(189) Disability and Workers’ Compensation Absences Associated with Major Depressive Disorder and the Overlap with Family Medical Leaves Among US Employees

Background: Major depressive disorder (MDD) is a chronic psychiatric disease that affects approximately 7.1% of United States (US) adults, with 80% experiencing difficulties with work, home, or social activities. The US Family and Medical Leave (FML) Act of 1993 allows eligible employees to take unpaid, job-protected leaves for specified medical reasons (such as MDD) with continuation of group health insurance coverage under the same terms and conditions as if the employee had not taken leave. Once opened, an FML claim remains open for a year. Because FML is unpaid, some employees take overlapping leaves under their other paid benefits. Paid US employee benefits include Short- and Long-term Disability (STD and LTD, respectively) for non-work-related injuries/illnesses and Workers’ Compensation (WC) for work-related injuries/illnesses.

Objectives: To retrospectively examine the use of paid leaves with non-paid FML leaves in linked medical and disability claims for employees with MDD and compare the leaves and the overlap with non-MDD controls.

Methods: Retrospective analysis of the US Workpartners’ Research Reference Database (RRDb) between 2018 and 2022. All included employees had two years of post-index FML, STD, LTD, and WC eligibility. Employees with MDD were identified by International Classification of Diseases 10th revision (ICD-10) codes in medical claims (first date=index date). The comparison/control group was a 3:1 random subset of employees without MDD, with the index date randomly assigned between 2018 and 2020. The following outcomes were evaluated and compared between the MDD and control cohorts: FML claims opened in the year after the index date; STD, LTD, and WC leaves begun during the first 2 years after the index date; and to measure overlap: STD, LTD, and WC leaves begun during the year after the filing for an FML leave. All reported comparisons P< 0.01.

Results: We identified 7888 employees with MDD and 23,586 non-MDD controls. FML claims were filed by 1806 (22.9%) of the employees with MDD and 1950 (8.3%) of control employees. In the year following the FML claim, MDD patients and controls filed claims for: STD 12.3% vs 3.3%; LTD 0.3% vs 0.1%; and WC 0.8% vs 0.1%, respectively. Compared with (non-MDD) controls, employees with MDD were more likely to have claims in the 2 years following their index dates for: STD 277%; LTD 272%; and WC 306%. In addition, compared with controls, employees with MDD taking FML were more likely to have overlapping claims for STD 370%; LTD 505%; and WC 580%.

Conclusions: Employees with major depressive disorder utilize a variety of paid and unpaid leaves at rates about three times that of controls, with overlapping FML leaves about 3.7—5.8 times higher than controls .