The American Association of Suicidology said it best when it created this logo for the association: “Suicide prevention is everyone’s business.” By everyone, the association includes employers and work organizations. Considering that the workplace is where the majority of working-age adults spend a significant portion of their day, and sometimes night, it only makes sense that employers and coworkers join the national fight against suicide.
Over the past 10 years, work organizations have begun to realize that they can help identify and treat working adults suffering from depression -- a leading risk factor for suicide and also the leading cause of lost work productivity. Despite the knowledge that depression is highly correlated with suicide risk, workplaces have been slow to embrace their potentially critical role in preventing suicide through workplace-based programs. Many of the programs already being offered by employers address depression and can be easily and often freely expanded to also include elements of suicide prevention. The connection between depression and suicide is clear, and employers, large and small, have an important role to take in addressing the public health problem of suicide in our country.
Detecting and treating depression among employees is one way employers can play a significant role. In fact, many employers are already making inroads in minimizing the negative effects of depression and related mental health issues through employer-sponsored benefits such as employee assistance programs (EAPs), workplace wellness programs and occupational health services.
Some of the more commonly offered employer-sponsored interventions at the workplace to identify and respond to depression include workplace-based public awareness campaigns that involve posting suicide warning signs, referral resources and general anti-stigma messages, workplace-based depression screening, such as the program offered through Screening for Mental Health
and other early interventions that can be cost-effectively offered through EAP counseling, wellness programs and related occupational health programs.
Improving the detection and treatment of depression and therefore preventing suicide will have a positive impact on the employee and, in the process, the business success of the company. By expanding existing workplace-based wellness programs that often focus heavily on identification and treatment of depression among employees, employers are able to increase the number of employees seeking and obtaining treatment -- depression often has low rates of treatment because it is not accurately identified. In fact, prior research shows that, at any given time, depression affects between one-tenth and one-fifth of U.S. employees (Kessler et al., 2008). For employers, this means that for every 100 employees, depression costs employers about $62,000 annually. The majority of this cost does not come from treatment (treatment only accounts for about $9,000), but, rather, costs related to lost work time resulting from sick day absence, work disability (short term and long term disability days) and "presenteeism" (underperformance at the workplace because of illness). In addition, depression and suicide contribute to hidden costs to employers such as lowered morale, increased stress and lower employee engagement and loyalty. The effect of a suicide on coworkers can also be devastating.
In addition to treatment of depression, employers who work with their EAPs and other wellness programs to identify and respond to depression will improve other chronic health conditions. This is because employees who suffer from depression also suffer from an average of 5.1 other chronic health conditions that can complicate treatment and increase costs to the workplace. For example, some of the most serious comorbid conditions in terms of lost productivity with depression include anxiety (48% of employees with depression also have anxiety); chronic fatigue (46%), obesity (29%), chronic sleeping problems (26%) and chronic back and neck pain (32%). (The statistics are from data collected by Integrated Benefits Institute, a leading research organization in health and productivity. See www.ibiweb.org
for more information.)
Research suggests that medication and psychotherapy are effective in 70% to 80% of depression cases (RAND, 2008). Employers can require their EAPs and other workplace wellness programs to screen all employees for depression using free and simple validated tools such as the 9-item Patient Health Questionnaire (PHQ-9), where the ninth question asks specifically about suicide risk. Employers can also provide comprehensive depression care management programs for employees screened or otherwise identified to have serious depressive symptoms or for those at increased risk, such as employees who recently went out of the workplace on short-term disability (Desiron, de Rijk, Van Hoof, & Donceel, 2011; Lerner, Rodday, Cohen, & Rogers, 2013; Lo Sasso, Rost, & Beck, 2006).
EAPs are one way through which workplaces have historically and effectively provided help to employees with depression and other mental health and personal problems. EAPs have been shown to be effective in reducing depressive symptoms among employees, including thoughts about suicide (University of Michigan Depression Center
). EAPs can provide identification and screening services, such as on-site employee depression screening; however, EAP services go well beyond simple screening and identification. Depending on the services purchased by the employer, EAPs can provide comprehensive assessment, short-term counseling and referral and case management services for longer-term help in the community. Additionally, well-positioned EAPs, those with more on-site access and easy access to consultation with workplace managers and leaders, help to ensure that EAPs are even more effective at recognizing and responding quickly to employee problems such as suicide risk.
Additionally, strategically positioned programs can offer responses that are integrated and in line with the culture of the broader work organization to better serve employees while also supporting workplace productivity. Highly visible and management-supported EAPs can help to reduce stigma toward mental health problems, which in turn will encourage employees to seek help at an earlier stage of their problems and be more responsive to early intervention.
It is important that all employees in the workplace take suicide risk seriously. They should be trained to identify depression and suicide risk among coworkers, not be afraid to ask questions about the well-being of coworkers and refer them to EAPs or other resources when needed. Some examples of companies working to train employees (a designated employee, group of employees or all employees) and raise awareness of suicide and mental health in general are: Chesapeake Energy, DuPont and Johnson & Johnson (see Partnership for Workplace Mental Health
for these and other examples).
EAPs can work with employers to develop appropriate training material to help reduce the stigma of mental health problems, not limited to just depression and suicide, so that everyone is able to play a role in contributing to the well-being of the workplace. Just as employees understand and can identify physical safety risks such as falling hazards and safe lifting practices, employees should also understand what to look for when employees may be at risk for a mental health problem.
Even employers who are not able to provide comprehensive services such as EAPs and workplace wellness programs can take small steps that can have a huge impact on saving lives.
One simple first step employers can take to increase awareness of depression and suicide at the workplace is to promote the phone number for the National Suicide Prevention Lifeline (1-800-273-8255) at different locations throughout the workplace where employees will readily see signs, posters and online messages. The Lifeline is a free hotline that can be utilized by anyone who might want to talk with a professional about mental health issues and well-being. Promoting the Lifeline is free to the employer and can be a good way to demonstrate the employer’s interest in the mental wellness of employees. Utilizing free hotline services such as Lifeline is especially important for employees who don’t have access to EAP or other workplace wellness programs.
Overall, we know that workplaces that offer more control to their employees with regard to working conditions that can lower workplace stress, do better with regard to workplace productivity and depression. Therefore, it is critical that employers step up the plate and review and revise workplace policies and programs that are designed to support employees who may be suffering from depression and therefore have increased risk for suicide. By expanding existing programs to include assessment and treatment for depression, employers are working to improve productivity while also preventing suicide at the same time. It is a win-win for employers, employees and society as a whole.
This article was written by Dr. Jacobson Frey; Kimberly Jinnett, PhD; and Jungyai Ko, MSSA.