Differentiating « Burnout » from Depression: the role of cortisol
By Dr. Sonia J. Lupien, Ph.D.
According to the World Health Organization (WHO), major depression will be the second cause of invalidity in humans by 2020, after cardiovascular disease. This constitutes a phenomenal rise over the next years.
Mental health in the workplace
One in two workers who will be absent from work because of mental health troubles will be absent for an average of 13 days or will never return to work. On average, the costs associated with an absence of about forty days, per employee, are at the order of ten thousand dollars. A recent study attributed the costs of depression in the workplace at the order of 4.5 billion Canadian dollars.
The long term effects
This situation entails negative consequences for the four big players of workplaces : the insurance companies, the employers, the mental health system, and the individual.
a- The insurance companies
In 1991, 15% of insurance claims were related to mental health troubles. Ten years later, this number had tripled. Today, about 40% of insurance claims are related to these types of troubles, which costs insurance companies some fifteen to thirty-three million dollars per year. In the long run, there is a risk of lowered insurance coverage, or at the very least, a modification to its nature given the costs which never cease to augment, as would the elevated invalidity coverage, because of the notable rate of absenteeism related to the aforementioned troubles.
b- The employers
1- The costs of replacement and legal actions
The costs for employers are enormous as are there different inter-related sources. Firstly, it costs to replace absent employees. Secondly, there are more and more legal actions taken by employees against employers that are related to stress or to mental health. These have doubled over the last years. The best example to illustrate this phenomenon is to take American enterprises as a case study. In effect, these companies are bound to insure the psychological well-being of their employees. Yet, the augmentation of legal cases related to stress and job strain make it such that in the United States, nine out of ten lawsuits are successfully won.
2- The costs of presenteeism and of absenteeism
What costs a lot for companies, which we probably underestimate and is beginning to be very important, is what we qualify as « presenteeism » or « the Quidam effect ». This last phenomenon takes into account the fact that the body is at work, but the head is not. Employees that suffer from stress and/or mental health problems present themselves at work, but their performance is diminished considerably.
A study from the United States demonstrated that during a two-week period, absenteeism would cost one hour per employee, for a total of eight billion dollars annually. When it comes to the effects of presenteeism, this equals four hours lost per week, for a total of thirty-six billion dollars annually. This leads us to believe that presenteeism and the potential means for preventing it will become more and more the order of the day for decision-makers and for researchers.
c- The health care system
« Burnout » or professional exhaustion was identified in 1980; it did not exist before. It was characterized as being a mental trouble linked to job strain, the majority coming from types of work that necessitate high empathy on the part of the worker (e.g., professor, nurse, physician, etc.). Today, « burnout » is a very blurry psychiatric entity, which causes a difficulty in differentiating a diagnosis of « burnout » from one of depression. Furthermore, it is very difficult for a treating physician to diagnose « burnout », which leaves place open to the possibility of numerous maltreatments.
In effect, a person who presents a state of psychological distress might be diagnosed a particular illness. This often pushes physicians to pull the person out of their work and to prescribe a psychiatric evaluation and to have a validation of the diagnosis issued by a family doctor. This effectively surcharges already long waiting lists in psychiatry. The more a person is held waiting, however, the more they are in prolonged absence.
For psychiatrists, this causes grumbling. They complain of this surcharge often related to unjustified cases.
A group of psychiatrists from the West Island carried out a study where only 25% of cases examined, which were on their waiting lists showing troubles with « burnout » or of depression (Lalla F, Rosenberg L, Brown R. 2004. ‘Inappropriate Interventions : An examination of how the medical model can complicate recovery and function’, December 3, 2004, Pointe-Claire).
d- The individual
Being diagnosed with a mental health problem is not an easy thing for the individual. In fact, the diagnosis can stick to the skin for a long time. The diagnosis can, in the long run, end by affecting and driving one towards diminished self-esteem. When it comes to the long term consequences, this can translate into a loss of revenues and a negative evaluation from peers and from family. Likewise, pulling back the individual from their workplace while they suffer from mental health problems implies pulling back the social support formed as a result from interactions in the workplace.
In fact, employees spend on average eight hours per day in a social environment which has almost become the only place for relationships and social support. At home, it’s the family that takes the shift. Social support becomes in essence the best means of negotiating mental health problems. Indeed, more and more psychiatrists doubt the efficacy of pulling the worker out of their workplace. In doing so, they are being removed from a social support network that they need to better recover.
In the end, it iss the individual who losses the most, since beyond the suffering, they are at risk of reductions in insurance coverage that they need, as well as an evaluation in mental health once interviewed for a job. If they prove to have genuine suffering from a mental health problem, they should take their pain with patience since the waiting lists are overloaded, without even talking about the costs of a bad diagnosis from all points of view.