 percent of workers in 1998. Goetzel said these findings are a reflection of the greater U.S. population, which has continued to experience rising rates of obesity.

By contrast, 9.9 percent of employees in the new study had high cholesterol compared with 18.8 percent of employees with high cholesterol in the 1998 study.

Larry Boress, president and CEO of the Midwest Business Group on Health, says the study is important because it helps employers identify and target areas to improve employee health and reduce health spending.

Rebecca Vesely is a writer based in San Francisco. Comment below or email

Rebecca Vesely is a writer based in San Francisco.

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