Mental health and well-being at the workplace

INTRODUCTION The World Health Organization (WHO) conceptualized mental well-being as a state where the individual is able to understand his abilities, cope with normal life stressors, work productively, understand his abilities, and contribute productively to the community.1 Mental health and well-being are a broad concept with a primary focus on the health of the workforce.2 Certain workplace factors, such as shift work, work demands, and work stress, can put an employee at higher risk of mental problems.3 Impact of poor mental well-being at the workplace Poor mental health and lower well-being of the workers can lead to lower employee satisfaction, lower work performance, burnout, and increased risk of occupational hazards. As the workers are also part of the community, the effects of poor mental health can also affect the family and society. Higher mental health and well-being can lead to greater work productivity, more prosocial behaviors, increased creativity, increased longevity, improved physical health, and more positive interpersonal relationships.4 According to the WHO, around 60% of the total world population is in work, of which 61% work in informal jobs. It is estimated that 12 billion working days are lost every year due to depression and anxiety and 50% of the total societal cost of mental health conditions is caused due to indirect costs, including reduced productivity.5 Sociodemographics of workforce in India According to the annual report of the Periodic Labour Force Survey (July 2021–June 2022), published in February 2023, the worker–population ratio (WPR) in India is around 73.8 for males and 31.7 for females. The WPR is higher among the rural population, for both males and females, compared with the urban population.6 The proportion distribution of workers in broad industries in India is presented in Table 1. While about half of the workforce is still employed in the agricultural sector, service sector and manufacturing comprise a quarter of the employed population in India. The same survey also suggests that among those with regular wages or salaries, more than half do not have a written job contract, and about half are not eligible for paid leave or social security benefits. The average hours per week of self-employed, regular wage or salaried employees, and casual laborers ranged from 40 to 50 hours.Table 1: Proportion distribution of workers in different broad industriesMigration for employment purposes is also a reality in India. It has been estimated through census data that of 27.4% of individuals who had changed residence, 8.8% moved for employment reasons and 2.3% moved for business motives.7 Economic reasons were more common for migration to urban areas, especially for men. The migrant population, especially in the unorganized sector, faces multiple difficulties, including acculturation stress, physical hazards at the workplace, and uncertainty of job security. These difficulties were starkly brought to light during the coronavirus disease 2019 (COVID-19) pandemic.8 Hence, we see that the workplace characteristics may be different in India as compared to some of the developed Western countries. The proportion of workers in the informal sector is quite high in India, which has a consequence on job security, insurance and other benefits, and the potential to have disability and pension benefits. The workplace characteristics also need to consider a large agrarian economy alongside a booming service economy and a gradually expanding industry. However, all of these are on the lower side of the value addition chain by global comparisons. Thus, the economic aspects of the workplace need due consideration for drawing inferences from the literature and recommendations about workplace well-being. Added to it are the cultural tenets of collectivism yet subtly creeping individualism at the social level. The young demography of the country with the dynamics of competition and espoused values of being “settled” as drivers of the employment market also has connotations for the Indian workplace well-being. Varied geographies, workplace patterns, literacy, avenues of social and economic mobility, and proclivities of migration (internal and external) are other factors that make unitary recommendations for well-being challenging in the Indian workplace. Hence, the present clinical practice guidelines take a pragmatic approach and suggest careful consideration of the mentioned factors before application. MENTAL HEALTH AND WELL-BEING AT THE WORKPLACE Formal sector There is abundant literature on mental health and well-being at the workplace, especially related to the formal sector. We present some Indian studies on the epidemiology of well-being at the workplace. A study conducted by Manah Wellness among 1764 employees who were employed in white-collar jobs, residing in urban India in 2022, using the Emotional Check-In Tool, found that nearly 29% of the respondents showed moderate-to-severe signs of depression, 55% had moderate-to-severe signs of anxiety, and 78% had moderate-to-high amount of stress. However, despite this, around 99% reported moderate-to-high psychological well-being.9 A review of various studies that assessed the prevalence of noncommunicable diseases and mental illness in Indian workplaces found that a range of 10% to 52.9% of workers suffered from depression and a range of 7% to 57% of workers suffered from anxiety, while a range of 3.8% to 75.5% of workers suffered from workplace stress.10 Another study conducted by Deloitte on mental health and well-being at the workplace among 3995 respondents across 12 industries found that more than 80 percent of respondents reported being affected by at least one adverse mental health symptom with depression being the most common symptom (59%), followed by emotional exhaustion or burnout (55%), irritability or anger (51%), sleep issues (50%), and anxiety (49%). The same survey also tried to find out the sources of stress among these respondents, and they found that workplace-related stressors were the most common (47%), followed by financial stress (46%), COVID-19-related factors (42%), family relationships (39%), and social connections (37%).11 Another survey conducted by the White Swan Foundation for Mental Health among 800 workers found that despite more than half (56.0%) reporting mental health issues and nearly two-thirds (64.3%) reporting knowing someone at the workplace having mental health issues, only 24.6% felt that their workplace was extremely supportive for people with mental health issues and only one in four people received mental health support at the workplace. Furthermore, only one in ten people had access to Employee Assistance Program services.12 Informal sector Though a large proportion of workers in India are employed in the informal sector, there is a lack of literature on the mental health concerns of the individuals employed in the informal sector. A qualitative study suggested that the structural, financial, and physical violence faced by women may have mental health consequences.13 Another study among older individuals in the informal sector suggested that they suffer poor cognitive function more commonly than individuals in the formal sector.14 Agrarian distress has been highlighted as a major source of mental health concerns for vulnerable farmers and is associated with farmer suicides.15 Armed forces Individuals from the armed forces have also been exposed to significant stress that may result in mental health concerns. A study by Rao et al. (2008) found that about 28.8% of the Central Industrial Security Force (CISF) personnel had high stress levels.16 It was seen that those individuals posted in high stress areas were more likely to manifest symptoms related to mental health distress. Irregular work timings and inability to take leave were the most common workload factors related to stress. A study by Basavanna and colleagues in 199617 among more than 2000 police personnel found that 28.6% to 48% screened positive for having a psychiatric disorder, with depressive disorders and anxiety disorders being the more common ones. Among the armed forces, stress has been commonly reported.18 There have been several instances of suicide (with 533 suicides and 15 cases of fratricide between 2007 and 2010). However, non-service-related reasons seem to be the important causes of suicides in this population. Medical health professionals Medical health professions are considered one of the most stressful ones.19 Medical students, residents, and practicing physicians have high work-related stress, stress of the responsibility of human lives, attending to patients at different times, heavy workload, and the need to constantly update knowledge to keep abreast. This results in higher rates of depression, burnout, substance use disorders, sleep disturbances, and suicide than the general population. The reader is referred to the previous Indian Psychiatric Society Clinical Practice Guidelines (IPS CPG) for a detailed discussion on mental health issues among medical health professionals.19 Factors affecting psychological well-being and mental health at the workplace Poor mental health and well-being are one of the major reasons for employees' poor performance at the workplace dropping out of work. The WHO has identified ten risk factors for poor mental health in workplace20: Work content or task design Workload and work pace Work schedule Control Environment and equipment Organizational culture and function Interpersonal relationships at work Role in organization Career development Home–work interface. A meta-analysis of seven longitudinal studies with 28431 participants found that shift work was associated with an increased risk of adverse mental health outcomes (effect size = 1.28, 95% confidence interval (CI): 1.02, 1.74), especially for depressive symptoms (effect size = 1.33, 95% CI: 1.02, 1.74). Gender was found to have a significant role in this, with female shift workers more likely to experience depressive symptoms than female non-shift workers and male counterparts.21 A systematic review of nine studies that tried to assess the effect of employment conditions and psychosocial workplace exposures on the mental health of young workers found that exposure to contemporaneous sexual harassment was associated with the incidence of depressive symptoms. Furthermore, poor psychosocial job quality (low job control, high job demands and job and was associated with depressive A study among participants across found that among patients with a of depression in the 12 had in the work 60% of the participants from had for or due to of from other factors that have been found to affect the mental health and well-being are mental illness and family of mental A study found that mental among occupational mental health was related to the of Work from and Work from especially by the has and mental health and in of and more with and family were as major factors in positive mental health However, there is also a in the of work productivity, lack of access to a where they work increased and lack of for This has in work from being associated with depression, anxiety, and sleep Work from has also been associated with an in by individuals workplace stress have been referred to or may on their may for about such workplace stress, in with other life stressors, results in psychiatric such as psychiatric be and and may be The individual may also leave for a of for from his mental health This be in with the in the and be to psychiatric disorders there is a risk of to the risk be to previous individuals may with only difficulties, which the of a psychiatric or may be as an the workplace the work and other life are of an interpersonal may significant stress, in the symptoms of distress. to workplace stress, and and use of to work. of or at work, in the workplace, to report to or a from work can be 1: of individuals with workplace-related at the workplace The WHO not for mental illness in the workplace due to a lack of for or the of well-being at the workplace has for the well-being in a workplace There are several to assess mental health well-being at the workplace. The of these in their to those at risk of mental health issues that they can be identified and to assess the positive aspects of work and to the work-related factors that well-being. et have that be to assess workplace mental health, and the reader is referred to this for a of the and their characteristics are presented in Table with potential for workplace mental and to The of and on their The for the workplace can the workplace is to the of the It can also be to employee well-being and find out the to there may be for on a regular to assess the well-being in the and in where one or employees experience significant distress that results in at work. need to be about to such and or by or who be the employees for these employees or who have access to the data from the or are likely to the they are the of the and is with the data from the the data to or some are on the a suggested for different to different of and well-being is being conducted at the of there a about on the part of the mental health This that the mental health is to the individual employee and the in confidence to the mental health can be by the to employee or or Hence, the of the be in a written on who have access to the and the results be be conducted by who are not employed by the where the employees work. Furthermore, during mental health professionals make it to the employees they to the and which not be THE systematic and have on the various aspects of workplace of the studies have it is to out the most among A review of systematic that on mental health in the workplace on work outcomes found that the workplace had to both mental and physical health and mental health had the that in exposure were for anxiety A review of studies that on mental health and among workers found that most studies have from and The review also found that the most common assessed was burnout, stress, and work The most commonly were and and workload and stress and A review of 80 that on mental well-being found the quality for and and individual psychological with the most common positive effect reported for burnout or stress and mental A systematic review of that on mental health at the workplace in India found that there were four of mental health in Wellness Program on and such as and Employee Assistance Program on Employee Program health physical and mental Program The review found that the of the studies to the studies have and physical and mental health studies their employees on psychological and studies on by for their mental health, including However, the of these and these are have not been in this A review of that on and for mental health at the workplace found that most on workplace have on a population, or The review found that psychosocial were the most common in all or were in the that all general workers or not workers with mental illness The review found the with to physical and were associated with a effect on positive mental well-being = 95% CI: and a large effect on quality of life = 95% CI: A meta-analysis that only on physical and showed a effect of the on work = 95% CI: to had effects on burnout = 95% CI: to and = 95% CI: to and had a effect on general distress = 95% CI: to and a large effect on well-being = 95% CI: to had a effect on well-being = 95% CI: to through showed a effect on symptoms of common mental disorders = 95% = to depression = 95% CI: to burnout = 95% CI: to stress = 95% CI: to and work = 95% = to and a effect on well-being = 95% CI: to the studies that on were on and were there were a effect on anxiety symptoms = a effect on stress = a effect on = = and a large effect on = showed a effect on depression symptoms = 95% CI: to and a effect on stress = 95% CI: to These also to an of in burnout symptoms. to a effect on = 95% CI: = 95% CI: and = 95% CI: and large effect on positive = 95% CI: were found to have a effect on general distress = 95% CI: and burnout 95% CI: a effect on depression 95% CI: and stress 95% CI: a large effect on anxiety = 95% CI: and a effect on 95% CI: A outcomes among physicians was found to be with 60% of those who followed the being likely to report than a The review found the with to the showed effects on depressive symptoms in patients with depressive symptoms = 95% CI: were found to have effects on depressive symptoms = 95% = to psychosocial was found to be for burnout symptoms. were found to have a effect on depression 95% CI: anxiety = 95% CI: and symptoms of common mental disorders = 95% = a effect on burnout = 95% = large effects on stress 95% CI: and 95% CI: and a effect on work = 95% CI: showed a effect on symptoms of common mental disorders = 95% = A systematic of including the and Table to A systematic review and meta-analysis of that tried to assess the of occupational mental health found that these had a significant effect on psychological well-being = 95% CI: and work = 95% CI: psychological was found to be to There was significant between and and between characteristics that can a of to using for and and and using and A systematic review of studies that on the effect of at the workplace on health outcomes found that the effect of on mental health was especially on Thus, literature has on to well-being in the workplace. However, of the literature has from the There is from India as MENTAL HEALTH A review of Guidelines on mental health reported that the had for both the quality and of the followed by the Health and and the on the are the of have found that in the development and is for the Furthermore, this can lead to a positive effect on the employees' mental health and on that are on the at the workplace have been found to have a positive This the workplace factors that need to be in the a or using to on the and and expanding the on the medical and to work and for that high among workers can lead to or positive as there be a between the high of the participants and the can Hence, there is a need to can be and not to make the for the that focus on both physical and mental health or have mental health have been found to have a greater effect on workplace psychosocial physical health, and be as as with or related to or at are at and employee These are as to stress emotional positive mental health among 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