Understanding Depression and Anxiety in the Workplace

TCHRA Spring ConferenceMay 20, 2014

Mark Meier, MSW, LICSW

My Perspective on Depression

Professional• Clinician - 19

years• Mental

Health/Crisis Experience

• Face It Foundation

Academician• U of MN Faculty

• School of Medicine• School of Social Work

• Curriculum Development

• Published articles• 200+ presentations

Face It Foundation

Our Mission“Through education, online tools, and peer support, Face It works with men to understand and overcome depression.”

Additional Perspective

My Perspective on Depression

Professional• Clinician - 19

years• Face It

Foundation• Consultant• Mental

Health/Crisis Experience

Academician• U of MN Faculty

• School of Medicine• School of Social Work

• Curriculum Development

• Published articles• 200+ presentations

Patient• Depression• Hospitalization• Treatment• Recovery

At That Time…

What If I Had Succeeded?

While I Was Depressed

• Completed college and graduate school• Administrator large dialysis clinic• Completed high-level research projects• Developed professional training courses for

physicians and medical schools

True or False?

We all get depressed from time to time?

The Answer Is…Probably Not

We all experience normal and generally temporary feelings of sadness, grief, anger, anxiety, fear, fatigue, agitation, and loss of hope. Depression is differentiated by intensity, duration, and impact.

Recurrent thoughts of death or suicide

The Depression Continuum

Mild Severe

ModerateSub-Threshold

Depression & Anxiety

In the National Comorbidity Survey (2005), 58% of patients diagnosed with major depression were found to have an anxiety disorder; among these patients, the rate of comorbidity with GAD was 17.2%, and with Panic Disorder, 9.9%.

Anxiety DisordersAnxiety Disorders affect about 40 million American

adults age 18 years and older (about 18%) in a given year, causing them to be filled with fearfulness and uncertainty. Unlike the relatively mild, brief anxiety caused by a stressful event (such as speaking in public or a first date), anxiety disorders last at least 6 months and can get worse if they are not treated. for the anxiety disorder.

http://www.nimh.nih.gov/health/publications/anxiety-disorders/introduction.shtml Accessed November 15, 2011

Types of Anxiety Disorders• Panic Disorder• Obsessive Compulsive Disorder• Generalized Anxiety Disorder• Post-Traumatic Stress Disorder• Specific Phobias“Each anxiety disorder has different symptoms, but

all the symptoms cluster around excessive, irrational fear and dread.”

http://www.nimh.nih.gov/health/publications/anxiety-disorders/introduction.shtml Accessed November 15, 2011

Depression Is…

• Pain for spouses and partners• Unpredictability for families and children• Frustration for those who watch their loved

ones struggle to improve• Misunderstood and “not real” to many• Immeasurable and intense suffering for those

afflicted• Leading cause of suicide

Death by Suicide

Death by Homicide

38,364

14,748

Centers for Disease Control, 2012

Suicide vs. Homicide - 2010

Male Female

30,277

8,087

Centers for Disease Control, 2012

Suicide by Gender- 2010

What Causes Depression?

It Depends On Who You Listen To…

“It is widely believed that major depressive disorder is the result of an imbalance of neurotransmitters in the brain that is believed to influence a person’s mood. It is suspected that this chemical imbalance in the brain may impair effective communication between nerve cells, resulting in MDD.”

www.lexapro.com (accessed February 8, 2011)

“There are many theories about the cause of depression. One common theory is that depression is caused by an imbalance of naturally occurring substances in the brain. Although the exact way that Cymbalta works in people is unknown, it is believed to be related to an increase in the activity of serotonin and norepinephrine which are two naturally occurring substances in the brain.”

www.cymbalta.com (Accessed February 8, 2011)

Antidepressant Treatment in the U.S.Antidepressants are the most common prescription medication for Americans age 18-44, and the third most common drug across all ages.

CDC/NCHS, National Health and Nutrition Examination Surveys, 2005–2008, Slide courtesy Susannah Tye, PhD - Mayo Clinic Depression Center

Recent Findings“The magnitude of benefit of antidepressant

medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial.”

Antidepressant Drug Effects and Depression Severity: A Patient-Level Meta-analysis. JAMA, January 6, 2010 – Vol ume 303, No. 1

Additional Findings“There has been a recent significant increase in

polypharmacy involving antidepressant and antipsychotic medications. While some of these combinations are supported by clinical trials, many are of unproven efficacy. These trends put patients at increased risk of drug-drug interactions with uncertain gains for quality of care and clinical outcomes.”

National Trends in Psychotropic Medication Polypharmacy in Office-Based Psychiatry. Archives General Psychiatry. 2010; 67 (1): 26-36

What Really Causes Depression?

“The mechanisms of complex disorders such as depression cannot be defined by simple etiological models. With burgeoning neurobiological information, it is evident that depression is a disorder of multiple neurobiological systems involving molecular, cellular, neuroanatomical, neurochemical, neuroendocrinological, neurophysiological, and neuropsychological domains mediated by multiple etiological factors including genetic vulnerability, developmental insults, and psychosocial stressors”

Risk Factors in Depression. Keith Dobson and David Dozois. Elsevier 2008

www. http://www.health.harvard.edu/newsweek/what-causes-depression.htm Accessed March 19, 2014

Depression And The Workplace

“No employer is exempt from the adverse consequences of depression in the workplace.”

Paul Greenberg, M.S., M.A.

Director, Health Economics Practice“Is Depression a Roadblock to Career Success?” March 22, 2004

The Evidence “Major depressive disorder (MDD), a highly debilitating and widely distributed illness in the general population, is ranked by the World Health Organization as among the most burdensome diseases to society. Thus, nearly 30 million of the US adult population may be affected by MDD, with approximately one-third being classified as severely depressed. Severe depression has profound social and economic consequences, with individuals often experiencing high rates of complicating comorbidities and mortality (e.g.,increased risk and poor outcome of cardiovascular disease and suicidality), reduced quality of life, and significant personal and societal costs due to decreased work productivity, increased absenteeism, and utilization of health care services.”

Christopher V. Goff, JD,MA CEO, Employers Health Purchasing Corp. of Ohio Depression in the Workplace, Vol 1 #1, 2006

For every depressed individual, it is estimated5-6 additional individuals are directly impacted in their day to day activities and functioning.

How Does Depression Impact Others In Your Company?

• Creates negative team environment• Can lead to frustration and anger between

colleagues• Creates environment of mistrust• Disrupts workflow and project management• Interferes with new ideas, creativity, and

initiative

Economic Burden of DepressionD

olla

rs in

Bill

ions

1990 2000 2013(projected)

$43b

$83b

$107b

*Greenberg P, et al. The Economic Burden of Depression in the United States: How Did it Change Between 1990 and 2000? J Clin Psych, 64:12, Dec 2003

“Presenteeism”(Decreased ability to perform duties

at work due to depression)

Presenteeism Absenteeism

$35.7Billion

$8.3Billion

One Large Insurer

• $438/month PMPM cost for health care provided to men diagnosed with mood disorder - depression

vs. • $173/month for men without diagnosis

depression

How Depression Impacts Individuals at Work

I am unmotivated to get things done

I have difficulty concentrating

Tasks seem overwhelming

I have difficulty making it into the office or I leave early

I suffer from chronic physical pain that makes it uncomfortable for me to work

I have more problems with co-workers

I use substances such as alcohol or drugs

83%

82%

62%

45%

24%

20%

6%

How Would Your Organization Compare?

“Can people acknowledge they have depression at this company and still get ahead in their careers?

Employeeswith depression

Benefit ManagersMiddle Managers

41%Agree

76%Agree

86%Agree

University of Michigan Depression Center, 2005

“The company has taken steps to ensure support by co-workers & supervisors”

Employeeswith depression

Middle Managers Benefit Managers

37%Agree

72%Agree

83%Agree

University of Michigan Depression Center, 2005

“People can acknowledge they have depression at this company and be treated with respect & compassion”

Employeeswith depression

Middle Managers Benefit Managers

51%Agree

95%Agree

90%Agree

University of Michigan Depression Center, 2005

Creating REAL Impact• Think Differently…• Offer regular trainings and promote genuine

conversations• Create an environment where individuals

want to come forward

Creating REAL Impact• Encourage and EXPLAIN the EAP• Support those who need treatment• Promote a Healthy Workplace• Identify Resources

Thank You!

Mark Meier612.789.9897mmeier@faceitfoundation.org