This study revealed that 52.4% of the study participants were moderately, severely, or very severely work impaired. Previous studies reported that about 19% of workers with depression suffered from very severe work impairment and about 21% did not experience any effect on their work performance . A longitudinal study that compared work performance in depressed patients versus those who had rheumatoid arthritis and those who are healthy documented that depressed individuals showed more work impairment than the other two groups. In some instances, rehabilitation services are needed in addition to medical treatment to regain job performance [20, 21].
The current study documents that depressed patients with insufficient income (from the patient’s perspective) are more work impaired than those with sufficient income. A systematic review investigated the relatedness of many factors to depression among nurses reported that insufficient income was more associated with more sever levels of depression . It is possible that lack of motivation to work caused by the low income may have a role in lower work performance.
In this study, depressed patients whose educational degree is less than secondary school were significantly more work impaired than those who had higher education. completing education till secondary school. Authors believe that this might be due to the common association of lower educational degrees with unfavorable work stressors such as insufficient income. A cohort study that screened about 14268 subjects reported that depression was related to work impairment and partly confirmed that job stressors add to this impact .
This study emphasizes that, being a farmer or a manual worker with depression is significantly associated with work impairment than being in depressed and in a professional job. It could be attributed to job characteristics such as long work hours, high job demands, and lower autonomy. This accords with some studies showed the interaction between job characteristics and work impairment in depressed workers .
The current study reports that depressed workers in morning shifts had significant work impairment than those who work night or rotating shifts. This might be attributed to diurnal variation of depressive symptoms among the study participants or sleep deprivation . Some research report that work impairment due to mental health issues such as job stress are worst in the late night and early morning shift workers .
The current study documents that patients whose work is an own business were more work impaired than those who work in governmental or private sectors. Authors believe that an own business gives more chance to the depressed patient to have more days off and lose more work hours. Being scheduled to work less than 80 hours during the last 2 weeks was significantly associated with more work impairment. This suggests less pressure to do work and more chance for the occurrence of work impairment.
Depressed workers who missed 5 or more working hours during the past 2 weeks had significantly more work impairment than those who lost less. A survey that used Patient Health Questionnaire 9-item screen (PHQ-9) reported that for every 1 point increase in the PHQ score, there was a significant mean productivity loss of 1.65% .
This study documents that bipolar depression can significantly impact work performance. A systematic review that analyzed 14 work impairment articles documented that patient with bipolar disorders reported work performance improvement upon treatment . In another study neuropsychological assessment of both unipolar and bipolar patients during a depressive episode emphasized that, bipolar group achieved significantly lower levels of cognitive performance. This would be linked to many aspects of job performance such as memory and concentration at work . This was also proved by brain imaging in other studies .
According to this study, the higher HDRS, the more is the affection of work performance. HDRS of 25 or more significantly impairs work performance and is considered as severe depression. In the current study, depression severity based on HDRs was significantly associated with more work impairment. A study that examined the effect of depression (diagnosed by Beck’s Depression Inventory) on academic performance of students reported that significant affection was more apparent in moderately and severely depressed students . A systematic review that included 10 published studies emphasized that functional impairment was more associated with moderate to severe depression whereas affective impairment was associated with mild depression .
The current study documents that depression for more than 3 years is more associated with lower work performance, and that this impact is significant. This is supported by another study that reported early intervention to treat depression (by first line antidepressants) as protective against work impairment and long term disability .
Previous hospitalization and having 2 or more depressive episodes are significantly related with lower job performance according to the current study. This accords with the previous results about the relatedness of depression severity with work impairment. In the current study, requiring more than one line of treatment (medical treatment and electroconvulsive therapy) is significantly associated with work impairment. Some research work referred that antidepressant treatment is associated with improved work performance and reduced absence .
In our study, having 5 or more depressive symptoms can significantly impair work performance. According to the (DSM), diagnosis of major depression can be based on the presence of 5 or more depressive symptoms .
According to the current findings, death thoughts (as a symptom of severe depression) are significantly associated with work impairment. Other research articles documented that hypersomnia and sad mood significantly impact performance not only in work, but also social, home, and private activities .
According to this study, having other chronic controlled non disabling medical conditions significantly impairs work performance. A systematic review supported the association between many personal, work related, and clinical factors in depressed patients and lower work participation including the presence of chronic physical illnesses .
The current study reports that being a depressed smoker or drug user is significantly related with more impairment of performance. It is agreed upon that there is a reciprocal relationship between smoking and depression . Depressed patients are at twice risk to smoke than non-depressed ones . Results from the British 1946 cohort emphasized that smoking per se greatly impacts physical performance . In the current study, drug using depressed patients were occasional, and had more severe recurrent episodes. Their worse work performance is thought to be due to depression rather than the occasional drug use.
The current study reports that depressed patients with positive family history for depression are significantly work impaired. Other research studies documented that familial predisposition is associated with more severe forms such as major depressive disorders .
In the current study, poor concentration and poor memory were the most encountered features of work impairment among the study participants. Authors believe that these features are crucial for job performance and represent a fair explanation to having more than half of the study participants exceeding the mean work impairment score. In the current study, degrees of impairment encountered were mild followed by non to minimal impairment, severe, very severe, and moderate work impairment. Data from the Canadian Community Health Survey 2002 documented that commonest work interference scores among the examined individuals were mild followed by non to minimal, very severe, moderate, and severe work impairments .
The current study investigated many factors; sociodemographic, occupational, and clinical, regarding their relatedness to work impairment in depressed patients. From organizational psychology perspective, some factors may have contributed to improved work performance among the patients, such as social support at work; it relates directly to higher job control, and better organizational productivity . Other factors might have existed, this could be a point for further research.
The current study may be limited by the subjective nature of some items of the questionnaire such as income, and whether the work environment is hazardous or not. Not all depressed patients have help seeking behaviors, so authors expect the prevalence of work impairment among depressed workers to be more. Many depressed workers continue working with impaired productivity (presentism) and this has its impact on productivity. Authors recommend workplace screening that targets psychiatric illnesses such as depressive and any other disorders that can impact worker’s work performance. This is cost-effective steps that greatly enhance productivity and improve economy.