Assessment and Treatment of Mood and Anxiety Disorders in the Workplace

  • Danielle S. TaubmanEmail author
  • Vytas Velyvis
  • Sagar V. Parikh
Part of the Integrating Psychiatry and Primary Care book series (IPPC)


Given the high prevalence of mental health problems among working adults, efforts to increase mental health promotion, prevention, and intervention are being increasingly directed toward the workplace. Research clearly shows that the earlier mental health issues are identified and treated, the sooner improvements in work functioning tend to occur. While employee assistance programs (EAPs) have proliferated over the last few decades and effective evidence-based treatments for most mental health conditions are known and often available, EAPs do not typically provide mental illness prevention or assistance for employees who are already struggling with a mental illness. This means many employees do not receive the treatment they need. This may result in social, personal, and economic problems for these employees, their employers, and society in general. First, this chapter addresses the various burdens of mental illness in the workplace, with a special focus on mood and anxiety disorders. Next, the authors discuss assessment and screening strategies and existing interventions and treatment methods. Finally, this chapter describes different aspects of workplace accommodations that are designed to help individuals with a mental health problem return to the workforce, as well as potential gaps in the knowledge base for addressing mood and anxiety disorders in the workplace.


Workplace Workforce Mood disorders Depression Bipolar disorder Anxiety Assessment Treatment Employee assistance programs Workplace accommodation Workplace wellness programs 


  1. 1.
    Moncrieff J, Pomerleau J. Trends in sickness benefits in Great Britain and the contribution of mental disorders. J Public Health Med. 2000;22(1):59–67.PubMedCrossRefGoogle Scholar
  2. 2.
    Shiels C, Gabbay MB, Ford FM. Patient factors associated with duration of certified sickness absence and transition to long-term incapacity. Br J Gen Pract. 2004;54(499):86–91.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Black D. Working for a healthier tomorrow. London: Cross-Government Health, Work and Well-being Programme; 2008.Google Scholar
  4. 4.
    Harvey SB, Henderson M, Lelliott P, Hotopf M. Mental health and employment: much work still to be done. Br J Psychiatry J Ment Sci. 2009;194(3):201–3.CrossRefGoogle Scholar
  5. 5.
    Cattrell A, Harris EC, Palmer KT, Kim M, Aylward M, Coggon D. Regional trends in awards of incapacity benefit by cause. Occup Med. 2011;61(3):148–51.CrossRefGoogle Scholar
  6. 6.
    Hees HL, de Vries G, Koeter MWJ, Schene AH. Adjuvant occupational therapy improves long-term depression recovery and return-to-work in good health in sick-listed employees with major depression: results of a randomised controlled trial. Occup Environ Med. 2013;70(4):252–60.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Harvey SB, Henderson M. Occupational psychiatry. Psychiatry. 2009;8(5):174–8.CrossRefGoogle Scholar
  8. 8.
    Mykletun A, Harvey SB. Prevention of mental disorders: a new era for workplace mental health. Occup Environ Med. 2012;69(12):868–9.PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003;289(23):3095–105.CrossRefGoogle Scholar
  10. 10.
    Wang PS, Berglund P, Kessler RC. Recent care of common mental disorders in the United States. J Gen Intern Med. 2000;15(5):284–92.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Wang PS, Demler O, Kessler RC. Adequacy of treatment for serious mental illness in the United States. Am J Public Health. 2002;92(1):92–8.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Wang PS, Lane M, Olfson M, Pincus HA, Wells KB, Kessler RC. Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):629–40.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Knudsen AK, Øverland S, Aakvaag HF, Harvey SB, Hotopf M, Mykletun A. Common mental disorders and disability pension award: seven year follow-up of the HUSK study. J Psychosom Res. 2010;69(1):59–67.PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Knudsen AK, Harvey SB, Mykletun A, Øverland S. Common mental disorders and long-term sickness absence in a general working population. The Hordaland Health Study. Acta Psychiatr Scand. 2013;127(4):287–97.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Knudsen AK, Øverland S, Hotopf M, Mykletun A. Lost working years due to mental disorders: an analysis of the Norwegian Disability Pension Registry. PLoS One [Internet]. 2012 Aug 15 [cited 2018 Jul 17];7(8). Available from:
  16. 16.
    Harvey SB, Glozier N, Henderson M, Allaway S, Litchfield P, Holland-Elliott K, et al. Depression and work performance: an ecological study using web-based screening. Occup Med Oxf Engl. 2011;61(3):209–11.CrossRefGoogle Scholar
  17. 17.
    Timbie JW, Horvitz-Lennon M, Frank RG, Normand S-LT. A meta-analysis of labor supply effects of interventions for major depressive disorder. Psychiatr Serv. 2006;57(2):212–8.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Joyce S, Modini M, Christensen H, Mykletun A, Bryant R, Mitchell PB, et al. Workplace interventions for common mental disorders: a systematic meta-review. Psychol Med. 2016;46(4):683–97.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    LaMontagne AD, Martin A, Page KM, Reavley NJ, Noblet AJ, Milner AJ, et al. Workplace mental health: developing an integrated intervention approach. BMC Psychiatry. 2014;14:131.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Stansfeld S, Candy B. Psychosocial work environment and mental health--a meta-analytic review. Scand J Work Environ Health. 2006;32(6):443–62.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Netterstrøm B, Conrad N, Bech P, Fink P, Olsen O, Rugulies R, et al. The relation between work-related psychosocial factors and the development of depression. Epidemiol Rev. 2008;30:118–32.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Nieuwenhuijsen K, Bruinvels D, Frings-Dresen M. Psychosocial work environment and stress-related disorders, a systematic review. Occup Med. 2010;60(4):277–86.CrossRefGoogle Scholar
  23. 23.
    Ndjaboué R, Brisson C, Vézina M. Organisational justice and mental health: a systematic review of prospective studies. Occup Environ Med. 2012;69(10):694–700.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Harvey SB, Modini M, Joyce S, Milligan-Saville JS, Tan L, Mykletun A, Bryant RA, Christensen H, Mitchell PB. Can work make you mentally ill? A systematic meta-review of work-related risk factors for common mental health problems. Occup Environ Med. 2017;74(4):301–10.PubMedCrossRefGoogle Scholar
  25. 25.
    Henderson M, Harvey SB, Overland S, Mykletun A, Hotopf M. Work and common psychiatric disorders. J R Soc Med. 2011;104(5):198–207.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Walton L. Exploration of the attitudes of employees towards the provision of counselling within a profit-making organisation. Couns Psychother Res. 2003;3(1):65–71.CrossRefGoogle Scholar
  27. 27.
    Carroll M. Workplace counselling: a systematic approach to employee care. London: SAGE Publications, Inc; 1996.Google Scholar
  28. 28.
    Goss S, Mearns D. Applied pluralism in the evaluation of employee counselling. Br J Guid Couns. 1997;25(3):327–44.CrossRefGoogle Scholar
  29. 29.
    Hanisch SE, Twomey CD, Szeto ACH, Birner UW, Nowak D, Sabariego C. The effectiveness of interventions targeting the stigma of mental illness at the workplace: a systematic review. BMC Psychiatry. 2016;16:1.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Malachowski C, Kirsh B. Workplace antistigma initiatives: a scoping study. Psychiatr Serv. 2013;64(7):694–702.PubMedCrossRefGoogle Scholar
  31. 31.
    Szeto ACH, Dobson KS. Reducing the stigma of mental disorders at work: a review of current workplace anti-stigma intervention programs. Appl Prev Psychol. 2010;14(1):41–56.CrossRefGoogle Scholar
  32. 32.
    World Health Organization. Depression and other common mental disorders: global health estimates. Geneva: World Health Organization; 2017.Google Scholar
  33. 33.
    Pearson C, Janz T, Ali J. Mental and substance use disorders in Canada. Statistics Canada; 2013. Report No.: 82-624–X.Google Scholar
  34. 34.
    Kessler RC, Petukhova M, Sampson NA, Zaslavsky AM, Wittchen HU. Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Methods Psychiatr Res. 2012;21(3):169–84.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Center for Behavioral Health Statistics and Quality. 2016 National Survey on Drug Use and Health: detailed tables. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2017.Google Scholar
  36. 36.
    Mental Health and Mental Disorders | Healthy People 2020 [Internet]. 2014 [cited 2018 Jul 18]. Available from:
  37. 37.
    Wulsin L, Alterman T, Bushnell PT, Li J, Shen R. Prevalence rates for depression by industry: a claims database analysis. Soc Psychiatry Psychiatr Epidemiol. 2014;49(11):1805–21.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Stone D, Holland K, Bartholow B, Crosby A, Davis S, Wilkins N. Preventing suicide: a technical package of policy, programs, and practices. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2017.Google Scholar
  39. 39.
    McTernan WP, Dollard MF, LaMontagne AD. Depression in the workplace: an economic cost analysis of depression-related productivity loss attributable to job strain and bullying. Work Stress. 2013;27(4):321–38.CrossRefGoogle Scholar
  40. 40.
    Greenberg PE, Fournier A-A, Sisitsky T, Pike CT, Kessler RC. The economic burden of adults with major depressive disorder in the United States (2005 and 2010). J Clin Psychiatry. 2015;76(2):155–62.CrossRefGoogle Scholar
  41. 41.
    Donohue JM, Pincus HA. Reducing the societal burden of depression: a review of economic costs, quality of care and effects of treatment. Pharmacoeconomics. 2007;25(1):7–24.PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Birnbaum HG, Kessler RC, Kelley D, Ben-Hamadi R, Joish VN, Greenberg PE. Employer burden of mild, moderate, and severe major depressive disorder: mental health services utilization and costs, and work performance. Depress Anxiety. 2010;27(1):78–89.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Wang J, Schmitz N, Smailes E, Sareen J, Patten S. Workplace characteristics, depression, and health-related presenteeism in a general population sample. J Occup Environ Med. 2010;52(8):836–42.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Almond S, Healey A. Mental health and absence from work: new evidence from the UK Quarterly Labour Force Survey. Work Employ Soc. 2003;17(4):731–42.CrossRefGoogle Scholar
  45. 45.
    Organisation for Economic Co-operation and Development. Sick on the job? Myths and realities about mental health and work. Paris, France: OECD Publishing; 2012.Google Scholar
  46. 46.
    Lerner D, Adler D, Hermann RC, Chang H, Ludman EJ, Greenhill A, et al. Impact of a work-focused intervention on the productivity and symptoms of employees with depression. J Occup Environ Med. 2012;54(2):128–35.PubMedPubMedCentralCrossRefGoogle Scholar
  47. 47.
    Kessler RC, Akiskal HS, Ames M, Birnbaum H, Greenberg P, Hirschfeld RMA, et al. Prevalence and effects of mood disorders on work performance in a nationally representative sample of US workers. Am J Psychiatry. 2006;163(9):1561–8.PubMedPubMedCentralCrossRefGoogle Scholar
  48. 48.
    Lerner D, Henke RM. What does research tell us about depression, job performance, and work productivity? J Occup Environ Med. 2008;50(4):401–10.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Adler DA, McLaughlin TJ, Rogers WH, Chang H, Lapitsky L, Lerner D. Job performance deficits due to depression. Am J Psychiatry. 2006;163(9):1569–76.PubMedPubMedCentralCrossRefGoogle Scholar
  50. 50.
    Burton WN, Pransky G, Conti DJ, Chen C-Y, Edington DW. The association of medical conditions and presenteeism. J Occup Environ Med. 2004;46(6 Suppl):S38–45.PubMedCrossRefPubMedCentralGoogle Scholar
  51. 51.
    Haslam C, Atkinson S, Brown SS, Haslam RA. Anxiety and depression in the workplace: effects on the individual and organisation (a focus group investigation). J Affect Disord. 2005;88(2):209–15.PubMedCrossRefPubMedCentralGoogle Scholar
  52. 52.
    Suzuki K, Ohida T, Kaneita Y, Yokoyama E, Miyake T, Harano S, et al. Mental health status, shift work, and occupational accidents among hospital nurses in Japan. J Occup Health. 2004;46(6):448–54.PubMedCrossRefPubMedCentralGoogle Scholar
  53. 53.
    Dewa CS, Lin E. Chronic physical illness, psychiatric disorder and disability in the workplace. Soc Sci Med. 2000;51(1):41–50.PubMedCrossRefPubMedCentralGoogle Scholar
  54. 54.
    Kessler RC, Merikangas KR, Wang PS. The prevalence and correlates of workplace depression in the National Comorbidity Survey Replication. J Occup Environ Med Am Coll Occup Environ Med. 2008;50(4):381–90.CrossRefGoogle Scholar
  55. 55.
    Evans-Lacko S, Koeser L, Knapp M, Longhitano C, Zohar J, Kuhn K. Evaluating the economic impact of screening and treatment for depression in the workplace. Eur Neuropsychopharmacol J Eur Coll Neuropsychopharmacol. 2016;26(6):1004–13.CrossRefGoogle Scholar
  56. 56.
    Knapp M, McDaid D, Parsonage M. Mental health promotion and mental illness prevention: the economic case. London, UK: Department of Health; 2011.Google Scholar
  57. 57.
    Wang PS, Simon GE, Avorn J, Azocar F, Ludman EJ, McCulloch J, et al. Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: a randomized controlled trial. JAMA. 2007;298(12):1401–11.PubMedPubMedCentralCrossRefGoogle Scholar
  58. 58.
    Jarman L, Martin A, Venn A, Otahal P, Taylor R, Teale B, et al. Prevalence and correlates of psychological distress in a large and diverse public sector workforce: baseline results from Partnering Healthy@Work. BMC Public Health. 2014;14:125.PubMedPubMedCentralCrossRefGoogle Scholar
  59. 59.
    Kawakami N, Tsutsumi A. The Stress Check Program: a new national policy for monitoring and screening psychosocial stress in the workplace in Japan. J Occup Health. 2016;58(1):1–6.PubMedCrossRefPubMedCentralGoogle Scholar
  60. 60.
    Tan L, Wang M-J, Modini M, Joyce S, Mykletun A, Christensen H, et al. Preventing the development of depression at work: a systematic review and meta-analysis of universal interventions in the workplace. BMC Med. 2014;12:74.PubMedPubMedCentralCrossRefGoogle Scholar
  61. 61.
    Pomaki G, Franche R-L, Murray E, Khushrushahi N, Lampinen TM. Workplace-based work disability prevention interventions for workers with common mental health conditions: a review of the literature. J Occup Rehabil. 2012;22(2):182–95.PubMedCrossRefPubMedCentralGoogle Scholar
  62. 62.
    Wan Mohd Yunus WMA, Musiat P, Brown JSL. Systematic review of universal and targeted workplace interventions for depression. Occup Environ Med. 2018;75(1):66–75.PubMedCrossRefPubMedCentralGoogle Scholar
  63. 63.
    Nieuwenhuijsen K, Faber B, Verbeek JH, Neumeyer-Gromen A, Hees HL, Verhoeven AC, et al. Interventions to improve return to work in depressed people. Cochrane Database Syst Rev. 2014;(12):CD006237.Google Scholar
  64. 64.
    Gayed A, Milligan-Saville JS, Nicholas J, Bryan BT, LaMontagne AD, Milner A, et al. Effectiveness of training workplace managers to understand and support the mental health needs of employees: a systematic review and meta-analysis. Occup Environ Med. 2018;75(6):462–70.PubMedCrossRefPubMedCentralGoogle Scholar
  65. 65.
    Lee Y, Rosenblat JD, Lee J, Carmona NE, Subramaniapillai M, Shekotikhina M, et al. Efficacy of antidepressants on measures of workplace functioning in major depressive disorder: a systematic review. J Affect Disord. 2018;227:406–15.PubMedCrossRefPubMedCentralGoogle Scholar
  66. 66.
    Nigatu YT, Liu Y, Uppal M, McKinney S, Rao S, Gillis K, et al. Interventions for enhancing return to work in individuals with a common mental illness: systematic review and meta-analysis of randomized controlled trials. Psychol Med. 2016;46(16):3263–74.PubMedCrossRefPubMedCentralGoogle Scholar
  67. 67.
    Kitchener BA, Jorm AF. Mental health first aid training in a workplace setting: a randomized controlled trial [ISRCTN13249129]. BMC Psychiatry. 2004;4:23.PubMedPubMedCentralCrossRefGoogle Scholar
  68. 68.
    Ahola K, Vuori J, Toppinen-Tanner S, Mutanen P, Honkonen T. Resource-enhancing group intervention against depression at workplace: who benefits? A randomised controlled study with a 7-month follow-up. Occup Environ Med. 2012;69(12):870–6.PubMedCrossRefPubMedCentralGoogle Scholar
  69. 69.
    Tsutsumi A, Nagami M, Yoshikawa T, Kogi K, Kawakami N. Participatory intervention for workplace improvements on mental health and job performance among blue-collar workers: a cluster randomized controlled trial. J Occup Environ Med. 2009;51(5):554–63.PubMedCrossRefPubMedCentralGoogle Scholar
  70. 70.
    Tsutsumi A. Development of an evidence-based guideline for supervisor training in promoting mental health: literature review. J Occup Health. 2011;53(1):1–9.PubMedCrossRefGoogle Scholar
  71. 71.
    Greden JF. Workplace mental health programmes: the role of managers. Lancet Psychiatry. 2017;4(11):821–3.PubMedCrossRefPubMedCentralGoogle Scholar
  72. 72.
    Milligan-Saville JS, Tan L, Gayed A, Barnes C, Madan I, Dobson M, et al. Workplace mental health training for managers and its effect on sick leave in employees: a cluster randomised controlled trial. Lancet Psychiatry. 2017;4(11):850–8.PubMedCrossRefPubMedCentralGoogle Scholar
  73. 73.
    Dimoff J, Kevin Kelloway E, Burnstein MD. Mental health awareness training (MHAT): the development and evaluation of an intervention for workplace leaders. Int J Stress Manag. 2015;23:167–89.CrossRefGoogle Scholar
  74. 74.
    Beck A, Crain LA, Solberg LI, Unützer J, Maciosek MV, Whitebird RR, et al. The effect of depression treatment on work productivity. Am J Manag Care. 2014;20(8):e294–301.PubMedPubMedCentralGoogle Scholar
  75. 75.
    Lam RW, Parikh SV, Ramasubbu R, Michalak EE, Tam EM, Axler A, et al. Effects of combined pharmacotherapy and psychotherapy for improving work functioning in major depressive disorder. Br J Psychiatry J Ment Sci. 2013;203(5):358–65.CrossRefGoogle Scholar
  76. 76.
    Furukawa TA, Horikoshi M, Kawakami N, Kadota M, Sasaki M, Sekiya Y, et al. Telephone cognitive-behavioral therapy for subthreshold depression and presenteeism in workplace: a randomized controlled trial. PLoS One. 2012;7(4):e35330.PubMedPubMedCentralCrossRefGoogle Scholar
  77. 77.
    Lagerveld SE, Blonk RWB, Brenninkmeijer V, Wijngaards-de Meij L, Schaufeli WB. Work-focused treatment of common mental disorders and return to work: a comparative outcome study. J Occup Health Psychol. 2012;17(2):220–34.PubMedCrossRefGoogle Scholar
  78. 78.
    Bender A, Kennedy S. Mental health and mental illness in the workplace: diagnostic and treatment issues. Healthc Pap. 2004;5(2):54–67.PubMedCrossRefGoogle Scholar
  79. 79.
    US Equal Employment Opportunity Commission. EEOC issues publication on the rights of job applicants and employees with mental health conditions [Internet]. 2016 [cited 2018 Jul 18]. Available from:
  80. 80.
    Canadian Human Rights Commission. Accommodation works!: a user-friendly guide to working together on health issues in the workplace. Ottawa, ON: Canadian Human Rights Commission; 2014.Google Scholar
  81. 81.
    Goldner E, Bilsker D, Gilbert M, Myette L, Corbière M, Dewa CS. Disability management, return to work and treatment. Healthc Pap. 2004;5(2):76–90.PubMedCrossRefPubMedCentralGoogle Scholar
  82. 82.
    Denne J, Kettner G, Ben-Shalom Y. The role of the physician in the return-to-work process following disability onset. Washington, DC: Office of Disability Employment Policy, US Department of Labor; 2015.Google Scholar
  83. 83.
    Smith DL, Atmatzidis K, Capogreco M, Lloyd-Randolfi D, Seman V. Evidence-based interventions for increasing work participation for persons with various disabilities: a systematic review. OTJR Occup Particip Health. 2017;37(2_suppl):3S–13S.CrossRefGoogle Scholar
  84. 84.
    Lam RW, McIntosh D, Wang J, Enns MW, Kolivakis T, Michalak EE, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: Section 1. Disease burden and principles of care. Can J Psychiatry Rev Can Psychiatr. 2016;61(9):510–23.CrossRefGoogle Scholar
  85. 85.
    Parikh SV, Lam RW, Ovanessian MM, Filteau M-J, Hill M. Evaluation of a disease-management intervention designed to reduce depression disability. J Eval Clin Pract. 2011;17(2):322–5.PubMedCrossRefPubMedCentralGoogle Scholar
  86. 86.
    Garin O, Ayuso-Mateos JL, Almansa J, Nieto M, Chatterji S, Vilagut G, et al. Validation of the “World Health Organization Disability Assessment Schedule, WHODAS-2” in patients with chronic diseases. Health Qual Life Outcomes. 2010;8:51.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Danielle S. Taubman
    • 1
    Email author
  • Vytas Velyvis
    • 2
  • Sagar V. Parikh
    • 1
  1. 1.Department of Psychiatry and Comprehensive Depression CenterUniversity of MichiganAnn ArborUSA
  2. 2.CBT AssociatesTorontoCanada

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