General Mental Health Interventions
Employers can use direct interventions, which target mental health outcomes through psychological education, or indirect interventions, which target risk factors associated with depression and anxiety such as obesity or physical activity.
- Both direct and indirect interventions are effective at improving depression and anxiety outcomes, although the size of the effect is small.
- Programs that use cognitive behavior therapy (CBT), meditation, and a combination of techniques appear be effective at improving depression and anxiety.
- Programs that combine several different techniques appear to be more effective compared to programs that use single technique. Note: This finding is mainly for programs that are generally delivered face-to-face either through individual coaching or group-based workshops.
- Employers can make mental health programs available to all employees, or those at risk. However, at risk employees may show the most overall improvement in outcomes.
- Employers are encouraged to provide primary and secondary prevention programs to maximize the benefit of these programs for different employee groups across the organization.
Stress Management Interventions (SMIs)
Evidence since the 1970s shows that SMIs targeted at employees at risk for stress are highly effective at reducing symptoms of stress, and moderately effective at improving anxiety and overall health.
- Interventions using cognitive behavioral therapy (CBT) are associated with the highest level of effectiveness, so employers are encouraged to provide these.
- Relaxation techniques also appear to provide some benefit. However, organization- level approaches to date have been associated with small or negative outcomes, although these are not statistically significant.
- Stress management interventions improve productivity at work, but may not reduce absenteeism among employees.
Physical Activity Programs
Several studies have found that exercise programs are effective at improving activity- related outcomes. However, few have evaluated the effect of exercise in the workplace on mental health.
- Exercise programs delivered in the workplace are significantly effective at absenteeism but the effect size is small.
- Activity programs do not appear to significantly improve mood and overall quality of life, however, this may be due to the low dose (average number of activity minutes per week) observed in existing studies.
- Other barriers that exist in the workplace, such as lack of time or cost, may also prevent employees from achieving the mental health benefit from being active.
- Employers are encouraged to address barriers to the best of their ability given operational and resource constraints.
- Employers are strongly advised to promote the Physical Activity Guidelines for Americans issued by the Department of Health and Human Services and adopted by the American Heart Association.
Alcohol Misuse Programs
We could not identify a meta-analysis of workplace alcohol misuse prevention programs. This may be due to HR concerns, stigma or low federal funding for substance abuse programs.
- There is some evidence to support that workplace alcohol interventions can improve alcohol-use related outcomes in the workplace, but this is from a very low evidence base.
- Intervention methods that may be effective include health and lifestyle checks, psychosocial skills training and peer-referral.
- Employers are encouraged to discuss integrated behavioral interventions with their EAP and telehealth providers to ensure a consistency of approach and messaging.
Digital Mental Health Interventions
Digital programs including apps are appealing to employers because they offer individual tailoring, feedback and theoretically scale at a more affordable price per employee.
- Overall, digital interventions are effective at improving general mental health and stress, but not depression and anxiety.
- Digital tools that use meditation and stress management techniques are more effective than digital tools that use CBT techniques.
- Digital stress management interventions should be targeted toward employees at high risk of stress, rather than the general employee population.
- Digital meditation apps are an effective way to reduce stress in the general population.
- Preliminary findings suggest that the following design features may increase program engagement and completion: interventions that are shorter (6-7 weeks), use SMS and email to engage, and incorporate persuasive technology are effective at improving mental health-related outcomes.
Employee Assistance Programs
EAPs are a staple of workplace benefits; however, few rigorous evaluations of EAPs have been conducted. Furthermore, employee utilization is low and employer investment in declining.
- Employee assistance programs that use counseling and multi-component interventions can be effective at reducing absenteeism, presenteeism, well-being and workplace functioning.
- The effectiveness of EAPs can vary depending on the current mental health status of the employee, level of investment by employers and usage rates by employees.
- EAPs appear to be cost effective, although few independent evaluations have been published.
- Employers should consider the advantages and disadvantages of different EAP formats and decide which would be the best fit for them.
- There is a large amount of variability in the quality and types of services provided by EAPs. Low cost EAPs are often very limited in the offerings they provide.
Return to Work Programs
Return to Work (RTW) programs are tertiary prevention or treatment programs that seek to re-integrate employees with prolonged absence from work due to mental health-related issues.
- Adding work-directed programs or telephonic CBT to clinical rehabilitation programs appear to be moderately more effective than clinical RTW programs alone.
- While most RTW interventions consist of education with or without antidepressants, other components such as physical activity can be added to optimize mental health outcomes.
- The current evidence on the cost-effectiveness is sparse and generally indicates that it does not yield a significant return on investment.
Stigma Reduction Programs
Stigma reduction programs are considered to be systemic or organization-level programs that promote mental health awareness and seek to organizational stigma toward employees with mental health issues.
- Stigma programs appear to improve manager and employee knowledge and behavior, but the effect on attitudes is less positive.
- Brief stigma reduction interventions are effective in the short term but may require periodic refresher trainings to maintain effectiveness.
- Stigma reduction interventions may improve employee self-reported mental health outcomes, but the effect is not statistically significant.
Organizational Climate Programs
Initial evidence indicates that a perceived positive organizational climate is associated with better mental health outcomes.
- Supportive leadership and supervision are associated with positive employee mental health outcomes.
Economic effectiveness of workplace mental health programs
- Primary and secondary prevention programs are associated with positive cost-benefits.
- RTW programs do not show significant differences across groups.
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