By Alison Herman
In February 2016, the British Medical Journal released an expansive study of workplace discrimination against people with major depressive disorder (MDD) spanning 35 countries with a total of 834 participants. The analysis revealed anticipated and experienced discrimination against a majority of the study’s participants (62.5%). Both anticipated and experienced discrimination had a deterrence effect with respect to employment, discouraging people with MDD from applying for work.
The countries included in the analysis were separated into groups according to their scores on the Human Development Index (HDI), which are determined on the basis of average life expectancy, average number of years of schooling, and gross national income per capita (Brouwers et al. 3). The groups were very high development, high development, and middle and low development countries together. Employment deterrence was stronger and more prevalent among workers in very highly developed nations as compared to countries with low and middle development status. Although this distinction of workplace discrimination across different countries provides a valuable insight, the cross-cultural nature of the study also limits its generalizability because differences across cultures and countries make it difficult to draw concrete conclusions.
Participants were selected by their mental health specialists, who were instructed to choose a minimum of 25 people who experienced MDD in the past year and were deemed representative of the general population of patients across age, race, and gender. The study’s authors point out that this purpose-driven sampling further limits the generalizability of results because lack of randomization does not control for factors which may skew the results.
High rates of discrimination raises the question: Is disclosing your mental health status prudent?
CNN’s article “Depression in the workplace: don’t ask, don’t tell?” quotes Clare Miller, director of the American Psychiatric Foundation’s Partnership for Workplace Mental Health, as saying disclosure may be prudent in cases where your condition requires special accommodations or significantly affects your job performance. In the latter case, she advises, “Try to do it early in the game as opposed to waiting until you get a bad performance review.” The study’s authors recommend a decision aide to weigh the costs and benefits of disclosure as a possible means of addressing workplace discrimination.
Additionally, the high rate of anticipated and experienced discrimination has troubling consequences. According to Brouwers et al., 30% of the participants “had stopped themselves from applying for work, education or training because of anticipated discrimination” (Brouwers et al. 1). This figure increases to 60% of participants for the very highly developed countries alone. These findings are consistent with labor statistics; Heather Stuart of the Department of Community Health and Epidemiology at Queen’s University reports that unemployment rates for people with MDD range estimate three to five times that of the general population. The effect of workplace discrimination on labor force participation places workers with MDD in a double bind: their absence from the workplace hinders normalization of depression in the workplace and this unaffected level of stigma further discourages seeking employment.
Furthermore, this employment effect presents an issue for effective management of depression since holding a job has been shown to promote feelings of self-efficacy and thereby benefit people with depression. Without the palliative effects of work on depression as a result of high levels of unemployment, patients have little opportunity to redress the root cause of their employment struggles.
Overall, in terms of intervention to remedy some of the ill effects of workplace discrimination, the authors suggest a balanced approach to both decrease stigma in the workplace and to increase confidence of people with MDD applying for jobs. One aspect of this approach that they suggest is implementation of legislation, such as the institution of disability quotas, in order to address the effects of discrimination. However, the authors are missing a crucial issue about the application of this legislation in practice. As Heather Stuart notes, “Employers are more likely to hire someone with a physical disability, thus raising doubts about the effectiveness of disability quotas as a method of affirmative action for people with mental disorders.”
Furthermore, the suggestion that we work toward increasing motivation for MDD as a solution has troubling implications. Placing the onus of resolution of the issue on people with depression places an additional burden on them and suggests that they are the root of the issue, when in fact the problem lies with prejudiced and discriminatory employers. Rather than a balanced approach to the problem, solutions should primarily seek to normalize depression and change negative and misinformed opinions of employers. Such an approach would help to address discrimination on a systematic level rather than relying on each individual person to find increased motivation to apply for work; further, improving the atmosphere of professional settings for people with MDD would preclude any need for a personal approach.
Brouwers, E. P M, J. Mathijssen, T. Van Bortel, L. Knifton, K. Wahlbeck, C. Van Audenhove, Kadri, Ch Chang, B. R. Goud, D. Ballester, Lf Tófoli, R. Bello, M. F. Jorge-Monteiro, H. Zäske, I. Milaćić, A. Uçok, C. Bonetto, A. Lasalvia, G. Thornicroft, and J. Van Weeghel. “Discrimination in the Workplace, Reported by People with Major Depressive Disorder: A Cross-sectional Study in 35 Countries.” BMJ Open 6, no. 2 (February 23, 2016). doi:10.1136/bmjopen-2015-009961.