According to the National Mental Health Association (NMHA), depression affects about five million women working outside the home each year.

For many women, the economic reality of our times has forced them to make adjustments in their lives to compensate for unexpected reductions in family income or for the increased cost of everything from gasoline to groceries. As a result, many women have had to make the decision to return to the workplace, often ending maternity leave sooner than they had planned because the family can no longer afford for her to stay home with the child. Others are increasing their work loads from part-time to full time, while some already retired women are reentering the workplace due to financial needs.

These stressors can cause in many women increased family tension, increased resentment towards society and the government, and can often lead to increased stress in their relationships, all of which can lead to clinical depression. In the workplace, depression significantly impacts mood and motivation and is therefore detrimental to healthy workplace climate, and can have a negative impact on the individual's ability to focus and remain productive. In many cases, pressure and anxiety in the workplace feeds the strain on the home environment, which, in turn, negatively affects the workplace.


Mild depression and how it can easily turn into a severe and more complicated form, ultimately leading to suicide

Suicide claimed 32,637 lives in 2006 and, according to the National Center for Health Statisics (NCHS), is one of the leading causes of death in the United States. The National Hospital Ambulatory Medical Care Survey reports that, in that same year, 594,000 people visited the emergency departments of American hospitals as a result of self-inflicted injuries, many of which may have been suicide attempts.

Research shows that 90 percent of people who die by suicide suffer with depression and/or another mental health disorder, and suicidal thoughts and suicidal behaviors can be symptomatic of moderate to severe depression. Difficult and stressful events, such as the impact of the economic slowdown and the rising cost of living, as well as other risk factors such as untreated depression, can increase the risk for suicide. However, the good news is that these symptoms of depression usually respond to medication and therapy.

Unfortunately, depression and suicide continue to be considered "taboo subjects in many settings. In the workplace, an employee with suicidal ideations may avoid discussing their problem because of fear of stigmatization or even retaliation. Even women who are seeking treatment often refuse to disclose information to their employer out of concern of losing their jobs - "they'll think I'm crazy or damaged or not able to do my job.

Exacerbating the issue further is the tendency of people suffering with depression or other mental illnesses to seek assistance from their primary care physician rather than from a mental health professional. This effort to avoid possible stigma can result in improper or incomplete treatment. While it is true that a medical doctor can prescribe medications and provide some level of care, studies have shown that a combination of psychotherapy and proper psychotropic medication management by a qualified medical professional is the most effective means of treating depression and other psychiatric disorders.


Rising numbers of women suffering from severe depression and the factors involved.

In the United States, women are twice as likely as men to be diagnosed with depression, a fact that may be attributable to biological, life cycle or hormonal causes that are unique to women. Some women suffer with severe premenstrual syndrome (PMS), postpartum depression, premenstrual dysphoric disorder, menopause and other conditions resulting from hormonal changes.

Psychosocial factors that are unique to women also tend to increase incidences of depression. Because women tend to be the major providers of care in this country and, therefore, have many roles to juggle: those of employee, wife, mother, daughter, friend and neighbor, they often feel overwhelmed by these layers of responsibilities. When coupled with symptoms of depression, these feelings can have a detrimental impact on a woman's job performance. Untreated depression interferes with every aspect of an employee's life, and that includes the workplace.


Ways to cope with depression and anxiety

It not always possible to prevent clinical depression, but it is possible to alleviate the symptoms and minimize the negative impact that a severe episode would have in the life of the employee. Depression is highly treatable and crisis can be avoided, or at least better managed, with good health habits such as healthy eating, adequate exercise, including making time for favorite activities, relaxation and rest and positive social interactions (working on developing and maintaining healthy relationships). All of these positive behavior choices help the individual maintain "balance, which is the key to a healthy lifestyle and good stress management.

It is important for the individual to get professional help early - when the symptoms first present themselves - and to make those "small changes in their lifestyle that incorporate healthier habits. It is important for the employee to take care of herself inside and out by eating right, sleeping regularly, resting, exercising, pampering herself on occasion, and socializing in a purposeful, healthy way.

Specific recommendations for coping with depression and anxiety include:

- If the employee suspects that she is suffering from depression, or that her stress levels are growing beyond her control, she should immediately schedule a medical checkup in order to rule out any medical causes.

- In the workplace, as well as at home, it is important for the woman who feels overwhelmed by life to break large tasks into small ones and then to set realistic goals - both short- and long-term - and then to allow herself to celebrate and enjoy the small accomplishments.

- Avoid negative people whenever possible, and refuse to accept her own or anyone else's negative thinking.

- Make the time and then take the time to perform positive daily affirmations using positive thinking techniques such as positive self talk and visualizations exercises, all of which can help bring back a sense of joy and feelings of energy into each day.

- Start new habits that include doing things that are healthy and which add to feelings of well being. These can include spending time outdoors and with others who are supportive.

- Keep a journal for personal discovery and insight.

- Forgiveness - work on letting go of what hurts you or angers you.


How human resources executives and employee assistance programs can work with mental health professionals to treat employees dealing with these mental health issues

It all begins with education. Educating those charged with leadership in the organization about causes of the illness, triggers that can lead to a crisis (decompensation) and how to prevent crises at the workplace, treatment options, and the prognosis for the employee's particular disorder is important. It is also important for those who are involved with employee welfare to be able to identify signs of depression that often get misdiagnosed or are left untreated. These include physical complaints such as fatigue, headaches, chronic pain and changes in physical movements in which the employee appears to be either agitated or slowed down (sluggish).

Skill-building between employees and managers helps to create a positive workplace, which in turn reduces employee stress and improves productivity. It is important to create an open line of communication in such a way that the employee feels assured she will not be stigmatized or her employment negatively impacted.

It is also important to stay current about resources that are available in the community. Employers can get involved with local advocacy programs, which provide education to employees and their families as well as provide emotional support; many of these services are free of charge. It is also important for the employer to encourage preventive care; very often employees will postpone or avoid necessary care because they don't want to or think they can't afford to miss work.

Employers and employees also benefit from training sessions that focus on the established techniques that address maintaining a healthy and balanced lifestyle for busy people. Positive changes in workplace culture that promote a healthier and more energizing environment can begin with inviting local agencies, both governmental and private, to make short presentations about their services and how they can enhance the employee's lives - both at home and in the workplace.

Depression can be treated. With timely intervention, therapy and proper medication (particularly the newer antidepressants, which can help normalize the chemical imbalance in the brain) and making the necessary lifestyle changes that promote healing, growth and balance, employees and employers can minimize the negative effects of depression - both for the employee and for the workplace.