Beyond Return to Work: The Effect of Multimorbidity on Work Functioning Trajectories After Sick Leave due to Common Mental Disorders

Self-Perceived Difficulty in Job Performance by Working Patients with Uveitis: Global Assessment and by Subscales of Work Demands

PURPOSE

To evaluate a worker's self-perceived difficulty in job performance as a whole and by subscales of job demands in a sample of working patients with uveitis and to analyze the relationship with sociodemographic, occupational, and clinical variables.

METHODS

A cross-sectional, cross-association study was conducted. Participants completed the Work Role Functioning Questionnaire (WRFQ) to assess self-perceived difficulty in job performance. Clinical data were collected from the patients' medical records or instruments used to evaluate clinical parameters in practice. Two clinical groups were established for this study. Bivariate and multivariate analyses were performed to assess associations between variables.

RESULTS

Sixty participants were included in the study. In the multivariate linear regression analysis, active uveitis was significantly associated with a worse WRFQ total score (coefficient, -25.1; 95% CI, -36.6 to -13.6; p < 0.001). Acute course uveitis was significantly associated with a better total score than recurrent and chronic uveitis (coefficient, 17.7; 95% CI, 3.7 to 31.7; p = 0.014). In bivariate analysis, patients with active uveitis also scored worse on all subscales and on the total score.

CONCLUSIONS

Patients with active uveitis presented with greater self-perceived difficulty in the performance of their work as a whole and in all subscales of work demands. Patients with acute uveitis presented with less difficulty than those with recurrent and chronic uveitis. Early and correct treatment of uveitis in specialized units may reduce its impact on patients' work impairment.

The association between long working hours, shift work, and suicidal ideation: A systematic review and meta-analyses

OBJECTIVES

The association between occupational psychosocial factors and mental health has been studied in several systematic reviews. However, few systematic reviews exist that specifically address suicidal ideation. Therefore, this systematic review and meta-analysis aimed to examine the associations between long working hours, shift work, and suicidal ideation.

METHODS

We systematically screened and collected studies published between January 1970 and September 2022 from three electronic databases and Google Scholar. We conducted a meta-analysis using a random-effects model and assessed the risk of bias using a navigation guide. Additionally, the grading of recommendations assessment, development and evaluation (GRADE) approach was used to consider five items, including the risk of bias and publication bias.

RESULTS

Twenty-eight articles were included in this meta-analysis. After adjusting for covariates, the overall odds ratio (OR) for long working hours and shift work were 1.44 [95% confidence interval (CI) 1.26-1.63] and 1.34 (95% CI 1.22-1.47), respectively. Compared with those who worked <40 hours per week, those who worked >55 hours per week had a 1.65 (95% CI 1.37-1.98) higher risk of suicidal ideation, and fixed night shift workers had 1.37 (95% CI 1.03-1.83) higher risk than non-shift workers.

CONCLUSIONS

Evidence has shown associations between long working hours, shift work, and suicidal ideation. Implementing evidence-based interventions to address these risk factors may help prevent the progression of suicidal ideation. However, further studies are critically needed, especially those using standardized exposure definitions and longitudinal data.

Sickness absence transitions among Swedish twins with back, neck or shoulder pain and common mental disorders applying a multi-state approach

We aimed to investigate transitions to and from sickness absence, or disability pension among individuals with back, neck, or shoulder pain and/or with common mental disorders (CMDs), and the role of familial (genetics and shared environment) influences on the transitions. Swedish twins born 1935-1985 who responded to pain and CMDs survey items (N = 41,516) were followed on average 8.7 years for sickness absence states in national registers. Multi-state Cox regression models were applied for three exposure groups: pain, CMDs, and presence of both, compared to unexposed. Exposure discordant twin pairs, stratified by zygosity, were analysed to assess the role of familial factors. Hazard Ratios (HR) with 95% confidence intervals and transition intensities were calculated. HRs were similar for transitions between states among those with pain or CMDs. The highest HRs were for transitions from entry to sickness absence and sickness absence to disability pension among those with both pain and CMDs (HRs: 1.61 and 1.43, respectively). Higher HRs for dizygotic compared to monozygotic twins for the first transition to sickness absence and for altering back to not being sickness absent indicate familial confounding. Back, neck, or shoulder pain and/or CMDs indicate a higher risk to become sickness absent and for repeated sickness absence episodes over time compared to unaffected.

Lengths of inpatient stay and sick leave of patients with mental diseases: disorder-specific effects of flexible and integrated treatment programs in Germany

Mental disorders pose a worldwide growing public health burden. One of the major challenges for healthcare systems remains to respond to the need of patients with mental disorders for continuous and flexible treatment. The EVA64 study evaluates novel programs of flexible and integrative treatment (FIT) in hospitals. This manuscript presents results from the evaluation of FIT hospitals in comparison to hospitals from regular routine care. In addition to data from adult patients, we also present data from affiliated child and adolescent psychiatric wards employing FIT programs. Using comprehensive claims data, primary outcomes are the utilization of inpatient care and sick leave for a priori defined clusters of mental disorders. We stratify between patients already under treatment (ongoing treatment) and patients with incident treatment cases (initial treatment) at the point of inclusion in the study. In the initial treatment group, we found a significant reduction in the length of inpatient stay of 4.1 days in FIT hospitals compared to routine care. While patients with mood affective disorders (-1.8 days) and patients with neurotic, stress-related, and somatoform disorders (-3.6 days) showed an even stronger effect of the reduction of inpatient lengths of stay, the effect was significantly weaker in patients with mental and behavioral disorders due to use of alcohol (+3.3 days). Regarding the duration of sick leave, we found no significant treatment effect of FIT programs compared to routine care. In the ongoing treatment group of adult patients, we found a significantly lower utilization of inpatient treatment by 1.3 days as well as a shorter duration of sick leave by 4.3 days in FIT hospitals compared to routine care. In the cohort of children and adolescent patients, we also did not observe a significant treatment effect in either the initial treatment group or the ongoing treatment group. Registration: this study was registered in the database "Health Services Research Germany" (trial number: VVfD_EVA64_15_003713).

Common mental disorders and associated factors in nursing workers in COVID-19 units

OBJECTIVE

To analyze the interfaces between mental illness, based on common mental disorder screening, and sociodemographic, health and life habits aspects of nursing workers at COVID-19 units.

METHOD

A mixed methods study, carried out with 327 nursing workers from COVID-19 units of seven public and philanthropic, medium and large hospitals in Brazil. The collection included a socio-employment, health and lifestyle questionnaire, the Self-Reporting Questionnaire, and interviews. chi-square and Fisher's exact tests were applied to quantitative data and thematic content analysis, with the help of NVivo in the qualitative ones.

RESULTS

Common mental disorders were screened in 35.5% of the sample and were associated with female sex (p = 0.004), age up to 40 years (p = 0.003), nurse (p = 0.014), reporting previous illness (p = 0.003), using psychoactive drugs (p < 0.001), medication that was not used before the pandemic (p < 0.001) and reporting poor sleep/eating quality (p < 0.001). The impacts of the pandemic on social and family life presented interfaces with mental illness.

CONCLUSION

The presence of psychological illness is suggested, possibly associated with the repercussions of the pandemic on work and personal life.

Trajectory analyses in insurance medicine studies: Examples and key methodological aspects and pitfalls

BACKGROUND

Trajectory analyses are being increasingly used in efforts to increase understanding about the heterogeneity in the development of different longitudinal outcomes such as sickness absence, use of medication, income, or other time varying outcomes. However, several methodological and interpretational challenges are related to using trajectory analyses. This methodological study aimed to compare results using two different types of software to identify trajectories and to discuss methodological aspects related to them and the interpretation of the results.

METHODS

Group-based trajectory models (GBTM) and latent class growth models (LCGM) were fitted, using SAS and Mplus, respectively. The data for the examples were derived from a representative sample of Spanish workers in Catalonia, covered by the social security system (n = 166,192). Repeatedly measured sickness absence spells per trimester (n = 96,453) were from the Catalan Institute of Medical Evaluations. The analyses were stratified by sex and two birth cohorts (1949-1969 and 1970-1990).

RESULTS

Neither of the software were superior to the other. Four groups were the optimal number of groups in both software, however, we detected differences in the starting values and shapes of the trajectories between the two software used, which allow for different conclusions when they are applied. We cover questions related to model fit, selecting the optimal number of trajectory groups, investigating covariates, how to interpret the results, and what are the key pitfalls and strengths of using these person-oriented methods.

CONCLUSIONS

Future studies could address further methodological aspects around these statistical techniques, to facilitate epidemiological and other research dealing with longitudinal study designs.

Transtornos mentais comuns e fatores associados em trabalhadores de enfermagem de unidades COVID-19

RESUMO Objetivo: Analisar as interfaces entre o adoecimento mental, a partir do rastreamento de transtornos mentais comuns, e aspectos sociodemográficos, de saúde e hábitos de vida de trabalhadores de enfermagem de unidades COVID-19. Método: Estudo de métodos mistos, realizado com 327 trabalhadores de enfermagem de unidades COVID-19 de sete hospitais do Brasil, públicos e filantrópicos, de médio e grande porte. A coleta incluiu um questionário sociolaboral, de saúde e hábitos de vida, o Self-Reporting Questionnaire, e entrevistas. Foram aplicados Testes Qui-Quadrado e Exato de Fisher nos dados quantitativos e análise temática de conteúdo, com auxílio do software NVivo nos qualitativos. Resultados: Os transtornos mentais comuns foram rastreados em 35,5% da amostra e se associaram ao sexo feminino (p = 0,004), idade de até 40 anos (p = 0,003), enfermeiro (p = 0,014), relatar doença prévia (p = 0,003), usar psicoativos (p < 0,001), medicamentos que não utilizava antes da pandemia (p < 0,001) e relatar má qualidade do sono/alimentação (p < 0,001). Os impactos da pandemia na vida social e familiar apresentaram interfaces com o adoecimento mental. Conclusão Sugere-se a presença de adoecimento psíquico, possivelmente associado às repercussões da pandemia no trabalho e na vida pessoal.

Role of social benefits for future long-term sickness absence, disability pension and unemployment among individuals on sickness absence due to mental diagnoses: a competing risk approach

Purpose

To investigate associations between social benefits and disability pension (DP), long-term sickness absence (LTSA, ≥ 90 days), or unemployment among Swedish twins with sickness absence (SA) due to mental diagnoses.

Methods

This population-based prospective twin study included register data on first incident SA spell (< 90 days) due to mental diagnoses (ICD 10 codes F00-F99) during the follow-up 2005–2016. SA < 90 days due to other diagnoses than mental diagnoses or any other social insurance benefit was identified for the preceding year of the first incident SA spell due to mental diagnoses (coded yes/no). Comparing those with any previous social benefits vs without, cumulative incidence curve to compare time to an event, and Cox proportional hazards models for cause-specific hazard ratios (HR, 95% confidence intervals, CI) treating first incident DP, LTSA and unemployment as competing risks were modeled.

Results

During follow-up, 21 DP, 1619 LTSA, and 808 unemployment events took place. Compared to those without, those with at least one benefit had a higher risk for DP (HR 5.03; 95%CI 1.80, 14.01), LTSA (1.67; 1.50, 1.84) and unemployment (1.24; 1.03, 1.50). The cumulative incidence for DP was very low, < 1%, for LTSA 80% with any previous social benefits vs. 60% without, and for unemployment ≤ 5%.

Conclusion

Social benefits received during the preceding year of SA due to mental diagnoses (< 90 days) predict DP, LTSA, and unemployment. Hence, previous social benefits may provide means for early identification of persons at risk for exit from labor market.

Everyday lives of middle-aged persons living with multimorbidity: protocol of a mixed-methods systematic review

INTRODUCTION

Multimorbidity is the simultaneous occurrence of several (chronic) diseases. Persons living with multimorbidity not only have complex care needs, but the burden of care often has a negative impact on their family lives, leisure time and professional activities. The aim of this project is to systematically review the literature to assess how multimorbidity affects the everyday lives of middle-aged persons, and to find out what abilities and resources help in the development of coping strategies to overcome the challenges of living with it.

METHODS AND ANALYSIS

We will systematically search for studies reporting on the everyday life experiences of middle-aged persons (30-60 years) with multimorbidity (≥2 chronic conditions) in MEDLINE, CINAHL, PsycINFO, Social Sciences Citation Index, Social Sciences Citation Index Expanded, PSYNDEX and The Cochrane Library from inception. We will include all primary studies that use quantitative, qualitative and mixed methodologies, irrespective of publication date/study setting.Two independent reviewers will screen titles/abstracts/full texts, extract data from the selected studies and present evidence in terms of study/population characteristics, data collection method and the phenomenon of interest, that is, everyday life experiences of middle-aged persons with multimorbidity. Risk of bias will be independently assessed by two reviewers using the Mixed Methods Appraisal Tool. We will use a convergent integrated approach on qualitative/quantitative studies, whereby information will be synthesised narratively and, if possible, quantitatively.

ETHICS AND DISSEMINATION

Ethical approval is not required due to the nature of the proposed systematic review. Results from this research will be disseminated at relevant (inter)national conferences and via publication in peer-reviewed journals.

PROSPERO REGISTRATION NUMBER

CRD42021226699.

Sick leave and return to work for patients with anxiety and depression: a longitudinal study of trajectories before, during and after work-focused treatment

OBJECTIVES

Sick leave due to anxiety and depression is a heterogeneous process constituting a pressing public health issue. This longitudinal study aimed to identify sick leave trajectories among patients before, during and after work-focused treatment, in all 29.5 months. We then aimed to determine the background and clinical characteristics of these trajectory groups.

METHODS

Background and clinical data were collected by patient self-report (N=619) in an observational study in a specialised mental healthcare clinic. Sick leave was recorded from national registry data. A latent growth mixture model identified trajectories. Multinomial logistic regression determined differences in background characteristics while a one-way analysis of variance (ANOVA) identified clinical differences.

RESULTS

We identified three trajectories: The 'Resilient' group (47.7%) had low sick leave throughout the period. The two other groups ('Recovery', 31.8% and 'High risk', 20.5%) had similar pretreatment trajectories: lower sick leave one year prior which increased to high sick leave at the start of treatment. After treatment, the 'Recovery' group made an almost full return to work while the 'High risk' group remained at high sick leave. The two groups with high sick leave had more women and higher age compared with the 'Resilient' group. All groups had similar clinical scores at the start of treatment, but the 'High risk' groups had residual depressive symptoms at the end of treatment. Effect sizes for anxiety and depression were moderate or large for all groups, (Cohen's d=0.74-1.81), and 87.2% of the total sample were fully working one year after treatment.

CONCLUSION

We found three subgroups with distinctly different trajectories. Female gender and higher age were associated with high sick leave at the start of treatment, while residual depressive symptoms at the end of treatment predicted continued sick leave. The study points to the possibility of improving patient outcomes in the future by stratifying and tailoring treatment to patient characteristics.

Developing a collaborative and sustainable return to work program for employees with common mental disorders: a participatory research with public and private organizations

PURPOSE

To disentangle the key steps of the return to work (RTW) process and offer clearer recovery-focused and sustainable RTW for people on sick leave due to common mental disorders (CMDs).

METHODS

This participatory research involves two large Canadian organizations. In each organization, we established an advisory committee composed of RTW stakeholders. We collected information in semi-structured interviews from RTW stakeholders (n = 26) with each member of the advisory committee in each organization, as well as with employees who had recently experienced CMDs. The interviews examined the RTW process for employees on sick leave due to CMDs as well as RTW stakeholders' perceptions of barriers and facilitators. A thematic approach was used to synthesize the data, following which, results were discussed with the two advisory committees to identify solutions considering key RTW steps.

RESULTS

Ten common key steps within the three RTW phases emerged from the semi-structured interviews with RTW stakeholders and discussions with the two advisory committees: 1) At the beginning of sickness absence and involvement of disability management team (phase 1), we found 3 steps (e.g., taking charge of the file), 2) during the involvement in treatment rehabilitation with health professionals and preparation of the RTW (phase 2), 4 steps (e.g., RTW preparation), and finally 3) the RTW and follow-up (phase 3) consists of 3 steps (e.g., gradual RTW).

CONCLUSION

A participatory study involving RTW stakeholders helped identify 10 common key steps within three phases to support RTW sustainability of people with CMDs. Future research will need to address how RTW coordinators intervene in the RTW process of employees with CMDs within these steps.IMPLICATIONS FOR REHABILITATIONRehabilitation professionals will benefit from a detailed description of the RTW process (10 steps spread out over 3 RTW phases), allowing them to standardize it while adopting a personalized approach for the employee on sick leave.Rehabilitation professionals are informed of stakeholders' role and actions required in the RTW process; as such the communication between RTW stakeholders should be improved.RTW coordinators will be able to tailor more precisely their intervention, considering the detailed RTW process and RTW stakeholders' role and actions, and thus will become the pivot occupational health specialists for the RTW process.

The association between mental-physical multimorbidity and disability, work productivity, and social participation in China: a panel data analysis

Background

The co-occurrence of mental and physical chronic conditions (mental-physical multimorbidity) is a growing and largely unaddressed challenge for health systems and wider economies in low-and middle-income countries. This study investigated the independent and combined (additive or synergistic) effects of mental and physical chronic conditions on disability, work productivity, and social participation in China.

Methods

Panel data study design utilised two waves of the China Health and Retirement Longitudinal Study (2011, 2015), including 5616 participants aged ≥45 years, 12 physical chronic conditions and depression. We used a panel data approach of random-effects regression models to assess the relationships between mental-physical multimorbidity and outcomes.

Results

After adjusting for socio-economic and demographic factors, an increased number of physical chronic conditions was independently associated with a higher likelihood of disability (Adjusted odds ratio (AOR) = 1.39; 95% CI: 1.33, 1.45), early retirement (AOR = 1.37 [1.26, 1.49]) and increased sick leave days (1.25 days [1.16, 1.35]). Depression was independently associated with disability (AOR = 3.78 [3.30, 4.34]), increased sick leave days (2.18 days [1.72, 2.77]) and a lower likelihood of social participation (AOR = 0.57 [0.47, 0.70]), but not with early retirement (AOR = 1.24 [0.97, 1.58]). There were small and statistically insignificant interactions between physical chronic conditions and mental health on disability, work productivity and social participation, suggesting an additive effect of mental-physical multimorbidity on productivity loss.

Conclusion

Mental-physical multimorbidity poses substantial negative health and economic effects on individuals, health systems, and societies. More research that addresses the challenges of mental-physical multimorbidity is needed to inform the development of interventions that can be applied to the workplace and the wider community in China.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10414-7.

Urban-rural differences in the impacts of multiple chronic disease on functional limitations and work productivity among Chinese adults

BACKGROUND

Chronic disease multimorbidity has become a major challenge for health systems. While a lot of research has evaluated the direct economic burden of multimorbidity on health care utilization and cost, little attention has been given to the impacts on work productivity and functional limitations, as indirect indicators of disease burden.

OBJECTIVES

This study aims to examine the prevalence of multimorbidity among Chinese adults and its impact on functional disability and work productivity. It also investigates urban-rural differences in these relationships.

METHOD

This study utilized the data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015, including 11,176 participants aged 45 years and older. Multivariable logistic regression models were used to estimate the effect of multimorbidity on functional disability (i.e. ADL: activities of daily life; IADL: instrumental activities of daily life), and work productivity loss due to health problems. Negative binomial regression models were used to assess the association of multimorbidity with sickness absences from agricultural work and employed non-agricultural work.

RESULTS

68.8% of total participants in CHARLS had multimorbidity in China in 2015. Rural residents with multimorbidity reported higher proportions of physical functions and days of sick leave than urban residents. Multimorbidity was positively associated with ADL limitation (odds ratio 1.924, 95% CI 1.656-2.236), IADL limitation (1.522, 1.326-1.748), limited work due to health problems (1.868, 1.601-2.178) and days of sick leave (for agricultural work, incidence rate ratio 1.676, 95% CI 1.390-2.020; for employed non-agricultural work, 2.418, 1.245-4.696). For the rural group, the impact of multimorbidity on functional limitations and work productivity loss (except for early retirement), was less than the urban group.

CONCLUSIONS

Multimorbidity poses significant challenges for functional health and work productivity These have significant negative economic consequences for individuals, the Chinese health system and the society.

The disease burden of multimorbidity and its interaction with educational level

Introduction

Policies to adequately respond to the rise in multimorbidity have top-priority. To understand the actual burden of multimorbidity, this study aimed to: 1) estimate the trend in prevalence of multimorbidity in the Netherlands, 2) study the association between multimorbidity and physical and mental health outcomes and healthcare cost, and 3) investigate how the association between multimorbidity and health outcomes interacts with socio-economic status (SES).

Methods

Prevalence estimates were obtained from a nationally representative pharmacy database over 2007–2016. Impact on costs was estimated in a fixed effect regression model on claims data over 2009–2015. Data on physical and mental health and SES were obtained from the National Health Survey in 2017, in which the Katz-10 was used to measure limitations in activities of daily living (ADL) and the Mental Health Inventory (MHI) to measure mental health. SES was approximated by the level of education. Generalized linear models (2-part models for ADL) were used to analyze the health data. In all models an indicator variable for the presence or absence of multimorbidity was included or a categorical variable for the number of chronic conditions. Interactions terms of multimorbidity and educational level were added into the previously mentioned models.

Results

Over the past ten years, there was an increase of 1.6%-point in the percentage of people with multimorbidity. The percentage of people with three or more conditions increased with +2.1%-point. People with multimorbidity had considerably worse physical and mental health outcomes than people without multimorbidity. For the ADL, the impact of multimorbidity was three times greater in the lowest educational level than in the highest educational level. For the MHI, the impact of multimorbidity was two times greater in the lowest than in the highest educational level. Each additional chronic condition was associated with a greater worsening in health outcomes. Similarly, for costs, where there was no evidence of a diminishing impact of additional conditions either. In patients with multimorbidity total healthcare costs were on average €874 higher than in patients with a single morbidity.

Conclusion

The impact of multimorbidity on health and costs seems to be greater in the sicker and lower educated population.

[Return to Work after Mental Disorders - A Scoping Review]

OBJECTIVE

Workers on sick-leave due to a mental disorder have enormous problems to return to work. The main objective of this review is to examine different return-to-work (RTW) interventions.

METHODS

We conduct a systematic literature research.

RESULTS

88 articles were screened and 29 studies included. The included RTW-interventions build on different approaches: 1) individual, 2) workplace, 3) mental health services. The majority of the interventions showed positive effects on the return-to-work process.

CONCLUSION

Even if not all interventions could be readily transferred to the German context, the findings indicate ways improving the transition from the mental health system to the workplace.

Multimorbidity and the Transition Out of Full-Time Paid Employment: A Longitudinal Analysis of the Health and Retirement Study

Objectives

This study aims to examine whether older workers aged 50–64 years with multimorbidity are at increased risk to transition from full-time paid employment to part-time employment, partial retirement, unemployment, disability, economic inactivity, full retirement or die than workers without a chronic health condition and workers with one chronic health condition, and whether socioeconomic position (SEP) modifies these transitions.

Method

Using data from the Health and Retirement Study (1992–2014; n = 10,719), sub-distribution hazard ratios with 95% confidence intervals were calculated with a time-varying Fine and Gray competing-risks survival regression model to examine exit from full-time paid employment. We investigated the modifying effect of SEP by examining its interaction with multimorbidity.

Results

Workers with multimorbidity had a higher risk of transitioning to partial retirement (1.45; 1.22, 1.72), disability (1.84; 1.21, 2.78) and full retirement (1.63; 1.47, 1.81), and they had a higher mortality risk (2.58; 1.71, 3.88) than workers without chronic disorders. Compared to workers with one chronic health condition, workers with multimorbidity had an increased risk for partial (1.19; 1.02, 1.40) and full retirement (1.29; 1.17, 1.42), and mortality (1.49; 1.09, 2.04). Only SEP measured as educational level modified the relationship between multimorbidity and mortality.

Discussion

Workers with multimorbidity seem more prone to leave full-time paid employment than workers without or with one a chronic health condition. Personalized work accommodations may be necessary to help workers with multimorbidity prolong their working life.

Job crafting as a work adjustment strategy for workers returning after long-term sickness absence due to common mental disorders

The purpose of this qualitative study was to examine the way workers with common mental disorders use job crafting to adjust their work to their levels of functioning after returning from long-term sick leave. Thirty-eight workers who had returned within the last 24 months from sickness absence due to common mental disorders were interviewed using semistructured interviews. Questions were asked about how they job crafted to match their changed needs for work functioning post return. To interpret the results, we coded the data according to the Wrzesniewski and Dutton typology of job crafting and conducted thematic analysis. We identified task, relational and cognitive job crafting strategies that workers had employed after returning to work. Our findings have important implications for how managers and organizations can support workers to make adjustments that enable them to stay and thrive at work with reduced work functioning.

Implications of multimorbidity on healthcare utilisation and work productivity by socioeconomic groups: Cross-sectional analyses of Australia and Japan

BACKGROUND

Multimorbidity, the presence of 2 or more non-communicable diseases (NCDs), is a major contributor to inequalities of health in Australia and Japan. We use nationally representative data to examine (i) the relationships between multimorbidity with healthcare utilisation and productivity loss and (ii) whether these relationships differed by socioeconomic groups.

METHODS

Cross-sectional analyses using the Household, Income, and Labour Dynamics in Australia (HILDA) and the Japanese Study of Aging and Retirement (JSTAR) surveys. We examined 6,382 (HILDA) and 3,503 (JSTAR) adults aged ≥50 years. We applied multivariable regression, logistic and negative binomial models.

RESULTS

Prevalence of multimorbidity was overall 38.6% (46.0%, 36.1%, 28.9% amongst those in the lowest, middle and highest education group, respectively) in Australia, and 28.4% (33.9%, 24.6%, 16.6% amongst those in the lowest, middle and highest education group, respectively) in Japan. In Australia and Japan, more NCDs was associated with greater healthcare utilisation. In Australia and Japan, more NCDs was associated with higher mean number of sick leave days amongst the employed and lower odds of being employed despite being in the labour force. The association between multimorbidity and lower retirement age was found in Australia only.

CONCLUSION

Having more NCDs pose significant economic burden to the health system and wider society in Australia and Japan. Targeted policies are critical to improve financial protection, especially for lower income groups who are more likely to have multiple NCDs. These individuals incur both high direct and indirect costs, which lead to a greater risk of impoverishment.

One-year trajectories of mental health and work outcomes post return to work in patients with common mental disorders

BACKGROUND

We investigated one-year trajectories of symptom recovery, work functioning and the return to work percentage (RTW%) among patients with common mental disorders (CMDs).

METHODS

Data were used from a cluster-randomised controlled trial evaluating a problem-solving intervention for CMD patients (N = 158) who had returned to work. Information on anxiety and depressive symptoms, work functioning and RTW% was collected at baseline and 3, 6 and 12 months follow-up. Latent class growth analyses were used to identify trajectories for the four outcomes and investigate how these trajectories clustered in higher order latent classes. Additionally, we investigated the relation between patient characteristics and class membership.

RESULTS

We identified four trajectories for all four outcomes and derived three higher order latent classes: slow recovery (42% [66/158]) (high anxiety and depressive symptoms, moderate to low work functioning and fast RTW); fast recovery (25% [40/158]) (low anxiety and depressive symptoms, high work functioning and fast RTW); and gradual recovery (33% [52/158] (decreasing anxiety and depressive symptoms, increasing or low work functioning and fast RTW). Participants with a higher work engagement and readiness to stay at work were more likely to belong to the fast recovery class.

LIMITATIONS

Due to the relatively small sample size, some trajectories consisted of few participants. Symptom severity was self-reported.

CONCLUSIONS

Many CMD patients experience high levels of mental health symptoms and work functioning problems during the year post RTW. Creating realistic recovery expectations (for both patients and their environments) could be important for successful and sustainable recovery and work participation.

The Influence of Multi-morbidity on the Work Ability of Ageing Employees and the Role of Coping Style

Purpose With an ageing workforce, employees are increasingly confronted with multi-morbidity. Especially physical and mental health problems often occur together. This study aims to (i) explore the effect of multi-morbidity on work ability of ageing employees, more specifically the effects of the number of health problems and the combination of physical and mental health problems, and to (ii) explore to what extent the effects of physical and mental health problems on work ability are explained by applying differing coping styles. Methods A 1 year follow up study (2012-2013) was conducted among 7175 employees aged 45-64 years. Linear regression analyses were conducted to examine longitudinal relationships between multi-morbidity, coping styles and work ability. To determine whether coping styles mediate the effects of multi-morbidity on work ability, Sobel tests were conducted. Results A higher number of health problems was related to poorer work ability, but this negative effect stabilized from three health problems onwards. The combination of physical and mental health problem(s) was more strongly related to poorer work ability than only physical health problems. The negative relation between physical health problems and work ability was partly suppressed by active coping, while the negative relation between the combination of physical and mental health problem(s) on work ability was partly explained by avoidant coping. Conclusions Ageing employees with multi-morbidity have a reduced work ability, especially when mental health problems are present. The greater negative effects of the combination of physical and mental health problems on work ability are partially due to unfavorable coping styles.

Multimorbidity and Its Impact on Workers: A Review of Longitudinal Studies

Objective

This study investigates the impact of multimorbidity on work through a literature review of longitudinal studies.

Methods

A systematic review was carried out in the databases Lilacs, SciELO, PAHO, PubMed/Medline, Scopus, Web of Science, and Cochrane. There were no restrictions regarding the year of publication or language to maximize the identification of relevant literature. The quality of studies was assessed by the protocol STrengthening the Reporting of OBservational studies in Epidemiology (STROBE).

Results

An initial database search identified 7522 registries, and at the end of the analysis, 7 manuscripts were included in the review. Several studies have demonstrated direct and indirect impacts of multimorbidity on the health of workers. For this, the number of missed days due to health-related issues was evaluated, as well as the reduction in work productivity of the unhealthy worker, vulnerability of the worker with multimorbidity regarding higher indices of dismissal and recruitment difficulties, and incidence of early retirement and/or receipt of benefits due to disabilities.

Conclusions

Multimorbidity has a negative impact on work, with damages to quality of life and work productivity, worsening the absenteeism/presenteeism indices, enhancing the chances of temporary or permanent leaves, and lowering employability and admission of individuals with multimorbidity.

The Work Role Functioning Questionnaire v2.0 Showed Consistent Factor Structure Across Six Working Samples

Objective The Work Role Functioning Questionnaire v2.0 (WRFQ) is an outcome measure linking a persons' health to the ability to meet work demands in the twenty-first century. We aimed to examine the construct validity of the WRFQ in a heterogeneous set of working samples in the Netherlands with mixed clinical conditions and job types to evaluate the comparability of the scale structure. Methods Confirmatory factor and multi-group analyses were conducted in six cross-sectional working samples (total N = 2433) to evaluate and compare a five-factor model structure of the WRFQ (work scheduling demands, output demands, physical demands, mental and social demands, and flexibility demands). Model fit indices were calculated based on RMSEA ≤ 0.08 and CFI ≥ 0.95. After fitting the five-factor model, the multidimensional structure of the instrument was evaluated across samples using a second order factor model. Results The factor structure was robust across samples and a multi-group model had adequate fit (RMSEA = 0.63, CFI = 0.972). In sample specific analyses, minor modifications were necessary in three samples (final RMSEA 0.055-0.080, final CFI between 0.955 and 0.989). Applying the previous first order specifications, a second order factor model had adequate fit in all samples. Conclusion A five-factor model of the WRFQ showed consistent structural validity across samples. A second order factor model showed adequate fit, but the second order factor loadings varied across samples. Therefore subscale scores are recommended to compare across different clinical and working samples.

Minor psychiatric disorders in nursing: prevalence and associated factors

ABSTRACT Objective: to investigate the prevalence of Minor Psychiatric Disorders and associated factors in nursing workers. Method: observational and analytical sectional study. Data were collected from 285 nursing workers. A questionnaire containing sociodemographic, occupational, psychosocial aspects of work and mental health was used. Bivariate and multivariate analysis were performed by binary logistic regression. Results: the global prevalence of suspected Minor Psychiatric Disorders among nursing workers was 32.6%. Higher prevalence rates were found among female, young, married/common-law married individuals, in the nursing assistant/technician categories, with income up to four minimum wages, developing high-demand work with low social support, high effort-reward imbalance, and over-commitment. Conclusion: the variables that remained associated with the mental health outcome in the final model were: female gender, married/common-law married, high-demand work, high effort-reward imbalance, and over-commitment.

Strategies to keep working among workers with common mental disorders - a grounded theory study

PURPOSE

Most people with common mental disorders (CMDs) are employed and working, but few studies have looked into how they manage their jobs while ill. This study explores workers' experiences of strategies to keep working while suffering from CMDs.

METHODS

In this grounded theory study, we interviewed 19 women and eight men with depression or anxiety disorders. They were 19-65 years old and had different occupations. Constant comparison method was used in the analysis.

RESULTS

We identified a core pattern in the depressed and anxious workers' attempts to sustain their capacities, defined as Managing work space. The core pattern comprised four categories describing different cognitive, behavioral, and social strategies. The categories relate to a process of sustainability. Two categories reflected more reactive and temporary strategies, occurring mainly in the onset phase of illness: Forcing the work role and Warding off work strain. The third category, Recuperating from work, reflected strategies during both onset and recovery phases. The fourth category, Reflexive adaptation, was present mainly in the recovery phase and involved reflective strategies interpreted as more sustainable over time.

CONCLUSIONS

The results can deepen understanding among rehabilitation professionals about different work-related strategies in depressed and anxious workers. Increased awareness of the meaning and characteristics of strategies can inform a person-oriented approach in rehabilitation. The knowledge can be used in clinical encounters to reflect together with the patient, exploring present options and introducing modifications to their particular work and life context. Implications for rehabilitation Self-managed work functioning in common mental disorders involves diverse strategies. Strategies interpreted as sustainable over time, seem to be reflective in the sense that the worker consciously applies and adapts the strategies. However, at the onset of illness, such reflection is difficult to develop as the worker might not want to realize their reduced functioning. Rehabilitation professionals' awareness of different strategies can facilitate a person-centered approach and understanding of the vocational rehabilitation process.