How Can TMS Help Solve This Growing Problem?
Driving across town one afternoon, I recently became absorbed in a story on NPR radio that really hit home. Over the years, I’ve treated many patients just like Jay Lynch, Professor of Medicine at University of Florida. His story illustrates the unwitting situation now called “Presenteeism”, a term coined in 2001 by Cary Cooper, Professor of Organizational Psychology and Health at Manchester University (source).
Presenteeism usually starts with no warning signs. Perhaps you will recognize a friend or colleague in Dr. Jay Lynch’s story.
Dr. Jay Lynch’s Journey with Depression
During his career as an Oncologist, Dr. Lynch worked primarily with cancer patients. Many of his patients fought long and difficult battles with their disease. Some survived and some didn’t. The stress of these losses started to take a tangible emotional toll on Dr. Lynch, as you would imagine it might, because he put his heart into his work. He truly cared for his patients and their families.
Then a series of unexpected events hit. First, 9/11. Then a couple weeks after that, the son of one of his best friends killed himself. Next, a patient to whom he was very close passed away. And on top of that, his wife injured her back and it became his responsibility to manage their four children.
Dr. Lynch started to play mind games. In one of them, he asked himself a question; “What if I was going to write a book and have the perfect suicide, what would that look like?” Lynch remembers. “If I can pull it off and it looks like an accident, then everybody’s happy.”
He never told anyone he was having these kinds of thoughts – not his wife, not his friends and definitely not anyone at work. Dr. Lynch kept working, but just couldn’t hold up under such emotional stress. This is a rather extreme example of Presenteeism. Suicidal ideation is certainly not required to be considered a part of this phenomenon.
What Exactly is Presenteeism?
Presenteeism is defined as “the problem of workers being on the job, but, because of illness or other medical conditions, not fully functioning”.
The mental health of workers is an area of increasing concern to organizations. Depression is a major cause of disability, absenteeism, presenteeism, and productivity loss among working-age adults. The ability to identify major depression in the workplace is complicated by a number of issues such as employees’ serious concerns about confidentiality, or the impact it may have on their job – that cause some people to avoid screening.
In a case such as Dr. Lynch’s, a good professional reputation is highly correlated to success, as the medical community defines it. It is quite understandable how stress factors can build without anyone really recognizing it – even Dr. Lynch himself.
Who Does Presenteeism Affect?
The highest rates of Presenteeism are likely to be found among:
- Workaholics: Those who exhibit workaholism tend to demonstrate higher levels of Presenteeism. Workaholics tend to work excessively and compulsively, and they are internally motivated to work to an excessive extent. In addition to their high levels of Presenteeism, researchers discovered that workaholics also displayed the highest burnout and lowest happiness levels relative to other groups who were not defined as workaholics.
- Performance-based self-esteem (PBSE): PBSE has also been considered an antecedent of Presenteeism. This term describes the idea that individuals’ self-esteem may depend on their performance. Employees who demonstrate high levels of PBSE have to prove their worth while on the job. Researchers found that PBSE positively predicted Presenteeism; however, they also discovered that the relationship between PBSE and Presenteeism was strengthened when workers experienced high physical and psychological work demands.
Are Employers Aware of Presenteeism Related to Depression?
Think about the medical setting that employs physicians such as Dr. Lynch. Is it reasonable that the culture of any given organization actually rewards its employees for workaholic-type behavior? They may not accept the concept that a more balanced approach actually increases worker productivity. Why? One might guess that the individuals who manage such organizations are workaholics themselves.
While many employers have always been aware of costs due to Absenteeism, there is now increasing evidence that Presenteeism may also result in significant costs to the organization in the form of decreased productivity while at work.
Depression is estimated to cause 200 million lost workdays each year at a cost to employers of $17 to $44 billion.
Other eye-opening facts and figures:
- Approximately 80% of persons with depression reported some level of functional impairment because of their depression, and 27% reported serious difficulties in work and home life.
- In a given year, 18.8 million American adults (9.5% of the adult population) will suffer from a depressive illness.
- It is estimated that 20% of people aged 55 years or older experience some type of mental health issue.
- Depression is the most prevalent mental health problem among older adults.
What Research is Being Conducted to Address These Issues?
Unlike Absenteeism, which is the rate of workers not coming to work due to illness, Presenteeism is just now making its way into health care literature. In September 2015, I conducted a PubMed search for the term “Absenteeism” which resulted in 9,864 English language citations. In contrast, the same search for the term “Presenteeism” returned 561 English language citations.
Research on the impact of Presenteeism is mainly focused on productivity loss due to chronic conditions such as allergies, arthritis, depression, and diabetes. By singling out depression, these statistics offer hope that an effective screening and treatment of Major Depressive Disorder can significantly influence the rates of Presenteeism:
- Research shows that rates of depression vary by occupation and industry type. Among full-time workers aged 18 to 64 years, the highest rates of workers experiencing a major depressive episode in the past year were found in the personal care and service occupations (10.8%) and the food preparation and serving related occupations (10.3%)
- Occupations with the lowest rates of workers experiencing a major depressive episode in the past year were engineering, architecture, and surveying (4.3%); life, physical, and social science (4.4%); and installation, maintenance, and repair (4.4%)
What Can Employers Do To Decrease Depression-Related Presenteeism?
Evidence linking work organization with depression and other mental health problems, and with increased productivity losses, is beginning to accumulate. A number of studies of a diverse group of occupations have identified several job stressors (e.g., high job demands; low job control; lack of social support in the workplace) that may be associated with depression. Although the evidence is mounting of the links between job stress and depression, there is less evidence of effective interventions to prevent depression in the workplace.
There are a number of strategies employers can pursue to support employees’ mental health such as holding depression recognition screenings; placing confidential self-rating sheets in cafeterias, break rooms, or bulletin boards; promoting greater awareness through employee assistance programs (EAP); training supervisors in depression recognition; and ensuring workers’ access to needed psychiatric services through health insurance benefits and benefit structures.
In addition to its direct medical and workplace costs, depression also increases health care costs and lost productivity indirectly by contributing to the severity of other costly conditions such as heart disease, diabetes, and stroke. However, routine, systematic clinical screening can successfully identify patients who are depressed, allowing them to access care earlier in the course of their illnesses.
Research suggests that an impressive 80% of patients with depression will improve with treatment.
How Does TMS Fit Into This Solution For Employers?
Imagine a global corporate office with one or more highly-paid top executives who suffer from depression. Or, imagine a small company with one or two owners whose successful operation largely depends upon their effective performance. Or, imagine any in-between size company. Presenteeism due to depression could be quickly and effectively decreased. Transcranial Magnetic Stimulation could be an ideal solution to a wide-spread and expensive problem.
We’ve discussed the prevalence and related costs of depression in the workplace. As a psychiatrist who has successfully treated many patients with circumstances similar to those of Dr. Lynch, I encourage readers to pass this information on to others who may have an interest, or know someone who does. Oftentimes, it is simply awareness and requests for treatments such as TMS that most effectively bring these treatments into the mainstream.
Who do you know who could benefit by reading this article? Please share this link, or publicize it on your own social media. You may never know who you’ve helped.