EAP 2.0: reimagining the role of the employee assistance program in the new workplace.

Mental illness is a highly prevalent problem that affects millions of individuals. Like many other previous natural disasters and terrorist attacks, the recent Covid-19 pandemic has placed an enormous stress on the world and its workforce. In many ways the pandemic revealed gaps in the quality and availability of mental health resources, and, by magnifying the intense demand, it also spurred innovation. Telemedicine and virtual trauma-related services became examples of ways in which evaluation, treatment and counselling services could be delivered directly and efficiently to people who were confined to their dwellings and hospital beds. For many, the workplace has been a source of stress but also a vital component of one's self-worth, day-to-day purpose, and a resource for wellness programs and brief counselling services, not to mention, at least in many countries like the United States, a source for health insurance. The employee assistance program (EAP) is an example of a workplace-counselling and triage service that has enormous potential to meet the growing needs of individuals both in 'normal' times and during disasters. By better understanding the EAP's current structure alongside the advent of new technologies, it may be possible to develop a new and improved EAP model to meet a changing global landscape. For EAP to succeed and ultimately be scalable in an increasingly competitive and value-conscious marketplace, its processes of care will first require a bottom-up review with meaningful outcomes data. This will be necessary to drive continuous quality improvement and to demonstrate EAP 2.0's value to both employer and employee alike.

A missing element in disaster mental health: behavioral health surveillance for first responders.

Considerable literature exists on surveillance for medical effects of responses to a disaster but there is a dearth of information on conducting surveillance of behavioral health effects for first responders. This article reviews the literature and rationale behind behavioral health surveillance in the context of medical surveillance of first responders, examines special populations and ethical issues, discusses a model currently used by the U.S. military, discusses unresolved issues, and concludes with some practical suggestions.

Ultrasound biomicroscopy in asymmetric pigment dispersion syndrome and pigmentary glaucoma.

OBJECTIVE: To identify differences in anterior chamber anatomy among patients with asymmetric pigment dispersion syndrome and no other discernible cause for the asymmetry. METHODS: Ultrasound biomicroscopy and A-scan biometry were performed on both eyes of 13 patients with asymmetric pigment dispersion syndrome without a known cause for asymmetric involvement. A radial perpendicular image in the horizontal temporal meridian detailing the scleral spur, angle anatomy, and iris configuration was obtained for each eye by 2 examiners. RESULTS: There were no differences in lens thickness (P = .33), refractive error (P = .84), or axial length (P = .99) between more and less affected eyes. However, the mean +/- SD iris concavity (P<.001), iris-lens contact distance (P = .02), and distance from the scleral spur to the iris insertion (0.42 +/- 0.11 vs 0.29 +/- 0.06 mm) (P = .002) were greater in the more affected eye of each patient. CONCLUSION: A more posterior iris insertion predisposes to the phenotypic expression of pigment dispersion syndrome.

Is there a duty for private employers to provide emergency mental health care services?

This article presents a discussion of whether employers in private companies have a duty to provide an emergency action plan with a mental health component for its employees. It discusses basic negligence concepts and focuses mainly on the "duty of care" component of negligence. It then applies the negligence concepts to private employers and discusses how private companies arguably might have a duty under the laws of negligence to provide employees with an emergency action plan, specifically a plan including mental health provisions.

How much does quality mental health care profit employers?

OBJECTIVE: Employers provide most American mental health benefits and are increasingly cost conscious. However, commonplace anxiety and depressive disorders have enormous economic and workplace performance costs. METHODS: We performed multiple literature searches on several areas of pertinent research (and on key articles) covering the past 5 years. RESULTS: Substantial research exists about anxiety and depression costs, such as performance and productivity, absenteeism, presenteeism, disability, physical disability exacerbation, mental health treatment, increased medical care costs, exacerbating of physical illness, and studies of mental health care limitations and cost-offset. Research addressing the potential value of higher quality mental health care is limited. CONCLUSIONS: Commonplace anxiety and depressive disorders are costly in the workplace. Employers and researchers remain largely unaware of the value of quality care and psychiatric skills. Effective solutions involve the increased use of psychiatric skills and appropriate treatment.

Rethinking first response: effects of the clean up and recovery effort on workers at the world trade center disaster site.

OBJECTIVE: We sought to describe the physical and mental health effects of the cleanup and recovery effort on workers at the World Trade Center disaster site. METHODS: A mailed survey was sent to truck drivers, heavy equipment operators, laborers, and carpenters. It assessed work-related exposures and somatic and mental health symptoms. In one open-ended question, respondents shared any aspect of their experiences they wished; these 332 narrative responses were analyzed using qualitative techniques. RESULTS: Respondents reported suffering debilitating consequences of their work, including depression, drug use, and posttraumatic stress disorder. They felt poorly prepared to work in a disaster, lacked protective equipment and training, and felt overwhelmed by the devastation they faced. CONCLUSIONS: These workers' experiences were qualitatively similar to the experiences of the first responders. To protect workers in the future, the focus on preparing "first" responders should be reconsidered more broadly.

Beyond symptomatic improvement:assessing real-world outcomes in patients with major depressive disorder.

OBJECTIVE: To quantify the negative impact that major depressive disorder (MDD) has on quality of life, disability, and work, family, and overall psychosocial functioning. Available scales that assess these areas of impairment as they relate to patients with MDD are described. DATA SOURCES: PUBMED SEARCHES WERE CONDUCTED USING THE FOLLOWING TERMS: (MDD OR major depressive disorder) AND (absenteeism OR absente*); AND (quality of life OR QOL); AND (psychosocial function*); AND (presente* OR presenteeism); AND (health care cost* OR [health care] cost*); AND (health outcome*); AND (functional outcome*); AND (family life); AND (disabil* OR disability); AND (work function*); AND (unemployment OR unemploy*). The literature search was conducted in July 2008 and was restricted to English language articles. There were no limits set on the dates of the search. STUDY SELECTION: Two hundred twenty potential articles were identified. Among these studies, 48 presented primary data directly demonstrating the effect of MDD on quality of life, disability, and work, family, and overall psychosocial functioning. DATA EXTRACTION: Primary data were compiled from these studies and are summarily described. Available scales that assess quality of life, disability, and work, family, and overall psychosocial functioning are also described. DATA SYNTHESIS: MDD was found to be associated with significant disability and declines in functioning and quality of life. The Sheehan Disability Scale, the 36-item Short-Form Health Survey, and the Work Limitations Questionnaire were the most commonly used scales according to this review of the literature, but the majority of studies used direct and indirect disability measures, such as health care and other disability-related costs. CONCLUSIONS: In addition to assessing symptomatic outcomes, physicians should routinely assess their depressed patients on "real-world" outcomes. The development of a concise functional outcome measure specific to MDD is necessary for busy clinical practices.

Etiology of depression and implications on work environment.

OBJECTIVE: We describe the etiology of clinical forms of depression and their interaction with workplace factors. METHODS: We performed selective literature searches in pertinent research areas and reviewed the literature in the context of clinical experience in several depression programs at Johns Hopkins. RESULTS: Substantial research exists about the causes of depression. The causes of clinical forms of depression are complex. Genetic factors, several specific brain disorders, gender, as well as life events or circumstances all are involved in the causal pathway. Research addressing how the work environment impacts depression and its role in aggravating or alleviating depression is more limited. CONCLUSIONS: Research findings about the various causal connections in depressive disorders may provide some guides to treatment as well as to further research on depression in the workplace.

Building resistance, resilience, and recovery in the wake of school and workplace violence.

Incidents of school and workplace violence are rare but devastating events that can result in significant psychological consequences in communities. The majority of people in the United States will experience some type of traumatic event in their lifetime, but most of them will have no disruption or only transient disruption in functioning. They are either resistant to the development of symptoms or resilient, able to bounce back quickly. By enhancing resistance and promoting resilience, even fewer individuals may develop mental disorders. This article takes a closer look at the concepts of resistance, resilience, and recovery and the need for research on interventions that promote them, in the hope of applying the concepts and interventions to schools and the workplace.