Hospital battles depression in the workplace

Depression is widespread cause of absenteeism

Listless, fatigued, emotionally drained. Employees are dragging themselves to work despite a bout of depression. And while they may not see much hope that they will feel better, you should.

About 17% of Americans will experience a major depressive episode in their lifetimes1 and depression is a significant cause of absenteeism and low productivity. By addressing depression, Vanderbilt University in Nashville, TN, hopes not only to help employees in their personal lives, but to boost their performance at work as well.

"So many [wellness] programs focus on things like tobacco cessation, blood pressure, and so on, when in fact targeting depression and stress would have the greatest impact on your health care claims," says Jim Kendall, LCSW, CEAP, manager of Work/Life Connections-EAP, the employee assistance program at Vanderbilt.

"You hear people say, 'I've been functioning like I'm in a fog.' Lack of clarity and concentration and memory problems are first symptoms. Those things really do have a direct impact in the workplace," he says.

Once employees receive treatment for their depression, their mood and productivity improves, he says. In a follow-up just four weeks after treatment, employees show improvement on depression inventories of 50%-70%, Kendall says.

A study of 46,000 employees at six large companies over a three-year period found that, as a group, people with the highest risk factors for depression also had the higher health care costs.2 In 2002, the American College of Occupational and Environmental Medicine issued a position statement advocating depression screening as "an appropriate part of the practice of clinical occupational medicine."

"Depression is probably the greatest problem that we as employers have right now," says Mary Yarbrough, MD, MPH, director of health and wellness at Vanderbilt.

Depression is a health risk

Wellness programs often begin with a health risk appraisal, completed confidentially by the employee. Commonly, they look for obvious health risks, such as high blood pressure or smoking.

"If you're not attending to people's emotional issues and you're just dealing with physical issues, then you're missing the boat on an opportunity to really impact your employees," says Kendall.

But then what? If the health risk appraisal includes questions related to mental health, then you need a plan to address the answers. "Asking the question is fine," he says. "But what happens if you find somebody who says, 'I've been thinking that life might not be worth living.' You need to be able in some way to respond when people are in the greater danger zones."

Vanderbilt asks employees who complete a health risk appraisal whether they would like to be contacted about follow-up. A "Healthy Steps" coach then calls and talks to the employee about stress and depression, providing follow-up services.

Meanwhile, many employees contact the Work-Life Connections-EAP directly, seeking help. Within 48 hours of their call, an EAP counselor meets with the employee and provides referrals to therapists or physicians. They also provide some initial support to help the employee with day-to-day coping skills.

"The action plan might include some ways to focus on relationships, socialization, and exercise. We'll gear our suggestions to practical, step-by-step actions to feel better. We'll give them a realistic timeline of how long it's going to take based on their current situation," says Kendall.

Meanwhile, Kendall and his colleagues provide educational seminars throughout the campus, focusing on such topics as stress management and depression. They are trying to raise awareness of depression as well as of the EAP services.

"A lot of times, people will tell you what's going on in their lives and they won't label it depression," he says.

The U.S. Preventive Services Task Force identified two simple questions that can serve as a depression screen: "Over the past two weeks, have you felt down, depressed, or hopeless?" and "Over the past two weeks, have you felt little interest or pleasure in doing things?"3

Trust is a huge factor when it comes to helping employees with their mental health problems. Vanderbilt maintains separate programs for faculty and physicians and for nurses.

"Next to child care, this service is recognized as being the most valuable to our faculty and physicians," says Yarbrough. "They have different needs. People who have to maintain a license have special considerations. You have to design your program to support that."

For example, EAP programs also deal with alcohol and drug abuse problems, and state licensing bodies have guidelines and reporting requirements related to those issues, she notes.

In-house EAP program

While many hospitals outsource their EAP programs to emphasize confidentiality and privacy, Vanderbilt has been able to create that environment with an in-house program.

"There has to be a place where they feel safe and it's confidential," says Yarbrough. "There has to be a trust between the employer and the employee to have that kind of service in your institution."

Ultimately, a strong program that addresses depression and other mental health needs can help employees remain focused on their work — and patient safety. And it can help with retention of valuable employees, says Yarbrough.

"These are human resources that are not replaceable," she says. "It's worth investing in those people."


1. Kessler, Ronald, et al. The epidemiology of major depressive disorder: Results from the National Comorbidity Survey Replication (NCS-R). JAMA 2003; 289(23):3,095-3,105.

2. Goetzel RZ, Anderson DR, Whitmer RW, et al, and the HERO Research Committee. The relationship between modifiable health risks and health care expenditures: An analysis of the multi-employer HERO health risk and cost database. J Occup Environ Med 1998; 40:843-854.

3. U.S. Preventive Services Task Force: Screening for Depression: Recommendations and Rationale. Ann Intern Med 2002; 136(10):760-764.

OSHA, AAOHN renew their alliance

The U.S. Occupational Safety and Health Administration renewed its alliance with the American Association of Occupational Health Nurses, based in Atlanta. The alliance has worked on issues such as musculoskeletal disorders, workplace violence, and promoting the use of automated external defibrillators in the workplace. AAOHN and OSHA first signed an alliance agreement. This is the second renewal.