Every illness has direct costs and indirect costs.
Direct costs affect the person with the illness by directly impacting his or her health and ability to function normally.
Indirect costs affect the circle of people in the ill person’s life by impacting his or her function at work, in the family, or in the community. Indirect costs can even impact society at large by affecting costs associated with healthcare and medical disability.
Below is a summary of three costs of depression. This is not a definitive list, but includes some of the major ways that depression impacts the world today:
#1: The Financial Cost of Depression
In the United States alone, the annual cost of treating depression with prescription drugs and medical services has now reached almost $30 billion.1
But direct medical costs are just the tip of the economic iceberg: for every one dollar spent on direct treatment, nearly seven more are spent to treat other physical ailments that flare up with mental illness, including chest or abdominal pain, sleep disorders, or migraines. These extra dollars also pay workplace costs incurred due to absenteeism or low work performance. Finally, they represent the loss of lifetime earnings when a person loses their life due to depression.
Altogether, this brings the national economic burden of depression to over $210 billion each year.1
The global economic burden of depression and anxiety disorders is estimated at $1 trillion each year, with an eye-popping 12 billion days of lost productivity.2
#2: The Relationship Cost of Depression
Just as depression depletes financial capital, it also depletes social capital — the sense of belonging and trust in one’s community as well as a general belief in the reciprocal care of community members.3 Depression cripples one’s ability to engage positively with others or provide financial, physical, and emotional support.
It’s sobering to think that depression can fracture something as fundamental to our societal fabric as relationships.
And depressed individuals are just as likely to be perpetrators of the damage as victims. Each depressed person can act as an epicenter, creating shock waves that hurt many others. Depression’s primary victims are those closest to the epicenter, which is why researchers have studied its impact on marriage and family for almost 50 years.
Depression and Marriage
Developing a depressive disorder early in life decreases the probability of ever marrying.4
A rocky marriage can make one feel depressed, but it’s a two-way street: depression can also create or exacerbate marital issues.5
It’s not surprising, then, that depression increases the risk of separation and divorce.
The World Health Organization (WHO) recently surveyed 46,000 citizens of 19 countries in the Americas, Asia and South Pacific, Europe, the Middle East and Africa to determine the impact of 18 mental disorders (including depression) on marriage and divorce rates.6 Regarding getting married, they too found that depressed individuals were less likely to marry. Divorce rates were calculated in a subset of 30,000 individuals from 12 countries. The authors were particularly struck by one finding: nearly half of the total impact of mental disorders on divorce could be attributed to just two disorders: alcohol abuse and depression. Depression conferred the greatest risk and was associated with the highest numbers of divorce of all 18 disorders.
Depression and Family
Research tells us that parental depression deteriorates the quality of parenting, and poor parenting contributes to a child’s depression.7
While this is true for both mothers and fathers, I’m personally more concerned with the effects of maternal depression. Depressed mothers can be more emotionally distant, less responsive and empathetic, harsher and more punitive toward their children.8
In turn, their children can be less responsive to their mothers even in infancy, and throughout childhood and adolescence tend toward social isolation as well as more frequent behavioral issues (e.g. hyperactivity, aggression) and emotional problems (e.g. depression).
They can also suffer developmental delays that translate into poorer concentration and academic performance. The children of depressed mothers exhibit structural alterations in the brain regions involved in attention and decision-making.9 Reduced activity in these areas impairs basic cognitive functions, like learning and memory, as well as the ability to cope with life stressors.10
Depression, Suicide, and Grief
Depression is a major cause of suicide, which in turn is among the major causes of all deaths. About one million Americans attempt suicide every year and almost 45,000 succeed, making suicide the 10th leading cause of death.11
About 800,000 commit suicide worldwide every year, placing it among the top 20 causes of death globally.12
Grief is one of the most painful human emotions. With suicide, grief takes on more harrowing qualities: confusion, terror, guilt, rejection, abandonment, shame and anger.13
Being an eye-witness to a suicide can induce symptoms of Post-Traumatic Stress Disorder (PTSD): horror, preoccupation with traumatic memories, intense fear and vulnerability.14
These characteristics make suicide bereavement fundamentally different from other types of bereavement. Suicide survivors can founder in this unfathomable grief, unable to move on with their own lives, experiencing physical and mental distress and — disturbingly — their own suicidal behavior.15
#3: The Health Cost of Depression
As depression increases in a population, so do the rates of cardiovascular disease, cancer, hypertension, diabetes, asthma, chronic respiratory disorders, arthritis, and chronic pain.16
In a WHO Mental Health Survey study of 85,000 citizens from 17 countries, suffering from depression increased the odds of concurrently suffering from ten chronic health conditions spanning cardiovascular, respiratory, gastrointestinal, metabolic, and chronic inflammation/pain disorders.
The odds of most ailments increased by at least 50% (e.g. hypertension, asthma, ulcers, or arthritis), but some were much higher. Depressed individuals were twice as likely to suffer from heart disease and over twice as likely to suffer chronic pain and headaches.
Depression likely impacts health both directly and indirectly: directly through biological mechanisms we will discuss in later posts, and indirectly by promoting negative lifestyle choices such as:
- physical inactivity and careless diet (both contributing to obesity and disease),
- drinking,
- smoking, and
- substance abuse.
Deepening feelings of depression, characterized by helplessness and lack of control, will invariably worsen the course of the disease by promoting poor health behaviors and also poor compliance with prescribed treatments.
Depression increases the risk of an early death, but not just because it increases the risk of suicide. Depression also paves the pathway to – and then harshens the journey through – illness.
Conclusion and Action Steps
These are just some of the depressing costs of depression. All give us good reason to find effective ways to fight this global epidemic.
- Learn more about depression symptoms
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1 Greenberg, P. E., Fournier, A. A., Sisitsky, T., Pike, C. T., & Kessler, R. C. (2015). The economic burden of adults with major depressive disorder in the United States (2005 and 2010). The Journal of clinical psychiatry, 76(2), 155-162.
2 Chisholm, D., Sweeny, K., Sheehan, P., Rasmussen, B., Smit, F., Cuijpers, P., & Saxena, S. (2016). Scaling-up treatment of depression and anxiety: a global return on investment analysis. The Lancet Psychiatry, 3(5), 415-424.
3 De Silva, M. J., McKenzie, K., Harpham, T., & Huttly, S. R. (2005). Social capital and mental illness: a systematic review. Journal of Epidemiology & Community Health, 59(8), 619-627.
4 Whisman, M. A., Tolejko, N., & Chatav, Y. (2007). Social consequences of personality disorders: Probability and timing of marriage and probability of marital disruption. Journal of personality disorders, 21(6), 690-695.
5 Beach, S. R., & Whisman, M. A. (2012). Affective disorders. Journal of Marital and Family Therapy, 38(1), 201-219.
6 Breslau, J., Miller, E., Jin, R., Sampson, N. A., Alonso, J., Andrade, L. H., … & Fukao, A. (2011). A multinational study of mental disorders, marriage, and divorce. Acta Psychiatrica Scandinavica, 124(6), 474-486.
7 Chapman, R., Parkinson, M., & Halligan, S. (2016). How do parent-child interactions predict and maintain depression in childhood and adolescence? A critical review of the literature. Adolescent Psychiatry, 6.
8 Letourneau, N. L., Tramonte, L., & Willms, J. D. (2013). Maternal depression, family functioning and children’s longitudinal development. Journal of Pediatric Nursing, 28(3), 223-234.
9 Lebel, C., Walton, M., Letourneau, N., Giesbrecht, G. F., Kaplan, B. J., & Dewey, D. (2016). Prepartum and postpartum maternal depressive symptoms are related to children’s brain structure in preschool. Biological Psychiatry, 80(11), 859-868.
Sandman CA, Buss C, Head K, Davis EP (2015): Fetal exposure to maternal depressive symptoms is associated with cortical thickness in late childhood. Biological Psychiatry 77:324–334.
10 Reising, M. M., Bettis, A. H., Dunbar, J. P., Watson, K. H., Gruhn, M., Hoskinson, K. R., & Compas, B. E. (2017). Stress, coping, executive function, and brain activation in adolescent offspring of depressed and nondepressed mothers. Child Neuropsychology, 1-19.
11 Statistics are from the American Foundation for Suicide Prevention (https://afsp.org/about-suicide/suicide-statistics/). Source data is from the Center for Disease Control’s and Prevention (CDC) Data & Statistics Fatal Injury Report for 2016.
12 World Health Organization. (2017). Depression and other common mental disorders: global health estimates.
13 Jordan, J. R. (2008). Bereavement after suicide. Psychiatric Annals, 38(10).
14 Zisook, S., Chentsova-Dutton, Y., & Shuchter, S. R. (1998). PTSD following bereavement. Annals of clinical psychiatry, 10(4), 157-163.
15 Erlangsen, A., Runeson, B., Bolton, J. M., Wilcox, H. C., Forman, J. L., Krogh, J., … & Conwell, Y. (2017). Association between spousal suicide and mental, physical, and social health outcomes: a longitudinal and nationwide register-based study. Jama Psychiatry, 74(5), 456-464.
16 Kessler, R. C. (2012). The costs of depression. Psychiatric Clinics, 35(1), 1-14.
Dr. Pamela Coburn-Litvak has published research articles on exercise and stress in Neuroscience and Neurobiology of Learning and Behavior. Her latest book, Leaving the Shadowland of Stress, Anxiety, and Depression, was published in 2020.
After receiving a Ph.D. in Neurobiology and Behavior from the State University of New York at Stony Brook, she served as both Assistant Professor of Physiology & Pharmacology and Special Assistant to the Vice President for Research Affairs at Loma Linda University in Loma Linda, California. She then joined the Biology department at Andrews University and developed courses in human physiology as well as the neurobiology of mental illness. She also founded Rock @ Science LLC, a company that specializes in health and science education and web development. She co-developed the brain and body physiology segment of the Stress: Beyond Coping seminar with its creator, Dr. William “Skip” MacCarty, DMin.
Dr. Coburn-Litvak currently lives in California with her husband. Their two daughters are mostly grown and attending school elsewhere.
When she’s not studying or teaching about stress, she enjoys stress-relieving activities like puttering around the garden, taking nature walks with her family, knitting, cooking, and reading.