Understanding Depression and Anxiety in the Workplace

1. Understanding Depression and Anxiety in the Workplace TCHRA Spring Conference May 20, 2014 Mark Meier, MSW, LICSW

2. My Perspective on Depression • Professional • Clinician - 19 years • Mental Health/Crisis Experience • Face It Foundation • Academician • U of MN Faculty • School of Medicine • School of Social Work • Curriculum Development • Published articles • 200+ presentations

3. Face It Foundation

4. Our Mission “Through education, online tools, and peer support, Face It works with men to understand and overcome depression.”

5. Additional Perspective

6. My Perspective on Depression • Professional • Clinician - 19 years • Face It Foundation • Consultant • Mental Health/Crisis Experience • Patient • Depression • Hospitalization • Treatment • Recovery • Academician • U of MN Faculty • School of Medicine • School of Social Work • Curriculum Development • Published articles • 200+ presentations

7. At That Time…

8. What If I Had Succeeded?

9. 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

10. True or False? We all get depressed from time to time?

11. 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.

12. Recurrent thoughts of death or suicide

13. The Depression Continuum Mild Severe Sub-Threshold Moderate

14. 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%.

15. 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

16. 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

17. 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

18. Suicide vs. Homicide - 2010 38,364 14,748 Death by Homicide Death by Suicide Centers for Disease Control, 2012

19. Suicide by Gender- 2010 30,277 8,087 Female Male Centers for Disease Control, 2012

20. What Causes Depression?

21. 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)

22. “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)

23. 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

24. 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 Meta- analysis. JAMA, January 6, 2010 – Vol ume 303, No. 1

25. Additional Findings “There has been a recent significant increase in polypharmacyinvolving 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 drug-drug 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

26. What Really Causes Depression?

27. “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 systemsinvolving molecular, cellular, neuroanatomical, neurochemical, neuroendocrinological, neurophysiological, and neuropsychological domainsmediated by multiple etiological factors including genetic vulnerability, developmental insults, and psychosocial stressors” Risk Factors in Depression. Keith Dobson and David Dozois. Elsevier 2008

28. www. http://www.health.harvard.edu/newsweek/what-causes-depression.htm Accessed March 19, 2014

29. Depression And The Workplace

30. “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

31. 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 risk and poor outcome of cardiovascular disease and suicidality), reduced quality of life, and significant personal and societal costs due to decreased work productivity, increased absenteeism, and utilization of health care services.” Christopher V. Goff, JD,MA CEO, Employers Health Purchasing Corp. of OhioDepression in the Workplace, Vol 1 #1, 2006 For every depressed individual, it is estimated 5-6 additional individuals are directly impacted in their day to day activities and functioning.

32. 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

33. Economic Burden of Depression $107b $83b $43b Dollars in Billions 1990 2000 2013 (projected) *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

34. “Presenteeism”(Decreased ability to perform duties at work due to depression) $35.7 Billion $8.3 Billion Presenteeism Absenteeism

35. 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

36. How Depression Impacts Individuals at Work I am unmotivated to get things done 83% I have difficulty concentrating 82% Tasks seem overwhelming 62% I have difficulty making it into the officeor I leave early 45% I suffer from chronic physical pain that makes it uncomfortable for me to work 24% 20% I have moreproblems with co-workers I use substances such as alcohol or drugs 6%

37. How Would Your Organization Compare?

38. “Can people acknowledge they have depression at this company and still get ahead in their careers? 86% Agree 76% Agree 41% Agree Employees with depression Middle Managers Benefit Managers University of Michigan Depression Center, 2005

39. “The company has taken steps to ensure support by co-workers & supervisors” 83% Agree 72% Agree 37% Agree Employees with depression Middle Managers Benefit Managers University of Michigan Depression Center, 2005

40. “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

41. Creating REAL Impact • Think Differently… • Offer regular trainings and promote genuine conversations • Create an environment where individuals want to come forward

42. Creating REAL Impact • Encourage and EXPLAIN the EAP • Support those who need treatment • Promote a Healthy Workplace • Identify Resources

43. Thank You! Mark Meier 612.789.9897 mmeier@faceitfoundation.org