This Evidence Summary was originally published on ScienceForWork.
Article by Iulia Alina Cioca
- To promote mental health, give employees more control over the scheduling of their own work and introduce programs to facilitate a healthy lifestyle, for example enabling employees to engage in physical activity
- Screen employees when appropriate; recommend and support Cognitive-Behavioral Therapy and other effective interventions for those diagnosed with a mental health disorder
- Recognize interventions which do not work and might even have adverse effects. Thinking again about prior decisions might save money and time.
What does work have to do with mental health? When I told a friend the topic of the article I was writing, he dismissed it by saying: “but people who work don’t have mental health problems, otherwise how could they work?”. He was right and wrong at the same time. It’s true that the most common mental health disorders, namely anxiety and depression, are the leading cause of sickness absence and long-term work disability in developed countries. But it’s wrong to assume that work and mental health are two separate affairs: work-related factors such as high demands and low control cause stress and increase the risk of being diagnosed with anxiety or depression. Such disorders are often treatable and sometimes preventable, therefore it is logical to look at what organizations can do to prevent these conditions and to support employees who suffer from them. Aside from better well-being for your employees, taking action might also improve organizational and economic outcomes of your company. But how do you choose an intervention with the best chances of actually working?
Not all interventions are created equal
A very recent systematic review conducted by Joyce et al. (2016) takes a thorough look at what managers can do in the workplace to combat common mental health disorders. They analyzed existing research and summarized what we know about what could work, and what might not.
The best way to conclude whether a particular intervention is useful or not is to try it out with a group of randomly selected people, while another, very similar to the first one, acts as a control group and continues to work as normal. After a period of time, improvements in the group who received the treatment indicate that the intervention might be effective. This conclusion becomes stronger every time independent teams of researchers repeat this trial and get the same results. Unfortunately, research involving this type of trials is not always available, and therefore it is also useful to look at less-solid research which might still indicate whether an intervention works or not.
The review presented here gathers both high-quality and lower-quality research about promoting mental health in the workplace. It indicates a few specific well-established interventions which should improve both your employees’ mental health and broader outcomes in your organization. At the same time, some popular interventions not only fail to bring the desired results, but they might even make things worse for your employees.
Here’s what works
Firstly, for workers diagnosed with anxiety or depression, Cognitive-Behavioral Therapy (CBT) helps reduce their symptoms and psychological distress, but also the time it takes for them to return to work after sick leave. For those who keep working throughout the treatment, CBT also improves job performance and productivity. CBT assumes that our emotions and behaviors are determined by our thoughts/thinking, so therapy aims to change a person’s specific misconceptions and harmful assumptions. Within the various CBT programs, one particular intervention stands out as the most effective: problem-solving therapy, which focuses on building practical problem-solving skills.
For employees suffering from anxiety disorders or Post-Traumatic Stress Disorder (PTSD), following an incident at work, exposure therapy is likely to reduce their symptoms, accelerate their return to work, and improve their productivity.
Both CBT and PTSD exposure therapy address people already suffering from a diagnosed mental health disorder. Unfortunately, the evidence is less clear for proactive interventions aiming to prevent anxiety or depression. For a start, promoting physical activity is likely to reduce employees’ anxiety and could also reduce absenteeism in the organization. It can be particularly effective against mental health disorders when it is part of a more extensive workplace health promotion program, aiming to change employees’ lifestyles in multiple ways.
Other interventions increase the control which employees have over their work, and they are also likely to help prevent mental health disorders. For example, such interventions consist of setting up committees for problem-solving or stress reduction, allowing employees to schedule their shifts themselves, and facilitating gradual or partial retirement.
What doesn’t work and might even cause harm
Unfortunately, certain interventions cause more harm than good for the people they pledge to protect. Performing mental health screenings too regularly and on all employees can increase distress, heighten stigma and make people feel less well because they then focus more on their symptoms. Workplace screening can slightly improve mental health, but only if you limit it to appropriate situations and follow up with concrete actions or support.
Another intervention which will potentially harm employees is involving them in psychological debriefing following a potentially traumatic event in the workplace. This particular intervention does not relieve stress, as it claims to, and can actually produce adverse effects.
Takeaways for your practice
Firstly, take action for the employees who already suffer from a mental health problem: help them get effective therapies such as CBT or PTSD exposure therapy.
- As a manager, make yourself aware of certified psychotherapists to deliver these therapies, and suggest institutions or psychotherapists which your employees can reach out to.
- You can also make it easier for employees to access these therapies by fully or partially supporting the costs or by allowing a flexible work schedule.
By supporting such interventions for those who need them, you can expect improvements not only in their well-being, but also within your organization.
Secondly, think proactively about preventing mental health problems in your company:
- Increase the control employees have by giving them flexibility in how they schedule their shifts and by implementing a gradual retirement program.
- You could also design and implement a wider health-promotion program which includes physical activity in the workplace. Find a space in the building and turn it into a gym, or offer membership to a gym close to the office. You could also check if the workload of your employees leaves them with enough time to actually take advantage of this program: there are indications that these factors might play a role (Mazzola, Moore and Alexander, 2016). In particular, promote aerobic exercise or a combination of exercise and relaxation, which is most likely to reduce your employees’ anxiety.
We critically evaluated the trustworthiness of the research we used to inform this Evidence Summary. The original study reviews 481 single research studies of varying quality. Depending on the kind of studies available for each intervention, the trustworthiness of the conclusions differs:
Joyce, S., Modini, M., Christensen, H., Mykletun, A., Bryant, R., Mitchell, P. B. & Harvey, S. B. (2016). Workplace interventions for common mental health disorders: A systematic meta-review. Psychological Medicine, 46, 4, 683–697.
Mazzola, J. J., Moore, J. T., and Alexander, K. (2016). Is work keeping us from acting healthy? How workplace barriers and facilitators impact nutrition and exercise behaviors. Stress and Health.
This Evidence Summary was originally published on ScienceForWork.ScienceForWork is an independent, non-profit foundation that provides leaders and decision-makers with trustworthy and actionable insights from behavioural science.