Introduction
depression, presenteeism, anxiety
As described by the World Health Organisation, “mental health is a state of wellbeing in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (World Health Organization Results from the The fact that mental health and work are strongly intertwined and the current mental health situation of the workforce around the world set the implementation of mental health interventions in the workplace as a priority. Workplace-based mental health interventions are needed not only to improve employees’ mental health but also to reduce the negative economic consequences derived from poor mental health. The workplace itself is an ideal and challenging setting to promote mental health. People spend a lot of time at their workplace where a variety of psychosocial risks can be present in addition to other difficulties including consequences of a national crisis and discrimination based on sociodemographic characteristics (Wolrd Health Organization A lot of attention has been paid by implementation research to interventions that can promote mental health at work. Previous literature suggests that integrated approaches applied at multiple levels within an organization are recommendable to ensure that the intervention actually leads to better mental wellbeing in the workplace (Cooper and Dewe Furthermore, little is known about the effectiveness, usability and transferability of the same multilevel intervention in different work settings and countries (De Angelis et al. MENTUPP (Mental Health Promotion and Intervention in Occupational Settings) is a Horizon 2020 funded project which aims to improve mental health in the workplace by developing a complex evidence-based multilevel intervention. The intervention targets both non-clinical and clinical mental health conditions, and addresses stigmatizing attitudes. The project specifically focuses on SMEs within the construction, health and information and communication technology (ICT) sectors. These sectors have been selected as they have been linked to high levels of stress and negative mental health outcomes (Niedhammer et al. The aim of the MENTUPP pilot was to test and optimise the intervention, implementation, and evaluation strategy via a comprehensive process evaluation and an outcome evaluation to obtain first results on the effectiveness of the intervention. During the development of the MENTUPP intervention, a program theory was developed based on a participatory approach amongst the researchers involved in the MENTUPP consortium. This resulted in the MENTUPP Theory of Change which visualises the hypothesised causal mechanism of the intervention and enabled us to select the most important long-term, intermediate and proximate outcomes (Tsantila et al. The focus of this article is on the outcome evaluation of the long-term outcomes defined by our ToC and assesses whether the desired changes of the intervention were reached. The assessment of the intermediate outcomes and the results of the process evaluation will be reported in a different publication to investigate the causal mechanisms and the circumstances underlying the achieved (or not) change. A more rigorous outcome evaluation, will be conducted via a large-scale currently ongoing cRCT.This article reports on the long-term outcomes of the pilot trial in relation to four research questions (RQs):Is there an improvement in mental wellbeing, burnout, depression, anxiety, personal stigma towards depression and anxiety, absenteeism and presenteeism after implementing the MENTUPP intervention for six months?Are the changes in the long-term outcomes comparable for the construction, health and ICT sector?Do the changes in the long-term outcomes vary depending on employees’ leadership role in the SME?Did we develop suitable indicators and select appropriate evaluation measures for the assessment of our long-term outcomes?