Workplace Telecommunications Technology to Identify Mental Health Disorders and Facilitate Self-Help or Professional Referrals

Abstract

Purpose.

Test the feasibility and impact of an automated workplace mental health assessment and intervention.

Design.

Efficacy was evaluated in a randomized control trial comparing employees who received screening and intervention with those who received only screening.

Setting.

Workplace.

Subjects.

463 volunteers from Boston Medical Center, Boston University, and EMC and other employed adults, among whom 164 were randomized to the intervention (N = 87) and control (N = 77) groups.

Intervention.

The system administers a panel of telephonic assessment instruments followed by tailored information, education, and referrals.

Measures.

The Work Limitation Questionnaire, the Medical Outcomes Questionnaire Short Form-12, the Patient Health Questionnaire-9, question 10 from the Patient Health Questionnaire to measure functional impairment, and the Perceived Stress Scale-4 and questions written by study psychiatrists to measure emotional distress and social support respectively. The WHO-Five Well-being Index was administered to measure overall well-being.

Analysis.

Independent sample t-tests and χ² tests as well as mean change were used to compare the data.

Results.

No significant differences on 16 of the 20 comparisons at 3- and 6-month time points. The intervention group showed a significant improvement in depression (p ≤ .05) at 3 months and on two Work Limitation Questionnaire subscales, the Mental-Interpersonal Scale (p ≤ .05) and the Time and Scheduling Scale (p ≤ .05), at 3 and 6 months respectively with a suggestive improvement in mental health at 6 months (p ≤ .10).

Conclusions.

This is a potentially fruitful area for research with important implications for workplace behavioral interventions. (Am J Health Promot 2011;25[3]:207–216.)

Keywords

Automated Mental Health Assessment Workplace Mental Health Assessment Computers in Mental Health Assessment Behavioral Telehealth Prevention Research Manuscript format: research Research purpose: intervention testing Study design: randomized trial Outcome measure: productivity morbidity behavioral Setting: workplace Health focus: stress management Strategy: education skill/building/behavior change Target population: adults Target population circumstances: employees

References

Kessler

Chiu

Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Arch Gen Psychiatry. 2005;62:617–627.

Harnois

Gabriel

Mental Health at Work: Impact, Issues and Good Practices. Geneva, Switzerland: World Health Organization; 2000.

US Department of Health & Human Services. Mental Health: A Report of the Surgeon General. Rockville, Md: Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health; 1999.

Kessler

Berglund

Foster

CL.

The social consequences of psychiatric disorders. Am J Psychiatry. 1997;154:1405–1411.

Kessler

Heeringa

Lakoma

Individual and societal effect of mental disorders on earnings in the United States: Results from the national comorbidity survey replication. Am J Psychiatry. 2008;165:663–665.

Robinson

Chimento

Bush

Papy

Comprehensive mental health insurance benefits: Case studies. National Advisory Mental Health Council, Health Care Reform for Americans with Severe Mental Illness: report of the National Advisory Mental Health Council. Rockville, Md: Center for Mental Health Services, Substance Abuse and Mental Health Services Administrations; 2001.

Wang

Simon

Avorn

Telephone screening, outreach and care management for depressed workers and impact on clinical and work productivity outcomes: A randomized controlled trial. JAMA. 2007;298:1401–1411.

Corrigan

How stigma interferes with mental health care. Am Psychol. 2004;59:614–625.

Wallace

The Psychology of the Internet. Cambridge, United Kingdom: Cambridge University Press; 1999.

10.

Locke

Kowaloff

Hoff

Computer based interviews for screening blood donors for risk of HIV transmission. JAMA. 1993;268:1301–1305.

11.

World Health Organization Regional Office for Europe and the International Diabetes Federation, Europe. Diabetes mellitus in Europe: A problem at all ages and in all countries: A model for prevention and self care. G Ital Diabetol. 1990;10(suppl):1–14. Available at: http://whqlibdoc.who.int/euro/-1993/EUR_ICP_NCD_023(1).pdf. Accessed December 12, 2008.

12.

Newnham

Hooke

Page

AC.

Monitoring treatment response and outcomes using the World Health Organization's Wellbeing Index in psychiatric care. J Affect Disord. 2010;122:133–138.

13.

Bech

Rating Scales for Psychopathology, Health Status and Quality of Life: A Compendium on Documentation in Accordance With the DSM-III-R and WHO Systems. Berlin, Germany: Springer; 1993.

14.

Bech

Gudex

Johansen

The WHO (Ten) Well-Being Index: Validation in diabetes. Psychother Psychosom. 1996;65:183–190.

15.

Bech

Quality of Life in the Psychiatric Patient. London, United Kingdom: Mosby-Wolfe; 1998.

16.

Lerner

Amick

Rogers

The Work Limitations Questionnaire. Med Care. 2001;39:72–85.

17.

Lerner

Reed

Massarotti

The Work Limitation Questionnaire's validity and reliability among patients with osteoarthritis (OA). J Clin Epidemiol. 2002;55:197–208.

18.

Ware

Kosinski

Keller

SD.

A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Med Care. 1966;34:220–233.

19.

Spitzer

Kroenke

Williams

JB.

Validation and utility of a self-report version of PRIME-ME: The PHQ primary care study. JAMA. 1999;282:1737–1744.

20.

Cohen

Williamson

GM.

Perceived stress in a probability sample of the United States. In: Spacapan

Oskamp

, eds. The Social Psychology Of Health. Newbury Park, Calif: Sage; 1988.

21.

Stevens

Migneault

Fava

Health Technology Questionnaire: Psychometric properties of a health behavior change measure [abstract]. Ann Behav Med. 2006;31(suppl):S126.

22.

Friedman

Stollerman

Mahoney

Rozenblyum

The virtual visit: Using telecommunications technology to take care of patients. J Am Med Inform Assoc. 1997;4:413–425.

23.

Friedman

Rozenblyum

Belfer

A telecommunications system to manage patients with chronic disease. Medinfo: AMIA. 1998;9:1330–1334.

24.

Farzanfar

Stevens

Vachon

Design and development of a mental health assessment and intervention system. J Med Syst. 2007;31:49–62.

25.

Horowitz

Wilner

Alvarez

Impact of Event Scale: A measure of subjective stress. Psychosom Med. 1979;41:209–218.

26.

Bryant

Moulds

Guthrie

RM.

Acute Stress Disorder Scale: A self-report measure of acute stress disorder. Psychol Assess. 2000;12:61–67.

27.

Connor

Davidson

JRT

Churchill

Psychometric properties of the Social Phobia Inventory (SPIN). Br J Psychiatry. 2000;176:379–386.

28.

Robert

Hirschfeld

Williams

Development and validation of a screening instrument for bipolar spectrum disorder: The Mood Disorder Questionnaire. Am J Psychiatry. 2000;157:1873–1875.

29.

Abrams

HS.

Harvard Community Health Plan's Mental Health Redesign project, A managerial and clinical partnership. Psychiatr Q. 1993;64:13–31.

30.

Cartreine

Ahern

Locke

SE.

A road map to computer-based psychotherapy in the U.S.

Harv Rev Psychiatry. 2010;18:89–95.

31.

Mundt

Kobak

Taylor

Administration of the Hamilton Depression Rating Scale using interactive voice response technology. MD Comput. 1998;15:31–39.

32.

Kobak

Taylor

Dottl

A computer-administered telephone interview to identify mental disorders. JAMA. 1997;278:905–910.

33.

Erdman

Greist

Gustafson

Suicide risk prediction by computer interview: A prospective study. J Clin Psychiatry. 1987;48:464–467.

34.

Ben-Porath

Butcher

JN.

Computers in personality assessment: A brief past, an ebullient present, and an expanding future. Comput Hum Behav. 1986;2:167–182.

35.

Baer

Greist

An interactive computer-administered self-assessment and self-help program for behavior therapy. J Clin Psychiatry. 1997;58(suppl):23–28.

36.

Bachofen

Nakagawa

Marks

Home self-assessment and self-treatment of obsessive-compulsive disorder using a manual and a computer-conducted telephone interview: Replication of a UK-US study. J Clin Psychiatry. 1999;60:545–549.

37.

Sharp

Bartholomew

Pelosi

AJ.

Computerized assessment of common mental disorders in primary care: Effects on clinical outcome. Fam Pract. 1996;13:120–126.

38.

Marks

Cavanagh

Gega

Hands-on Help: Computer-Aided Psychotherapy. New York, NY: Psychology Press; 2007.

39.

Cohen

Stratified Power Analysis for the Behavioral Sciences. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.