Depressed Workers Need More Than Medications

An employer might not expect a worker who breaks a leg to return to work and function at an optimal level right away, but may be less patient with one recovering from depression.

Yet forbearance with such employees may be necessary, a study in the September American Journal of Psychiatry suggested. The study found that even if depressed employees show clinical improvement, they may still not be able to perform up to snuff on the job. As a result, researchers are testing a new tactic: helping employees understand how depression is impacting their ability to work and identifying means to better manage their performance.

Although past investigations have demonstrated that depression impairs work performance and productivity, detailed inquiries into the impact of depression on people's work are really in a nascent stage. So Debra Lerner, Ph.D., a research scientist at Tufts-New England Medical Center, and her colleagues conducted a study, using nondepressed comparison groups to judge the impact of depression in the workplace.

Over an 18-month period, they tracked the performance of 286 subjects with a DSM-IV major depressive disorder and/or dysthymia, 93 subjects with rheumatoid arthritis, and 193 depression-free, healthy control subjects. Yardsticks deployed at baseline, six, 12, and 18 months included the Work Limitations Questionnaire for work outcomes and the Patient Health Questionnaire-9 for depression.

At baseline and each follow-up, the rheumatoid arthritis group's ability to handle physical job demands was inferior to that of the depression group and the healthy control group. However, the depression group had some difficulties with managing physical job tasks as well—such as those involving mobility, stationary work, and repetitive motion. And at baseline and each follow-up, the depression group performed significantly worse mentally than did either the rheumatoid arthritis group or the healthy control group.

Depressed subjects had the most trouble with three types of mental function— mental-interpersonal duties (for example, concentrating on work), time management (for instance, following a work routine), and meeting output demands (such as handling the workload and completing work on time).

Changes in depression severity and job performance among the depressed subjects were inversely and significantly linked. For example, a 1.0-point decrease in depression severity on the Patient Health Questionnaire was associated with a 1.2-point improvement in the performance of mental-interpersonal tasks on the Work Limitations Questionnaire. Nonetheless, depressed subjects meeting criteria for clinical improvement still performed worse than healthy control subjects.

“We don't know the causes per se,” Lerner told Psychiatric News, especially since the study did not measure the work impact of taking antidepressants. “[But] what we [do] know is that 44 percent of the depression group was taking an antidepressant at the beginning of the study. [Thus] medication alone may not be sufficient.”

So what else do depressed employees need?

For one, “All health professionals must attend to patients' social role and vocational functioning in addition to their emotional well-being,” David Adler, M.D., told Psychiatric News. Adler is a professor of psychiatry at Tufts-New England Medical Center and one of the study investigators.

For another, depressed employees can benefit from learning new ways of managing their work, according to Lerner, Adler, and their colleagues.

“We are currently testing a new intervention approach,” Lerner explained. “[It] emphasizes helping employees understand how depression is impacting their ability to work, identifying opportunities for changing how they manage their work tasks, and practicing these changes. For instance, several employees find themselves `zoning out' at work—playing computer games or being distracted by problems at home. In some cases, we are asking them to fill out daily diaries to help them document these episodes and identify patterns. Once the patterns are understood, we attempt to modify them.”

All things considered, interventions to help depressed employees cope are urgently needed, lerner and her group concluded. “We are testing one program in the Lockheed Martin Corporation Aeronautics Division,” Lerner said, “and will soon be rolling out a test with state government employees in Maine.”

The study was funded by the National Institute of Mental Health and the National Center for Research Resources.

“Job Performance Deficits Due to Depression” is posted at<http://ajp.psychiatryonline.org/cgi/content/full/163/9/1569>.▪