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Clinical and Financial Outcomes Associated With a Workplace Mental Health Program Before and During the COVID-19 Pandemic

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Is participation in a comprehensive employer-sponsored mental health benefit associated with reduced symptoms for employees and positive financial return on investment for employers?

Findings  In this cohort study of 1132 employees participating in a workplace mental health program from 66 employers in the US, participants reported reduced symptoms of depression and anxiety. The program provided a positive return on investment for all salaries above the federal minimum wage.

Meaning  Results of this study suggest that employer-sponsored, evidence-based workplace mental health programs can be beneficial for both employers and employees.


Importance  Investment in workplace wellness programs is increasing despite concerns about lack of clinical benefit and return on investment (ROI). In contrast, outcomes from workplace mental health programs, which treat mental health difficulties more directly, remain mostly unknown.

Objective  To determine whether participation in an employer-sponsored mental health benefit was associated with improvements in depression and anxiety, workplace productivity, and ROI as well as to examine factors associated with clinical improvement.

Design, Setting, and Participants  This cohort study included participants in a US workplace mental health program implemented by 66 employers across 40 states from January 1, 2018, to January 1, 2021. Participants were employees who enrolled in the mental health benefit program and had at least moderate anxiety or depression, at least 1 appointment, and at least 2 outcome assessments.

Intervention  A digital platform that screened individuals for common mental health conditions and provided access to self-guided digital content, care navigation, and video and in-person psychotherapy and/or medication management.

Main Outcomes and Measures  Primary outcomes were the Patient Health Questionnaire-9 for depression (range, 0-27) score and the Generalized Anxiety Disorder 7-item scale (range, 0-21) score. The ROI was calculated by comparing the cost of treatment to salary costs for time out of the workplace due to mental health symptoms, measured with the Sheehan Disability Scale. Data were collected through 6 months of follow-up and analyzed using mixed-effects regression.

Results  A total of 1132 participants (520 of 724 who reported gender [71.8%] were female; mean [SD] age, 32.9 [8.8] years) were included. Participants reported improvements from pretreatment to posttreatment in depression (b = −6.34; 95% CI, −6.76 to −5.91; Cohen d = −1.11; 95% CI, −1.18 to −1.03) and anxiety (b = −6.28; 95% CI, −6.77 to −5.91; Cohen d = −1.21; 95% CI, −1.30 to −1.13). Symptom change per log-day of treatment was similar post–COVID-19 vs pre–COVID-19 for depression (b = 0.14; 95% CI, −0.10 to 0.38) and anxiety (b = 0.08; 95% CI, −0.22 to 0.38). Workplace salary savings at 6 months at the federal median wage was US $3440 (95% CI, $2730-$4151) with positive ROI across all wage groups.

Conclusions and Relevance  Results of this cohort study suggest that an employer-sponsored workplace mental health program was associated with large clinical effect sizes for employees and positive financial ROI for employers.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: April 22, 2022.

Published: June 9, 2022. doi:10.1001/jamanetworkopen.2022.16349

Open Access: This is an open access article distributed under the terms of the CC-BY-NC-ND License. © 2022 Bondar J et al. JAMA Network Open.

Corresponding Author: Adam M. Chekroud, PhD, Department of Psychiatry, Yale University, New Haven, CT 06511 (adam.chekroud@yale.edu).

Author Contributions: Dr Bondar and Ms Babich Morrow had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of analysis. Dr Bondar and Ms Babich Morrow contributed equally to the manuscript.

Concept and design: Bondar, Babich Morrow, Brown, Krystal, Chekroud.

Acquisition, analysis, or interpretation of data: Bondar, Babich Morrow, Gueorguieva, Hawrilenko, Krystal, Corlett, Chekroud.

Drafting of the manuscript: Bondar, Babich Morrow, Hawrilenko, Corlett, Chekroud.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Bondar, Babich Morrow, Gueorguieva, Hawrilenko, Krystal, Chekroud.

Obtained funding: Krystal, Chekroud.

Administrative, technical, or material support: Babich Morrow, Brown, Krystal, Chekroud.

Supervision: Brown, Chekroud.

Conflict of Interest Disclosures: Dr Bondar and Ms Babich Morrow reported being employed by and holding equity in Spring Care. Dr Gueorguieva reported receiving royalties from the book Statistical Methods in Psychiatry and Related Fields published by CRC Press and being an inventor on US patent application 20200143922. Drs Brown and Hawrilenko reported being employed by and holding equity in Spring Care. Dr Krystal reported being a consultant for Aptinyx Inc; Atai Life Sciences; AstraZeneca Pharmaceuticals; Biogen Idec; Biomedisyn Corporation; Bionomics Limited (Australia); Boehringer Ingelheim International; Cadent Therapeutics Inc; Clexio Bioscience Ltd; COMPASS Pathways Limited, United Kingdom; Concert Pharmaceuticals Inc; Epiodyne Inc; EpiVario Inc; Greenwich Biosciences Inc; Heptares Therapeutics Limited (UK); Janssen Research & Development; Jazz Pharmaceuticals Inc; Otsuka America Pharmaceutical Inc; Perception Neuroscience Holdings Inc; Spring Care Inc; Sunovion Pharmaceuticals Inc; Takeda Industries; Taisho Pharmaceutical Co Ltd; being on the scientific advisory board of Biohaven Pharmaceuticals; BioXcel Therapeutics Inc; Cadent Therapeutics Inc; Cerevel Therapeutics LLC; EpiVario Inc; Eisai Inc; Jazz Pharmaceuticals Inc; Lohocla Research Corporation; Novartis Pharmaceuticals Corporation; PsychoGenics Inc; RBNC Therapeutics Inc; Spring Care Inc; Tempero Bio Inc; Terran Biosciences Inc; holding stock in Biohaven Pharmaceuticals; Sage Pharmaceuticals; Spring Care Inc; having stock options in Biohaven Pharmaceuticals Medical Sciences; EpiVario Inc; RBNC Therapeutics Inc; Terran Biosciences Inc; Tempero Bio Inc; being an inventor on 9 patents (patent numbers 5447948, 8778979, 9592207; patent application numbers 15379013, 61973961, 62444552, 62719935, 63/125,181; and USPTO docket number Y0087.70116US00); being an editor of Biological Psychiatry and receiving research support from AstraZeneca Pharmaceuticals and Novartis (both provide drugs for research related to NIAAA grant “Center for Translational Neuroscience of Alcoholism [CTNA-4]”). Dr Chekroud reported holding equity in Spring Care; Carbon Health Technologies Inc; Wheel Health Inc; Parallel Technologies Inc; Healthie Inc; and UnitedHealthcare; being the lead inventor on 3 patent submissions relating to treatment for major depressive disorder (US Patent and Trademark Office docket number Y0087.70116US00 and provisional application numbers 62/491 660 and 62/629 041); having done paid consultancy for Fortress Biotech about antidepressant drug development; and providing unpaid advisory services to health care technology startups. No other disclosures were reported.

Additional Contributions: Jessica Streeter, PhD (Spring Health), provided guidance on employee retention analysis. Dr Streeter receives a salary and holds equity.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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