Investing in the Mental Health of the Labor Force: Epidemiological and Economic Impact of Mental Health Disabilities in the Workplace

  • Carolyn S. DewaEmail author
  • David McDaid


By the year 2020, depression will emerge as one of the leading causes of disability globally, second only to ischemic heart disease (World Health Organization 2001). Thus, governments are taking notice of the mental health of workers. For example, the European Ministers of Health have endorsed a detailed action plan calling for employers to “create healthy workplaces by introducing ­measures such as exercise, changes to work patterns, sensible hours, and healthy management styles,” and also to “include mental health in programs dealing with occupational health and safety” (World Health Organization 2005). More recently the European Union’s Pact for Mental Health and Wellbeing identifies the workplace as one of its four areas for action (Commission of the European Communities 2008).


Mental Disorder Gross Domestic Product Mental Health Problem Sickness Absence Labor Force Participation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Dr. Dewa gratefully acknowledges the support provided by her CIHR/PHAC Applied Public Health Chair. The Centre for Addiction and Mental Health receives funding from the Ontario Ministry of Health and Long Term Care to support research infrastructure. This article does not necessarily reflect their views. Any remaining errors are the sole responsibility of the authors.


  1. Access Economics & SANE Australia (2003) Bipolar disorder: costs. An analysis of the burden of bipolar disorder and related suicide in Australia. SANE Australia, MelbourneGoogle Scholar
  2. Alfredsson L, Akerstedt T, Mattsson M, Wilborg B (1991) Self-Reported health and well being amongst night security guards: a comparison with the working population. Ergonomics 34(5):525–530PubMedCrossRefGoogle Scholar
  3. Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, de Girolamo G, Graaf R, Demyttenaere K, Gasquet I, Haro JM, Katz SJ, Kessler RC, Kovess V, Lepine JP, Ormel J, Polidori G, Russo LJ, Vilagut G, Almansa J, Arbabzadeh-Bouchez S, Autonell J, Bernal M, Buist-Bouwman MA, Codony M, Domingo-Salvany A, Ferrer M, Joo SS, Martinez-Alonso M, Matschinger H, Mazzi F, Morgan Z, Morosini P, Palacin C, Romera B, Taub N, Vollebergh WA (2004a) Disability and quality of life impact of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl (420):38–46Google Scholar
  4. Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, de Girolamo G, Graaf R, Demyttenaere K, Gasquet I, Haro JM, Katz SJ, Kessler RC, Kovess, V, Lepine JP, Ormel J, Polidori G, Russo LJ, Vilagut G, Almansa J, Arbabzadeh-Bouchez S, Autonell J, Bernal M, Buist-Bouwman MA, Codony M, Domingo-Salvany A, Ferrer M, Joo SS, Martinez-Alonso M, Matschinger H, Mazzi F, Morgan Z, Morosini P, Palacin C, Romera B, Taub N, Vollebergh WA (2004b) Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl (420):21–27Google Scholar
  5. Amick BC 3rd, Kawachi I, Coakley EH, Lerner D, Levine S, Colditz GA (1998) Relationship of job strain and iso-strain to health status in a cohort of women in the United States. Scand J Work Environ Health 24(1):54–61PubMedGoogle Scholar
  6. Andlin-Sobocki P, Jonsson B, Wittchen HU, Olesen J (2005) Cost of disorders of the brain in Europe. Eur J Neurol (12 Suppl 1):1–27Google Scholar
  7. Beneficiaries in Current Payment Status (2004) Accessed 1 Sept 2006
  8. Biffl G, Leoni T (2009) Arbeitsplatzbelastungen, arbeitsbedingte Krankheiten und Invalidität. Österreichisches Institut für Wirtschaftsforschung.$.PDF
  9. Black C (2008) Working for a healthier tomorrow. TSO, LondonGoogle Scholar
  10. Bourbonnais R, Comeau M, Vezina M, Dion G (1998) Job strain, psychological distress, and burnout in nurses. Am J Ind Med 34(1):20–28PubMedCrossRefGoogle Scholar
  11. Bourbonnais R, Mondor M (2001) Job strain and sickness absence among nurses in the province of Quebec. Am J Ind Med 39(2):194–202PubMedCrossRefGoogle Scholar
  12. Bowden CL (2005) Bipolar disorder and work loss. Am J Manage Care 11(3 Suppl):S91–S94Google Scholar
  13. Brown J, Reetoo KN, Murray KJ, Thom W, Macdonald EB (2005) The involvement of occupational health services prior to ill-health retirement in NHS staff in Scotland and predictors of re-employment. Occup Med 55(5):357–363CrossRefGoogle Scholar
  14. Buist-Bouwman MA, de Graaf R, Vollebergh WA, Ormel J (2005) Comorbidity of physical and mental disorders and the effect on work-loss days. Acta Psychiatr Scand 111(6):436–443PubMedCrossRefGoogle Scholar
  15. Bureau of Labor Statistics (2009) Labor force statistics from the current population survey. Accessed 28 Sept 2009
  16. Central Statistics Office (2002) Quarterly national household survey statistical release, disability in the labour force second quarter. Central Statistics Office, DublinGoogle Scholar
  17. Clumeck N, Kempenaers C, Godin I, Dramaix M, Kornitzer M, Linkowski P, Kittel F (2009) Working conditions predict incidence of long-term spells of sick leave due to depression: results from the Belstress I prospective study. J Epidemiol Community Health 63(4):286–292PubMedCrossRefGoogle Scholar
  18. Cohidon C, Imbernon E, Gorldberg M (2009) Prevalence of common mental disorders and their work consequences in France, according to occupational category. Am J Ind Med 52(2):141–152PubMedCrossRefGoogle Scholar
  19. Comino EJ, Harris E, Chey T, Manicavasagar V, Penrose Wall J, Powell Davies G, Harris MF (2003) Relationship between mental health disorders and unemployment status in Australian adults. Aust NZ J Psychiatry 37(2):230–235CrossRefGoogle Scholar
  20. Commission of the European Communities (2008) European pact for mental health and wellbeing. Commission of the European Communities. Accessed 1 Oct 2009
  21. Conti DJ, Burton WN (1994) The economic impact of depression in a workplace. J Occup Med 36(9):983–988PubMedGoogle Scholar
  22. D’Souza RM, Strazdins L, Clements MS, Broom DH, Parslow R, Rodgers B (2005) The health effects of jobs: status, working conditions, or both? Aust NZ J Psychiatry 29(3):222–228Google Scholar
  23. D’Souza RM, Strazdins L, Lim LL, Broom DH, Rodgers B (2003) Work and health in a contemporary society: demands, control, and insecurity. J Epidemiol Community Health 57(11):849–854PubMedCrossRefGoogle Scholar
  24. Deb S, Lyons I, Koutzoukis C, Ali I, McCarthy G (1999) Rate of psychiatric illness 1 year after traumatic brain injury. Am J Psychiatry 156(3):374–378PubMedGoogle Scholar
  25. Department of Work and Pensions (2007) Incapacity benefit payments in Great Britain. Department of Work and Pensions, LondonGoogle Scholar
  26. Department of Work and Pensions and Department of Health (2008) Improving health and work: changing lives. Department of Work and Pensions, LondonGoogle Scholar
  27. Dewa CS, Goering P, Lin E, Paterson M (2002) Depression-related short-term disability in an employed population. J Occup Environ Med 44(7):628–633PubMedCrossRefGoogle Scholar
  28. Dewa CS, Hoch JS, Lin E, Paterson M, Goering P (2003) Pattern of antidepressant use and ­duration of depression-related absence from work. Br J Psychiatry 183:507–513PubMedCrossRefGoogle Scholar
  29. Dewa CS, Lin E (2000) Chronic physical illness, psychiatric disorder and disability in the workplace. Soc Sci Med 51(1):41–50PubMedCrossRefGoogle Scholar
  30. Dewa CS, Lin E, Kooehoorn M, Goldner E (2007) Association of chronic work stress, psychiatric disorders, and chronic physical conditions with disability among workers. Psychiatr Serv 58(5):652–658PubMedCrossRefGoogle Scholar
  31. Dewe P, Kompier M (2008) Wellbeing and work: future challenges. Foresight, Government Office for Science, LondonGoogle Scholar
  32. Ettner SL, Frank RG, Kessler R (1997) The impact of psychiatric disorders on labor market outcomes. Ind Labor Relat Rev 51(1):64–81CrossRefGoogle Scholar
  33. Ettner SL, Grywacz J (2001) Worker perceptions of how jobs affect health. J Occup Health Psychol 6(2):101–113PubMedCrossRefGoogle Scholar
  34. Faragher EB, Cass M, Cooper CL (2005) The relationship between job satisfaction and health: a meta-analysis. Occup Environ Med 62(2):105–112PubMedCrossRefGoogle Scholar
  35. Finkelstein EA, Corso PS, Miller TR (2006) The incidence and economic burden of injuries in the United States. Oxford University Press, OxfordCrossRefGoogle Scholar
  36. Garrison R, Eaton WW (1992) Secretaries, depression and absenteeism. Women Health 18(4):53–76PubMedCrossRefGoogle Scholar
  37. Global Business and Economic Roundtable on Addiction and Mental Health (2006) On the road to mental health in the workplace. Global Business and Economic Roundtable on Addiction and Mental Health, TorontoGoogle Scholar
  38. Godin I, Kornitzer M, Clumeck N, Linkowski P, Valente F, Kittel F (2009) Gender specificity in the prediction of clinically diagnosed depression. Results of a large cohort of Belgian workers. Soc Psychiatry Psychiatr Epidemiol 44(7):592–600PubMedCrossRefGoogle Scholar
  39. Greenberg PE, Kessler R, Birnbaum HG, Leong SA, Lowe SW, Bergland PA, Corey-Lisle PK (2003) The economic burden of depression in the United States: how did it change between 1990 and 2000? J Clin Psychiatry 64(12):1465–1475PubMedCrossRefGoogle Scholar
  40. Grzywacz J, Ettner SL (2000) Lost time on the job: the effect of depression versus physical health conditions. Econ Neurosci 2(6):41–46Google Scholar
  41. Grzywacz JG, Dooley D (2003) “Good jobs” to “bad jobs”: replicated evidence of an employment continuum from two large surveys. Soc Sci Med 56(8):1749–1760PubMedCrossRefGoogle Scholar
  42. Harkonmaki K, Lahelma E, Martikainen P, Rahkonen O, Silventoinen K (2006) Mental health functioning (SF-36) and intentions to retire early among ageing municipal employees: the Helsinki Health Study. Scand J Public Health 34(2):190–198PubMedCrossRefGoogle Scholar
  43. Hauptverband der der österreichischen Sozialversicherungsträger (2008) Statistisches Handbuch der österreichischen Sozialversicherung 2008. Hauptverband der der österreichischen Sozialversicherungsträger, ViennaGoogle Scholar
  44. Health and Safety Executive (2008) Estimated days (full-day equivalent) off work and associated average days lost per (full-time equivalent) worker and per case due to a self-reported work-­related illness or workplace injury. Health and Safely Executive. Accessed 1 Oct 2009
  45. Health Insurance Association of America (1995) Disability claims for mental and nervous disorders. Health Insurance Association of America, Washington, DCGoogle Scholar
  46. Hoge CW, Toboni HE, Messer SC, Bell N, Amoroso P, Orman DT (2005) The occupational burden of mental disorders in the US military: psychiatric hospitalizations, involuntary separations, and disability. Am J Psychiatry 162(3):585–591PubMedCrossRefGoogle Scholar
  47. Houtman ILD (2004) Work-related stress. European Foundation for the Improvement of Living and Working Conditions, DublinGoogle Scholar
  48. Ibrahim SA, Scott FE, Cole DC, Shannon HS, Eyles J (2001) Job strain and self-reported health among working women and men: an analysis of the 1994/5 Canadian National Population Health Survey. Women Health 33(1–2):105–124PubMedGoogle Scholar
  49. Institute of Health Economics (1997) Läkemedlen och sjukvårdskostnaderna: några utvecklingslinjer. Institute of Health Economics.Lund, SwedenGoogle Scholar
  50. Jarvisalo J, Andersson B, Boedeker W, Houtman I (eds) (2005) Mental disorders as a major challenge in the prevention of work disability: experiences in Finland, Germany, the Netherlands and Sweden. The Social Insurance Institution, Helsinki, FinlandGoogle Scholar
  51. Karpansalo M, Kauhanen J, Lakka TA, Manninen P, Kaplan GA, Salonen JT (2005) Depression and early retirement: prospective population based study in middle aged men. J Epidemiol Community Health 59(1):70–74PubMedCrossRefGoogle Scholar
  52. Kessler R, Frank RG (1997) The impact of psychiatric disorders on work loss days. Psychol Med 27:861–873PubMedCrossRefGoogle Scholar
  53. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE (2005) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62(6):617–627PubMedCrossRefGoogle Scholar
  54. Kessler RC, Ormel J, Demler O, Stang PE (2003) Comorbid mental disorders account for the role impairment of commonly occurring chronic physical disorders: results from the National Comorbidity Survey. J Occup Environ Med 45(12):1257–1266PubMedCrossRefGoogle Scholar
  55. Kilian R, Becker T (2007) Macro-economic indicators and labour force participation of people with schizophrenia. J Ment Health 16(2):211–222CrossRefGoogle Scholar
  56. Klepper B, Salber P (2005) The business case for reform. Employers must demand needed change to create a sustainable system of care. Mod Healthc 35(41):22PubMedGoogle Scholar
  57. Knapp M, Mangalore R, Simon J (2004) The global costs of schizophrenia. Schizophr Bull 2:297–293Google Scholar
  58. Koopmanschap MA, van Ineveld BM (1992) Towards a new approach for estimating indirect costs of disease. Soc Sci Med 34(9):1005–1010PubMedCrossRefGoogle Scholar
  59. Korten A, Henderson S (2000) The Australian national survey of mental health and well-being. Common psychological symptoms and disablement. Br J Psychiatry 177:325–330PubMedCrossRefGoogle Scholar
  60. Laitinen-Krispijn S, Bijl RV (2000) Mental disorders and employee sickness absence: the NEMESIS study. Netherlands Mental Health Survey and Incidence Study. Soc Psychiatry Psychiatr Epidemiol 35(2):71–77PubMedCrossRefGoogle Scholar
  61. Langlois JA, Rutland-Brown W, Wald MM (2006) The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil 21(5):375–378PubMedCrossRefGoogle Scholar
  62. Lerner D, Adler DA, Chang H, Lapitsky L, Hood MY, Perissinotto C, Reed J, McLaughlin TJ, Berndt ER, Rogers WH (2004) Unemployment, job retention, and productivity loss among employees with depression. Psychiatr Serv 55(12):1371–1378PubMedCrossRefGoogle Scholar
  63. Lerner D, Amick BC 3rd, Lee JC, Rooney T, Rogers WH, Chang H, Berndt ER (2003) Relationship of employee-reported work limitations to work productivity. Med Care 41(5):649–659PubMedGoogle Scholar
  64. Lisbon European Council. Lisbon European Council presidency conclusions [Internet]. 2000 [cited 2007 Apr 2]. Available from: http://ve.evint/vedocs/cns.Data/docs/pressData/en/ec/odocr1.en.htm PubMedGoogle Scholar
  65. Lim D, Sanderson K, Andrews G (2000) Lost productivity among full-time workers with mental disorders. J Ment Health Policy Econ 3(3):139–146PubMedCrossRefGoogle Scholar
  66. Lim KL, Jacobs P, Ohinmaa A, Schopflocher D, Dewa CS (2008) A new population-based measure of the economic burden of mental illness in Canada. Chron Dis Can 28(3):92–98Google Scholar
  67. Mailhan L, Azouvi P, Dazord A (2005) Life satisfaction and disability after severe traumatic brain injury. Brain Inj 19(4):227–238PubMedCrossRefGoogle Scholar
  68. Marcotte DE (2004) Essential to understand the relationship between mental illness and work. Healthc Pap 5(2):26–31PubMedGoogle Scholar
  69. Marcotte DE, Wilcox-Gok V, Redmon DP (2000) The labor market effects of mental illness. The case of affective disorders. In: Research in human capital and development. Stamford: JAI PressGoogle Scholar
  70. Marcotte DE, Wilcox-Gök V, Redmon P (1999) Prevalence and patterns of major depressive disorder in the United States labor force. J Ment Health Policy Econ 2:121–131Google Scholar
  71. Marwaha S, Johnson S (2004) Schizophrenia and employment: a review. Soc Psychiatry Psychiatr Epidemiol 39:337–349PubMedCrossRefGoogle Scholar
  72. McClanathan A (2004) Behavioral health benefits: key to a healthy workforce. Empl Benefits J 29(1):11–16PubMedGoogle Scholar
  73. McDaid D (2008) Mental health reform: Europe at the cross-roads. Health Econ Policy Law 3(Pt 3):219–228PubMedGoogle Scholar
  74. McDaid D, Curran C, Knapp M (2005) Promoting mental well-being in the workplace: a European policy perspective. Int Rev Psychiatry 17(5):365–373PubMedCrossRefGoogle Scholar
  75. Mechanic D, Bilder S, McAlpine DD (2002) Employing persons with serious mental illness. Health Aff 21(5):242–253CrossRefGoogle Scholar
  76. Murphy JM, Laird NM, Monson RR, Sobol AM, Leighton AH (2000) Incidence of depression in the Stirling County Study: historical and comparative perspectives. Psychol Med 30(3):505–514PubMedCrossRefGoogle Scholar
  77. Newman SC, Bland RC (1998) Incidence of mental disorders in Edmonton: estimates of rates and methodological issues. J Psychiatr Res 32:273–282PubMedCrossRefGoogle Scholar
  78. NICE (2009) Promoting mental wellbeing at work. National Institute for Health and Clinical Excellence, LondonGoogle Scholar
  79. Nicholas G (1998) Workplace effects on the stigmatization of depression. J Occup Environ Med 40(9):793–800CrossRefGoogle Scholar
  80. Office of the Deputy Prime Minister (2004) Mental health and social exclusion. Social Exclusion Unit report. Office of the Deputy Prime Minister, LondonGoogle Scholar
  81. Offord DR, Boyle MH, Campbell D, Goering P, Lin E, Wong M, Racine YA (1996) One-year prevalence of psychiatric disorder in Ontarians 15 to 64 years of age. Can J Psychiatry 41(9):559–563PubMedGoogle Scholar
  82. Organisation for Economic Co-operation and Development (2003) Transforming disability into ability: policies to promote work and income security for disabled people. OECD, ParisGoogle Scholar
  83. Parent-Thirion A, Fernández Macías E et al (2007) Fourth European Working Conditions survey. European Foundation for the Improvement of Living and Working Conditions, DublinGoogle Scholar
  84. Patel A, Knapp M, Henderson J, Baldwin D (2002) The economic consequences of social phobia. J Affect Disord 68(2–3):221–233PubMedCrossRefGoogle Scholar
  85. Rice DP, Miller LS (1996) The economic burden of schizophrenia: conceptual and methodological issues and cost estimates. In: Moscarelli M, Rupp A, Sartorius N (eds) Handbook of mental health economics and health policy, volume 1, schizophrenia. Wiley, LondonGoogle Scholar
  86. Sanderson K, Andrews G (2006) Common mental disorders in the workforce: recent findings from descriptive and social epidemiology. Can J Psychiatry 51(2):63–75PubMedGoogle Scholar
  87. Scheid TL (1999) Employment of individuals with mental disabilities: business response to the ADA’s challenge. Behav Sci Law 17:73–91PubMedCrossRefGoogle Scholar
  88. Shields M (2004) Stress, health and the benefit of social support. Health Rep 15(1):9–38PubMedGoogle Scholar
  89. Smith JL, Rost KM, Nutting PA, Libby AM, Elliott CE, Pyne JM (2002) Impact of primary care depression intervention on employment and workplace conflict outcomes: is value added? J Ment Health Policy Econ 5(1):43–49PubMedGoogle Scholar
  90. Statistics Canada (2003) Canadian community health survey: mental health and well-being. Accessed 8 Sept 2003
  91. Stephens T, Jourbert N (2001) The economic burden of mental health problems in Canada. Chron Dis Can 22(1):18–23Google Scholar
  92. Stewart WF, Ricci JA, Chee E, Hahn SR, Morganstein D (2003) Cost of lost productive work time among US workers with depression. J Am Med Assoc 289(23):3135–3144CrossRefGoogle Scholar
  93. Tagliaferri F, Compagnone C et al (2006) A systematic review of brain injury epidemiology in Europe. Acta Neurochir 148(3):255–268CrossRefGoogle Scholar
  94. Tarricone R, Gerzeli S, Montanelli R, Frattura L, Percudani M, Racagni G (2000) Direct and indirect costs of schizophrenia in community psychiatric services in Italy. The GISIES study. Interdisciplinary Study Group on the Economic Impact of Schizophrenia. Health Policy 51(1):1–18PubMedCrossRefGoogle Scholar
  95. The Standing Senate Committee on Social Affairs, Science and Technology (2006) Out of the shadows at last transforming mental health, mental illness and addiction services in Canada. The Senate, OttawaGoogle Scholar
  96. Thomas C, Morris S (2003) Cost of depression among adults in England in 2000. Br J Psychiatry 183:514–519PubMedCrossRefGoogle Scholar
  97. Thurman DJ, Alverson C, Browne D, Dunn KA, Guerrero J, Johnson R, Johnson V, Langlois JA, Pilkey D, Sneizek JE, Toal S (1999) Traumatic brain injury: a report to congress. Centers for Disease Control and Prevention, AtlantaGoogle Scholar
  98. Vanderploeg RD, Curtiss G, Luis CA, Salazar AM (2007) Long-term morbidities following ­self-reported mild traumatic brain injury. J Clin Exp Neuropsychol 29(6):585–598PubMedCrossRefGoogle Scholar
  99. Waghorn G, Lloyd C (2005) The employment of people with mental illness. AeJAMH 4(2 Suppl):1–43Google Scholar
  100. Wang J, Adair CE, Patten SB (2006) Mental health and related disability among workers: a ­population-based study. Am J Ind Med 49:514–522PubMedCrossRefGoogle Scholar
  101. Wang PS, Beck AL, Berglund P, McKenas DK, Pronk NP, Simon GE, Kessler RC (2004) Effects of major depression on moment-in-time work performance. Am J Psychiatry 161(10):1885–1891PubMedCrossRefGoogle Scholar
  102. Watson Wyatt Worldwide (2000) Staying at Work 2000/2001 – the dollars and sense of effective disability management. Watson Wyatt Worldwide, VancouverGoogle Scholar
  103. Westerhout E (2001) Disability risk, disability benefits, and equilibrium unemployment. Int Tax and Public Finance 8(3):219–243CrossRefGoogle Scholar
  104. Wittchen HU, Jacobi F (2005) Size and burden of mental disorders in Europe – a critical review and appraisal of 27 studies. Eur Neuropsychopharmacol 15(4):357–376PubMedCrossRefGoogle Scholar
  105. World Health Organization (2005) Mental health action plan for Europe. Facing the challenges, building solutions. World Health Organization, CopenhagenGoogle Scholar
  106. World Health Organization (2001) The World Health Report 2001 mental health: new understanding, new hope. WHO, GenevaGoogle Scholar
  107. Wyatt W (1997) Staying @ work. Watson Wyatt Canada, TorontoGoogle Scholar
  108. Yasuda S, Wehman P, Targett P, Cifu D, West M (2001) Return to work for persons with traumatic brain injury. Am J Phys Med Rehabil 80(11):852–864PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Work & Well-being Research & Evaluation ProgramCentre for Addiction and Mental HealthTorontoCanada

Personalised recommendations