The worst thing for your mental health may be work or school. The other worst thing may be staying home.

by John McManamy


THESE ARE tough times, and Corporate America, Corporate Canada, and Corporate Everywhere Else have a lot to be scared of. What has changed over the years, however, is that psychiatric disability represents one of the highest concerns among employers. Ironically, the monster they fear may be the monster they helped create, such are the hazards of the modern workplace.

A 2003 AdvancePCS Center for Work and Health survey estimated that depression in the work place costs employers $44 billion a year. Twenty percent of the costs were due to absenteeism while 80 percent could be attributed to "presenteeism," ie reduced on-the-job productivity. Depression was estimated to result in 5.6 hours a week of lost productivity. The numbers do not include short and long term disability.

A 2010 Gallup Poll found that stress topped the list (at 32 percent) of things workers were least satisfied with about their jobs. Only 26 percent reported completely satisfaction with their on-the-job stress levels. Stress accounts for some $300 billion a year lost by US business in the form of absenteeism and other costs, and is often a prelude to depression.



Why Depression and a Career Don't Mix

In 2004, The NY Times reported on a University of Michigan survey of 443 depressed workers that found that only four in ten felt they could acknowledge their illness and still get ahead in their careers. Only 14 percent had taken advantage of employee assistance programs for workers who suffered from depression. Eight in ten of the depressed workers had difficulty concentrating, 8a simlar number lacked motivation, one in four complained of chronic physical pain, and 50 percent missed one to three days of work because of their illness.

At a session of the 2002 DBSA annual conference in Orlando, Daniel Conti PhD, then director of the employee assistance program at Bank One, talked about the many issues surrounding mental health at work:

At Bank One, in 1989, psychiatric disabilities (mostly depression) were the seventh-leading cause of short-term disability (STD) and fourth in STD days. By 2000, the figures were number two in both categories (number one is pregnancy and childbirth). "We're not an anomaly," Dr Conti reports. "Psychiatric disabilities are jumping in this country," at a pace that outstrips physical disabilities.




Part of the reason is depression and other mental illness tends to strike people in their productive years, as opposed to say heart disease, which takes its major toll in late life. Also, greater public and physician awareness and improved disability management programs have resulted in more people seeking treatment.

But public enemy number one appears to be today's work environment, with no end of potential stressors. Stress is now accepted as the most commonly endorsed health risk. The jobs that are most toxic are those with high responsibility and low control.

Vast numbers of us now working in information technology or customer service have more to fear from depression, which affects our ability to think and relate to people, than many types of physical injuries. An ad for a teller, for instance, reads: "Superior interpersonal skills ...handle delicate issues ... create enthusiasm."

"What would depressive illness do to that?" Dr Conti asks.



Run Like Hell From Disability

Once an employee has left his or her job, returning to work is very difficult. "Run like hell [from disability], if you can," Dr Conti advises. "Leave the job only if you have to, if you can no longer perform the job." Disability, he points out, is set up to provide job protection for an employee too ill to work. It is not curative, and will not make the job less stressful. Once away from the workplace, motivation for activity drops, with predictable results. Unfortunately, "we teach people to become disabled."

Achieving the opposite - enabling employees to stay on their jobs - is clearly a work-in-progress.

Do's and Don'ts of Depression and Work

At the same session, Dr Conti advised: build relationships at work, ensure a life outside of work, and find a way out if the workplace is toxic. Disclosing your illness to your boss or colleagues may or may not be appropriate. Two of the biggest mistakes, he said, are saying nothing, and walking around with a signboard with, "Ask me about my depression." A woman fearful of disclosing her depression to a male supervisor might hint at something gynecological, as men will run away from that, he advised.

If disability is appropriate, Dr Conti advised structuring days to include activity with other people, and include work issues in therapy. In returning to work after a disability, find out if it's possible to gradually go back to full time.

Depression and the Bank One Experience

In June 2001, the Wall Street Journal devoted a major portion of its feature pages to depression in the workplace. Among other things, it looked at the experience of Dr Conti's Chicago-based Bank One Corp. In 1991, Bank One discovered that treating depression cost the company's health plan nearly as much as to treat heart disease. Even more pronounced was depression's impact on absenteeism, with its employees losing 10,859 workdays over a two-year period compared to high blood pressure which resulted in 947 work days lost and diabetes which accounted for 795 days lost.

In response, Bank One developed an early intervention program involving manager and employee workshops and hiring a staff psychologist. The company also reduced out-of-pocket expenses for the first 12 therapy visits in its self-insured plan. But the HMOs involved with Bank One have been a disappointment, and the emphasis on short term therapy and quickly returning to work has created a revolving door of those who relapse. Ironically, Bank One's attempt to combat depression has resulted in four times as many employees on short term disability for depression over the 1989 rate. But Dr Conti told the Wall Street Journal: "In the long run, it will pay off in lower numbers of serious cases and more productive workers. People will get help earlier and arrest the disease in earlier stages.

Published 2000, latest update Jan 20, 2011, reviewed Dec 4, 2016


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