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Mental health has become an increasingly significant issue in the workplace. Non–health care workers are experiencing increased levels of psychological symptoms in their workplaces, especially during the COVID-19 pandemic, which limited social interactions and health service access. These conditions have a negative effect on employees’ mental health and may also be associated with work-related outcomes, such as reduced levels of work engagement. Cognitive behavioral therapy (CBT) is one of the most effective methods used for treating workers with mental illness and preventing work-related psychological outcomes. The delivery of internet-based CBT (iCBT) has been established as a result of both technological improvements that have influenced health promotion and prevention components, and limited social contact and health service access.
The purpose of this systematic review is to synthesize the best available evidence concerning the preventive effect of iCBT on employees.
A systematic search will be conducted across 12 electronic databases, including a hand search for main journals and reference lists. Randomized controlled trials testing the effects of iCBT on psychological outcomes and work engagement among employees will be eligible. Initial keywords will cover the concepts of employees, workers, non–health care personnel, internet-based, web-based, eHealth cognitive behavioral interventions, stress, depression, anxiety, and work engagement, and then a full search strategy will be developed. Following titles, abstracts and the full text will be screened for assessment against the inclusion criteria for the review. Search results will be fully reported and presented per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two independent reviewers will screen and extract data, appraise methodological quality using the Cochrane risk-of-bias assessment tool, and assess overall quality of evidence with the Grading of Recommendations Assessment, Development, and Evaluation approach. A random effects meta-analysis and standardized mean differences using review manager software will be applied to synthesize the effect of iCBT based on similar outcomes.
This protocol was registered in the International Prospective Register of Systematic Reviews in March 2022 and is now an ongoing process. The data will be analyzed in August 2022, and the review process should be completed by December 2022. All included studies will be synthesized and presented to demonstrate the effectiveness of iCBT in decreasing psychological distress and optimizing work engagement outcomes among employees.
According to the findings of this study, iCBT therapies will be used to promote mental health concerns such as depressive symptoms, anxiety, psychological distress, stress, insomnia, and resilience among non–health care professionals. In addition, the results will be used to ensure the policy related to reducing psychological distress and optimizing work engagement in the workplace.
PRR1-10.2196/38597
The extended COVID-19 pandemic has had an impact on the mental health of both health care workers and non–health care personnel [
Previous systematic reviews have found that psychological distress such as stress, depression, and anxiety have been endured by a large number of employees around the world [
To minimize these consequences, a greater understanding of interventions that facilitate the improvement of psychological problems among employees is essential for protecting and promoting the mental health of workers during the prolonged COVID-19 pandemic [
Cognitive behavioral therapy (CBT) is one of the most effective interventions to not only treat mental illnesses [
Previous systematic reviews have suggested that group iCBT interventions enhanced work performance among mental health workers [
A preliminary search of the Cochrane Database of Systematic Reviews, The JBI Database of Systematic Reviews and Implementation Reports, and the previous registration of an ongoing study in International Prospective Register of Systematic Reviews (PROSPERO) found no recent systematic reviews on this topic in progress. Therefore, the aim of this systematic review and meta-analysis is to evaluate the efficacy of iCBT as a preventive intervention on work engagement and psychological outcomes for nonclinical workers.
An objective of this systematic review is to synthesize the best available evidence concerning the preventive effect of iCBT on employees. Review questions are as follows: (1) in comparison to controls, what is the preventive effect of iCBT in improving psychological outcomes (including stress, anxiety, depression, insomnia, and resilience) among healthy non–health care employees? (2) In comparison to controls, do iCBT interventions, as preventive interventions, enhance work engagement among healthy non–health care employees?
The proposed systematic review will be conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions [
A summary of the protocol and supplemental data were registered in PROSPERO (CRD42022320589) [
This systematic review will admit studies that (1) involved participants who were healthy non–health care workers of any sociocultural background, such as office workers, military personnel, and teachers; (2) examined programs using iCBT or iCBT with co-interventions; and (3) included our primary outcomes, including psychological distress, depression, stress, anxiety, insomnia, and resilience, and examined our secondary outcome—work engagement. Due to logistic issues, we considered studies reported in English without any year restriction.
Exclusion criteria for this systematic review are studies that (1) involved participants who were health care professionals and those with mental disorders or physical illnesses who were different in context from non–health care workers, and (2) tested only face-to-face CBT.
For this review, the iCBT program, as a preventive intervention, is defined as a psychotherapy program based on CBT principles such as cognitive restructuring, behavioral activation, and behavioral experiments, delivered via the internet, remotely, or through mobile-based platforms in an individual or group formats. This is in accordance with the aim of this review, which is to test the effectiveness of the core method of iCBT interventions on psychological distresses and work engagement outcomes.
This review will consider studies that compare intervention groups with no intervention controls, active controls, placebo controls, and usual-care groups.
The studies that evaluate the effect of iCBT on any aspect of psychological outcomes including depression, stress, anxiety, insomnia, and resilience will be considered primary outcomes. This review will also consider studies of the effect on work engagement, which is operationalized as a good, satisfying state of mind associated with work, characterized by vitality, dedication, and immersion as a secondary outcome.
This review will consider only randomized controlled trials. Studies reported in English will be included without any year restriction.
The 6 electronic databases to search published studies include PubMed, CINAHL, Embase, Ovid, MEDLINE, Scopus, and IEEE Xplore. Ongoing clinical trials will be searched in the clinical trial registry. Sources of unpublished studies or gray literature to be searched include Google Scholar, ProQuest Dissertations, and Theses Global and Ethos. The date when each database will be last searched is May 2022.
The search strategy targets published and unpublished studies. The Peer Review of Electronic Search Strategies checklist [
Keywords and Medical Subject Headings terms (ie,
A pilot test with 6 studies will be undertaken to guarantee consistency between the 2 reviewers responsible for the selection and data extraction process. Then, 2 independent reviewers will assess each eligible study for methodological quality prior to inclusion in the review, using the Cochrane risk-of-bias tool for randomized trials [
The overall quality of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation method. Findings for each outcome will be rated as high, moderate, low, or very low quality. Items include study design, risk of bias, imprecision, inconsistency, indirectness, and publication bias. Any disagreements that arise between the reviewers will be resolved through discussion or with other reviewers.
Data will be extracted from studies included in the review by 2 independent reviewers. A pilot test will be conducted on 6 studies to ascertain agreement between the reviewers. The data extracted will include specific details about the populations, interventions, comparison, outcomes, findings, and measurement of significance to the review objective. Any disagreements that arise between the reviewers will be resolved through discussion or with a third reviewer. Authors of papers will be contacted to request missing or additional data, where required.
Outcomes will be analyzed as continuous and dichotomous outcomes whenever possible. Meta-analyses will be performed using the random effects model for outcomes using Review Manager (RevMan) [
This study was supported by the Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Thailand, in January 2022. This systematic review protocol was started in February 2022 and registered in PROSPERO in March 2022. As of August 2022, the data were analyzed, and the final report of the review were completed at the end of December 2022.
The characteristics of the included studies and the description of iCBT interventions will be summarized. The findings from the meta-analysis will show and describe the ability of iCBT to change psychological distress and work engagement outcomes among employees. When quantitative synthesis is not possible, a narrative synthesis of the results will be used.
Here we provide a short summary of the main findings related to the aim and hypothesis of this review. The discussion will be motivated by the fact that the iCBT intervention will benefit selected outcomes based on the existing pool effect size of all included studies and how they add new findings to these fields. In addition, here we shall explain why the effective iCBT interventions yielded the results that they did and how they would be supported by the current evidence and comparison to prior work.
There will be strengths and limitations to this review. In contrast to previous reviews, we will concentrate on healthy non–health care workers. The new evidence of preventive psychological and work engagement outcomes is to be included in our review. Only randomized controlled trials were included in the study because they are regarded as the most suitable research designs.
The meta-analysis will be carried out in order to pool the effect size among individual studies for each outcome. This result could predict the evidence supporting the use of iCBT interventions in clinical practice. The limitations to this review will be explained in terms of the possibilities for future research, such as the generalizability of the findings, confirming further results, and clarifying more outcomes in future research.
The findings from this review will provide evidence for clinical and policy implications that internet delivery has the potential to improve the benefits of CBT in terms of reducing psychological consequences and increasing work engagement level. This conclusion will be used to assist in making decisions regarding implementing iCBT techniques as a preventive intervention for healthy non–health care employees in clinical practice, such as the variety of program characteristics, including content and duration, which will be examined for use in enhancing employee outcomes. The efficacy of iCBT will also be used to improve the negative impacts of psychological conditions and support high levels of work engagement in the workplace.
According to the findings of this study, iCBT therapies will become a strategy for promoting mental health issues among healthy non–health care workers, such as depressive symptoms, anxiety, psychological distress, stress, insomnia, and resilience. The summary of this review will also support future decision-making regarding the adoption of an internet-based intervention to reduce psychological discomfort among employees. Importantly, the findings will be used to ensure workplace policies that aim to alleviate the negative impacts of psychological conditions.
Summary of systematic search strategies.
cognitive behavioral therapy
internet-based cognitive behavioral therapy
International Prospective Register of Systematic Reviews
This study was supported by the Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Thailand.
WL, PB, and PKY conceived the initial concept for the review. All authors revised and approved the protocol, which was developed by WL. WL and PB will carry out the search strategy, screening, extraction, and analysis of the included studies. WL will draft the final manuscript of this systematic review with contributions and approval from all authors.
None declared.