Breaking the Silence

Website for the American Mental Health Counselors Association's Breaking the Silence initiative to address mental health stigma.

Recognizing Common Mental Health Problems in the Workplace

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By contributing blogger Joel E. Miller

Here’s a brief guide to the most common mental health problems in the workplace, and how they affect both employees and employers.

Symptoms of these common problems—depression, bipolar disorder, attention deficit hyperactivity disorder (ADHD), and anxiety—are all described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). But symptoms tend to manifest differently at work than they do at home or in other settings.

The (Big) Cost of Ignoring Employee Mental Health Problems

Even when symptoms of mental disorders go unnoticed, the economic consequences are tangible. Studies around the world that assess the full work impact of mental health disorders often use the World Health Organization (WHO) Health and Work Performance Questionnaire, which not only asks employees to report how many days they called in sick, but also asks them to assess, on a graded scale, how productive they were on the days they actually were at work. The results are measured in days out of work (absenteeism) and lost productivity (“presenteeism”).

In one study examining the financial impact of 25 chronic physical and mental health problems, researchers polled 34,622 employees at 10 companies. The researchers tabulated the amount of money the companies spent on medical and pharmacy costs for employees, as well as employees’ self-reported absenteeism and lost productivity, using the WHO questionnaire.

When researchers ranked the most costly health conditions (including direct and indirect costs), depression ranked first, and anxiety ranked fifth—with obesity, arthritis, and back and neck pain in between.

Many of the studies in this field have concluded that the indirect costs of mental health disorders—particularly lost productivity—exceed companies’ spending on direct costs, such as health insurance contributions and pharmacy expenses. Given the generally low rates of treatment, the researchers suggest that companies should invest in the mental health of workers—not only for the sake of the employees, but to improve their own bottom line.

The field of clinical mental health counseling plays a critically important role in addressing the needs of companies in general and workers with mental health conditions in particular. Clinical mental health counselors (CMHCs) are highly skilled professionals who provide flexible, consumer-oriented therapy. They combine traditional psychotherapy with a practical, problem-solving approach that creates a dynamic and efficient path for change and problem resolution.


The Four Most Common Mental Health Problems in the Workplace

1.    Depression

Depression is the best-studied mental health disorder in the workplace, partly because it is so common in the general population. One survey of a nationally representative sample reported that about 6 percent of employees experience symptoms of depression in any given year.

Although the DSM-5 lists low mood as the defining symptom of depression, in the workplace this disorder is more likely to manifest in both behaviors—such as nervousness, restlessness, or irritability—and physical complaints, such as a preoccupation with aches and pains. In addition, depressed employees may become passive, withdrawn, aimless, and unproductive. They also may be fatigued at work, partly as a result of the mood disorder or because they are having trouble sleeping at night. Depression may also impair judgment or cloud decision-making.

Researchers who analyzed employee responses to the WHO questionnaire found that workers with depression reported the equivalent of 27 lost work days per year—nine of them because of sick days or other time taken out of work, and another 18 reflecting lost productivity. Other research has found that employees with depression are more likely than others to lose their jobs and to change jobs frequently.

Part of the problem may be lack of treatment. In one study, only 57 percent of employees with symptoms of major depression said they had received mental health treatment in the previous 12 months. Of those in treatment, fewer than half—about 42 percent—were receiving treatment considered adequate, on the basis of how consistent it was with established guidelines on minimal standards of care. The researchers estimated that overall, when lack of treatment and inadequate treatment were taken into account, only about one in four employees with major depression received adequate treatment for the disorder.


2.    Bipolar Disorder

Bipolar disorder is typically characterized by cycling between elevated (manic) and depressed moods. In a manic phase, employees with a bipolar disorder may appear highly energetic and creative, but their actual productivity may suffer. During full-blown mania, a person may become self-aggrandizing or disruptive, flout workplace rules, be overly aggressive, and make mistakes in judgment (such as overspending a budget). During the depressive phase, an employee may exhibit depressive symptoms as described above. Although mania may be more noticeable at work, the research suggests that the depressive phase of bipolar disorder can impair performance more than the manic phase.

One nationally representative study estimated that about 1 percent of American employees suffer from bipolar disorder in any year. Based on employee responses to the WHO questionnaire, the researchers estimated that employees with bipolar disorder lost the equivalent of about 28 work days per year from sick time and other absences, and another 35 in lost productivity. The authors note that although bipolar disorder may be more disabling than depression is for employees on an individual level, the cost to employers is still less than that attributed to depression, because the latter is more common.

In a departure from the typical findings about low treatment rates for other mental health disorders, about two-thirds of employees with bipolar disorder said they had received treatment for it. But the likelihood of receiving adequate care depended on the type of clinician they saw. Only about 9 percent of those who sought care from general practitioners received care in keeping with published guidelines for bipolar disorder, compared with 45 percent of those who sought care from mental health professionals.


3.    Anxiety Disorders

Anxiety disorders in the workplace may manifest as restlessness, fatigue, difficulty concentrating, and excess worrying. Employees may require constant reassurance about performance. Sometimes, as with depression, physical symptoms or irritability may be noticeable.

Anxiety disorders affect about 6 percent of the population at some point in life, but typically go undiagnosed for 5 to 10 years. And only about one in three individuals with a diagnosed anxiety disorder receives treatment for it. At the same time, the studies suggest that people with anxiety disorders are more likely than others to seek out medical care, but for physical problems related to the anxiety—such as gastrointestinal distress, sleep disturbances, or heart trouble—rather than for the anxiety itself.

It is probably not surprising, then, that anxiety disorders cause significant work impairment. Generalized anxiety disorder, for example, results in work impairment (as measured by sick days and lost productivity) similar to that attributed to major depression.


4.    ADHD

Though often considered a problem only in children, ADHD also affects adults. An international survey in 10 countries (including the United States) estimated that 3.5 percent of employees have ADHD. In the workplace, symptoms of ADHD may manifest as disorganization, failure to meet deadlines, inability to manage workloads, problems following instructions from supervisors, and arguments with co-workers.

For an employee with ADHD, workplace performance—and the employee’s career—may suffer. Studies estimate that people with ADHD may lose 22 days per year (a combination of sick days and lost productivity), compared with people without the disorder. In addition, people with ADHD are 18 times more likely to be disciplined for behavior or other work problems, and they are likely to earn 20 percent to 40 percent less money than others. They are also two to four times as likely as other employees to be terminated from a job.

Treatment rates among employees with ADHD are especially low. In the United States, for example, only 13 percent of workers with ADHD reported being treated for this condition in the previous 12 months.


A Win-Win Investment in Employee Health

The research literature on mental health problems in the workplace suggests that the personal toll mental health problems have on employees—and the commensurate financial costs companies bear—could be eased if a greater proportion of workers who need treatment were able to receive it. The authors of such studies advise employees and employers to think of mental health care as an investment, one that’s worth the up-front time and cost.

Considering the number of sick days and lost productivity attributable to mental illness in the workplace, employers that are able to recognize the most common mental health problems and create a pathway for affected employees to receive needed treatment are making a winning investment—one that pays off in improved health of employees, and in improved productivity and cost savings for employers.

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