Understanding Depression and
Anxiety in the Workplace
TCHRA Spring Conference
May 20, 2014
Mark Meier, MSW, LICSW
My Perspective on Depression
Academician
Professional
• U of MN Faculty
• Clinician - 19 years
• Mental
Health/Crisis
Experience
• Face It Foundation
• 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
Academician
Professional
Patient
• U of MN Faculty
•
•
•
•
•
•
•
•
• School of Medicine
• School of Social Work
• Curriculum
Development
• Published articles
• 200+ presentations
Clinician - 19 years
Face It Foundation
Consultant
Mental
Health/Crisis
Experience
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.
Depressed Mood
-Most of the day
-Nearly everyday
Markedly diminished
interest or pleasure
in all or almost all
activities
Inability to think/concentrate
Fatigue or Loss of Energy
Indecisiveness
nearly everyday
Insomnia
Recurrent thoughts of death
or suicide
Significant Weight Loss/Gain
Changes in appetite
Hypersomnia
Feelings of Worthlessness
Early Waking
Excessive or Inappropriate
Guilt
Psychomotor Agitation
or Retardation
The Depression Continuum
Mild
Sub-Threshold
Severe
Moderate
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 Disorders
Anxiety 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
Suicide vs. Homicide - 2010
38,364
14,748
Death by
Homicide
Death by
Suicide
Centers for Disease Control, 2012
Suicide by Gender- 2010
30,277
8,087
Female
Male
Centers for Disease Control, 2012
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 Metaanalysis. 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 drugdrug 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
and poor outcome
of cardiovascular
For every
depressedrisk
individual,
it is estimated
disease5-6
andadditional
suicidality),individuals
reduced quality
life, and impacted
significant personal
areofdirectly
and societal costs due to decreased work productivity, increased
in their day to day activities and functioning.
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
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 Depression
$107b
120
$83b
100
Dollars in Billions
80
$43b
60
40
20
0
1990
2000
*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
2013
(projected)
“Presenteeism”
(Decreased ability to perform duties
at work due to depression)
$35.7
Billion
$8.3
Billion
Presenteeism
Absenteeism
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
83%
I have difficulty concentrating
82%
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
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?
41%
Agree
Employees
with depression
76%
Agree
Middle Managers
University of Michigan Depression Center, 2005
86%
Agree
Benefit Managers
“The company has taken steps to ensure
support by co-workers & supervisors”
83%
Agree
72%
Agree
37%
Agree
Employees
with depression
Middle Managers
University of Michigan Depression Center, 2005
Benefit Managers
“People can acknowledge they have depression at this
company and be treated with respect & compassion”
95%
Agree
90%
Agree
51%
Agree
Employees
with depression
Middle Managers
Benefit Managers
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 Meier
612.789.9897
mmeier@faceitfoundation.org