• Seymour L, Grove B. Workplace interventions for people with common mental health problems: evidence review and recommendations. London (UK): British Occupational Health Research Foundation (BOHRF); 2005 Sep. 96 p. [83 references]

This is the current release of the guideline.

Mental health problems in the work environment

Note: Severe mental illnesses, such as psychosis, schizophrenia or bi-polar disorder were specifically excluded.

Management
Prevention
Treatment

Family Practice
Internal Medicine
Nursing
Preventive Medicine
Psychiatry
Psychology

Allied Health Personnel
Health Care Providers
Nurses
Occupational Therapists
Physicians
Psychologists/Non-physician Behavioral Health Clinicians
Social Workers

• To provide evidence-based answers on key questions related to mental ill health in the workplace
• To assist managers, occupational health professionals and other interested parties in making management decisions and offering advice in the confidence that they are based on the most robust evidence available
• To provide employers and occupational health professionals with information to prevent or limit mental health in their workplace, minimise sickness absence and enable workers who experience mental ill health to remain in work, restored to full productivity

Adults in the workforce with common mental health problems

Prevention

Stress management interventions

Retention and Rehabilitation Interventions

1. Cognitive behavioural therapy (CBT)
2. Job reorganisation
3. Other cognitive/educational interventions
4. Multi-modal interventions
5. Supervisory training
6. Selective case management
7. Computer-aided CBT

• Incidence and prevalence of common mental health problems
• Cost of mental health problems at work
• Incidence of absenteeism due to mental health problems
• Retention of employees with common mental health problems

Hand-searches of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases

The literature was searched systematically to April 2004 using a variety of standard methods. (See Appendix B: Inclusion and exclusion criteria and Appendix C: Search history in the original guideline document for details on search strategy.)

Databases searched were PsychInfo, NIOSHTIC, CISDOC, MEDLINE, CINAHL, Sociofile, ASSIA, IBSS, Cochrane, Business Source Premier, Emerald, PubMed and EMBASE.

The Research Working Group (RWG) did not limit our data pool to experimental studies only; the RWG included a range of studies that were relevant to the research questions (i.e. cohort studies, case studies, participative action research and non-intervention studies).

The RWG also did not omit studies that described non-work based interventions; our main criteria were that the study passed the critical appraisal process and that employment was among the outcome measures. As a consequence there are several studies where the intervention was targeted at practitioners such as primary care physicians, but the outcomes were focused on return to work or remaining in employment for people with common mental health problems.

Electronic searches produced more than 15,000 references. Subsidiary searches included the Chartered Management Institute library database (200 references) and the Faculty of Occupational Medicine website (6 references).

The study selection is shown diagrammatically in Figure 1 on page 20 of the original guideline document. The process used is summarised as follows:

• More than 200 titles and abstracts were considered. Abstracts were reviewed independently by the Senior Researcher and Scientific Secretary. Members of the Research Working Group (RWG) subsequently reviewed identified abstracts to select full papers for review.
• 144 of these papers were retrieved. 59 of these papers informed the context of the review and were read only by the Scientific Secretary and the Senior Researcher.
• The remaining 85 papers were critically appraised by RWG members and assessed for methodological quality, using a pro-forma adapted from that used by CASP (Critical Appraisal Skills Programme) for this review. (see Appendix D of the original guideline document)
• RWG members identified 68 follow-on references for consideration, drawn from the bibliographies of the first tranche of studies. References were reviewed by the Scientific Secretary and the Senior Researcher.
• 48 of these studies were not followed up for a variety of reasons (i.e. a focus on severe and enduring mental ill health, not relevant to workplace outcomes, not relevant to mental health, already reviewed in the first tranche and included in a meta-analysis that had already been reviewed).
• RWG members reviewed and critically appraised a total of 20 follow-on papers.
• External peer reviewers also identified an additional six studies for consideration and these went through the critical appraisal process.
• 19 experimental studies were included dealing with various aspects of management relevant to occupational health guidelines and their main findings are listed in Table I of the original guideline document.
• 12 non-experimental and narrative studies were included and their main conclusions are listed in Table II of the original guideline document.

19 experimental studies and 12 non-experimental and narrative studies

Weighting According to a Rating Scheme (Scheme Given)

Royal College of General Practitioners (RCGP) Three Star System

*** Strong evidence – provided by generally consistent findings in multiple, high quality scientific studies.

** Moderate evidence – provided by generally consistent findings in fewer, smaller or lower quality scientific studies.

* Limited or contradictory evidence – provided by one scientific study or inconsistent findings in multiple scientific or narrative studies.

- No scientific evidence – based on theoretical considerations.

Revised Scottish Intercollegiate Guidelines Network (SIGN) Grading System: Levels of Evidence

1++ High quality meta analyses, systematic reviews of randomised controlled trials or randomised controlled trials with a very low risk of bias

1+ Well conducted meta analyses, systematic reviews of randomised controlled trials or randomised controlled trials with a low risk of bias

1- Meta analyses, systematic reviews of randomised controlled trials or randomised controlled trials with a high risk of bias

2++ High quality systematic reviews of case-control or cohort or studies. High quality case-control or cohort studies with a very low risk of confounding, bias, or chance and a high probability that the relationship is causal

2+ Well conducted case control or cohort studies with a low risk of confounding, bias, or chance and a moderate probability that the relationship is causal

2- Case control or cohort studies with a high risk of confounding, bias, or chance and a significant risk that the relationship is not causal

3 Non-analytic studies (e.g. case reports, case series)

4 Expert opinion

Review of Published Meta-Analyses
Systematic Review with Evidence Tables

Studies were critically appraised by the Research Working Group members and assessed for methodological quality, using a pro-forma adapted from that used by CASP (Critical Appraisal Skills Programme) for this review. (see Appendix D of the original guideline document).

The revised Scottish Intercollegiate Guidelines Network (SIGN) grading system (2000) was used to grade each identified paper. The strength of evidence for each statement was graded using the Royal College of General Practitioners (RCGP) three star system (1995) as modified in the Swedish Council on Technology Assessment in Health Care report for scientific studies and the British Occupational Health Research Foundation (BOHRF) Occupational Health Guidelines for the Management of Low Back Pain at Work.

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

External Peer Review
Internal Peer Review

Not stated

Definition of Common Mental Health Problems

Common mental health problems as those that:

• Occur most frequently and are more prevalent
• Are mostly successfully treated in primary rather than secondary care settings
• Are least disabling in terms of stigmatising attitudes and discriminatory behaviour

Prevention of Common Mental Health Problems

• Amongst employees who have not manifested with common mental health problems or who are not at high risk, the evidence suggests that a range of stress management interventions can have a beneficial and practical impact.
• These interventions also provide employees with a range of useful skills that can be exploited to their own and their organisation's wider benefit.
• The extent to which any of these interventions prevent common mental health problems remains unclear.

Retention at Work

• Amongst employees deemed to be at risk, either through their job role or who have been assessed as at risk, the evidence from the included studies demonstrates that individual rather than organisational approaches to managing common mental health problems are most likely to be effective.
• However it is imperative that those populations are identified accurately so that interventions can be correctly targeted and applied and the anticipated benefits of retaining key skills in organisations can be realised.

Rehabilitation

• For people already experiencing common mental health problems at work, the evidence from the included studies demonstrates that, the most effective approach is brief (up to 8 weeks) of individual therapy, especially cognitive behavioural in nature (CBT).
• The research on CBT delivered via computer-aided software would ideally benefit from a corroborative study. This approach appears promising, although its effectiveness has currently only been demonstrated in the short term (i.e., at one month).
• A stronger effect is associated with employees in high-control jobs.

Recommendations for Practice

The recommendations for practice have emerged from the data pool that supports evidence of effective practice.

• The evidence supports the use of CBT in brief therapy sessions of up to 8 weeks with people already presenting with common mental health problems.
• CBT is most effective for jobs that already involve a high degree of decision latitude.
• Jobs with low decision latitude should prioritise increasing control potential accompanied by CBT interventions.
• Early psychological interventions are effective for common mental health problems, delivered in the workplace, comprising 4-5 sessions of CBT to increase activity and coping skills for those off sick for two weeks (van der Klink et al., 2003)
• Interventions conducted by general practitioners (GPs) or occupational health (OH) Physicians or referred by them to psychologists or psychotherapists should be cognitive in nature.
• Supervisors should keep in touch with employees on mental ill health sickness absence at least once every two weeks (Nieuwenhuijsen et al., 2004)
• No intervention has effects that last forever; training programmes might be more effective at sustaining changes if they include booster and follow-up sessions (Reynolds et al., 1993)

Interventions worth Consideration

Although the evidence base did not strongly support these practices, the guideline Working Group members think that any are worthy of implementation and review if a workplace cannot implement the recommendations for practice.

• Other cognitive/educational approaches (sometimes described as directive or activating)
• Multi-modal interventions (especially via the Internet or other forms of facilitated self help) for employees identified or deemed to be at high risk
• Interventions to train and improve supervisory behaviour
• Selective use of case management with those at risk of long term absence
• Computer-aided CBT available in an amended 3-4 session format, to make it more acceptable to employees.

None provided

The evidence included 19 experimental studies dealing with various aspects of management relevant to occupational health guidelines (see Table I in the original guideline document for details) and 12 non-experimental and narrative studies (see Table II in the original guideline for details). The 19 experimental studies included randomized controlled trials, quasi-randomized controlled studies, controlled intervention studies, systematic literature reviews, and a meta-analysis.

Appropriate use of workplace interventions for people with common mental health problems to:

• Prevent or limit mental ill health in the workplace
• Minimise sickness absence and enable workers who experience mental ill health to remain in work, restored to full productivity

Not stated

The studies that have informed this review had various limitations across a range of criteria. (See the section titled "Limitations in the Evidence" in the original guideline document for details.)

An implementation strategy was not provided.

Getting Better
Living with Illness
Staying Healthy

Effectiveness
Patient-centeredness
Timeliness

• Seymour L, Grove B. Workplace interventions for people with common mental health problems: evidence review and recommendations. London (UK): British Occupational Health Research Foundation (BOHRF); 2005 Sep. 96 p. [83 references]

Not applicable: The guideline was not adapted from another source.

2005 Sep

British Occupational Health Research Foundation - Private Nonprofit Organization

British Occupational Health Research Foundation

The Research Working Group

Group Members: Dr Kit Harling (Chair) Consultant Occupational Physician, Avon Partnership Occupational Health Service; Director, NHS Plus; Dr Ira Madan (Vice Chair) Consultant Occupational Physician, Guy's & St Thomas's NHS Foundation Trust; Dr Bob Grove (Senior Researcher) Director Employment Programme, Sainsbury Centre for Mental Health; Linda Seymour (Scientific Secretary) Research & Policy Development Manager, mentality @ The Sainsbury Centre for Mental Health; Dr Jed Boardman, Consultant/Senior Lecturer in Social Psychiatry, South London and Maudsley NHS Trust and Health Services Research Dept, Institute of Psychiatry King's College London; Dr Dennis Ferriday, Director Health Services (Europe), Ford Motor Company; Dr Fiona Ford (representing RCGP) Senior Lecturer in General Practice, University of Central Lancashire; Ann Kelly, Representing Chartered Management Institute; Dr Noel McElearney (BOHRF Trustee) Director Health Safety & Environment, Scottish & Newcastle plc; Tom Mellish (resigned March 2005) Health & Safety Officer, TUC; Hugh Robertson (from April 2005) Senior Health & Safety Officer, TUC; Susan Scott-Parker, Chief Executive, Employers Forum on Disability; Simon Pickvance, Senior Occupational Health Adviser, Sheffield Occupational Health Advisory Service; Professor Jenny Secker, Professor of Mental Health, Anglia Polytechnic University & South Essex Partnership NHS Trust; Professor Justine Schneider, Professor of Mental Health & Social Care, Nottingham University; Grahame Whitfield, Department for Work and Pensions; Ben Willmott, Employee Relations Adviser, CIPD; Brian Kazer, Chief Executive, British Occupational Health Research Foundation

Conflicts of interest were formally reviewed in respect of all members of the research working group. No conflicts of interest were found.

This is the current release of the guideline.

None available

This NGC summary was completed by ECRI on May 7, 2007. The information was verified by the guideline developer on May 23, 2007.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.