MENTUPP Publications
Arensman E, Leduc M, O’Brien C, Corcoran P, Griffin E, Leduc C, Coppens E, Tsantila F, Ross V, Abdulla K, Hauck P, Amann BL, Aust B, Cerga-Pashoja A, Cresswell‑Smith J, D’Alessandro L, Fanaj N, Greiner B, Luyten J, Mathieu S, Maxwell M, Qirjako G, Reich H, Sanches S, Tóth MD, Kilroy J, Michell K, Reavley N, McDaid D, Van Audenhove C and MENTUPP consortium
Implementation and evaluation of a multi-level mental health promotion intervention for the workplace (MENTUPP): study protocol for a cluster randomised controlled trial.
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Well-organised and managed workplaces can be a source of wellbeing. The construction, healthcare and information and communication technology sectors are characterised by work-related stressors (e.g. high workloads, tight deadlines) which are associated with poorer mental health and wellbeing. The MENTUPP intervention is a flexibly delivered, multi-level approach to supporting small- and medium-sized enterprises (SMEs) in creating mentally healthy workplaces. The online intervention is tailored to each sector and designed to support employees and leaders dealing with mental health difficulties (e.g. stress), clinical level anxiety and depression, and combatting mental health-related stigma. This paper presents the protocol for the cluster randomised controlled trial (cRCT) of the MENTUPP intervention in eight European countries and Australia.
Paterson C, Leduc C, Maxwell M, Aust B, Amann BL, Cerga-Pashoja A, Coppens E, Couwenbergh C, O’Connor C, Arensman E, Greiner B.
Evidence for implementation of interventions to promote mental health in the workplace: a systematic scoping review protocol. Systematic Reviews 2021.
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Mental health problems are common in the working population and represent a growing concern internationally, with potential impacts on workers, organisations, workplace health and compensation authorities, labour markets and social policies. Workplace interventions that create workplaces supportive of mental health, promote mental health awareness, destigmatise mental illness and support those with mental disorders are likely to improve health and economical outcomes for employees and organisations. Identifying factors associated with successful implementation of these interventions can improve intervention quality and evaluation, and facilitate the uptake and expansion. Therefore, we aim to review research reporting on the implementation of mental health promotion interventions delivered in workplace settings, in order to increase understanding of factors influencing successful delivery.
Hogg B, Medina JC, Gardoki-Souto I, Serbanescu I, Moreno-Alcázar A, Cerga-Pashoja A, Coppens E, Ditta Tóth M, Fanaj M, Greiner BA, Holland C, Kõlves K, Maxwell M, Qirjako G, De Winter L, Hegerl U, Pérez-Sola V, Arensman E, Amann B.L. and MENTUPP Consortium.
Workplace Interventions to Reduce Depression and Anxiety in Small and Medium-Sized Enterprises: A Systematic Review. Journal of Affective Disorders. 2021.
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Depression and anxiety are the most prevalent mental health difficulties in the workplace, costing the global economy $1 trillion each year. Evidence indicates that symptoms may be reduced by interventions in the workplace. This paper is the first to systematically review psychosocial interventions for depression, anxiety, and suicidal ideation and behaviours in small-to medium-size enterprises (SMEs).
Hogg A., Moreno-Alcázar, A., Ditta Tóth, M., Serbanescu, I., Aust, B., Leduc, C., Paterson, P., Tsantilla, F., Abdulla, K., Cerga-Pashoja,A., Cresswell-Smith, J., Fanaj, N., Meksi, A., Ni Dhalaigh, D., Reich de Paredes, H., Ross, V., Sanches, S., Thomson, K., Van Audenhove, C., Pérez, V., Ella Arensman, A., Gyorgy Purebl, G., Amann, A.L and the MENTUPP consortium.
Supporting employees with mental illness and reducing mental illness-related stigma in the workplace: an expert survey. European Archives of Psychiatry and Clinical Neuroscience. https://doi.org/10.1007/s00406-022-01443-3
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An expert survey was designed to support the development of a workplace-based multi-country intervention tackling depression, anxiety, and mental illness-related stigma in small- and medium-sized enterprises (SMEs). Academic experts and representatives of SME organisations, specific sector organisations, labour or advocacy groups, and occupational health organisations, were contacted across eight European countries and Australia. The survey comprised closed and open text questions to assess expert opinion about interventions for employees with mental health difficulties, interventions supporting their managers, and anti-stigma interventions. The survey was available in six languages. The online platform Qualtrics was used for data collection. Quantitative data was analysed through descriptive statistics and qualitative data was analysed through thematic analysis. Sixty-five of 146 experts responded, representing a 42% response rate. Results showed only 26.2% of experts agreed that employees could speak openly about mental health issues, and 81.5% of experts indicated a large or medium unmet need for support for employees with mental health issues. Psychoeducational materials, face-to-face workshops and interventions based on cognitive behavioural therapy were ranked most likely to be taken up by employees. Experts rated as most useful for managers’ guidelines on how to act if an employee has mental health issues (67.7%). The greatest number of experts indicated workshops of people with lived experience of mental illness (80.0%) and awareness campaigns (78.5%) were most required to tackle stigma. Responses were consistent between experts from different countries and areas of expertise. Experts in this multinational survey assessed that interventions supporting mental health in the workplace and tackling stigma are greatly needed. A multicomponent intervention with a wide range of materials and tools is supported.
Arensman E, O’Connor C, Leduc C, Griffin E, Cully G, Ní Dhálaigh D, Holland C, Van Audenhove C, Coppens E, Tsantila F, Ross V, Aust B, Pashoja AC, Cresswell-Smith J, Cox L, de Winter L, Fanaj N, Greiner BA, Hegerl U, Mathieu S, Moreno-Alcázar A, Orchard W, Paterson C, Purebl G, Qirjako G, Reich H, Corcoran P.
Mental Health Promotion and Intervention in Occupational Settings: Protocol for a Pilot Study of the MENTUPP Intervention. Int J Environ Res Public Health. 2022.
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Depression and anxiety are the most prevalent mental health difficulties in the EU, causing immense suffering and costing the global economy EUR 1 trillion each year in lost productivity. Employees in construction, health and information and communications technology have an elevated risk of mental health difficulties. Most mental health interventions for the workplace have been targeted at larger companies and small and medium-sized enterprises (SMEs) are often overlooked despite most people being employed in SMEs. The MENTUPP intervention aims to improve mental health and wellbeing and reduce depression, anxiety, and suicidal behaviour. The MENTUPP project involves the development, implementation, and evaluation of a multilevel intervention targeting both clinical and non-clinical mental health issues and combating the stigma of mental (ill-)health, with a specific focus on SMEs. The intervention is underpinned by a framework of how to create a mentally healthy workplace by employing an integrated approach and has been informed by several systematic reviews designed to understand organisational mental health interventions and a consultation survey with key experts in the area. The intervention is facilitated through the MENTUPP Hub, an online platform that presents interactive psychoeducational materials, toolkits, and links to additional resources in an accessible and user-friendly manner. This paper presents the pilot study protocol for delivering the MENTUPP intervention in eight European countries and Australia. Each intervention country will aim to recruit at least 23 participants in 1-3 SMEs in one of the three high-risk sectors. The central aim of the pilot study will be to examine the feasibility, acceptability, and uptake of the MENTUPP intervention across the target SMEs. The findings will contribute to devising the protocol for a cluster randomised controlled trial (cRCT) of the MENTUPP intervention. Findings from this study will also be used to inform the optimisation phase of the MENTUPP intervention which will aim to improve the materials and the implementation of the intervention as well as enhancing the evaluation strategy which will be employed for the cRCT.
Birgit A. Greiner, Caleb Leduc, Cliodhna O’Brien, Johanna Cresswell-Smith, Reiner Rugulies, Kristian Wahlbeck, Kahar Abdulla, Benedikt L. Amann, Arlinda Cerga Pashoja, Evelien Coppens, Paul Corcoran, Margaret Maxwell, Victoria Ross, Lars de Winter, Ella Arensman, Birgit Aust.
The effectiveness of organisational-level workplace mental health interventions on mental health and wellbeing in construction workers: A systematic review and recommended research agenda. PLOS ONE, 17(11). 2022.
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Objectives
This systematic review assesses the scientific evidence regarding the effectiveness of organisational-level workplace mental health interventions on stress, burnout, non-clinical depressive and anxiety symptoms, and wellbeing in construction workers.
Methods
Eligibility criteria were randomized controlled trials (RCTs), cluster randomized controlled trials (cRCTs), controlled or uncontrolled before- and after studies published in peer-reviewed journals between 2010 and May 2022 in five databases (Academic Search Complete, PsycInfo, PubMed, Scopus and Web of Science). Outcomes were stress, burnout and non-clinical depression and anxiety symptoms, and wellbeing (primary) and workplace changes and sickness absenteeism (secondary). Quality appraisal was conducted using the QATQS scale, a narrative synthesis was applied. The protocol was published in PROSPERO CRD42020183640 https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020183640.
Main results
We identified five articles (four studies) with a total sample size of 260, one cRCT, one controlled before- and after study, and two uncontrolled before- and after studies. The methodological quality of one study was rated as moderate, while for three studies it was weak. One study showed significant effects of a work redesign programme in short-term physiological stress parameters, one study showed a significant employee perceived improvement of information flow after supervisor training and one study showed a substantial non-significant decline in sick leave. There was no significant effect on general mental health (SF12) nor on emotional exhaustion. The focus of all studies was on physical health, while detailed mental health and wellbeing measures were not applied.
Main conclusions
The evidence for the effectiveness of organisational-level workplace mental health interventions in construction workers is limited with opportunities for methodological and conceptual improvement. Recommendations include the use of a wider range of mental health and wellbeing outcomes, interventions tailored to the specific workplace and culture in construction and the application of the principles of complex interventions in design and evaluation.
Mónika Ditta Tóth, Sarah Ihionvien, Caleb Leduc, Birgit Aust, Benedikt L Amann, Johanna Cresswell-Smith, Hanna Reich, Grace Cully, Sarita Sanches, Naim Fanaj, Gentiana Qirjako, Fotini Tsantila, Victoria Ross, Sharna Mathieu, Arlinda Cerga Pashoja, Ella Arensman, György Purebl; MENTUPP Consortium.
Evidence for the effectiveness of interventions to reduce mental health related stigma in the workplace: a systematic review. BMJ Open, 13(2). 2023.
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Objectives
Increasing access to mental health support is a key factor for treating mental disorders, however, important barriers complicate help-seeking, among them, mental health related stigma being most prominent. We aimed to systematically review the current evidence for interventions focusing on reducing stigma related to mental health problems in small and medium enterprises (SMEs).
Design
Systematic review with a focus on interventions targeting mental health related stigma in the workplace in accordance with PRISMA guidelines. The methodological quality of included articles was assessed using the Quality Assessment Tool for Quantitative Studies Scale.
Data sources
PubMed, Ovid Medline, PsycINFO, Scopus, and Cochrane databases and Google Scholar were searched from January 2010 until November 2022.
Eligibility criteria for selecting studies
We included experimental or quasi-experimental studies about workplace interventions aiming to reduce stigma, where the outcomes were measured in terms of stigmatisation against depression, anxiety and/or other mental health problems.
Data extraction and synthesis
Records were screened by two independent reviewers after inspecting titles and abstracts and a full-text read of the articles to assess whether they meet inclusion criteria. The results were synthesised narratively.
Results
We identified 22 intervention studies, 3 with high quality, 13 with moderate quality and 6 with weak quality. Only 2 studies included SMEs, but no study focused on SMEs exclusively . The mode of delivery of the intervention was face to face in 15 studies, online in 4 studies and mixed in 3 studies. We found a significant reduction in stigmatising attitudes in almost all studies (20/22), using 10 different instruments/scales. Effects seemed to be independent of company size. Online interventions were found to be shorter, but seemed to be as effective as face-to-face interventions.
Conclusions
Although we did not find interventions focusing exclusively on SMEs, it is likely that antistigma interventions also will work in smaller workplaces.
Trial registration
PROSPERO: ID: CRD42020191307
Fotini Tsantila, Evelien Coppens, Hans De Witte, Kahar Abdulla, Benedikt L. Amann, Ella Arensman, Birgit Aust, Johanna Creswell-Smith, Luigia D’Alessandro, Lars De Winter, Asmae Doukani, Naim Fanaj, Birgit Greiner, Eve Griffin, Caleb Leduc, Margaret Maxwell, Cliodhna O’ Connor, Charlotte Paterson, György Purebl, Hanna Reich, Victoria Ross, Jaap Van Weeghel & Chantal Van Audenhove.
Developing a framework for evaluation: a Theory of Change for complex workplace mental health interventions. BMC Public Health, 23(1171). 2023.
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Background
There is a gap between the necessity of effective mental health interventions in the workplace and the availability of evidence-based information on how to evaluate them. The available evidence outlines that mental health interventions should follow integrated approaches combining multiple components related to different levels of change. However, there is a lack of robust studies on how to evaluate multicomponent workplace interventions which target a variety of outcomes at different levels taking into account the influence of different implementation contexts.
Method
We use the MENTUPP project as a research context to develop a theory-driven approach to facilitate the evaluation of complex mental health interventions in occupational settings and to provide a comprehensive rationale of how these types of interventions are expected to achieve change. We used a participatory approach to develop a ToC involving a large number of the project team representing multiple academic backgrounds exploiting in tandem the knowledge from six systematic reviews and results from a survey among practitioners and academic experts in the field of mental health in SMEs.
Results
The ToC revealed four long-term outcomes that we assume MENTUPP can achieve in the workplace: 1) improved mental wellbeing and reduced burnout, 2) reduced mental illness, 3) reduced mental illness-related stigma, and 4) reduced productivity losses. They are assumed to be reached through six proximate and four intermediate outcomes according to a specific chronological order. The intervention consists of 23 components that were chosen based on specific rationales to achieve change on four levels (employee, team, leader, and organization).
Conclusions
The ToC map provides a theory of how MENTUPP is expected to achieve its anticipated long-term outcomes through intermediate and proximate outcomes assessing alongside contextual factors which will facilitate the testing of hypotheses. Moreover, it allows for a structured approach to informing the future selection of outcomes and related evaluation measures in either subsequent iterations of complex interventions or other similarly structured programs. Hence, the resulting ToC can be employed by future research as an example for the development of a theoretical framework to evaluate complex mental health interventions in the workplace.
Tsantila Fotini, Coppens Evelien, De Witte Hans, Arensman Ella, Amann Benedikt, Cerga-Pashoja Arlinda, Corcoran Paul, Creswell-Smith Johanna, Cully Grace, Toth Monika Ditta, Greiner Birgit, Griffin Eve, Hegerl Ulrich, Holland Carolyn, Leduc Caleb, Leduc Mallorie, Ni Dhalaigh Doireann, O’Brien Cliodhna, Paterson Charlotte, Purebl György, Reich Hanna, Ross Victoria, Rugulies Reiner, Sanches Sarita, MENTUPP consortium members.
Outcome assessment of a complex mental health intervention in the workplace. Results from the MENTUPP pilot study. Int Arch Occup Environ Health (2023). https://doi.org/10.1007/s00420-023-01996-3.
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Objective
Multicomponent interventions are recommendable to achieve the greatest mental health benefits, but are difficult to evaluate due to their complexity. Defining long-term outcomes, arising from a Theory of Change (ToC) and testing them in a pilot phase, is a useful approach to plan a comprehensive and meaningful evaluation later on. This article reports on the pilot results of an outcome evaluation of a complex mental health intervention and examines whether appropriate evaluation measures and indicators have been selected ahead of a clustered randomised control trial (cRCT).
Methods
The MENTUPP pilot is an evidence-based intervention for Small and Medium Enterprises (SMEs) active in three work sectors and nine countries. Based on our ToC, we selected the MENTUPP long-term outcomes, which are reported in this article, are measured with seven validated scales assessing mental wellbeing, burnout, depression, anxiety, stigma towards depression and anxiety, absenteeism and presenteeism. The pilot MENTUPP intervention assessment took place at baseline and at 6 months follow-up.
Results
In total, 25 SMEs were recruited in the MENTUPP pilot and 346 participants completed the validated scales at baseline and 96 at follow-up. Three long-term outcomes significantly improved at follow-up (p < 0.05): mental wellbeing, symptoms of anxiety, and personal stigmatising attitudes towards depression and anxiety.
Conclusions
The results of this outcome evaluation suggest that MENTUPP has the potential to strengthen employees’ wellbeing and decrease anxiety symptoms and stigmatising attitudes. Additionally, this study demonstrates the utility of conducting pilot workplace interventions to assess whether appropriate measures and indicators have been selected. Based on the results, the intervention and the evaluation strategy have been optimised.