Treating depression helps the workplace

Programs boost job performance

Depression takes a toll on nurses and other health care workers. They may have trouble focusing on instructions, staying on task, or problem-solving, in addition to personal and physical problems that accompany depression.

That lag in productivity has a quantifiable cost in "presenteeism," but it also represents an opportunity. A focused program that includes care coordination, work coaching and cognitive behavior therapy can help employees cope with depression and improve their functioning at work, says Debra Lerner, MS, PhD, director of the program on Health, Work and Productivity at Tufts University in Medford, MA.

Lerner developed the Work and Health Initiative to address a pervasive and often unrecognized condition. About one in five nurses suffers from depression, a rate that is twice the national average, a recent study showed.1 In a pilot study, the initiative improved work performance and reduced absenteeism, producing a cost-savings of $6,000 per participant.2

"There is a lot of undiagnosed depression. Even among people who do have a diagnosis, there is under-treatment," says Lerner. And the treatment for people with depression rarely addresses specific issues with functioning at work, she says.

"Usually physicians don't hear about work problems until the employee is on the verge of losing their job or wants to file a disability claim," she says.

The Work and Health Initiative provides voluntary, confidential support to employees who have depression and are struggling at work, Lerner says.

Plan for better job function

The Work and Health Initiative is an eight-week program that connects employees with counselors in hour-long phone-based sessions. The counselors work with employees to create a plan for addressing functional problems at work.

The initiative uses work coaching to target specific performance issues and cognitive-behavioral therapy to change behavior. The counselor also provides care coordination with the employee's provider, such as communicating about the effectiveness of antidepressant medication.

"If the employee will give us permission to contact their physician or therapist, we will send a report every four weeks while they're in our program updating the provider about depression symptoms and how well the person is functioning on the job," says Lerner. "We can close the loop on the medical care system and the workplace."

In a study of 79 Maine government employees, the Work and Health Initiative led to improved symptoms. That group also showed significant improvement on job tasks, time management and productivity and reduced absenteeism compared to a control group.2

It's important for employees to know that they can get help with work functioning as an adjunct to medical treatment for depression, says Lerner. The services can be coordinated through an employee assistance program.

"There is a connection between having depression and having difficulty functioning at work. A lot of people don't make that connection," she says. "It is important to let them know they can get help."

The Work and Health Initiative is not yet commercially available, but Lerner hopes to have a product by early 2014. Meanwhile, employee assistance programs can help employees with depression in a disease management model, she says. Just as "a person with cancer or migraine headaches or COPD has the medical side and the functional side [that] both need to be addressed," depression also has functional dimensions that impact the workplace, she says.


1. Letvak SA, Ruhm CJ and Gupta SN. Nurses' presenteeism and its effects on self-reported quality of care and costs. Amer Jrl Nursing 2012; 112:30-38.

2. Lerner D, Adler D, Hermann RC, et al. Impact of a work-focused intervention on the productivity and symptoms of employees with depression. JOEM 2012; 54:128-135.