Mental health includes emotional, psychological, and social well-being. It affects how people think, feel, and act. It also helps to determine how they handle stress, relate to others, and make choices. Mental health conditions appear when a person experiences distress or difficulties in some of these areas.
Mental health conditions concern a person’s state of anxiety, mood tone, personality, behavior, and general psycho-physical well-being; a health
condition can range from mild to severe, can be disabling and interfere considerably with their quality of life.
Mental health conditions are not always visible to others; that is one of the main issues for people suffering from “invisible illness” that still nowadays have often to face a lack of social awareness and stigma.
Here we describe depression as an example of mental health condition.
The case of depression
Age: 38 year old
The case of Frida that suffers from depression
Frida, aged 48, shows symptoms of depression. She states that she has daily crying spells, feels sad “all the time”, has trouble sleeping at night, and is overeating. She reports that her sleeping is disturbed in that it frequently takes her several hours to fall asleep, that some nights she cannot fall asleep at all, and that if she does, she sleeps for only a few hours. She states that she spends the time awake “thinking” and “worrying”. For some time, she has been feeling sad and tired but above all, she has lost interest in her work, and during her working hours, she often struggles to concentrate and make decisions. Sometimes she cannot go to work and spends the day in bed. It seems to her that her situation is more than just a “bad period”. Frida feels terribly guilty about her condition that is affecting her relationship with her husband and children and is keeping her away from participating in family events. Most of all, she reports that she feels unable to work outside her home at this time; therefore, the situation was beginning to have financial impact. She often feels uneasy about being with her colleagues, with whom she would like to confide, but she fears being judged as lazy or moody. She is afraid to speak to the manager and reveal her situation but she does not know what to do.
1 What is it
Depression, otherwise known as major depressive disorder or clinical depression is a common and serious mood disorder. Those who suffer from depression experience persistent feelings of sadness and hopelessness and lose interest in activities they once enjoyed. It is not the same as grief or sadness, which are usually natural reactions to an adverse event or situation (e.g. problems at work or the death of a loved one). The underlying causes may be difficult to ascertain; often, depression has no single cause but is a reaction to a combination of factors. Depression is most common in people aged between 25 and 44, and women are more likely than men to experience depression; however, around one in six people experience depression at some time in their lives.
To be diagnosed with depression, the individual must be experiencing five or more symptoms during the same 2-week period:
- Depressed mood most of the day, nearly every day.
- Markedly diminished interest or pleasure in all, or almost all, activities for most of the day.
- Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
- A slowing down of thought and a reduction of physical movement.
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
- Diminished ability to think or concentrate, or indecisiveness, nearly every day.
- Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
To receive a diagnosis of depression, these symptoms must cause the individual clinically significant distress or impairment in social, occupational, or other important areas of functioning. However, manifestations of depression can vary in their intensity and duration. Particular depressive episodes can occur in postpartum women or in concurrence with the period of menstruation, or emerge due to environmental factors, such as seasonal changes.
Treatment of depression includes the following therapies, which are sometimes used alone and sometimes in combination with each other.
- Antidepressants, drugs that act on the central nervous system in different ways, are useful in the acute phases of the depressive crisis, reduce symptoms over 4-6 weeks and are taken for a period of 8-10 months. Since depression is a recurring disease, the specialist, once the acute episode has terminated, may prescribe a preventive or long-term maintenance therapy, in order to decrease the risk of future episodes, especially for certain people at high risk.
- Psychotherapy is an effective treatment for clinical depression. On its own it may not be enough to treat severe depression, but it can play an important role when used with other treatments, including medications. Indeed, while antidepressants have no effects on the causes that lead to depression, psychotherapy, on the other hand, helps people to recognize stress triggers and problems, as well as to change certain behaviors and ways of thinking; it is more effective in maintaining long-term benefits and preventing relapses.
4 Psychosocial issues and impact of the disease on employment
Depression is one of the major mental health issues. It is a problem for those who are suffering and for their families. Moreover, it is increasingly becoming a major issue in the workplace.
- Depression is not always visible to others, especially in those cases in which depression is not particularly severe; thus, it can be placed under the umbrella term “invisible illness”. People affected by invisible illnesses often face a lack of social awareness and additional stigma. As a result, these individuals often face more skepticism, and are accused of being lazy or moody. These attitudes just contribute to increase feelings of shame, guilt and lack of self-esteem already present in a depressed person.
These behaviors should be prevented at the workplace, by increasing awareness of all the company staff: perceiving understanding and solidarity from one’s own working group is a fundamental first step.
- On the other hand, sometimes a person who is depressed doesn’t realize the gravity of the situation, diminishing his suffering as a “bad patch”. Because of the disease, he may also appear to be unwilling or unable to seek medical attention. Colleagues, as well as family and friends, may try to encourage and support the sufferer in this process of awareness and searching for medical examination and therapy.
To manage workers with depression and help them continue working or returning to work, employers can promote some interventions
Depressive symptoms, such as tiredness, lack of energy and initiative, as well as impairment in thinking, concentrating and making decisions, have important repercussions on working life. One of the consequences is absenteeism; another is presenteeism. Many people with depression continue to work but do not function at their full capacity (e.g. they may perform poor-quality work, miss the deadlines, may be paralyzed with indecision or have difficulties getting along with coworkers, etc.).
- Understanding employees’ needs on different levels and finding compromises are crucial for good management of the disease and to help people return to work and/or continue working.
- Supporting an open and frank flow of communication between the employer and the employee with depression during the whole process is crucial.
- Rearrangements in schedules, timetables and flexible working hours may be more effective than letting people work from home (e.g. “smart working”), thus increasing feelings of loneliness and avoidance of social contact.
- An occupational psychologist/support desk in the company can be useful to the person, offering them the opportunity to talk freely about their problem with a competent professional.
- Work on the environment to avoid stigma: in particular, it is important that colleagues support a coworker with depression and this can only be achieved by educating the entire group of colleagues.