Anxiety Disorders and Work Performance

  • Jaye Wald


Anxiety disorders are among the most prevalent group of psychiatric illnesses in the workforce (American Psychiatric Association (APA) 2000; Sanderson and Andrews 2006).The lifetime prevalence of anxiety disorders (as a group) in the general population is approximately 14% (APA 200; SEMeD/MHEDEA Investigators 2004a; Kessler et al. 2005). These disorders typically follow a chronic course and are accompanied by substantial functional impairment and an elevated suicide risk (Khan et al. 2002; Spitzer et al. 1995; van Balkom et al.2008; Yonkers et al.2003). More than half of the persons diagnosed with an anxiety disorder will have a comorbid psychiatric condition, the most com2008). Chronic medical conditions (e.g., cardiovascular disease, chronic pain, asthma) are also common among people with anxiety disorders (Demyttenare et al. 2008; Roy-Bryne et al. 2008; Zvolensy and Smits 2008). Despite significant advances in evidence-based interventions, these disorders tend to go unrecognized and untreated (Lim et al. 2000; Schonfeld et al.1997).


Anxiety Disorder Obsessive Compulsive Disorder Generalize Anxiety Disorder American Psychiatric Association Sickness Absence 
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  1. Abramowitz JS, McKay D, Taylor S (2008) Clinical handbook of obsessive-compulsive disorder and related problems. John Hopkins University Press, New YorkGoogle Scholar
  2. Adler DA, McLaughlin TJ, Rogers WH, Chang H, Lapitsky L, Lerner D (2006) Job performance deficits due to depression. Am J Psychiatry 163:1569–1576PubMedCrossRefGoogle Scholar
  3. Amaya-Jackson L, Davidson JR, Hughes DS, Swartz M, Reynolds V, George KV, Blazer DG (1999) Functional impairment and utilization of services associated with post traumatic stress in the community. J Trauma Stress 12:709–724PubMedCrossRefGoogle Scholar
  4. American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders, 4th edn, text revision. Author, Washington, DCGoogle Scholar
  5. Baldwin ML, Marcus SC (2006) Perceived and measured stigma among workers with serious mental illness. Psychiatr Serv 57:388–392PubMedCrossRefGoogle Scholar
  6. Becker D, Whitley R, Bailey EL, Drake RE (2007) Long-term employment trajectories among participants with severe mental illness in supported employment. Psychiatr Serv 58:922–928PubMedCrossRefGoogle Scholar
  7. Bond GR, Drake RE, Becker DR (2008) An update on randomized controlled trials of evidence-based supported employment. Psychiatr Rehabil J 31:280–290PubMedCrossRefGoogle Scholar
  8. Breslau N, Lucia VC, Davis GC (2004) Partial PTSD versus full PTSD: An empirical investigation of associated impairment. Psychol Med 34:1205–1204PubMedCrossRefGoogle Scholar
  9. Bruch MA, Fallon M, Heimberg RG (2003) Social phobia and difficulties in occupational adjustment. J Couns Psychol 50:109–117CrossRefGoogle Scholar
  10. Bryson G, Greig Bell T, Kaplan E (1999) The Work Behavior Inventory: Prediction of future work success of people with schizophrenia. J Psychiatr Rehabil 23:113–117Google Scholar
  11. Buist-Bowman MA, de Graaf R, Vollebergh WAM (2005) Comorbidity of physical and mental disorders and the effect on work-loss days. Acta Psychiatr Scand 111:436–443CrossRefGoogle Scholar
  12. Burton WN, Pransky G, Conti DJ, Chen CY, Edington SW (2004) The associatioin of medical conditions and presenteeism. J Occup Environ Med 46:S38–S45PubMedCrossRefGoogle Scholar
  13. Carlier IV, Lamberts RD, Gersons (1997). Risk factors for posttraumatic stress symptomatology in police officers. J Nerv Ment Dis 185:498–506Google Scholar
  14. Cole DC, Mondoch MV, Hogg-Johnson S (2002) Listening to injured workers: How recovery expectations predict outcomes – a prospective study. Can Med Assoc J 166:749–754Google Scholar
  15. Coles A (1996) Reasonable accommodations in the workplace for persons with affective mood disorders: A case study. J Appl Rehabil Couns 27(4):40–44Google Scholar
  16. Demyttenare K, Bonnewyn A, Bruffaerts R, De Graf R, Haro JM, Alonso J (2008) Comorbid painful physical symptoms and anxiety: Prevalence, work loss, and help seeking. J Affect Disord 109:264–272CrossRefGoogle Scholar
  17. 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 58:652–658PubMedCrossRefGoogle Scholar
  18. Diefenbach GJ, Abramowitz JS, Norberg MM, Tolin DF (2007) Changes in quality of life following cognitive-behavioral therapy for obsessive-compulsive disorder. Behav Res Ther 45:3060–3068PubMedCrossRefGoogle Scholar
  19. Dugas MJ, Robichaud M (2006) Generalized anxiety disorder: From science to practice. Routledge, New YorkGoogle Scholar
  20. El-Guebaly N, Currie S, Williams J, Wang J, Beck CA, Maxwell C, Pattern SB (2007) Association of mood, anxiety, and substance use disorders with occupational status and disability in a ­community sample. Psychiatr Serv 58:659–667PubMedCrossRefGoogle Scholar
  21. ESEMeD/MHEDEA Investigators 2000 (2004a). Prevalence of mental disorders in Europe: Results from the European Study of the Epidemiology of Mental Disorders (ESEMed) project. Acta Psychiatr Scand 109 (Suppl 1):21–27Google Scholar
  22. ESEMeD/MHEDEA Investigators 2000 (2004b). 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 109 (Suppl 1):38–46.Google Scholar
  23. Ettigi P, Allen M, Chirban JT, Jake JR, Reid WS (1997) The quality of life and employment in panic disorder. J Nerv Ment Dis 185:368–372PubMedCrossRefGoogle Scholar
  24. Evans S, Giosan C, Patt I, Spielman L, Difede J (2006) Anger and its association to distress and social/occupational functioning in symptomatic disaster relief workers responding to the September 11, 2001, World Trade Center Disaster. J Trauma Stress 19:147–152PubMedCrossRefGoogle Scholar
  25. Fehm L, Pelissolo A, Furmark T, Wittchen HU (2000) Size and burden of social phobia in Europe. Eur Neuropsychopharmacol 15:453–462CrossRefGoogle Scholar
  26. Fischler GL, Booth N (1999) Vocational impact of psychiatric disorders: A guide for rehabilitation professionals. Aspen Publishers, Inc., Gaithersburg, MDGoogle Scholar
  27. Foa EB, Hembree EA, Cahill SP, Rauch AM, Riggs DS, Feeny NC, Yadin E (2005) Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics. J Consult Clin Psychol 73:953–964PubMedCrossRefGoogle Scholar
  28. Friedman MJ, Keane TM, Resick PA (eds) (2007) Handbook of PTSD: Science and practice. Guilford Press, New YorkGoogle Scholar
  29. Gates LB (2000) Workplace accommodation as a social process. J Occup Rehabil 10:85–98CrossRefGoogle Scholar
  30. Gates LB, Akabas SH, Oran-Sabia V (1998) Relationship accommodations involving the work group: Improving work prognosis for persons with mental health conditions. Psychiatr Rehabil J 21(3):264–272Google Scholar
  31. Gewurtz R, Kirsh B, Jacobson N, Rappolt S (2006) The influence of mental illness on work potential and career development. Can J Community Ment Health 25:207–220Google Scholar
  32. Goracci A, Martinucci M, Kaperoini A, Fagliolini A, Sbaragli C, Corsi E, Castrogiovanni P (2007) Quality of life and subthreshold obsessive-compulsive disorder. Acta Neuropsychiatr 19:357–361CrossRefGoogle Scholar
  33. Grant BF, Hasin DS, Stinson FS, Dawson DA, Ruan WJ, Goldstein RB, Smith SM, Saha TD, Huang B (2005) Prevalence, correlates, co-morbidity, and comparative disability of DSM-IV generalized anxiety disorder in the USA: Results from the National Epidemiologic Survey on alcohol and related conditions. Psychol Med 35:1747–1759PubMedCrossRefGoogle Scholar
  34. Greenberg PE, Stiglin T, Kessler RC, Finkelstein SN, Berndt ER, Davidson JR, Ballenger JC, Fyer AJ (1999) The economic burden of anxiety disorders in the 1990s. J Clin Psychiatry 60:427–435PubMedCrossRefGoogle Scholar
  35. Hannula JA, Lahtela K, Järvikoski, Salminen JK, Mäkelä P (2005) Occupational Functioning Scale (OFS) – An instrument for assessment of work ablility in psychiatric disorders. Nord J Psychiatry 60:372–378Google Scholar
  36. Harvey AG, Bryant RA (2002) Acute stress disorder: A synthesis and critique. Psychol Bull 128:886–902PubMedCrossRefGoogle Scholar
  37. Haslam C, Atkinson S, Brown SS, Haslan RA (2005a) Anxiety and depression in the workplace: Effects on the individual and organization (a focus group investigation). J Affect Disord 88:209–215PubMedCrossRefGoogle Scholar
  38. Haslam C, Atkinson S, Brown SS, Haslan RA (2005b) Perceptions of the impact of depression and anxiety and the medication for these issues of safety in the workplace. Occup Environ Med 62:538–545PubMedCrossRefGoogle Scholar
  39. Hoffman DL, Dukes EM, Wittchen HU (2008) Human and economic burden of generalized anxiety disorder. Depress Anxiety 25:72–90PubMedCrossRefGoogle Scholar
  40. Karasek R, Brisson C, Kawakami N, Houtman I, Bongers P, Amick B (1998) The job content questionnaire (JCQ): an instrument for internationally comparative assessments of psychosocial job characteristics. J Occup Health Psychol 34:322–355CrossRefGoogle Scholar
  41. Kessler RC, Chiu, Demler O et al (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:617–627Google Scholar
  42. Khan A, Leventhal RM, Khan S, Brown WA (2002) Suicide risk in patients with anxiety disorders: A meta-analysis of the FDA database. J Affect Disord 68:183–190PubMedCrossRefGoogle Scholar
  43. Knekt P, Lindfors O, Laakesonen MA, Raitasalo R, Haaramo P, Jarvikoski A, The Helskinki Psychotherapy Study Group (2008) Efffectiveness of short-term and long-term psychotherapy on work ability and functional capacity – A randomized clinical trial on depressive and anxiety disorders. J Affect Disord 107:95–106PubMedCrossRefGoogle Scholar
  44. Laitinen-Krispijn S, Bijl RV (2000) Mental disorders and employee sickness absence: The NEMESIS study. Soc Psychiatry Psychiatr Epidemiol 35:71–77PubMedCrossRefGoogle Scholar
  45. Latas M, Starcevic V, Vucinic D (2004) Predictors of work disabilities in patients with panic disorder. Eur Psychiatry 19:280–284PubMedCrossRefGoogle Scholar
  46. Leon AC, Shear MK, Portera L, Klerman GL (1992) Assessing impairment in patients with panic disorder: The Sheehan Disability Scale. Soc Psychiatry Psychiatr Epidemiol 27:78–85PubMedCrossRefGoogle Scholar
  47. Lerner D, Amick B III, Rogers WH, Malspeis S, Bungay K, Cynn D (2001) The work limitations questionnaire. Med Care 39:72–85PubMedCrossRefGoogle Scholar
  48. Lerner D, Adler DA, Chang H, Berndt ER, Irish JT, Lapitsky L, Hood MY, Reed J, Rogers WH (2004) The clinical and occupational correlates of work productivity loss among employed patients with depression. J Occup Environ Med 46:S46–S55PubMedCrossRefGoogle Scholar
  49. Lim D, Sanderson K, Andrews G (2000) Lost productivity among full-time workers with mental disorders. J Ment Health Policy Econ 3:139–146PubMedCrossRefGoogle Scholar
  50. Linden M, Muschalla B (2007) Anxiety disorders and workplace-related anxieties. J Anxiety Disord 21:467–474PubMedCrossRefGoogle Scholar
  51. MacDonald-Wilson K, Rogers ES, Massaro J (2003) Identifying relationships between functional limitations, job accommodations, and demographic characteristics of persons with psychiatric disabilities. J Vocat Rehabil 18:15–24Google Scholar
  52. Mancuso LL (1990) Reasonable accommodations for workers with psychiatric disabilities. Psychosoc Rehabil 14:3–19Google Scholar
  53. Marchand A, Demers A, Durand P (2005) Does work really cause distress? The contribution of occupational tructure and work organization to the experience of psychological stress. Soc Sci Med 61:1–14PubMedCrossRefGoogle Scholar
  54. Mataix-Cols D, Cowley AJ, Hankins M, Schneider A, Bachofen M, Kenwright M, Gega L, Cameron R, Marks IM (2005) Reliability and validity of the Work and Social Adjustment Scale in phobic disorders. Compr Psychiatry 46:223–228PubMedCrossRefGoogle Scholar
  55. Matthews LR (2005) Work potential of road accident survivors with post-traumatic stress disorder. Behav Res Ther 43:475–483PubMedCrossRefGoogle Scholar
  56. Matthews L, Chinnery D (2005) Prediction of work functioning following accidental injury: The contribution of PTSD symptom severity and other established risk factors. Int J Psychol 40:339–348CrossRefGoogle Scholar
  57. McCrum BW, Burnside LK (1997) Organising for work: A job clinic for people with mental health needs. J Ment Health 6:503–514CrossRefGoogle Scholar
  58. McDonald H, Karlinsky H, Colotla V, Flamer S (2003) Posttraumatic stress disorder (PTSD) in the workplace: A descriptive study of workers experiencing PTSD resulting from work injury. J Occup Rehabil 13:63–77CrossRefGoogle Scholar
  59. Melchior M, Caspi A, Milne BJ, Danese A, Poulton R, Moffitt T (2007) Work stress precipitates depression and anxiety in young, working women and men. Psychol Med 37:1119–1129PubMedCrossRefGoogle Scholar
  60. Mogotsi M, Kaminer D, Stein DJ (2000) Quality of life in the anxiety disorders. Harv Rev Psychiatry 8:273–282PubMedGoogle Scholar
  61. Mundt JC, Marks IM, Greist JH, Shear K (2002) The Work and Social Adjustment Scale: A simple accurate measure of impairment in functioning. Br J Psychiatry 180:461–464PubMedCrossRefGoogle Scholar
  62. Murray SA, Duxbury L, Higgins C (2006) The individual and organizational consequences of stress, anxiety, and depression in the workplace: A case study. Can J Community Ment Health 25:143–157Google Scholar
  63. Norman SB, Stein MB, Davidson JRT (2007) Profiling posttraumatic functional impairment. J Nerv Ment Dis 195:48–53PubMedCrossRefGoogle Scholar
  64. Pull CB (2008) Recent trends in the study of specific phobias. Curr Opin Psychiatry 21:43–50PubMedCrossRefGoogle Scholar
  65. Rapaport MH, Clary C, Fayyad R, Endicott J (2005) Quality of life impairment in depressive and anxiety disorders. Am J Psychiatry 162:1171–1178PubMedCrossRefGoogle Scholar
  66. Reilly MC, Zbrozek AS, Dukes EM (1993) The validity and reproducibility of a work productivity and impairment instrument. Pharmacoeconomics 4:353–365PubMedCrossRefGoogle Scholar
  67. Roy-Bryne PP, Davidson KW, Kessler RC, Asmundson GJG, Goodwin RD, Kubzansky L, Lydiard B, Massie MJ, Katon W, Laden SK, Stein MB (2008) Anxiety disorders and comorbid medical illness. Gen Hosp Psychiatry 30:208–225CrossRefGoogle Scholar
  68. Saint-Arnaud L, Saint-Jean M, Damasse J (2006) Towards an enhanced understanding of factors involved in the return-to-work process of employees absent due to mental health problems. Can J Community Ment Health 25:303–315Google Scholar
  69. Sanderson K, Andrews G (2002) Prevalance and severity of mental health – related disability and relationship to diagnosis. Psychiatr Serv 53:80–86PubMedCrossRefGoogle Scholar
  70. Sanderson K, Andrews G (2006) Common mental disorders in the workforce: Recent findings from descriptive and social epidemiology. Can J Psychiatry 51:63–75PubMedGoogle Scholar
  71. Sanderson K, Andrews G, Jelsma W (2001) Disability measurement in the anxiety disorders: Comparison of three brief measures. J Anxiety Disord 15:333–344PubMedCrossRefGoogle Scholar
  72. Sanderson K, Tilse E, Nicholson J, Oldenburg B, Graves N (2007) Which presenteeism measures are mores sensitive to depression and anxiety. J Affect Disord 101:65–74PubMedCrossRefGoogle Scholar
  73. Schneier FR, Heckelman LR, Garkinkel R, Campeas R, Fallon BA, Gitow A, Street L, DelBene D, Liebowitz MR (1994) Functional impairment in social phobia. J Clin Psychiatry 55:322–331PubMedGoogle Scholar
  74. Schonfeld WH, Verboncoeur CJ, Fifer SK, Lipschurtz RC, Lubeck DP, Bueshing DP (1997) The functioning and well-being of patients with unrecognized anxiety disorders and major depressive disorder. J Affect Disord 43:105–119PubMedCrossRefGoogle Scholar
  75. Schroer CAP, Janssen M, van Amelsvoort V, Bosma H, Swaen GMH, Nijhuis FJN, Eijk JV (2005) Organizational characteristics as predictors of work disability: A prospective study among sick employees of for-profit and not-for-profit organizations. J Occup Rehabil 15:435–445PubMedCrossRefGoogle Scholar
  76. Secker J, Membry H (2003) Promoting mental health through employment and developing healthy orkplaces: The potential of natural supports at work. Health Educ Res 2003(18):207–215CrossRefGoogle Scholar
  77. Sheehan DV (1983) The anxiety disease. Scribners, New YorkGoogle Scholar
  78. Spitzer RL, Kroenke K, Linzer M, Hahn SR, Williams JB, deGruy FV III, Brody D, Davies M (1995) Health-related quality of life in primary care patients with mental disorders: Results from the PRIME-MD 1000 Study. J Am Med Assoc 274(19):1511–1517CrossRefGoogle Scholar
  79. Stansfield SA, Robertson-Blackmore E, Zagorski BM, Munce S, Stewart DE, Weller I (2008) Work characteristics and social phobia in a nationally representative employed sample. Can J Psychiatry 52:371–376Google Scholar
  80. Stein MB, Roy-Byrne PP, Craske MG, Bystritky A, Sullivan G, Pyne JM, Katon W, Sherbourne CD (2005) Functional impact and health utility of anxiety disorders in primary care outpatients. Med Care 43:1164–1170PubMedCrossRefGoogle Scholar
  81. Stravynski A (2007) Fearing others: The nature and treatment of social phobia. Cambridge University Press, New YorkCrossRefGoogle Scholar
  82. Taylor S (2000) Understanding and treating panic disorder. John & Wiley Sons, New YorkGoogle Scholar
  83. Taylor S, Wald J, Asmundson GJG (2006) Factors associated with occupational impairment in people seeking treatment for posttraumatic stress disorder. Can J Community Ment Health 25:289–301Google Scholar
  84. van Balkom AJLM, van Boeijen CA, Boeke JP, van Oppen P, Kempe PT, van Dyck R (2008) Comorbid depression, but not comorbid anxiety disorders, predicts poor outcome in anxiety disorders. Depress Anxiety 25:408–415PubMedCrossRefGoogle Scholar
  85. Van der Klink J, Blonk RWB, Schene AH, van Dijk FJH (2001) The benefits of interventions for work-related stress. Am J Public Health 91:270–276PubMedCrossRefGoogle Scholar
  86. Von Korff M, Ustun TB, Ormel J et al. (1996). Self-report disability in an international primary care study of psychological illness. Journal of Clinical Epidemiology, 49:297–303Google Scholar
  87. Waghorn G, Chant D, White P, Whiteford H (2005) Disability, employment, and work performance among people with ICD-10 anxiety disorders. Aust NZ J Psychiatry 39:55–66Google Scholar
  88. Waghorn GR, Chant DC (2005) Employment restrictions among persons with ICD-10 anxiety disorders: Characteristics from a population survey. J Anxiety Disord 19:642–657PubMedCrossRefGoogle Scholar
  89. Ware JE, Kosinski M, Keller SD (1996) A 12-Item Short-Form Health Survey: Construction of scales and preliminary tests of reliability and validity. Med Care 34:220–233PubMedCrossRefGoogle Scholar
  90. Ware JE, Sherbourne CD (1992) The MOS 36-item short form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483PubMedCrossRefGoogle Scholar
  91. Wittchen HU, Fehm L (2001) Epidemiology, patterns of comorbidity, and associated disabilities of social phobia. Psychiatr Clin North Am 24:617–641PubMedCrossRefGoogle Scholar
  92. Wittchen HU, Fuetsch M, Sonntag H, Muller N, Liebowitz M (2000) Disability and quality of life in pure and comorbid social phobia. Findings from a controlled study. Eur Psychiatry 15:46–58PubMedCrossRefGoogle Scholar
  93. Wittchen HU, Kessler RC, Beesdo K, Krause P, Hofler M, Hoyer J (2002) Generalized anxiety and depression in primary care: Prevalence, recognition, and management. J Clin Psychiatry 63(Suppl 8):24–32PubMedGoogle Scholar
  94. Yonkers KA, Bruce SE, Dyck IR, Keller MB (2003) Chronicity, relapse, and illness – course of panic disorder, social phobia, and generalized anxiety disorder. Depress Anxiety 17:173–179PubMedCrossRefGoogle Scholar
  95. Zvolensy MJ, Smits JA (eds) (2008) Anxiety in health behaviors and physical illness. Springer Science and Business Media, New YorkGoogle Scholar

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© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of PsychiatryUniversity of British ColumbiaVancouverCanada

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