Mental Health and the Weight of Depression

May is Mental Health Month and since psychiatric conditions affect one in every five U.S. adults and teenagers, every opportunity to build awareness and reduce the stigma that still surrounds them can be helpful.1,2 In this post, we focus on major depression, which affects nearly 7% of adults each year in the U.S., making it one of the most common psychiatric conditions in the country.3,4  

Depression is so widespread that its outsized economic impact hits the national wallet hard. One study found that depression costs society $210 billion each year when disorders associated with it are included in the calculation.5 About half of that amount is attributable to workplace costs, like presenteeism.5 Presenteeism occurs when a depressed employee goes to work, but has limited productivity due to his or her depression symptoms. Given that depression symptoms can make it difficult to stay motivated and can harm a person’s ability to maintain relationships, its workplace impacts are not surprising. Depression-related presenteeism causes a loss of about 32 annual workdays for the average person suffering from the condition.5 It represents more than a third of the economic burden of people who have major depression.5

The healthcare system also struggles under the weight of depression in the U.S. The supply of psychiatrists and inpatient psychiatric beds has been shrinking for years, even as the population of people with psychiatric disorders has grown.6 A study published last year found that from 2003 to 2013, the number of practicing psychiatrists in the U.S. declined by more than 10-percent.7 Between 2010 and 2016, the number of inpatient psychiatric beds available in the United States fell by around 17-percent.8 This translates into reduced access to mental healthcare even when barriers like cost, uninsurance, and a lack of transportation are adequately addressed.

The challenges don’t end there. When people are able to access the care they need, they often struggle to adhere to their treatment plans. About 50-percent of patients receiving antidepressant therapy discontinue treatment prematurely for a variety of reasons.9 And there are some unique treatment adherence hurdles associated with depression that aren’t generally issues in the treatment of physical conditions in the absence of psychiatric comorbidities. For example, depression can (although does not always) negatively affect a patient’s decision-making abilities and cognition. Stigma is a factor that can affect the way a patient perceives his or her condition. It can also impact whether patients believe medication could be useful to them. Fear that antidepressants are addictive or can alter personality adds additional potential for treatment nonadherence.10

Nonadherence in psychiatry is associated with poorer outcomes, such as suicide and costly inpatient hospital stays.11 The challenge is to help members improve their adherence to antidepressant treatment by attending to the distinctive challenges presented by stigma and the negative effects depression can have on motivation, cognition, and decision-making. While a trusting patient-provider relationship can protect against nonadherence,11,12 there are effective outreach strategies that can help close adherence gaps once they occur. Eliza’s health engagement management strategies and multi-channel solutions have proven to be successful in closing HEDIS antidepressant medication management gaps.  

Using theory- and focus group-informed, targeted outreach, an Eliza solution achieved a 13-percent increase in antidepressant adherence for a payer with a large Medicaid population by delivering the right message to the right members at the right time.

Antidepressant medication management is just one of Eliza’s behavioral health solutions that helps payers improve outcomes and engage members. For more information on Eliza’s behavioral health programs, contact us at or 1.844.343.1441.

Dr. Gaiser holds a PhD and MA in Health Policy, both from Brandeis University, an MPH with a concentration in Health Communication from Tufts University School of Medicine, and a BA in Journalistic Communication from Purdue University. Her doctoral research examined shared medical decision-making (SDM) for antidepressant treatment. The study also examined how SDM and patient-provider trust affect treatment acceptance for 3 chronic conditions. Melanie has additional content expertise in behavioral health and healthcare cultural competence. Her work in broadcast and print journalism spanned more than a decade in the local (Boston), national, and international arenas.

In her role as Manager of Engagement Research and Strategy at Eliza, Melanie focuses on strategic research and development for Eliza’s Health Engagement Design group. She combines her diverse experience in research methodology, sales, and communication to serve as a boundary spanner, facilitating collaborative partnerships between Eliza’s technical, science, and creative groups.

A dog-obsessed Francophile, Melanie enjoys gardening, traveling, writing, and hiking in search of alpine waterfalls. She geeks out by reading about food policy issues and behavioral economics.



  1. National Institute of Mental Health. (n.d.). Any mental illness (AMI) among U.S. adults. Retrieved from
  2. National Institute of Mental Health. (n.d.). Any disorder among children. Retrieved from
  3. National Institute of Mental Health. (n.d.). Major depression among adults. Retrieved from
  4. National Institute of Mental Health. (n.d.). Depression. Retrieved from
  5. Greenberg, P., Fournier, A., Sisitsky, T., Pike, C., & Kessler, R. (2015). The economic burden of adults with major depressive disorder in the United States (2005 and 2010). Journal of Clinical Psychiatry, 76(2), 155-162. doi: 10.4088/JCP.14m09298
  6. American Hospital Association. (2012). Trendwatch – Bringing behavioral health into the care continuum: Opportunities to improve quality, costs and outcomes. Washington, DC: author.
  7. Bishop, T., Seirup, J., Pincus, H., & Ross, J. (2016). Population of US practicing psychiatrists declined, 2003-2013, which may help explain poor access to mental health care. Health Affairs, 35(7), 1271-1277. doi: 10.1377/hlthaff.2015.1643
  8. Fuller, D., Sinclair, E., Geller, J., Quanbeck, C., & Snook, J. (2016). Going, going, gone: Trends and consequences of eliminating state psychiatric beds, 2016. Arlington, VA: Treatment Advocacy Center. Retrieved from
  9. Sansone, R., & Sansone, L. (2012). Antidepressant adherence: Are patients taking their medications? Innovations in Clinical Neuroscience, 9(5-6), 41-46. Retrieved from
  10. Chakraborty, K., Avasthi, A., Kumar, S., & Grover, S. (2009). Attitudes and beliefs of patients of first episode depression towards antidepressants and their adherence to treatment. Social Psychiatry and Psychiatric Epidemiology, 44(6), 482-488. doi: 10.1007/s00127-008-0468-0
  11. Chapman, S., & Horne, R. (2013). Medication nonadherence and psychiatry. Current Opinion in Psychiatry, 26(5), 446-452. doi: 10.1097/YCO.0b013e3283642da4
  12. de las Cuevas, C., de Leon, J., Penate, W., & Betancort, M. (2017). Factors influencing adherence to psychopharmacological medications in psychiatric patients: A structural equation modeling approach. Patient Preference and Adherence, 11, 681-690. doi: 10.2147/PPA.S133513


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