Anxiety, depression could be costing Singapore’s GDP almost $16b a year

Various studies have been pointing to a rise in the number of people dealing with these conditions, which were exacerbated by the pandemic.

Natasha Ann Zachariah

Natasha Ann Zachariah

The Straits Times


The potential loss in GDP is a result of absenteeism, reduced productivity and the use of healthcare resources. PHOTO: ST FILE

June 12, 2023

SINGAPORE – After an emotional breakdown in front of her boss, Ms Debra Low knew she had hit a breaking point.

The sudden outburst in 2016 followed months of her struggling with her workload as a social media and community manager for a telco. Stress, a heavy workload and disrupted sleep would trigger her mental state, making her careless, tired and disengaged while at the office.

Following that episode, she consulted a psychologist, and was officially diagnosed with moderate anxiety and depression.

The 33-year-old, who eventually left that job, said: “I was underperforming and felt like my mind was in a fog at times. I felt I was a burden to the team and a deadweight.

“I didn’t express my difficulties to the team, but I was struggling,” said Ms Low, who is now a freelance social media marketer and also teaches art.

Anxiety and depression could cost the workplace

Ms Low is not alone in dealing with anxiety and depression – and grappling with these issues at work.

Various studies in Singapore and globally point to a rise in the number of people dealing with these conditions, which were exacerbated by the pandemic.

A recent study conducted by Duke-NUS Medical School and the Institute of Mental Health (IMH) has suggested that people with anxiety and depression symptoms here could be costing Singapore nearly $16 billion a year, or about 2.9 per cent of the nation’s gross domestic product.

This is a result of absenteeism, reduced productivity and the use of healthcare resources.

The researchers said this is the first study after the pandemic that estimates the prevalence of and quantifies the financial cost of depression and anxiety symptoms among Singaporean adults.

Published in the open access, peer-reviewed journal BMC Psychiatry, the study surveyed 5,725 Singaporeans above 21 years old between April and June 2022.

From this pool, 350 respondents screened positive for depression or anxiety symptoms, and were asked about healthcare utilisation, days missed from work, and productivity due to these symptoms.

The results showed that direct annual healthcare costs averaged about $1,050 for those who had anxiety and depression symptoms. From the study’s results, over the past year, 13 per cent visited the emergency department at least once, while 9 per cent had at least one hospital admission.

Stress, a heavy workload and disrupted sleep would trigger Ms Debra Low’s mental state, making her careless, tired and disengaged while at the office. PHOTO: COURTESY OF JAN KOK

They were also likely to miss an additional 17.7 days of work on average each year, which cost about $4,980 per worker. Presenteeism is also an issue, with 40 per cent reporting being less productive at work. This equates to $28,720 in economic losses annually. In total, these symptoms caused $15.7 billion in increased costs.

The results in the study mirror global findings.

The World Health Organisation reported in September 2022 that an estimated 12 billion working days are lost globally every year to depression and anxiety. This amounts to about US$1 trillion (S$1.34 trillion) per year in lost productivity.

Helping employees manage anxiety and workplace blues

To support staff, companies here are beefing up their employee benefits, resources and programmes to address mental health issues.

These include having activities such as fitness and art classes to keep employees healthy and engaged, and offering counselling sessions or flexible work arrangements for better work-life balance.

Additionally, some companies are looking at changing their employee insurance benefits to include mental health claims, or offering mental health care breaks. Managers are also being trained to spot colleagues with anxiety and depression symptoms, while mental first aid training in the workplace is also being offered.

Singapore Management University (SMU) takes a community-oriented support system approach to helping employees manage stress.

The university has round-the-clock counselling services, and talks and workshops that cover emotional and mental aspects. It has established an internal network of “well-being champions”, including 60 staff volunteer first responders and 20 employee engagement ambassadors, to provide immediate emotional support and referrals to well-being resources.

SMU also reviewed its critical illness leave policy, and included mental illness as one of the critical illnesses, eligible for up to six months’ leave.

Professor Lily Kong, SMU’s president, said that while providing comprehensive mental health support might cost extra, the university sees it as an “important investment” to have productive, healthier employees.

She added: “But more than a functional reason, fundamentally, as employers, we have a moral responsibility to do what we can to ensure the well-being of our colleagues.”

At the National Healthcare Group (NHG), Adjunct Associate Professor Yong Keng Kwang has been tasked to look at the well-being of the company’s 22,000 staff, from their physical and occupational well-being to their mental health.

He is the group’s first chief wellness officer – a job position that is gaining traction globally as more companies look to manage burnout and address mental health issues among staff.

NHG offers a wide range of mental health support for its employees, including self-help resources, access to a staff support service, and professional care by psychologists or psychiatrists.

Prof Yong said: “We can’t have double standards. We advocate and promote mental health (among the public), and shouldn’t overlook our own people who may have mental health challenges, even though it may be mild or in the initial stages.”

He noted that multiple avenues are open for staff to get help.

During the pandemic, the group did receive more feedback from staff who felt the strain of their workload, but only a few of them sought help, said Prof Yong.

This was also a key finding from the Duke-NUS-IMH study, which noted that 65 per cent of the respondents never sought care from the formal healthcare system.

To encourage more staff to get help if necessary, some NHG institutions have engaged external mental healthcare providers so that employees can be assured of their privacy.

Prof Yong said that these initiatives could be costly but are necessary. The group is considering including mental health treatments as part of its employee benefits.

Prof Yong, who is also the group’s chief nurse, said: “Mental health challenges can be as severe as a physical health condition. It requires the same weighting, in terms of giving people the time to recover.”

Both SMU and NHG are part of WorkWell Leaders, a charity that brings together more than 130 CEOs and leaders across public, private and people sectors to champion well-being as a strategic priority for their organisations.

For a majority of the large employers with WorkWell Leaders, employee assistance programmes and mental health benefits are incorporated as part of their staff package.

Ms Anthea Ong, founder and chairman of WorkWell Leaders, said that the pandemic helped spotlight mental health not as a new problem, but a bigger problem at the office.

Applauding the moves by companies that are integrating well-being into corporate strategy and workplace culture, she said: “It’s not just the right thing to do but, more importantly, it’s the smart thing to do.

“When your employees feel safe, you encourage more creativity and teamwork which will then help your teams and employees to thrive. This would then benefit their mental health and improve business performance.”

The former Nominated Member of Parliament and social entrepreneur also called for a national strategy that would include having a national chief human resource officer (CHRO)-as-a-service, akin to the Infocomm Media Development Authority’s chief technology officer-as-a-service programme that helps small and medium-sized enterprises (SMEs) self-assess their digital readiness.

Therefore, a CHRO-as-a-service would help SMEs with their human resource challenges such as workplace mental health, added Ms Ong.

Wellness breaks to prevent breakdowns

Smaller organisations, too, despite limited resources, are finding ways to help their employees cope.

Psalt Care, a charity organisation set up to support and sustain persons with mental health and addiction challenges, offers its peer employees “mental wellness breaks”. More than half of its staff members are peers in recovery from mental health conditions, including depression and anxiety.

There is no limit to how long they can be away for, though the breaks are usually between one and two weeks away from work, said Psalt Care’s executive director Jackie Tay.

While on the break, they are encouraged to follow a daily maintenance programme. It includes activities such as exercising, getting proper nutrition, rest and practising gratitude, among other things. They also need to check in with a peer supporter or participate in peer support group sessions regularly.

Mr Tay said that other staff will step in and take on the responsibilities of co-workers.

“Part of the process is teaching people how to identify their triggers early and take preventive steps. It’s very powerful as opposed to suffering in silence and hanging on till they reach a breaking point where the consequences may be more adverse,” he added.

Debunking stigmas about people with mental health issues

Some who suffer from anxiety and depression said that while such initiatives are helpful, companies must go beyond offering only resources.

Cindy, a former sales engineer who declined to give her full name, said it is necessary for more education in the workplace about how mental health issues can be debilitating for those who suffer from them.

In 2017, the computing graduate was diagnosed with depression and a depersonalisation disorder, where a person experiences a sense of detachment from his body.

This was five years after she battled her issues, which affected her at work. At times, she was unable to respond to her colleagues, zoned out from work or felt her energy zapped by depression.

She felt misunderstood by others, including her colleagues, some of whom could not understand that she was affected by her mental condition. She said misunderstandings arose, and she was perceived as being lazy and not trying hard enough.

Unable to hold a full-time job for the past six years, Cindy is apprehensive about returning to the workforce.

Since August 2022, the 39-year-old regularly attends activities and counselling with Club Heal, a non-profit organisation that helps people with mental health issues regain confidence in themselves and work towards reintegrating with society.

She said: “I want to get well and get back into the workforce again, but it may be difficult for me to work for a company and with colleagues who don’t understand how depression affects the way I work.

“People need to acknowledge our struggles. We just want to be understood, not judged for our mental condition.”

Meanwhile, Ms Low says that those who suffer from mental health issues need to be responsible as well. For example, they should alert their colleagues so that schedules and workload can be reassigned in a timely manner.

“Yes, I have a mental health condition, but if I know that tomorrow may not be a good day, or I may have a relapse, I need to be accountable to the best of my ability.”

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