Depression cuts deep

Prevention key to avoid higher costs, disability: Studies

Workers who have had a disability leave related to a mental illness are seven times more likely to have another disability episode related to that illness. And even employees with depression who have been treated with antidepressants suffer significant productivity losses, such as absenteeism, disability leave and presenteeism, according to two recent studies looking at mental illness.

“With mental health, I don’t think employers really understand the chronicity of it, the chronic nature of mental illness,” said Susan Novo, manager of health and disability at Cowan Insurance Group in Ottawa.

Physical ailments are often short term and even a chronic problem such as a back strain can be accommodated, but mental health is much different, she said.

“It’s a really tough condition to manage well and to treat. The key is often prevention or, really, intervention.”

Much of depression in the workplace can be explained by greater stress because of cutbacks, financial restraints, greater workloads, smaller resources and fear of job loss.

“Definitely the depression in the workplace has always been an issue but now it’s becoming a bit more apparent,” said Novo. “There’s still a huge stigma attached to depression, seeking assistance, so that’s part of the problem as well — you might have a lot of undiagnosed or untreated, depressed employees and so, by the time they get into the system, it really is part of them.”

Depressed workers at high risk of further episodes: CAMH

In looking at employment data for more than 10,000 workers from a large Canadian employer, Centre for Addiction and Mental Health (CAMH) found a history of a mental disorder-related disability leave puts a worker at a significantly higher risk of another episode.

People with a mental disorder are more likely to have had a previous disability episode (51 per cent) than someone with a physical disability (40 per cent). And among those who have gone on short-term disability (STD) leave for a mental disorder, there is a greater proportion who have had a prior disability episode related to that disorder (19 per cent) compared to someone with a physical disorder (five per cent).

There are several reasons behind the numbers in Factors Associated With Short-Term Disability Episodes. Often depression is chronic and difficult to treat as it can take a while to figure out the appropriate dose of medication, said Carolyn Dewa, head of the work and well-being research and evaluation program at CAMH in Toronto, and co-author of the study.

Employers also strive to get people on leave back to work but, once they return, “there isn’t really anything in place to prevent another disability episode,” she said. “Oftentimes the disability system is structured around physical disabilities (instead).”

And while managers seem to want to know how to communicate with people who have gone on a leave related to a mental illness, they fear they might make the situation worse.

“Part of it, too, is the way our disability management system is set up,” said Dewa, as policies around privacy mean when an employee returns from a STD leave, he is accommodated but co-workers don’t know why.

“A lot of people don’t understand mental illness is not a selective disorder, everyone’s at risk, and they would be treated in the same way, with accommodations,” she said.

In doing the study, CAMH had concerns the findings would bias employers against people with mental illness, making them consider these people a burden. But it’s hoped if employers understand many of these troubled people are long-standing, valuable employees, “those aren’t the folks that you want to lose, and there are things that can be done to keep people from going on disability,” said Dewa.

“There is a pressing need to devise strategies that address the needs of the working population,” said the CAMH study. “This will only be achieved by understanding the patterns of disability related to mental illness relative to other types of disability.”

And while employers are aware of the rising disability rate, there’s still considerable skepticism around the causes of mental illness.

“They are not always huge investments (required), it’s just some change in policies or attitudes, such as maybe training for managers so they understand how to communicate in a way that’s comfortable,” said Dewa.

Productivity drops, even after treatment: Thomson Reuters

While numerous studies have documented the negative effect of depression on productivity, a report by Thomson Reuters suggests even those employees with depression who have been treated with antidepressants suffer productivity losses.

The research was based on administrative claims data in the United States from people with depression who were treated with antidepressants and people from the same employers without any mental health conditions. They were followed for up to one year to compare the number of workdays missed because of absence or STD.

A significantly higher proportion (18 per cent) of patients with depression used STD leave than the matched controls (seven per cent). The number of STD days used was also higher, at 53 versus 42. And overall, the average costs associated with STD were much higher among patients with depression, at US$1,038 versus US$325. When it came to absences, the number was higher among depressed patients (30) than matched controls (27), as were costs (US$4,925 versus US$3,360).

“Even after receiving antidepressant treatment, patients with depression still have significant productivity deficits,” said Suellen Curkendall, director of outcomes research in Healthcares USA at Thomson Reuters in Washington and co-author of the study Productivity Losses Among Treated Depressed Patients Relative to Health Controls.

“Patients who are depressed, a very small portion of those patients achieve remission on the first drug they try. They have to try another drug and maybe a third drug, and they need therapy,” she said. “And many people are not getting the second drug and the third drug and the therapy.”

An employer can’t just assume a problem isn’t there anymore because an employee has access to a prescription, said Curkendall.

“More is needed and an investment on the part of employers to make sure patients have access, enough care to actually treat the condition, would have a better payoff in terms of better productivity and attendance,” she said. “It’s worth it for employers to be sure these things are treated.”

Since it can take a few medications and several weeks to find the right dosage, a person can take several months to find the right fit. And some of the medication has really harsh side effects, said Novo.

“Once people are on medication, people think, ‘She’s treated, get them back, what’s the delay?’ So a lot of this is a lack of comprehension as well on the employer’s side,” she said.

However, further research is needed to determine whether improved therapy could help to reduce absenteeism, presenteeism and disability.

“We know what medications these patients have been dispensed… but we do not know whether they went to counselling and we didn’t check that,” said Curkendall. “Since we don’t have the data, we can’t say patients with counselling had better results.”

Workplace supports

Relapse should be a critical consideration of disability management programs, said the CAMH study.

“The design of programs should focus not only on returning workers to work but also on helping them to remain healthy once they return. This will only be achieved by understanding the patterns of disability related to mental illness relative to other types of disability.”

If there were healthier workplaces, not only would people coming back from disability benefit but so would the whole workforce, said Dewa. And while an employee assistance program (EAP) can help, people may fear confidential information is revealed, so the usage is still very low — about 12 per cent of employees.

Employers should also provide time for employees with depression to seek therapy, as often counsellors don’t work on weekends.

“If you’re afraid you’ll lose your job, you may not seek counselling,” she said.

The key to all of this is prevention beforehand, said Novo. Employers can look at implementing set policies and procedures when it comes to return-to-work planning. Employers should be flexible, look at scheduling and job duties and have a really good understanding of job demands and design.

They can also run lunch-and-learn sessions on mental health.

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