Take Home Messages:

Employers should be aware of and manage risk factors for depression.

Some risk factors such as a close family member with depression or previous depressive episodes cannot be modified. Others, like poor perceived job control and unclear and unattainable work goals, can be influenced by employers.

Employers should recognise and screen high risk employees as part of preventing depression.

Other prevention strategies include improving employee stress management and coping skills, as well as educating employees about work life balance and mental health.

Why the research matters: 

Depression is one of the leading causes of disability. People with depression cost their employers significantly more than colleagues without depression.

Depression rates are increasing and so will the associated costs if management is not improved.

What the research involved:

The author has reviewed research concerning factors that contribute to depression in the workplace and potential barriers to optimal management. The article focuses on possible interventions and means of preventing workplace depression.

Summary of research findings:

Modifiable and non-modifiable risk factors exist for depression. Knowledge of these factors may help to identify people at risk of depression. Modifiable risks may be targeted by employers in prevention strategies.

Non modifiable factors (cannot be changed):

• Genetics (having a close family member with depression);
• Female gender (twice as likely to become depressed than males);
• Poor parenting;
• Predisposed personality types;
• Anxiety that starts early in life;
• History of trauma or abuse;
• Having had a serious episode of depression previously; and
• A serious physical disorder, such as long term back pain.

Modifiable but not obviously work related factors:

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

Modifiable workplace factors that can be addressed by employers:

• Workplace stress;
• Burnout, where employers 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;
• Unclear or unattainable work goals; and
• Unemployment.

The study recommends employers focus on the following key areas for prevention.

1. Primary Prevention (preventing the illness occurring in the first place), which includes:
   • Assessing company culture and staff attitudes;
   • Educating about and promoting mental health;
   • Promotion of healthy work-life balance;
   • Prevention of burnout, which includes identifying those with high job stress;
   • Supportive management structure;
   • Improved social supports at work;
   • Improving perceived job control;
   • Improved emotional attention from others at work; and
   • Clear job descriptions and well defined advancement paths.

   Not all of these recommendations will be suitable to small to medium sized organisations

2. Secondary prevention (early recognition of illness and intervention):
   • Identifying high risk individuals, such as those who are frequently absent or complain of stress;
   • Screening of high risk individuals; and
   • Identifying and managing burnout.
3. Tertiary prevention:
   • Optimisation treatment of symptomatic disease;
   • Aim to reduce symptoms, improve function and reduce relapse;
   • Medication therapy;
   • Psychotherapy (usually counselling with a psychologist);
   • Proper referral and utilisation of available health resources; amd
   • De-stigmatise illness.

Original research:

Challenges and Opportunities for Preventing Depression in the Workplace: A Review of the Evidence Supporting Workplace Factors and Interventions

Gregory P. Couser, MD, MPH

J Occup Environ Med. 2008; 50: 411–427

Link to PubMed abstract