YOUR HEALTH AT WORK: DEALING WITH DEPRESSION ON THE
By Carol Milano
If a member is depressed, isn't that a personal problem? Why
would it matter to a supervisor? A major reason is that American
employers are losing as much as $44 billion each year due to
workers who are seriously depressed. Most of those costs are
invisible -- depressed people still report to work, but are probably
less effective than usual. Too many of them are not getting the
help they need.
What causes depression? Since family life is more important
than work to most of us, domestic events, such as a divorce or
a new child, are frequent triggers. Work situations can also
lead to depression. "One very stressful situation is having
a job with a great deal of responsibility, but not enough authority
to carry it out. Another is being in a workplace where you don't
feel the culture is fair and honest, so that you expect to get
back less than you put in," explains Jeffrey Kahn, MD, Clinical
Associate Professor of Psychiatry at Weill Cornell Medical College
in New York.
A tragedy, such as a bus accident or a police officer being
shot, can bring out strong emotions, as can the downsizing of
a department when many co-workers are laid off. "Particularly
for someone with other problems, any of these can trigger a depression,"
Dr. Kahn notes. "Having an unusually difficult boss can
lead to depression for some workers. A supervisor doesn't usually
have evil intentions, but may need training or guidance in order
to do a better job. In fact, a supervisor may even become depressed
because of anxiety about a promotion, and having to cope with
feeling like a boss instead of a team member after many years."
Dr. Kahn recommends that union officials stay alert to any
department with more accidents than usual, higher absenteeism,
greater medical costs, and more requests for transfer. These
can be a clue that something in that department needs to be explored;
often, the problem may be one specific supervisor.
Symptoms of Depression
The two main types of depression have somewhat different symptoms.
Major depression shows a marked change from how the member has
usually been perceived. He or she may be crying, fatigued, and
appearing not to enjoy anything. A supervisor might notice decreased
productivity; less efficiency; more use of medical care; mention
of suicide, hopelessness or family problems; or even signs of
doing drugs. It is important to notice problems early, so that
members can get help before they feel worse.
Atypical depression presents a more subtle contrast to the
members typical state. Co-workers or a boss could observe irritability,
great sensitivity to criticism, lethargy, and a degree of withdrawal.
Several factors contribute to lower productivity. Depression
can impair concentration, so that a member can't do the job no
matter how hard he or she tries. "More absenteeism or lateness,
less interaction with co-workers, and more irritability or arguments,
which disrupt performance, are also common," Dr. Kahn reports.
He also cites a condition known as ‘presenteeism: a member
who shows up physically but accomplishes little. "Some people
who feel like they can't get up in the morning manage to force
themselves to get to work, but arent themselves when they are
How To Help a Depressed Member
Many people see depression as a weakness, so they try to deny
it. However, "these problems are real," Dr. Kahn maintains.
A supervisor's goal is to help the member get needed assistance.
Approaching someone who seems depressed requires some sensitivity.
"Try to keep a businesslike perspective -- you don't want
them to feel like youre intruding," he advises. A possible
opening could be saying, "Joe, you seem a little less involved
in your work and kind of sad. Would it help to talk to someone?"
The member may reply, "No, I'm okay," or explain
it by saying, "I just can't learn to use this new computer."
That's because people often don't realize theyre depressed. Dont
contradict -- use what they're telling you, and put things in terms
people can understand. Try saying, ‘It seems like this
computer problem has really gotten to you. Maybe if you talk
to someone, you'll be more relaxed about it."
A supervisor also has to consider the seriousness of the situation.
Are any risk factors involved? Does the member talk about hopelessness
or suicide? "If a bus driver or police officer is seriously
depressed, you have to question their judgment: is it okay for
them to be working? And if their performance will affect future
evaluations, intervene in a supportive way. Talk to the member
to see what's going on, starting with what you already know,"
Dr. Kahn suggests.
Barriers to treatment can include fear of stigma (though less
prevalent than in the past), and people who are unaware of their
own unhappiness and attribute it to other things. If a member
feels that seeking help means he or she has emotional problems,
it's easier to believe the difficulty is just a computer problem,
Any EAP may be a good first step. It's less intimidating, and
an EAP staff member may be able to refer the member to a psychiatrist
in your health plan network. "A good psychiatric consultation
can provide diagnosis, develop a treatment plan, and start getting
things back on track," says Dr. Kahn, an expert in workplace
depression. "The right approach can make things much better
for a member."
Treatment and Recovery
Symptoms of possible depression may also indicate an anxiety
disorder, a thyroid problem, or some other condition, so an accurate
diagnosis is essential. A good psychiatrist or another mental
health professional specialist specifically trained in depression
can make the determination. Different types of treatment are
available, including support groups and psychotherapy; prescription
medication is commonly used together with therapy.
Can a patient work during treatment? Modern anti-depressant
drugs have few serious side effects, and seldom affect job performance.
However, severe depression will usually require some time off.
"It depends on the exact diagnosis and the members personality,"
Dr. Kahn observes. "On safety-sensitive jobs, a patient
may have to be reassigned, temporarily, simply because of the
condition, until he or she gets better." Medication typically
starts working after 3 or 4 weeks; therapy to understand the
problems may take a little longer.
After being treated for depression, people show a range of
responses when coming back to work. "Some get back in the
saddle immediately, while others need time to get back up to
speed," Dr. Kahn has found. Supervisors should be alert
to any problems when a member returns to work, and accommodate
members treatment appointments whenever possible.
Dr. Kahn sees a growing awareness of depression in the workplace -- a problem that is certainly not going away. Unfortunately,
insurance coverage for mental health is declining, on average.
Currently, internists prescribe 70% of anti-depressant drugs;
this is cheaper than seeing a specialist but does not include
psychotherapy, which may be important for helping the patient
recover. "Getting on the right anti-depressant will address
the symptoms but not treat the issues that have caused them,"
he says. However, given the realities of today's insurance limits,
"Use the best resources available to you," he recommends.
The right approach to depression can definitely make things
better for a troubled member. While the problem can't be figured
out in the workplace, it can usually be treated successfully
once a member is referred for help.
RESOURCE FOR READERS AND MANAGERS: The new
book, "Mental Health and Productivity In The Workplace:
A Handbook For Organizations And Clinicians" (Jeffrey P.
Kahn and Alan M. Langlieb, Editors; Jossey-Bass/Wiley, 2003),
was developed specifically for Human Resource and other managers
(available online at: www.WorkPsychCorp.com/handbook.tpl).
of these articles appear on the publication's website, which
are often password-protected or members-only. For your convenience,
I've gathered them on my own website.