Defeating Depression with Resilience
A good way to reduce health care costs and increase vitality and productivity in your organization is to increase resilience to prevent or eliminate depression.
The business case for reducing depression in the workplace
The cost of depression for businesses is huge:
- Depression is estimated to cost employers between $17 and $51 billion each year, with 200 million workdays lost to the disease.
- Depression leads to more absenteeism than almost any other physical disorder.
- In a three-month period, people with depression miss an average of five workdays, and are significantly less productive for twelve additional workdays.
- Eighty percent of people with depression do not function well in their daily activities and one-third report serious difficulties in work and home life.
- Current research indicates that for every dollar spent on effective wellness programs medical costs in the U.S. decrease by $3.27 and absenteeism falls by $2.73.
Almost everyone is affected by people who have some degree of depression. Even if you are not depressed yourself, you almost certainly know someone who is. According to the National Institutes of Mental Health, depression affects approximately 20 million American adults 18 years and older, almost one in ten. Furthermore, depression is a growing problem. The World Health Organization says that by 2030, depression will be the largest cause of early death or disability.
Depression affects you physically, not just mentally. Depression increases the risk of coronary heart disease, and is a significant predictor of the annual number of deaths in a given age group. Depression related to stress can lead to high blood pressure and a weakened immune system, and makes women almost a third likelier to have a stroke. Depression can also cause poor health behavior, such as failing to take diabetes medication. Other negative health habits often associated with depression include smoking, excessive alcohol consumption, poor exercise, poor diet, and underdeveloped or nonexistent social support. If that is not enough, when depression occurs in combination with other serious illnesses such as cancer or HIV, people tend to have more severe symptoms of the medical illness, with the associated higher medical costs.
What is depression?
The World Health Organization defines depression as a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration. These problems can become chronic or recurrent and lead to substantial impairments in an individual’s ability to take care of his or her everyday activities.
What leads to depression? From time to time, everyone experiences events that leave them feeling helpless, useless, not appreciated, or a failure, and as a result, a person might feel depressed for a while. Serious depression, however, often results from more long-term, strategic causes, such as chronic overwork, job insecurity, deadlines that can’t be met, gossip, no hope of a promotion, the feeling that every move is being monitored, harassment, ongoing conflict with co-workers or supervisor, and lack of social support.
Signs of depression
(Source: American Psychological Association)
Resilience is a powerful antidote to depression
While there is more and more information about the connections between job stress and depression, less is known about ways to prevent depression. Fortunately, new research indicates that it may be possible to prevent depression from occurring in the first place by strengthening resilience. This may be the most effective way to deal with depression, because after all “an ounce of prevention is worth a pound of cure.”
Resilience is the ability to recover, learn, and grow stronger from adversity. Most people are able to do this to some degree, though clearly some do this better than others. Those with strong resilience are able to handle change and adversity exceedingly well, oftentimes without missing a beat. Even though they experience the same setbacks that others do, their response is different and they emerge challenged and optimistic rather than threatened and defeated. They are therefore less likely to become depressed.
The science of resilience and measuring resilience with the Resilience Scale™
While there are many interventions and programs that offer resilience programs, not all are evidence-based. We have been conducting research since 1987 to understand why some adults do better in life than others, adapting successfully to adversity. We have conducted surveys and studies to learn more about this human ability that we have come to call “resilience.” Our research has identified five characteristics that are strongly present in all people who have adapted well to adversity, which we call “the five core characteristics of resilience.”
Early in our research, we constructed a tool to measure resilience. We took the five core characteristics and, using verbatim statements from people we knew to be resilient, constructed an instrument called “The Resilience Scale” (RS), which is now in use worldwide. Over the past 25 years, the scale has proven to be a reliable and valid measure of resilience (See www.resiliencescale.com). We have tested it on thousands of people and the results have proven conclusively that it measures individual strengths that are potentially preventive for depression.
We have learned in numerous studies with thousands of people that as resilience scores go up, depression scores go down. We have also learned that other behaviors known to protect against depression increase along with resilience scores.
The five core components of resilience
It is clear that increasing a person’s resilience will prevent depression, but how do you help someone become more resilient? What is the process? It sounds challenging, if not impossible. The key is not to try to “become resilient” all at once, but rather to work on one aspect of resilience at a time. This should happen in discrete, orderly steps. Like the saying goes, you have to eat an elephant “one bite at a time.”
This is where the five core components of resilience come in. We have found that the most effective way to increase employee resilience is to focus on each component, one at a time, strengthening each. This will create a more resilient employee. The five core competencies of resilience are:
- A sense of purpose and meaning in life. If people can learn what they were born to do (their purpose), it gives them passion and creates meaning for them in life. They will begin to experience what Csikszentmihalyi refers to as “flow.” When a person is deeply immersed in work, focused and engaged, there is little opportunity for depression to take root. Within the organization, this means that an employee’s life direction, talents, and abilities must be consistent with the organization’s purpose. Thus, choosing employees who fit the organization is essential. Providing encouragement and opportunities to do work that fits with their abilities and desires is very important, and will reap tremendous rewards.
- A balanced outlook on life. Although change, adversity, and demands in the workplace are here to stay, feeling negative, threatened, defeated, hopeless, or helpless is not. People can learn to have a balanced perspective, and to respond to difficulties on the job in healthy ways. Two thousand years ago, Marcus Aurelius said, “You have power over your mind…not outside events. Realize this, and you will find strength.”
- The ability to persevere, no matter how difficult things become. Resilient people rarely give up. They recognize that it takes time and effort to achieve success. Perseverance is a habit that can be acquired like any other. Because perseverance without purpose is pointless, the first step is to know what your purpose is. Then, although you may experience rejection, fear, discouragement, and doubts, giving up will no longer be the likely outcome.
- The ability to depend on yourself. When people begin to understand that they are capable and competent, that they can depend on themselves, their self confidence and self-esteem grow. Self-reliance is not easy to achieve, however, and takes a lot of practice. People with self-reliance are self-starters, dependable, and resourceful. They are able to focus and prioritize more effectively. This, too, contributes to ‘flow’ and leaves little room for depression. Within the organization, employees can become self-reliant if given the encouragement, time, training, and support to do so.
- Self-acceptance. Resilience and self-acceptance go hand in hand. Resilient people do not judge themselves harshly. They don’t reject themselves. Resilient people have the courage of their convictions and aren’t riddled with self-doubt. Depressed people often are dissatisfied with themselves and are very critical of what they see as flaws; resilient people recognize their self-worth and grow to appreciate how unique they are. This realization sets them apart and allows them to be truly themselves and comfortable in the world.
The supporting players
We also identified four “supporting players” that strengthen resilience. While they are not essential to resilience, it is difficult to have a strong resilience without them. These four supports are:
- Taking care of yourself through exercise, nutrition, and stress reduction.
- Seeking support when needed, and giving support as well.
- Balancing rest, responsibility, and recreation.
- Engaging fully in life; not retreating from it.
With this fundamental understanding of the basis of resilience in hand, we have found ways to measure it and even to increase it in individuals and organizations.
Strategies for strengthening resilience in the members of your organization
Employee education interventions integrated into your health promotion program are a good place to start improving the resilience of the members of the organization. These interventions can take many forms:
- Online or web-based resilience strengthening modules.
- Face-to-face or phone coaching.
- Group classes organized around the resilience core.
- Employee newsletter or e-letters.
- Materials on resilience and how resilience defeats depression.
It is important to note that there are many available resilience interventions that are not evidence-based.
Be sure to select a resilience strengthening program that is research-based, and especially one that includes the five core components of resilience, as described above.
How to tell if your resilience training program is effective
An increase in resilience and a reduction in depression in the workforce indicate that your resilience training program is effective. Here are a few of the ways you can measure this:
- Use the Resilience Scale (either the 25-item scale or the shorter RS-14) to measure resilience before and after the intervention to assess changes in resilience.
- Incorporate questions specific to the Resilience Core into your company’s Health Risk Assessment (HRA) process.
- Monitor questions specific to depression in the HRA.
- Measure the use of resilience training through online programs, coaching, or other offerings and employee satisfaction with these programs.
- Compare scores on measures of depression and resilience between those who use resilience strengthening modules versus those who do not.
By expanding your existing employee assistance and wellness programs to include resilience training, your organization can increase worker resilience. This will reduce depression and contribute to increased morale and productivity of talented workers. An effective resilience training program, based on the five core components of resilience, with clearly measurable, positive outcomes, will help your organization to compete more effectively in the global marketplace.
About The Author
Gail Wagnild, RN, PhD is the Director of the Resilience Center and author of the Resilience Scale™. She is currently working with Life Advantages to produce a comprehensive suite of clinical programs for building and maintaining a resilient life for the EAP, Managed Behavioral, Wellness, Medicaid, and college student marketplaces.
Rose K. Gantner, EdD is Senior Director of Health Promotion, Consumer Education, Training and Innovation for UPMC Health Plan in Pittsburgh, PA. Prior to UPMC, Dr. Gantner worked as the Vice President of Managed care, EAP and Wellness at Corphealth, as a CEO for two hospitals in the Magellan Health Systems, and was the founder and director of her own counseling and psychological practice.