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INTRODUCTION

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Occupational mental health is increasingly recognized as an important focus of an effective occupational health and safety program. Although most workers attempt to conceal their mental health illnesses and treatments out of fear of stigma and the possibility of termination, psychiatric disorders are commonly encountered in the workplace. The amount of time a person spends at work and the structured nature of work make it an ideal place to detect mental health disorders. Some mental health conditions can even be ascribed to occupational stressors. For these reasons, occupational physicians are in a pivotal position to recognize, assess, and manage mental health conditions.

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Unaddressed mental health issues and occupational stress are significant occupational health problems and causes of considerable economic loss. Both diagnosed and undiagnosed psychiatric disorders can contribute to poor performance or quality of work, absenteeism, strain in work relationships, need for medication monitoring, and potential safety issues. In addition to mental health issues, violence and the threat of violence in the workplace is a growing concern that requires counsel and clinical assessment from occupational physicians.

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COMMON MENTAL HEALTH CONDITIONS IN THE WORKPLACE

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Though more than 200 psychiatric disorders are included in the Diagnostic and Statistical Manual of Mental Disorders, only the conditions that are most likely to present in today's work environment will be discussed in this chapter. Substance abuse diagnoses are covered in the following chapter. Practitioners familiar with these mental health conditions will be able to facilitate the evaluation, treatment, and management of employees with psychopathology.

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Many workers with mental health illnesses are taking prescription psychotropic agents. These medications, many of them quite likely to present problems of drug management, are seldom reported to employers. Although occupational physicians will almost always defer decisions on medication to mental health professionals, they nonetheless play an important role in monitoring workers for drug effects on work performance and for problematic side effects.

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MAJOR DEPRESSIVE DISORDER

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ESSENTIALS OF DIAGNOSIS

  • Feelings of worthlessness, hopelessness, and sometimes guilt.

  • Loss of energy or fatigue, daily.

  • Difficulty concentrating and making decisions.

  • Loss of interest or pleasure in activities; withdrawal from activities.

  • Disturbed sleep (insomnia, hypersomnia).

  • Reduced appetite and sex drive.

  • Thoughts of death and suicide.

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General Considerations
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The lifetime prevalence for major depressive disorder in US adults is 16.5%, with women being at a significant increased risk compared to men. Given the rate of occurrence, the personal pain, and the cost to employers associated with major depression, effective corporate health policy and clinical intervention should be the goals for health planning regarding this all too common mental disorder.

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Clinical Findings
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The hallmark of major depression is a severely depressed mood lasting at least 2 weeks. Symptoms most frequently include anhedonia, decreased energy, reduced participation in activities, and feelings of guilt or worthlessness. ...

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