Review

Economic analyses of mental health and substance use

interventions in the workplace: a systematic literature
review and narrative synthesis
Claire de Oliveira, Edward Cho, RuthAnne Kavelaars, Margaret Jamieson, Buddy Bao, Jürgen Rehm

Mental illness and substance use disorders in the workplace have been increasingly recognised as a problem in Lancet Psychiatry 2020;
most countries; however, evidence is scarce on which solutions provide the highest return on investment. We 7: 893–910

searched academic and grey literature databases and additional sources for studies that included a workplace Institute for Mental Health
Policy Research, Centre for
intervention for mental health or substance abuse, or both, and that did an economic analysis. We analysed the Addiction and Mental Health,
papers we found to identify the highest yielding and most cost-effective interventions by disorder. On the basis of Toronto, ON, Canada
56 studies, we found moderate strength of evidence that cognitive behavioural therapy is cost-saving (and in some (C de Oliveira PhD, E Cho MSc,
cases cost-effective) to address depression. We observed strong evidence that regular and active involvement of RA Kavelaars MSc,
M Jamieson MSc, B Bao MSc,
occupational health professionals is cost-saving and cost-effective in reducing sick leave related to mental health Prof J Rehm PhD); Centre for
and in encouraging return to work. We identified moderate evidence that coverage for pharmacotherapy and brief Health Economics and Hull
counselling for smoking cessation are both cost-saving and cost-effective. Addressing mental health and substance York Medical School, University
misuse in the workplace improves workers’ wellbeing and productivity, and benefits employers’ bottom line of York, York, UK (C de Oliveira);
Institute of Health Policy,
(ie, profit). Future economic analyses would benefit from the consideration of subgroup analyses, examination Management and Evaluation
of longer follow-ups, inclusion of statistical and sensitivity analyses and discussion around uncertainty, and (C de Oliveira) and Dalla Lana
consideration of potential for bias. School of Public Health
(Prof J Rehm), University of
Toronto, Toronto, ON, Canada;
Introduction The objectives of this Review are to provide a compre­ Epidemiological Research Unit,
According to WHO, mental illnesses were the leading hensive overview of the existing literature on Technische Universität
cause of years of life lost to disabilities in 2016.1 interventions targeting mental health and substance use Dresden, Dresden, Germany
Depression alone caused almost a third of this burden.1 disorders in the workplace that have measured the (Prof J Rehm); and Department
of International Health
Depending on the estimation method, the global resulting economic or financial return. Additionally, we Projects, Institute for
economic burden of mental illness was estimated to be aim to provide a list of the highest yielding and most Leadership and Health
either US$2·5 trillion in 2010 increasing to $6·1 trillion cost-effective interventions by disorder. Management, IM Sechenov
First Moscow State Medical
in 2030 (by use of the human capital approach) or
University, Moscow, Russia
$8·5 trillion in 2010 increasing to $16·5 trillion in 2030 Methods (Prof J Rehm)
(by use of the statistical life approach).2 Most of this Search strategy and selection criteria Correspondence to:
burden is due to absenteeism, presenteeism, and lost We included all studies that examined mental health or Dr Claire de Oliveira, Centre for
productivity. substance misuse, or both, examined workplace inter­ Health Economics, University of
Workplaces that promote mental health and support ventions targeting employed adults (aged 18 years or York, York YO10 5DD, UK
claire.deoliveira@york.ac.uk
individuals with mental illnesses are more likely than older), and included an economic analysis. We used the
workplaces that do not to reduce absenteeism and population, intervention, control, outcomes, and study
presenteeism, increase productivity, and might benefit design (known as PICOS) criteria to guide the develop­
from the resulting economic gains.3 Thus, in addition to ment of the search strategy. Our population included all
understanding whether workplace inter­ ventions are employed adults with a mental health or substance use
effective, employers are keen to understand whether disorder, or both, and excluded unpaid workers, and
their investments are cost-saving (ie, the financial individuals related to workers (eg, spouses). The inter­
benefits exceed the investment costs and thus the return vention had to target mental health or substance
on investment is positive) or cost-effective (ie, the effects misuse, or both, improve an outcome related to work,
on mental health or quality of life present good value for and be provided in a workplace or be sponsored by the
the money invested), or both. employer. Studies were excluded if the intervention was
There is a growing body of international evidence that imple­mented at a jurisdictional level. All studies on
initiatives around promotion, prevention, and early workplace interventions of supported employment or
intervention can provide positive returns on investment.4,5 accommo­dation were excluded as these have different
However, evidence is scarce on which solutions provide objectives than generic workplace interventions. The
the highest return on investment; as a result, few comparator had to be usual care or no care; studies
employers have adopted these initiatives.6 Previous without a control or comparison group were excluded
reviews have reported few studies on mental health (except studies with pretest and post-test analyses of the
interventions in the workplace, most of which were of same population). Outcomes included effect on mental
low quality; moreover, these reviews have not examined health or substance misuse, or both; outcomes related
substance use.3,7 to work, such as productivity; and economic or

www.thelancet.com/psychiatry Vol 7 October 2020 893

The Lancet Psychiatry, 7 (2020) 893-910. doi:10.1016/S2215-0366(20)30145-0
The Lancet Psychiatry, 7 (2020) 893-910. doi:10.1016/S2215-0366(20)30145-0
The Lancet Psychiatry, 7 (2020) 893-910. doi:10.1016/S2215-0366(20)30145-0
The Lancet Psychiatry, 7 (2020) 893-910. doi:10.1016/S2215-0366(20)30145-0
The Lancet Psychiatry, 7 (2020) 893-910. doi:10.1016/S2215-0366(20)30145-0
The Lancet Psychiatry, 7 (2020) 893-910. doi:10.1016/S2215-0366(20)30145-0
The Lancet Psychiatry, 7 (2020) 893-910. doi:10.1016/S2215-0366(20)30145-0
The Lancet Psychiatry, 7 (2020) 893-910. doi:10.1016/S2215-0366(20)30145-0
The Lancet Psychiatry, 7 (2020) 893-910. doi:10.1016/S2215-0366(20)30145-0
The Lancet Psychiatry, 7 (2020) 893-910. doi:10.1016/S2215-0366(20)30145-0
The Lancet Psychiatry, 7 (2020) 893-910. doi:10.1016/S2215-0366(20)30145-0
The Lancet Psychiatry, 7 (2020) 893-910. doi:10.1016/S2215-0366(20)30145-0
The Lancet Psychiatry, 7 (2020) 893-910. doi:10.1016/S2215-0366(20)30145-0
The Lancet Psychiatry, 7 (2020) 893-910. doi:10.1016/S2215-0366(20)30145-0
The Lancet Psychiatry, 7 (2020) 893-910. doi:10.1016/S2215-0366(20)30145-0
The Lancet Psychiatry, 7 (2020) 893-910. doi:10.1016/S2215-0366(20)30145-0
The Lancet Psychiatry, 7 (2020) 893-910. doi:10.1016/S2215-0366(20)30145-0