According to the Institute for Work and Health (2016), major depression is one of the leading causes of disability in Canada, representing an annual economic cost of at least $51 billion dollars due to productivity losses, increased turnover, and impaired job performance (Goetzel et al., 2002).
Health care workers are facing increasing job demands and high levels of work stress due to increased pressure on the system accompanied by financial and human resource challenges (Cooper et al., 2016; Statistics Canada, 2015). As a result, health care workers are particularly vulnerable to job burnout (Schmidt, Dichter, Bartholomeyczik, & Hasselhorn, 2014), poor mental health, and depression (Zhang et al., 2014).
In fact, in any given year Canadian nurses are twice as likely to experience major depressive disorder as other working women between 25 and 61 years of age (Gilmour & Patten, 2007; Ohler, Kerr, & Forbes, 2010), with higher rates among those working outside of hospitals (Enns et al., 2015). In one report, almost 50% of nursing assistants in nursing homes were at high risk of depression (Muntaner et al., 2014). Yet, depression amongst nursing home employees has received little attention until recently and studies have focused primarily on nursing staff.
Supporting the health care needs of our aging population is a critical challenge facing our country (The Conference Board of Canada, 2015) and our province. New Brunswick has the oldest population in Canada (Statistics Canada, 2015), providing the unique opportunity to examine the challenges of an aging society ahead of the curve. The province has recently implemented the Home First Strategy (Province of New Brunswick, 2015) to help manage the needs of seniors at different stages of their life. While this includes a shift to providing more in-home care services, nursing homes still play a vital role in health care delivery for seniors, often for those who are no longer safe to live at home due to disability, disease, or cognitive decline. Given the critical role that nursing homes play in our health care system as the population ages, it is important to understand and address employee wellbeing and mental health to ensure safe, high-quality, and cost-effective care.
Many organizations, including all nursing homes in New Brunswick, already offer Employee and Family Assistance Programs (EFAPs) that provide support and resources to their employees, including confidential counseling services. Initial evidence shows that EFAPs can be an effective intervention for depression (Nakao et al, 2007). However, the extent to which Canadian nursing home employees with depression are using their EFAP is unknown and it is unclear if they are an effective resource for identifying and treating employee depression.
Generally, it appears that EFAPs are used by a minority of employees. For example, Tarnowski and Mahieu (2013) found that only 6% of US employees accessed their EFAPs, while Csiernick and Csiernick (2012) reported that on average, only 12.2% of Canadian employees used their EFAP and that one fourth of them did not promote their program to employees after their initial orientation. In addition, managers frequently do not receive training about their EFAP (Csiernick & Csiernick, 2012), limiting their ability to refer it to employees. Surprisingly, there is also little information about the cost-effectiveness of EFAPs despite their prevalence (Lerner et al., 2013). Thus, EFAPs represent an important and likely underutilized resource that could be used more effectively for early detection and treatment of employee depression, ultimately leading to improved outcomes for employees, seniors and their families, nursing homes, and provincial health care systems. Given its aging population and publicly-operated nursing homes, NB is an ideal context to conduct this pilot study which will provide evidence to inform a larger multi-province study.