Mental Health: Depression, Anxiety and

Stress Disorders in the Workplace

Written by Dr Arien van der Merwe MBChB FRSPH MISMA

Depression affects more than 100 million people worldwide, and in the year 2000, was the second leading cause of disability among individuals aged 15–44. The World Health Organization (WHO) projects that by 2020 depression will be second only to ischemic heart disease as the leading cause of disability for all ages and both genders. In the United States, approximately 16.3 million American adults, or about 8.2% of the U.S. population over 18, suffer from either major depressive or dysthymic disorder. In the United Kingdom, depression is the third most common reason for a primary care consultation. Worldwide, about 850,000 lives are lost each year due to suicide, and suicide rates remain high in many geographic regions (e.g., Eastern Europe, South Korea, Japan, Finland, and Belgium) and demographic groups (e.g. teenagers, the elderly and chronically ill).

Aligned with this, a Business Day article reported on findings from The Organisation for Economic Co-operation and Development (OECD). The OECD found one in five workers has a mental illness, such as depression or anxiety. These conditions increasingly affect productivity in the workplace as many struggle to cope. People with mental illness are often off sick from work, and between 30-50 % of all new disability benefit claims in OECD nations are now due to poor mental health. Policy makers need to find new ways to tackle the social and economic problem of mental illness because trigger factors, such as stress at work, are likely to increase. Increasing job insecurity and pressure in today\’s workplace,will lead toan increase in mental health problems in the coming years. The percentage of workers exposed to work-related stress, or job strain, increased dramatically in the past decade.

More people are worried about their job security in the current economic climate. Two studies found that up to 40% of Europeans suffered from mental and neurological illnesses, and the annual cost of brain disorders was almost €800billion. TheOECD\’s report, titled, ‘Sick on the Job – Myths and Realities about Mental Health at Work’, found that most people with a mental disorder were working, with employment rates of 55-70%. This isabout 10-15% lower than for people without a disorder. However, people with mental illness were two to three times more likely to be unemployed than people with no mental health problems. This gap represents a major economic loss in productivity.

The OECD said most common mental disorders could get better, and the employment chances could be improved, with adequate management. Health systems in most countries, however, were narrowly focused on treating people with severe disorders such as schizophrenia, who accounted for only a quarter of all mental diseases. OECDcommented that taking more common disorders more seriously, would boost the chances for people to stay at, or return to, work. About 50% of people with severe mental disorders and more than 70% of those with moderate illness currently get no treatment at all.

The OECD urged policy makers to focus on providing good working conditions which would help employees reduce and manage stress, develop resilience, introduce systematic monitoring of sick leave and presenteeism (employees being at work but not optimally healthy), thereby increasing productivity and employee health and sense of wellbeing, also helping employers to reduce workplace conflict and avoid unnecessary dismissal caused by mental health problems.

Many studies also link depression to heart disease (e.g. both before and after a heart attackand heart failure), metabolic syndrome*and diabetes mellitus.

At the Samueli Institute(SI) in Virginia, US scientific research on brain, mind and healing, gets preference. According to the SI, there is a longstanding history of healing practices that compel the detailed study of the roles of the brain, mind and consciousness in health and illness. The growing body of basic and clinical scientific evidence supports the premise that a number of mind-body effects may be evoked by various spiritual and religious practices, experiences within the clinical encounter of medicine, and interactions with the environment. Researchers in their basic sciences laboratories are committed to employing state-of-the art developments in biosciences, coupled with innovative strategies and methods to study the outcomes, mechanisms and applications of novel approaches to health and healing. By employing a translational approach that is oriented toward advancing basic research to impact patient care and public health policy, this work is designed to implement an agenda of research applications ‘from bench to bedside to boardroom’.

Dr Andrew Weil, Professor of Integrative Medicine at Arizona State University, also proclaims the urgent need for an integrative** approach to mental health, incorporating the basics of integrative medicine and applying it to mental health.

Integrative mental health practices, based on helping employees develop stress resilience, should form an essential part of workplace wellness interventions, as a tool of education, information, preventative care, management and knowledge dissemination.

Summary of a few examples of an integrative mental health approach towards emotional wellbeing and resilience, that includes the biomedical model, but also the mental-emotional and psycho-spiritual aspects of being human:

• Caring for the body: fun and meaningful exercise (e.g. yoga, tai ‘chi, dance, aerobics), specific food to enhance mood and wellbeing, suitable nutriceuticals and evidenced based herbal remedies and pharmaceutical drugs when necessary, an anti-inflammatory diet, breathing techniques
• Re-training, re-programming and caring for the mind and brain:positive activity interventions, present moment mindfulness exercises, mantra meditation, visualisations or mental imagery, creative activities, news breaks, connection with nature. The brain is neuroplastic (malleable like clay) and old brain patterns can be changed and trained into new networks, new ways of thinking and feeling. The study of Epigenetics(epi = above, i.e more important than simply the genetic code) clearly shows that we are more than our genes or genetic programming. Genetic expression can be changed through brain repatterning and emotional wellbeing techniques.
• Spirituality and emotional wellbeing as caring and food for the soul:once again the essential, regular contact with nature, social connection with caring and positive people, exposing oneself to art and beauty, cultivating empathy and compassion for self and others, practising forgiveness, laughter, times of being quiet and silent. Pausing, breathing, appreciating and experiencing moments of deeper connection with the wonder and energy of life. This can be learnt to become new behaviour through regular practice, perseverance and patience (the 3P’s).

*A working definition of metabolic syndrome: 

Based on the ATP III (The Adult Treatment Panel III) guidelines published in the National Health Statistics Report, May 2009, approximately 34% (more than one third) of the adults in the United States could be diagnosed as having metabolic syndrome.This is in line with studies done in South Africa.A unified definition was finalised after a collaboration between the International Diabetes Federation, American Heart Association/National Heart, Lung and Blood Institute, the World Heart Federation, International Atherosclerosis Society and the International Association for the Study of Obesity. This new published definition involves the following factors:

• Increased waist circumference: Population – specific and country specific cut-off points to be used. Usually abdominal circumference more than 102 cm in men, and more than 88 cm in women
• Increased triglycerides (or drug treatment for it):1.7mmol/1 or above.
• Reduced HDL (or drug treatment for it) : < 1.0 mmol/l for men; < 1.3 mmol/l for women.
• Elevated blood pressure (or antihypertensive drugs used): 130 mmHg systolic; 85mmHg diastolic or above.
• Increased fasting glucose (drug treatment for increased glucose) >5.5 mmol/1.

**To clarify the meaning of \’Integrative Medicine\’ that guides the work of Dr. Andrew Weil and that of integrative medicine physicians and teachers around the world:

Integrative medicine is healing-oriented medicine that takes account of the whole person (body, mind, and spirit), including all aspects of lifestyle and relevant preventative measures. It emphasises the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative or complementary, from both East and West.

The principles of integrative medicine:

• A partnership between patient and practitioner in the healing process
• Appropriate use of conventional, complementary and alternative methods to facilitate the body\’s innate healing response
• Consideration of all factors that influence health, wellness and disease, including mind, emotions, spirit, social, community and environment, as well as the physical body
• A philosophy that neither rejects conventional medicine nor accepts alternative therapies uncritically
• Recognition that good medicine should be based in good science, be inquiry driven, and be open to new paradigms
• Use of natural, effective, less-invasive interventions whenever possible
• Use of the broader concepts of promotion of health and the prevention of illness as well as the treatment of disease
• Training of practitioners to be models of health and healing, committed to the inner process of self-exploration and self-development

For more information on workplace wellness, neuropeptides (‘molecules of emotion’), the integrative approach to managing depression, general info on occupational and executive health, please visit: https://drarien.co.za/oldsite/workplace-wellness

For more information on the DSM IV and the new DSM V (released in 2013) scale of mental disorders, please visit: http://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders