Take Home Messages:

Depression interferes with optimal employee well-being and function. It can contribute to anything from absenteeism to reduced attention to safety procedures.

Some of the main barriers to the effective management of depression include:

• A failure to effectively recognise and treat depression in the workplace;
• Stigma attached to depression and potential propagation by management;
• Poor referral to specialist and psychotherapy services; and
• Failure to properly train and educate those in supervisory roles.

Organisations can manage depression by developing systems that:

1. Recognise the presence and influence of a depressive illness. Remember that it is very common. Become skilled at screening and testing for depression.
2. Refer workers appropriately. Become familiar with local resources and develop a referral network.
3. Manage care through a dedicated case or care manager. Optimise medical care. Assist worker to overcome any barriers they face.
4. Advocate for all stakeholders to maximise worker productivity and health. This will include education about depression.

Why the research matters:

Depression is a common, costly and complex problem. It is important to understand the barriers that exist to the proper recognition and management of depression, as well as factors that impede education and advocacy.  Awareness of these barriers will help optimise management across all levels of the workplace.  

What the research involved:

The study is aimed at occupational and environmental practitioners. It aims to provide an update on the management of depression in the workplace. The study reviewed relevant medical literature and identified the following key issues:

• Relevant consequences of work place depression;
• Present barriers to its management; and
• The importance of ‘optimal integration’ by practitioners.

These ideas are discussed in relation to current practice. Potential future strategies and practice ideas are also raised.

Summary of research findings:

Consequences of depression in the workplace include:

• Decreased attention to safety;
• Possibility of reduced recovery from other illnesses/injury;
• Increased workers’ compensation costs;
• Complication of return to work practices;
• Reduction in productivity and increased absenteeism;
• Medication side effects such as drowsiness; and
• Interference with health promotion programs, such as smoking cessation.

Current barriers to the effective management of depression can be broken up into the following four groups:

1. Employee Factors:
   • Failure to perceive depressive symptoms, or misinterpretation of these symptoms;
   • Lack of motivation to seek help;
   • Confidentiality and privacy concerns;
   • Ignorance of treatment options / resources;
   • Stigma of depression / fear of labelling; and
   • Unconscious denial of symptoms.
2. Provider Factors:
   • Failure to recognise significant consequences of illness;
   • Failure to recognise depressive symptoms;
   • Failure to recognise previous episodes of depression;
   • Underutilisation of psychotherapy;
   • Ignorance of available mental health resources; and
   • Unwillingness to manage depression due to:
     • Lack of experience, training or skill;
     • Excessive workload;
     • Competing time demands;
     • Anticipated lack of reimbursement; and
     • Lack of interest.
3. Employer Factors:
   • Perception of depression management as a cost rather than an investment;
   • Unsupportive corporate culture;
   • Failure to train supervisors;
   • Perpetuation of stigma;
   • Failure to preserve privacy and confidentiality of medical issues; and
   • Lack of psychiatric services through limited health insurance and benefit structures.
4. Other factors:
   • The complex nature of depression as an illness;
   • The complex ties between workplace factors like job stress and depression; and
   • The general focus on acute problems and poor management of chronic problems.

Recommendations for practitioners:

1. Recognise the presence and influence of a depressive illness. Remember that it is very common. Become skilled at screening and testing for depression.
2. Refer workers appropriately. Become familiar with local resources and develop a referral network.
3. Manage care through a dedicated case or care manager. Optimise medical care. Assist worker to overcome any barriers they face.
4. Advocate for all stakeholders to maximise worker productivity and health. This will include education.

Interventions have only recently started to be evaluated for cost effectiveness. Practitioners should be aware of ongoing assessment of care models.

Original Research

A clinical perspective on workplace depression

Garson M. Caruso, MD, MPH

JOEM • Volume 50, Number 4, April 2008
 

Link to PubMed abstract