---
title: "Effectiveness and Cost–Benefit of a Worksite Mental Health Program in Malaysian Food Manufacturing"
id: "plos-one-10-evaluating-the-effectiveness-and-cost-benefit-of-a-worksite-mental-health"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-10-evaluating-the-effectiveness-and-cost-benefit-of-a-worksite-mental-health"
content_type: "clinical_feed_article"
specialty: "General"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360481"
published_at: "2026-10-12T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Effectiveness and Cost–Benefit of a Worksite Mental Health Program in Malaysian Food Manufacturing
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-10-evaluating-the-effectiveness-and-cost-benefit-of-a-worksite-mental-health
- **Specialty:** [General](https://medichelpline.com/clinical-feed/general.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360481)
- **Published At:** 2026-10-12T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- Investigators will evaluate a structured **Worksite Mental Health Program (WMHP)** among food manufacturing workers in Negeri Sembilan, Malaysia. - The study uses a quasi-experimental, two-arm repeated measures design with one intervention factory and one comparison factory; factory assignment aligns with intervention status. - Intervention consists of an eight-week WMHP combining psychoeducation, mindfulness practice, progressive muscle relaxation, and breathing exercises; the comparison group receives routine practices plus a general mental health pamphlet. - Assessments occur at baseline (T0), one month post-intervention (T1), and three months post-intervention (T2); data analysis will use Generalised Estimating Equations (GEE). - Primary outcomes are self-reported symptom severity for **depression**, **anxiety**, **stress**, and occupational **burnout** assessed using DASS-21 and OLBI instruments. - Secondary outcomes include job satisfaction, absenteeism, presenteeism, and economic outcomes; a cost–benefit analysis (CBA) will quantify productivity and economic impact. - The protocol frames the intervention using occupational job-stress models and an Input–Process–Output (IPO) logic model linking program inputs, processes, and psychological and economic outputs. - Eligibility: full-time Malaysian factory workers aged 18–60 employed ≥1 year, literate in Bahasa Melayu or English; exclusions include active psychiatric treatment, specified chronic illnesses, and pregnancy. - Investigators acknowledge potential confounding from factory-specific characteristics given single-factory allocation per arm and note that no datasets have yet been generated or analysed. - Funding source and trial registration are documented; the protocol states the funder had no role in design, analysis, or publication decisions.
## Clinical Analysis & Structured Key Points
Evaluating the effectiveness and cost–benefit of a worksite mental health program among manufacturing workers: A study protocol for a quasi-experimental study | PLOS One Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click here . Article Authors Metrics Comments Media Coverage Reader Comments Figures Figures Abstract Background Mental health problems lead to the loss of about 12 billion workdays worldwide each year. This creates a major economic burden. In food manufacturing, workers often face various psychosocial stressors. These include high workload, time constraint, repetitive tasks, and low autonomy. These conditions can affect both mental health and work performance. Workplace mental health interventions have shown promising results in mental health improvement. However, most studies come from high-income countries and service sectors. There is still limited evidence from industrial settings in middle-income countries. To address this gap, a structured Worksite Mental Health Program (WMHP) was developed. Method This study will employ a quasi-experimental two arm repeated measures design among workers from food manufacturing factories in Malaysia. The intervention group will receive an eight week WMHP including psychoeducation, mindfulness practices, progressive muscle relaxation, and breathing exercises. The comparison group will continue with routine workplace practices and receive a general mental health information pamphlet. Assessments will be carried out at baseline, one month post intervention, and at three months follow up. Primary outcomes include depression, anxiety, stress, and burnout. Secondary outcomes include job satisfaction, absenteeism, presenteeism, and economic outcomes. Changes over time will be analysed using Generalised Estimating Equations (GEE). A cost–benefit analysis (CBA) will also be conducted to assess economic impact. Anticipated results The program is expected to improve mental health and work performance, while simultaneously reducing absenteeism and presenteeism. The economic evaluation is expected to demonstrate positive productivity gains associated with the program. Conclusion This study will provide evidence on the effectiveness and economic value of a workplace mental health intervention in an industrial setting, informing workplace health strategies in Malaysia and similar contexts. Trial registration Thai Clinical Trials Registry (TCTR): TCTR20241217003 Citation: Yim WS, Sundram BM, Azzeri A, Lim YC, Supramaniam RK, Vallasamy SK, et al. (2026) Evaluating the effectiveness and cost–benefit of a worksite mental health program among manufacturing workers: A study protocol for a quasi-experimental study. PLoS One 21(10): e0360481. https://doi.org/10.1371/journal.pone.0360481 Editor: Rogis Baker, Universiti Pertahanan Nasional Malaysia, MALAYSIA Received: April 20, 2026; Accepted: September 7, 2026; Published: October 12, 2026 Copyright: © 2026 Yim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: No datasets were generated or analysed during the current study. All relevant data from this study will be made available upon study completion. Funding: This study was funded by the National Institute of Occupational Safety and Health Malaysia (NIOSH) through the NIOSH R&D Fund (NIOSH research grant/reference no.: 03.16/03/UM_CBA(E)/2024/01; Universiti Malaya research project no.: PV039-2025), awarded to BMS. Funder website: https://niosh.com.my/ . A NIOSH-affiliated co-investigator contributed to the conceptualisation of the study as a member of the research team. The funding organisation had no additional role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Introduction Workplace mental health refers to the emotional, psychological, and social well-being of workers in their work environment. This includes their ability to handle stress, perform well and positively impact their organisations. Decent work is defined as safe, secure, and productive employment that provides fair working conditions, supportive management, opportunities for growth, and respect for equality and workers’ rights [ 1 ]. Employment and working conditions are widely recognized as key social determinants of health [ 2 ]. Recent evidence further demonstrates that good quality work which characterized by fair conditions, job security, and supportive environments promotes better physical and mental wellbeing [ 3 ]. Mental health issues at work have become an important public health concern in the last few years. About 60% of the world population is part of the workforce [ 4 ], and about 15% of working-age adults have a mental disorder [ 3 , 5 ]. Poor mental health within workers not only compromises individual wellbeing but also incurs significant economic and social costs through absence from work (absenteeism), decrease productivity while working (presenteeism), and premature exit from workforce [ 6 ]. Depression and anxiety cause about 12 billion lost workdays around the world every year, which costs the global economy almost $1 trillion each year [ 7 ]. Excessive workload, prolonged working hours, limited job control, and poor organisational support are known psychosocial risks at work that can cause occupational mental health problems [ 8 , 9 ]. Evidence indicates that those who work long hours (≥55 hours per week) was associated with an estimated 745,000 deaths from stroke and ischaemic heart disease worldwide in 2016 [ 10 ]. These findings show that psychosocial working conditions are closely related to both mental and physical health. Persistent exposure to psychosocial stressors has been associated with increased symptoms of depression, anxiety and psychological distress, as well as occupational burnout and impaired work functioning [ 8 , 9 , 11 , 12 ]. Prolonged exposure to adverse working conditions may also contribute to emotional exhaustion and sleep disturbances [ 11 , 13 ]. In this study, these outcomes will be evaluated as self-reported symptom severity and occupational burnout rather than as clinical psychiatric diagnoses. The DASS-21 will assess symptoms of depression, anxiety and stress, while the OLBI will assess exhaustion and disengagement associated with burnout. There has been an increasing trend of mental health issues among working-age adults in Malaysia in recent years. This population were still experiencing more depressive and anxiety symptoms according to the National Health and Morbidity Survey (NHMS) 2023 [ 14 ]. These trends underscore the need for workplace mental health interventions, as working environment have significant impact on workers’ mental well-being, productivity and economic sustainability. The food manufacturing industry is a very important yet under-studied sector for mental health interventions at work. Food processing contributes a substantial share of Malaysia’s manufacturing output, accounting for about 10% of the sector [ 15 ]. In addition, around one-fifth of household consumption expenditure is spent on fast-moving consumer goods (FMCGs), including food and beverages which reflecting the sector’s economic significance [ 16 ]. Food manufacturing sector is commonly characterised by shift work, high production demands, repetitive tasks, and deadlines pressure. These conditions are recognised psychosocial risk factors for work-related mental illness [ 9 , 17 – 19 ]. Emerging international evidence suggests that workers in this sector experience both physical and psychological burdens. A study conducted among Korean food manufacturing workers indicated a significant correlation between adverse work environments, prolonged working hours, and the prevalence of sleep-related problems, musculoskeletal pain, and burnout [ 20 ]. According to a Malaysian systematic review, prolonged working hours, poor working conditions, insufficient organisational support, and low job control were listed as key contributors to depression, anxiety, and stress among food industry workers [ 21 ]. At policy level, international frameworks are starting to see mental health at work as an important component of occupational safety and health. World Health Organization (WHO) and International Labour Organization (ILO) have emphasised the need of psychosocial risks prevention, mental health promotion at work, and support for workers with mental health problems through actions at the organisational, managerial, and individual levels [ 3 , 6 ]. These recommendations are consistent with evidence from studies demonstrating the effectiveness of comprehensive workplace mental health interventions [ 9 , 22 , 23 ]. The Occupational Safety and Health Master Plan 2025 (OSHMP25) and initiatives from the Department of Occupational Safety and Health and the Social Security Organisation in Malaysia are testaments to these principles [ 24 ]. Beyond demonstrating effectiveness, economic evidence has become more important in informing employer and policy decisions related to workplace mental health interventions [ 25 , 26 ]. Findings from systematic reviews of economic evaluations indicate that such programs can produce favourable economic outcomes, largely through productivity improvements associated with reductions in absenteeism and presenteeism. Nevertheless, the strength and long-term sustainability of these economic benefits vary across studies [ 27 , 28 ]. Much of the available evidence originates from research conducted in high income countries and is largely based on service sector or white-collar occupational settings. In contrast, there remains limited economic evidence from middle income countries and from industrial work environments, where working conditions and organisational structures may differ substantially [ 29 , 30 ]. This evidence gap is particularly apparent in industrial sectors, including manufacturing, where workplace mental health interventions remain under-studied and where integrated evaluations combining effectiveness and economic outcomes are uncommon. Within manufacturing, evidence specific to the food manufacturing sector is especially limited, despite its high job demands and exposure to psychosocial risks. The absence of integrated cost–benefit analysis (CBA) in such settings may constrain the scalability and sustainability of workplace mental health interventions in cost-sensitive industries. This study aims to evaluate both the effectiveness and the cost–benefit of the Worksite Mental Health Program (WMHP) implemented in food manufacturing factories in Malaysia. The study integrates assessment of mental health outcomes with an economic evaluation to provide a more comprehensive understanding of the program’s impact. By doing so, the protocol seeks to generate evidence that is relevant for decision making and may inform the adoption, scale-up, and long-term sustainability of workplace mental health interventions in industrial settings. Materials and methods Study design This is a two-arm quasi-experimental study designed to evaluate the effectiveness of a WMHP among workers in a food manufacturing setting in Malaysia. The study compares an intervention factory receiving the WMHP in addition to routine workplace practices with a comparison factory continuing routine workplace practices and receiving a general mental health information pamphlet. Quasi-experimental design is commonly used in workplace intervention research where randomisation is infeasible due to operational, production, or organizational constraints [ 31 – 33 ]. Such approach enables evaluation of real-world effectiveness while maintaining methodological rigour with a comparison group and repeated outcome measurements. The study will include one intervention factory and one comparison factory. Intervention status will therefore be aligned with factory, and workers will be nested within their respective factory. Differences between the two groups may consequently reflect both the WMHP and factory-specific characteristics. Data will be collected at three timepoints: Baseline (T0) – prior to intervention Post-intervention, 1 month (T1) Post-intervention, 3 months (T2) The schedule of enrolment, intervention, and assessments is presented in Fig 1 [ 34 ]. Repeated assessments across multiple follow-up timepoints are recommended in psychosocial and workplace mental health interventions to capture both immediate and short-term sustained effects on psychological wellbeing and productivity [ 3 , 35 ]. This design allows assessment of both immediate and sustained effects of the WMHP on psychological wellbeing and workplace productivity. Download: PNG larger image TIFF original image Fig 1. SPIRIT schedule of enrolment, intervention and assessments. https://doi.org/10.1371/journal.pone.0360481.g001 Conceptual model This study is based on well-established occupational models of job stress and health, which view mental health outcomes as the consequence of extended exposure to psychosocial stressors in the workplace. The impact of these stressors is perceived to operate through individual stress responses, coping capacity, and behavioural adaptation within this perspective [ 36 – 38 ]. Within this model, WMHP targets both individual and contextual determinants of worker mental health. It aims to strengthen personal coping resources and fostering supportive organisational practices. According to this model, work environment is not only a determinant of physical safety but also a critical psychosocial ecosystem that shapes workers’ psychological wellbeing, motivation, and productivity. The WMHP is designed to interrupt this stress–health–productivity pathway by providing structured interventions within the work environment. There are 3 components within the program, includes psychoeducation to improve mental health literacy, mindfulness-based practices to enhance emotional awareness and attention regulation, and relaxation activities such as progressive muscle relaxation and breathing exercises to reduce physiological stress activation [ 37 – 39 ]. The purpose of these components is to improve self-regulation, resilience, and adaptive coping. In doing so, it enables workers to manage stressors more effectively and recover more rapidly. Ultimately, the intervention addresses both the proximal determinants of psychological strain and the distal outcomes that affect organisational performance. In manufacturing settings, workers are frequently exposed to high job demands, repetitive and monotonous tasks, strict production targets, and shift schedules that reduce recovery opportunities and limit decision latitude [ 9 , 18 , 38 ]. This activates a series of psychological and physiological stress responses, such as heightened arousal, emotional exhaustion, and impaired cognitive functioning. When these responses persist without adequate rest and coping mechanisms, they may contribute to symptoms of anxiety and depression, together with occupational burnout and impaired work functioning. From an organisational perspective, these effects always manifest as reduced engagement, higher absenteeism, presenteeism, and productivity loss. Eventually leading to significant indirect economic costs [ 40 , 41 ]. Consistent with the results of meta-analytic evidence, it is anticipated that improvements in psychological well-being and reductions in burnout will result in increased levels of work engagement, greater job satisfaction, and enhanced overall work performance. Simultaneously, these changes may result in decreased absenteeism and presenteeism, as well as reduced dependence on healthcare services [ 35 , 38 , 40 , 41 ]. These dual psychological and economic benefits provide a clear rationale for evaluating the effectiveness and cost benefit of the WMHP in food manufacturing settings where psychosocial risks are often overlooked compared to physical hazards. For evaluation purposes, this conceptual framework is operationalised using an Input–Process–Output (IPO) logic model [ 42 , 43 ]. Fig 2 illustrates the conceptual framework of the WMHP based on the IPO model, outlining the logical linkage between program resources, intervention processes, and resultant psychological, work-related, and economic outcomes. Download: PNG larger image TIFF original image Fig 2. Conceptual framework of the WMHP based on the Input–Process–Output (IPO) Model. https://doi.org/10.1371/journal.pone.0360481.g002 The IPO model provides a structured framework in understanding how programme components and its mechanisms are expected to produce measurable outcomes. As for the inputs, it consists of organisational and program resources such as trained facilitators, intervention materials, management support, and allocated time, together with relevant individual and workplace factors that may influence program implementation. These inputs support the intervention processes that include series of activities such as psychoeducation sessions, mindfulness practice, progressive muscle relaxation, and breathing exercises. These activities are designed to promote stress management, coping, and emotional regulation among participants. The final outputs occur across several levels. The program is expected to reduce symptoms of stress, anxiety, depression, and burnout while improving psychological well-being in short term. Intermediate outcomes include increased job satisfaction and reductions in absenteeism and presenteeism. In the long term, these enhancements may result in increased productivity and reduced healthcare utilisation, thereby generating economic benefits for the organization. By linking individual level mechanisms with organisational outcomes, this layered logic model supports an integrated evaluation of programme effectiveness and economic return within a single analytical framework [ 38 , 44 ]. Study setting The study will be conducted in two food manufacturing factories located in Negeri Sembilan, Malaysia. Food manufacturing factories that indicate their willingness to participate will first be compiled into a list. Two factories will then be selected from this list using simple random sampling so that each participating factory has an equal chance of being chosen for the study. The WMHP will be delivered by trained members of the research team using the standardised intervention protocol and materials. Study participants The study participants will comprise of full-time Malaysian workers working in two food manufacturing factories located in Negeri Sembilan. Eligible participants should age between 18 and 60 years old who have been employed at the factory for at least one year, ensuring adequate familiarity with the work environment. No minimum formal educational qualification will be required. However, participants must be able to read and understand either Bahasa Melayu or English sufficiently to review the participant information sheet, provide written informed consent, and complete the self-administered questionnaires. A standardised briefing will be provided before enrolment, during which potential participants may request clarification. Research personnel may provide procedural clarification during questionnaire administration but will not interpret individual questionnaire items or influence participants’ responses. Workers with a diagnosis of psychiatric disorder under active treatment will be excluded. The same goes for workers with chronic illnesses that may independently influence mental health or work performance, such as heart disease, chronic kidney disease, or cancer. Pregnant workers will not be included d
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