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Easing workplace depression


Depression is prevalent and, when left untreated, creates a significant drain on workplace productivity. Still, relatively few employers are addressing the issue head-on.

But those businesses committed to depression management are working to chip away stigma in the workplace, connect employees with treatment and create a culture of well-being, experts say.

“What's been happening, I think, is there's a growing acknowledgement that this is costing workplaces a lot of money,” said Ken Dolan-Del Vecchio, vice president of health and wellness at Prudential Financial Inc. in Newark, New Jersey.

If people are struggling at work due to depression, it's in employers' best interests to help them function more effectively, added Debra Lerner, a professor of medicine and psychiatry and director of the Program on Health, Work and Productivity at Tufts Medical Center in Boston.

Nearly one in four workers is diagnosed with depression in their lifetime, and two in five have taken time off from work because of it, according to a 2014 survey sponsored by Canton, Ohio-based Employers Health Coalition Inc., a national nonprofit employer-led coalition.

Workplace-related costs, including absences and presenteeism, or working at less than full capacity, accounted for roughly half of the $210.5 billion economic toll of major depressive disorders in the United States in 2010, researchers reported in the February 2015 issue of the Journal of Clinical Psychiatry. The study captured not only the direct costs of depression but also depression-related conditions, such as back problems and sleep disorders.

“There's a real opportunity here to not only address some of those costs of depression, but also some of these comorbid costs,” said Paul Greenberg, the study's lead author and managing principal of Boston-based Analysis Group Inc.

Depression also ranks as the second-leading cause of disability worldwide and the leading cause of disability among working-age adults, according to the latest global health statistics.

Two-thirds of employers responding to the Disability Management Employer Coalition's 2014 behavioral risk survey said they offer disease or case management for depression. Yet, just 26.7% said they offer depression awareness training, considered important for dispelling the stigma of depression.

Most employers are buying depression management packages from health plans or disease management companies “on the basis of cost, not on the basis of value,” said Kathryn Rost, principal investigator of a multiyear National Institute of Mental Health-funded project to improve depression management in the workplace.

In a randomized controlled trial published in peer-reviewed journal BMC Health Services Research in 2014, Ms. Rost and colleagues tested an intervention to steer employers toward “high-quality” depression care management products proven to combat absenteeism, productivity and other work outcomes. But after two years of follow-up, employers hadn't changed their buying habits.

Because the study coincided with the rollout of the Patient Protection and Affordable Care Act, Ms. Rost believes human resources managers were preoccupied and “just sat on the information.”

Donna Marshall, executive director of the Colorado Business Group on Health, which collaborated with Ms. Rost on the project, acknowledged that improved depression care proved to be a hard sell.

“We did not consider how difficult it would be to actually get folks interested in one topic for their employee population,” she said.

Fits and starts

The Northeast Business Group on Health began looking at depression care several years ago, spurred by high rates of antidepressant prescription claims paid by employers and low rates of depression reported by health plans. In 2012, the group launched One Voice, a plan to integrate behavioral health into primary care.

The initiative was modeled after a collaborative approach made popular in markets such as Minnesota, where large group practices and regional nonprofit health plans dominate.

But in New York, where small physician practices and for-profit health plans are common, paying for behavioral health services in primary-care settings, was “very challenging,” said Laurel Pickering, the health coalition's president and CEO.

Though the initiative didn't pan out as planned, it lives on as part of a statewide primary care transformation project, Ms. Pickering said.

Meanwhile, NEBGH is working to raise CEO awareness of depression in the workplace, while some of its member companies are focusing on employee education and access to care.

Erasing stigma

Long a taboo topic, depression is coming out of the shadows in some workplaces.

In 2013, Prudential convened a special event around depression, addiction and post traumatic stress disorder. Leaders of the organization shared personal struggles with those conditions.

“We're going for a culture where no human challenge is unspeakable,” Mr. Dolan-Del Vecchio explained.

Prudential offers its 20,000 U.S. employees webinars and multiple ways to access depression help, including on-site behavioral health counseling, life coaching and external employee assistance program services. A few years ago, it discontinued a vendor-based depression-and-anxiety screening program because it lacked a way to move people to assistance.

One encouraging sign: Prudential's “depression risk,” as gauged through employee health risk appraisals, dropped by 50%, to 13.1% from 26%, between the fourth quarter of 2007 and the end of 2014.

At American Express Co., EAP services have gained broad appeal since the company's rebranding, introduced in the U.S. in January 2013 and globally in March 2015. Today, the Healthy Minds brand, a companion to the company's Healthy Living prevention and disease management program, has become a hub for emotional well-being programs, including Healthy Minds Expat and Healthy Sleep.

While the New York-based financial services firm would not share specifics, Healthy Minds has “incredibly robust utilization,” according to Charles Lattarulo, director of Healthy Minds, which covers 95% of the firm's 54,000 U.S. and global employees. That's one reason the program has received multiple awards, including the American Psychological Foundation's inaugural Organizational Excellence Award in March, he said.

With campaigns such as “Improve Your Mood,” launched three years ago, Healthy Minds reaches beyond employees and family members with depression. “We talked about depression; we want to say the word,” Mr. Lattarulo said. “We also want to cast a wider net than that” to build resiliency and encourage employees to seek preventive care, he added.

Not every employer has the money, staffing or desire to build depression awareness programs from scratch.

Right Direction, a free depression tool-kit developed by Employers Health Coalition, based in Dublin, Ohio, and the Partnership for Workplace Mental Health, a program of the American Psychiatric Foundation, is filling a niche for some companies, including online shoe retailer Zappos.com and Online Computer Library Center Inc., a nonprofit digital library service.

Right Direction provides posters, PowerPoint templates and other resources to raise awareness of depression in the workplace and encourage employees to seek help. The program receives support from Takeda Pharmaceuticals U.S.A. Inc. and Lundbeck U.S. Since its launch in May 2013, 2,150 unique visitors — including employers and media — have downloaded material from the website's “For employers” section, and, according to Google Analytics, at least 2,000 employers have found the site, said an Employers Health spokesman.

Intervention hotline

Over several years, Ms. Lerner and colleagues at Tufts have developed a telephone-based invention to overcome depression's barriers to work performance. Trained counselors work with employees on understanding depression and being more involved in their care. They teach work-focused cognitive behavioral therapy strategies to help employees manage negative feelings and behaviors, and they coach employees on techniques, such as scheduling and prioritizing work, to help them function more effectively.

“These are not typical EAP services,” Ms. Lerner said. “Our program is really designed to fill a gap in services that emphasize helping people do the things they need to do in life.”

In March, Ms. Lerner's team published results of a randomized clinical trial of the phone-based intervention, now called Be Well at Work, and the results were significant: Productivity improved 44%, absences declined 53% and depression severity scores dropped 51%, versus changes of 13%, 13% and 25%, respectively, among control group participants.

In September, Tennessee became the first state to take the program live. The goal of the six-month pilot is to enroll 300 employees with the potential of expanding the intervention more broadly.

John Allen, director of behavioral health services with the Tennessee Department of Finance and Administration, said the state sought a depression management solution after determining that diagnosed depression among its 275,000 covered lives did not match the expected level based on the amount of chronic disease in the population.

Mr. Allen and his colleagues in human resources are focused not only on improving productivity but engaging employees with untreated depression.

“In a perfect world, we would both improve our members' health and lower our overall medical spend by providing the program,” he said.