Employers take action in the fight against depression; imaginative new programs begun by U.S. businesses are helping depression sufferers get the treatment they need - includes related information on identifying a depressed employee and using an employee assistance program - Special Report: Helping Employees Overcome Depression

Business & Health, April, 1994

Imaginative new programs begun by U.S. businesses are helping depression sufferers get the treatment they need.

Confronted by increasing mental health care expenditures and aware that early intervention can help limit costs and suffering, U.S. companies are beginning to approach the issues surrounding depressive illness. Among the tactics that they are employing: new or expanded Employee Assistance Program (EAP) services; depression awareness training for managers; restructured benefit plans; enhanced communication to raise employee awareness; and providing information from outside agencies.

Landmark research conducted

Westinghouse Electric Corp., headquartered in Pittsburgh, was an early leader in recognizing the prevalence of depressive disorders in the workplace.

During 1988 and 1989, Westinghouse conducted clinical interviews of 1,879 of its employees. The company's objectives were to determine how many workers were affected by depression and to identify risk factors associated with major depression and alcohol abuse and dependency. The results of this landmark research are outlined in "Depression: Corporate Experiences and Innovations," a publication of the Depression Awareness, Recognition and Treatment (D/ART) National Worksite Program. D/ART is an educational program sponsored by the National Institute of Mental Health (NIMH) in Bethesda, Md.

Among the survey's findings: [4]

* About 9% of male workers and 17% of female workers had experienced a major depressive episode in the previous year;

* Lifetime prevalence rates were 23% for men and 36% for women;

* The average age at the onset of depression was 30 years for men and 25 years for women;

* More than 50% of depressed individuals reported work-related problems, including difficulty in concentrating and feeling withdrawn from or irritable with coworkers; and,

* Certain risk factors were tied to the onset of the depressive episodes. They included "conflicting work demands, unclear job expectations and responsibilities, lack of intrinsic rewards, and negative job events."

Based on the information gained from the survey, Westinghouse began a pilot program to train managers and supervisors in matters relating to work and mental health. The company wanted to improve supervisors' awareness of mental and substance abuse problems. It also sought to change supervisors' behavior in order to increase the likelihood that they would identify troubled employees and refer those workers for treatment, before their problems became acute or disabling.

Throughout the time that the survey was being conducted, Westinghouse was going through significant reorganization and downsizing. That process is continuing, says E. Carroll Curtis, M.D., former medical director of the company

As a result of the downsizing, the pilot program had a "very limited start," Curtis recalls. Nevertheless, some supervisor training has been undertaken, he says. "One of the things we tried to accomplish was to help supervisors understand that the same symptoms can be attributable to more than one cause," he explains. such factors as the type of medication prescribed, the number of therapy sessions needed, and of course, whether inpatient care is deemed necessary.

Overall, First Chicago's benefits program supports active treatment of depression, Conti contends. "We have a generous mental health program." The bank's benefit plan has also been designed to ensure that a full range of alternatives to inpatient care, such as partial hospitalization and outpatient treatment, are made available.

Under the current benefit plan, there is a $350 deductible, after which 50% of outpatient treatment costs are reimbursed. First Chicago is now examining plans that offer 85% reimbursement from the first session, with no deductible. At some point in the future, however, the reimbursement rate would fall to 50% or less. The idea, Conti explains, is to encourage earlier intervention for disorders such as depression, while discouraging long-term courses of outpatient psychotherapy.

Ensuring a supportive environment

Unlike First National Bank of Chicago, Digital Equipment Corp., in Maynard, Mass., began its depression awareness program specifically to help support employees during a period of corporate downsizing. Like many vendors of information systems technology, Digital has undergone extensive restructuring during the past several years.

As a result, many of the company's 101,000 employees have recognized that they are facing increasing workloads, longer work days, and ongoing pressure to increase productivity. Changes such as these invariably result in elevated levels of worker stress.

"When you go through organizational restructuring, you are shifting your contract with employees," says Bruce Davidson, corporate manager of EAPs at Digital. "Anytime you change the corporate culture, you change employees' perception of their relationship to the company."

Because of all the recent up-heaval, Davidson says, "Digital recognizes that problems such as depression can occur and have an impact on productivity. We believe that treatment intervention is a good investment."