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The WORC Project

Valuing Employee Health

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(1) Cleary CM, Hilton MF, Sheridan J, Whiteford HA. Corporate barriers preventing the initiation of mental health programs. J Occup Health Safety - Aust NZ 2008;24(6):507-17.

(2) Hilton MF, Whiteford HA, Sheridan JS, Cleary CM, Chant DC, Wang PS, et al. The Prevalence of Psychological Distress in Employees and Associated Occupational Risk Factors. J Occup Environ Med 2008 Jul;50(7):746-57.

(3) Hilton MF, Scuffham PA, Sheridan J, Cleary CM, Whiteford HA. Mental Ill-Health and the Differential Effect of Employee Type on Absenteeism and Presenteeism. J Occup Environ Med 2008 Nov;50(11):1228-43.

Abstract List

The WORC Project has published 15 abstracts, which are listed below. To read the full abstract click on the bold title.

1. Baxter A, Whiteford HA, Cleary CM, Hilton MF. Association between treatment-seeking behaviour for mental health and employment status in a national study. Aust.N.Z.J.Psychiatry 41[Supplement 1], 4. 1-5-2007.

2. Hilton MF, Sheridan J, Cleary CM, Morgan A, Whiteford HA. The concealed burden of mental health. Aust.N.Z.J.Psychiatry 41[Supplement 1], A32. 1-5-2007.

3. Sheridan J, Hilton MF, Chant D, Whiteford HA. Early telephonic intervention in individuals with depression, who are not currently in treatment, successfully increases treatment seeking behaviour and decreases symptomatology. Aust.N.Z.J.Psychiatry 41[Supplement 1], A82. 1-5-2007

4. Cleary CM, Hilton MF, Sheridan JS, Whiteford HA. Employee engagement in an early identification of depression symptoms and facilitation of help seeking behaviour project. The World Psychiatric Association Section of Epidemiology and Public Health Meeting . 2005.

5. Hilton MF, Cleary CM, Whiteford HA. Prevalence of psychological distress by employment sector. The World Psychiatric Association Section of Epidemiology and Public Health Meeting . 2005.

6. Hilton MF, Sheridan J, Cleary C, Whiteford HA. Effectiveness of the Facilitation of help Seeking Behaviour in Employed People with Depression. The 5th Annual Health and Medical Research Conference of Queensland . 2005.

7. Hilton MF, Cleary CM, Whiteford HA. Corporate resistance to early intervention models for mental health. The World Psychiatric Association Section of Epidemiology and Public Health Meeting . 2005.

8. Morgan A, Chant D, Sheridan JS, Hilton MF, Kwapil K, Whiteford HA. A First Psychometric Analysis of Risk Assessments Among Participants in The WORC Project. Australian and New Zealand Journal of Psychiatry 39[Suppliment 2], A86-A87. 1-12-2005.

9. Sheridan JS, Hilton MF, Chant D, Kwapil K, Morgan A, Gibson S et al. Facilitation of help seeking behaviour in employed people: The effectiveness of one clinical contact. The World Psychiatric Association Section of Epidemiology and Public Health Meeting . 2005.

10. Sheridan JS, Hilton MF, Chant D, Morgan A, Gibson S, Whiteford HA. Facilitation of help seeking behaviour in employed people: The effectiveness of one clinical contact. Joint CINP/ASPR Scientific Meeting . 2005.

11. Sheridan JS, Chant D, Morgan A, Hilton MF, Whiteford HA. A First Analysis of Clinical Variables Among Participants in The WORC Project. Australian and New Zealand Journal of Psychiatry 39[Suppliment 2], A35-A36. 2005.

12. Whiteford HA, Sheridan J, Cleary CM, Hilton MF. The work outcomes research cost-benefit (WORC) project: the return on investment for facilitating help seeking behaviour. Australian and New Zealand Journal of Psychiatry 39[Suppliment 2], A37. 1-12-2005.

13. Bacon D, Scuffham P, Chant D, Sheridan JS, Hilton MF, Whiteford HA. The effect of depression on work - is a diagnosis required to impair performance or are symptoms sufficient? Health and Medical Research Conference of Queensland . 2006.

14. Hilton MF, Whiteford HA, Sheridan JS. Getting upstream of psychological disability in the workforce. The Third International Forum on Disability Management , 9. 8-10-2006.

15. Morgan A, Chant D, Sheridan JS, Hilton MF, Whiteford HA. Depression and suicidal ideation in full-time employees - prevalence, risk factors and barriers to treatment. Health and Medical Research Conference of Queensland . 2006.

Full Abstracts

Abstract 1:

Association between treatment-seeking behaviour for mental health and employment status in a national study

Reference: Baxter A, Whiteford HA, Cleary CM, Hilton MF. Association between treatment-seeking behaviour for mental health and employment status in a national study. Aust.N.Z.J.Psychiatry 41[Supplement 1], 4. 1-5-2007.

Background: The Work Outcomes Research Cost-benefit (WORC) Project is a prospective Australia-wide study evaluating cost effectiveness of facilitating treatment-seeking behaviour among employees. The relationship between prevalence of mental illness, treatment-seeking behaviour and employment status is investigated.

Aims: To determine (1) prevalence of mental illness across full-time, part-time and casual employees, and (2) to what degree treatment-seeking behaviour influences employment status.

Methods: The WORC Project screened 78,726 employees for prevalence of mental illness using the Kessler 6 (K6) scale, and collected data on general health, demographic, employment and treatment-seeking behaviour.

Results: For males prevalence of mental illness shows no statistical association with employment status, with prevalence rates of 5.6% for full-time employees, 6.1% for part-time and 6.0% for casuals. Full-time and casual females demonstrated a slight increase in prevalence (6.4% and 6.0%, respectively) compared to part-time (4.9%). Interestingly those highly symptomatic employees in treatment for mental health problems were more likely to be part-time (Males: 26.0%; Females: 27.1%) or casual (Males: 24.0%; Females: 24.2%) employees compared to full-time (Males: 19.5%; Females: 22.6%).

Conclusion: The increased rate of treated prevalence among part-time and casual employees indicates an association between some aspect of treatment-seeking behaviour and employment status. This suggests that treatment or some aspect that leads to treatment, such as symptomatic level, increases the likelihood of transitioning from full-time to part-time or casual employment.

Abstract 2:

The concealed burden of mental health

Reference: Hilton MF, Sheridan J, Cleary CM, Morgan A, Whiteford HA. The concealed burden of mental health. Aust.N.Z.J.Psychiatry 41[Supplement 1], A32. 1-5-2007.

Introduction: This abstract describes the hidden human and economic cost of untreated mental health (MH). Data presented here describes a unique and difficult to identify population of individuals with current MH symptoms who are not in treatment.

Methods: The WORC Project, is a prospective RCT evaluating a MH screening and early intervention program. 89,810 employees were screened using to the World Health Organisation Health and Performance at Work Survey (HPQ) including Kessler 6 (K6).

Results: K6 data indicates that 5.6% of male and 6.0% of female employees are at very high risk of a mental health disorder. Alarmingly, of those in the very high risk category 20% of males and 24% of females were in treatment. In terms of lost productivity, male employees at very high risk on the K6 have an annualised lost productivity of $8,591 compared to those at low risk, $2,332 for females. In white-collar workers the main factor in productivity loss was presenteeism (not functioning at work) for blue-collar workers the main contributor was absenteeism. An indicator of the severity of MH symptoms in the employed is that at intake telephone interview, 15% of individuals in the intervention (N=842) reported suicidal ideation in the previous 7-days.

Conclusion: In the workforce lost productivity associated with MH symptomatology places a huge economic burden on employers, the economy and individuals well-being. Clinical data suggests that employment status should not be considered a major factor in the decision making process when assessing symptom severity in a MH in a consumer.

Abstract 3:

Early telephonic intervention in individuals with depression, who are not currently in treatment, successfully increases treatment seeking behaviour and decreases symptomatology.

Reference: Sheridan J, Hilton MF, Chant D, Whiteford HA. Early telephonic intervention in individuals with depression, who are not currently in treatment, successfully increases treatment seeking behaviour and decreases symptomatology. Aust.N.Z.J.Psychiatry 41[Supplement 1], A82. 1-5-2007.

Introduction: The WORC Project is a prospective Australia wide study evaluating both the cost and clinical effectiveness of facilitating help seeking behaviour among employed people reporting depressive symptoms who are not currently receiving treatment. This is a preliminary analysis of the clinical effectiveness of the facilitating help seeking intervention.

Method: Employees who screen positive for depressive symptoms on the Kessler 6 (K6) and the Quick Inventory of Depressive Symptoms (QIDS) were phoned by a psychologist (N=842). This contact included feedback, discussion of assessment results, barriers to appropriate help seeking and encouragement to contact a health professional. Following this, individuals were randomised into either a single contact (SC[N=269]) or multiple contact (MC[N=295]) group. To date the QIDS has been readministered at 6 weeks, 3, 6, and 12-month time points. Further follow-up will be conducted.

Results: Both SC and MC groups demonstrated equivalent levels of depressive symptoms on entry. The MC group shows a greater decrease in severity of depressive symptoms than the SC group. Differences in treatment seeking behavior between SC and MC groups to date are not statistically different.

Conclusion: Help seeking behaviour can be facilitated by addressing both lack of knowledge and obstructive beliefs about depression and its treatment even with a brief intervention (SC group). However, MC produced significant and substantial reductions depressive symptoms than a SC.

Abstract 4:

Depression and suicidal ideation in full-time employees - prevalence, risk factors and barriers to treatment

Reference: Morgan A, Chant D, Sheridan JS, Hilton MF, Whiteford HA. Depression and suicidal ideation in full-time employees - prevalence, risk factors and barriers to treatment. Health and Medical Research Conference of Queensland . 2006.

Purpose of study: The current study investigated full-time employees with symptoms of depression and suicidal ideation who were not currently in treatment. It aimed to examine the differences between participants with and without suicidal ideation regarding barriers to treatment, demographics, depression severity and suicide risk.

Conclusions: Suicidal ideation was reported by 16.62% of the participants in the week prior to interview. The participants with suicidal ideation were significantly more depressed than participants without suicidal ideation across all individual symptoms of depression and a total severity measure. Participants with suicidal ideation were assessed for suicide risk, with 46.1% classified at a moderate-high risk of suicide. Barriers to treatment were also assessed between groups. The most commonly reported barrier for all participants was a belief that treatment was not necessary. Participants with suicidal ideation reported significantly more concerns about the efficacy or need for psychotherapy. They also reported that poor prior treatment prevented them from accessing help significantly more than people without suicidal ideation. Lastly, this study examined factors that increase a participant's likelihood of reporting suicidal ideation. Significant differences were found between groups for all demographic variables (sex, age, marital status, number of children) except for education level. Consistent with literature, the most commonly reported risk factors in this group included a recent stressor and a family history of suicidal thoughts and behaviours. As expected, past suicidal thoughts and attempts were also commonly reported. This research suggests that employment is not as protective against suicide as the previous literature implies.

Abstract 5:

Getting upstream of psychological disability in the workforce.

Reference: Hilton MF, Whiteford HA, Sheridan JS. Getting upstream of psychological disability in the workforce. The Third International Forum on Disability Management , 9. 8-10-2006.

Depression is the leading cause of non-fatal disability in the western world. Workforce psychological injuries are responsible for 21% of workers compensation claims. Many of these claims are due to secondary morbidity associated with depression. On average, a person with untreated depression has a 40% loss in productivity while at work. A conservative estimate is that depression accounts for a $4 billion productivity loss per annum in Australia. The WORC Project is an ongoing prospective Australia wide study evaluating the cost effectiveness, from the employers perspective, for an early detection and intervention program designed to capture employees with untreated depression. The WORC Project has screened 92,000 employees for depressive symptoms and assessed their work performance (presenteeism) and absenteeism rates using the World Health Organisation Performance at Work Questionnaire. The model of early identification of depression symptoms and encouragement to seek treatment is a cost effective method to increase employee mental well-being and work performance.

Abstract 6:

The effect of depression on work - is a diagnosis required to impair performance or are symptoms sufficient?

Reference: Bacon D, Scuffham P, Chant D, Sheridan JS, Hilton MF, Whiteford HA. The effect of depression on work - is a diagnosis required to impair performance or are symptoms sufficient? Health and Medical Research Conference of Queensland . 2006.

Purpose of study: An established body of research has consistently demonstrated that a diagnosis of depression is associated with impaired work performance. There is also clinical research that has compared people with undiagnosed symptoms of depression and people with diagnosed clinical depression in terms of psychosocial functioning. Both types of depression are associated with
significant impairment of psychosocial functioning and the two do not differ in the extent of impairment caused. This suggests that a diagnosis of depression is not necessary for impairment to occur and that the symptoms of depression are most influential in impairing psychosocial functioning. Whilst this phenomenon has been studied within the clinical literature, it has not been applied to work functioning. Application of this model to work functioning research would
potentially provide information regarding the specific mechanisms of depression that contribute to impairment. The aim of the current study is to investigate the effects of depression on work performance, specifically focusing on the differential effects of symptomatic depression compared to diagnosed clinical depression. It is hypothesized that the effect of depression on work performance will be similar to that on psychosocial functioning; that is, depressive symptoms will be more influential than diagnosed depression in causing impairment.

Conclusion: Preliminary findings suggest that both symptomatic and diagnosed depression significantly impair work performance. The finding that impaired work performance occurred even in the absence of diagnosed depression suggests that depressive symptoms are most influential in causing this effect.

Abstract 7:

The work outcomes research cost-benefit (WORC) project: the return on investment for facilitating help seeking behaviour

Reference: Whiteford HA, Sheridan J, Cleary CM, Hilton MF. The work outcomes research cost-benefit (WORC) project: the return on investment for facilitating help seeking behaviour. Australian and New Zealand Journal of Psychiatry 39[Suppliment 2], A37. 1-12-2005.

Purpose: The WORC Project is an ongoing prospective Australia wide study evaluating the cost effectiveness of facilitating help seeking behaviour among employed people with symptoms of depression.

Methods: The WORC Project has screened 85,000 employees for depressive symptoms using the Kessler 6 (K6) and assessed their work performance (presenteeism) and absenteeism rates using the World Health organisation Performance at Work Questionnaire. Those positive for depressive symptoms are further screened using the Quick Inventory of Depressive Symptomatology (QIDS-SR). Employees with depressive symptoms on both surveys are telephoned phoned by a psychologist who provides a single counselling session, facilitates help seeking behaviour and mails the respondents information. Participants with depressive symptoms are tracked over the next 18-months to assess symptomatology and work performance.

Results: 6.7% of full-time employees screen positive for depressive symptoms on the K6. Sixty-five percent of these have not sought advice from a MHP in the last 12-months. Current data show that employees at high risk of depression on the K6 have an annual productivity decrement of $12,700 as compared to non-depressive symptoms decrement of $3,030 (P<0.0001). Data also suggests that there is an average depression treatment effect increasing mean productivity by $7,800.

Conclusions: The prevalence of depression in employed people is higher than indicated in the 1997 and 2001 ABS surveys. Most individuals with current depression symptomatology do not seek treatment. Untreated depression results in a significant and substantial decrement in employee productivity. This productivity decrement can be reversed with appropriate treatments. The model of early identification of depression symptoms and encouragement to seek treatment is a cost effective method to increase employee mental well-being.

Abstract 8:

A First Analysis of Clinical Variables Among Participants in The WORC Project

Reference: Sheridan JS, Chant D, Morgan A, Hilton MF, Whiteford HA. A First Analysis of Clinical Variables Among Participants in The WORC Project. Australian and New Zealand Journal of Psychiatry 39[Suppliment 2], A35-A36. 2005.

Introduction: The Work Outcomes Research Cost-Benefit (WORC) Project is a prospective Australia wide study evaluating the cost effectiveness of facilitating an increase in help seeking behaviour among employed people reporting depressive symptoms. People, who screened positive on the QIDS, are phoned by a psychologist. This interaction includes feedback and discussion of assessment results, barriers to appropriate help seeking and encouragement to contact a health professional. These participants are randomized into two groups; a single contact group who receive no further contact and a multiple contact group.

Method: The WORC Project has invited 342,000 employees to answer a general health questionnaire (GHQ), the Kessler 6 (K6) and the World Health Organisation Work Performance questions (HPQ). Employees who screen positive for symptoms of depression on the K6 are further screened using the Quick Inventory of Depressive Symptoms (QIDS). People, who screened positive on the QIDS, are phoned by a psychologist and are randomized into either a single intervention or multiple contact groups. The QIDS is readministered at 6 weeks, 3, 6, 12 and 18 months from this call.

Results: Both groups of individuals classified as having depressive symptoms at baseline demonstrated reduced levels of depression at 6 weeks post baseline and following a single intervention from a psychologist, regardless of whether they had sought treatment. The group receiving multiple contacts, however, showed slightly more improvement in depressive symptoms than those who received only one contact. Differences between these groups will be presented, and discussed.

Conclusion: Help-seeking behaviour can be facilitated by addressing both lack of knowledge and obstructive beliefs about depression and its treatment. However, a single intervention results in a measurable decrease in depressive symptoms reported by participants regardless of whether they have accessed treatment or not.

Abstract 9:

Facilitation of help seeking behaviour in employed people: The effectiveness of one clinical contact.

Reference: Sheridan JS, Hilton MF, Chant D, Morgan A, Gibson S, Whiteford HA. Facilitation of help seeking behaviour in employed people: The effectiveness of one clinical contact. Joint CINP/ASPR Scientific Meeting . 2005.

Introduction: The Work Outcomes Research Cost-Benefit (WORC) Project is an ongoing prospective Australia wide study evaluating the cost effectiveness of increasing the probability of help seeking behaviour among people identified as having untreated symptoms of depression. The clinical effectiveness of a single phone contact by a psychologist is examined.

Method: The WORC Project has invited 342,000 employees to answer the Kessler 6 (K6). Employees who screen positive for symptoms of depression are further screened using the Quick Inventory of Depressive Symptomatology (QIDS). People, who screened positive on the QIDS, are phoned by a psychologist. This interaction includes feedback and discussion of assessment results, barriers to appropriate help seeking and encouragement to contact a health professional. The QIDS is readministered at 6 weeks from the baseline QIDS-SR.

Results: Thirty four participants had been classified as having untreated symptoms of depression. Thirty participants recognised that they had symptoms of depression, considered themselves to be depressed. Fifteen attributed their symptoms to external circumstances. Nineteen participants had concerns about treatment as a reason for not previously seeking help. Fourteen participants expressed beliefs that seeking treatment would mean that they had failed. Eleven participants expressed concerns about medication and 8 had concerns about psychotherapy, principally a belief that it would not help. At 6 weeks, 3 participants were in remission. Eight had seen a health professional regarding their symptoms of depression and 8 had commenced taking antidepressants. Eighteen had attended a health professional for physical and emotional reasons.

Conclusion: People with untreated symptoms of depression do not seek help because of their concerns about treatment, beliefs that they will be perceived as failing and a disbelief in the effectiveness of intervention. However, a single phone contact with a psychologist resulted in half the group seeing a health professional. Help-seeking behaviour can be facilitated by addressing both lack of knowledge and obstructive beliefs about depression and its treatment.

Abstract 10:

Facilitation of help seeking behaviour in employed people: The effectiveness of one clinical contact

Reference: Sheridan JS, Hilton MF, Chant D, Kwapil K, Morgan A, Gibson S et al. Facilitation of help seeking behaviour in employed people: The effectiveness of one clinical contact. The World Psychiatric Association Section of Epidemiology and Public Health Meeting . 2005.

Method: The WORC Project has invited 82,273 employees to answer the Kessler 6 (K6). Employees who screen positive for symptoms of depression are further screened using the Quick Inventory of Depressive Symptomatology (QIDS). People, who screened positive on the QIDS, are phoned by a psychologist. This interaction includes feedback and discussion of assessment results, barriers to appropriate help seeking and encouragement to contact a health professional. The QIDS is readministered at 6 weeks from the baseline QIDS-SR.

Results: Thirty-four participants had been classified as having untreated symptoms of depression. Thirty participants recognised that they had symptoms of depression, considered themselves to be depressed. Fifteen attributed their symptoms to external circumstances. Nineteen participants had concerns about treatment as a reason for not previously seeking help. Fourteen participants expressed beliefs that seeking treatment would mean that they had failed. Eleven participants expressed concerns about medication and 8 had concerns about psychotherapy, principally a belief that it would not help.

At 6 weeks, 3 participants were in remission. Eight had seen a health professional regarding their symptoms of depression and 8 had commenced taking antidepressants. Eighteen had attended a health professional for physical and emotional reasons.

Conclusion: People with untreated symptoms of depression do not seek help because of their concerns about treatment, beliefs that they will be perceived as failing and a disbelief in the effectiveness of intervention. However, a single phone contact with a psychologist resulted in half the group seeing a health professional. Help-seeking behaviour can be facilitated by addressing both lack of knowledge and obstructive beliefs about depression and its treatment.

Abstract 11:

A First Psychometric Analysis of Risk Assessments Among Participants in The WORC Project.

Reference: Morgan A, Chant D, Sheridan JS, Hilton MF, Kwapil K, Whiteford HA. A First Psychometric Analysis of Risk Assessments Among Participants in The WORC Project. Australian and New Zealand Journal of Psychiatry 39[Suppliment 2], A86-A87. 1-12-2005.

Introduction: The Work Outcomes Research Cost-Benefit (WORC) Project is a prospective Australia wide study evaluating the cost effectiveness of facilitating an increase in help seeking behaviour among employed people reporting depressive symptoms. Within this cohort, a significant proportion of individuals have reported suicidal ideation within seven days of contact. This group is examined in regards to level of depression in comparison to individuals reporting depressive symptoms without suicidal ideation.

Method: The WORC Project has invited 342,000 employees to answer a general health questionnaire (GHQ), the Kessler 6 (K6) and the World Health Organisation Work Performance questions (HPQ). Employees who screen positive for symptoms of depression on the K6 are further screened using the Quick Inventory of Depressive Symptoms (QIDS). People who screened positive on the K6 and the QIDS, are not currently in treatment, and reported thoughts of suicide within the prior seven days, are transferred to a psychologist for risk assessment. The QIDS is readministered at 6 weeks from this call.

Results: Individuals classified as at risk of suicide reported a greater degree of depressive symptoms than those not at risk. This group also exhibited greater resistance to intervention at follow up. Across all depressed participants a reduction in reported symptoms was demonstrated, however within the Risk Assessment group intervention increased depressive symptoms. Further differences between these groups will be discussed.

Conclusion: Suicidal ideation indicates a greater severity of depression than depression without ideation. Brief intervention results in a greater awareness of symptoms and a higher self-report of depressive symptoms. The presence of suicidal ideation suggests a distinct behavioural response to intervention separate from that of depressed individuals without suicidal ideation.

Abstract 12:

Effectiveness of the facilitation of help seeking behaviour in employed people with depression

Reference: Hilton MF, Sheridan JS, Cleary CM, Whiteford HA. Effectiveness of the facilitation of help seeking behaviour in employed people with depression. Health and Medical Research Conference of Queensland . 2005.

Purpose of Study: The Work Outcomes Research Cost-Benefit (WORC) Project is an ongoing prospective Australia wide study evaluating the cost effectiveness of facilitating help seeking behaviour among employed people with symptoms of depression.

Methods: The WORC Project has invited 342,000 employees to answer the Kessler 6 (K6) of which we have received 85,000 responses. Employees who screen positive for symptoms of depression are further screened using the Quick Inventory of Depressive Symptomatology (QIDS). People, who screened positive on the K6 and the QIDS, are phoned by a psychologist. This interaction includes feedback and discussion of assessment results, barriers to appropriate help seeking and encouragement to contact a mental health professional (MHP).

Results: 5.9% of employees screen positive for depressive symptoms. Sixty-eight percent of these have not sought advice from a MHP in the last 12-months. At 6-weeks post the first contact by a psychologist who facilitated help seeking behaviour, 40% had visited a MHP.

Conclusions: The prevalence of depression in employed people is higher than indicated in the 1997 and 2001 ABS surveys. Most individuals with current depression symptomatology do not seek treatment. Help-seeking behaviour can be facilitated by addressing both lack of knowledge and obstructive beliefs about depression and its treatment. The model of early identification of depression symptoms and encouragement to seek treatment is a cost effective method for employers to increase employee mental well-being, which results in productivity increases of up to $10,000 per employee encouraged into treatment.

Abstract 13:

Corporate resistance to early intervention models for mental health

Reference: Hilton MF, Cleary CM, Whiteford HA. Corporate resistance to early intervention models for mental health. The World Psychiatric Association Section of Epidemiology and Public Health Meeting . 2005.

Introduction: Untreated depression is associated with productivity decrements, Workcover claims, employee attrition and increased work place accidents. The Work Outcomes Research Cost-Benefit (WORC) Project is an Australian study evaluating the cost effectiveness of a depression screening and early intervention model. Despite evidence that early intervention in depression has a positive financial return on investment for employers, many employers decline involvement. The principal concerns of employers to participating in a mental health screening program are described.

Method: The WORC Project is inviting 320,000 employees across Australia. Employers with at least 1000 employees were approached to participate. Typically, an initial telephone call was made to the Occupational Health and Safety Manager. If engaged, further information was e-mailed. A follow-up telephone call was placed 2-weeks after the e-mail where the scheduling of a meeting was attempted. Thenceforth, levels of negotiation depended on employer management structure. The outcome of each contact with an employer representative was logged in a database.

Results: Fifty-four employers have declined participation to date. Analyses of the correspondence yielded 3 primary categories of reasons for not participating in an ostensibly free depression screening program. Each of the employers may be present in multiple categories (e.g. they supplied more than one reason). Cost implications to employer is the primary reason for non-participation [N=30]. Mental health being a sensitive topic being second [N=21] and depression not being a management priority being third [N=16].

Conclusion: The mental health literacy of corporate Australia is poor. There is under-recognition that mental health problems (MHP) exist and that early intervention will improve employee functioning. Corporate stigma extends to concerns that addressing MHP will produce adverse media attention, employee group unrest, litigation and/or Workcover claims. Furthermore, any identification of MHP will reflect poorly on management practices. The success of future Australian mental health programs in employers depends on the ongoing education of corporate Australia.

Abstract 14:

Prevalence of psychological distress by employment sector

Reference: Hilton MF, Cleary CM, Whiteford HA. Prevalence of psychological distress by employment sector. The World Psychiatric Association Section of Epidemiology and Public Health Meeting . 2005.

Introduction: Improving the emotional well-being of employees is increasing becoming recognised as a key factor for increasing corporate productivity. The prevalence of psychological distress in employees and the rate of help seeking behaviour was examined as part of The Work Outcomes Research Cost-Benefit (WORC) Project which is an ongoing prospective study evaluating the cost effectiveness for the early identification of depression and facilitation of help seeking behaviour.

Methods: 82,073 employees have been invited to answer the Kessler 6 (K6), self report presence of current psychological problems and visits to mental health professionals (MHP) as part of a Health Appraisal Survey. Response rate to the survey is 23.7%.

Results: Prevalence rates for very high level of psychological distress using the Kessler 10 (K6) scale have been reported by the Australian Bureau of Statistics in 1997 (2.2%) and 2001 (3.6%). The WORC Project indicates a 5.2% prevalence of very high level of psychological distress with only 32.6% visiting a MHP in the last 12-months.

Based on the K6, for public versus private sector employees, the prevalence for very high level of psychological distress are 5.6% and 4.4% respectively (p < 0.0003). For public versus private sector employees the self reported prevalence of anxiety disorder is 12% and 9% respectively, depression (23% and 16%) and any other emotional problems (13% and 10%) are all significantly different (p < 0.0005). The prevalence of self-report substance abuse (4%) was not different between employment sectors. However, public sector employees were more likely to have visited a MHP in the past 12 months than their private sector counterparts (36.5% public sector and 23.5% private sector, p<0.0005).

Conclusion: Evidence indicates an approximately linear increase in the prevalence of psychological distress across the years 1997-2005. The increased prevalence of psychological distress and higher rates of accessing care in the public employment sector may, in part, be attributed to increased retention of personnel with mental health problems within the public sector.

Abstract 15:

Employee engagement in an early identification of depression symptoms and facilitation of help seeking behaviour project

Reference: Cleary CM, Hilton MF, Sheridan JS, Whiteford HA. Employee engagement in an early identification of depression symptoms and facilitation of help seeking behaviour project. The World Psychiatric Association Section of Epidemiology and Public Health Meeting . 2005.

Introduction: The Work Outcomes Research Cost-Benefit (WORC) Project is an ongoing Australia wide study evaluating the cost effectiveness for early intervention in depression in employed people. An initial cohort of data was analysed to determine the willingness of employed people with depression symptoms to participate in a program aimed to address their emotional state.

Method: Employees answer the Kessler 6 (K6), embedded within the Health Appraisal Survey (HAS). respondents positive for depressive symptoms are subsequently asked the Quick Inventory of depressive Symptomatology (QIDS) over the telephone. Individuals positive for depression symptoms on both the K6 and QIDS-SR, that are not in current treatment for their symptoms, are asked to participate in the WORC Project. Participation involves psychologists employing motivational interviewing techniques to encourage symptomatic people into treatment.

Results: Of the 82,073 employees invited to date 23.7% have returned HAS surveys. Of those 5.7% scored positive for symptoms of depression with 33% granting consent for further contact. Using the QIDS–SR as a Gold Standard, there were 253 (68%) true positives (TP) for depression symptoms of which 143 (57%) were eligible and agreed to further participation. The remainder either declined further contact (N=17), or were ineligible (N= 93) due to co-morbid substance dependency (6% of ineligibles), co-morbid mania (11%) or, in treatment for depression symptoms (82%). Of the eligible participants 105 (73%) have consented. Thus, 0.l3% of the invited sample (0.54% of respondents to the original HAS survey) are eligible, depressed, and consented to participate in a program that encourages help seeking behaviour.

Conclusion: The major sources of attrition of recruiting participants are (1) getting them to respond to the HAS in the first instance and, (2) getting them to consent to further contact. Once screened in to the program 93% of people with depression symptoms agree to talk with a psychologist about their feelings. For a depression screening program to be effective, methods to encourage initial interest and confidence in confidentiality are of paramount importance.