Skip to main content
Download PDF

Managers’ attitudes to depression and the association with their rating of how work capacity is affected in employees with common mental disorders

BMC Research Notes volume 17, Article number: 144 (2024) Cite this article

Abstract

Objective

This explorative, cross-sectional study assessed the association between managers’ attitudes to employee depression and their rating of how common mental disorders (CMDs) affect employee work capacity.

Results

A principal component analysis was performed for the nine variables concerning managers’ rating of how CMDs can affect work capacity among employees. The analysis resulted in two factors: task-oriented- and relational work capacity. The result of the multivariate analysis of covariance showed a p value of 0.014 (Pillai’s trace) indicating a statistically significant association between managers’ attitudes towards employee depression and managers’ rating of how CMDs affect work capacity. The association was significant for both factors as indicated by the p value of 0.024 for task-oriented work capacity and the p value of 0.007 for relational work capacity. The R2 value was 0.022 for task-oriented work capacity and 0.017 for relational work capacity. We assumed that negative attitudes towards employee depression would be associated with a perception of decreased work capacity among employees with CMDs. The results showed a significant association; however, the effect (~ 2%) was small. Further studies of manager’s attitudes and other possible determinants of managers’ rating of CMD-related work capacity are needed to better understand these factors.

Peer Review reports

Background

Managers have a key role in occupational health with responsibilities for safety, prevention, and rehabilitation [1]. However, research on managers’ attitudes towards common mental disorders (CMDs) is scarce even though these disorders are one of the most prevalent occupational health problems in western countries [2, 3]. In a previous focus group study, we explored managers’ (n = 31) experience-based understanding of how CMDs affect employees’ capacity to work [4]. Five categories were identified: cognitive capacities, time management, work independence, flexibility, and social interactions. According to the managers, these changes in capacity to work among employees had negative consequences for work performance and output, and workplace and manager–employee interaction [4]; these findings are reflected in other qualitative studies [5, 6]. The qualitative findings of are to to a large extent in line with the results of a quantitative study [7] showing that multiple dimensions of work performance were impaired by CMD; mental-interpersonal tasks, time management, output (e.g. handling the workload and finishing work on time), and physical tasks.

Given the high prevalence of CMDs in the working-age population and the possible negative consequences for work performance, work participation and productivity, CMDs and work capacity are highly relevant issues for employers and for society at large.

In previous quantitative studies, we have shown that male Swedish managers were more likely to have more negative attitudes towards depression than their female counterparts, even after controlling for several other factors that might confound the association [8]. Also there was an association between managers’ negative attitudes to depression and managers’ reporting that they found out about employees’ CMD from self-disclosure from the employee to a lesser extent [9]. We have also found that managers with negative attitudes to employees with CMD were less likely to have taken managerial preventive actions, specifically reviewing assignments and work situation, and talking about CMD at the workplace [10]. Other studies have reported that managers’ negative attitudes towards CMD can affect managers’ behaviour and actions regarding supportive practices and hiring decisions [11, 12].

A Finnish study with a general population sample (n = 10,000) aged 15–80 years showed that 35–58% perceived people with depression as weak and 58% thought that people with depression should “pull themselves together” [13]. It can be assumed that such societal attitudes may influence managers’ perceptions of work performance and work capacity in employees with CMDs.

The present study draws upon previous research [4,5,6, 8,9,10,11,12], assuming that negative attitudes towards employee depression would be associated with a perception of decreased work capacity in employees with CMDs. Research on stigmatizing attitudes towards mental illness often focuses on individual factors rather than contextual factors [13,13,14]. According to Johns [15], the workplace context can affect the occurrence of attitudes and behaviours in organizations.

Thus, the aim of this explorative study was to assess the association between attitudes to depression and managers’ rating of how CMDs affect work capacity while also taking contextual factors into consideration.

The following research question was addressed:

To what degree are managers’ attitudes to employee depression associated with managers’ rating of how CMDs affect work capacity?

Methods

An explorative, cross-sectional study was considered relevant. This is a part of the New Ways research programme on mental health at work and the sub-project “Managers’ perspective– a missing piece” [8,9,10, 16]. In 2017, Swedish managers were invited to take part in a web-based survey.

An explorative, cross-sectional study was considered relevant. This is a part of the New Ways research programme on mental health at work and the sub-project “Managers’ perspective– a missing piece” [8,9,10, 16]. In 2017, Swedish managers were invited to take part in a web-based survey.

Study sample

Participants were recruited through The Citizen Panel, Laboratory of Opinion Research (LORE) at the University of Gothenburg, Sweden (n = 5000) (https://www.gu.se/en/som-institute/the-swedish-citizen-panel/citizen-panel-for-researchers) and the HELIX Competence Centre at Linköping University, Sweden (n = 556) (https://liu.se/en/research/helix-competence-centre). Participation was based on written informed consent. The initial question “I am not a manager” resulted in the exclusion of 795 individuals. Due to invalid e-mail addresses or technical errors, another 24 individuals were excluded, leaving 4737 eligible participants. Of these, 3358 participated and constituted the study population. An inclusion criterion for the present study was having experience of CMDs among employees at their current workplace in the last 2 years. The final study sample consisted of 1819 participants (Fig. 1); 927 respondents (51%) had experience of one employee with a CMD, and 892 respondents (49%) had experience of two or more employees with a CMD. The study sample included senior managers (such as administration manager, managing director), middle management (manager of managers), first-line managers, group leaders/supervisors and expert/operations managers (such as personnel manager, finance manager). Descriptive information on the participants is presented in Table 1.

Fig. 1
figure 1

Flowchart for selection of the study population of Swedish managers. Data was collected in 2017

Full size image
Table 1 Descriptive statistics of the study sample of Swedish managers (N = 1819). The data was collected in 2017
Full size table

Dependent variable

The dependent variable was the association between attitudes to depression and managers’ rating of how CMDs affect work capacity. This was measured using nine variables specifically designed for the survey. The variables were derived from an validated instrument, the Capacity to Work Index (C2WI) described elsewhere [17]. The C2WI was developed from qualitative studies of individuals with their own experience of working with CMDs [18,18,20].

The nine variables consisted of statements with the following response options: 1, not affected at all; 2, became somewhat more difficult; 3, became quite difficult/much more difficult; and 4, do not know. The “do not know” option offered valuable descriptive information and was included in the survey to increase validity; however, this option was excluded in the inferential analysis in the present study.

A principal component analysis with varimax rotation with Kaiser normalization was performed for the nine variables concerning managers’ rating of how CMDs can affect work capacity among employees which was the targeted outcome. The analysis resulted in components loading on two factors: task-oriented work capacity and relational work capacity.

Independent variable

Negative attitudes were measured using the Managerial Stigma towards Employee Depression (MSED) instrument [12, 21]. The MSED addresses stigma and its potential stereotypes, prejudices and discrimination by measuring affective, cognitive and behavioural attitudes towards employees with depression. The MSED comprises 12 items with statements reflecting managers attitudes on a 6-point Likert scale from 1 (strongly disagree) to 6 (strongly agree). A Swedish version of the MSED instrument was developed for the main project [8]. The Swedish version has been tested for internal consistency and found to be sufficient (α = 0.80) [8].

Covariates

Based on an earlier study, we identified four covariates [b]: sex, level of education, industry, and size of company. The response options for sex were “women”, “men”, and “non-binary”. These were dichotomized into “men” and “women,”. Only three respondents indicated non-binary and were therefore excluded. Level of education included five response options: “compulsory school”, “upper secondary school or equivalent”, “degree from college/university (minimum 3 years)”, and “other post-secondary education”. This was dichotomized into “secondary school or lower” and “post-secondary school” for the analysis.

Industry was assessed with the question “in which industry does the company’s/organization’s main activity belong?”. In accordance with the Swedish Standard Industrial Classification (https://www.scb.se/en/documentation/classifications-and-standards/swedish-standard-industrial-classifcation-sni/), 16 different industries were clustered into three categories according to the people-data-things hierarchy [22]. “Blue collar” refers to industries working with things, “white collar” refers to industries working with data, and “pink collar” refers to industries working with people. A fourth category “other type” was used for those industries not fitting into one of the three categories. In this study, the category “other type” was not included. A question on the total number of employees in the organization was used to represent the size of the company. The response options “0–9”, “10–49”, “50–250” and “251–1000” and “more than 1000” were grouped into “≤250” and “≥251”, respectively.

The questions from the survey that were used in this study are presented in the Supplementary file.

Statistical analysis

First, the correlation between managers’ attitudes to employees with depression and the two factors representing the association between attitudes to depression and managers’ rating of how CMDs affect work capacity was explored using Spearman’s rho. A non-parametric test was chosen because the data on attitudes was not normally distributed.

Second, a multivariate analysis of covariance (MANCOVA) was performed to further investigate how managers’ attitude towards employee depression was associated with managers’ attitudes to depression and managers’ rating of how CMD affect work capacity. Four co-variates were included simultaneously in the analysis: sex, level of education, industry, and size of company. In the analysis, the summed variable managers’ attitudes towards employees with CMD (i.e. the independent variable) was recoded into four groups based on the quartiles.

An expert statistician was consulted regarding data management and statistical methods. All analyses were done using IBM SPSS Statistics version 27. A p value < 0.05 was considered statistically significant.

Results

The results showed a significant, but weak, correlation (p = 0.012, rs = 0.060) between managers’ attitudes to depression among employees and relational work capacity. Regarding task-oriented work capacity, the association was non-significant (p = 0.054, rs = 0.046). However, there was a strong correlation between task-oriented work capacity and relational work capacity (p < 0.001, rs =0.510); accordingly, the choice was to include both factors in a subsequent analysis [23].

The results of the MANCOVA showed a p value of 0.014 (Pillai’s trace), indicating a statistically significant association between managers’ attitudes towards employee depression and managers’ rating of how CMDs affect work capacity. The association was significant for both factors as indicated by the p value of 0.024 for task-oriented work capacity and the p value of 0.007 for relational work capacity. R2 for task-oriented work capacity was 0.022 and 0.017 for relational work capacity. Accordingly, managers’ attitudes explained approximately 2% of variance in the dependent variable.

Discussion

We assumed that negative attitudes towards employee depression would be associated with a perception of decreased work capacity in employees with CMDs. The results showed a significant association; however, managers´attitudes only explained ∼ 2% of the variance in managers´rating of work capacity in employees with CMDs. This result warrants some consideration.

Research on stigmatizing attitudes towards mental illness often focuses on individual factors rather than contextual factors [14]. According to Johns [15], there are two levels of organizational context: a broadly conceptualized context and more particular contextual variables that shape behaviour or attitudes. Johns [15] argues that more particular contextual variables, for example, social structure and social influence, are ingrained in the broader context. Therefore, the workplace context can affect the occurrence of attitudes and behaviours in organizations. Two of the broadly described context variables according to Johns [15] are “occupation” and “place”. In this study, we controlled for industry (related to occupation) and the size of company (related to place). We also controlled for personal factors, sex and level of education, which have both shown an association with managerial stigma towards employees with depression [7, 11]. Controlling for these contextual and personal covariates should strengthen the association between managers’ attitudes towards employee depression and their rating of work capacity among employees with CMDs. Even so, the total effect i.e. was marginal at ∼2%. In another explorative study controlling for various covariates, we found no association between managers’ attitudes to employee depression and recommendation of sick leave in response to a CMD-labelled video case vignette [16]. Both results contrast with research on stigmatizing attitudes in a work context and the association with adverse work outcomes for persons with mental illness or mental health issues [10]. However, that research [10] included people with CMDs and severe mental disorders. Putting these two groups together overlooks the fact that symptom severity and the type of diagnosis may be associated with the degree of stigmatizing attitudes [24].

As measured in the present study, the importance of managers’ attitudes to employee depression is downplayed, which, in relation to previous research on managers’ attitudes to employee depression is a positive finding [10,11,12]. Our study seems to be the first exploring the association between managers’ attitudes to depression and managers’ rating of how CMDs affect employee work capacity. The results should be interpreted with caution given the low effect size. Further studies of managers’ attitudes and other possible determinants of managers’ rating of CMD-related work capacity are needed to better understand these factors. Increased understanding of such factors could influence managerial training and support more positive and health-promoting work environments for employees with CMD.

A strength of the study was the use of a validated instrument to measure managers’ attitudes towards employees with depression [21]. In addition, the questions regarding work capacity in relation to CMD were derived from a validated instrument [17]. Further strengths of the study were the large sample size of managers with experience of employees with CMDs and the inclusion of managers from a variety of work sectors and industries.

Limitations

The study’s cross-sectional design prevents causal inferences, and the study sample was not selected randomly. In future studies a randomized sample of managers should be used. The sample is biased towards more well-educated managers. This implies a probable under-representation of participants with negative attitudes. However, this study included a range of attitudes from negative to positive.

Data availability

The data used for this study have been archived at the Laboratory of Opinion Research (LORE) at the University of Gothenburg and can be obtained by contacting LORE at info@lore.gu.se.

Abbreviations

CMD:

common mental disorders

MANCOVA:

multivariate analysis of covariance

MSED:

managerial stigma towards employee depression

References

  1. Henshaw JL, Gaffney SH, Madl AK, Paustenbach DJ. The employer’s responsibility to maintain a safe and healthful work environment: an historical review of societal expectations and industrial practices. Empl Responsibilities Rights J. 2007;19:173–92.

    Article  Google Scholar 

  2. Lerner D, Henke RM. What does research tell us about depression, job performance, and work productivity? J Occup Environ Med. 2008;50:401–10.

    Article  PubMed  Google Scholar 

  3. Harvey SB, Henderson M, Lelliott P, Hotopf M. Mental health and employment: much work still to be done. Br J Psychiatry. 2009;194(3):201–3.

    Article  PubMed  Google Scholar 

  4. Tengelin E, Hensing G, Holmgren K, Ståhl C, Bertilsson M. Swedish managers’ experience-based understanding of the capacity to work in employees with Common Mental disorders: a Focus Group Study. J Occup Rehabil. 2022;32:685–96.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Martin A, Woods M, Dawkins S. How managers experience situations involving employee mental ill-health. Int J Workplace Health Manag. 2018;11:442–63.

    Article  Google Scholar 

  6. Jansson I, Gunnarsson AB. Employers’ views of the impact of mental health problems on the ability to work. Work. 2018;59:585–98.

    Article  PubMed  Google Scholar 

  7. Adler DA, McLaughlin TJ, Rogers WH, Chang H, Lapitsky L, Lerner D. (2006). Job performance deficits due to depression. Am J Psychiatry 2006; 163:1569–1576.

  8. Mangerini I, Bertilsson M, de Rijk A, Hensing G. Gender differences in managers’ attitudes towards employees with depression: a cross-sectional study in Sweden. BMC Public Health. 2020;20:1–15.

    Article  Google Scholar 

  9. Bertilsson M, Klinkhammer S, Staland-Nyman C, de Rijk A. How managers find out about common mental disorders among their employees. J Occup Environ Med. 2021;63:975–84.

    Article  PubMed  Google Scholar 

  10. Hultqvist J, Zhang P, Staland-Nyman C, Bertilsson M. Managers’ influence on the Prevention of Common Mental disorders in the workplace: a cross-sectional study among Swedish managers. J Occup Environ Med. 2023;65:1008–16.

    Article  PubMed  Google Scholar 

  11. Brouwers EPM. Social stigma is an underestimated contributing factor to unemployment in people with mental illness or mental health issues: position paper and future directions. BMC Psychol. 2020;8:36.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Martin A. Individual and contextual correlates of managers’ attitudes toward depressed employees. Hum Resour Manage. 2010;49(4):647–68.

    Article  Google Scholar 

  13. Aromaa E, Tolvanen A, Tuulari J, Wahlbeck K. Predictors of stigmatizing attitudes towards people with mental disorders in a general population in Finland. Nord J Psychiatry. 2011;65:125–32.

    Article  PubMed  Google Scholar 

  14. Angermeyer MC, Schomerus G. State of the art of population-based attitude research on mental health: a systematic review. Epidemiol Psychiatr Sci. 2017;26:252–64.

    Article  CAS  PubMed  Google Scholar 

  15. Johns G. The essential impact of context on organizational behavior. Acad Manage Rev. 2006;31:386–408.

    Article  Google Scholar 

  16. Hultqvist J, Hensing G, Stansfeld S, Bertilsson M. Managers’ sick leave recommendations for employees with common mental disorders: a cross-sectional video vignette study. BMC Psychol. 2023;11:52.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Hensing G, van Diepen C, Boström M et al. Validity of the capacity to Work Index: development of an instrument to measure work capacity in relation to depression and anxiety in the General Working Population. J Occup Rehabil. 2023. Published online November 8, 2023.

  18. Bertilsson M, Petersson E-L, Östlund G, Waern M, Hensing G. Capacity to work while depressed and anxious–a phenomenological study. Disabil Rehabil. 2013;35:1705–11.

    Article  PubMed  Google Scholar 

  19. Danielsson L, Bertilsson M, Holmgren K, Hensing G. Working in dissonance: experiences of work instability in workers with common mental disorders. BMC Public Health. 2017;17:472.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bertilsson M, Löve J, Ahlborg G Jr, Hensing G. Health care professionals’ experience-based understanding of individuals’ capacity to work while depressed and anxious. Scand J Occup Ther. 2015;22:126–36.

    Article  PubMed  Google Scholar 

  21. Martin AJ, Giallo R. Confirmatory factor analysis of a questionnaire measure of managerial stigma towards employee depression. Stress Health. 2016;32:621–815.

    Article  PubMed  Google Scholar 

  22. Lips-Wiersma M, Wright S, Dik B. Meaningful work: differences among blue-, pink-, and white-collar occupations. Career Dev Int. 2016;21:534–51.

    Article  Google Scholar 

  23. Wampold B. The great psychotherapy debate: models, methods, and findings. Mahwah, NJ: Lawrence Erlbaum; 2001.

    Google Scholar 

  24. Brouwers EPM, Joosen MCW, van Zelst C, Van Weeghel J. To disclose or not to disclose: a multi-stakeholder focus group study on mental health issues in the work environment. J Occup Rehabil. 2020;30:84–92.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank the participants for taking part in the study, Valter Sundh for statistical advice and Jesper Löve for the cultural translation of the MSED items from English to Swedish.

Funding

Funding for the “Managers’ Perspective–The Missing Piece” project in which data were collected was received from AFA Insurance, Sweden (no. 150378). The present study was funded by the Swedish Social Insurance Agency (FK 2021/011187). The funding bodies had no role in the design of the study, data collection and analysis, interpretation of the data or writing the manuscript. Open access funding was provided by Gothenburg University Library.

Open access funding provided by University of Gothenburg.

Author information

Authors and Affiliations

  1. Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, 405 30, Gothenburg, Sweden

    Jenny Hultqvist

  2. School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, 405 30, Gothenburg, Sweden

    Gunnel Hensing & Monica Bertilsson

  3. Region Västra Götaland, The Institute of Stress Medicine, 413 19, Gothenburg, Sweden

    Lisa Björk

  4. Department of Sociology and Work Science, University of Gothenburg, 405 30, Gothenburg, Sweden

    Lisa Björk

Authors
  1. Jenny Hultqvist
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gunnel Hensing
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lisa Björk
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Monica Bertilsson
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MB and GH designed and managed the data collection within the “Managers’ Perspective–The Missing Piece” project. MB designed the sub-project funded by the Swedish Social Insurance Agency about managers’ perceptions of work capacity of employees with CMD. MB, GH, LB and JH designed this specific study. JH performed the data analysis and drafted the manuscript. All authors revised the manuscript and read and approved the final version.

Corresponding author

Correspondence to Jenny Hultqvist.

Ethics declarations

Ethics approval and consent to participate

The study was approved (Dnr 165–17) by the Regional Ethical Review Board in Gothenburg, Sweden (later merged into the Swedish Ethical Review Authority, https://etikprovningsmyndigheten.se/en/). Participation was based on written informed consent obtained from the participants; information on the study was included in the e-mail inviting the managers to participate in the research. Furthermore, all methods were carried out in accordance with relevant guidelines and regulations.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hultqvist, J., Hensing, G., Björk, L. et al. Managers’ attitudes to depression and the association with their rating of how work capacity is affected in employees with common mental disorders. BMC Res Notes 17, 144 (2024). https://doi.org/10.1186/s13104-024-06750-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s13104-024-06750-7

Keywords

BMC Research Notes

ISSN: 1756-0500

Contact us