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Depression

Once assessment and planning have been completed, including analysis of the collected data, the next step is implementing the strategies and interventions that will comprise the workplace health program. The intervention descriptions on this page include the public health evidence-baseThe development, implementation, and evaluation of effective programs and policies in public health through application of principles of scientific reasoning, including systematic uses of data and information systems, and appropriate use of behavioral science theory and program planning models. for each intervention, details on designing programs related to depression, and links to examples and resources.

Before implementing any interventions, the evaluation plan should also be developed. Potential baseline, process, health outcomes, and organizational change measures for these programs are listed under evaluation of depression programs.

The mental health of workers is an area of increasing concern to organizations. Depression is a major cause of disability, absenteeism, presenteeism, and productivity loss among working-age adults. The ability to identify major depression in the workplace is complicated by a number of issues such as employees’ concerns about confidentiality or the impact it may have on their job that cause some people to avoid screening.

  • In a given year, 18.8 million American adults (9.5% of the adult population) will suffer from a depressive illness1
  • It is estimated that 20% of people aged 55 years or older experience some type of mental health issue. Depression is the most prevalent mental health problem among older adults2
  • Approximately 80% of persons with depression reported some level of functional impairment because of their depression, and 27% reported serious difficulties in work and home life3
  • Only 29% of all persons with depression reported contacting a mental health professional in the past year, and among the subset with severe depression, only 39% reported contact3
  • In a 3-month period, patients with depression miss an average of 4.8 workdays and suffer 11.5 days of reduced productivity1
  • In 2003, national health expenditures for mental health services were estimated to be over $100 million4
  • Depression is estimated to cause 200 million lost workdays each year at a cost to employers of $17 to $44 billion5, 6
  • Research shows that rates of depression vary by occupation and industry type. Among full-time workers aged 18 to 64 years, the highest rates of workers experiencing a major depressive episode in the past year were found in the personal care and service occupations (10.8%) and the food preparation and serving related occupations (10.3%)7
  • Occupations with the lowest rates of workers experiencing a major depressive episode in the past year were engineering, architecture, and surveying (4.3%); life, physical, and social science (4.4%); and installation, maintenance, and repair (4.4%)7

Depression is a complex condition characterized by changes in thinking, mood, or behavior that can affect anyone. Depression is influenced by a number of factors such as genetics; physiology (e.g., neurotransmitters), psychology (e.g., personality and temperament), gender, and the environment (e.g., physical environment and social support). Depression in working populations is equally complex and the causes are not well understood. However, there is recognition that both work and non-work related risk factors play a role such as the effects of worksites that produce excessive job stress on employees and employees’ depression effect on the worksite.8

Evidence linking work organization with depression and other mental health problems, and with increased productivity losses, is beginning to accumulate. A number of studies of a diverse group of occupations have identified several job stressors (e.g., high job demands; low job control; lack of social support in the workplace) that may be associated with depression. Although the evidence is mounting of the links between job stress and depression, there is less evidence of effective interventions to prevent depression in the workplace. There is a need to better understand organizational practices to reduce job stress, and aspects of job design that contribute to poor mental health, so that interventions can be developed to interventions that effectively target these risk factors in the workplace.9

However, there are a number of strategies employers can pursue to support employees’ mental health such as holding depression recognition screenings; placing confidential self-rating sheets in cafeterias, break rooms, or bulletin boards; promoting greater awareness through employee assistance programs (EAP); training supervisors in depression recognition; and ensuring  workers' access to needed psychiatric services through health insurance benefits and benefit structures.

In addition to its direct medical and workplace costs, depression also increases health care costs and lost productivity indirectly by contributing to the severity of other costly conditions such as heart disease, diabetes, and stroke. However, routine, systematic clinical screening can successfully identify patients who are depressed, allowing them to access care earlier in the course of their illnesses. Research suggests that 80% of patients with depression will improve with treatment.10

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Health-related programs for depression8,11    

Employee programs refer to activities that include active employee involvement, such as classes, seminars or competitions. Employee programs are frequently provided on-site at the workplace.

Employee Assistance Programs (EAPs) can offer information and referral services for employees with symptoms of depression
  • Active EAPs are one of the most effective ways to support employees with depression or other mental health problems, by offering counseling and referral services.
  • Optimal EAP programs are well integrated into the workplace; provide ongoing programming to engage current and future clients; offer customized services based upon the needs of the specific workplace and workers; and are responsive to acute and emerging workforce events, stressors, and changes
  • It is important to recognize that EAP programs, because they are generally contracted benefits outside of the organization, are often not able to address workplace issues that impact mental or physical health that relate to the work environment or organizational practice
Worksite health promotion programs such as physical activity are good adjunct therapies in preventing and treating depression
  • Employees who participate in physical activity programs can decrease depression symptoms and sometimes avoid mild depressive episodes
  • The health-related program strategies and interventions listed for physical activity include lifestyle activities recommended to address depression.
Raise awareness of the signs and symptoms of depression among managers and employees through training
  • Managers and employees who are able to recognize the signs and symptoms of depression such as tardiness, complaints of fatigue, reduction in work output or quality, safety problems or accidents, and changes in attitude may help in the early identification and referral to screening and treatment services for affected employees
Employee engagement/climate surveys can also provide information about relationships in the workplace and highlight areas where improvements can be made
  • Surveys can be used to ascertain information about relationships among coworkers (e.g., conflicts); job demands such as time pressures or physical demands; and assess the level of support provided by supervisors and colleagues which may contribute to the mental health of workers and be used to develop training, communications, or other interventions to address mental health in the workplace

Tools and Resources (more)

  • The Centers for Disease Control and Prevention's (CDC) Mental Health Workgroup provides basic public health information and data on mental health as well as links to mental health organizations by state
  • Mental Health America’s Factsheet: Co-occurring Disorders and Depression [http://www.mentalhealthamerica.net/index.cfm?objectid=C7DF94C1-1372-4D20-C8FE4E509C20471B] describes the prevalence of depression co-occurring with other medical illnesses such as chronic disease and substance misuse
  • Mental Health America’s Factsheet: Depression: What You Need to Know [http://www.mentalhealthamerica.net/go/information/get-info/depression/depression-what-you-need-to-know/depression-what-you-need-to-know] provides basic facts, symptoms, and treatment information on depression
  • Mental Health America’s Factsheet: Depression in the Workplace [http://www.mentalhealthamerica.net/index.cfm?objectid=C7DF951E-1372-4D20-C88B7DC5A2AE586D*] provides basic facts, symptoms, and employee attitudes toward depression
  • The Partnership for Workplace Mental Health is a project of the American Psychiatric Foundation. Its website provides extensive resources to promote effective mental health programs in the workplace
  • The Surgeon General’s Report on Mental Health provides extensive background material on depression and other mood disorders

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Health-related policies for depression

Workplace policies promote a corporate “culture of good healthThe creation of a working environment where employee health and safety is valued, supported and promoted through workplace health programs, policies, benefits, and environmental supports. Building a Culture of Health involves all levels of the organization and establishes the workplace health program as a routine part of business operations aligned with overall business goals. The results of this culture change include engaged and empowered employees, an impact on health care costs, and improved worker productivity..”

Policies that enhance worksite lifestyle programs such as physical activity are good adjunct therapies in preventing and treating depression
  • The health-related policy strategies and interventions listed for physical activity include major lifestyle activities recommended to address depression
Policies that describe appropriate standards of conduct can support good mental health
  • These policies can describe how coworkers should treat one another and be part of larger training efforts to improve managers and employee understanding and skills in problem solving, effective communication, and conflict resolution

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Health benefits for depression10, 12-13

Employee health benefits are part of an overall compensation package and affect an employee’s willingness to seek preventive services and clinical care.

Provide coverage for employees for low cost screening, diagnostic and treatment services for depression
  • Depression screening and treatment with psychotherapy and medications can be highly effective. Research suggests that 80% of patients with depression will improve with treatment
  • The United States Preventive Services Task Force recommends screening adults for depression in clinical practices that have systems in place to assure accurate diagnosis, effective treatment, and careful follow-up. Several depression screening tools used by primary care physicians, such as the Patient Health Questionnaire-9 (PHQ-9) are short and simple to administer. These screening tools consist of standard questions that assess the number and severity of an individual’s depressive symptoms. The screening results are used by primary care physicians to assure accurate diagnosis, effective treatment, and careful follow-up
  • The American Academy of Occupational and Environmental Medicine (ACOEM) supports the use of clinical depression screening tools to identify employees at risk for depression
  • A recent study showed a 6.1% increase in productivity and 22.8% fewer absences over two years for depressed individuals who received regular phone calls to encourage them to continue with depression treatment and medication. Employers saved more than $2600 annually for each employee
  • Most patients with depression present and are treated in the primary care setting. Patients who screen positive for depression and are diagnosed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnostic interview should begin treatment in the primary care or specialty mental health care setting or be referred for treatment to a mental health professional
  • A primary care treatment plan can include pharmacological therapy (such as tricyclic anti-depressants and selective-serotonin reuptake-inhibitors [SSRIs]), psychotherapy, or a combination of the two
Provide coverage for screening and counseling to reduce alcohol misuse
  • Other mental health disorders frequently co-occur with depression. For people struggling with co-occurring mental health and depression disorders, physical safety and overall health risks are greater; the impairment of life skills is greater; and the chances for successful treatment are much less
  • Depression and other mental health problems often lead to alcohol and substance misuse problems and may predate the substance misuse by 4-6 years; alcohol or other drugs may be used as a form of self-medication to alleviate the symptoms of the mental disorder
  • In some cases, alcohol and substance misuse precedes the development of depression and other mental health problems. For instance, anxiety and depression may be brought on as a response to stressors from broken relationships, lost employment, and other situations directly related to a drug-using lifestyle
  • A person with diagnosed depression should be screened and treated as needed for other mental health problems including alcohol and substance misuse

Tools and Resources (more)

  • The CDC Healthier Worksite Initiative includes recommendations on mental health screening and links to a screening locator
  • National Business Group for Health’s A Purchaser’s Guide to Clinical Preventive Services: Moving Science into Coverage [PDF - 13KB] provides benefits package language for clinical depression screening
  • The Substance Abuse and Mental Heath Services Administration’s (SAMHSA) National Mental Health Information Center. National Suicide Prevention Lifeline Brochure: When it seems like there is no hope, there is help offers information and assistance for the National Suicide Prevention Lifeline’s free and confidential service
  • The Substance Abuse and Mental Health Services Administration's (SAMHSA) Screening, Brief Intervention, and Referral to Treatment (SBIRT) Initiative is a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for persons with substance use disorders, as well as those who are at risk of developing these disorders within community and/or medical settings-including physician offices, hospitals, educational institutions, and mental health centers. The website provides a single, comprehensive repository of SBIRT information including training manuals, online resources, links to organizations and publications, and a list of references

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Environmental support for depression

Environmental support provides a worksite physically designed to encourage good health.

Environmental support for worksite health promotion such as physical activity programs can decrease depressive symptoms
  • See health-related environmental support strategies and interventions listed for physical activity including activities recommended to address depression
Employers should take into consideration reasonable accommodations for employees that request them
  • The Equal Employment Opportunity Commission (EEOC) has developed guidance and regulations under the Americans with Disabilities Act (ADA) addressing the duties of employers to make reasonable accommodations to employees with disabilities including mental health problems. The EEOC has a number of fact sheets and information on the ADA and reasonable accommodations on its web site
  • Reasonable accommodations are usually initiated following a discussion between the employee and employer. The employer is not required to provide accommodations that would create an “undue hardship” on the organization, and the employee is not required to accept accommodations that have not been requested or are not wanted
  • Examples of reasonable accommodations include changes in work schedules (e.g., telework); job modification; and modifications to the work environment (e.g., change in physical work space)
Create a supportive work environment
  • Employers can promote a supportive work environment for good physical and mental health by creating a positive social environment including standards for how workers interact with one another and social support networks among employees; educating employees about mental health resources available to them such as EAP programs; ensuring confidentiality and an employee’s right to privacy; and reducing stigmas associated with mental health issues by educating managers and employees about mental health, treating people with mental health problems with respect and dignity, and not labeling them by their condition

Tools and Resources

  • The Substance Abuse and Mental Health Services Administration (SAMHSA) has developed Workplaces That Thrive: A Resource for Creating Mental Health-Friendly Work Environments to help human resources professionals understand the benefits and design of a mental health-friendly workplace
  • The Substance Abuse and Mental Health Services Administration (SAMHSA) has developed Workplaces That Thrive: A Resource for Creating Mental Health-Friendly Work Environments to help human resources professionals understand the benefits and design of a mental health-friendly workplace
  • Mental Health America’s Factsheet: What to Do When You Think an Employee May Need Mental Health Help [http://www.mentalhealthamerica.net/go/employee-may-need-mental-health-help] provides strategies on establishing a mentally healthy working environment including investments in mental health benefits such as prevention and educational programs
  • National Business Group on Health’s An Employer’s Guide to Behavioral Health Services [PDF - 769KB] provides a number of evidence-based actionable strategies and recommendations that will allow employers to create and implement a system of affordable, effective, and high-quality behavioral health services. This report was done in collaboration with the Substance Abuse and Mental Health Services Administration (SAMHSA)
  • The Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Registry of Evidence-based Programs and Practices Model Programs for the Workplace (NREPP) [http://www.dsgonline.com/workplace_kit_testsite/pdf/nrepp.pdf* (PDF)] provides specific techniques and interventions that have been carefully implemented and evaluated and shown positive outcomes
  • The Substance Abuse and Mental Health Services Administration (SAMHSA) created the What a Difference a Friend Makes Campaign to encourage, educate, and inspire people between 18 and 25 to support their friends who are experiencing mental health problems
  • The Substance Abuse and Mental Health Services Administration (SAMHSA) has developed six Evidence-Based Practice Implementation Resource Kits to encourage the use of evidence-based practices in mental health. The kits contain information sheets, videos, and workbooks and manuals for practitioners

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