[Skip to Content]
[Skip to Content Landing]

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.

Sign in to take quiz and track your certificates

Buy This Activity
Our websites may be periodically unavailable between 7:00pm CT February 4, 2023 and 1:00am CT February 5, 2023 for regularly scheduled maintenance.

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 Credit(s)™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

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.

Linnan  LA , Cluff  L , Lang  JE , Penne  M , Leff  MS .  Results of the Workplace Health in America Survey.   Am J Health Promot. 2019;33(5):652-665. doi:10.1177/0890117119842047 PubMedGoogle ScholarCrossref
Baicker  K , Cutler  D , Song  Z .  Workplace wellness programs can generate savings.   Health Aff (Millwood). 2010;29(2):304-311. doi:10.1377/hlthaff.2009.0626 PubMedGoogle ScholarCrossref
Song  Z , Baicker  K .  Effect of a workplace wellness program on employee health and economic outcomes: a randomized clinical trial.   JAMA. 2019;321(15):1491-1501. doi:10.1001/jama.2019.3307 PubMedGoogle ScholarCrossref
Jones  D , Molitor  D , Reif  J .  What do workplace wellness programs do? evidence from the Illinois Workplace Wellness Study.   Q J Econ. 2019;134(4):1747-1791. doi:10.1093/qje/qjz023 PubMedGoogle ScholarCrossref
Goetzel  RZ , Ozminkowski  RJ .  The health and cost benefits of work site health-promotion programs.   Annu Rev Public Health. 2008;29(1):303-323. doi:10.1146/annurev.publhealth.29.020907.090930 PubMedGoogle ScholarCrossref
Friedrich  MJ .  Depression is the leading cause of disability around the world.   JAMA. 2017;317(15):1517. doi:10.1001/jama.2017.3826 PubMedGoogle ScholarCrossref
Maeng  D , Cornell  AE , Nasra  GS .  Utilization of an employee behavioral health program and its effects on outcomes for depression and anxiety disorders.   J Occup Environ Med. 2019;61(10):812-817. doi:10.1097/JOM.0000000000001678 PubMedGoogle ScholarCrossref
Schneider  RA , Grasso  JR , Chen  SY , Chen  C , Reilly  ED , Kocher  B .  Beyond the lab: empirically supported treatments in the real world.   Front Psychol. 2020;11:1969. doi:10.3389/fpsyg.2020.01969 PubMedGoogle ScholarCrossref
Wang  PS , Simon  GE , Avorn  J ,  et al.  Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: a randomized controlled trial.   JAMA. 2007;298(12):1401-1411. doi:10.1001/jama.298.12.1401 PubMedGoogle ScholarCrossref
Schneider  RL , Arch  JJ , Wolitzky-Taylor  KB .  The state of personalized treatment for anxiety disorders: a systematic review of treatment moderators.   Clin Psychol Rev. 2015;38:39-54. doi:10.1016/j.cpr.2015.02.004 PubMedGoogle ScholarCrossref
Ashar  YK , Chang  LJ , Wager  TD .  Brain mechanisms of the placebo effect: an affective appraisal account.   Annu Rev Clin Psychol. 2017;13(1):73-98. doi:10.1146/annurev-clinpsy-021815-093015 PubMedGoogle ScholarCrossref
Fournier  JC , DeRubeis  RJ , Hollon  SD ,  et al.  Antidepressant drug effects and depression severity: a patient-level meta-analysis.   JAMA. 2010;303(1):47-53. doi:10.1001/jama.2009.1943 PubMedGoogle ScholarCrossref
Vahratian  A , Blumberg  SJ , Terlizzi  EP , Schiller  JS .  Symptoms of anxiety or depressive disorder and use of mental health care among adults during the COVID-19 pandemic - United States, August 2020-February 2021.   MMWR Morb Mortal Wkly Rep. 2021;70(13):490-494. doi:10.15585/mmwr.mm7013e2 PubMedGoogle ScholarCrossref
Kroenke  K , Spitzer  RL , Williams  JB .  The PHQ-9: validity of a brief depression severity measure.   J Gen Intern Med. 2001;16(9):606-613. doi:10.1046/j.1525-1497.2001.016009606.x PubMedGoogle ScholarCrossref
Kroenke  K , Spitzer  RL , Williams  JBW , Löwe  B .  The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review.   Gen Hosp Psychiatry. 2010;32(4):345-359. doi:10.1016/j.genhosppsych.2010.03.006 PubMedGoogle ScholarCrossref
Leon  AC , Olfson  M , Portera  L , Farber  L , Sheehan  DV .  Assessing psychiatric impairment in primary care with the Sheehan Disability Scale.   Int J Psychiatry Med. 1997;27(2):93-105. doi:10.2190/T8EM-C8YH-373N-1UWD PubMedGoogle ScholarCrossref
Plummer  F , Manea  L , Trepel  D , McMillan  D .  Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic metaanalysis.   Gen Hosp Psychiatry. 2016;39:24-31. doi:10.1016/j.genhosppsych.2015.11.005 PubMedGoogle ScholarCrossref
Spitzer  RL , Kroenke  K , Williams  JBW , Löwe  B .  A brief measure for assessing generalized anxiety disorder: the GAD-7.   Arch Intern Med. 2006;166(10):1092-1097. doi:10.1001/archinte.166.10.1092 PubMedGoogle ScholarCrossref
Jacobson  NS , Truax  P .  Clinical significance: a statistical approach to defining meaningful change in psychotherapy research.   J Consult Clin Psychol. 1991;59(1):12-19. doi:10.1037/0022-006X.59.1.12 PubMedGoogle ScholarCrossref
Löwe  B , Unützer  J , Callahan  CM , Perkins  AJ , Kroenke  K .  Monitoring depression treatment outcomes with the patient health questionnaire-9.   Med Care. 2004;42(12):1194-1201. doi:10.1097/00005650-200412000-00006 PubMedGoogle ScholarCrossref
Cohen  J . The effect size: r. In:  Statistical Power Analysis for the Behavioral Sciences. Lawrence Erlbaum Associates; 1988:77-83.
Zou  H , Hastie  T .  Regularization and variable selection via the elastic net.   J R Stat Soc Series B Stat Methodol. 2005;67(2):301-320. doi:10.1111/j.1467-9868.2005.00503.xGoogle ScholarCrossref
R Core Team.  R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing; 2021.
Wagner  SL , Koehn  C , White  MI ,  et al.  Mental health interventions in the workplace and work outcomes: a best-evidence synthesis of systematic reviews.   Int J Occup Environ Med. 2016;7(1):1-14. doi:10.15171/ijoem.2016.607 PubMedGoogle ScholarCrossref
Huang  SL , Li  RH , Huang  FY , Tang  FC .  The potential for mindfulness-based intervention in workplace mental health promotion: results of a randomized controlled trial.   PLoS One. 2015;10(9):e0138089. doi:10.1371/journal.pone.0138089 PubMedGoogle ScholarCrossref
Tan  L , Wang  MJ , Modini  M ,  et al.  Preventing the development of depression at work: a systematic review and meta-analysis of universal interventions in the workplace.   BMC Med. 2014;12(1):74. doi:10.1186/1741-7015-12-74 PubMedGoogle ScholarCrossref
Milligan-Saville  JS , Tan  L , Gayed  A ,  et al.  Workplace mental health training for managers and its effect on sick leave in employees: a cluster randomised controlled trial.   Lancet Psychiatry. 2017;4(11):850-858. doi:10.1016/S2215-0366(17)30372-3 PubMedGoogle ScholarCrossref
Cuijpers  P , Karyotaki  E , Eckshtain  D ,  et al.  Psychotherapy for depression across different age groups: a systematic review and meta-analysis.   JAMA Psychiatry. 2020;77(7):694-702. doi:10.1001/jamapsychiatry.2020.0164 PubMedGoogle ScholarCrossref
Carl  E , Witcraft  SM , Kauffman  BY ,  et al.  Psychological and pharmacological treatments for generalized anxiety disorder (GAD): a meta-analysis of randomized controlled trials.   Cogn Behav Ther. 2020;49(1):1-21. doi:10.1080/16506073.2018.1560358 PubMedGoogle ScholarCrossref
Cuijpers  P , Karyotaki  E , Weitz  E , Andersson  G , Hollon  SD , van Straten  A .  The effects of psychotherapies for major depression in adults on remission, recovery and improvement: a meta-analysis.   J Affect Disord. 2014;159:118-126. doi:10.1016/j.jad.2014.02.026 PubMedGoogle ScholarCrossref
Trivedi  MH , Rush  AJ , Wisniewski  SR ,  et al; STAR*D Study Team.  Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice.   Am J Psychiatry. 2006;163(1):28-40. doi:10.1176/appi.ajp.163.1.28 PubMedGoogle ScholarCrossref
Warden  D , Rush  AJ , Trivedi  MH , Fava  M , Wisniewski  SR .  The STAR*D Project results: a comprehensive review of findings.   Curr Psychiatry Rep. 2007;9(6):449-459. doi:10.1007/s11920-007-0061-3 PubMedGoogle ScholarCrossref
Chekroud  AM , Zotti  RJ , Shehzad  Z ,  et al.  Cross-trial prediction of treatment outcome in depression: a machine learning approach.   Lancet Psychiatry. 2016;3(3):243-250. doi:10.1016/S2215-0366(15)00471-XPubMedGoogle ScholarCrossref
Chisholm  D , Sweeny  K , Sheehan  P ,  et al.  Scaling-up treatment of depression and anxiety: a global return on investment analysis.   Lancet Psychiatry. 2016;3(5):415-424. doi:10.1016/S2215-0366(16)30024-4 PubMedGoogle ScholarCrossref
Kessler  RC , Berglund  P , Demler  O ,  et al; National Comorbidity Survey Replication.  The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R).   JAMA. 2003;289(23):3095-3105. doi:10.1001/jama.289.23.3095 PubMedGoogle ScholarCrossref
Steffen  A , Nübel  J , Jacobi  F , Bätzing  J , Holstiege  J .  Mental and somatic comorbidity of depression: a comprehensive cross-sectional analysis of 202 diagnosis groups using German nationwide ambulatory claims data.   BMC Psychiatry. 2020;20(1):142. doi:10.1186/s12888-020-02546-8 PubMedGoogle ScholarCrossref
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right

Name Your Search

Save Search
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience

Lookup An Activity


My Saved Searches

You currently have no searches saved.


My Saved Courses

You currently have no courses saved.