Jon Ulven, PhD Licensed Psychologist Adult Psychology Department Chair Sanford Health

Transcription

1 Jon Ulven, PhD Licensed Psychologist Adult Psychology Department Chair Sanford Health

2 Overview of This Hour A little about me Definition of Depression and Perspective of this Illness Depression in the Workplace Coping with Risk of Suicide at Work Preventing Depression at Work Increasing Mindful Moments at Work

3 What Isn t Depression? Having a bad day Having a bad attitude Normal sadness Part of normal aging (60% of people aged 65 or older believe it is normal to get depressed as we age) Grieving *The Loss of Sadness: How Psychiatry Transformed Normal Sorrow Into Depressive Disorder by Horwitz & Wakefield (2007)

4 What is Depression? When we talk about Depression, I want you to be thinking about Major Depressive Disorder which is sometimes called Clinical Depression. The Diagnostic and Statistical Manual, 4 th Edition, Text Revision (DSM-IV-TR) states that Major Depressive Disorder requires the presence of a Major Depressive Episode.

5 Major Depressive Episode Sadness Interest Guilt Energy Concentration Appetite Psychomotor Sleep Suicidality

6 What is Major Depressive Disorder (MDD)? According to the DSM-IV criteria for MDD, patients must have the following: 1. 5 or more SIGECAPSS symptoms for at least 2 weeks (Must have SADNESS or INTEREST as 1 of the symptoms) 2. Symptoms represent a change from previous functioning. 3. Clinically significant distress or impairment in social or occupational functioning.

7 Impact of Depression Depression is a major public health problem that is associated with decreased functioning and increased mortality. The estimated annual economic consequences of depression were 83 billion dollars in 2000 and 118 billion euro in 2004

8 Prevalence of Depression Survey data from 14 countries found that the estimated lifetime prevalence of unipolar major depression and persistent depressive disorder (dysthymia) is 12% Europe and the U.S. are at 18%for lifetime prevalence By all measures world wide, depression is on the rise

9 Stats on Depression #2 cause of disability according to the World Health Organization People with depression have % higher health costs Over 30,000 suicide/year People with chronic depression will die up to 20 years earlier, even when co-morbid illnesses are controlled for

10 Associated Factors of Depression Sex Women are 2 times more likely to develop depression than men based Race Caucasians have the highest rates of depression Age Major depression is less common in older than younger adults. Lifetime prevalence over 65 years = 10%. Lifetime prevalence in younger age groups = 19 to 23% Prevalence of depression in older adults declines as we age Certain groups of older adults have higher rates (e.g., medically ill, residents in assisted living or nursing homes, people who receive home health care)

11 Depression in the Workplace

12 Signs of Depression at Work Decreased productivity Morale problems New difficulties with co-workers Lack of cooperation Absenteeism Frequent statements about being tired Decreased concentration Alcohol and Drug Abuse (Peterson, 2014)

13 Addressing Depression Concerns Learn about depression and sources of help Recognize when employees show signs of performance issues that may be depression related (refer appropriately) Focus on changes in work performance. You may suggest that employee seek professional help if there are personal concerns. Remind about confidentiality.

14 What if the Employee Starts Talking to Me about Health Problems? Do not offer a diagnosis (e.g., I think I know what this is ) Recommend EAP or other services A depressed employee will likely need some flexibility with work for treatment Severe depression can be life threatening Take threats toward self or others seriously Listen, but consider your limits

15 Case Example Ann Ann has been working with you for over a year It is Fall. You are noticing that Ann comes dragging into work at the last minute, is often sighing and appears exhausted She does not appear as neat as usual. Hair, make up and clothes not put together like they normally are She has fallen behind on a couple reports. Not a big deal but noticeable Pair up and discuss how you would approach Ann. What is in bounds and what is out of bounds to discuss?

16 Coping with Risk of Suicide at Work

17 Warning Signs of Suicide Risk Sudden changes in behavior or mood, uncharacteristic silence and withdrawal, neglecting work, appearance, or hygiene Talking or writing about death or dying (e.g., What s the point of living? No one would miss me if I was gone.) Seeking lethal means (saving pills, asking to borrow a gun) Giving away possessions Asking about details of life insurance, especially cause of death Showing interest in end-of-life affairs (e.g., making a will, discussing funeral preferences)

18 Interacting with Suicidal Employee (3A s: Ask, Agreement, Arrange) Ask Find the employee, don t leave them alone, take them to a private place Be direct about what you ve learned (e.g., it has come to my attention that you said that life wasn t worth living ) Ask the employee if they have had thoughts of ending their life Give the employee a chance to explain. Don t Give Advice! Don t rush this! Show concern and support Do not promise to keep the matter confidential (Cigna 2010)

19 3A s Continued Agreement Take as long as necessary to hear what the employee has to say until you understand how they are feeling and thinking Ask, Will you be willing to get help today? If they agree to talk to an EAP counselor, call immediately

20 3A s Continued Arrange Employee Assistance Program (EAP) is here to help you before, during, and after the crisis. Call your EAP and say that it is urgent. Ask to speak with an EAP Consultant. Do not hand the phone to the employee until you have spoken with the EAP Consultant Tell the EAP Consultant the basic facts. If the employee agrees to speak with the EAP Consultant, offer paper and pencil. Let them speak with the EAP Consultant in private. Ask employee if you could talk with the EAP Consultant to learn the action plan (do this with employee in the room) Arrange a time to follow up with the employee to see how they are doing and get feedback about how you handled things

21 What if the Employee won t get help?!? If there is immediate danger, call 911 and security (if available). Involuntary treatment might be necessary Consult at once with HR, security or risk management. Don t do this alone! You may also need to call the employee s emergency contact person to alert them of the concerns Don t put off talking to the employee about these issues

22 Don t Forget About You! Coping with a suicidal patient is very stressful. Don t ever do it alone. It s not good for your emotional well-being, and you should process the data gathered and decisions made with an appropriate person at work You can use EAP services for a session or two to discuss how this situation impacted you Consult with HR or your supervisor no matter how smoothly or challenging this is. It is smart to do

23 Case Example David David has always been aloof (e.g., off to himself, doesn t come to department events, people would say he is hard to get to know). One day, David has a rare demonstration of emotion in the office. He was heard by an employee pounding on his desk and muttering a swear word. Another co-worker checks in and at some point David says, It won t matter when I m not here. The co-worker asks if he is leaving, and he says, No never mind. The co-worker comes to you with this story about David. What would you do?

24 Case Example Susan Susan looks depressed. She is sullen, downtrodden, and clearly not herself You approach her with concern, and she says, I just don t think I can go on any longer You follow up with her, and she bursts into tears. She says that she has been stock piling medication and plans to overdose this weekend when her kids are with her exhusband You say that you need to get her help. She back tracks on her story, says she is fine, and won t consider help. How would you approach this?

25 Preventing Depression at Work

26 Self-Determination Theory (Deci and Ryan) Psychology Well-Being at Work and in General is about the following 3 things: Sense of autonomy Opportunities to feel competent Inter-relatedness Take inventory with your workers about how you are doing in these 3 areas

27 Evidence-Support Strategies Regular exercise is as effective as an antidepressant New data to add support to walking, described as a Superfood. Three, 5 minute walks in a 3 hour period reversed effects of sitting. New estimates of 7500 steps per day versus 10,000. Hotel Study. How do you incentivize movement in your work place? Reducing caffeine. Switch to half-caffeine or go decaf in the afternoon We are social beings and need connection Workers who have a friend at work tend to be healthier and more productive Stress Management What do you do for this?

28 Increasing mindful moments at work

29 What is Mindfulness? Increasing our focus on the here and now Nonjudgmentally accepting what is happening with our thoughts, emotions, bodily sensations, and surrounding environment Being in the Moment

30 What s So Great About Mindfulness? Mindfulness Meditation is an Effective Intervention for the following: Pain management Improving immune system functioning Improves sleep, decreases anxiety, guards against depression

31 3 Minute Breathing Space: Shutting Off Autopilot First Minute: Acknowledging What s going on with me at this moment? What body sensations or feelings am I experiencing? Second Minute: Gathering Gently bring attention to your breath. Experience each in-breath and out-breath (try saying in your mind, breathing in, breathing out) Third Minute: Expanding Start expanding your awareness to include your whole body and not just the breath In-breath take in any awareness of sensations, thoughts, feelings Out-breath imagine letting softening and letting go

32 How Do I Get Better at This? YouTube Search Mindfulness Meditation Smart Phone Apps Search Mindfulness Meditation Yoga and Mindfulness Classes in Your Community

33 Questions/Comments What are 3 things you will take away from this presentation?