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Special Report:
Improving Mental Health
Insurance Benefits Without
Increasing Costs
U.S. Department of Health and Human Services
Substance Abuse and Mental Health Services Administration
Center for Mental Health Services
Office of the Associate Director for Organization and Financing
Mental Disorders in the Workplace: Prevalence, Impact, and Treatment
Employers may be able to improve productivity in the workplace by promoting the mental health of their employees. Indeed, research shows that employees with mental disorders have higher absenteeism and lower productivity than their colleagues, but that treatment can improve both measures (Berndt, Finkelstein, Greenberg, et al., 1998; Mintz, Mintz, Arruda, et al., 1992; Simon, Katon, Rutter, et al., 1998). This chapter describes the prevalence of mental disorders in the workplace and discusses how such disorders, left untreated, can adversely affect employee productivity. It concludes with a summary of the literature on effective treatments for mental disorders.
Mental Disorders Are Prevalent
Mental disorders are more prevalent than is commonly realized (Kessler, McGonagle, Zhao, et al., 1994). During any year, 30 percent of the noninstitutionalized civilian population age 15 to 54 have a mental disorder. Over their lifetime, 48 percent of the noninstitutionalized civilian population age 15 to 54 have had at least one disorder, and 27 percent have had two or more disorders. The most common mental disorders among this age group are depression, anxiety, and substance abuse. Specifically, they include the following:
- Major depressive episodes occur in 10 percent of the population. Symptoms of depression can include decreased energy, fatigue, sleep disturbance, difficulty concentrating, indecision, daily feelings of worthlessness, and decreased pleasure or interest in activities.
- Panic disorder, the most debilitating anxiety disorder, affects 2 percent of the 15- to 54-year-old population. People with panic disorder have recurrent and unexpected panic attacks short periods of intense fear that can include choking, dizziness, and nausea.
- Generalized anxiety disorder excessive worry about many things occurs in 3 percent of the 15- to 54-year-old population. It lasts for about 6 months and is difficult to control. Symptoms can include difficulty concentrating, irritability, and sleep disturbance.
- Social phobia, which occurs in 8 percent of 15- to 54-year-olds, is excessive or unreasonable fear and anxiety about social or performance situations. For people with social phobia, avoiding or anticipating feared situations can significantly interfere with normal functioning in occupational settings, social activities, or relationships.
Unfortunately, mental disorders are prevalent among children as well. One-fifth of the children in the United States have a diagnosable mental disorder, and 5 to 9 percent have a severe emotional disturbance with extreme functional impairment (Friedman, Katz-Leavy, Manderscheid, et al., 1996). Thirteen percent of children and adolescents have an anxiety disorder, 10 percent have a disruptive disorder, and 6 percent have a mood disorder (Shaffer et al., 1996).2 Two of the most common disorders among children are attention-deficit hyperactivity disorder (ADHD), found in 3 to 5 percent of the school-age population, and major depressive disorder, which affects 2 to 5 percent of adolescents (Burns, Hoagwood, & Mrazek, 1998). The core symptoms of ADHD include impulsivity, overactivity, and abnormally high levels of inattention, all of which often cause difficulty in a variety of settings.
Children and other dependents who have serious mental illnesses can affect their parents' (or other family members') attendance at work. For example, working parents of children with serious mental illnesses sometimes need time off from their jobs to care for their children or to take them to MH providers for treatment.
Mental Disorders Are Associated with Lower Employee Productivity
People with mental disorders have lower productivity and more problems on the job than do other employees. This is not surprising, since many of the symptoms of mental illness, such as fatigue, difficulty concentrating, indecision, irritability, and panic attacks, can constrain the ability to perform even the simplest of tasks. Indeed, part of the diagnostic definition of major depressive episode, generalized anxiety disorder, and social phobia is that the illness impairs social, occupational, and other important areas of functioning. Employees who exhibit more symptoms of mental disorders are absent from work about three times as often as are other employees (French & Zarkin, 1998).
Despite the debilitating effects of mental disorders, a large share of the people affected are employed, though their performance on the job is probably not what it could be. Seventy-two percent of people with depression are part of the workforce. Employees with major depression and those with panic disorder are more likely to miss work than are other employees (Broadhead, Blazer, George, et al., 1990; Kouzis & Eaton, 1997). One study estimated that in 1990, absenteeism and reduced productivity resulting from depression accounted for $24 billion in financial losses to the economy (Greenberg, Stiglin, Finkelstein, et al., 1993). In the Global Burden of Disease study, Murray and Lopez (1996) found that major depression is second in disease burden, just behind ischemic heart disease, in established market economies. Furthermore, Conti and Burton (1994) found that depression accounts for 3 percent of short-term disability claims and that claimants for depression are more likely to return to short-term disability status within a year than are claimants for other health conditions.
Like depression, social phobia can interfere with productivity. Studies suggest that this disorder is associated with performing below one's full potential (Lader, 1998). In a postindustrial economy, where interpersonal skills are increasingly important to job performance, social phobia may hinder productivity by interfering with an employee's ability to speak at meetings or to interact successfully with coworkers and customers.
The stress of caring for a child with mental illness may reduce a parent's capacity to perform well in the workplace, but studies have not quantified the impact of this stress on performance (Tessler & Gamache, n.d.).
Effective Treatments for Mental Disorders Are Available
Effective treatments for mental disorders are available and can improve functioning (Nathan & Gorman, 1998), but efficacy varies with the illness. For some mental disorders, certain treatments appear more effective than others. But for disorders such as major depression, it is not clear that one option is more effective than another.
Both psychotherapy and psychotherapeutic medications address the symptoms of major depression, generalized anxiety disorder, social phobia, and panic disorder. New medications with fewer side effects are also available for major depression, social phobia, and panic disorder.
Studies show that employees with major depression who began taking medications perceived their level of performance at work to significantly increase within 4 weeks (Berndt et al., 1998). Psychosocial therapy over a 12-week or 6-month period also does much to alleviate the symptoms of major depression or generalized anxiety disorder, but studies have not shown whether therapy or medications are more effective. For instance, among people with acute depression, absenteeism is reduced and productivity improves regardless of whether treatment consists of short-term medications, psychotherapy lasting 10 to 16 weeks, or maintenance therapy over 6 to 9 months (Mintz et al., 1992; Simon et al., 1998).
For social phobia, exposure therapies, in which patients are encouraged to repeatedly experience the situations they fear, are the most effective treatment. Panic disorder is effectively treated with therapy that combines education about the disorder with coping skills, exposure, and efforts to change thought patterns. Studies have also found that less intensive treatment, less frequent therapy sessions, or self-education with a manual can be as effective as more intensive treatment.
Both medication and therapy are effective in treating children with ADHD and children with depression (Burns, Hoagwood, & Mrazek, 1998; U.S. Surgeon General, 1999). Medications such as Ritalin reduce the symptoms of ADHD in 70 to 80 percent of affected children. Psychosocial treatment, including parent and teacher training in behavior modification, tends to improve targeted behaviors or skills but is more effective when combined with medications.
For adolescents with depression, cognitive behavioral therapy (short-term directive therapy designed to change negative views) appears to be an effective treatment. Research suggests that therapy can also help younger children with depression. On the other hand, evidence is weak that nonhospital residential treatment facilities are effective for children with severe mental disorders. These licensed facilities offer 24-hour treatment services and account for nearly one-fourth of national spending on child mental health treatment (U.S. Surgeon General, 1999).
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