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

Abstract

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) Information on funding and support and author affiliations appears at the end of the article. 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 fin...

Mental disorders and employment status in the São Paulo Metropolitan Area, Brazil: gender differences and use of health services

“…Regarding sociodemographic characteristics according to the current employment situation, our results are similar to reports from other populations 6,7,8,9,10,11,12 . Generally, working is associ- ated with male gender, younger age, higher education and higher income in our study, but there are specific differences when compared to reports from developed countries, where the workforce has higher proportions of middle-aged and more educated individuals 6,8,9,10,11,12 .…”

“…Generally, working is associ- ated with male gender, younger age, higher education and higher income in our study, but there are specific differences when compared to reports from developed countries, where the workforce has higher proportions of middle-aged and more educated individuals 6,8,9,10,11,12 . Our findings may reflect the younger age structure and low levels of formal educational attainment in the general Brazilian population.…”

“…Results from the Global Burden of Disease (GBD) in Brazil showed that neuropsychiatric conditions were responsible for 21.5% of all disability-adjusted life years (DALYs) (25.1% among women and 18.6% among men), generating high social and economic costs 3,4 . Around the world, several studies were launched to estimate the prevalence and determinants of mental disorders in the general population, as well as to assess the impact of mental disorders on daily-living activities and work performance 5,6,7,8,9,10,11,12,13,14,15,16,17 , including in Brazil 18 . Most mental disorders have early onset, often leading to precocious and/or permanent disability, increasing the need for health care 15,16,17,18,19,20,21 .…”

“…Low treatment-seeking rates reduce adequate rehabilitation and subsequent return to the workforce 7,9,10,14,15,16,22,23 . These associations, though, are likely to be two-way, as unemployment and its adverse consequences may deleteriously impact mental health 6,7,9,12,15,16,18,19 .…”

Prevalence of depression morbidity among Brazilian adults: a systematic review and meta-analysis

“…76 Depressive individuals are less productive and have higher rates of absenteeism, which has a negative impact on the economy of their communities. 77,78 These persons also exhibit high-risk behaviors, such as alcohol and tobacco use, a sedentary lifestyle, and unhealthy eating habits. 5, 79,80 Future research should take into account these variables and focus on Brazilian regions that have been less extensively studied, such as the North, Northeast and Mid-West, and should include areas of lower population density, such as rural areas.…”