Depression at work, authenticity in question: Experiencing, concealing and revealing

Explaining depression in the language of burnout: Normative reasons for depression in place of deterministic causes

In recent years, there has been renewed interest in diversifying the understanding and discussion about the causes of depression to move beyond biomedical determinism-a view that biomedical factors are the ultimate cause of an individual's depression. There is increasing emphasis on diversity in how people seek to articulate the causes of depression to incorporate non-biomedical dimensions. Furthermore, the biomedical understanding of depression has been increasingly questioned due especially to emerging limitations in pharmacotherapy. These shifts encourage social analyses that explore what narratives as to the causes of depression are constructed and presented with relative plausibility in different contexts and why and how. By analysing published memoirs of individuals diagnosed with depression in Japan, this study aims to provide fresh insights into narratives around the causes of depression. It illustrates how memoirs portray depression and its perceived causes in characteristic ways in a nation that adopts Western diagnostic systems, biomedical therapeutics and other relevant technologies. I will show that 'burnout' is the dominant theme in the Japanese data, diverging from the predominantly biomedical narrative in Western societies. This burnout narrative depicts depression as the somewhat unfortunate but unsurprising result of overwork arising from individual active adaptations to structural features of the Japanese work culture. I argue that reasons, rather than causes, articulate the making of the burnout narrative by revealing the interplay between the structural and individual and ultimately enrich the understanding of depression. The paper concludes with a call for exploring the shifting relationship between illness and normalcy that the burnout narrative implies. I suggest that further studies could explore how the boundaries between normalcy and illness are enacted and re-enacted and to what avail through public discourse and through shifting diagnostic schemata in the context of different national norms and practices.

The lived experience of major and treatment-resistant depression in England: a mixed-methods study

INTRODUCTION

Major depressive disorder (MDD) is a common, frequently recurrent condition associated with decreased well-being and increased healthcare-related costs. Mixed-methods research provides multiple ways of illustrating the phenomenon to better understand patient experience, including where treatment is not working, referred to here as treatment-resistant depression (TRD).

METHODS

A mixed-methods study investigated the experiences of people with symptomatic MDD, symptomatic TRD or TRD in remission, surveying 148 adults recruited from English clinical sites to measure symptom severity (Patient Health Questionnaire-9 [PHQ-9]), HRQoL (EQ-5D-5L/World Health Organisation Brief Assessment of QoL [WHOQOL-BREF]) and work productivity/activity impairment (WPAI:D). Interviews with 26 survey respondents were analysed thematically. Integrated datasets explored areas of convergence and divergence, with concepts mapped against the EQ-5D-5L.

RESULTS

Qualitative data explained low WHOQOL-BREF domain scores and the interrelation of psychological, emotional, cognitive and physical difficulties. Tiredness, lack of energy and motivation impacted daily activities, socialising and career goals. Low work performance scores were explained by poor concentration, decision-making and motivation. Participants also described the influence of social support and housing insecurity. Only 19 % of HRQoL qualitative codes mapped to the EQ-5D-5L. Themes dominant in patients with TRD were inability to cope, self-care challenges, dissatisfaction with mental health services and treatment pessimism.

LIMITATIONS

Limited data collected on people with TRD in remission.

CONCLUSIONS

The EQ-5D-5L and WPAI:D likely underestimate how depression impacts the HRQoL and work of people with MDD or TRD. Qualitative data suggest increased distress for people with TRD compared to those with MDD. Clinical management and treatment access decisions should consider the broader impacts of depression and environmental factors affecting the patient's experience.

Face negotiation in graduate school: the decision to conceal or reveal depression among life sciences Ph.D. students in the United States

Background

Depression is one of the top mental health concerns among biology graduate students and has contributed to the "graduate student mental health crisis" declared in 2018. Several prominent science outlets have called for interventions to improve graduate student mental health, yet it is unclear to what extent graduate students with depression discuss their mental health with others in their Ph.D. programs. While sharing one's depression may be an integral step to seeking mental health support during graduate school, depression is considered to be a concealable stigmatized identity (CSI) and revealing one's depression could result in loss of status or discrimination. As such, face negotiation theory, which describes a set of communicative behaviors that individuals use to regulate their social dignity, may help identify what factors influence graduate students' decisions about whether to reveal their depression in graduate school. In this study, we interviewed 50 Ph.D. students with depression enrolled across 28 life sciences graduate programs across the United States. We examined (1) to what extent graduate students revealed their depression to faculty advisors, graduate students, and undergraduates in their research lab, (2) the reasons why they revealed or concealed their depression, and (3) the consequences and benefits they perceive are associated with revealing depression. We used a hybrid approach of deductive and inductive coding to analyze our data.

Results

More than half (58%) of Ph.D. students revealed their depression to at least one faculty advisor, while 74% revealed to at least one graduate student. However, only 37% of graduate students revealed their depression to at least one undergraduate researcher. Graduate students' decisions to reveal their depression to their peers were driven by positive mutual relationships, while their decisions to reveal to faculty were often based on maintaining dignity by performing preventative or corrective facework. Conversely, graduates performed supportive facework when interacting with undergraduate researchers by revealing their depression as a way to destigmatize struggling with mental health.

Conclusions

Life sciences graduate students most commonly revealed their depression to other graduate students, and over half reported discussing depression with their faculty advisor. However, graduate students were reluctant to share their depression with undergraduate researchers. Power dynamics between graduate students and their advisors, their peers, and their undergraduate mentees influenced the reasons they chose to reveal or conceal their depression in each situation. This study provides insights into how to create more inclusive life science graduate programs where students can feel more comfortable discussing their mental health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40594-023-00426-7.

Workers' Perspectives on Workplace Disclosure of Serious Mental Illness and Their Employers' Responses

Persons with serious mental illness are often reluctant to disclose their disability to an employer because of the intense stigma associated with their illness. Yet, disclosure may be desirable to gain access to employer-provided job accommodations, or to achieve other goals. In this article, we aimed to (1) describe the contexts in which workers in regular employment disclose a mental illness to their employer and (2) describe employer responses to disclosure, as perceived by the workers themselves. Semi-structured interviews were conducted with 40 workers, who were currently or formerly employed in a mainstream, regular job, post-onset of mental illness. Workers were asked to describe the circumstances that led to disclosure, and to describe their employers' responses to disclosure. Conventional content analysis was applied to identify common themes in the transcribed interviews. Analyses revealed five mutually exclusive disclosure contexts: seeking job accommodations, seeking protection, seeking understanding, responding to an employer's symptom-based inquiries, or being exposed by a third party or event. Analyses also revealed a wider range of employer responses-positive, negative, and ambiguous-than has been suggested by studies in which employers described their reactions to worker disclosure. Some themes were more prevalent among current versus former workers. Overall, the disclosure process appeared to be more complex than has been described by extant frameworks to date, and the linkages between disclosure contexts and employer response themes suggested that many workers did not receive the responses they were seeking from their employers.

'We're welcomed into people's homes every day' versus 'we're the people that come and arrest you': The relational production of masculinities and vulnerabilities among male first responders

Encouraging men to open-up about their feelings is a new cultural directive, yet little is known about how this works in practice, including to promote mental health. Ideals of hegemonic masculinity may be increasingly tolerating expressions of vulnerability in some areas of social life. However, the expression of vulnerability in paid work and/or career situations is regulated by organisational ideals and circumstances that may also produce distress. To address uncertainty in the literature, we investigated the experiences of men in traditionally male dominated professions, namely first responders (police, paramedics, and firefighters/rescue). Twenty-one UK based men of diverse ranks and experience currently working within first responder services participated in semi-structured telephone interviews. Distress was positioned as an inevitable part of the work. Yet, striking differences in institutionalised ways of expressing vulnerabilities differentiated the experiences of frontline workers, contributing to a wide spectrum of men's silence right through to relative openness about vulnerability, both in the workplace and domestic spheres. The findings provide importanat insights into how vulnerability is institutionally regulated, illuminating and contrasting how the possibilities for male vulnerabilities are socially produced.

The Three Cs of Disclosing Serious Mental Illness at Work: Control, Conditions, Costs

This Open Forum describes a framework for analyzing factors that influence an individual's decision to disclose serious mental illness in the competitive workplace. The disclosure decision is multifaceted, organized in dimensions of control, conditions, and costs. Control refers to the extent to which a mental illness is concealable, so that a worker may choose whether to disclose. The conditions workers impose on disclosure determine when, to whom, and how much they choose to say. The costs, both monetary and emotional, are a manifestation of the pervasive stigma associated with mental illness. The framework described here can form the basis for rigorous empirical studies of the disclosure decision that will inform both workers' decisions to disclose and employers' responses to disclosure. The objective of this research is to improve labor market outcomes for the significant numbers of workers with serious mental illness who can engage in mainstream, competitive employment.

Depression as a concealable stigmatized identity: what influences whether students conceal or reveal their depression in undergraduate research experiences?

BACKGROUND

Concealable stigmatized identities (CSIs) are identities that can be kept hidden or invisible and that carry negative stereotypes. Depression is one of the most common CSIs among undergraduates. However, to our knowledge, no studies have explored how students manage depression as a CSI in the context of undergraduate research, a high-impact practice for undergraduate science students. Concealing CSIs can cause psychological distress and revealing CSIs can be beneficial; however, it is unknown whether these findings extend to students with depression in the context of undergraduate research experiences. In this study, we interviewed 35 life sciences majors with depression from 12 research-intensive institutions across the United States who participated in undergraduate research. We sought to understand to what extent students reveal their depression in research and to describe the challenges of concealing depression and the benefits of revealing depression in this specific context. Additionally, we explored whether students knew scientists with depression and how knowing a scientist with depression might affect them.

RESULTS

Most students did not reveal their depression in their undergraduate research experiences. Those who did typically revealed it to another undergraduate researcher and few revealed it to a faculty mentor. Students who concealed their depression feared the potential consequences of revealing their identity, such as being treated negatively by others in the lab. Students who revealed their depression highlighted a set of benefits that they experienced after revealing their depression, such as receiving support and flexibility from their research mentor. We found that few students knew a specific scientist with depression. However, students perceived that knowing a scientist with depression would help them realize that they are not the only one experiencing depression in science and that people with depression can be successful in science.

CONCLUSIONS

This study illustrates that students with depression would benefit from research environments that are supportive of students with depression so that they can feel comfortable revealing their depression if they would like to. We also identified that students may benefit from knowing successful scientists with depression. We hope this study encourages undergraduate research mentors to support students with depression and ultimately reduces the stigma around CSIs such as depression.