When employees injure their spine, they often receive physical therapy for this common condition. They learn how to strengthen weak muscles, lift properly and sit ergonomically. Essentially, they are taught proven strategies to get them back on their feet and back on the job.
But it’s been a different story for employees with depression, another common disorder. In fact, 12 percent of employees at some point in their life have been diagnosed with depression, costing American business about $23 billion in sick days alone, according to a 2013 Gallup poll (Witters, D., Agrawl, S., & Liu, D. “Depression costs U.S. workplaces $23 billion in absenteeism.” Gallup Wellbeing, July 24, 2013).
Depression can profoundly affect a person’s ability to work. For many, it erodes concentration, time management, task completion, and the ability to get along with supervisors and co-workers. Indeed, lost productivity caused by Major Depression, a severe form of depression, is estimated at $102 billion annually (Greenberg, P, Fournier, A-A, et al, “The Economic Burden of Adults with Major Depressive Disorder in the United States,” 2015).
Of course, there’s a great difference between treating employees with back problems and those with depression. Unlike people who know they have a herniated disc, many people with a mood disorder don’t know they are depressed. And aware or not, employees with such an insidious disorder often fail to see how it impairs them at work. Traditional treatment for depression — brief goal-oriented psychotherapy and antidepressants—can ease symptoms. However, because they do not focus specifically on work-related functioning, they may not resolve depression-related work impairment. All these factors argue for employers to be more aggressive in addressing depression.
Until recently, few, if any, workplace interventions existed to identify employees with depression and also help them overcome related work impairments. But a recent study I co-authored with my colleagues at Tufts reveals an exciting new solution, confirming the results of earlier, smaller-scale trials (Lerner D, Adler D, Hermann RC, Chang H, Ludman EJ, Greenhill A, Perch K, McPeck WC, Rogers WH. “Impact of a Work-Focused Intervention on the Productivity and Symptoms of Employees with Depression,” 2012).
In a national, randomized clinical trial (Lerner, Adler, Rogers, Chang, Greenhill, Cymerman, Azocar, “A Randomized Clinical Trial of a Telephone Depression Intervention to Reduce Employee Presenteeism and Absenteeism,” 2015.), we found that helping employees develop strategies for depression-related problems at work significantly improved job performance and significantly relieved depressive symptoms. Basically, this intervention helped employees do better at work and helped them feel better, too.
This finding differed from our study’s control group — employees with depression who were referred to their employer’s EAP or health care provider. Although the control group showed some improvement, they had smaller gains in symptom severity, productivity and absenteeism.
How It Works
Our intervention is low-cost and easy to implement. And it removes most barriers that keep depressed people from seeking help, such as difficulty accessing providers close by, transportation, childcare or costs. Employers can readily adapt it to their workplace — much like other wellness programs — by facilitating access to the program online and leveraging incentives and the support of their medical director.
To start, employees at their workplace voluntarily take a web-based assessment on depression and its effect on their work. Screening out other factors impacting work performance and mental health (bipolar disorder, psychosis and alcohol abuse) the evaluation takes no more than seven minutes. And, in accordance with the law it’s completely confidential, allaying privacy concerns, too.
Employees receive results from the screener immediately — along with data showing how their scores compare to those of co-workers and their national peers.
A Wake-up Call
This information can be a much-needed wake-up call for folks with depression.
Overall, people with depression don’t always connect their problems at work to how they are feeling. This includes individuals with short-term, severe depression and those with a less intense yet chronic form of the disorder. Each group was represented in our intervention, with symptoms ranging from moderate to severe.
Participants with scores signaling depression and associated work impairments were offered our free, work-focused intervention. About a third enrolled. We believe employees who enroll, in general, are interested in feeling better and improving job performance.
Eight Telephonic Coaching Sessions
The depression intervention consisted of eight, 30- to 50-minute coaching sessions on the phone. A specific coach was assigned to each participant for the intervention’s duration of approximately four months. All sessions were strictly confidential and could take place when and where employees chose. Allowing this flexibility and confidentiality is a key feature to help address concerns about being stigmatized for depression.
The coaches were Optum EAP counselors, trained in engaging and educating participants about depression and skilled in customizing strategies for associated work issues.
During the sessions, employees learned about depression, its symptoms and how it manifests on the job. And they worked with their counselor to define their own depression-related work problems and how to resolve them. Here’s an example of a typical session.
A Typical Session Scenario
An employee with depression describes working hours long after the close of business, but producing less than co-workers on a more normal work schedule. Frustrated and anxious, he works even more hours, but ends up more tired, and accomplishing less. He feels incompetent and fears that others in the company see him that way, too.
Without judgment, the counselor listens carefully and helps the employee identify the cycle and factors driving it. They talk about the employee’s difficulty concentrating for extended periods and habit of postponing tough assignments until late in the day. Feeling overwhelmed, declining self-esteem, and poor sleep schedule are also discussed.
Together the counselor and employee devise strategies to stop the cycle. Divide challenging projects into manageable chunks. Take short breaks to regain focus. Tackle tough assignments earlier in the day when energy is higher. Make a daily to-do list. Practice replacing negative thoughts about self-worth with positive ones, and develop strategies for better sleep hygiene.
These are practical, coping methods. More importantly, they are developed in a collaborative coaching context.
Weekly Homework and Check-ins
To make these self-help strategies stick, participants did weekly homework. Counselors checked each week to see how the new strategies were working. Any success was applauded. Any glitch was addressed. And every two weeks, participants were re-assessed on their functioning at work and their depressive symptoms.
If employees were seeing a provider for their depression, with the employee’s permission, the counselor shared these results with the clinician of choice.
Our results were remarkable. Compared to our control group of employees, our participants made notable progress in their ability to work and their work performance. They also showed improvement in their mood disorder. Case in point: they showed a 44 percent improvement in work productivity compared to the control group’s 13 percent. And sick days were down by 53 percent versus the control group’s 13 percent. The severity of their depressive symptoms also dropped by 51 percent; the control group, by 26 percent.
The benefit-to-cost ratio was estimated at $6.19 for every $1; the annual productivity cost savings per employee, at about $6,000.
Depression is a debilitating disease. It affects millions of American workers on and off the job, draining billions from their employers in productivity losses and sick days and taking an inestimable emotional and physical toll on those with the disorder. As our study shows, employers have a unique opportunity to end this negative cycle. Employers would do well — and do good — to embrace it.
Optum does not recommend or endorse any treatment or medications, specific or otherwise. The information provided is for educational purposes only and is not meant to provide medical advice or otherwise replace professional advice. Consult with your clinician, physician or mental health care provider for specific health care needs, treatment or medications. Certain treatments may not be included in your insurance benefits. Check your health plan regarding your coverage of services.