Table 1 Characterization of interventions to reduce mental health stigma in the workplace

Dimoff et al. (2016)

Canada

Managers and supervisors in universities and telecommunications companies (N = 420)

Public and private sector

Higher education and telecommunications

Randomized controlled clinical trial design

Intervention with a session length of 3 h. The training program is configured for the mental health literacy of organizational leaders, with a sequence of early identification and recognition, early engagement or action, and assessment, planning, and monitoring

Seeks to increase the mental health literacy of organizational leaders in terms of improving knowledge and attitudes towards mental health and fostering self-efficacy and intention to promote mental health at work

The intervention had a direct effect on knowledge and self-efficacy but indirect effects on attitudes and intentions. Also, the program led to a reduction in the duration of short-term disability claims

Relatively small sample size in both studies. The results, are based only on data from two organizations and there is a need to replicate these findings in a variety of organizational contexts

Dobson et al. (2021)

Canada

Office, kitchen, and health area maintenance staff (N = 123)

Public sector

Cluster randomized design, with pretest, post-test, and 3-month follow-up in 2 implementation groups in 4 workplaces

The intervention has a duration of 3 months. This is the Working Mind Program designed to reduce mental health stigmatization in the workplace

It seeks to reduce stigmatizing attitudes towards mental disorders, improve resilience and promote mental health in the workplace

Qualitative data provided additional evidence of program benefits in participants. The program effectively decreased mental health stigma and increased self-reported resilience and coping skills at pre and post-assessment in both groups. The effects of the program were sustained through the 3-month follow-up

The cluster randomization yielded groups that were not equivalent at baseline. The moderate attrition at the presurvey time point in the delayed group and at the time of follow-up assessment in the immediate group. Future program evaluations should consider longer follow-up intervals

Gould et al. (2007)

United Kingdom

Active military personnel (N = 124)

Public sector

Military context in the UK Royal Navy

Quasi-experimental pre-and post-test design

The intervention is called TRiM, that is, Trauma Risk Management, and it is a psychoeducational management strategy (based on peer groups). It is based on a didactic and role-playing strategy. Intervention with a duration of 2.5 days

It seeks to modify negative attitudes towards people with PTSD and stress and increase supportive behaviors in the face of possible risk situations

It improved attitudes towards people with post-traumatic stress and seeking support from trained personnel. However, there was no significant effect on changing attitudes toward seeking help from normal support networks in the military and general health

The generalizability is a major limitation of the study because the military is a unique organization. A further limitation is that this was a brief longitudinal study. Self-report questionnaires were used and it is possible that initial positive attitudes occurred because of participants providing socially desirable responses

Griffiths et al. (2016)

Australia

Officials of a multidepartmental government organization (N = 507)

Public sector

Government organizations

Randomized controlled clinical trial design, with baseline, post-intervention, and six-month follow-up outcome measures

It is a two-module online induction program (MH-Guru) on mental health at work, focusing on depression and anxiety. It uses a simple, interactive multimedia format that contains graphics and exercises in the program. The intervention lasts two weeks

It seeks to increase anxiety and depression literacy, decrease negative attitudes to these conditions, provide counseling to supervisors and colleagues to help co-workers with mental health problems, and promote help-seeking

A brief online educational program effectively reduced stigma and improved mental health literacy among the staff of different seniority positions and work settings. In turn, the program was well accepted by the trainees

The study attrition at 6-months. Other limitations were the failure to separate out information and treatment help seeking outcomes and the absence of a measure of treatment help-seeking behaviour for the 6-month period prior to the final follow-up. The design involved randomization at the individual rather than departmental level. The study it focused on one type of organization

Hamann et al. (2016)

Germany

Managers or members of the human resources department (N = 580) from different organizations

Private sector

The business environment in the HR area of several companies focuses on the management level

Pre-experimental design (Pre- and post-test design)

Workshop modality, highly standardized and manualized workshop format, integrating didactic lectures, small group activities (role-playing), and showing the experience of workers with depression. Intervention duration of 1 or 1.5-day seminar

Seeks to reduce stigma towards people with depression by bosses and managers

Stigma towards depression was significantly reduced, and managers' knowledge of mental disorders and how they manifest themselves at work was improved

Participants may not be representative for managers. The design was pre-post and therefore lack a control group. Short-term results were obtained and cannot predict whether the effects observed will last for longer or translate into practice

Hanisch et al. (2017)

United Kingdom

Managers or directors of a multinational company (N = 48)

Private sector

Multinational business environment

Pre-experimental design (pre-post-test design with a 3-month follow-up for training evaluation)

Leadership Training in Mental Health Promotion (LMHP) is a digital game-based training program for leaders. The training is a single session, lasting 1.5 to 2 h

Seeks to promote employees' mental health and reduce the stigma regarding mental problems at work

A positive impact was found on mental health knowledge, attitudes toward people with mental health problems, and self-efficacy to deal with mental health situations; the exception was the intention to promote employees' mental health, which was initially already high

The study lacked a control group due to formal restrictions of the participating site. To measure knowledge, a quiz was developed which was not validated. Participants might have been presensitized as a result of stigma reduction efforts that have been going on in the UK

Hossain et al. (2009)

Australia

Extension agents and advisors (EAAs) who have frequent contact with farmers may manifest mental health problems (N = 32)

Private sector

Agricultural activity sector

Pre-experimental design (Pre- and post-test design)

The MHFA, or Mental Health First Aid, was applied as a knowledge and skills training modality. This intervention promotes the recognition of mental health risk behaviors in users. There is no report of session duration

It seeks to increase the skills and knowledge of agents in recognizing symptoms of mental disorders to provide initial help and offer guidance

An improvement in the ability to recognize a mental disorder was obtained, as well as an increase in the participants' confidence to help people with mental health problems and a decrease in social distance. Finally, positive beliefs about treatment increased

The design was pre-post and therefore lack a control group. This study has limitations in its ability to identify the use and impact of training. It is recommended further studies be carried out to evaluate the impact of training on the mental health and wellbeing

Jensen et al. (2016)

Denmark

Workers from various organizations (N = 566)

Private, public, and NGO sectors

Public, private, and non-governmental organizations (NGOs)

Randomized controlled clinical trial design, with a waiting list control group

The MHFA or Mental Health First Aid was applied. The intervention was based on exercises, knowledge presentations, and discussions. The course lasted two days with 12 h of training

Seeks to improve confidence in helping people with a mental disorder, enhancing the knowledge and ability to recognize mental disorders, and increasing positive attitudes towards these people

A significant difference was found between trained employees in the intervention group compared to the control group at a 6-month follow-up on elements of confidence in contacting, talking to, and providing help to people suffering from mental health problems. Participants improved in knowledge and ability to recognize schizophrenia. However, changes in attitudes were limited

The higher attrition rate among participants in the intervention group compared to the control group, a tendency too in other studies of the effect of MHFA training. The trial also implied a risk of contamination between the two groups (e.g., workplace cross-groups). The limited focus on helping-behaviour in the questionnaire

Jorm et al. (2010)

South Africa

School teachers (N = 423)

Public and private sector

School context

Randomized controlled clinical trial design

The intervention is based on the MHFA or Mental Health First Aid. The first part focused on mental health knowledge, and the second part was on skills development. One or two-day session, 7 h long

It seeks to increase knowledge on depression, suicide, and anxiety disorders, decrease stigmatizing attitudes and increase confidence in providing help to those who present these problems

Mental health knowledge increased, beliefs about treatment changed, some aspects of stigma were reduced, and confidence in providing help to students and colleagues increased. Much of the changes found were maintained six months after the training

This effectiveness trial carried out under real-life rather than optimal conditions. The pre-test assessment had to be carried out after group assignment. Two schools withdrew from the project because changed circumstances did not allow them to conduct the training as planned

Knifton et al. (2009)

United Kingdom

Workers in contact with people experiencing mental health problems (N = 137)

It is not clear whether the organizations belong to the private or public sector

Benefits, housing, employment, voluntary sector agencies

Pre-experimental design (Pre- and post-test design)

Workshop modality employs service user narratives, experiential group learning, and didactic teaching approaches. The workshop duration was 6 h

It seeks to promote positive attitudes, challenging negative stereotypes towards mental health problems and generating a positive behavioral intention in the target audience

There was a significant improvement in participants' knowledge of mental health problems. Prejudices regarding unpredictability and recovery in people with mental disorders were significantly modified, but dangerousness did not change. Social distance significantly improved only in relation to "moderate" social contact

There was no control group, so quantitative results cannot be compared with a non-intervention group. The sample size within this study was quite modest (137, 63 post-data) and in particular had a smaller number of males

Krameddine et al. (2013)

Canada

Police officers (N = 663)

Public sector

Police and law enforcement providers

Pre-experimental design (Pre- and post-test design)

Trained using carefully protocolized role-play with actors in 6 real situations. Intervention of 1-day duration

It seeks to improve interactions with those with a mental disorder by increasing empathy, communication skills, and ability to handle potentially difficult situations

There were changes in attitudes toward people with mental disorders and significant improvements in both directly and indirectly, measured behaviors

The design was pre-post and therefore lack a control group. Anonymous self-report measures of attitudes and supervisor surveys were used, and no interviews were conducted

Kubo et al. (2018)

Japan

Workers in a manufacturing company (N = 91)

Private sector

Industrial manufacturing sector

Pre-experimental design (Pre- and post-test design)

It consists of a training program based on MHFA or Mental Health First Aid, following the basic principles of this international intervention. The program is 12 h long, 2 h each day

It seeks to generate changes in confidence and practical skills to support early depression and prevent suicide, as well as to reduce stigma towards mental health problems

The program had a positive impact on promoting support for co-workers with mental health problems

The design was pre-post and therefore lack a control group. Evaluation using self-rated questionnaire and short-term follow up period were other limitations of the study

Lunasco et al. (2010)

United States

Military (N = 320)

Public sector

Military. The training was done in military operations

Pre-experimental design (Pre- and post-test design)

Uses the One Shot—One Kill (OS-OK), a culturally sensitive mental health prevention program. Intervention duration in a 2-day, 4-h format

It seeks to reduce stigma and improve help-seeking behaviors in a "culture of war" context

Positive responses were observed, demonstrating that the intervention program is culturally sound, increasing help-seeking among military members

The design was pre-post and therefore lack a control group. Although data were collected regarding soldiers’ perceptions of their mastery of skills across health-related areas, this data was not included in the study

Moffitt et al. (2014)

United Kingdom

Firefighters (N = 176)

Public sector

Public protection services

Randomized controlled clinical trial design

Fire department line managers were randomly assigned to 3 training conditions: LWW (a program aimed at promoting wellness and awareness of mental health problems), MHFA (Mental Health First Aid, a protocolized international training program), or LS (a purely educational control condition). Duration LWW and MHFA 2 days and LS 1 h

Seeks to promote wellness and reduce mental health stigma

LWW and MHFA courses were associated with statistically significant improvements in attitudes toward mental disorders and knowledge/self-efficacy around mental health

The quantitative evaluation is limited, as one of the questionnaires had untested psychometric properties. The control condition was limited as it was only offered for one hour, making comparison with two-day training problematic. It may have been possible to conduct a more in-depth qualitative analysis with a smaller number of participants

Moll et al. (2015)

Canada

Health officials (N = 200)

Public sector

Health organizations

Randomized controlled clinical trial design

Two intervention modalities were compared: Beyond Silence, a peer-led program tailored to the healthcare workplace, and Mental Health First Aid (MHFA), a standardized literacy-based training program. Both interventions had a duration of 12 h of training

It seeks to increase mental health literacy, reduce stigmatized beliefs, and increase help-seeking behaviors or the helpfulness of healthcare employees toward people with mental disorders

Changes in knowledge, attitudes toward mental disorders, and help-seeking and help-giving behavior were observed, although the study will continue, as this was an initial report

Although the research questions are analyzed through a clinical trial, a mixed methods approach can be particularly important for understanding program implementation. The results cannot be generalized on a larger scale to other workplaces

Moll et al., (2018a, 2018b)

Canada

Health officials (N = 192)

Public sector. Health organizations

Randomized controlled clinical trial design

Two intervention modalities were compared: Beyond Silence, a contact-based workplace education program, and Mental Health First Aid (MHFA), a standard mental health literacy training program. Both interventions had a duration of 12 h of training

Seeks to promote mental health literacy to promote early intervention and support for health officials with mental health problems

Neither program led to significant increases in help-seeking or disclosure behaviors. Both programs increased mental health literacy, improved attitudes toward seeking treatment, and decreased stigmatizing beliefs, with more sustained changes in Beyond Silence with respect to the most prominent stigmatizing beliefs

The study was conducted with hospital employees in one geographic region of Ontario. Participants in the study were volunteers, so they may be more open and receptive to the educational programs. Research is needed to explore whether the findings are replicated in smaller organizations in rural settings in other jurisdictions

Moll et al., (2018a, 2018b)

Canada

Health officials (N = 182)

Public sector

Health organizations

Randomized controlled clinical trial design

The interventions Beyond Silence, a contact-based on-the-job training program, and Mental Health First Aid (MHFA), a standard mental health literacy program, were compared. Both interventions had a duration of 12 h of training

Seeks to promote mental health education in the workplace for health care workers

Five common key strengths of the programs were: contact-based educational approach, information tailored to the work context, varied stakeholder perspectives, sufficient time to integrate and apply to learn, and organizational support. Beyond Silence outperforms the first three

Generalizability is limited by the small sample of participants who were likely the early adopters and motivated to participate in workplace mental health training. The study was restricted to a 1 medium and 1 large hospital in the same urban center

Nishiuchi et al. (2007)

Japan

Supervisors of a traditional sake beer brewer (N = 46)

Private sector

Sake brewery industrial area

Randomized controlled clinical trial design

The education program includes guidelines for promoting worker mental health in the intervention group. In terms of duration, it was a single-session intervention

Seeks to determine whether a stress reduction education program influences supervisors' knowledge, attitudes (stigma), and behavior for stress management

The supervisor's knowledge and behavior in managing stress in the workplace were improved for at least six months. Stigmatizing attitudes were also reduced

Lack of the process evaluation is a limitation. The study was conducted within a single workplace, and therefore our study population was not sufficiently representative of all supervisors across occupations. A six- month follow-up alone cannot determine the educational effect

Oakie et al. (2018)

Canada

Workers from the same organization (N = 40)

Sector not identified

Unidentified organizational scope

Quasi-experimental pre-and post-test design

The Peer Health Awareness Training (CHAT) program was implemented, complementary to the Mental Health Awareness Training (MHAT) program. CHAT is based on providing information about mental health and promoting awareness through coping techniques. The duration of the intervention was 2 h

It seeks to influence variables such as knowledge, stigma, self-efficacy to recognize and address mental health problems, intention to promote good mental health, and willingness to use resources

Employees trained with CHAT showed increased knowledge, self-efficacy, mental health promotion, and willingness to use resources. However, this was not replicated in the case of stigma reduction, where there were no significant differences

The small sample size was a significant challenge and reduced the statistical power of the analyses. All of the measures used were self-report. Another limitation is the lesser control of the quasi-experimental design

Quinn et al. (2011)

United Kingdom

Employees of public and private organizations (N = 87)

Private and public sectors

Construction and telecommunications associations sector

Pre-experimental design (Pre- and post-test design)

Characterized by service user narratives, group experiential learning, and didactic teaching approaches. Intervention of 9 sessions of one day each

It seeks to promote positive attitudes and challenge negative stereotypes about mental health problems, creating a positive behavioral intention in the target audience

A reduction in stigma toward people with mental health problems was determined. People saw themselves as less stigmatizing compared to other people

The sample was opportunistic and there was no comparison group. The study was modest in size and did not include a follow-up period. The questionnaire used in the evaluation was not a standardized instrument. There was a lack of qualitative data to understand the changes

Reavley et al. (2018)

Australia

State civil servants (N = 608)

Public sector

Government organizations

Randomized controlled clinical trial design

The MHFA (Mental Health First Aid) program was applied in e-learning or mixed modality (face-to-face and e-learning), incorporating a series of interactive and didactic resources. The intervention lasted 10 h, six online and four face-to-face

Look for changes in knowledge, stigmatizing attitudes, confidence to provide support, and intention to support a person with depression or post-traumatic stress disorder

The compared interventions had positive effects on the outcome variables. In turn, the mixed MHFA intervention was slightly more effective than MHFA e-learning in improving knowledge and stigmatizing attitudes

The larger than expected attrition and consequent lack of power to assess differences between the two modes of MHFA delivery. An additional limitation is the fact that intentions may not translate into actual behaviors

Shann et al. (2019)

Australia

Leaders of organizations (N = 196)

Sectors not reported

Organizations from different sectors of activity

Field randomized controlled clinical trial design

This is a brief online workplace mental health intervention aimed at leaders. No information is presented on the duration of the intervention

It seeks to reduce the stigma related to depression in the leaders of an organization, as well as to identify key factors in the transfer of learning

Results revealed significant reductions in stigma toward behavioral and affective components of depression among leaders who completed the intervention. Attitudes and knowledge are insufficient to ensure the transfer of learning, with factors such as work environment, collective willingness, organizational capacity to solve problems, attitudes of others at work, and the broader political context playing an important role

Factors including the nature of the work environment, the collective readiness and capability of the organization to address these issues, the attitudes of others at work, and the broader political context affected the application of learning from the intervention. Another limitation is the specificity of the sample of workers (only leaders of organizations)

Svensson and Hansson (2014)

Sweden

Staff of social security offices, employment agencies, social services, schools, police departments, correctional treatment units, rescue services, and recreation centers (N = 561)

Public sector

Public sector organizations, public administration

Randomized controlled clinical trial design, with two follow-up times

It measures the effectiveness of the MHFA (Mental Health First Aid) program. Intervention with a duration of 20 h, distributed in 2 days

It seeks to increase awareness of mental disorders and supportive behavior and improve attitudes toward these people

Both knowledge and confidence in providing help to someone in need improved. At the two-year follow-up, the improvements were sustained

The sample is not representative of the general public. The majorities of the participants had a high level of education and were women and generalizations must be made with caution. The attrition rate between base-line and six months follow-up was rather high

Szeto et al. (2019)

Canada

First responders (e.g., police, firefighters, paramedics, emergency services) (N = 4649)

Sectors not reported, although the public sector is predominant

Pre-experimental design (Pre- and post-test design)

With a 3-month follow-up in 5 groups of first responders in 16 workplaces. The Road to Mental Readiness for First Responders (R2MR), a resilience and anti-stigma program, was tested with meta-analytic methods, with a regular duration of 4 h or an extended period of 8 h

It seeks to decrease stigma toward mental disorders and increase resilience. The extended version also incorporates creating a supportive work environment and following up after stressful events

The intervention effectively reduced mental health stigma and increased resilience skills after program implementation in participants from the various work settings of the first responder groups

The study design was a pre-post test with a follow-up open trial. Despite the large pre-post sample, there was substantial attrition at the follow-up time point. Finally, the current study conducted follow-up assessment at a 3-month period; this may not be sufficient to assess its effects

Tynan et al. (2018)

Australia

Coal mining workers (N = 1275) and their supervisors (N = 117)

Private sector

Coal mining industrial sector

Pre-experimental design (Pre- and post-test design)

This multi-component program includes the MATES intervention (peer-based mental health and suicide prevention program) and training aimed at supervisors. The duration of each specific component of the program is reported from 1 h to 2 days

It seeks to evaluate the feasibility, acceptability, and effectiveness of a peer-based program focused on mental health and suicide prevention, specifically on its identification and promotion of supportive behaviors

Both workers and supervisors were more confident that they could identify a co-worker with mental health problems, help a co-worker, family member, or themselves identify where to get support. They were also more willing to talk to a co-worker about mental health

The design was pre-post and therefore lack a control group. The process evaluation measured participants' perceptions and attitudes, but did not determine whether this translates into changes in their behavior