Clinical depression is one of the most common illnesses affecting working adults. Yearly, approximately one in ten American adults experiences a depressive disorder. Moreover, there is much evidence that there is a substantial degree of co-occurrence among medical, psychiatric, and substance abuse disorders. For example, depression occurs in up to two-thirds of patients who have suffered a heart attack and up to 25 % of cancer and post-stroke patients.¹ Depression is a major occupational health issue that needs to be addressed. It is a workplace health issue that significantly impacts the bottom line. In this situation analysis, the literature revealed that depression-related illness predominated in prevalence and cost over other traditional occupational health issues, such as substance abuse disorders.²

Employers of all sizes are beginning to recognize that depressive disorders. often constitute their single highest mental health (medical) and disability cost. Employers experience expensive consequences of depression through absenteeism, lower productivity, disability, accidents and the inappropriate use of medical services.³ A large percentage of employers understand the relationship between health and productivity and are improving their management strategies by developing and implementing programs supportive of work/family/life issues, such as flextime, part-time schedules, child care benefits, personal leave, wellness health programs, and family counseling. As illustrated in this report, innovative employers have developed practices in conjunction with their health and human resource systems for managing both the direct and indirect cost consequences of mental illness in general and of depressive disorders in particular.⁴ To recap briefly, these employers are encouraging early recognition, appropriate and cost-effective care management, accommodations, and timely return to work. This is especially evident with the larger employer (over 1,000 employees) who is more apt to have the resources in terms of time, staff and capital expenditures. It is important to note, though, that smaller enterprises (under 50 employees) can partially implement aspects of these programs without incurring financial costs.

In spite of the many advances in the workplace in understanding mental illness and the implementation of preventive and promotional programs, many employers remain unaware and, perhaps, unconcerned about the overall impact of depression on their enterprises. For example, failure to recognize and treat co-occurring illnesses such as depression and heart disease, may lead not only to serious consequences for the employee but can ultimately contribute to increased health care costs, excess absenteeism, and unnecessary disability. From the standpoint of the the worker, although there are many interventions, effective medications, and legal recourse, there are barriers to recognition and treatment, including fear of stigma, under-recognition of symptoms by health care providers, limitation on insurance coverage, and inadequate or inappropriate treatment. Unfortunately, without access to recognition and treatment of a depressive disorder, the protection and requirements of laws such as the American with Disabilities Act become moot for many employees.

Despite increasing attention in the media, on the part of federal and state government agencies, campaigns by consumer and mental health advocacy organizations, technical support provided by NGOs and academic institu-