Targeting symptoms, rather than disorders, might help reduce work impact of mental health issues

Symptoms such as insomnia and emotional distress account for much of the work impact of mental health problems such as depression and anxiety, reports a study in the February issue of Medical Care. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Many adults who don't have a formal psychiatric diagnosis still have mental health symptoms that interfere with full participation in the workforce, according to the new research by Kajal Lahiri, PhD, Pinka Chatterjee, PhD, and graduate student Souvik Banerjee of University at Albany, SUNY. They write, "From a policy perspective, interventions targeting workplace consequences of mental illness may benefit not only those who meet diagnostic criteria for mental illness, but also many of those with subclinical levels of symptoms."

Specific Mental Health Symptoms Affect Work Outcomes

Using combined data from three national databases, the researchers looked at how the relationship between mental health symptoms and work-related outcomes-for example, being employed or number of work absences. The analysis used a novel statistical modeling approach that captured the effects of mental health symptoms in individuals, whether or not they had clinically diagnosed psychiatric disorders.

"Variation in symptoms of disorders across many symptoms is typically more informative about the underlying health condition and is potentially richer than standard binary measures for any particular psychiatric disorder," Dr Lahiri and coauthors write. The study focused on symptoms associated with four mental health conditions: major depression, generalized anxiety disorder, social phobia, and panic attacks. The study methodology explicitly assessed symptom overlap across disorders.

For depression and anxiety, the model identified some specific symptoms as "crucial for labor market outcomes." For major depression, the factors with the greatest impact on work-related outcomes were insomnia and hypersomnia (sleeping too much), indecisiveness, and severe emotional distress. For women with major depression, fatigue was an additional important symptom.

For generalized anxiety disorder, the duration of the episode of anxiety was the factor with the greatest impact on work-related outcomes. Other important symptoms were difficulty controlling worry and emotional distress related to worry, anxiety, or nervousness.

Findings Suggest Treating Mental Health Symptoms, Not Diagnoses

Further analysis suggested that significant numbers of Americans did not meet diagnostic criteria for depression or anxiety, yet still had similarly poor mental health as diagnosed individuals. Depression symptoms had a greater impact on workforce participation than anxiety symptoms. Symptoms of panic attack and social phobia did not seem to have a significant impact on work outcomes.

The study comes at a time when clinicians and policymakers are increasingly skeptical about the usefulness of categorizing psychiatric disorders. Patients with mental health issues are usually treated according to their symptoms, rather than any diagnosis. Social Security and other disability programs with skyrocketing enrolments also focus less on diagnoses and more on individuals' capacity for work.

The results show that many Americans who don't meet diagnostic criteria still have mental health symptoms that interfere with their work participation. From a research standpoint, the authors suggest that considering non-diagnosed people as "healthy" is likely to underestimate the true impact of mental health symptoms on workforce participation.

From a policy perspective, they write, "Interventions targeting workplace consequences of mental illness may benefit not only those who meet diagnostic criteria, but also many of these with subclinical levels of symptoms." Targeting the symptoms most strongly related to occupational outcomes-for example, sleep problems related to depression or episodes of anxiety that last a long time-might be especially helpful for improving work functioning. "Besides the afflicted individuals, employers also would potentially stand to gain from improved work functioning of those individuals," Dr Lahiri and coauthors add.