Systematic review of common mental disorders at work

The UNSW School of Psychiatry, in collaboration with The Black Dog Institute and Beyondblue, have recently completed a detailed systematic meta-review examining the links between work and common mental disorders.  A meta-review is a method of systematically appraising the results of existing academic reviews and is one of the best ways of appraising the evidence from a broad range of research studies.

This project, which was funded by Beyondblue, involved undertaking an exhaustive seach of the academic literature in order to answer the following questions: 

  1. How does work contribute to the development of depression and anxiety disorders?
  2. What interventions have been effective in addressing depression and anxiety disorders in the workplace?
  3. What are the costs associated with depression and anxiety disorders in the workplace?
  4. How does work protect against, and contribute to the recovery from depression and anxiety disorders?

The review was published in late 2013.  A link to a brief summary is supplied below. 

The key findings of our review were:

  • Mental health conditions in the workplace are a major public health and economic problem.  It is estimated that depression alone costs Australian employers $12.3 billion each year.
  • The vast majority of mental health conditions seen in the workplace are either depression or anxiety conditions.  These conditions are treatable and, at times, preventable. 
  • Preventing workers from becoming mentally unwell and assisting those who develop a mental health condition remain at work is in the best interest of employers, individuals and the community. 
  • There is a general consensus that work is able to promote better mental health and facilitate recovery from mental health conditions. However, certain types of work or work environments can contribute to the onset of, and exacerbate existing, depression and anxiety.
  • The relationship between work and mental health conditions is not simple.  While high job demands, change and trauma in the workplace can increase the risk of developing mental health conditions among workers, a variety of other individual and organisational factors can mitigate against this increased risk. 
  • Although it is limited, the available research evidence suggests the following interventions may be effective in promoting mental health in the workplace:
    • increasing employee control
    • promoting physical activity
    • stress management approaches which utilise cognitive behavioural therapy (CBT) techniques
    • support and ‘watchful waiting’, not routine psychological debriefing, following a potentially traumatic event in the workplace
    • workplace counselling which uses evidence-based therapeuitic techniques
    • medication and psychological therapies for those diagnosed with a mental health condition
    • modified CBT delivered as part of a return to work program
    • gradual re-exposure to the workplace as part of a structured treatment program for those with anxiety or post-traumatic stress disorder (PTSD)
  • There is potential for there to be a wide gap between what the evidence suggests is best practice and what is actually being implemented in some workplaces.   This non-evidence based approach to workplace mental health may be ineffective and potentially harmful.
  • Given the cost, both economic and personal, of mental health conditions in the workplace there is an urgent need for additional research and support dedicated to finding practical workplace solutions.  Such research needs to involve both worker and employer groups from the outset.
  • Reducing the burden of mental health conditions among the working population and improving the occupational outcomes for those with mental health conditions are achievable and important goals.  Success in this endeavour will require close collaboration between health professionals, researchers, workers, employers and policy makers.