Impact of evidence-based psychotherapy on employee retention A cohort study on employer-sponsored mental health care

Main Article Content

Maja Falcon, PhD Connie E. Chen, MD Roja Bandari, PhD Bob Kocher, MD Nirav R. Shah, MD, MPH

Abstract

Objective: To examine the relationship between mental health treatment and employee retention.


Study Design: Retrospective Cohort Study


Methods: 14 companies (184,715 employees) were studied evaluating retention among individuals who used an evidence-based mental health benefit.  Among three companies who provided health plan claims (n=24,947), we compared 1,966 employees who used the evidence-based mental health benefit and 1,063 who had usual care. Survival analysis was used to compare the probability of staying at the company for the two cohorts.  Cox Proportional Hazards Models were used to evaluate the hazard ratio of leaving the company for those who used the evidence-based mental health benefit versus usual care.


Results: Among 14 companies (184,715 employees) with the evidence-based mental health benefit, 11% who used the evidence-based mental health benefit left the company within 12 months, compared to 22% of those who did not. Among three companies who provided health plan claims, 12 month rates of employee turnover were 7% for the evidence-based mental health benefit versus 15% for health plan psychotherapy (p<0.005). Among the subgroup of employees with an anxiety diagnosis, the relative risk of employees leaving the company was 27% lower among those who used the evidence-based mental health benefit versus usual care (p=0.03).


Limitations: Employees have the option to choose between the evidence-based mental health benefit and usual care so we are not able to account for immeasurable differences between the two groups.


Conclusions: Use of an evidence-based mental health benefit over health plan mental health care (usual care) is associated with lower employee turnover.

Keywords: Psychotherapy, Employee Assistance Program, Mental Health, Depression, Anxiety, Employee Turnover, Evidence-based treatment, Productivity

Article Details

How to Cite
FALCON, Maja et al. Impact of evidence-based psychotherapy on employee retention. Medical Research Archives, [S.l.], v. 9, n. 11, nov. 2021. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2574>. Date accessed: 29 jan. 2023. doi: https://doi.org/10.18103/mra.v9i11.2574.
Section
Research Articles

References

1. NIMH » Mental Illness. Accessed October 7, 2020. https://www.nimh.nih.gov/health/statistics/mental-illness.shtml
2. Greenberg PE, Kessler RC, Birnbaum HG, Leong SA, Lowe SW, Corey-Lisle PK. The Economic Burden of Depression in the United States: How Did It Change Between 1990 and 2000? J Clin Psychiatry. 2003;64(12):1465-1475.
3. Goetzel RZ, Ozminkowski RJ, Sederer LI, Mark TL. The Business Case for Quality Mental Health Services: Why Employers Should Care About the Mental Health and Well-Being of Their Employees. Journal of Occupational and Environmental Medicine. 2002;44(4):320–330.
4. Lerner D, Adler DA, Chang H, et al. The Clinical and Occupational Correlates of Work Productivity Loss Among Employed Patients With Depression. Journal of Occupational and Environmental Medicine. 2004;46(6):S46. doi:10.1097/01.jom.0000126684.82825.0a
5. Cunha JM, Arkes J, Lester PB, Shen Y-C. Employee retention and psychological health: evidence from military recruits. Applied Economics Letters. 2015;22(18):1505-1510. doi:10.1080/13504851.2015.1042136
6. Garcia SMS, Ortman BV, Burnett DG. Mental Health Diagnoses and Attrition in Air Force Recruits. Mil Med. 2015;180(4):436-444. doi:10.7205/MILMED-D-14-00311
7. Lo W-Y, Chien L-Y, Hwang F-M, Huang N, Chiou S-T. From job stress to intention to leave among hospital nurses: A structural equation modelling approach. Journal of Advanced Nursing. 2018;74(3):677-688. doi:10.1111/jan.13481
8. Lerner D, Adler DA, Chang H, et al. Unemployment, Job Retention, and Productivity Loss Among Employees With Depression. PS. 2004;55(12):1371-1378. doi:10.1176/appi.ps.55.12.1371
9. Allen, David G. Retaining Talent: A Guide to Analyzing and Managing Employee Turnover. Published online 2008:57.
10. Greenberg PE, Fournier A-A, Sisitsky T, Pike CT, Kessler, Ronald C. The Economic Burden of Adults With Major Depressive Disorder in the United States (2005 and 2010). The Journal of Clinical Psychiatry. Published online 2015. Accessed October 7, 2020. http://www.psychiatrist.com/JCP/article/Pages/economic-burden-adults-major-depressive-disorder-united.aspx
11. Holstein R, Paul DP. ‘Phantom Networks’ of Managed Behavioral Health Providers: An Empirical Study of Their Existence and Effect on Patients in Two New Jersey Counties. Hospital Topics. 2012;90(3):65-73. doi:10.1080/00185868.2012.714689
12. Cama S, Malowney M, Bodurtha Smith AJ, et al. Availability of Outpatient Mental Health Care by Pediatricians and Child Psychiatrists in Five U.S. Cities. International Journal of Health Services. Published online 2017. Accessed October 7, 2020. https://journals.sagepub.com/doi/10.1177/0020731417707492
13. Malowney M, Keltz S, Fischer D, Boyd JW. Availability of Outpatient Care From Psychiatrists: A Simulated-Patient Study in Three U.S. Cities. PS. 2014;66(1):94-96. doi:10.1176/appi.ps.201400051
14. Melek S, Davenport S, Gray TJ. Addiction and mental health vs. physical health: Widening disparities in network use and provider reimbursement. MIlliman Research Report. Published online 2019.
15. Bledsoe BE. Critical Incident Stress Management (cism): Benefit or Risk for Emergency Services? Prehospital Emergency Care. 2003;7(2):272-279. doi:10.1080/10903120390936941
16. Lilienfeld SO. Psychological Treatments That Cause Harm - Scott O. Lilienfeld, 2007. Perspectives on Psychological Science. Published online 2007. Accessed October 7, 2020. https://journals.sagepub.com/doi/10.1111/j.1745-6916.2007.00029.x
17. Chambless DL, Hollon SD. Defining empirically supported therapies. Journal of Consulting and Clinical Psychology. Published online 1998. Accessed October 7, 2020. /doiLanding?doi=10.1037%2F0022-006X.66.1.7
18. Tolin DF, McKay D, Forman EM, Klonsky ED, Thombs BD. Empirically Supported Treatment: Recommendations for a New Model. Clinical Psychology: Science and Practice. 2015;22(4):317-338. doi:10.1111/cpsp.12122
19. Wolitzky-Taylor K, Zimmermann M, Arch JJ, De Guzman E, Lagomasino I. Has evidence-based psychosocial treatment for anxiety disorders permeated usual care in community mental health settings? Behaviour Research and Therapy. 2015;72:9-17. doi:10.1016/j.brat.2015.06.010
20. Hansen NB, Lambert MJ, Forman EM. The Psychotherapy Dose-Response Effect and Its Implications for Treatment Delivery Services. Clinical Psychology: Science and Practice. 2002;9(3):329-343. doi:10.1093/clipsy.9.3.329
21. Simon GE, Revicki D, Heiligenstein J, et al. Recovery from depression, work productivity, and health care costs among primary care patients. General Hospital Psychiatry. 2000;22(3):153-162. doi:10.1016/S0163-8343(00)00072-4
22. Wang PS, Simon GE, Avorn J, et al. Telephone Screening, Outreach, and Care Management for Depressed Workers and Impact on Clinical and Work Productivity Outcomes: A Randomized Controlled Trial. JAMA. 2007;298(12):1401. doi:10.1001/jama.298.12.1401
23. Schneider RA, Grasso JR, Chen SY, Chen C, Reilly ED, Kocher B. Beyond the Lab: Empirically Supported Treatments in the Real World. Front Psychol. 2020;11. doi:10.3389/fpsyg.2020.01969
24. Petersen T. Analysis of Event Histories. In: Arminger G, Clogg CC, Sobel ME, eds. Handbook of Statistical Modeling for the Social and Behavioral Sciences. Springer US; 1995:453-517. doi:10.1007/978-1-4899-1292-3_9
25. Schoenbaum M, Unützer J, Sherbourne C, et al. Cost-effectiveness of Practice-Initiated Quality Improvement for Depression: Results of a Randomized Controlled Trial. JAMA. 2001;286(11):1325. doi:10.1001/jama.286.11.1325
26. Andrews DR, Wan TTH. The importance of mental health to the experience of job strain: an evidence-guided approach to improve retention. Journal of Nursing Management. 2009;17(3):340-351. doi:10.1111/j.1365-2934.2008.00852.x