Currently accepted at: Journal of Medical Internet Research
Date Submitted: Jul 16, 2025
Open Peer Review Period: Jul 17, 2025 - Sep 11, 2025
Date Accepted: Jan 5, 2026
(closed for review but you can still tweet)
This paper has been accepted and is currently in production.
It will appear shortly on 10.2196/80689
The final accepted version (not copyedited yet) is in this tab.
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Impact of internet-based cognitive behavioural therapy on workplace functioning: Evidence from a real-world national evaluation
ABSTRACT
Background:
Depression and anxiety significantly impact labour participation and productivity, leading to adverse health and economic outcomes at a population level. Internet-based Cognitive Behavioural Therapy (iCBT) has emerged as a cost-effective intervention within workplace settings, but more generalisable evidence is lacking.
Objective:
This naturalistic, observational study investigated the impact of iCBT on work-related outcomes using nationally representative data from patients enrolled in routine care in Ireland.
Methods:
We analysed retrospective data from N=7125 patients enrolled in iCBT through the Irish national health service 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). We used mixed-effects models to assess pre-post treatment changes in outcomes, and estimated cost-savings from productivity improvement using Irish median salary data.
Results:
Overall, patients showed significant improvements in all WPAI outcomes with small effect sizes (6-9%, d=.18-30). Greater improvements in workplace functioning were linked to larger reductions in depression (r=.10-.34) and anxiety symptoms (r=.06-.33), both of which on average reduced by ~3 points. Patients with higher baseline clinical severity experienced more substantial improvements in workplace functioning than subclinical patients. These productivity gains correspond to >€4000 annual savings per patient treated, totalling to over €29 million for our nationally representative sample.
Conclusions:
Our findings support iCBT as a scalable, cost-effective intervention that can effectively improve workplace functioning by attenuating symptoms of depression and anxiety when integrated within public health service provision
Citation
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Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.