Indicated Prevention Interventions in the Workplace for Depressive Symptoms: A Systematic Review and Meta-analysis


      Depressive symptoms are highly prevalent and cause substantive morbidities and loss of functioning among employees. Depression may be prevented at its early stages. However, there is a paucity of information regarding indicated preventive interventions for depression among employees. The objective of this review is to examine the effectiveness of indicated interventions for the reduction of depressive symptoms in the workplace.

      Evidence acquisition

      A systematic review and meta-analysis of articles published between January 2000 and September 2017 was conducted using major electronic databases, including PubMed/MEDLINE, PsycINFO, EMBASE, SOCINDEX, and ABI/ProQuest. Studies were selected based on a set of predefined inclusion criteria. Primary outcome measures were depressive symptomatology, and the interventions were preventive in nature. Studies were pooled based on the intervention type and the effect size was measured using the standardized mean difference.

      Evidence synthesis

      A computer and hand search of the literature yielded 4,462 papers, from which 16 trials were identified to be suitable for meta-analysis. Eight of 16 studies reported significant effects for workplace preventive interventions targeting depressive symptoms in which six were cognitive behavioral therapy (CBT)–based interventions and two were non–CBT-based interventions. Small to medium effect sizes were found for both CBT- and non–CBT-based interventions (standardized mean difference= –0.44, 95% CI= –0.61, –0.26, I2=62.1% and standardized mean difference= –0.32, 95% CI= –0.59, –0.06, I2=58%, respectively).


      This review demonstrates that indicated interventions can significantly reduce the level of depressive symptoms among workers. The implementation of evidence-based workplace interventions should consequently be considered to prevent the development of depressive symptoms among employees.
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        • Kessler RC
        • Berglund P
        • Demler O
        • et al.
        The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R).
        JAMA. 2003; 289: 3095-3105
        • Stewart WF
        • Ricci JA
        • Chee E
        • Hahn SR
        • Morganstein D
        Cost of lost productive work time among U.S. workers with depression.
        JAMA. 2003; 289: 3135-3144
        • Jorm AF
        • Patten SB
        • Brugha TS
        • Mojtabai R
        Has increased provision of treatment reduced the prevalence of common mental disorders? Review of the evidence from four countries.
        World Psychiatry. 2017; 16: 90-99
        • Wang PS
        • Simon G
        • Kessler RC
        The economic burden of depression and the cost-effectiveness of treatment.
        Int J Methods Psychiatr Res. 2003; 12: 22-33
        • Cuijpers P
        • de Graaf R
        • van Dorsselaer S
        Minor depression: risk profiles, functional disability, health care use and risk of developing major depression.
        J Affect Disord. 2004; 79: 71-79
        • Pietrzak RH
        • Kinley J
        • Afifi TO
        • Enns MW
        • Fawcett J
        • Sareen J
        Subsyndromal depression in the United States: prevalence, course, and risk for incident psychiatric outcomes.
        Psychol Med. 2013; 43: 1401-1414
        • Sanderson K
        • Cocker F
        Presenteeism: implications and health risks.
        Aust Fam Physician. 2013; 42: 172-175
        • Lexis MAS
        • Jansen NWH
        • Huibers MJH
        • et al.
        Prevention of long-term sickness absence and major depression in high-risk employees: a randomised controlled trial.
        Occup Environ Med. 2011; 68: 400-407
        • van den Heuvel SG
        • Geuskens GA
        • Hooftman WE
        • Koppes LL
        • van den Bossche SN
        Productivity loss at work; health-related and work-related factors.
        J Occup Rehabil. 2010; 20: 331-339
        • Atlantis E
        • Chow CM
        • Kirby A
        • Singh MF
        An effective exercise-based intervention for improving mental health and quality of life measures: a randomized controlled trial.
        Prev Med. 2004; 39: 424-434
        • De Zeeuw ELEJ
        • Tak ECPM
        • Dusseldorp E
        • Hendriksen IJM
        Workplace exercise intervention to prevent depression: a pilot randomized controlled trial.
        Ment Health Phys Act. 2010; 3: 72-77
        • Furukawa TA
        • Horikoshi M
        • Kawakami N
        • et al.
        Telephone cognitive-behavioral therapy for subthreshold depression and presenteeism in workplace: a randomized controlled trial.
        PloS One. 2012; 7: e35330
      1. Mrazek PJ Haggerty RJ Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research. National Academies Press, Washington, DC1994
        • Cuijpers P
        • Beekman ATF
        • Reynolds 3rd, CF
        Preventing depression: a global priority.
        JAMA. 2012; 307: 1033-1034
        • Barrera AZ
        • Torres LD
        • Munoz RF
        Prevention of depression: the state of the science at the beginning of the 21st Century.
        Int Rev Psychiatry. 2007; 19: 655-670
        • Mykletun A
        • Harvey SB
        Prevention of mental disorders: a new era for workplace mental health.
        Occup Environ Med. 2012; 69: 868-869
        • Martin A
        • Sanderson K
        • Cocker F
        Meta-analysis of the effects of health promotion intervention in the workplace on depression and anxiety symptoms.
        Scand J Work Environ Health. 2009; 35: 7-18
        • Nigatu YT
        • Liu Y
        • Uppal M
        • et al.
        Interventions for enhancing return to work in individuals with a common mental illness: systematic review and meta-analysis of randomized controlled trials.
        Psychol Med. 2016; 46: 3263-3274
        • Tan L
        • Wang M-J
        • Modini M
        • et al.
        Preventing the development of depression at work: a systematic review and meta-analysis of universal interventions in the workplace.
        BMC Med. 2014; 12: 74
        • Corbiere M
        • Shen J
        • Rouleau M
        • Dewa CS
        A systematic review of preventive interventions regarding mental health issues in organizations.
        Work. 2009; 33: 81-116
        • Dietrich S
        • Deckert S
        • Ceynowa M
        • Hegerl U
        • Stengler K
        Depression in the workplace: a systematic review of evidence-based prevention strategies.
        Int Arch Occup Environ Health. 2012; 85: 1-11
        • Furlan AD
        • Gnam WH
        • Carnide N
        • et al.
        Systematic review of intervention practices for depression in the workplace.
        J Occup Rehabil. 2012; 22: 312-321
        • Pomaki G
        • Franche R-L
        • Murray E
        • Khushrushahi N
        • Lampinen TM
        Workplace-based work disability prevention interventions for workers with common mental health conditions: a review of the literature.
        J Occup Rehabil. 2012; 22: 182-195
        • Adler DA
        • Lerner D
        • Visco ZL
        • et al.
        Improving work outcomes of dysthymia (persistent depressive disorder) in an employed population.
        Gen Hosp Psychiatry. 2015; 37: 352-359
        • Geraedts AS
        • Kleiboer AM
        • Twisk J
        • Wiezer NM
        • van Mechelen W
        • Cuijpers P
        Long-term results of a web-based guided self-help intervention for employees with depressive symptoms: randomized controlled trial.
        J Med Internet Res. 2014; 16: e168
        • Grime PR.
        Computerized cognitive behavioural therapy at work: a randomized controlled trial in employees with recent stress-related absenteeism.
        Occup Med. 2004; 54: 353-359
        • Imamura K
        • Kawakami N
        • Tsuno K
        • Tsuchiya M
        • Shimada K
        • Namba K
        Effects of web-based stress and depression literacy intervention on improving symptoms and knowledge of depression among workers: a randomized controlled trial.
        J Affect Disord. 2016; 203: 30-37
        • Kojima R
        • Fujisawa D
        • Tajima M
        • et al.
        Efficacy of cognitive behavioral therapy training using brief e-mail sessions in the workplace: a controlled clinical trial.
        Ind Health. 2010; 48: 495-502
        • Mino Y
        • Babazono A
        • Tsuda T
        • Yasuda N
        Can stress management at the workplace prevent depression? A randomized controlled trial.
        Psychother Psychosom. 2006; 75: 177-182
        • Phillips R
        • Schneider J
        • Molosankwe I
        • et al.
        Randomized controlled trial of computerized cognitive behavioural therapy for depressive symptoms: effectiveness and costs of a workplace intervention.
        Psychol Med. 2014; 44: 741-752
        • Ruwaard J
        • Lange A
        • Bouwman M
        • Broeksteeg J
        • Schrieken B
        E-mailed standardized cognitive behavioural treatment of work-related stress: a randomized controlled trial.
        Cogn Behav Ther. 2007; 36: 179-192
        • Bond FW
        • Bunce D
        Mediators of change in emotion-focused and problem-focused worksite stress management interventions.
        J Occup Health Psychol. 2000; 5: 156-163
        • van Straten A
        • Cuijpers P
        • Smits N
        Effectiveness of a web-based self-help intervention for symptoms of depression, anxiety, and stress: randomized controlled trial.
        J Med Internet Res. 2008; 10: e7
        • Vuori J
        • Toppinen-Tanner S
        • Mutanen P
        Effects of resource-building group intervention on career management and mental health in work organizations: randomized controlled field trial.
        J Appl Psychol. 2012; 97: 273-286
        • The Cochrane Collaboration
        The Cochrane Manual.
        2nd ed. The Cochrane Collaboration, Oxford, UK2008
        • Egger M
        • Davey Smith G
        • Schneider M
        • Minder C
        Bias in meta-analysis detected by a simple, graphical test.
        BMJ. 1997; 315: 629-634
        • Higgins JPT
        • Altman DG
        • Gotzsche PC
        • et al.
        The Cochrane Collaboration's tool for assessing risk of bias in randomised trials.
        BMJ. 2011; 343: d5928
        • Imamura K
        • Kawakami N
        • Furukawa TA
        • Matsuyama Y
        • Shimazu A
        • Kasai K
        Effects of an internet-based cognitive behavioural therapy intervention on preventing major depressive episodes among workers: a protocol for a randomised controlled trial.
        BMJ Open. 2015; 5e007590.
        • Rost K
        • Smith JL
        • Dickinson M
        The effect of improving primary care depression management on employee absenteeism and productivity. A randomized trial.
        Med Care. 2004; 42: 1202-1210
        • Beck A
        • Crain AL
        • Solberg LI
        • et al.
        Severity of depression and magnitude of productivity loss.
        Ann Fam Med. 2011; 9: 305-311
        • Nieuwenhuijsen K
        • Faber B
        • Verbeek JH
        • et al.
        Interventions to improve return to work in depressed people.
        Cochrane Database Syst Rev. 2014;; CD006237.
        • Chenoweth D
        • Leutzinger J
        The economic cost of physical inactivity and excess weight in American adults.
        J Phys Act Health. 2006; 3: 148-163
        • Krueger H
        • Turner D
        • Krueger J
        • Ready AE
        The economic benefits of risk factor reduction in Canada: tobacco smoking, excess weight and physical inactivity.
        Can J Public Health Rev. 2014; 105: e69-e78
        • Woo J-M
        • Postolache TT
        The impact of work environment on mood disorders and suicide: evidence and implications.
        Int J Disabil Hum Dev. 2008; 7: 185-200
        • Couser GP.
        Challenges and opportunities for preventing depression in the workplace: a review of the evidence supporting workplace factors and interventions.
        J Occup Environ Med. 2008; 50: 411-427
        • Hirschfeld RMA
        • Dunner DL
        • Keitner G
        • et al.
        Does psychosocial functioning improve independent of depressive symptoms? A comparison of nefazodone, psychotherapy, and their combination.
        Biol Psychiatry. 2002; 51: 123-133