How does Chronic Stress Lead to Depression?

Introduction


A threat to your life or safety triggers a primal physical response from the body, leaving you breathless, heart pounding, and mind racing. From deep within your brain, a chemical signal speeds stress hormones through the bloodstream, priming your body to be alert and ready to escape danger. Concentration becomes more focused, reaction time faster, and strength and agility increase. When the stressful situation ends, hormonal signals switch off the stress response and the body returns to normal.


So, the stress is good for humans.  It keeps us alert, motivated and primed to respond to danger.  As anyone who has faced a work deadline or competed in a sport knows, you can understand that stress mobilizes the body to respond, improving performance. 


However, at the stressful conditions of the modern society, too much stress, or chronic stress may lead to major depression in susceptible people. Many of us now harbor anxiety and worry about daily events and relationships. Stress hormones continue to wash through the system in high levels, never leaving the blood and tissues. And so, the stress response that once gave ancient people the speed and endurance to escape life-threatening dangers runs constantly in many modern people and never shuts down.


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Research now shows that such long-term activation of the stress system can have a hazardous, even lethal effect on the body, increasing risk of obesity, heart disease, depression, and a variety of other illnesses.


How it works?


The HPA axis is a feedback loop by which signals from the brain trigger the release of hormones needed to respond to stress. Because of its function, the HPA axis is also sometimes called the “stress circuit.”


Briefly, in response to a stress, the brain region known as the hypothalamus releases corticotropin-releasing hormone (CRH). In turn, CRH acts on the pituitary gland, just beneath the brain, triggering the release of another hormone, adrenocorticotropin (ACTH) into the bloodstream. Next, ACTH signals the adrenal glands, which sit atop the kidneys, to release a number of hormonal compounds.


These compounds include epinephrine (formerly known as adrenaline), Norepinephrine (formerly known as noradrenaline) and cortisol. All three hormones enable the body to respond to a threat. Epinephrine increases blood pressure and heart rate, diverts blood to the muscles, and speeds reaction time. Cortisol, also known as glucocorticoid, releases sugar (in the form of glucose) from the body reserves so that this essential fuel can be used to power the muscles and the brain.


Normally, cortisol also exerts a feedback effect to shut down the stress response after the threat has passed, acting upon the hypothalamus and causing it to stop producing CRH.


This stress circuit affects systems throughout the body. The hormones of the HPA axis exert their effect on the autonomic nervous system, which controls such vital functions as heart rate, blood pressure, and digestion.


The HPA axis also communicates with several regions of the brain, including the limbic system, which controls motivation and mood, with the amygdala, which generates fear in response to danger, and with the hippocampus, which plays an important part in memory formation as well as in mood and motivation. In addition, the HPA axis is also connected with brain regions that control body temperature, suppress appetite, and control pain.


Similarly, the HPA axis also interacts with various other glandular systems, among them those producing reproductive hormones, growth hormones, and thyroid hormones. Once activated, the stress response switches off the hormonal systems regulating growth, reproduction, metabolism, and immunity. Short term, the response is helpful, allowing us to divert biochemical resources to dealing with the threat.


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The Stress-Depression Connection


Chronic s tress, such as taking care of a terminally ill family member at home, or sharp and severe, such as losing a job or the death of a loved one -- can lead to major depression in susceptible people.  Both types of stress lead to over-activity of the body's stress-response mechanism.  


Sustained or chronic stress, in particular, leads to elevated hormones such as cortisol, the "stress hormone," and reduced serotonin and other neurotransmitters in the brain, including dopamine, which has been linked to depression.  When these chemical systems are working normally, they regulate biological processes like sleep, appetite, energy, and sex drive, and permit expression of normal moods and emotions. When the stress response fails to shut off and reset after a difficult situation has passed, it can lead to depression.


This theoretical assumption has been confirmed by the several clinical studies. One of the recent researches, conducted on mice, corroborated the theoretical assumption that a long-term exposure to cortisol may actually contribute to depression development. The mice were exposed to acute (24 hours) and chronic (17 to 18 days) doses of the rodent stress hormone corticosterone, putting it into their drinking water.



The mice with chronic exposure, in comparison to those with acute one, took longer to go out of small dark compartments into a brightly lit open field, a common test for anxiety in animals. Those with chronic exposure were more fearful and less willing to explore their new environment, also not showing normal reactions when being startled, another indication that their nervous system was overwhelmed.



Researchers noted that people with Cushing's disease, when too much cortisol is released, suffer depression and anxiety and those receiving corticosteroid therapy for inflammatory conditions also have mood problems.


Learned Helplessness and Clinical Depression


In studying how stressful events may lead to depression, researchers have developed a theory called, "learned helplessness." This theory states that when people experience chronic or repeated stressful events, they learn to feel helpless. This feeling of helplessness is strengthened when a person believes he or she has no control over the stressful situation. Although the research to support this theory was initially done with animals, the effects of learned helplessness may be seen in depressed humans.


People who are depressed very often have negative beliefs about their ability to manage aspects of their lives based on perceived failures in the past. For example, imagine an adolescent girl living in a home with verbally abusive parents who tell her that she is stupid and cannot do anything right. Over time the young girl may believe her parents and come to doubt her abilities and self-worth. She may begin to feel helpless and believe that most things are beyond her control. This feeling of helplessness may make her vulnerable to developing clinical depression at some point in her life.


How to deal with chronic stress?


There are multiple suggestions for relieving from stress negative consequence you can find online. There is no point to remove stress from your life completely, since you cannot regulate the external conditions and life events. But you can adapt your body to handle these stressful life conditions without losing the grounds, being able to manage successfully inside the reasonable response to the external life. One size does not fit all, and you need to find your own mental relaxers and guards.


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There are few popular suggestions:


1.       Adopt a pet. Interaction with pets is relaxing and may therefore aid in stress management. Pet therapy is acknowledged approach to reduce stress. But be careful to chose this method, as adoption a pet requires taking responsibility for this creature life and well-being. Are you ready for that?
2.       Apply Positive Self-Talk. Self-talk is one way to deal with stress. We all talk to ourselves; sometimes we talk out loud but usually we keep self-talk in our heads. Self-talk can be positive ("I can do this" or "Things will work out") or negative ("I'll never get well" or "I'm so stupid"). Negative self-talk increases stress. Positive self-talk helps you calm down and control stress. With practice, you can learn to turn negative thoughts into positive ones.
3.       Use Emergency Stress Stoppers. There are many stressful situations — at work, at home, on the road and in public places. We may feel stress because of poor communication, too much work and everyday hassles like standing in line. Emergency stress stoppers help you deal with stress on the spot. Try these emergency stress stoppers. You may need different stress stoppers for different situations and sometimes it helps to combine them.
·         Count to 10 before you speak.
·         Take three to five deep breaths.
·         Walk away from the stressful situation, and say you'll handle it later.
·         Go for a walk.
·         Don't be afraid to say "I'm sorry" if you make a mistake.
·         Set your watch five to 10 minutes ahead to avoid the stress of being late.
·         Break down big problems into smaller parts. For example, answer one letter or phone call per day, instead of dealing with everything at once.
·         Drive in the slow lane or avoid busy roads to help you stay calm while driving.
·         Smell a rose, hug a loved one or smile at your neighbor.
4.       Find Pleasure. When stress makes you feel bad, do something that makes you feel good. Doing things you enjoy is a natural way to fight off stress. You don't have to do a lot to find pleasure. Even if you're ill or down, you can find pleasure in simple things such as going for a drive, chatting with a friend or reading a good book.
5.       Relax. Relaxation is more than sitting in your favorite chair watching TV. To relieve stress, relaxation should calm the tension in your mind and body. Deep breathing is a form of relaxation you can learn and practice at home using the following steps. It's a good skill to practice as you start or end your day. With daily practice, you will soon be able to use this skill whenever you feel stress.
·         Sit in a comfortable position with your feet on the floor and your hands in your lap or lie down. Close your eyes.
·         Picture yourself in a peaceful place. Perhaps you're lying on the beach, walking in the mountains or floating in the clouds. Hold this scene in your mind.
·         Inhale and exhale. Focus on breathing slowly and deeply.
·         Continue to breathe slowly for 10 minutes or more.
·         Try to take at least five to 10 minutes every day for deep breathing or another form of relaxation.
6.       Watch TV. It was proven that the simple watching of television can reduce the level of stress a person can carry at a moment, and it can lower the anxiety level. This is very helpful in the matter: how does stress lead to depression. Also, a very important thing to know is that watching television for a very long period of time, or watching low-quality programs, that our personality rejects sub-consciously, can lead to stress build up, and this is bad for our body and mind, even if it looks like we are enjoying the viewing.
7.       Get to Fitness. In general, physical exercises proved to be an efficient and easy-to-perform, approach for stress reduction. Some of such activities might be especially effective, such as meditation, yoga, dancing, or water related procedures.
8.       Get Massage. Another way to get rid of stress is to go get a massage, when one goes to massage therapy, one can effectively relax muscles, ease muscle spasms and pain, increase blood flow in the skin and muscles, relieve mental and emotional stress, and induce relaxation.
9.       Write about it. Many people claim that self-assessment in written form helps to put the stress factors in proportion and assists in dealing with them. Write self-evaluation, email to a close friend, or start a blog. While writing is not able to substitute the professional consultation, it does help to ventilate the feelings and develop an action plan on how to deal with stressors.
10.   Get enough sleep. Lack of rest just aggravates stress. Adequate sleep fuels your mind, as well as your body. Feeling tired will increase your stress because it may cause you to think irrationally.
11.   See a Doctor. If your stress management efforts aren't helpful enough, see your therapist. Do not wait the moment when depression will penetrate full speed in your mind and body.


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How NOT to Deal with Chronic Stress


Some of the coping strategies may temporarily reduce stress, but they may also cause more damage in the long run:
  • Smoking tobacco.

  • Drinking too much alcohol.

  • Overeating or undereating.

  • Zoning out for hours in front of the TV or computer.

  • Withdrawing from friends, family, and activities.              

  • Using pills or drugs to relax.      

  • Sleeping too much.

  • Procrastinating.

  • Filling up every minute of the day to avoid facing problems.

  • Taking out your stress on others (lashing out, angry outbursts, physical violence).





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Spiritual Causes of Depression through Eyes of Christians

“Spiritual” causes of depression are in some ways as speculative as psychological or even physiological explanations. Just as there are currently no way to exactly measure brain chemistry, there are no ways for us to “see” all of what is happening spiritually within a person. Many of the spiritual causes of depression are essentially refined or redefined versions of psychological causes. For example, instead of talking about behavior, Christians talk about sin. In the area of cognition Christians emphasize not only one’s faulty view of oneself, but also a faulty view of God and his character. Finally, while secular psychology recognizes a distinction between body and mind, Christians should have a proper understanding of both the distinctions and interrelations between the human body and soul.


The Biblical point of view


What does the Bible say about depression? Little or nothing! It provides no support to those who become truly depressed from whatever cause. Paul went through terrible trials (2 Cor. 11:22-30) yet there is not a glimmer of depression in his letters. Indeed Paul instructs Christians to "Rejoice always in the Lord" (Philip.4:4), and so important is this that he repeats it "Again I say rejoice"! Two verses later again he instructs "Be anxious for nothing". Only a few verses further on he gives clear directives for the sound Christian life; "Whatsoever things are true, whatsoever things are noble...if there is any virtue, and if there is anything praiseworthy, think on these things."


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Thus the Christian is instructed to have a very positive mind set. Therefore, is it not obvious that the Christian who sinks into despair and despondency for whatever cause is actually disobeying the Bible's clear requirements. He is NOT fixing his eyes upon Jesus and the glorious hope of the future that is a continual refrain in the Bible. Read Philip. 4:4-13 and check if those who are depressed are obeying God's word to mankind.


There is also little about depression in the Old Testament. Asaph was despondent when he saw the lives of the rich until he went into the House of the Lord! There he took a step back from his personal viewpoint and saw it all from God's long term plan - and his heart was lifted (Ps. 73:1-17).


David was persecuted by King Saul and felt low at times. But on one such time, he asks "Why are you cast down, O my soul?" (Psalm 42:5) Notice that this is a question, implying that the heart had no business in being cast down. He then gives his heart the very positive instruction "Hope in God.." Thus, his reaction to depression was exactly the same as Asaph's - a drawing back from his own little viewpoint and looking towards God and seeing life from His perspective. What may seem to be an exception, in Ps. 6:6 David calls upon the Lord to rebuke his troublesome enemies. But this is not the usual long term depression. David was a fighter against great odds and he knew the Lord was with him.


So, while very few episodes in Bible are clearly identified as depression, there are plenty of others, more inferred based on their responses to situations. Jeremiah, in the book of Lamentations, expresses deep pain and agony of the soul: “Is it nothing to you, all you who pass by? Look and see if there is any sorrow like my sorrow, which was brought upon me” (Lam. 1:12). One of the most familiar passages is Psalm 42-43.  Psalm 42 begins with, “As the deer pants for the water brooks, so my soul pants for You, O God” (42:1), and continues with:
“Why are you in despair, O my soul?

And why have you become disturbed within me?



O my God, my soul is in despair within me” (Psalm 42:5-6)


The phrase “Why are you in despair, O my soul?” is repeated at the end of Psalm 42 and again in Psalm 43. Some authors have also suggested that Job, Saul, Elijah and even Jesus in the desert showed signs of depression.


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Depression can be more difficult to deal with in Christian circles because the expectations for “life and life abundant” is much higher and because of emotional ties particular theological positions. Just as scientists have biases toward exclusively physiological explanations of depression and psychologists towards exclusively psychological explanations, Christians often gravitate toward interpreting all events in spiritual terms. While it is true that “our battle is not against flesh and blood,” Christians should also keep in mind that the physical world is real and that simple explanations are often incomplete.


Christian Thinking


Admitted many theological and biblical discussions have little or no bearing on one’s life. But in the area of depression, the Christian’s thought life plays a major role. The cognitive theory of depression in psychology has done much to help explain the significance of many of Paul’s charges such as “taking every thought captive” (2 Cor. 10:5), “if there is anything excellent or praiseworthy – think about such things” (Phil. 4:9), and to have the mind of Christ (1 Cor. 2:16).


The two most common areas of faulty Christian thinking are one’s view of oneself and one’s view of God. The generalizing events are often applied to specifically Christian ideas such as, “I sinned in area X, therefore I must be an evil person, unworthy of God.” False doctrine, especially in the area of salvation, may also play a critical role. If one incorrectly believes that is possible to lose one’s salvation, he or she may experience depression from anxiety.


Many Christians also develop faulty views of God which can result in depression. Often Christian’s project onto God their own false expectations of themselves or false expectations placed upon them by parents or teachers. In his discussion of Psalm 13:1-6, Neil Anderson says, “Even though he believes in God, David is depressed because what he believes about God is not true. How can an omnipotent and omniscient God forget about David for even one minute, much less forever?”  Depressed people also tend to feel abandoned by God, characterized by David’s words, “My God, my God, why have you forsaken me?” (Ps. 22:1). “Does God abandon God’s people? No. Do people with depression feel that God has abandoned them? Yes?”


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Sin and Depression


No other cause of depression should be as carefully discussed as that of sin. Unfortunately, the stigma in society at large surrounding mental illnesses is heightened rather than lessened in the Christian discussion. But at the same time, sin is very real and very harmful. Often depressed people are characterized by irrational guilt and shame, yet those that fail to deal with habitual sin often fall further and further into depression.


Consider the following statement, “Compassion cannot ignore unbelief or son. Too often, family and friends think the depressed person is very fragile and cannot handle any frank discussion about sin or hard-heartedness. But to ignore these issues when they are obvious in someone’s life is to treat that person without love or compassion.” Some might consider this approach too harsh, while others might consider it too soft. Either way, assuming that sin alone is the cause and cure of depression is probably no more helpful than assuming that medical treatments alone can cure depression. But ignoring sin is equally unhelpful.


Spiritual Warfare


 In C.S. Lewis’s The Screwtape Letters, an elder demon Screwtape writes lessons to his nephew Wormwood on how to cause the most damage to his human “student.” Screwtape suggests to Wormwood that his most successful course of action is either to cause his student to think about demons and the spiritual realm so much that it causes him to obsess and fear it or to ensure that his student never thinks about spiritual things and remains woefully ignorant on the matter. While it is true that those who do emphasize demonic activity often go to extremes, others tend to react too strongly against such overemphasis and ignore or downplay the reality of spiritual realm and its affects on our lives. As is true elsewhere, a balanced approach is vital.


Biblically, there is a good deal of support for the idea that demons can cause mental and spiritual depression. Job experienced severe ailments, both physical and spiritual, and it is very clear that God allowed Satan to directly cause the problems. Saul was tormented by “a demon sent from God” (1 Sam. 19:19). Jesus cast demons out of many people during his ministry on earth. Even Paul was sent a “messenger from Satan” (2 Cor. 12:7).


Similar to any of the other causes of depression, spiritual warfare may or may not play a role in a particular individual’s depression. And if it does play a role, it is probably one of several factors that should be considered.


How should a Christian treat depression?


Christians tend to look for the real cause of depression in themselves, not relying entirely on the theoretical medical causes proposed by psychiatrists/psychologists. There are some stages of depression that are considered common to all cases.
  1. The person records the progress of his "illness" in some detail, from childhood to recovery.

  2. They are told by their doctor/psychiatrist that they are "ill" with depression.

  3. This is attributed to "a chemical imbalance" - usually serotonin.

  4. They express their great gratitude and relief for this "discovery" as they can now offload their sense of guilt for their condition and can blame something over which they can have no control and therefore cannot be held responsible for: They have got an "illness".

  5. They are prescribed drugs that lift their mood.

  6. However, they still realize that there is something not right, and begin to take positive steps to get back to normal.

  7. Eventually they are well on their way to becoming normal people - with or without the drugs.

  8. At the end they understand the certain attitudes to life that are far from normal and that might lead to the illness on the first place - attention seeking, excessive fear of what others are thinking of them, perfectionism, etc. Some admit that they were mainly to blame for their depression.

  9. They realize that they are now a much stronger person than they were before their depression.

  10. Most admit that they were glad they had gone through their experience because they had learnt so much more about themselves and now had a changed, more relaxed, attitude to life.



So, how should the Christian deal with his depression?
  1. If the root problem is self-centeredness, then the answer is obvious; he must begin to take a real interest in other people and their circumstances. This must be a genuine interest, and not one that is seeking to obtain their approval. There are many passages in the Bible that tell us to put others before ourselves (Eph. 2:3-4, Heb.12:11-14.)

  2. The Bible never says that life - Christian or otherwise - will be smooth and trouble free. When we realize this, we must stand up to the problems of life, no matter how big they may be. They are sent to strengthen us and test how strong our Christian faith truly is (James 1:2-4). For the Christian, he should never forget that no matter how bad the circumstances may seem to him, he must never ever forget that ultimately, God is in complete control of all events. Whatever happens, he must never run away from the problem(s) but must deal with them in a mature Christian way; no other attitude is honoring to God.

  3. Any tendency to mope and have a "pity party" must be firmly resisted. An active, loving and outgoing life must be maintained - irrespective of how we feel.

  4. Realize that you can't base life on your emotions. Christians base life on truth, not emotions. Philippians 4:1 commands us to rejoice (whether we feel like it or not!). And James 1:2 asks us to “Consider it all joy when we fall into various trials.” Notice that James doesn't tell us to feel joyful; he tells us to reckon, to choose to think about your situation as a spot where you can have joy. This question of feelings is very important. The Bible never tells us to do the right thing "if and when we feel like doing it." It is very clear indeed that we must do good things for others whether we feel like doing them or not. This includes doing the mundane things we all have to do at times. Let us do them all to the glory of God. You can be absolutely sure that the good feelings will come in due time once you have trained yourself to do what is right in the first place. This can take six weeks to retrain the autonomic nervous system so that we have a better set of habits that become part of us.

  5. Heed God's Advice. However, many people talk about “faith” and only mean a vague hope that God will somehow pull them through. That's too nebulous a concept to be reliable. Many of the same people who claim to have faith keep plunging through life ignoring God's principles for healthy living. If we spurn the good advice that the Bible contains, we won't escape the consequences - even if we have faith.

  6. There is one physical thing that can be done that is far more effective than any medication. Tests have shown the very positive benefits of doing regular (fairly hard) exercise! This gets the whole body working more normally. It lifts depression and if it is followed by a warm shower, then the resulting glow over the whole body gives a further uplift and positive sense of well-being.



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Should you Disclose your Depression on Job Application?

Why would they hire me, if there were someone else out there with the same educational credentials and with no history of illness? The stigma is crazy. I guess because mental illness, in general, affects work performance badly, affects decision making, affects people mind (and body as well). I guess I fear disclosing that I'm mentally ill, because people wouldn't trust me or WORSE...start fearing me. People tend to stay away from things they don’t understand or don’t want to understand, or perhaps have no time to understand (From Healthboards Message Board).




Overview


Every employer is looking for the most appropriate employee, matching to the announced position requirements. The logic of job selection involves elimination of candidates until only one candidate remains, but the expectation is that this inevitably discriminatory process should be fair. Among people with a disability and professional rehabilitation counselors there is a widespread conviction that this is not the case for jobseekers with a medical history of depression. There can be no doubt that people with depression or any other disability may experience vocational discrimination. The reasons for this are multiple, interactive and complex but a major contributing factor for this exclusion has to do with employers whose negative attitudes are kept in place by myths regarding people with a depression as workers and a desire to avoid 'risky hires'. In some cases, the worst employer nightmare can be even true, if the hired employee will experience a major depressive episode, which is going to negatively affect the performance.


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Job Application: Disclose or Not Disclose?


First of all, unlike insurance policies where the applicant has a positive obligation to disclose information about the medical conditions, prospective employees do not have to provide information about themselves. If prospective employees choose to provide information they should ensure the information is true and not misleading.


Yes, as a general rule, you employer does not have any rights, as such, to request information from a prospective employee about medical condition, but honestly, if the candidate wants the job, it would be wise in certain cases to supply the required information as long as it is a reasonable and lawful request. Note that employer may find multiple legal excuses why you are not the best candidate for the position, while the real reason is the fact that you have depression. You will not be able to claim unfair business practices after all, since you will no real facts to prove your conditions was the roadblock for hiring.


If you decided to disclose your medical conditions, in any case, there is no need to give a full disclosure of your past medical records/history. You may disclose just your recent medical history/records relating the period of sickness in question. Past medical records are not relevant, and not required.



While it is well known that almost everyone has/will suffer some form of depression in their lives, and theoretically the fact of disclosure should not affect your chances of being hired, the real life is different.



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A different story is when your medical condition requires special accommodations. To enable an employer to make reasonable adjustments for a candidate with severe depression, the employer should be honestly informed in details, what the conditions are and what is needed to make it work.


Note that If the position requires the employee to meet certain medical requirements then the employer could ask the employee to complete an additional health questionnaire and make this and the successful medical assessment a condition of employment.


Also, for some positions, the particular medical conditions are not posted on the job description, but they are quite understandable. Some medications might jeopardize the performance, and the warning to operate machinery, to drive, etc. can be located on the label. If that is a case, and you are well aware that the restricted operations are those, you will have to perform at the new position, it is your moral and legal obligations to tell the truth. As far as your medical condition may impact yourself or others at job, you should not hide the fact, and the consequences might be far worse that not to be hired.


You should think twice before not disclosing you medical conditions, while you are on medications, if you are aware that the company is known be regular random drug testing or as you apply for a government job.


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What employer can do, if he learns that you failed to disclose your medical conditions at job application?


If the employee has failed to disclose the medical conditions, deliberately giving false answers to the directly posted questions on the job application or additional medical history forms, the employer could argue there has been a breach of the duty of mutual trust and confidence. The employee's employment could be fairly and lawfully terminated. The challenge for the employer is determining if the lie could justify termination and ensuring their actions are not discriminatory. If the employee provided the information as a condition of their employment and/or the employer relied on this information to recruit the employee, the employer could claim there has been a breach of the contract or a misrepresentation that led to the employer into entering into the contract. The employee could face a civil court claim to recover damages and to answer claims of fraud and negligence.


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