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Systematic review

Workplace-based interventions for employees’ mental health

The report reviews the research about the effects of workplace-based interventions for employees’ mental Health.

The report reviews the research about the effects of workplace-based interventions for employees’ mental Health.


Key message

The Norwegian Knowledge Centre for the Health Services (NOKC) was asked by the The Norwegian Institute of Public Health to systematically review the research about the effects of workplace-based interventions for employees’ mental health.

We included three systematic reviews of high quality:

  • Preventing occupational stress in healthcare workers
  • Psychosocial interventions for prevention of psychological disorders in law enforcement officers
  • Flexible working conditions for all employees’ Stress management for health personell probably reduces the risk of anxiety.
  • There is probably a positive short-tem effect on stress and burn-out.

The quality of the evidence is low. It is uncertain if mental image training, physical training or stress management have an effect on anxiety, depression, post-traumatic stress, stress or burn-out in police personell.

The quality of the evidence is very low. It is uncertain if gradual retirement, or involuntary part-time  work has an effect on employees’ mental health. It is uncertain if flexible work arrangements reduces stress, mental strain, or affect the quality of life, restitution,  self image, quality of sleep, and alertness in employees.

The quality of the evidence is very low. We did not find documentation on workplace-based interventions for employees’ mental health for outcomes such as employees function, productivity, absense, disability, sick-leave, costs and adverse events.

The included high quality systematic reviews are not updated and more recently published randomized controlled trials may alter the conclusions.

There is a need for updated systematic reviews in this field. 

Summary

Background

Work can have positive effects for employees’. Employment secures the employer with income and social contact, but work can also have negative effects on mental health. According to data from the International Organization for Economic Cooperation and Development one in five employees will experience mental health problems. Data from international research has shown that up to six percent of female employees and up to seven percent of male employees have depression or symptoms of depression. Exactly how many employees who develop mental health problems can vary across workplaces, based on the employee composition on demographic variables such as gender, age, social status, ethnicity, education and professional background as well as from the various work conditions. There are many and complex causes for developing mental health problems in employees. Conditions at the workplace may be one factor. We do not know exactly how many employees who will develop mental health problems as a result of work related factors in Norway.

There is a variation in the risk for employees to develop mental health problems across different occupations and different workplaces. Internationally, there is evidence that police personnel are at increased risk of stress, depression and physical injury associated with the job. Shift work can increase the risk of sleep problems. Health professionals are exposed to work-related stress, increasing the risk for developing anxiety, depression, and burnout and reduced quality of life.

Objective

The Norwegian Knowledge Centre for the Health Services (NOKC) was asked by the The Norwegian Institute of Public Health to systematically review the research about the effects of workplace-based interventions for employees’ mental health.

Method

We developed and performed a systematic search for systematic reviews in the Cochrane Database of Systematic Reviews, PsychInfo, Embase, Medline, Sociological Abstracts, Social Services Abstract, CINAHL, Google Scholar, SveMed + and ISI Social Science citation. The search was finalised in February 2013.

The keywords were developed on the basis of our predefined inclusion criteria:

  • Population:
  • Employees Intervention: Interventions intended to prevent mental illness, or promoting employees' mental health
  • Comparison: Usual practice, other intervention or no intervention
  • Outcomes:
    • Primary outcome: Employees’ mental health.
    • Secondary outcomes: Employees’ quality of life, coping, daily functioning, work functioning, productivity, disability and early retirement, sick leave, costs, and adverse events.
  • Study design: Systematic review of high quality
  • Language: No restrictions to publication language
  • Publication year: 2000-2013 Two authors independently read all the titles and abstracts to assess the relevance according to the inclusion criteria. Possibly relevant articles were obtained in full text and assessed by two people independently. Relevant systematic reviews were critically appraised by two authors, using the Knowledge Centre checklist for systematic reviews quality. Only systematic reviews of high quality were included. Information from the included systematic reviews was obtained. Two authors graded the confidence of the evidence for all the outcomes using the GRADE method.

Results

We included three systematic reviews of high quality. They had performed their litterature search in 2006, 2008 and 2009. One review focused on effect of stress reduction to healthcare workers. One review focused on effect of psychological interventions and physical activity interventions for police personell. One review focused on effect of flexible work arrangements for all employees’. The documentation concerns the following interventions; stress management, psychological measures, physical activity and flexible working arrangements. The three systematic reviews included in total 39 studies. 29 were randomized controlled studies and 10 controlled before-and after-studies. 21 studies reported findings that were relevant for our objective. None of the included studies were conducted in Norway. We did not find documentation on workplace-based interventions for employees’ mental health for outcomes such as function, productivity, absense, disability, sick-leave, costs and adverse events.

Discussion

The evidence was graded to be low or very low. Although the quality of the evidence was low, it does not mean that the interventions have no effect. When the documentation is of very low quality, it is considerable uncertainty with respect to the effect estimates and we cannot say for sure if they show the true effect of the interventions. All we can say is that there are several findings in favor of the employment-based measures on some of the main outcomes and for certain groups of employees. For example, we found that stress management reduced the risk of anxiety in healthcare workers compared to no intervention. Physical exercise and psychological interventions reduced the risk of depression among police personell compared with no intervention, or to be waitlisted. Flexible employment led to improved quality of life compared with fixed start-up time. But there are very few studies for each of these comparisons.  

More recent studies could have emerged without being captured in our report because we only searched for existing systematic reviews.

Conclusion

  • Stress management for healthcare workers may possibly reduce the risk of anxiety. There may possibly be a positive short-tem effect on stress and burn-out. The quality of the evidence is low.
  • It is uncertain if mental image training, physical training or stress management has an effect on anxiety, depression, post-traumatic stress, stress or burn-out in police personell. The quality of the evidence is very low.
  • It is uncertain if gradual retirement, or involuntary part-time work has an effect on employees’ mental health.
  • It is uncertain if flexible work arrangements reduces stress, mental strain, or affect the quality of life, restitution, self image, quality of sleep, and alertness in employees. The quality of the evidence is very low.
  • We cannot conclude about the effectiveness on several secondary outcomes because we did not find documentation on workplace-based interventions for employees’ mental health for outcomes such as function, productivity, absense, disability, sick-leave, costs and adverse events. The high quality systematic reviews are not updated and more recently published randomized controlled trials can exist and they could alter the conclusions.
  • There is a need for updated systematic reviews in this field. 

About this publication

  • Year: 2013
  • By: Norwegian Knowledge Centre for the Health Services
  • Authors Dalsbø TK, Dahm KT, Austvoll-Dahlgren A, Knapstad M, Gundersen M, Reinar LM.
  • ISSN (digital): 1890-1298
  • ISBN (digital): 978-82-8121-544-3