Everyone agrees that Dorothy is one of the hardest-working people they know. Up by 5:00 a.m. and out of the house until well after 8:00 p.m., Dorothy is certainly one to keep herself busy: getting her workout and housework done before she heads to the office, planning for upcoming committee meetings during her lunchbreak at noon, attending back-to-back meetings for local groups that she’s a member of, including a local animal rights group and wildlife conservancy, serving on the board of the PTA at her son’s school, hosting meetings for her book club, preparing dinner for her family, and retiring to her home office to work on her novel, all before laying her head back down on her pillow at the end of the night.

On the outside, she’s a glowing workaholic: unwaveringly ambitious, determined, driven, disciplined, energetic, eager, and zealous—the type of person who can never seem to sit still and is happiest when active. But Dorothy’s harboring an unpleasant secret. Like the approximately 280 million adults around the world (by WHO estimates) who are also afflicted with the disease, Dorothy is suffering from depression—unbeknownst to her family, her friends, her peers, and her community.

This lack of awareness amongst those closest to her is perhaps due to the type of depression that she is struggling with, known as “high-functioning depression:” a non-clinical form of depression characterized by the absence of the more trademark symptoms of depression—namely, functional impairment, poor performance, failure to concentrate, lethargy, withdrawal, and isolation—rendering it a much more private and hidden battle. It’s a form of depression that is seen (or, rather, not seen) most often among leaders, entrepreneurs, “perfectionists” and multi-hyphenate people, and—much like the duration of persistent depressive disorder (PDD) (under which high-functioning depression is often categorized)—it can linger on for years, often until it either abates, or worse, intensifies. In Dorothy’s case, though she appears motivated and engaged on the outside, on the inside, she struggles with feelings of worthlessness, numbness, apathy and disinterest, and passive suicidality—some of the hallmark traits associated with the condition.

Depression in the Workplace

While high-functioning depression often evades notice entirely, regardless of setting or how close the observers are to the person afflicted, even the severest forms of depression can just as easily go unnoticed in the workplace. One of the principal drivers of lost productivity and low morale, employers often find it hard to distinguish between what performance outcomes are indicative of underlying mental health issues like depression…or just ill-suited staff.

Nevertheless, anywhere from one in six to 85 percent of employees are estimated to experience mental health challenges each year—mostly depression and anxiety. According to NAMI, nearly two-thirds of missed workdays are attributable to poor mental health which, according to the WHO, translates to an estimated 12 billion workdays lost each year at a cost of $1 trillion in lost productivity. Furthermore, research shows that depression is one of the leading drivers of higher turnover, as approximately half of full-time employees have left their job for mental health reasons, including nearly 70 percent of millennials and over 80 percent of Gen Zers.

In recent years, employers around the world have continued to strengthen their commitment to the wellbeing of their employees—especially their mental wellbeing: they’ve invested in EAPs, they’ve started offering mental health days, they’ve begun to prioritize team building and peer support, they try to help employees find meaning in their roles, and so much more. Still, employers tend to struggle with one crucial aspect of their response plan: that is, being able to identify just who in their workplace is struggling with depression.

And that’s totally understandable. Unlike with physical ailments, mental health issues are oftentimes harder to perceive “with the naked eye.” People’s tendency to mask their symptoms due to persisting stigma or fear of discrimination or retaliation certainly doesn’t help. But while employers have plenty of excuses as to why it’s hard for them to spot depression in their workplace, that doesn’t mean that it’s okay for them to throw in the towel and give up trying. In fact, as we now know, being able to spot early warning signs of depression could save employers thousands, if not millions, in productivity—and even more importantly, it could save lives.

Warning Signs and Risk Factors of Depression

So how can employers identify depression in their workplace?

According to experts, some of the most common signs of moderate to major depression include:

• Difficulty concentrating on and completing tasks; missing deadlines
• Poor or worsening memory
• Poor judgment and trouble making decisions
• Tiredness, loss of energy; fatigue
• Persistent feelings of sadness, numbness, or hopelessness
• Social isolation or withdrawal
• Changes in appetite and/or sleep
• Uncharacteristic weight gain or loss
• Decline in physical appearance; poor hygiene
• Mood swings, irritability, and uncharacteristic anger or rage
• Loss of self-confidence, low self-esteem, and feelings of guilt or shame
• Risk-taking or escapist behaviors
• Substance abuse
• Frequent accidents, illnesses, or injuries
• Frequent sick days
• Self-harm or suicidal thoughts or tendencies

Additionally, some signifiers of high-functioning depression to look out for include:

• Tearfulness or frequent crying
• Lower productivity or reduced performance
• Less involvement in activities; less enthusiasm
• Self-criticism; “perfectionism”
• Agitation

Even in the absence of these indicators, the presence of poor performance or organizational outcomes like increased absenteeism or presenteeism, decreased productivity or low morale, and higher turnover can be taken as signs that something in the workplace is awry and needs to be investigated. Very often, what’s ‘awry’ is the state of workers’ overall health and wellbeing in which employers will have to quickly intervene to refer employees to the right support to safeguard their health as well as the health and efficiency of the organization.

But not only can adverse workplace conditions serve as signs of worker depression and other mental health ailments, but they can also function as causes or risk factors. Poor working conditions have long-since been found to inflict high levels of stress, anxiety, helplessness, and despair onto workers, which can in turn lead to chronic stress, burnout, and depression. Some of the known workplace conditions that contribute to poor health outcomes include:

• High job demands; long hours, tight deadlines, challenging targets
• Little autonomy; lack of control over job design or workload
• Under-use of skills or being under-skilled; lack of opportunities for growth or upskilling
• Remote, isolated, or unsocial work environments
• Low or lack of support from peers and management
• Job insecurity, inadequate wages, and fear of redundancy
• Lack of communication; unclear job role or responsibilities
• Discrimination, violence, harassment, and workplace bullying
• Hazardous working conditions
• Traumatic or crisis situations

In general, other well-known risk factors for depression that leaders and managers can familiarize themselves with to have a better understanding of who in their workplace is at risk of the illness include:

• Family history of depression or other mental health issues
• Serious loss, including loss of loved ones, finances, employment, etc.
• Relationship conflicts
• Past or current abuse; childhood trauma
• Pregnancy or childbirth
• Co-morbidities, including thyroid disease, chronic pain, anxiety, sleep problems
• Medications
• Substance abuse; family history of substance abuse

Lastly, it’s important for employers to be aware of behaviors or other signs that workers are hiding their depression or struggling with high-functioning depression, which can include:

• Taking on more work, working overtime, working after-hours or on the weekend
• Hanging around the office later than necessary
• Appearing lethargic, tired, bored, or apathetic
• Appearing unauthentically or overly cheerful

While supervisors or managers by no means supplant counselors, clinicians, and coaches when it comes to providing healthcare, they can, however, play a huge role in helping to initiate and facilitate the process of receiving professional care by being able to promptly identify employees who are in need of that kind of support; engage in an open, comforting, and genuine conversation with them, in which managers actively listen to their employees and reassure them that their experience—along with the pain they might be feeling—is valid; and effectively communicate the resources and services that are available to them whether onsite or in the local community and encourage employees to use them. And that starts, of course, by understanding the underlying causes, risk factors, and warning signs associated with depression in the workplace.

Responding to Depression

As mental health continues to be mythologized and stigmatized to this day, it is very much part of employer’s duty of care to address mental health head-on in the workplace. In fact, when employees are given the space and empowerment to speak out and seek help for their depression, they have at least an 80 percent chance of experiencing a healthy turnaround.

So how can employers create that safe and supporting environment that not only enables but encourages workers to take care of their mental wellbeing?

Like all well thought out and successful initiatives, it starts with training: specifically, training managers on how to talk about mental health with their teams, recognize the signs of poor mental health amongst members of their teams, and how to provide adequate and appropriate support to struggling employees. This includes training managers on how to be better communicators; how to lead with empathy and compassion, and how to actively listen. It also includes training all staff in mental health literacy and awareness in efforts to reduce stigma, resistance against help-seeking, and bias against peers. Employers can also focus on resilience-building training efforts, including stress-management workshops which help employees locate and build upon both the internal and external resources they have at their disposal to prevent or mitigate stress.

As employers seek to train employees on how to be kinder, more compassionate, and more understanding toward themselves and towards each other, the next natural step to take toward creating a more resilient, mentally healthy workplace is to build upon existing peer connections and foster a sense of community, togetherness, and belonging. This can range from encouraging frequent collaboration and teamwork, or instituting peer support groups, to organizing social events that allow coworkers to have fun together and form genuine friendships outside of work. As research shows, social connectedness is one of the strongest protective factors against depression and is overall one of the main determinants of mental health.

Likewise, perceived psychological and physical safety is another driving force behind the state of one’s overall health and wellbeing. When the workplace is and, more importantly, feels safe to employees, they’re more likely to be less anxious, less stressed, and more optimistic, and they are also more likely to be well-rested, to have a more stable diet, and physically healthier—all of which significantly reduces their risk for depression. Some of the key ways in which employers can cultivate a psychologically safe workplace include:

• Instituting routine one-on-ones between managers and their employees
• Prioritizing flexibility; allowing employees to work from home or break up their hours as needed, and offering versatility to their assignments
• Allowing and even encouraging employees to leave the workspace when they are stressed or anxious to prevent them from becoming overwhelmed
• Creating a break room or “safe space” that employees can access to rest, recharge, and regain their composure as needed
• Operationalizing DEIA norms, policies, and programs
• Providing reasonable accommodations to those struggling with their mental health, including extra time to complete tasks, reduced workloads, and PTO
• Investing in and implementing return-to-work programs that help employees reacclimate to the workplace after a leave of absence

In addition to psychological safety, research has shown that the corresponding sense that you matter to your employer and that you, as an individual, are cared about by your employer holds equal weight over employees’ health and wellness outcomes. By providing a living wage, including employees in the decision-making process, recognizing and rewarding hard work, and demonstrating how an individual’s role aligns with the organization’s overall mission, employers can help to signify to their employees that they are more than just a number or a “cog in the machine” which can help them to feel less drained, indifferent, and dispassionate about their work and their lives, and thus prevent against burnout, despair, and depression. Similarly, by providing ample opportunities for professional growth and upskilling, employers convey a sense of belief in their employees’ potential, encouraging them to believe in their own selves and hold onto hope that they can continue to better themselves and grow in both their professional and personal lives, and that they will not remain stuck where they are now.

But, of course, as employers will surely want their employees to stay with them for the long-term—and hopefully as many employees will want to do the same—perhaps the most important step that employers can take to create a safe, engaging, and healthy workplace is to protect and prioritize work-life balance: making sure that one’s work does not overshadow or deplete their private life, making sure that they’re able to find both pleasure and meaning in their professional and personal lives, making sure that they have enough time, resources, and support to accomplish all of their goals, whether those pertain to work or their life outside of it, and making sure that they feel fulfilled, satisfied, and continuously inspired. That is how employers can help to protect their employees against the grips of despair, dejection, and helplessness.