JMIR Publications

ABSTRACT

Background:

Depression and anxiety can significantly impact workplace productivity, for instance, by increasing absenteeism and presenteeism. This loss of productivity leads to diminished workplace economic outcomes. Internet-based Cognitive Behavioural Therapy (iCBT) has emerged as a cost-effective intervention within workplace settings that improves workplace productivity loss due to depression and anxiety, but more generalisable evidence beyond the workplace, such as in a national health service setting, is lacking.

Objective:

This naturalistic, observational study investigated the impact of iCBT on work productivity metrics using nationally representative data from patients enrolled in the Irish national health service (i.e., the Health Services Executive).

Methods:

We analysed retrospective data from N=7,125 patients enrolled in iCBT at the Health Service Executive between March 2023-May 2024. The Work Productivity and Activity Impairment (WPAI) questionnaire was used to measure absenteeism, presenteeism, overall productivity loss, and activity impairment. Secondary outcomes included depression (Patient Health Questionnaire-9) and anxiety (Generalised Anxiety Disorder-7). Missing data were handled using multiple imputation. We used mixed-effects models to assess pre-post treatment changes in outcomes, and then utilized Irish national salary estimates from 2022 to derive cost-savings based upon productivity improvement during use of the iCBT program.

Results:

From baseline to follow-up absenteeism reduced by 6.85% (95% CI = 5.79% to 7.91%, d = .21), presenteeism reduced by 5.84% (95% CI = 4.59 to 7.09, d = .18), productivity loss reduced by 9.48% (95% CI = 8.30 to 10.66, d = .27), and activity impairment reduced by 8.34% (95% CI = 7.07 to 9.61, d = .30). Depression symptom scores reduced by 2.70 points (CI = 2.50 to 2.90, d = .51) and anxiety symptom scores reduced by 2.71 points (95% CI = 2.51 to 2.91, d =.52) scores post-treatment. Larger reductions in depression and anxiety symptoms were linked to greater improvements in workplace functioning outcomes (r=.06-.34). Patients with higher baseline clinical severity experienced ~5% greater improvements in workplace functioning than subclinical patients. These improvements in work productivity from baseline to follow-up corresponded to >€4,000 annual savings per patient treated, which equated to an estimated annual savings of €29 million in the sample (in 2022 €’s).

Conclusions:

Taken together, these findings contribute to the growing literature on the work-related cost-effectiveness of iCBT by demonstrating work productivity improvements and cost-savings in a national health service setting. Findings further identified that patients with clinical symptoms are expected to benefit more and thereby have greater cost-savings than subclinical patients. These findings implicate that implementing iCBT at a national level can provide a scalable and cost-effective way to improve mental health and subsequently mitigate workplace productivity losses across a population.