"How many business owners would willingly absorb an additional yearly expense of $6,000 per employee, with no return on investment? This figure represents the estimated cost of untreated depression in a single worker, manifested in lost workdays, "presenteeism," errors, accidents, and increased use of medical benefits and disability claims. According to the National Institute of Mental Health, 19 million American adults, or 10 percent of the population, suffer some form of depression during prime career years. This invisible affliction can disable employees on every rung of the corporate ladder, irrespective of IQ, competence, strength of character or gender. Estimates suggest it is severely under-diagnosed, with only 25 percent of victims receiving effective treatment. The majority suffer silently, with impaired performances taking an annual toll of $44 billion on the economy. This figure places untreated depression in the top three most costly workplace problems.
Often attributed to "weakness of character," depression has an identifiable physical basis in brain chemistry. For decades, scientists have recognized an association with low levels of the neurotransmitters serotonin and norepinephrine. Newer research has implicated nerve cells and ways in which the brain's chemistry can be permanently damaged by hard-wired stress responses, due to genetic predisposition, prolonged exposure to stress, or a single traumatic event. These dramatic alterations in brain chemistry clearly shift depression from the realm of free will into the arena of physical impairment.
Common symptoms include:
Persistent sad mood
Feelings of hopelessness
Excess guilt/worthlessness
Loss of interest in daily activities
Increased lethargy
Sleep disturbances
Negative thoughts
Excessive crying
Changes in appetite (gain or loss of 10 pounds)
Irritability, increase in conflicts
Inability to concentrate or make decisions
Social withdrawal
Thoughts of suicide or completed suicide
Stigma attached to "mental illness," along with fear of punitive organizational bias, may encourage employees to conceal depression. Males are particularly vulnerable to these concerns and may self-medicate with alcohol, gambling, or promiscuous affairs rather than risk the social embarrassment of seeking treatment. Depression is often manifested in ways that aren't obvious, disguising its prevalence. It may be exhibited through negative attitudes towards fellow employees, supervisors and the workplace in general, thereby masking the actual illness with the appearance of a "work performance problem."
Other barriers include difficulty accessing health benefits (large deductibles) and lack of knowledge regarding effective treatment. Primary care physicians are often the only source of contact among those who actually seek care. Research indicates that these providers, who are not mental health specialists, may miss the diagnosis in as many as 50 percent of patients.
Advances in recent years have created highly effective treatment. According to the National Institute of Mental Health, the ideal regimen of medication combined with psychotherapy is fully effective in more than 80 percent of all cases. Promising new interventions include medications that block excess stress chemicals, an over-the-counter hormone therapy directed at mid-life-onset depression, and a procedure involving electronic deep-brain stimulation. Clinical trials are underway with a series of fast-acting medications that promise to relieve depression in hours or days, rather than the eight weeks required by traditional anti-depressants.
With most adults participating in the workforce, business is an ideal gatekeeper for early detection. Proactive organizations around the country are developing programs to reduce costs and alleviate suffering. A comprehensive model includes the following:
Education
Providing accessible information about depression and treatment is one of the best ways to combat stigma. The National Alliance for Mental Health produces low-cost hand-outs, including an outstanding brochure on "Men and Depression." Featuring testimonials by males who have suffered and sought treatment, this publication legitimizes depression as a "male" experience.
Training
One of the best ways to ensure that depressed workers get help is to train managers to recognize symptoms and refer people for appropriate treatment. Managers should be taught to consider "Depression Rule-Outs" whenever formerly effective employees develop sustained patterns of poor performance or exhibit problems that "mask" depression (alcohol/gambling).
Employee Assistance Programs (EAP)
EAP counselors routinely screen for depression and can be highly effective in early detection. Besides facilitating prompt referrals to treatment, they can also reduce the prevalence of related problems such as substance abuse.
Depression screening
Employers can provide Internet-based screening tools that help employees understand depression and determine if they are affected. Such tools are so effective at early detection that both the U.S. Army and the San Francisco Giants organization are implementing this methodology.
While there are costs associated with developing a program to reduce depression, research has shown that related financial gains more than offset investments. Gains include increases in workplace morale and employee loyalty. According to one grateful employee who received treatment after a workplace referral to his EAP, "It feels great to be told that there's no crime in having this problem, and that the real crime is in not getting it treated. I'll always be grateful to my company for sending me the message that it's okay to take care of myself physically, mentally and emotionally, in order to be at the top of my game!"
Judith Humble is a licensed clinical social worker and certified employee assistance professional with 16 years of experience providing mental health services, training and consultation to the business community. Judith can be reached at (859) 576-0002, or judith_humble@yahoo.com.