Productivity impact of stigma in the

workplace: A Global Perspective

Sara Evans-Lacko, PhD

Overview

1. Context around economic and social impact of

workplace mental health problems in Europe

2. Factors associated with improved workplace

openness, including productivity

3. How can we engage employers and managers

to promote mental health

Mental health problems in the workplace

• By far, the greatest contributor to the overall economic impact of mental health problems is loss in productivity…. but

• Beliefs reported by employers (survey of 500 UK employers)– 44% thought employees ‘suffering from stress are able to work effectively at

all time points

– 42% thought workplace policies for mental health / stress were designed to avoid litigation

• Global INDIGO survey (35 countries) showed 71% of people with depression conceal their diagnosis in the workplace

• Public stigma and workplace culture may influence both openness and disclosure and productivity

3Lasalvia, et al., 2013 Lancet; Henderson et al. 2013 BJP

Productivity

90%Mortality

6%

Service costs

4%

Total cost = £9 bn

Thomas & Morris Brit J Psychiatry 2003

Presenteeism costs (not shown) could be up to five times the size of absenteeism costs

Costs of depression for adults in England–absenteeism & unemployment

Mental illness & employment

Source: OECD, Sick on the job. Myths and realities about mental health and work, 2012.

0

20

40

60

80

100

Severe disorder Moderate disorder No disorder (↘)

Marmot Review 2010

Comparative employment rates by disability

0

5

10

15

20

2006 2010

% u

ne

mp

loye

d

No mental healthproblems

Mental healthproblems

Recession, unemployment, stigma (EU)

Source: Evans-Lacko, Knapp, McCrone, Thornicroft, Mojtabai PLOS ONE 2013

Recession widened the gap in

unemployment rates between

individuals with and without MH

problems …

The disadvantage facing people with mental health problems is greater in countries with higher levels of stigmatizing attitudes towards mental illness.

Probability of rejecting a person with depression for a job, by employment status

Angermeyer, M., Matschinger H., Schomerus, G., SPPE, 2013

What factors improve / worsen social exclusion in the workplace

9

Participant characteristics (n=7,065)

10

• 7 European countries • 7 European countries: Denmark, France, Germany, Italy, Spain, UK,

Turkey

• ~1,000 respondents / country who were in employment

• 20% of employed respondents reported a previous diagnosis of depression

11

Individual

Workplace

Country level

Likelihood of disclosure to employer

Perceived discomfort regarding depression in the workplace

Study 1

12

Country / Population level

variableIndividual level variable

0.7

0.73

1.55

2.08

1.03

0 0.5 1 1.5 2 2.5

Female gender

Offered help

Offered flexible working pattern

Avoided talking about it

Replacement ratio

Odds ratio

Employees feeling uncomfortable

Greater than 1 represents a greater likelihood of discomfort

Likelihood of disclosure to an employer

Population level variableIndividual level variable

1.49

3.06

2.05

0.5

1.31

2.16

0.5

0.59

1.02

0 0.5 1 1.5 2 2.5 3 3.5

Female gender

Older age (45-54 relative to 16-24)

Middle age (25-44 relative to 16-24)

University education

Working in a larger company

Offered help

Offered flexible working pattern

Encouraged talking to healthcare prof.

Replacement ratio

Greater than 1

represents a

greater likelihood

of disclosure

DO THESE FACTORS INFLUENCE PRODUCTIVITY AND COST

14

15

Individual

Workplace

Country level

Presenteeism

Absenteeism

Study 2

0 0.5 1 1.5 2 2.5

Avoid talking about it

Offered help

No manager support

Fear losing job

Employer wouldn't understand

16

Country / Population

variable

Individual level variable

Factors associated with absenteeism

Greater than 1

represents a

greater likelihood

of absenteeism

Controlled for: gender, age, education, country prevalence depression, GDP

*

*

*

*

0 0.2 0.4 0.6 0.8 1 1.2 1.4

Avoid talking about it

Offered help

No manager support

Fear losing job

Employer wouldn't understand

Factors associated with presenteeismamong employees with depression

17

Country / Population level

variable

Individual level variable

Greater than

1 represents

a greater

likelihood of

presenteeism

Controlled for: gender, age, education, prevalence depression, GDP

*

*

*

*

Can we make a case for investment to employers?

18

Case for investment is most effective when it is sector specific

Make sector specific outcome and economic arguments: Demonstrate that mental health can be improved by in the workplace, but also economic benefits to employer

Cost payoffs from an employer based perspective for screening & treatment of employees with depression over 27 months in Germany

Hypothetical cohort of 500 employees

(€)

Total insured population in Germany 3 (€)

Pharmacotherapy

Intervention costs1 41,491 3,136,719,600

Additional healthcare costs 26,908 2,034,244,800

Productivity losses (absenteeism) -37,404 -2,827,742,400

Productivity losses (presenteeism) -62,097 -4,694,533,200

Psychotherapy

Intervention costs 53,515 4045734000

Additional healthcare costs 26,908 2034244800

Productivity losses (absenteeism) -38,180 -2,886,408,000

Productivity losses (presenteeism) -62,097 -4694533200

Evans-Lacko et al., 2016

From the perspective of the employer, both pharmacotherapy and psychotherapy appear cost-

saving, despite costs of screening all employees

Growing evidence supporting anti-stigma programmes targeted at the workplace

Employers are interested but outreach is needed to link evidence and practice

Summary & Conclusions• Mental health problems are common in the workplace and associated with

significant social and economic impacts

• People with mental illness are disadvantaged -- even compared with other disability

• Employers/managers can facilitate a positive culture of openness and capacity to support people with mental health problems

• This can in turn influence productivity--more openness and comfort to offer help and support the employee rather than avoid them is associated with less absenteeism and more presenteeism

• Employers are beginning to engage with workplace

• Need to make sector specific case to employees –there is a case for investment from the employer perspective

• Employers need direct support to implement effective programmes which reaches managers but also employees

Thank you for your attention

Contact: S.Evans-Lacko@lse.ac.uk