The annual cost of depression in the United States is $43.7 billion, on a par with heart disease, according to a study made public yesterday.
About 11 million people suffer from depression in a given year, and nearly two-thirds go undiagnosed and untreated, said the study, which was published in the Journal of Clinical Psychiatry.
"What's striking is that the costs of depression are comparable to those for other major diseases," said Paul Greenberg, a health economist at the Analysis Group, a business consulting concern in Cambridge, Mass., who led the study. "In allocating resources as a society, we should consider depression as an important health problem, too."
Dr. Frederick Goodwin, director of the National Institute of Mental Health, said that among major diseases, clinical depression ranks second only to advanced coronary heart disease in the total number of days patients spend in the hospital or disabled at home.
"Major depression is far more disabling than many medical disorders, including chronic lung disease, arthritis and diabetes," he said.
The study shows that health insurance for mental illness is not a luxury or a frill, said Tipper Gore, the vice president's wife, who advises President Clinton on the issue.
The greatest source of economic burden, accounting for more than half the total, comes from depression's impact on work performance, especially in those who receive no treatment. The cost of days lost from work is about $11.7 billion, and impairment from the symptoms while people continue on the job costs $12.1 billion.
The impairments include poor concentration and memory, indecisiveness, fatigue, apathy and a lack of self-confidence -- and, in those with mania, a grandiose, unrealistic overconfidence.
All these symptoms reduce people's capacity to work; on average, the report estimates that depression reduces output by 20 percent.
"Depression tends to strike people in the most productive phase of life, and the most productive people," Dr. Goodwin said.
When someone is depressed on the job, it can also hamper co-workers, although the report did not include the costs of this effect.
The costs of depression were calculated for 1990, the most recent year for which complete data are available. In that year, 290 million working days were lost because people's depression was so severe they could not work at all, the report estimates.