Promoting Mental Health and Happiness in Healthcare Workers Through Workplace Interventions: A Realist Review

Abstract

Mental health issues among healthcare workers are a significant concern, with depression and anxiety disorders alone costing approximately US$1 trillion in lost productivity globally in 2017. This realist review aimed to examine how workplace-based organizational interventions can improve the mental health and wellbeing of healthcare workers, adopting a broader definition of outcomes, including diverse study designs, and focusing on a comprehensive range of healthcare workers. The review identified several themes and patterns of mechanisms for designing and implementing interventions, including stakeholder engagement and support, approaches to developing interventions, managing expectations, the complexity of evaluating organizational-level interventions, distinguishing between process and mechanism, sustainability and longevity of interventions, and a broad definition of mental health. The discussion emphasizes the contextual factors and processes underlying interventions that influenced how specific mechanisms contributed to achieving positive outcomes. Key considerations include aligning the rationale, strategy, and theoretical framework with the intervention's structure and content; the critical role of employee engagement; managing complexity; sustainability and long-term impact; and the need for a broader conceptualization of mental health that includes positive constructs such as happiness. The review highlights the importance of understanding mechanisms and processes for implementing effective workplace mental health interventions and the need for more research from low- and middle-income countries. It also underscores the necessity for robust definitions and approaches to workplace mental health, moving beyond the traditional focus on negative mental health to encompass constructs of mental wellbeing and happiness.