Greenberg P E, Stiglin L E, Finkelstein S N, Berndt E R
Analysis Group, Inc., Cambridge, MA 02138.
J Clin Psychiatry. 1993 Nov;54(11):405-18.
We estimate in dollar terms the economic burden of depression in the United States on an annual basis.
Using a human capital approach, we develop prevalence-based estimates of three major cost-of-illness categories: (1) direct costs of medical, psychiatric, and pharmacologic care; (2) mortality costs arising from depression-related suicides; and (3) morbidity costs associated with depression in the workplace. With respect to the latter category, we extend traditional cost-of-illness research to include not only the costs arising from excess absenteeism of depressed workers, but also the reductions in their productive capacity while at work during episodes of the illness.
We estimate that the annual costs of depression in the United States total approximately $43.7 billion. Of this total, $12.4 billion-28%-is attributable to direct costs, $7.5 billion-17%-comprises mortality costs, and $23.8 billion-55%-is derived from the two morbidity cost categories.
Depression imposes significant annual costs on society. Because there are many important categories of cost that have yet to be estimated, the true burden of this illness may be even greater than is implied by our estimate. Future research on the total costs of depression may include attention to the comorbidity costs of this illness with a variety of other diseases, reductions in the quality of life experienced by sufferers, and added out-of-pocket costs resulting from the effects of this illness, including those related to household services. Finally, it may be useful to estimate the additional costs associated with expanding the definition of depression to include individuals who suffer from only some of the symptoms of this illness.
我们以美元为单位估算了美国抑郁症每年造成的经济负担。
采用人力资本法，我们对疾病成本的三个主要类别进行了基于患病率的估算：（1）医疗、精神科和药物治疗的直接成本；（2）抑郁症相关自杀导致的死亡成本；（3）工作场所抑郁症相关的发病成本。对于后一类，我们扩展了传统的疾病成本研究，不仅包括抑郁症患者旷工过多导致的成本，还包括他们在发病期间工作时生产能力的下降。
我们估计美国抑郁症的年度总成本约为437亿美元。其中，124亿美元（占28%）归因于直接成本，75亿美元（占17%）为死亡成本，238亿美元（占55%）来自两类发病成本。
抑郁症每年给社会带来巨大成本。由于还有许多重要的成本类别尚未估算，这种疾病的实际负担可能比我们的估计更大。未来关于抑郁症总成本的研究可能包括关注这种疾病与多种其他疾病的合并症成本、患者生活质量的下降以及这种疾病影响导致的额外自付费用，包括与家庭服务相关的费用。最后，估计将抑郁症的定义扩大到包括仅患有部分症状的个体所带来的额外成本可能会有所帮助。
