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Understanding Depression and Anxiety in the Workplace
TCHRA Spring ConferenceMay 20, 2014
Mark Meier, MSW, LICSW
My Perspective on Depression
Professional• Clinician - 19
years• Mental
Health/Crisis Experience
• Face It Foundation
Academician• U of MN Faculty
• School of Medicine• School of Social Work
• Curriculum Development
• Published articles• 200+ presentations
Face It Foundation
Our Mission“Through education, online tools, and peer support, Face It works with men to understand and overcome depression.”
Additional Perspective
My Perspective on Depression
Professional• Clinician - 19
years• Face It
Foundation• Consultant• Mental
Health/Crisis Experience
Academician• U of MN Faculty
• School of Medicine• School of Social Work
• Curriculum Development
• Published articles• 200+ presentations
Patient• Depression• Hospitalization• Treatment• Recovery
At That Time…
What If I Had Succeeded?
While I Was Depressed
• Completed college and graduate school• Administrator large dialysis clinic• Completed high-level research projects• Developed professional training courses for
physicians and medical schools
True or False?
We all get depressed from time to time?
The Answer Is…Probably Not
We all experience normal and generally temporary feelings of sadness, grief, anger, anxiety, fear, fatigue, agitation, and loss of hope. Depression is differentiated by intensity, duration, and impact.
Recurrent thoughts of death or suicide
The Depression Continuum
Mild Severe
ModerateSub-Threshold
Depression & Anxiety
In the National Comorbidity Survey (2005), 58% of patients diagnosed with major depression were found to have an anxiety disorder; among these patients, the rate of comorbidity with GAD was 17.2%, and with Panic Disorder, 9.9%.
Anxiety DisordersAnxiety Disorders affect about 40 million American
adults age 18 years and older (about 18%) in a given year, causing them to be filled with fearfulness and uncertainty. Unlike the relatively mild, brief anxiety caused by a stressful event (such as speaking in public or a first date), anxiety disorders last at least 6 months and can get worse if they are not treated. for the anxiety disorder.
http://www.nimh.nih.gov/health/publications/anxiety-disorders/introduction.shtml Accessed November 15, 2011
Types of Anxiety Disorders• Panic Disorder• Obsessive Compulsive Disorder• Generalized Anxiety Disorder• Post-Traumatic Stress Disorder• Specific Phobias“Each anxiety disorder has different symptoms, but
all the symptoms cluster around excessive, irrational fear and dread.”
http://www.nimh.nih.gov/health/publications/anxiety-disorders/introduction.shtml Accessed November 15, 2011
Depression Is…
• Pain for spouses and partners• Unpredictability for families and children• Frustration for those who watch their loved
ones struggle to improve• Misunderstood and “not real” to many• Immeasurable and intense suffering for those
afflicted• Leading cause of suicide
Death by Suicide
Death by Homicide
38,364
14,748
Centers for Disease Control, 2012
Suicide vs. Homicide - 2010
Male Female
30,277
8,087
Centers for Disease Control, 2012
Suicide by Gender- 2010
What Causes Depression?
It Depends On Who You Listen To…
“It is widely believed that major depressive disorder is the result of an imbalance of neurotransmitters in the brain that is believed to influence a person’s mood. It is suspected that this chemical imbalance in the brain may impair effective communication between nerve cells, resulting in MDD.”
www.lexapro.com (accessed February 8, 2011)
“There are many theories about the cause of depression. One common theory is that depression is caused by an imbalance of naturally occurring substances in the brain. Although the exact way that Cymbalta works in people is unknown, it is believed to be related to an increase in the activity of serotonin and norepinephrine which are two naturally occurring substances in the brain.”
www.cymbalta.com (Accessed February 8, 2011)
Antidepressant Treatment in the U.S.Antidepressants are the most common prescription medication for Americans age 18-44, and the third most common drug across all ages.
CDC/NCHS, National Health and Nutrition Examination Surveys, 2005–2008, Slide courtesy Susannah Tye, PhD - Mayo Clinic Depression Center
Recent Findings“The magnitude of benefit of antidepressant
medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial.”
Antidepressant Drug Effects and Depression Severity: A Patient-Level Meta-analysis. JAMA, January 6, 2010 – Vol ume 303, No. 1
Additional Findings“There has been a recent significant increase in
polypharmacy involving antidepressant and antipsychotic medications. While some of these combinations are supported by clinical trials, many are of unproven efficacy. These trends put patients at increased risk of drug-drug interactions with uncertain gains for quality of care and clinical outcomes.”
National Trends in Psychotropic Medication Polypharmacy in Office-Based Psychiatry. Archives General Psychiatry. 2010; 67 (1): 26-36
What Really Causes Depression?
“The mechanisms of complex disorders such as depression cannot be defined by simple etiological models. With burgeoning neurobiological information, it is evident that depression is a disorder of multiple neurobiological systems involving molecular, cellular, neuroanatomical, neurochemical, neuroendocrinological, neurophysiological, and neuropsychological domains mediated by multiple etiological factors including genetic vulnerability, developmental insults, and psychosocial stressors”
Risk Factors in Depression. Keith Dobson and David Dozois. Elsevier 2008
www. http://www.health.harvard.edu/newsweek/what-causes-depression.htm Accessed March 19, 2014
Depression And The Workplace
“No employer is exempt from the adverse consequences of depression in the workplace.”
Paul Greenberg, M.S., M.A.
Director, Health Economics Practice“Is Depression a Roadblock to Career Success?” March 22, 2004
The Evidence “Major depressive disorder (MDD), a highly debilitating and widely distributed illness in the general population, is ranked by the World Health Organization as among the most burdensome diseases to society. Thus, nearly 30 million of the US adult population may be affected by MDD, with approximately one-third being classified as severely depressed. Severe depression has profound social and economic consequences, with individuals often experiencing high rates of complicating comorbidities and mortality (e.g.,increased risk and poor outcome of cardiovascular disease and suicidality), reduced quality of life, and significant personal and societal costs due to decreased work productivity, increased absenteeism, and utilization of health care services.”
Christopher V. Goff, JD,MA CEO, Employers Health Purchasing Corp. of Ohio Depression in the Workplace, Vol 1 #1, 2006
For every depressed individual, it is estimated5-6 additional individuals are directly impacted in their day to day activities and functioning.
How Does Depression Impact Others In Your Company?
• Creates negative team environment• Can lead to frustration and anger between
colleagues• Creates environment of mistrust• Disrupts workflow and project management• Interferes with new ideas, creativity, and
initiative
Economic Burden of DepressionD
olla
rs in
Bill
ions
1990 2000 2013(projected)
$43b
$83b
$107b
*Greenberg P, et al. The Economic Burden of Depression in the United States: How Did it Change Between 1990 and 2000? J Clin Psych, 64:12, Dec 2003
“Presenteeism”(Decreased ability to perform duties
at work due to depression)
Presenteeism Absenteeism
$35.7Billion
$8.3Billion
One Large Insurer
• $438/month PMPM cost for health care provided to men diagnosed with mood disorder - depression
vs. • $173/month for men without diagnosis
depression
How Depression Impacts Individuals at Work
I am unmotivated to get things done
I have difficulty concentrating
Tasks seem overwhelming
I have difficulty making it into the office or I leave early
I suffer from chronic physical pain that makes it uncomfortable for me to work
I have more problems with co-workers
I use substances such as alcohol or drugs
83%
82%
62%
45%
24%
20%
6%
How Would Your Organization Compare?
“Can people acknowledge they have depression at this company and still get ahead in their careers?
Employeeswith depression
Benefit ManagersMiddle Managers
41%Agree
76%Agree
86%Agree
University of Michigan Depression Center, 2005
“The company has taken steps to ensure support by co-workers & supervisors”
Employeeswith depression
Middle Managers Benefit Managers
37%Agree
72%Agree
83%Agree
University of Michigan Depression Center, 2005
“People can acknowledge they have depression at this company and be treated with respect & compassion”
Employeeswith depression
Middle Managers Benefit Managers
51%Agree
95%Agree
90%Agree
University of Michigan Depression Center, 2005
Creating REAL Impact• Think Differently…• Offer regular trainings and promote genuine
conversations• Create an environment where individuals
want to come forward
Creating REAL Impact• Encourage and EXPLAIN the EAP• Support those who need treatment• Promote a Healthy Workplace• Identify Resources
