The recent tragic passing of Prof. Bongani Mayosi, known to have suffered from depression, has mobilised a renewed awareness of the significance and potentially devastating effects of depression in the workplace. In terms of prevalence, depression is the “common flu” of mental illness of our times. According to the World Health Organization (WHO, 2017), depression is the leading cause of ill health and disability worldwide, with an increase in prevalence of 18% between 2005 and 2015.
Depression is a serious and debilitating condition which also increases the sufferer’s risk of associated conditions, including substance use disorders and diseases such as diabetes and heart disease, and most alarmingly, the risk of suicide. According to Dr. Saxena of the WHO, about 800 000 people commit suicide worldwide every year, amounting to one suicide every four seconds. According to the South African Depression and Anxiety Group (SADAG), around a fifth (20%) of all South Africans will experience a depressive disorder at least once during their lifetime and the incidence of suicide in South Africa has increased to 23 suicides per day (this figure excludes unsuccessful suicide attempts).
A single academic institution typically has thousands of employees. Academia has been identified by researchers as being a particularly stressful work environment. Studies have found that among the factors found to be associated with stress in academia, a lack of necessary support systems and high workload levels are included. Associated consequences such as low job satisfaction, which is likely to affect staff’s productivity, were also identified in the study. The latter is concerning, especially given that studies have found work satisfaction to be a strong predictor of longevity as well as overall well-being. Other studies have linked stress in academia to factors including inadequate recognition for community service, a lack of clear evaluative criteria, a lack of time to stay current in one’s field and a lack of preparation time, a lack of impact on decision making, differences with one’s departmental chair, excessive self-expectations, pressure to obtain research funding, interactions with and demands from students, etc.
One study at a Welsch university found that 74 percent of respondents reported moderate levels of stress, and 10 percent fell into the ‘serious stress’ category. Seventy-four percent of respondents rated work as the most significant source of stress in their lives. Of course, academia by no means represents the only stressful work environment. Most work environments contain stressors which, if severe enough, can lead to the development of depression in the employee. A study conducted in the UK suggests that among the most stressful occupations, ambulance work, teaching, social services, customer services, correctional services and police services are included.
A 2017 report by the World Federation for Mental Health (WFMH) highlights that the relationship between workplace stress and poor mental health is well established. What needs to be understood is that workplace stress and depression have a reciprocally reinforcing relationship: workplace stress can lead to depression, and in turn, the depression can lead to higher levels of work stress – we thus see a “vicious cycle” in the relationship between stress and depression in the workplace.
Workplace stress and depression may be compounded and exacerbated in the lives of many employees by a number of factors. Firstly, part of the severity of the impact of workplace depression is the employee’s sense of being trapped in an unsatisfying and unhealthy work environment. Many employees simply do not see a “way out”: in a country challenged in terms of job opportunities (more so in some occupations than in others), employees may not be able to resign from their current position, given that they have no security or guarantee of finding new employment. This can lead to a subjective experience of great powerlessness which further exacerbates the mental illness.
Furthermore, many employees may be hesitant to indicate to their line managers or employers that they are struggling mentally, as they may fear being stigmatised and that the disclosure of mental difficulties may compromise their career advancement, creating prejudiced perceptions of their competence in the workplace. In addition, many employees may experience social pressure to achieve and rise through the ranks, something which, in the employee’s mind, might be compromised should they disclose their struggle with mental illness.
Also, an employee might have a poor relationship with their direct line manager or employer, or find him-/herself within a work context where there may be either a real or perceived lack of empathy and understanding of mental health issues. There are many additional factors that can potentially compound a depressed employee’s dilemma, but ultimately, what it boils down to is that many depressed employees find themselves in what feels to them like an inescapable double-bind. In the end, they are faced with the decision either to disclose or not to disclose - to ask for help in the workplace, or not?
Many of the above-mentioned aggravating factors in relation to workplace depression can be alleviated by fostering a work environment which is aware of and sensitive to the implications of workplace depression, the needs associated with it, as well as the implementation of measures and systems of support for employees suffering with it. Such initiatives may often be driven by the human resources departments of organisations. Managers and employers would also do well in being able to identify some of the typical warning signs that reveal an employee may be struggling mentally.
Depression is characterised by a range of symptoms and signs including a depressed mood, diminished interest or pleasure in all (or almost all) activities, significant weight loss or gain stemming from changes in appetite, insomnia or hypersomnia, fatigue, feelings of worthlessness and/or guilt, diminished concentration, and suicidal ideation or suicide attempts. Unfortunately, some of these symptoms may not be externally observable, and thus be hard to identify in places of work. The above being said, there may be employees who do not outwardly show any of these signs, and who appear to be coping with their work demands. Some depressed employees may push themselves to maintain adequate or even above-average levels of productivity. This will however come at a huge cost to the physical and mental health of these employees, who would be at risk of heading towards burnout or breakdown.
The best indicator of the presence of depression in an employee is the employee’s confession of experiencing mental health difficulties. Such disclosures and expressions need to be taken seriously by employers. Should employees choose to disclose their mental health challenges, employers and their line managers need to work collaboratively in an attempt to mobilise the necessary support for the employee.
Sometimes guidance from the organisation’s human resources department may be needed. Employees need to be aware of their rights in terms of requesting support, including their right to confidentiality related to such disclosures. Workplaces that are known to be particularly stressful need to provide employees with constructive avenues of coping, should they experience mental health issues in the workplace.
In conclusion, it is clear that depression in general is reaching epidemic proportions, and workplaces are by no means exempt from this problem. Work contexts that are known to be particularly stressful need to foster an awareness of the possibility of mental health problems among their employees, as well as to provide employees with avenues of seeking help and support.
Fortunately, depression is a treatable condition, and most patients respond positively to suitable interventions, whether this be via psychotherapy, psychopharmacological treatment, or a combination of both treatment modalities. Psychotherapy is however the first port of call in the treatment of depression. The efficacy of treatment for workplace depression would however be at least partially determined by the extent to which the patient’s needs are recognised and accommodated in the workplace.
Mariska Pienaar is a registered counselling psychologist and holds a Masters in Counselling Psychology from the University of KwaZulu-Natal.