Depression is a leading mental health condition for working aged adults. The Center for Workplace Mental Health estimates between 6% and 7% of workers experience depression and many more suffer with undiagnosed conditions. According to the Anxiety and Depression Association of America (ADAA), it is common for someone with an anxiety disorder to also experience depression or vice versa. ADAA reports almost one-half of those diagnosed with depression are also diagnosed with an anxiety disorder. Yet, they are separate conditions with unique treatments.

Economic Costs of Depression

A 2018 analysis presented in Scientific American indicated that the annual cost of depression in the United States is $210 Billion. The Center for Workplace Mental Health estimates employees with depression miss an average of 31.4 workdays each year and lose another 27.9 workdays to presenteeism, which costs employers an estimated $44 billion annually. The Center for Workplace Mental Health has an online calculator to “estimate the prevalence of the disorders in your workforce, their cost to your bottom line, and the potential savings to be had from implementing intervention programs”.

Causes of Depression

Harvard Health Research suggests that depression does not result from simply having too much or too little of certain brain chemicals. Rather, there are many possible causes of depression, including faulty mood regulation by the brain, genetic vulnerability, stressful life events, medications and underlying medical problems. Researchers believe that several of these forces interact to bring on depression. With this level of complexity, it explains how two people might have similar symptoms of depression, but the problem is on the inside, and therefore what treatments will work best, may be entirely different.

Symptoms of Depression

Dark. Tired. Sad. Lonely. Empty. Anxious. Irritable. These are some of the more common symptoms of depression. According to the ADAA, women are diagnosed with depression at a higher rate than are men. The ADAA also states there are major gender differences how depression manifests summarized below:

Another major difference between the genders is that men are significantly less likely to seek treatment for depression than are women. This is a major impetus for improving access to care for men in industries like construction, mining and oil/gas extraction.

How Depression Manifests at Work

Depression may manifest in the workplace as performance-related challenges, including but not limited to:

The Human Cost of Depression

The National Alliance on Mental Illness (NAMI) states that only half of all Americans experiencing an episode of major depression receive treatment. NAMI also reports an average delay of 11 years from the onset of mental health symptoms to receiving effective treatment.

The major impact on people from depression is a lower quality of life, especially during episodes of major depression. The ADAA reports that depression is the leading cause of disability in the United States among people ages 15 to 44. The World Health Organization indicates that by 2030, depression will be the leading cause of lost productivity in all economically advanced countries.

Comorbidities of Depression

Mental health is rarely an isolated condition. According to data from Springbuk Analytics, 69% of patients with a mental health condition also have a chronic condition. These long-term health challenges often involve chronic pain, discomfort, regular doctor visits and regular medications — any of which can impact mental health problems.

Depression is known to co-occur with other chronic health conditions and together this affects quality and longevity life. The added complexity of co-occurring mental health diagnoses also results in increased costs in health insurance benefit claims. When patients have a mental health condition and at least one chronic condition, costs rise by 126% (Holmes Murphy Analytics).

The three examples below illustrate the effects of depression and comorbidity of other chronic health conditions:

1. Musculoskeletal Pain: Depression has been shown to increase the severity and intensity of pain, and chronic musculoskeletal pain increases the risk for depression. Of people who live with depression, 65% also have chronic pain and employers incur an extra $4,300 spend per worker per year for those with a major depressive disorder and chronic pain (Hinge Health).

2. Diabetes: 12% of those diagnosed with diabetes also have depression. In addition, the risk of those diagnosed with depression are 60% more likely to develop diabetes. This bi-directional association is found in other chronic conditions as well, such as cardiovascular disease. (Depression in Diabetes Mellitus).

3. Cancer: People with mental illness are 24% less likely to get screened for cancer than the general population. Early cancer screening has been shown to reduce mortality. Delayed cancer diagnosis among people with mental illness could be one reason they are also more likely to die of cancer than the general population (Lancet Psychiatry).

To effectively manage the combination of mental health and chronic conditions, organizations must take a holistic approach and work to address physical health and mental health together.

Precautions for Addressing Depression and Mental Health in the Workplace

Employers are encouraged to thoughtfully consider how to address mental health in the workplace. Addressing mental health in the workplace requires understanding the regulatory and legal framework for employers. For example, human resources and employment legal counsel can provide an overview of employment practices liability, including non-discrimination, privacy and confidentiality. Moreover, it is important for employers to understand the interface between the Americans With Disabilities Act, The Family and Medical Leave Act, Workers Compensation, as well as short- and long-term disability benefit programs. An integrated disability management program has been one response to the increasing complexity of benefits administration and the management of employment leaves and accommodations.

Employers are admonished to avoid making diagnoses. The intent of addressing mental health and depression in the workplace is to help employees seek proper care. The role of leadership and management is to set the tone for mental health as a diversity, inclusion and equality aspect of workforce development. Leaders and managers can help establish a culture of psychological safety where employees can openly communicate about mental health in the workplace. It is important the company leaders develop policies, procedures and protocols to address mental health in the workplace. Providing training for managers and supervisors at a minimum establishes the expectations for how mental health is to be addressed in the workplace and what resources are available to help employees.

Strategies for Addressing Depression and Other Mental Health Conditions in the Workplace

1. Check the utilization rate of your company’s Employee Assistance Program (EAP) to guage the effectiveness of your education, communication and promotion practice.
2. Institute an EAP Awareness promotion campaign (via contact information in company newsletters, wallet cards for new hires, mailings home, refrigerator magnets, etc.).
3. Provide training for leadership team and supervisory staff.
4. Evaluate behavioral health benefits in employee health benefits and determine if additional services are necessary to help reduce the impact of chronic conditions.
5. Review EAP and behavioral health services in annual open enrollment and benefits publications, as well as in new hire orientation and onboarding processes.
6. Ensure access to variety of treatment options—including telehealth and teletherapy to get to hard-to-reach populations.
7. Offer anonymous online depression and/or mental health screening.

Why Addressing Depression in the Workplace Is a Leadership Imperative

Depression is prevalent. Workers are suffering in silence. This takes a toll on the individual workers, their families, as well as your business. Depression can manifest in various ways in the workplace. Ignoring the existence of depression and other mental health conditions in the workplace is a costly mistake. Addressing depression is a safety, health and wellness imperative. Doing so will reduce human suffering in construction businesses and reduce the economic costs. It is possible to do well by doing good. Addressing mental health in the workplace is proven to be a sound business strategy.