Table 2

Characteristics of included studies evaluating screening followed by feedback, advice and/or allocation to treatment

Study characteristicsPopulationScreening tool; deliveryScreening processSample size; gender
(% male);
mean age (years)
Study design; measurement time points; intervention; control groupTreatment description; delivery; adherence
(% of participants)
Outcomes of interest (scale)Efficacy of screening*/intervention
Lexis et al;† The Netherlands in 200738 Employees of large banking company (formally employed, not specified if full time/part time, mean work hours/week≈35).Balansmeter, 34 items assessing multiple health domains including mental health; Delivered by occupational health service from participating company using posted questionnaire.N=23 973 invited to complete screening (completed by n=9157). Those screening ‘at-risk’ of sickness absence and reporting mild-severe depression symptoms on the HAD-D (n=211) (and who were not absent from work, not pregnant, not receiving treatment at the time of screening) were invited to complete a baseline questionnaire (assessing BDI-II among others). Eligible responders (n=139) were randomised.IG:
Baseline, 6-month, 12-month and 18‡-month follow-ups;
screening+psychological treatment; screening+care as usual
Individual psychological treatment (PST and CBT). Delivered face-to-face in seven standardised 45 min sessions (+up to five additional sessions if needed); delivered by external psychologists that regularly provided psychological healthcare for the company; 55%.Mental health symptoms: depression (HADS-D, BDI-II), psychological distress (BSI).
Sickness absence: duration, frequency, incidence of long-term absence (individual record linkage using company registers of certified sickness absence).
Quality of life and functioning: self-rated health (SF-36).
Work-related: job demands, decision latitude, social support (JCQ), job insecurity (VBBA).
Significant intervention effect in decreasing depression (both HADS-D and BDI-II) and psychological distress at both 6 months and 12 months.
Significant intervention effect on sickness absence duration at 12 months, but not 18 months. No effect on frequency or long-term absence.
No effect observed for work-related variables (job demands, decision latitude, social support, job insecurity) nor for self-rated health.
Klasen et al36 2-year, 3-year, 4-year and 5-year follow-upSickness absence: duration, frequency, incidence of long-term absence (individual record linkage using company registers of certified sickness absence).
Work-related: termination of employment contract (company registers).
Lexis et al 38 observed no effect on sickness absence duration, frequency, or risk of long-term absence at 5 years follow-up. A significant effect favouring intervention observed for termination of employment.
Bolier et al;§ The Netherlands in 201139 Nurses/allied health professionals employed at an academic medical centre (formally employed, mix of temporary, part time and full time, mean work hours/week≈31).WHS Mental Module screening for work functioning and mental health complaints; Delivered by the research team online.Participants prerandomised according to cluster (ward). N=1140 invited, n=366 enrolled (completed baseline and were not expected to be on sick leave for >2 weeks at the study commencement). Once completed, intervention participants received automatically generated results and access to intervention. Control participants did not receive screening results or any intervention.IG:
Cluster RCT;
baseline, 3-month, 6-month follow-ups;
Screening and feedback+online intervention; wait-list control.
Participants offered choice of online self-help interventions tailored to reported symptoms, accessed via a website with a log in; delivered online by the research team; 5%Mental health symptoms: depression and anxiety (BSI).
Positive mental health: positive mental health (MHC-SF), well-being (WHO-5).
Work-related outcomes: work engagement (UWES-9).
No effect of intervention on depression, anxiety or well-being.
Significant effect of intervention on positive mental health at 3 months and 6 months observed.
Significant effect of intervention on work engagement (decline in control group).
Ketelaar et al;¶ The Netherlands in 201141 3-month and 6-month follow-ups.User satisfaction (participant perspectives on screening including usefulness of advice/e-mental health programme provided, acceptability of feedback, perceived efficacy or the advice/e-mental health programme, and preferences regarding future screening).5% of participants from Boiler et al started the e-health interventions. 17% (14 from 82) of participants reported wanting feedback differently. 0% (0 from 4) participants felt following e-mental health intervention helped improve their mental health/work functioning. 33% (23 from 69) would appreciate to be periodically offered the screening intervention in the future.
Wang et al; USA in 200445 Workers from various large companies/industries enrolled in a behavioural healthcare provider (formally employed full-time mean work hours/week≈42).Two-phase screening:
(1) Health Risk Appraisal (screening for psychological distress using K6) followed by (2) more specific assessment of depression using the QIDS-SR; Delivered by the behavioural healthcare company via telephone.
Phase (1) invited N=113 843 via targeted email, N≈150 000 via company-wide email, and N=1 14 635 via healthcare member mail survey. Those interested and screening positive with healthcare coverage (n=7978) were invited via letter/telephone to participate in phase (2). In phase (2), those screening positive (without history of mania, substance dependence, suicidal ideation/attempts, or specialist mental health treatment in the prior year) were randomised.IG:
baseline, 6, 12 months;
screening+telephone intervention programme; screening+care as usual.
Intervention involved assessment, facilitated appropriate in-person treatment (ie, psychotherapy/medication), and
supported treatment adherence. Those declining in-person treatment offered structured psychotherapy intervention
via telephone. All sent psychoeducational workbook; Delivered by mental health professionals employed by the healthcare provider who received training/supervision from research team; 90% completed initial care management contact.
Mental health symptoms: depression (QIDS-SR)
Work-related: productivity including hours, performance, turnover, incidents (HPQ)
Significant intervention effect at 6 months and 12 months on decrease in depression severity. Significant intervention effect at 12 months on proportion of participants with improved symptoms/recovery.
Significant intervention effect at 6 months and 12 months on effective hours worked and role retention. No effect on actual hours worked, job performance or incidents.
Addley et al;** UK in 200943 Administrative and executive grade employees within civil service (formally employed, 87% full time).Health risk appraisal (‘LPAA’) assessing multiple health domains including stress; delivered by the company occupational health service.N=1503 invited to complete baseline questionnaire. From the n=334 who completed, n=180 were randomised. Those allocated to intervention completed the LPAA, which provides a printout of an individual’s health risk profile and general advice. Those allocated to control received no LPAA or subsequent intervention.IG—group A:
51% aged 25–44
50% aged 25–44
baseline and 12 months;
IG—group A: screening+healthworks;
no intervention
IG—group A received 45 min HRA assessment, feedback, ‘Healthworks’ half-day health and well-being education programme, access to lifestyle modules, and up to 12 months of health coaching; Delivered by the company occupational health service and company sport organisation; all attended healthworks programmeMental health symptoms: psychological distress (GHQ-12).
Positive mental health: well-being (WHO-5 and MHC-SF).
Work-related outcomes: work ability (WAI) and job satisfaction (single item).
No effect of either intervention on any outcome variables.
  • *A significant intervention effect refers to instances where a study reported a significant difference in a particular outcome between intervention and control groups comparing preintervention and postintervention scores on that outcome.

  • †Klasen et al 36 reports results of (Kant et al 37 (see table 1) and Lexis et al 38 at 2–5 years follow-up (in 1-year increments).

  • ‡Sickness absence only data for 12-month and 18-month follow-up only.

  • §Gärtner et al 40 (see table 1) and Boiler et al 39 report revaluations from the one, three-armed trial ‘Mental Vitality @ Work’ trial. As such, the control groups between these two studies are the same.

  • ¶Ketelaar et al 41 report additional data from the intervention groups reported in Gärtner et al 40 and Boiler et al. 39

  • **Three-arm trial comparing two interventions to control, both reported in the one paper. Results from other intervention arm are reported in table 1. Note the Cochrane recommended formula for calculating SD from SEs was applied to extracted quantitative data from this study.

  • BDI-II, Beck Depression Inventory; BSI, Brief Symptom Inventory; CBT, cognitive–behavioural therapy; CG, control group; GHQ-12, General Health Questionnaire; HADS, Hospital Anxiety and Depression Scale; HPQ, Health and Productivity Questionnaire; IG, intervention group; JCQ, Job Content Questionnaire; K6, Kessler Psychological Distress Scale; LPAA, Lifestyle and Physical Activity Assessment; MHC-SF, Mental Health Continuum Short Form; PST, problem-solving therapy; QIDS-SR, Quick Inventory of Depressive Symptomatology-Self Report; RCT, randomised controlled trial; SF-36, 36 Item Short Form Survey; UWES-9, The Utrecht Work Engagement Scale; VBBA, Questionnaire on the Experience and Evaluation of Work; WAI, Work Ability Index; WHS, Work Health Surveillance.