Practical pathway for the management of depression in the workplace: a Canadian perspective

Pratap Chokka1*, Ash Bender2, Stefan Brennan3, Ghalib Ahmed4, Marc Corbière5, David J. A. Dozois6, Jeff Habert7, John Harrison8, Martin A. Katzman9, Roger S. McIntyre10, Yang S. Liu11, Karen Nieuwenhuijsen12, Carolyn S. Dewa13

1Department of Psychiatry, University of Alberta, Grey Nuns Hospital, Edmonton, AB, Canada 2Work, Stress and Health Program, The Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada 3Department of Psychiatry, University of Saskatchewan, Royal University Hospital, Saskatoon, SK, Canada 4Department of Family Medicine and Psychiatry, University of Alberta, Edmonton, AB, Canada 5Department of Education, Career Counselling, Université du Québec à Montréal, Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada 6Department of Psychology, University of Western Ontario, London, ON, Canada 7Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada 8Metis Cognition Ltd., Kilmington, United Kingdom; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, United Kingdom; Alzheimercentrum, AUmc, Amsterdam, Netherlands 9START Clinic for the Mood and Anxiety Disorders, Toronto, ON, Canada; Department of Psychiatry, Northern Ontario School of Medicine, and Department of Psychology, Lakehead University, Thunder Bay, ON, Canada 10Department of Psychiatry, University of Toronto, Toronto, ON, Canada 11Department of Psychiatry, University of Alberta, Edmonton, AB, Canada 12Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands 13Department of Psychiatry and Behavioural Sciences, University of California, Davis, Davis, CA, United States

Major depressive disorder (MDD) and other mental health issues pose a substantial burden on the workforce. Approximately half a million Canadians will not be at work in any week because of a mental health disorder, and more than twice that number will work at a reduced level of productivity (presenteeism). Although it is important to determine whether work plays a role in a mental health condition, at initial presentation, patients should be diagnosed and treated per appropriate clinical guidelines. However, it is also important for patient care to determine the various causes or triggers including work-related factors. Clearly identifying the stressors associated with the mental health disorder can help clinicians to assess functional limitations, develop an appropriate care plan, and interact more effectively with worker’s compensation and disability programs, as well as employers. There is currently no widely accepted tool to definitively identify MDD as work-related, but the presence of certain patient and work characteristics may help. This paper seeks to review the evidence specific to depression in the workplace, and provide practical tips to help clinicians to identify and treat work-related MDD, as well as navigate disability issues.