[Severe depression and work]

The prevalence of depression and processes liable to increase the severity of these disorders can be examined both by analysing the changes in the working environment and those relating to difficulties in diagnosis and treatment. The promotion of excellence, extensive competition in working relationships and the rise in different forms of violence, the increase in disadvantaged and unemployed populations are the major changes found : these result in an increase in work demands and by reduced resources to respond to these. The morbid process is liable to be increased due to the dual effect of the social invisibility of the disorder and people's isolation. Failure to manage patients and provide care may result in a worsening of the consequences of depression in terms of sustained incapacity or suicide attempts which are often seen in severe forms of depression. The treatment and prevention approach in this situation involves a combination of both care offered to the patient and interventions in the working environment in order to reduce their pathogenic potential.