What Is Depression?

Depression is not just having a bad day or feeling the occasional blues. Depression—formally known as major depressive disorder (MDD)—is a mental illness that can be serious and even potentially life-threatening. People with depression experience not only sadness but a wide range of other emotional, physical, and cognitive symptoms that can interfere with their ability to function well and enjoy life.

Depression is very common, affecting almost one-third of U.S. adults (29%) at any point in their lifetime and about 18% currently.¹ Depression can affect anyone—even a person who appears to live in relatively ideal circumstances.

MDD is described in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision. The American Psychiatric Association (APA) lists the symptoms of MDD as follows:²

• Feeling sad
• Loss of interest or pleasure in activities previously enjoyed
• Difficulty concentrating and making decisions
• Changes in appetite, including overeating or not eating enough
• Trouble sleeping or sleeping too much
• Fatigue
• Restless activity (e.g., handwringing or pacing) or slowed movements and speech
• Feelings of worthlessness or guilt
• Thoughts of suicide or self-harm

Symptoms of MDD must be present for at least 2 weeks.³

How Depression Affects Employees and Employers

Nearly everyone knows or cares for someone or is themselves a person who has experienced depression at some point in their lives. However, not everyone is aware of how widespread the effects of depression can be.

Physical Effects

Depression can adversely impact the physical body in several ways. For instance, people with depression might experience:⁴

• Sleep problems
• Unhealthy changes in weight (either losing or gaining)
• Chronic pain (e.g., musculoskeletal pain)
• Headache
• Gastrointestinal upset
• Fatigue or lethargy
• Decreased sex drive

Depression is associated with an extensive list of chronic health conditions, both in terms of increasing the risk of their occurrence and of worsening symptoms in existing conditions.⁵ These conditions include cancer, cardiovascular disease, stroke, type 2 diabetes, Alzheimer’s disease, Parkinson’s disease, respiratory illness, infectious diseases, inflammation and autoimmune disorders, obesity, and chronic kidney disease.^6,7,8

Psychiatric and Functional Effects

People with depression experience excessively sad moods and an inability to enjoy activities they usually would. They may experience a lack of motivation, hopelessness, poor social connectedness, anxiety, and co-occurring mental disorders, notably anxiety disorders and substance use disorders.^9,10

Depression can be very debilitating. Many people with depression experience major disruptions in their work, academic, and social/family lives.¹¹

Depression is associated with a high risk of suicide, underscoring the critical importance of people receiving timely diagnosis and treatment. MDD accounts for up to half of all completed suicides per year, and the risk of suicide in people with depression is nearly 20 times higher than in the general population.¹² The lifetime risk of suicide among people with depression is estimated at 31%.¹³ This risk is more than 3 times higher in men than in women.

Work-Related Effects

Left untreated, depression can have an adverse impact on work performance; this can be due to difficulties focusing and with decision-making, time management problems, an inability to complete physical tasks, and struggles with communication.

Consider the following examples of how depression affects a person’s ability to participate in the workforce:

• Presenteeism — In a survey of 75,000 U.S. adults under age 65, those with depression reported significantly more presenteeism at work than adults without depression (20.1% vs 9.1%).¹⁴
• Absenteeism — Amongst 1,000 U.S. employees, 20% reported taking off 1–5 days from work due to an episode of depression, 5% took off 6–10 days, and nearly 4% took off 21 or more days.¹⁵
• Work productivity loss — Mean annual adjusted productivity costs among workers with MDD are estimated at $12,348 per person for Medicare recipients; $11,811 for Medicaid recipients; $10,665 for workers with commercial insurance; and $13,080 for workers insured through the Veterans Administration.¹⁶
• Cost to employers — Depression costs workplaces $198 billion a year.¹⁷

How Is Depression Treated?

Although depression is a serious illness, it is very treatable. The key is getting people access to care as soon as possible. People with depression may not seek help due to stigma or failing to realize they have depression and that it is treatable.¹⁸

Tips for Employers: How You Can Help Employees with Depression

Between 11% and 49% of workers with depression do not reveal their diagnosis to their employer for fear of losing their job.^19,20 This disheartening fact underscores the powerful role employers and other leadership can have in setting a tone of acceptance and support that makes employees feel safe asking for help.

Tips to help employers concerned about depression in the workplace include the following:

• Encouraging employees to get help if they are experiencing depression. One important step is to include depression screening in health risk appraisals and employee assistance programs. Employers should also confirm that their health plans are using a validated screening tool, like the Patient Health Questionnaire (PHQ-9).
• Advocating for collaborative care. Employers should also inform their health plans that they want primary care clinicians to conduct routine depression screenings and to offer collaborative care. Collaborative care is provided in the primary care setting by a care manager, a primary care provider, and a specialty mental health provider. It is essential that employers require their health plans to turn on the CPT billing codes for collaborative care that became available in 2017 and allow providers to bill for the care.
• Promoting the use of Employee Assistance and health programs: Early intervention is key. Remind employees of the availability of resources for staying mentally and physically healthy and productive. Inform employees often on how to access mental health information and care confidentially. Push these messages out during times of high stress, like during the holiday season or following a natural disaster.
• Educating employees and managers about mental health conditions, including depression. Supervisors and employees should be trained on how to start a conversation if they are concerned about a colleague. Content about depression should be included in company newsletters, on the intranet, and on other regular employee communication platforms.

Resources

Managers, supervisors, and other employers can learn more about depression in the workplace through the following resources.

• APA Foundation’s Center for Workplace Health’s Depression Calculator breaks down the economic impact of the illness and includes resources to help employers support employee mental health.
• The Anxiety and Depression Association of America's Find a Therapist Directory can help people with depression identify a licensed mental health provider who specializes in helping people manage anxiety and depression.