Addressing Psychosocial, Organizational, and Environmental Stressors Emerging From the COVID-19 Pandemic and Their Effect on Essential Workers' Mental Health and Well-being

Stress has taken a heavy toll on essential workers’ physical and emotional health during the COVID-19 pandemic. Armed with an understanding of what psychosocial, organizational, and environmental factors are significant contributors to, or mitigators of, stress, employers can take steps to effectively protect and promote employee health and wellbeing.

Abstract

Objective: This study aimed to identify stressors faced by essential workers amid the coronavirus disease pandemic and effective interventions mitigating these stressors. Methods: We reviewed literature on psychosocial, organizational, and environmental stressors faced by essential workers during the pandemic, the consequences of those stressors, and interventions to improve worker health and well-being. Findings: Stressors included elevated risk of coronavirus disease 2019 exposure, fear of spreading the virus, lack of social and organizational supports, and financial insecurity. Negative outcomes included burnout, depression, and high turnover. Promising interventions included robust safety protocols, increased wages, childcare benefits, enhanced access to mental health services, and frequent leadership communications. Conclusion: Stress has taken a heavy toll on essential workers' physical and emotional health, productivity, and job satisfaction. To effectively protect Total Worker Health, employers should adopt evidence-based interventions promoting psychosocial, organizational, and environmental health and safety.

LEARNING OUTCOMES

• Readers are expected to list three psychosocial, organizational, and environmental (POE) stressors faced by workers as a consequence of the COVID-19 pandemic.

• Readers are expected to list three POE outcomes resulting from their experience with the COVID-19 pandemic.

• Readers are expected to list three POE interventions available to employers to address mental health and well-being challenges faced by workers as a consequence of the COVID-19 pandemic.

Given the rapid evolution of who works, how they work, and where they work— developments that have accelerated in response to the coronavirus disease (COVID-19) pandemic—the workforce and workplace are being transformed in ways that will have lasting consequences postpandemic.¹ Moreover, given that a substantial proportion of adult life is spent at work, exposed to workplace stressors, hazards, and toxins, one's job and factors surrounding that job can be viewed as social determinants of health and important contributors to larger population health or illness.² Thus, there is a critical need to explore how large-scale disruptions like the COVID-19 pandemic have and will affect the workforce and workplace with specific attention given to mental health, substance use disorders, and well-being. Furthermore, it is important to understand the underlying mechanics of resilient workplace structures that support and maintain workforce health, well-being, and productivity before, during, and after crises.

Essential workers, in the context of the COVID-19 pandemic, were those whose employers required them to continue to report for work to a location outside the home during mandatory stay-at-home orders rather than to work remotely. Such workers perform jobs critical for the functioning of society and that support a viable infrastructure. Because of the nature of on-site work during the pandemic, essential workers had more contact with coworkers and the public, which likely put them at higher risk for exposure to the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) virus.³ Given the added stresses placed on essential workers, we targeted this population to explore which modifiable psychosocial, organizational, and environmental (POE) risk factors were associated with negative health outcomes and which existing or novel workplace interventions are available to effectively mitigate these negative impacts of the COVID-19 pandemic or similar public health emergencies.

To this end, we conducted a literature review focused on occupational stressors (either introduced or exacerbated by COVID-19) and their outcomes among essential workers. For the purposes of this review, we reference all essential workers, unless discussing a specific subset of the workforce, such as food service, health care, or retail personnel.

Applying a POE Framework

The interaction of various psychosocial factors (P), organizational conditions (O), and environmental exposures (E) can drive beneficial or detrimental outcomes for individual workers and enterprises (Fig. 1). These are explained hereinafter.

FIGURE 1.

Psychosocial, organizational, and environmental domains featuring psychosocial factors, organizational conditions, and environmental exposures affecting worker and enterprise outcomes.

Psychosocial and personal factors (P) are aspects of a worker's psychological state, such as mood, stress, cognition, and personality that contribute to physical and emotional health, substance use, safety, and the health and safety of others in the work setting.⁴ Furthermore, one's psychological state of mind is an important consideration when evaluating and tailoring intervention to promote worker or organizational health.⁵

Similarly, social factors provide critical context. For example, experiencing social support inside and outside of work contributes to health, safety behaviors, and workplace interactions.⁶ Other social contexts such as type of job, cultural norms of region or workforce, and experiences of stigma or discrimination play a role.⁷ Work-related and personal trauma are also influential.⁸ Finally, personal characteristics such as demographic features (race, sex, sexual orientation, immigration status, age, and ethnicity) provide critical context given their interplay with social contexts, psychology, and other aspects of POE: organizational conditions and environmental exposures. For example, personal biology, such as illness, genotype, or epigenetic changes, can affect workers' susceptibility and resiliency to exposures or organizational conditions.⁹

Organizational conditions (O) of work include the set of programs, policies, and environmental supports conducive to a healthy and safe workplace culture.¹⁰ Leadership commitment is central to the success of the POE framework because leaders set the tone for organizational efforts that support Total Worker Health by dedicating the necessary staff, time, expertise, and resources for effective implementation. Most importantly, leading by example personifies the types of behaviors desired by officials at an organization.¹¹

Effective leaders understand the trade-offs between their first priority of delivering products and services to customers versus attending to the personal and interpersonal needs of employees. Leaders at all levels, including supervisors at the unit level, are critical to provide on-the-ground coordination of resources across functions. Supportive organizational policies and newly established cultural norms can facilitate the application of worker safety and health practices. Targeted and appropriately resourced initiatives need to be agreed upon using a participatory based decision-making process that involves front-line workers, supervisors, and functional leaders.¹²

Environmental exposures (E) include biological, chemical, mechanical/ergonomic, and physical hazards that are linked to worker illness and injury. For some exposures, these can include neurologic, cognitive, and mental health outcomes. Furthermore, physical comfort (eg, visual, thermal, noise) has also been linked to productivity gains and losses.¹³ Moreover, workplace and personal strategies to reduce exposure to hazards, including to the SARS-CoV-2 virus, can also impact performance by reducing psychosocial stress and enhancing mental health and well-being.¹¹ At the same time, some strategies to reduce exposure to hazards, such as use of personal protective equipment (PPE) for long periods during the COVID-19 pandemic or social isolation,¹⁴ may have unintended negative impacts on the psychosocial environment or organizational conditions and therefore could paradoxically worsen mental health and well-being.

METHODS

A scoping search of the literature was conducted to better understand the stressors faced by essential workers related to the COVID-19 pandemic and to identify associations between these stressors and health and well-being outcomes. Organizational interventions and frameworks that can effectively promote and protect essential workers' health and safety were examined. Figure 2 provides a pictorial depiction of the logic model used as part of the POE framework for this literature review. The search was initiated in October 2021. The databases searched included Google Scholar, PubMed, and Science Direct. The last search was conducted on November 9, 2021. Most of the articles referenced were published in 2020 and 2021 during the height of the COVID-19 pandemic.

FIGURE 2.

Logic model depicting ways POE stressors can be addressed by interventions and the process and outcomes affected.

Key search terms included (in alphabetical order): burnout, COVID-19, employee health, employee productivity, employee mental health, employee attraction, employee retention, essential worker, essential worker health, food production workers, government employees, health care, health care workers, low wage, mental health, occupational health, occupational health and safety, psychosocial health, psychosocial organizational and environmental interventions, restaurant employees, restaurant workers health and safety, service industry, total worker health, turnover, United States, well-being, and worker health. Inclusion criteria for articles included in this review were as follows: the article addressed at least one POE factor related to total worker health, reviewed a workplace program applicable to essential workers' health and well-being, and discussed or was applicable to essential worker health in the context of the COVID-19 pandemic.

Seventy (70) articles meeting the inclusion criteria were included in this review.

RESULTS

Workplace Stressors

The COVID-19 pandemic presented many stressors to the essential workforce, interfering with workers' mental health and well-being, both in and out of the workplace. Using the POE framework, we grouped the stressors presented and exacerbated by the pandemic into three categories: (1) psychosocial, (2) organizational, and (3) environmental, as shown in Table 1.

TABLE 1.

COVID-19 Stressors Faced by Essential Workers

Psychosocial Stressors	Organizational Stressors	Environmental Stressors
• Work-life imbalance • Fear of COVID-19 infection • Isolation and stigmatization • Lack of social support • Feeling obligated to work in extenuating circumstances, including when sick	• Increased job demands without better compensation • Staffing shortages • Irregular shifts • Role conflicts • Low wages • Inconsistency of wage structures • Lack of employer-sponsored benefits • Unhealthy built environment • Workplace harassment and emotional labor • Unclear workplace policies • Poor human and resource management	• Physical environment that is conducive to virus transmission • Frequent human interactions • Exposure to coworkers, clients or patients, or members of the public who have symptoms of illness • Inadequate protections against virus transmission

Psychosocial Stressors

In many ways, the COVID-19 pandemic presented an enormous challenge to the mental health and psychosocial well-being of essential workers. First, it disrupted work-life balance^15–20 as increased demands and irregular schedules took a heavy toll on workers' productivity, resilience, and emotional capacity. At the same time, school and daycare closures across the country significantly exacerbated work-family conflict.¹⁷ In fact, an estimated one million households had at least one adult who could not work because of childcare challenges during the pandemic,²⁰ and many millions may have kept working but struggled because of inadequate childcare resources.

Many essential workers have low income and live in close quarters with family and community members.³ As such, a major source of stress reported by this group throughout the pandemic was fear of COVID-19 infection and fear of spreading it to others.^{8,16,17,21,22} The fear of COVID-19 infection and concern regarding infecting others also led to interpersonal isolation and fear of stigmatization by their community.^{15,17,21–28}

For many workers, reduced staffing, requirements for social distancing, and use of PPE meant losing a sense of workplace community.^{15,17,21–28}

A lack of professional and personal support from supervisors and organizations during the pandemic was commonly reported.^9,15,29–32 With perceived and actual job security at an all-time low for many essential industries, many employees did not feel able to communicate needs and express concerns, which made managerial support even more difficult to attain during the pandemic.^25,30

Organizational Stressors

As organizations scrambled to respond to new challenges brought by the COVID-19 pandemic, workers faced chaos, fear, and uncertainty in their roles. When employers began experiencing staffing shortages and increased workloads due to workplace COVID-19 outbreaks and employee turnover, workers who remained in their roles reported being overwhelmed with increased job demands and new responsibilities for which they were often underprepared or undertrained.^{9,16,19,25,33,34} Role ambiguity, role conflict, and lack of coordination between worker and supervisor expectations were also frequently reported sources of occupational stress during the pandemic.^9,15

Stress over low hourly wages became more pronounced as COVID-19 caused widespread fragility across essential industries—workers already living paycheck to paycheck reported fearing for their futures as they watched their career prospects hang in the balance.^{2,3,6,7,13,14,16,17,19,24–27} For laid-off workers, COVID-19 government assistance in the form of increased unemployment benefits provided many with more money week by week than they were making from work.²⁵

Many workers reported feeling stressed because of irregular shifts or a sudden increase or decrease in hours (depending on staffing levels) during the pandemic, adding to financial insecurities and work-family conflict.^{9,16,20,25,34,35} In some cases, “hazard” pay was discontinued as the pandemic lingered over a longer-than-expected period.³⁶ For food industry workers in particular, the inconsistency of a tipped wage structure made forecasting week-to-week income extremely difficult, exacerbating existing financial stress.^20,25 Results from a 2021 survey of restaurant workers revealed that 51% of those put on leave at the start of the pandemic said that they would not come back to their jobs unless they were offered higher steady wages and consistent schedules.²⁰

Fear of contracting COVID-19 at work amplified workers' discontent and worry over a lack of employer-sponsored benefits.²⁵ Lack of employer-sponsored childcare benefits forced many working parents to stay home with children and sacrifice their income as a result. Lack of paid sick leave resulted in many employees reporting that they came to work while sick, fearing they would lose their job if they took time off to recover.²⁵

Poor human and resource management, such as inefficient work process, unfair organizational practices and policies, poor supervisor behavior, shortages of PPE and other safety resources, unsafe working conditions, lack of coordination between supervisor and employee expectations, and overworking or undertraining employees resulted in uncertainty, stress, fear, frustration, and, in some cases, physical injury among workers during the pandemic. ^{9,15,25,29,32,37}

Workplace harassment, emotional labor, and other interpersonal stressors were also exacerbated by the pandemic, in addition to emotional fatigue from having to “police” the actions of colleagues and customers not following COVID-19 safety protocols.^{9,15,16,25,29,30,38}

Environmental Stressors

Driven by mitigation strategies to limit community and occupational transmission of the SARS-CoV-2 virus, some organizations invested in infrastructure updates to their buildings, such as physical barriers (shields) and air purification systems.¹⁹ However, some work environments remained higher risk because of the nature of the work, such as food service and health care, and these hazards posed significant stressors for some workers.¹⁶ Elevated perceived risk in the work environment (vis a vis virus transmission) was a major correlate of reporting negative mental health outcomes among essential workers.^{4,15,21,22,24,25} For example, more than 75% of respondents in a 2021 survey of restaurant workers reported that their mental health had been negatively impacted in the 12 preceding months,²⁰ largely attributed to work environments that contained frequent human contact, potentially infected working surfaces, and poor ventilation, which were inherently conducive to fomite-based, airborne, or aerosol virus transmission.^{4,15,16,19,20,22,24,25,34,39,40} Another example was found in the 2021 study of grocery workers by Ceryes et al.¹⁶ The authors found an association between heightened psychological distress and the inability to socially distance at work, lack of access to sufficient PPE, and having to commute via public transit throughout the pandemic.¹⁶

Stress Modifiers

The severity of stress experienced by essential workers during the COVID-19 pandemic was associated, in varying degrees, with individual characteristics that may have functioned as occupational stress modifiers. The most common individual occupational stress modifiers identified were sex, age, socioeconomic and sociodemographic status, education level, seniority, preexisting health conditions, and family status.

Within the essential workforce, females experienced higher levels of occupational stress compared with their male coworkers.^{9,21,24,31,41} Elevated stress in female workers was attributed, in part, to the “double stress” women faced in managing increased responsibilities at home in addition to higher levels of workplace discrimination.⁹ A 2021 report identified that employees with children at home due to school closures had higher levels of anxiety or depression “even when counseling needs [were] met.”¹²

Low-income workers and people of color experienced higher COVID-19 infection rates, discrimination, and occupational stress compared with their White, higher-income counterparts, largely because they represented a higher proportion of the essential workforce and had fewer opportunities to work remotely.^4,9,39 Workers with one or more preexisting health conditions, either psychological or physical, experienced higher levels of stress than their healthier coworkers.⁴²

Although having a higher level of education was associated with higher occupational stress relative to less educated workers, seniority and job tenure were negatively correlated with stress levels in workers.^9,26 Young employees (aged 20–30 years old) were at the highest risk of any other working age group to experience heightened stress and other negative mental health outcomes.^{9,21,24,26,31} Nonmarried essential workers also reported higher levels of occupational stress than their married coworkers.³¹

Finally, the pandemic negatively affected many non–health care employees working in health care settings, such as in food services and maintenance.⁴³ These workers were routinely exposed to COVID-19 patients and deaths, yet they were mostly excluded from the widely popular “health care heroes” narrative.⁴³

Outcomes Associated With COVID-19 Stressors

As new and exacerbated stressors stemming from the COVID-19 pandemic became everyday hurdles for the essential workforce, negative psychosocial and physical outcomes surfaced for individual workers as well as their organizations. Some of these outcomes are listed in Table 2.

TABLE 2.

COVID-19–Related Outcomes

Psychosocial Outcomes	Physical Outcomes	Organizational Outcomes
• Psychological stress, distress, and anxiety • Burnout • Stigma and feelings of isolation • Posttraumatic and other stress disorders • Insomnia • Anger and cynicism • Behavioral deviance	• Heightened risk of contracting COVID-19 • Heightened risk of sustaining an injury • Substance and alcohol use • Death	• High employee turnover rates and voluntary resignations • Inability to fill job vacancies • Decreased employee productivity

Psychosocial Outcomes

A majority of studies identified psychological stress, distress, and anxiety as the leading psychosocial outcomes out of all the psychosocial outcomes experienced by essential workers because of stressors caused by the COVID-19 pandemic. ^{3,8–10,12–14,16,17,20,22,27,31,33,37,38} Essential workers reported experiencing symptoms of burnout because of the added stress and demands that the pandemic brought.^9,22,24 Burnout is associated with a range of symptoms, including loss of concentration, impaired cognitive function and judgment, and inability to effectively problem solve.^9,23,33,37 Depression and related symptoms were also commonly reported because of a host of factors such as feelings of isolation at home and at work, stigmatization, interpersonal conflict, worry for the future, continual exposure to the virus, and regular reminders of death.^{8,9,21–25,28,41,44,45}

Essential workers in health care settings (regardless of whether they were in caregiving roles or not) reported feeling symptoms of trauma and posttraumatic stress disorder as a result of proximity to death and illness, constantly thinking about death, and witnessing death and severe illness in coworkers and patients.^26,41,44,46 In some cases, essential workers reported experiencing trauma and deep guilt because they felt responsible for passing the virus to loved ones and community members who either became ill or died. ^26,41,44,46 Essential workers, especially young workers, experienced heightened anger and cynicism because of low wages, low decision latitude, job insecurity, unsafe working conditions, poor management, lack of benefits, overwork, and other pandemic-related stressors at work.^7,27,33

Coronavirus disease stressors also negatively impacted essential workers' health behaviors, such as increasing alcohol and substance use as a mechanism of self-prescribed stress relief,^18,23,29 not sleeping enough, and decreasing physical activity.²⁹ Insomnia and other sleep issues were reported by essential workers to be a result of pandemic-related stressors that disrupted their sleep routines. These included long or irregular work hours, loss of consistent routine,^{9,21,22,26,29,33,44} stress, distress, anxiety, depression, and trauma. ^{9,21,22,26,29,33,44} Other behavioral impacts such as impaired decision making and judgment, loss of motivation, antisocial behavior, lateness, reluctance to work, noncompliance with safety protocols, absenteeism, and interpersonal deviance were reported by essential workers and their employers to be either brought on or worsened by pandemic-related stressors.^{8,9,18,23,33,47,4849}

Physical Outcomes

Essential workers experienced a higher-than-average burden of many poor physical outcomes during the COVID-19 pandemic. According to a study conducted at the University of Pennsylvania's Wharton School of Business, essential workers were 55% more likely to contract COVID-19 compared with nonessential workers during the pandemic, disproportionately affecting low-income people and people of color.⁵⁰ Essential workers were also found to experience heightened rates of chronic fatigue, lethargy, headaches, increased blood pressure, and increased risk of cardiovascular disease.^9,37 Rao et al³ found a positive association between per-capita COVID-19 death rates and a community's concentration of essential workers.

The change in the pace of work combined with added stress led to a heightened risk of sustaining an injury at work.^9,29 It was not uncommon for essential workers to also report symptoms of long COVID and other long-lasting complications such as difficulty breathing, chronic fatigue, and other physical impairments or disability.⁵¹

Organizational Outcomes

Low employee retention and high turnover rates were characteristic of essential industries throughout the pandemic, particularly in food services, health care, transportation, and hospitality.^{6,9,20,25,47,52,53} Of note, voluntary resignations in the restaurant industry were at an all-time high during the pandemic's height²⁰; in addition, many restaurant workers who had not yet quit their jobs were either contemplating or had the intention of leaving their job in the near future.^6,9,25,47 A 2021 study of the restaurant industry revealed that full-service restaurants were operating with roughly six fewer employees in the “back of the house” and approximately three fewer employees in the “front of the house” compared with 2019.²⁰ There were also 70% more job vacancies and 10% fewer people looking for work in the United States compared with prepandemic. This shortage of staff meant that restaurants had to offer higher wages and incentives to attract new employees.²⁰ According to the same study, 71% of respondents believed that higher payment through unemployment benefits or jobs in other industries was the primary driver of the restaurant industry's labor shortage, along with lack of benefits, inconsistent hours, and low wages.²⁵

Throughout the pandemic, many employers saw a decline in workers' quality of performance, exhibited by inefficient work practices, absenteeism, noncompliance with safety protocols, lower quality customer or patient services, and other unusual behaviors.^{9,37,47,48,54,55} Employees cited lack of motivation, job dissatisfaction, low decision latitude, inability to concentrate, demands outside of the workplace, and compassion fatigue as reasons for this decline. ^{9,37,47,48,54,55}

Occupational Interventions to Address COVID-19 Stressors

The literature search uncovered a range of dynamic, promising, and effective occupational intervention strategies to mitigate the POE outcomes affecting workers' mental health and well-being. Common characteristics of successful occupational interventions are summarized below in Table 3.

TABLE 3.

Occupational Interventions to Address COVID-19 Stressors

Psychosocial Interventions	Organizational Interventions	Environmental Interventions
• Facilitating employee resiliency and self-help behaviors • Promoting interpersonal support and social connectedness • Using digital mental health resources and apps • Promoting workplace culture, camaraderie, and morale • Administering education, training, and stigma reduction • Providing robust and accessible professional mental health services • Offering psychological first aid, crisis counseling, and other rapidly accessible mental health services • Measuring impact of COVID-19 and making changes to mental health strategies	• Regular, clear, and coordinated communication • Supportive leadership and management practices • Flexibility and supporting work-life balance • Participatory interventions and problem solving • Organizational resiliency and job security through reallocation of resources • Increased wages and benefits • Emergency benefits, services, and additional COVID-19 assistance	• Implementation and enforcement of robust safety measures • Supplying sufficient PPE to all employees

Psychosocial Occupational Interventions

Organizational encouragement of employee “self-help” and self-care behaviors, facilitated through organizational policies and employer-sponsored access to digital platforms, has been associated with higher stress management and resilience in employees.^{31,33–35,56–58} Supervisors have been found to play an important role in empowering employees to self-advocate and self-monitor.^35,56 Research has shown that perceived self-efficacy and having tangible career prospects, along with demonstrated organizational support and high decision latitude, allow workers to become more resilient to occupational stressors.⁴⁶

One of the most powerful indicators of people's mental health is feeling a sense of support, connectedness, and belonging to one's family, friends, and community.^{21,23,46,53,58,59} Organizational interventions that facilitate interpersonal support and social connectedness begin with supervisors who lead by example,^{15,21,23,30,58,60} highlighting shared goals and promoting a team growth mindset.^15,61,62 One-on-one, small group, or team meetings aimed at understanding what workers are going through, how the organization can better support employees moving forward, and what experiences employees share among each other are reported to be effective in achieving supervisory support goals.^33,34,61,63 Some employers implemented “buddy” systems, encouraging employees to regularly check-in with colleagues for mutual support at work. This has been shown to reduce workers' psychological distress and feelings of isolation in times of high stress as well as enhancing perceived organizational and interpersonal support.^27,34,63 Organizations used communication platforms (such as Slack or Teams) and allowed employees to check-in with one another outside of work.^33,34,61,63

Promoting a positive and cohesive workplace culture is essential to optimizing organizational functioning and maintaining high morale amid crises such as the COVID-19 pandemic.^20,25,27 Organizations and supervisors have done so by integrating informal aspects of fun into the workplace, such as light-hearted team challenges and employee social events.⁵³ Furthermore, supervisors promoted camaraderie, teamwork, and adoption of leadership and growth mindsets.^27,57 Research has shown that, when teams learn and grow together, overall workplace functioning, collaboration, and performance improve substantially, which promotes individual resilience and organizational sustainability during uncertain times.^27,57

The pandemic has underscored the need for organizations to provide pandemic-specific education programs and trainings to equip workers with essential emotional, practical, and cognitive skills and supports necessary to effectively cope with heightened occupational stress. Some employers have adopted psychological trainings informed by employees who worked throughout the pandemic¹² and emotional “inoculation” techniques—employers educate employees on the potential impact of forthcoming stressors and allow them to develop coping plans before the stressors occur so that employees will be prepared and equipped with resources to quickly act upon stress-producing situations. These techniques have been shown effective in protecting health care workers' psychological well-being during the 2014–2015 Ebola epidemic and the 2003 SARS outbreak in Canada.⁴⁶

Organizations also worked to destigmatize employees who are seeking mental health resources through awareness and education programs (eg, inviting expert speakers, holding trainings, and providing tools in the form of mental health first aid).^{12,15,35,41,64} Regularly messaging employees about what mental health resources are available to them has also been a successful means of raising awareness and destigmatizing mental health care.¹²

Much of the existing literature supports expansion of employee assistance programs to offer online mental health resources,^12,61 such as free counseling or other mental health services via telehealth platforms.^12,31,33,61 Organizations have also removed barriers to mental health resources by providing free subscriptions to mental health applications. ^12,31,33,61 Nicksic¹² and Integrated Benefits Institute strongly recommended giving employees unlimited visits to mental health providers to foster continuity of care.^{41,45,58,61,63} Some employers made free counseling available in employee rest areas, allowing staff to decompress during the workday.⁴⁶ Employers also informed employees of available emergency counseling services, mental health crisis hotlines, drop-in mental health clinics,^31,33,63 and psychological first aid programs for employees experiencing acute trauma symptoms.⁶¹

Although many of the aforementioned resources have been made available to employees, there is inadequate research focused on the impact these interventions had on employee mental health and well-being.¹²

Organizational Interventions

The most effective strategy for organizations and supervisors to implement highlighted in the literature was to regularly engage with workers in clear and coordinated communication.^{5,19,25,27,30,33,38,41,44,58,62,65,66} Effective virtual and in-person communication structures were shown to increase organizational efficiency and achieve employee buy-in (adherence) more likely.^{5,19,25,27,30,33,38,41,44,58,62,65,66}

Social and family-specific supervisory support was a major influence on employee health and well-being, resulting in reduced work-family conflict, increased job satisfaction, and improved perceptions of organizational support.^{8,27,59,67,68} Supervisors were encouraged to make themselves available to their staff, be transparent, welcome constructive criticism, listen empathetically in times of grief or high stress,²⁷ give positive employee feedback,⁶¹ recognize employees' hard work, and inform workers of alternative work arrangements, resources, and career growth opportunities available to them.^12,15,20

Flexible work arrangements,^19,20,29,61 such as flexible hours, condensed work weeks, cross-training, offering low-exposure positions to high-risk workers, and implementing “core [availability] periods”⁶¹ (outside of which hours can be flexible), were found to reduce work-family conflict and lower levels of anxiety and depression in workers.²⁹ Organizations also introduced less punitive absence policies so that employees did not fear reprisals for not attending work if they felt unwell.^19,69 Organizations also developed reintegration protocols, including reassimilation training, education programs, and resources that provided emotional and physical support for employees returning after pandemic-related leaves of absence.²⁷

Some organizations included workers in the development, implementation, and ongoing evaluation of interventions through focus groups, employee feedback surveys, and individual health risk assessments.^{12,15,19,57,60,61,66} Research shows that giving workers the opportunity and authority to participate in decision-making processes increased organizational efficiency, led to more effective interventions, gave employees a sense of ownership (incentive to “buy-in”), and, in general, achieved positive outcomes for employees' mental health and organizational performance during the pandemic. ^{12,15,19,57,60,61,66}

Some employers responded to organizational imbalance caused by the pandemic by reallocating resources and finding ways to improve organizational resiliency. To provide additional assistance to employees in roles with lower job security, organizations arranged for pay-cuts in executive and management (low-risk) roles.^25,61 In some cases, organizations provided furlough leave to employees who could not work because of temporary organizational insolvency or personal health reasons, which improved reported job security. Others established work-sharing arrangements, trained employees to perform tasks outside of their normal duties,^19,61 and developed contingency plans to deploy in the event of staff shortages so as not to overburden remaining employees.¹⁹

Organizations found other ways to rethink their business models to better serve the interest of workers during the pandemic.^28,61 For example, one food service organization phased out structured tipping models and instead put in place a more consistent payment model to stabilize employees' income.^20,25,70 Offering higher livable wages has been shown to effectively support employee retention and attraction.^{20,25,52,68,70} Alternatively, some employers offered ongoing “hazard pay” for high-risk roles.²⁰ Offering workers opportunities for career growth has also been shown to improve employee retention.^52,70

Many organizations expanded health benefits^{20,25,61,68,70} and offered free access to employee assistance programs^12,61 to support workers and their families during the pandemic. These benefits included mental health care, COVID-19–related medical expenses (for workers and their family members), childcare,⁶¹ eldercare,⁶¹ trauma counseling, additional PTO and sick leave, and generous unemployment packages,^{3,6,7,13,36,55,65} as well as tangible supports, such as food delivery, and alternative housing to protect family members.^25,27,61 The survey of food service workers by Lippert et al²⁵ during the pandemic found a strong desire among respondents for employers to extend full-time benefits to part-time workers. Expanding benefits and making employees feel supported have been shown to produce lower levels of health-related anxiety, work-family conflict, and strengthen organizational loyalty.²⁵

Environmental Interventions

To promote environmental safety during the pandemic, many organizations regularly and clearly communicated required safety protocols, provided up-to-date safety recommendations,^{16,19,20,25,26,38,45,57,61,66,71} offered ample safety resources and PPE to all employees,^{16,19–21,26,27,45,72} and diligently implemented environmental COVID-19 safety controls.^{16,19,20,25,26,38,45,57,61,66,71} To enhance engagement and compliance with safety rules, employers consulted with their workers on the types of environmental interventions that would make employees feel safer at work, and then the employers committed to implementing those policies.⁷¹

Employers also reduced physical and ambient COVID-19 hazards by ensuring that workspaces were well ventilated, facilitate social distancing, and were installed with appropriate physical barriers.^19,59 To proactively prevent disease spread, organizations engaged in activities such as safety planning, training, workshops, and developing participatory safety protocols for employees.^{16,19,26,27,66,72}

DISCUSSION

The COVID-19 pandemic has forced organizations to quickly adapt to the stressors negatively impacting the health and well-being of workers. Whereas different enterprises face unique challenges to the pandemic and its aftermath, there are multiple interventions available within the POE framework.^12,29 For large organizations especially, it may be difficult to standardize intervention implementation and resource allocation across multiple departments and locations. For implementation efforts to take hold, it is important that effective communication, continual alignment, and buy-in from all levels of the organization are in place to support effective uptake of available resources and successful implementation.^12,73

There are many barriers standing in the way of successful interventions, and they include financial constraints, scarcity of PPE and other supplies, supervisor and worker turnover, lack of continuity, job demands, and lack of employee time, knowledge, and required skills to facilitate intervention implementation.^12,73 Furthermore, less is known about how environmental and administrative controls to prevent transmission of infectious agents or manage exposure to other workplace hazards may enhance or detract from the psychosocial environment or workplace culture, which could influence mental health and well-being.

Lack of employee awareness and utilization of resources has been shown to be a significant barrier to effective occupational interventons,^12,31 tying back to ineffective organizational communication. Some employers addressed this by speaking directly to workers one-on-one or through town hall meetings with groups of employees. They also strengthened their managerial training, emphasizing the importance of mental well-being, internally networking to better understand how to reach the right people, developing stronger marketing and communication strategies, and creating incentives for employee engagement.¹²

Many employers faced reluctance or refusal from their employees to acknowledge and communicate when they are experiencing mental health issues, even when showing signs of psychological stress.^12,46,64 Employees often prefer to emphasize tangible problems in the workplace, such as lack of sufficient PPE, over the need for psychological support.⁴⁶ However, the two sets of needs are not mutually exclusive; instead, they are often complementary of each other.

Not discussed in this review is the political blowback experienced by employers and their workers from misinformation and disinformation campaigns directed at public health prevention measures such as mask wearing, social distancing, vaccination, and clinically effective treatments. The hesitancy in adopting recommended public health policies and, in some cases, outright resistance to such policies likely influenced individuals' physical health and their mental health. Such challenges faced by businesses in their public response to the pandemic are beyond the scope of this paper but would be worth exploring in future studies. Of particular interest would be identifying effective strategies employers have used to negate pseudoscience advice offered on the internet and counter such efforts with credible and easily consumed information regarding COVID-19 prevention and treatment.

Finally, there is disconnect between existing research and organizational interventions that consider a POE framework.^21,64 Most existing psychosocial interventions place emphasis on individual psychopathology and not enough emphasis on systemic, structural, social, and environmental factors contributing to poor mental health outcomes. This is concerning because many workers see tangible and structural organizational changes as central in affecting their mental health, more so than individual psychological counseling or therapy.¹²

CONCLUSIONS

The COVID-19 pandemic uncovered numerous POE stressors affecting essential workers. This has led to increases in work-life imbalance, fear of infection, difficulties in navigating a new work environment, and a lack of managerial support as compounding psychosocial stressors. Organizational stressors included increased job demands, low wages, irregular shifts, and poor human resources. Working in an environment with insufficient protection and loosely administered safety controls added stressors to these workers.

Perhaps central to the success of any intervention is vocal and consistent leadership messaging in addressing workforce mental health and well-being. This is achieved when leadership, at all levels of the organization from the CEO to the supervisor, is intentional and unapologetic in its advocacy of individual, organizational, and environmental health, with a clear link to how these factors are inherently tied to organizational resilience and success.

This paper has identified several evidence-based interventions available to employers, classified under the broad categories of POE, which have produced promising results and may be effectively deployed in future crises. There is much that can be learned and applied from the current literature as well from research underway that examines the most effective ways employers can protect and promote the health and well-being of the essential workforce moving forward.