Journal of Occupational Rehabilitation

, Volume 17, Issue 4, pp 623–640 | Cite as

Receiving Treatment and Labor Force Activity in a Community Survey of People with Anxiety and Affective Disorders

  • Geoffrey Waghorn
  • David Chant


Introduction Standard treatments for depression and anxiety disorders are generally expected to benefit individuals, employers, and the wider community through improvements in work-functioning and productivity. Although some evidence supports expectations of treatment benefits, these are rarely examined at a population level. Methods We investigated receiving treatment, labor force activity, and self-reported work performance among people with ICD-10 affective and anxiety disorders. Data were collected by the Australian Bureau of Statistics using representative multistage sampling strategies. This large household probability sample consisted of 37,580 working age individuals. A secondary analysis was conducted using multiple binary logistic regression. Results After statistically controlling for eight covariates: extent of employment restrictions; mental health status; age; sex; partner status; country of birth; age left school; and educational attainment; receiving treatment was consistently associated with non-participation in the labor force, and was negatively associated with work performance. Conclusions At a population level, receiving treatment for anxiety and depression was negatively associated with being employed or looking for work. This could be an unintended side effect of treatment, although other explanations are also possible. These results justify more specific longitudinal investigations into how different forms of mental health treatment influence labor force activity among working age community residents with anxiety and affective disorders.


Anxiety Depression Disability Employment Treatment Work performance 


  1. 1.
    Conti DJ, Burton WN. The economic impact of depression in a workplace. J Occup Environ Med. 1994;36:983–8.Google Scholar
  2. 2.
    Lerner D, Adler DA, Chang H, et al. Unemployment, job retention, and productivity loss among employees with depression. Psychiatr Serv. 2004;55:1371–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Stewart WF, Ricci JA, Chee E, Hahn SR, Morganstein D. Cost of lost productive work time among US workers with depression. J Am Med Assoc. 2003;289:3135–44.CrossRefGoogle Scholar
  4. 4.
    Allen P. For the employer productivity is critical. Healthc Pap. 2004;5:95–7.PubMedGoogle Scholar
  5. 5.
    Berndt ER, Finkelstein SN, Greenberg PE, Howland RH, Keith A. Workplace performance effects from chronic depression and its treatment. J Health Econ. 1998;17:511–35.PubMedCrossRefGoogle Scholar
  6. 6.
    Dewa C, Lin E. Chronic physical illness, psychiatric disorder and disability in the workplace. Soc Sci Med. 2000;51:41–50.PubMedCrossRefGoogle Scholar
  7. 7.
    Lim D, Sanderson K, Andrews G. Lost productivity among full-time workers with mental disorders. J Mental Health Policy Econ. 2000;3:139–46.CrossRefGoogle Scholar
  8. 8.
    Andrews G, Henderson S, Hall W. Prevalence, co-morbidity, disability and service utilisation. Overview of the Australian national mental health survey. Brit J Psychiatr. 2001;178:145–53.CrossRefGoogle Scholar
  9. 9.
    Barlow DH (editor). Clinical handbook of psychological disorders. 2nd ed. New York: The Guilford Press; 1993. Chap. 1–5.Google Scholar
  10. 10.
    Andrews G, Hunt C. Treatments that work in anxiety disorders. Med J Aust. 1995;168:628–34.Google Scholar
  11. 11.
    Waghorn G, Chant D, Lloyd C. Labor force activity among Australians with musculoskeletal disorders comorbid with depression and anxiety disorders. J Occup Rehabil. 2006;16:241–52.PubMedCrossRefGoogle Scholar
  12. 12.
    Andrews G, Hall W, Teesson M, Henderson S. The mental health of Australians. National survey of mental health and wellbeing. Report 2. Canberra: Mental Health Branch, Commonwealth Department of Health and Aged Care; 1999.Google Scholar
  13. 13.
    Bijl RV, de Graaf R, Hiripi E, et al. The prevalence of treated and untreated mental disorders in five countries. Health Aff. 2003;22:122–33.CrossRefGoogle Scholar
  14. 14.
    Henderson S, Andrews G, Hall W. Australia’s mental health: an overview of the general population survey. Aust N Z J Psychiatr. 2000;33:197–205.CrossRefGoogle Scholar
  15. 15.
    Katon WJ, Unutzer J, Simon G. Treatment of depression in primary care. Where are we, where can we go? Med Care 2004;42(12):1153–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Nathan PE, Gorman JM. (editors) A guide to treatments that work. New York: Oxford University Press; 1998.Google Scholar
  17. 17.
    Wang PS, Berglund P, Kessler RC. Recent care of mental disorders in the United States. Prevalence and conformance with evidence-based recommendations. J Gen Intern Med. 2000;15:284–92.PubMedCrossRefGoogle Scholar
  18. 18.
    Schoenbaum M, Unutzer J, McCaffery D, Duan N, Sherbourne C, Wells KB. The effects of primary care depression treatment on patients’ clinical status and employment. Health Serv Res. 2002;37:1145–58.PubMedCrossRefGoogle Scholar
  19. 19.
    Zhang M, Rost K, Fortney J, Smith R. A community study of depression treatment and employment. Psychiatr Serv. 1999;50:1209–13.PubMedGoogle Scholar
  20. 20.
    Kessler R, Frank G. The impact of psychiatric disorders on work loss days. Psychol Med. 1997;27:861–73.PubMedCrossRefGoogle Scholar
  21. 21.
    Waghorn G, Chant D. Labor force activity by people with depression and anxiety disorders: a population level second order analysis. Acta Psychiatr Scand. 2005;112:415–24.PubMedCrossRefGoogle Scholar
  22. 22.
    Waghorn G, Chant D. Work performance among Australians with anxiety and depression: a population level second order analysis. J Nerv Mental Dis. 2006;194(12):898–904.CrossRefGoogle Scholar
  23. 23.
    Australian Bureau of Statistics. Survey of disability, ageing and carers, Australia. Technical paper. Confidentialised unit record file 1998. Canberra: Commonwealth Government; 1999.Google Scholar
  24. 24.
    Waghorn G, Chant D, White P, Whiteford H. Disability, employment and work performance among persons with ICD-10 anxiety disorders. Aust N Z J Psychiatr. 2005;39:55–66.CrossRefGoogle Scholar
  25. 25.
    World Health Organization. International classification of diseases, 10th ed. (ICD-10). Geneva: World Health Organization; 1993.Google Scholar
  26. 26.
    National Centre for Classification in Health. ICD-10-AM mental health manual. An integrated classification tool for community-based mental health services. Canberra: Australian Government Department of Health and Ageing; 2002.Google Scholar
  27. 27.
    World Health Organization. International classification of impairments, disabilities and handicaps. Geneva: World Health Organization; 1980.Google Scholar
  28. 28.
    Australian Bureau of Statistics. Australian bureau of statistics classification of qualifications (ABSCQ). Cat. 2901.0. Canberra: Australian Government; 1996.Google Scholar
  29. 29.
    Salyers M, Bosworth HB, Swanson JW, Lamb-Pagone J, Osher FC. Reliability and validity of the SF-12 health survey among people with severe mental illness. Med Care 2000;38:1141–50.PubMedCrossRefGoogle Scholar
  30. 30.
    Ware JE, Kosinski MA, Keller S. A 12-item short form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996;34:220–33.PubMedCrossRefGoogle Scholar
  31. 31.
    Australian Bureau of Statistics. Mental health and wellbeing: profile of adults, Australia 1997. Catalogue No. 4326.0. Canberra: Australian Government; 1998.Google Scholar
  32. 32.
    Kish L, Frankel MR. Balanced repeated replications for standard errors. J Amer Stat. Assoc 1970; 65:1071–94.CrossRefGoogle Scholar
  33. 33.
    Särndal CE, Swensson B, Wretman J. Model assisted survey sampling. New York: Springer-Verlag; 1992.Google Scholar
  34. 34.
    SAS Institute. SAS 8.02 users guide [Computer software]. Cary, NC: SAS Institute; 2003.Google Scholar
  35. 35.
    Wittchen H, Essau C. An overview of the composite international diagnostic interview. Int J Meth Psychiatr Res. 1993;3:220–33.Google Scholar
  36. 36.
    Verbeek JH. How can doctors help their patients to return to work? PLoS Med. 2006;3:312–5.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.The Queensland Centre for Mental Health Research and the School of Population HealthThe Park, Centre for Mental HealthBrisbaneAustralia
  2. 2.The Queensland Centre for Mental Health Research and the Department of PsychiatryThe University of QueenslandBrisbaneAustralia

Personalised recommendations