Systematic review of intervention practices for depression in the workplace

What is the volume, quality and characteristics of evidence relating to the effectiveness and cost-effectiveness of multi-disciplinary occupational health interventions aiming to improve work-related outcomes for employed adults? An evidence and gap map of systematic reviews

Background

In the UK, tens of millions of working days are lost due to work-related ill health every year, costing billions of pounds. The role of Occupational Health (OH) services is vital in helping workers to maintain employment when they encounter injury or illness. OH providers traditionally rely on a clinical workforce to deliver these services, particularly doctors and nurses with OH qualifications. However, the increasing demand for OH services is unlikely to be met in the future using this traditional model, due to the declining number of OH-trained doctors and nurses in the UK. Multi-disciplinary models of OH delivery, including a more varied range of healthcare and non-healthcare professionals, could provide a way to meet this new demand for OH services. There is a need to identify collaborative models of OH service delivery and review their effectiveness on return-to work outcomes. There is an existing pool of systematic review evidence evaluating workplace based, multi-disciplinary OH interventions, but it is difficult to identify which aspects of the content and/or delivery of these interventions may be associated with improved work-related outcomes.

Objectives

The aim of this evidence and gap map (EGM) was to provide an overview of the systematic review evidence that evaluates the effectiveness and cost-effectiveness of multi-disciplinary OH interventions intending to improve work-related outcomes.

Search Methods

In June 2021 we searched a selection of bibliographic databases and other academic literature resources covering a range of relevant disciplines, including health care and business studies, to identify systematic review evidence from a variety of sectors of employment. We also searched Google Search and a selection of topically relevant websites and consulted with stakeholders to identify reports already known to them. Searches were updated in February 2023.

Selection Criteria

Systematic reviews needed to be about adults (16 years or over) in employment, who have had absence from work for any medical reason. Interventions needed to be multi-disciplinary (including professionals from different backgrounds in clinical and non-clinical professions) and designed to support employees and employers to manage health conditions in the workplace and/or to help employees with health conditions retain and/or return to work following medical absence. Effectiveness needed to be measured in terms of return to work, work retention or measures of absence, or economic evaluation outcomes. These criteria were applied to the title and abstract and full text of each systematic review independently by two reviewers, with disagreements resolved through discussion. We awarded each systematic review a rating of 'High', 'Medium' or 'Low' relevance to indicate the extent to which the populations, interventions and their contexts synthesised within the review were consistent with our research question. We also recorded the number of primary studies included within each of the 'High' and 'Medium' reviews that were relevant to research question using the same screening process applied at review level.

Data Collection and Analysis

Summary data for each eligible review was extracted. The quality of the systematic reviews, rated as 'High' or 'Medium' relevance following full text screening, was appraised using the AMSTAR-2 quality appraisal tool. All data were extracted by one reviewer and checked by a second, with disagreements being settled through discussion. Summary data for all eligible systematic reviews were tabulated and described narratively. The data extracted from reviews of 'High' and 'Medium' relevance was imported into EPPI-Mapper software to create an EGM.

Stakeholder Involvement

We worked alongside commissioners and policy makers from the Department of Health and Social Care (DHSC) and Department of Work and Pensions (DWP), OH personnel, and people with lived experience of accessing OH services themselves and/or supporting employees to access OH services. Individuals contributed to decision making at all stages of the project. This ensured our EGM reflects the needs of individuals who will use it.

Main Results

We identified 98 systematic reviews that contained relevant interventions, which involved a variety of professionals and workplaces, and which measured effectiveness in terms of return to work (RTW). Of these, we focused on the 30 reviews where the population and intervention characteristics within the systematic reviews were considered to be of high or medium relevance to our research questions. The 30 reviews were of varying quality, split evenly between High/Moderate quality and Low/Critically-Low quality ratings. We did not identify any relevant systematic review evidence on any other work-related outcome of interest. Interventions were heterogenous, both within and across included systematic reviews. The EGM is structured according to the health condition experienced by participants, and the effectiveness of the interventions being evaluated, as reported within the included systematic reviews. It is possible to view (i) the quality and quantity of systematic review evidence for a given health condition, (ii) how review authors assessed the effectiveness or cost-effectiveness of the interventions evaluated. The EGM also details the primary studies relevant to our research aim included within each review.

Authors’ Conclusions

This EGM map highlights the array of systematic review evidence that exists in relation to the effectiveness or cost-effectiveness of multi-disciplinary, workplace-based OH interventions in supporting RTW. This evidence will allow policy makers and commissioners of services to determine which OH interventions may be most useful for supporting different population groups in different contexts. OH professionals may find the content of the EGM useful in identifying systematic review evidence to support their practice. The EGM also identifies where systematic review evidence in this area is lacking, or where existing evidence is of poor quality. These may represent areas where it may be particularly useful to conduct further systematic reviews.

Return-to-Work Experiences in Ontario Policing: Injured But Not Broken

PURPOSE

Police officers and others working in police services are exposed to challenging and traumatic situations that can result in physical and/or psychological injuries requiring time off work. Safely returning to work post-injury is critical, yet little is known about current return-to-work (RTW) practices in police services. This study examines RTW practices and experiences in police services from the perspective of RTW personnel and workers with physical and/or psychological health conditions.

METHODS

We used a purposive sampling approach to recruit sworn and civilian members from several police services in Ontario, Canada. The recruited members had experienced RTW either as a person in a RTW support role or as a worker with a work-related injury/illness. We conducted and transcribed interviews for analysis and used qualitative research methods to identify themes in the data.

RESULTS

Five overarching themes emerged. Two pointed to the context and culture of police services and included matters related to RTW processes, injury/illness complexity, the hierarchical nature of police organizations, and a culture of stoicism and stigma. The remaining three themes pointed to the RTW processes of accommodation, communication and trust-building. They included issues related to recovery from injury/illness, meaningful accommodation, timely and clear communication, malingering and trust.

CONCLUSIONS

Our findings point to potential areas for improving RTW practices in police services: greater flexibility, more clarity, stricter confidentiality and reduced stigma. More research is needed on RTW practices for managing psychological injuries to help inform policy and practice.

Responsivity and relation to depressive symptoms of occupational behavior and experience patterns

Introduction

Work stress is a frequent factor in the development of depression. However, not only workplace environment, but also personal attitudes may affect stress experience. The aim of this study was to investigate the change sensitivity of occupational attitudes in psychosomatic inpatients and assess the relationship of changes to depressive symptom reduction.

Methods

The data set encompassed N = 1708 inpatients from two German psychosomatic rehabilitation clinics at admission and discharge. Responsivity of AVEM measures was evaluated by Bonferroni-corrected t-tests and Cohen's dz effect sizes for paired samples. The relation of occupational behavior and experience patterns and depressive symptoms as assessed by the BDI-II questionnaire was calculated by Pearson correlation analysis of pre-post differential values.

Results

Changes in work attitudes were found on eight out of eleven AVEM subscales (Padj ≤ 0.001, Cohen's dz = -0.45 to 0.43) and all AVEM coping styles. Most patients (57.4%) were classified to have a Burnout occupational coping style at admission. Changes following rehabilitation were most frequently observed from Burnout to Sparing coping styles (8.3%). Small to moderate associations between changes in occupational attitudes and depressive symptom reduction were found for all subscales (r = -0.39 to 0.25) except work ambition, and for occupational coping styles Burnout (r = 0.19), Sparing (r = -0.18) and Healthy (r = -0.10), but not Ambitious.

Discussion

The data support responsivity of occupational behavior and experience patterns within a psychosomatic rehabilitation setting. Correlations with depressive symptom reduction suggest that occupational attitudes are related but separate treatment targets.

How Does Organizational Toxicity Affect Depression? A Moderated Mediation Model

Organizational toxicity is a key organizational issue today, impacting the success of both employees and organizations negatively alike. Negative working conditions revealed by organizational toxicity pave the way for an organizational atmosphere to arise, which negatively influences the physical and psychological well-being of employees, causing burn-out syndrome and depression. Thus, organizational toxicity is observed to have a destructive impact on employees and can threaten the future of companies. In this framework, this study examines the mediating role of burnout and moderator role of occupational self-efficacy, in the relationship between organizational toxicity and depression. Conducted as cross-sectional, this study adopts a quantitative research approach. To that end, convenience sampling was used to collect data from 727 respondents who are employed at five-star hotels. Data analysis was completed with SPSS 24.0 and AMOS 24 packages. Consequent to the analyses, organizational toxicity was determined to have a positive effect on burnout syndrome and depression. Moreover, burnout syndrome was found to have a mediating effect on the relationship between organizational toxicity and depression. In addition, occupational self-efficacy was found to have a moderator role on the effect of employees' burnout levels on their depression levels. According to the findings, occupational self-efficacy is an influential variable on reducing the impact that organizational toxicity and burnout have on depression.

Workplace-based occupational therapy for mental health in Africa: a scoping review protocol

INTRODUCTION

Although mental health at work is a pressing and growing concern, mental healthcare accounts for less than 2% of global healthcare, with marked inequality across continents. Africa has the smallest proportion of mental health service providers, and the highest rate of out-of-pocket expenditure for mental health service users. Poor mental health at work results in costs to workers, employers and the economy. This review aims to collaborate with stakeholders to identify literature on workplace-based occupational therapy interventions supporting the mental health of workers in Africa.

METHODS AND ANALYSIS

We will search Medline (PubMed), EBSCOhost (Academic Search Premier, AfricaWide Information, CINAHL, Health Source: Nursing/Academic), Scopus, Web of Science, Sabinet, Cochrane and OTSeeker for qualitative and quantitative primary research studies. Grey literature will be searched via Sabinet and ProQuest. No language or date restrictions will be applied. Title and abstract screening as well as full-text screening will be done independently by two reviewers. Data extracted will include information about the articles, characteristics of studies and interventions, and findings. Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines will be used for reporting results. Three groups of stakeholders will be consulted during the review process: service users/workers, employers and service providers/occupational therapists.

ETHICS AND DISSEMINATION

This scoping review does not require ethics approval. Findings of the review will be disseminated through stakeholder engagements, peer-reviewed publications and conference presentations.

Prenatal work stress is associated with prenatal and postnatal depression and anxiety: Findings from the Norwegian Mother, Father and Child Cohort Study (MoBa)

BACKGROUND

An emerging body of research suggests that stress experienced in the workplace can have detrimental impacts on maternal mental health, including greater risk of postnatal depression. However, few longitudinal studies have examined these associations during the perinatal period. The objective of this study was to examine the associations between prenatal work stress and subsequent depression and anxiety.

METHODS

This study is based on the Norwegian Mother, Father and Child Cohort Study (MoBa), and included 77,999 employed women recruited between 1999 and 2008. The exposure variable was prenatal work stress measured at 17 weeks' gestation, using an 8-item scale examining factors including autonomy, working relationships, and work enjoyment. Outcomes included depression and anxiety at 30 weeks' gestation and 6 months postpartum, measured using the Symptom Checklist-8. Analyses comprised of unadjusted and adjusted logistic regressions.

RESULTS

After covariate adjustment, prenatal work stress was associated with depression and anxiety at 30 weeks' gestation (OR = 1.33, 95% CI: 1.19-1.49), and 6 months postpartum (OR = 1.44, 95% CI: 1.28-1.61). Most associations remained after adjustment for additional work-related variables and maternity leave.

LIMITATIONS

Work stress was measured once during pregnancy, thus variation of associations by trimester could not be investigated. Findings are reported for a sample with high socioeconomic status, and may not generalize to other populations.

CONCLUSIONS

Women dealing with work stress during pregnancy are more likely to experience subsequent depression and anxiety. Findings can inform the development of workplace strategies to support the mental health of expecting and new mothers.

Understanding work participation among employees with common mental disorders: What works, for whom, under what circumstances and how? A systematic realist review protocol

BACKGROUND:

Work participation among employees with common mental disorders (CMDs) is an increasingly important, yet highly complex phenomenon. Given the call for preventing instead of reacting to negative work outcomes, there is a need to understand how employees with CMDs can continue working.

OBJECTIVES:

1) to provide insights in applying a realist approach to the literature review process and 2) to present a way to develop an explanatory framework on work participation, the related causal mechanisms and the interaction with the work context.

METHODS:

A systematic realist literature review, using stay at work (SAW) and work performance (WP) as outcomes of work participation. This protocol paper explains the rationale, tools and procedures developed and used for identification, selection, appraisal and synthesis of included studies.

RESULTS:

The review process entailed six steps to develop so called ‘middle range program theories’. Each step followed a systematic, iterative procedure using context-mechanism-outcome (CMO) configurations.

CONCLUSIONS:

Conducting a realist review adds on the understanding to promote work participation, by examining the heterogeneity and complexity of intervention- and observational studies. This paper facilitates other researchers within the field of occupational health by demonstrating ways to develop a framework on work participation using realist synthesis.

The potential of using hair cortisol to measure chronic stress in occupational healthcare; a scoping review

OBJECTIVES

Workplace-based selective prevention of mental health problems currently relies on subjective evaluation of stress complaints. Hair cortisol captures chronic stress responses and could be a promising biomarker for the early identification of mental health problems. The objective was to provide an overview of the state-of-the-art knowledge on the practical value of hair cortisol in the occupational setting.

METHODS

We performed a scoping review of cross-sectional and longitudinal studies in PubMed, Embase, and PsycINFO up to November 2019 assessing the relations of hair cortisol with work-related stressors, perceived stress, and mental health outcomes in healthy workers.

RESULTS

We found five longitudinal studies, of which two observed an increase in work-related stressors to be associated with higher hair cortisol, one found a relation with lower hair cortisol and one did not find a relationship. Findings of cross-sectional studies were also mixed. The one available longitudinal study regarding mental health showed that hair cortisol was not related to depressive symptoms.

CONCLUSIONS

Hair cortisol measurement within occupational health research is still in its early stage and more longitudinal studies are urgently needed to clarify its relationship with work-related stressors and perceived stress before hair cortisol can be used to identify workers at risk for mental health problems.

Understanding depression as a workplace issue: Clarifying employers' attitudes to manage employees with depression

BACKGROUND

Sickness absence due to depression has indirect and direct costs for employers. Whilst employers play a key role in establishing supportive work environments and providing work adjustments, there is a lack of knowledge on employers' attitudes to support employees with depression.

OBJECTIVE

To investigate employers' attitudes to manage employees' depression, focusing on the employers' opportunities and challenges to support employees with depression.

METHODS

Individual interviews were conducted with five employers. Interview transcripts were analysed using qualitative content analysis.

RESULTS

Four categories emerged from the interviews: Attitude to and understanding of depression affect supportive practices; Dilemma between supporting employees with depression and accommodating workplace needs; The employer-employee relationship influences supportive practices; and Work accommodations target the employee's ability to work.

CONCLUSION

Employers may need a wider understanding of depression and the importance of the work environment influencing work disability due to depression. Studies should investigate how knowledge of work disability due to depression can be transferred to workplaces.Conflicting agendas of the vocational rehabilitation stakeholders poison opportunities to support, and initiatives may aim to promote employers' understanding of the benefits of collaborating with other stakeholders. The involvement of decision-makers to provide initiatives that support employers in managing employees with depression to promote their work participation is recommended.

Return on Investment (ROI) and Development of a Workplace Disability Management Program in a Hospital-A Pilot Evaluation Study

The progressive ageing of the working population and the increase in related chronic diseases tend to affect working capacity. The aim of this study was to evaluate a Workplace Disability Management Program (WDMP) within a pediatric hospital. Absenteeism due to healthcare workers’ (HCWs) pre- and post- WDMP and the related costs were used for the program evaluation. The Return on Investment (ROI), the Break-Even Analysis (BEA) and the value of the average annual productivity of HCWs who took advantage of the Disability Management (DM) interventions to assess the economic impact of the program, were also used. The HCWs enrolled in the program were 131 (approximately 4% of hospital staff), of which 89.7% females and with an average age of 50.4 years (SD ± 8.99). Sick leave days of the HCWs involved decreased by 66.6% in the year following the end of WDMP compared to the previous one (p < 0.001). The total estimated cost reduction of absenteeism is 427,896€ over a year. ROI was equal to 27.66€. BEA indicated that the break-even point was reached by implementing the program on 3.27 HCWs. The program evaluation demonstrated the particular effectiveness of the implemented WDMP model, acting positively on the variables that affect productivity and the limitation to work.

Interventions to improve return to work in depressed people

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 April 4th 2020.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) and cluster-RCTs of work-directed and clinical interventions for depressed people that included days of sickness absence or being off work as an outcome. We also analysed the effects on depression and work functioning.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted the data and rated the certainty of the evidence using GRADE. We used standardised mean differences (SMDs) or risk ratios (RR) with 95% confidence intervals (CI) to pool study results in studies we judged to be sufficiently similar.  MAIN RESULTS: In this update, we added 23 new studies. In total, we included 45 studies with 88 study arms, involving 12,109 participants with either a major depressive disorder or a high level of depressive symptoms. Risk of bias The most common types of bias risk were detection bias (27 studies) and attrition bias (22 studies), both for the outcome of sickness absence. Work-directed interventions Work-directed interventions combined with clinical interventions A combination of a work-directed intervention and a clinical intervention probably reduces days of sickness absence within the first year of follow-up (SMD -0.25, 95% CI -0.38 to -0.12; 9 studies; moderate-certainty evidence). This translates back to 0.5 fewer (95% CI -0.7 to -0.2) sick leave days in the past two weeks or 25 fewer days during one year (95% CI -37.5 to -11.8). The intervention does not lead to fewer persons being off work beyond one year follow-up (RR 0.96, 95% CI 0.85 to 1.09; 2 studies, high-certainty evidence). The intervention may reduce depressive symptoms (SMD -0.25, 95% CI -0.49 to -0.01; 8 studies, low-certainty evidence) and probably has a small effect on work functioning (SMD -0.19, 95% CI -0.42 to 0.06; 5 studies, moderate-certainty evidence) within the first year of follow-up.  Stand alone work-directed interventions A specific work-directed intervention alone may increase the number of sickness absence days compared with work-directed care as usual (SMD 0.39, 95% CI 0.04 to 0.74; 2 studies, low-certainty evidence) but probably does not lead to more people being off work within the first year of follow-up (RR 0.93, 95% CI 0.77 to 1.11; 1 study, moderate-certainty evidence) or beyond (RR 1.00, 95% CI 0.82 to 1.22; 2 studies, moderate-certainty evidence). There is probably no effect on depressive symptoms (SMD -0.10, 95% -0.30 CI to 0.10; 4 studies, moderate-certainty evidence) within the first year of follow-up and there may be no effect on depressive symptoms beyond that time (SMD 0.18, 95% CI -0.13 to 0.49; 1 study, low-certainty evidence). The intervention may also not lead to better work functioning (SMD -0.32, 95% CI -0.90 to 0.26; 1 study, low-certainty evidence) within the first year of follow-up.   Psychological interventions A psychological intervention, either face-to-face, or an E-mental health intervention, with or without professional guidance, may reduce the number of sickness absence days, compared with care as usual (SMD -0.15, 95% CI -0.28 to -0.03; 9 studies, low-certainty evidence). It may also reduce depressive symptoms (SMD -0.30, 95% CI -0.45 to -0.15, 8 studies, low-certainty evidence). We are uncertain whether these psychological interventions improve work ability (SMD -0.15 95% CI -0.46 to 0.57; 1 study; very low-certainty evidence). Psychological intervention combined with antidepressant medication Two studies compared the effect of a psychological intervention combined with antidepressants to antidepressants alone. One study combined psychodynamic therapy with tricyclic antidepressant (TCA) medication and another combined telephone-administered cognitive behavioural therapy (CBT) with a selective serotonin reuptake inhibitor (SSRI). We are uncertain if this intervention reduces the number of sickness absence days (SMD -0.38, 95% CI -0.99 to 0.24; 2 studies, very low-certainty evidence) but found that there may be no effect on depressive symptoms (SMD -0.19, 95% CI -0.50 to 0.12; 2 studies, low-certainty evidence). Antidepressant medication only Three studies compared the effectiveness of SSRI to selective norepinephrine reuptake inhibitor (SNRI) medication on reducing sickness absence and yielded highly inconsistent results. Improved care Overall, interventions to improve care did not lead to fewer days of sickness absence, compared to care as usual (SMD -0.05, 95% CI -0.16 to 0.06; 7 studies, moderate-certainty evidence). However, in studies with a low risk of bias, the intervention probably leads to fewer days of sickness absence in the first year of follow-up (SMD -0.20, 95% CI -0.35 to -0.05; 2 studies; moderate-certainty evidence). Improved care probably leads to fewer depressive symptoms (SMD -0.21, 95% CI -0.35 to -0.07; 7 studies, moderate-certainty evidence) but may possibly lead to a decrease in work-functioning (SMD 0.5, 95% CI 0.34 to 0.66; 1 study; moderate-certainty evidence). Exercise Supervised strength exercise may reduce sickness absence, compared to relaxation (SMD -1.11; 95% CI -1.68 to -0.54; one study, low-certainty evidence). However, aerobic exercise probably is not more effective than relaxation or stretching (SMD -0.06; 95% CI -0.36 to 0.24; 2 studies, moderate-certainty evidence). Both studies found no differences between the two conditions in depressive symptoms.

AUTHORS' CONCLUSIONS

A combination of a work-directed intervention and a clinical intervention probably reduces the number of sickness absence days, but at the end of one year or longer follow-up, this does not lead to more people in the intervention group being at work. The intervention may also reduce depressive symptoms and probably increases work functioning more than care as usual. Specific work-directed interventions may not be more effective than usual work-directed care alone. Psychological interventions may reduce the number of sickness absence days, compared with care as usual. Interventions to improve clinical care probably lead to lower sickness absence and lower levels of depression, compared with care as usual. There was no evidence of a difference in effect on sickness absence of one antidepressant medication compared to another. Further research is needed to assess which combination of work-directed and clinical interventions works best.

Leave of absence due to depression

Objective:

to analyze the occurrence of leave of absence due to depression among workers.

Method:

census, descriptive-analytical study, with retrospective collection. Population composed of 2,267 workers on leave due to depression with data from the Unified Benefits Information System. The independent variables were: sex, age group, income; county, origin, number of leaves of absence and type of benefit. For data analysis, descriptive statistics were used and the chi-square and Fisher’s exact tests were applied. The variables that presented a value of p≤0.20 were submitted to logistic regression.

Results:

there was a predominance of females, age ≥50 years, from the capital, with income of one to two minimum wages, urban origin and single removal. Single leaves of absence occurred mainly due to a mild depressive episode and the benefit granted to the significant majority was social security sickness benefit. Among those who were on leave of absence more than once, the main cause was recurrent depressive disorder, a current mild episode and, in terms of benefit, social security sickness benefit. There was a statistical association between total time and absence from work. In logistic regression, it was found that the time ≥60 days, was 3.1 times longer in recurrent depressive disorder.

Conclusion:

there were an expressive quantitative number of absences due to depression, in which it was observed, especially, that the absence time remained long.

Effects of Vocational Re-training on Employment Outcomes Among Persons with Disabilities in Germany: A Quasi-Experiment

Purpose To investigate how completing vocational re-training influenced income and employment days of working-age people with disabilities in the first 8 years after program admission. The investigation also included the influence of vocational re-training on the likelihood of receiving an earnings incapacity pension and on social security benefit receipt. Methods This retrospective cohort study with 8 years follow up was based on data from 2399 individuals who had completed either a 1-year vocational re-training program (n = 278), or a 2-year vocational re-training program (n = 1754) or who were admitted into re-training but never completed the program (n = 367). A propensity score-based method was used to account for observed differences and establish comparability between program graduates and program dropouts. Changes in outcomes were examined using the inverse probability-weighted regression adjustment method. Results After controlling for other factors, over the 8 years after program admission, graduates of 1-year re-training, on average, were employed for an additional 405 days, 95% CI [249 days, 561 days], and had earned €24,260 more than without completed re-training, 95% CI [€12,805, €35,715]. Two-year program completers, on average, were employed for 441 additional days, 95% CI [349 days, 534 days], and had earned €35,972 more than without completed re-training, 95% CI [€27,743, €44,202]. The programs also significantly reduced the number of days on social-security and unemployment benefits and lowered the likelihood of an earnings incapacity pension. Conclusion Policies to promote the labor market re-integration of persons with disabilities should consider that vocational re-training may be an effective tool for sustainably improving work participation outcomes.

Long-Term Attitude Change After a Single-Day Manager Training Addressing Mental Health at the Workplace

Mental health problems have become one of the most common causes of incapacity for work, and engender high costs to society. Especially managerial behavior was found to have a great impact on employees' well-being. In order to support those in leading positions in dealing with their own, as well as their employees', psychological stress factors, we conducted a specific manager training. At the same time, we wanted to find out about the training's short- and long-term effects. Participants were asked to give information about their knowledge and attitudes concerning mental health (Mental Health Knowledge Schedule, Social Distance Scale), as well as to comment on their own health condition (12-Item Short Form Health Survey, Patient Health Questionnaire) and working situation (Effort-Reward Inventory, Irritation Scale). Data were collected at baseline, as well as 3 and 12 months after the training. Results show long-term improvements in knowledge and attitudes measured by the Mental Health Knowledge Schedule (MAKS: Mt1 = 22.88, Mt2 = 23.79, Mt3 = 23.79, p = 0.005) but not in the Social Distance Scale (SoDi: Mt1 = 0.96, Mt2 = 0.85, Mt3 = 0.84, p = 0.165). Over the period of time observed, no changes were found regarding health- or work-related instruments. Due to the uncontrolled design of the study, further research is needed to determine the exact effectiveness.

Does stigmatization moderate the association between intention and implementation of learned prevention-strategies at work after a depressive episode? - a cross-sectional pilot study

Background

A depressive episode is a frequent reason for production loss due to long periods of absence at work. To maintain work ability after depression, affected employees need to implement learned coping strategies from interventions at work. Based on the theory of planned behavior, this paper examines how stigmatization relates to the implementation of the learned strategies at the workplace. Further, differences between employees with single or recurrent depressive episode were considered.

Methods

Data of an online survey from 112 participants who returned to work after sick leave because of a depressive episode were analyzed [men = 28 (25%); Age: mean = 42.3, SD = 10.9]. The strategies learned were asked openly, intention and implementation with a questionnaire based on the theory of planned behavior and stigmatization with an adapted version of the German inventory of subjective stigma experience.

Results

Intention is positively (β = .46, p < .001) and anticipated (β = −.18, p = .052) and experienced stigmatization not (β = −.11, p = .27) correlated with implementation. Only anticipated stigmatization moderates the association between intention and implementation (β = .26, p = .003). If individuals report a high intention to implement the learned strategies, stigmatization has no influence on implementation. Under low intention, stigmatization leads to less implementation. Participants with recurrent depressive episodes report higher anticipated stigmatization than participants with a single episode.

Conclusion

When employees return to work after a depressive episode, it is important to address anticipated stigmatization and to develop an organizational culture that helps them to reduce their fear of stigmatization and strengthens their work ability via implementing learned prevention-strategies. The reduction of patient’s anticipated stigmatization should already be considered in the therapy and reduced in cooperation with occupational physicians.

Evidence of Workplace Interventions-A Systematic Review of Systematic Reviews

Work environment factors are highly correlated with employees' health and well-being. Our aim was to sum up current evidence of health promotion interventions in the workplace, focusing on interventions for the prevention of musculoskeletal disorders, psychological and behavioral disorders as well as interventions for older employees and economic evaluations. We conducted a comprehensive literature search including systematic reviews published from April 2012 to October 2017 in electronic databases and search engines, websites of relevant organizations and institutions. It consisted of simple and specific terms and word combinations related to workplace health promotion based on the search strategy of a previous review. After full-text screening, 74 references met the eligibility criteria. Using the same search strategy, there was a higher proportion of relevant high-quality studies as compared with the earlier review. The heterogeneity of health promotion interventions regarding intervention components, settings and study populations still limits the comparability of studies. Future studies should also address the societal and insurer perspective, including costs to the worker such as lost income and lost time at work of family members due to caregiving activities. To this end, more high-quality evidence is needed.

Evidence available for patient-identified priorities in depression research: results of 11 rapid responses

OBJECTIVES

Patient priority setting projects (PPSPs) can reduce research agenda bias. A key element of PPSPs is a review of available literature to determine if the proposed research priorities have been addressed, identify research gaps, recognise opportunities for knowledge translation (KT) and avoid duplication of research efforts. We conducted rapid responses for 11 patient-identified priorities in depression to provide a map of the existing evidence.

DESIGN

Eleven rapid responses.

DATA SOURCES

Single electronic database (PubMed).

ELIGIBILITY CRITERIA

Each rapid response had unique eligibility criteria. For study designs, we used a stepwise inclusion process that started with systematic reviews (SRs) if available, then randomised controlled trials and observational studies as necessary.

RESULTS

For all but one of the rapid responses we identified existing SRs (median 7 SRs per rapid response, range 0-179). There were questions where extensive evidence exists (ie, hundreds of primary studies), yet uncertainties remain. For example, there is evidence supporting the effectiveness of many non-pharmacological interventions (including psychological interventions and exercise) to reduce depressive symptoms. However, targeted research is needed that addresses comparative effectiveness of promising interventions, specific populations of interest (eg, children, minority groups) and adverse effects.

CONCLUSIONS

We identified an extensive body of evidence addressing patient priorities in depression and mapped the results and limitations of existing evidence, areas of uncertainty and general directions for future research. This work can serve as a solid foundation to guide future research in depression and KT activities. Integrated knowledge syntheses bring value to the PPSP process; however, the role of knowledge synthesis in PPSPs and methodological approaches are not well defined at present.

Return-to-Work Following Depression: What Work Accommodations Do Employers and Human Resources Directors Put in Place?

The magnitude of economic and social costs related to common mental disorders has a profound impact on the workplace. Returning to work following depression is, therefore, a major issue for all stakeholders involved (employee, employer, human resources director, union, physician, etc.). Considering their role in the organization, Human Resources Directors (HRD) and employers have a decisive impact on the return-to-work (RTW) process. Purpose This study aims to determine which RTW accommodations are implemented, following depression, by one of the central stakeholders: HRD and employers. Methods 219 HRD/employers participated in a semi-structured telephone interview about RTW of employees after depression. From that interview, the question related to this article was: Do you put in place work accommodations for employees after a sick leave due to depression (yes or no)? If their response was positive, we asked: If yes, what were the work accommodations? Results 170 HRD/employers specified accommodations. The most common categories identified were related to: work schedule, task modifications, job change and work environment change. Accommodations directly related to the employee or the colleagues were considerably less mentioned and those concerning other RTW stakeholders, including supervisor, were almost absent. Conclusion Our results suggest that accommodations directly related to work aspects seemed to predominate in our sample of HRD/employers when an employee returned-to-work following depression. The relational aspect and the involvement of the different stakeholders are also not prioritized to accommodate the RTW. These results contrast with employer best practice guidelines for the RTW of workers with common mental disorders.

Health-Related Internet Usage and Design Feature Preference for E-Mental Health Programs Among Men and Women

Background

Major depressive episodes (MDEs) are prevalent in the workplace and affect workers’ health and productivity. Therefore, there is a pressing need for innovation in the prevention of MDEs in the workplace. Electronic mental (e-mental) health programs are a cost-effective approach toward the self-management of stress and emotional issues. E-mental health dropout rate, MDE prevalence, and symptoms greatly vary by sex and age. Thus, the development and implementation of e-mental health programs for the prevention of MDEs need to be examined through a sex and age lens to enhance program use and effectiveness.

Objective

This study aimed to examine design feature preferences based on sex and age for an e-mental health program targeted toward depression prevention.

Methods

Household residents across Canada were contacted using the random digit dialing method. 500 women and 511 men who were 18 years and older and who were at high risk of having MDEs were interviewed. Internet use was assessed using questions from the 2012 Canadian Internet Use Survey conducted by Statistics Canada, and preferred design features of e-mental health program questions were developed by the BroMatters team members. The proportions of likely use of specific features of e-mental health programs in women were estimated and compared with those in men using chi-square tests. The comparisons were made overall and by age groups.

Results

Men (181/511, 35.4%) and women (211/500, 42.2%) differed significantly in their likelihood of using an e-mental health program. Compared with men (307/489, 62.8%), women (408/479, 85.2%) were more likely to use the internet for medical or health-related information. Women were more likely to use the following design features: practices and exercises to help reduce symptoms of stress and depression (350/500, 70.7%), a self-help interactive program that provides information about stress and work problems (302/500, 61.8%), the ability to ask questions and receive answers from mental health professionals via email or text message (294/500, 59.9%), and to receive printed materials by mail (215/500, 43.4%). Men preferred to receive information in a video game format (156/511, 30.7%). Younger men (46/73, 63%) and younger women (49/60, 81%) were more likely to access a program through a mobile phone or an app, and younger men preferred having access to information in a video game format.

Conclusions

Factors such as sex and age influenced design feature preferences for an e-mental health program. Working women who are at high risk for MDEs preferred interactive programs incorporating practice and exercise for reducing stress, quality information about work stress, and some guidance from professionals. This suggests that sex and age should be taken into account when designing e-mental health programs to meet the needs of individuals seeking help via Web-based mental health programs and to enhance their use.

Work-focused interventions that promote the labour market transition of young adults with chronic disabling health conditions: a systematic review

Objective

Young adulthood is an important transitional life phase where careers are established. Young adults with chronic disabling health conditions are underrepresented in the labour market. Our study aims to examine the effectiveness of work-focused interventions that support the labour market transition of young adults with chronic disabling health conditions; and to examine whether the effectiveness of work-focused interventions differ across work transition phase (eg, preparation, entry and sustaining work, employment advancement) and disability type.

Methods

A systematic review of articles published between January 1990 and July 2018 was conducted. Medline, EMBASE and PsycInfo were searched, and titles/abstracts and full texts of articles were reviewed for eligibility. Relevant articles were appraised for methodological quality. A best evidence synthesis was applied to medium-quality/high-quality studies to develop recommendations.

Results

5816 articles were identified; 10 articles were relevant and of moderate–high methodological quality. Six intervention categories were identified which focused on young adults with mental health or intellectual/learning disabilities (n=3) and addressed employment preparation (n=10) and/or work entry (n=9). No interventions addressed at-work issues or career advancement. Strong evidence existed for tailored supported employment (SE) interventions having a positive impact on preparation and entry into competitive employment. Also, moderate evidence existed for the positive impact of SE on preparation and entry into competitive employment for young adults with mental health conditions.

Conclusions

Tailored SE is recommended to foster preparation and entry into the labour market. Evidence-based interventions are needed to facilitate sustained work and career advancement of young adults living with different disabling health conditions.

Indicated Prevention Interventions in the Workplace for Depressive Symptoms: A Systematic Review and Meta-analysis

CONTEXT

Depressive symptoms are highly prevalent and cause substantive morbidities and loss of functioning among employees. Depression may be prevented at its early stages. However, there is a paucity of information regarding indicated preventive interventions for depression among employees. The objective of this review is to examine the effectiveness of indicated interventions for the reduction of depressive symptoms in the workplace.

EVIDENCE ACQUISITION

A systematic review and meta-analysis of articles published between January 2000 and September 2017 was conducted using major electronic databases, including PubMed/MEDLINE, PsycINFO, EMBASE, SOCINDEX, and ABI/ProQuest. Studies were selected based on a set of predefined inclusion criteria. Primary outcome measures were depressive symptomatology, and the interventions were preventive in nature. Studies were pooled based on the intervention type and the effect size was measured using the standardized mean difference.

EVIDENCE SYNTHESIS

A computer and hand search of the literature yielded 4,462 papers, from which 16 trials were identified to be suitable for meta-analysis. Eight of 16 studies reported significant effects for workplace preventive interventions targeting depressive symptoms in which six were cognitive behavioral therapy (CBT)-based interventions and two were non-CBT-based interventions. Small to medium effect sizes were found for both CBT- and non-CBT-based interventions (standardized mean difference= -0.44, 95% CI= -0.61, -0.26, I²=62.1% and standardized mean difference= -0.32, 95% CI= -0.59, -0.06, I²=58%, respectively).

CONCLUSIONS

This review demonstrates that indicated interventions can significantly reduce the level of depressive symptoms among workers. The implementation of evidence-based workplace interventions should consequently be considered to prevent the development of depressive symptoms among employees.

Managing employees' depression from the employees', co-workers' and employers' perspectives. An integrative review

Purpose: To synthesize evidence on factors promoting or hindering work participation (WP) of employees with depression from the employees', co-workers' and employers' perspectives, as well as an additional focus on the influence of the employee's occupation.Methods: An integrative review was conducted. Pre-defined eligibility criteria guided study selection. Articles were critically appraised using tools developed by Joanna Briggs and Mixed Methods Appraisal Tool. Findings were analysed and synthesised using qualitative inductive content analysis.Results: Seventeen studies were included: 12 quantitative studies, three qualitative studies and two mixed methods studies. From these, 144 findings were extracted and combined into six categories from which two syntheses were developed. One synthesis demonstrated that employees, co-workers and employers hold different perspectives on rehabilitation stakeholders' responsibilities hindering WP. The other synthesis revealed that WP is influenced by interactions between individual and occupational factors.Conclusions: Sufficient treatment from health professionals promotes WP. Employees' fear of stigmatization hinders WP. Co-workers and employers find that open communication is important, however, employers are concerned about entering employees' private sphere. When managing employees with depression, employers intervene at the individual level. There is a need for structural interventions to promote WP among employees with depression.Implications for RehabilitationThe responsibilities of rehabilitation stakeholders should be clarified to promote collaboration.Structural workplace interventions should be initiated to supplement individual level interventions.Workplace interventions may focus on more open communication and awareness towards mental illness.Interactions between the occupational factors and individual factors should be carefully considered.

Work Participation Among Employees with Common Mental Disorders: A Meta-synthesis

Purpose The aim was to aggregate knowledge about the opportunities, challenges and need for support employees with common mental disorders experience in relation to work participation in order to develop recommendations for practice. Methods A meta-synthesis was conducted using a meta-aggregative approach to accurately and reliably present findings that could be used to meet our aim. Qualitative inductive content analysis was used to analyze and synthesize the findings. Results In all, 252 findings were extracted from 16 papers, and six categories were generated and aggregated into two synthesized findings. One synthesized finding indicates that a strong work identity and negative perceptions regarding mental disorders can impede work participation, creating an essential need for a supportive work environment. The other reveals that the diffuse nature of the symptoms of mental disorders causes instability in life and loss of control, but through the use of internal motivation and external support, employees may be able to regain control of their lives. However, external support is hampered by insufficient cooperation and coordination between vocational stakeholders. Conclusions Based on the synthesized findings, we recommended that the employer is involved in the rehabilitation process, and that rehabilitation professionals seek to strengthen the employee's ability to manage work-related stress. In addition, rehabilitation professionals should provide individualized and active support and ensure meaningful cooperation across the multidisciplinary disciplines involved in the rehabilitation process.

Effectiveness of Workplace Interventions in Return-to-Work for Musculoskeletal, Pain-Related and Mental Health Conditions: An Update of the Evidence and Messages for Practitioners

Purpose The objective of this systematic review was to synthesize evidence on the effectiveness of workplace-based return-to-work (RTW) interventions and work disability management (DM) interventions that assist workers with musculoskeletal (MSK) and pain-related conditions and mental health (MH) conditions with RTW. Methods We followed a systematic review process developed by the Institute for Work & Health and an adapted best evidence synthesis that ranked evidence as strong, moderate, limited, or insufficient. Results Seven electronic databases were searched from January 1990 until April 2015, yielding 8898 non-duplicate references. Evidence from 36 medium and high quality studies were synthesized on 12 different intervention categories across three broad domains: health-focused, service coordination, and work modification interventions. There was strong evidence that duration away from work from both MSK or pain-related conditions and MH conditions were significantly reduced by multi-domain interventions encompassing at least two of the three domains. There was moderate evidence that these multi-domain interventions had a positive impact on cost outcomes. There was strong evidence that cognitive behavioural therapy interventions that do not also include workplace modifications or service coordination components are not effective in helping workers with MH conditions in RTW. Evidence for the effectiveness of other single-domain interventions was mixed, with some studies reporting positive effects and others reporting no effects on lost time and work functioning. Conclusions While there is substantial research literature focused on RTW, there are only a small number of quality workplace-based RTW intervention studies that involve workers with MSK or pain-related conditions and MH conditions. We recommend implementing multi-domain interventions (i.e. with healthcare provision, service coordination, and work accommodation components) to help reduce lost time for MSK or pain-related conditions and MH conditions. Practitioners should also consider implementing these programs to help improve work functioning and reduce costs associated with work disability.

The clinical effectiveness of a cognitive behavioural therapy intervention in a work setting: a 5-year retrospective analysis of outcomes

Background

The National Institute for Health and Clinical Excellence (NICE) guidance recommends Cognitive Behavioural Therapy (CBT) as part of multidisciplinary occupational mental health interventions for people with long-term or recurrent short-term sickness absence from work (NICE, 2009). Despite this, there is a paucity of data for both randomised trials for CBT and literature that supports the transferability of CBT into occupational environments.

Aims

This service evaluation aimed to evaluate the clinical effectiveness of CBT by analysing data from a partnership scheme between a local authority and a local heath board using a routine employee population.

Methods

A clinical cohort of 81 employees referred through the partnership scheme completed CBT over a 5-year period via a CBT nurse therapist. A sample of 76 employees was included in the evaluation who completed pre-/post-measures to establish outcome. Of these, 30 were followed up at a 3-year point, completing the same measures.

Results

Each of the clinical measures yielded significant outcomes at 95% confidence intervals, and large effect sizes using Cohen's d both at post-test and follow-up. No significant difference was shown between post-treatment and follow-up outcomes. CBT was demonstrated to be clinically effective within an occupational mental health setting.

Conclusions

In conclusion, partnership schemes with a focus on mental health between public sector agencies can have a positive outcome for the funding agency as well as individual employees.

Preliminary Analyses Showed Short-Term Mental Health Improvements after a Single-Day Manager Training

Psychosocial working conditions attract more and more attention when it comes to mental health in the workplace. Trying to support managers to deal with their own as well as their employees' psychological risk factors, we conducted a specific manager training. Within this investigation, we wanted to learn about the training's effects and acceptance. A single-day manager training was provided in a large industrial company in Germany. The participants were asked to fill out questionnaires regarding their own physical and mental health condition as well as their working situation. Questionnaires were distributed at baseline, 3-month, and 12-month follow-up. At this point of time the investigation is still ongoing. The current article focuses on short-term preliminary effects. Analyses only included participants that already completed baseline and three months follow-up. Preliminary results from three-month follow-up survey (n = 33, nmale = 30, Mage = 47.5) indicated positive changes in the manager's mental health condition measured by the Patient Health Questionnaire for depression (PHQ-9: Mt1 = 3.82, Mt2 = 3.15). Training managers about common mental disorders and risk factors at the workplace within a single-day workshop seems to promote positive effects on their own mental health. Especially working with the managers on their own early stress symptoms might have been an important element.

Cohort profile: workers' compensation in a changing Australian labour market: the return to work (RTW) study

PURPOSE

Workers' compensation claims for older workers and workers who have suffered psychological injury are increasing as a proportion of total claims in many jurisdictions. In the Australian state of Victoria, claims from both these groups are associated with higher than average wage replacement and healthcare expenditures. This cohort profile describes a longitudinal study which aims to investigate differences in the return to work (RTW) process for older workers compared with younger workers and claimants with musculoskeletal injuries compared with those with psychological injuries.

PARTICIPANTS

This prospective cohort study involved interviewing workers' compensation claimants at three time points. The cohort was restricted to psychological and musculoskeletal claims. Only claimants aged 18 and over were recruited, with no upper age limit. A total of 869 claimants completed the baseline interview, representing 36% of the eligible claimant population. Ninety-one per cent of participants agreed at baseline to have their survey responses linked to administrative workers' compensation data. Of the 869 claimants who participated at baseline, 632 (73%) took part in the 6-month follow-up interview, and 572 (66%) participated in the 12-month follow-up interview.

FINDINGS TO DATE

Information on different aspects of the RTW process and important factors that may impact the RTW process was collected at the three survey periods. At baseline, participants and non-participants did not differ by injury type or age group, but were more likely to be female and from the healthcare and social assistance industry. The probability of non-participation at follow-up interviews showed younger age was a statistically significant predictor of non-participation.

FUTURE PLANS

Analysis of the longitudinal cohort will identify important factors in the RTW process and explore differences across age and injury type groups. Ongoing linkage to administrative workers' compensation data will provide information on wage replacement and healthcare service use into the future.

Enabling the return-to-work process among people with affective disorders: A multiple-case study

BACKGROUND

The Individual Enabling and Support (IES) model is an adapted, supported employment program developed to meet motivational, cognitive and time-use needs of people with affective disorders. Vocational programs for this target group have been developed but more knowledge is needed about the important characteristics and perceived usefulness of the programs. The aim of this study was to illustrate the IES model and process from multiple perspectives.

METHODS

Five participants were included in this multiple-case study. The material comprised interviews with participants, intervention documents, memos and interviews with employment specialists. Within and cross-case analyzes and an analytical generalization were performed.

RESULTS

The cases illustrated different IES processes, and the theme; Enabling engagement in return to work (RTW) was formulated. Continuous support from the employment specialist and a focus on personal resources and motivation were essential to overcome low self-confidence regarding RTW. Motivational, cognitive and time-use strategies gave an opportunity to learn new behavior and coping strategies for job seeking, getting employed and working.

CONCLUSION

Providing a combination of these strategies integrated with supported employment could promote self-efficacy and engagement in the RTW process among people on sick leave due to an affective disorder.

Systematic review of universal and targeted workplace interventions for depression

Depression is increasingly being recognised as a significant mental health problem in the workplace contributing to productivity loss and economic burden to organisations. This paper reviews recently published randomised controlled trials (RCTs) of universal and targeted interventions to reduce depression in the workplace. Studies were identified through searches of EMBASE, MEDLINE/PubMed, PsycINFO, PsycARTICLES Full Text, and Global Health and Social Policy and Practice databases. Studies were included if they included an RCT of a workplace intervention for employees targeting depression as the primary outcome. Twenty-two published RCTs investigating interventions utilising various therapeutic approaches were identified. The cognitive behavioural therapy (CBT) approach is the most frequently used in the workplace, while interventions that combine different therapeutic approaches showed the most promising results. A universal intervention in the workplace that combines CBT and coping flexibility recorded the highest effect size (d=1.45 at 4 months’ follow-up). Most interventions were delivered in group format and showed low attrition rates compared with other delivery formats. Although all studies reviewed were RCTs, the quality of reporting is low. Interventions using different therapeutic approaches with different modes of delivery have been used. Most of these interventions were shown to reduce depression levels among employees in the workplace, particularly those that combine more than one therapeutic approaches.

Physical Activity and Exercise Interventions in the Workplace Impacting Work Outcomes: A Stakeholder-Centered Best Evidence Synthesis of Systematic Reviews

Background:

The prevention of work disability is beneficial to employees and employers, and mitigates unnecessary societal costs associated with social welfare. Many service providers and employers have initiated workplace interventions designed to reduce unnecessary work disability.

Objective:

To conduct a best-evidence synthesis of systematic reviews on workplace interventions that address physical activities or exercise and their impact on workplace absence, work productivity or financial outcomes.

Methods:

Using a participatory research approach, academics and stakeholders identified inclusion and exclusion criteria, built an abstraction table, evaluated systematic review quality and relevance, and interpreted the combined findings. A minimum of two scientists participated in a methodological review of the literature followed by a consensus process.

Results:

Stakeholders and researchers participated as a collaborative team. 3363 unique records were identified, 115 full text articles and 46 systematic reviews were included, 18 assessed the impact of physical fitness or exercise interventions. 11 focused on general workers rather than workers who were absent from work at baseline; 16 of the reviews assessed work absence, 4 assessed productivity and 6 assessed financial impacts.

Conclusion:

The strongest evidence supports the use of short, simple exercise or fitness programs for both workers at work and those absent from work at baseline. For workers at work, simple exercise programs (1–2 modal components) appear to provide similar benefits to those using more complex multimodal interventions. For workers off-work with subacute low back pain, there is evidence that some complex exercise programs may be more effective than simple exercise interventions, especially if they involve workplace stakeholder engagement, communication and coordination with employers and other stakeholders. The development and utilization of standardized definitions, methods and measures and blinded evaluation would improve research quality and strengthen stakeholder-centered guidance.

Supported employment adapted for people with affective disorders-A randomized controlled trial

BACKGROUND

While effective vocational methods for gaining employment exist for people with schizophrenia and similar conditions, no evidence exists with regard to people with affective disorders. We aimed to study the effectiveness of a newly developed Individual Enabling and Support (IES) model adapted for the target group and compared to traditional vocational rehabilitation (TVR).

METHODS

An assessor-blinded randomized controlled trial (RCT) with a parallel design was performed. Sixty-one participants received IES or TVR. The primary outcome was employment rate at 12-month follow-up. Secondary vocational outcomes, depression severity, and quality of life were also studied. Trial register number is ISRCTN93470551.

RESULTS

IES was more effective for employment compared to TVR (42.4% vs. 4%; difference 38%, 95% CI 0.12-0.55). Significant group differences were present in secondary vocational outcomes (hours and weeks employed, time to employment), and depression severity. The IES-group had significantly lowering in depression scores and increased quality of life scores during the intervention period.

LIMITATIONS

This RCT was limited by the small sample size due to restriction of recruitment to middle-sized cities within geographically diverse sites in southern Sweden. Larger trials are needed, also in primary health care and employment services settings.

CONCLUSIONS

IES is more effective than TVR for attaining employment and improving depressive symptoms. On a societal level, IES closes the time and service gap between treatment and employment, and thus lowers sick-leave costs.

Workplace Interventions to Prevent Disability from Both the Scientific and Practice Perspectives: A Comparison of Scientific Literature, Grey Literature and Stakeholder Observations

Purpose The significant individual and societal burden of work disability could be reduced if supportive workplace strategies could be added to evidence-based clinical treatment and rehabilitation to improve return-to-work (RTW) and other disability outcomes. The goal of this article is to summarize existing research on workplace interventions to prevent disability, relate these to employer disability management practices, and recommend future research priorities. Methods The authors participated in a year-long collaboration that ultimately led to an invited 3-day conference, Improving Research of Employer Practices to Prevent Disability, held October 14-16, 2015, in Hopkinton, Massachusetts, USA. The collaboration included a topical review of the literature, group conference calls to identify key areas and challenges, drafting of initial documents, review of industry publications, and a conference presentation that included feedback from peer researchers and a question/answer session with an expert panel with direct employer experience. Results Evidence from randomized trials and other research designs has shown general support for job modification, RTW coordination, and organizational support, but evidence is still lacking for interventions at a more granular level. Grey literature reports focused mainly on job re-design and work organization. Panel feedback focused on organizational readiness and the beliefs and values of senior managers as critical factors in facilitating changes to disability management practices. While the scientific literature is focused on facilitating improved coping and reducing discomforts for individual workers, the employer-directed grey literature is focused on making group-level changes to policies and procedures. Conclusions Future research might better target employer practices by tying interventions to positive workplace influences and determinants, by developing more participatory interventions and research designs, and by designing interventions that address factors of organizational change.

Sustaining Work Participation Across the Life Course

Introduction Many disability prevention strategies are focused on acute injuries and brief illness episodes, but there will be growing challenges for employers to manage circumstances of recurrent, chronic, or fluctuating symptoms in an aging workforce. The goal of this article is to summarize existing peer-review research in this area, compare this with employer discourse in the grey literature, and recommend future research priorities. Methods The authors participated in a year-long sponsored collaboration that ultimately led to an invited 3-day conference, "Improving Research of Employer Practices to Prevent Disability", held October 14-16, 2015, in Hopkinton, Massachusetts, USA. The collaboration included a topical review of the scientific and industry literature, group discussion to identify key areas and challenges, drafting of initial documents, and feedback from peer researchers and a special panel of experts with employer experience. Results Cancer and mental illness were chosen as examples of chronic or recurring conditions that might challenge conventional workplace return-to-work practices. Workplace problems identified in the literature included fatigue, emotional exhaustion, poor supervisor and co-worker support, stigma, discrimination, and difficulties finding appropriate accommodations. Workplace intervention research is generally lacking, but there is preliminary support for improving workplace self-management strategies, collaborative problem-solving, and providing checklists and other tools for job accommodation, ideas echoed in the literature directed toward employers. Research might be improved by following workers from an earlier stage of developing workplace concerns. Conclusions Future research of work disability should focus on earlier identification of at-risk workers with chronic conditions, the use of more innovative and flexible accommodation strategies matched to specific functional losses, stronger integration of the workplace into on-going rehabilitation efforts, and a better understanding of stigma and other social factors at work.

Black and Blue: Depression and African American Men

Depression is a common mental disorder affecting individuals. Although many strides have been made in the area of depression, little is known about depression in special populations, especially African American men. African American men often differ in their presentation of depression and are often misdiagnosed. African American men are at greater risk for depression, but they are less likely to participate in mental health care. This article explores depression in African American by looking at environmental factors, sigma, role, and other unique to this populations, such as John Henryism. Interventions to encourage early screening and participation in care are also discussed.

The role of empowerment and quality of life in depression severity among unemployed people with affective disorders receiving mental healthcare

PURPOSE

Sick leave and unemployment are highly prevalent among people with affective disorders. Their depression severity is disabling and inversely related to having employment. No evidence-based vocational rehabilitation exists for this target group. Knowledge is therefore needed to understand the psychosocial factors that affect depression severity in order to develop new rehabilitation interventions. This study examined relationships between depression severity and empowerment, working life aspirations, occupational engagement, and quality of life in unemployed people with affective disorders receiving mental healthcare.

METHOD

In this cross-sectional study of 61 participants, instruments on psychosocial factors and questions on descriptive sociodemographic and clinical characteristics were administered. Descriptive, correlation, and regression statistics were applied.

RESULTS

Correlation and regression analyses showed significant inverse relations between depression severity and empowerment and quality of life. The odds for more severe depression decreased with higher empowerment and quality of life. However, neither extent of engagement in daily life nor working life aspiration was related to depression severity.

CONCLUSIONS

An empowerment approach and strategies, which support the quality of life, are needed in development of vocational rehabilitation interventions, and bridging of mental healthcare and vocational services. Implications for Rehabilitation Enhancing empowerment and quality life in the return to work process can decrease depression severity in unemployed people with affective disorder. There is a need to address work issues in addition to symptom reduction in primary and mental healthcare. Bridging the service and time gap between vocational rehabilitation and healthcare is recommended for mitigating long-term unemployment for people with affective disorders who want to work.

Mental Health Interventions in the Workplace and Work Outcomes: A Best-Evidence Synthesis of Systematic Reviews

Background:

Mental health issues in the workplace are a growing concern among organizations and policymakers, but it remains unclear what interventions are effective in preventing mental health problems and their associated organizational consequences. This synthesis reports on workplace mental health interventions that impact absenteeism, productivity and financial outcomes.

Objective:

To determine the level of evidence supporting mental health interventions as valuable to work outcomes.

Methods:

Databases were searched for systematic reviews between 2000 and 2012: Medline, EMBASE, the Cochrane Database of Systematic Reviews, DARE, CINAHL, PsycINFO and TRIP. Grey literature searches included health-evidence.ca, Rehab+, National Rehabilitation Information Center (NARIC), and Institute for Work and Health. The assessment of articles for inclusion criteria and methodological quality was conducted independently by two or more researchers, with differences resolved through consensus.

Results:

The search resulted in 3363 titles, of which 3248 were excluded following title/abstract review, with 115 articles retrieved for full-text review. 14 articles finally met the inclusion criteria and are summarized in this synthesis.

Conclusion:

There is moderate evidence for the effectiveness of workplace mental health interventions on improved workplace outcomes. Certain types of programs, such as those incorporating both mental and physical health interventions, multicomponent mental health and/or psychosocial interventions, and exposure in vivo containing interventions for particular anxiety disorders had a greater level of research evidence to support their effectiveness.

Psychological and Social Work Factors as Predictors of Mental Distress and Positive Affect: A Prospective, Multilevel Study

Occupational health research has mainly addressed determinants of negative health effects, typically employing individual-level self-report data. The present study investigated individual- and department-level (means of each work unit) effects of psychological/social work factors on mental distress and positive affect. Employees were recruited from 63 Norwegian organizations, representing a wide variety of job types. A total of 4158 employees, in 918 departments, responded at baseline and at follow-up two years later. Multilevel linear regressions estimated individual- and department-level effects simultaneously, and accounted for clustering of data. Baseline exposures and average exposures over time ([T1+T2]/2) were tested. All work factors; decision control, role conflict, positive challenge, support from immediate superior, fair leadership, predictability during the next month, commitment to organization, rumors of change, human resource primacy, and social climate, were related to mental distress and positive affect at the individual and department level. However, analyses of baseline exposures adjusted for baseline outcome, demonstrated significant associations at the individual level only. Baseline “rumors of change” was related to mental distress only and baseline “predictability during the next month” was not a statistical significant predictor of either outcome when adjusted for outcome at baseline. Psychological and social work factors were generally related to mental distress and positive affect in a mirrored way. Impact of exposures seemed most pervasive at the individual level. However, department-level relations were also discovered. Supplementing individual-level measures with aggregated measures may increase understanding of working conditions influence on employees`health and well-being. Organizational improvements focusing on the work factors in the current study should be able to reduce distress and enhance positive affect. Furthermore, both targeting individual employees and redesigning working conditions at the work unit level seems important.

Workplace interventions for common mental disorders: a systematic meta-review

Depression and anxiety disorders are the leading cause of sickness absence and long-term work incapacity in most developed countries. The present study aimed to carry out a systematic meta-review examining the effectiveness of workplace mental health interventions, defined as any intervention that a workplace may either initiate or facilitate that aims to prevent, treat or rehabilitate a worker with a diagnosis of depression, anxiety or both. Relevant reviews were identified via a detailed systematic search of academic and grey literature databases. All articles were subjected to a rigorous quality appraisal using the AMSTAR assessment. Of the 5179 articles identified, 140 studies met the inclusion criteria, of which 20 were deemed to be of moderate or high quality. Together, these reviews analysed 481 primary research studies. Moderate evidence was identified for two primary prevention interventions; enhancing employee control and promoting physical activity. Stronger evidence was found for CBT-based stress management although less evidence was found for other secondary prevention interventions, such as counselling. Strong evidence was also found against the routine use of debriefing following trauma. Tertiary interventions with a specific focus on work, such as exposure therapy and CBT-based and problem-focused return-to-work programmes, had a strong evidence base for improving symptomology and a moderate evidence base for improving occupational outcomes. Overall, these findings demonstrate there are empirically supported interventions that workplaces can utilize to aid in the prevention of common mental illness as well as facilitating the recovery of employees diagnosed with depression and/or anxiety.

Early and Late Return to Work After Sick Leave: Predictors in a Cohort of Sick-Listed Individuals with Common Mental Disorders

OBJECTIVES

The study aims to identify individual and workplace factors associated with early return to work (RTW)-defined as within 3 months-and factors associated with later RTW-between 3 and 12 months after being sick-listed-in a cohort of newly sick-listed individuals with common mental disorders.

METHODS

In a prospective cohort study, a cross-sectional analysis was performed on baseline measures of patients granted sick leave due to common mental disorders. A total of 533 newly sick-listed individuals fulfilled the inclusion criteria and agreed to participate. A baseline questionnaire was sent by post within 3 weeks of their first day of certified medical sickness; 354 (66%) responded. Those who were unemployed were excluded, resulting in a study population of 319 individuals. Sick leave was recorded for each individual from the Social Insurance Office during 1 year. Analyses were made with multiple Cox regression analyses.

RESULTS

Early RTW was associated with lower education, better work ability at baseline, positive expectations of treatment and low perceived interactional justice with the supervisor. RTW after 3 months was associated with a need to reduce demands at work, and turnover intentions.

CONCLUSIONS

Early RTW among sick-listed individuals with common mental disorders seems to be associated with the individual's need to secure her/his employment situation, whereas later RTW is associated with variables reflecting dissatisfaction with work conditions. No health measures were associated with RTW. The study highlights the importance of considering not only health and functioning, but also workplace conditions and relations at the workplace in implementing RTW interventions.

Efficacy of temporary work modifications on disability related to musculoskeletal pain or depressive symptoms--study protocol for a controlled trial

INTRODUCTION

Previous research suggests that work with a suitable workload may promote health and work retention in people with disability. This study will examine whether temporary work modifications at the early stage of work disability are effective in enhancing return to work (RTW) or staying at work among workers with musculoskeletal or depressive symptoms.

METHODS AND ANALYSIS

A single-centre controlled trial with modified stepped wedge design will be carried out in eight enterprises and their occupational health services (OHSs) in nine cities in Finland. Patients seeking medical advice due to musculoskeletal pain (≥4 on a scale from 0-10) or depressive symptoms (≥1 positive response to 2 screening questions) and fulfilling other inclusion criteria are eligible. The study involves an educational intervention among occupational physicians to enhance the initiation of work modifications. Primary outcomes are sustained RTW (≥4 weeks at work without a new sickness absence (SA)) and the total number of SA days during a 12-month follow-up. Secondary outcomes are intensity of musculoskeletal pain (scale 0-10), pain interference with work or sleep (scale 0-10) and severity of depressive symptoms (Patient Health Questionnaire, PHQ-9), inquired via online questionnaires at baseline and 3, 6, 9 and 12 months after recruitment. Information on SA days will be collected from the medical records of the OHSs over 12 months, before and after recruitment. The findings will give new information about the possibilities of training physicians to initiate work modifications and their effects on RTW in employees with work disability due to musculoskeletal pain or depressive symptoms.

ETHICS AND DISSEMINATION

The Coordinating Ethics Committee of Hospital District of Helsinki and Uusimaa has granted approval for this study. The results will be published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ISRCTN74743666.

Interventions to improve return to work in depressed people

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.

Prevalence rates for depression by industry: a claims database analysis

PURPOSE

To estimate and interpret differences in depression prevalence rates among industries, using a large, group medical claims database.

METHODS

Depression cases were identified by ICD-9 diagnosis code in a population of 214,413 individuals employed during 2002-2005 by employers based in western Pennsylvania. Data were provided by Highmark, Inc. (Pittsburgh and Camp Hill, PA). Rates were adjusted for age, gender, and employee share of health care costs. National industry measures of psychological distress, work stress, and physical activity at work were also compiled from other data sources.

RESULTS

Rates for clinical depression in 55 industries ranged from 6.9 to 16.2 %, (population rate = 10.45 %). Industries with the highest rates tended to be those which, on the national level, require frequent or difficult interactions with the public or clients, and have high levels of stress and low levels of physical activity.

CONCLUSIONS

Additional research is needed to help identify industries with relatively high rates of depression in other regions and on the national level, and to determine whether these differences are due in part to specific work stress exposures and physical inactivity at work.

CLINICAL SIGNIFICANCE

Claims database analyses may provide a cost-effective way to identify priorities for depression treatment and prevention in the workplace.

Experiences of work and sickness absence in employees with depression: an interpretative phenomenological analysis

PURPOSE

The experience of employment with depression is explored to develop understanding of the mediators that may influence the management of depression-related sickness absence and improve theoretical understanding.

METHOD

Data were collected from seven semi-structured interviews and Interpretative Phenomenological Analysis used to explore the data.

RESULTS

Three interrelated themes were drawn from the participants' accounts: (1) the interaction between depression and work; (2) illness beliefs; and (3) organisational context and depression. The analysis revealed that participants appeared to hold five key perceptions about their depression and work: low control in the workplace; lack of line manager support; diminishing ability to work; the need to address depressive symptoms; and perceptions of depression. Their strength resulted in individuals reaching sickness absence thresholds. The themes and participants' accounts of their work and sickness absence and return to work behaviour are discussed in relation to relevant theory and evidence to understand how these perceptions and beliefs mediate behaviour.

CONCLUSION

Individuals' health (illness representations) and work beliefs (outcome expectancies and self-efficacy for work tasks and management of health at work) appear to influence individuals' sickness absence decisions and experiences and these are mediated by individuals' experiences of organisational policies, line manager support and the messages and actions of GPs.

Psychological and social work factors as predictors of mental distress: a prospective study

Studies exploring psychological and social work factors in relation to mental health problems (anxiety and depression) have mainly focused on a limited set of exposures. The current study investigated prospectively a broad set of specific psychological and social work factors as predictors of potentially clinically relevant mental distress (anxiety and depression), i.e. “caseness” level of distress. Employees were recruited from 48 Norwegian organizations, representing a wide variety of job types. A total of 3644 employees responded at both baseline and at follow-up two years later. Respondents were distributed across 832 departments within the 48 organizations. Nineteen work factors were measured. Two prospective designs were tested: (i) with baseline predictors and (ii) with average exposure over time ([T1+T2]/2) as predictors. Random intercept logistic regressions were conducted to account for clustering of the data. Baseline “cases” were excluded (n = 432). Age, sex, skill level, and mental distress as a continuous variable at T1 were adjusted for. Fourteen of 19 factors showed some prospective association with mental distress. The most consistent risk factor was role conflict (highest odds ratio [OR] 2.08, 99% confidence interval [CI]: 1.45–3.00). The most consistent protective factors were support from immediate superior (lowest OR 0.56, 99% CI: 0.43–0.72), fair leadership (lowest OR 0.52, 99% CI: 0.40–0.68), and positive challenge (lowest OR 0.60, 99% CI: 0.41–0.86). The present study demonstrated that a broad set of psychological and social work factors predicted mental distress of potential clinical relevance. Some of the most consistent predictors were different from those traditionally studied. This highlights the importance of expanding the range of factors beyond commonly studied concepts like the demand-control model and the effort-reward imbalance model.

The effect of exercise-based management for multidirectional instability of the glenohumeral joint: a systematic review

BACKGROUND

The most commonly recommended treatment for multidirectional instability (MDI) of the glenohumeral joint is exercise-based management. The primary objective of this review was to evaluate the effectiveness of exercise-based management in patients with MDI. The secondary aim was to observe the types of exercise protocols and outcomes used, as well as any adverse results associated with exercise.

METHODS

The Cochrane Database of Systematic Reviews, Medline, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), PEDro, Current Contents, Allied and Complementary Medicine (AMED), Australasian Medical Index (AMI), Ausport, and Clinical Trials Registers were searched for published and unpublished studies from the inception date to June 2012 using the keywords multidirectional instability, glenohumeral, and exercise. Selection criteria included all study designs (except case reports and case series) and participants with clinically diagnosed MDI using exercise-based management. Inclusion criteria were not limited by outcomes. The authors' own risk-of-bias tool was used for quality assessment of studies. The GRADE approach (Grading of Recommendations, Assessment, Development and Evaluation) was used to synthesize the evidence.

RESULTS

The risk of bias was high in all 7 included studies. For before-and-after comparisons of exercise-based management, GRADE assessment showed very low-quality evidence for improvements in shoulder kinematics, the Rowe score, overall status rating, and peak muscle strength.

CONCLUSIONS

The effect of exercise-based management on MDI was variable across the included studies because of study heterogeneity and a high level of bias. There is a need for high-quality intervention studies to be undertaken to validate the effect of exercise for MDI.

Process evaluation of a problem solving intervention to prevent recurrent sickness absence in workers with common mental disorders

Common mental disorders (CMDs) are a major cause of sickness absence. Twenty to 30% of the workers who return to work after sickness absence due to CMDs experience recurrent sickness absence. We developed the Stimulating Healthy participation And Relapse Prevention (SHARP)-at work intervention, a problem solving intervention delivered by occupational physicians (OPs), to prevent recurrent sickness absence in this worker population in The Netherlands. A process evaluation was conducted alongside a cluster-randomised controlled trial to (1) evaluate whether the SHARP-at work intervention was implemented according to the protocol and differed from treatment in the control group, and (2) to investigate the relationship between the key elements of the intervention and the effect outcome (i.e. recurrent sickness absence). We collected process data for both the intervention and control group on recruitment, reach, dose delivered, dose received, fidelity, context and satisfaction. Data on recurrent sickness absence was collected through the registry system of the collaborating occupational health service. The study was performed in the Netherlands, and between 2010 and 2012, 154 OPs and 158 participants participated. Compared to the control group, participants in the intervention group more frequently had two or more consultations with the OP (odds ratio [OR] = 3.2, 95% confidence interval [CI] = 1.2-8.8) and completed more assignments (OR = 33.8, 95% CI = 10.4-109.5) as recommended in the intervention protocol. OPs and participants were satisfied with the intervention and rated it as applicable. Several individual intervention components were linked to the effect outcome. The process evaluation showed that the SHARP-at work intervention was conducted according to the protocol for the majority of the participants and well-received by OPs and participants. Furthermore, the intervention differed from treatment in the control group. Overall, the results provide support for implementing the intervention in practice.