ORIGINAL ARTICLE Receiving Workplace Mental Health Accommodations and the Outcome of Mental Disorders in Employees With a Depressive and/or Anxiety Disorder Carmelle Bolo, BSc, Jitender Sareen, MD, Scott Patten, MD, PhD, Norbert Schmitz, PhD, Shawn Currie, PhD, and JianLi Wang, PhD Objectives: To investigate the association between receiving workplace ac- commodations and the 1-year risk of mood/anxiety disorders. Methods: A general population sample of employees in Alberta, Canada, with a prior or current mental disorder (N = 715) was observed for 1 year. Mental disorders were determined on the basis of the Diagnostic and Statistical Manual, 4th revision, criteria. Results: In participants who needed but did not receive any accommodations, 30.8% had a mood/anxiety disorder 1 year later. Receiving needed accommodations was associated with a lowered risk of 24.5%. Lo- gistic regression showed that the percentage of having accommodation needs met was significantly associated with the risk of a mental disorder 1 year later (odds ratio = 0.27; 95% confidence interval = 0.11 to 0.65). Conclusions: Receiving needed accommodations was associated with better outcomes for mental disorders. Studies are needed to confirm the effectiveness of specific accommodations for enhancing the prognosis of mood/anxiety disorders. M ental disorders, such as depression and anxiety, are prevalent in the labor force and present considerable personal and eco- nomic burdens. In developed countries such as Canada, mental health problems are the main illness of the working population, accounting for about 40% of all illness in those under 65 years. 1 Because of the nature of mental disorders, they can have significant impacts in terms of health care costs, lost workdays, work disruptions, and decreased quality of life. 2–4 In Canada, the estimated annual societal cost of mental illness was $51 billion in 2003. 5 Maintaining a healthy and productive workforce is beneficial for both the employer and the employee. To promote the well-being of employees with mental disor- ders, certain workplace accommodations may be required. Work- place accommodations are modifications to the work environment or services that enable people with disabilities to work effectively in their current employment. 6 These accommodations allow individuals to continue working despite their illness and can also aid in the return to work process after an extended sick leave. Providing reasonable accommodations has become a legal duty for employers, as reflected in the Employment Equity Act, and the Treasury Board of Canada’s Policy on the Duty to Accommodate Persons With Disabilities in the Federal Public Service. 7,8 From the Department of Community Health Sciences (Ms Bolo, and Drs Patten and Wang), Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Psychiatry (Dr Sareen), Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Psychiatry (Drs Pat- ten and Wang), Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Psychiatry (Dr Schmitz), Faculty of Medicine, McGill University. Montreal, Quebec, Canada; and Mental Health Information and Evaluation Unit (Dr Currie), Mental Health and Addiction Program, Alberta Health Services, Calgary, Alberta, Canada. This study was supported by operating grants from the Canadian Institutes of Health Research (MOP-84308, MOP-89747). The authors declare no conflicts of interest. Address correspondence to: JianLi Wang, Room 4D69, TRW Building, 3280 Hospital Dr NW, Calgary, AB T2N 4Z6, Canada (jlwang@ucalgary.ca). Copyright C  2013 by American College of Occupational and Environmental Medicine DOI: 10.1097/JOM.0b013e31829fd065 Although employees with a physical illness may need accom- modations such as a ramp for wheelchair access, individuals with a mental illness may also need accommodations but of different forms. In a previous publication using the same cohort for the current study, Wang et al 9 reported that among 784 workers with a mood and/or anxiety disorder, the top two accommodations needed were “having weekly meetings between the supervisor and the employee which may help to deal with problems before they become serious” and “exchanging minor tasks with other employees.” Nevertheless, at the time of publication, follow-up data regarding the mental health outcomes of these participants were not yet available. In principle, receiving needed workplace mental health accommodations not only allows the employees to continue working but can also improve the prognosis of these mental health problems. To our knowledge, there is a lack of studies examining the effects of accommodations in workers with mental disorders specif- ically. Looking at workers with disabilities in general, workplace accommodations were found to be positively associated with job retention, higher levels of well-being, and helped mitigate the neg- ative effects of temporary status and underemployment. 10,11 Only one study focused on employees with severe mental illness in a social enterprise setting and looked at how workplace accommoda- tions affected job satisfaction (N = 248). 12 Villotti et al 12 found that in addition to certain individual and environmental factors, workplace accommodations are important in promoting job sat- isfaction. Unfortunately, investigating how receiving accommoda- tions affected the prognosis of mental illness was not one of their objectives. Using data from a representative longitudinal cohort, our ob- jective was, among workers with a current or prior mood/anxiety dis- order, to investigate the association between receiving mental health accommodations and the risk of mood and/or anxiety disorders 1 year later. METHODS This study uses a prospective cohort design with a sam- ple from a population-based cohort initiated in January 2008, in Alberta, Canada. The target population of the cohort study was em- ployees between the ages of 25 and 65 years, currently working in the province of Alberta, and recruited through random digit dialing. A total of 4239 participants were interviewed and included in the cohort at baseline (T1). The overall response rate at the 12-month follow-up (T2) was 71.0% of the baseline participants. Of these T2 participants, those with a mood/anxiety disorder in the past 12 months (referred to as “current disorder”) and/or a mood/anxiety disorder sometime in their past (referred to as “prior disorder”) were asked questions about workplace mental health accommodations (N = 784). These participants were reinterviewed at 24 months (T3). There were 69 participants who were lost to follow-up, and therefore a total of 715 participants were available for this study (response rate = 91.2%). The demographic, socioeconomic, and clinical char- acteristics of the participants at T2 are presented in Table 1. No financial incentives were provided for participation. A more detailed Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. JOEM  Volume 55, Number 11, November 2013 1293