Depression in the Workplace Presenteeism: Depressed workers experience

Depression in the Workplace Presenteeism: Depressed workers experience broad impairment in many workplace functions and have a 4.2-fold increase in impaired work performanceequivalent to 5 hours of lost work per week ( Stewart, Ricci, Chee, et al., 2003) US National Safety Council

(1985) Depression is the third most common health problem 6-10% of any workforce suffers from depression 10,000,000 or more workers are disabled by depression each year in the US. The rate of depression is rising. (note below 2003)

Current estimates Goldberg and Steury, 2001: 1.8-3.6% of workers suffer from major depression. 17-48% of workers needing to go on shortterm disability due to depressive symptoms. Dewa, Hoch, Paterson & Goering (2003) 60% of individuals who are claiming shortterm disability through workers compensation use anti-depressant medication.

Working with Depression Toronto Star Nov 20, 2007 Andrea Gordon Ipsos Reid poll (Nov. 19, 2007) One in four working Canadians say they suffer from depression the highest prevalence ever reported. Of the 4,122 employees surveyed, 18 per cent said they've been diagnosed with depression. An additional 8 per cent said they were undiagnosed but believe they

have the illness. Westinghouse % of mangers who were clinically depressed Female mangers 16.6% Male mangers 8.6% Note: Many of these depressed workers are taking antidepressant drugs to control their illness Financial Costs

of Depression Depression costs business; Workplace support is 'good management practice,' forum told Researchers seeking 65,000 subjects for Canadian study The Toronto Star April 15, 2005 by Robin Harvey Dr. Ron Kessler (Harvard Medical school study on depression in the workplace, 2004)

Research has shown it costs employers $10 to $35 (U.S.) per day for each employee with undiagnosed and untreated depression With proper treatment, within a year all costs are recovered and a firm actually makes an extra $1,100 to $1,800 per year per employee,

15 to 24 days excess sick leave a year 20 to 30 "presenteeism" days (days when they show up for work but accomplish very little Fewer than one in five people gets treatment for depression Of those who do get treatment, about a third get inappropriate care, Kessler said. United States Over 75% of the total costs of depression are not direct treatment

costs, but rather costs incurred due to lost productivity. 1980 = 16.3 billion dollars 1990 = 36.9 billion dollars United States US Today (Metlife, 2003)

Depression is in the top five causes of workplace disability National Institute for Mental Healthcited in Orvis 2002 Costs to workplace = $44 billion / year Costs to US Economy overall = $70+ billion / year United States $26.1 billion for medical care,

$5.4 billion for suicide-related mortality $44.0 to $51.5 billion for lost productivity rner, Adler, Chang, et al., 2004; Stewart, Ricci, Chee, et al., 2003; Greenberg, ssler, Birnbaum , et al., 2003) Cited in Bender 2008 Presenteeism

Depressed workers experience broad impairment in many workplace functions and have a 4.2-fold increase in impaired work performanceequivalent to 5 hours of lost work per week ( Stewart, Ricci, Chee, et al., 2003) UNITED KINGDOM Job Turnover = double for depressed workers Absences = 61% are due to mental illness

(mainly due related to depression) IBM (1980) Cost of IBMs mental health benefit plan covering 208,000 employees and 442,000 dependents = $ 26,600,000 Costs to Workers Depression is related to:

The general wellbeing of workers, their family and their co-workers; Deterioration in quality of life; Increased accidents; A breakdown in marital and other interpersonal relationships on and off work; Suicide; Drug use; Frequency and severity of physical symptoms. Heart disease; Depression as a risk factor for heart disease.

Many studies show depression among those experiencing heart disease Assumed CAD depression (Krantz & McCeney, 2002). Many studies now finding depression preceding CAD (Pratt et al. 1996)

Depression doubles chance of heart attack (Cohen & Alderman, 2001; Ford et al., 1998, Glassman & Shapiro, 1998; Carney, 1988) Cycle Popular Press: Relationship between Heart Disease and Depression Depression Is Widespread Among Heart Attack Patients HealthNewsDigest.com - May 23, 2005 One in five patients hospitalized for heart attack suffers from major depression, and these patients may be more likely than other heart attack patients to need hospital care again within a year for a cardiac problem and three

times as likely to die from a future attack or other heart problems, problems, according to a new evidence report by HHS' Agency for Healthcare Research and Quality. Younger Women Prone to Depression after Heart Attack New York Times Syndicate - April 25, 2006 While an episode of depression after a heart attack is fairly common, new research shows that women aged 60 and younger are far more likely to suffer from it than others. The finding is important because people who struggle with depression after a heart attack are more likely to be hospitalized and die from cardiac problems, and have higher health care costs, compared with heart attack patients who don't become depressed. Exercise Helps Heart Attack Patients Who Are Depressed, Without Social Support AScribe Newswire - May 04, 2004 DURHAM, N.C., May 4 (AScribe Newswire) -- Heart attack patients who are depressed or without social support are more than twice as likely to die of a second heart attack if they do not exercise, according the results of a large-scale national trial led by Duke

University Medical Center researchers. Poor Mental Health Puts Women at Risk for Heart Disease HealthNewsDigest.com - May 31, 2004 Jennifer Wider, M.D. Society for Womens Health Research Youve heard it all before, maintaining a good diet and exercise will help ward off heart disease. But were you aware that your state of mind might affect your risk too? A new study from Emory University in Atlanta found that good mental health is just as important as other factors in the prevention of heart disease, particularly for women over the age of 45. More than 3,000 adults between the ages of 25 and 74 participated in the study. The researchers discovered that the prevalence of cardiovascular disease was lowest in adults with good mental health and higher among adults with major or minor depression or other mental health issues. The association between mental health status and heart disease risk was the most pronounced among women aged 45 to 74.

Limited Role of Supervisors and Health and Safety Staff Dont: overreact if one of two signs are observed; make a Diagnosis. Any action taken by management should be based upon observation and evaluation of the employees job

performance or the evaluation that the employee is unfit to work safely; and expect your staff to identify and deal with depression without a lease a day training workshop Vulnerable Populations Women

Younger workers Those who have experienced an injury or trauma (e.g. loss of spouse) Observable signs of depression

Mask of depression Drowsiness at work

Lack of energy Eating Frequent absences due to a variety of vague physical symptoms Hostile or Impatient behaviors Medication or substance abuse Comments implying self-doubt Excessive day-dreaming or trouble concentrating Decreasing quality of work Difficulty making decisions Signs of increased risk of suicide Observable effects of antidepressant medication

Tremor and muscle twitches

Signs of dizziness or loss of consciousness, especially after a postural change General confusion and memory problemssigns of rechecking things that have already been done or difficulty following orders Squinting and sings of blurred vision Extreme signs of fatigue or drowsiness on the job Inappropriate behaviors, such as excessive horseplay or overreacting to others, an signs of hyperactivity A rash (in a number of cases) Complaints of vague disturbances such as headaches, nausea, irregular heartbeat and/or frequent aches and pains

Frequent absences due to the above vague disturbances Does the workplace contribute to Depression and suicide? WCB/WSIB Civil Law cases Depression and Suicide: Workplace factors

The depressive behaviour of others (Horowaty, Pliner, Flett, 1990, Coyne, 1976) Particular toxic agents (Sjogren, Gustavsson, Hogstedt, 1990) A poor person-job fit (Palmore, 1970)

Work conditions resulting in cumulative strain (Horovitz, 1981) Changes in working conditions and/or work relationships Uncertainty associated with changes such as downsizing, reorganization

Depression and Suicide: Workplace factors The depressive behaviour of others (Horowaty, Pliner, Flett, 1990, Coyne, 1976) Particular toxic agents (Sjogren, Gustavsson, Hogstedt, 1990)

A poor person-job fit (Palmore, 1970) Work conditions resulting in cumulative strain (Horovitz, 1981) Changes in working conditions and/or work relationships

Uncertainty associated with changes such as downsizing, reorganization Cited in Bender, 2008 Canadian National Health Survey, Wang (2004) found significant associations between sources of perceived stress, including skill discretion, psychological demands,

job insecurity, social support from coworkers or supervisors, and major depression onset. Cited in Bender, 2008 gender differences Shields (2006) found that women report being in high strain jobs more often, but for them, only low coworker support is significantly associated with depression. Men in high-strain positions are 2.5 times more likely to have experienced a depressive episode compared with those

in low-strain positions, whereas women are 1.6 times more likely. Cited in Bender, 2008 Bullying, violence and depression (Steele L, Dewa C, Lee K 2007; Wieclaw, Agerbo, Mortenson, et al. 2006; Kivimaki Virtanen, Vartia, et al., 2000) Cited in Bender, 2008

Job dissatisfaction, decreasing decision latitude, support from coworkers or supervisors (Shields, 2006). Stress A reaction to environmental demands

Stressors versus stress Classification of Stressors by Complexity Biological Psychologic al Interperson al Sociocultural A Definition of Stress Stress is the nonspecific response of

the body to any demand placed upon it. (Hans Selye) Reaction: Flight, flight or freeze A mobilization to action Reaction: Flight, flight or freeze mobilization to action Ulcers in Executive

Monkeys Ulcers in Executive Monkeys Reacting to Stress: Selyes three major stages: Alarm reaction: defensive forces are mobilized Resistance stage: body adapts to stressors

Exhaustion: stressors negates bodys coping mechanisms. Reacting to Stress: Selyes three major stages: Alarm reaction: defensive forces are mobilized

Resistance stage: body adapts to stressors Exhaustion: stressors negates bodys coping mechanisms. STRESS, CHANGE AND SICKNESS:THE SOCIAL READJUSTMENT SCALE* If any of these life events have happened to you in the last 12 months, check Happened column and enter Value in Your Score column. Item

Life Event Happened Item Your Score 1. Death of spouse 100 2. Divorce 73 3. Marital separation 65 4. Jail term 63 5. Death of close family member 63 6. Personal injury or illness 53

7. Marriage 50 8. Fired at work 47 9. Marital reconciliation 45 10. Retirement 45 11. Change in health of family member 44 12. Pregnancy 40 13. Sex difficulties

39 14. Gain of new family member 39 15. Business readjustment 39 16. Change in financial state 38 17. Death of close friend 37 18. Change to different line of work 36 19. Change in number of arguments with spouse 35 20. Mortgage over $50,000

31 21. Foreclosure of mortgage or loan 30 22. Change in responsibilities at work 29 23. Son or daughter leaving home 29 24. Trouble with inlaws 29 25. Outstanding personal achievement 28 26. Wife begins or stop work 26

27. Begin or end school 26 28. Change in living conditions 25 29. Revision of personal habits 24 30. Trouble with boss 23 31. Change in work hours or conditions 20 32. Change in residence 20 33. Change in schools

20 34. Change in recreation 19 35. Change in church activities 19 36. Change in social activities 18 37. Mortgage or loan less than $50,000 17 38. Change in sleeping habits 16 39. Change in number of family gettogethers 15

40. Change in eating habits 15 41. Vacation 13 42. Christmas 12 43. Minor violations of the law 11 Total score for 12 months:____________ Note: The more change you have, the more likely you are to get sick. Of those people with over 300 Life Change Units for the past year, almost 90% get sick in the near future; with 150 to 299 Life Change Units, about 50% get sick in the near future, and with less than 150 Life Change Units,

only about 30% get sick in the near future. *See Holmes & Rahe: Journal of Psychosomatic Research, 11:213, 1967. Dealing with Stress: The organizational/ergonomic approach (eliminating or reducing unnecessary stressors) The Individual Approach (living in an imperfect world) When this slide is not in presentation mode, you may double click anywhere on it to learn more about office ergonomics.

Too much (or too little) challenge can make you sick. Are you under the right amount of stress? Stress and Performance: The Inverted U Cooper and Marshall Model Who is liable for stress on the job? Any company, unless it learn to monitor, diagnose and treat a stressful situation before it goes to court.and document these

activities. (World Health Organization, 2005 cited in Bender, 2005) Workplace Stressors that impact mental health lack of recognition inequity poor interpersonal relationships poor working conditions, poor leadership and communication, conflicting home and work demands Etc.

Role conflict Interrole conflict Intrarole conflict Role ambiguity

Work-Nonwork Stressors (McShane) Time-based conflict Strain-based conflict

Role Behaviour conflict Note: Canadian Statistics on work overload The Depression Suite (Hara Estroff Marano, June, 2003) The job is stressful.

CEOs face crippling isolation. Success itself is a letdown. Hard-charging success typically comes at the cost of intimate relationships. Those at the top have the power, the resourcesand the temptationto mask their problems. Not just anybody can treat CEOs

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