The Effect of Depression on Paid Sick Leave due to Metabolic and Cardiovascular Disease in low- wage workers. (Depression and Sick Leave)

Abstract

Background: Colombia's health system allows workers to claim paid sick leave due to health conditions, some of this conditions are related to metabolic and cardiovascular disease. There has been an association between these diseases and depression. However, the effect of behavioral disorders such as depression on absence from work is unknown in the developing world. The objective of the research is to estimate whether low-wage workers suffering from depression, metabolic disease, and cardiovascular disease request more paid sick days than people with the same medical comorbidities, but without depression. Data and Methods: We conducted a retrospective study using data from an insurer in the southwestern region of Colombia in 2016. Depression was identified using an international algorithm that detects chronic conditions from diagnosis and pharmacy data. Outcome variables were the number of days on sick leave allowed by the insurer in one year, and the amount paid by the insurer. We used multivariate regression to estimate whether depression increases sick leave due to metabolic and cardiovascular disease after pre-processing the data using coarsened exact matching. Results: Individuals diagnosed with depressive disorders and absent from work due to metabolic and cardiovascular disease tend to have more paid sick days throughout the year than individuals with no depression suffering from these diseases. Additional absence days were statistically significant in nutritional and metabolic disease (10.6 days) and circulatory diseases (7.4 days). Conclusions: Depression comorbid with a physical disease increases the number of days and consequently the associated costs to the insurer. The incremental cost due to depression is higher compared to what insurers receive annually from the government to cover health services; consequently, additional research is warranted to identify prevention activities that can treat depression, thus lowering the healthcare system's financial burden.