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Kilgour E, Kosny A, McKenzie D, Collie A. Healing or harming? Healthcare provider interactions with injured workers and insurers in workers' compensation systems. JOURNAL OF OCCUPATIONAL REHABILITATION 2015; 25:220-39. [PMID: 24871375 DOI: 10.1007/s10926-014-9521-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
INTRODUCTION Healthcare providers (HCPs) are influential in the injured worker's recovery process and fulfil many roles in the delivery of health services. Interactions between HCPs and insurers can also affect injured workers' engagement in rehabilitation and subsequently their recovery and return to work. Consideration of the injured workers' perceptions and experiences as consumers of medical and compensation services can provide vital information about the quality, efficacy and impact of such systems. The aim of this systematic review was to identify and synthesize published qualitative research that focused on the interactions between injured workers, HCPs and insurers in workers' compensation systems in order to identify processes or interactions which impact injured worker recovery. METHOD A search of six electronic databases for literature published between 1985 and 2012 revealed 1,006 articles. Screening for relevance identified 27 studies which were assessed for quality against set criteria. A final 13 articles of medium and high quality were retained for data extraction. RESULTS Findings were synthesized using a meta-ethnographic approach. Injured workers reported that HCPs could play both healing and harming roles in their recovery. Supportive patient-centred interaction with HCPs is important for injured workers. Difficult interactions between HCPs and insurers were highlighted in themes of adversarial relations and organisational pressures. Insurer and compensation system processes exerted an influence on the therapeutic relationship. Recommendations to improve relationships included streamlining administrative demands and increasing education and communication between the parties. CONCLUSION Injured workers with long term complex injuries experience difficulties with healthcare in the workers' compensation context. Changes in insurer administrative demands and compensation processes could increase HCP participation and job satisfaction. This in turn may improve injured worker recovery. Further research into experiences of distinct healthcare professions with workers' compensation systems is warranted.
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Affiliation(s)
- Elizabeth Kilgour
- Institute for Safety Compensation and Recovery Research (ISCRR) and Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Level 11, 499 St Kilda Rd, Melbourne, VIC, 3004, Australia,
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Health-related quality of life and productivity losses in patients with depression and anxiety disorders. J Occup Environ Med 2014; 56:420-4. [PMID: 24709765 DOI: 10.1097/jom.0000000000000112] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess the explanatory power of disease severity and health-related quality of life (HRQOL) on absenteeism and presenteeism in a working population suffering from depression and/or anxiety disorders. METHODS We used data of a large, multicenter, randomized trial (n = 644). Pearson chi-squared tests, analysis of variance, and multinomial logistic regression analyses were performed to explore associations of the type of the disorder and HRQOL with different types of productivity losses. Multivariate regression analyses were performed to assess associations with the duration of absenteeism. RESULTS The type of the disorder, disease severity, and HRQOL were associated with different types of productivity losses. Health-related quality of life and age were significantly associated with the duration of absenteeism. CONCLUSIONS Our findings indicate that HRQOL may significantly explain the type of productivity loss as well as the duration of absenteeism.
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Nieuwenhuijsen K, Faber B, Verbeek JH, Neumeyer-Gromen A, Hees HL, Verhoeven AC, van der Feltz-Cornelis CM, Bültmann U. Interventions to improve return to work in depressed people. Cochrane Database Syst Rev 2014:CD006237. [PMID: 25470301 DOI: 10.1002/14651858.cd006237.pub3] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Work disability such as sickness absence is common in people with depression. OBJECTIVES To evaluate the effectiveness of interventions aimed at reducing work disability in employees with depressive disorders. SEARCH METHODS We searched CENTRAL (The Cochrane Library), MEDLINE, EMBASE, CINAHL, and PsycINFO until January 2014. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster RCTs of work-directed and clinical interventions for depressed people that included sickness absence as an outcome. DATA COLLECTION AND ANALYSIS Two authors independently extracted the data and assessed trial quality. We used standardised mean differences (SMDs) with 95% confidence intervals (CIs) to pool study results in the studies we judged to be sufficiently similar. We used GRADE to rate the quality of the evidence. MAIN RESULTS We included 23 studies with 26 study arms, involving 5996 participants with either a major depressive disorder or a high level of depressive symptoms. We judged 14 studies to have a high risk of bias and nine to have a low risk of bias. Work-directed interventions We identified five work-directed interventions. There was moderate quality evidence that a work-directed intervention added to a clinical intervention reduced sickness absence (SMD -0.40; 95% CI -0.66 to -0.14; 3 studies) compared to a clinical intervention alone.There was moderate quality evidence based on a single study that enhancing the clinical care in addition to regular work-directed care was not more effective than work-directed care alone (SMD -0.14; 95% CI -0.49 to 0.21).There was very low quality evidence based on one study that regular care by occupational physicians that was enhanced with an exposure-based return to work program did not reduce sickness absence compared to regular care by occupational physicians (non-significant finding: SMD 0.45; 95% CI -0.00 to 0.91). Clinical interventions, antidepressant medication Three studies compared the effectiveness of selective serotonin reuptake inhibitor (SSRI) to selective norepinephrine reuptake inhibitor (SNRI) medication on reducing sickness absence and yielded highly inconsistent results. Clinical interventions, psychological We found moderate quality evidence based on three studies that telephone or online cognitive behavioural therapy was more effective in reducing sick leave than usual primary or occupational care (SMD -0.23; 95% CI -0.45 to -0.01). Clinical interventions, psychological combined with antidepressant medication We found low quality evidence based on two studies that enhanced primary care did not substantially decrease sickness absence in the medium term (4 to 12 months) (SMD -0.02; 95% CI -0.15 to 0.12). A third study found no substantial effect on sickness absence in favour of this intervention in the long term (24 months).We found high quality evidence, based on one study, that a structured telephone outreach and care management program was more effective in reducing sickness absence than usual care (SMD - 0.21; 95% CI -0.37 to -0.05). Clinical interventions, exercise We found low quality evidence based on one study that supervised strength exercise reduced sickness absence compared to relaxation (SMD -1.11; 95% CI -1.68 to -0.54). We found moderate quality evidence based on two studies that aerobic exercise was no more effective in reducing sickness absence than relaxation or stretching (SMD -0.06; 95% CI -0.36 to 0.24). AUTHORS' CONCLUSIONS We found moderate quality evidence that adding a work-directed intervention to a clinical intervention reduced the number of days on sick leave compared to a clinical intervention alone. We also found moderate quality evidence that enhancing primary or occupational care with cognitive behavioural therapy reduced sick leave compared to the usual care. A structured telephone outreach and care management program that included medication reduced sickness absence compared to usual care. However, enhancing primary care with a quality improvement program did not have a considerable effect on sickness absence. There was no evidence of a difference in effect on sickness absence of one antidepressant medication compared to another. More studies are needed on work-directed interventions. Clinical intervention studies should also include work outcomes to increase our knowledge on reducing sickness absence in depressed workers.
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Affiliation(s)
- Karen Nieuwenhuijsen
- Coronel Institute of Occupational Health/Dutch Research Center for Insurance Medicine, Academic Medical Center, University of Amsterdam, POBox 22700, Amsterdam, 1100 DE,
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Braathen TN, Brage S, Tellnes G, Irene O, Chris J, Eftedal M. A prospective study of the association between the readiness for return to work scale and future work participation in Norway. JOURNAL OF OCCUPATIONAL REHABILITATION 2014; 24:650-657. [PMID: 24395042 DOI: 10.1007/s10926-013-9497-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM The aim of the study was to investigate the associations between the Norwegian version of the Readiness for return to work (RTW) scale and future work participation among persons in inpatient occupational rehabilitation. METHODS A prospective cohort with one year follow up. The participants (n = 179) were persons with reduced work ability who participated in a one-week inpatient rehabilitation program. Four readiness for RTW factors were identified at baseline using explorative factor analysis: 'RTW inability' and 'RTW uncertainty' among persons not working, and 'uncertain work maintenance' and 'proactive work maintenance' among persons working. Work participation was measured as days without sickness benefits in the year following the rehabilitation program. The associations between work participation and readiness for RTW factors were analyzed in multivariate linear regression models controlling for gender, age, subjective health complaints, employment status and previous sickness benefit. RESULTS High scores on the RTW inability factor were associated with low future work participation among persons not working before the rehabilitation program. Among persons working before the program, the proactive work maintenance factor was associated with high future work participation. Neither the RTW uncertainty factor nor the uncertain work maintenance factor was associated with future work participation. CONCLUSIONS The associations between two readiness for RTW factors (RTW inability and proactive work maintenance) and future work participation indicate that these factors can be used as screening tools to tailor occupational rehabilitation programs.
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Affiliation(s)
- Tore N Braathen
- Department of Community Medicine, Institute of Health and Society, The University of Oslo, Oslo, Norway,
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155
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The Diagnostic Apathia Scale predicts the ability to return to work following depression or anxiety. Acta Neuropsychiatr 2014; 26:364-71. [PMID: 25253543 DOI: 10.1017/neu.2014.23] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the validity of a new apathy rating scale in predicting the ability to return to work (RTW) in patients with depression or anxiety a year after discharge from a psychiatric hospital. METHODS We evaluated 56 patients with depression or anxiety, who participated in an on-going randomised clinical trial using RTW as primary outcome. The degree of apathy was measured by the Diagnostic Apathia Scale, which contains six items covering the following neuropsychological symptoms: concentration/memory problems, difficulties in decision making, lassitude, tiredness/fatigue, insomnia, and reduced ability to work and engage in personal interests. The scale was analysed for psychometric validity (scalability) and for its ability to predict RTW. Finally, the predictive validity of the Diagnostic Apathia Scale regarding RTW was compared with scales measuring severity of depression/anxiety symptoms, disability, and psychological well-being. RESULTS The Diagnostic Apathia Scale displayed sufficient scalability, that is, the total score was a psychometrically valid measure of apathy. Only the Diagnostic Apathia Scale, and not the scales measuring severity of symptoms, disability, or psychological well-being, had predictive validity regarding RTW. Thus, 76% with 'clinically significant apathy' at baseline were unable to RTW versus 50% of the patients without apathy (p<0.05). CONCLUSION The Diagnostic Apathia Scale was found to have an acceptable predictive validity in terms of patients' ability to RTW 1 year after discharge from hospitalisation for depression or anxiety.
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Egan M, Daly M, Delaney L. Childhood psychological distress and youth unemployment: evidence from two British cohort studies. Soc Sci Med 2014; 124:11-7. [PMID: 25461857 DOI: 10.1016/j.socscimed.2014.11.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The effect of childhood mental health on later unemployment has not yet been established. In this article we assess whether childhood psychological distress places young people at high risk of subsequent unemployment and whether the presence of economic recession strengthens this relationship. This study was based on 19,217 individuals drawn from two nationally-representative British prospective cohort studies; the Longitudinal Study of Young People in England (LSYPE) and the National Child Development Study (NCDS). Both cohorts contain rich contemporaneous information detailing the participants' early life socioeconomic background, household characteristics, and physical health. In adjusted analyses in the LSYPE sample (N = 10,232) those who reported high levels of distress at age 14 were 2 percentage points more likely than those with low distress to be unemployed between ages 16 and 21. In adjusted analyses of the NCDS sample (N = 8985) children rated as having high distress levels by their teachers at age 7 and 11 were 3 percentage points more likely than those with low distress to be unemployed between ages 16 and 23. Our examination of the 1980 UK recession in the NCDS cohort found the difference in average unemployment level between those with high versus low distress rose from 2.6 pct points in the pre-recession period to 3.9 points in the post-recession period. These findings point to a previously neglected contribution of childhood mental health to youth unemployment, which may be particularly pronounced during times of economic recession. Our findings also suggest a further economic benefit to enhancing the provision of mental health services early in life.
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Affiliation(s)
- Mark Egan
- Behavioural Science Centre, Stirling Management School, Stirling University, FK94LA, United Kingdom.
| | - Michael Daly
- Behavioural Science Centre, Stirling Management School, Stirling University, FK94LA, United Kingdom
| | - Liam Delaney
- Behavioural Science Centre, Stirling Management School, Stirling University, FK94LA, United Kingdom; UCD Geary Institute, University College Dublin, Belfield, Dublin 4, Ireland
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Hjarsbech PU, Nielsen MBD, Andersen MF, Rugulies R, Christensen U. Struggling at work – a qualitative study of working Danes with depressive symptoms. Disabil Rehabil 2014; 37:1674-82. [DOI: 10.3109/09638288.2014.973970] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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158
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Goorden M, Vlasveld MC, Anema JR, van Mechelen W, Beekman ATF, Hoedeman R, van der Feltz-Cornelis CM, Hakkaart-van Roijen L. Cost-utility analysis of a collaborative care intervention for major depressive disorder in an occupational healthcare setting. JOURNAL OF OCCUPATIONAL REHABILITATION 2014; 24:555-62. [PMID: 24085535 DOI: 10.1007/s10926-013-9483-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
PURPOSE Major depression is associated with high levels of absence and reduced productivity. Therefore the costs to society are high. The aim of this study was to evaluate the cost-utility of collaborative care for major depressive disorder (MDD) compared to care as usual in an occupational healthcare setting. A societal perspective was taken. METHODS In this randomised controlled trial, 126 sick-listed workers with MDD were included (65 collaborative care, 61 care as usual). Baseline measurements and follow up measures (3, 6, 9 and 12 months) were assessed by questionnaire. We applied the Trimbos/iMTA questionnaire for costs associated with psychiatric illness, the SF-HQL and the EQ-5D respectively measuring the health care utilization, production losses and general health related quality of life. RESULTS The average annual healthcare costs in the collaborative care group were €3,874 (95 % CI €2,778-€ 5,718) compared to €4,583 (95 % CI €3,108-€6,794) in the care as usual group. The average quality of life years (QALY's) gained were lower in the collaborative care group, 0.05 QALY. The majority of the ICERS (69 %) indicate that collaborative care is less costly but also less effective than care as usual. Including the productivity costs did not change this result. CONCLUSIONS The cost-utility analysis showed that collaborative care generated reduced costs and a reduction in effects compared to care as usual and was therefore not a cost-effective intervention.
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Affiliation(s)
- Maartje Goorden
- Institute for Medical Technology Assessment, Institute of Health Policy and Management, Burgermeester Oudlaan 50, PO Box 1738, 3000 DR, Rotterdam, The Netherlands,
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159
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Dewa CS, Loong D, Bonato S, Thanh NX, Jacobs P. How does burnout affect physician productivity? A systematic literature review. BMC Health Serv Res 2014; 14:325. [PMID: 25066375 PMCID: PMC4119057 DOI: 10.1186/1472-6963-14-325] [Citation(s) in RCA: 350] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 07/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interest in the well-being of physicians has increased because of their contributions to the healthcare system quality. There is growing recognition that physicians are exposed to workplace factors that increase the risk of work stress. Long-term exposure to high work stress can result in burnout. Reports from around the world suggest that about one-third to one-half of physicians experience burnout. Understanding the outcomes associated with burnout is critical to understanding its affects on the healthcare system. Productivity outcomes are among those that could have the most immediate effects on the healthcare system. This systematic literature review is one of the first to explore the evidence for the types of physician productivity outcomes associated with physician burnout. It answers the question, "How does burnout affect physician productivity?" METHODS A systematic search was performed of: Medline Current, Medline in process, PsycInfo, Embase and Web of Science. The search period covered 2002 to 2012. The searches identified articles about practicing physicians working in civilian settings. Articles that primarily looked only at residents or medical students were excluded. Productivity was captured by hours worked, patients seen, sick leave, leaving the profession, retirement, workload and presenteeism. Studies also were excluded if: (1) the study sample was not comprised of at least 50% physicians, (2) the study did not examine the relationship between burnout and productivity or (3) a validated measure of burnout was not used. RESULTS The search identified 870 unique citations; 5 met the inclusion/exclusion criteria. This review indicates that globally there is recognition of the potential impact of physician burnout on productivity. Productivity was examined using: number of sick leave days, work ability, intent to either continue practicing or change jobs. The majority of the studies indicate there is a negative relationship between burnout and productivity. However, there is variation depending on the type of productivity outcome examined. CONCLUSIONS There is evidence that burnout is associated with decreased productivity. However, this line of inquiry is still developing. A number of gaps are yet to be filled including understanding how to quantify the changes in productivity related to burnout.
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Affiliation(s)
- Carolyn S Dewa
- Centre for Research on Employment and Workplace Health, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada.
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Gender and family disparities in suicide attempt and role of socioeconomic, school, and health-related difficulties in early adolescence. BIOMED RESEARCH INTERNATIONAL 2014; 2014:314521. [PMID: 25136577 PMCID: PMC4127271 DOI: 10.1155/2014/314521] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 06/09/2014] [Accepted: 06/13/2014] [Indexed: 11/17/2022]
Abstract
Suicide attempt (SA) is common in early adolescence and the risk may differ between boys and girls in nonintact families partly because of socioeconomic, school, and health-related difficulties. This study explored the gender and family disparities and the role of these covariates. Questionnaires were completed by 1,559 middle-school adolescents from north-eastern France including sex, age, socioeconomic factors (family structure, nationality, parents' education, father's occupation, family income, and social support), grade repetition, depressive symptoms, sustained violence, sexual abuse, unhealthy behaviors (tobacco/alcohol/cannabis/hard drug use), SA, and their first occurrence over adolescent's life course. Data were analyzed using Cox regression models. SA affected 12.5% of girls and 7.2% of boys (P < 0.001). The girls living with parents divorced/separated, in reconstructed families, and with single parents had a 3-fold higher SA risk than those living in intact families. Over 63% of the risk was explained by socioeconomic, school, and health-related difficulties. No family disparities were observed among boys. Girls had a 1.74-time higher SA risk than boys, and 45% of the risk was explained by socioeconomic, school, and mental difficulties and violence. SA prevention should be performed in early adolescence and consider gender and family differences and the role of socioeconomic, school, and health-related difficulties.
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161
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de Jonge P, Zuidersma M, Bültmann U. The presence of a depressive episode predicts lower return to work rate after myocardial infarction. Gen Hosp Psychiatry 2014; 36:363-7. [PMID: 24713326 DOI: 10.1016/j.genhosppsych.2014.03.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 03/04/2014] [Accepted: 03/04/2014] [Indexed: 11/26/2022]
Abstract
CONTEXT No studies have evaluated whether the presence of a depressive episode is associated with an increased risk of not returning to work following myocardial infarction (MI). OBJECTIVES To examine the prospective associations between depressive episode and anxiety disorders with return to work (RTW) after MI at 3 and 12 months based on International Classification of Diseases, 10th Revision. DESIGN Prospective cohort study. SETTING Four hospitals in the North of The Netherlands. PARTICIPANTS From a sample of patients hospitalized for MI (n=487), we selected those who had a paid job at the time of the MI (N=200). MAIN EXPOSURE MEASURES Presence of a depressive episode and presence of any anxiety disorder during the first 3 months post-MI. MAIN OUTCOME MEASURES RTW at 12 months post-MI. RESULTS Of the patients with work prior to MI, 75% had returned to work at 12 months. The presence of a depressive episode during the first 3 months (prevalence: 19.4%) was a significant predictor of no RTW at 12 months post-MI, also after controlling for confounders [odds ratio (OR) 3.48; 95% confidence interval (CI): 1.45-8.37]. The presence of an anxiety disorder (prevalence: 11.9%) had a borderline significant association with no RTW as well. This association remained after controlling for confounders (OR 2.90; 95% CI: 1.00-6.38) but diminished when controlling for depression. CONCLUSIONS The presence of a depressive episode was associated with an increased risk of no RTW in MI patients. The association between anxiety and risk of no RTW could in part be explained by the presence of depression. Further studies may address the possibility of countering the effect of depression by effective treatment.
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Affiliation(s)
- Peter de Jonge
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands.
| | - Marij Zuidersma
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands
| | - Ute Bültmann
- Division of Community and Occupational Medicine, Department of Health Sciences, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands
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Gärtner FR, Nieuwenhuijsen K, Ketelaar SM, van Dijk FJH, Sluiter JK. The mental vitality @ work study: effectiveness of a mental module for workers' health surveillance for nurses and allied health care professionals on their help-seeking behavior. J Occup Environ Med 2014; 55:1219-29. [PMID: 24064780 DOI: 10.1097/jom.0b013e31829f310a] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To study the effectiveness of a mental module for workers' health surveillance for health care workers. METHODS Nurses and allied health care professionals from one organization were cluster-randomized at ward level to an intervention or control group. The intervention included screening for work functioning impairments and mental health complaints. Positively screened workers were invited to visit their occupational physician. Outcome measures, including help-seeking behavior, work functioning, and mental health, were assessed at baseline, 3-month follow-up, and 6-month follow-up. RESULTS An effect of study-group × time interaction on help-seeking behavior was found (P = 0.02). Workers in the intervention group showed less work functioning impairments over time than the control group (P = 0.04). CONCLUSION The module can be used to stimulate help seeking from the occupational physician and to improve functioning in workers with mild to moderate work functioning, mental health complaints, or both. TRIAL NUMBER NTR2786.
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Affiliation(s)
- Fania R Gärtner
- From the Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Geraedts AS, Kleiboer AM, Wiezer NM, van Mechelen W, Cuijpers P. Short-term effects of a web-based guided self-help intervention for employees with depressive symptoms: randomized controlled trial. J Med Internet Res 2014; 16:e121. [PMID: 24800966 PMCID: PMC4026573 DOI: 10.2196/jmir.3185] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 03/20/2014] [Accepted: 04/18/2014] [Indexed: 01/21/2023] Open
Abstract
Background Depressive disorders are highly prevalent in the working population and are associated with excessive costs. The evidence for effective worker-directed interventions for employees with depressive symptoms is limited. Treating employees with depressive symptoms before sick leave via the Internet could be beneficial and cost saving. Objective In this study, we developed and tested the effectiveness of a Web-based guided self-help course for employees with depressive symptoms. We report on the posttreatment effectiveness of the intervention. Methods This study is a two-arm randomized controlled trial comparing a Web-based guided self-help course to care as usual (CAU). We recruited employees from 6 different companies via the companies’ intranet and posters. The main inclusion criterion was elevated depressive symptoms as measured by a score of ≥16 on the Center for Epidemiological Studies Depression scale (CES-D). The intervention (Happy@Work) was based on problem-solving treatment and cognitive therapy and consisted of 6 weekly lessons. Participants were asked to submit their weekly assignment via the website after completion. They subsequently received feedback from a coach via the website. Self-report questionnaires on depressive symptoms (CES-D; primary outcome), anxiety measured by the Hospital Anxiety and Depression Scale (HADS), burnout measured by the Maslach Burnout Inventory (MBI), and work performance measured by the Health and Work Performance Questionnaire (HPQ; secondary outcomes) were completed at baseline and at posttreatment. Results A total of 231 employees were randomized to either the intervention group (n=116) or CAU (n=115).The posttreatment assessment was completed by 171 (74.0%) participants. Both the intervention and the CAU group showed significant improvements in the primary outcome of depressive symptoms, but no differences between the conditions was found (d=0.16, 95% CI –0.10 to 0.41, P=.29). Significant but small effects in favor of the intervention group were found for anxiety symptoms (d=0.16, 95% CI –0.09 to 0.42, P=.04) and exhaustion (d=0.17, 95% CI –0.09 to 0.43, P=.02). Conclusions This study showed that a Web-based guided self-help course for employees with depressive symptoms was not more effective in reducing depressive symptoms among employees than CAU. Large improvements in depressive symptoms in the CAU group were unforeseen and potential explanations are discussed.
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Affiliation(s)
- Anna S Geraedts
- VU University Amsterdam, Department of Clinical Psychology, Amsterdam, Netherlands.
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Machado DDA, Silva GF, Torres AR, Cerqueira ATDAR. Depressive symptoms and harmful alcohol use in hepatitis C patients: prevalence and correlates. Rev Soc Bras Med Trop 2014; 47:149-57. [DOI: 10.1590/0037-8682-0270-2013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 04/11/2014] [Indexed: 02/06/2023] Open
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165
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Ernstsen L, Lillefjell M. Physical functioning after occupational rehabilitation and returning to work among employees with chronic musculoskeletal pain and comorbid depressive symptoms. J Multidiscip Healthc 2014; 7:55-63. [PMID: 24489473 PMCID: PMC3904812 DOI: 10.2147/jmdh.s55828] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The aim of this investigation was to assess whether measures of physical functioning after multidisciplinary rehabilitation are associated with return to work among individuals with chronic musculoskeletal pain conditions and comorbid depressive symptoms. Methods Included were 92 employees with chronic musculoskeletal disorders who had participated in a 57- week multidisciplinary rehabilitation program. Their ages ranged from 25–59 years. The Hospital Anxiety and Depression Scale was used to assess depressive symptoms. Different aspects of physical functioning (muscle strength, mobility, endurance capacity, and balance) were measured with single-item visual analog scales, and physical fitness was measured with the validated COOP/WONCA charts. Being on “active work strategies,” such as receiving rehabilitation benefit/vocational rehabilitation or being reported partly or completely fit, was defined as “on their way into/in work”. Cross-sectional associations were measured using logistic regression models, estimating odds ratio with 95% confidence intervals. Results There were no differences between the “on their way into/in work” group (n=70) and the “on their way out/out of work” group (n=22) regarding age, sex, or levels of anxiety or pain. Surprisingly, regression analyses showed that those with higher levels of physical functioning had significantly lower odds of returning to work. Conclusion The findings of an inverse relationship between self-reported physical function and returning to work in this sample illustrate that the return-to-work process among employees with chronic musculoskeletal pain and comorbid depressive symptoms is multifactorial and influenced by factors other than physical functioning at the individual level. Further research, especially longitudinal studies, is needed to assess the occupational trajectories among employees with chronic musculoskeletal pain and comorbid depressive symptoms after participation in a multidisciplinary rehabilitation program.
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Affiliation(s)
- Linda Ernstsen
- Faculty of Nursing, Sør-Trøndelag University College, Trondheim, Norway
| | - Monica Lillefjell
- Department of Occupational Therapy, Faculty of Health Education and Social Work, Sør-Trøndelag University College, Trondheim, Norway
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de Vries G, Hees HL, Koeter MWJ, Lagerveld SE, Schene AH. Perceived impeding factors for return-to-work after long-term sickness absence due to major depressive disorder: a concept mapping approach. PLoS One 2014; 9:e85038. [PMID: 24454786 PMCID: PMC3893138 DOI: 10.1371/journal.pone.0085038] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 11/23/2013] [Indexed: 11/29/2022] Open
Abstract
Objective The purpose of the present study was to explore various stakeholder perspectives regarding factors that impede return-to-work (RTW) after long-term sickness absence related to major depressive disorder (MDD). Methods Concept mapping was used to explore employees', supervisors' and occupational physicians' perspectives on these impeding factors. Results Nine perceived themes, grouped in three meta-clusters were found that might impede RTW: Person, (personality / coping problems, symptoms of depression and comorbid (health) problems, employee feels misunderstood, and resuming work too soon), Work (troublesome work situation, too little support at work, and too little guidance at work) and Healthcare (insufficient mental healthcare and insufficient care from occupational physician). All stakeholders regarded personality/coping problems and symptoms of depression as the most important impeding theme. In addition, supervisors emphasized the importance of mental healthcare underestimating the importance of the work environment, while occupational physicians stressed the importance of the lack of safety and support in the work environment. Conclusions In addition to the reduction of symptoms, more attention is needed on coping with depressive symptoms and personality problems in the work environment support in the work environment and for RTW in mental healthcare, to prevent long term sickness absence.
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Affiliation(s)
- Gabe de Vries
- Program for Mood Disorders, Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Hiske L. Hees
- Program for Mood Disorders, Pro Persona, Arnhem, The Netherlands
| | - Maarten W. J. Koeter
- Program for Mood Disorders, Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Aart H. Schene
- Program for Mood Disorders, Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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REFERENCES. Monogr Soc Res Child Dev 2013. [DOI: 10.1002/mono.12067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Gordon RA, Crosnoe R, Wang X. Physical attractiveness and the accumulation of social and human capital in adolescence and young adulthood: assets and distractions. Monogr Soc Res Child Dev 2013; 78:1-137. [PMID: 24329915 PMCID: PMC5558203 DOI: 10.1002/mono.12060] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Beauty has a well-documented impact on labor market outcomes with both legal and policy implications. This monograph investigated whether this stratification is rooted in earlier developmental experiences. Specifically, we explored how high schools’ dual roles as contexts of social relations and academic progress contributed to the long-term socioeconomic advantages of being physically attractive. Integrating theories from multiple disciplines, the conceptual model of this study contends that physically attractive youths’ greater social integration and lesser social stigma help them accumulate psychosocial resources that support their academic achievement while also selecting them into social activities that distract from good grades. A mixed methods design, combining statistical analyses of the National Longitudinal Survey of Adolescent Health and qualitative analyses of a single high school, supported and expanded this model. The data revealed that the benefits of attractiveness flowed through greater social integration but were partially offset by social distractions, especially romantic/sexual partnerships and alcohol-related problems. Interview and ethnographic data further revealed that adolescents themselves understood how physical attractiveness could lead to favorable treatment by teachers and classmates while also enticing youth to emphasize socializing and dating, even when the latter took time from other activities (like studying) and marginalized some classmates. These patterns, in turn, predicted education, work, family, and mental health trajectories in young adulthood. The results of this interdisciplinary, theoretically grounded, mixed methods study suggest that adolescence may be a critical period in stratification by physical appearance and that the underlying developmental phenomena during this period are complex and often internally contradictory. The monograph concludes with discussion of theoretical and policy implications and recommendations for future developmental research.
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Arends I, van der Klink JJL, van Rhenen W, de Boer MR, Bültmann U. Prevention of recurrent sickness absence in workers with common mental disorders: results of a cluster-randomised controlled trial. Occup Environ Med 2013; 71:21-9. [PMID: 24158311 DOI: 10.1136/oemed-2013-101412] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Workers with common mental disorders (CMDs) frequently experience recurrent sickness absence but interventions to prevent this are lacking. The goal of this study was to evaluate the effectiveness of the Stimulating Healthy participation And Relapse Prevention at work intervention in preventing recurrent sickness absence in workers who returned to work after sickness absence due to CMDs. METHODS We performed a cluster-randomised controlled trial with 3 months, 6 months and 12 months follow-up. Treatment providers were randomised to either a 2-day training in the Stimulating Healthy participation And Relapse Prevention at work intervention, that is, a problem-solving intervention, or usual care. Primary outcome measures were the incidence of recurrent sickness absence and time to recurrent sickness absence. Secondary outcome measures were mental health complaints, work functioning and coping behaviour. RESULTS 80 participants were randomised in the intervention group and 78 in the control group. The adjusted OR for the incidence of recurrent sickness absence was 0.40 (95% CI 0.20 to 0.81) and the adjusted HR for time to recurrent sickness absence was 0.53 (95% CI 0.33 to 0.86) for the intervention group compared with care as usual. CONCLUSIONS This study demonstrates the 12-month effectiveness of a problem-solving intervention for reducing recurrent sickness absence in workers with CMDs and emphasises the importance of continuous attention in the post return to work phase for workers who have been on sickness absence due to CMDs.
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Affiliation(s)
- Iris Arends
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen/University of Groningen, Groningen, The Netherlands
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170
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Proeschold-Bell RJ, Miles A, Toth M, Adams C, Smith BW, Toole D. Using Effort-Reward Imbalance Theory to Understand High Rates of Depression and Anxiety Among Clergy. J Prim Prev 2013; 34:439-53. [DOI: 10.1007/s10935-013-0321-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chau K, Baumann M, Chau N. Socioeconomic inequities patterns of multi-morbidity in early adolescence. Int J Equity Health 2013; 12:65. [PMID: 23962097 PMCID: PMC3765191 DOI: 10.1186/1475-9276-12-65] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 05/10/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Multi-morbidity such as cumulating mental health, behavioral, and school difficulties (consumptions of alcohol, tobacco, cannabis, and hard drugs, obesity, depressive symptoms, suicide attempts, involvement in violence, and low school performance) is common in early adolescence and can be favored by a number of socioeconomic factors (gender, age, nationality, family structure, parents' education, father' occupation, and income). This study assessed the concurrent roles of various socioeconomic factors in multi-morbidity defined as cumulated number of difficulties (CD) which has been partially documented. METHODS Adolescents from middle schools in north-eastern France (N = 1,559) completed a questionnaire measuring socioeconomic characteristics and mental health, behavioral, and school difficulties. Data were analyzed using logistic regression models. RESULTS Alcohol use affected 35.2% of subjects, tobacco use 11.2%, cannabis use 5.6%, hard drugs use 2.8%, obesity 10.6%, depressive symptoms 13.3%, suicide attempts 9.9%, involvement in violence 10.3%, and low school performance 8.2%. Insufficient income and non-intact families impacted most mental health, behavioral, and school difficulties with adjusted odds ratios (ORa) between 1.51 and 3.72. Being immigrant impacted illicit drugs use and low school performance (ORa 2.31-4.14); low parents' education depressive symptoms (1.42) and school performance (3.32); and manual-worker/inactive offspring low school performance (2.56-3.05). Multi-morbidity was very common: CD0 44.1%, CD1 30.8%, CD2-3 18.4%, and CD ≥ 4 6.7%. Insufficient income, divorced/separated parents, reconstructed families, and single parents played impressive roles with strong ORa gradients (reaching 4.86) from CD1 to CD ≥ 4. Being European immigrant, low parents' education, and low fathers' occupations had significant gender-age-adjusted odds ratios for CD2-3 and CD ≥ 4, but these became non-significant when adjusted for all socioeconomic factors. Older adolescents had higher risks for multi-morbidity which did not change when adjusting for all socioeconomic factors. CONCLUSIONS Multi-morbidity including a wide range of mental health, behavioral, and school difficulties was common in early adolescence. Insufficient income and non-intact families played impressive roles. Being immigrant, low parents' education, and low fathers' occupations also played strong roles but these were explained by insufficient income and non-intact families. Prevention against multi-morbidity should be designed to help adolescents to solve their difficulties, especially among adolescents with socioeconomic difficulties.
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Affiliation(s)
- Kénora Chau
- Université de Lorraine, Vandoeuvre-lès-Nancy, France
- University of Luxembourg, INtegrative research unit on Social and Individual DEvelopment (INSIDE), Walferdange, Luxembourg
| | - Michèle Baumann
- University of Luxembourg, INtegrative research unit on Social and Individual DEvelopment (INSIDE), Walferdange, Luxembourg
| | - Nearkasen Chau
- INSERM, U669, Paris F-75014, France
- Univ Paris-Sud and Univ Paris Descartes, UMR-S0669, Paris, France
- Inserm, U669, 8 rue du Breuil, F-54180 Heillecourt, France
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Nieuwenhuijsen K, Noordik E, van Dijk FJH, van der Klink JJ. Return to work perceptions and actual return to work in workers with common mental disorders. JOURNAL OF OCCUPATIONAL REHABILITATION 2013; 23:290-9. [PMID: 23124685 DOI: 10.1007/s10926-012-9389-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
INTRODUCTION Return to work (RTW) perceptions have been found to predict actual RTW of workers with common mental disorders. This study aims to (1) assess the relative value of RTW self-efficacy (RTW-SE) and RTW expectation in predicting actual RTW and (2) explore the role of mental health symptoms, work characteristics and their interaction as determinants of these RTW perceptions at baseline and over time. METHODS Workers (N = 179) with common mental disorders were included at the start of their sick leave and followed-up at 3, 6, 9, and 12 months. RTW self-efficacy, RTW expectation, mental health and RTW were assessed by self-report. Kaplan-Meier survival analysis was used to test the predictive value of RTW-SE and RTW expectation against the actual RTW. Linear regression was used to study the associations of mental health symptoms, work characteristics and their interaction with RTW-SE at baseline. Mental health symptoms in relation to RTW-SE over the first 6 months were analyzed using Linear Mixed Models. RESULTS Compared to RTW expectation, differences in RTW-SE were more predictive of actual RTW. At baseline, lower fatigue, depressive symptoms, and work pace- and load were associated with higher RTW-SE. Decreasing levels of fatigue and depressive symptoms over time were associated with parallel improvements in RTW-SE. Workers with high work pace and workload at baseline showed lower levels of RTW-SE at all time points. CONCLUSIONS We recommend the use of the RTW-SE scale to detect workers with common mental disorders at risk of a late RTW. Work characteristics and changes in mental health symptoms were associated with RTW-SE over time.
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Affiliation(s)
- Karen Nieuwenhuijsen
- Academic Medical Center (AMC), Coronel Institute of Occupational Health, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands.
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Ogawa T, Shigemura J, Yoshino A, Nomura S. Interpersonal sensitivity associated with return to work status following sick leave: a cross-sectional study among Japanese workers with major depressive disorder. Asian J Psychiatr 2013; 6:146-50. [PMID: 23466112 DOI: 10.1016/j.ajp.2012.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Revised: 09/27/2012] [Accepted: 10/08/2012] [Indexed: 12/01/2022]
Abstract
AIM We examined the relationship between return to work (RTW) from sick leave (SL) and personality traits in workers with major depressive disorder (MDD). METHODS Eighty-eight Japanese individuals with ≥2 weeks of SL episode and with ≥2 months of pharmacotherapy history were assessed. Measurements included Mini-International Neuropsychiatric Interview (MINI), Hamilton Rating Scale for Depression (HAM-D), Neuroticism, and Interpersonal Sensitivity Measure (IPSM). Multivariate analyses were conducted to clarify the association between personality traits and RTW status. In order to minimize the state effect of depressive symptoms to personality traits, we performed an additional analysis among a subgroup of subjects in remission (HAM-D ≤7). RESULTS Thirty-seven subjects (42.0%) had returned to work. Among whole subjects, factors associated with RTW status were: shorter SL duration in the past 5 years, longer treatment duration of the recent major depressive episode, HAM-D ≤7, and IPSM ≤94. In the subgroup of remission subjects (n=53), factors associated with RTW status were: IPSM ≤94, no comorbid current anxiety disorder, and shorter SL duration in the past 5 years. CONCLUSIONS Low interpersonal sensitivity, along with depression remission, was associated with post-SL RTW status among workers with MDD.
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Affiliation(s)
- Tetsuo Ogawa
- Department of Psychiatry, Self-Defense Force Fukuoka Hospital, Japan
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Thielen K, Nygaard E, Andersen I, Diderichsen F. Employment consequences of depressive symptoms and work demands individually and combined. Eur J Public Health 2013; 24:34-9. [PMID: 23377143 DOI: 10.1093/eurpub/ckt011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Denmark, like other Western countries, is recently burdened by increasingly high social spending on employment consequences caused by ill mental health. This might be the result of high work demands affecting persons with ill mental health. Therefore, this study assesses to what extent depressive symptoms and high work demands, individually and combined, have an effect on employment consequences. METHODS We conducted a population-based 7-year longitudinal follow-up study with baseline information from the year 2000 on socio-demographics, lifestyle, depressive symptoms and work demands. In total, 5785 employed persons, aged 40 and 50 years, were included. Information about employment status, sick leave and work disability was obtained from registers. Logistic regression models were used to measure separate and combined effects of depressive symptoms and work demands on job change, unemployment and sick leave during 2001-02 and work disability during 2003-07. RESULTS After adjustment for covariates, high physical work demands and depressive symptoms had a graded effect on subsequent unemployment, sick leave and permanent work disability. Persons with both depressive symptoms and high physical demands had the highest risks, especially for sick leave, but the combined effect did not exceed the product of single effects. Persons who perceived high amount of work changed job significantly more frequently. CONCLUSION Persons with depressive symptoms might have an increased risk of negative employment consequences irrespective of the kind and amount of work demands. This might be an effect on the level of work ability in general as well as partly the result of health selection and co-morbidity.
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Affiliation(s)
- Karsten Thielen
- Department of Social Medicine, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
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175
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Vemer P, Bouwmans CA, Zijlstra-Vlasveld MC, van der Feltz-Cornelis CM, Hakkaart-van Roijen L. Let's get back to work: survival analysis on the return-to-work after depression. Neuropsychiatr Dis Treat 2013; 9:1637-45. [PMID: 24187499 PMCID: PMC3810438 DOI: 10.2147/ndt.s49883] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Absence from work due to mental disorders is substantial. Additionally, long-term absence from work is associated with a reduced probability of return-to-work (RTW). Major depressive disorder (MDD) is a prevalent condition in Dutch occupational health care settings. An early estimate of the prognosis regarding RTW in patients with MDD could serve both as a point of departure for the identification of high-risk cases and as an instrument to monitor the course of the disorder and of RTW. In the current study, we aimed to assess the added value of health-related quality of life (HRQoL) and severity of depression to predict the time to RTW. PATIENTS AND METHODS Data were derived from a prospective longitudinal study aimed to evaluate the cost effectiveness of a collaborative care treatment in sick-listed workers with MDD. We included demographic, job-related, and health-related variables. Severity of depression was measured using the Patient Health Questionnaire Depression Scale-9 (PHQ-9). HRQoL was measured using two generic preference-based instruments, the EuroQol 5-Dimension (EQ-5D™) and the Medical Outcomes Study Short Form Health Survey (SF-36). A survival model was constructed by applying different survival functions to assess the best fit for the data. Additionally, survival analyses were performed to assess the added value of the two HRQoL measures and depression severity for predicting RTW. RESULTS Females and older patients had a longer time to RTW. The same was true for patients with a full-time job and patients with more decision latitude. Patients in a management position and patients with more social support had a shorter time to RTW. Severity of depression was not predictive for the time to RTW. HRQoL measured by the SF-36 was a significant predictor for the time to RTW. CONCLUSION HRQoL emerged as a significant predictor for the time to RTW. However, severity of depression was not predictive for the time to RTW. These results suggest the importance of assessing HRQoL in addition to severity of disease to assess functionality.
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Affiliation(s)
- Pepijn Vemer
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam
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Volker D, Vlasveld MC, Anema JR, Beekman AT, Roijen LHV, Brouwers EP, van Lomwel AGC, van der Feltz-Cornelis CM. Blended E-health module on return to work embedded in collaborative occupational health care for common mental disorders: design of a cluster randomized controlled trial. Neuropsychiatr Dis Treat 2013; 9:529-37. [PMID: 23637534 PMCID: PMC3639217 DOI: 10.2147/ndt.s43969] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Common mental disorders (CMD) have a major impact on both society and individual workers, so return to work (RTW) is an important issue. In The Netherlands, the occupational physician plays a central role in the guidance of sick-listed workers with respect to RTW. Evidence-based guidelines are available, but seem not to be effective in improving RTW in people with CMD. An intervention supporting the occupational physician in guidance of sick-listed workers combined with specific guidance regarding RTW is needed. A blended E-health module embedded in collaborative occupational health care is now available, and comprises a decision aid supporting the occupational physician and an E-health module, Return@Work, to support sick-listed workers in the RTW process. The cost-effectiveness of this intervention will be evaluated in this study and compared with that of care as usual. METHODS This study is a two-armed cluster randomized controlled trial, with randomization done at the level of occupational physicians. Two hundred workers with CMD on sickness absence for 4-26 weeks will be included in the study. Workers whose occupational physician is allocated to the intervention group will receive the collaborative occupational health care intervention. Occupational physicians allocated to the care as usual group will give conventional sickness guidance. Follow-up assessments will be done at 3, 6, 9, and 12 months after baseline. The primary outcome is duration until RTW. The secondary outcome is severity of symptoms of CMD. An economic evaluation will be performed as part of this trial. CONCLUSION It is hypothesized that collaborative occupational health care intervention will be more (cost)-effective than care as usual. This intervention is innovative in its combination of a decision aid by email sent to the occupational physician and an E-health module aimed at RTW for the sick-listed worker.
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Affiliation(s)
- Daniëlle Volker
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht ; Tranzo Department, Tilburg University, Tilburg
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Norder G, Roelen CAM, van Rhenen W, Buitenhuis J, Bültmann U, Anema JR. Predictors of recurrent sickness absence due to depressive disorders--a Delphi approach involving scientists and physicians. PLoS One 2012; 7:e51792. [PMID: 23284768 PMCID: PMC3527456 DOI: 10.1371/journal.pone.0051792] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 11/09/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Depression is a common and highly recurrent mental disorder that is accompanied by poor functioning at home and at work. Not all depressed employees report sick and little is known about variables associated with sickness absence (SA) due to depression. Recurrent SA due to depression tends to marginalize employees from the workforce and exclude them from social participation. Therefore, this study sought group consensus on factors predicting recurrent SA due to depression. METHODOLOGY/PRINCIPAL FINDINGS 23 scientists in the field of work and mental health and 23 physicians with expertise in assessing work disability were invited for a Delphi study. Sixty-seven factors retrieved from the literature were scored for their impact on the recurrence of SA due to depression, range 1 (no impact) to 10 (very high impact) in two Delphi rounds. The third Delphi round addressed the assessability and modifiability of elected predictors. Group consensus was defined as 75% agreement. In the first round (response 78%), group consensus was reached on a high impact of 13 factors on recurrent SA due to depression. The second round (response 79%) added another 8 factors with high impact on recurrent SA due to depression. The panelists were of the opinion that stressful life and work events, age at first diagnosis, duration of the last depressive episode, anxiety, lifetime number of depressive episodes, and psychological work demands were readily assessable in consultation with patients. Furthermore, work factors, particularly decision latitude, psychological job demands, and commitment to work, were recognized as modifiable. CONCLUSIONS/SIGNIFICANCE Although results have to be validated with further quantitative research, physicians may identify employees at risk of recurrent SA due to depression and may support them to adjust their work aimed at increasing commitment to work and preventing future SA due to depression.
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Affiliation(s)
- Giny Norder
- 365/Occupational Health Service Utrecht, Utrecht, The Netherlands.
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Arends I, Bruinvels DJ, Rebergen DS, Nieuwenhuijsen K, Madan I, Neumeyer-Gromen A, Bültmann U, Verbeek JH. Interventions to facilitate return to work in adults with adjustment disorders. Cochrane Database Syst Rev 2012; 12:CD006389. [PMID: 23235630 DOI: 10.1002/14651858.cd006389.pub2] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Adjustment disorders are a frequent cause of sick leave and various interventions have been developed to expedite the return to work (RTW) of individuals on sick leave due to adjustment disorders. OBJECTIVES To assess the effects of interventions facilitating RTW for workers with acute or chronic adjustment disorders. SEARCH METHODS We searched the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR) to October 2011; the Cochrane Central Register of Controlled Trials (CENTRAL) to Issue 4, 2011; MEDLINE, EMBASE, PsycINFO and ISI Web of Science, all years to February 2011; the WHO trials portal (ICTRP) and ClinicalTrials.gov in March 2011. We also screened reference lists of included studies and relevant reviews. SELECTION CRITERIA We selected randomised controlled trials (RCTs) evaluating the effectiveness of interventions to facilitate RTW of workers with adjustment disorders compared to no or other treatment. Eligible interventions were pharmacological interventions, psychological interventions (such as cognitive behavioural therapy (CBT) and problem solving therapy), relaxation techniques, exercise programmes, employee assistance programmes or combinations of these interventions. The primary outcomes were time to partial and time to full RTW, and secondary outcomes were severity of symptoms of adjustment disorder, work functioning, generic functional status (i.e. the overall functional capabilities of an individual, such as physical functioning, social function, general mental health) and quality of life. DATA COLLECTION AND ANALYSIS Two authors independently selected studies, assessed risk of bias and extracted data. We pooled studies that we deemed sufficiently clinically homogeneous in different comparison groups, and assessed the overall quality of the evidence using the GRADE approach. MAIN RESULTS We included nine studies reporting on 10 psychological interventions and one combined intervention. The studies included 1546 participants. No RCTs were found of pharmacological interventions, exercise programmes or employee assistance programmes. We assessed seven studies as having low risk of bias and the studies that were pooled together were comparable. For those who received no treatment, compared with CBT, the assumed time to partial and full RTW was 88 and 252 days respectively. Based on two studies with a total of 159 participants, moderate-quality evidence showed that CBT had similar results for time (measured in days) until partial RTW compared to no treatment at one-year follow-up (mean difference (MD) -8.78, 95% confidence interval (CI) -23.26 to 5.71). We found low-quality evidence of similar results for CBT and no treatment on the reduction of days until full RTW at one-year follow-up (MD -35.73, 95% CI -113.15 to 41.69) (one study with 105 participants included in the analysis). Based on moderate-quality evidence, problem solving therapy (PST) significantly reduced time until partial RTW at one-year follow-up compared to non-guideline based care (MD -17.00, 95% CI -26.48 to -7.52) (one study with 192 participants clustered among 33 treatment providers included in the analysis), but we found moderate-quality evidence of no significant effect on reducing days until full RTW at one-year follow-up (MD -17.73, 95% CI -37.35 to 1.90) (two studies with 342 participants included in the analysis). AUTHORS' CONCLUSIONS We found moderate-quality evidence that CBT did not significantly reduce time until partial RTW and low-quality evidence that it did not significantly reduce time to full RTW compared with no treatment. Moderate-quality evidence showed that PST significantly enhanced partial RTW at one-year follow-up compared to non-guideline based care but did not significantly enhance time to full RTW at one-year follow-up. An important limitation was the small number of studies included in the meta-analyses and the small number of participants, which lowered the power of the analyses.
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Affiliation(s)
- Iris Arends
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University ofGroningen, Groningen,
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Zimmerman M, Martinez JH, Young D, Chelminski I, Dalrymple K. Sustained unemployment in psychiatric outpatients with bipolar depression compared to major depressive disorder with comorbid borderline personality disorder. Bipolar Disord 2012; 14:856-62. [PMID: 23057759 DOI: 10.1111/bdi.12014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The morbidity associated with bipolar disorder is, in part, responsible for repeated calls for improved detection and recognition. No such clinical commentary exists for improved detection of borderline personality disorder in depressed patients. Clinical experience suggests that borderline personality disorder is as disabling as bipolar disorder; however, no studies have directly compared the two disorders. For this reason we undertook the current analysis from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project comparing unemployment and disability rates in patients with bipolar disorder and borderline personality disorder. METHODS Patients were interviewed with semi-structured interviews. We compared three non-overlapping groups of depressed patients: (i) 181 patients with DSM-IV major depressive disorder and borderline personality disorder, (ii) 1068 patients with major depressive disorder without borderline personality disorder, and (iii) 84 patients with bipolar depression without borderline personality disorder. RESULTS Compared to depressed patients without borderline personality disorder, depressed patients with borderline personality disorder were significantly more likely to have been persistently unemployed. A similar difference was found between patients with bipolar depression and major depressive disorder without borderline personality disorder. No differences were found between patients with bipolar depression and depression with borderline personality disorder. CONCLUSIONS Both bipolar disorder and borderline personality disorder were associated with impaired occupational functioning and thus carry a significant public health burden. Efforts to improve detection of borderline personality disorder in depressed patients might be as important as the recognition of bipolar disorder.
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Affiliation(s)
- Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI 02904, USA.
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Audhoe SS, Hoving JL, Nieuwenhuijsen K, Friperson R, de Jong PR, Sluiter JK, Frings-Dresen MHW. Prognostic factors for the work participation of sick-listed unemployed and temporary agency workers with psychological problems. JOURNAL OF OCCUPATIONAL REHABILITATION 2012; 22:437-46. [PMID: 22481379 PMCID: PMC3484312 DOI: 10.1007/s10926-012-9358-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
INTRODUCTION Among the working population, unemployed and temporary agency workers are a particularly vulnerable group, at risk for sickness absence due to psychological problems. Knowledge of prognostic factors for work participation could help identify sick-listed workers with a high-risk for work disability and provide input for sickness absence counseling. The purpose of this study was to identify prognostic factors for the work participation of medium- and long-term sick-listed unemployed and temporary agency workers with psychological problems. METHODS A cohort of 932 sick-listed unemployed and temporary agency workers with psychological problems was followed for one and a half years. Data collection was conducted at three time-frames: 10 months, 18 months and 27 months after reporting sick. Univariate and multiple logistic regression analyses were performed. RESULTS Perceived health, full return-to-work (RTW) expectations, age and work status at 18 months were strong prognostic factors for work participation at subsequent time-frames in the univariate analyses. Multiple logistic regression revealed that full RTW expectation was a prognostic factor for future work participation in both the medium- and long-term, whereas moderate-to-good perceived health was a prognostic factor for work participation in the medium-term. Being under 45 years of age and having a positive work status at 18 months were prognostic factors for work participation in the long-term. CONCLUSIONS Workers' self-appraisal of health, age and work status were strong prognostic factors for the future work participation of sick-listed unemployed and temporary agency workers with psychological problems. These findings could help occupational and insurance physicians identify high-risk sick-listed workers for sickness absence counseling.
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Affiliation(s)
- Selwin S Audhoe
- Coronel Institute of Occupational Health/Research Center for Insurance Medicine, Academic Medical Center, University of Amsterdam, P.O. BOX 22700, 1100 DE, Amsterdam, The Netherlands.
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Holwerda A, van der Klink JJL, Groothoff JW, Brouwer S. Predictors for work participation in individuals with an Autism spectrum disorder: a systematic review. JOURNAL OF OCCUPATIONAL REHABILITATION 2012; 22:333-352. [PMID: 22270229 DOI: 10.1007/s10926-011-9347-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Research shows that only about 25% of people with autism are employed. METHOD We conducted a systematic review on factors facilitating or hindering work participation of people with autism in longitudinal studies. An extensive search in biomedical and psychological databases yielded 204 articles and 18 satisfied all inclusion criteria. We assessed the methodological quality of included studies using an established criteria list. RESULTS Seventeen factors were identified and categorized as disease-related factors, personal factors or external factors. Limited cognitive ability was the only significant predictor consistently found for work outcome. Functional independence and institutionalization were both reported by one study to be significantly related to work outcome. Inconsistent findings or non significant findings were reported for the other fourteen factors. CONCLUSION These findings emphasize the need for more high quality cohort studies focussing on work participation as the main outcome among people with Autism.
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Affiliation(s)
- Anja Holwerda
- Department of Health Sciences, Community and Occupational Medicine, University Medical Centre Groningen, University of Groningen, Building 3217, Room 621, P.O. Box 196, 9700 AD, Groningen, The Netherlands.
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Huijs JJJM, Koppes LLJ, Taris TW, Blonk RWB. Differences in predictors of return to work among long-term sick-listed employees with different self-reported reasons for sick leave. JOURNAL OF OCCUPATIONAL REHABILITATION 2012; 22:301-11. [PMID: 22302668 DOI: 10.1007/s10926-011-9351-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
INTRODUCTION The present study aimed to gain insight in the predictors of full return to work (RTW) among employees on long-term sick leave due to three different self-reported reasons for sick leave: physical, mental or co-morbid physical and mental problems. This knowledge can be used to develop diagnosis-specific interventions that promote earlier RTW. METHODS This prospective cohort study with a two-year follow-up employs a sample of 682 Dutch employees, sick-listed for 19 weeks (SD = 1.68), who filled out two questionnaires: at 19 weeks and 2 years after the start of sick leave. The dependent measure was duration until full RTW, the independent measures were cause of sick leave, health characteristics, individual characteristics and work characteristics. RESULTS Reporting both physical and mental problems as reasons for sick leave was associated with a longer duration until full RTW. Nonparametric Cox survival analysis showed that partial RTW at baseline and lower age were strong predictors of earlier RTW in all three groups, and that RTW self-efficacy predicted earlier RTW in two groups. Other predictors of full RTW varied among groups. CONCLUSIONS Tailoring for different reasons for sick leave might improve the effects of new interventions because the predictors of full RTW differ among groups. Enhancement of partial RTW and RTW self-efficacy may be relevant components of any intervention, as these were predictors of full RTW in at least two groups.
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Affiliation(s)
- Jenny J J M Huijs
- TNO, Behavioural and Societal Sciences, Participation and Social Cohesion, P.O. Box 718, 2130 AS Hoofddorp, The Netherlands.
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Chau K, Baumann M, Kabuth B, Chau N. School difficulties in immigrant adolescent students and roles of socioeconomic factors, unhealthy behaviours, and physical and mental health. BMC Public Health 2012; 12:453. [PMID: 22712754 PMCID: PMC3515352 DOI: 10.1186/1471-2458-12-453] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 06/06/2012] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND School is a multi-cultural setting where students need social, material, physical, and mental resources to attain school achievement. But they are often lacking, especially for immigrant students. In an early adolescence context, this study assessed risk for school difficulties among European and non-European immigrants and the roles of socioeconomic characteristics, physical health, psychological health, social relationships, living environment, and unhealthy behaviours. METHODS This cross-sectional study included 1,559 middle-school adolescents from north-eastern France, who completed a self-administered questionnaire including socioeconomic characteristics (gender, age, family structure, father's occupation, and family income), WHO-Quality of life (measuring the four dimensions physical health, psychological health, social relationships, and living environment), unhealthy behaviours (last-30-day uses of tobacco, alcohol, cannabis, and other illicit drugs and no regular sports/physical activities), grade repetition, low school performance (<10/20), and school dropout ideation at 16 years. Data were analyzed using logistic models. RESULTS Grade repetition affected 14.8% of students, low school performance 8.2%, and school dropout ideation 3.9%. European immigrants had a higher risk for grade repetition only with a gender-age-adjusted odds ratio (OR) of 2.44, vs. French students. This odds ratio decreased to 1.76 (contribution 47%) with further adjustment for all confounders (family structure, father's occupation, family income, physical health, psychological health, social relationships, living environment, and unhealthy behaviours). Non-European immigrants had a statistically higher risk for all grade repetition, low school performance, and school dropout ideation with ORs of 3.29, 3.02, and 3.42, respectively vs. French students. These odds ratios decreased to 1.76, 1.54, and 1.54, respectively (contributions 66%, 73%, and 78%) with further adjustment for all confounders. CONCLUSIONS Compared with French students, European immigrant students were more affected only by grade repetition while non-European immigrant students by all grade repetition, low school performance, and school dropout ideation. The contribution of socioeconomic characteristics, physical health, psychological health, social relationships, living environment, and unhealthy behaviours was very high and much higher for non-European than for European immigrant students. Public policy should focus on these factors and services to reduce school difficulties.
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Affiliation(s)
- Kénora Chau
- Service of Pedopsychiatry, Hôpital d'Enfants de Nancy-Brabois, Université de Lorraine, Faculté de médecine, Vandoeuvre-lès-Nancy, France
- University of Luxembourg, INtegrative research unit on Social and Individual DEvelopment (INSIDE), Walferdange, Luxembourg
| | - Michèle Baumann
- University of Luxembourg, INtegrative research unit on Social and Individual DEvelopment (INSIDE), Walferdange, Luxembourg
| | - Bernard Kabuth
- Service of Pedopsychiatry, Hôpital d'Enfants de Nancy-Brabois, Université de Lorraine, Faculté de médecine, Vandoeuvre-lès-Nancy, France
| | - Nearkasen Chau
- INSERM, U669, Paris, F-75014, France
- Univ Paris-Sud and Univ Paris Descartes, UMR-S0669, Paris, France
- Inserm, U669, 8 rue du Breuil, F-54180, Heillecourt, France
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184
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Sick leave patterns among 5-year cancer survivors: a registry-based retrospective cohort study. J Cancer Surviv 2012; 6:315-23. [PMID: 22706884 DOI: 10.1007/s11764-012-0228-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 05/11/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE The aims of this study were to observe the sick leave rates of cancer survivors for five consecutive years following a first lifetime diagnosis of invasive cancer and to identify socio-demographic and clinical predictors of sick leave taken in the fifth year after diagnosis. METHODS This registry study comprised 2,008 Norwegian individuals (18-61 years old) with their first lifetime diagnosis of invasive cancer in 1999 and alive in 2004 and a cancer-free control group (n = 3,240) matched by sex, age, educational level, and employment status in 1998. Sick leave was defined as at least one sick leave period >16 days within the year in question. RESULTS A total of 75 % of the long-term cancer survivors (LTCSs) took sick leave within the first 12 months after their diagnosis. The sick leave rate stabilized at a slightly higher level in the following 4 years compared to the year before diagnosis, with approximately 23 % of the male and 31 % of the female LTCSs taking sick leave. Being single with children, having low education, working in health and social work sector, or having taken sick leave the year before diagnosis (1998) predicted the sick leave taken 5 years after diagnosis (2004) among LTCSs. Compared to the controls, LTCSs with rectal, lymphogenic, breast, or "other" types of cancer had significantly higher sick leave rates 5 years after diagnosis. Socio-demographic factors explained more of the variance in sick leave than did clinical factors. CONCLUSION Employed LTCSs struggle with their ability to work 5 years after diagnosis. More research is needed to identify factors that would promote LTCSs' health and ability. IMPLICATIONS FOR CANCER SURVIVORS A socioeconomic and work environmental perspective seems necessary for achieving effective occupational rehabilitation and preventing sick leave among LTCSs.
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Holma IAK, Holma KM, Melartin TK, Rytsälä HJ, Isometsä ET. A 5-year prospective study of predictors for disability pension among patients with major depressive disorder. Acta Psychiatr Scand 2012; 125:325-34. [PMID: 22054701 DOI: 10.1111/j.1600-0447.2011.01785.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE There is a scarcity of prospective long-term studies on work disability caused by depression. We investigated predictors for disability pension among psychiatric patients with MDD. METHOD The Vantaa Depression Study followed up prospectively 269 psychiatric in- and out-patients with DSM-IV MDD for 5 years with a life chart, including 230 (91.3%) patients belonging to labour force. Information on disability pensions was obtained from interviews, patient records and registers. RESULTS Within 5 years, 20% of the patients belonging to labour force at baseline were granted a disability pension. In multivariate analyses, the significant baseline predictors for granted disability pension were age ≥50 years (HR = 3.91, P < 0.001), subjective inability to work (HR = 2.14, P = 0.008) and introversion (HR = 1.08, P = 0.049). When follow-up variables were included, the predictors were age more than 50 (OR = 6.25, P < 0.001), proportion of time spent depressed (OR = 14.6, P < 0.001), number of comorbid somatic disorders (OR = 1.47, P = 0.013) and lack of vocational education (OR = 2.38, P = 0.032). CONCLUSION Of psychiatric patients with depression, one-fifth were granted a disability pension within 5 years. Future disability pension can be predicted by baseline older age, personality factors, functional disability, lack of vocational education and comorbid somatic disorders. Longitudinally, accumulation of time spent depressed appears decisive for pensioning.
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Affiliation(s)
- I A K Holma
- Mood, Depression, and Suicidal Behaviour Unit, National Institute for Health and Welfare, Helsinki, Finland
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Cimo A, Stergiopoulos E, Cheng C, Bonato S, Dewa CS. Effective lifestyle interventions to improve type II diabetes self-management for those with schizophrenia or schizoaffective disorder: a systematic review. BMC Psychiatry 2012; 12:24. [PMID: 22443212 PMCID: PMC3340308 DOI: 10.1186/1471-244x-12-24] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 03/23/2012] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The prevalence of type II diabetes among individuals suffering from schizophrenia or schizoaffective disorders is more than double that of the general population. By 2005, North American professional medical associations of Psychiatry, Diabetes, and Endocrinology responded by recommending continuous metabolic monitoring for this population to control complications from obesity and diabetes. However, these recommendations do not identify the types of effective treatment for people with schizophrenia who have type II diabetes. To fill this gap, this systematic evidence review identifies effective lifestyle interventions that enhance quality care in individuals who are suffering from type II diabetes and schizophrenia or other schizoaffective disorders. METHODS A systematic search from Medline, CINAHL, PsycINFO, and ISI Web of Science was conducted. Of the 1810 unique papers that were retrieved, four met the inclusion/exclusion criteria and were analyzed. RESULTS The results indicate that diabetes education is effective when it incorporates diet and exercise components, while using a design that addresses challenges such as cognition, motivation, and weight gain that may result from antipsychotics. CONCLUSIONS This paper begins to point to effective interventions that will improve type II diabetes management for people with schizophrenia or other schizoaffective disorders.
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Affiliation(s)
- Adriana Cimo
- Centre for Research on Employment and Workplace Health, Centre for Addition and Mental Health, 455 Spadina, Suite 300, Toronto, Ontario M5S 2G8, Canada
| | - Erene Stergiopoulos
- Centre for Research on Employment and Workplace Health, Centre for Addition and Mental Health, 455 Spadina, Suite 300, Toronto, Ontario M5S 2G8, Canada
| | - Chiachen Cheng
- Centre for Research on Employment and Workplace Health, Centre for Addition and Mental Health, 455 Spadina, Suite 300, Toronto, Ontario M5S 2G8, Canada
- Canadian Mental Health Association, Clinic & Resource Centre, 272 Park Avenue, Thunder Bay, P7B 1C5, Canada
| | - Sarah Bonato
- Library Services, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, M5S 2S1, Canada
| | - Carolyn S Dewa
- Centre for Research on Employment and Workplace Health, Centre for Addition and Mental Health, 455 Spadina, Suite 300, Toronto, Ontario M5S 2G8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, M5T 1R8, Canada
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Vlasveld MC, van der Feltz-Cornelis CM, Bültmann U, Beekman ATF, van Mechelen W, Hoedeman R, Anema JR. Predicting return to work in workers with all-cause sickness absence greater than 4 weeks: a prospective cohort study. JOURNAL OF OCCUPATIONAL REHABILITATION 2012; 22:118-26. [PMID: 21842133 PMCID: PMC3274679 DOI: 10.1007/s10926-011-9326-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Long-term sickness absence is a major public health and economic problem. Evidence is lacking for factors that are associated with return to work (RTW) in sick-listed workers. The aim of this study is to examine factors associated with the duration until full RTW in workers sick-listed due to any cause for at least 4 weeks. METHODS In this cohort study, health-related, personal and job-related factors were measured at entry into the study. Workers were followed until 1 year after the start of sickness absence to determine the duration until full RTW. Cox proportional hazards regression analyses were used to calculate hazard ratios (HR). RESULTS Data were collected from N = 730 workers. During the first year after the start of sickness absence, 71% of the workers had full RTW, 9.1% was censored because they resigned, and 19.9% did not have full RTW. High physical job demands (HR .562, CI .348-.908), contact with medical specialists (HR .691, CI .560-.854), high physical symptoms (HR .744, CI .583-.950), moderate to severe depressive symptoms (HR .748, CI .569-.984) and older age (HR .776, CI .628-.958) were associated with a longer duration until RTW in sick-listed workers. CONCLUSIONS Sick-listed workers with older age, moderate to severe depressive symptoms, high physical symptoms, high physical job demands and contact with medical specialists are at increased risk for a longer duration of sickness absence. OPs need to be aware of these factors to identify workers who will most likely benefit from an early intervention.
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Affiliation(s)
- M C Vlasveld
- Diagnostics and Treatment, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
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de Vries G, Koeter MWJ, Nabitz U, Hees HL, Schene AH. Return to work after sick leave due to depression; a conceptual analysis based on perspectives of patients, supervisors and occupational physicians. J Affect Disord 2012; 136:1017-26. [PMID: 21774988 DOI: 10.1016/j.jad.2011.06.035] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Revised: 06/24/2011] [Accepted: 06/25/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVES This study aims to investigate the most important factors facilitating a return to work after sick leave due to depression from the perspectives of patients, supervisors and occupational physicians. METHODS Concept mapping was used to develop a conceptual framework. Using purposive sampling, 32 participants representing Employees, supervisors and occupational physicians, were asked to formulate statements on what enables patients with sick leave due to depression to return to work. A total of 41 participants rated and grouped the statements. Data were analyzed using the statistical program Ariadne. RESULTS The concept mapping yielded 60 statements that consisted of promoting factors for return to work. Based on these statements, three meta-clusters and eight clusters were identified. The three meta-clusters consisted of work-related, person-related and healthcare- related clusters. The work-related meta-cluster comprised of "Adaptation of work", "Understanding and support in the workplace" and "Positive work experiences". The person- related meta-cluster encompassed "Positive and valid self-perception", "Competence in self management", "Positive level of energy", and "Balanced home/work environment". The healthcare-related meta-cluster was composed of "Supportive healthcare". Stakeholder groups differ in opinion, in what they see as most important for return to work. LIMITATIONS The low number of participants and the high educational level of participants are a limitation for generalization of the findings. CONCLUSIONS The study generated different statements that stakeholders consider important for return to work after sick leave due to depression. These findings can be used as a checklist for coordination of the return to work process. Differences in opinion regarding what stakeholders see as most important for return to work should receive special consideration during the re-integration process.
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189
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Employment experience of cancer survivors 2 years post-diagnosis in the Study of Cancer Survivors-I. J Cancer Surviv 2012; 6:210-8. [DOI: 10.1007/s11764-011-0212-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 12/05/2011] [Indexed: 11/26/2022]
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Nielsen MBD, Bültmann U, Madsen IEH, Martin M, Christensen U, Diderichsen F, Rugulies R. Health, work, and personal-related predictors of time to return to work among employees with mental health problems. Disabil Rehabil 2011; 34:1311-6. [PMID: 22200251 DOI: 10.3109/09638288.2011.641664] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To identify health-, personal- and work-related factors predictive of return to work (RTW) in employees sick-listed due to common mental health problems, such as, stress, depression, burnout, and anxiety. METHODS We distributed a baseline questionnaire to employees applying for sickness absence benefits at a large Danish welfare Department (n = 721). A total of 298 employees returned the questionnaire containing information on possible predictors of RTW. We followed up all baseline responders for a maximum of one year in a national registry of social transfer payments, including sickness absence benefits. RESULTS At baseline, about 9% of respondents had quit their job, 10% were dismissed and the remaining 82% were still working for the same employer. The mean time to RTW, measured from the first day of absence, was 25 weeks (median = 21) and at the end of follow-up (52 weeks) 85% had returned to work. In the fitted Cox model we found that fulfilling the DSM-IV criteria for depression predicted a longer time to RTW (HR: 0.61, CI: 0.45-0.84), whereas a better self-rated health predicted a shorter time to RTW (HR: 1.18, CI: 1.03-1.34). Employees working in the municipal (HR: 0.62, CI: 0.41-0.94) and private sector (HR: 0.65, CI: 0.44-0.96) returned to work slower compared to employees working in the governmental sector. Gender, education, cohabitation, size of workplace, low-back and upper-neck pain and employment at baseline did not predict RTW. CONCLUSION Our results indicate that time to RTW is determined by both health- and work-related factors.
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191
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Are Occupational Factors and Mental Difficulty Associated With Occupational Injury? J Occup Environ Med 2011; 53:1452-9. [DOI: 10.1097/jom.0b013e318237a14b] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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192
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Haugli L, Maeland S, Magnussen LH. What facilitates return to work? Patients' experiences 3 years after occupational rehabilitation. JOURNAL OF OCCUPATIONAL REHABILITATION 2011; 21:573-81. [PMID: 21442204 PMCID: PMC3217144 DOI: 10.1007/s10926-011-9304-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
OBJECTIVE We have limited knowledge about the specific elements in an occupational rehabilitation programme that facilitate the process leading to return to work (RTW) as perceived by the patients. The aim of the study was to explore individual experiences regarding contributing factors to a successful RTW, 3 years after a resident occupational rehabilitation programme. METHODS The study is based on interviews of 20 individuals who attended an occupational rehabilitation programme 3 years earlier. Ten informants had returned to work (RTW) and ten were receiving disability pension (DP). Data were analysed by systematic text condensation inspired by Giorgi's phenomenological analysis. RESULTS The core categories describing a successful RTW process included positive encounters, increased self-understanding and support from the surroundings. While the informants on DP emphasized being seen, heard and taken seriously by the professionals, the RTW group highlighted being challenged to increase self-understanding that promoted new acting in every-day life. Being challenged on self-understanding implied increased awareness of own identity, values and resources. Support from the surroundings included support from peer participants, employer and social welfare system. CONCLUSION Successful RTW processes seem to comprise positive encounters, opportunities for increased self-understanding and support from significant others. An explicit focus on topics like identity, own values and resources might improve the outcome of the rehabilitation process.
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Affiliation(s)
- Liv Haugli
- Air-National Center in Occupational Rehabilitation, Rauland, Norway.
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Dewa CS, Thompson AH, Jacobs P. The association of treatment of depressive episodes and work productivity. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2011; 56:743-50. [PMID: 22152643 DOI: 10.1177/070674371105601206] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE About one-third of the annual $51 billion cost of mental illnesses is related to productivity losses. However, few studies have examined the association of treatment and productivity. The purpose of our research is to examine the association of depression and its treatment and work productivity. METHODS Our analyses used data from 2737 adults aged between 18 and 65 years who participated in a large-scale community survey of employed and recently employed people in Alberta. Using the World Health Organization's Health and Work Performance Questionnaire, a productivity variable was created to capture high productivity (above the 75th percentile). We used regression methods to examine the association of mental disorders and their treatment and productivity, controlling for demographic factors and job characteristics. RESULTS In the sample, about 8.5% experienced a depressive episode in the past year. The regression results indicated that people who had a severe depressive episode were significantly less likely to be highly productive. Compared with people who had a moderate or severe depressive episode who did not have treatment, those who did have treatment were significantly more likely to be highly productive. However, about one-half of workers with a moderate or severe depressive episode did not receive treatment. CONCLUSIONS Our results corroborate those in the literature that indicate mental disorders are significantly associated with decreased work productivity. In addition, these findings indicate that treatment for these disorders is significantly associated with productivity. Our results also highlight the low proportion of workers with a mental disorder who receive treatment.
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Affiliation(s)
- Carolyn S Dewa
- Centre for Research on Employment and Workplace Health, Centre for Addiction and Mental Health, Toronto, Ontario.
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Stergiopoulos E, Cimo A, Cheng C, Bonato S, Dewa CS. Interventions to improve work outcomes in work-related PTSD: a systematic review. BMC Public Health 2011; 11:838. [PMID: 22040066 PMCID: PMC3219578 DOI: 10.1186/1471-2458-11-838] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 10/31/2011] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder acquired at work can be debilitating both for workers and their employers. The disorder can result in increased sick leave, reduced productivity, and even unemployment. Furthermore, workers are especially unlikely to return to their previous place of employment after a traumatic incident at work because of the traumatic memories and symptoms of avoidance that typically accompany the disorder. Therefore, intervening in work-related PTSD becomes especially important in order to get workers back to the workplace. METHODS A systematic literature search was conducted using Medline, PsycINFO, Embase, and Web of Science. The articles were independently screened based on inclusion and exclusion criteria, followed by a quality assessment of all included articles. RESULTS The systematic search identified seven articles for inclusion in the review. These consisted of six research articles and one systematic review. The review focused specifically on interventions using real exposure techniques for anxiety disorders in the workplace. In the research articles addressed in the current review, study populations included police officers, public transportation workers, and employees injured at work. The studies examined the effectiveness of EMDR, cognitive-behavioural techniques, and an integrative therapy approach called brief eclectic psychotherapy. Interestingly, 2 of the 6 research articles addressed add-on treatments for workplace PTSD, which were designed to treat workers with PTSD who failed to respond to traditional evidence-based psychotherapy. CONCLUSIONS Results of the current review suggest that work-related interventions show promise as effective strategies for promoting return to work in employees who acquired PTSD in the workplace. Further research is needed in this area to determine how different occupational groups with specific types of traumatic exposure might respond differently to work-tailored treatments.
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Affiliation(s)
- Erene Stergiopoulos
- Centre for Research on Employment and Workplace Health, Centre for Addition and Mental Health, 455 Spadina Avenue, Suite 300, Toronto, M5S 2G8, Canada
| | - Adriana Cimo
- Centre for Research on Employment and Workplace Health, Centre for Addition and Mental Health, 455 Spadina Avenue, Suite 300, Toronto, M5S 2G8, Canada
| | - Chiachen Cheng
- Centre for Research on Employment and Workplace Health, Centre for Addition and Mental Health, 455 Spadina Avenue, Suite 300, Toronto, M5S 2G8, Canada
- Canadian Mental Health Association, Clinic & Resource Centre, 272 Park Avenue, Thunder Bay, P7B 1C5, Canada
| | - Sarah Bonato
- Library Services, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, M5S 2S1, Canada
| | - Carolyn S Dewa
- Centre for Research on Employment and Workplace Health, Centre for Addition and Mental Health, 455 Spadina Avenue, Suite 300, Toronto, M5S 2G8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, M5T 1R8, Canada
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Escorpizo R, Reneman MF, Ekholm J, Fritz J, Krupa T, Marnetoft SU, Maroun CE, Guzman JR, Suzuki Y, Stucki G, Chan CCH. A conceptual definition of vocational rehabilitation based on the ICF: building a shared global model. JOURNAL OF OCCUPATIONAL REHABILITATION 2011; 21:126-133. [PMID: 21328061 DOI: 10.1007/s10926-011-9292-6] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND The International Classification of Functioning, Disability and Health (ICF) is a conceptual framework and classification system by the World Health Organization (WHO) to understand functioning. The objective of this discussion paper is to offer a conceptual definition for vocational rehabilitation (VR) based on the ICF. METHOD We presented the ICF as a model for application in VR and the rationale for the integration of the ICF. We also briefly reviewed other work disability models. RESULTS Five essential elements of foci were found towards a conceptual definition of VR: an engagement or re-engagement to work, along a work continuum, involved health conditions or events leading to work disability, patient-centered and evidence-based, and is multi-professional or multidisciplinary. CONCLUSIONS VR refers to a multi-professional approach that is provided to individuals of working age with health-related impairments, limitations, or restrictions with work functioning and whose primary aim is to optimize work participation. We propose that the ICF and VR interface be explored further using empirical and qualitative works and encouraging stakeholders' participation.
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Escorpizo R, Finger ME, Glässel A, Gradinger F, Lückenkemper M, Cieza A. A systematic review of functioning in vocational rehabilitation using the International Classification of Functioning, Disability and Health. JOURNAL OF OCCUPATIONAL REHABILITATION 2011; 21:134-146. [PMID: 21328062 DOI: 10.1007/s10926-011-9290-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Vocational rehabilitation (VR) is aimed at engaging or re-engaging individuals with work participation and employment. The International Classification of Functioning, Disability and Health (ICF) by the World Health Organization can be operationalized in the context of VR. The objective of this study is to review the literature to identify outcomes or measures being used in VR using a systematic review methodology and link those measures to the ICF. METHODS We applied a structured search strategy using multiple databases. Items or constructs of the measures or outcomes identified were linked to the ICF by two trained individuals. RESULTS We have identified 648 measures which contained 10,582 concepts that were linked to the ICF which resulted in 87 second-level ICF categories. Out of the 87 categories, 31 (35.6%) were related to body functions, 43 (49.4%) were related to activities and participation, and 13 (14.9%) were related to environmental factors. No category was related to body structures. CONCLUSIONS Our review found great diversity in the ICF contents of the measures used in different VR settings and study populations, which indicates the complexity of VR. This systematic review has provided a list of ICF categories which could be considered towards a successful VR.
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Escorpizo R, Finger ME, Glässel A, Cieza A. An international expert survey on functioning in vocational rehabilitation using the International Classification of Functioning, Disability and Health. JOURNAL OF OCCUPATIONAL REHABILITATION 2011; 21:147-155. [PMID: 21152958 DOI: 10.1007/s10926-010-9276-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Vocational rehabilitation (VR) is a key process in work disability (WD) management which aims to engage or re-engage individuals to work and employment. The International Classification of Functioning, Disability and Health (ICF) by the World Health Organization (WHO) can be interfaced with VR but there is a lack of evidence of what ICF contents experts in the field consider. The objective of this study is to survey the experts in the VR field with regard to what factors are considered important to patients participating in VR using the ICF as the language to summarize the results. METHODS An internet-based survey was conducted with experts from six WHO Regions (Africa, the Americas, Eastern Mediterranean, Europe, South-East Asia, and Western Pacific). Experts were asked six open-ended questions on factors that are important in VR. Each question was related to a component of the ICF (body functions, body structures, activities and, environmental factors, and personal factors). Responses were linked to the ICF. RESULTS Using a modified stratified randomized sampling, 201 experts were sent the survey and 151 experts responded (75% response rate). We identified 101 ICF categories: 22 (21.8%) for body functions, 13 (12.9%) for body structures, 36 (35.6%) for activities and participation, and 30 (29.7%) for environmental factors. CONCLUSIONS There was a multitude of ICF functioning domains according to the respondents which indicates the complexity of VR. This expert survey has provided a list of ICF categories which could be considered in VR.
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Kronström K, Karlsson H, Nabi H, Oksanen T, Salo P, Sjösten N, Virtanen M, Pentti J, Kivimäki M, Vahtera J. Optimism and pessimism as predictors of work disability with a diagnosis of depression: a prospective cohort study of onset and recovery. J Affect Disord 2011; 130:294-9. [PMID: 21055822 DOI: 10.1016/j.jad.2010.10.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Revised: 10/07/2010] [Accepted: 10/08/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND Personality characteristics are assumed to affect to the vulnerability to depression and its outcomes. The aim of this study was to examine optimism and pessimism as predictors of depression-related work disability and subsequent return to work. METHODS We conducted a prospective cohort study of 38,214 public sector employees with no record of diagnosed depression. Optimism and pessimism were measured using the Revised Life Orientation Test (LOT-R). Records of long-term (>90 days) work disability with a diagnosis of depression and subsequent return to work until the end of 2005 were obtained from the national health registers. RESULTS During the mean follow-up of 4.0 (SD=2.3) years, 287 employees encountered work disability with a diagnosis of depression. Of them, 164 (57%) returned to work during the follow-up. One unit increase in the optimism mean score (range 1-4) was associated with a 25% lower risk of work disability due to depression and a 37% higher probability of returning to work after a work disability period when adjusted for age and sex. In the fully-adjusted model hazard ratios per one unit increase in optimism were 0.79 (95% CI 0.66-0.96) for work disability and 1.30 (95% CI 1.01-1.66) for return to work. The pessimism mean score (range 1-4) was only associated with a lower probability of returning to work (fully-adjusted HR per one unit increase 0.66, 95% Cl 0.49-0.88). CONCLUSION The level of optimism was a stronger predictor of work disability with a diagnosis of depression than the level of pessimism, while both optimism and pessimism predicted returning to work.
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Affiliation(s)
- Kim Kronström
- Department of Psychiatry, University of Turku, 20500 Turku, Finland.
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