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WHO guidelines on mental health at work. Geneva: World Health Organization; 2022.

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WHO guidelines on mental health at work.

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Research gaps

The GDG identified several gaps in the evidence included within the scope of these guidelines.

Overall research gaps

Across all intervention types, there is a critical need, where applicable, to increase the volume and quality of evidence for effectiveness and feasibility in under-researched populations – i.e. the informal sector, SMEs and LMICs – and for the selective at-risk workforce, such as international and national humanitarian workers, health workers not responsible for direct clinical care (e.g. workers in health administration), community health workers and other occupations at risk of negative mental health outcomes.

Across all intervention types, there is a need for sociodemographic subgroup analyses to determine whether there are differential benefits or harms associated with intervention recipients’ sociodemographic (e.g. gender, age, race) or occupational status (e.g. occupational sector, contract status (formal, informal, self-employed, size of workplace). This includes clear reporting of these characteristics under study or review, and clear reporting of the mental health status of participants at baseline.

Overall, there is a need for implementation research to study the acceptability, accessibility and uptake of interventions in order to better inform implementation guidance.

Overall, there is a need for quality investigation to study the effectiveness and feasibility of delivering preventive interventions which are combined at multiple levels of delivery (e.g. combinations of organizational, managers, workers and individual interventions).

There is a need to increase the availability of high-quality research on organizational interventions (including policies), and their impact on mental health and work-related outcomes, regarding salient risk and protective factors at work (which were not encountered by the evidence reviews of these guidelines) such as bullying, parental leave etc.

There is also a need to increase high-quality research in the cost-effectiveness of interventions for mental health at work.

Research gaps for organizational interventions

Across organizational interventions

An increase is required in better-quality evidence – utilizing validated and culturally suitable measures of mental health outcomes, psychosocial risks, and work-related outcomes – which assesses organizational interventions that mitigate the known risk factors to workers’ mental health. This includes clear specification of the risk factors addressed by the intervention, and designs which allow for establishing which components of the intervention have had an impact on the outcomes.

Cluster-randomized designs, which include process evaluations, can be used to assess the effectiveness of complex interventions in work settings, and the feasibility and acceptability to stakeholders.

The common components for effective implementation of organizational interventions need to be identified to allow for better synthesis and comparison of research.

There is a need for an increase in better-quality investigation of emerging risk factors for the future of work and how these can be mitigated. The evidence base should also be strengthened, taking account of ongoing changes to the working environment for policy-making and implementation.

For selective at-risk workers

An increase is needed in better-quality studies which assess organizational interventions that mitigate the known risk factors for the mental health of health, emergency and humanitarian workers. Studies should utilize validated and culturally suitable measures of mental health outcomes, including disaggregation by sociodemographic status, occupation and setting.

More research is required on comparative effectiveness and cost-effectiveness of organizational interventions compared to other intervention levels for health, emergency and humanitarian workers.

For workers with mental health conditions

An increase is needed in better-quality studies which investigate the effectiveness, cost-effectiveness and implementation of organizational interventions (such as reasonable accommodations) delivered to workers with symptoms of emotional distress or meeting criteria for mental health conditions, in order to improve positive mental health and reduce symptoms of mental health conditions, suicidal behaviours and substance use. While there is a relatively better body of work in the field of return-to-work interventions, there remains a gap in evidence for workplace accommodations for workers with mental health conditions – i.e. those who are in work either following a return to work or never having taken absence due to a mental health condition.

Increased evidence on the factors for feasible, non-stigmatizing implementation of accommodations for workers with mental health conditions.

Research priorities for manager training

Common to all manager training for mental health

Research on manager training for mental health should include measurement of supervisees’ work-related outcomes such as absenteeism, presenteeism, productivity and performance.

Increase evidence of the effectiveness of manager training for mental health on priority outcomes (e.g. workers’ suicidal behaviours and substance use, managers’ leadership style).

Include a longer duration of follow-up (greater than 6 months) for key outcomes such as supervisees’ mental health.

An increase in studies that identify effective components of manager training for mental health, including delivery components (e.g. duration) and content components.

An increase in better-quality studies and/or trials of leadership-oriented manager training and its impact on health outcomes.

An increase in better-quality studies on interventions that address help-seeking outcomes effectively (e.g. by mitigating stigma in the workplace).

For selective at-risk sectors

More studies to investigate the effectiveness and feasibility of manager training for mental health in health, emergency and humanitarian work settings.

Research priorities for worker training

Common across workers' training

An increase in better-quality evidence for mental health literacy and awareness training and its effects on provision of help to colleagues in distress and on increasing help-seeking behaviours (including for the prevention of suicide).

An increase in studies which identify effective components of workers’ training for mental health, including delivery components (e.g. duration) and content components.

For selective at-risk workers

An increase in higher-quality and sufficiently powered research to determine the effectiveness of training health, humanitarian and emergency personnel in knowledge, attitudes and skills for mental health.

An increase in evidence which identifies medium- to long-term follow-up duration effects to inform decisions as to how frequently training should be delivered.

Research gaps for individual interventions

Common across individual interventions

An increase in better-quality studies which ascertain the incidence of workers meeting the criteria for mental health diagnosis through use of diagnostic assessments at baseline and follow-up to determine the extent of prevention of mental ill-health.

An increase in better-quality studies which assess the comparative efficacy and cost-effectiveness of specific individual interventions, which include medium- to long-term follow-up to assess sustainability of effects.

An increase in better-quality studies which include validated work-related outcomes when assessing the effects of individual interventions, including longer-term durations of follow-up.

An increase in studies which identify effective components of (work-focused) psychosocial interventions for mental health and work-related outcomes, such as delivery components (e.g. duration) and content components (e.g. mode of psychosocial intervention).

An increase in studies of individual interventions which include suicidal behaviours and substance use outcomes.

Increased use of cluster randomized controlled designs in this field.

An increase in effectiveness and implementation research which delineates additive or comparative effects of multimodal programmes (e.g. combining individual and organizational interventions) compared to single-intervention types (e.g. individual interventions alone).

Research gaps for absence due to mental health conditions

An increase in better-quality studies which focus on sustainable return to work (e.g. by increasing the duration of follow-up to a minimum of 12 months).

Greater inclusion of outcomes that indicate the benefit of the intervention – such as duration of time returned to work, duration of time from partial return to work until full return to work, productivity and ability to work (rather than only outcomes on reduction in absence days due to mental health conditions).

An increase in studies that investigate cost-effectiveness of the intervention options for return to work following absence due to mental health conditions.

An increase in better-quality research to assess which combination of work-directed and clinical interventions are most effective and feasible.

Research gaps for gaining employment for people living with mental health conditions

An increase in studies which investigate the effectiveness of recovery-oriented strategies that enhance vocational and economic inclusion and that consistently include outcomes on recovery for mental health conditions and work-related outcomes of interest to employers.

An increase in better-quality studies which investigate the cost-effectiveness of options for recovery-oriented strategies that enhance vocational and economic inclusion.

An increase in studies which investigate the effectiveness and feasibility of implementing recovery-oriented strategies for people living with mild-to-moderate mental health conditions.

Research gaps for screening programmes

In order to be able to make a recommendation, high-quality and sufficiently powered research is needed to evaluate the benefits and harms of screening programmes at work and their efficacy in reducing the symptoms of mental health conditions.

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