Every year depression affects one in every five employees and costs American businesses $210 billion in medical bills and lost productivity.

In fact, for every worker with a depressive disorder, a company loses an average of 32 productive workdays per year. Depressed employees are also four to five times more likely to experience work-related problems than employees with chronic physical illnesses like diabetes or heart disease.

So why do many companies fail to help their workers battle mental health disorders?

“There’s a silence around this issue at many companies,” says Harvard Business School Assistant Professor Ashley V. Whillans. “We need to stop trying to paint this picture of the perfect employee who never needs help.”

Whillans, who studies how people navigate trade-offs between time and money, recently co-wrote a forthcoming article for the International Journal of Human Resource Management, Improving Resilience Among Employees High in Depression, Anxiety, and Workplace Distress (pdf), which shows that a workplace-based wellness program can help employees suffering from mental health issues.

A potential solution: resilience training

Previous research shows that workplace depression and anxiety can be reduced by coaching employees to increase their resilience, the ability to maintain good mental health despite psychological or physical setbacks. In fact, one study found that over a two-month period, a business-initiated resilience program resulted in a significant reduction in presenteeism (employees working while sick), which led to a company gain of $1,846 per person in terms of greater productivity, the journal article says.

Image: Harvard Business School

While some workers suffer from depression or anxiety on an ongoing basis, others have tough spells only occasionally, often triggered by major life transitions—a new job, a sick parent, a partner’s layoff, or a return to work after a maternity leave, Whillans says.

“Most employees will go about their day-to-day lives and be fine most of the time,” Whillans says. “But when we face unexpected stressors in our lives, that’s when we need to have skills to cope. And it’s when workplaces need to make sure employees are getting the help they need.”

Stressed-out workers seek online tools

Whillans decided to explore whether an internet-based platform called Happify, which coaches people to increase their levels of resilience, might be an effective solution for companies. She co-wrote the journal article with HBS doctoral student Grace Cormier, as well as three employees of Happify, Allison L. Williams, Acacia C. Parks, and Julia Stafford.

Happify, which funded the research, competes in an increasingly crowded digital health space where technology helps users combat mental health disorders by relaxing, meditating, and completing other mind-calming exercises. Competitors include meQuilibrium, Headspace, Big Health, and myStrength.

The research team conducted an eight-week study, selecting new users of the Happify platform who were employed full time and reported high levels of clinical depression or anxiety, as well as those experiencing workplace distress, with signs of presenteeism or burnout.

One group was given full access to the Happify platform, which offers techniques developed by therapists in positive psychology, cognitive-behavioral therapy, as well as mindfulness and meditation-based stress reduction. This first group logged in to complete various activities and games at least twice per week that showed them, for example, how to savor the present moment, block negative thoughts, express gratitude, set goals, emphasize their strengths, give to others, and empathize with their own troubles through self-compassion.

A second group was given educational materials about how to improve their mental well-being—the equivalent of handing people a self-help book. A third group included people who signed up for the Happify program, but didn’t end up using it much, if at all.

Participants in the three groups were asked about their symptoms at the beginning and end of the eight-week study. To measure depression levels, people were asked how often they felt down, hopeless, or were tired. Anxiety symptoms were measured by asking people how frequently they felt nervous, anxious, or on edge and were “worrying too much about different things.”

To measure presenteeism, participants were asked how often they were unable to concentrate on their jobs or how often they delayed starting new projects at work because of stress. People were also asked whether they agreed with statements like “I feel burned out from work.” Based on these answers, the research team assigned participants different resilience scores.

The results

The first group of workers with clinical depression and anxiety who regularly completed the training activities saw a 25 percent boost in resilience, much higher than the second group that was provided reading materials, which saw a 14.8 percent increase. Meanwhile, the group that didn’t use Happify much or at all saw only an 11 percent increase in resilience. Among workers with high workplace distress, people who used Happify saw a 20.9 percent increase in resilience, much more than both the psychoeducation group, which saw an 11.6 percent increase, and the group that didn’t use Happify, which saw only a 6.3 percent increase.

All in all, the results show that these resilience programs can help many employees feel better.

“I do think that the effects are striking,” Whillans says. “All employees benefit from these programs, but those at risk of depression, anxiety, and workplace distress benefit the most. I would think these programs would be especially useful to employees who work very stressful jobs.”

Technology-based therapy has certain advantages over other employee services, such as in-person counseling, the researchers say. Online programs allow employees to keep their identities hidden—since many workers shy away from seeking workplace-based therapy, fearing their careers could be negatively impacted. Plus, tech tools allow users to log in on their smartphones, laptops, or tablets at whatever time is convenient for them and for however long they want.

“It’s a big commitment to take time off work to go see a therapist, with the logistics of an hour-long appointment, time getting there and back, time in the waiting room. A lot of people don’t feel like they have that time,” Parks says. “This technology is not meant to replace in-person therapy, but because we know therapy can’t reach everyone it needs to, these types of online programs could be a good alternative or a supplement.”

Whillans says an online program may also encourage higher participation rates than certain special events that companies organize to encourage people to relax.

For example, a bag lunch get-together or an ice cream social might fall flat with introverted employees, and a weekly yoga class held during office hours might sound appalling to self-conscious workers who don’t want their colleagues seeing them in workout clothes.

“Moving the needle on workplace wellbeing may sound simple, but it can be hard to get employees to get involved,” Whillans says. “Managers need to be deliberate and thoughtful about what they offer. It’s not enough to put a ping-pong table in the office and expect your culture to change and your employees to relax at work.”

How companies can encourage employee wellness

Companies should consider wellness programs that give workers a variety of choices, so they can pick the activities that appeal to them, she says. And if a business is going to spend money on a wellness strategy, the company should test it out with a small group of employees first and see if it catches on before launching it to the entire organization.

It’s also crucial for managers to openly express support for wellness initiatives and encourage people to use them, Whillans says. For example, managers can ask their staff to block off one hour every week during office hours to work on their own wellness—whether it’s using an online intervention tool or even just getting up from their desks and taking a long walk. Companies can even build in incentives or rewards for workers who follow through.

“Employees aren’t going to ask for time to work on their own wellness. In fact, workers will say they don’t have time. But that’s exactly why workplaces need to help employees take time for themselves,” Whillans says. “Managers have to tell their employees, ‘I really want you to take this one hour every week during your normal work time to do something positive for your own mental well-being.’”

And managers should set a good example by taking breaks themselves.

“I’ve heard of cases where the employees are encouraged to use an intervention program, and they look at their managers and their managers are not doing it,” Parks says. “Employees need to see their managers taking time out to do this, even if it’s just for a few minutes, because that’s the best way to encourage everyone else to step away from work for a while.”

Just talking about the issue of mental health in the workplace and acknowledging that workers may experience low points in their lives is bound to go a long way toward helping employees feel emotionally supported by their companies, Whillans says.

“Companies should start having meaningful conversations about this and normalizing the use of wellbeing interventions,” she says. “Employees need to know that they can still get where they want to go in their careers and also take time for themselves. And they’ll be happier and healthier if they do.”

This article was originally published by Harvard Business School Working Knowledge.