INTRODUCTION
According to the 2021 National Mental Health Survey published by the Ministry of Health and Welfare, 18.9% of individuals in South Korea were at risk of depression, and 13.6% had suicidal thoughts [1]. Notably, a 2016 social survey revealed that 55.2% of the population experienced stress in their daily lives, with workplace stress being the highest at 73.3% [2]. While many previous studies have identified a relationship between job stress and symptoms of depression and anxiety, these studies often focused on specific occupations, and the job stress factors associated with depressive symptoms differed depending on the study subjects [3-5].
The proportion of citizens who reported needing psychological counseling or psychiatric treatment has increased over the past 2 years, indicating a change in demand and awareness regarding mental health services. The demand for psychological counseling has increased, and the number of general consultations at mental health welfare centers has also increased significantly, with 1.01 million consultations recorded in the first half of this year, representing a 131% increase compared to 870,000 consultations in 2019. However, among those diagnosed with mental disorders, only 12.1% sought counseling from professionals, such as doctors, for mental health issues at some point in their lives (referred to as mental health services). In South Korea, the utilization rate of mental health services over the past year was 7.2%, which was significantly lower than that in the United States (43.1% in 2015), Canada (46.5% in 2014), and Australia (34.9% in 2009) [1].
According to a meta-analysis conducted in 1977 of the effectiveness of 375 psychological counseling studies, the effects of such counseling were statistically and clinically significant [6]. In domestic peer counseling research, the effectiveness of counseling is generally set in terms of interpersonal relationships, self-concept, social skills, attitudes related to school, and communication [7]. Most outcome studies on counseling in South Korea have validated counseling effectiveness using comparisons between pre- and post-test groups [8]. Although numerous studies have addressed the correlation between job stress and various mental disorders, including depression and anxiety, among workers, few studies have focused on the effectiveness of psychological counseling for individuals who require stress management but do not exhibit clear clinical symptoms.
Furthermore, a study examining recent trends in counseling psychology in South Korea found that among the outcome studies published from 2000 to 2009, mostly focused on children and adolescents (20.3%) and college students (37.1%), while studies involving adult workers were limited [8]. Therefore, this study aimed to investigate the effectiveness of psychological counseling conducted in the workplace, not only in clinical groups but also in stress management groups among workers. To confirm the effectiveness of counseling, pre- and post-evaluations using the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) counseling effectiveness assessment scale were conducted to report the quantitative differences.
METHODS
Study participants
This longitudinal study included of Koreans aged 18 to 65 years who attended a mental health program at the Workplace Mental Health Institute, Kangbuk Samsung Hospital, Seoul, South Korea. Participants comprised 93 employees from 12 companies and local government organizations who voluntarily participated in psychological counseling services conducted at the workplace upon invitation from their companies and completed the CORE-OM at least twice.
Measures (CORE-OM)
The CORE-OM was developed in the late 1990s in the United Kingdom as part of an effort to create a tool that could comprehensively measure key outcomes in counseling and is usable by both counselors and researchers [9]. It consists of four sub-domains: subjective well-being, psychological problems, life functioning, and risk, comprising 34 items. Responses were recorded on a five-point Likert scale (0 [not at all] to 4 [most or all of the time]), with higher scores indicating more severe psychological issues and lower functional levels. Scores were calculated using the mean total score and the mean score for each sub-domain.
Study design
Counselors administered the CORE-OM twice to participants who voluntarily sought individual psychological workplace counseling and agreed to participate in the study; once before starting or after the first counseling session, and again after the counseling concluded. Individual counseling sessions were conducted without specifying a particular counseling approach or the number of sessions, based on the issues or symptoms presented by the clients; each session was 50 minutes long. Participants who did not complete the CORE-OM after counseling were excluded from the analysis. The data were collected between February 2022 and December 2023.
Reliable change analysis
The informed consent was waived because the research was based on general survey. Jacobson and Truax [10] developed the reliable change index (RCI) formula to determine whether the changes observed in participants during the process of measuring counseling effectiveness are clinically significant. The RCI is calculated to determine changes in participants that are reliable and not due to chance or measurement error.
X1 represents the mean pre-CORE-OM score and X2 represents the mean post-CORE-OM score. Sdiff is the standard error (SE) of the difference between the two scores [11]. Sdiff represents the range of the expected change scores even if no actual change occurred. S1 is the standard deviation (SD) of the pre-scores and rXX denotes the reliability of the measurement tool. As the SE of the measurement corresponds to the SD of the theoretical distribution, a general interpretation of the SD of a normal distribution can be directly applied. Specifically, at a 95% confidence level, an RCI value greater than 1.96 suggests that it would be unlikely to occur in the absence of actual change. The CORE-OM indicates lower psychological well-being and a functional level with a higher score. Therefore, for participants where a positive improvement is observed, the reliable change (RC) value is adjusted by changing its sign after the calculation [12].
Statistical analysis
A paired t-test was performed on the total CORE-OM scores before and after the intervention. Similarly, a paired t-test was performed for the CORE-OM scores in the four sub-domains before and after the intervention. The difference in changes in total score by sex was calculated using an independent samples t-test, assuming equal variances, whereas the difference in changes in total score by psychological state of the groups was calculated using an independent samples t-test, assuming unequal variances. Additionally, the differences in the mean scores of the groups by cumulative sessions were assessed using a one-way analysis of variance (ANOVA), followed by Scheffe’s post hoc analysis. Finally, a RC analysis was performed and the changes in mean scores by RC groups were calculated using an independent samples t-test assuming unequal variance. All analyses were performed using STATA version 18.0 (StataCorp.).
RESULTS
Sociodemographic characteristics
The Workplace Mental Health Institute, Kangbuk Samsung Hospital, targeted participants who agreed to provide information, including 93 employees from 11 of 12 companies participating in the CORE-OM test, having participated in psychological workplace counseling sessions twice or more. The number of participants per company ranged from 1 to 20. Among the 93 participants, 37.6% (n = 35) were male and 62.4% (n = 58) were female. Regarding age distribution, the participants were in their 20s (16%), 30s (66%), 40s (16%), and 50s (2%) (Table 1). According to the assessments of the clinical psychologists, the participants were categorized into the stress management group (57%), at-risk group (1%), clinical group (19%), or normal group (23%). The mean± SD pre- and post-CORE-OM total scores were 1.34± 0.55 and 0.88± 0.41, respectively. A t-test showed a statistically significant decrease in scores from pre- to post-assessment (P= 0.000) (Table 2).
Specifically, for the subjective well-being sub-domain, encompassing items 4, 14, 17, and 31, the mean pre-counseling score was 1.69± 0.77 and the mean post-counseling score was 1.086± 0.58 (P < 0.001). Similarly, for the psychological problems sub-domain, encompassing items 2, 11, 15, 20, 5, 23, 27, 30, 8, 18, 13, and 28, the mean pre-assessment score was 1.56± 0.68 and the mean post-assessment score was 1.017± 0.53 (P= 0.000). For the life functioning sub-domain, encompassing items 7, 12, 21, 32, 1, 3, 19, 26, 10, 25, 29, and 33, the mean pre-assessment score was 1.51± 0.60 and the mean post-assessment score was 1.073± 0.50 (P< 0.001). Finally, for the crisis sub-domain, encompassing items 9, 34, 16, 24, 6, and 22, the mean pre-assessment score was 0.34± 0.45 and the mean post-assessment score was 0.097± 0.22 (P < 0.001).
The mean change in the total score did not significantly differ by sex, at 16.69 for males and 15.02 for females. Additionally, the mean change in the total score by psychological state for the 53 participants in the stress management group, 18 in the clinical group, and one in the at-risk group (totaling 72 participants categorized as the problem group) was 17.25; that for the normal group was 10.14. The t-test showed a statistically significant difference in changes in the total score by psychological state.
The second analysis approximately classified cumulative sessions into quartiles, and group differences in the means of the total score were determined using ANOVA. When divided into groups based on cumulative sessions, 26.88% had 4 sessions or fewer (group 1), 51.61% had 5–7 sessions (group 2), 83.33% had 8–10 sessions (group 3), and 100% had 11–20 sessions (group 4), with significant differences between groups (P= 0.0023). Scheffe’s post hoc analysis revealed a significant mean difference of 0.007 in the total score between group 1 and group 4: the group with four or fewer cumulative sessions differed significantly from the group with 11 or more sessions.
Participants were further classified into groups based on cumulative sessions, at 26.88% with 4 sessions or fewer (group A), 51.61% with 5–7 sessions (group B), 69.89% with 8–9 sessions (group C), and 100% with 10–20 sessions (group D). The total scores of the groups significantly differed (P= 0.0031). Scheffe’s post hoc analysis revealed a significant mean difference of 0.006 in the total score mean between group A and group D (Table 3).
Of the 93 participants, 36 (38.71%) had RC. Assuming RC1 for the group with negative RC less than 1.96, and RC2 for the remaining group, the mean changes in scores in the RC group were examined using an independent samples t-test assuming unequal variances. The mean total score between the two groups showed a statistically significant difference (P< 0.001). However, the changes in the mean score in the RC1 group ranged from 0.03 to 0.41, which was smaller than the change in the mean score in the RC2 group, ranging from –1.35 to 2.21.
A sub-analysis was conducted on the 36 of the 93 participants who showed RC. Based on their psychological state, they were categorized into a normal group (nine individuals) and a problem group (27 individuals). For participants where the RC was less than 1.96, the mean total score of the problem group (0.23) was significantly different than the normal group (0.19) (P< 0.05).
In addition, the cumulative number of sessions ranged from 1 to 15, with a mean of 7.42. The participants were classified into two groups; eight or more cumulative sessions or fewer than eight cumulative sessions, assuming equal variances, and an independent sample t-test was conducted. For participants where RC was less than 1.96 and they had eight or more cumulative sessions, the mean total score was statistically significantly different (P= 0.013).
DISCUSSION
This study demonstrated that the effectiveness of psychological counseling conducted at the workplace for South Korean employees, as measured by the CORE-OM, increased with the number of sessions. This finding aligns, to a degree, with previous studies that estimated the number of counseling sessions required for individuals with mental disorders to recover to a normal functioning level: approximately eight sessions for 50% recovery and approximately 21 sessions for 85% recovery [13]. This is consistent with numerous studies conducted from the 1950s to the 2000s, which have consistently shown a positive relationship between the number of counseling sessions attended by clients and the effectiveness of counseling. Accordingly, this underscores that as counseling duration increases, the therapeutic benefits increase [14-16]. However, most previous studies have targeted children, adolescents, and college students, making the current study distinct in estimating the appropriate number of sessions that demonstrate RC among adult working professionals. Furthermore, statistically significant decreases were observed in the post-intervention scores compared with the pre-intervention scores, across all sub-domains. The most significant reduction was observed in the psychological problem sub-domain. In contrast, previous studies have evaluated counseling outcomes by measuring various changes, such as specific psychological problem improvements, subjective well-being, subjective discomfort [17], positive emotions [18], satisfaction with basic psychological needs [19], clinical scales, health and functional levels, and life functioning [20]. However, highlighting specific areas where counseling outcomes are prominent may be meaningful in timely contexts.
The changes in the total score did not significantly differ by sex. This finding aligns with the conclusions of meta-analyses on the relationship between sex and outcomes in psychological counseling, indicating lack of statistical significance sex and therapeutic outcomes [21]. Furthermore, this aligns with the finding in this study showing no effect of sex on the impact of short-term counseling on developmental changes in the participants [22].
In addition, the changes in the total score by psychological status differed significantly. This finding aligns with the expectation before the study that greater changes would be found in the problem group.
Finally, when participants were divided into quartiles based on cumulative session numbers, the change in score in the group with 11 or more sessions was higher than that in the group with 10 or fewer sessions. This indicates that clinically, when individuals who require psychological counseling attend the sessions, a slight but notable difference exists in the change in score when more than 10 sessions are recommended, empirically. As seen in previous studies analyzing the dose-effect relationship in psychological counseling, a mean of 11 sessions was required for functional improvement in patients with functional disabilities [15]. These results suggest that the therapeutic effects obtained by individuals may be greater when long-term psychological counseling exceeds 10 sessions compared to short-term interventions that last fewer than five sessions.
Additionally, an analysis was conducted using the RCI value, which is a commonly used metric for assessing effectiveness in psychology and counseling. When classifying the participants into groups based on the criterion of eight sessions, which is close to the mean number of sessions for all participants, those with eight or more sessions showed a significantly greater difference in the mean score. This suggests that for the RC group, eight or more sessions of counseling is more effective. Although the exact number of sessions was not specified, it was concluded from both the analysis dividing the entire group into quartiles and the RC analysis that the effectiveness increases as the cumulative number of sessions increases. In other words, long-term counseling was more effective for individuals than short-term counseling. Even when considering individuals who may have experienced some alleviation of acute issues through short-term interventions, consistent long-term counseling with individuals who require interventions is clearly more effective.
This study investigated the effectiveness of workplace psychological counseling conducted in South Korean workplaces and determined the recommended number of counseling sessions required to observe the effects. This distinguishes itself from the predominant literature that has focused on students diagnosed with existing illnesses. However, this study had several limitations. Employees from 11 companies were targeted, which makes it challenging to generalize the findings to all South Korean workers. Large-scale studies with more participants who complete both the pre- and post-assessments are necessary in the future.
Additionally, the study was conducted among companies that have contracted with the a specific institution, potentially influencing the results because of the focus on employee mental health management in their internal culture, which may introduce a selection bias. Moreover, counseling effectiveness was evaluated using a single measure, the CORE-OM, without a multifaceted evaluation across various domains, such as anxiety, depression, functioning, and physical health. Sociodemographic characteristics in addition to age and sex, such as marital status, education level, occupation, and comorbidities, were not included in the study.
In conclusion, psychological counseling for office workers showed increased effectiveness, as measured by the COREOM, as the number of sessions accumulated. All four sub-domains (subjective well-being, psychological problems, life functioning, and crisis) improved after counseling. When analyzed by dividing the cumulative sessions into quartiles, longterm counseling (more than 11 sessions) was found to be more effective than short-term counseling (less than five sessions). Additionally, the RC analysis indicated that approximately 36% of all participants showed RC, and the group with eight or more sessions had greater change than the group with fewer than eight sessions, further confirming that greater cumulative sessions lead to better outcomes.
PDF Links
PubReader
ePub Link
XML Download
Full text via DOI
Download Citation
Print
