Research reportWork functioning in persons with depressive and anxiety disorders: The role of specific psychopathological characteristics
Introduction
The prevalence of depressive and anxiety disorders is high. In the ESEMED study among the European population, 14% reported a lifetime history of any mood disorder and 13.6% a lifetime history of any anxiety disorder (Alonso et al., 2004). Depressive and anxiety disorders have major impact on functioning in daily life, and interfere with working and productivity (Stewart et al., 2003, Kessler and Frank, 1997, Adler et al., 2006, Lim et al., 2000, O'Neill et al., 2008, Waghorn and Chant, 2005). In a working population a prevalence of 6.1% for depressive disorders and a prevalence of 9.9% for anxiety disorders were found (Laitinen-Krispijn and Bijl, 2000). Depressive and anxiety disorders are associated with the highest productivity-loss related costs of all chronic illnesses (Druss et al., 2000, Buist-Bouwman et al., 2005, Verow and Hargreaves, 2000, Glozier, 2002). Working individuals with depressive and anxiety disorders not only have more absenteeism from work than their healthy counterparts, but they also report lower productivity due to decreased work performance while working (Stewart et al., 2003, Adler et al., 2006, Kessler and Frank, 1997, Goetzel et al., 2004, Waghorn and Chant, 2006).
Work absenteeism and decreased work performance may depend on specific psychopathological characteristics, however not much is known yet about which characteristics are most important. Since not many studies have been able to compare the impact of depressive and anxiety disorders on work functioning, it is unknown whether there are really differences or mainly similarities in work function. Other aspects, such as severity of disorders (Wang et al., 2006, Waghorn and Chant, 2007), comorbidity of depressive and anxiety disorders (De Graaf et al., 2004), chronicity (Saarni et al., 2007, Waghorn et al., 2006), and types of disorders (Lim et al., 2000, Waghorn and Chant, 2006), may also further determine the impact of depressive or anxiety disorders on work functioning. Also receipt of treatment and disabilities in depressed or anxiety persons – which likely are partially proxy for severe and chronic disorders – has shown to be associated with poorer work performance (Waghorn et al., 2005b, Waghorn and Chant, 2006). However, a thorough, comprehensive examination of the role of psychopathological characteristics on work functioning has hardly been conducted.
Insights in which specific psychopathological characteristics are risk factors for absenteeism and decreased work performance, may provide opportunities for preventive strategies for prolonged absenteeism and productivity-loss among workers with depressive and anxiety disorders. Therefore, this study examines the association of detailed characteristics of depressive and anxiety disorders with work functioning (both absenteeism and decreased work performance) in a large sample, using data from NESDA (the Netherlands Study of Depression and Anxiety). We will examine and compare the impact of depressive and anxiety disorders on work functioning, and will explore the differential role that severity, comorbidity, type and duration may play in the link between depression and anxiety disorders with work function.
Section snippets
Study sample
NESDA is a multi site naturalistic cohort study (n = 2981, age 18–65 years) examining the long-term course and consequences of depressive and anxiety disorders designed to include respondents from different health care settings and in different stages of their developmental history of disorders. Participants with and without depressive and/or anxiety disorders were recruited in the general population (through the earlier NEMESIS (Bijl et al., 1998) and ARIADNE (Landman-Peeters et al., 2005)
Sample description
In this sample of 1876 men and women, 432 (23.0%) persons were free of any lifetime diagnoses of anxiety or depressive disorders. Compared to persons without psychopathology, those with psychopathology were more likely to be female (65.6% versus 59.3%, p = .02), were lower educated (12.4 versus 13.3 years, p < .001), tended to work less hours a week (31.1 versus 32.1 h, p = .09) and reported more somatic conditions (1.3 versus 1.0, p < .001). Moreover, persons with psychopathology had more work
Discussion
The results of the present study confirm the association between psychopathology and work functioning among working people. Current depressive disorders were associated with a seven-fold higher risk of long-term absence and five-fold higher risk of impaired work performance, whereas current anxiety disorders increased odds for long-term absence and impaired work performance with approximately a factor two. Persons with remitted depressive disorders had both more absenteeism and decreased work
Role of the funding source
The infrastructure for the NESDA study is funded through the Geestkracht programme of the Dutch Scientific Organisation (ZON-MW, grant number 10-000-1002) and matching funds from participating universities and mental health care organizations (VU University Medical Centre, GGZ inGeest, Leiden University Medical Centre, GGZ Rivierduinen, University Medical Centre Groningen, Lentis, GGZ Friesland, GGZ Drenthe). The funding organizations had no further role in analysis and interpretation of data;
Conflict of interest
None.
Acknowledgements
The infrastructure for the NESDA study is funded through the Geestkracht programme of the Dutch Scientific Organisation (ZON-MW, grant number 10-000-1002) and matching funds from participating universities and mental health care organizations (VU University Medical Centre, GGZ Buitenamstel/Geestgronden, Leiden University Medical Centre, GGZ Rivierduinen, University Medical Centre Groningen, Lentis, GGZ Friesland, and GGZ Drenthe).
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