AAOHN: 'How to Really Address Depression in the Workplace'

Laura McKibbin and Kelly Putnam believe that managing depression is a "huge untapped opportunity" for U.S. employers. They also believe that occupational health professionals are in the best position to address the problem of depression in the workplace.

Speaking at the American Association of Occupational Health Nurses' 2006 Symposium and Expo in Albuquerque, N.M., McKibbin and Putnam asserted that there's a compelling case for focusing more company energy and resources on managing workplace depression. To support that contention, they noted that depression is:

  • Prevalent Depression currently affects about 19 million Americans each year, according to the National Institute of Mental Health;
  • Costly Depressed workers generate twice the health care claims as non-depressed workers, according to one study; and
  • Highly treatable More than 80 percent of those who receive proper treatment experience relief or elimination of their symptoms, another study asserts.

Still, a survey conducted by the Association for Worksite Health Promotion found that only 12 percent of companies offered programs to address depression, which begs the question: Why aren't employers doing more to tackle the issue?

The Stigma

McKibbin and Putnam talked about the organizational, individual and occupational barriers that keep employers from more aggressively managing workplace depression. Permeating all of those barriers, they added, is the stigma associated with depression.

The stigma surrounding depression is what makes workers reluctant to seek help they often fear they'll be labeled weak, incompetent or unstable and employers reluctant to focus more of its resources on managing depression.

"There's no real, logical, legal reason we shouldn't be doing anything about depression except that most of us still have a stigma around depression," McKibbin said.

Putnam, who is the executive director for the wellness program at Mercy Medical Center North Iowa (a multiple-site health care network spanning 16 counties in Iowa) and McKibbin, who is a licensed social worker, spearheaded a depression initiative for the health system called "Beyond Bootstraps."

The 2-year "Beyond Bootstraps" campaign was designed around the theme that depression is not a personal weakness, but instead is a complex and serious illness that can happen to the best and brightest employees and treating it requires much more than "pulling yourself up by the bootstraps," as the old adage says.

Why OHNs?

McKibbin and Putnam assert that occupational health nurses are in the best position to bring about change in the way employers identify and treat depression more so than employee assistance programs (EAPs) or worksite health/wellness promotion programs.

"We really look at your field as the hope," McKibbin said.

The role of the OHN in addressing depression in the workplace is no different than working with chronic illnesses and injuries, according to McKibbin and Putnam. Just as with managing chronic illnesses and injuries, the role of the OHN in managing depression involves:

  • Ensuring that quality, cost-effective treatment is provided.
  • Coordinating care.
  • Monitoring medications.
  • Maintaining the employee's at-work status or returning the employee to work as soon as feasible.

OHNs are in the best position to bring about change in the way their employers manage depression because OHNs already are skilled at managing lost productivity, already are competent in case-managing and coordinating care across many disciplines and bring a high level of professional credibility. As for the last point, McKibbin and Putnam contend that OHNs' medical background, training and expertise might provide OHNs with more credibility than their colleagues in counseling, EAPs, social work or health promotion.

Overcoming the Obstacles

While McKibbin and Putnam believe there's a strong case for aggressively addressing depression in the workplace, they also acknowledge that OHNs who, they add, likely are well-aware of the magnitude of the problem depression presents face challenges in making that case. In an article written by the duo for the March 2004 issue of the AAOHN Journal ("Managing Workplace Depression: An Untapped Opportunity for Occupational Health Professionals"), they point out that "lack of verbal, political and financial support" from upper management" is one of the organizational obstacles to implementing an effective program that addresses depression.

Those barriers likely stem from an organization's lack of education about depression, lack of understanding of the strong business case for addressing depression and uncertainty as to the role of the organization in addressing depression.

Overcoming those barriers involves:

  • Educating the employer on the definition and prevalence of depression. (One in 20 workers is affected by depression, according to the National Institute of Mental Health.)
  • Presenting the business case for managing depression. In terms of human costs, depression can be as debilitating as any major chronic illness, and 15 percent of people suffering from depression commit suicide. In terms of the financial costs, one expert estimated that depression costs U.S. employers $33 billion per year, while addressing depression can reduce an employer's health care costs from $850 to $150 per month for each worker who has depression.
  • Clarifying the employer's role in managing depression. The employer's role is never to diagnose depression or mandate assessment or treatment. "But we do need to be more proactive than we have been," McKibbin said, "and our current approaches are not working."

For more information and strategies on managing depression in the workplace, visit http://www.kailo.org. The Web site contains their presentation ("Beyond Bootstraps: How to Really Address Depression in the Workplace") from the AAOHN Conference and Expo as well as the related article that appeared in the March 2004 issue of the AAOHN Journal.

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