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Depression: The Unseen Safety Risk

Human resources and EAPs may deal with it the most, but depression is a costly - and dangerous - issue in occupational safety.

Here's why.Do you know of employees at your company who are tired all the time, complain of aches and pains, have trouble completing projects or focusing on their work, or are even accident-prone? If so, they may be among the millions of people suffering depression.

Clinical depression is a serious mental illness and a bigger problem in the workplace than you may realize. Each year, between 15 million and 20 million adult Americans, or as much as 10 percent of the adult population, experience a depressive illness. At any time, one employee in 20 has depression.

Ronald Kessler, Ph.D., a professor of health care policy at Harvard Medical School, says depression is "common and amazingly impairing in a deep and broad way." Kessler, whose research focuses on the epidemiology of mental disorders, notes that depressed workers "tell us of having problems with time and motion, lifting things and having accidents on the job."

Workplace Impact

Depression results in more than 200 million lost workdays and costs the U.S. economy $43.7 billion annually. Much of that cost is hidden, including $23.8 billion lost to U.S. businesses in absenteeism and lost productivity.

Claims for short-term disability for those with depression are comparable to other chronic medical conditions, including diabetes, heart disease and lower back pain. People with unrecognized depression are also greater users of health care for physical ailments.

Beyond productivity issues, studies suggest that depressed workers may be more prone to accidents. Stephen Heidel, M.D., MBA, an occupational psychiatrist in San Diego, notes a lack of concentration, fatigue, failing memory and slow reaction time as reasons that workers who are depressed may not work safely.

"If you're a word processor, you'll just turn out fewer documents, but if you're operating machinery, you could lose a finger," says Heidel, president and chief executive officer of Integrated Insights, a firm that offers behavioral health services and employee assistance programs (EAPs). "If you address [depression] problems, accident rates go down."

Kessler has seen evidence that depressed workers also may show "suicidal flirtations" by not caring about working safely or purposely not wearing personal protective equipment (PPE).

Even if you agree that depression is a serious problem in the workplace, you may be reluctant, or not know how, to get involved. Because of the pervasiveness of depression, mental health experts believe that management, supervisors and even safety and health pro- fessionals have an obligation to:

  • Learn about depression and the sources of help, including your company's health benefits and EAP.
  • Recognize when an employee shows signs of a problem affecting performance or safety that may be depression-related.
  • Discuss changes in work performance or safety with the employee. You may suggest that the employee seek consultation from human resources or the EAP to determine if professional help is needed. As a first step, a thorough physical examination may be recommended to rule out other illnesses. A physical, however, should not be a substitute for seeing a mental health professional.

Warning Signs

Depression affects employees at all levels. Supervisors and others who spot warning signs can help employees afraid to seek treatment, reducing employer costs in the long run.

While you should never try to be an "armchair psychiatrist" and diagnose depression yourself, knowledge of the symptoms can help you better understand depression. According to the National Mental Health Association, professional help should be sought if someone experiences five or more of the following symptoms for more than two weeks or if the symptoms interfere with daily life:

  • Persistent sad, anxious, nervous or "empty" moods;
  • Sleeping too little, early-morning awakening or sleeping too much;
  • Reduced appetite and weight loss, or increased appetite and weight gain;
  • Loss of interest in activities once enjoyed;
  • Restlessness or irritability;
  • Persistent physical symptoms that do not respond to treatment (such as headaches, chronic pain or digestive disorders);
  • Difficulty concentrating, remembering or making decisions;
  • Fatigue or loss of energy;
  • Feeling guilty, hopeless or worthless; and
  • Thoughts of suicide or death.

The National Institute of Mental Health lists several depression warning signs in the workplace (see "Workplace Depression Symptoms"). Heidel suggests that safety and health professionals may need to condition themselves to be on the lookout for these workplace symptoms. "Mental health issues are a lot less concrete and more subjective," he says. "It takes a certain mindset to think about these issues."

How to Get Involved

Companies should be proactive in dealing with depressed workers so they can receive the best care as quickly as possible, says Roslyn Stone, MPH, vice president for Corporate Wellness, a provider of occupational health services in Mount Kisco, N.Y. "That's what is going to get the employee back to work."

Every week a depressed employee is not at work, he or she becomes more emotionally withdrawn from the workplace. Once out of work for six weeks, the likelihood of that worker returning to work "decreases exponentially," Stone says.

In addition to referring someone to the company's EAP, an outside EAP provider or a mental health professional, an employer should provide reasonable accommodations under the Americans with Disabilities Act, including giving the worker time off to attend appointments and modifying work assignments.

Mental health experts agree that the best way to approach a potentially depressed worker is from a business perspective. A drop in productivity or an increase in accidents are two reasons for reaching out to an employee who may be depressed, says occupational psychiatrist Jeffrey P. Kahn, M.D., of WorkPsych Associates, an executive and corporate mental health consulting firm in New York City and Westchester. "You want to be careful that you don't intrude on employees' personal lives."

When talking to someone who may be depressed, base comments on observable behaviors (see "What can you say to a potentially depressed employee?"). "Managers are not there to talk about medical problems. They are there to talk about work performance and behavior," Heidel says. "You're not training people to be psychiatrists. You're training them to be good supervisors."

For companies not involved in mental health issues, one way to begin is to form a steering committee, says Judith Holder, Ph.D., a licensed psychologist and director of Duke Occupational Mental Health Programs (an external EAP) at Duke University Medical Center. The goal of the committee - made up of an occupational doctor or nurse and personnel from risk management, human resources, EAP and health/wellness - is to determine what to include in a program, such as supervisor training to identify signs of depression or designing employee wellness programs.

Companies without occupational health personnel or an EAP still can be proactive, Holder says. For example, bring in a consultant to schedule a "lunch-and-learn" series on topics such as stress, insomnia, transition, work conflicts and work/family balance issues, all of which can contribute to depression.

A Supportive Environment

Employers also can help reduce depression in the workplace by providing a good, healthy work environment, Holder says. In this type of setting, depressed workers "have a focus, want to get up in the morning and are able to perform. It gives them a sense of accomplishment and achievement, which can help them begin to feel better over a period of time."

Promote a positive work environment with adequate lighting, low levels of noise, readily available PPE, opportunities to develop skills, input into job duties and clear performance expectations. "Research also has shown that a supportive boss goes a long way to helping individuals, whether or not depressed, feel appreciated and valued," she says.

Several experts interviewed agreed that the workplace seldom causes depression. "The workplace scenario most likely to trigger depression is when people feel like they are in a seriously hostile and unsupportive environment," Kahn says.

Because the workplace usually does not cause depression, companies may be reluctant to put adequate resources into dealing with the problem. Kahn has a quick response for those employers:

"With the right help, depressed workers can get better, and this will help your bottom line because they will be more productive and loyal, there will be a reduction in other medical care costs, and turnover, recruitment and retraining will decrease."


What Causes Depression?

According to the National Mental Health Association, many things can contribute to clinical depression. For some, a number of factors seem to be involved. For others, a single factor can trigger the illness. Often times, people become depressed for no apparent reason.

Causes of depression:

  • Biological. People with depression typically have too little or too much of certain brain chemicals, called "neurotransmitters." Changes in these brain chemicals may cause, or contribute to, depression.
  • Cognitive. People with negative thinking patterns - people who are pessimistic, have low self-esteem, worry too much or feel they have little control over life events - are more likely to develop depression.
  • Genetic. A family history of depression increases the risk for developing the illness. Depression, however, can also occur in people who have had no family members with the disorder.
  • Situational. Difficult life events, including the death of a loved one, divorce, financial problems or moving to a new place, can contribute to depression.
  • Co-occurring. Depression is more likely to occur along with certain medical illnesses, such as stroke, heart disease, cancer, Parkinson's disease, Alzheimer's disease, diabetes and hormonal disorders. This is called "co-occurring depression" and should be treated in addition to the physical illness.
  • Medications. Some medications for various illnesses can actually cause depression.

Generally, there are three types of depression. Major depression is a combination of symptoms (see "Warning Signs" above) that's disabling and makes daily functioning extremely difficult, if not impossible. Dysthymia is marked by chronic symptoms that are not disabling, but keeps one from functioning well or from feeling good. Bipolar disorder, also called manic-depressive illness, is less common, involves cycles of depression and elation, and is often recurring.

The number of Americans treated for depression soared from 1.7 million in 1987 to 6.3 million in 1997, researchers reported in the Jan. 9 issue of the Journal of American Medical Association. Still, only one-third of those with depression seek treatment. Employees often are concerned that treatment will have a negative impact on their jobs. Employers should assure them that privacy and confidentiality laws apply to mental health situations.


Workplace Depression Symptoms

In the workplace, symptoms of depression often may be recognized by:

  • Decreased productivity
  • Morale problems
  • Lack of cooperation
  • Safety risks, accidents
  • Absenteeism
  • Frequent statements about being tired all the time
  • Complaints of unexplained aches and pains
  • Alcohol and drug abuse


What can you say to a potentially depressed employee?

The Society for Human Resource Management suggests the following:

"I'm concerned that recently you've been late to work often and aren't meeting your performance objectives. I'd like to see you get back on track. I don't know whether this is the case for you, but if personal issues are affecting your work, you can speak confidentially to one of our employee assistance counselors. The service was set up to help employees. Our conversation today and appointments with the counselor will be kept confidential. Whether or not you contact this service, you will still be expected to meet your performance goals."

For more information:

Employee Assistance Professionals Association, (703) 522-6272,

National Foundation for Depressive Illness, (800) 239-1265

National Institute of Mental Health, (800) 421-4211,

National Mental Health Association, (800) 969-NMHA,

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