Chapter 36: Occupational Mental Health & Substance Use Disorders

INTRODUCTION

Occupational mental health is increasingly recognized as an important focus of an effective occupational health and safety program. Unaddressed mental health issues, including substance use disorders, are significant occupational health problems and causes of considerable economic loss. Both diagnosed and undiagnosed psychiatric disorders and substance use disorders can contribute to poor performance or quality of work, absenteeism, decreased function while in the workplace (ie, presenteeism), strain in work relationships, and potential safety issues (including fatalities). Rates of absenteeism and presenteeism are higher for mental health disorders than other chronic medical conditions, and stress and anxiety account for more work absences than physical injuries or illnesses.

Although some workers may conceal their psychiatric disorders and substance use disorders out of fear of stigma and the possibility of termination, these mental health issues 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 and substance use disorders. Some mental health conditions can be ascribed to occupational stressors. For these reasons, occupational physicians are in a pivotal position to recognize, assess, and manage mental health conditions.

COMMON MENTAL HEALTH CONDITIONS IN THE WORKPLACE

Though more than 200 psychiatric disorders, including substance use 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. Practitioners familiar with these mental health conditions will be able to facilitate the evaluation, treatment, and management of employees with psychopathology.

MAJOR DEPRESSIVE DISORDER

General Considerations

Depression is one of the most prevalent mental health disorders, affecting 16 million Americans every year, 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 employee health policy and clinical intervention should be the goals for health planning regarding this all too common mental disorder.

Clinical Findings

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. Other signs include impairment in concentration or cognitive functioning, sleep disturbance, changes in appetite (usually decreased), somatic complaints such as body aches and constipation, and thoughts of death.

Initial episodes of depression are more likely to be preceded by a recognizable stressor ...