JMIR Publications

ABSTRACT

Background:

This paper presents empirical findings from a multi-year applied real-world evaluation study conducted at a commercial employee assistance program in the United States.

Objective:

To test for changes in clinical and work outcomes after counseling and explore possible moderator effects for client, clinical and COVID-19 pandemic factors.

Methods:

Self-report outcomes assessed with standardized measures were collected at the start of counseling from 23,572 employees during the normal course of business at CuraLinc Healthcare from 2017 to June 2021. A total of 4,017 employees had valid Pre and 30-day Post use data on one or more of the outcomes. Four longitudinal samples were examined based on the outcome, including depression outcomes on the Patient Health Questionnaire (PHQ-9; n=346/2,555); alcohol misuse outcomes on the Alcohol Use Disorders Identification Test (AUDIT-10; (n=313/1,690); hours of work absence outcomes on the Workplace Outcome Suite (n=2,925/20,992); and work productivity outcomes) on the Stanford Presenteeism Scale (n=3,013/20,211). Tests indicated the longitudinal samples were each a fair representation of the larger groups that only had outcome data at the start of counseling.

Results:

Tests with each outcome found significant improvement after counseling (all P<.001) with large statistical effect sizes (partial eta squared). The average level of depression symptoms was reduced by 58% (eta2=0.63). Among cases at-risk with depression disorder, 86% had a reliable clinical improvement in reducing symptom severity. The average level of alcohol misuse was reduced by 64% (eta2=0.67) Among cases at-risk with alcohol misuse, 71% had a reliable clinical improvement in reducing symptom severity. Average hours of work absence in the past month were reduced by 79% (eta2=0.24). The level of work productivity improved by 35% (eta2=0.48). Moderator tests indicated the improvement was generally consistent across different sub-groups of clients based on age, gender, clinical use characteristics and other study context factors. Some differences were found with the primary clinical issue matching the outcome, with alcohol and men, as well as some differences by formal referral into counseling (versus the more common self-referral type). Comparison of the pre-pandemic years to the period during the COVID-19 pandemic revealed very similar improvement in all four outcomes for groups of in-person sessions pre-pandemic, in-person sessions during the pandemic and online video sessions during the pandemic. Also, 95.2% (19,269/20,245) of employees were satisfied with their service use experience during the same time frame as the outcome study.

Conclusions:

Providing effective brief counseling from a high-quality employee assistance program is one way companies can support employees with depression or alcohol issues. Work impairments in missed work and lost productivity associated with a wide range of behavioral health, family, personal and work issues can also be restored after the use of brief counseling. Limitations of the study design and future directions are also discussed. Clinical Trial: N/A