Contents

1. Recognising  depression 

Risk factors

Symptoms

Workplace indications

Why would someone who is depressed still come to work?

2. Managing  depression  in the workplace

What to do

Consequences of  depression  in the workplace for employers

Common barriers to the effective management of depression  in the workplace

3. Challenges for employees returning to work after depression 

What can be done to help?

Return to work programs and shortterm disability management

4. Mental Health Promotion

5. Preventing  depression  in the workplace

6. Treatment

Counselling and medication therapy

Antidepressant medications

Psychotherapy and counselling

How long will someone require treatment?

 

 

Depression is a leading cause of suffering, dysfunction and disability. It is also becoming more common.

Each year depression will affect about one in ten people in the workplace. It is most common between the ages of 30 and 40 when workers are in their prime. People with illnesses that affect mood will miss an average of 27 to 65 days per year, and therefore depression severely reduces productivity.

Many people who have depression are not properly diagnosed. Of those who are, many do not receive adequate treatment. This causes employees unnecessary distress and affects the bottom line of business.

 

1. Recognising depression

 

At least 80% of people with depression can be treated successfully with medication, psychotherapy or a combination of both. Workplaces should be able to respond to this health issue in the same way that they respond to more traditional problems such as back injury.

 

Risk factors

It is more useful to consider possible risk factors for depression rather than thinking of it as a disease with a specific cause. There are many risk factors that make someone more likely to develop depression.

Employers should be aware of and manage these risk factors. Some factors such as a family member with depression or previous episodes of depressive cannot be changed. Others like poor perceived job control and unclear and unattainable goals can be.

Non-modifiable factors

The following risk factors cannot be changed:

• Genetics (having a close family member with depression)
• Female gender (twice as likely to become depressed)
• An upbringing with poor or neglectful parenting
• Predisposing personality types
• Anxiety that starts early in life
• History of trauma or abuse
• Having had a serious episode of depression previously
• A serious physical disorder, such as long term back pain

 

Modifiable, but not work related, factors

• Poverty
• Divorce and other severely stressful events
• Substance misuse
• Low self esteem
• A sense of helplessness or hopelessness
• Social stigma
• Poor social support, such as poor family or social networks

 

Modifiable workplace factors that can be addressed by employers

• Workplace stress
• Burnout, where employees become physically exhausted and may doubt their competence
• Job dissatisfaction
• Job insecurity, for example through down-sizing
• Poor perceived job control
• Inadequate employment
• Poor effort reward balance
• Unfair treatment by supervisors
• Unattainable work goals
• Unemployment

 

Case Study - Jake

Jake was finding it harder to concentrate at work and was becoming increasingly tired during the week. His office was downsizing and the thought of being made redundant was often on his mind. He was getting more irritable at home with his children and his wife was getting frustrated because he was not doing his fair share of work around the house. Jake was finding that he felt flat much of the time and would often feel sad for no apparent reason. His wife started to think he was going down a path he'd been down five years ago, when he experienced depression.

As part of the downsizing, his department was merged with another sales team and he got a new supervisor. The new supervisor instituted clearly defined sales targets and offered bonus incentives to sales staff that were performing well. Jack was surprised to find he ranked second highest in the sales targets and was very pleased with his bonus. Even though he was busier at work, he felt more productive and lively. He soon found that he had more energy and was more engaging at home with his family. His wife was pleased that he seemed to be enjoying work again and that they had stopped bickering.

 

Symptoms

The following are symptoms that may be experienced by someone with depression:

1. A loss of interest in activities that are usually pleasurable (such as hobbies)
2. A constant feeling of being down
3. Reduced energy levels or increased levels of fatigue
4. Weight loss / weight gain
5. Increased or decreased appetite
6. Increased or decreased need for sleep
7. Feelings of oppressive sadness or worthlessness
8. Feelings of guilt
9. Feelings of hopelessness
10. A general feeling of being lost
11. Reduced ability to concentrate or think
12. Decreased libido (sexual desire)
13. Recurrent thoughts of death, self-harm or suicide

 

Workplace indications

Depression causes changes in the mind and the body and affects each person differently. Some people with depression may feel sluggish and much more tired than usual. Others will feel sad almost all the time, cry a lot, and be swamped with feelings of hopelessness. Being aware of how depression affects people may help you to recognise it in the workplace.

The following may be signs that an employee is suffering from depression:

1. Difficulty concentrating on tasks
2. Turning up late to work
3. Looking more tired than usual, or complaining about being tired more frequently
4. Getting angry of frustrated more regularly, with self or colleagues
5. Looking sad and down most of the time
6. May comment about feeling hopeless or useless
7. Social isolation, perhaps evidenced by eating alone at lunchtimes
8. Difficulty in meeting deadlines
9. Difficulty with multitasking
10. Drinking more alcohol (which may be observed over lunch or Friday after work drinks)

 

Why would someone who is depressed still come to work?

Even when people are severely depressed they may continue to attend work. Reasons for this may include:

1. Fear of losing their job
2. Desire to keep a structured life or sense of normalcy
3. Need for money
4. Insufficient sick leave
5. A sense of duty to employer or colleagues
6. A desire to help customers

 

2. Managing depression in the workplace

 

What to do?

It is important to act on your concern – depression is common but under-recognised and your concerns are probably justified.

Managers should initiate a conversation with the employee as early as possible, and keep the concern on the person’s health rather than concern about their performance.

Some suggested statements that can be used to raise concern include:

• “You’ve been looking really tired lately, is everything okay?”
  • “I’ve noticed that you’ve been turning up to work late, is anything going on?”
  • “Is there any support that we can offer?”

Initiating a discussion can be as easy as asking if there is anything you can do to help. These statements may prompt the person to reveal that they are having trouble and from here it is appropriate to refer the person to somewhere they can obtain help.

Prompting people, asking if they are okay, and referring them appropriately does not mean you take on the role of counsellor. You are simply encouraging the person to get help.

Referrals may be made to:

1. A general practitioner
2. Human resources for support
3. Employee assistance program
4. A psychologist

 

Consequences of depression in the workplace for employers

Employees with depression may:

·       Demonstrate decreased attention to safety

·       Require increased recovery time from other illnesses or injuries

·       Have much more complicated return to work issues

·       Experience medication side effects such as drowsiness

This can impact on employers through:

·       Increased workers' compensation costs

·       Reduction in productivity and increased absenteeism

·       Interference with health promotion programs, such as smoking cessation, which are less likely to work in the presence of depression

People with depression cost their employers significantly more than colleagues without depression. Proper prevention and early identification, however, will ultimately save employers money.

Current research supports the screening of employees for depression.  This practice has come to the attention of progressive companies.  It is suggested that specialist services be consulted before screening is undertaken.

Case Study – Angela

Angela’s supervisor was concerned by her poor performance over the past few months. She had become inappropriately angry with several clients and lost several important accounts, which was unusual for her. Several of her colleagues had mentioned that she had been rude to them at lunchtimes when they asked about her family.

Her supervisor set aside some time and mentioned that something seemed to be troubling her and asked if there was anything she could do to help. Angela burst into tears and said that she was getting a divorce. The supervisor suggested she see a counsellor through the organisations EAP (Employee Assistance Program). She also contacted human resources and arranged for Angela to have several afternoons off for the next few weeks. Angela was very grateful for the help and found that the counselling helped her to deal with her anger and frustration. She became better at expressing her feelings and soon found that she was able to rely on her some of her friends at work for support. After taking two weeks leave during her divorce finalisation she was able to work and resume normal duties.

 

Common barriers to the effective management of depression in the workplace

There are many barriers to identifying and managing depression in the workplace. Awareness of these barriers allows them to be modified to improve the workplace.

Employee factors

1. Failure to perceive (or misinterpretation of) depressive symptoms
2. Lack of motivation to seek help (as depression often reduces motivation)
3. Confidentiality and privacy concerns
4. Ignorance of treatment options and resources
5. Stigma of depression and a fear of being labelled
6. Unconscious denial of symptoms.

 

Employer factors

1. Perception of depression management as a cost rather than an investment
2. Unsupportive corporate culture
3. Failure to train supervisors properly about mental health issues
4. Perpetuation of stigma surrounding mental illness
5. Failure to preserve privacy and confidentiality of medical issues
6. Lack of psychiatric services through limited health insurance and benefit structures

 

Health care provider factors

1. Failure to recognise significant consequences of illness
2. Failure to recognise depressive symptoms
3. Failure to recognise previous episodes of depression
4. Underutilisation of psychotherapy and counselling
5. Ignorance of available mental health resources
6. An unwillingness to manage depression due to:

• Lack of experience, training or skill
• Excessive workload
• Competing time demands
• Anticipated lack of reimbursement
• Lack of interest in managing the condition

Other factors:

• The complex nature of depression as an illness
• The complex ties between workplace factors like job stress and depression
• The general focus on acute problems and poor management of chronic problems.

 

Case Study – Kumar

Kumar had recently moved to America to work as a computer scientist and was excited at the prospect of a new job. He was troubled from the start by language barriers and occasionally left meetings unsure of what was said. He was also finding it difficult to make new friends and he was working so hard he did not get to see his family very often. He started putting on weight and found he was sleeping for much of the weekend. At night he tried to study English phrase books but found he was falling asleep before he got anything done.

Kumar’s wife was worried about her husband. She told him he should ask his boss for some help. He said that it was a bad idea, and that nothing was wrong. He did not know anything about depression and felt guilty about his poor performance at work. He was worried he would lose his job if he mentioned he was having problems and figured they would go away by themselves.

At the time of his performance review, Kumar’s supervisor asked Kumar how he was fitting in. He seemed to genuinely care and Kumar explained to him that he was struggling. His boss was surprised he had not said something sooner and said he would be sure to explain things to Kumar if he did not understand. He also suggested a local Hindi speaking GP for Kumar to see. The GP explained a little about depression and recommended Kumar join a local group that met weekly to socialise and to see him again the next month.

During the next month, Kumar spoke to his supervisor more often to clarify things he did not understand and quickly found his work became much more efficient. He thoroughly enjoyed spending time with some other new arrivals and made friends quickly. He found he had more energy and was finally able to study effectively after work. At his next performance review his supervisor was very pleased and commented that Kumar’s work had improved greatly.

 

 

3. Challenges for employees returning to work after depression

 

Employees who have been absent from work with a depressive illness are likely to feel anxious or a sense of trepidation at the prospect of returning to work. This may be because they:

• Are anxious about seeing their colleagues again after an extended period
• Fear judgment from colleagues
• Fear discussions of the reason for their absence
• Are worried about what people have been saying during their absence
• Are concerned their colleagues will feel they have let the team down
• May have to confront something such as a personal conflict that contributed to their initial depression

The longer someone has not been involved with or connected with work in some way, the stronger these feelings are likely to be. If not properly dealt with, then this anxiety can become as much of a hurdle in return to work as the depression itself.

 

What can be done to help?

Try to keep employees connected to the work place during time off. This will give the employee a sense of remaining involved and reduce return to work anxiety.

Suggestions for staying in touch include:

1. Calling the employee occasionally to let them know what has been happening
2. Being clear and letting them know that you are not checking up on them, just keeping them up to date
3. Encouraging colleagues who they may have interacted with socially to call and ask how they are
4. Considering occasional email updates about changes in the workplace, or any ongoing projects
5. Being aware that some people will not be interested in chatting, but be sure to avoid situations where no one speaks to the absent employee

Suggestions for colleagues of people affected by depression

1. Not avoiding talking to someone for fear of saying the wrong thing – people are very likely to be aware of you trying to avoid them
2. Learning a little about depression and knowing that it is a very common illness
3. Being respectful of a person’s confidential medical history – there is no need to pry
4. Being sure to welcome back your colleague and being aware that they may have just gone through a very traumatic experience and are likely to be anxious about returning to work

 

Return to work programs and short-term disability management

Promotion of return to work programs as well as supervisor training and education in optimal return to work practices will reduce the amount of time lost to depression. Having people return to work should be the goal of such programs. This may include part time work or altered duties.

The goals of management for people with depression on short-term disability should be:

1. Ensuring people receive appropriate care
2. Ongoing liaison with the affected employee
3. Examination and mitigation of contributory workplace issues
4. Provision of support and follow-up for the employee’s return to work
5. Partnering with human resources and supervisors to accommodate return to work
6. Recognising that returning to work through altered duties or part time work is optimal

These interventions have been found to:

1. Decrease the average number of days absent
2. Reduce the likelihood of another depression related absence   

 

Case Study – Sally

Sally had worked as a teacher at her local high school for several years and was known for being approachable and friendly. Half way through the second semester Sally found herself becoming inexplicably sad.  Eventually she took an overdose of pain killer medication.

When her boyfriend informed the school, her principal decided not to call Sally as he did not want to bother her and thought he would wait to hear from her. Her colleagues and friends at the school did not contact her because they were worried they would say the wrong thing and upset her.

As she began to get better, she started to become anxious about returning to school, and worried about what people had been saying about her, and would think of her. She tried to start back at school after the holidays but felt like everyone was avoiding her and her depression relapsed. She was unable to continue working and had to go on extended sick leave before she eventually resigned.

 

Case Study – Fiona

 Fiona worked as the manager of a large retail chain and was well-liked by other employees. After Christmas one year people started noticing that she was becoming very skinny. Fiona noticed when she looked in the mirror but she had lost interest in food. She also had trouble sleeping and was increasingly tired at work. Soon she started making mistakes and began crying a lot for no reason. Unable to continue, she discussed her problems with human resources and went to see a GP who put her on antidepressant medication and suggested she undertake counselling.

Over the next few weeks, her supervisor called her after the usual weekly meeting to update her on any changes in the office, and how the company was going. She stayed in touch with colleagues through occasional emails and soon started to look forward to returning to work. She returned to work on part time duties as she was still getting tired early in the day.  After several weeks of therapy and medication she found she was getting her appetite and energy back and was able to return to full time work.

 

 

4. Mental Health Promotion

 

Many people still view depression as a personal weakness rather than a treatable medical illness. Depression interventions should focus on removing the stigma attached to mental illness. This will facilitate earlier identification and appropriate treatment. Interventions, including benefit structures and disability management programs should be constantly evaluated and improved.

Health promotion programs to raise depression awareness should focus on the following three messages:

1. Depression is an illness not a personal flaw or weakness. If recognised it can be treated.
2. Effective medications and psychological treatments exist. They are often used in combination.
3. Even the most serious forms of depressive illness usually respond rapidly to treatment.

Workplace health practitioners may need to present a ‘business case’ to organisations to argue for improved depression management.

Suggestions for the implementation of depression awareness programs include:

1. Lunchtime seminars on mental health topics, such as identifying and coping with stress
2. Emails on mental health topics, such as “everyone feels down sometimes”
3. Posters promoting wellness topics, including advice about available help
4. Articles in employee newsletters on topics such as “holiday blues”
5. Website information on corporate health services, or depression education
6. Pamphlets identifying depression as an under-recognised and under-treated illness

 

 

5.Preventing depression in the workplace

 

A lot can be done to prevent depression in the workplace. Many of the suggestions involve being aware of the workplace culture and its staff. Some suggestions for preventing depression are listed below:

1. Promotion of healthy work-life balance
2. Prevention of burnout, which includes identifying those with high job stress. Burnout is one of the many causes of depression
3. Supportive management structure that responds to employee concerns and problems
4. Improving the social supports of employees by providing activities that promote forming friendships
5. Improving perceived job control
6. Clear job descriptions and well defined advancement paths
7. Identifying high risk individuals, such as those who are frequently absent or complain of stress
8. Screening of high risk individuals

 

6. Treatment

 

Depression is under-recognised and under-treated.

Everyone experiences depression differently and will have differing treatments.

If the depression occurs in response to a life event such as a divorce, then psychotherapy or counselling may be more helpful. If a person has more physical symptoms of depression, and they feel generally tired and sluggish for example, they may be more likely to be prescribed medication.

 

Counselling and medication therapy

Both medication and counselling work equally well for mild cases of depression. Psychotherapy has only recently been validated as a treatment option for depression and it is currently underutilised despite the fact that it is scientifically proven to work.

Doctors may be more likely to prescribe antidepressants if there is poor perceived access to quality counselling services. Psychotherapy is more costly in the short term but typically less expense over time.

Severe cases of depression will require both counselling and medication therapy. Hospitalisation may be necessary.

 

Antidepressant medications

Antidepressant medications are usually taken as a daily tablet. They help to fix the changes in brain chemistry that occur in depression. They can help people to feel less sad, anxious, tired and sluggish.

Antidepressants are taken during an episode of depression and for six to nine months afterwards to prevent more episodes. Therapy should continue even in the absence of symptoms for the recommended time period. Patients at high risk will need to continue medication therapy indefinitely to prevent recurrence. Be aware that someone who is taking antidepressants may not appear to have any symptoms of depression but should continue treatment as prescribed by their health care professional.

People often do not want to take antidepressants for extended periods. Clinicians need to educate patients about their importance.

Drugs that work for one person will not necessarily work for another, and they generally do not work right away.

It is important to remember that drugs affect everyone differently. Ongoing monitoring and blood tests may be necessary for the duration of treatment and people will often have to try various medications before they find one that works.

Antidepressants should not be suddenly stopped. Their dose must be reduced over time.

 

Psychotherapy and counseling

Psychotherapy is a valid treatment for depression. It is conducted by counsellors or psychologists (neither of whom can prescribe drugs) or by psychiatrists (who can prescribe drugs). Psychotherapy usually starts with one on one counselling, but can also include group therapy and phone interviews.

Psychotherapy sessions will usually last for about an hour. People will typically require several sessions per week for at least a month to see any benefit. People who are undergoing counselling may need to be away from the workplace regularly.

Psychotherapy can be used in acute episodes of depression and for the ongoing treatment of symptoms. Its use will reduce further episodes of depression.

Psychotherapy will cause changes in someone’s mood before their physical symptoms. It is very useful for resolving interpersonal conflicts and aids in decision making. It is most useful for depression that occurs in relation to an event such as the death of a family member. It is considered safe and has no side effects.

The following three types of psychotherapy have been proven to benefit those with depression. Psychotherapy sessions are likely to incorporate elements of all three:

Cognitive behavioural therapy (CBT)aims to educate people about their thought patterns. People with depression tend to have negative and irrational thoughts, like “My work is never good enough”. People are taught to rationalise and weigh up the evidence for such thoughts. It reduces reflexive negative