Sustaining Work Participation Across the Life Course

Work accommodations for employees with common mental disorders and associated manager-related determinants: a cross-sectional study among Swedish managers

PURPOSE

To investigate frequencies of managers' reported use of work accommodations (WAs) for employees with common mental disorders (CMD), and to examine associations between manager-related characteristics and the use of diverse WAs.

MATERIAL AND METHODS

3358 managers took part in a web-survey, of these, 1779 were included in this study. The survey listed 15 WAs grouped into seven types using principal component analysis. The relationships between managers' person-related, knowledge-related, and work-related characteristics with the seven WAs were tested with multivariate logistic regression analyses.

RESULTS

Reported use of WAs was high. Compared to work-related characteristics, person-related and knowledge-related characteristics were stronger associated with WAs. The two characteristics associated with most WAs types were (1) confidence in supporting employees with CMD (5 WA types) and (2) managerial training on CMD (4 WA types).

CONCLUSION

Managers report an extensive use of different types of WAs. WAs were related to a variety of determinants, depending on the WA type, but using WAs depends on the manager as an individual rather than on their work environment. To increase equal access to WAs, organizations should encourage managers to use WAs in order to support and improve the work capacity for employees with CMD.

Managers' Influence on the Prevention of Common Mental Disorders in the Workplace: A Cross-Sectional Study Among Swedish Managers

OBJECTIVE

To investigate the association among managers' attitudes toward subordinates with common mental disorders (CMDs), self-confidence in supporting these subordinates, and managerial preventive actions (MPAs).

METHODS

A cross-sectional study was conducted among Swedish managers (n = 2988) and two types of MPAs: reviewing assignments and work situation (MPA-review), and talking about CMD at the workplace (MPA-talk). Binary logistic regression models were applied and adjusted for individual and organizational covariates.

RESULTS

Managers with negative attitudes toward subordinates with CMD were less likely to have done both MPAs. Managers with higher self-confidence in supporting these subordinates were more likely to have done both MPAs compared with managers with lower self-confidence.

CONCLUSIONS

Managerial negative attitudes toward CMD and self-confidence in supporting subordinates with CMD have a role in MPAs and should be addressed in manager training programs to encourage preventive actions.

Preventing job loss and functional decline: Description and demonstration of the Veterans Health Administration supported Employment: Engage and Keep (SEEK) program

The high incidence of untreated mental health concerns among veterans can harm other areas of life, including employment. Loss of employment can lead to other adverse outcomes, such as financial instability, functional decline, and increased risk for suicide. Current Veterans Health Administration (VHA) vocational services are limited in that they primarily serve veterans who are unemployed and already enrolled in VHA. There is a need to prevent job loss among veterans who are struggling with mental health and vocational concerns and are not accessing VHA services, thus decreasing the risk of suicide and more costly interventions. Consistent with the existing national VHA initiatives on increasing access to health care and preventing suicide, a novel work-based intervention, Supported Employment: Engage and Keep (SEEK), was created. Building on the supported employment framework, SEEK assertively outreaches to already employed veterans by collaborating with workplaces that employ veterans. SEEK providers build rapport with employers and veterans and become a trusted VHA resource. SEEK engages veterans, facilitates enrollment in needed health care, and provides needed job maintenance support. This article outlines the SEEK model and provides a case demonstration and analysis of the course of SEEK care provided to a veteran at risk of losing their job. Clinical recommendations for implementing SEEK and future directions for evaluating this model are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Job Leeway Scale: Initial Evaluation of a Self-report Measure of Health-Related Flexibility and Latitude at Work

Purpose Evidence suggests that workers manage health-related challenges at work, in part, by using available leeway to perform work differently. The purpose of this study was to evaluate the reliability and validity of the Job Leeway Scale (JLS), a new 18-item self-report questionnaire designed to assess worker perceptions of available flexibility and latitude to manage health-related challenges at work. Methods Workers seeking assistance for workplace difficulties due to chronic medical conditions (n = 119, 83% female, median age = 49) completed the JLS along with other workplace and health measures. Construct validity was assessed using exploratory factor analysis (EFA), and concurrent validity was assessed by associations with related measures. Results Mean item scores ranged from 2.13 to 4.16 within a possible range of 0-6. The EFA supported three underlying factors: organizational leeway (9 items), task leeway (6 items), and staffing leeway (3 items). Internal consistency (alpha) ranged from 0.78 to 0.91 for subscale scores and 0.94 for the total score. The JLS showed moderate correlations with other work outcome measures including work fatigue, self-efficacy, engagement, and productivity. Conclusion The JLS is a promising new measure with initial support for its reliability and validity to assess worker beliefs of available flexibility to manage health symptoms at work, and this construct may have organizational implications for worker support and accommodation.

Education and employment status among adults with Loeys-Dietz syndrome and vascular Ehlers-Danlos syndrome in Norway, a questionnaire based study

OBJECTIVES

To describe education level and employment status among adults with Loeys-Dietz syndrome and vascular Ehlers-Danlos syndrome, and explore factors related to work participation.

MATERIALS AND METHODS

Cross-sectional postal survey in 2018. Individuals with molecularly verified diagnosis were recruited through a National Resource Centre for Rare Disorders. A study specific questionnaire included topics on disease burden and validated instruments regarding education level, employment, pain, fatigue, psychological distress, and satisfaction with life.

RESULTS

Fifty persons (56% women) aged 18-67 years, participated. Almost 60% reported education level ≤13 years. Two thirds (66%) received disability benefits, 21 (42%) had full-time disability pension. The median age at ending work was 41 years. Full-time employed and students were younger (p = 0.014), less fatigued (p = 0.035), had less sleep problems (p = 0.028) and higher satisfaction with life (p<0.001) than those who received disability pension. A third (32%) were currently or used to be in sedentary work, and 68% currently had or used to be in practical work requiring much standing and walking (23%), much walking and lifting (34%) or heavy manual work (11%).

CONCLUSIONS

There is a potential that more adults with these diagnoses can sustain employment for more years. Health and social service follow-up routines and future studies should include details on employment perspectives to reveal those at risk of poor employment and to identify modifiable factors for work participation.

An interpretative phenomenological analysis of the meaning of work to women living with breast cancer

OBJECTIVE

Work is an important aspect of everyday life. This remains true for those living with and beyond cancer. Less is known about how the meaning of work may change over the cancer journey, the needs of the individual in response to changes and how healthcare professionals and employing organisations can meet these needs. The aim of this study was to explore the lived experience of work after treatment for breast cancer in a group of professional working women within the UK.

METHODS

This article presents an Interpretative Phenomenological Analysis (IPA) of the experiences of 15 professional women diagnosed with breast cancer.

RESULTS

We discuss these women's journey from (1) rethinking the meaning of work to (2) making decisions about work ability and advice on work to (3) transitioning back in to the workplace and the value of continued engagement with employer.

DISCUSSION

The findings from this study demonstrate the complex interplay between living with cancer, treatment decisions and work. This study highlights two key areas for inclusion in practice: (1) support from Healthcare Professionals and judgements of functional ability and work ability and (2) the role of line managers in managing cancer and work.

Association of stigmatizing attitudes with people’s opinion of depression as a valid reason for sickness absence: A Swedish vignette study

BACKGROUND: Depression is a common cause of sickness absence (SA) and also highly associated with stigma. Few studies have addressed the role of stigma in relation to SA. OBJECTIVE: To investigate if attitudes to depression were associated with the public’s opinion of depression as a valid reason of SA. METHODS: The study population (n = 2413) originated from a web-based panel of citizens. The survey included a short vignette describing a person with symptoms of depression and the person’s work tasks, followed by a question on recommendation of SA. Negative attitudes were measured by the Depression Stigma Scale. Logistic regressions were used to estimate the odds ratios (OR) for the likelihood of not recommending SA, controlling for individual and work-related co-variates. RESULTS: The crude association between negative attitudes and not recommending SA was OR 2.15 (95% CI, 1.76–2.62). In the fully adjusted model the OR was 1.76 (95% CI, 1.40 –2.21) for not recommending SA. CONCLUSIONS: Participants with negative attitudes to depression were more likely to not consider depression as a valid reason of sickness absence. The study supports theories on layered stigma; attitudes from one arena are related to other arenas. Future studies are needed to confirm our findings.

A Worksite Self-management Program for Workers with Chronic Health Conditions Improves Worker Engagement and Retention, but not Workplace Function

Purpose An increasing number of workers in the US have chronic health conditions that limit their ability to work, and few worksite interventions have been tested to improve worker coping and problem solving at work. The purpose of this study was to evaluate a worksite-based health self-management program designed to improve workplace function among workers with chronic health conditions. Methods We conducted a randomized, controlled trial of a worksite self-management program ("Manage at Work") (clinicaltrials.gov #NCT01978392) for workers with chronic health conditions (N = 119; 82% female, ages 20-69). Most workers were recruited from the health care or light manufacturing industry sectors. Workers attended a 5-session, facilitated psychoeducational program using concepts of health self-management, self-efficacy, ergonomics, and communication. Changes on outcomes of work engagement, work limitation, job satisfaction, work fatigue, work self-efficacy, days absent, and turnover intention at 6-month follow-up were compared to wait-list controls. Results The most prevalent chronic health conditions were musculoskeletal pain, headaches, vision problems, gastrointestinal disorders, respiratory disorders, and mental health disorders. The self-management program showed greater improvement in work engagement and turnover intent at 6-month follow-up, but there was no evidence of a parallel reduction in perceived work limitation. Trends for improved outcomes of work self-efficacy, job satisfaction, and work fatigue in the intervention group did not reach statistical significance in a group x time interaction test. Conclusions Offering a worksite self-management program to workers with chronic health conditions may be a feasible and beneficial strategy to engage and retain skilled workers who are risking disability.Clinical trial registration: Clinicaltrials.gov #NCT01978392.

["I Think it is Important in Many Aspects in Life" - Young Adults' Perception of Participation]

PURPOSE

This study explores young adults' lay perception of participation. It focuses on the definition of the concept and the life areas in which the target group views it as important to take part in.

METHODS

In guided group interviews (N=6), 20 young adults with and without disabilities were surveyed about their perception of participation. To also include people with more severe disabilities, proxy interviews (N=3) were conducted. The data of the interview were analyzed via qualitative content analysis based on Mayring.

RESULTS

Participation is understood as being multifaceted and individually different. Six aspects of participation definition could be detected: togetherness; social inclusion/participation in society; open-mindedness/interest; equal opportunities/equal treatment; freedom of choice/autonomy; to have a voice. Besides that, seven areas of participation were mentioned as important for young adults: social environment; work/education; leisure; media; mobility; politics/finances; self-administration.

CONCLUSION

Within young adults' complex perception of participation, social aspects are particularly important, besides equal rights and autonomy. Participation in sexuality and new media is given a crucial value, which is why these topics should be given more attention to. Life areas in which participation is described as relevant can vary depending on the interests of the individual. This demonstrates the subjective character of the concept, and the importance to consider the perception and preference of a person or a group.

Supporting employees with chronic conditions to stay at work: perspectives of occupational health professionals and organizational representatives

Background

Supporting employees with chronic conditions can prevent work-related problems and facilitate sustainable employment. Various stakeholders are involved in providing support to these employees. Understanding their current practices and experienced barriers is useful for the development of an organizational-level intervention to improve this support. The aim of this study was to explore the current practices of occupational physicians and organizational representatives, identifying both barriers to providing support and opportunities for improvement.

Methods

Two focus groups with sixteen occupational physicians and seven semi-structured interviews with organizational representatives were held between January and June 2018. Data was analyzed using thematic content analysis.

Results

Several barriers to offer support were identified, including barriers at the organizational level (negative organizational attitudes towards employees with chronic conditions), the employee level (employees’ reluctance to collaborate with employers in dealing with work-related problems), and in the collaboration between occupational physicians and organizational representatives. In addition, barriers in occupational health care were described, e.g. occupational physicians’ lack of visibility and a lack of utilization of occupational physicians’ support. Opportunities to optimize support included a shared responsibility of all stakeholders involved, actively anchoring prevention of work-related problems in policy and practice and a more pronounced role of the health care sector in preventing work-related problems.

Conclusions

Preventing work-related problems for employees with chronic conditions can be achieved by addressing the identified barriers to provide support. In addition, both occupational physicians and organizational representatives should initiate and secure preventive support at the organizational level and in occupational health care. These insights are helpful in developing an intervention aimed at supporting employees with chronic conditions to stay at work.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10633-y.

Development of an Intervention to Create a Supportive Work Environment for Employees with Chronic Conditions: An Intervention Mapping Approach

Purpose This study describes the development of an evidence-based intervention to create a supportive work environment for employees with chronic conditions. Occupational physicians (OPs) play an important role in guiding organizations in this process of organizational change. Supportive work environments can aid in preventing work-related problems and facilitate sustainable employment. Current workplace interventions for employees with chronic conditions are mainly focused on return to work or a reduction in sick leave at the individual worker's level. This study contributes to the literature an organizational-level intervention which utilizes a preventive approach. Methods Intervention mapping (IM) is a six-step, structured protocol that was used to develop this intervention. In step 1, a needs assessment was conducted to define the problem and explore the perspectives of all stakeholders involved. The program outcomes and the performance objectives of employees with chronic conditions and occupational physicians were specified in step 2. In step 3, appropriate methods and practical applications were chosen. Step 4 describes the actual development of the intervention, consisting of (1) a training for occupational physicians to teach them how to guide organizations in creating a supportive work environment; (2) a practical assignment; and (3) a follow-up meeting. The intervention will be implemented in a pilot study in which occupational physicians will put their acquired knowledge and skills into practice within one of their organizations, which is delineated in step 5. Conclusions IM proved to be a valuable and practical tool for the development of this intervention, aiming to facilitate sustainable employment for employees with chronic conditions.

Determinants of Managerial Preventive Actions in Relation to Common Mental Disorders at Work: A Cross-Sectional Study Among Swedish Managers

OBJECTIVE

Manager characteristics (personal, work-, and competence-related) were investigated as determinants of managerial preventive actions (MPAs) in relation to common mental disorders (CMDs) among employees.

METHODS

A web survey (n = 2921) among Swedish managers measured diverse managerial characteristics and two types of MPAs: reviewing assignments and work situation (MPA-review); talking about CMDs at the work place (MPA-talk).

RESULTS

MPA-review was reported by 50% and MPA-talk by 57% of managers. Characteristics that related to more MPAs were female gender, workplace offering lectures on CMDs, workplace offering stress counseling, being responsible for the work environment, management training on CMDs, and more than 10 years of managerial experience (MPA-talk only).

CONCLUSION

Managers who are female, have had training on CMDs, and work for organizations paying attention to CMD prevention initiate MPAs more often.

Aging at Work: A Review of Recent Trends and Future Directions

Demographic data suggest a rapid aging trend in the active workforce. The concept of aging at work comes from the urgent requirement to help the aging workforce of the contemporary industries to maintain productivity while achieving a work and private life balance. While there is plenty of research focusing on the aging population, current research activities on policies covering the concept of aging at work are limited and conceptually different. This paper aims to review publications on aging at work, which could lead to the creation of a framework that targets governmental decision-makers, the non-governmental sector, the private sector, and all of those who are responsible for the formulation of policies on aging at work. In August 2019 we searched for peer-reviewed articles in English that were indexed in PubMed, IEEE Xplore, and Springer and published between 2008 and 2019. The keywords included the following phrases: “successful aging at work”, “active aging at work”, “healthy aging at work”, “productive aging at work”, and “older adults at work”. A total of 47,330 publications were found through database searching, and 25,187 publications were screened. Afterwards, 7756 screened publications were excluded from the further analysis, and a total of 17,431 article abstracts were evaluated for inclusion. Finally, further qualitative analysis included 1375 articles, of which about 24 are discussed in this article. The most prominent works suggest policies that encourage life-long learning, and a workforce that comprises both younger and older workers, as well as gradual retirement.

Personality as a Resource for Labor Market Participation among Individuals with Chronic Health Conditions

Background: The link between personality traits and employment status in individuals with chronic health conditions (CHCs) is largely unexplored. In this study, we examined this association among 21,173 individuals with CHCs and whether this association differs between individuals suffering from a heart disease, depression, anxiety, cancer, chronic obstructive pulmonary disease, musculoskeletal disease (MSD) and type 2 diabetes mellitus (T2DM). Methods: This study was conducted using baseline data from the Lifelines Cohort Study. Employment status and the presence of CHCs were determined by questionnaire data. The Revised Neuroticism-Extroversion-Openness Personality Inventory (NEO-PI-R) was used to measure eight personality facet traits. We conducted disease-generic and disease-specific logistic regression analyses. Results: Workers with higher scores on self-consciousness (OR: 1.02; 95% CI: 1.01-1.02), impulsivity (1.03; 1.02-1.04), excitement seeking (1.02; 1.01-1.02), competence (1.08; 1.07-1.10) and self-discipline (1.04; 1.03-1.05) were more often employed. Adults with higher scores on anger-hostility (0.97; 0.97-0.98), vulnerability (0.98; 0.97-0.99), and deliberation (0.96; 0.95-0.97) were least often employed. Personality facets were associated strongest with employment status among individuals suffering from MSD and weakest in individuals with T2DM. Conclusions: Personality might be a key resource to continue working despite having a CHC. This may be relevant for the development of targeted personality-focused interventions.

Implementation of Early Intervention Protocol in Australia for 'High Risk' Injured Workers is Associated with Fewer Lost Work Days Over 2 Years Than Usual (Stepped) Care

Purpose To evaluate whether a protocol for early intervention addressing the psychosocial risk factors for delayed return to work in workers with soft tissue injuries would achieve better long-term outcomes than usual (stepped) care. Methods The study used a controlled, non-randomised prospective design to compare two case management approaches. For the intervention condition, workers screened within 1-3 weeks of injury as being at high risk of delayed returned to work by the Örebro Musculoskeletal Pain Screening Questionnaire-short version (ÖMPSQ-SF) were offered psychological assessment and a comprehensive protocol to address the identified obstacles for return to work. Similarly identified injured workers in the control condition were managed under usual (stepped) care arrangements. Results At 2-year follow-up, the mean lost work days for the Intervention group was less than half that of the usual care group, their claim costs were 30% lower, as was the growth trajectory of their costs after 11 months. Conclusions The findings supported the hypothesis that brief psychological risk factor screening, combined with a protocol for active collaboration between key stakeholders to address identified psychological and workplace factors for delayed return to work, can achieve better return on investment than usual (stepped) care.

Cardiovascular and Psychophysical Response to Repetitive Lifting Tasks in Women

Background

Understanding the cardiovascular and psychophysical demands of repetitive lifting tasks is important in job design strategies. This study determined the cardiovascular (oxygen consumption (VO₂) and heart rate (HR) and psychophysical response to repetitive lifting tasks in women.

Methods

Ten female (age 27 ± 5 yrs) participants transferred 11.4, 15.9, and 20.5 kg weights back and forth from a rung 40.6 cm high to a rung 156.2 cm high. Rungs were 195.6 cm apart horizontally. Three, 10 minute bouts (1 = 11.4 kg; 2 = 15.9 kg; 3 = 20.5 kg) were performed at 6 lifts per minute. Cardiovascular and psychophysical (rating of perceived exertion, RPE) parameters were monitored throughout the bouts. VO₂max and HRmax were determined via a maximal treadmill test.

Results

VO₂, HR, and RPE were significantly different between each work bout (p < 0.01), with each outcome variable increasing as load increased. VO₂max and HRmax equaled 46.5 ± 7.5 mL·kg⁻¹·min⁻¹ and 191 ± 11 bpm, respectively. Work at 11.4 kg was performed at 38% VO₂max and 63% HRmax; at 15.9 kg at 41% VO₂max and 72% HRmax; and at 20.5 kg at 49% VO₂max and 81% HRmax. RPE at 11.4, 15.9, and 20.5 kgs were: 8.4 ± 1.6, 11.4 ± 1.9, and 15.0 ± 2.2.

Conclusion

During these repetitive lifting tasks, metabolic cost and perceived exertion increased with weight lifted; average work intensity ranged from 63 to 81% of HRmax and 38 to 49% of VO₂max. Results have important implications in relation to job pacing and design, and worksite health promotion strategies aimed at reducing work place injury.

An Enduring Health Risk of Childhood Adversity: Earlier, More Severe, and Longer Lasting Work Disability in Adult Life

Objectives

Childhood adversity has been linked with adult health problems. We hypothesized that childhood adversity would also be associated with work limitations due to physical or nervous health problems, known as work disability.

Method

With data from the Panel Study of Income Dynamics (PSID) (1968-2013; n = 6,045; 82,374 transitions; 129,107 person-years) and the 2014 PSID Childhood Retrospective Circumstances Study, we estimated work disability transition probabilities with multinomial logistic Markov models. Four or more adversities defined a high level. Microsimulations quantified adult work disability patterns for African American and non-Hispanic white women and men, accounting for age, education, race, sex, diabetes, heart disease, obesity, and sedentary behavior.

Results

Childhood adversity was significantly associated with work disability. Of African American women with high adversity, 10.2% had moderate work disability at age 30 versus 4.1% with no reported adversities; comparable results for severe work disability were 5.6% versus 1.9% (both p < .01). Comparable results for whites were 11.3% versus 4.7%, and 3.5% versus 1.1% (p < .01). The association of childhood adversity with work disability remained significant after adjusting for diabetes, heart disease, obesity, and sedentary behavior (p < .05).

Conclusions

Childhood adversity may increase work disability throughout adult life.

Obstacles to returning to work with chronic pain: in-depth interviews with people who are off work due to chronic pain and employers

Background

The global burden of chronic pain is growing with implications for both an ageing workforce and employers. Many obstacles are faced by people with chronic pain in finding employment and returning to work after a period of absence. Few studies have explored obstacles to return-to-work (RTW) from workers’ and employers’ perspectives. Here we explore views of both people in pain and employers about challenges to returning to work of people who are off work with chronic pain.

Methods

We did individual semi-structured interviews with people who were off work (unemployed or off sick) with chronic pain recruited from National Health Service (NHS) pain services and employment services, and employers from small, medium, and large public or private sector organisations. We analysed data using the Framework method.

Results

We interviewed 15 people off work with chronic pain and 10 employers. Obstacles to RTW for people with chronic pain spanned psychological, pain related, financial and economic, educational, and work-related domains. Employers were concerned about potential attitudinal obstacles, absence, ability of people with chronic pain to fulfil the job requirements, and the implications for workplace relationships. Views on disclosure of the pain condition were conflicting with more than half employers wanting early full disclosure and two-thirds of people with chronic pain declaring they would not disclose for fear of not getting a job or losing a job. Both employers and people with chronic pain thought that lack of confidence was an important obstacle. Changes to the job or work conditions (e.g. making reasonable adjustments, phased return, working from home or redeployment) were seen by both groups as facilitators. People with chronic pain wanted help in preparing to RTW, education for managers about pain and supportive working relationships.

Conclusions

People with chronic pain and employers may think differently in terms of perceptions of obstacles to RTW. Views appeared disparate in relation to disclosure of pain and when this needs to occur. They appeared to have more in common regarding opinions about how to facilitate successful RTW. Increased understanding of both perspectives may be used to inform the development of improved RTW interventions.

Patient perspectives on employment participation in the "hypermobile Ehlers-Danlos syndrome"

BACKGROUND

"Ehlers-Danlos syndrome" (EDS) is a heritable connective disorder influencing multiple aspects of daily life. Most studies have focused on describing the physical symptoms and level of disability, but little knowledge exists about the psychosocial effects of the pathology. Participation in employment is an aspect that strongly influences quality of life of patients with chronic pathologies. This study, therefore, aimed to explore the lived experiences in employment participation of patients diagnosed with "hypermobile EDS".

METHODS

An inductive thematic analysis, using semi-structured interviews was used. Nine patients, purposively selected by a continuum sampling strategy, were included. Interviews were audio-recorded and transcribed verbatim.

RESULTS

Data analysis resulted in three main themes: (1) elements assisting participation in employment, (2) limitations in employment participation, and (3) unemployment due to the "hypermobile EDS". On the one hand, the results show that related health complaints can impede employment participation to an important extent. On the other hand, patients also report several aspects of work that can affect their well-being in a positive way.

CONCLUSION

There are specific reasons for a person with "hypermobile EDS" to participate in employment. These reasons are different for each person and may even vary in time.Implications for rehabilitation"Hypermobile EDS" greatly impacts activities and participation in daily life. "Living with limitations" is the central theme in the lives of "Hypermobile EDS" patients.Various aspects influence work participation in people with "Hypermobile EDS", such as work pressure, tasks, and transport to work.Work has positive effects in the lives of people with "Hypermobile EDS."Work can create difficulties when the job requirements and tasks do not match the functional abilities of a person with "Hypermobile EDS."

Opinion paper: the role of work in the management of medically unexplained physical symptoms

OBJECTIVES

Patients with medically unexplained physical symptoms suffer from chronic fatigue and/or pain in combination with a variety of other symptoms. A flexible, biopsychosocial approach is needed for diagnostic screening and global management. It is crucial to involve the direct patient environment, including family, friends, colleagues as well as health providers, evaluation, and reintegration sector. The aim of this paper is to review the importance of work in the management of medically unexplained physical symptoms.

METHODS

In this paper, different actors involved explain their views and handling concerning work in the management of MUPS.

RESULTS

Symptom severity and lack of understanding from the environment can negatively impact on earning an independent income from labor for years. Work, whether or not paid, is however, an important life domain with positive effects on physical, psychological, and social well-being. Therefore, health actors are pivotal in starting the professional reintegration process as soon as possible and should discuss this item from the early stage onward. Support services can be consulted in mutual interaction as required. A case manager, acting as a central intermediator within this multidisciplinary approach, may promote effective communication and coordination between the patients and their surrounding actors.

CONCLUSION

The professional reintegration process should start as soon as possible within the management of medically unexplained physical symptoms. As such, the care sector, the evaluation sector, and the professional integration sector should collaborate and effectively communicate with each other.

Education and work participation among adults with congenital unilateral upper limb deficiency in Norway: A cross-sectional study

Objectives

To describe level of education and work participation among adults with congenital unilateral upper limb deficiency (CUULD) in Norway and to explore associations between work participation and demographic and clinical factors.

Methods

Cross-sectional study. In 2012, a postal questionnaire was sent to 186 persons with congenital limb deficiency (CLD), age ≥ 20 years, registered at the TRS National Resource Center for Rare Disorders. In the original CLD study, 77 persons with CUULD responded. In this paper 64 persons with CUULD of working age (20–67 years) are included. Data on demographic factors as education level and work participation, and clinical factors including limb deficiency characteristics, chronic pain (Standardized Nordic Questionnaire), fatigue (Fatigue Severity Scale), physical and mental health (SF-36) were analyzed through descriptive and comparable statistics and logistic regression analyses.

Results

Sixty-four persons participated, mean age 43.4 (SD 13.7; range 20–67 years), 45 were women. Education level >13 years was reported by 34. Forty- three of the 64 participants were employed, 21 were prematurely retired (disability benefits). 11 of the 43 employed, and 6 of the 21 prematurely retired had completed vocational education. Physically demanding occupations (work activities that required standing, walking and lifting) were reported by 25 of the 43 employed and 13 of the 21 prematurely retired. 17 of the 64 reported need for further adaptions in their workplaces. The strongest predictors of work participation were younger age (OR 0.86) and good physical health (OR 1.21).

Conclusion

Two thirds of persons with CUULD were employed; while one third was prematurely retired and had left work earlier than expected. This suggests that persons with CUULD may experience challenges in work participation. Although levels of education were relatively high, several had chosen careers that required physical strain. Younger age and good physical health were the most important factors mediating work participation.

Lifetime Disadvantages after Childhood Adversity: Health Problems Limiting Work and Shorter Life

We examine how childhood adversity relates to work disability and life expectancy, using 1999-2015 data from the Panel Study of Income Dynamics. We estimate the probabilities of work disability and death, adjusting for age, sex, race/ethnicity, and education in a nationally representative sample of African American, Hispanic, and white women and men. We find that people in all these groups who experienced high adversity childhoods (individuals with four or more of six adversity indicators) had significantly more work disability and shorter lives than those who experienced no adversity. These findings provide evidence that childhood adversity is associated with substantial disability, and a reduction in life expectancy of at least a decade. Childhood adversity was generally associated with more lost years of life for men than for women, and more disability for women than for men. The results are robust, even when controlling for diabetes, heart disease, depression, obesity, and sedentary behavior.

The association of fatigue, pain, depression and anxiety with work and activity impairment in immune mediated inflammatory diseases

Impairment in work function is a frequent outcome in patients with chronic conditions such as immune-mediated inflammatory diseases (IMID), depression and anxiety disorders. The personal and economic costs of work impairment in these disorders are immense. Symptoms of pain, fatigue, depression and anxiety are potentially remediable forms of distress that may contribute to work impairment in chronic health conditions such as IMID. The present study evaluated the association between pain [Medical Outcomes Study Pain Effects Scale], fatigue [Daily Fatigue Impact Scale], depression and anxiety [Hospital Anxiety and Depression Scale] and work impairment [Work Productivity and Activity Impairment Scale] in four patient populations: multiple sclerosis (n = 255), inflammatory bowel disease (n = 248, rheumatoid arthritis (n = 154) and a depression and anxiety group (n = 307), using quantile regression, controlling for the effects of sociodemographic factors, physical disability, and cognitive deficits. Each of pain, depression symptoms, anxiety symptoms, and fatigue individually showed significant associations with work absenteeism, presenteeism, and general activity impairment (quantile regression standardized estimates ranging from 0.3 to 1.0). When the distress variables were entered concurrently into the regression models, fatigue was a significant predictor of work and activity impairment in all models (quantile regression standardized estimates ranging from 0.2 to 0.5). These findings have important clinical implications for understanding the determinants of work impairment and for improving work-related outcomes in chronic disease.

Measuring Work Ability with Its Antecedents: Evaluation of the Work Ability Survey

Purpose The revised version of the Work Ability Survey (WAS-R) assesses work ability on several sub-scales at the intersection of personal and organizational capacity, thus adding to the measurement of work ability by integrating the holistic model. It, therefore, improves on two features of the current standard measurement tool of work ability, the Work Ability Index (WAI): (1) a ceiling effect and (2) limited detail due to a focus on physical health and personal capacity. Method In two samples (n ₁ = 1093, n ₂ = 359), psychometric properties and the structure of the WAS-R were analyzed. To evaluate construct validity, inter-correlations of the WAS-R and WAI, sickness absence, expected and desired retirement age, and post-retirement work intention were calculated. Results The WAS-R was found to be distributed closer to normality than the WAI. The structural analyses yielded acceptable results for the hypothesized model. The WAS-R was adequately correlated with the WAI, negatively with sickness absence, and positively with desired retirement age. Conclusions The WAS-R extends the measurement of work ability, reflecting organizations' work demands. Its broad sub-scales lead to high acceptance of the results within the participating companies. In particular, the organizational capacity scales can be used to guide interventions aiming at organizational characteristics to improve work ability.

Work disability in the United States, 1968-2015: Prevalence, duration, recovery, and trends

The United States workforce is aging. At the same time more people have chronic conditions, for longer periods. Given these trends the importance of work disability, physical or nervous problems that limit a person's type or amount of work, is increasing. No research has examined transitions among multiple levels of work disability, recovery from work disability, or trends. Limited research has focused on work disability among African Americans and Hispanics, or separately for women and men. We examined these areas using data from 30,563 adults in the 1968-2015 Panel Study of Income Dynamics. We estimated annual probabilities of work disability, recovery, and death with multinomial logistic Markov models. Microsimulations accounting for age and education estimated outcomes for African American, Hispanic, and non-Hispanic white women and men. Results from these nationally representative data suggested that the majority of Americans experience work disability during working life. Most spells ended with recovery or reduced severity. Among women, African Americans and Hispanics had less moderate and severe work disability than whites. Among men, African Americans became severely work disabled more often than whites, recovered from severe spells more often and had shorter severe spells, yet had more severe work disability at age 65. Hispanic men were more likely to report at least one spell of severe work disability than whites; they also had substantially more recovery from severe work disability, and a lower percentage of working years with work disability. Among African Americans and Hispanics, men were considerably more likely than women to have severe work disability at age 65. Work disability declined significantly across the study period for all groups. Although work disability has declined over several decades, it remains common. Results suggest that the majority of work disability spells end with recovery, underscoring the importance of rehabilitation and workplace accommodation.

Disability at Work: A Look Back and Forward

Purpose This article presents new evidence on employment barriers and workplace disparities facing employees with disabilities, linking the disparities to employee attitudes. Methods Analyses use the 2006 General Social Survey to connect disability to workplace disparities and attitudes in a structural equation model. Results Compared to employees without disabilities, those with disabilities report: lower pay levels, job security, and flexibility; more negative treatment by management; and, lower job satisfaction but similar organizational commitment and turnover intention. The lower satisfaction is mediated by lower job security, less job flexibility, and more negative views of management and co-worker relations. Conclusion Prior research and the present findings show that people with disabilities experience employment disparities that limit their income, security, and overall quality of work life. Technology plays an increasingly important role in decreasing employment disparities. However, there also should be increased targeted efforts by government, employers, insurers, occupational rehabilitation providers, and disability groups to address workplace barriers faced by employees with disabilities, and by those with disabilities seeking to return to work.

Future Directions in Employment, Occupational Rehabilitation, and Disability: Introduction to the Special Section

Purpose From an array of disciplinary perspectives, the articles in this special section examine opportunities and challenges in the economic, social, and civic participation of individuals across the spectrum of disabilities. Methods At multiple levels of analysis, the contributors consider employment law and policy frameworks, occupational and vocational rehabilitation strategies, and corporate practices in support of the full and equal inclusion of people with disabilities in society. Results and Conclusions The implications for policymakers, public and private sector stakeholders, and occupational rehabilitation professional are presented to help inform future policies, practices, and strategies to improve employment outcomes for people with disabilities.

Employer Policies and Practices to Manage and Prevent Disability: Conclusion to the Special Issue

Purpose Research of employer policies and practices to manage and prevent disability spans many disciplines and perspectives, and there are many challenges related to stakeholder collaboration, data access, and interventions. The purpose of this article is to synthesize the findings from a conference and year-long collaboration among a group of invited researchers intended to spur new research innovations in this field. Methods A multidisciplinary team of 26 international researchers with published research in employer-based disability management or related fields were invited to attend a 3-day conference in Hopkinton, Massachusetts, USA. The conference goals were to review the status of current research of workplace disability management and prevention, examine its relevance for employer decision-making, compare conceptual frameworks or theoretical perspectives, and recommend future research directions. In this paper, we summarize key points from the 6 resulting papers, compare them with an earlier 2005 conference on improving return-to-work research, and conclude with recommendations for further overarching research directions. Results/Conclusion In comparison with the 2005 conference, a greater emphasis was placed on organizational and social factors, employer roles and responsibilities, methods of implementation, non-clinical approaches, and facilitating stay-at-work as well as return-to-work. A special panel of employer consultants and representatives who were featured at the 2015 conference reinforced the importance of organizational culture, leadership style, and financial decision-making strategies at the employer level. Based on the conference proceedings, we recommend that future research in this area should strive for: (a) broader inclusion of workers and workplaces; (b) attention to multilevel influences in the workplace;