title: A synthesis of the evidence for managing stress at work: a review of the reviews reporting on anxiety, depression, and absenteeism.
abstract: BACKGROUND
  Psychosocial stressors in the workplace are a cause of anxiety and depressive illnesses, suicide and family disruption.
  
  
  METHODS
  The present review synthesizes the evidence from existing systematic reviews published between 1990 and July 2011. We assessed the effectiveness of individual, organisational and mixed interventions on two outcomes: mental health and absenteeism.
  
  
  RESULTS
  In total, 23 systematic reviews included 499 primary studies; there were 11 meta-analyses and 12 narrative reviews. Meta-analytic studies found a greater effect size of individual interventions on individual outcomes. Organisational interventions showed mixed evidence of benefit. Organisational programmes for physical activity showed a reduction in absenteeism. The findings from the meta-analytic reviews were consistent with the findings from the narrative reviews. Specifically, cognitive-behavioural programmes produced larger effects at the individual level compared with other interventions. Some interventions appeared to lead to deterioration in mental health and absenteeism outcomes.Gaps in the literature include studies of organisational outcomes like absenteeism, the influence of specific occupations and size of organisations, and studies of the comparative effectiveness of primary, secondary and tertiary prevention.
  
  
  CONCLUSIONS
  Individual interventions (like CBT) improve individuals' mental health. Physical activity as an organisational intervention reduces absenteeism. Research needs to target gaps in the evidence.
authors.affiliation: Centre for Psychiatry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E14NS, UK. k.s.bhui@qmul.ac.uk
authors.forename: Kamaldeep S
authors.initials: KS
authors.lastname: Bhui
authors.forename: Sokratis
authors.initials: S
authors.lastname: Dinos
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Stansfeld
authors.forename: Peter D
authors.initials: PD
authors.lastname: White
mesh_terms: D000041:Absenteeism; D001007:Anxiety / Q000517:prevention & control / Q000628:therapy; D003863:Depression / Q000517:prevention & control / Q000628:therapy; D003866:Depressive Disorder / Q000517:prevention & control / Q000628:therapy; D015444:Exercise; D006801:Humans; D008603:Mental Health; D016272:Occupational Health; D011613:Psychotherapy; D012107:Research Design; D013315:Stress, Psychological / Q000517:prevention & control* / Q000628:therapy*; D017132:Workplace