توسعه دستورالعمل ها برای پیشگیری محیط کار از مشکلات بهداشت روانی: مطالعه اجماع دلفی با متخصصان و کارکنان استرالیا

The purpose of the research was to conduct a Delphi expert consensus study (with employer, health professional and employee experts) to develop guidelines for the workplace prevention of mental health problems. A systematic review of websites, books, pamphlets and journal articles was conducted; a 363-item survey developed; and 314 strategies were endorsed as essential or important by at least 80% of all three panels. The endorsed strategies provided information on: creating a positive work environment; reducing job strain; rewarding employee efforts; workplace fairness; provision of supports; supportive change management; provision of training; provision of mental health education; and employee responsibilities.

The 2007 Australian National Survey of Mental Health and Wellbeing (NSMHWB) estimated that mental disorders affect as many as one in five people in a 12-month period (Slade, Johnston, Oakley Browne, Andrews & Whiteford, 2009). Depression, anxiety and related disorders are the most prevalent mental disorders and are among the leading causes of disability worldwide (World Health Organisation, 2008). In addition to social impact, mental disorders can significantly affect workplace productivity due to absenteeism and presenteeism (being sub-optimally productive at work) (Cocker et al., 2011, Goetzel et al., 2004 and Sanderson and Andrews, 2006). The ability to work plays a critical role in mental and physical wellbeing (LaMontagne et al., 2010 and Wilkinson and Marmot, 2003). Work is a primary determinant of socioeconomic position and plays a key role in social connectedness, the development of identity and self-esteem. However, there is strong evidence that a poor psychosocial work environment can increase the risk of mental health problems, particularly depression (Bonde, 2008 and Stansfeld and Candy, 2006). Research in this area has focussed on job strain (LaMontagne, Keegel, Vallance, Ostry, & Wolfe, 2008), effort-reward imbalance (Siegrist, 1996) and organisational justice (Kivimaki, Elovainio, Vahtera, & Ferrie, 2003). Interventions that aim to increase employee control have been shown to have beneficial effects on mental health (Egan, Bambra, & Thomas, 2007), For example, problem solving or steering committees comprising employee representatives and managers have led to improvements in measures of mental health in a number of environments including US local government agencies (Landsbergis & Vivona-Vaughan, 1995), the UK Civil Service (Bond & Bunce, 2001) and Canadian hospitals (Bourbonnais, Brisson, & Vinet, 2006). There is evidence that job-stress interventions, particularly those that use a ‘systems approach’, that is, targeting both working conditions (e.g. task restructuring) and individual skills and behaviours (individual stress management and physical training) are most likely to result in health benefits (Egan et al., 2007 and LaMontagne et al., 2007). Moreover, the workplace is increasingly recognised as an important setting for health promotion, not only to address health problems caused by work, but also to address non work-related problems that may become visible or be exacerbated within the working environment (LaMontagne et al., 2012, Martin et al., 2009 and Sanders and Crowe, 1996). Until relatively recently, much workplace health promotion activity has focussed on physical, rather than mental health promotion (Sturgeon, 2006) and the literature on the prevention of mental health problems in the workplace is relatively limited. In a recent systematic review of workplace (secondary) prevention studies that used control groups and assessment of depressive disorder with a validated screening instrument, Dietrich, Deckert, Ceynowa, Hegerl, and Stengler (2012) identified only one (French) study that met the inclusion criteria. This gap in evidence is particularly striking in the Australian context, as the majority of research has been carried out in Europe and the US, which have different health and occupational health and safety (OHS) regulatory frameworks. However, some evidence suggests that workplace interventions may produce improvements in mental health literacy (Kitchener & Jorm, 2004) and reduce depression and anxiety symptoms. In a 2009 study, Martin, Sanderson, Scott, and Brough (2009) systematically reviewed workplace interventions that aimed to reduce symptoms of depression and anxiety in participants, some of whom had diagnosed disorders. Over half the interventions used psychoeducation with cognitive behaviour therapy or training in coping skills within a stress management framework, while the others focused on physical activity, poor work environment and cardiovascular disease. A meta-analysis of 17 studies showed small but positive overall effects of the interventions on symptoms of depression and anxiety. In addition, implementation of research findings in workplace policies and practices remains a significant challenge. While evidence of the effectiveness of interventions may be increasing, workplace health researchers often struggle to effectively communicate research findings to workplace decision-makers. In turn, workplace practices may not adequately inform research. Such knowledge exchange, which incorporates the idea of knowledge as a changing set of understandings shaped by both researchers and users, is increasingly recognised as an effective means of taking up research information (Greenhalgh, Robert, Bate, Kyriakidou, Macfarlane & Peacock, 2004). It involves engaging decision makers in all relevant sectors and represents a move towards viewing practice-based evidence as equally relevant as evidence-based practice (Marmot, 2004). In this context, assessing expert consensus offers a way of bringing together available research evidence and best practice in order to enable recommendations and decisions to be made. Such methods have been widely applied in the development of clinical practice guidelines. The most commonly used consensus method is the Delphi process (Jones & Hunter, 1995), which has been used to develop mental health first aid guidelines using the expertise of professionals, consumers and carers (Jorm et al., 2008, Kelly et al., 2008 and Langlands et al., 2008). In a workplace setting, the Delphi consensus method has also been used to develop guidelines for organisations supporting employees returning to work after an episode of anxiety, depression or a related mental health problem (Reavley, Ross, Killackey, & Jorm, 2012). This aim of the study was to develop guidelines for organisations wishing to implement a strategy for workplace prevention of common mental health problems (depression and anxiety disorders), encompassing mental health problems that may be caused by work, and also those that may become apparent in the working environment. Once established, the guidelines may be used to facilitate the development of preventive policy and practice in the workplace setting.

Developing and building on consensus between managers, employees and health professionals is of critical importance in improving workplace prevention of mental health problems, as evidence suggests that interventions that address both working conditions and individual skills and behaviours are the key to preventing mental health problems (LaMontagne et al., 2007). Interventions should therefore be carried out in collaboration with key stakeholders in order to maximise the chances of success. It is hoped that these guidelines will facilitate the development of high-quality, comprehensive and effective programs. Further research is needed to explore how these guidelines might be implemented in workplaces of different types and sizes.