Abstract

Background

The average person spends ^1/3 of their lives working. However, approximately 15% of working adults worldwide are struggling with a mental disorder at any given time. The COVID-19 pandemic has spearheaded the importance of employee mental health, highlighting the role that employers can play in preserving employee wellbeing. Although Employee Assistance Programs (EAPs) are slowly becoming an established practice, it is still a relatively new phenomenon in most of Asia. This study therefore aims to investigate the prevalence of employees in the Southeast Asian region who have access to EAPs and understand the relationship between EAP access and employee wellbeing.

Methods

This cross-sectional, online survey-based study involved 15,302 employees from Malaysia, Singapore, Philippines, Thailand, Indonesia, and Vietnam who completed the Depression, Anxiety, Stress Scales (DASS-21), Thriving from Work Questionnaire (TfWQ), and sociodemographic measures. Employee productivity and turnover intention was also measured as a secondary outcome. Hierarchical regression models were conducted to determine the influence of EAP access on employee wellbeing. Subgroup analyses were conducted on employees with access to EAPs to explore how different forms of EAP services contribute to employee wellbeing.

Results

Only 29.04% of employees in the region reported being aware of having access to any forms of EAP services provided by their employers. After controlling for sociodemographic variables, access to EAP was significantly associated with improved mental health, thriving, and productivity, and reduced turnover intention (p鈥�<鈥�0.001) among employees in the region. Subgroup analyses revealed that employees had access to well-being and mental health webinars, talks, or workshops (12.64%), followed by sponsored counselling, therapy or carelines (11.16%). Access to regular mental health risk assessment and screening was the form of EAP service significantly associated with the highest number of outcomes.

Conclusion

Having access to EAP services alone is associated with improved employee wellbeing outcomes. However, different forms of EAP services can vary in their impact on employee wellbeing. Our findings suggest a need to improve accessibility and diversity of EAP offerings for employees in Southeast Asia post-pandemic.

Background

The COVID-19 pandemic triggered an estimated 25% increase in the prevalence of depression and anxiety worldwide [1], and although the world has largely transitioned to pre-pandemic norms, mental health continues to be a growing global public health concern. An estimated 15% of working-age adults worldwide are living with a mental disorder [2], though this figure is likely an underestimation given that large-scale studies have shown that approximately half the world鈥檚 population would develop a mental disorder at any point throughout their lifetime [3]. Given that employees spend roughly ^1/3 of their lifetime working [4], the rising mental health concerns affecting the adult working population have highlighted the role employers and organisations play in preserving employee well-being.

The primary method of action in managing employee well-being is through employee assistance programs (EAPs), which often exist as a system of resources and services that attempt to address aspects of employee work, life, and health, all with the dual aim of alleviating existing difficulties and relieving future adversities afflicting employees [5]. EAPs are employer-sponsored programs often designed to help employees resolve acute but modifiable behavioural health issues, usually with the ultimate goal of restoring employee effectiveness on the job [6]. While EAPs were initially introduced into the workplace primarily to manage cases of alcohol and substance abuse [7], modern full-service EAPs have evolved to provide a myriad of services that can include physical wellness programs, mental health programs, substance abuse interventions, work-life programs that address work-life balance and family support, group-specific assistance programs targeted to specific employee groups such as those with chronic diseases, financial wellbeing programs, and more [5].

In the past decade, organisations have widely adopted EAPs in a bid to prioritise employee wellness and wellbeing, with approximately 95% of large organisations in America having adopted EAPs in 2016 [5]. This number will likely have increased听in the past few years, as organisations worldwide continue to grapple with the mental health impact of the pandemic [8], and how the pandemic has changed traditional ways of working and challenged traditional employee-employer relationships [9]. Indeed, despite traditionally low EAP utilisation rates, national survey data indicated that EAP utilisation in America was higher in June 2020 compared to the same period in 2019, an increase directly attributable to the mental health impact of the COVID-19 pandemic at the time [10]. Despite the pandemic鈥檚 end, the demand for EAPs have not diminished, as employees continue to seek out and prefer employment at organisations that provide support for employee mental health and well-being [11].

As global industry demands rose for EAP services, so has the body of research evaluating the effectiveness of EAPs and demonstrating the benefits of its implementation. In a systematic review of 17 studies evaluating the effectiveness of EAPs,听Joseph et al. found that utilising EAPs lead to enhanced employee outcomes, specifically improving levels of employee presenteeism, productivity and psychosocial functioning [12]. The use of EAPs have also been shown to improve employee mental health, with a number of studies worldwide reporting reduced levels of employee depression, anxiety, and stress following EAP service utilisation by employees [13,14,15,16,17,18,19,20]. Additionally, several studies have further demonstrated that merely providing employees access to an effective EAP can significantly reduce turnover intention, whilst promoting employee retention and organisational commitment [21, 22]. Specifically, EAPs are thought to provide these benefits by way of helping employees develop help-seeking behaviours and skills, improving workplace mental health literacy, and reducing stigmatising and negative attitudes towards mental health in the workplace [23].

Despite the well-documented benefits of EAPs, employer-sponsored mental well-being initiatives are a relatively nascent phenomenon in Southeast Asia. Nonetheless, turning a blind eye to employee mental health can negatively affect employers in the region. A nationwide study of adults in Singapore estimated that employees with untreated symptoms of depression and anxiety contribute to SGD $15.7 billion in increased annual costs for employers due to absenteeism, presenteeism, and higher healthcare costs [24]. In Malaysia, untreated mental health conditions in the workplace were estimated to cost the Malaysian economy at least RM14.46 billion in 2018 [25], though this estimate has likely increased due to the continued increase in the lifetime prevalence of mental disorders in Malaysia [26]. Overall, a substantial body of evidence has demonstrated the adverse consequences of disregarding employee wellbeing, which include loss of productivity via absenteeism and presenteeism, increased turnover intention, and increased healthcare costs [27,28,29]. Importantly, the role of EAPs within an organisation also goes beyond providing employees support within times of crisis, as EAPs also play a crucial role in optimising employee performance which ultimately impacts business performance [6].

Thriving is considered to be the highest level of well-being obtainable [30]. Although there is no definite consensus on how to operationalize thriving, Brown et al. broadly defines thriving as a joint experience of development and success that is realised through an effective level of holistic functioning, observed through high levels of well-being and high levels of perceived self-performance [31]. Within the context of the workplace, Peters et al.鈥檚 newly introduced concept of Thriving from Work (TfW) is most aligned with this definition of thriving, as TfW considers the state of positive mental, physical, and social functioning of employees and how this influences an employee鈥檚 ability to achieve their full potential in their work, home, and community [32]. Albeit it being a new construct, employee thriving and wellbeing are connected, with existing research demonstrating relationships between employee thriving and improved mental health well-being, better subjective health, higher job satisfaction and commitment, lower turnover intention, higher organisational citizenship behaviour, improved creative performance, performing more meaningful work, and higher life satisfaction [30, 33,34,35]. With younger generations of employees prioritising holistic well-being in the workplace and work-life balance [36], understanding the role EAPs can play in developing employee thriving is becoming increasingly important.

In a region where mental health awareness is still in its infancy, this study attempts to contribute to ongoing efforts to highlight the growing issue of employee mental health and well-being and how it links with employee performance at the workplace. To our knowledge, there is no existing literature that has looked into the prevalence of employees in the region with access to EAPs, nor has past research studied the relationship between having access to workplace EAPs and employee well-being. Hence, the primary objective of this study is to develop a more comprehensive understanding of EAP access among Southeast Asian employees and further understand its relationship to employee mental health and wellbeing in the region. As a secondary objective, we also aim to explore the relationship between EAP access and employee turnover and productivity.

Methods

Design and sample

This study employed a cross-sectional, online survey-based design. Participants of the study were recruited in October 2022 via convenience sampling through online advertisement channels such as Facebook, Instagram, LinkedIn, and Google ads. Inclusion criteria was set to employed adults (aged 18鈥�65听years old) living in Southeast Asia, specifically Malaysia, Singapore, Philippines, Thailand, Indonesia, and Vietnam. Respondents who did not meet the inclusion criteria were excluded from the final study sample.

At the beginning of the online survey, participants were informed on the background and purpose of the study, the voluntary nature of their participation, and their right to withdraw their participation at any time throughout the survey with no consequences. All participants provided digital implied consent by proceeding with the online questionnaire if they agreed to participate in the study. No payment or tokens were provided for participation in this study, and no personal identifiable information was collected. This study received ethical approval from the Medical Research and Ethics Committee, Ministry of Health Malaysia (NMRR ID-23鈥�02731-OXD). All research procedures were conducted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its following updates, except that this study was not pre-registered.

Measures

Sociodemographic questions

The sociodemographic questions measured individual and work-related characteristics. Specifically, participants were asked to supply their year of birth, gender, employment status, country of residence, and current monthly household income. Monthly household income was classified into low, middle, high income levels based on country-specific thresholds.鈥夆墹鈥塎YR 5,000,鈥夆墹鈥塈DR 5,000,000,鈥夆墹鈥塖GD 2,000,鈥夆墹鈥塗HB 15,000,鈥夆墹鈥塒HP 21,914, was classified as low income,鈥�>鈥塎YR 11,000,鈥�>鈥塈DR 12,000,000,鈥�>鈥塖GD 6,000,鈥�>鈥塗HB 50,000,鈥�>鈥塒HP 131,484,鈥�>鈥塙SD 500 was classified as high income, and income falling between these cutoffs were categorised as middle income for residents of Malaysia, Indonesia, Singapore, Thailand, the Philippines, and Vietnam, respectively. Income level cut-offs for Malaysia, Singapore, the Philippines, and Vietnam were based on government-defined thresholds [37,38,39,40]. The middle income level for Thailand and Indonesia was defined by a reported monthly income ranging from the 20th to 80th percentile of the income distribution [41, 42].

Access to employee assistance programs

Respondents were asked of their knowledge of existing workplace well-being support being provided by their current employer. As EAPs have evolved beyond traditional workplace counselling, this question was presented as a pick-all-that-apply question, where respondents were presented with a list of services that are currently implemented in modern full-service EAPs and had the option to choose multiple options if relevant. During regression modelling, responses were dichotomised into 鈥淵es鈥� or 鈥淣o鈥� categories, wherein the 鈥淣o鈥� category includes all 鈥淢y workplace does not provide any of these鈥� and 鈥淚 don鈥檛 know鈥� responses.

Depression, anxiety, stress scales (DASS-21)

The DASS-21 is a set of self-report scales that measure the emotional states of depression, anxiety, and stress [43]. The scale consists of 21 items equally divided into three subscales, where items are scored on a 4-point Likert scale ranging from 0 鈥� 鈥渄id not apply to me at all鈥� to 4 鈥� 鈥渁pplied to me very much or most of the time.鈥� Final scale scores are听obtained by summing up each item's scores on the three subscales and multiplying subscales scores by 2. Higher scores indicate higher severity for each subscale, and further cutoff scores are used to further classify each subscale score into conventional severity levels听鈥撎齆ormal, Mild, Moderate, Severe, and Extremely Severe [43]. The DASS-21 scale has been previously validated for use among Asian populations [44,45,46,47,48], and internal consistency of the DASS-21 items in this study is 伪鈥�=鈥�0.96.

Thriving from work questionnaire (TfWQ)

Thriving was measured using the 8-item short form Thriving from Work Questionnaire (TfWQ). The TfWQ is a newly developed scale that measures the extent to which employees are thriving from the work they are doing [30]. Although thriving has traditionally been measured using the Thriving at Work (TAW) scale [49], a significant criticism against the construct and measurement of TAW lies in its narrow focus on vitality and learning only within the workplace context [30]. The conceptualisation and measurement of TfW are more aligned with Brown et al.,鈥檚 definition of thriving, describing it as the joint experience of development and success that requires holistic functioning to achieve [31]. The TfWQ acknowledges the impact of work on employees鈥� holistic well-being both at work and outside of work, taking into consideration the interconnectedness and bi-directional influence of work. Items on the TfWQ are scored on a 6-point scale ranging from 鈥淣ever鈥� to 鈥淎lways鈥�. The TfWQ has been validated in a sample of working adults, and the internal consistency of the scale for this study is 伪鈥�=鈥�0.87.

Productivity

Productivity was measured using a 1-item measure of productivity taken from the productivity scale in the 58-item National Institute of Occupational Safety and Health (NIOSH) Worker Well-being Questionnaire (WellBQ) [50], 鈥淚n the past month, how often did you not work at times when you were supposed to be working?鈥�, with a 7-point Likert scale response ranging from 1鈥�=鈥夆�淣ever鈥� to 7鈥�=鈥夆�淎lways鈥�, with lower scores indicating higher productivity. Items from the productivity scale were adapted from The World Health Organization Health and Work Performance Questionnaire (HPQ), an established and validated measure of work performance in employees [51, 52].

Turnover intention

Turnover intention was measured using a 5-point single-item measure, 鈥淗ow often do you think about quitting your job?鈥� adapted from Konovsky & Cropanzano鈥檚 (1991) scale on turnover intention [53,54,55], a validated measure of employee turnover intention that has been used cross-culturally [56, 57]. Responses range from 鈥淣ever鈥� to 鈥淎lways,鈥� applying Bocklisch et al.鈥檚 recommendations to satisfy the criterion of an equidistant distribution. Higher scores indicate higher turnover intention [58].

Data analysis

The study鈥檚 significance level was set at 0.05, and all statistical analyses were conducted using the statistical software RStudio version 2022.07.0鈥�+鈥�548. To describe the characteristics of the study participants, descriptive statistics for all variables were reported, reporting means and standard deviations (SD) for continuous data, and frequency and percentage for categorical data.

Initial exploration of the relationship between all outcome variables and access to EAP was conducted using univariate Pearson correlations. To investigate the relationship between EAP access and all five dependent variables, hierarchical linear regression models were performed with country, gender, age and monthly income entered in step one, and access to EAP entered in step two. Model diagnostics were run to ensure that the assumptions of normality, linearity, homoscedasticity, and multicollinearity were not violated, and values for unstandardised B, standard error, R² and R²-change, and F and F-change are reported.

Subgroup analyses were performed on employees who reported having access to EAPs, where we report the percentage of employees with access to different forms of modern EAP services. Pearson correlations were conducted to explore the relationship between the access to different forms of EAP service and all outcome variables. Variables with significant relationships at a univariate level were then entered into a multiple linear regression model to investigate the relationship between access to different forms of EAP service and all outcome variables.

Results

Descriptive statistics

Table 1 displays the sociodemographic characteristics of the study participants. A majority of participants were residents of Malaysia (41.77%) and Thailand (34.47%). Participants mostly identified as female (79.62%) and reported being 18鈥�29听years of age (41.34%), with a near equal split between low (47.73%) and middle (40.09%) income groups. 40.43% of participants reported severe or extremely severe depression symptoms, 40.48% for anxiety, and 31.24% for severe or extremely severe stress (Table听2). Of the 15,302 participants who fulfilled the inclusion criteria, only 29.04% reported having access to EAPs via their employers. A country-level breakdown revealed that the largest percentage of employees with access to EAPs are in the Philippines (62.84%), followed by Singapore (46.96%), Vietnam (40.88%), Malaysia (36.73%), Indonesia (25.00%), and finally Thailand (17.96%).

Table 1 Descriptive breakdown of respondents鈥� sociodemographic characteristics

Table 2 Descriptive statistics of all outcome variables

Access to EAP and employee wellbeing

Exploratory Pearson correlation analyses revealed that all outcome variables were significantly associated with having access to EAP (Supplementary Table听1). The first step of the hierarchical regression model revealed that all sociodemographic variables significantly accounted for the variance in thriving from work (R ²鈥�=鈥�0.056, F(12, 15,289)鈥�=鈥�75.22), depression (R ²鈥�=鈥�0.152, F(12, 15,289)鈥�=鈥�229.00), anxiety (R ²鈥�=鈥�0.132, F(12, 15,289)鈥�=鈥�193.1), stress (R ²鈥�=鈥�0.105, F(12, 15,289)鈥�=鈥�148.8), productivity (R ²鈥�=鈥�0.046, F(12, 15,289)鈥�=鈥�61.89) and turnover intention (R ²鈥�=鈥�0.052, F(12, 15,289)鈥�=鈥�69.20).

The second step of the hierarchical regression models revealed that having access to EAPs significantly predicted employee wellbeing. Having access to an EAP significantly explained an additional 3.0% of the variance for thriving from work (螖F鈥�=鈥�501.78, p鈥�<鈥�0.001), an additional 2.6% of the variance for depression (螖F鈥�=鈥�484.26, p鈥�<鈥�0.001), an additional 1.4% of variance for anxiety (螖F鈥�=鈥�244.6, p鈥�<鈥�0.001), and听an additional 2.0% of the variance for stress (螖F鈥�=鈥�355.35, p鈥�&濒迟;鈥�0.001). Access to EAP also significantly explained an additional 0.056% of variance for productivity (螖F鈥�=鈥�9.058, p鈥�=鈥�0.003), and an additional 2.40% of variance for turnover intention (螖F鈥�=鈥�404.72, p鈥�&濒迟;鈥�0.001).

Table 3. Results of hierarchal regression analysis investigating the relationship between Access to EAP and employee wellbeing

Table 3 Results of hierarchal regression analysis investigating the relationship between Access to EAP and employee wellbeing

Subgroup analyses

Of the employees听who did have access to EAPs, the most common type of EAP service that employees have access to are well-being and mental health webinars, talks, or workshops (12.64%), sponsored counselling, therapy or carelines (11.16%), and mental health coaching (7.48%) (Table听4). Univariate analyses revealed that sponsored counselling, therapy, and careline was the only type of EAP service not significantly associated with any outcome variable (Supplementary Table听2).

Table 4 Types of EAP services respondents have access to

Multiple linear regression analyses revealed that having access to regular mental health risk screening and assessment was the only type of EAP service that was significantly associated with improved depression (B鈥�=鈥夆垝2.40, p鈥�<鈥�0.001), anxiety (B鈥�=鈥夆垝1.53, p鈥�<鈥�0.001), stress (B鈥�=鈥夆垝1.51, p鈥�<鈥�0.001), higher productivity (B鈥�=鈥夆垝0.23,听p鈥�<鈥�0.001), and lower turnover intention (B鈥�=鈥夆垝0.11, p鈥�=鈥�0.037) overall. Well-being and mental health webinars, talks, or workshops were significantly associated with higher thriving from work (B鈥�=鈥�0.72, p鈥�=鈥�0.003) and lower stress (B鈥�=鈥夆垝0.90, p鈥�=鈥�0.006), while having access to workplace wellbeing policies, such as mental health days, dedicated wellbeing champions, or flexible wellbeing budgets, was only significantly associated with higher thriving from work scores (B鈥�=鈥�1.54, p鈥�&濒迟;鈥�0.001). Holistic wellness programs, such as those that target mental, physical, and financial well-being) were significantly associated with higher thriving from work (B鈥�=鈥�1.40, p鈥�<鈥�0.001) and lower turnover intention (B鈥�=鈥夆垝0.14, p鈥�=鈥�0.007), while self-guided tools such as self-care activities, lessons, and modules were significantly associated with lower depression (B鈥�=鈥夆垝0.98, p鈥�=鈥�0.029), anxiety (B鈥�=鈥夆垝0.87, p鈥�=鈥�0.016), and turnover intention (B鈥�=鈥夆垝0.10, p鈥�=鈥�0.035). Interestingly, well-being and mental health webinars, talks, or workshops (B鈥�=鈥�0.13, p鈥�=鈥�0.007) and self-guided tools (B鈥�=鈥�0.11, p鈥�=鈥�0.047) were significantly associated with lower employee productivity. Having access to mental health coaching and mental health training for managers were not significantly associated with any of the study鈥檚 primary or secondary outcome variables (Table听5).

Table 5 Results of subgroup analysis investigating the relationship between type of EAP service and employee wellbeing听(n = 4444)

Discussion

Rising concern for employee mental health has generated increased industry and research interest in protecting employee wellbeing. In this cross-sectional study involving 15,302 employees across the Southeast Asian region, we investigated the relationship between EAP access and employee wellbeing and found that having access to EAP services significantly predicted improved employee wellbeing, after controlling for sociodemographic variables such as country, age, gender, and income level. Compared to employees who did not have access to EAP services, our results showed that having access to EAP services significantly predicted improved depression, anxiety, stress, thriving from work, productivity, and reduced turnover intention among employees in the region. Additionally, we also found that having access to regular mental health risk screening or assessment at work was associated with the highest number of outcome variables, significantly predicting improved employee depression, anxiety, stress, productivity, and reduced turnover intention. Overall, our findings suggest that having access to EAP services is associated with improved employee wellbeing across the Southeast Asian region.

Our findings reveal that having access to EAPs alone is significantly associated with improved employee mental health and wellbeing in the workplace. Safeer and Allen have suggested that employees can benefit from EAPs and workplace health programs without necessarily utilising these initiatives, provided however that the workplace in question has already established a general culture of health in the organisation [59]. Separately, previous research has found that workplace health friendliness, measured by employees鈥� perceived access to workplace wellness initiatives including EAPs, was positively associated with employee physical and mental health, well-being, and health behaviours [60]. Although our study did not look into workplace health culture or friendliness, our findings are seemingly in line with previous research that point to the potential benefits of providing employees access to EAPs. Moreover, EAPs are proposed as a form of job resource that employees can use at their own initiative [5], and under the Conservation of Resources (COR) theory, having access to sufficient resources can听enable employees to cope more effectively against stressors by better anticipating and handling potential stressors [61]. As low EAP utilisation continue to pose an issue to stakeholders [6], our results seem to suggest employees鈥� access to EAPs is itself a key element to the promotion of employee wellbeing in the workplace, as coping resources may not necessarily need to be used to be considered effective, and employees鈥� perceived availability of and accessibility to EAPs can be sufficient to promote employee mental health and wellbeing [62].

Previous studies have shown that providing employees access to an effective EAP can translate to reduced turnover intention and increased organisational commitment [21, 22]. Furthermore, a study of employees in Singapore demonstrated that having access to comprehensive employee services such as wellness programs and EAPs was negatively associated with intention to quit and positively related to organisational commitment [63]. The impact of EAPs on organisational outcomes is often attributed to social exchange theory and the norms of reciprocity. Through the provision of EAPs, organisations demonstrate goodwill and support to their employees, who would then be compelled to reciprocate the gesture through ways that benefit the organisation, such as by improving productivity or strengthening organisational commitment [5, 64]. Results of this study further lend support to this theory, as we found that across employees in the region, having access to EAPs was significantly associated with improved organisational outcomes, specifically improved employee productivity and reduced turnover intention. However, of the two secondary, organisational outcomes that we investigated, employee productivity鈥攚hile significant鈥攈ad the smallest effect size, explaining a near 0% of variance in the hierarchical model. This suggests that other contributing factors play a stronger role in predicting and improving employee productivity in the region.

To our knowledge, this study was the first to investigate the prevalence of EAP access in the Southeast Asia region. Across employees of the six countries sampled in this study, 29.04% reported having access to EAP services provided by their employers. At a country level, the percentage of employees with access to EAPs in the Philippines (62.84%) and Singapore (46.96%) are nearly equivalent to the rates reported by employees in the United States, with 54% of private employees and 79% of state and government employees having access to EAPs [65]. Outside of North America, EAPs are mostly underdeveloped, with many parts of the world still resistant to the notion that employers should get involved in an issue as personal as employees鈥� mental health [6]. In comparison to USA and Canada, where more than 75% of organisations offer EAP services to employees [66], it is estimated that only 10% of organisations in China have adopted EAPs for their employees as of 2019 [67], and a study of 43 hospitals across 22 countries in the Arab region revealed that only 39.5% of hospitals have an established employee wellness program in place [68]. Although the COVID-19 pandemic has spearheaded discussions on the importance of employee mental health in the workplace [69], our findings suggest that EAP provision continues to be a nascent phenomenon among employers in the region.

Subgroup analyses revealed that out of the different types of services that would normally be provided as part of an EAP, having access to sponsored counselling, therapy, or careline was the only type of EAP service not significantly associated with any of the study鈥檚 outcomes. This finding is interesting given that counselling and psychotherapy are traditional forms of EAP services that are still predominantly implemented today [70]. Indeed, even among our study鈥檚 participants, sponsored counselling, therapy or careline services were the second most accessible types of EAP service available. Our results are thus in contrast to existing research in the field that emphasises EAP counselling and therapy for improving employee mental health and wellbeing [71]. One possible explanation for this could lie within the perceptions of employees towards counselling and psychotherapy services in general. Research has shown that employees are sceptical towards talking therapies such as counselling and psychotherapy, unconvinced on the efficacy of the approach in dealing with stressors and distrustful of the corporate confidentiality that comes with using an employer-sponsored service [72]. This negative perception, in addition to the stigma against accessing mental health services that is prevalent in Southeast Asian cultures [73], likely limits the benefits of EAPs that provide counselling, psychotherapy, or careline services only. Separately, traditional counselling, therapy, or careline services are often most helpful to individuals who are already experiencing distress [74], where the focus is more towards de-escalation or management of the presenting issue. Hence, the beneficial impact of these may not be as pronounced when compared to primary forms of workplace EAP interventions such as mental health screenings or wellbeing seminars and workshops.

Alternatively, our results also revealed that having access to regular mental health risk screening or assessment was negatively associated with employee depression, anxiety, stress, and turnover intention, and positively associated with employee productivity. Mental health screenings and assessment have emerged as a compelling component of preventative mental health care, overcoming barriers such as stigma, poor health literacy, and lack of resources [73, 75]. Regular mental health screenings and assessments within the workforce allows employees to gain awareness of their current mental health status, thus enabling the detection of individuals who are already at risk or experiencing early symptoms and allowing for early intervention and preventative care [75]. At the same time, regular employer-sponsored mental health screenings can help overcome the initial internal barrier towards mental health help seeking as employees would not feel obligated towards any specific form of mental health care afterwards. This may be particularly important to cater to employees with differing levels of mental health needs or who may prefer alternative approaches to address their current issues [72, 73]. Regardless if employees accept or refuse recommendations for further care or treatment, undergoing the mental health screening itself would be beneficial for employees and employers alike as it allows an understanding of the current mental health status of the workforce. Overall, our findings show heterogeneity in the relationships between types of EAP services and employee wellbeing with no clear discernible trend, suggesting that employees in the region would benefit more from full-service EAPs, which go beyond traditional counselling and therapy and instead offer a more comprehensive suite of services that can cater to the diverse mental health needs of every employee [6].

The findings of this study should be interpreted within the context of its several limitations. As an exploratory, public health study, our findings offer unique insights into the benefits that EAPs can bring to employees within the workplace. However, as this was a cross-sectional study that only looked into employees鈥� access to EAPs, no elements of causality can be established in the relationship between access to EAPs and employee wellbeing. Moreover, this study investigated overall access to EAP for employees in the region without taking into account extraneous variables such as size of company, type of industry, work experience, or EAP utilisation. Additionally, effect sizes produced by our regression models were decidedly small. Despite this, the relationships revealed by our analyses were indeed significant, allowing us to identify access to EAPs as an important predictor of employee wellbeing in the region. Future studies can build upon this finding by expanding on this relationship via experimental means or by identifying more contributing factors to the relationship between EAPs and employee mental health. Results from our subgroup analysis of employees with access to EAPs should also be interpreted with caution, as subgroup analyses can lead to a higher probability of false positives due to multiple testing [76]. Finally, while recruiting via online channels allowed us to obtain a large sample size, our respondents were unrepresentative of the population and were skewed towards employees in Malaysia (41.77%), who identified as female (79.62%), and are within the 18鈥�29-year-old age range (41.34%). Despite our attempts to control for this statistically, the听demographic imbalances in our sample ultimately limits the generalizability of our findings across the region.

Conclusion

This cross-sectional study investigated the relationship between EAPs and employee wellbeing, focusing on employees鈥� access to EAPs and its relationship to employee thriving, mental health, productivity, and turnover intention. We found that having access to EAPs was significantly associated with better employee thriving, reduced turnover intention, and improved depression, anxiety, stress, and productivity. Subgroup analyses suggest that access to varied and comprehensive types of EAP services is associated with greater improvements in employee wellbeing, highlighting the importance of catering to employees' diverse mental health needs. Future studies are needed to further investigate other underlying variables that contribute to the relationship between EAPs and employee wellbeing, such as the broader organisational climate, type and scale of other discretionary employee benefits available, and actual EAP utilisation. As post-pandemic norms continue to spotlight the importance of employee mental health and wellbeing in the workplace, our study offers unique insights into the value of improving accessibility to and diversifying EAP services for employees in the Southeast Asian region.