Abstract
Rising costs to the economy from absenteeism and a greater public awareness of
stress, anxiety and depression have raised the profile and desire to tackle mental health
issues in the workplace.
This thesis considers the advancement and transferability of Mindfulness from its
original setting in healthcare into the workplace sector. A multidisciplinary perspective
brings together health economics, psychology and leadership theory perspectives.
Various intervention types and outcomes of Mindfulness trials are reviewed, with the
principal exploration of programme transferability across sectors. The novel element of
this thesis reviews both health and business outcomes of Mindfulness in the workplace
and importantly considers an economic evaluation from the employer’s perspective.
Process and methods
This thesis is structured in the following way: the rationale for a workplace mental health
intervention and consideration of the evidence-base of Mindfulness in various settings
is discussed in Chapter one. In Chapter two, a systematic review of the impact on job
performance and the cost-effectiveness of Mindfulness interventions in the workplace
is presented. Chapter three reports on the randomised control trial (RCT) which was
conducted for this PhD project (registration number: CRD42021279822). The chapter
reports on the process and results for effectiveness, with the main outcome of stress
measured using the “The Perceived Stress Scale”. Secondary measures included Five
Facet Mindfulness Questionnaire, The World Health Organization Quality of LifeBREIF, Cognitive Failures Questionnaire, Multifactor Leadership Questionnaire,
bespoke Service Use Measure, ICECAP-A and EQ-5D-3L. Chapter four presents the
results from the RCT and considers cost-effectiveness via a cost-consequence
analysis. This method was chosen as the trial did not find effects when evaluating the
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primary outcome. Chapter five reports on the employer perspective considering
outcomes relevant to the workplace. Chapter six brings together the findings in a
discussion and makes future recommendations.
Results
In terms of the primary outcome measure, Perceived Stress Scale (PSS), the
intervention was not found to be effective. Reasons for this are presented in Chapter
three and discussed in detail in Chapter six. From an employer perspective, the cost
consequence analysis provides the full range of costs and outcomes for the employer
to consider. The outcomes and possible reasons for the results are explored with
theories offered and recommendations made for further research. The secondary
outcome measures: the Five Factor Mindfulness Questionnaire found statistically
significant changes with higher Mindfulness traits in the intervention group. There were
no statistically significant changes observed in either of the World Health Organization
measures or the leadership measure. The three economic evaluation measures,
ICECAP-A, EQ5D-3L including the VAS reported no statistically significant changes.
The Cognitive Failures Questionnaire reported no statistically significant changes
immediately following the intervention, however at the 12-month follow-up there were
statistically significant changes in favour of the intervention group.
Conclusions
The Mindfulness intervention used in this trial was not found to be effective nor costeffective when delivered in a public sector workplace in the United Kingdom (UK). It is
important that results of trials and studies are published even if they are not found to
be effective or cost-effective, in such cases a cost consequence analysis allows
analysts to unpack wider findings and link them to process evaluation considerations.
The trial provided valuable insights and learning when considering Mindfulness in the
workplace. This thesis reviews various outcomes and considers healthcare, the costeffectiveness and the business case of Mindfulness from an employer perspective