Estimating the Economic Benefits of Eliminating Job Strain as a Risk Factor for Depression

Joint ICOH-WOPS & APA-PFAW global roundtable perspectives: exploring national policy approaches for psychological health at work through the 'National Policy Index' lens

Worker psychological health is a significant global imperative that requires national policy action and stakeholder engagement. While national policy is a critical lever for improving worker psychological health, some countries are more progressive than others in relation to policy development and/or implementation. At the Joint Congress of the International Commission on Occupational Health, Scientific Committee on Work Organization and Psychosocial Factors and the Asia Pacific Academy for Psychosocial Factors at Work in Tokyo (September 2023), a Global Roundtable was held that to initiate international dialogue and knowledge exchange about national policy approaches for work-related psychological health. The Global Roundtable involved experts from diverse regions alongside an engaged audience of congress attendees and facilitators. Qualitative data were analysed against the five components of the National Policy Index tool comprising, policy priority, specific laws, nation-wide initiatives, sector-oriented initiatives, national survey and/or studies. Analysis revealed that while work-related psychological health is a policy priority across many countries, at the same time, there are global gaps in both legislation specificity and active regulation across different countries. For future policy development across countries, it will be beneficial to continue and deepen international discourse and for countries to share their approaches with others.

Work-related causes of mental health conditions and interventions for their improvement in workplaces

Mental health problems and disorders are common among working people and are costly for the affected individuals, employers, and whole of society. This discussion paper provides an overview of the current state of knowledge on the relationship between work and mental health to inform research, policy, and practice. We synthesise available evidence, examining both the role of working conditions in the development of mental disorders, and what can be done to protect and promote mental health in the workplace. We show that exposure to some working conditions is associated with an increased risk of the onset of depressive disorders, the most studied mental disorders. The causality of the association, however, is still debated. Causal inference should be supported by more research with stronger linkage to theory, better exposure assessment, better understanding of biopsychosocial mechanisms, use of innovative analytical methods, a life-course perspective, and better understanding of the role of context, including the role of societal structures in the development of mental disorders. There is growing evidence for the effectiveness of interventions to protect and promote mental health and wellbeing in the workplace; however, there is a disproportionate focus on interventions directed towards individual workers and illnesses, compared with interventions for improving working conditions and enhancing mental health. Moreover, research on work and mental health is mainly done in high-income countries, and often does not address workers in lower socioeconomic positions. Flexible and innovative approaches tailored to local conditions are needed in implementation research on workplace mental health to complement experimental studies. Improvements in translating workplace mental health research to policy and practice, such as through workplace-oriented concrete guidance for interventions, and by national policies and programmes focusing on the people most in need, could capitalise on the growing interest in workplace mental health, possibly yielding important mental health gains in working populations.

Expanding the Focus of Occupational Safety and Health: Lessons from a Series of Linked Scientific Meetings

There is widespread recognition that the world of work is changing, and agreement is growing that the occupational safety and health (OSH) field must change to contribute to the protection of workers now and in the future. Discourse on the evolution of OSH has been active for many decades, but formalized support of an expanded focus for OSH has greatly increased over the past 20 years. Development of approaches such as the National Institute for Occupational Safety and Health (NIOSH)'s Total Worker Health® concept and the World Health Organization (WHO)'s Healthy Workplace Framework are concrete examples of how OSH can incorporate a new focus with a wider view. In 2019, NIOSH initiated a multi-year effort to explore an expanded focus for OSH. This paper is a report on the outputs of a three-year cooperative agreement between NIOSH and The University of Texas School of Public Health, which led to subject matter expert workshops in 2020 and an international conference of global interest groups in 2021. This article traces the background of these meetings and identifies and assesses the lessons learned. It also reviews ten thematic topics that emerged from the meetings: worker health inequalities; training new OSH professionals; future OSH research and practice; tools to measure well-being of workers; psychosocial hazards and adverse mental health effects; skilling, upskilling and improving job quality; socioeconomic influences; climate change; COVID-19 pandemic influences; and strategic foresight. Cross-cutting these themes is the need for systems and transdisciplinary thinking and operationalization of the concept of well-being to prepare the OSH field for the work of the future.

Burden of cardiovascular diseases and depression attributable to psychosocial work exposures in 28 European countries

BACKGROUND

This study aimed to estimate the annual burden of cardiovascular diseases and depression attributable to five psychosocial work exposures in 28 European Union countries (EU28) in 2015.

METHODS

Based on available attributable fraction estimates, the study covered five exposures, job strain, effort-reward imbalance, job insecurity, long working hours and workplace bullying; and five outcomes, coronary/ischemic heart diseases (CHD), stroke, atrial fibrillation, peripheral artery disease and depression. We estimated the burden attributable to each exposure separately and all exposures together. We calculated Disability-Adjusted Life Years (DALY) rate per 100 000 workers in each country for each outcome attributable to each exposure and tested the differences between countries and between genders using the Wald test.

RESULTS

The overall burden of CHD attributable to the five studied psychosocial work exposures together was estimated at 173 629 DALYs for men and 39 238 for women, 5092 deaths for men and 1098 for women in EU28 in 2015. The overall burden of depression was estimated at 528 549 DALYs for men and 344 151 for women (respectively 7862 and 1823 deaths). The three highest burdens in DALYs in EU28 in 2015 were found for depression attributable to job strain (546 502 DALYs), job insecurity (294 680 DALYs) and workplace bullying (276 337 DALYs). Significant differences between countries were observed for DALY rates per 100 000 workers.

CONCLUSIONS

Such results are necessary as decision tools for decision-makers (governments, employers and trade unions) when defining public health priorities and work stress preventive strategies in Europe.

Worker and manager perceptions of the utility of work-related mental health literacy programmes delivered by community organisations: a qualitative study based on the theory of planned behaviour

OBJECTIVES

Reluctance to seek help is a leading contributor to escalating mental injury rates in Australian workplaces. We explored the benefit of using community organisations to deliver mental health literacy programmes to overcome workplace barriers to help-seeking behaviours.

DESIGN

This study used a qualitative application of the theory of planned behaviour to examine underlying beliefs that may influence worker's intentions to participate in mental health literacy programmes delivered by community organisations and manager support for them.

SETTING

This study took place within three large white-collar organisations in the Australian state of Victoria.

PARTICIPANTS

Eighteen workers and 11 managers (n=29) were interviewed to explore perspectives of the benefits of such an approach.

RESULTS

Community organisations have six attributes that make them suitable as an alternative mental health literacy programme provider including empathy, safety, relatability, trustworthiness, social support and inclusivity. Behavioural beliefs included accessibility, understanding and objectivity. The lack of suitability and legitimacy due to poor governance and leadership was disadvantages. Normative beliefs were that family and friends would most likely approve, while line managers and colleagues were viewed as most likely to disapprove. Control beliefs indicated that endorsements from relevant bodies were facilitators of participation. Distance/time constraints and the lack of skills, training and lived experiences of coordinators/facilitators were seen as barriers.

CONCLUSIONS

Identifying workers' beliefs and perceptions of community organisations has significant implication for the development of effective community-based strategies to improve worker mental health literacy and help seeking. Organisations with formal governance structures, allied with government, peak bodies and work-related mental health organisations would be most suitable. Approaches should focus on lived experience and be delivered by qualified facilitators. Promoting supervisor and colleague support could improve participation. Models to guide cross-sector collaborations to equip community organisations to deliver work-related mental health literacy programmes need to be explored.

Effects of a Mindfulness App on Employee Stress in an Australian Public Sector Workforce: Randomized Controlled Trial

Background

Workplace-based mindfulness programs have good evidence for improving employee stress and mental health outcomes, but less is known about their effects on productivity and citizenship behaviors. Most of the available evidence is derived from studies of mindfulness programs that use class-based approaches. Mindfulness apps can increase access to training, but whether self-directed app use is sufficient to realize benefits equivalent to class-based mindfulness programs is unknown.

Objective

We assessed the effectiveness of a mindfulness app, both with and without supporting classes, for reducing employees’ perceived stress. Changes in mindfulness, mental health, quality of life, perceptions of job demand, control and support, productivity indicators, organizational citizenship, and mindful behaviors at work were also investigated.

Methods

Tasmanian State Service employees were invited by the Tasmanian Training Consortium to a 3-arm randomized controlled trial investigating the effects of a mindfulness app on stress. The app used in the Smiling Mind Workplace Program formed the basis of the intervention. The app includes lessons, activities, and guided meditations, and is supported by 4 instructional emails delivered over 8 weeks. Engagement with the app for 10-20 minutes, 5 days a week, was recommended. Reported data were collected at baseline (time point 0), 3 months from baseline (time point 1 [T1]), and at 6-month follow-up (time point 2). At time point 0, participants could nominate a work-based observer to answer surveys about participants’ behaviors. Eligible participants (n=211) were randomly assigned to self-guided app use plus four 1-hour classes (app+classes: 70/211, 33.2%), self-guided app use (app-only: 71/211, 33.6%), or waitlist control (WLC; 70/211, 33.2%). Linear mixed effects models were used to assess changes in the active groups compared with the WLC at T1 and for a head-to-head comparison of the app+classes and app-only groups at follow-up.

Results

App use time was considerably lower than recommended (app+classes: 120/343 minutes; app-only: 45/343 minutes). Compared with the WLC at T1, no significant change in perceived stress was observed in either active group. However, the app+classes group reported lower psychological distress (β=−1.77, SE 0.75; P=.02; Cohen d=–0.21) and higher mindfulness (β=.31, SE 0.12; P=.01; Cohen d=0.19). These effects were retained in the app+classes group at 6 months. No significant changes were observed for the app-only group or for other outcomes. There were no significant changes in observer measures at T1, but by time point 2, the app+classes participants were more noticeably mindful and altruistic at work than app-only participants.

Conclusions

Including classes in the training protocol appears to have motivated engagement and led to benefits, whereas self-guided app use did not realize any significant results. Effect sizes were smaller and less consistent than meta-estimates for class-based mindfulness training.

Trial Registration

Australian New Zealand Clinical Trials Register ACTRN12617001386325; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372942&isReview

Depression among healthcare workers in North West Armed Forces hospital-Tabuk, Saudi Arabia: Prevalence and associated factors

BACKGROUND

Depression among healthcare workers results in adverse effects which might include impairment of work performance, reduced productivity and increase in the employee turnover rate. Despite of that, few published studies have been cited concerning depression among hospital healthcare workers in the Kingdom of Saudi Arabia. This study aims to estimate the prevalence and identify the determinants of depression among health care workers working at North West Armed Forces hospital in Tabuk city, KSA.

METHODS

This is a cross-sectional study design that was adopted to include a representative sample of physicians and nurses working at North West Armed Forces hospital throughout the study period, provided that they worked at this hospital for at least 6 months. A self-administered questionnaire was applied including three parts; the socio-demographic characteristics of the participants, factors that could be associated with depression and the patient health-9 questionnaire to diagnose depression.

RESULTS

The study included 255 healthcare workers. Females represent 58.8 % of the participants. Their age ranged between 22 and 50 years (30.6 ± 5.3 years). About two-thirds of them were nurses (64.3 %) and the remaining 35.7 % were physicians; mainly registrars (22.8 %). The prevalence of depression was 43.9 %. being severe among 0.8 % of them. Results of multivariate logistic regression analysis revealed that HCWs who lost beloved person in the last 6 months were at 3.67 higher risk for developing depression compared to those who didn't report such history (adjusted odds ratio = 3.67; 95 % confidence interval (CI) = 1.84-7.30, p < 0.001). Compared to HCWs of less than 5 years of experience, those with higher experience (5-10 and > 10 years) were at lower significant risk to develop depression (AOR = 0.16; 95 % CI = 0.07-0.037, p < 0.001 and AOR = 0.05; 95 % CI = 0.01-0.029, p = 0.001), respectively.

CONCLUSION

Depression is a relatively common health problem affecting healthcare workers in North West Armed forces hospital, Tabuk. However, in majority of cares, the depression was mild.

Stress at work is associated with intima media thickness in older male employees, independent of other sources of stress perception

Chronic stress at work shows a moderate but robust longitudinal association with cardiovascular disease (CVD). Atherosclerosis is a pathophysiological process of most CVD, for which intima media thickness (IMT) of the carotid artery is used as an early marker. Its relationship with stress at work has remained largely unexplored, and the present study therefore aimed to elucidate the association between stress at work, assessed as effort-reward imbalance (ERI), and IMT. This cross-sectional study comprised of 501 male German employees aged 42 (19-64) years at enrollment into the Mannheim Industrial Cohort Study. Clinical assessments used fasting blood samples and IMT measurement. Self-report questionnaires assessed sources of perceived stress. Analyses adjusted for medical history, life style, and socio-economic status (SES) indicators as well as general perceived stress and worries to determine the specificity of ERI. Linear regression models estimated the association of ERI with IMT, stratifying for age groups and adjusting for potential confounders. ERI ratio increased until the age of 50 years and abated thereafter. In participants younger than 50 years IMT measurements were not associated with ERI ratios. However, despite lower mean ERI ratios in participants older than 50 years, this age group showed a significant relationship with IMT (standardized Beta = .36, p < .01), adjusting for multiple confounders including general perceived stress and worries. These analyses suggest that atherosclerosis in older employees is specifically related to stress at work. Longitudinal studies will help to elucidate the temporal relationship between stress exposure and downstream biological mechanisms.Lay summaryOur study explored the association of job stress and the calcification of the carotid artery in German employees. We found out that this association is stronger in employees older than 50 years. In addition, it is independent of medical risk factors and stress caused by private issues.

Resource allocation for depression management in general practice: A simple data-based filter model

Background

This study aimed to illustrate the potential utility of a simple filter model in understanding the patient outcome and cost-effectiveness implications for depression interventions in primary care.

Methods

Modelling of hypothetical intervention scenarios during different stages of the treatment pathway was conducted.

Results

Three scenarios were developed for depression related to increasing detection, treatment response and treatment uptake. The incremental costs, incremental number of successes (i.e., depression remission) and the incremental costs-effectiveness ratio (ICER) were calculated. In the modelled scenarios, increasing provider treatment response resulted in the greatest number of incremental successes above baseline, however, it was also associated with the greatest ICER. Increasing detection rates was associated with the second greatest increase to incremental successes above baseline and had the lowest ICER.

Conclusions

The authors recommend utility of the filter model to guide the identification of areas where policy stakeholders and/or researchers should invest their efforts in depression management.

Stress, mental and physical health and the costs of health care in German high school students

Stress is a mind-body phenomenon, which affects both mental and physical health and is highly relevant to the health care system. Yet, knowledge on the costs of stress and related health problems in adolescence is missing. The present study addresses this gap by investigating direct health care costs in relation to stress, mental health problems and physical health in high school students. The sample comprised 284 pupils from four schools in Heidelberg (mean age 16.75 ± 0.64 years, 59.64% female). Self-reported health care utilization and medication intake within 1 month were translated into costs. We established correlative associations of the dichotomized overall costs (no vs. any) with stress, mental health problems and physical health within generalized structural equation models. In particular, mental health problems and physical health were examined as mediators of the association between stress and costs. An increase of stress by 1 SD corresponded increased chances for costs by OR 1.39 (Odds Ratio; 95% CI  0.13-0.53, p = 0.001). When mediators were analysed separately, both mental and physical health (problems) fully mediated the association. Yet, when examined together, only mental health problems acted as a mediator. Our results indicate the health economic relevance of stress-related mental health problems in high school students. The finding is meant to set the stage for further cost-of-illness studies of stress and related health problems, as well as economic evaluations. Longitudinal research is needed to allow conclusions on directionality.

Protecting the Mental Health of Small-to-Medium Enterprise Owners: A Randomized Control Trial Evaluating a Self-Administered Versus Telephone Supported Intervention

OBJECTIVE

Small-medium enterprises (SMEs) are under-represented in occupational health research. Owner/managers face mental ill-health risks/exacerbating factors including financial stress and long working hours. This study assessed the effectiveness of a workplace mental health and wellbeing intervention specifically for SME owner/managers.

METHODS

Two hundred ninety seven owner/managers of SMEs were recruited and invited to complete a baseline survey assessing their mental health and wellbeing and were then randomly allocated to one of three intervention groups: (1) self-administered, (2) self-administered plus telephone, or (3) an active control condition. After a four-month intervention period they were followed up with a second survey.

RESULTS

Intention to treat analyses showed a significant decrease in psychological distress for both the active control and the telephone facilitated intervention groups, with the telephone group demonstrating a greater ratio of change.

CONCLUSION

The provision of telephone support for self-administered interventions in this context appears warranted.

Effects of a Classroom Training Program for Promoting Health Literacy Among IT Managers in the Workplace: A Randomized Controlled Trial

OBJECTIVE

IT managers have received limited attention in health literacy research, although they are subject to special professional demands. The aim of this study was to evaluate a training program designed to promote health literacy among managers.

METHODS

A randomized controlled trial with a sample of 171 industry managers from one IT company was conducted. Effects of classroom training on health literacy, psychological well-being, self-rated health, and cortisol awakening response were investigated using pre- (t0), post- (t1), and follow-up (t2) surveys.

RESULTS

The intervention effects (time and group) were not significant for the primary outcome of health literacy. At the second measuring point, psychological well-being and self-rated health significantly decreased, and cortisol awakening response significantly increased.

CONCLUSION

Our study did not show beneficial intervention effects of a training program on promoting health literacy.

Bringing new tools, a regional focus, resource-sensitivity, local engagement and necessary discipline to mental health policy and planning

Background

While reducing the burden of mental and substance use disorders is a global challenge, it is played out locally. Mental disorders have early ages of onset, syndromal complexity and high individual variability in course and response to treatment. As most locally-delivered health systems do not account for this complexity in their design, implementation, scale or evaluation they often result in disappointing impacts.

Discussion

In this viewpoint, we contend that the absence of an appropriate predictive planning framework is one critical reason that countries fail to make substantial progress in mental health outcomes. Addressing this missing infrastructure is vital to guide and coordinate national and regional (local) investments, to ensure limited mental health resources are put to best use, and to strengthen health systems to achieve the mental health targets of the 2015 Sustainable Development Goals.

Most broad national policies over-emphasize provision of single elements of care (e.g. medicines, individual psychological therapies) and assess their population-level impact through static, linear and program logic-based evaluation. More sophisticated decision analytic approaches that can account for complexity have long been successfully used in non-health sectors and are now emerging in mental health research and practice. We argue that utilization of advanced decision support tools such as systems modelling and simulation, is now required to bring a necessary discipline to new national and local investments in transforming mental health systems.

Conclusion

Systems modelling and simulation delivers an interactive decision analytic tool to test mental health reform and service planning scenarios in a safe environment before implementing them in the real world. The approach drives better decision-making and can inform the scale up of effective and contextually relevant strategies to reduce the burden of mental disorder and enhance the mental wealth of nations.

MicroRNA-202-3p Targets Brain-Derived Neurotrophic Factor and Is Involved in Depression-Like Behaviors

BACKGROUND

Brain-derived neurotrophic factor (BDNF) and microRNA (miRNA) play crucial roles in the etiology of depression. However, the molecular mechanisms underlying this disease are not fully understood. The primary objective of this study was to investigate the relationship between miR-202-3p and BDNF in a chronic unpredictable mild stress (CUMS) model.

METHODS

Depression model was established with chronic mild unpredictable mild stimulation (CUMS) combined with solitary feeding. The expression levels of miR-202-3p and BDNF in rat hippocampus were measured by qRT-PCR. The novelty inhibition feeding test (NSFT), sucrose preference test (SPT), and forced swimming test (FST) were used to evaluate the functions of miR-202-3p and BDNF. Target gene prediction and screening and luciferase reporter assay were used to verify the target of miR-202-3p. The expression levels of BNDF, CREB1 and p-CREB1 were detected by Western blot.

RESULTS

Upregulation of miR-202-3p was associated with decreased expression of BDNF in the hippocampus of the CUMS model. Antidepressant was observed when LV-BDNF or LV-si-miR-202-3p was injected into the hippocampus. In addition, in the rat hippocampus and cultured nerve cells, the expression levels of BDNF and cyclic AMP response element binding protein 1 (CREB1), which is a target gene of BDNF, were reduced after LV-miR-202-3p injection. Overexpression of miR-202-3p aggravated depressive behavior and decreased the expression levels of BDNF. Luciferase reporter assay also confirmed that BDNF was a target of miR-202-3p.

CONCLUSION

Silencing miR-202-3p can reduce the damage to hippocampal nerve in CUMS rats; the mechanism may be related to the upregulation of BNDF expression. miR-202-3p may be an effective target for the treatment of depression.

Exploring the Association Between Health Literacy and Psychological Well-Being Among Industry Managers in Germany

OBJECTIVE

Industry managers are typically exposed to high work demands but have received limited attention by research, particularly concerning the issue of health literacy and how this relates to their psychological well-being. The aim of this study was to explore the association between health literacy and psychological well-being among managers in Germany.

METHODS

An online survey of a sample of 126 commercial industry managers was conducted. Effects of health literacy on psychological well-being (WHO-5 index) were investigated using path analysis.

RESULTS

The findings show a quarter of managers were classified as having poor well-being. Health literacy, namely the facets self-regulation (β = 0.40, P < 0.001), self-perception (β = 0.26, P < 0.001), self-control (β = 0.25, P < 0.01), and proactive approach to health (β = 0.09, P < 0.05), were positively associated with psychological well-being.

CONCLUSION

The study indicates that higher health literacy is associated with decreased risk of poor well-being.

Mindfulness-Based Resilience Training in the Workplace: Pilot Study of the Internet-Based Resilience@Work (RAW) Mindfulness Program

Background

The impact of mental illness on society is far reaching and has been identified as the leading cause of sickness absence and work disability in most developed countries. By developing evidence-based solutions that are practical, affordable, and accessible, there is potential to deliver substantial economic benefits while improving the lives of individual workers. Academic and industry groups are now responding to this public health issue. A key focus is on developing practical solutions that enhance the mental health and psychological resilience of workers. A growing body of research suggests resilience training may play a pivotal role in the realm of public health and prevention, particularly with regards to protecting the long-term well-being of workers.

Objective

Our aim is to examine whether a mindfulness-based resilience-training program delivered via the internet is feasible and engaging to a group of high-risk workers. Additionally, we aim to measure the effect of the Resilience@Work Resilience@Work Mindfulness program on measures of resilience and related skills.

Methods

The current pilot study recruited 29 full-time firefighters. Participants were enrolled in the 6-session internet-based resilience-training program and were administered questionnaires prior to training and directly after the program ended. Measurements examined program feasibility, psychological resilience, experiential avoidance, and thought entanglement.

Results

Participants reported greater levels of resilience after Resilience@Work training compared to baseline, with a mean increase in their overall resilience score of 1.5 (95% CI -0.25 to 3.18, t₁₄=1.84, P=.09). Compared to baseline, participants also reported lower levels of psychological inflexibility and experiential avoidance following training, with a mean decrease of -1.8 (95% CI -3.78 to 0.20, t₁₃=-1.94, P=.07). With regards to cognitive fusion (thought entanglement), paired-samples t tests revealed a trend towards reduction in mean scores post training (P=.12).

Conclusions

This pilot study of the Resilience@Work program suggests that a mindfulness-based resilience program delivered via the Internet is feasible in a high-risk workplace setting. In addition, the firefighters using the program showed a trend toward increased resilience and psychological flexibility. Despite a number of limitations, the results of this pilot study provide some valuable insights into what form of resilience training may be viable in occupational settings particularly among those considered high risk, such as emergency workers. To the best of our knowledge, this is the first time a mindfulness-based resilience-training program delivered wholly via the internet has been tested in the workplace.

A New Online Mental Health Training Program for Workplace Managers: Pre-Post Pilot Study Assessing Feasibility, Usability, and Possible Effectiveness

BACKGROUND

Mental health has become the leading cause of sickness absence in high-income countries. Managers can play an important role in establishing mentally healthy workplaces and coordinating their organization's response to a mentally ill worker.

OBJECTIVE

This pilot study aims to evaluate the feasibility, usability, and likely effectiveness of a newly developed online training program for managers called HeadCoach. HeadCoach aims to build managers' confidence in supporting the mental health needs of staff and promote managerial behavior most likely to result in a more mentally healthy workplace.

METHODS

In total, 66 managers from two organizations were invited to participate in this pre-post pilot study of HeadCoach, which was made available to managers to complete at their own pace over a 4-week period. Data were collected at baseline and post intervention via an online research platform. The difference in mean scores for each outcome between these two time points was calculated using paired samples t tests.

RESULTS

Of all the invited managers, 59.1% (39/66) participated in the trial, with complete pre-post data available for 56.4% (22/39) of the participants. The majority of respondents reported positive engagement with the program. During the study period, managers' knowledge regarding their role in managing mental health issues (P=.01) and their confidence in communicating with employees regarding mental illness (P<.001) significantly increased. In addition, a significant increase was observed from the baseline in managers' self-reported actions to use strategies to prevent and decrease stress among their team members (P=.02).

CONCLUSIONS

Although caution is needed due to the absence of a control group, preliminary results of this study suggest that HeadCoach could be a feasible, acceptable, and efficient method of training managers in best workplace practices to help support the mental health needs of their staff.

Providing mental health first aid in the workplace: a Delphi consensus study

BACKGROUND

Mental health problems are common in the workplace, but workers affected by such problems are not always well supported by managers and co-workers. Guidelines exist for the public on how to provide mental health first aid, but not specifically on how to tailor one's approach if the person of concern is a co-worker or employee. A Delphi consensus study was carried out to develop guidelines on additional considerations required when offering mental health first aid in a workplace context.

METHODS

A systematic search of websites, books and journal articles was conducted to develop a questionnaire with 246 items containing actions that someone may use to offer mental health first aid to a co-worker or employee. Three panels of experts from English-speaking countries were recruited (23 consumers, 26 managers and 38 workplace mental health professionals), who independently rated the items over three rounds for inclusion in the guidelines.

RESULTS

The retention rate of the expert panellists across the three rounds was 61.7 %. Of the 246 items, 201 items were agreed to be important or very important by at least 80 % of panellists. These 201 endorsed items included actions on how to approach and offer support to a co-worker, and additional considerations where the person assisting is a supervisor or manager, or is assisting in crisis situations such as acute distress.

CONCLUSIONS

The guidelines outline strategies for a worker to use when they are concerned about the mental health of a co-worker or employee. They will be used to inform future tailoring of Mental Health First Aid training when it is delivered in workplace settings and could influence organisational policies and procedures.

Compassion Fatigue among Healthcare, Emergency and Community Service Workers: A Systematic Review

Compassion fatigue (CF) is stress resulting from exposure to a traumatized individual. CF has been described as the convergence of secondary traumatic stress (STS) and cumulative burnout (BO), a state of physical and mental exhaustion caused by a depleted ability to cope with one's everyday environment. Professionals regularly exposed to the traumatic experiences of the people they service, such as healthcare, emergency and community service workers, are particularly susceptible to developing CF. This can impact standards of patient care, relationships with colleagues, or lead to more serious mental health conditions such as posttraumatic stress disorder (PTSD), anxiety or depression. A systematic review of the effectiveness of interventions to reduce CF in healthcare, emergency and community service workers was conducted. Thirteen relevant studies were identified, the majority of which were conducted on nurses (n = 10). Three included studies focused on community service workers (social workers, disability sector workers), while no studies targeting emergency service workers were identified. Seven studies reported a significant difference post-intervention in BO (n = 4) or STS (n = 3). This review revealed that evidence of the effectiveness of CF interventions in at-risk health and social care professions is relatively recent. Therefore, we recommend more research to determine how best to protect vulnerable workers at work to prevent not only CF, but also the health and economic consequences related to the ensuing, and more disabling, physical and mental health outcomes.

Enhanced Co-Worker Social Support in Isolated Work Groups and Its Mitigating Role on the Work-Family Conflict-Depression Loss Spiral

This paper examines a loss spiral model (i.e., reciprocal relationships) between work-family conflict and depression, moderated by co-worker support. We expected that the moderation effect due to co-worker support would be evident among those working in isolation (i.e., mining workers) due to a greater level of intragroup attraction and saliency attributable to the proximity effects. We used a two wave panel study and data from a random population sample of Australian employees (n = 2793, [n = 112 mining, n = 2681 non-mining]). Using structural equation modelling we tested the reciprocal three way interaction effects. In line with our theory, co-worker support buffered the reciprocal relationship between WFC and depression, showing a protective effect in both pathways. These moderation effects were found in the mining industry only suggesting a proximity component moderates the social support buffer hypothesis (i.e., a three way interaction effect). The present paper integrates previous theoretical perspectives of stress and support, and provides insight into the changing dynamics of workplace relationships.

An integrated workplace mental health intervention in a policing context: Protocol for a cluster randomised control trial

BACKGROUND

In this paper, we present the protocol for a cluster-randomised trial to evaluate the implementation and effectiveness of a workplace mental health intervention in the state-wide police department of the south-eastern Australian state of Victoria. n. The primary aims of the intervention are to improve psychosocial working conditions and mental health literacy, and secondarily to improve mental health and organisational outcomes.

METHODS/DESIGN

The intervention was designed collaboratively with Victoria Police based on a mixed methods pilot study, and combines multi-session leadership coaching for the senior officers within stations (e.g., Sergeants, Senior Sergeants) with tailored mental health literacy training for lower and upper ranks. Intervention effectiveness will be evaluated using a two-arm cluster-randomised trial design, with 12 police stations randomly assigned to the intervention and 12 to the non-intervention/usual care control condition. Data will be collected from all police members in each station (estimated at >20 per station). Psychosocial working conditions (e.g., supervisory support, job control, job demands), mental health literacy (e.g., knowledge, confidence in assisting someone who may have a mental health problem), and mental health will be assessed using validated measures. Organisational outcomes will include organisational depression disclosure norms, organisational cynicism, and station-level sickness absence rates. The trial will be conducted following CONSORT guidelines. Identifying data will not be collected in order to protect participant privacy and to optimise participation, hence changes in primary and secondary outcomes will be assessed using a two-sample t-test comparing summary measures by arm, with weighting by cluster size.

DISCUSSION

This intervention is novel in its integration of stressor-reduction and mental health literacy-enhancing strategies. Effectiveness will be rigorously evaluated, and if positive results are observed, the intervention will be adapted across Victoria Police (total employees ~16,500) as well as possibly in other policing contexts, both nationally and internationally.

TRIAL REGISTRATION

Current Controlled Trials: ISRCTN82041334. Registered 24th July, 2014.

Depression in working adults: comparing the costs and health outcomes of working when ill

Objective

Working through a depressive illness can improve mental health but also carries risks and costs from reduced concentration, fatigue, and poor on-the-job performance. However, evidence-based recommendations for managing work attendance decisions, which benefit individuals and employers, are lacking. Therefore, this study has compared the costs and health outcomes of short-term absenteeism versus working while ill (“presenteeism”) amongst employed Australians reporting lifetime major depression.

Methods

Cohort simulation using state-transition Markov models simulated movement of a hypothetical cohort of workers, reporting lifetime major depression, between health states over one- and five-years according to probabilities derived from a quality epidemiological data source and existing clinical literature. Model outcomes were health service and employment-related costs, and quality-adjusted-life-years (QALYs), captured for absenteeism relative to presenteeism, and stratified by occupation (blue versus white-collar).

Results

Per employee with depression, absenteeism produced higher mean costs than presenteeism over one- and five-years ($42,573/5-years for absenteeism, $37,791/5-years for presenteeism). However, overlapping confidence intervals rendered differences non-significant. Employment-related costs (lost productive time, job turnover), and antidepressant medication and service use costs of absenteeism and presenteeism were significantly higher for white-collar workers. Health outcomes differed for absenteeism versus presenteeism amongst white-collar workers only.

Conclusions

Costs and health outcomes for absenteeism and presenteeism were not significantly different; service use costs excepted. Significant variation by occupation type was identified. These findings provide the first occupation-specific cost evidence which can be used by clinicians, employees, and employers to review their management of depression-related work attendance, and may suggest encouraging employees to continue working is warranted.

Accuracy of general practitioner unassisted detection of depression

OBJECTIVE

Primary care is an important setting for the treatment of depression. The aim of the study was to describe the accuracy of unassisted general practitioner judgements of patients' depression compared to a standardised depression-screening tool delivered via touch-screen computer.

METHOD

English-speaking patients, aged 18 or older, completed the Patient Health Questionnaire-9 (PHQ-9) when presenting for care to one of 51 general practitioners in Australia. General practitioners were asked whether they thought the patients were clinically depressed. General practitioner judgements of depression status were compared to PHQ-9 results.

RESULTS

A total of 1558 patients participated. Twenty per cent of patients were identified by the PHQ-9 as being depressed. General practitioners estimated a similar prevalence; however, when compared to the PHQ-9, GP judgement had a sensitivity of 51% (95% CI [32%, 66%]) and a specificity of 87% (95% CI [78%, 93%]).

CONCLUSIONS

General practitioner unassisted judgements of depression in their patients lacked sensitivity when compared to a standardised psychiatric measure used in general practice.

Workplace mental health: developing an integrated intervention approach

BACKGROUND

Mental health problems are prevalent and costly in working populations. Workplace interventions to address common mental health problems have evolved relatively independently along three main threads or disciplinary traditions: medicine, public health, and psychology. In this Debate piece, we argue that these three threads need to be integrated to optimise the prevention of mental health problems in working populations.

DISCUSSION

To realise the greatest population mental health benefits, workplace mental health intervention needs to comprehensively 1) protect mental health by reducing work-related risk factors for mental health problems; 2) promote mental health by developing the positive aspects of work as well as worker strengths and positive capacities; and 3) address mental health problems among working people regardless of cause. We outline the evidence supporting such an integrated intervention approach and consider the research agenda and policy developments needed to move towards this goal, and propose the notion of integrated workplace mental health literacy.

SUMMARY

An integrated approach to workplace mental health combines the strengths of medicine, public health, and psychology, and has the potential to optimise both the prevention and management of mental health problems in the workplace.

Psychological distress, related work attendance, and productivity loss in small-to-medium enterprise owner/managers

Owner/managers of small-to-medium enterprises (SMEs) are an under-researched population in terms of psychological distress and the associated health and economic consequences. Using baseline data from the evaluation of the Business in Mind program, a mental health promotion intervention amongst SME owner/managers, this study investigated: (i) prevalence of high/very high psychological distress, past-month sickness absenteeism and presenteeism days in SME owner/managers; (ii) associated, self-reported lost productivity; and (iii) associations between work, non-work and business-specific factors and work attendance behaviours. In our sample of 217 SME owner/managers 36.8% reported high/very high psychological distress. Of this group 38.7% reported past-month absenteeism, 82.5% reported past-month presenteeism, and those reporting presenteeism were 50% less productive as than usual. Negative binomial regression was used to demonstrate the independent effects of socio-demographic, work-related wellbeing and health-related factors, as well as various individual and business characteristics on continuous measures of absenteeism and presenteeism days. Health-related factors (self-rated health and treatment) were the strongest correlates of higher presenteeism days (p < 0.05). Work-related wellbeing factors (job tension and job satisfaction) were the strongest correlates of higher absenteeism days (p < 0.05). Higher educational attainment, treatment and neuroticism were also correlated with more absenteeism days. SME-specific information about the occurrence of psychological distress, work attendance behaviour, and the variables that influence these decisions, are needed for the development of guidelines for managing psychological distress within this sector.

The annual costs of cardiovascular diseases and mental disorders attributable to job strain in France

BACKGROUND

Work stress has become a major occupational risk factor in industrialized countries and an important economic issue. The objective was to estimate the annual costs of coronary heart diseases (CHD) and mental disorders (MD) attributable to job strain exposure according to Karasek's model in France for the year 2003 from a societal perspective.

METHODS

We produced attributable fraction estimates which were applied to the number of cases (morbidity and mortality) and the costs of CHD and MD. Relative risk estimates came from a systematic literature review of prospective studies. We conducted meta-analyses based on this selection of studies. Prevalence of exposure to job strain came from the national SUMER survey conducted in France in 2003. Costs included direct medical costs and indirect costs: production losses due to sick leaves and premature deaths.

RESULTS

Between 8.8 and 10.2% of CHD morbidity was attributable to job strain, and between 9.4 and 11.2% of CHD mortality was attributable to this exposure for men. Between 15.2 and 19.8% of MD was attributable to job strain for men, and between 14.3 and 27.1% for women. As a whole, between 450 000 and 590 000 cases of diseases and 910-1130 deaths were attributable to job strain for men. From 730 000 to 1 380 000 cases of diseases and from 150 to 280 deaths were attributable to job strain for women. The total number of sick leave days amounted from 5 to 6.6 million days for men, and from 8.5 to 16 million days for women. The total costs of CHD and MD attributable to job strain exposure ranged from 1.8 to 3 billion euros for the year 2003 (0.12-0.19% GDP). Medical costs accounted for 11% of the total costs, value of life costs accounted for 13-15% and sick leave costs for 74-77%. The cost of CHD was estimated at 113-133 million euros and the cost of MD was between 1.7 - 2.8 billion euros in 2003.

CONCLUSION

This study on the economic burden of diseases attributable to job strain in France provides relevant insights for policy-makers when defining public health priorities for prevention policies.