Managing employee depression in the workplace.

Employee depression is a pervasive and costly problem in American business and industry. Recent research and new technology have improved our understanding of this malady but there are many myths and much that is unknown about its causes and cures. Managing employee workplace depression involves education and support and may also involve the organization in required accommodation and/or litigation. Common sense and good human resource management are essential.

Introduction

Clinical depression has become one of the most costly problems in the American workplace. It has been estimated that more than 19 million American adults (9.5% of the population) suffered from this disorder in 2001 (20). A study by the Massachusetts Institute of Technology found that depression costs American industry $43.7 billion annually (20). These costs include $23.8 billion in lost time due to absenteeism and reduced productivity, $7.5 billion in lost earnings due to depression related suicide and $12.4 billion in direct care costs. Costs could mount even further if a worker's untreated depression contributes to alcoholism, drug abuse or other physical or mental disorders.

The good news is that in more than 80% of cases, treatment is effective (20). Treatment, which normally involves medication and therapy, enables people with depressive symptoms to return to their normal activities. And nearly everyone gets some degree of relief.

Defining Depression

The newest evidence indicates that recurrent depression is a neurodegenerative disorder, disrupting the structure and function of brain cells, destroying nerve cell connections, even killing certain brain cells and precipitating cognitive decline. At the very least, depression sets up neural roadblocks to the processing of information and keeps us from responding to life's challenges (13).

This article reviews current findings concerning workplace depression, its causes, impact and costs and recommends actions managers can take to help afflicted employees.

Recent Findings. Using refined imaging techniques, medical and psychological research has begun to provide insights into the neurobiology of depression. Though in its infancy, the work reveals:

* Regarding depression as "just a chemical imbalance" wildiy misconstrues the disorder. It is not possible to explain either the disease or its treatment based solely on levels of transmitters.

Human emotions take shape in a neural circuit involving several key brain structures. In depression, faulty circuitry fails both in generating positive feelings and inhibiting disruptive negative ones.

* Stress-related events may kick off 50% of all depression, and early life stress can prime people for later depression.

* Depression is not just a disorder from the "neck up" -- it involves many body systems.

* Just as nerve cell connections can be destroyed in depression, perhaps they can be rebuilt.

* The adult brain has a degree of plasticity that is astonishing researchers. "The big news is the structural plasticity of the brain (13)."

In summary, the most important finding to come out of current research is this: There are long-lasting, even permanent, changes in structure and function that can affect the ways brains process information.

Myths of Workplace Depression

Recent research and new technologies, such as imaging techniques, are helping bring about a radically revised view of depression. In the process, researchers are debunking some long-held beliefs and "myths," such as the following:

"Depression Is Just a Chemical Imbalance in the Brain." Regarding depression as just a chemical imbalance greatly misconstrues the disorder. The latest evidence indicates that recurrent depression is a neurodegenerative disorder that disrupts the structure and function of brain cells, destroying nerve cell connections, even killing certain brain cells and precipitating cognitive decline. In a best case scenario, depression sets up neural roadblocks to information processing and keeps an individual from responding to life's challenges.

"Depression Is Strictly a Disorder from the Neck Up." Because it involves many body systems, depression can magnify and/or follow on the heels of other health afflictions, such as cardiac and osteoporosis problems and physical injury. It can be triggered by external events in a person's life or work environment. On the other hand, depression, fear and stress-related ailments can result from internal, physical factors -- like a faulty gene controlling a brain enzyme (13).

"Depression can by cured by medication."

Most episodes of depression are responsive to treatment (10). Moderate and severe cases will normally require medication in addition to psychotherapy. Mild cases may respond to psychotherapy alone.

Unfortunately, neither therapy nor medication bring quick results, and major depression is predominantly a recurrent illness. (Eighty percent of the people who have had one episode will eventually have another one at some future date (6)). The real value of antidepressants may be in the effect they have on neuronal plasticity. Thus, medication may help the brain adapt and adjust through structural change (3).

Common Symptoms

Managers can help employees get early treatment for depression by recognizing its symptoms and encouraging treatment. Some training may be necessary as no two people experience depression in the same manner, and symptoms vary in severity and duration among people. However, some common symptoms include:

* Persistent sad, anxious or empty moods

* Sleeping too little, early morning awakening or sleeping too much

* Reduced appetite and/or weight loss or increased appetite and weight gain

* Restlessness, irritability

* Persistent physical symptoms that don't respond to treatment (such as headaches, chronic pain or digestive disorders)

* Difficulty concentrating, remembering or making decisions

* Fatigue or loss of energy

* Feeling guilty, hopeless or worthless

* Thoughts of suicide or death

* Loss of interest in activities once enjoyed (15)

Common Causes

Insight into causation can aid employer efforts to assist employees in coping with depression. Such assistance might include accommodation (job design, workplace design, group assignment, flex time or workload adjustment, etc.) or provision of medical and psychological attention. Unfortunately, it is not yet clear what causes depression. However, some recent studies suggest that stress might play a significant two-way role -- as both a possible cause and a consequence of depression (3). The stress of social isolation, deprivation of maternal care in infancy, workplace and social stress and trauma may permanently sensitize the central nervous system so that it perpetually over-responds to stress. In addition, some inherited factors can create a biological vulnerability to depression. Then some early stressful experience, such as physical or sexual abuse, sets up the brain to overreact to environmental pressures. Then even small degrees of later stress can elicit an outpouring of stress hormones (13).

Recent findings indicate that smoking may also be a cause of depression. Additional study is required to determine whether the consequences are manifested through smoking's impact on general health or through other means [13]. It may also result from personal characteristics that make individuals susceptible to both smoking and depression.

Impact of Depression in the Workplace

The enormous cost of employee depression is felt in many ways that diminish worker productivity and increase employer costs of operation. Some relevant consequences of employee depression follow [11,13,20]:

* Higher health insurance costs

* Higher absenteeism and turnover

* Declining productivity

* Poor interpersonal relations

* Cognitive decline

* Reduced information processing

* Low motivation and slowed movements

* Loss of interest and goal focus

* Reduced ability to think and concentrate

* Impaired short-term memory

* Reduced ability to adapt to change and see alternatives

* Increased number and severity of accidents

* Higher workers compensation insurance costs

* Increased alcohol and drug abuse

* Anxiety and overreaction to stress

* Reduced morale and job satisfaction

* Increased tendency to focus on negative events

* Reduced desire to cooperate.

In addition to workplace consequences, employees may suffer any number of personal life consequences that affect their wellbeing and eventually impact workplace performance. Unfortunately, antidepressants may have undesirable side effects and may provide only temporary relief -- although most victims of depression can be helped. Dealing with the societal norms and personal prejudices associated with mental illnesses as well as the conflicting demands of federal law requires a delicate humanitarian economic balancing act (11). The culture and climate of the workplace has to be changed. Leadership training concerning the symptoms, costs and consequences of workplace depression as well as encouraging diversity and tolerance and reducing fear and stress can help to detoxify mental illness (14).

Costs of Depression