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Anxiety and depression in the workplace:

Effects on the individual and organisation
(a focus group investigation)

Article in Journal of Affective Disorders · November 2005

DOI: 10.1016/j.jad.2005.07.009 · Source: PubMed

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 Journal of Affective Disorders 88 (2005) 209 – 215
www.elsevier.com/locate/jad

Brief report

Anxiety and depression in the workplace: Effects on the individual

and organisation (a focus group investigation)
C. Haslam a,*, S. Atkinson b, S.S Brown b, R.A. Haslam b
a
Institute of Work, Health and Organisations, University of Nottingham, William Lee Buildings 8,
Nottingham Science and Technology Park, University Boulevard, Nottingham, NG7 2RQ, UK
b
Health and Safety Ergonomics Unit, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK
Received 4 January 2005; received in revised form 22 July 2005; accepted 22 July 2005

Abstract

Background: While the prevalence of anxiety and depression has increased, little is known of the impact on working life. The
aim of this study was to explore the effects of anxiety and depression and the treatment for these conditions on performance and
safety in the workplace.
Method: Nine focus groups were conducted with employees who had suffered anxiety and depression. A further 3 groups
comprised staff from human resources and occupational health. The sample comprised 74 individuals aged 18–60 years, from a
range of occupations. Results were presented to a panel of experts to consider the clinical implications.
Results: Workers reported that the symptoms and medication impaired work performance, describing accidents which they
attributed to their condition/medication. Respondents were largely unprepared for the fact that the medication might make them
feel worse initially. Employees were reluctant to disclose their condition to colleagues due to the stigma attached to mental
illness.
Limitations: People who had experienced problems with managing their symptoms and medication at work are more likely to
volunteer to participate in such a study than those who had a satisfactory experience. Also, the researchers had no background
information on severity of mental health problems of participants.
Conclusions: Anxiety and depression were associated with impaired work performance and safety. The authors consider the
implications for health care and the management of mental health problems at work.
D 2005 Elsevier B.V. All rights reserved.

Keywords: Anxiety; Depression; Medication; Work; Safety

1. Introduction

Anxiety and depression has increased sharply in

* Corresponding author. recent years (HSC, 2004), and prescriptions for med-
E-mail address: [email protected] (C. Haslam). ication have also increased. Laboratory studies show
0165-0327/$ - see front matter D 2005 Elsevier B.V. All rights reserved.
doi:10.1016/j.jad.2005.07.009
210 C. Haslam et al. / Journal of Affective Disorders 88 (2005) 209–215

that psychotropic medicines impair attention, mem- material into themes using the method described by
ory and motor coordination (Potter, 1990), but it is Knodel (1993). Reliability was ensured through sys-
unclear how this translates to the workplace (Tilson, tematic review of the data by 3 researchers.
1990). Lack of treatment may also be a problem as
employees suffering with anxiety or depression are
likely to experience symptoms (e.g. fatigue and poor 3. Results
concentration) that impair performance. This research
used a qualitative approach to collect data on anxiety Demographic profiles of participants (n = 74) are
and depression and the use of psychotropic medica- shown in Tables 1 and 2. Table 3 lists areas of expertise
tion among the working population. of the expert panel. Table 4 shows the medication taken
and proportion receiving each class of drug.
The physical symptoms included: nausea, head-
2. Method aches, dizziness, trembling, insomnia and lack of
energy. Psychological symptoms involved: poor con-
Twelve focus groups were used to collect informa- centration, extreme emotional distress and lack of
tion on the experiences of people with anxiety and motivation. Respondents reported that they were
depression. Various recruitment techniques were used: unable to concentrate or to make decisions. Partici-
liaison with established contacts in organisations and pants found it difficult to distinguish between the
trades unions; mail shots, telephone calls and emails symptoms and the medication as both were reported
to organisations; advertisements in newspapers, pro- to lead to: confusion, dizziness, shaking, nausea, sleep
fessional publications and local radio; and distribution disturbance and difficulties with decision making.
of posters to organisations. Established organisational Work performance was thought to suffer due to the
contacts, advertisements and posters produced most symptoms and medication. A 43-year-old female con-
respondents. sultant psychiatrist explained:
Twelve focus groups were conducted. Nine
involved people with personal experience of anxiety/ bI get very indecisive, which isn’t very good when
depression in the previous 2 years and who had taken you are meant to make decisions and then I can feel
prescribed medication during that period. No informa- myself getting pushed into making hasty and perhaps
tion was gathered on the presence of physical illnesses wrong decisions.Q
or other types of medication. The groups comprised: Non-compliance with medication was common
(over 2/3rds of the sample) due to unpleasant side
! Individuals from health care, social services, edu- effects, lack of improvement in symptoms or because
cation, manufacturing, engineering, retail, service the medication initially made users feel worse.
industries (6 groups), Respondents were largely ill prepared for their med-
! Individuals attending anxiety management courses ication and would have welcomed more information
(3 groups). from doctors. Some people took less than the pre-
scribed amount or stopped taking the medication due
Three focus groups were conducted with staff ha- to concerns about dependency.
ving responsibility for human resources, occupational Workers described a range of accidents, which they
health and health and safety. The aim was to examine attributed to their condition or medication, including
organisational policy relating to mental health. The industrial injuries and falls:
results from the 12 groups were presented to a panel
of experts to consider the clinical implications. bI had a series of falls at the time. . . I would go faster
Two focus group interview schedules were deve- and faster and faster. If I’d got a large queue, I’d try
loped, one for employees and one for organisational and deal with them really quickly and then, because I
representatives. Each discussion lasted for approxi- know they’re all waiting I wouldn’t take a break. I’d
mately 90 min and was recorded. The recorded mate- go faster and faster and I’m sure I would walk faster
rial was transcribed and analysed by sorting verbatim and faster. I had a series of falls and they actually sent
 C. Haslam et al. / Journal of Affective Disorders 88 (2005) 209–215 211

me for some tests because of it.Q [female working in mental health problems in the workplace. Respondents
university administration] commented that danxiety and depression should be as
easy to talk about as a coldT. Participants felt that there
The risks associated with self-medication, such as needs to be increased awareness and understanding
alcohol, herbal products and caffeine, were discussed from managers.
by the expert panel. Alcohol was identified as a parti- Respondents noted that lack of flexibility meant
cular work hazard, self-medication with herbal pro- there was little scope for maintaining people with
ducts may involve larger doses than recommended anxiety and depression at work. Organisational repre-
and excessive use of caffeine was also considered a sentatives commented that the extent of support
problem. offered varied according to the size and culture of
Respondents felt stigmatised because people did not the organisation. Some employees stated that they
understand conditions like anxiety and depression. had very supportive managers who offered work mo-
Recognition of anxiety and depression as genuine ill- dification, reduced hours, redeployment, etc., to enable
nesses was thought to be a first step in dealing with sufferers to keep working. But many (over 75%) iden-

Table 1
Employee focus group participant details
Group Gender Employment Age range
mean (S.D.)
Anxiety management 8 female Secretarial, Sales, 18–55
group 1 Unemployed (2) Photographic 36 (14.3)
assistant, Care assistant, Sales
consultant, Prevocational tutor
Anxiety management 5 female Scientific officer (NHS), 28–63
group 2 3 male Retired (2), Administrator, 47 (13.3)
Veterinary Surgeon, Car mechanic,
Electrician
Anxiety management 3 male Programme Area Manager/Lecturer, 22–55
group 3 1 female Primary School Head 40 (15.5)
Teacher, Unemployed, Researcher
Employee Group 1 2 female Teacher (3), University administrator, 35–60
5 male Teacher in higher education, Registrar 45 (9.3)
in primary school, University technician
Employee Group 2 7 female Admin in university (2), Bank, Council 29–53
worker, University administrator, 44 (8.2)
Enquiry officer—police station,
Public sector
Employee Group 3 5 female Car leasing—payroll, Food manufacturing, 30–56
2 male Advisory teacher, 45 (10.2)
Accounts—coach company, Personnel,
Mental Health Social
Worker, Freelance Lecturer
Employee Group 4 3 female Front line manager—food company, 33–58
[Managers] 2 male Personnel manager (NHS), 48 (8.9)
Health and safety manager (2), Head
teacher, Worker in higher
education
Employee Group 5 2 female Lawyer in Civil service, Veterinary 45–54
[Managers] 2 male Surgeon, Deputy governor of prison, 48 (3.8)
Computing services at university
Employee Group 6 3 female Locum staff grade psychiatrist, 28–54
1 male Consultant psychiatrist, Former GP, 40 (11.16)
Senior House Officer
212 C. Haslam et al. / Journal of Affective Disorders 88 (2005) 209–215

tified management methods as contributory factors in Table 3

their anxiety and depression and felt that unmanage- Range of disciplines covered by the expert panel
able workloads had contributed to the development of Validation group panel of experts
their mental health problems. When managers were Union representative—MSF (Manufacturing, Science and Finance)
approached, they were often dismissive because no Psychiatrist and academic researcher
Health Safety and Environment Advisor
one else had indicated that they were having problems.
Occupational Physician
Colleagues were identified as providers of practical Professor of Occupational Health Psychology
support and an opportunity for sufferers to talk about General Practitioner
their problems. Support networks were often lost when Senior lecturer and researcher in mental health in the workplace
people were absent through sickness. Union representative—UNISON (Public service union)
Clinical Psychologist who runs anxiety and depression
Organisational representatives mentioned various
management courses
methods of rehabilitation, including: phased returns
to work, therapeutic hours over 4 to 6 weeks starting
with as little as 2 h a day or excusing staff from pressure through having to cover the shortfall. They
dfrontlineT duties such as customer contact. Partici- felt that organisations need to appreciate that such
pants felt that occupational health staff should identify measures will ultimately result in improved staff mor-
the implications for work of any medication taken. ale and productivity along with reductions in sickness
Liaison between employers and physicians about absence rates and staff turnover.
rehabilitation was mentioned as enabling workers to
return to work earlier. The expert panel felt that
prolonged absence from work removes the person’s 4. Discussion
social network and can exacerbate problems. Organi-
sational representatives noted that employees return- The physical and psychological symptoms of anxi-
ing to work on reduced hours should be dextraT to the ety and depression were reported to impair work per-
staff needed, to avoid other workers being put under formance and increase the risk of accidents. Non-

Table 2
Organisational representatives
Group Gender Employment
Organisational group 1 Male Occupational Health Nurse—manufacturing
Male Occupational Health Physician—manufacturing
Female Occupational Health and Safety Advisor—manufacturing
and construction
Organisational group 2 Male Training Manager—Human resources development
Male Hospital Human Resources Manager
Female Counselling and Support Unit Manager
Female Human Resources Manager in SME
Female Senior Human Resources Advisor—healthcare
Female Personnel Officer—education
Female Senior Personnel Officer–education
Organisational group 3 Male Occupational Health Nurse—manufacturing
Male Occupational Health Nurse—manufacturing
Male Union Health and Safety Representative
Female Occupational Health Nurse—manufacturing
Female Health and Safety Officer—borough council
Female Occupational Health Nurse—health care
Female Occupational Health Nurse—ambulance service
Female Nurse Specialist (Occupational Health)—healthcare
Female Occupational Health Nurse—health care
Female Occupational Health Nurse Specialist—civilian and
service employees
 C. Haslam et al. / Journal of Affective Disorders 88 (2005) 209–215 213

Table 4
Summary of psychotropic medication
Drug group % respondents prescribed Drug Proprietary name
this class of drug
Selective serotonin 72 Citalopram Cipramil
reuptake inhibitors Fluoxetine Prozac
Fluvoxamine Maleate Faverin
Paroxetine Seroxat
Sertraline Lustral
Benzodiazepines 30 Diazepam Valium
Lorazepam Ativan
Temazepam
Anti depressants 19 Venlaxafine Efexor
Mirtazapine Zispin
Nefazodone Hydrochloride Dutonin
Flupentixol Fluanxol
Tricyclics 9 Imipramine Hydrochloride Tofranil
Amitriptyline Hydrochloride Lentizol/Triptafen/Triptafen-M
Dothiepin Hydrochloride Prothiaden
Doxepin Sinequan
Anti manic 6 Lithium Citrate Li-Liquid/Priadel
Lithium Carbonate Camcolit/Liskonum/Priadel
Beta blockers 4 Oxprenolol Hydrochloride Slow-Trasicor
(Modified release)
Trasidrex (with diuretic)
Pindolol Visken
Viskaldix (with diuretic)
NB: some respondents were prescribed more than one class of drug.

compliance with medication was common, which may ing a physical rather than mental illness (Manning and
lead to poor control of symptoms and impaired work White, 1995).
performance. The side effects of medication were con- The results suggest that anxiety and depression and
sidered to be similar to the symptoms of anxiety and medication impact on work. At the individual
depression. This finding concurs with a growing body employee level this leads to impaired work perfor-
of evidence which suggests that even newer generation mance, accidents and sickness absence. At the organi-
antidepressants are by no means free of side effects sational level there are likely to be effects on
(Glenmullen, 2000). People in this study were unpre- productivity, staff morale, accidents, absences and
pared for the fact that their medication might initially staff turnover. Fig. 1 represents these inter-relation-
make them feel worse. ships as a schematic model. Based on the results, the
Most respondents believed that unmanageable authors outline some recommendations for workplace
workloads contributed to their anxiety and depression. and health care practices.
While some had supportive managers, many workers Workplace practices:
felt that their managers offered little help. Respondents
felt stigmatised and were reluctant to tell people at work ! mental health issues should be an integral part of
about their illness. They perceived a lack of under- health and safety training,
standing about the nature of anxiety and depression ! organisations should conduct risk assessments
among their colleagues and managers. This study con- relating to mental health,
curs with research showing that people hold negative ! maintaining workers with anxiety and depression at
beliefs about depression (Jorm et al., 1997) and that work or rehabilitating workers following sickness
managers are more likely to believe sick-notes declar- absence requires coordination between managers
214 C. Haslam et al. / Journal of Affective Disorders 88 (2005) 209–215

CONTRIBUTING ANXIETY & MEDICATION EFFECT ON EFFECT ON

FACTORS DEPRESSION INDIVIDUAL ORGANISATION

High Mental ill-health Unpleasant side

workloads effects of Loss of social Poor staff
prescribed networks/Isolation morale/unhealthy
medication which organisation
Insensitive Psychological
management symptoms occur immediately
(poor concentration, (confusion, dizziness,
emotional distress, shaking, nausea,
Poor lack of motivation, sleep disturbance, Unemployment Increased
communication difficulties with difficulties with staff turnover
decision making) decision making)

Low awareness
of mental Sickness
health issues Physical absence
symptoms
(nausea, headaches,
Poor industrial dizziness, trembling, Non compliance
relations insomnia, fatigue) (lack of information,
lack of confidence in Accidents Reduced
treatment)
productivity

Stigma
Self medication
(alcohol, caffeine, Impaired work
herbal remedies) performance

Fig. 1. Schematic model of the factors contributing to anxiety and depression and the impact of these conditions on work.

and staff from occupational health and health and problems faced by employees with anxiety and
safety. depression.

Health care practices:

Acknowledgements
! there is a need for careful patient monitoring during
treatment, This work was funded by the UK Health and
! patients need accessible information leaflets, Safety Executive. The views expressed are those of
explaining the actions of medication and potential the authors and do not necessarily reflect HSE policy.
impact on safety, We would like to thank our focus group participants
! more liaison is required between health care pro- for their support and for the time they gave so gener-
fessionals and employers, ously to this study.
! employees should be actively involved in treatment
and rehabilitation.
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