Abstract
BackgroundMany organisations promote eHealth applications as a feasible, low-cost method of addressing mental ill-health and stress amongst their employees. However, there are good reasons why the efficacy identified in clinical or other samples may not generalize to employees, and many Apps are being developed specifically for this group. The aim of this paper is to conduct the first comprehensive systematic review and meta-analysis evaluating the evidence for the effectiveness and examine the relative efficacy of different types of eHealth interventions for employees.MethodsSystematic searches were conducted for relevant articles published from 1975 until November 17, 2016, of trials of eHealth mental health interventions (App or web-based) focused on the mental health of employees. The quality and bias of all identified studies was assessed. We extracted means and standard deviations from published reports, comparing the difference in effect sizes (Hedge’s g) in standardized mental health outcomes. We meta-analysed these using a random effects model, stratified by length of follow up, intervention type, and whether the intervention was universal (unselected) or targeted to selected groups e.g. “stressed”.Results23 controlled trials of eHealth interventions were identified which overall suggested a small positive effect at both post intervention (g = 0.24, 95% CI 0.13 to 0.35) and follow up (g = 0.23, 95% CI 0.03 to 0.42). There were differential short term effects seen between the intervention types whereby Mindfulness based interventions (g = 0.60, 95% CI 0.34 to 0.85, n = 6) showed larger effects than the Cognitive Behaviour Therapy (CBT) based (g = 0.15, 95% CI 0.02 to 0.29, n = 11) and Stress Management based (g = 0.17, 95%CI -0.01 to 0.34, n = 6) interventions. The Stress Management interventions however differed by whether delivered to universal or targeted groups with a moderately large effect size at both post-intervention (g = 0.64, 95% CI 0.54 to 0.85) and follow-up (g = 0.69, 95% CI 0.06 to 1.33) in targeted groups, but no effect in unselected groups.InterpretationThere is reasonable evidence that eHealth interventions delivered to employees may reduce mental health and stress symptoms post intervention and still have a benefit, although reduced at follow-up. Despite the enthusiasm in the corporate world for such approaches, employers and other organisations should be aware not all such interventions are equal, many lack evidence, and achieving the best outcomes depends upon providing the right type of intervention to the correct population.
Highlights
Mental health problems in the workforce are common and have a substantial impact on employee wellbeing, productivity, absenteeism, compensation claims, and the social welfare systems [1,2,3]
This review demonstrated the evidence that certain types of eHealth interventions delivered to employees via their workplace can be effective at reducing mental health and stress symptoms the evidence base is affected by a small study effect that seems to inflate effectiveness
If an eHealth intervention is to be offered to all employees, in a universal fashion, Mindfulness approaches appear to have a stronger effect than the other types
Summary
Mental health problems in the workforce are common and have a substantial impact on employee wellbeing, productivity, absenteeism, compensation claims, and the social welfare systems [1,2,3]. The majority of mental ill-health seen in the workforce is due to common mental disorders, most notably, depression and anxiety [6,7,8], accounting for up to 12% of the Australian working population [9]. Despite mental illness being the leading cause of work incapacity and sickness absence [14], and depression estimated to be the leading cause of disability at work by 2020 [15], a recent systematic meta-review found that there no workplace mental health interventions that could be considered evidence-based [16]. Many organisations promote eHealth applications as a feasible, low-cost method of addressing mental ill-health and stress amongst their employees. The aim of this paper is to conduct the first comprehensive systematic review and meta-analysis evaluating the evidence for the effectiveness and examine the relative efficacy of different types of eHealth interventions for employees
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