The phrase "workplace injury" typically conjures a physical ailment-a back injury, a laceration, a respiratory illness-but there's another, often overlooked consequence of on-the-job injuries that can affect both employees and a company's bottom line: depression. According to the Centers for Disease Control and Prevention (CDC), depression "is one of the leading causes of disease or injury worldwide for both men and women," with a resulting total economic burden in the United States of $210.5 billion in 2010.
CDC's National Health and Nutrition Examination Survey indicated that between 2009-2012, 7.6 percent of Americans over the age of 12 struggled with depression, and nearly 43 percent of those who suffered from severe depressive symptoms also experienced "serious difficulties in work, home and social activities." The workplace is clearly not immune from the effects of depression.
CDC stresses that depression can lead to loss of work, absenteeism and lower productivity, and it may also put individuals at greater risk for substance abuse, smoking or other mental disorders. A study published in the Journal of Clinical Psychology revealed that depression resulted in workplace-related costs exceeding $51 billion in the year 2000[i].
Depression presents additional challenges for employees who have suffered an injury in the workplace. In fact, the aftermath of an on-the-job injury may create circumstances that can lead to depression-all of which can impact workers' compensation and an injured employee's transition back to work.
The Injury-Depression Connection
A serious workplace injury can upset multiple aspects of an employee's life. According to Lawrence Raymond, MD, Medical Director, HEALTHWORKS Division, Carolinas HealthCare System, injured employees experience not only loss of functional capacity at work, but disruptions to income, home life, and hobbies. If that worker is also in chronic pain, the risk for depression is further worsened.
As a result, depression can put a strain on the workers' compensation system. "Depression is likely to prolong the [worker's] disability and the costs associated with that injury," Dr. Raymond says. "Depression in and of itself is also a risk factor for low back pain and smoking. And then there's the issue of presenteeism, in which a depressed worker comes to work, but his or her productivity is impacted. This, in turn, may spill over to other workers and influence their productivity."
Despite the potentially far-reaching effects of depression, treatment for depression that manifests as a result of on-the-job injury might not be covered by workers' compensation benefits. If that's the case, employees who suffer from depression may be less likely to receive either medication or cognitive therapy-and a lack of appropriate treatment could result in a longer time away from work or impacted performance once they do return.
To avoid these complications and ensure injured workers can make a smooth transition from workers' compensation back to a normal work routine, employers must take proactive steps to address depression in the workplace.
Workplace Prevention and Intervention
Dr. Raymond stresses that employers can do one simple thing to help identify and prevent depression in the workforce: pay attention. An observant, attentive supervisor may be able to identify a potential problem and take appropriate action, such as making a referral or asking the worker if he or she needs help. Dr. Raymond advises employers to be on the lookout for the following warning signs, especially in the cases of injured employees who have recently resumed work: difficulty adjusting after returning to the workplace, changes in appearance or attention to grooming, appearing listless or sad, a decline in productivity or struggles with timeliness on the job.
"Problems in these areas are pretty big tip-offs," Dr. Raymond explains. "Even a supervisor not medically trained would pick up on those signs. In an ideal case, there would be an adjunct form of therapy available to all workers through an employee assistance program (EAP), but smaller employers might not have access to that. Either way, a savvy supervisor should size up workers returning to the job to determine if depression is part of the picture."
But supervisors needn't wait for the injured employee to return to work before taking action. Dr. Raymond advises supervisors to gather other workers in advance to explain the situation and ask everyone to keep an eye out on the returning worker. This strategy allows employees to look out for one another and assumes the employee has given the supervisor permission to let coworkers know relevant information about the reason for their absence.
"This is a worthwhile intervention," Dr. Raymond says. "It demystifies the process."More generally, providing education surrounding depression in the workplace can head off future problems. Dr. Raymond applauds employers who host "lunch and learn" sessions to bring physicians, physical therapists or mental health professionals into the workplace to discuss health issues with staff. Such programs can help erase the stigma of mental health illness, prevent fear avoidance among injured workers and generally help all staff look out for signs of depression-a process that helps ensure the workforce is less inclined to stigmatize a depressed worker, whether that worker suffered an injury or not.
Programs like Carolinas HealthCare System's Mental Health First Aid training offer free support to employers who are committed to addressing depression among their workforce. Mental Health First Aid, a national program that HEALTHWORKS has adapted for the Charlotte, N.C. area, trains staff to identify risk factors and warning signs surrounding mental illness and addiction, outlines strategies for coping with crisis situations and provides information about where to turn for help.
This type of intervention can help ensure an injured worker is best equipped to recover and resume a healthy and productive life-both at work and at home. Depression doesn't affect workers in a vacuum, after all, so employers need to be invested, aware and ready to reach out. "Be in touch with the worker. If he or she cannot return to the workplace, don't lose touch," Dr. Raymond advises. "Make a phone call or a house call. Don't let the worker feel uncared for because the workplace is a very important part of life." To learn more about workplace health, click here.