JMIR Publications

ABSTRACT

Background:

Mental health and sleep problems are prevalent in the workforce, corresponding to costly impairment in productivity and increased healthcare utilization. Digital mindfulness interventions are efficacious in improving sleep and mental health in the workplace, however, evidence is limited supporting their pragmatic utility, potential for improving productivity, and ability to reduce employer costs.

Objective:

This pragmatic, cluster-randomized controlled trial aimed to evaluate the experimental effects of implementing a commercially available mindfulness app–Calm–with employees of a large, multisite employer in the United States. Outcomes included mental health (depression, anxiety, stress), sleep (insomnia, daytime sleepiness), resilience, productivity impairment (absenteeism, presenteeism, overall work impairment, non-work activity impairment), and healthcare utilization (medical visit frequency).

Methods:

Employees were randomized at the worksite level to receive either Calm app intervention or waitlist control. Participants in the Calm group were instructed to use Calm for 10 min/day for eight weeks; individuals with elevated baseline insomnia symptoms could opt-in to six weeks of sleep coaching. All outcomes were assessed every two weeks, with the exception of medical visits (weeks four and eight only). Effects of Calm intervention on outcomes were evaluated via mixed effects modeling, controlling for relevant baseline characteristics, with fixed effects of the intervention on outcomes assessed at weeks two, four, six, and eight. Models were analyzed via complete-case (CC) and intent-to-treat (ITT) analysis.

Results:

1029 employees enrolled (n=585 in Calm group, including n=101 opted-in to sleep coaching; and n=444 in waitlist control). Of these, 192 (n=88 for Calm and n=104 for waitlist) completed all five assessments. In the CC analysis at week eight, employees at sites randomized to Calm experienced significant improvements in depression (p=.02), anxiety (p=.01), stress (p<.001), insomnia (p<.001), sleepiness (p<.001), resilience (p=.02), presenteeism (p=.01), overall work impairment (p=.004), and non-work impairment (p<.001), and reduced medical care visit frequency (p<.001) and productivity impairment costs (p=.01), relative to waitlist control. In the ITT analysis at week eight, significant benefits of the intervention were observed for depression (p<.046), anxiety (p=.01), insomnia (p<.001), sleepiness (p<.001), non-work impairment (p=.04), and medical visit frequency (p<.001).

Conclusions:

Results suggest that Calm is an effective workplace intervention for improving mental health, sleep, resilience, and productivity, and reducing medical visits and reducing costs due to work impairment. Future studies should identify optimal implementation strategies that maximize employee uptake and large-scale implementation success across diverse, geographically dispersed employers. Clinical Trial: ClinicalTrials.gov NCT05120310