Understanding the economics of workplace interventionsfor common mental disorders

Anxiety and depressive disorders are the most common form of occupational health problems and are major causes of sickness absence, lost productivity and staff turnover, resulting in substantial costs to UK employers and the economy more generally. Economic hardship may increase the number of anxiety and depression cases in the workplace, and people with such problems may be vulnerable to losing their employment or performing in a below-average way. However, the association between anxiety and depressive disorders and employment across different macroeconomic situations in the UK has not been widely studied. Similarly, the economic case for workplace interventions to prevent lost productivity associated with such disorders has also not been well established in the UK. My thesis focuses on the links between common mental disorders and employment. A systematic review was performed to explore what economic evidence exists on workplace interventions that aim to prevent common mental disorders. The review shows that there is some evidence to support the economic case for workplace-initiated interventions of this kind. Another component of my thesis used data from three national cross-sectional surveys (from the Health Survey for England) to examine the links between common mental disorders and employment and the effects of macroeconomic recession. The study findings showed that the likelihood of both unemployment and anxiety or depression were higher during the recession period, while women were more affected by such problems during this period. During a recession, people who were in employment were more likely to work as an employee than be self-employed. Men with some anxiety or depression problems were less likely than women to be employees, whereas men with major problems were more likely to work as employees than women. Another part of this study evaluated the cost-effectiveness of a workplace intervention to prevent sickness absence for people with common mental disorders. Analyses were conducted from both societal and employer perspectives. These cost-effectiveness results came from a transferability study and indicated that the workplace intervention can be cost-effective in preventing the incidence of and time-to recurrent sickness absence. A third empirical component looked at a training programme for managers in a large UK company which aimed to help them recognise and respond appropriately to mental health problems in the people they supervise. A survey was conducted of managers who participated in the training. A costeffectiveness analysis was designed for the training programme and approved by the company, but the data were not provided to me to allow this part of my study to be completed. Findings from this overall study have implications for policy discussion, for employers and for future research.