Economic evaluations of mental health interventions: A systematic review of interventions with work-focused components

Abstract

Mental health disorders represent a major and increasing public health issue and economic burden to employers, workers and health insurance systems.The aim of this systematic review was to analyze the cost-benefit, cost-effectiveness and cost-utility results of interventions intended to improve employees' mental health, prevent common mental disorders (CMD) or promote return-to-work (RTW) after an absence due to CMD, thus encompassing primary, secondary and tertiary prevention. Given the interactions between work and mental health, we restricted our selection to interventions with work-focused components: the interventions had to address employees’ specific working situations and actions had to be tailored to take account of the specific difficulties or challenges encountered by them.Studies were searched for in eight electronic databases and through backward citation tracking (2007–2019). Two researchers independently performed screening, data extraction and scientific quality assessment.Our systematic review included 11 economic evaluation studies. We found strong evidence of positive economic results for RTW interventions from the employer’s and societal perspectives. These interventions could take different forms: structured guidance with individualized support in order to implement problem-solving treatment and elaborate an action plan, which could be accompanied by cognitive-behavioural therapy; training for managers to enhance their skills in RTW communication with employees; and an internet-based module with occupational physicians guidance. There were not enough studies in the other categories combining the type of prevention (primary, secondary or tertiary) with the economic perspective (employers’, societal, employees’, healthcare system’s) to produce evidence concerning the economic balance of interventions.Our results have important practical implications for the orientation of investments in prevention for employers as well as for society.