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When employees fail to show up to work due to an acute or chronic medical condition, the impact of that absenteeism on productivity and performance is clear. In recent years, however, experts in employee health have been paying closer attention to a phenomenon called "presenteeism," whose impact is not as readily measured but is potentially more harmful than outright absenteeism.
"Presenteeism [occurs] when an employee goes to work sick but cannot work at full capacity."1 Its impact was graphically demonstrated in a study recently published in the American Journal of Psychiatry, the monthly scientific journal of the Washington, DC-based American Psychiatric Association (APA). The study was conducted by the departments of psychiatry and public health at Yale University in New Haven, CT, and the Yale Department of Veterans Affairs Public Health System in West Haven, CT.
The study, drawn from surveys conducted in 1993 and 1995, was designed to measure the effects of depressive symptoms and satisfaction with health care on work outcomes. Among the key findings:
• The odds of missed work due to health problems in 1995 were twice as high for employees with depressive symptoms in both 1993 and 1995 as for those without depressive symptoms.
• The odds of decreased effectiveness at work in 1995 was seven times as high.
• Among individuals with depressive symptoms in 1993, a report of one or more problems with clinical care in 1993 predicted a 34% increase in the odds of persistent depressive symptoms and 66% increased odds of decreased effectiveness at work in 1995. (For more on the effects of chronic illness on work place performance, see "News briefs," in this issue.)
The study involved nearly 15,000 employees of three corporations, about 1,200 of whom met the criteria for depressive symptoms. The first phase, the Employee Health Care Value Survey, involved using a 154-item questionnaire that was filled out by 14,587 employees in 1993. During the second phase, a 116-item survey was mailed in 1995 to 9,294 randomly sampled employees who had responded to the first survey and still were employed by the corporations. It included a 12-item short-form health survey. This was used, in part, to determine clinically significant depressive symptoms.
In the 1995 survey, participants were asked if they had missed one or more days from work because of health problems in the four weeks preceding the survey. They were also asked to rate the impact of their health on effectiveness at work, on a score of zero (unable to accomplish anything because of health) to 100 (no health problems).
Based on these responses, the odds of taking sick days at work in 1995 were 2.17 times as high for respondents with chronic depressive illness as for respondents without depressive symptoms in 1993 or 1995. The odds of reporting decreased effectiveness in the workplace in 1995 were 7.20 times higher.
The study’s findings "suggest that depression has a substantial and persistent association with decreased workplace productivity, an impact that may be underestimated when one looks only as days missed from work,"1 the authors wrote.
"The impact of depression on function at work was substantially higher than its association with missed days at work," they continued. "These findings suggest that previous reports of absenteeism may represent only a fraction of the cost of depression in the workplace."1
Presenteeism, they note, has become an increasing concern of employers in recent years. "Presenteeism would be expected to be particularly likely when an employee is reluctant to report an illness or believes the illness would not be regarded as a legitimate reason for missing work," they explain. "The perceived stigma associated with depressive disorders may thus result in a high proportion of hidden costs to employers that are not readily evident from health or disability claims data."1
The significance of these findings was not lost on the APA. "The message is clear," notes Lloyd Sederer, MD, the APA’s director of the division of clinical services. "There is both medical and financial value in better detection and effective treatment for depression in the workplace."
[For more information, contact:
• Benjamin G. Druss, MD, MPH, Departments of Psychiatry and Public Health, Yale University, Department of Veterans Affairs Connecticut Healthcare System, 116A, 950 Campbell Ave., West Haven, CT 06516. E-mail: firstname.lastname@example.org.]
1. Druss BG, Schlesinger M, Allen HM Jr. Depressive symptoms, satisfaction with health care, and 2-year work outcomes in an employee population. Am J Psychiatry 2001; 158:731-734.