The Effect of Messaging Therapy for Depression and Anxiety on Employee Productivity


The World Health Organization estimates that more than 300 million people suffer from depression worldwide, and mental and behavioral disorders top the list of the leading categories of diseases and disorders in the USA, coming in second only to cardiovascular disease. Such impact is seen to disproportionately affect the workplace since over 70% of those diagnosed with depression are also employed. Past research has suggested that employee absenteeism can be reduced through treatment for depression and anxiety, yet no study to date has examined the effectiveness of text therapy as a scalable delivery medium. Employing a retrospective within-subjects design, this study evaluated the treatment outcomes of text therapy for depression and anxiety and the impact such treatment had on engagement with employment. Adults seeking text therapy treatment for a variety of disorders were recruited from a text therapy service (N = 51). Clinical outcomes were measured using the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-2 after 14 to 15 weeks of treatment. An additional outcome variable was measured with the Work Productivity and Activity Impairment scale. Treatment acceptability was assessed with ratings of cost-effectiveness and return on investment concerning increased employee productivity. Participants reported significantly less depression and anxiety (PHQ-9, d = 1.34; and GAD-2, d = 1.17) overall. Thirty-one of the 38 participants (84%) with clinically elevated depression and 25 of the 39 participants (64%) with clinically elevated anxiety experienced clinically significant symptom reduction. Participants reported significantly less work missed (d = 0.30), less impairment while at work (d = 1.03), less overall work impairment (d = 0.53), and less impairment in other activities (d = 1.16). Cost-effectiveness analyses suggest that text therapy is 40.0% the cost of face-to-face services and offers increased return on investment. Mobile-enabled asynchronous text therapy with a licensed therapist could be an acceptable and clinically beneficial medium for individuals with depression and anxiety seeking to improve their work productivity.

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  1. Beck, A., Crain, L., Solberg, L. I., Unutzer, J., Maciosek, M. V., Whitebird, R. R., & Rossom, R. C. (2014). The effect of depression treatment on work productivity. American Journal of Managed Care, 20(8), 294–301.

    Google Scholar 

  2. Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., & Thornicroft, G. (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 45(1), 11–27.

    Article  PubMed  Google Scholar 

  3. Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., Beekman, A. T., & Reynolds, C. F. (2013). The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta-analysis of direct comparisons. World Psychiatry, 12(2), 137–148.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Donker, T., Straten, A. V., Marks, I., & Cuijpers, P. (2011). Quick and easy self-rating of Generalized Anxiety Disorder: validity of the Dutch web-based GAD-7, GAD-2, and GAD-SI. Psychiatry Research, 188(1), 58–64.

    Article  PubMed  Google Scholar 

  5. Evans-Lacko, S., Koeser, L., Knapp, M., Longhitano, C., Zohar, J., & Kuhn, K. (2016). Evaluating the economic impact of screening and treatment for depression in the workplace. European Neuropsychopharmacology, 26(6), 1004–1013.

    Article  Google Scholar 

  6. Facts & Statistics. Anxiety and Depression Association of America. (2016). Retrieved from adaa/press-room/facts-statistics.

  7. Fogarty, S. (2006). Comorbidity addressed effectively via an integrated solution. Compensation & Benefits Review, 38(5), 46–51.

    Article  Google Scholar 

  8. Hanisch, S. E., Twomey, C. D., Szeto, A. C., Birner, U. W., Nowak, D., & Sabariego, C. (2016). The effectiveness of interventions targeting the stigma of mental illness at the workplace: a systematic review. BMC Psychiatry, 16(1), 1.

    Article  Google Scholar 

  9. Hull, T. D., & Mahan, K. (2017). A study of asynchronous mobile-enabled SMS text psychotherapy. Telemedicine and e-Health, 23, 240–247.

  10. Jacobson, N. S., & Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12–19.

    Article  PubMed  Google Scholar 

  11. Kessler D, Lewis G, Kaur S, Wiles N, King M, Weich S, Sharp DJ, Araya R, Hollinghurst S, Peters TJ (2009) Therapist-delivered internet psychotherapy for depression in primary care: a randomised controlled trial. The Lancet 374(9690):628–634

    Article  Google Scholar 

  12. Kroenke, K. (2007). Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine, 146(5), 317–325.

    Article  PubMed  Google Scholar 

  13. Kroenke, K., Strine, T. W., Spitzer, R. L., Williams, J. B., Berry, J. T., & Mokdad, A. H. (2009). The PHQ-8 as a measure of current depression in the general population. Journal of Affective Disorders, 114(1–3), 163–173.

    Article  PubMed  Google Scholar 

  14. Leichsenring, F. (2004). Randomized controlled versus naturalistic studies: a new research agenda. Bulletin of the Menninger Clinic, 68, 137–151.

    Article  Google Scholar 

  15. Marlowe, J. F. (2002). Depression’s surprising toll on worker productivity. Employee Benefits Journal, 27(1), 16–21.

    PubMed  Google Scholar 

  16. Murray, C. J. (2013). The state of US health, 1990–2010. Jama, 310(6), 591–608.

    Article  PubMed  Google Scholar 

  17. Pratt, C. C., McGuigan, W. M., & Katzev, A. R. (2000). Measuring program outcomes: using retrospective pretest methodology. American Journal of Evaluation, 21(3), 341–349.

    Article  Google Scholar 

  18. Richmond, M. K., Pampel, F. C., Wood, R. C., & Nunes, A. P. (2016). Impact of employee assistance services on depression, anxiety, and risky alcohol use: a quasi-experimental study. Journal of Occupational and Environmental Medicine, 58(7), 641–650.

    Article  PubMed  Google Scholar 

  19. Richmond, M. K., Pampel, F. C., Wood, R. C., & Nunes, A. P. (2017). The impact of employee assistance services on workplace outcomes: Results of a prospective, quasi-experimental study. Journal of Occupational Health Psychology, 22(2), 170–179.

    Article  PubMed  Google Scholar 

  20. Rost, K., Smith, J. L., & Dickinson, M. (2004). The effect of improving primary care depression management on employee absenteeism and productivity. Medical Care, 42(12), 1202–1210.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Sasso, A. T., Rost, K., & Beck, A. (2006). Modeling the impact of enhanced depression treatment on workplace functioning and costs. Medical Care, 44(4), 352–358.

    Article  PubMed  Google Scholar 

  22. Seligman, M. E. (1995). The effectiveness of psychotherapy. The consumer reports study. American Psychologist, 50, 955–974.

    Article  Google Scholar 

  23. Sipkoff, M. (2006). Depression is prevalent and pernicious, costing employers billions each year. Depression in the Workplace: a Special Publication from Managed Care Magazine, 1, 4–8.

    Google Scholar 

  24. Willis Towers Watson National Business Group on Health. (2013). U.S. Employers rank workplace stress as top workforce risk issue. National Business Group on Health. Retrieved February 1, 2018, from

  25. World Health Organization. (2017a). Depression Fact Sheet. Retrieved October 15, 2017, from

  26. World Health Organization. (2017b). Mental Health in the Workplace. Retrieved November 15, 2017, from

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Author information




The first author primarily drafted the paper. The second author designed the study, helped draft the report (except for the “Methods” and “Results” sections), and supplied information regarding the age, gender, and diagnoses of the participants. The third author provided statistical assistance, drafted the “Methods” and “Results” sections, and had access to the data.

Corresponding authors

Correspondence to Meghan DellaCrosse or Thomas D. Hull.

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The first author declares no disclosures. The second author is an employee of the sponsor. The third author works for the sponsor as a consultant.

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DellaCrosse, M., Mahan, K. & Hull, T.D. The Effect of Messaging Therapy for Depression and Anxiety on Employee Productivity. J. technol. behav. sci. 4, 1–5 (2019).

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  • Psychotherapy
  • SMS text
  • Text therapy
  • Mobile health
  • Employee productivity
  • Employee mental health