Prevalence rates for depression by industry: a claims database analysis

Abstract

Purpose

To estimate and interpret differences in depression prevalence rates among industries, using a large, group medical claims database.

Methods

Depression cases were identified by ICD-9 diagnosis code in a population of 214,413 individuals employed during 2002–2005 by employers based in western Pennsylvania. Data were provided by Highmark, Inc. (Pittsburgh and Camp Hill, PA). Rates were adjusted for age, gender, and employee share of health care costs. National industry measures of psychological distress, work stress, and physical activity at work were also compiled from other data sources.

Results

Rates for clinical depression in 55 industries ranged from 6.9 to 16.2 %, (population rate = 10.45 %). Industries with the highest rates tended to be those which, on the national level, require frequent or difficult interactions with the public or clients, and have high levels of stress and low levels of physical activity.

Conclusions

Additional research is needed to help identify industries with relatively high rates of depression in other regions and on the national level, and to determine whether these differences are due in part to specific work stress exposures and physical inactivity at work.

Clinical significance

Claims database analyses may provide a cost-effective way to identify priorities for depression treatment and prevention in the workplace.

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Acknowledgments

We wish to gratefully acknowledge the collaboration and support of Highmark Inc., headquartered in Pittsburgh and Camp Hill, Pennsylvania, whose data is analyzed in this paper. We thank Brian Day, Andrea DeVries, and Cara Hirsch at Highmark for their assistance in establishing and guiding the project, and Jerry O’Donnell, also at Highmark, for his assistance with the data.

Funding was provided by the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention.

Conflict of interest

The authors declare they have no conflicts of interest.

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Corresponding author

Correspondence to Lawson Wulsin.

Additional information

The findings and conclusions in this paper are those of the authors, and do not necessarily represent the views of the National Institute for Occupational Safety and Health. NIOSH Occupational Risk for Depression Draft 4.16.13.

Appendices

Appendix 1

Sample definitions of SIC two-digit industries.

Source: United States Department of Labor (http://www.osha.gov/pls/imis/sic_manual.html).

Industries with high prevalence of depression

41: Local and suburban transit and interurban highway passenger transportation

This major group includes establishments primarily engaged in furnishing local and suburban passenger transportation, such as those providing passenger transportation within a single municipality, contiguous municipalities, or a municipality and its suburban areas, by bus, rail, or subway, either separately or in combination, and establishments engaged in furnishing transportation to local scenic features. Also included are establishments primarily engaged in furnishing highway passenger.

Transportation and establishments furnishing highway passenger terminal or maintenance facilities. Intercity bus lines are included in this major group, but interurban railways are classified in Major Group 40.

65: Real estate

This major group includes real estate operators, and owners and lessors of real property, as well as buyers, sellers, developers, agents, and brokers. Establishments primarily engaged in the construction of buildings for sale (operative builders) are classified in Industry 1531.

83: Social services

This major group includes establishments providing social services and rehabilitation services to those persons with social or personal problems requiring special services and to the handicapped and the disadvantaged. Also included are organizations soliciting funds to be used directly for these and related services. Establishments primarily engaged in providing health services are classified in Major Group 80; those providing legal services are classified in Industry 8111; and those providing educational services are classified in Major Group 82.

39: Miscellaneous manufacturing industries

This major group includes establishments primarily engaged in manufacturing products not classified in any other manufacturing major group. Industries in this group fall into the following categories: jewelry, silverware, and plated ware; musical instruments; dolls, toys, games, and sporting and athletic goods; pens, pencils, and artists’ materials; buttons, costume novelties, miscellaneous notions; brooms and brushes; caskets; and other miscellaneous manufacturing industries.

72: Personal services

This major group includes establishments primarily engaged in providing services generally to individuals, such as laundries, dry cleaning plants, portrait photographic studios, and beauty and barber shops. Also included are establishments operating as industrial launderers and those primarily engaged in providing linen supply services to commercial and business establishments.

81: Legal services

This major group includes establishments which are headed by members of the bar and are engaged in offering legal advice or legal services.

86: Membership organizations

This major group includes organizations operating on a membership basis for the promotion of the interests of their members. Included are organizations such as trade associations; professional membership organizations; labor unions and similar labor organizations; and political and religious organizations. This major group does not include business establishments operated by membership organizations, which are classified according to their primary activity.

62: Securities and commodities

This major group includes establishments engaged in the underwriting, purchase, sale, or brokerage of securities and other financial contracts on their own account or for the account of others; and exchanges, exchange clearinghouses, and other services allied with the exchange of securities and commodities.

27: Publishing and printing

This major group includes establishments engaged in printing by one or more common processes, such as letterpress; lithography (including offset), gravure, or screen; and those establishments which perform services for the printing trade, such as bookbinding and platemaking. This major group also includes establishments engaged in publishing newspapers, books, and periodicals, regardless of whether or not they do their own printing. News syndicates are classified in Services, Industry 7383. Establishments primarily engaged in textile printing and finishing fabrics are classified in Major Group 22, and those engaged in printing and stamping on fabric articles are classified in Industry 2396. Establishments manufacturing products that contain incidental printing, such as advertising or instructions, are classified according to the nature of the products for example, as cartons, bags, plastics film, or paper.

Industries with low prevalence of depression

79: Amusement and recreation services

This major group includes establishments engaged in providing amusement or entertainment services, not elsewhere classified. Establishments primarily engaged in operating motion picture theaters are classified in Industry Group 783, and those operating museums, art galleries, arboreta, and botanical and zoological gardens are classified in Major Group 84.

32: Stone, clay, and glass products

This major group includes establishments engaged in manufacturing flat glass and other glass products, cement, structural clay products, pottery, concrete and gypsum products, cut stone, abrasive and asbestos products, and other products from materials taken principally from the earth in the form of stone, clay, and sand. When separate reports are available for mines and quarries operated by manufacturing establishments classified in this major group, the mining and quarrying activities are classified in Division B, Mining. When separate reports are not available, the mining and quarrying activities, other than those of Industry 3295, are classified herein with the manufacturing operations.

16: Heavy construction other than building construction contractors

This major group includes general contractors primarily engaged in heavy construction other than building, such as highways and streets, bridges, sewers, railroads, irrigation projects, flood control projects and marine construction, and special trade contractors primarily engaged in activities of a type that are clearly specialized to such heavy construction and are not normally performed on buildings or building-related projects. Specialized activities that are covered here include grading for highways and airport runways; guardrail construction; installation of highway signs; trenching; underwater rock removal; and asphalt and concrete construction of roads, highways, streets and public sidewalks. Establishments primarily engaged in specialized activities that may be performed on buildings or on other heavy construction projects are classified in Major Group 17. These include contractors primarily engaged in painting (including bridge painting and traffic lane painting), electrical work (including work on bridges, power lines, and power plants), and carpentry work.

12: Coal mining

This major group includes establishments primarily engaged in producing bituminous coal, anthracite, and lignite. Included are mining operations and preparation plants (also known as cleaning plants and washeries), whether or not such plants are operated in conjunction with mine sites. The production of coal fuel briquettes and packaged fuel is classified in Manufacturing, Industry 2999. Establishments primarily engaged in the production of gas and hydrocarbon liquids from coal at the mine site are classified in Major Group 13.

37: Transportation equipment

This major group includes establishments engaged in manufacturing equipment for transportation of passengers and cargo by land, air, and water. Important products produced by establishments classified in this major group include motor vehicles, aircraft, guided missiles and space vehicles, ships, boats, railroad equipment, and miscellaneous transportation equipment, such as motorcycles, bicycles, and snowmobiles. Establishments primarily engaged in manufacturing mobile homes are classified in Industry 2451. Establishments primarily engaged in manufacturing equipment used for moving materials on farms; in mines and on construction sites; in individual plants; in airports; or on other locations off the highway are classified in Major Group 35.

33: Primary metal industries

This major group includes establishments engaged in smelting and refining ferrous and nonferrous metals from ore, pig, or scrap; in rolling, drawing, and alloying metals; in manufacturing castings and other basic metal products; and in manufacturing nails, spikes, and insulated wire and cable. This major group includes the production of coke. Establishments primarily engaged in manufacturing metal forgings or stampings are classified in Industry Group 346.

45: Transportation by air

This major group includes establishments engaged in furnishing domestic and foreign transportation by air and also those operating airports and flying fields and furnishing terminal services. Establishments primarily engaged in performing services which may incidentally use airplanes (e.g., crop dusting and aerial photography) are classified according to the service performed.

34: Fabricated metal products

This major group includes establishments engaged in manufacturing industrial and commercial machinery and equipment and computers. Included are the manufacture of engines and turbines; farm and garden machinery; construction, mining, and oil field machinery; elevators and conveying equipment; hoists, cranes, monorails, and industrial trucks and tractors; metalworking machinery; special industry machinery; general industrial machinery; computer and peripheral equipment and office machinery; and refrigeration and service industry machinery. Machines powered by built-in or detachable motors ordinarily are included in this major group, with the exception of electrical household appliances. Power-driven hand tools are included in this major group, whether electric or otherwise driven. Establishments primarily engaged in manufacturing electrical equipment are classified in Major Group 36, and those manufacturing hand tools, except powered, are classified in Major Group 34.

35: Industrial and commercial machinery and computer equipment

This major group includes establishments engaged in manufacturing industrial and commercial machinery and equipment and computers. Included are the manufacture of engines and turbines; farm and garden machinery; construction, mining, and oil field machinery; elevators and conveying equipment; hoists, cranes, monorails, and industrial trucks and tractors; metalworking machinery; special industry machinery; general industrial machinery; computer and peripheral equipment and office machinery; and refrigeration and service industry machinery. Machines powered by built-in or detachable motors ordinarily are included in this major group, with the exception of electrical household appliances. Power-driven hand tools are included in this major group, whether electric or otherwise driven. Establishments primarily engaged in manufacturing electrical equipment are classified in Major Group 36, and those manufacturing hand tools, except powered, are classified in Major Group 34.

Appendix 2

Antidepressant drug names used for alternative case definitions for depression.

Amitriptyline, Amoxapine, Budeprion SR, Bupropion, Buproprion SR, Celexa, Citalopram, Cymbalta, Desipramine, Desyrel, Doxepin, Effexor, Effexor XR, Elavil, Eskalith, Eskalith CR, Fluoxetine, Fluvoxamine, Imipramine, Lexapro, Lithium carbonate, Lithium citrate, Lithobid, Luvox, Maprotiline, Mirtazapine, Nefazodone, Norpramin, Nortriptyline, Pamelor, Paroxetine, Paxil, Paxil CR, Prozac, Prozac-Weekly, Remeron, Sarafem, Serentil, Sertraline, Sinequan, Serzone, Tofranil, Tofranil-PM, Wellbutrin, Wellbutrin SR, Wellbutrin XL, Zoloft.

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Wulsin, L., Alterman, T., Timothy Bushnell, P. et al. Prevalence rates for depression by industry: a claims database analysis. Soc Psychiatry Psychiatr Epidemiol 49, 1805–1821 (2014). https://doi.org/10.1007/s00127-014-0891-3

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Keywords

  • Depression
  • Occupation
  • Industry
  • Group medical insurance claims
  • Work stress
  • Prevalence rates