Article in review: Hogg, B., Carles Medina, J., Gardoki-Souto, I., Serbanesc, I., Moreno-Alcazar , A., Cerga-Pashoja, A. … & Amann, B. (2021). Workplace interventions to reduce depression and anxiety in small and medium-sized enterprises: A systematic review. Journal of Affective Disorders. https://doi.org/10.1016/jad.2021.04.071
According to Hogg et al., (2021), depression and anxiety are the most common mental health difficulties that impact workplaces; and they are costly for organisations. In 2019 the World Health Organisation found that the global cost of lost productivity as a result of depression and anxiety was 1 trillion euros. This literature review by Hogg and colleagues looked at research related to workplace interventions conducted in small to medium size organisations and found there is benefit in businesses of this size supporting mental health interventions for staff.
The below study cites research identified for consideration in the systematic review, whereby those authors/articles have not been cited in their entirety herein. We can happily provide further information on all authors, if requested.
Workplaces and mental health
Workplace interventions to support people and prevent and treat depression and anxiety have been demonstrated to have a positive effect and save some of the costs associated with depression and anxiety in the workplace. Evidence has shown that larger organisations benefit by providing CBT therapies to employees, however small to medium-size operations have not had the same results. This has been explained by their interest in company-related rather than humanitarian factors, along with limitations in knowledge of and captivity to deliver programs.
Aim of the study
The systematic literature review by Hogg et al., (2021) was conducted to consider research that looked at psychosocial interventions by small to medium-sized employers, which were aimed at targeting depression, anxiety, and suicide ideation/ behaviours. Following an extensive database search, 1238 potential articles were identified, with seven eventually being included in the review. Of these:
- three were randomised control trials
- two were before and after designs
- one was a non randomised trial
- one was a retrospective study
Randomised control trials
The first of the randomized control trails was by Blonk and colleagues, conducted in 2006. In the study, 122 self-employed people on sick leave were allocated to one of three groups to receive 11 two-weekly sessions of CBT, a combined intervention of CBT and stress management advice by a labour expert, or two GP checks as part of the control group. While all three groups reported a decrease in depression and anxiety, the participants in the combined intervention group returned to work on average 80 days earlier than those in the other two groups.
A similar approach was taken in an Australian study by Martin and colleagues (2020), involving a sample group of 297 small to medium enterprise owners. Participants were allocated to receive a DVD resource and kit on CBT and stress management, the resources plus telephone support, or the active control group who received psychoeducational material only. A significant decrease in psychological distress was noted amongst the groups to review the kit and telephone support, and the active control group. Meanwhile, Saraf et al., (2019) also found that a group of participants receiving five CBT sessions had reduced levels of anxiety when compared to a control group, but not at a level that could be considered significant.
Before and After Studies
In a study by Schwatka et al., (2018) a group of 1935 employees participated in a Worksite Wellness Program, which included risk assessments, phone counselling, and access to resources. They found that there was a reduction in the number of program participants reporting depression when compared to baseline, at both the one and two-year follow-up.
Similarly, Kim and colleagues (2014) facilitated employee workshops to brainstorm improvements at a company level and combined this with the dissemination of stress management information based on CBT. There was no significant decrease in depressive symptoms, despite some reports of short-term improvements related to a reduction in job stress.
In the sole retrospective study, Demou and colleagues (2018) assessed the effectiveness of telephone-based case management and therapeutics face-to-face support service delivered to 11,748 employees with a range of illnesses and disorders. A total of 1696 participants with symptoms completed the Hospital Anxiety and Depression scale questionnaire. There was a significant reduction in depression amongst these participants when compared to baseline. A total of 83% of participants described their mental illness as “resolved” on completion of the program.
Sørensen, et al., (2019) conducted the longitudinal non-randomised trial in which participants were interviewed. Those with clinical symptoms were allocated to one group to receive psychotherapy and medical support, those with subclinical symptoms were provided with CBT with the intent to prevent the onset of clinical symptoms, and a third group that did not meet criteria formed the control. In both groups receiving active treatment, there was a reduction in depression.
Findings in context
Putting the results from these works into context, the data suggests that psychosocial interventions for depression and anxiety are acceptable in small to medium-size enterprises.
Only two studies included the cost and none of them looked particularly at the financial impact in terms of costs for companies, services, or individuals or the most cost-effective mode of delivery. This research is timely because of the economic stresses on small to medium enterprises as a result of COVID-19.
Despite determining there is low number of robust studies on the topic, with a total study population of 5111l, the review found that CBT interventions can be effective in targeting depression and anxiety in people at small to medium enterprises. Further research should focus on the effectiveness of CBT or other interventions.