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High cholesterol, poor eating habits, and drinking lots of booze may be bad for you, but a new economic study finds that stress and depression rack up more in employee medical costs.

The study, conducted by the nonprofit Health Enhancement Research Organization, based in Birmingham, Alabama, and led by researcher Ron Goetzel, followed some 46,000 employees from six corporations for up to three years, resulting in more than 113,000 person-years of data. The aim was to assess ten modifiable health risks and their impact on health-care expenditures.

Depression and high stress had the greatest impact, concludes the study, which was published in the October issue of the Journal of Occupational and Environmental Medicine, beating out other single risk factors such as high blood sugar, obesity, and smoking. Workers who reported being depressed had medical expenses that were 70 percent higher than nondepressed workers, and racked up some $3,189 dollars in health-care costs. Workers who said they were under constant stress had medical expenditures that were 46 percent higher than their stress-free peers, or $2,287 a year. And people who said they suffered from both psychological and social problems had medical costs that were 147 percent higher than the risk-free crowd. By contrast, people suffering from high blood pressure incurred medical costs that were just 11 percent higher than those with cooler thermometers.

Researchers say there are several reasons why being seriously down in the dumps or freaked out ends up boosting the bills. For example, these workers may be more likely to seek medical attention for minor physical ailments, such as headaches or fatigue, when that time would be better spent addressing their psychological or social issues. Also, stress and depression can lead to other more serious illnesses, such as heart disease.

Almost one-third of the participants were classified as sedentary, or those who did no exercise at all during a given week; 31 percent were ex-smokers and 19 percent were current tobacco users; 20 percent each were extremely obese or underweight, had high cholesterol, suffered from high levels of stress, or had bad nutritional habits; under 5 percent had high blood sugar, high blood pressure, drank excessive amounts of alcohol, or said they were depressed. Slightly less than 60 percent of the individuals were under age 45, 58 percent were male, and 56 percent held professional or managerial jobs.

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