Stress lavoro correlato

Stress lavoro correlato e benessere organizzativo

Workplace mental health interventions

The workplace has been increasingly identified as an appropriate setting for primary care interventions to improve health and also hence in turn improve workplace productivity. Gains from investment in the wellbeing of employees goes beyond financial ones. Greater wellbeing may also lead to improved commitment by employees, reduced labour turnover, quality of goods and services as well as innovation. From a positive stance, intervention in the workplace may have a positive impact on the quality of life of employees and hence improve both economic and social sustainability.

Whilst significant progress in the field of health promotion has been made in workplaces in the developed world, the focus has been on stress in general and the identification of individuals with CMDs has not been a specific focus. Although it is common sense that dysfunctional work environments can contribute to the onset of CMDs, particularly in vulnerable individuals, there is a dearth of data regarding the potential impact of workplace stress management programs on the incidence of CMDs. Given the recognised impact of CMDs on productivity, it is surprising that there has not been as yet widespread investment in enhanced assessment and treatment programs in the workplace.

It is interesting to note that in developed countries, mental health promotion in the workforce has been seen in some ways as separate from public health. This has meant that for example in many European countries there has been a lack of a coordinated effort to institute mental health promotion and intervention programmes in the workplace. WHO have called for an integrated approach to the promotion of mental health in Europe, across communities, educational settings and workplaces. Specifically, there is a need for workplaces to be modified to be conducive to good mental health, including changes to working hours and patterns, exercise and supportive management, as well as providing specific attention to mental health in occupational health and safety programmes.

Empirically, it is conceivable that workplace productivity can be improved if CMDs are identified and treated. On the basis of a clinical trial of people with chronic depression, Berndt et al (1997) demonstrated an inverse relationship between severity of depression and work performance. Furthermore, treatment improves work performance rapidly with approximately two-thirds of the improvement occurring during the first few weeks. The improvement was greatest with those individuals with the least severity of depression at baseline, supporting the notion that a population-based approach may lead to a greater level of improvement in workplace productivity, rather than exclusively focusing on a clinical subsample of more impaired individuals.

The argument for intervention programs that are based in the workplace is further strengthened by population epidemiological studies. As described by Andrews et al (2001), according to a collation of data from the Australian National Survey of Mental Health and Wellbeing and the World Health Report, only a third of individuals with a mental disorder sought treatment. The workplace provides an ideal setting where high-risk individuals may receive treatment. There is evidence that work productivity improves with alleviation of the severity of depression. Longitudinal studies have confirmed that treatment for depression is associated with a reduction in absenteeism and improvement in individuals' capacity to maintain employment. In addition, treatment for depression may lead to indirect cost benefits as a result of improved workplace productivity and a reduction in the "spillover" effect on other employees.

In a cost-effectiveness study in the US, Zhang et al (1999) showed that the cost of treatment for depression was completely offset by savings from loss in productivity due to lost work days alone. Furthermore, estimates of the economic burden of depression do not take account of the indirect costs including the burden experienced by individuals' families and the suffering endured by individuals. Employers bear the cost of reduced productivity, and hence as concluded by Zhang et al (1999), employers ought to play an important role in providing employees with necessary assistance.

It is evident that symptom remission associated with the natural course and also treatment of CMDs is not sufficient to allow depressed workers to resume full productivity. Specifically tailored interventions and rehabilitation efforts are required. Interventions targeted at addressing barriers in the workplace are also important and it has been demonstrated that improvement in time management, output and physical tasks improve workplace retention as well as productivity of individuals with CMDs.

Wang et al (2007) conducted a randomised controlled trial involving 604 employees in the USA to investigate the impact of a telephone-based support program for employees identified as having depression. Individuals received telephone support and were encouraged to seek treatment from providers to whom recommendations were given. A structured telephone-based psychotherapy program was also offered to individuals who declined referral to clinicians for face-to-face treatment. The WHO Health and Productivity Questionnaire was used to assess workplace performance. Over a 12-month period the intervention group had significantly lower reports of depression severity, and most importantly from the perspectives of employers, reported a significantly higher level of workplace productivity with respect to hours worked as well as having significantly higher job retention rates. Hence enhanced depression treatment not only improved clinical outcomes but also had a positive impact on workplace productivity. Wang et al (2007) suggest that such programs may be considered as social capital investments rather than workplace costs.

Munn-Giddings et al (2005) investigated a participatory approach to the promotion of well-being in two large NHS health services in the UK. Workshops were run in collaboration with senior managers and employees of these services. This process identified the stress experienced by employees in working with limited resources in a high pressure environment. This powerlessness was mirrored by middle management, despite employees' perception that middle management would not believe their views. The Participatory Action approach engaged staff in the task of generating solutions and developing a strategic plan for the service with ownership by all employees.

In a review of studies specifically addressing workplace task-restructuring interventions, Bambra et al (2007) confirmed that interventions that increase demand or decrease control have an adverse impact on the psychological health of employees. Hence interventions, including job enrichment and enlargement, teamworking and the development of autonomous work groups, that enhance job control may reduce job-strain and hence may have a positive impact on the health of employees.

In addition to mental health promotion in the workplace, specific interventions to assist people with CMDs ought to be delivered in a systematic manner. The case for widespread interventions across the workforce is strengthened by findings from the study by LaMontagne et al (2008), which identified that depression attributable to job-strain is underestimated by compensation claim statistics in Victoria, Australia, by approximately 30-fold. Primary care interventions ought to include education and provision of appropriate treatment options. Vocational rehabilitation for individuals with CMDs also has a role in improving personal coping skills and providing improvements to work tasks in order to enable individuals to be productive in their work.