September 2021

Mental well-being at work: An expanding frontier in Total Worker Health® research (pdf)

Contributed by William S. Shaw, Ph.D., University of Connecticut School of Medicine

Job strain and mental health. Psychological job strain exerts a clear influence on the long-term mental health outcomes of workers. Classically, these factors have included job stress and other measures of psychological work demands, job strain (high demands with low decision latitude), long working hours, and poor social or organizational support. Multiple systematic reviews have reached similar conclusions of an independent effect of workplace psychosocial factors on mental health, including depression (Theorell et al., 2015), burnout (Aronsson et al., 2017), and suicidal ideation (Milner et al., 2018).

Review of reviews. A recent meta-review by Niedhammer and colleagues (2021) appeared in the Scandinavian Journal ofWork, Environment, and Health. Their meta-review synthesized the outcomes of 72 review articles on this subject, with a focus on several categories of physical and mental health outcomes in working populations. They defined psychosocial variables broadly but excluded the effects of shift work and factors related to circadian rhythm disruption. Mental health outcomes included depression, burnout, anxiety, sleep problems, suicidal ideation, suicide, and use of psychotropic medications. Their meta-review showed convincing evidence of the associations among many workplace psychosocial factors, especially as they relate to mental illness and cardiovascular disorders.

Interconnectedness of well-being at work and home. Day-to-day stressors at work and home are substantially intertwined, and the scientific literature contains many examples of the interrelationships between work stressors, personal and family functioning, and other lifestyle influences on mental health. Having more social support at home and being able to successfully combine work and family roles, for example, are protective factors against the negative effects of job factors on psychological distress (Viertiö et al., 2021). Similarly, social stressors at work can spill over to affect marital and family relationships (Pluut, et al., 2021), impacting mental health. Work-family conflict and spillover are now central concepts in the job stress literature. The COVID-19 pandemic has provided further evidence of the mental health interactions that exist between work and home. The Total Worker Health (TWH) perspective is especially helpful to address this complex blend of strains at work and well-being at home to reduce symptoms of depression, anxiety, and worry. A more holistic view of worker well-being is needed to understand how negative effects of job stress can be suppressed or buffered by personal risk factors, health status, work arrangements, and organizational factors.

CPH-NEW focus on mental health. During the next five years as a TWH Center of Excellence, our research and outreach projects reflect the growing focus on employee mental health. Our studies will focus particularly on essential workers in education and in healthcare, and on small and medium sized enterprises.

Our Total Teacher Health study will explore how work organization factors affect the mental health and well-being of schoolteachers, and whether educator design teams can stimulate school interventions to improve work-life balance, burnout, and work engagement. Our SHIFT II study will investigate factors that contribute to chronic workplace stress in health care that have been linked to depression, poor sleep, absenteeism, job dissatisfaction, and turnover.

The SHIFT II and HITEC IV studies will develop and evaluate tools to embed and sustain participatory worker teams as a means of organizational quality improvement for wellbeing. In our TWH Employer Crisis Preparedness project, we will integrate worker well-being into crisis preparedness efforts by developing training curricula and evaluation instruments. These projects will focus on overcoming obstacles to mental well-being at work, and they will build on our previous work to create and test participatory models of intervention and implementation.

Our TWH R2P (“Research to Practice”) Hub will disseminate the knowledge from our research studies and translate that knowledge to practical application in real world settings. CPH-NEW will offer education, training, and program tools to OSH practitioners and employers to help them promote a positive psychosocial work environment. Professionals can participate in CPH-NEW continuing education and training such as e-Learning; capacity-building trainings to learn how to organize and lead participatory design teams; and quarterly TWH Trendswebinars. Professionals seeking more advanced training on psychosocial issues can participate our partner program, the UConn graduate certificate in Occupational Health Psychology. We will also expand our Healthy Worksite Participatory Program (HWPP) toolkit to help organizational leaders promote a positive psychosocial work environment using a TWH approach. These tools, trainings, and other resources are freely available on the CPH-NEW website.

More broadly, we are excited that NIOSH, along with many other TWH Centers of Excellence have prioritized mental health as an important workplace health outcome. We look forward to engaging with our partners at CPH-NEW and with our research affiliates, students, advisors, and collaborators to develop and test innovative strategies for meeting the urgent need for improved employee mental health and well-being.


  • Aronsson G, Theorell T, Grape T, Hammarström A, Hogstedt C, Marteinsdottir I, et al. A systematic review including meta-analysis of work environment and burnout symptoms. BMC Public Health. 2017;17(1):264.
  • Milner A, Witt K, LaMontagne AD, Niedhammer I. Psychosocial job stressors and suicidality: a meta-analysis and systematic review. Occup Environ Med. 2018;75(4):245-253.
  • Niedhammer I, Bertrais S, Witt K. Psychosocial work exposures and health outcomes: a meta-review of 72 literature reviews with meta-analysis. Scand J Work Environ Health.2021;47(7):489-508.
  • Pluut H, Ilies R, Su R, Weng Q, Liang AX. How social stressors at work influence martial behaviors at home: An interpersonal model of work-family spillover. J Occup Health Psych. 2021.
  • Theorell T, Hammarstrom A, Aronsson G, Träskman Bendz L, Grape T, Hostedt C et al. A systematic review including meta-analysis of work environment and depressive symptoms. BMC Public Health. 2015; 15:738.
  • Viertio S, Kiviruusu O, Piirtola M, Kaprio J, Korhonen T, Marttunen M, Suvisaari J. Factors contributing to psychological distress in the working population, with a special referenceto gender difference. BMC Public Health. 2021;21(1):611.

William S. Shaw is a faculty member in the Division of Occupational and Environmental Medicine at the University of Connecticut School of Medicine, and Co-Director of the Center for Promotion of the Health in the New England Workplace. He is a clinical psychologist and engineer with 25 years of research experience focusing on pain and work disability.