According to the Conference Board of Canada, nearly three million Canadians will experience depression in their lifetime—for most, during their prime working age of 24 to 44. The impact depression has on the workplace can be considerable. People with depression have higher rates of absenteeism and short-term disability than those without. They also experience higher rates of job turnover and productivity loss.
Despite growing awareness of the issue, many workplaces still struggle with what to do to help individuals experiencing depression. A research team at the Institute for Work & Health (IWH) is helping fill that knowledge gap.
The team conducted a systematic review of the research to date on interventions to help workers with depression. The team also sought out practices and approaches not currently captured in the research by conducting surveys, focus groups and interviews about workplace supports for people with depression. Based on both the systematic review and the consultation, the team developed a free guide on strategies to support employees with depressive symptoms. The Evidence-informed guide to supporting people with depression in the workplace is now available on the Institute’s tools and guides webpage.
“We have drawn upon the best research evidence and integrated it with both practitioner expertise and stakeholder values and preferences,” says IWH Scientist Dr. Dwayne Van Eerd, one of the project co-leads. “We hope this helps bridge the research-to-practice gap and the research-to-policy gap that currently exist for depression-related disability management programs.”
Findings from the systematic review
For the systematic review—an update of a 2012 review—the team conducted a literature search that identified studies that were potentially eligible for inclusion. Of these, 27 studies met all inclusion criteria: they involved a work-related intervention; focused on workers with depression; had a comparison group; had return to work or staying at work as an outcome; and were of high or medium quality when it came to the research methods used.
Most of the included studies were conducted in the Netherlands, the U.S. or Canada. There were 13 intervention types covered. The majority of the studies (18 out of 27) examined some form of cognitive behavioural therapy (CBT). A few studies looked at coordination of services and enhanced care management. The remaining one-off articles focused on various interventions such as strength training, aerobic training, relaxation training, stress reduction, part-time sick leave, nature-based rehabilitation and psychodynamic psychotherapy. As the single studies didn’t provide enough evidence of effectiveness, the review team did not comment on these latter interventions.
The systematic review found moderate evidence that:
- generic CBT can help workers with depressive symptoms stay at work, but has no effect on helping people return to work; and
- work-focused CBT can help people with depressive symptoms stay at work and return to work after a depression-related absence.
“CBT teaches people strategies and skills to address the problems that come up in the here and now,” says IWH Associate Scientist Dr. Kim Cullen, another co-lead on the study. The technique involves identifying, questioning and changing the thoughts, attitudes and beliefs that are related to the emotional and behavioural reactions that cause difficulty. Work-focused CBT involves using the same technique to address the thoughts, emotions, reactions and behaviours that come up at work.
“For example, workers currently on leave due to depression may feel particularly anxious about certain aspects of their jobs when contemplating returning to work,” says Cullen. “If so, they may benefit from a counselling approach that helps them examine their self-talk and thought patterns around those challenging tasks. In time, these individuals may find themselves more capable of managing their feelings around those job elements when they arise.”
The number of medium or high quality studies included in the review was large enough to allow the team to probe a little more about how CBT should be delivered, Cullen notes. For example, does it matter whether CBT is delivered by clinicians or non-clinicians (such as peers or co-workers)? Only three studies in the review looked at interventions delivered by non-clinicians, but they seemed to have positive effects on return to work and stay at work. Does CBT have to be delivered one-on-one? Four of the studies looked at group therapy. This, too, seemed to help people stay at work and return to work. Does it matter whether CBT is delivered in person? Four studies looked at CBT delivered online or on the phone; these remote forms of delivery also seemed to help people stay at work.
Beyond the published evidence
Looking at the programs and practices examined in the peer-reviewed literature, the team noted an absence of one group of programs and practices that is known to affect workers’ health outcomes. “The interventions we found in the literature were primarily those that target the individual. They address people’s coping skills or resilience,” Cullen said at a recent IWH Speaker Series presentation on this project. “There has been very little research—in fact, we found none—focusing on interventions that deal with organizational factors such as job stressors, social support at the workplace, job accommodations and so on. We know workplaces are addressing these factors, but their practices just haven’t shown up in the research literature yet.”
That’s where the research team’s consultation with workplace practitioners and workers came in. The consultatin included surveys, focus groups, and interviews with human resources (HR) professionals, disability management professionals, occupational health and safety practitioners, and more. The aim was to find out what types of support they provide to workers with depression. The team also surveyed workers for their experiences receiving support—or not—for their depression at work.
The resulting guide outlines practices and strategies that may be useful to workers, co-workers, managers, union representatives and HR practitioners in all workplaces, regardless of sector or size. The strategies are grouped into three broad categories: workplace culture, workplace processes and resources (both at and outside of work).
Depression is a challenging condition to address in the workplace because it is invisible to others, as well as episodic and unpredictable in nature, says Emma Irvin, head of IWH’s systematic review program and another co-lead on the project.
This can make it particularly difficult for supervisors and managers to plan for work needs and implement and evaluate policies, she adds.
Because of this challenge, workplaces look to evidence-based practices whenever possible to minimize the effects of depression in their workforces. We hope that our work on the systematic review and the guide helps provide that service to workplaces.