Editor's Picks Research Update

Diagnosis and Referral of Workplace Depression

As a psychological disorder, depression is relatively common and it affects the efficiency and output of employees’ hence the diagnosis should be prompt and treatment or referral offered appropriately by the employer. This review was carried out to outline possible diagnostic and screening method for depression and other depressing disorders, symptomatic differentiation of different depressive conditions and the most effective way of diagnosis, treating and referring workplace depression.

Diagnosis and Referral of Workplace DepressionThe review notes that symptoms of workplace depression are usually not apparent to the patient but are first noticed by co-workers, managers, supervisors, occupational health workers and human resource personnel. Affected individual may show symptoms of social withdrawal from workplace meetings and gatherings; absenteeism from work, patients may reduce or stop interaction with co-workers, gets angry easily, prone to accidents and errors, reduction in productivity despite effort and complaints from co-workers and manager, alcohol and drug misuse and dependence, sadness, fatigue, and laziness.

Screening tools have been designed and can be used at the workplace to quickly access workers who exhibit symptoms of depression. These tools are not diagnostic but are used to identify patients who will need further evaluation by a trained and experienced psychiatrist. It is important to note that most patients do not report any related symptom(s) of depression and as such, detail review by the clinician will be invaluable in assessing such patients. A thorough mental state interview which includes the presence of symptoms; family, social and previous medical and psychological illness history will help the clinician make a diagnosis and to formulate the best treatment plan.

The initial evaluation of workplace depression is initially carried out by the occupational health staff, social worker or the psychologist. However, the presence of symptoms e.g. suicidal risk/attempt, marked depression or frank psychosis, substance abuse, the presence of other medical disorders and emotional crisis should necessitate an urgent referral to a specialist for proper assessment and treatment.

As with any medical condition, symptoms overlap and other disorders may mimic depression. It is important to differentiate depression from other medical conditions because treatment of depression is specific. Medical conditions like hypothyroidism (reduce production of thyroid hormone), Parkinson’s disease, alcohol and substance abuse, cancers and brief personal depression (recent divorce, bereavement or disappointment) or even side effect of certain drugs can mimic depression and there should be considered as differential diagnosis of depression during mental state evaluation by the physician.

Employees showing symptoms related to depression should be referred for expert assessment and evaluation. Depression is a disease entity and has different types depending on the symptom complex. It is the role of the clinician to assess each patient not only to establish a diagnosis but to identify the type of depression. Treatment of depression varies depending on the type. Also, the outcome, prognosis, and the response pattern differ greatly amongst the different subtypes of depression.

The importance of early diagnosis and treatment of depression cannot be emphasized, prompt referral and treatment bring succor to employees alongside preventing productivity lost to the employers. Every establishment should have occupational mental health professionals because they are the first line of the treatment and proper referral of workers suffering from depression.

You have just read a summary of the research paper: Kahn, Jeffrey P. “Diagnosis and referral of workplace depression.” Journal of Occupational and Environmental Medicine 50.4 (2008): 396-400. Free full-text pdf available here.

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