Anxiety disorders pose productivity threat through myriad conditions
Anxiety disorders pose productivity threat through myriad conditions
Heightened government focus highlights advances in treatment
If the White House has taken notice, it may be time for health promotion professionals to redouble their efforts at addressing a significant threat to workplace health and bottom-line costs: anxiety disorders.
On June 7, 1999, the Clinton Administration convened the first-ever White House Conference on Mental Health to help dispel myths about people who suffer from mental illness. It is precisely these myths that keep many employees from reporting problems in this area. However, those myths are belied by scientific research.
"Research on the brain has shown that mental illnesses can be diagnosed, and that these diseases are treatable," notes Steven E. Hyman, MD, director of the National Institute of Mental Health (NIMH), Bethesda, MD. "We’ve learned that these diseases should be treated just like general medical disorders. If you had heart disease, you would get not only medication, but also rehabilitation, dietary counseling, and stress reduction; so it is with a mental illness."
Focusing on anxiety
Perhaps the most significant area of mental illness for workplace health professionals is anxiety disorders, which according to the NIMH, afflict more than 19 million adults ages 18 to 54. In 1990, anxiety disorders cost the United States $46.6 billion. Research has shown that the average annual cost per sufferer is $1,542, and that the average annual cost in the workplace is $256 per suffering worker. Of that figure, 88% is attributable to lost productivity while at work — as opposed to absenteeism.1 A closer look at what anxiety disorders are and how they affect an individual shows why. There are five major categories of anxiety disorders:
• Panic disorder, in which feelings of extreme fear and dread strike unexpectedly and repeatedly for no apparent reason, accompanied by intense physical symptoms.
• Obsessive-compulsive disorder (PCD), characterized by intrusive, unwanted, repetitive thoughts and rituals performed out of a feeling of urgent need.
• Post-traumatic stress disorder, a reaction to a terrifying event that keeps returning in the form of frightening, intrusive memories and brings on hypervigilance and a deadening of normal emotions.
• Phobias, including specific phobia (a fear of an object or situation), and social phobia (a fear of extreme embarrassment).
• Generalized anxiety disorder, exaggerated worry and tension over everyday events and decisions.
Those symptoms, notes the NIMH, are often chronic, and usually become worse if left untreated. "Tormented by panic attacks, irrational thoughts, and fears, compulsive behavior or rituals, flashbacks, or nightmares, or countless frightening physical symptoms, people with anxiety disorders are heavy utilizers of emergency rooms and other medical services. Their work, family, and social lives are disrupted, and some even become housebound. Many of them have co-occurring disorders such as depression, alcohol or drug abuse, or other mental disorders."2
"Of these five conditions, panic disorders and OCD’s can be particularly debilitating," notes Lynn Cave, who helps develop educational programs for the NIMH. "Agoraphobia, for example, is a panic disorder in which the individual may not be able to leave their home. If you are caught up in rituals (OCDs), work can also be severely impacted."
A workplace issue
Kathryn M. Magruder, PhD, MPH, associate professor, department of psychiatry and behavioral sciences at the Medical University of South Carolina, Charleston, agrees that anxiety disorders should be seen as a critical workplace issue.
Health promotion professionals should be concerned about anxiety disorders "because, first of all, they are fairly common," notes Magruder. "And, they often co-occur with other anxiety disorders and other psychiatric disorders such as depression. That makes them much more complicated; any time you have two disorders occurring together, it makes them more difficult to treat."
It’s often been seen that an anxiety disorder may precede development of an alcoholism disorder, says Magruder, so it may provide an opportunity for early and effective intervention. "This is to everyone’s benefit — employers, individuals, and co-workers."
And, as previously noted, anxiety disorders are costly. "In contrast with depression, where most of your costs come from lost productivity, there are also direct medical expenses related to anxiety disorders," she notes. "People who are having panic attacks may think they are having a heart attack, and often they will go to a doctor. Unfortunately, even the doctor may not recognize this to be a panic attack, and he may order very expensive work-ups. A lot of things may have to be investigated before the correct diagnosis is made."
This can increase the frustration and stress of the employee. "The person knows something is wrong, but when no answers are forthcoming they become more frustrated," says Magruder. "Then, of course, the anxiety grows, and that adds to the medical expense."
Perhaps even more important, she adds, is the effect of anxiety disorders on workplace activity. "These people tend not to be absent so much, but anxiety interferes with them performing their job as they should," she explains. "With agoraphobia [even if they are not homebound], they don’t want be near people; with other conditions, you may have a drinking problem, a feeling of losing control, and so forth."
Delivering the message
The good news is that significant advancements are being made. "There has been a revolution in neuroscience; we more fully understand the pathways in the brain and how they work, and we are poised for new treatments," notes Cave.
Magruder concurs. "There are a lot of new medications available, some of which have been approved for depression and are in fact now also indicated for anxiety disorders. This is really good news for everybody."
"We feel the time is ripe for education. We have to take this message to the workplaces — that anxiety disorders are real and treatable," Cave asserts.
To that end, NIMH has allied itself with the Employee Assistance Professionals of America (EAPA), of Arlington, VA, to create a work site education program on anxiety disorders. Called the Anxiety Disorders Workplace Education Program, it is being designed "to provide employee assistance professionals with research-based information about anxiety disorders; how to recognize them; and what treatments work," Cave explains.
Rick Wilde, RN, COHN, CEAP, medical supervisor at the General Motors plant in Fort Wayne, IN, has participated in EAPA focus groups seeking input for the planned program. "We talked about creating an awareness program," he notes. "This is extremely important, because many people don’t know about anxiety disorders, and therefore they can’t recognize the signs and the symptoms. This program should be focused on early recognition and treatment. With early recognition comes early intervention and treatment — which leads to better treatment outcomes.
"We are going to provide the necessary tools and resources to help employee assistance professionals create and implement educational programs for both employers and employees," Cave adds.
The training programs and materials will be developed first for the EAP professionals, and then materials will be developed for educating employers. "After all, they are the ones who determine the scope of benefits their employees will receive, and often mental health benefits are not on par with those offered for other medical disorders," notes Cave. "It’s important to educate them about how well the new treatments work."
Wilde keeps coming back to the awareness theme. "We think the program should be similar to the AIDS awareness and breast cancer awareness programs that are now being seen nationally — more awareness-oriented vs. detail-oriented," he says. "Our goal is to get these people into the medical system."
Overcoming stigmas
Such a program will help individuals "get into the medical system" by overcoming their reluctance to admit they have such a problem. "It may remove some of the stigma attached to these disorders just to know that there are many other people out there with same thing," Cave explains. "Those who suffer from anxiety disorders need to know that a lot of normal’ people have them. In fact, it would be great if some celebrity would step forward and say that they have an anxiety disorder; it would create a lot of positive awareness."
The program should be directed at the entire family, he adds. "It should go out to spouses and other family members because you are dealing with the whole family when an anxiety disorder hits," he explains.
The program will also spread the good news that there are now psychotherapies, such as cognitive behavior, as well as medication treatments that are proving efficacious in cases of anxiety disorders, Cave says. "They enable employees to function."
Finally, the program will also be designed to help make employees aware of the various signs and symptoms of these disorders.
This is important not only for employees, but for health promotion professionals as well, adds Magruder. "It’s very important to get the individuals who need treatment hooked into it."
Magruder says you can often identify an employee who may be suffering from an anxiety disorder through a sudden loss of productivity; they are just not doing as well on job as they had been. Or, you may note frequent medical visits. If you notice those or other classic symptoms, you should do the following:
• Get the person to understand they may have a problem.
• Get them to a physician.
Of course, this is sometimes easier said than done. "If they are reluctant to see a physician, you may want to make them aware of screenings that are available on the Internet, such as the Anxiety Disorders of America Web site," says Magruder. "The important thing is to get them help."
References
1. Greenberg PE, Sisitsky T, Kessler RC, et a. The Economic Burden of Anxiety Disorders in the 1990s. J Clin Psychiatry 1999; 60:427-435.
2. Anxiety Disorder Education Program, National Institute of Mental Health. NIMH Web site: www.nimh.nih.gov/anxiety.
• Kathryn M. Magruder, Department of Psychiatry and Behavioral Sciences, the Medical University of South Carolina, 67 President St., P.O. 250861, Charleston, SC 29425. Telephone: (843)-577-5011, ext. 7280.
• Lynn Cave, National Institute of Mental Health, 6001 Executive Boulevard, Room 8184, MSC 9663, Bethesda, MD 20892-9663. Telephone: (301) 443-4536. Fax: (301) 443-0008.
• Rick Wilde, General Motors Corp., 12200 Lafayette Center Road, Roanoke, IN 46783. Telephone: (219) 673-2113.
Books and Articles
• Babior S, Goldman C. Working with Groups to Overcome Panic, Anxiety, and Phobias: Structured Exercises in Healing. Duluth, MN: Whole Person Associates; 1996.
• Chambless DL, Gillis, MM. Cognitive Therapy of Anxiety Disorders. J Consult Clin Psychol 1993; 61(2):248-260.
• Kronke K, et al. Physical Symptoms in Primary Care. Predictors of Psychiatric Disorders and Functional Impairment. Arch Fam Med 1994; 3(9):774-779.
• Maser JD, Cloninger RD, eds. Comorbidity of Mood and Anxiety Disorders. Washington, DC: American Psychiatric Association, 1990.
• Mavissakalian MR, Prien RF, eds. Long-Term Treatments of Anxiety Disorders. Washington, DC: American Psychiatric Press Inc.; 1996.
• Zajecka JM, Ross, JS. Management of Comorbid Anxiety and Depression. J Clin Psychiatry 1995; 56(Suppl):10-13.
Videotapes
• Distinguished Professors of Psychiatry Series. Panic Disorder: Presented by Donald F. Klein. Ft. Washington, PA; 1994. To order, call (800) 263-6372.
• National Institute of Mental Health (For professional and lay audiences). Panic Disorder: Stories of Hope. Profiles three people with panic disorder and their journeys to recovery. Bethesda, MD: Modern Educational Services. Cost: $14.50. Telephone: (800) 237-4599.
Hotline
• NIMH maintains a toll-free information line for English- and Spanish-speaking callers. Materials are free of charge. Call 1-88-88-ANXIETY.
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