Depression in the Workplace – The High Cost of Presenteeism

Absenteeism due to mental illness is expensive – estimates of the costs to the Canadian economy are as high as 51B including direct medical costs, direct work losses, and decreased productivity.1 But what is the cost of presenteeism? Studies suggest that losses from presenteeism can be 7.5 or more times higher than losses from absenteeism.2

What is presenteeism? If it is so costly, how can we learn more about it? Many of the answers to these questions, at least with respect to depression in the workplace, lie in important new research carried out by the Conference Board of Canada with funding from Lundbeck Canada.

Before getting to those answers, some context may be helpful: one in five Canadians will experience a mental health issue in his or her lifetime, four per cent of working adults experience not just moods, but depression at any given time, and depressive episodes can lead to an 11 per cent decline in an employee’s productivity, due to factors such as increased confusion, inattention, memory issues, apathy and sleep dysfunction. With the decline in productivity, we get to the heart of “presenteeism,” as defined in the study: “when an employee is physically at work but not fully productive due to physical or mental conditions.” What is helpful about the new study is that it provides data on the workplace effects of depression during and after depressive episodes, and looks at the effects of presenteeism from the perspective of both employees and supervisors.

About the Study

Between February 18 and March 5, 2013, the Conference Board surveyed 2,004 individuals, selected at random, who were employed on a full- or part-time basis. Questionnaires were available in English and French. The response rate was 12.5 per cent.

Survey respondents were employed by companies of varying sizes: small (less than 50 employees), medium (50-499 employees) and large (500 or more employees). Of the 2,004 individuals surveyed, a total of 655 had taken a short- or long-term leave of absence due to a health issue at some point in their working career. Of those, almost one quarter (23 per cent) reported that their leave was due to a mental health condition, or a mental and physical health issue (substance abuse and addiction issues were not included in the study). Respondents included 727 front-line supervisors.

Employee Responses

Key findings from the perspective of employees include:

    • Of the 147 respondents who reported having taken a mental health related leave of absence, 69 per cent had experienced a depressive episode. Of those, 83 percent took prescription medication to treat their depression and 80 per cent were still taking medication.
    • Women were more likely than men to report a leave of absence due to a mental health issue and were more likely to have taken prescription medication.
    • Older workers were less likely to report a leave of absence due to a mental health issue but once they reported their issue, they were just as likely as younger workers to say that their issue was related to depression and to take prescription medication.
    • Of those who had taken a leave of absence because of a depressive episode, 66 per cent encountered challenges on their return to work. Most commonly, they had difficulty concentrating and remembering things, key symptoms that had an impact on their work. More specifically, men were more likely to report cognitive difficulties than women (77 vs 62 per cent), and professional, front-line and operations employees reported experiencing cognitive difficulties more often than managers and senior leaders (70 vs 40 per cent).

These findings related to gender, age and cognition are consistent with previous research.


    • Cognitive difficulties are both a core symptom of a major depressive incident, and a common residual symptom of depression that can place an individual at greater risk for relapse or recurrence.
    •  95 per cent of employees said their cognitive impairments impacted their work performance, at least on “some days.”
    • Supervisors and employees agreed that some employees experienced cognitive difficulties either while they were dealing with depression or on their return to work after a leave. These difficulties included challenges to concentration, memory, decision-making and task performance.
    • Front-line managers and supervisors need awareness and education to recognize cognitive and other symptoms of depression and ensure that employees receive appropriate treatment and support.

Supervisor Responses

Respondents who were direct supervisors of employees dealing with depression were surveyed to determine if their perspectives on the abilities of employees who had taken a leave due to a depressive episode were the same as the employees. The perspective of supervisors is important because the supervisor is often the first person an employee contacts when issues arise. Facts that emerged from the study include:

    • Only 36 per cent of employees thought it would be helpful to discuss their mental health issues with their supervisor, a finding that confirms earlier research demonstrating that employees do not believe their managers are equipped to support them in the event of a mental health issue.
    • Of the supervisors surveyed in this study, 61 per cent had supervised or were currently supervising at least one employee who was known to be at work during a depressive period (they may have been unaware of others who did not disclose).
    • Supervisors in small organizations (less than 50 employees) were less likely to have supervised an employee during a depressive period, possibly because fewer employees report to them.
    • Supervisors in the Atlantic region were more likely to have supervised an employee during such a period, in keeping with findings from other studies that individuals from that region were more likely to report that they had experienced a mental health issue.
    •  A “significant portion” or 52 per cent of supervisors had no experience managing an employee who had taken a leave of absence for a health-related issue, while a quarter had supervised or managed an employee who had taken a leave due to a mental health issue (7 per cent) or mental and physical health issue (18 per cent).
    • Of the 184 supervisors who reported supervising an employee who had taken a leave due to a mental health issue, 76 reported managing an employee dealing with a period of depression who later returned to work.
    • Supervisors were “significantly more emphatic” than employees in their beliefs about the cognitive difficulties of employees, a finding that researchers explain by suggesting that supervisors are more able to notice changes in the performance of employees, and they expect more difficulties with employees because of the stigma associated with mental illness.

What to Do?

Recommendations arising from the research include:

    • Provide graduated return to work strategies or workplace accommodations to help employees who experience depression reintegrate into the workplace and reduce the risk of relapse or recurrence. Once these measures are in place, employees should be treated like all other employees during performance management.
    • Ensure that front-line managers and supervisors can recognize the symptoms of mental health issues and offer appropriate resources and support.
    • Offer mental health awareness and education programs to alleviate the stigma associated with mental illness.

Finally, this study did not explore actual productivity losses related to workplace depression – different employees and employers are affected differently and are able to cope differently. What it shows, however, is that the potential for such losses is great and that this potential exists, not just when employees are absent on leave, but also while they are present in the workplace during and after depressive episodes. It gives shape and definition to presenteeism in relation to depression, helps explain why presenteeism is so costly, and provides recommendations for a way forward to greater workplace productivity.


1 Chénier, L. 2013. Depression in the workplace. Ottawa, ON: The Conference Board of Canada. Except as noted, this report is the source of all data cited here. For information about the report see

2 “What can you do to combat presenteeism in your workplace?” Moods Magazine. Retrieved 14 May 2014 from

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