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Rapid Overview
The aim of this project was to conduct a rapid review of interventions to explore the use of WEMWBS and evaluate which interventions are the most effective at increasing wellbeing.
Specifically, we aimed to answer the following research questions:
1. What evaluation research has been carried out to assess the effectiveness of programmes and pilots on mental wellbeing, as defined by WEMWBS?
2. What is the strength of evidence of the evaluation research? 3. What are the key findings from the evaluation research?
In this comprehensive rapid review of traditional databases, grey literature and a Call for Evidence, we identified 228 records (209 unique studies) that used the WEMWBS to assess how different interventions improved wellbeing.
Based on a priori knowledge, mapping exercises and consultation with experts, five key intervention themes emerged: Psychological (n=80); Social (n=54); Art, culture and environment (n=29); Health Promotion (n=18); and Other (n=28).
Evidence was synthesised across nineteen subthemes.
The meta-analyses examining change in WEWMBS score from pre to post intervention maximised the number of studies which could be included (n=188; 84%) and therefore provides the best assessment of what worked to improve wellbeing. Where >0.60 indicates a large effect size, >0.50 indicates a medium effect size and >0.20 indicates a small effect size, it was evident that interventions based on building emotional resilience, focusing on personal wellbeing and learning self-management techniques had the greatest impact on wellbeing (n=15 of 18 studies). Other interventions with medium to large effects included those related to art and social or psychological aspects. There was no evidence to suggest that peer-support or environmental interventions altered wellbeing and there was insufficient evidence from the remaining subthemes to make other conclusions. However, there was a general trend that counselling, large-scale funding interventions and recovery colleges each improved wellbeing. Finally, the impact of person-centred support and advice interventions appeared large, but a single SMD could not be estimated due to substantial differences in intervention design, delivery and target demographic. Effect sizes of all meta-analyses are presented in Table 1.
Due to the breadth of studies captured in this review, it is unsurprising that single interventions had substantially larger impacts than others on wellbeing. For example, larger improvements in wellbeing were commonly observed in studies with longer interventions (e.g. weekly sessions for 6- 12 weeks) compared to single sessions. Due to differences in design and delivery of each intervention, the overall SMD in each meta-analysis must be interpreted with caution. While the SMD provide an overall indication of what type of interventions work, further investigation into the components of successful intervention (e.g. target demographic, setting, length, frequency and duration) is needed. The WWCW Quality Checklist: quantitative evidence of intervention effectiveness suggested that there was moderate to high quality of evidence across included studies. However, as described above, the checklist is likely to have overestimated the quality of the studies. The key limitation of the evidence base was the lack of control groups, which are crucial for assessing if the intervention worked.
Only 77 of 208 studies examined a control group, with just over half of these using randomisation to allocate individuals to condition. The lack of control groups shifts the summary of evidence substantially (see Appendix F & G). For example, interventions on resilience, wellbeing and self-management appeared to have the largest positive impact on wellbeing when considering pre and post scores in the intervention group for all studies (see Table 1), however no study found evidence supporting the intervention in comparison to the control group (n=3 null associations; n=0 positive). Other subthemes that had strong evidence of improved wellbeing from pre to post but little to no evidence when compared to a control group included: psychoeducation, person-centred support and advice, community and peer support, social prescribing.
This rapid review summarises the key findings of mental wellbeing interventions conducted over the past 15 years and highlights several areas for future research. There was clear evidence that a broad range of interventions are effective at improving mental wellbeing, with medium to strong effects shown for psychological, social and art interventions. However, the quality of the evidence and the heterogeneity between individual intervention design, delivery and target group makes it challenging to draw strong conclusions, particularly the absence of a control group in most studies. With specific methodological changes in place, the valuable work that various stakeholders (e.g. from the NHS, government, academia, community organisations) are doing will help improve national wellbeing, and help future researchers and policy makers understand what works for mental wellbeing.