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Welcome

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• Dr. Mary Baker

President Year of the Brain 2015 European Brain Council Welcome address Objectives of the conference

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Robert Madelin

Senior Adviser for Innovation European Political Strategy Centre European Commission Conference Opening

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Setting the Scene

The societal impact of depression in Europe

Session Chair: Prof. David Nutt President European Brain Council

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Depression: definition and key facts on the burden of disease

• Prof. Gabriel Ivbijaro

President, World Federation for Mental Health

Setting the Scene

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Professor Gabriel Ivbijaro MBE JP

MBBS, FRCGP, FWACPsych, MMedSci, DFFP, MA, IDFAPA

WFMH President

Family Doctor London UK Visiting Professor Population Health NOVA University Lisbon Portugal

Depression: definition and key facts on the burden of disease

LIFTING THE DARK CLOUDS: What can Europe do to reduce the burden of depression in the workplace?

Acknowledgements

8 Depression: definition and key facts on the burden of disease

• Members of the European

Brain Council

• Co-participants & co-

presenters

• Dr Mary Baker, organisers

and sponsors

What I hope to cover

9 Depression: definition and key facts on the burden of disease

• Provide some key

definitions

• Highlight some key

findings

• Propose some potential

solutions and highlight the role of advocacy

Depression: some facts from WHO

10 Depression: definition and key facts on the burden of disease

Depression in the workplace: some facts

• 10% of the employed population have taken time off

work for depression

• Average of 36 workdays lost per depression episode
• 50% of people with depression are untreated
• Up to 94% experience cognitive symptoms
• 43% of managers want better policies

(European Depression Association (EDA) 2012)

11 Depression: definition and key facts on the burden of disease

Unemployment, underemployment & depression

• Depressive disorder is a leading cause of psychiatric

morbidity

• Adverse psychosocial factors in the workplace lead to an

increase in depressive symptoms (Bonde 2008)

• Return to work after depression is more likely in people:
• With higher educational achievement
• With a good income
• With a perception that their health is generally good
• With less physical & mental health co-morbidity
• With premorbid feelings of general wellbeing & social inclusion
• Who were always physically active (Elinson et al 2004)

12 Depression: definition and key facts on the burden of disease

Life expectancy England & EU in 15+: Birth, 1990 and 2013

13 Depression: definition and key facts on the burden of disease Public Health England

What is a Disability Adjusted Life Year?

DALY: a measure of the overall burden of disease It adds the years of life lost due early death and years spent living with disability or ill-health together

14 Depression: definition and key facts on the burden of disease Public Health England

Leading causes of DALYs in 2013 and percentage change since 1990 (Males)

15 Depression: definition and key facts on the burden of disease

Public Health England

Leading causes of DALYs in 2013 and percentage change since 1990 (Females)

16 Depression: definition and key facts on the burden of disease

Public Health England

Advocacy is necessary

17 Depression: definition and key facts on the burden of disease

Would you ever tell your boss you have depression?

Photo: ALAMY

18 Depression: definition and key facts on the burden of disease

How to respond?

19 Depression: definition and key facts on the burden of disease

Individual & community response Health response NGO response Government & employer response Health promotion & prevention Early recognition & access to health Advocacy, support & community resilience Legal framework & policies

WFMH response

• Make mental health visible – World Dignity Project

www.worlddignityproject.com

WMHD 2016:

• Psychological & mental health first aid

WMHD 2017:

• Mental health in the workplace

Please become a partner gabriel.ivbijaro@gmail.com

20 Depression: definition and key facts on the burden of disease

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Comorbidity of depression and physical illness: a major challenge

• Prof. Norman Sartorius

Former Director of WHO, Division of Mental Health

Setting the Scene

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Comorbidity of depression and physical illness

• Prof. N. Sartorius, MD, PhD, FRCPsych

Geneva

Professor N. Sartorius, Brussels 2015 23

Definitions

• Multimorbidity is the simultaneous presence of several

diseases

• Comorbidity is the simultaneous presence of one or more

diseases with an index disease

• Multimorbidity usually leads to general practice while

comorbidity leads to specialists

• Comorbidity is usually less well recognized and managed then

multimorbidity

Professor N. Sartorius, Brussels 2015 24

Definitions

• Depressive disorders are well defined syndroms responding to

specific treatment interventions

• Depresive symptoms can be observed in the course of

depressive disorders and in persons who do not have depressive disorders

Professor N. Sartorius, Brussels 2015 25

Definitions

Some of the symptoms of depression are observable in the course of physical illnesses and vice versa – some of the symptoms of physical illness can be seen in depression

Professor N. Sartorius, Brussels 2015 26

Depressive symptoms

Symptoms of depressive disorders Symptoms

• f physical

illness Depressive symptoms

Professor N. Sartorius, Brussels 2015 27

Definitions

There are significant cultural differences

– in the expression of experience of depresion; – in the perception of gravity and origin of symptoms by individuals and communities – In the definition of health and the thresholds of illness

Professor N. Sartorius, Brussels 2015 28

Definitions

Disease Illness Sickness

Professor N. Sartorius, Brussels 2015 29

The diagnosis of depression

• Symptoms are no more than one ingredient of diagnosis:
• thers include information about person’s life and family,

about the environment and about the course of the ailment

• This information also allows the identification of individuals at

higher risk of depression

Professor N. Sartorius, Brussels 2015 30

Comorbidity of depression

• Depressive disorders are most frequently comorbid with

chronic noncommunicable diseases including in particular

– Diabetes – Cardiovascular diseases – Cancer – Arthroses

Professor N. Sartorius, Brussels 2015 31

Cancer and diabetes

• Depressive symptoms and other signs of distress are frequent

in people with cancer.

• The prevalence of depressive disorders in people with cancer

varies with the site of the cancer and with its severity

– Cancer of the brain, head and neck …….. 40-85% – Pancreas……………………………………………… 35-50% – Breast …………………………………………………. 19-37% – Various other sites……………..……………….. 10-30%

Professor N. Sartorius, Brussels 2015 32

Depressive disorders and cardiovascular diseases

• Depressive disorders increase the risk of mortality for coronary

heart disease

• The prevalence of depressive disorder in various forms of

cardiovascular illness varies from 10 to 30 %,

• The incidence of depression and of cardiovascular diseases has

a dose-effect relationship with the history of abuse in childhood

Professor N. Sartorius, Brussels 2015 33

8% 6% 18% 6% 6% 20% 10% 35% 15% 18% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% % EDS in 'no diabetes' % EDS in diabetes

Global and continental prevalence of an episode of depressive symptoms [EDS] in people with and without diabetes (Mommersteeg et al, 2013)

Professor N. Sartorius, Brussels 2015 34

Depression often goes undetected in people with diabetes:

Professor N. Sartorius, Brussels 2015

Hermanns et al., 2009 30 25 22 25 25 51 56 70 75 78 75 75 49 44 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

NIH 1993 Rubin 2004 Pouwer 2006 subthreshold Pouwer 2006 - clinical Hermanns 2006 subthreshold Katon 2004 Hermanns 2006 clinical

detection rate detection no detection

36

Professor N. Sartorius, Brussels 2015

Depresive disorders and other physical illnesses

• The presence of depressive disorders increases the probability
• f falling ill with diseases depending on self-neglect
• The non-recognition of depressive disorders can lead to (un-

necessary) treatment of mis-diagnosed conditions similar in their symptoms to depressive disorders

Professor N. Sartorius, Brussels 2015 39

Consequences of comorbidity

• Comorbidity of depressive and physical disorders leads to

– Higher prevalence of complications of the physical illness – Higher cost of treatment of physical illness – Higher mortality rates of both depressive and physical illness – Higher suicide rates for those with depressive and those with physical illness

Professor N. Sartorius, Brussels 2015 40

Conclusions

• Better recognition (and treatment) of depressive disorders

would improve health care in general

• The simultaneous treatment of depressive disorders and

comorbid physical illness would reduce the number of complications of comorbid illnesses, premature mortality and the cost of care

• Effective action is possible now.

Professor N. Sartorius, Brussels 2015 41

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Burden and impact of depression in the workplace

Amelia Mustapha

Expert Platform on Mental Health, Focus on Depression

Setting the Scene

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Amelia Mustapha

Founding Member of the EDA Member of the Expert Platform on Depression

The Burden and Impact of Depression in the Workplace

The burden of depression

• Depression is already the most prevalent health problem in many EU

Member States

Source: Olesen J, Gustavsson A, Svensson M, et al. The economic cost of brain disorders in Europe. Eur J Neurol 2012; 19 :155–162

The IDEA Survey

Ipsos MORI conducted a European survey of more than 7,065 adults aged 16-64 who are workers or managers, who have worked within the last 12 months

20% of working people in Europe have received a diagnosis of depression

20% 19% 19% 26% 12% 21% 23% 19% 78% 79% 79% 72% 86% 78% 75% 80% 2% 2% 3% 1% 2% 1% 3% ALL (n=7065) France (n=1003) Germany (n=1001) Great Britain (n=1002) Italy (n=1017) Spain (n=1008) Turkey (n=1021) Denmark (n=1013)

Yes No Refused

= significant difference on “Yes” with a 95% confidence interval Base: 7065 Adults aged 16-64 September 2012 – Source: Ipsos MORI

Have you ever personally been diagnosed as having depression by a doctor/medical professional?

Of these people, 51% have taken time off work due to depression

51% 53% 61% 58% 48% 52% 25% 60% 41% 41% 33% 32% 43% 42% 66% 31% 1% 1% 2% 3% 1% 2% 7% 5% 4% 10% 6% 5% 9% 8% ALL (n=1407) France (n=191) Germany (n=187) Great Britain (n=265) Italy (n=124) Spain (n=214) Turkey (n=230) Denmark (n=195) Yes No Prefer not to say Not applicable

Base: 1407 Adults aged 16-64 who have been diagnosed with depression September 2012 – Source: Ipsos MORI = significant difference on “Yes” with a 95% confidence interval

Have you personally ever taken time off work because of your depression?

On average people need to take off one month or more during a depressive episode

Average number of working days

Base: 722 Adults aged 16-64 who take time off work because of depression September 2012 – Source: Ipsos MORI = significant difference on “Average number of days” with a 95% confidence interval

The last time you experienced depression, how many working days did you have to take off work because of your depression?

35.9 35.4 41.3 41.0 23.1 30.6 32.4 39.2 All (n=715) France (n=102) Germany (n=114) Great Britain (n=154) Italy (n=59) Spain (n=110) Turkey (n=58) Denmark (n=117)

Respondents collectively took off more than 21,000 days from work

3,852 3,110 5,291 3,641 1,158 2,807 1,566 1000 2000 3000 4000 5000 6000

Denmark France GB Germany Italy Spain Turkey Days Lost

European total = 21,426

Base: 676 Adults aged 16-64 who are currently employed who took time off work because of depression September 2012 – Source: Ipsos MORI

Total number of days taken off work by respondents the last time they were depressed, based on average amount of time taken off

Cognitive symptoms contribute to low work productivity

• Many patients with depression experience cognitive symptoms such as:

– reduced ability to think – concentrate – learn – remember – make decisions

• Persistence of cognitive symptoms in patients with depression can

contribute to impaired work function and predict poor occupational

• utcome

Source: Conradi et al. Psychol Med 41:1165, 2011

52 Base: 7065 Adults aged 16-64 September 2012 – Source: Ipsos MORI = significant superior per row to “colour-coded item” with a 95% confidence interval

88% 88% 91% 90% 84% 93% 86% 87% 57% 45% 51% 67% 48% 52% 64% 70% 44% 32% 46% 50% 32% 39% 51% 57% 33% 24% 19% 40% 22% 29% 7% 47%

ALL (n=7065) France (n=1003) Germany (n=1001) Great Britain (n=1002) Italy (n=1017) Spain (n=1008) Turkey (n=1021) Denmark (n=1013)

Low mood or sadness Trouble concentrating Indecisiveness Forgetfulness

There is low awareness compared to mood symptoms

Which, if any, of the following attributes/symptoms do you associate with depression in general?

53

60% 12% 25% 3%

Yes - I was signed off work by my doctor Yes - I told my employer even though I wasn’t signed off work by a doctor No - I did not tell my employer Not applicable

Base: 715 Adults aged 16-64 who take time off work because of depression September 2012 – Source: Ipsos MORI

One in four people with depression did not tell their employer why they took time off work

Still thinking about the last time you were off work due to depression, did you tell your employer that the reason you needed to take time off work was because of your depression?

A third of employees who took time off for depression didn’t disclose due to fear of putting their job at risk

30% 30% 12% 49% 9% 8%

Base: 177 Adults aged 16-64 who take time off work because of depression and did not tell their employer September 2012 – Source: Ipsos MORI

I felt that they wouldn’t understand Job at risk/ too risky given the economic climate I felt that my employer wouldn’t know how to support / help me It’s private – I wouldn’t want to tell anyone Other I didn’t want to burden my employer with my problems

Why didn’t you tell your employer about your depression?

Nearly 1 in 3 managers say there is no formal support in place for dealing with depression

Base: 792 Adults aged 16-64 who are managers September 2012 – Source: Ipsos MORI

26% 43% 30% 18% 2% 28% Informal advice from friends or colleagues Support from a medical professional Support from my HR department Advice from external sources such as websites or printed materials There is no formal support or resources in place Other

What support, if any, do you have as a manager in dealing with employees who have depression?

56

Which, if any, of the following do you think would be useful to support employees with depression in your place of work?

Base: 780 Adults aged 16-64 who line manage one or more people September 2012 – Source: Ipsos MORI 22% 34% 37% 33% 45% 37% 16% 2% 8%

Educational leaflets or brochures Training for HR teams Training for all employees Specific line manager training Counsellors or counselling services Better Gvt legislation/policies to protect employees Better Gvt legislation/policies to protect employers Other None of these

Depressive, time off, etc… = significant difference with a 95% confidence interval

Manager want more training, services and better legislation

In Summary

• Depression is a prevalent condition amongst workers in Europe
• Symptoms of depression, specifically cognitive symptoms, are poorly

recognised but can have high impact on productivity at work

• The indirect costs of depression, including lost days at work, are significant
• It is vital that the European workforce remains healthy and productive
• We need to ensure wellbeing of employees in order to secure economic

prosperity in Europe

• More needs to be done via policies and legislation to support and protect

both employees and employers

Exciting Developments for 2016

• Treatment of depression in the workplace – a simulation
• Challenges presented by High Professional Class

http://www.expertplatform.eu/about-us

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Managing depression: a testimony

David Kinder Deputy Director for Workforce, Pay & Pensions, HM Treasury

Setting the Scene

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Q&A with the audience

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Moderator: John Bowis Former MEP, Honorary President Health First Europe Panel discussion

Recognising depression in the workplace as key health priority: what can the EU do?

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Introductory statement

• Dr. Mary Baker

President Year of the Brain 2015 European Brain Council Panel discussion

Recognising depression in the workplace as key health priority: what can the EU do?

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Addressing Depression in the Workplace What role for the EU?

• Dr. Mary Baker

European Brain Council

Depression & work: the facts are clear!

• Leading cause of disability world-wide
• Disproportionally affects adults of working age

− 1 in 10 EU citizen experience a depressive episode each year − 86-87% of cases occur in adults of working age

• Significant costs to the economy

− €92 billion in EU in 2010 − 59% indirect costs e.g. absenteeism, presenteeism

• Significant costs to employers

− More work absences; Loss of productivity on the work

• Significant costs to individuals at work

− Considerable stigma attached; Cognitive symptoms

Depression & work: EU policy response

• The EU has a key role to play in promoting:

− High standards for working conditions − Mental health & well-being of its citizens

• Some current employment, public health, and health & safety policies provide

vehicles for guidance

• European Strategy on Health and Safety at Work (2014-2020)

− Mental health issues and risks have received enhanced attention

• EU Joint Action on Mental Health and Well-Being (2013-2016)

− WP on ‘mental health at workplaces’ − Platform for collaboration between EU agencies, Member States, health and employment stakeholders

Cases for a stronger policy response

OECD ‘Invest and prioritise in policies that strive to improve the inclusion

• f people with mental ill-health in the labour market and support

the building of a mentally resilient, productive workforce is crucial as population continue to age rapidly and working environments change at ever faster rates’ (Fit Mind Fit Job Report - 2015) WHO Psychosocial risks, work-related stress, job strain and the associated depression risks are preventable public health issue (European Mental Health Action Plan 2013-2020)

Mental health at work An investment rather than a cost

‘Improving mental health is vital to both economic growth and happiness and could be the most important single step forwards (economically and socially) in the 21st century’

Professor Richard Layard - LSE ‘Mental Health: The New Frontier for Labour Economics’

Depression & work: key policy principles

• 1. Promote good mental health at work

− Educate about depression, address stigma

• 2. Recognise and address new and emerging psycho-social risks

− Job insecurity, work intensification and high demand, high emotional load, poor work-life balance

• 3. Provide practical support for employees with depression

− Aid retention at work − Facilitate return to work

• 4. Break the silo mentality

− Health, employment and education policies – need for inter-sectorial approach

• 5. Include all stakeholders in agenda setting & policy development

− Policymakers, healthcare professionals, employees, employers, patients groups

Opening the panel discussion…

How can EU policies better…

• support early intervention to protect mental health and well

being and retain people in the labour market?

• address & prevent new and emerging psycho-social risks?
• synergize across policy areas (health, employment, education)

and break the silo mentality?

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Panel discussion

Recognising depression in the workplace as key health priority: what can the EU do? Paul Arteel

Executive Director, GAMIAN-Europe

• Prof. Stephen Bevan

Director Center for Workforce Effectiveness The Work Foundation

José Miguel Caldas de Almeida

Coordinator EU Joint Action on Mental Health & Well-being

Jürgen Scheftlein

Policy officer for Mental Health & Well-being DG SANTE - European Commission

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Conference restarts at 16:45

Pause for Coffee

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Welcome Back

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Moderator Prof. Stephen Bevan

Director Center for Workforce Effectiveness, The Work Foundation, UK

Best practises and unmet needs: how can we best work together to target the impact of depression in the workplace in Europe?

Panel discussion

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Introductory statement

• Dr. Petr Winkler

European Psychiatry Association (EPA)

Panel discussion

Best practises and unmet needs: how can we best work together to target the impact of depression in the workplace in Europe?

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Addressing depression in the workplace: priority for businesses in Europe

petr.winkler@nudz.cz Lifting The Dark Clouds Brussels 9th December 2015

Why is it a priority?

Burden

• Leading cause of disability worldwide
• 1 in 10 Europeans takes days off

because of depression each year

• Largely underdiagnosed
• €92 billion costs to European

economies

Costs to bussinesses Absenteeism Presenteeism Recruitment Training

• Worsened decision making
• Worsened atmosphere in the

workplace

• Social Capital
• Experience

Intangible costs

Tertiary resolution Managing mental health issues Secondary intervention Suppport when mental health at risk Primary engagement Promote good mental health

Benefits of investments for businesses

Reducing costs Increasing productivity CSR

CBT

What we know works or what is promissing

• Org. setting – Job-Demand-Control(-Support)

Screening – enable people to identify themselves Training of managers to recognise problems Pharmacotherapy Problem solving treatment (problem-solving skills) Flexible working hours, other rsnbl adjustments Enhanced care for workers with depression Worksite stress reduction programme Enhanced role for the ocupational therapist MH promo, awareness training, stigma reduction Employee assistance programmes

Top management plays a key role!

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Panel discussion

Best practises and unmet needs: how can we best work together to target the impact of depression in the workplace in Europe?

• Dr. Jorge Costa-David

Principal Administrator Health & Safety at work DG EMPL - European Commission

Kris De Meester

Chair - Health & Safety Working Group BusinessEurope

David Kinder

Deputy Director for Workforce, Pay & Pensions HM Treasury

• Dr. Vedat Mizrahi

Medical & Occupational Health Director Unilever - Europe

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• Dr. Mary Baker

President Year of the Brain 2015 European Brain Council

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Conference Closure

Please Join us for the conference cocktail in the bar on the ground floor

Networking Cocktail