Abstract
BackgroundDespite increased interest in workplace mental health interventions, the evidence for beneficial effects is mixed. Furthermore, many existing studies lack methodological rigor. We report results from a group randomized control trial to test the efficacy of a vastly popular intervention in Canada, the Road to Mental Readiness (R2MR) program, which has been widely disseminated in military, first responder, and civilian settings.MethodsThe trial took place among Canadian Armed Forces military recruits completing their basic military qualification (BMQ) training, and randomized 65 platoons (N = 2831) into either (a) an Intervention (R2MR at week 2 of BMQ), or (b) a delayed Intervention Control (R2MR at week 9 of BMQ) condition. The principal investigator, participants, and data collection staff were blinded to platoon condition. Individual-level psychological functioning, resilience, mental health service use attitudes, intentions, and behaviours, and additional covariates were assessed with questionnaires around week 2 (a day or two before Intervention platoons received R2MR), at week 5, and at week 9 (a day or two before the Control platoons received R2MR). Military performance outcomes were obtained from administrative databases.ResultsThe full trial results were mixed; for some outcomes (psychological functioning, resilience, and military performance), we saw no evidence of beneficial effects; where we did see benefits (mental health service use attitudes, intentions, behaviours), the effects were very small, or disappeared over time. Analyses among two subsamples (Group 1: Intervention platoons with a Fidelity Check and their Controls, and Group 2: Intervention platoons without Fidelity Check and their Controls) indicated that for some outcomes (attitudes and help-seeking), under high fidelity conditions, the beneficial effects of R2MR were increased and better sustained; Conversely, under poor fidelity conditions, decreased beneficial effects or even iatrogenic effects were observed. Analyses across three training divisions indicated the larger organizational climate further influences efficacy.ConclusionsOur findings paint a very complex picture in which it is made evident that sensible, evidence-informed workplace mental health interventions such as R2MR may work under high fidelity conditions, but may yield no discernable benefit or even inadvertent iatrogenic effects if implemented poorly or without sufficient consideration to the larger organizational context.Trial registrationISRCTN 52557050 Registered 13 October 2016.
Highlights
Despite increased interest in workplace mental health interventions, the evidence for beneficial effects is mixed
The full trial results were mixed; for some outcomes, we saw no evidence of beneficial effects; where we did see beneficial effects, the effects were very small and some disappeared over time
Our work extends the existing literature by showing that for some outcomes (MHSU attitudes and help-seeking), under high fidelity conditions, the efficacy of programs like Road to Mental Readiness (R2MR) may be increased - this is encouraging as it suggests these programs may yield beneficial effects for such outcomes when implemented with fidelity; our findings show that for some outcomes (MHSU attitudes, help-seeking, and military performance), under poor fidelity conditions, there may be decreased beneficial or even iatrogenic effects
Summary
Despite increased interest in workplace mental health interventions, the evidence for beneficial effects is mixed. There has been increasing interest in developing and implementing workplace mental health interventions to minimize these costs [4]. Nowhere have the interest and enthusiasm been greater than in military and public safety organizations where individuals are at an increased risk for developing mental health problems [5, 6] due to the stressful and oftentimes traumatogenic nature of their occupations. The need for methodologically rigorous empirical tests of large workplace mental health interventions, especially in large military organizations that have been early and enthusiastic adopters of such programs, has never been greater
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