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What Does Research Tell Us About Depression, Job Performance, and Work Productivity?
Abstract
To assess the work impact of depression.
A review of research articles published since 2002, reporting on the magnitude and/or nature of depression's impact on work.
This research is characterized by the use of three outcome indicators (employment status, absenteeism, and presenteeism metrics) and three research designs (population-based, workplace, and clinical). The literature documents that, compared to non-depressed individuals, those with depression have more unemployment, absences, and at-work performance deficits. Methodological variation makes it difficult to determine the magnitude of these differences. Additionally, the research suggests that the work impact of depression is related to symptom severity and that symptom relief only partly reduces the adverse work outcomes of depression.
Research has contributed to knowledge of the multidimensional work impact of depression. Further developing intervention research is an important next step.
... There is considerable evidence of harmful effects from anticipated discrimination and internalized stigma for those with any mental illness label (e.g., poor wellbeing; Schauman et al., 2019) and even the symptoms themselves have harmful effects (e.g., absenteeism; Lerner & Henke, 2008). The prevalence of mental illness and mental illness stigma, in addition to their consequences, suggests that these variables are important for further study. ...
... Employees may stay home from work due to health problems (absenteeism), or they may go to work despite being ill, potentially inhibiting recovery and work performance (presenteeism, see Gosselin et al., 2013). Lerner and Henke (2008) found that severe depressive symptoms were associated with absenteeism and presenteeism, and these symptoms decreased with symptom improvement, supporting a possible causal connection. Goetzel et al. (2004) evaluated the costs of absenteeism and presenteeism due to various illnesses and found mental health problems to be among the costliest to organizations. ...
... Severe mental illness symptoms impair functioning in daily life, including work (Gilmour & Patton, 2007;Lerner & Henke, 2008), meaning that PWA is likely low when mental illness symptoms are most severe. Although there is research on parallel relationships (e.g., depressive symptoms and impairment; Gilmour & Patton, 2007), there is a shortage of research that focuses more narrowly on PWA (which is a cognition-focused ability variable; see Marcus et al., 2007;Folkman et al., 1986) among people with diagnosed mental illness. ...
Many working adults must contend with the labelling effect of having a diagnosed mental illness. These employees must navigate both stigma and impairment in the workplace, which may affect their perceived ability to continue working in their current job. The current study tested potential predictors (symptom severity, anticipated discrimination, and internalized stigma) of perceived work ability. Participants had a diagnosed mental illness and were employed in the United States. Data were collected from Amazon’s MTurk, with recruitment screening from CloudResearch and additional quality controls built into the Qualtrics surveys (e.g., captchas and attention checks). Respondents completed two self-report surveys, one week apart. Using structural equation modeling (SEM), symptom severity and anticipated discrimination were found to be negatively associated with perceived work ability, but internalized stigma did not. Results lay the groundwork for future research, including intervention studies designed to support the work ability of employees with mental illness.
... Depression is a significant predictor of low psychological adjustment levels and major health issues (Fried et al., 2022;Herrman et al., 2022;Marwaha et al., 2023;Jacobson & Newman, 2017;Lin et al., 2018;Thapar et al., 2022). Moreover, employee depression can significantly and negatively affect workers' perceptions, attitudes, and behaviors, both directly and indirectly (Adler et al., 2006;Birnbaum et al., 2010;Evans-Lacko & Knapp, 2016;Jacobson & Newman, 2017;Lerner & Henke, 2008;Lin et al., 2018;Rotenstein et al., 2016), so investigating this relationship is essential (Shoss et al., 2023). ...
... First, it expands the extant scholarship on job insecurity by probing its influence on employee depression, a topic that until now remains largely unaddressed (Lin et al., 2021;Shoss et al., 2023). By evaluating this association, this analysis offers valuable revelations regarding the ramifications of job insecurity vis-à-vis employee mental health, which, in turn, both directly and indirectly affects their perceptions, attitudes, and conduct within the workplace (Adler et al., 2006;Birnbaum et al., 2010;Evans-Lacko & Knapp, 2016;Jacobson & Newman, 2017;Lerner & Henke, 2008;Lin et al., 2018;Rotenstein et al., 2016). ...
... Among various psychological states, we focus on employee depression, which is the most common workplace illness (Lin et al., 2018;Rotenstein et al., 2016). Research has shown that depression relates negatively to employee adjustment, social relationships, productivity, and workplace performance (Adler et al., 2006;Birnbaum et al., 2010;Evans-Lacko & Knapp, 2016;Jacobson & Newman, 2017;Lerner & Henke, 2008;Lin et al., 2018;Rotenstein et al., 2016). ...
In an era where artificial intelligence (AI) is reshaping workplace dynamics, this study addresses the pressing need to understand the intricate relationships between job insecurity, psychological safety, and employee depression. Despite extensive research in this domain, significant gaps remain, particularly in comprehending how technological advancements influence these relationships. This research overcomes these challenges by introducing a novel approach that incorporates the mediating role of psychological safety and the moderating influence of employee self-efficacy in AI use. To empirically test our hypotheses, we employed a stratified random sampling method to collect data from 408 employees across various South Korean firms. Also, we utilized 3 wave time-lagged research design to enhance the robustness of the findings. The results which were based on the structural equation modeling analysis indicate that all study hypotheses are supported. The findings not only bridge a crucial gap in the existing literature but also offer a more comprehensive understanding of the psychological impacts of job insecurity in an AI-integrated work environment. This research marks a significant contribution by elucidating the nuanced mechanisms through which job insecurity affects employee well-being in the context of rapid technological change.
... In terms of relevancy to our context (i.e., workplace), depression is known to be one of the most common mental illnesses at work [12,13]. There is a negative correlation between employees' work performance [12,34], occupational functioning, absenteeism, and productivity [14][15][16][17]. ...
... By relying on extant studies [15][16][17], the dependent variable of this researchdepression-was controlled by several variables including employees' tenure, gender, position, and education. These were gathered at the first time point. ...
... The literature survey reveals that few works have delved into the association between CSR and employees' mental health, including depression, anxiety, and burnout at work [2,3,8,11]. Considering that employees' mental health significantly influences their perceptions, attitudes, behaviors, and even job performance, either directly or indirectly [2,3,8,[11][12][13][14][15][16][17], our initiative to explore this relationship and demonstrate the effect of CSR on their depression is an essential endeavor. ...
As corporate social responsibility (CSR) has progressively ascended to prominence among academics and industry professionals, numerous studies have embarked on examining its impact on employees’ perceptions, attitudes, and behaviors. Notwithstanding, the current body of research has predominantly overlooked the influence of CSR on employees’ mental health, encompassing depression, anxiety, and burnout. In order to acknowledge the critical role of employee mental health within an organization, our exploration is focused on discerning the effect of CSR on depressive states. Furthermore, our paper undertakes a thorough analysis of the link between CSR and depression, probing its underlying processes and potential contingent factors. We posit that CSR can alleviate the incidence of employee depression by amplifying the sense of meaningfulness that work provides. Moreover, the element of prosocial motivation among employees may act as a positive moderating variable that intensifies the beneficial effect of CSR on the sense of meaningfulness derived from work. By relying on data obtained through a tripartite online survey involving 214 South Korean workers, this paper scrutinized the proposed hypotheses via the application of moderated mediation analysis with structural equation modeling. We contend that the insights yielded by this study bear significant theoretical and practical implications.
... Depression is characterized by a range of symptoms including persistent sadness, loss of interest or pleasure in activities, changes in appetite or weight, sleep disturbances, loss of energy, feelings of worthlessness or excessive guilt, difficulty thinking or concentrating, and recurrent thoughts of death or suicide (Aekwarangkoon & Thanathamathee, 2022;Daly & Robinson, 2022;Goodwin et al., 2022). Depression in the workplace is a significant concern, associated with decreased productivity, increased absenteeism, and diminished work quality (Adler et al., 2006;Birnbaum et al., 2010;Bracke et al., 2020;Evans-Lacko & Knapp, 2016;Gao et al., 2024;Hakanen & Schaufeli, 2012;Herrman et al., 2022;Jacobson & Newman, 2017;Lerner & Henke, 2008;Rotenstein et al., 2016). From an academic standpoint, the relationship between leadership style and employee mental health has been a subject of increasing interest, with particular focus on how positive leadership styles, like servant leadership, can mitigate negative psychological outcomes among employees. ...
... Drawing from previous research (Evans-Lacko and Knapp, 2016;Jacobson & Newman, 2017;Lerner & Henke, 2008), this study incorporated several control variables, such as tenure, gender, education, and position, to account for the potential influence of factors like employee tenure, gender, position, and education. Data on these control variables were gathered during the initial survey. ...
This study investigates the nuanced interplay between servant leadership, authentic leadership, job stress, and employee depression within South Korean corporations, employing a three-wave time-lagged research design. A stratified random sample of 206 employees participated across three temporal phases, providing insights into the dynamics of leadership and employee well-being. The research utilized validated scales to measure servant leadership, authentic leadership, job stress, and depression, ensuring methodological rigor and the reliability of findings. The study’s results underscore the mediating role of job stress in the relationship between servant leadership and employee depression, highlighting that the influence of servant leadership on reducing depression operates significantly through its impact on diminishing job stress. Furthermore, the analysis reveals that authentic leadership moderates the relationship between servant leadership and job stress, amplifying the decreasing effect of servant leadership on employee job stress. These findings extend the theoretical understanding of leadership’s role in shaping employee mental health, emphasizing the critical interplay between servant and authentic leadership styles in mitigating job stress and, subsequently, depression. The study’s implications for theory and practice suggest that fostering an integrated leadership approach, combining servant and authentic leadership characteristics, can significantly contribute to enhancing employee psychological well-being in the face of organizational challenges. The research contributes to the leadership literature by elucidating the pathways through which leadership influences mental health and by demonstrating the importance of leadership synergy in organizational settings.
... Work: Depressed individuals tend to work less than non-depressed individuals (Lerner & Henke, 2008). These data are also correlative, but we can infer that depression causes people to work less than non-depressed individuals with further analysis. ...
... The social risk theory predicts that low mood will cause behaviours that could minimise one's social risk. Thus, the theory seems well placed to explain why low mood affects a wide range of social behaviours: causing people to socialise, parent, and work less than those in a neutral mood (Beck, 1995;Gotlib, 1992;Gunlicks & Weissman, 2008;Lerner & Henke, 2008;Sledge & Lazar, 2014). The theory can easily explain why low mood causes people to socialise less than controls: if an individual poses more of a social burden than they do a social asset, retracting from social events could be beneficial. ...
There are three main accounts of the proper function of the low mood system (LMS): the social risk theory, the disease theory, and the propitiousness theory. Adjudicating between these accounts has proven difficult, as there is little agreement in the literature about what a theory of the LMS’s proper function is supposed to explain. In this article, drawing upon influential work on the evolution of other affective systems, such as the disgust system and the fear system, I argue that a theory of the proper function of the low mood system should: (i) account for the reliable, distal causes and effects of the system’s activation, and (ii) explain how having a system that performed such a function increased fitness in ancestral environments. On this basis, I show that the proper function of the low mood system is to limit resource expenditure in relatively unpropitious circumstances, exactly as hypothesised by the propitiousness theory.
... Low mood, I maintain, also has a global demotivational effect on action. To begin with, it affects social behaviour: people in a low mood are less skilled at social interactions (Gotlib 1992), and tend to socialise (ibid), work (Lerner and Henke 2008), and parent (Beck 1995) less than those in a neutral mood. Admittedly, these data are correlational, but since therapies and drugs that alleviate low mood symptoms also tend to increase socialisation, working, and parenting behaviours, we can safely conclude that low mood is the cause of these changes in social behaviour (Briley and Moret 2010;Gunlicks and Weissman 2008;Murray et al. 2003;Sledge and Lazar 2014). ...
Does low mood have intentional content? If so, what is it? Philosophers have tried to answer both questions by appealing to low mood’s phenomenal character. However, appeals to phenomenology have not settled this debate. Thus, I take a different approach: I tackle both questions by examining low mood’s complex functional role in cognition. I argue that if we take this role into account, we have excellent reason to believe that low mood a) has content, and b) has the following indicative-imperative content: Good events are, on average, less likely to occur than bad events & Limit [the subject’s] resource expenditure!
... introduzione Nel quadro generale della situazione occupazionale italiana, la gestione dei lavoratori affetti da disabilità, in particolare se psichica, rappresenta un argomento attuale e di grande interesse. La disabilità psichica è una condizione caratterizzata da problematiche emozionali, cognitive e comportamentali associate a difficoltà di tipo relazionale in grado di compromettere in misura variabile il funzionamento di vita e lavorativo (1,11,14,19). L' eterogeneità delle manifestazioni cliniche della disabilità psichica, e spesso anche l'andamento discontinuo dei sintomi, fanno sì che i criteri necessari per definire le misure di tutela possano essere individuati meno facilmente rispetto alla disabilità fisica. Il collocamento lavorativo dell'individuo affetto da disabilità, normato dalla Legge n. 68/99, prevede un adattamento dell'ambiente di lavoro al lavoratore disabile. ...
Introduzione: La gestione dei lavoratori portatori di disabilità psichica rappresenta un argomento attuale e di grande interesse. L’obiettivo dell’articolo è quello di presentare l’esperienza di gestione dei casi di disabilità psichica presenti all’interno del personale dipendente di una azienda ospedaliero-universitaria italiana e di descrivere gli interventi relativi alle tutele preventive adottate e ai percorsi terapeutici specialistici intrapresi. Metodi: Un gruppo di 100 lavoratori affetti da disturbi psichiatrici è stato inserito in un programma di sorveglianza medica della durata di almeno 6 mesi. I lavoratori sono stati seguiti nell’ambito di un protocollo che ha incluso visite psichiatriche, interventi psicoterapici, visite del medico competente e valutazioni medico-legali. Sono state somministrate scale di valutazione della gravità di malattia e dell’efficacia dei trattamenti (CGI) e del funzionamento globale (GAF) al baseline e dopo 6 mesi di follow-up. Risultati: Il campione è risultato composto principalmente da infermieri (44%) e da Operatori Socio Sanitari (24%) e i più comuni disturbi diagnosticati sono stati i disturbi dell’umore e d’ansia. La partecipazione al programma di sorveglianza medica con la messa in atto di strategie terapeutiche specialistiche e di interventi organizzativi ha comportato una riduzione statisticamente significativa della gravità di malattia e un miglioramento del funzionamento globale e ha consentito di conservare mansione e sede lavorativa nella quasi totalità dei casi. Discussione: I risultati di questa esperienza consentono di affermare che l’integrazione delle competenze costituisce un valido strumento sia per l’inquadramento diagnostico multidisciplinare che per il monitoraggio e la gestione dei lavoratori con disabilità psichica nell’ambito della sorveglianza sanitaria periodica.
... Psychological distress is associated with absenteeism, presenteeism and, reduced employee performance (Cocker et al. 2013). This adds up to short-term and long-term absences as well as employees quitting their jobs (Burton et al. 2008;Lerner and Henke, 2008). ...
The main purpose of this study is to examine the relationship between psychological distress and absenteeism and presenteeism during the Covid-19 pandemic. We predict that the independent variable “psychological distress” has a significant contribution to the dependent variables “absenteeism” and “presenteeism”. Based on the literature, several studies investigated the relationship between those variables in a normal context (before the pandemic) and also during the pandemic, and they also looked into the effect of the Covid-19 pandemic on the mental health of individuals. However, this relationship has not been investigated in Morocco. This study has its originality, and therefore it will contribute to the literature. Data were collected from 220 participants working full-time and part-time in different departments within different sectors in Morocco, using a survey in the French language that was distributed online. The hypotheses were tested using IBM SPSS Statistics 25. Findings showed that psychological distress and its sub-dimensions have significant contributions to absenteeism and presenteeism and their sub-dimensions.
... These factors can contribute to emotional exhaustion and elevate stress levels in caregiving roles. 50,51 Moreover, they can lead to a high level of workrelated and emotional stress, which increases the risk of developing depressive symptoms. 52 This can interfere with the ability of professionals to empathize with patients, negatively affecting the quality of care. ...
... In the tech sector, these challenges can result in missed deadlines, reduced innovation, and higher turnover rates. Presenteeism, where employees are physically present but unable to function optimally due to mental health struggles, is a significant contributor to decreased productivity [32]. Employees with depression, for example, report notably higher rates of presenteeism, leading to substantial productivity losses [33]. ...
Background/Objectives: Mental health challenges significantly impact employee productivity, especially in high-stress industries like technology. This study aims to investigate the factors influencing the intention to use psychological support services among Romanian tech employees, focusing on barriers and motivators related to availability, accessibility, affordability, and acceptability. Methods: A cross-sectional survey was conducted among 372 Romanian tech employees using a structured online questionnaire. The survey assessed socio-demographic data, prior experience with mental health services, perceived distress levels, and barriers categorized into four dimensions. Data were analyzed using descriptive statistics and inferential analysis to identify key predictors of the intention to use these services. Results: Key factors influencing the use of psychological support services included prior experience with mental health services, the need to take time off work, and the absence of a companion. Barriers such as cost, transportation, awareness of services, and stigma were not significant. The regression model explained 8.4% of the variance in the likelihood of using these services, suggesting that additional factors may need further exploration. Conclusions: Addressing practical barriers, such as time constraints and the absence of support during access, is essential to improving accessibility of these services. Leveraging positive past experiences with mental health services can enhance engagement. These findings can guide the development of targeted interventions to promote the uptake of psychological support services in the tech sector, contributing to a healthier and more productive workforce.
... However, the precise influence of OPP on mental health in the workplace, particularly regarding depression, has been relatively overlooked in scholarly discussions, despite its potentially significant impact at both personal and organizational levels. Given the widespread prevalence and intense severity of depression in the workplace (Lerner & Henke, 2008) and its profound costs to individuals, enterprises, and the broader society (Greenberg et al., 2015), it is imperative to explore how OPP may promote the onset and exacerbation of depressive symptoms employees, thereby compromising their health, efficiency, and overall performance. ...
This research examines the dynamics between organizationally prescribed perfectionism (OPP), psychological safety, burnout, depression, and coaching leadership in the context of the South Korean workforce. By applying several theories, we developed a moderated mediation model. This model suggests that psychological safety and burnout act as sequential mediators between OPP and depression, while coaching leadership moderates the relationship between OPP and psychological safety. Our data, collected from 413 employees across four waves using a time-lagged design, support our proposed model. Structural equation modeling revealed that OPP directly and indirectly affects depression via psychological safety and burnout. Furthermore, the impact of OPP on psychological safety is reduced under strong coaching leadership. These findings underscore the need to address perfectionism in the workplaces and highlight the central roles of psychological safety and coaching leadership in enhancing employee resilience and well-being. This study enriches existing literature by bringing together different theoretical frameworks to provide a comprehensive understanding of how perfectionism affects employee outcomes. It also provides practical recommendations for organizations seeking to foster a supportive and thriving work environment amidst increasing demands for perfectionism.
... Механизам који лежи у основи овог утицаја може се објаснити на следећи начин: радни притисак утиче на негативне стилове суочавања, а они доприносе развоју професионалног сагоревања (Zhou et al., 2024). Изгарање на послу код полицијских службеника негативно утиче на квалитет услуге коју они пружају (Lerner & Henke, 2008). ...
Research consistently highlights policing as one of the most challenging professions. The daily pressure faced by officers can have a significant impact on their psychophysical functioning. Various levels of risk threaten the safety of both police officers and the individuals they serve. From managing public events to responding to crimial activity, police officers are constantly tested in their ability to handle stress. Prolonged exposure to stressful situations can take a serious toll on their physical and emotional health, often hindering efforts to adopt healthy habits or maintain overall well-being. One of the most notable psychological effects of chronic stress is burnout syndrome, which represents the final stage in an officer's attempt to adapt to the stressors they encounter.
... This improved significantly toward the end of treatment and remained at a moderate level six months later [115]. However, it has been known for some time that mental health complaints such as stress, mild depression, and anxiety disorders, often referred to as common mental disorders, can lead to impairments in work performance [116][117][118]. These disabilities may lead not only to decreased output but can also have major repercussions in some professions such as nursing and medical care. ...
Background
Symptoms of anxiety and depression are very common among healthcare workers (HCWs) and could impact the quality of care.
Objective
This study aimed to evaluate the prevalence of these disorders in a public health company and their association with work ability and work-related stress.
Methods
A cross-sectional study involved 80 HCWs being treated for mental disorders (MD), 55 HCWs who said they suffered from MD but were not being treated, and 824 healthy colleagues. All workers completed the Work Ability Index (WAI), the Siegrist's Effort/Reward Imbalance questionnaire (ERI), the Goldberg's scales of anxiety and depression (GADS), and the Warr's scale of job satisfaction.
Results
Three-quarters of workers with MD suffered from anxiety and/or depression. Workers who declared at the periodic medical examination in the workplace that they were being treated for MD had significantly lower levels of work ability than those of their colleagues who declared good mental health. They also reported greater work stress (high effort, low rewards, high overcommitment) and lower job satisfaction than their healthy colleagues. Symptomatic but untreated workers reported significantly lower work ability, lower satisfaction, and greater occupational stress than their healthy colleagues. In the entire sample, there were many workers with symptoms of anxiety or depression who did not declare these disorders during the examination. Overall, there were 328 suspected cases of anxiety (34.2%) and 334 cases of depression (34.8%). Anxious workers [OR = 8.11, 95% confidence interval (CI) = 3.74–17.58] and depressed workers (OR = 4.49, 95% CI = 2.22–9.10) had an increased risk of being classified as having “poor work ability”.
Conclusion
The negative association between psychological symptoms and work ability even in undiagnosed/untreated workers demonstrates the usefulness of screening for these symptoms in work environments.
... Poor mental well-being can lead to increased absenteeism, burnout, and, eventually, turnover (Kircanski, Joormann, and Gotlib 2012). Studies have shown that mental health challenges such as depression reduce a person's ability to perform physical job tasks by 20% and interfere with cognitive performance by 35% (Dewa, Thompson, and Jacobs 2011;Lerner and Henke 2008). However, enhanced well-being can have a positive influence on employees' work-related attitudes, behaviors, productivity, and performance (Gallup 2023;Huang et al. 2016;Kundi et al. 2021;Lu, Yu, and Shan 2022). ...
... Approximately half a million Canadians cannot work due to mental health problems each week [5]. Around 20% of the time, depression hinders an individual's capacity to fulfill physical job requirements, while cognitive performance experiences a decline of approximately 35% due to depression [6]. Depression imposes a significant burden on individuals struggling with it, their families, communities, and society [7][8][9]. ...
Purpose
Major depressive disorder (MDD) is one of the leading causes of work-related disability, and accessing telehealth therapies can be a promising modality for workers with MDD. Barriers to accessing in-person mental healthcare, such as limited availability and accessibility in rural and remote communities, financial constraints, and stigma, have highlighted the need for alternative approaches like telehealth. This study investigated the efficacy of telehealth interventions including CBT for adults over 18 diagnosed with MDD.
Methods
This rapid review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure a transparent methodology. Out of the 2549 studies screened, 19 were incorporated into the rapid review, and of those, 10 were included in the subsequent meta-analyses. Articles were screened independently by two reviewers, with the disagreements reconciled through discussion. A reviewer extracted data from eligible articles. Descriptive statistics and narrative syntheses were used to describe outcomes. Two meta-analyses were conducted to investigate the efficacy of cognitive behavioral therapy (CBT) delivered by telehealth (tCBT). The first compared tCBT to in-person CBT (pCBT). The second meta-analysis compared tCBT to a control group that did not receive CBT or another telehealth-based treatment. Non-CBT interventions investigated within the non-CBT group included somatic rhythm therapy, problem-solving therapy, psychiatry, behavioral activation, and interpersonal psychotherapy.
Results
Overall, individuals with MDD who received tCBT showed significant improvement in depression symptoms. However, the efficacy of tCBT compared to non-telehealth control groups varied across studies. The first meta-analysis indicated the magnitudes of effect were similar for both interventions in reducing depression symptoms 0.023 (95% CI − 0.120 to 0.166); p = 1.00. In the second meta-analysis, the ratio of means comparing tCBT (0.51 ± 0.14 SD) to the control group (0.68 ± 0.12 SD) exhibited a statistically significant 25% reduction with regard to depression scores (one-sided p = 0.002), favouring tCBT to non-telehealth, non-CBT study groups.
Conclusions
Telehealth-based CBT demonstrated positive effects on depression symptoms; it was generally superior when compared to control groups not receiving CBT and was on par with pCBT. The growing mental health burden in the community underscores the need for accessible telehealth services like tCBT. Effective policy formulation and implementation in national health agendas are essential to meet the increasing demand for mental health support.
... Therefore, having good mental health is crucial because of their age and circumstances (Chan et al, 2019). Depression, anxiety and stress are psychological reactions that can reduce a person›s productivity and quality of life (Adaramola, 2012;Lerner & Henke, 2008). They can even lead to wrong decisions (Leykin et Starcke & Brand, 2012). ...
Background Studying dentistry is known to be stressful for students, due to the highly demanding type of study. In the academic year 2021\2022, the Iraqi Ministry of Higher Education and Scientific Research launched a unified central exam (UCE) for dental and pharmaceutical students in all Iraqi universities. Objectives This study aimed to assess the level of anxiety, stress, and depression associated with this new exam system. Materials and Methods Depression, anxiety and Stress Scale-21 (DASS-21) was used in an Arabic version. This tool was uploaded online and sent to the dental students in Tikrit University immediately after the UCE and once again after an ordinary exam. Descriptive statistical analysis and ordinal regression were conducted. Results 258 students participated in this study. 64.4% were females. Extremely severe anxiety was reported higher with statistically significant results in UCE among year 2 and 5 dental students (p-value 0.007 and 0.024, respectively). Stress was statistically significant among final-year dental students in the UCE compared to the ordinary exam (p-value= 0.033). Around 41% of the dental students showed extremely severe depression regardless of the exam type they sat. Conclusion An increase in negative emotions was noticed among dental students. Anxiety and stress were noticed among those students more after sitting the UCE compared to the ordinary exam. However, depression was prevalent among dental students in general regardless of the type of exam. It is recommended to consider and support the mental health among dental students.
... [50] Effective bereavement leave policies not only acknowledge the personal and emotional toll of loss but also contribute to organizational morale and employee loyalty by demonstrating empathy and support. [51] Previous studies across various countries have highlighted that annual leave is often deprioritized by both employers and employees, as seen in Australia [9], Lithuania [2], and the United States [10]. Similarly, while paid sick leave is crucial for employee well-being, some workers lack adequate access [11] [12]. ...
Effective leave management encompasses integrated processes that involve employees, supervisors and human resource managers. The study aimed to determine the impact of leave practices on employees’ well-being and organizational performance in Morogoro Municipality. The study used a mixed approach (triangulation) qualitative and quantitative approach based on an exploratory sequential design. The study involved 200 respondents including 87(43.5%) from the Department of Education, 62(31%) from the Department of Health, and 51(25.5%) were headquarter employees. The study used multi-stage, purposive, stratified and convenience sampling techniques to select the respondents. The data were collected using semi- structured interviews, questionnaires, and documentation. The study found that supportive leave policies and practices significantly enhance employee well-being by reducing stress, preventing burnout, and promoting a healthier work-life balance. Conversely, inadequate or poorly implemented leave policies contribute to high levels of presenteeism, decreased job satisfaction, and increased turnover rates that negatively affect organizational performance. Recommendations for action include promoting work-life balance, fostering a supportive organizational culture, addressing financial constraints, streamlining leave processes, monitoring and evaluating leave practices, mitigating presenteeism, tailoring policies to local needs, and engaging with stakeholders. Implementing these measures will improve employee well-being and enhance organizational performance, resulting in a more productive and motivated workforce in Morogoro Municipality and other areas.
... Depression's presenteeism productivity losses are from 5 to 10 times greater than those for absenteeism . Workers with depression experience a 20% decrease in work performance related to physical job demands and a 35% decrease in performance related to mental and interpersonal demands (Lerner & Henke, 2008). Compared with workers without depression, those with depression are more likely to experience greater impairment related to time management (Lerner et al., 2004). ...
... In addition, 71% of adults reported at least one symptom of stress, such as a headache or feeling overwhelmed or anxious [13]. Depression interferes with a person's ability to complete physical job tasks about 20% of the time and reduces cognitive performance about 35% of the time [14]. Mental health issues affect businesses and their employees. ...
People show different emotional and psychological states over time due to stress, workload, sleep and other factors. This study examined the emotional and psychological states of 200 Junior High School Teachers. The study employed the quantitative method. The instrument used was a questionnaire. The collected data was analysed using frequencies, percentages, Pearson's Correlation and Regression. The instrument was made based on the experiences of the researchers and available literature. Confirmatory Factor analysis led to the reduction of the number of items on the questionnaire to 40. The results showed that teachers do not freely express their emotions, which affects their sleep patterns. The final questionnaire has strong psychometric properties, including a clear factor structure and adequate reliability. Based on these findings, we recommend that stakeholders like the Ministries of Health and Labour educate teachers on emotion management and encourage them to seek psychological and medical support. We also urge the Ministry of Education to prioritize mental well-being among teachers by incorporating coping methods like positive, emotional, religious, and social coping. To the Mental Health Authority, we recommended that they must intensify their efforts to demystify mental health services, making them accessible to all, and to avoid viewing mental health problems solely through a spiritual lens.
... In areas where mental healthcare is available, stigma, cost, feeling misunderstood by providers, and scheduling delays often discourage agricultural producers from seeking help [7,23]. Left untreated, mental health conditions (e.g., depression, anxiety, and substance use) can lead to reduced quality of life [24], absenteeism and presenteeism in work contexts [25], higher rates of agricultural-related injury [26], and suicidal ideation [27]. ...
Agricultural producers (i.e., farmers, ranchers) and agricultural workers (i.e., hired labor, farmworkers) have worse mental health than the general population and often lack access to mental healthcare. In response, the United States Department of Agriculture’s National Institute of Food and Agriculture funded four regional Farm and Ranch Stress Assistance Networks in 2019. In the north central region, the North Central Farm and Ranch Stress Assistance Center (NCFRSAC) was created in 2020 to develop, deliver, and expand stress and mental health assistance to agricultural producers, workers, and families in 12 states. Since 2020, the NCFRSAC has expanded a telephone helpline for agricultural producers and workers and published a clearinghouse website. In addition, the network has trained over 11,000 agricultural supporters in mental health programming, trained over 18,000 agricultural producers in stress management and mental health awareness programming, engaged over 850 farmworkers in support groups, and delivered more than 1200 hours of professional behavioral health services. As circumstances and conditions within agriculture change, such as commodity prices and export policies, NCFRSAC can continue to be responsive by modifying approaches and offering new resources to agricultural communities.
... Work-related stress and the mental health of agricultural producers are a public health concern. When neglected or untreated, anxiety and depression can lead to a reduced quality of life [53], absenteeism and presenteeism in the workplace which reduce productivity and output [54], and agricultural-related injury [55]. These situations and experiences threaten agricultural productivity in the US and increase concerns for the already dwindling agricultural workforce. ...
Agricultural producers have worse mental health than the general population; however, recent research has not considered differences in stressors and mental health conditions by gender. A survey was mailed to a random sample of farmers in Illinois to screen for symptoms of anxiety and depression and identify sources of stress and social support. Men experienced more stress related to environmental and economic conditions than women, while women tended to have slightly higher levels of geographic isolation stress than men. Overall, there were no significant differences by gender in the proportion meeting the criteria for depression or anxiety; however, the results are higher than what is observed in the general population. Among those farmers who experience higher levels of stress about geographic isolation, the odds for women farmers to experience depressive symptoms are four times more than men farmers (OR 4.46 (0.91, 21.8); p = 0.06). Additional research should examine the relationship between social support and mental health. Interventions to reduce stress by gender should be considered.
... Managers have a key role in occupational health with responsibilities for safety, prevention, and rehabilitation [1]. However, research on managers' attitudes towards common mental disorders (CMDs) is scarce even though these disorders are one of the most prevalent occupational health problems in western countries [2,3]. In a previous focus group study, we explored managers' (n = 31) experience-based understanding of how CMDs affect employees' capacity to work [4]. ...
Objective
This explorative, cross-sectional study assessed the association between managers’ attitudes to employee depression and their rating of how common mental disorders (CMDs) affect employee work capacity.
Results
A principal component analysis was performed for the nine variables concerning managers’ rating of how CMDs can affect work capacity among employees. The analysis resulted in two factors: task-oriented- and relational work capacity. The result of the multivariate analysis of covariance showed a p value of 0.014 (Pillai’s trace) indicating a statistically significant association between managers’ attitudes towards employee depression and managers’ rating of how CMDs affect work capacity. The association was significant for both factors as indicated by the p value of 0.024 for task-oriented work capacity and the p value of 0.007 for relational work capacity. The R² value was 0.022 for task-oriented work capacity and 0.017 for relational work capacity. We assumed that negative attitudes towards employee depression would be associated with a perception of decreased work capacity among employees with CMDs. The results showed a significant association; however, the effect (~ 2%) was small. Further studies of manager’s attitudes and other possible determinants of managers’ rating of CMD-related work capacity are needed to better understand these factors.
... It is currently a prominent public health concern and a leading cause of global mental health disability [3]. Individuals with MDD often exhibit social dysfunction, resulting in impairments in both occupational and relational aspects [4,5]. These dysfunctions not only diminish the quality of life but also escalate societal costs [6,7]. ...
Background
Few studies have focused on functional impairment in depressed patients during symptomatic remission. The exact relationship between cognitive performance and functional outcomes of patients with Major depressive disorder (MDD) remains unclear.
Methods
Participants diagnosed with MDD were included and interviewed at both baseline and follow-up. Cognitive function was assessed during acute episodes using the Cambridge Neuropsychological Test Automated Battery (CANTAB), which targeted attention (Rapid Visual Processing - RVP), visual memory (Pattern Recognition Memory - PRM), and executive function (Intra-Extra Dimensional Set Shift - IED). The 17-item Hamilton Depression Scale (HAMD) was used for symptom assessment. Participants were divided into two groups based on their SDSS (Social Disability Screening Schedule) scores, and the differences between their demographic information, HAMD scores, and baseline CANTAB test results were compared. Logistic regression analysis was used to identify cognitive predictors of social function during symptomatic remission.
Results
According to the SDSS score at follow-up, 103 patients were divided into the normal social function group (n = 81,78.6%) and the poor social function group (n = 22, 21.4%) during clinical remission. Participants with poorer social function performed worse in the visual memory (PRM) and executive function tests (IED) at the baseline. Logistic regression analysis suggested that performance on the PRM (95%CI = 0.31–0.93, p = 0.030) and IED (95%CI = 1.01–1.13, p = 0.014) tests, instead of less severe symptoms, significantly contributed to functional outcomes.
Conclusion
Better performance in visual memory and executive function during acute episodes may predict better social functional outcomes in individuals with MDD. A potential early intervention to improve social function in individuals with MDD could include the treatments for executive function and visual memory.
... Overcoming these challenges is effortful and may result in exhaustion, distress, and anxiety (Hurlbutt & Chalmers, 2004). Moreover, autism often cooccurs with other mental health conditions (Hudson et al., 2019), which are, in turn, linked to unemployment, absenteeism, and reduced productivity (Bryan et al., 2021;Lerner & Henke, 2008). In addition to the personal characteristics of autistic people seeking employment, features of the work environment can also impede or promote employment outcomes. ...
Previous research on employment outcomes of autistic adults mainly assessed if they work and under what terms, with mostly anecdotal descriptions of where they work. This study aimed to identify the employment sector distribution of autistic employees compared to the general workforce in the Netherlands and to explore possible background predictors. Participants were 1115 employed autistic adults (476 male; 627 female; 12 other; mean age: 40.75) who completed a cross-sectional survey assessing employment sector, gender, age, age at diagnosis, educational level, degree of autistic traits, and presence of focused interests. Dutch workforce data were retrieved from the Central Bureau of Statistics. Results indicated significant differences in sector distribution across the two populations. Autistic adults were over-represented in the sectors healthcare & welfare, information technology, and public–army–charity, which were the three most-common sectors for this group. In economics & finances, and industry & construction, higher proportions were found in the general workforce. Most autistic employees in the healthcare & welfare sector were females while having a higher educational degree and being male predicted placement in information technology. The broad distribution of autistic employees beyond the information technology sector was notable, supporting the need for an individual approach to employment integration.
Lay Abstract
Studies on employment of autistic individuals mainly assessed if they work and what their working conditions are (e.g. weekly hours, salary) while less is known about where they work. We explore this issue in our study, by examining which employment sectors do autistic adults work in, and comparing them to the general workforce in the Netherlands. We also explored the possibility that gender, age, age at diagnosis, level of education, degree of autistic traits and presence of focused interests could lead to a higher likelihood of working in specific sectors. We assessed data from a survey filled in by 1115 employed autistic adults (476 male; 627 female; 12 other; mean age: 40.75). Dutch workforce information was based on data form the Central Bureau of Statistics. Results showed that a higher proportion of autistic employees worked in healthcare & welfare, information technology, and the public–army–charity sectors. These were the three most-common sectors for this group. A lower proportion of autistic employees worked in economics & finances, and industry & construction, compared to the general workforce. Most autistic employees in the healthcare & welfare sector were females while having a higher educational degree and being male increased the chance of working in information technology. In addition to the common impression that most autistic individuals have interests or abilities that align with employment in information technology and technology sectors, we found that autistic employees worked in various sectors. It is important to address individual characteristics and needs of autistic individuals, while encouraging diverse employment opportunities.
... Mental health is important to employee performance, and worse mental health is associated with reduced job performance (Montano et al., 2017). For example, depression is particularly detrimental to work performance and absences, and the effects of depression on productivity loss may be double that of physical illness-related absences (Lerner & Henke, 2008;Wang et al., 2004). Critically, weight stigma is associated with increased symptoms of depression and anxiety, reduced self-esteem, lower life satisfaction and well-being, and more suicidal ideation (Hunger et al., 2020a). ...
... Furthermore, the condition is exacerbated by sleep problems, changes in appetite, fatigue, and difficulty concentrating (WHO, 2023). The course of depression can be persistent or recurring, profoundly affecting an individual's ability to function effectively in various aspects of life (Hirschfeld et al., 2000;Lerner and Henke, 2008;Stegenga et al., 2012;Evans-Lacko and Knapp, 2016). ...
Background: Medical students may experience mental health disorders like anxiety and depression during medical school, which can negatively impact their productivity, education, and overall quality of life. Currently, there are no studies examining the mental health of medical students in Yemen. Our study aimed to estimate prevalence of depression and anxiety among Yemeni medical students.
Methods: The study utilized a cross-sectional design. A survey was conducted using validated psychometric tests: the Patient Health Questionnaire-9 (PHQ-9) for depression and the Generalized Anxiety Disorder-7 (GAD-7) for anxiety. A survey of medical students from 10 Yemeni medical schools took place from June 6 to July 20, 2023. It included only actively enrolled students in the 7-year undergraduate program.
Results: A total of 706 responses were collected. The prevalence of depression was 48.4 % for cases classified as moderate, moderately severe, and severe, while it was 20 % for cases categorized as moderately severe and severe. The rate of suicide ideation was 14.7 %. Anxiety was found to have a prevalence of 34.8 % for cases categorized as moderate and severe. Furthermore, both depression and anxiety were higher among females, and in earlier academic years; all of these associations had a p-value <0.05. Conversely, age, living status, income stability, and displacement risk all showed no significant association with depression or anxiety.
Conclusion: Our study highlighted the prevalence of depression and anxiety among Yemeni medical students. Tailored interventions are imperative to address these challenges. Future research needs to examine the root causes that might contribute to these disorders.
... Depression has garnered intense scholarly interest in the field of applied psychology because of its high individual and organizational costs (Greenberg et al., 2021;Lerner & Henke, 2008) and the proliferation of evidence indicating that workplace mistreatment is detrimental to mental health. However, the literature is currently silent on the possibility that the negative outcomes of workplace mistreatment may vary across different racial groups, despite strong theoretical reasons to expect this to be the case and the critical implications of such a possibility. ...
Previous studies have found that workplace mistreatment positively relates to depression, a critical mental health disorder. However, it is unknown whether mistreatment affects all individuals’ depressive symptoms equally. Drawing from the hopelessness theory of depression and the stigma literature, we suggest that Blacks suffer from greater depression than Whites when they experience similar levels of workplace mistreatment because Blacks, as members of a racial minority group, are more likely to attribute workplace mistreatment to their race. This, in turn, causes them to make a pessimistic attribution (i.e., attributions that are internal, stable, and global) about themselves that, ultimately, leads to depression. We tested these predictions across two studies. In Study 1, we used a multiyear time-lagged design and multiple indicators of depression (i.e., self-reported clinical depression scale, device-traced sleep quantity, and self-reported sleep quality) and found that the positive relationship between workplace mistreatment and depression was stronger for Blacks than Whites, and that these patterns were consistent across the various indicators (although only results with the clinical depression scale and sleep quantity were statistically significant). In Study 2, we found that the influence of workplace mistreatment on depression is partly due to racial differences in how workplace mistreatment is attributed. We conclude by discussing the theoretical and practical implications of these findings and directions for future research.
... Moreover, depression is responsible for a number of additional costs and disadvantages for individuals and societies. For example, depression negatively affects educational (Fletcher, 2010) and labor market outcomes of affected individuals (Lerner and Henke, 2008), and increases healthcare utilization and costs (Boer et al., 1997). Depression is negatively related to household income and the probability of being married (Smith and Smith, 2010). ...
The present research investigated the relationship between self-respect (i.e., a person’s belief of possessing the same rights as others) and depressive symptoms. Based on earlier longitudinal findings that self-respect fosters assertiveness and that assertiveness negatively predicts depressive symptoms, we tested these relationships in Western and non-Western countries. Additionally, we explored associations with suicidal ideation. Across seven countries ( N = 2408) we found that self-respect and depressive symptoms were negatively correlated. In addition, we found evidence for an indirect path via assertiveness as well as negative correlations with suicidal ideation in countries with available measures. Finally, within-manuscript meta-analyses confirmed the main path between self-respect and depressive symptoms across all seven countries. This research presents the first evidence for the negative association between self-respect (feeling equal to others) and depressive symptoms and highlights new directions for linking self and self-regard to mental health.
... Depression is known to decrease quality of life [12]and healthy behaviors [13]. As a result of these behaviors, depression also may compromise job performance, [14,15] which may exact a particularly heavy toll for dental students. ...
Purpose: The stress experience in dental school high. Every year students face academic and clinical challenges and the relative levels of these perceived stressors and potentially associated depression are not well established. The goal of this study is to describe dental students' perceived stress and depression levels, and additionally, compares stress and depression levels across demographically-defined groups. Methods: Three hundred and eighteen dental students at Loma Linda University participated in a descriptive, cross-sectional study in the Fall of 2015. Perceived stress and depression were assessed using validated self-report questionnaires. Descriptive and mean comparison tests were performed to compare differences. Results: The response rate for the study was 75%, with a majority of respondents being male. Stress levels were moderate (Dental Environment Scale 66.4 ± 17.3), depression levels were low (Center for Epidemiological Studies Depression Scale Revised 12.1 ± 11.0). Females had higher levels of stress and depression than males. Conclusion: Stress experienced at dental school is most notable during clinical years, and varies meaningfully by group. Depression follows similar trends.
... 8 Depression inhibits performance of physical job tasks around 20 percent of the time and performance of time management, mental-interpersonal tasks, and output tasks at least 35 percent of the time. 9 And individuals with mental illnesses are more likely to experience decreased daily functioning, understanding, and communication ability than individuals without such conditions. 10 A range of views persists about the most effective interventions for employees with common forms of mental illness. ...
Mild and moderate mental illnesses can hinder labor force participation, lead to work interruptions, and hamper earning potential. Targeted interventions have proven effective at addressing these problems. But their potential depends on labor protections that enable people to take advantage of these interventions while keeping jobs and income.
... Bipolar disorder and anxiety are also associated with reduced productivity due to presenteeism, though to a lesser degree than MDD [32]. Workers with MDD experience a 20% decrease in work performance related to physical job demands and a 35% decrease in performance related to mental and interpersonal demands [33]. Mood and anxiety disorders have also been identified as among the most reported causes of work disability in US adults [34] and the third leading cause of short-term disability leaves in US companies [35]. ...
Purpose of Review
This article seeks to provide a broad overview of the workplace mental health literature, highlight practical implications of current research, and formulate key recommendations for stakeholders. Various aspects of disability related to mental health disorders, their associated financial costs, and the impact of stigma are covered. This article also discusses key strategies for assessing mental health problems among employees and reviews different types of interventions in the workplace.
Recent Findings
Workplace mental health is an evolving area, particularly in the wake of the pandemic. While established national workplace mental health standards do not currently exist, mental illness continues to have a severe impact on the health of organizations, employees, and the economy. Additional research is needed to fully understand and address the diversity of mental health needs among the broad range of employees and organizations across the USA.
Summary
Employers have a responsibility and an opportunity to create workplaces that support the whole person, not just the employee. While research in the area has increased in the last decade, there is still much to learn in terms of the most effective ways to support our workforce.
Due to the growing prevalence of autism diagnosis, counselors in various settings are more likely to encounter autistic adults seeking employment-related counseling and support. Research on employment in the field of autism has focused mostly on a person-environment fit perspective, which does not take into account the complexity of career behavior and contemporary developments in vocational psychology. The current study examined career narratives of autistic adults, with the aim of understanding how they perceive their work experiences and construct their career identities in relation to labor market norms. Twelve autistic employees took part in narrative interviews, which were analyzed employing dialogical narrative analysis. Findings revealed the recurrence of two major themes, conceptualized as a two-dimensional ‘autism career identity construction model’: (1) adapting vs. defiant views on job market demands and career norms, and (2) acceptance vs. rejection of the autism diagnosis. Findings illustrate ways in which autistic individuals position themselves in relation to both dimensions. The possible contribution of the model to theoretical understandings in the field is discussed, as well as potential applications for career counseling and vocational rehabilitation practices.
Background:
Globally, anxiety and depression are primary contributors to work disability and impact the mental and physical wellbeing of educators.
Objective:
To determine the prevalence and independent predictors of likely Generalized Anxiety Disorder (GAD) and likely Major Depressive Disorder (MDD) among teachers in Newfoundland and Labrador, Alberta, and Nova Scotia.
Methods:
The study utilized a cross-sectional design. Educators from the three Canadian provinces participated by completing an online survey after enrolling in the Wellness4Teachers program, a free self-subscription daily supportive text messaging initiative. The program was launched at the beginning of the 2022/2023 academic year, and all teachers in the three provinces were eligible to enroll. Likely GAD and likely MDD among subscribers were assessed using the Generalized Anxiety Disorder-7 scale and Patient Health Questionnaire-9, respectively. Data analysis was conducted using SPSS version 28.
Results:
Out of 1912 Wellness4Teachers subscribers, 763 completed the survey, yielding a 39.9% response rate. The prevalence of likely MDD was 55.7%, and likely GAD was 46.0%. After controlling for all other variables in the regression model, participants who reported high stress were 7.24 times more likely to experience MDD (OR = 7.24; 95% CI: 4.22-12.42) and 7.40 times more likely to experience GAD (OR = 7.40; 95% CI: 4.63-11.80) than those with mild to moderate stress. Participants with emotional exhaustion were 4.92 times more likely to experience MDD (OR = 4.92; 95% CI: 3.01-8.05) and 4.34 times more likely to experience GAD (OR = 4.34; 95% CI: 2.47-7.62) than those who did not. Also, respondents with a lack of professional accomplishment were 2.13 times as likely to have MDD symptoms (OR = 2.13; 95% CI: 1.41-3.23) and 1.52 times more likely to experience GAD symptoms (OR = 1.524; 95% CI: 1.013-2.293) than those who did not. Similarly, respondents with low resilience were 1.82 times more likely to have likely MDD compared to those with normal to high resilience (OR = 1.82; 95% CI: 1.24-2.66). Additionally, respondents with low resilience were 3.01 times more likely to experience likely GAD compared to those with normal to high resilience (OR =3.01; 95% CI: 2.03-7.62). Participants with over 20 years of teaching experience were 0.28 times less likely to experience GAD symptoms than those with five years or less teaching experience (OR = 0.28; 95% CI: 0.12 - 0.64). Sociodemographic and work-related variables did not independently predict likely GAD and likely MDD.
Conclusions:
This study underscores the need for governments and policymakers in the education sector to implement comprehensive mental health support programs. Addressing the unique stressors faced by educators, reducing emotional exhaustion, and enhancing resilience are crucial steps toward mitigating anxiety and depression, promoting educators' wellbeing, and improving the quality of educational delivery.
International registered report:
RR2-10.2196/37934.
Introduction
Depressive symptoms, goal progress, and goal characteristics are interrelated, but the directionality of these relationships is unclear.
Methods
In a 6‐wave longitudinal study ( N = 431; 2002 total surveys), we examine the bidirectionality of the relationships between depressive symptoms, goal characteristics (commitment, self‐efficacy, and perception of other's support), and goal progress for academic and interpersonal goals at 2‐week intervals. Separate random‐intercept cross‐lagged panel models were tested for each goal characteristic across both goals.
Results
At the within‐person level, goal progress significantly positively predicted commitment, self‐efficacy, and perception of others' support for the goal. Most of the other hypothesized paths were nonsignificant, including paths between depressive symptoms and progress. At the between‐person level, all variables were significantly correlated, with some effects significantly larger for the interpersonal than the academic goal.
Discussion
The results suggest that when it comes to depressive symptoms and goal pursuit, general tendencies may be more important than variations over 2‐week intervals.
Background
As China has undergone the processes of urbanization and economic development, a large migrant population has emerged, creating new family migration trends. Family migration brings about changes in urban integration costs and benefits, affecting health investment.
Objective
The primary objective of this research is to investigate the influence of urban integration of migrant workers' families on their mental wellbeing, with the aim of offering policy recommendations conducive to the realization of a comprehensive public health strategy in China.
Methods
This paper uses multi-dimensional indexes to measure family urban integration, covering economic, social and psychological dimensions, which may consider the complexity of integration. Utilizing a machine learning clustering algorithm, the research endeavors to assess the level of urban integration experienced by migrant workers and their respective families. The analysis discerns three distinct clusters denoting varying degrees of urban integration within these familial units, namely high-level, medium-level, and low-level urban integration. We applied binary logit regression models to analyze the influence of family urban integration on the mental health among migrant workers. Then we conducted a series of robustness tests.
Results
The results show that family urban integration decreases the probability of depressive symptoms by 14.6 percentage points. Further mechanism tests show that family economic integration enhances the psychological wellbeing of migrant workers by elevating their income status. Family social integration decreases depressive symptoms by increasing social status. Family psychological integration increases the psychological health of migrant workers by making them more satisfied with their lives. The heterogeneity test shows that family urban integration and its different dimensions have a strong impact on the depressive symptoms of women, first-generation, and less-educated groups.
Conclusions
This study finds that family urban integration and its economic, social, and psychological dimensions significantly reduced the depressive symptoms of migrant workers. The results of this study lead the authors to recommend formulating a family-centered policy for migrant workers to reside in urban areas, optimizing the allocation of medical resources and public services, and improving family urban integration among migrant workers in order to avoid mental health problems in the process of urban integration.
Background
Individuals with severe mental illness experience greater unemployment and barriers to workforce re-entry. However, less is known about additional indicators of employment stability for individuals across mental illness severity.
Aims
This study aims to examine associations between mental illness severity, use and adequacy of mental health treatment, and indicators of employment stability.
Methods
In this repeated cross-sectional study, 2010–2019 data from the U.S. National Survey of Drug Use and Health were used to construct multivariate logistic regression models predicting the odds of part-time employment, past-year work interruption, number of past-year employers, and past-month health-related work absence by mental illness severity and adequacy of mental health treatment.
Results
Compared to individuals with no mental illness, those with any and severe mental illness had significantly higher odds of part-time employment (adjusted odds ratios [AORs] = 1.51 and 2.16, 95% confidence intervals [CIs] 1.4–1.6 and 2.0–2.3), multiple past-year employers (AORs = 1.78 and 2.34, CIs 1.7–1.9 and 2.1–2.6), past-year work interruption (AORs = 1.69 and 2.20, CIs 1.6–1.8 and 2.1–2.4), and >7 days of past-month work absence (AORs = 2.51 and 3.82, CIs 2.3–2.8 and 3.3–4.5). Among respondents with mental illness, perceived inadequacy of mental treatment predicted higher odds of all adverse employment outcomes.
Conclusions
Compared to those with no mental illness, individuals with mental illness of any severity have higher odds of employment instability. Policy and programmatic support aimed at addressing the needs of individuals with mental illness, including access to adequate mental health treatment, are needed to facilitate continued, competitive employment.
The majority of adult workers in the United States have reported at least one symptom of a mental health problem. This research examines how workplace stigma influences mental health engagement and the negative effects that stigma has
on salespeople’s well-being. It also explores how selling organizations can offer social support in the form of mental health literacy to encourage mental health engagement and increase job satisfaction. Insights for this research were
obtained from both in-depth interviews and surveys with B2B salespeople from diverse industries. Results indicate that workplace stigma is negatively related to mental health engagement. However, when organizations offer social support to
salespeople by promoting mental health literacy, mental health literacy is positively related to help-seeking. The findings also suggest that when employees believe they are acquiring the knowledge and confidence needed to take an active role
in their mental health, they are more satisfied with their jobs. Recommendations are offered on how to cultivate positive mental well-being in B2B sales environments.
Purpose
Based on the componential theory of organizational creativity and innovation, this study examined the relationship between managerial coaching (MC) and innovative work behavior (IWB). It focused on the mediating role of psychological empowerment and the moderating role of task interdependence.
Design/methodology/approach
The self-administered questionnaires were used to collect data from 420 employees of the United Arab Emirates’s public sector organizations. A hierarchical linear model (HLM) with different regression techniques was used.
Findings
The results showed that MC directly influences IWB. The path analysis also revealed that MC has an indirect effect on IWB via psychological empowerment. The moderating role of task independence in MC and IWB was also revealed.
Practical implications
The findings shall provide insights that will help practitioners and academics understand frontline employees' innovative behavior in public sector settings and formulate strategies that will increase the involvement of employees in displaying innovation-based activities at the workplace.
Originality/value
This study adds value to the literature by integrating the componential theory of organizational creativity and innovation in public sector settings.
Aim
Educational attainment is consistently highly valued by young people with mental ill health, yet maintenance and completion of education is a challenge. This paper reports on the implementation of a supported education programme for youth mental health.
Methods
Between 10 October 2019 and 10 October 2020, a supported education programme was delivered within primary and tertiary youth mental health services. A description of the programme, context, and adjustments required due to COVID‐19 is presented, and the educational outcomes of young people referred to the programme were explored. Two case studies are also presented.
Results
The programme received 71 referrals over this period, of which 70.4% had not yet completed secondary school and 68% were experiencing multiple mental health conditions. Overall outcomes were positive, with 47.5% of the 40 young people who chose to engage with the programme maintaining or re‐engaging with education. However, the remainder of those who engaged withdrew from the programme, often reporting challenges due to COVID‐19 such as social isolation or increased uncertainty. Additionally, a number of young people declined or disengaged from the programme to focus on employment.
Conclusion
This report of the experience of integrating a supported employment programme in Australian youth mental health services reinforces the need for such support, and provides preliminary evidence for its successful implementation as part of routine care. The disengagement in response to COVID‐19 highlights the real‐world challenges of the pandemic, while young people's voicing of employment goals indicates the need for combined educational and vocational support—to assist transition and progression between these goals.
The current study examines the intermediary procedures (mediators and moderators) which underlie the corporate social responsibility (CSR)‐employee burnout link. Burnout is a multifaceted psychological construct that has been widely explored in the academic literature and is related to important outcomes for individuals and organizations. Despite its significance, few studies have investigated the impact of CSR on burnout. The present research proposes that CSR diminishes employee burnout through the sequential mediation of psychological safety and job stress. Additionally, this paper proposes that work overload negatively moderates the influence of CSR on employee psychological safety. Survey data obtained from 413 South Korean workers over three‐waves were utilized, and structural equation modeling was used to test a moderated mediation model with related hypotheses. The findings demonstrated that CSR diminishes employee burnout via sequential mediation of psychological safety and job stress. Furthermore, work overload has a negative moderating influence on the association between CSR and psychological safety. The practical and theoretical implications of this research are described.
Depression is a mood disorder that affects millions of people and is one of the most prevalent mental health problems worldwide. Biological, social, and psychological factors are associated with the emergence of this disorder. Among social factors, work is an area of particular importance. Depression is one of the leading causes of time off work and performance problems. Work can also trigger depression. This paper explores the potential connection between work and depression. Specifically, it analyzes the relationship between the processes of signification at work, understood as composed of senses and meanings, and depressive symptoms. The main thesis underlying this paper is that impediments and blockages in the meaning-making process may play a role in the emergence of depressive symptoms, as they affect the psychological function of work. This function consists of the possibility for workers to build meaningful experiences of transformation of themselves and their material and social reality. When individuals are prevented from developing such experiences, human action becomes disconnected from its sense for the person. As such, depression emerges as a pathology of action and meaning-making capabilities, a state of emptying and abandonment of the power to act against external resistance, enabling people to transform themselves through work.
Objectives: Presenteeism adversely affects workers' quality of life, leading to further deterioration of their health and affecting their ability to continue working. Unemployment is one of the most serious consequences for workers experiencing presenteeism. A worker's ability to work depends on the degree of mismatch between the health status, and job demands and work factors. The COVID-19 pandemic has affected workers' experiences of presenteeism as well as their employment status. We examined the association between presenteeism and risk of job resignations and unemployment among Japanese workers during the COVID-19 pandemic.
Methods: A prospective study of 27,036 Internet monitors was conducted, starting in December 2020, with 18,560 (68.7%) participating in the follow-up by December 2021. The Work Functioning Impairment Scale (WFun) was used to measure the degree of work function impairment.
Results: The group with the highest WFun scores had higher odds ratios (ORs) for both retirement and unemployment for health reasons than the group with the lowest WFun scores. ORs were 2.99 (95%CI: 2.48-3.62, p<0. 001) and 1.82 (95%CI: 1.65-2.00, p<0.001), respectively.
Conclusions: Workers with work functioning impairment were at increased risk of resignation or unemployment. Management strategies for workers with work functioning impairment are needed to reduce their disadvantages in employment.
The global prevalence of depression has risen over the past three decades across all socioeconomic groups and geographic regions, with a particularly rapid increase in prevalence among adolescents (aged 12–17 years) in the United States. Depression imposes large health, economic, and societal costs, including reduced life span and quality of life, medical costs, and reduced educational attainment and workplace productivity. A wide range of treatment modalities for depression are available, but socioeconomic disparities in treatment access are driven by treatment costs, lack of culturally tailored options, stigma, and provider shortages, among other barriers. This review highlights the need for comparative research to better understand treatments’ relative efficacy, cost-effectiveness, scalability, and potential heterogeneity in efficacy across socioeconomic groups and country and cultural contexts. To address the growing burden of depression, mental health policy could consider reducing restrictions on the supply of providers, implementing digital interventions, reducing stigma, and promoting healthy lifestyles.
Expected final online publication date for the Annual Review of Public Health, Volume 45 is April 2024. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
Depression, a prevalent and severe condition associated with persistent feeling of sadness, loss of pleasure with large social and personal costs, is currently managed in an unsatisfactory manner. Because all the currently available antidepressants work through monoaminergic pathways, innovative non-monoaminergic techniques for potentially better treatment are attracting a lot of attention. One such technique targeting non-monoaminergic pathway is potentially better treatment for depression. Melatonin plays a vital role in synchronization circadian rhythms, which is known to be disturbed in depressed patient. Agomelatine is a novel antidepressant that works on melatonin receptors by resynchronizing of circadian rhythm. In animal models of depression, such as the learned helplessness model, chronic mild stress model, forced swim test, and chronic psychosocial stress test, agomelatine has exhibited an antidepressant-like effect. Furthermore, agomelatine has been shown to restore normal circadian rhythms in animal models of a disrupted circadian system. Agomelatine (Valdoxan) was licenced for the treatment of depression in Europe in 2009 after an evaluation of clinical studies, making it the first antidepressant with a non-monoaminergic mechanism of action. Agomelatine possesses an excellent safety profile and does not affect weight, sexual function, or produce withdrawal syndrome. Agomelatine is a promising antidepressant for the near future due to its potency and high tolerance.
To assess the ability of internists to identify functional disabilities reported by their patients.
Comparison of responses by physicians and a random sample of their patients to a 12-item questionnaire about physical and social function.
A hospital-based internal medicine group practice in Boston, Massachusetts, and selected office-based internal medicine practices in Los Angeles, California.
Five staff physicians, three general internal medicine fellows, and 34 internal medicine residents in the hospital-based practice and 178 of their patients. Seventy-six physicians in the office-based practices and 230 of their patients.
Physicians underestimated or failed to recognize 66% of disabilities reported by patients. Patient-reported disabilities were underestimated or unrecognized more often in the hospital-based practice than in the office-based practices (75% compared with 60%, P less than 0.05). Physicians overstated functional impairment in 21% of paired responses in which patients reported no disability.
Physicians often underestimate or fail to recognize functional disabilities that are reported by their patients. They overstate functional impairment to a lesser degree. Because these discrepancies may adversely affect patient care and well-being, medical educators and clinicians should pay more attention to the assessment of patient function.
We analyzed data from two national surveys to estimate the short-term work disability associated with thirty-day major depression. Depressed workers were found to have between 1.5 and 3.2 more short-term work-disability days in a thirty-day period than other workers had, with a salary-equivalent productivity loss averaging between 395. These workplace costs are nearly as large as the direct costs of successful depression treatment, which suggests that encouraging depressed workers to obtain treatment might be cost-effective for some employers.
Employers are playing an increasingly influential role in determining the scope and character of health coverage in the United States. This study compares the health and disability costs of depressive illness with those of four other chronic conditions among employees of a large U.S. corporation.
Data from the health and employee files of 15,153 employees of a major U.S. corporation who filed health claims in 1995 were examined. Analyses compared the mental health costs, medical costs, sick days, and total health and disability costs associated with depression and four other conditions: heart disease, diabetes, hypertension, and back problems. Regression models were used to control for demographic differences and job characteristics.
Employees treated for depression incurred annual per capita health and disability costs of $5,415, significantly more than the cost for hypertension and comparable to the cost for the three other medical conditions. Employees with depressive illness plus any of the other conditions cost 1.7 times more than those with the comparison medical conditions alone. Depressive illness was associated with a mean of 9.86 annual sick days, significantly more than any of the other conditions. Depressed employees under the age of 40 years took 3.5 more annual sick days than those 40 years old or older.
The cost of depression to employers, particularly the cost in lost work days, is as great or greater than the cost of many other common medical illnesses, and the combination of depressive and other common illnesses is particularly costly. The strong association between depressive illness and sick days in younger workers suggests that the impact of depression may increase as these workers age.
The objective of this work was to develop a psychometrically sound questionnaire for measuring the on-the-job impact of chronic health problems and/or treatment ("work limitations").
Three pilot studies (focus groups, cognitive interviews, and an alternate forms test) generated candidate items, dimensions, and response scales. Two field trials tested the psychometric performance of the questionnaire (studies 1 and 2). To test recall error, study 1 subjects were randomly assigned to 2 different questionnaire groups, a questionnaire with a 4-week reporting period completed once or a 2-week version completed twice. Responses were compared with data from concurrent work limitation diaries (the gold standard). To test construct validity, we compared questionnaire scores of patients with those of healthy job-matched control subjects. Study 2 was a cross-sectional mail survey testing scale reliability and construct validity.
The study subjects were employed individuals (18-64 years of age) from several chronic condition groups (study 1, n = 48; study 2, n = 121) and, in study 1, 17 healthy matched control subjects.
Study 1 included the assigned questionnaires and weekly diaries. Study 2 included the new questionnaire, SF-36, and work productivity loss items.
In study 1, questionnaire responses were consistent with diary data but were most highly correlated with the most recent week. Patients had significantly higher (worse) limitation scores than control subjects. In study 2, 4 scales from a 25-item questionnaire achieved Cronbach alphas of > or = 0.90 and correlated with health status and self-reported work productivity in the hypothesized manner (P < or = 0.05).
With 25 items, 4 dimensions (limitations handling time, physical, mental-interpersonal, and output demands), and a 2-week reporting period, the Work Limitations Questionnaire demonstrated high reliability and validity.
Workforce productivity has become a critical factor in the strength and sustainability of a company's overall business performance. Absenteeism affects productivity; however, even when employees are physically present at their jobs, they may experience decreased productivity and below-normal work quality--a concept known as decreased presenteeism. This article describes the creation and testing of a presenteeism scale evaluating the impact of health problems on individual performance and productivity. A total of 175 county health employees completed the 34-item Stanford Presenteeism Scale (SPS-34). Using these results, we identified six key items to describe presenteeism, resulting in the SPS-6. The SPS-6 has excellent psychometric characteristics, supporting the feasibility of its use in measuring health and productivity. Further validation of the SPS-6 on actual presenteeism (work loss data) or health status (health risk assessment or utilization data) is needed.
This report describes the World Health Organization Health and Work Performance Questionnaire (HPQ), a self-report instrument designed to estimate the workplace costs of health problems in terms of reduced job performance, sickness absence, and work-related accidents-injuries. Calibration data are presented on the relationship between individual-level HPQ reports and archival measures of work performance and absenteeism obtained from employer archives in four groups: airline reservation agents (n = 441), customer service representatives (n = 505), automobile company executives (n = 554), and railroad engineers (n = 850). Good concordance is found between the HPQ and the archival measures in all four occupations. The paper closes with a brief discussion of the calibration methodology used to monetize HPQ reports and of future directions in substantive research based on the HPQ.
Work limitation rates are crucial indicators of the health status of working people. If related to work productivity, work limitation rates may also supply important information about the economic burden of illness.
Our objective was to assess the productivity impact of on-the-job work limitations due to employees' physical or mental health problems.
Subjects were asked to complete a self-administered survey on the job during 3 consecutive months. Using robust regression analysis, we tested the relationship of objectively-measured work productivity to employee-reported work limitations.
We attempted to survey employees of a large firm within 3 different jobs. The survey response rate was 2245 (85.9%). Full survey and productivity data were available for 1827 respondents.
Each survey included a validated self-report instrument, the Work Limitations Questionnaire (WLQ). The firm provided objective, employee-level work productivity data.
In adjusted regression analyses (n = 1827), employee work productivity (measured as the log of units produced/hour) was significantly associated with 3 dimensions of work limitations: limitations handling the job's time and scheduling demands (P = 0.003), physical job demands (P = 0.001), and output demands (P = 0.006). For every 10% increase in on-the-job work limitations reported on each of the 3 WLQ scales, work productivity declined approximately 4 to 5%.
Employee work limitations have a negative impact on work productivity. Employee assessments of their work limitations supply important proxies for the economic burden of health problems.
Evidence consistently indicates that depression has adversely affected work productivity. Estimates of the cost impact in lost labor time in the US workforce, however, are scarce and dated.
To estimate the impact of depression on labor costs (ie, work absence and reduced performance while at work) in the US workforce.
All employed individuals who participated in the American Productivity Audit (conducted August 1, 2001-July 31, 2002) between May 20 and July 11, 2002, were eligible for the Depressive Disorders Study. Those who responded affirmatively to 2 depression-screening questions (n = 692), as well as a 1:4 stratified random sample of those responding in the negative (n = 435), were recruited for and completed a supplemental interview using the Primary Care Evaluation of Mental Disorders Mood Module for depression, the Somatic Symptom Inventory, and a medical and treatment history for depression. Excess lost productive time (LPT) costs from depression were derived as the difference in LPT among individuals with depression minus the expected LPT in the absence of depression projected to the US workforce.
Estimated LPT and associated labor costs (work absence and reduced performance while at work) due to depression.
Workers with depression reported significantly more total health-related LPT than those without depression (mean, 5.6 h/wk vs an expected 1.5 h/wk, respectively). Eighty-one percent of the LPT costs are explained by reduced performance while at work. Major depression accounts for 48% of the LPT among those with depression, again with a majority of the cost explained by reduced performance while at work. Self-reported use of antidepressants in the previous 12 months among those with depression was low (<33%) and the mean reported treatment effectiveness was only moderate. Extrapolation of these survey results and self-reported annual incomes to the population of US workers suggests that US workers with depression employed in the previous week cost employers an estimated 44 billion dollars per year in LPT, an excess of 31 billion dollars per year compared with peers without depression. This estimate does not include labor costs associated with short- and long-term disability.
A majority of the LPT costs that employers face from employee depression is invisible and explained by reduced performance while at work. Use of treatments for depression appears to be relatively low. The combined LPT burden among those with depression and the low level of treatment suggests that there may be cost-effective opportunities for improving depression-related outcomes in the US workforce.
Depression can have a serious impact on a person's ability to work. The purpose of this study was to describe depressed persons who work and depressed persons who do not work and to identify factors related to depressed persons' working.
The combined 1994 and 1995 National Health Interview Survey Disability Supplement was used to identify persons aged 18 to 69 with depression. Sociodemographic, health, functional, and disability characteristics of working depressed persons and nonworking depressed persons were compared with use of a chi square test of significance. After adjustment for sociodemographic variables, multiple logistic regression analysis was used to identify factors associated with work among depressed persons.
Approximately half of the persons who reported major depression were in the labor force. Compared with nonworking depressed persons, working depressed persons tended to be younger, to be male, to be better educated, to have a higher income, to live alone or with a nonrelative, and to live in an urban or suburban location. They less often perceived themselves as unable to work or as disabled and were healthier and less impaired by social, cognitive, and physical limitations than their nonworking counterparts. After sociodemographic factors were controlled for, health and functional characteristics were strongly associated with depressed persons' working.
Depressed persons who work and who do not work differed across sociodemographic, health, functional, and disability factors. Understanding the factors associated with depressed persons' working and not working may help policy makers, employers, and clinicians shape health care benefits packages, employee assistance programs, disability programs, and treatment programs appropriately. In particular, it may be important to focus on individuals with depression and comorbid general health conditions.
Evidence about the total cost of health, absence, short-term disability, and productivity losses was synthesized for 10 health conditions. Cost estimates from a large medical/absence database were combined with findings from several published productivity surveys. Ranges of condition prevalence and associated absenteeism and presenteeism (on-the-job-productivity) losses were used to estimate condition-related costs. Based on average impairment and prevalence estimates, the overall economic burden of illness was highest for hypertension (368), depression and other mental illnesses (327). Presenteeism costs were higher than medical costs in most cases, and represented 18% to 60% of all costs for the 10 conditions. Caution is advised when interpreting any particular source of data, and the need for standardization in future research is noted.
Physicians regard individuals with dysthymia as having relatively normal levels of functioning. This study examines in detail the work impact of dysthymia in a population of employed primary care patients. As part of an observational study conducted between 2001 and 2003 in clinics associated with three health plans in Massachusetts, we compared 69 patients diagnosed with DSM-IV dysthymia without concurrent major depressive disorder to 175 depression-free controls. Patients were employed at least 15 h per week, had no immediate plans to leave the labor market, and no major comorbid medical conditions. We assessed work absences and productivity loss due to on-the-job performance limitations ("presenteeism"). Patients with dysthymia, compared with controls, had less stable work histories and a greater frequency of significant problems at work. While absence rates were not significantly different (1.2 vs. 0.74 days, P<.09), individuals with dysthymia experienced significantly greater on-the-job productivity loss (6.3% vs. 2.8%, P<.0001). Dysthymia is an unrecognized cause of work impairment that has long-term negative consequences for individuals and their employers. The persistence of dysthymia with its serious impact on work functioning calls out for the development of new interventions.
This study examined the prevalence, impact on health-related quality of life (HRQoL), and outcome of physical symptoms in depressed patients during 9 months of antidepressant therapy.
Open-label, randomized, intention-to-treat trial with enrollment occurring April through November 1999.
Thirty-seven primary care clinics within a research network.
Five hundred seventy-three depressed patients started on one of three selective serotonin reuptake inhibitors (SSRIs) by their primary care physician and who completed a baseline interview.
Patients were randomized to receive fluoxetine, paroxetine, or sertraline.
Outcomes assessed included physical symptoms, depression, and multiple domains of HRQoL. Prevalence of physical symptoms was determined at baseline and after 1, 3, 6, and 9 months of treatment. Stepwise linear regression models were used to determine the independent effects of physical symptoms and depression on HRQoL domains. Of the 14 physical symptoms assessed, 13 were present in at least a third to half of the patients at baseline. Each symptom showed the greatest improvement during the initial month of treatment. In contrast, depression continued to show gradual improvement over a 9-month period. Physical symptoms had a predominant effect on pain (explaining 17% to 18% of the variance), physical functioning (13%), and overall health perceptions (13% to 15%). Depression had the greatest impact on mental (26% to 45%), social (14% to 32%), and work functioning (9% to 32%).
Physical symptoms are prevalent in depressed patients and initially improve in the first month of SSRI treatment. Unlike depression, however, improvement in physical symptoms typically plateaus with minimal resolution in subsequent months.
This study evaluated the effects of antidepressants and psychotherapy on work impairment in depressed patients. Original databases from 10 published treatment studies were compiled and analyzed (N = 827). Functional work impairment was common at baseline, manifested by unemployment (11%) or on-the-job performance problems (absenteeism, decreased productivity, interpersonal problems, 44%). Generally, work outcomes were good when treatment was symptomatically effective, but the trajectories of work restoration and symptom remission were different, with work recovery appearing to take considerably longer. Relapse was an important determinant of long-term occupational outcome, particularly for seriously ill patients for whom relapse meant rehospitalization or other profound social disruption. Affective impairment was distinguished from functional impairment, with the former characterizing milder depression and the latter characterizing moderate to severe depression. Some methodological recommendations are discussed.
Objective: To assess the ability of internists to identify functional disabilities reported by their patients.
Design: Comparison of responses by physicians and a random sample of their patients to a 12-item questionnaire about physical and social function.
Setting: A hospital-based internal medicine group practice in Boston, Massachusetts, and selected office-based internal medicine practices in Los Angeles, California.
Subjects: Five staff physicians, three general internal medicine fellows, and 34 internal medicine residents in the hospital-based practice and 178 of their patients. Seventy-six physicians in the office-based practices and 230 of their patients.
Measurements and Main Results: Physicians underestimated or failed to recognize 66% of disabilities reported by patients. Patient-reported disabilities were underestimated or unrecognized more often in the hospital-based practice than in the office-based practices (75% compared with 60%, P < 0.05). Physicians overstated functional impairment in 21% of paired responses in which patients reported no disability.
Conclusions: Physicians often underestimate or fail to recognize functional disabilities that are reported by their patients. They overstate functional impairment to a lesser degree. Because these discrepancies may adversely affect patient care and well-being, medical educators and clinicians should pay more attention to the assessment of patient function.
Population and migration -- Macroeconomic trends -- Economic globalisation -- Prices -- Labour market -- Science and technology -- Environment -- Education -- Public policies -- Quality of life -- Focus on: energy
Background:
Lost productivity from attending work when unwell, or "presenteeism", is a largely hidden cost of mental disorders in the workplace. Sensitive measures are needed for clinical and policy applications, however there is no consensus on the optimal self-report measure to use. This paper examines the sensitivity of four alternative measures of presenteeism to depression and anxiety in an Australian employed cohort.
Methods:
A prospective single-group study in ten call centres examined the association of presenteeism (presenteeism days, inefficiency days, Work Limitations Questionnaire, Stanford Presenteeism Scale) with Patient Health Questionnaire depression and anxiety syndromes.
Results:
At baseline, all presenteeism measures were sensitive to differences between those with (N=69) and without (N=363) depression/anxiety. Only the Work Limitations Questionnaire consistently showed worse productivity as depression severity increased, and sensitivity to remission and onset of depression/anxiety over the 6-month follow-up (N=231). There was some evidence of individual depressive symptoms having a differential association with different types of job demands.
Limitations:
The study findings may not generalise to other occupational settings with different job demands. We were unable to compare responders with non-responders at baseline due to anonymity.
Conclusions:
In this community sample the Work Limitations Questionnaire offered additional sensitivity to depression severity, change over time, and individual symptoms. The comprehensive assessment of work performance offers significant advantages in demonstrating both the individual and economic burden of common mental disorders, and the potential gains from early intervention and treatment.
This study evaluated the effects of antidepressants and psychotherapy on work impairment in depressed patients. Original databases from 10 published treatment studies were compiled and analyzed (N = 827). Functional work impairment was common at baseline, manifested by unemployment (11%) or on-the-job performance problems (absenteeism, decreased productivity, interpersonal problems, 44%). Generally, work outcomes were good when treatment was symptomatically effective, but the trajectories of work restoration and symptom remission were different, with work recovery appearing to take considerably longer. Relapse was an important determinant of long-term occupational outcome, particularly for seriously ill patients for whom relapse meant rehospitalization or other profound social disruption. Affective impairment was distinguished from functional impairment, with the former characterizing milder depression and the latter characterizing moderate to severe depression. Some methodological recommendations are discussed.
Are inverse relations between psychiatric disorders and socioeconomic status due more to social causation (adversity and stress)
or social selection (downward mobility of genetically predisposed)? This classical epidemiological issue is tested by focusing
on ethnic status in relation to socioeconomic status. Ethnic status cannot be an effect of disorder because it is present
at birth whereas socioeconomic status depends on educational and occupational attainment. A birth cohort sample of 4914 young,
Israel-born adults of European and North African background was selected from the country's population register, screened,
and diagnosed by psychiatrists. Results indicate that social selection may be more important for schizophrenia and that social
causation may be more important for depression in women and for antisocial personality and substance use disorders in men.
Although depression is one of the most common problems of medical and psychiatric outpatients, it has not been clear whether the extent of medical comorbidity among depressed patients varies across major types of clinical settings in which depressed patients receive care--especially by type of treating clinician (general medical versus mental health specialty) or type of payment for services (prepaid versus fee-for-service).
The authors examined these issues using data on 1,152 adult outpatients with current depressive symptoms and a lifetime history of unipolar depressive disorder who received care in one of three health care delivery systems in three U.S. sites.
Depressed patients had a similarly high prevalence (64.9%-71.0%) of any of eight common chronic medical conditions whether they were seen in the general medical or specialty mental health sector; however, those visiting medical clinicians had a significantly higher prevalence of the two most common chronic medical conditions, hypertension and arthritis. Among depressed patients with hypertension, those visiting the general medical sector were more likely to be taking antihypertensive medication than were those visiting the mental health specialty sector. Type of payment (prepaid versus fee-for-service) was unrelated to either prevalence or severity of comorbid medical conditions, suggesting that the typical depressed patient in all types of practices studied had medical comorbidity.
These data suggest that clinicians in all health care settings must be prepared to encounter chronic medical conditions and complaints in the depressed patients who visit them.
We describe the functioning and well-being of patients with depression, relative to patients with chronic medical conditions or no chronic conditions. Data are from 11,242 outpatients in three health care provision systems in three US sites. Patients with either current depressive disorder or depressive symptoms in the absence of disorder tended to have worse physical, social, and role functioning, worse perceived current health, and greater bodily pain than did patients with no chronic conditions. The poor functioning uniquely associated with depressive symptoms, with or without depressive disorder, was comparable with or worse than that uniquely associated with eight major chronic medical conditions. For example, the unique association of days in bed with depressive symptoms was significantly greater than the comparable association with hypertension, diabetes, and arthritis. Depression and chronic medical conditions had unique and additive effects on patient functioning.
Major depression is thought to be underdiagnosed and undertreated in primary medical care facilities. The authors conducted a clinical trial that included a three-phase assessment so only ambulatory medical patients judged eligible for treatment of this disorder in medical settings were recruited. In addition to administering the Center for Epidemiologic Studies-Depression scale and the Diagnostic Interview Schedule's (DIS) Depression section, the psychiatrists evaluated the DIS-positive patients. This third assessment determined that clinical characteristics of DIS-positive patients were such that 70% of the patients could be treated for major depression in a primary care setting, 13% should probably be referred to a mental health facility, and 17% were experiencing conditions other than major depression.
Major depression is a frequent and disabling psychiatric disorder in the United States. This report examines the prevalence and risk factor profile of both pure and comorbid major depression according to data from the National Comorbidity Survey.
To estimate the prevalence of psychiatric comorbidity in the United States, a national sample of 8,098 persons 15-54 years of age from the 48 conterminous states was surveyed with a modified version of the Composite International Diagnostic Interview. Results: From the survey data the prevalence of current (30-day) major depression was estimated to be 4.9%, with a relatively higher prevalence in females, young adults, and persons with less than a college education. The prevalence estimate for lifetime major depression was 17.1%, with a similar demographic distribution. Both 30-day and lifetime prevalence estimates were higher than estimates from the earlier Epidemiologic Catchment Area study. When pure major depression was compared with major depression co-occurring with other psychiatric disorders, the risk factor profiles exhibited clear differences.
These findings suggest a greater burden of major depression in community-dwelling persons than has been estimated from previous community samples. The risk factor profile showed significant differences between persons with pure and combined major depression.
The objective of this article is to consider whether randomized clinical trials (RCTs) are able to determine the validity of transferring treatments for major depression from the psychiatric to the primary care sector. This clinical issue is of growing concern in the United States since both governmental and professional bodies are establishing guidelines for the treatment of medical patients with the affective disorder. The article's method involves analysis of how the competing aims of rigorous scientific methodology (internal validity) and generalization of study findings (external validity) are best balanced within the RCT. Experiences in recruiting medical patients with major depression and providing pharmacologic, psychotherapeutic, and usual care interventions compatible with the sociotechnical characteristics of ambulatory medical centers are described to illustrate the complexities of investigating transferability of treatments for major depression with RCT methodology.
General population data are presented on the prevalence and correlates of comorbidity between DSM-III-R major depressive disorder (MDD) and other DSM-III-R disorders. The data come from the US National Comorbidity Survey, a large general population survey of persons aged 15-54 years in the non-institutionalised civilian population. Diagnoses are based on a modified version of the Composite International Diagnostic Interview (CIDI). The analysis shows that most cases of lifetime MDD are secondary. In the sense that they occur in people with a prior history of another DSM-III-R disorder. Anxiety disorders are the most common primary disorders. The time-lagged effects of most primary disorders on the risk of subsequent MDD continue for many years without change in magnitude. Secondary MDD is, in general, more persistent and severe than pure or primary MDD. This has special public health significance because lifetime prevalence of secondary MDD has increased in recent cohorts, while the prevalence of pure and primary depression has remained unchanged.
Depression is a socially important condition that is often undertreated. This article reviews data from the Medical Outcomes Study illustrating the policy importance of depression, highlighting style of treatment under prepaid managed or fee-for-service care and strategies to improve the cost-effectiveness and efficiency of care.
To examine relationships between recent DSM-III-R psychiatric disorders and work impairment in major occupational groups in the US labour force.
Data are from the US National Comorbidity Survey (NCS), a survey of respondents ages 15-54 in the US. Employed people are the focus of the report.
There is substantial variation across occupations in the 30-day prevalences of NCS/ DSM-III-R psychiatric disorders, with an average prevalence of 18.2% (range: 11.0-29.6%) for any disorder. The average prevalences of psychiatric work loss days (6 days per month per 100 workers) and work cutback days (31 days per month per 100 workers), in comparison, do not differ significantly across occupations. Work impairment is more strongly concentrated among the 3.7% of the workforce with co-morbid psychiatric disorders (49 work loss days and 346 work cutback days per month per 100 workers) than the 14.5% with pure disorders (11 work loss days and 66 work cutback days per month per 100 workers) or the 81.8% with no disorder (2 work loss days and 11 work cutback days per month per 100 workers). The effects of psychiatric disorders on work loss are similar across all occupations, while effects on work cutback are greater among professional workers than those in other occupations.
The results reported here suggest that work impairment is one of the adverse consequences of psychiatric disorders. The current policy debate concerning insurance coverage for mental disorders needs to take these consequences into consideration.
Few data are available regarding the impact of improved depression treatment on daily functioning and disability.
In two studies of more intensive depression treatment in primary care, patients initiating antidepressant treatment were randomly assigned to either usual care or to a collaborative management programme including patient education, on-site mental health treatment, adjustment of antidepressant medication, behavioural activation and monitoring of medication adherence. Assessments at baseline as well as 4 and 7 months included several measures of impairment, daily functioning and disability: self-rated overall health, number of bodily pains, number of somatization symptoms, changes in work due to health, reduction in leisure activities due to health, number of disability days and number of restricted activity days.
Average data from the 4- and 7-month assessments in both studies, intervention patients reported fewer somatic symptoms (OR 0.68, 95% CI 0.46, 0.99) and more favourable overall health (OR 0.50, 95% CI 0.28, 0.91). While intervention patients fared better on other measures of functional impairment and disability, none of these differences reached statistical significance.
More effective acute-phase depression treatment reduced somatic distress and improved self-rated overall health. The absence of a significant intervention effect on other disability measures may reflect the brief treatment and follow-up period and the influence of other individual and environmental factors on disability.
Utilizing data from a clinical trial and an econometric model incorporating the impact of a medical intervention and regression to the mean, we present evidence supporting the hypotheses that for chronically depressed individuals: (i) the level of perceived at-work performance is negatively related to the severity of depressive status; and (ii) a reduction in depressive severity improves the patient's perceived work performance. Improvement in work performance is rapid, with about two-thirds of the change occurring already by week 4. Those patients having the greatest work improvement are those with both relatively low baseline work performance and the least severity of baseline depression.
To assess effects of stepped collaborative care depression intervention on disability.
Randomized controlled trial.
Four primary care clinics of a large health maintenance organization.
Two hundred twenty-eight patients with either 4 or more persistent major depressive symptoms or a score of 1.5 or greater on the Hopkins Symptom Checklist. Depression items were randomized to stepped care intervention or usual care 6 to 8 weeks after initiating antidepressant medication.
Augmented treatment of persistently depressed patients by an on-site psychiatrist collaborating with primary care physicians. Treatment included patient education, adjustment of pharmacotherapy, and proactive monitoring of outcomes.
Baseline, 1-, 3-, and 6-month assessments of the Sheehan Disability Scale and the social function and role limitation subscales of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36).
Patients who received the depression intervention experienced less interference in their family, work, and social activities than patients receiving usual primary care (Sheehan Disability Scale, z = 2.23; P =.025). Patients receiving intervention also reported a trend toward more improvement in SF-36-defined social functioning than patients receiving usual care (z = 1.63, P =.10), but there was no significant difference in role performance (z = 0.07, P =.94).
Significant disability accompanied depression in this persistently depressed group. The stepped care intervention resulted in small to moderate functional improvements for these primary care patients. Arch Fam Med. 2000;9:1052-1058
We conceptualize employment status not as a dichotomy of working versus not working but as a continuum ranging from adequate employment to inadequate employment (involuntary part-time or low wage) to unemployment. Will shifts from adequate to inadequate employment increase depression as do shifts from employment to unemployment, and to what extent does prior depression select workers into such adverse employment change? We analyze panel data from the National Longitudinal Survey of Youth for the years 1992-1994 for the 5,113 respondents who were adequately employed in 1992. Controlling for prior depression, both types of adverse employment change resulted in similar, significant increases in depression. These direct effects persisted despite inclusion of such potential mediators as changes in income, job satisfaction, and marital status. Marital status buffered the depressive effect of both types of adverse change, but education and job dissatisfaction amplified the effect of unemployment on depression. Prior depression did not predict higher risk of becoming inadequately employed but did predict increased risk of unemployment, particularly for those with less education. These results confirm that both unemployment and inadequate employment affect mental health, and they invite greater efforts to monitor the extent and impact of underemployment.
With the admission of people who experience psychiatric disabilities in the state-federal vocational rehabilitation system and the Social Security disability rolls in the 1960s, assessment of their capacity to work has been a major concern. Given the rising rates of claims for psychiatric disability in both the public and the private sectors, and the disappointing employment outcomes of people with psychiatric disabilities compared to those with other disabilities, there have been numerous initiatives to accurately assess their employment potential. Historically, such assessment within the Social Security Administration has relied upon evaluation of a person's medical impairment, but numerous studies suggest a weak relationship between measures of psychiatric diagnosis or symptoms and work outcome. Efforts have been undertaken to identify valid and reliable methods of assessing the ability of people with psychiatric disabilities to work. The authors review (a) methods of assessing work function for this population, and (b) the literature on predictors of work functioning and the nature of psychiatric disability, and suggest implications for disability determination policies and for future research.
Although it is known that antidepressant treatment improves psychosocial functioning, whether such changes occur independent of depressive symptoms is not known. This study compared efficacy of nefazodone, psychotherapy, and their combination in improving psychosocial functioning in chronically depressed outpatients.
Patients with chronic forms of major depressive disorder were randomized to 12 weeks of nefazodone, Cognitive Behavioral Analysis System of Psychotherapy (CBASP), or combined nefazodone/CBASP. Psychosocial assessments measured overall psychosocial functioning, work functioning, interpersonal functioning, and general health.
Relative to community norms, patients with chronic major depression evidenced substantially impaired psychosocial functioning at baseline. Combined treatment produced significantly greater psychosocial improvement than either CBASP alone or nefazodone alone on all primary measures. Combined treatment remained superior to nefazodone on primary measures of work, social, and overall functioning, and superior to CBASP on social functioning when depressive symptoms were controlled. Unlike the two groups receiving nefazodone, CBASP alone's effect on psychosocial function was relatively independent of symptom change. Psychosocial functioning improved more slowly than depressive symptoms, and moderate psychosocial impairments remained at end point.
Combined treatment had greater effect than either monotherapy. Change in depressive symptoms did not fully explain psychosocial improvement. Moderate residual psychosocial impairment remained, suggesting the need for continuation/maintenance treatment.
To evaluate the effects of depression treatment in primary care on patients' clinical status and employment, over six months.
Data are from a randomized controlled trial of quality improvement for depression that included 938 adults with depressive disorder in 46 managed primary care clinics in five states.
Observational analysis of the effects of evidence-based depression care over six months on health outcomes and employment. Selection into treatment is accounted for using instrumental variables techniques, with randomized assignment to the quality improvement intervention as the identifying instrument.
Patient-reported clinical status, employment, health care use, and personal characteristics; health care use and costs from claims data.
At six months, patients with appropriate care, compared to those without it, had lower rates of depressive disorder (24 percent versus 70 percent), better mental health-related quality of life, and higher rates of employment (72 percent versus 53 percent), each p<.05.
Appropriate treatment for depression provided in community-based primary care substantially improves clinical and quality of life outcomes and employment.
Background:
Depression causes significant functional impairment in sufferers and often leads to adverse employment outcomes for working individuals. Recovery from depression has been associated with better employment outcomes at one year.
Aims of the study:
The study s goals were to assess a primary care depression intervention s impact on subsequent employment and workplace conflict outcomes in employed patients with depression.
Methods:
In 1996-1997, the study enrolled 262 employed patients with depression from twelve primary care practices located across ten U.S. states; 219 (84%) of the patients were followed at one year. Intent-to-treat analyses assessing intervention effects on subsequent employment and workplace conflict were conducted using logistic regression models controlling for individual clinical and sociodemographic characteristics, job classification and local employment conditions. To meet criteria for subsequent employment, persons working full-time at baseline had to report they were working full-time at follow-up and persons working part-time at baseline had to report working part-/full-time at follow-up. Workplace conflict was measured by asking patients employed at follow-up whether, in the past year, they had arguments or other difficulties with people at work .
Results:
Findings showed that 92.1% of intervention patients met criteria for subsequent employment at one year, versus 82.0% of usual care patients (c2=4.42, p=.04). Intervention patients were less likely than usual care patients to report workplace conflict in the year following baseline (8.1% vs. 18.9%, respectively; c2=4.11; p=.04). The intervention s effect on subsequent employment was not mediated by its effect on workplace conflict.
Discussion:
The intervention significantly improved employment outcomes and reduced workplace conflict in depressed, employed persons at one year. Economic implications for employers related to reduced turnover costs, for workers related to retained earnings, and for governments related to reduced unemployment expenditures and increased tax receipts may be considerable.
Limitations:
Although similar primary care depression interventions have been shown to produce comparable effects on subsequent employment at one year, replications in larger samples of depressed, employed patients in different economic climates may be necessary to increase the generalizability and precision of estimates.
Implications for health care provision and use:
Primary care interventions that enhance depression treatment and improve clinical outcomes can contribute meaningful added value to society by improving employment and workplace outcomes.
Implications for health policies:
Federal/state governments may realize economic benefits from reduced unemployment expenditures and increased tax receipts should primary care depression interventions that improve employment outcomes be broadly disseminated. Policy initiatives to increase the dissemination of such interventions may be an innovative approach for improving labor force participation by depressed individuals.
Implications for further research:
Formal cost-benefit analyses are needed to explore whether economic benefits to societal stakeholders from these and other labor outcomes equal or exceed the incremental costs of disseminating similar primary care interventions nationally. Researchers in other nations may wish to consider investigating the impact primary care depression interventions might have on employment and workplace outcomes in their countries.
A multi-employer database that links medical, prescription drug, absence, and short term disability data at the patient level was analyzed to uncover the most costly physical and mental health conditions affecting American businesses. A unique methodology was developed involving the creation of patient episodes of care that incorporated employee productivity measures of absence and disability. Data for 374,799 employees from six large employers were analyzed. Absence and disability losses constituted 29% of the total health and productivity related expenditures for physical health conditions, and 47% for all of the mental health conditions examined. The top-10 most costly physical health conditions were: angina pectoris; essential hypertension; diabetes mellitus; mechanical low back pain; acute myocardial infarction; chronic obstructive pulmonary disease; back disorders not specified as low back; trauma to spine and spinal cord; sinusitis; and diseases of the ear, nose and throat or mastoid process. The most costly mental health disorders were: bipolar disorder, chronic maintenance; depression; depressive episode in bipolar disease; neurotic, personality and non-psychotic disorders; alcoholism;, anxiety disorders; schizophrenia, acute phase; bipolar disorders, severe mania; nonspecific neurotic, personality and non-psychotic disorders; and psychoses. Implications for employers and health plans in examining the health and productivity consequences of common health conditions are discussed.
While there is a growing literature on various aspects of depression in women, there is little research about the economic cost of depression in women. This analysis focuses on the direct and indirect cost to employers of female compared to male employees treated for depression, and their service utilization patterns.
We used a claims database from a national, Fortune 100 company to analyze the direct (medical and prescription drug) and indirect (disability and illness-related work absence) costs to an employer for female and male beneficiaries with depression.
In 1998, the average female employee with depression cost this company 8502 for male employees with depression. These women had significantly greater work absence costs which led to higher total costs than men, even though their medical costs were lower than those of comparable men.
Our analysis of the indirect costs associated with depressed female and male employees is limited to the costs of disability and sporadic illness-related work absences. The data available from this one employer did not allow accounting for the cost of reduced productivity while at work.
We recommend that employers consider programs to improve the management of individuals with depression, in particular women. Also, further research is necessary to encourage the medical community to be more sensitive to the symptoms of depression in women.
The economic burden of depression is substantial. The condition is highly prevalent, with both psychiatric and physical symptoms that often inflict pain. The chronic and often debilitating nature of depression results in costly medical therapies, as well as impaired workplace productivity. As a result, the overall economic burden of depression is comparable to that of serious physical illnesses, such as cancer and heart disease. This article presents an overview of the economic burden of depression and provides background on the relationship between depression and pain in this context. Research findings are also presented on the economic burden associated with a particular manifestation of pain among depressed patients, fibromyalgia. When painful physical symptoms accompany the already debilitating psychiatric and behavioral symptoms of depression, the economic burden that ensues for patients and their employers increases considerably. On purely economic grounds, more aggressive outreach may be warranted for patients with depression and comorbid pain to initiate treatment before symptoms are allowed to persist. However, more research is needed to assess the comprehensive economic impact that depression with painful physical symptoms can have on society.
Associations between chronic conditions and work performance (absenteeism, presenteeism, and critical incidents) were studied in reservation agents, customer service representatives, executives, and railroad engineers. Conditions and work performance were assessed with the World Health Organization's Health and Work Performance Questionnaire. Analysis of covariance was used to estimate associations. More work performance was lost from presenteeism than absenteeism. However, chronic conditions more consistently had negative impacts on absenteeism than presenteeism. Conditions with significant effects included arthritis, asthma, chronic obstructive pulmonary disease-emphysema, depression, and chronic headaches. Arthritis had the largest aggregate effect on absenteeism-presenteeism. Only depression affected both absenteeism-presenteeism and critical incidents. Some chronic conditions have substantial workplace effects. Disease management programs for these conditions might have a positive return on investment (ROI). Health and productivity tracking surveys are needed to evaluate ROI and provide quality assurance.
Background:
Conservative estimates indicate between 10% and 20% of all individuals with major depressive disorders (MDDs) fail to respond to conventional antidepressant therapies. Amongst those with MDD, individuals with treatment-resistant depression (TRD) have been found to be frequent users of healthcare services and to incur significantly greater costs than those without TRD. Given the prevalence of the disorder, it is understandable that MDDs are responsible for a significant amount of both direct and indirect healthcare costs.
Objective:
To provide empirical findings for employees likely to have TRD based on analysis of employer claims data, in the context of previous research.
Methods:
We conducted a claims data analysis of employees of a large national (US) employer. The data source consisted of medical, pharmaceutical and disability claims from a Fortune 100 manufacturer for the years 1996-1998 (total beneficiaries >100000). The employee sample included individuals with medical or disability claims for MDDs (n = 1692). A treatment pattern algorithm was applied to classify MDD patients into TRD-likely (n = 180) and TRD-unlikely groups. Treated prevalence of select comorbid conditions and the patient costs (direct and indirect) from the employer perspective by condition were compared among TRD-likely and TRD-unlikely employees, and with a 10% random sample of the overall employee population for 1998.
Results:
The average annual cost of employees considered TRD-likely was dollars US 14490 per employee, while the cost for depressed but TRD-unlikely employees was dollars US 6665 per employee, and dollars US 4043 for the employee from the random sample. TRD beneficiaries used more than twice as many medical services compared with TRD-unlikely patients, and incurred significantly greater work loss costs.
Conclusion:
TRD has gained increasing recognition due to both the clinical challenges and economic burdens associated with the condition. TRD imposes a significant economic burden on an employer. TRD-likely employees are more likely to be treated for selected comorbid conditions and have higher medical and work loss costs across all conditions.
Employers who are developing strategies to reduce health-related productivity loss may benefit from aiming their interventions at the employees who need them most. We determined whether depression's negative productivity impact varied with the type of work employees performed. Subjects (246 with depression and 143 controls) answered the Work Limitations Questionnaire and additional work questions. Occupational requirements were measured objectively. In multiple regression analyses, productivity was most influenced by depression severity (P < 0.01 in 5/5 models). However, certain occupations also significantly increased employee vulnerability to productivity loss. Losses increased when employees had occupations requiring proficiency in decision-making and communication and/or frequent customer contact (P < 0.05 in 3/5 models). The Work Limitations Questionnaire can help employers to reduce productivity loss by identifying health and productivity improvement priorities.
A self-reported measure of four domains of work impairment based on the Work Limitations Questionnaire was completed by 16,651 employees of a large financial services corporation. Using a multivariate model to control for coexisting conditions, age, and gender, significant relationships were observed between medical conditions and patterns of impaired work performance. Depression was highly associated with work limitations in time management (odds ratio [OR] = 2.05), interpersonal/mental functioning (OR = 2.50), and overall output (OR = 2.24). Arthritis (OR = 1.56) and low back pain (OR = 1.32) were associated with physical function limitations. These same two conditions were associated with limitations in mental/interpersonal functioning but with low back pain having the higher odds ratio (OR = 1.54 vs. 1.22). These results suggest that worksite interventions (eg, disease management programs) should be tailored to the unique effects observed with specific medical conditions. More targeted programs could have important benefits for productivity in the workplace.
This report presents an overview of methodological issues in estimating the indirect workplace costs of illness from data obtained in employee surveys using the World Health Organization Health and Work Performance Questionnaire (HPQ). The HPQ is a brief self-report questionnaire that obtains three types of information: screening information about the prevalence and treatment of commonly occurring health problems; information about three types of workplace consequences (sickness absence, presenteeism, and critical incidents); and basic demographic information. The report considers two sets of methodological issues. The first set deals with measurement. The rationale for the HPQ approach to measurement is described in this section. In addition, data are presented regarding the accuracy of HPQ measures, documenting that the HPQ has excellent reliability, validity, and sensitivity to change. The second set of methodological issues deals with data analysis. A number of analysis problems are reviewed that arise in using self-report nonexperimental survey data to estimate the workplace costs of illness and the cost-effectiveness of treatment. Innovative data analysis strategies are described to address these problems.
The response of ethnic minorities to mental health care is largely unstudied.
To determine the effect of appropriate care for depression on ethnic minorities.
Observational analysis of the effects of evidence-based depression care over 6 months on clinical outcomes and employment status is examined for ethnic minorities and nonminorities. Selection into treatment is accounted for using instrumental variables techniques, with randomized assignment to the quality improvement intervention as the identifying instrument.
Six managed care organizations across the United States. Patients One thousand three hundred fifty-six depressed adults, including 601 white, 258 Latino, 56 African American, and 24 Asian or Native American patients. Intervention Quality improvement interventions aimed at increasing guideline-concordant depression care.
At 6 months, minority patients who received appropriate care, compared with those who did not receive it, had lower rates of probable depressive disorder (20.5% vs 70.5%); the findings were similar for nonminority patients (24.3% vs 71.2%). Nonminority patients who received appropriate care were found to have higher rates of employment than were those who did not receive appropriate care (71.4% vs 52.4%). This was not true of minority patients (68.2% vs 56.5%).
Evidence-based care for depression is equally effective in reducing depressive disorders for minority and nonminority patients. However, functional outcomes of care, such as continued employment, may be more limited for minority than nonminority patients. Because minority members are less likely to get appropriate care, efforts should be made to engage minority members in effective care for depression.