Common Mental Disorders in the Workforce: Recent Findings from Descriptive and Social Epidemiology

Article excerpt

Objective: To review the recent descriptive and social epidemiology of common mental disorders in the workplace, including prevalence, participation, work disability, and impact of quality of work, as well as to discuss the implications for identifying targets for clinical and preventive interventions.

Method: We conducted a structured review of epidemiologic studies in community settings (that is, in the general population or in workplaces). Evidence was restricted to the peer-reviewed, published, English-language literature up to the end of June 2005. We further restricted evidence to studies that used recent classification systems; then, if evidence was insufficient, we reviewed studies that used standardized psychiatric screening scales. To distinguish this article from recent reviews of health and work quality, we focused on new areas of investigation and new evidence for established areas of investigation: underemployment, organizational justice, job control and demand, effort-reward imbalance, and atypical (nonpermanent) employment.

Results: Depression and simple phobia were found to be the most prevalent disorders in the working population. The limited data on rates of participation suggested higher participation among people with depression, simple phobia, social phobia, and generalized anxiety disorder. Depression and anxiety were more consistently associated with "presenteeism" (that is, lost productivity while at work) than with absenteeism, whether this was measured by cutback days or by direct questionnaires. Seven longitudinal studies, with an average sample size of 6264, showed a strong association between aspects of low job quality and incident depression and anxiety. There was some evidence that atypical work was associated with poorer mental health, although the findings for fixed-term work were mixed.

Conclusions: Mental health risk reduction in the workplace is an important complement to clinical interventions for reducing the current and future burden of depression and anxiety in the workplace.

(Can J Psychiatry 2006;51:63-75)

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Clinical Implications

* The effect of depression and anxiety on work ability is significant, and maintaining capacity and productivity in the work role is an important goal of clinical treatment.

* Quality of work in terms of control and demand, effort-reward imbalance, and organizational justice is a critical social influence on mental health and offers opportunities for mental health promotion and early intervention.

* Identifying subpopulations in the workforce that may be at increased risk for depression and anxiety is an important area of future research both to inform early intervention and to encourage access to appropriate treatment.

Limitations

* Most population-based psychiatric surveys used crude measures of work disability.

* Studies on the association of work quality and mental health all relied on screening instruments to assess psychiatric status; thus, these findings may not be generalizable to classification-based disorders.

* Much of our understanding of the nature of "presenteeism" (that is, lost productivity from coming to work when sick) comes from studies that used nonstandardized measures of mental health, which were thus excluded from this review.

Key Words: epidemiology, employment, work disability, work quality

In many industrialized countries, the rising administrative and insurance costs of mental disorders in the workplace have prompted burgeoning interest in the interrelations between work and mental health and how best to minimize the impact on the individual and the employer (1,2). Epidemiologic data, especially longitudinal etiologic research, can provide information to inform early intervention and mental health promotion in the workplace. …