Join us as we unveil New York Times bestseller James Clear's groundbreaking methods for crafting habits that stick.
Register Now

Presenteeism: The Hidden Productivity Killer in Your Workplace

Presenteeism can show up in different ways. For Joe Flanagan, an electronic engineer, his anxiety reached the point where he was having multiple panic attacks in a single day. The anxiety made his work all but unmanageable.

“To say that it took a toll on my productivity at work would be an understatement,” he says. “Imagine explaining how to use a complex machine to a client or having a team meeting and suddenly having a panic attack.” Nearly unable to do his job, and on the verge of being laid off as a result, Flanagan took a crucial step: He asked for help.

Flanagan’s story is just one example of what presenteeism can look like. A model employee might still be at work, but deadlines pass them by, projects go unfinished, and clients leave. Meanwhile, the employee feels underwater.

Presenteeism defined

So what is presenteeism? Presenteeism occurs when employees are on the job but not performing at full capacity. The term does not refer to employees slacking off or pretending to be sick to avoid working, but includes employees who may struggle to stay productive due to physical or mental health conditions. Since the person is physically present, presenteeism isn’t always easy to recognize or measure.

With more people working remotely, experts have also observed the rise of “digital presenteeism.” Without the face time that comes with in-person work, employees may feel pressured to work longer hours and go above and beyond their duties to prove their value. People who work remotely may also find it hard to shut down, since technology makes it possible to be reachable 24/7. These challenges that underlie digital presenteeism can contribute to mental health issues and burnout, and make it difficult to work effectively.

Signs of presenteeism

Although falling productivity levels can be a major sign of presenteeism, there are more subtle signs, too, such as:

  • Disinterest in results or project goals
  • A declining standard of work
  • Turning work in late or not at all
  • Lack of engagement with colleagues and managers, including being more isolated and not engaging in online or in-person communication
  • Working long hours or weekends to catch up
  • Making more mistakes than usual
  • Catching colds or other illnesses more easily
  • Irritability and frustration
  • Displaying signs of burnout, such as loss of motivation, detachment, self-doubt, or a decreased sense of accomplishment

Many of these symptoms are familiar to people like Erin, a writer who asked that her last name not be used. She says her depression and anxiety once pushed her to a point where she was barely functioning on the job. “I showed up every day, but once I arrived, I counted down the hours until I could leave,” she says. “The simplest tasks overwhelmed me, every email I received caused anxiety, and my responsibilities fell by the wayside.“

Project manager Christian Sismone has also struggled with depression and anxiety symptoms at work. She says she tends to push herself too hard, drinks to cope with stress, and at one time was so burnt out that she had what she describes as a “nervous breakdown.”

Presenteeism vs. absenteeism

Both absenteeism and presenteeism in the workplace take a toll on workers and employers. With presenteeism, employees are on the job but aren’t working productively. With absenteeism, employees are not physically present at work. They develop a pattern of missing work, often taking sick days, arriving late, leaving early, or being away for long, unplanned periods of time. Whereas absenteeism accounts for four missed workdays per year, employees struggle with presenteeism for 57.5 days per year.

Causes of presenteeism

The underlying causes of presenteeism include:

  • Physical health concerns such as migraines, hypertension, seasonal allergies, back pain, gastrointestinal disorders, and asthma
  • Mental health conditions such as anxiety and depression
  • A culture of overwork, with employers expecting people to log longer hours and employees feeling pressured to go into work even when sick

While physical health conditions contribute to presenteeism, research shows a strong link between presenteeism and mental health disorders, particularly depression. In one study of employees at a large financial services firm, workers with depression were more likely to struggle with time management, mental functioning, and interpersonal communication, and had lower work output overall. Another study of more than 6,000 employees across three different companies found that those with depressive symptoms were seven times more likely to experience “decreased effectiveness” on the job than employees without depression symptoms.

“When you’re struggling with untreated mental health symptoms, normal, everyday tasks can feel completely impossible,” says Katie McKenna, a therapist with 10 years of experience treating clients with a range of mental health concerns. “Focusing and sustaining attention becomes overwhelming, and our work is often impacted.”

About one in five adults in the United States reports having a mental health condition in a given year, yet fewer than half receive treatment. Going without care for a mental health condition not only leads to considerable distress and suffering, but it’s also a major factor behind presenteeism.

Cost of presenteeism

Having an unproductive day or two happens to everyone, but when presenteeism becomes chronic, it can have a ripple effect for both workers and businesses. The effects of presenteeism in the workplace can include:

  • Worsening mental and physical health among employees
  • Lower employee morale
  • More mistakes
  • Higher turnover rates

These effects contribute to the high cost of presenteeism for organizations. Presenteeism costs employers double or triple the amount of medical care paid through insurance premiums and claims. In a study called the “American Productivity Audit,” researchers projected that presenteeism costs U.S. employers more than $150 billion annually.

According to research published in the Journal of the American Medical Association in 2003, U.S. companies spent about $33 billion annually on depression-related productivity loss alone. This and other studies indicate that the cost of depression-related presenteeism far outweighs the cost of depression-related absenteeism—a much more conspicuous sign of an employee’s underlying health issue.

How to reduce presenteeism

Recognizing the early signs of presenteeism can limit its impact and help employees get the support they need. Employers who take a proactive approach can keep presenteeism from becoming a chronic problem. Here are a few tips for reducing presenteeism:

1.Assess the problem

One of the most important steps in addressing presenteeism is simply to acknowledge that it exists and could be affecting employees’ performance. According to a study on presenteeism among workers of a large U.S. health care company, the problem wasn’t fully understood until employees were asked to complete an annual health risk appraisal that assessed quantity and quality of work, work not completed, and concentration on work. From there, researchers were able to estimate daily productivity loss per person, plus annual costs.

2. Offer comprehensive mental health benefits

The researchers found that to improve productivity, employers should consider presenteeism data when planning comprehensive wellness initiatives. Therapy and medication have been shown to be highly effective at helping people manage conditions like anxiety and depression and regain their footing at work.

“Therapy teaches you how to respond effectively to negative automatic thoughts that hijack your mind and cause distress,” says McKenna. “It’s important to learn about yourself, your triggers, and your patterns, so you can plan for how you’ll cope with difficult situations before they happen. I find that developing this foundation with a therapist helps people feel more in control of their lives and restores their ability to achieve their goals at work.”

This rings true for Flanagan, who says that after about 20 weeks of therapy, he saw “huge improvements” in his mental health and performance at his engineering job. For Erin, a combination of therapy and medication have been indispensable in managing her mental health, with a noticeable impact at work. “I’m now an efficient employee and enthusiastic participant, [and am] able to show up each day as the best version of myself,” she says.

A survey of employees receiving mental health care through Lyra Health reinforces the role of quality care in reducing presenteeism. In the survey of about 500 employees, 70 percent of those who showed clinical improvement after receiving mental health treatment also demonstrated increased on-the-job productivity. The data was gathered from employee responses to the Work Limitations Questionnaire (WLQ), a validated survey that measures health-related productivity loss at work.

These findings align with a growing body of research that indicates the potential cost savings and return on investment for employers that invest in workforce mental health programs.

Dan Schawbel, a workplace expert and author of Back to Human: How Great Leaders Create Connection in the Age of Isolation, says employers have a responsibility to support employee mental health, as it directly affects on-the-job functioning and productivity. “When companies support mental health, they are helping workers get the care they need so they can be fully productive after recovery,” he says.

He adds that “a strong mental health program can differentiate companies in the talent marketplace, especially now since there’s such a widespread mental health epidemic.”

3. Provide health education

Since health issues are the main causes of presenteeism, educating employees about their physical and mental health can help them perform at their best. These education programs often focus on lifestyle changes and treatment options, and have proven to be low-cost ways to improve productivity for many companies.

4. Set reasonable expectations

If your work culture celebrates overwork, your organization may be unwittingly contributing to presenteeism. Set clear, fair expectations around work hours and deadlines and be transparent about any performance concerns.

5. Lead by example

Your actions speak louder than words in communicating what is expected of employees. Strive for a healthy work-life balance in your own life, disconnecting when needed and making sure employees know they’re free to do the same.

If you’re considering how to reduce presenteeism and boost productivity and engagement, remember that employers play an important role. While you can’t control employees’ health, you can take steps to ensure that the workplace doesn’t contribute to physical or mental illnesses that raise the risk of presenteeism.


If you want help connecting with a therapist, Lyra can assist you. You can get started today if Lyra is offered by your employer. Sign up now.

For employers who want to learn more about how Lyra’s enhanced EAP addresses network adequacy and quality issues, download our whitepaper on quality or get in touch.

And check in frequently here or follow us on Facebook, LinkedIn, and Twitter for more insights into supporting employees’ mental health.

The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

By The Lyra Team
12 of December 2019 - 8 min read
Mental health at work
Share this article
Stay in touch and get the latest blogs

Take your workforce to the next level