New data reveals hidden reasons employees struggle at work

A data review into what led hundreds of people to be referred into occupational health by their manager sheds new light on the causes of workplace struggles.

Neurodivergent conditions, including autism, dyslexia and ADHD, are now the third biggest reason for an employee to struggle at work.

The data analysis of 135,000 occupational health referrals shows that one in ten employees needed help to manage a neurodivergent condition in the workplace.

Mental health remained the leading cause of referral, accounting for one in three cases. However, men were more likely to struggle with depression, while women were more often affected by anxiety.

Other findings include a worrying rise in heart issues among young women, aged 16-19, and bowel conditions in young men. In response, our clinical team outlines five emerging trends and practical steps employers can take to address them.

1. Recognise the need for earlier neurodiversity support

There are many reasons why more people with neurodivergent conditions are now being referred to occupational health. Greater awareness within schools, higher education and society is encouraging more people to disclose conditions and seek support.

However, increased workplace demands, mental health struggles and menopause can also make it more difficult for individuals to cope with symptoms, leading more managers to refer employees into occupational health due to perceived performance issues.

Critical to supporting neurodivergent individuals to remain in work is involving occupational health sooner to carry out a needs assessment. This can identify specific challenges impacting performance and provide reasonable recommendations for support.

These adjustments can be as simple as daily planning strategies or providing access to AI tools that proof-read documents. Access to Work funding can also be used to cover the cost of assistive technology, such as voice-to-text software or large screens.

Although budgetary constraints might deter some employers from making this investment, it’s important to note that neurodivergent conditions are protected under the Equality Act. This means failure to support individuals can lead to far more costly tribunals and fines.

2. Help men to remove ‘I’m fine masks’

The research also shows that two thirds of all occupational health referrals are for women, indicating that men are not gaining the same access to support as female colleagues.

This means from the age of 20, acute stress and anxiety issues are often evolving into more serious mental health issues, such as depression. As a result, by the age of 40-49 over one in ten men (11%) are being referred into occupational health for depression, compared to 7% of women in this age category.

For employers concerned about suicide prevention, the leading cause of death in men under the age of 50, this is a worrying trend. It’s therefore essential to not only ensure that mental health resources are in place but proactively signpost employees to use them.

We often see men who are struggling lack the mental energy to initiate a self-referral and instead wear the ‘I’m fine’ mask when asked how they’re doing. That’s why it’s so important for managers to be encouraged to have courageous conversations — asking ‘How are you really?’ — so those who need support can be guided toward it.

Education can also be provided to help individuals and managers recognise the signs of depression, including loss of energy, persistent low mood, reduced eye contact and noticeable changes in weight and attitude, so they can be referred into existing support, such as access to talking therapy already paid for via the Employee Assistance Programme (EAP).

3. Support women to reduce anxiety levels

Anxiety is the number one reason for females under the age of 50 to be referred into occupational health. After this stress levels, and musculoskeletal (MSK) issues push anxiety into second place.

Supporting women to manage anxiety levels is therefore imperative for boosting wellbeing at work, especially when it comes to younger women, aged 16-19. This demographic has the highest levels of anxiety, with a fifth of all occupational health referrals due to anxiety.

For the most part, anxiety serves a good purpose, alerting individuals when they are threatened so they can prepare for that threat. Problems arise when people start to think about what could go wrong all the time, instead of responding to actual threats, causing them to experience the same distress as if it were actually happening.

It’s therefore vital to equip employees with strategies for recognising the symptoms of anxiety. These include rapid breathing, pounding heart, feeling sick to your stomach, having trouble sleeping, headaches and panic attacks – so they can understand what’s triggering them and reduce intrusive thoughts, or take practical steps to improve their situation.

Although a referral into occupational health can provide insights on reasonable adjustments to support this, education on how to build resilience, manage uncertainty and control thoughts and feelings can also help. Physical activity and mindfulness are also very beneficial for reducing anxiety levels.

4. Understand the link between mental health and bowel issues

Men are more likely to be referred into occupational health due to bowel conditions, including IBS and colitis, than women, making this a top-10 condition for all male age groups.

Interestingly, the gut and brain communicate constantly via nerves, hormones and immune signals, meaning poor mental health can also trigger poor bowel health. Likewise, poor gut health can lead to inflammation, which is linked to depression.

Fortunately, the reverse is true, and the trillions of bacteria living in the gut (the microbiome) can produce chemicals that affect brain function, including serotonin, which regulates mood.

In tackling male and female mental health, it’s therefore worth considering that mental health and physical health are intrinsically linked and focusing on ‘whole person’ initiatives. The gut-brain connection means that improving gut health can have a positive impact on mental health, to support better mood, reduce anxiety and even ease symptoms of depression.

5. Address increasing heart issues among younger women

Heart issues account for 5% of occupational health referrals for men, aged over 50, but surprisingly, the data shows 2% of 16–19-year-old women are also being referred for heart issues.

Although the reasons for this are not yet fully understood, several factors could be contributing to this trend among younger women. For example, heightened anxiety can affect heart rhythm and cardiovascular health, leading to irregular heartbeats, dizziness and fainting.

While smoking and vaping can harm blood vessels and heart function, as can conditions such as anorexia, viral infections, auto-immune diseases and rising rates of obesity. By providing education around healthy lifestyle habits, including a balanced diet, regular exercise, avoiding smoking and support for mental health, employers can help to protect heart health.

Encourage employees of all ages who are worried about their heart health to have regular check-ups. Symptoms to be watch for include chest pain or tightness, palpitations or rapid heartbeat, dizziness or fainting spells, shortness of breath and unexplained fatigue.

Supporting Neurodiverse Talent: A Fireside Chat

9.30am, Wednesday 24th September 2025

Join PAM Group’s director of psychology for a personal and interactive discussion about what it really takes to support neurodivergent employees. Find out why neurodiversity is now the third biggest reason for employees to struggle at work and have your questions answered.

How can PAM Group help?

If you would like to discuss the opportunities for using occupational health to keep your people health and in work, please drop us a note via this contact page