31 72 Definition A persistent feeling of sadness, despondency, or hopelessness. Depression might be sympto- matic of a psychiatric disorder, or it can occur in response to situational stress. There is often no single obvious cause however, risk factors include hormonal disorders, illness or med- ications, family history, or disturbing events. Types of depression can range from less-severe mental distress (dysthymia) to major depression and bipolar depression or manic-depressive illness. It may be difficult to differentiate depression from a normal episode of grief or feeling “blue.” Grief reaction is a normal response to traumatic or troubling events such as the loss of a loved one, job difficulties, financial problems, family issues, or illness. Characteristics The severely depressed employee usually displays a lack of desire to socialize, feelings of worthlessness and poor self-esteem, poor work performance, and thoughts of self-injury or destruction. Fatigue and general feelings of ill health and reduction in activities of daily living may be apparent. Because employees often do not present with depression as their chief complaint, consider red flags that could include complaints of nonspecific symptoms, chronic pain, somatic complaints, low energy, insomnia, bouts of crying, irritability, appetite loss or overeating, weight change, boredom, loss of concentration or memory, constipation, or loss of libido. Most cases of the blues or grief response alleviate quickly and do not pre- vent finding enjoyment. The key component of depression is that the pervasive feeling of sadness exists most days for a period of at least 2 weeks. Policy Employee displaying symptoms of depression should be evaluated in the occupational health unit and referred to available EAP or to an emergency crisis intervention agency. Objectives Clinical Assessments and Interventions Referral for Medical Action Depression Psychiatric emergency. Suicidal tendency. Follow-up Actions Discuss treatment plan with health care professional (with employee consent). If medication is prescribed, dis- cuss drug side effects, particularly those that have a potential work impact. Discuss issues related to drug and food interactions with prescription medications (including the use of over-the-counter (OTC) medica- tions). Assess extent and severity of the problem. Maintain a support- ive environment. Identify behaviors and complaints that might indicate an underlying depression. Discuss any family history of depression and alcohol abuse. Perform a lethality assessment to identify the employee’s risk to self or others. Ask such questions as “When you feel de- pressed, have you ever wanted to hurt yourself?” or “Do you feel that life is not worth living when you feel depressed?” Identify whether the employee has a plan or method for self-harm (suicide) or harming others. Actively listen to the employee. Maintain non-judgmental and confidential communications. Guideline continues on next page
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