Acciones e investigaciones Sociales. Nº 46 (2025)
179
Esta obra está bajo una licencia internacional CreativeCommons Atribución-NoComercial 4.0.
Mental Health Promotion through training for voluntary agents in the
workplace. A longitudinal study.
Promoción de la Salud Mental mediante formación a agentes voluntarios en
el Medio Laboral. Un estudio longitudinal.
Santiago Gascón-Santos1* , Liu Xiaojia2, Yago Pérez-Montesinos1, Ricardo Fueyo-Díaz1,
Adrián Alacreu-Crespo1, Alejandra Aguilar Latorre1 and Isabel Irigoyen Recalde3.
* Corresponding author: sgascon@unizar.es
1 Universidad de Zaragoza, Departamento de Psicología y Sociología. España.
2 Guangzhou University. School of Education. China.
3 Hospital Universitario “Royo Villanova”. Zaragoza. Gobierno de Aragón. España.
https://doi.org/10.26754/ojs_ais/accionesinvestigsoc.20254610991
Received 2024-08-29. Accepted 2024-10-07
Abstract
Introduction: This longitudinal study presents the first data (at six and twelve months) on the benefits
of implementing a training on first aid dispensing and mental health promotion to a network of
volunteer agents in organisations. In addition to training, the action focused on the creation of
exchange and follow-up groups. The aim was to improve psychosocial conditions in the working
environment, to detect psychopathological symptoms early, to provide support techniques, to
orientate towards health services and to encourage actions that promote well-being. Material and
Methods: 685 employees from 22 companies participated (477 in the intervention group and 208 in
the control group). The following instruments were used: 1) Demographic and employment data
sheet; 2) General Health Questionnaire (GHQ-12); 3) Five items of The Columbia-Suicide Severity
Rating Scale, and 4) Maslach Burnout Inventory (MBI General Survey). Results: The intervention group
showed significant improvements over time in the dimensions of depersonalisation and self-
fulfilment. Differences in General Health, depersonalisation and personal accomplishment were also
identified between this group and the control group. Conclusion: The implementation of a network of
mental health promoters in organisations improved key aspects of employees' psychological well-
Acciones e investigaciones Sociales. Nº 46 (2025)
180
Esta obra está bajo una licencia internacional CreativeCommons Atribución-NoComercial 4.0.
being, confirming the desirability of further study in these settings and underlining the effectiveness
of structured and sustainable interventions for the promotion of mental health in the work
environment.
Keywords: mental health training; health promotion; prevention; suicide; work environment.
Resumen
Introducción: Este estudio longitudinal presenta los primeros datos (a los seis y a los doce meses) de
los beneficios de implementar una formación sobre dispensación de primeros auxilios y promoción de
la salud mental a una red de agentes voluntarios en organizaciones. Además de la formación, la acción
se enfocó en la creación de grupos de intercambio y seguimiento. Se buscó mejorar las condiciones
psicosociales del medio laboral, detectar síntomas psicopatológicos de manera temprana,
proporcionar técnicas de apoyo, orientar hacia los servicios de salud y fomentar acciones que
promuevan el bienestar. Material y Métodos: Participaron 685 empleados de 22 empresas (477 en el
grupo de intervención y 208 en el grupo control). Se utilizaron los siguientes instrumentos: 1) Ficha de
datos demográficos y laborales; 2) Cuestionario de Salud General (GHQ-12); 3) Cinco ítems de The
Columbia-Suicide Severity Rating Scale, y 4) Maslach Burnout Inventory (MBI General Survey).
Resultados: El grupo de intervención mostró mejoras significativas en el tiempo en las dimensiones
de despersonalización y realización personal. También se identificaron diferencias en Salud General,
despersonalización y realización personal entre este grupo y el grupo control. Conclusión: La
implementación de una red de agentes promotores de salud mental en las organizaciones mejoró
aspectos clave del bienestar psicológico de los empleados, confirmando la conveniencia de continuar
con el estudio en estos medios y subrayando la efectividad de intervenciones estructuradas y
sostenibles para la promoción de la salud mental en el entorno laboral.
Palabras clave: formación en salud mental; promoción de la salud; prevención; suicidio; medio
laboral.
INTRODUCTION
Mental disorders affect more than 900 million people worldwide (Sutar, Kumar, & Yadav, 2023) and it is
estimated that more than 700,000 die each year by suicide. In a lifetime, one in three people have had or
will have suicidal ideation (Wang et al., 2024). Suicidal ideation is a phenomenon in which biological,
psychological and social variables interact. Therefore, it is necessary to know the protective or risk factors
in order to plan preventive interventions (Evans, & Abrahamson, 2020; Gullestrup, King, Thomas, & La
Montagne, 2023).
Acciones e investigaciones Sociales. Nº 46 (2025)
181
Esta obra está bajo una licencia internacional CreativeCommons Atribución-NoComercial 4.0.
In Spain and other neighbouring countries, symptoms of mild mental disorders are treated in Primary Care
(PC), with severe cases being referred to Mental Health Services (MHS). This means that many disorders
could have been addressed with pharmacological treatment, or that patients with severe conditions
remain on waiting lists, which contributes to overloading the MHS (Wang et al., 2021). Although developed
countries have high-level health systems, they are far from having a sufficient network to meet the demand
for mental health care (Wang et al., 2021), which is a social challenge with no immediate solution.
The protection and restoration of mental health are concerns of the individual and the community and
consist of actions that create environments and conditions that encourage people to adopt and maintain
healthy lifestyles, as well as the ability to detect signs that go unnoticed or do not reach professionals
(Herrman, & Jané-Llopis, 2012). When someone suspects that they may have a mental health problem, it
is common for them to think that they can solve it on their own. If it gets worse, it is normal that they have
not turned to professionals, or that services are overcrowded. For this reason, "Mental Health Promoters"
(MHPs) can be a support mechanism that acts as a link with health professionals (Kalra, 2012).
There is no doubt that training people on how to act in an emergency or use a defibrillator is an
incalculable benefit. Similarly, having people who know how to provide psychological first aid could
contribute to the early detection of disorders and help to manage these potential cases (Shah et al.,
2020). Likewise, there is consensus in considering workplaces as privileged spaces to carry out health
promotion actions, due to the amount of time spent in them and the special proximity with colleagues
(Laranjo et al., 2015). In this environment, a high percentage of mental problems are caused by
psychosocial risks (Derdowski, & Mathisen, 2023). The European Agency for Safety and Health at Work
indicates that half of workers consider that stress is present in their environment (EU-OSHA, 2020).
Stress and other psychopathologies tend to be denied when they are made public, but if they are
addressed as an organisational problem, and not as a weakness, they can be prevented (Gascón et al.,
2013).
Several research studies have described experiences on the responsibility of individuals in the
management of their own health, showing the benefits of promoting health and well-being at work,
especially in longitudinal studies over time (Jain et al., 2021; Jarman et al., 2016), which increases the
awareness of companies and organisations, understanding that it is not an unnecessary expense but an
investment that favours both individuals and the social climate and the good development of the company
(Graeser, 2011; Ornek & Esin, 2020).
The results presented in this article are part of a longitudinal study aimed at suicide prevention addressed
through continuous promotion of mental health in the workplace. The aim was to involve managers and
workers in improving conditions so that they would be able to detect possible early symptoms of
psychopathology, including suicidal ideation, learn techniques for providing support, referral to health
Acciones e investigaciones Sociales. Nº 46 (2025)
182
Esta obra está bajo una licencia internacional CreativeCommons Atribución-NoComercial 4.0.
services and promotion of holistic health activities. There are warning indicators of mental problems and
it is vital to detect them: changes in eating or sleeping habits, isolation, loss of energy, malaise, feelings of
hopelessness, use of alcohol or other substances, neglect of hygiene habits, etc. (Wanigasooriya, et al.,
2021). These signs can warn of mental and emotional exhaustion, depression or other pathologies, and
can manifest themselves in multiple ways, including as a heart attack or suicide.
High levels of stress are also reflected in poor company performance and higher accident rates due to
errors (O'Connor, Thayer & Vedhara, 2021). The European Union (EU-OSHA, 2020) devotes special
attention to mental health and the prevention of work-related stress. Therefore, the aim of this study was
to create a network of WMP in organisations through training actions and exchange and monitoring groups
to improve psychosocial factors, detect signs of pathology and promote well-being among employees.
In this initial phase, the aim was to observe the trend of the results during the first year of the longitudinal
study. It was considered that adequate on-the-job training of MHPs, as well as participation in the network
and follow-up by the research team, would contribute to improving health indices, reducing the risk of
suicide, which is expected to be confirmed in the five-year research, through measures of variables related
to mental health, well-being or reduction of suicidal ideation.
The following hypotheses were established for this study:
Hypothesis 1: employees and managers of those companies in which mental health training groups
(with their corresponding follow-up) operate, show improvements over time in terms of health
indices, burnout and a decrease in possible suicidal ideation.
Hypothesis 2: the employees and managers of the companies that make up the intervention group
(with actions of the mental health promotion agents) will show differences with respect to the control
group in terms of health indices, burnout and reduction of suicidal ideation.
METHODOLOGY
A longitudinal study is currently being carried out in 47 companies in Aragon (N.E. Spain) in its three
provinces of Huesca, Teruel and Zaragoza. However, in the present article, the results of the first phase
of the study in the province of Zaragoza are shown, therefore, this study was a pragmatic parallel
controlled trial consisting of two arms with pre-, 6-month follow-up, and 12-month follow-up
measurements. Data collection was conducted from February 2023 to June 2024. At all three
assessments, participants received information sheets, informed consent forms and a booklet of
questionnaires.
The project was approved by the Clinical Research Ethics Committee of Aragón (CEICA, PI22/217). The
procedures carried out complied with ethical standards and with the 1975 Declaration of Helsinki. The
professionals were informed that their participation was voluntary and that the responses obtained
Acciones e investigaciones Sociales. Nº 46 (2025)
183
Esta obra está bajo una licencia internacional CreativeCommons Atribución-NoComercial 4.0.
would be treated anonymously and confidentially. All of them signed an informed consent form and
were subsequently informed of the results.
Participants
A total of 1491 people were informed about the objectives of the study at their workplaces. The companies
were randomly assigned to one of the two groups. Thus, 477 employees belonging to the companies in the
intervention group and 208 employees belonging to the organisations in the control group answered the
pre-assessment questionnaires (baseline measure). Of the intervention group, 403 responded to the six-
month assessment and 285 to the 12-month assessment. Of the control group, 147 employees and
managers responded to the questionnaires at six months and 106 at 12 months. All participants had a
personalised and anonymous key, so only the responses of those who participated in the three
measurement moments were considered (figure 1).
Figure 1
Flow chart of participants during the study
Acciones e investigaciones Sociales. Nº 46 (2025)
184
Esta obra está bajo una licencia internacional CreativeCommons Atribución-NoComercial 4.0.
The inclusion criteria for participation in either of the two groups were: a) being between 18 and 60 years
old, b) having a contract in the company for at least one year and c) not suffering from any mental disorder
(following the GHQ-12 screening criteria).
Instruments
In the pre- and post-evaluations, participants answered the following questionnaires:
- Demographic and labour data sheet. The following variables were collected: gender, age,
cohabitation, and working time in the field.
- General Health Questionnaire (GHQ -12, Goldberg & Williams, 1988). It values general aspects of
cognitive function and psychological symptoms and is used in psychiatric populations to obtain the
general assessment of cognitive functioning in recent weeks. In their short version, the 12 items report
four subscales: somatic symptoms, anxiety and insomnia, social dysfunction, and depression. Using
the Likert scale between 0 and 3, 0 indicating always and 3 never. The Spanish validated version
revealed a Cronbach's alpha of 0.76 on the global scale (Goldberg et al., 1996). In the present study,
an alpha of 0.78 was obtained.
- Maslach Burnout Inventory (MBI General survey, Maslach, Jackson & Leiter, 1996). It provides
information about the three dimensions that constitute their theoretical model of burnout:
Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA). The
questionnaire was validated in Spanish by Gil Monte (2002), who found a reliability of α: 0.89 for
the EE, 0.67 for DP and 0.74 for PA. The 16 items are rated using a Likert scale on which the
frequency with which the described situation has been experienced, from 0 to 6, is indicated. Thus,
for example, to the question "I feel emotionally exhausted at work", the answer should inform of
the frequency with which it happens, ranging from 0, never, to 6, daily. Low scores on professional
efficiency and high scores in exhaustion and cynicism mean perceptions of being "more burned by
work". In the present study, values of α: 0.86 for the EE, 0.69 for DP and 0.77 for PA were obtained.
- First five items of The Columbia-Suicide Severity Rating Scale (C-SSRS; Posner, et al. 2011). These
questions assessed the severity of possible suicidal ideation on a 5-point ordinal scale (from 1 = wish
to die to 5 = suicidal ideation with specific plan and intent).
Training
The training consisted of workshops given by psychology and medicine professionals in twelve 90-
minute sessions, with a total duration of 18 hours, in groups of 6-10 people, following a theoretical-
practical methodology, through which aspects related to mental health in everyday life were defined
and developed. The intervention programme is briefly described in Table 1.
Acciones e investigaciones Sociales. Nº 46 (2025)
185
Esta obra está bajo una licencia internacional CreativeCommons Atribución-NoComercial 4.0.
Table 1
Training programme for Mental Health Promoters
PSYCHOEDUCATION
Session 1. Physical, psychological and social health.
Session 2. Knowledge of elementary psychological problems; risk, predisposing,
precipitating and maintaining factors.
INDIVIDUAL WELLBEING
Session 3. Responsibility for one’s own health.
Session 4. Self-care strategies: healthy lifestyles, rest habits, sport, nutrititon.
Session 5 and 6. Individual psychological techniques.
Session 7. Recognition of precursor signs of psychopathology.
Session 8. Well-being through social relationships.
Session 9. Community resources and services.
WELFARE AT WORK
Session 10. Knowledge of psychosocial factors related to health, as well as the resources
available for their optimisation. Support dispensing techniques.
Session 11. Promotion, prevention and intervention.
Session 12. Review of topics and techniques learned.
Procedure: In the selected companies, all staff were invited to voluntarily attend an informative talk on
mental health, psychosocial factors at work and suicide risk, giving the option to discuss the topics with the
attendees. Information was also given about the MHP, what it consisted of and who could participate as
agents. Those who applied as volunteers were required to commit to attending the sessions. In addition to
following the workshops, these agents could participate in other more specialised dissemination activities,
as well as obtain publications.
In the intervention group companies, 5 groups were formed with a total of 39 volunteer agents who were
trained in MHP and who participated in subsequent exchange and follow-up activities.
Teams of participants worked in groups to identify risk factors and protective factors and were enlightened
on how they directly and indirectly influence mental health. Special importance was given to the
knowledge of basic emotions and their manifestations, cognitive functioning and its biases, as well as the
promotion of healthy lifestyles. Emphasis was placed on knowledge, both of one's own resources and of
the resources offered by the health system and the company's prevention service, emergency telephones
and others. The central aspect was for participants to acquire training in psychological first aid.
Acciones e investigaciones Sociales. Nº 46 (2025)
186
Esta obra está bajo una licencia internacional CreativeCommons Atribución-NoComercial 4.0.
The MHP agents subsequently attended follow-up sessions every two months and had the possibility of
maintaining direct contact with the research group to solve doubts or in case of possible crisis situations.
Statistical analysis
Initially, the Kolmogorov-Smirnov normality test was applied to assess the normal distribution of the
variables. Since the variables did not have a normal distribution, non-parametric tests were used.
Subsequently, a descriptive analysis including frequencies and percentages was performed, together
with Friedman's two-way analysis of variance by rank summary and Wilcoxon's paired-samples tests
for variables. Kendall's W (w) was calculated as a measure of effect size. The significance level was set
at p < 0.05, and all statistical analyses were run using SPSS software (IBM Corp, 2017).
RESULTS
Table 2 describes the baseline characteristics of the entire sample and compares the two groups. The
cohort consisted of 685 participants. In the intervention group, 40.7% were female and in the control
group, 34.13%. The mean age was 39.07 (SD 4.65) in the intervention group, while in the control group
it was 43.3 (SD 5.11). No statistically significant differences were found between the two groups in the
main study variables.
Table 2
Participants in the baseline assessment
TOTAL SAMPLE
N=685
INTERVENTION. GROUP
N=477
CONTROL GROUP
N=208
P-VALUE (CI)
Gender (n %)
42.04% F (288)
57.9% M (397)
40.7% F (194)
59.2% M (283)
34.13% F (71)
65.65% M (137)
.788
Age (mean SD)
41.29 (3.81)
39.07(4.65)
43.3 (5.11)
.381 (-3.27; .34)
Convivience
(family living n%)
65,8% Yes (451)
34,1% No (234)
67.7% Yes (323)
32.2% No (154)
63,2% Yes (131)
36,7% No (77)
.837 (-119; .087)
Seniority (mean SD)
18.70 (10.27)
17.91 (9.82)
19.07 (8.47)
.217 (-2.03; .021)
General Health
25.71 (5.63)
24.02 (5.22)
23.94 (4.76)
.844(-12.33;16.51)
Burnout
EE
DP
PA
18.16 (6.39)
8,58 (3.11)
7.74 (3.64)
19.89 (9.01)
7.93 (2.79)
8.93 (3.88)
17.64 (4.72)
9.02 (3.63)
7.01 (3.11)
.081 (-11.62; 9.29)
.073 (-6.06; 4.77)
.116 (-2.882; -.993)
SI
.089 (1.68)
.094 (1.91)
.070 (1.33)
.476 (-8.77; -.093)
Note. EE: Emotional Exhaustion; DP: Depersonalization; PA: Personal Accomplishment; SI: Suicide ideation
Acciones e investigaciones Sociales. Nº 46 (2025)
187
Esta obra está bajo una licencia internacional CreativeCommons Atribución-NoComercial 4.0.
Table 3 shows the evolution of both groups at each of the three measurement points (T0, T1 and T2).
In general, improvements over time were observed in the intervention group, although not in all cases
they were statistically significant. They were significant in the depersonalisation dimension [F(2.07) =
7.3942, p = .003, w = 1.603], in the personal accomplishment dimension [F(4.19) = 8.532, p < .001, w
= 2.586] and in the suicidal ideation variable [F(6.04) = 8.972, p = .023, w = 4.211]. As for the control
group, the variables studied did not improve, or worsened slightly, without these differences being
statistically significant.
Regarding the contrast between groups, statistically significant differences were found between the
intervention and control groups in the General Health variable (T2-T1; p= 0.038) and (T2-T0; p<0.001);
in the PD depersonalisation dimension (T2-T1; p=0.053) and (T2-T0; p=0.026); in the PD personal
accomplishment dimension (T2-T1; p<0.001) and (T2-T0; p=0.043), and the differences between
groups in suicidal ideation (T2-T1; p= 0.067) and (T2-T0; p<0.055) were close to statistical significance.
Table 3
Health variable scores, at baseline (T0), six months (T1) and twelve months (T2).
Control group
N=208
P-value
General Health (mean SD)
T0
23.93 (4.76)
T1
24.58 (10.03)
T2
26.35 (9.83)
F(1.18) = 9.02, p = .095, w = .153
T1-T0
.70
0.817
T2-T0
2.47
0.001
T2-T1
1.79
0.038
Emotional Exhaustion (EE)
T0
17.64 (4.72)
T1
18.25 (8.23)
T2
19.70 (8.11)
F(1.01) = 7.11, p = .164, w = .236
T1-T0
.74
.097
T2-T0
1.98
.171
T2-T1
1.46
.332
Depersonalization (DP)
T0
9.02 (3.63)
T1
8.63 (4.34)
T2
10.22 (6.11)
F(2.38) = 6,42, p = .062, w = 1.071
Acciones e investigaciones Sociales. Nº 46 (2025)
188
Esta obra está bajo una licencia internacional CreativeCommons Atribución-NoComercial 4.0.
T1-T0
-.40
.078
T2-T0
1.20
.026
T2-T1
1.61
.053
Personal Accomplishment (PA)
T0
7.01 (3.11)
T1
7.48 (3.81)
T2
6.72 (5.03)
F(1.78) = 5,61, p = .093, w = .624
T1-T0
.47
.085
T2-T0
-.29
.043
T2-T1
-.76
.001
Suicide ideation (SI)
T0
.070 (1.33)
T1
.077 (1.89)
T2
.059 (.33)
F(2.66) = 4,85, p = .087, w = .591
T1-T0
.007
.163
T2-T0
.011
.067
T2-T1
.018
.055
Note. Significant differences (p < 0.05) are highlighted in bold.
DISCUSSION
Initial results confirmed the trend that training of mental health promoters (MHP) and their follow-up
contribute, on a day-to-day basis, to improving some variables of health and well-being, as well as to
reducing suicidal ideation (González-Andrade et al., 2011), bearing in mind that particularly severe
cases are directed to health services in their earliest manifestations.
As indicated, the results analysed during the first year, in one of the three study provinces, are part of
a longitudinal investigation aimed at suicide prevention addressed through ongoing mental health
promotion in the workplace, through training and monitoring of the volunteer promoters.
The hypotheses are partially confirmed: on the one hand, hypothesis 1, the members of the
companies in which the health promoters work showed statistically significant improvements in some
variables related to burnout, health and suicidal ideation. On the other hand, with respect to
hypothesis 2, the trend that these same variables improved in a statistically significant way in the
intervention group when contrasted with the control group was confirmed. However, it was surprising
not to observe statistically significant changes in the Emotional Exhaustion dimension, since, according
to several studies, this variable interacts directly with the Depersonalisation dimension and, both, with
the Lack of Personal Fulfilment at Work dimension (Gascón et al., 2013; Leiter, 2018). Given the
sequential dependence of the latter two on the former, it was to be expected that the cycle would
Acciones e investigaciones Sociales. Nº 46 (2025)
189
Esta obra está bajo una licencia internacional CreativeCommons Atribución-NoComercial 4.0.
occur inversely and that the first signs of improvement would be reflected in the Emotional Exhaustion
variable.
Although suicidal ideation decreased in those companies in which the intervention took place, it
should be noted that the initial rates were low in both groups and that the inter- and intra-group
differences were not statistically significant.
It should be noted that health variables, in general, and those related to burnout, or suicidal ideation, are
slow to establish and grow, therefore, it should also be understood that their decrease and disappearance
cannot be instantaneous and requires a process (Derdowski & Mathisen, 2023; Leiter, 2018). Data
obtained during one year of follow-up reflect a positive trend that will need to be corroborated over time
(Jarman, et al. 2016).
In any case, we cannot confirm that these actions contribute directly and causally to suicide prevention,
just as we cannot differentiate the contribution of road improvements, the renewal of the car fleet,
advertising campaigns, or increased penalties to the reduction in traffic fatalities. All these variables
contribute to the reduction in fatal accidents and the trend over time should be analysed (Nilsen, et al.,
2020).
The strength is that it is a novel study, with a sample that is difficult to access and whose results from
the first year of follow-up show a clear trend of improvements in mental health, which are expected
to be corroborated in the following years of follow-up. By following up in the three provinces of the
study and analysing the results over time, it is hoped that this type of intervention through continuing
education will contribute to the understanding that suicide prevention should be understood as one
of the final consequences of a true promotion of mental health in different settings.
The main limitations of the study are, on the one hand, the fact that the participants were not
randomly assigned to one of the two conditions (the fact of belonging to one or the other company
determined their assignment to the control group or to the intervention group) and, on the other
hand, as it is a follow-up of subjects over time, it entails the phenomenon of experimental mortality.
Taking these considerations into account, we can conclude that there is a positive trend in the
improvement of mental health over time, which encourages both the continuation of training and
follow-up activities, the inclusion of new companies in this longitudinal project and the possibility to
offer the possibility to participate also to those centres that formed the control group.
DATA AVAILABILITY STATEMENT
The raw data supporting the conclusions of this article will be made available by the authors, without
undue reservation.
Acciones e investigaciones Sociales. Nº 46 (2025)
190
Esta obra está bajo una licencia internacional CreativeCommons Atribución-NoComercial 4.0.
DECLARATION OF GENERATIVE AI AND AI-ASSISTED TECHNOLOGIES IN THE WRITING PROCESS
In the preparation of our manuscript, we have not used any generative artificial intelligence or AI-
assisted technologies in the writing process.
CONFLICT OF INTEREST
The authors declare that the research was conducted in the absence of any commercial or financial
relationships that could be construed as a potential conflict of interest.
AUTHOR CONTRIBUTIONS
Conceptualization: SGS, II, and AAC. Data curation: YPM, RFD, and AAL. Formal Analysis: SGS, RFD, AAC
and AAL. Funding acquisition: SGS, and LX. Investigation: SGS, AAC and YPM. Methodology: SGS, AAL
and II. Project administration: LX and SGS. Resources: SGS and LX. Software: RFD and AAC. Supervision:
SGS and YPM. Visualization: SGS, and AAC. All authors contributed to writing—review and editing,
contributed to the article, and approved the submitted version.
ACKNOWLEDGEMENTS
We would like to thank the Alliance of Guangzhou International Sister-City Universities (GISU) and the
Government of Aragon for their support. We express our heartfelt gratitude to the companies, their
employees and managers who generously participated in this study. Without all of them, this study
would not have been possible.
REFERENCES
Derdowski, L. A., & Mathisen, G. E. (2023). Psychosocial factors and safety in high-risk industries: A
systematic literature review. Safety science, 157, https://doi.org/10.1016/j.ssci.2022.105948
EU-OSHA (2020). Third European Survey of Enterprises on New and Emerging Risks (ESENER 3). First
findings. http://www.esener.eu
Evans, A., & Abrahamson, K. (2020). The influence of stigma on suicide bereavement: A systematic
review. Journal of psychosocial nursing and mental health services, 58(4), 21-27.
https://doi.org/10.3928/02793695-20200127-02
Gascón S, Leiter M, Andrés E… & Martínez‐Jarreta B (2013). The role of aggressions suffered by
healthcare workers as predictors of burnout. Journal of clinical nursing, 22(21-22), 3120-
3129. https://doi.org/10.1111/j.1365-2702.2012.04255.x
Gil-Monte, P. R. (2002). Validez factorial de la adaptación al español del Maslach Burnout Inventory-
General Survey. Salud pública de México, 44, 33-40: http://www.insp.mx/salud/index.html
Acciones e investigaciones Sociales. Nº 46 (2025)
191
Esta obra está bajo una licencia internacional CreativeCommons Atribución-NoComercial 4.0.
Goldberg, D.P.; Lobo, A.; Munoz, P.E.; Williams, P. (2016). Cuestonario de Salud General GHQ
(General Health Questionnaire): Guia Para El Usario; Masson: Barcelona, Spain, 1996.
González-Andrade, F., López-Pulles, R., Gascón, S., & García Campayo, J. (2011). Epidemiological
issues regarding suicides in Ecuador: an 8-year report. Journal of Public Health, 19(2), 161-
169. https://doi.org/10.1007/s10389-010-0372-4
Graeser, S. (2011). Salutogenic factors for mental health promotion in work settings and organizations.
International Review of Psychiatry, 23(6), https://doi.org/10.3109/09540261.2011.637909
Gullestrup, J., King, T., Thomas, S. L., & LaMontagne, A. D. (2023). Effectiveness of the Australian
MATES in construction suicide prevention program: a systematic review. Health promotion
international, 38(4), https://doi.org/10.1093/heapro/daad082
Herrman, H., & Jané-Llopis, E. (2012). The status of mental health promotion. Public Health Reviews,
34(2), 1-21.
Jain, A., Hassard, J., Leka, S., Di Tecco, C., & Iavicoli, S. (2021). The role of occupational health
services in psychosocial risk management and the promotion of mental health and well-
being at work. International journal of environmental research and public health, 18(7),
3632. https://doi.org/10.3390/ijerph18073632
Jarman L, Martin A, Venn A, Otahal P, Blizzard L, Teale B, et al. (2016) Workplace Health Promotion
and Mental Health: Three-Year Findings from Partnering Healthy@Work. PLoS ONE 11(8):
e0156791. https://doi.org/10.1371/journal.pone.0156791
Kalra, G., Christodoulou, G., Jenkins, R., Tsipas, V., Christodoulou, N., Lecic-Tosevski, D., ... & Bhugra,
D. (2012). Mental health promotion: guidance and strategies. European Psychiatry, 27(2),
81-86. https://doi.org/10.1016/j.eurpsy.2011.10.001
Laranjo L, Arguel A, Neves AL, and Lau Annie Y S. The influence of social networking sites on health
behavior change: a systematic review and meta-analysis. J Am Med Inform Assoc 2015
Jan;22(1):243-256. https://doi.org/10.1136/amiajnl-2014-002841
Leiter, M. P. (2018). Burnout as a developmental process: Consideration of models. In Professional
burnout (pp. 237-250). CRC Press.
Lubin Pigouche P., Maciá Antón A., and Rubio de Lemus, P. Psicología Matemática II. Universidad
Nacional de Educación a Distancia. Madrid. Espain, 2005.
Maslach, C.; Jackson, S.E.; Leiter, M.P. Maslach Burnout Inventory, 3rd ed.; Consulting Psychologist
Press: Palo Alto, CA, USA, 1996.
Nilsen P, Seing I, Ericsson C, Birken S A & Schildmeijer K (2020). Characteristics of successful changes
in health care organizations. BMC health services research, 20(1), 1-8. Nilsen et al. BMC
Health Services Research (2020) 20:147. https://doi.org/10.1186/s12913-020-4999-8
Acciones e investigaciones Sociales. Nº 46 (2025)
192
Esta obra está bajo una licencia internacional CreativeCommons Atribución-NoComercial 4.0.
O'Connor D, Thayer J F & Vedhara K (2021). Stress & health: A review of psychobiological processes. Annual
review of psychology, 72, 663-88. https://doi.org/10.1146/annurev-psych-062520-122331
Ornek, O. K., & Esin, M. N. (2020). Effects of a work-related stress model based mental health
promotion program on job stress, stress reactions and coping profiles of women workers: a
control groups study. BMC public health, 20. https://doi.org/10.1186/s12889-020-09769-0
Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., ... & Mann, J. J. (2011).
The Columbia–Suicide Severity Rating Scale: initial validity and internal consistency findings from
three multisite studies with adolescents and adults. American journal of psychiatry, 168(12), 1266-
1277. https://doi.org/10.1176/appi.ajp.2011.10111704
Shah, K., Bedi, S., Onyeaka, H., & Chaudhari, G. (2020). The role of psychological first aid to support public
mental health. Cureus, 12(6). https://doi.or/10.7759/cureus.8821
Sutar, R., Kumar, A., & Yadav, V. (2023). Suicide and prevalence of mental disorders: A systematic
review and meta-analysis of world data on case-control psychological autopsy studies.
Psychiatry research, 115492. https://doi.or/10.1016/j.psychres.2023.115492.
Wang, C., López-Núñez, M. I., Pan, R., Wan, X., Tan, Y., Xu, L., ... & Aparicio García, M. E. (2021). The
impact of the COVID-19 pandemic on physical and mental health in China and Spain: cross-
sectional study. JMIR formative research, 5(5). https://doi.or/10.2196/27818
Wang, W., Volkow, N. D., Berger, N. A., Davis, P. B., Kaelber, D. C., & Xu, R. (2024). Association of
semaglutide with risk of suicidal ideation in a real-world cohort. Nature medicine, 30(1),
168-176. https://doi.or/10.1038/s41591-023-02672-2
Wanigasooriya, K., Palimar, P., Naumann, D. N., Ismail, K., Fellows, J. L., Logan, P., ... & Ismail, T.
(2021). Mental health symptoms in a cohort of hospital healthcare workers following the
first peak of the COVID-19 pandemic in the UK. BJPsych Open, 7(1).
https://doi.or/10.1192/bjo.2020.150