Take Home Messages:

Optimising depression management in the workplace gives a 10% increase in productivity and reduces the number of days employees are absent by 25%. Although the costs of better treatment may be higher, they should be considered in light of these significant improvements to workplace efficiency.

Depression worsens other chronic illnesses a person may have, such as diabetes, and is likely to make people less healthy by disrupting their diet, exercise and taking of prescribed medications.

Depression makes people more likely to develop unexplained medical problems such as non specific tummy pain.

People on long term disability due to chronic pain are more likely to be depressed. Such patients should be screened for depression.

Increased attention should be given to the prevention of depression, and screening of individuals based on known risks for depression.

Why the research matters: 

Depression has significant associated direct and indirect costs.

Despite good evidence for the benefits of optimal management of depression, substandard care persists.

There is a large gap between knowledge and practice.

There are complex links between depression, chronic pain and ongoing serious illnesses. Improving the management of depression is likely to have flow on effects on other ongoing illnesses and medical complaints.

What the research involved:

The authors have reviewed literature relevant to depression to produce a guide for occupational and environmental practitioners.

The article aims to explore:

• The development and persistence of unexplained medical symptoms such as pain in depression;
• The impact of depression on social and occupational functioning;
• The adverse effect of depression in patients with other chronic medical illness in regards to their general health, exercise, diet and taking of medication as prescribed;
• Medical outcomes associated with depression; and
• The significant direct and indirect costs of depression.

Summary of research findings:

The accuracy of diagnosis and standard of care of depression is suboptimal.

Optimising depression management in the workplace will give a 10% increase in productivity and reduce the number of days employees are absent by 25%.

Somatisation is the name given to the appearance of physical symptoms in the absence of any discernible physical abnormalities. The presence of such medical symptoms is very common in depression. They are often the initial reason for attending a care provider. The number and severity of such symptoms increases with the degree of psychological distress and the duration of impairment seen in an individual’s depressive episode.

Patients with depression have a heightened sensitivity to symptoms of other coexisting illnesses. For example, if two people both have diabetes (of identical severity) but one also has depression, the person with depression will report more symptoms of diabetes such as increased thirst. 

Patients with chronic (long term) illnesses are more likely to suffer depression than healthy persons. Depression will worsen the outcome of a chronic disease and make complications more likely.

Depression reduces adherence to medications. It also promotes unhealthy lifestyle though poor diet and exercise and makes people less likely to stop smoking.

Depression causes measurable biological changes such as altering cells involved in blood clotting. However, these effects are not well understood.

Depression early in life is a risk factor for developing chronic pain. Chronic pain is a risk factor for the development of depression.

People on long term disability due to chronic pain are more likely to be depressed. Such patients should be screened for depression.

Depression is a problem for medical practitioners as it:

• Causes patients to attend their care provider complaining of physical symptoms such as fatigue and pain;
• Compromises the medical care of other long-term conditions; and
• Makes establishing the cause of chronic pain more difficult.

Original research:

Gaps in Depression Care: Why Primary Care Physicians Should Hone Their Depression Screening, Diagnosis, and Management Skills

Michelle D. Seelig, MD, MSHS Wayne Katon, MD

J Occup Environ Med • Volume 50, Number 4, April 2008(2008;50:451–458)

Link to PubMed abstract