Depression, Stress and Anxiety Climb the Corporate Ladder

Just because they run a company doesn't mean CEOs and executives are immune to mental health factors.

By Ronald S. Leopold, MD, MPH

Arthur Martin*, a corporate vice president, forced himself to scroll through the spreadsheets. He was tired, restless and unable to concentrate. The Board would meet in less than an hour. The calculations were finally done, but the real decisions had not been made, and Martin was reluctant to make the recommendations his CEO expected of him.

He had felt stressed before, but this was different. This was detached, apathetic, easily distracted from tasks that never used to faze him, mired in a swamp of diffidence and fear that was lit by occasional flashes of unreasonable anger. Normally operating in executive overdrive, he could barely drag himself to work in low gear. For the past month, his wife had been urging him to "see somebody," but making an appointment seemed too cumbersome a task. Worse, it seemed an admission of defeat for the keen mind that had served him so well in business.

Executive productivity is a subject of increasing concern, and true mental wellness is at its center. The stakes that ride on intelligent concentration, effective management and sound business judgment have never been higher. Recent headlines suggest an epidemic of bad judgment at top levels of some large corporations. While many factors drive this type of behavior, it's important to note that untreated depression and high-level stress can also cause lapses in judgment. Depression, stress and anxiety are just as common among high-level executives as they are among the workforce as a whole. The consequences, however, are far greater.

Depression, Stress and Anxiety

Psychiatric claims make up 7 percent of all MetLife's group short-term disability (STD) claims, but the percentage is nearly twice as high for white-collar employees. Among this group, 55 percent of psychiatric STD claims are related to depression, and 30 percent are submitted for stress and anxiety. Substance abuse disorders account for less than 8 percent of claims.

Statistics reflect that the more "sedentary" the work, the higher the number of psychiatric claims. This disparity cannot be accounted for by differences in age and sex alone. Much has been written about the therapeutic value in manual labor, the healthy release of endorphins brought on by physical exercise, but 21^st century line jobs are often automated and sedentary.

There is also difficulty in defining the productivity of a high level executive. Organizations can put hard numbers on widget production, call center volume or total sales per quarter. But as you ascend the organization chart, the stakes get higher and the rules of the game are tougher to identify.

Psychiatric disorders also commonly surface as co-morbidities. For example, many times, depression will surface as a secondary problem in individuals with low back disorders, cancer, cardiac conditions, musculoskeletal disorders, pain syndromes and in women following pregnancy and delivery. These conditions, as co-morbidities, are often under-recognized and under-treated. Even after treating a psychiatric illness, there are often significant stigmas to reporting these disorders. Both patients and providers play into this deception: True stress disorders claims, for instance, may be reported as high blood pressure, headaches, or malaise and fatigue.

Barriers to Combating Psychiatric Illnesses

Historically, psychiatric illnesses have been under-recognized. This is especially true for the "softer" conditions: depression, stress and anxiety. The conditions can be insidious. Health care providers, especially those in non-behavioral fields, are often under-trained or under-motivated to identify and treat these conditions.

Many patients are reluctant to discuss their moods, feelings and ability to concentrate. The reasons for this are many: social stigma, socioeconomic standing, education level, culture and ethnicity all come to mind. Some of these barriers can be especially difficult for those in high-level positions. Admitting that they're "out of their control" or need help can be a difficult task for someone in a powerful position.

It is very common for executives to believe they can handle unusually high levels of stress: normally they can. But can they also recognize when it becomes too much, that they can no longer cope and need to make a change?

What's the Solution?

Gaining an understanding of how to recognize and treat a psychiatric problem — at any level — is critical. When day-to-day stress begins to accumulate and the work-home axis slips out of balance, executive decision-making can become compromised. Untreated psychiatric problems among key corporate decision makers can prove disastrous for a company in both the short and long term.

How can a CEO or HR manager tell when an executive is in trouble? How can someone make the same assessment of a CEO? Focusing on true functional impairment is often key to recognizing these disorders. Common symptoms include restlessness, apathy, difficulty concentrating, sleeplessness, lack of motivation, and weight gain or loss. Impairment may come on gradually and then build rapidly. When personal issues persist and worsen to the point of encroaching on work or home life, a clinically significant situation has likely developed.

A work environment that promotes good mental health among employees will always be more productive in the long term. Employers need to be cognizant of that fact and encourage employees to seek assistance through such vehicles as employee assistance programs. It is also important to offer employees group health insurance coverage that doesn't create barriers to obtaining care for mental health. Plans must make the process easy for employees like Arthur Martin to "see somebody." Work environments that allow for flexible work arrangements and guilt-free vacations can also contribute to good mental health.

The important thing to remember is that psychiatric illnesses are just as likely to occur among senior management as they are among any other employees of the company — and there is a solution. Treatment can help individuals address their problems head on and become functional again.

Ronald S. Leopold, MD, MPH is National Medical Director, MetLife Disability.

*Arthur Martin is a fictitious character.

How to Tell Your Boss He's Depressed

So your boss is depressed. No, we're not talking about the occasional "I can't believe we just lost that account" type of attitude. Uh uh. We mean the much more serious mental condition known as depression.

As serious an issue as depression may be, it's extremely difficult for employees to tell their boss that he or she needs help. Well, we'd like to know how you would handle things. Would you tell your boss? How would you do it? Or if you've actually been in this position before, how exactly did you deal with the whole situation?

Please let us know by e-mailing us at B+H@medec.com. And yes, complete confidentiality is guaranteed on all submissions.

More Business & Health Articles on This Topic:

Depression in the Workforce (April 1, 2000)

Working With Depression, Part I: The Business Case for Quality Mental Health Services (August 1, 2002)

Working With Depression, Part II: Finding and Funding Effective Treatment (August 1, 2002)

Resource Links:

National Institute of Mental Healthhttp://www.nimh.nih.gov

This government agency, whose mission is to "diminish the burden of mental illness through research," offers news, patient resources, clinical studies and publications.

National Mental Health Associationhttp://www.nmha.org

A "nonprofit organization addressing all aspects of mental health and mental illness." The NMHA "works to improve the mental health of all Americans, especially the 54 million individuals with mental disorders, through advocacy, education, research and service."

Academy of Organizational and Occupational Psychiatry http://www.aoop.org

A professional membership organization whose mission is to "enhance psychiatry's contribution to the well-being and productivity of workers, leaders, and work organizations."

The Club of Geneva http://wspartners.com

Inspired by the Club of Rome's impact on environmental issues, this international group is a global catalyst of knowledge and capital resources for the ongoing process of improvement of work environment issues, efficiency and well-being in the workplace.

The American Psychiatric Associationhttp://www.psych.org/

BehaveNet^TM
http://www.behavenet.com/

Ronald Leopold. Depression, Stress and Anxiety Climb the Corporate Ladder.

Business and Health

2002;12.