YOUR HEALTH AT WORK: DEALING WITH DEPRESSION ON THE JOB
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 there."

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, for example.

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).

Many 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.