Take Home Messages:

Emotional symptoms of depression include complaints of sadness and feelings of hopelessness.

Physical symptoms include an increased need for sleep and weight loss or gain. Complaints of non-specific symptoms such as headache are common.

Depression is more likely to occur if a person has other ongoing serious medical problems such as cancer or a recent stroke.

Personal crisis such as divorce, deaths, financial problems and house evictions make depression more likely.

Occupational contexts associated with depression include supervisor problems, harassment, high job demands, demotion and job loss. 

In the workplace, signs of depression may include withdrawal from social activities, reduced productivity or increased interpersonal conflict. Colleagues may raise concerns or report change in a person’s behaviour.

A risk of suicide, self harm or threats of violence towards others necessitate urgent psychiatric referral.

Why the research matters: 

Depression is very common. It will affect one in five people.

It is under recognised and under diagnosed.  Unrecognised depression causes unnecessary employee distress and reduces productivity.

The correct treatment of depression will typically result in full remission but before treatment can occur, depression must be recognised.

What the research involved:

A review of literature relevant to the diagnosis and recognition of depression in the workplace.

The article aims to:

1. Outline the process of screening for and diagnosing depression
2. Describe the connection between a depressed mood and physical symptoms
3. Demonstrate the many different ways depression and disorders of mood may manifest

Summary of research findings:

Signs of depression in the workplace include:

• Social withdrawal (e.g. From meals, or reduced participation in meetings);
• Ongoing unexplained physical complaints like headaches or arm pains;
• Sadness or fatigue, which may be interpreted as laziness;
• Irritability or anxiety;
• More interpersonal conflict;
• Increased absences from work;
• Reduced productivity, which may occur in the context of increased effort;
• More accidents and errors;
• Increased passivity or rigidity;
• Increased concern from co-workers; and
• Increased use of alcohol and drugs.

When assessing for depression, the following factors should be assessed by mental health care providers:

• Emotional symptoms and signs
• Complaints of sadness, hopelessness, loneliness and self denigrating thoughts;
• Appears sad, tired, tearful, avoidant, reserved; and
• The person assessing the depression may feel increased sadness, sympathy or irritation.
• Physical signs and symptoms
• Increased need for sleep or an inability to sleep;
• Loss of interest in food, or increased hunger;
• Slower or sluggish movements; and
• Complaints of non-specific symptoms such as headache or tummy pain.

Certain contexts or events put people at increased risk of depression. These include:

1. Medical contexts
   • After a stroke, cancer, car crash or serious illness
   • Physical disability
   • Those regularly attending health services
   • People with chronic fatigue syndrome or post traumatic stress disorder
2. Personal contexts
   • Family problems such as marriage, separation, new child, illnesses or deaths
   • Financial changes such as bankruptcy or retirement
   • Social changes, such as moving house or social network changes
3. Occupational contexts (may be actual or perceived)
   • Supervisor problems
   • Harassment
   • Need for executive coaching
   • Increased work hours or job demands
   • Job loss or retention (supervisor guilt)
   • Job demotion or promotion

Health care providers need to be aware of indications for referral. Indications for urgent psychiatric review include:

• Risk of suicide or self harm;
• Risk of violence to others;
• Marked severity of symptoms, such as severe anxiety or sadness;
• Problems with thought organisation;
• Ongoing drug or alcohol abuse;
• Child abuse, which may be indirect through neglect; and
• Life issues or emotional crisis requiring rapid intervention.

Original research:

Diagnosis and referral of workplace depression

Jeffrey P Kahn, MD

J Occup Environ Med. 2008;50:396-400

Link to PubMed abstract