Single out high-risk workers for screening

Mental health screening should be part of your overall plan to assess risk, implement interventions, and establish outcomes measurement strategies, says Nancy W. Spangler, MS, OTR/L, a consultant to the Partnership for Workplace Mental Health and president of Leawood, KS-based Spangler Associates Inc. She suggests the following approaches:

1. Add questions about mental health and stress to health risk appraisals.

"This is a valuable and low-cost way to increase awareness," says Spangler. She advises using validated tools, including the World Health Organization Health and Work Performance Questionnaire or the Work Limitations Questionnaire.

2. Screen high-risk groups.

These include employees with other medical conditions, people who access employee assistance programs, those who are frequently absent from work, and employees in particularly high-stress positions.

Also screen any employee who has been off work for five days or more with an occupational injury or accident. For these cases, Spangler suggests using a nine-item depression scale, called the patient health questionnaire.

"This tool may be helpful for both screening and monitoring progress," she says. Spangler points to one study that found a high prevalence of depressive symptoms at one month (43%) and six months (27%) post-workplace injury. In addition, the researchers found that few of the injured employees were receiving any treatment for depression(13% and 24%, respectively).1

3. Collaborate with others in your organization who may be able to influence mental health awareness.

Enlist the help of human resources, leadership, employee assistance, safety, and communications.

4. Communicate with referral clinicians.

Inform independent medical examiners, rehabilitation, and disability vendors that your organization values a comprehensive biopsychosocial approach to functional capacity examinations, work accommodations, and return-to-work strategies.


  1. Franche RL, Carnide N, Hogg-Johnson S, et al. Course, diagnosis, and treatment of depressive symptomatology in workers following a workplace injury: a prospective cohort study. Can J Psychiatry2009; 54(8):534-546.