Group-level workplace interventions to improve mental health in low control, high-demand office-based jobs. A scoping review

Abstract Objectives Workplace psychosocial risk factors, including low autonomy and high demands, have negative consequences for employee mental health and wellbeing. There is a need to support employees experiencing mental health and well-being problems in these jobs. This scoping review aims to describe group-level workplace interventions and their approaches to improving the mental health and well-being of employees in office-based, low autonomy, and high demands jobs. Methods Following PRISMA-ScR guidelines, a search was conducted across 4 databases (Medline, PsycINFO, CINAHL, ASSIA). We explored studies presenting group-level interventions, mode of implementation, facilitators and barriers, and intervention effectiveness. The search was restricted to include office-based, low autonomy, and high-demands jobs. Primary outcome of interest was mental health and secondary outcomes were work-related and other well-being outcomes. Results Group-level workplace interventions include an array of organizational, relational, and individual components. Almost all included a training session or workshop for intervention delivery. Several had manuals but theories of change were rare. Most workplace interventions did not use participatory approaches to involve employees in intervention development, implementation and evaluation, and challenges and facilitators were not commonly reported. Key facilitators were shorter intervention duration, flexible delivery modes, and formalized processes (e.g. manuals). A key barrier was the changeable nature of workplace environments. All studies employing behavioural interventions reported significant improvements in mental health outcomes, while no clear pattern of effectiveness was observed for other outcomes or types of interventions employed. Conclusions Group-based interventions in low-autonomy office settings can be effective but few studies used participatory approaches or conducted process evaluations limiting our knowledge of the determinants for successful group-based workplace interventions. Involving stakeholders in intervention development, implementation, and evaluation is recommended and can be beneficial for better articulation of the acceptability and barriers and facilitators for delivery and engagement.

S15 TI ( (group N2 (process or method* or based or approach or intervention*)) ) OR AB ( (group N2 (process or method* or based or approach or intervention*)) ) S14 TI ( "call centre" or "call center" ) OR AB ( "call centre" or "call center" ) OR TI ( "contact center" or "contact centre" ) OR AB ( "contact center" or "contact centre" ) S13 DE "Job Characteristics" S12 TI (worker* or employee*) N2 workplace OR AB (worker* or employee*) N2 workplace S11 TI "low autonomy work*" OR AB "low autonomy work*" S10 TI ( "office workers" or "office work" or "office settings" or "desk work*") OR AB ("office workers" or "office work" or "office settings" or "desk work*" or "office employees" ) S9 TI ( "white collar jobs" or "white collar worker*" ) OR AB ( "white collar jobs" or "white collar worker*" ) S8 DE "Workplace Intervention" S7 TI ( (change or modification or promotion or intervention* or effect* or switch or altering or evaluation or prevention or program?e). ) OR AB ( (change or modification or promotion or intervention* or effect* or switch or altering or evaluation or prevention or program?e). ) S6 TI ( job N1 (strain or control or demand) ) OR AB ( job N1 (strain or control or demand) ) S5 TI ( (employee N2 (burn out or burnout or burn-out) ) OR AB ( (employee N2 (burn out or burnout or burn-out) ) S4 TI "employee mental health" OR AB "employee mental health" S3 TI (mental illness or mental health or mental disorder ) OR AB (mental illness or mental health or mental disorder ) TI ( (participatory or group*) N2 approach* ) OR AB ( (participatory or group*) N2 approach* ) S16 TI participatory N2 approach* OR AB participatory N2 approach* S15 TI ( (group N2 (process or method* or based or approach or intervention*)) ) OR AB ( (group N2 (process or method* or based or approach or intervention*)) ) S14 TI ( "call centre" or "call center" ) OR AB ( "call centre" or "call center" ) OR TI ( "contact center" or "contact centre" ) OR AB ( "contact center" or "contact centre" ) S13 (MH "Job Characteristics") or (MH "Work Environment") S12 TI (worker* or employee*) N2 workplace OR AB (worker* or employee*) N2 workplace S11 TI "low autonomy work*" OR AB "low autonomy work*" S10 TI ( "office workers" or "office work" or "office settings" or "desk work*") OR AB ("office workers" or "office work" or "office settings" or "desk work*" or "office employees" ) S9 TI ( "white collar jobs" or "white collar worker*" ) OR AB ( "white collar jobs" or "white collar worker*" ) S8 Group-level workplace mental health interventions

Participatory approach:
Group-level workplace mental health interventions       • Due to outdoor activity, the weather caused walking session was cancelled once; however this was compensated for by adding an extra walking session on another day in the same week.
• Programs that utilise employee's lunchtime could be implemented in other companies with this type of a structural timetable

Depression
• Seven months after the intervention, the prevalence of potential depression was 8% (n=23) in the intervention group and 12% (n=33) in the comparison group.• The intervention had a statistically significant effect (OR=0.40, 95% CI 0.19 to 0.82, p=0.01) on depression at T2 after depressive symptoms at baseline were adjusted for (model 1); • After additional adjustment for socio-demographic factors and job strain (model 2), the OR for depression at T2 in the intervention group compared with the comparison group was 0.40 (95% CI 0.19 to 0.85, p=0.02).• Stratified according to job strain at baseline the adjusted ORs for depression at T2 in the intervention group was 0.15 (95% CI 0.03 to 0.81, p=0.03) among those with job strain (model 3b).

Stress
• The intervention group rated themselves lower on perceived stress (PSS-14) and higher in resiliency (CD-RISC) than the control group at the postintervention time point (P < 0.001, P < 0.001, respectively).• There was a nonsignificant, slight increase in perceived stress at six-month follow-up.

Work Outcomes
• NA

Other outcomes
• Intention to treat analysis: With regard to the Five Facets of Mindfulness Questionnaire (FFMQ) the mindfulness intervention group rated themselves significantly higher post-intervention on all facets of mindfulness (p= <0.001-0.008),with the exception of non-judgmental awareness (p=0.227)than control.• Significant post-intervention increases were found in the mindfulness treatment group on all components of vigor (Shirom Vigor Scale) including physical strength (P = 0.021), cognitive liveliness (P < 0.001), and emotional energy (P = 0.027).• Analysis of within-group pre-to post-effect sizes (ESs) showed improvements over the course of the trial in all measures examined.• In the ITT sample, average within-group ES from baseline to postintervention ranged from d = 0.30 to 1.03 (mean = 0.67) for the intervention group and d = −0.23 to 0.25 (mean = 0.03) for wait-list controls.• Six-month follow-up showed that the intervention group ES continued to increase over time, ranging from d = 0.52 to 1.08 (mean = 0.81) • At follow-up, P values representing within-group changes from baseline for the intervention group were all significant (p= 0.003 to < 0.001).
• By follow-up, measures of mindfulness in the ITT sample had improved substantially.
• Improvements taken from the FFMQ ranged from an 11.2% increase in the "nonjudgmental awareness" facet from baseline, to a 25.8% increase in the "observe" facet.

Arrendondo et al. 2017 4 Mental Health outcomes Perceived Stress
• The intervention group rated themselves lower on perceived stress (PSS-14) and higher in resiliency (CD-RISC) than the control group at the postintervention time point (P < 0.001, P < 0.001, respectively).• Significantly lower median lower scores in the interventional group compared with the control group maintained at week-20 (18.0 [17.0, 22.0] vs 30.0 [21.5, 32.0])

Burnout (Maslach Burnout Inventory-General Survey)
• Higher values observed in the interventional group compared to the control group, without statistical significance, neither at week-8 nor at week-20.

Work Outcomes
• NA .0] vs. 17.0 [13.0, 20.0] non-react), and were maintained at week-20 in all subscales (p < 0.05, in all cases).• Significantly higher values in all subscales in the intervention vs. control groups were maintained at week-20 in all subscales (p < 0.05, in all cases)

Other outcomes
Self-compassion • Post-intervention, higher median significant values in the intervention vs. control groups were observed in all subscales of self-compassion (p < 0.05, in all cases), except for common humanity.• At week-20, all subscales in the interventional groups showed higher significant values compared with control group (p < 0.05, in all cases).

Experiences Questionnaire-Decentering
• Post-intervention, a significant higher median was observed in the interventional group compared with the control group.
• This significant higher value was maintained at week-20.

Heart rate variability
• Post-intervention, the SDNN and RMSSD values at baseline and prior to the first coherent breathing (pre 1) were lower than after the first coherent breathing (post 1).At the end of the sessions, the values prior to the second coherent breathing (pre 2) were generally higher than those observed at • baseline (pre 1).
• SDNN and RMSSD values after the second coherent breathing (post 2) showed a further increase compared to pre 2. The SDNN and RMSSD values showed a similar pattern during the eight sessions.
Group-level workplace mental health interventions Mental Health outcomes • IG showed significantly higher adjusted percentages of participants scoring, on average, in the highest categories for the mental health SF-36 domain: mental health (p=0.027)

Work Outcomes
• IG showed significantly higher adjusted percentages of participants scoring, on average, in the highest categories for the SF-36 domain of role limitations due to physical problems (p=0.026)• Proportions were similar in both groups and between-group differences were not significant for role limitations due to emotional problems.

Other outcomes
• Post-intervention, intervention group showed a significantly higher mean change in SF-36 vitality compared to CG (after multivariate adjustment, 12.65 vs 4.98; p=0.003) • IG showed significantly higher adjusted percentages of participants scoring, on average, in the highest categories for the following SF-36 domains: General health (p=0.014),mental health (p=0.027),role limitations due to physical problems (p=0.026),and social functioning (p=0.007).• Proportions were similar and between-group differences were not significant for bodily pain and role limitations due to emotional problems • The adjusted change over time for Purpose in Life (PiL) was significantly higher in the IG than in the CG (P < .001)• IG had statistically significant reductions in the sleep problems index I (p=0.024) and index II (p=0.021) as well as reductions in sleep disturbance (p=0.013) and higher levels of optimal sleep (p=0.004);but no significant differences were observed for other sleep measures, including sleep adequacy, quantity, somnolence, snoring, and shortness of breath.• No significant differences were observed for 7 of the 8 Profile of Mood States (POMS) domains (anger, confusion, depression, tension, vigor, and summary score); • IG reported a significantly greater reduction in fatigue (p=0.027).
• IG had a larger mean decrease in depressive symptoms (0.042), although at 6 months, there was no significant difference in the percentage of IG and CG participants classified as being at risk of clinical depression (CESD total score ≥16).The change in total activity score from baseline to 6 months did not significantly differ between IG and CG.• No significant difference for BMI and cardiometabolic risk factors of HbA1c, triglycerides, LDL, and systolic blood pressure.
• The intervention was a significant predictor of positive change in vitality (IG = 11.67 vs CG = 7.1, p=0.038).
• No other measures were statistically significant.

Mental Health Outcomes
• IG showed significantly higher adjusted percentages of participants scoring, on average, in the highest categories for the mental health SF-36 domain: mental health (p<0.001 at 6; 12 and 18 months follow-up) • Compared to baseline, mean depression scores (CESD total scores) were significantly lower at months 6 and 12 (P <.0001 for both time points) and at month 18 (P=0.0003).There was also a modest reduction in the prevalence of depression at months 6, 12, and 18 compared to baseline, which was statistically significant at months 6 and 12 (P < .05)after adjustment for multiple comparisons, but not at month 18.

Work Outcomes
• NA

Other outcomes
• At 18-month follow-up, there were sustained improvements vitality and general health domains of SF-36 and PiL (P < .001for all measures).Sleep, mood, vigor, physical activity, and blood pressure were also improved at 18 months (P < .05for all measures).• Participants reported less sleep disturbance and better sleep quality at months 6 and 12 (P< .05);better sleep adequacy at months 6, 12, and 18 months (P < .05)compared to baseline; higher mean prevalence of optimal sleep at month 6 compared to baseline (P =0.003), but this difference was not sustained at month 12 or 18. • No statistically significant difference was observed for shortness of breath at months 6, 12, or 18 compared to baseline.
• Mean walking MET minutes were not significantly different from baseline for months 6 and 12 but were significantly different for month 18 (P= 0.018.Participants showed a statistically significant increase in total physical activity score (IPAQ score) at months 6, 12, and 18 compared to baseline (P = 0.0035, .0001,<.0001, respectively • There were no statistically significant differences from baseline at months 6, 12, and 18 for body weight, BMI, and body fat.Waist-to-hip ratio was significant at months 12 and 18 compared to baseline (P= 0.031).Mean hip circumference was statistically lower at months 6, 12, and 18 compared • to baseline (P < .0001for all time points).Waist circumference, on average, was lower at months 6, 12, and 18 and achieved statistical significance at months 12 (P <.001) and 18 (P = 0.041).

Mental Health Outcomes
• In terms of effects on stress outcomes morale improved, and sickness absence duration decreased in the PAR intervention group compared with the control group; work stress did not change across the workgroups.

Work Outcomes
• organizational and job design factors improved in the intervention workgroups relative to the control workgroups.

Other outcomes
• Participants very positively rated the participative process of the intervention workshops.

Mental Health Outcomes
• NA • Employees in group 2 (control) were significantly more mindful than those in group 1 (intervention) at baseline.Regarding the main effect for time, Bonferroni pairwise comparisons (.01 level) revealed that the mean mindfulness scores were higher at t3 than those at t1, regardless of the group.• As employees developed their mindfulness skills, their psychological distress tends to diminish (There was a negative correlation between the mindfulness gain scores and the gain scores for all the indicators of psychological distress (stress: r=−.

Applying stress control skills
• Scores for will to apply these stress control skills ("I am trying to expand the repertoire of my ways of thinking by considering things from different points of view") increased by 0.42 points in the intervention group and by 0.07 points in the control group, showing a significant between-group difference of 0.35 points (95% CI: 0.14 to 0.56; p<0.01).

Work Outcomes
• NA

Other outcomes
Self-esteem

Mental Health Outcomes
No significant changes in these variables were observed in the control group.

Emotional Exhaustion
• As can be seen in Table 2, there was a significant main effect for time, and a significant group by time interaction, for emotional exhaustion.Within-groups simple contrasts indicated that in the SMT group there was a significant decrease in emotional exhaustion between Time 1 and Time 2 (F(1, 67)= 6.89, p < .01,η² =.09), and between Time 1 and Time 3 (F(1, 67) = 18.88, p < .001,η² = .22),while no significant changes in emotional exhaustion were observed in the control group.Between groups simple effects contrasts, with Time 1 emotional exhaustion scores entered as a covariate, showed that emotional exhaustion was significantly lower in the SMT group at Time 3 (F(1, 150) = 5.45, p < .05,η² = .04),but not at Time 2

Depersonalization
• As can be seen in Table 2, there was a significant group by time interaction for depersonalization.Within-groups simple contrasts indicated that in the SMT group there was a significant decrease in depersonalization between Time 1 and Time

Mental Health Outcomes
Mood states • After 10 weeks, the items of "fatigue-inertia" decreased and " vigor-activity " and " friendliness " in POMS 2 increased in the intervention group (p<0.05).A significant interaction effect for group × time was seen in the items of " fatigue-inertia " , " vigor-activity " and " friendliness " in POMS 2 between the two groups (p<0.05).

Job-related stress
• The BJSQ items of "interpersonal stress" decreased and "vigor," "support from superiors, colleagues and family/friends," and "satisfaction with job/daily life" increased in the intervention group (p<0.05).A significant interaction effect for group × time was seen in the BJSQ items of "interpersonal stress," "vigor," "support from superiors, colleagues and family/friends," and "satisfaction with job/daily life" between the two groups (p<0.05).

Other Outcomes
• The BJSQ items of "support from superiors, colleagues and family/friends," and "satisfaction with job/daily life" increased in the intervention group (p<0.05).A significant interaction effect for group × time was seen in the BJSQ items of "support from superiors, colleagues and family/friends," and "satisfaction with job/daily life" between the two groups (p<0.05).• In the intervention group, the number of exercise participation was positively correlated with the change in "vigor-activity" in POMS 2 (r=0.467,p=0.011).

Mental Health Outcomes • NA Work Outcomes Work Performance
• The average score on the work performance scale increased significantly in the intervention group by 0.61 points (from a baseline mean of 7.6).• No significant changes occurred in any of the comparable outcomes in the weighted control group.
• Improvements in work performance were significantly greater in the intervention group than the control group in regression analysis: a greater average reduction of close to one point on the 0 to 10 scale of work performance (0.79).Sickness absence • No significant changes occurred in any of the comparable outcomes in the weighted control group.
• Improvements in sickness absence were significantly greater in the intervention group than the control group in regression analysis: a greater average reduction of more than one-third of a monthly absenteeism day (0.36).In the case of absenteeism, the significant effect was due more to an increase in the control group than to a decrease in the intervention group.

Other Outcomes
• The average number of health risk factors assessed in the HRA decreased significantly in the weighted intervention group between baseline and the 12-month follow-up, with a mean decrease of 20.48 health risk factors.

Work Group Productivity
• the treatment work units showed an average of 23% improvement in sales (revenue per order) compared to the control work unit's 17% increase.

Absenteeism
• the treatment group's work units showed an average of 24% reduction in absenteeism as compared to the control work unit's 7% drop.

Other Outcomes
• For affect, the training group showed significantly less negative affect (negative arousal) than the control on the PANAS post-measure [F (

Mental Health
• There was an improvement in mental health (4.760 ≤ F ≤ 8.087, 0.008 ≤ p ≤ 0.037) • Both the circuit training (CT) and brisk walking (BW) groups showed reduced levels of depression, anxiety, and stress, and this reduction was also present in the control © group.

Work Outcomes
• NA Other Outcomes • Both exercise programs (CT and BW) maintained the body weight and body mass index while reducing body fat mass (a group × time interaction; 4.864 ≤ F ≤ 6.524, 0.001 ≤ p ≤ 0.015), although the CT intervention also showed relevant (inter-group) reductions in the waist-hip ratio (F = 11.311,p =0.007) and increased skeletal muscle mass (F = 15.062,p = 0.003).Both exercise programs (CT and BW) improved the cardiorespiratory fitness test scores (a group × time interaction; F = 18.054, p < 0.001).There were no changes in the lipid profile or blood pressure after the interventions

Mental Health Depression
• The Coping With Strain (CWS) course significantly reduces symptoms of depression among those who participate, and the effects are maintained four years after the intervention.The effects of CWS in reducing depressive symptoms were estimated from three models, including calculation of effect sizes.• Across groups, participants on average experienced a reduction of 3.46 points on the Beck Depression Inventory (BDI) scale in the 8 weeks the course lasted (p < 0.001).• While participating in the CWS course, effect sizes in IG1 (M1-M2) and II (M3-M4) showed some effect, respectively 0.51 and 0.40.In IG2 there was a low effect (0.15) while the participants were waiting for the course to start (M1-M3).The effect size revealed some effect (0.35) between IG1 at M2 and the delayed intervention (IG2) at M3.The effect size showed moderate or high effect on all follow-ups in both intervention groups after participating in the CWS course.

Work Outcomes
• NA Other Outcomes

Smith
Mental Health Anxiety • Participants in the music relaxation intervention revealed a significant reduction in state anxiety scores post assessment compared to pre assessment t(df0=16.8(30),p=<0.01.There was a 21 point reduction (CI=18.5=23.5) in state anxiety level post intervention.There was no significant change in pre and post scores for the discussion group.

Work Outcomes
• NA

Mental Health
Psychological distress • The intervention effects (time x group) were not significant for psychological distress among both male (p=0.456) and female (p=0.714)subordinates • Young male subordinates engaged in white-collar occupations showed significant intervention effects for psychological distress (p=0.012)

Work Outcomes Job Performance
• The intervention effects (time x group) were not significant for job performance among both male (p= 0.252) and female (p= 0.106) subordinates • Young male subordinates engaged in white-collar occupations showed significant intervention effects for job performance (p=0.029)

Mental Health
• NA

Work Outcomes
Job Satisfaction • Employees receiving the alignment job design (AJD) intervention experienced increased job satisfaction (compared to the control group) (d=0.98,p<0.01)., • Employees in the high-involvement work processes (HIWP) intervention experienced significantly improved job satisfaction (d=1.54 ( p<0.001) when compared to the control group on these same measures.• The autonomous work teams' intervention did not improve employee job satisfaction (relative to the control group).

Organizational Commitment
• Employees receiving the alignment job design (AJD) intervention showed no difference in commitment (compared to the control group • Employees in the high-involvement work processes (HIWP) intervention experienced a significant d score (d=0.75, p<0.01) for organizational commitment when compared to the control group on these same measures.• The autonomous work teams' intervention did not improve organizational commitment (relative to the control group).

(••• 5 •
Online & in-person; Office based delivery • 18 weeks • Mixed group-level & individual components ±10.61 (Int) 45.38 ± 11.32 (cont) • Group instruction & support during weekly lunch hour classes at the worksite • Classes led by registered dietician, physician, • and/or a cooking instructor • Nutrition education lectures • Cooking demonstrations • Interactive online message board • Low-fat vegan menu options at workplace cafeteria (where available) Gift voucher (for control group ONLY) In-person; Workplace & non-workplace delivery • Training sessions delivered by two trainers who were also employees (one from occupational health services and one form human resources).The two employees from each organization were trained at the Finnish Institute of Occupational Health (non-workplace) Main intervention: 4 half-day session, delivered over 1 or 2 weeks (workplace, delivered by the two trainers)

••••
Online & in-person; Non-workplace delivery • 2.5 days (follow-up @ 12 & 18 months) • Group-level Intervention components Commercially available intervention • Trained coaches • In-person Interactive sessions • Comprehensive online support (e-course) Participants design their own 'action plan' to sustain change postIn person; Workplace delivery • 4 x 4 hrs/week

••••••••o••••
In-person; workplace & non-workplace delivery • 2 x 3 hr training session over two weeks & a 3 hr training session 2 months after Group-level workplace mental health interventions Follow up: 6m after final training (outcome measures also measured 2m after training) Mixed group-level & individual components Intervention components Protected time for intervention participation (during work hours) • Onsite (conference rooms) • Support materials included homework assignments, handouts, training session summary sheets and CD's In-person; workplace delivery • 10 weeks (10 mins per day, 3 x week) • Group-level active rest program Intervention components Commercially available fitness programme • Fitness instructor • Onsite (conference room, could not be observed by others) sessions include warm-up (stretching), cognitive functional training, aerobic exercise, body weight resistance training and cool-down • Anthropometry and blood pressure measurements • Physical activity measurement (accelerometer) Online & in-person; workplace delivery • 12 months follow up • Mixed group-level & individual components Intervention components • Intervention program via e-mail communication • Personalized health and well-being report • Tailored advice on improvement of personal health • Unlimited web portal access (articles, assessments, interactive online behaviour-change programs) Individual stress management components o Seminars, self-assessments, skills training o Voluntary component o A participant manual • Organisational stressor reduction process o Workshop facilitator (psychologist), development of action plan and evaluation o Feedback and recommendation loops implemented Routine In-person; workplace delivery • 3 x 30 min session per week, over 12 weeks Protected worktime to participate in intervention (i.e.extra 15 min added to lunch break) • Facilitator from research team • CT intervention: Practice equipment (resistance bands, free weights, aerobic steppers, medicine balls, bosu balls, and exercise mats) • BW intervention: Walking sessions around workplace Participatory approachIn-person; workplace & non-workplace (home) delivery • 8 x 2.5 hr/week & 2 booster sessions 1 or 2 months after (follow-up @ 8 months & 3 times over next 3 years) • Group-level Intervention components • CWS work manual for home assignments • Standardized manual for course leaders & textbook for participants • Delivered by a trained therapist and assistant In-person; workplace delivery • 15 min • Group-level Intervention components • Facilitator (research team member) for both intervention and control • Live improvised guitar music • Progressive Muscle Relaxation (PMR) exercises • Control: participant-led discussion on experiences & distressing call during shift Music relaxation intervention Participatory approach: Not reported

Table S1 .
Full descriptive table of included studies

Table S2 .
Detailed barriers, facilitators and recommendations for group-based mental health interventions

Table S3 .
Effectiveness of interventions • Intention to treat analysis: Between-Group Difference, mean, adjusted = -0.06(-0.11 to -0.01); p=0.02 • Completers analysis: Between-Group Difference, mean, adjusted = -0.11(-0.18 to -0.03); p=0.005 At the midpoint of the study, there was a trend (P = 0.10) toward the low-use of a worksite web-based program for stress management group reporting higher levels of stress (mean 54.8) compared with the high-use group (mean 48.7).By the end of the program, this trend had firmed to a significantly (P = 0.05) higher reporting of stress in the low-use group (mean 53.0) compared with the high-use group (mean 45.1).

•
Self-esteem score increased by 1.73 points in the intervention group and by 0.76 points in the control group, showing a non-significant between-group difference of 0.97 points (95% CI: -2.17 to 0.23; p=0.11) 3 (F(1, 67) = 4.43, p < .05,η² = .06),but not between Time 1 and Time 2, while no significant changes in depersonalization were observed in the control group.Between-groups simple effects contrasts, with age, time in line of work and Time 1 depersonalization scores Work-related self-efficacy as a moderator of SMT entered as covariates, showed that depersonalization was significantly lower in the ACT group at Time 3 (F(1, 148) = 4.29, p < .05,η² = .03),but not at Time 2.
• Improvements in health risk factors were significantly greater in the intervention group than the control group in regression analysis: a greater average reduction of nearly one-half a health risk factor (0.45 Munz 2001 23 Mental Health Outcomes Perceived Stress • The self-management training group showed significantly less perceived stress than the control group on the PSS post-measure [F (1, 74) = 11.72,p < .05].Depression • the training group showed less depression on the CES-D post-measure than the control group [F (1, 75) =8.03, p < .05].The training group did report significantly higher scores than the control group on the WAS subscale of Job Independence [F (1,73) =8.53, p < .05].