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Productivity impact of stigma in the
workplace: A Global Perspective
Sara Evans-Lacko, PhD
Overview
1. Context around economic and social impact of
workplace mental health problems in Europe
2. Factors associated with improved workplace
openness, including productivity
3. How can we engage employers and managers
to promote mental health
Mental health problems in the workplace
• By far, the greatest contributor to the overall economic impact of mental health problems is loss in productivity…. but
• Beliefs reported by employers (survey of 500 UK employers)– 44% thought employees ‘suffering from stress are able to work effectively at
all time points
– 42% thought workplace policies for mental health / stress were designed to avoid litigation
• Global INDIGO survey (35 countries) showed 71% of people with depression conceal their diagnosis in the workplace
• Public stigma and workplace culture may influence both openness and disclosure and productivity
3Lasalvia, et al., 2013 Lancet; Henderson et al. 2013 BJP
Productivity
90%Mortality
6%
Service costs
4%
Total cost = £9 bn
Thomas & Morris Brit J Psychiatry 2003
Presenteeism costs (not shown) could be up to five times the size of absenteeism costs
Costs of depression for adults in England–absenteeism & unemployment
Mental illness & employment
Source: OECD, Sick on the job. Myths and realities about mental health and work, 2012.
0
20
40
60
80
100
Severe disorder Moderate disorder No disorder (↘)
Marmot Review 2010
Comparative employment rates by disability
0
5
10
15
20
2006 2010
% u
ne
mp
loye
d
No mental healthproblems
Mental healthproblems
Recession, unemployment, stigma (EU)
Source: Evans-Lacko, Knapp, McCrone, Thornicroft, Mojtabai PLOS ONE 2013
Recession widened the gap in
unemployment rates between
individuals with and without MH
problems …
The disadvantage facing people with mental health problems is greater in countries with higher levels of stigmatizing attitudes towards mental illness.
Probability of rejecting a person with depression for a job, by employment status
Angermeyer, M., Matschinger H., Schomerus, G., SPPE, 2013
What factors improve / worsen social exclusion in the workplace
9
Participant characteristics (n=7,065)
10
• 7 European countries • 7 European countries: Denmark, France, Germany, Italy, Spain, UK,
Turkey
• ~1,000 respondents / country who were in employment
• 20% of employed respondents reported a previous diagnosis of depression
11
Individual
Workplace
Country level
Likelihood of disclosure to employer
Perceived discomfort regarding depression in the workplace
Study 1
12
Country / Population level
variableIndividual level variable
0.7
0.73
1.55
2.08
1.03
0 0.5 1 1.5 2 2.5
Female gender
Offered help
Offered flexible working pattern
Avoided talking about it
Replacement ratio
Odds ratio
Employees feeling uncomfortable
Greater than 1 represents a greater likelihood of discomfort
Likelihood of disclosure to an employer
Population level variableIndividual level variable
1.49
3.06
2.05
0.5
1.31
2.16
0.5
0.59
1.02
0 0.5 1 1.5 2 2.5 3 3.5
Female gender
Older age (45-54 relative to 16-24)
Middle age (25-44 relative to 16-24)
University education
Working in a larger company
Offered help
Offered flexible working pattern
Encouraged talking to healthcare prof.
Replacement ratio
Greater than 1
represents a
greater likelihood
of disclosure
DO THESE FACTORS INFLUENCE PRODUCTIVITY AND COST
14
15
Individual
Workplace
Country level
Presenteeism
Absenteeism
Study 2
0 0.5 1 1.5 2 2.5
Avoid talking about it
Offered help
No manager support
Fear losing job
Employer wouldn't understand
16
Country / Population
variable
Individual level variable
Factors associated with absenteeism
Greater than 1
represents a
greater likelihood
of absenteeism
Controlled for: gender, age, education, country prevalence depression, GDP
*
*
*
*
0 0.2 0.4 0.6 0.8 1 1.2 1.4
Avoid talking about it
Offered help
No manager support
Fear losing job
Employer wouldn't understand
Factors associated with presenteeismamong employees with depression
17
Country / Population level
variable
Individual level variable
Greater than
1 represents
a greater
likelihood of
presenteeism
Controlled for: gender, age, education, prevalence depression, GDP
*
*
*
*
Can we make a case for investment to employers?
18
Case for investment is most effective when it is sector specific
Make sector specific outcome and economic arguments: Demonstrate that mental health can be improved by in the workplace, but also economic benefits to employer
Cost payoffs from an employer based perspective for screening & treatment of employees with depression over 27 months in Germany
Hypothetical cohort of 500 employees
(€)
Total insured population in Germany 3 (€)
Pharmacotherapy
Intervention costs1 41,491 3,136,719,600
Additional healthcare costs 26,908 2,034,244,800
Productivity losses (absenteeism) -37,404 -2,827,742,400
Productivity losses (presenteeism) -62,097 -4,694,533,200
Psychotherapy
Intervention costs 53,515 4045734000
Additional healthcare costs 26,908 2034244800
Productivity losses (absenteeism) -38,180 -2,886,408,000
Productivity losses (presenteeism) -62,097 -4694533200
Evans-Lacko et al., 2016
From the perspective of the employer, both pharmacotherapy and psychotherapy appear cost-
saving, despite costs of screening all employees
Growing evidence supporting anti-stigma programmes targeted at the workplace
Employers are interested but outreach is needed to link evidence and practice
Summary & Conclusions• Mental health problems are common in the workplace and associated with
significant social and economic impacts
• People with mental illness are disadvantaged -- even compared with other disability
• Employers/managers can facilitate a positive culture of openness and capacity to support people with mental health problems
• This can in turn influence productivity--more openness and comfort to offer help and support the employee rather than avoid them is associated with less absenteeism and more presenteeism
• Employers are beginning to engage with workplace
• Need to make sector specific case to employees –there is a case for investment from the employer perspective
• Employers need direct support to implement effective programmes which reaches managers but also employees
Thank you for your attention
Contact: S.Evans-Lacko@lse.ac.uk
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