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Toropova A, Björk Brämberg E, Bergström G. Return to Work Trajectories of Swedish Employees on Sick-Leave Due to Common Mental Disorders. JOURNAL OF OCCUPATIONAL REHABILITATION 2024:10.1007/s10926-024-10216-9. [PMID: 38907784 DOI: 10.1007/s10926-024-10216-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/09/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVES Recent research has emphasized that return to work (RTW) is a dynamic, gradual and often uneven process with a great degree of individual variation. This study aimed to identify RTW trajectories of Swedish employees on sick-leave due to common mental disorders (CMDs). The second aim was to explore which demographic, employment, health-related and work environment characteristics predicted RTW trajectory membership. METHODS Data comes from two 2-armed cluster-randomized controlled trials (RCT) with a 12-month follow-up. A participative problem-solving intervention aimed to reduce sick-leave was compared to care as usual (CAU) involving any kind of work-directed interventions. Participants on sick-leave due to CMDs at baseline (N = 197) formed the study sample. Latent growth mixture modeling and logistic regression were the main analytical approaches. RESULTS Five distinct RTW trajectories of Swedish employees were identified: Early RTW (N = 65), Delayed RTW (N = 50), Late RTW (N = 39), Struggling RTW (N = 21) and No RTW (N = 22). RTW trajectories differed consistently with regard to previous sick-leave duration and social support at work. More unique predictors of RTW trajectories included gender, rewards at work, work performance impairment due to health problems, home-to-work interference and stress-related exhaustion disorder. CONCLUSION The study may have important clinical implications for identifying patients belonging to a particular RTW trajectory. Knowledge on the modifiable work environment factors that differentiated between the RTW trajectories could be useful for designing effective workplace interventions, tailored to particular needs of employees with CMDs. However, in a first step, the results need to be replicated.
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Affiliation(s)
- Anna Toropova
- Unit of Intervention and Implementation Research for Worker Health, Institute for Environmental Medicine, Karolinska Institute, 171 77, Stockholm, Sweden.
| | - Elisabeth Björk Brämberg
- Unit of Intervention and Implementation Research for Worker Health, Institute for Environmental Medicine, Karolinska Institute, 171 77, Stockholm, Sweden
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Gunnar Bergström
- Unit of Intervention and Implementation Research for Worker Health, Institute for Environmental Medicine, Karolinska Institute, 171 77, Stockholm, Sweden
- Department of Occupational Health Sciences and Psychology, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
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Holmlund L, Ljungberg HT, Bültmann U, Brämberg EB. Navigating work and life- a qualitative exploration of managers' and employees' views of return-to-work after sick leave due to common mental disorders. BMC Public Health 2024; 24:372. [PMID: 38317150 PMCID: PMC10840186 DOI: 10.1186/s12889-024-17765-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 01/13/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Incorporating multiple perspectives and contexts in knowledge mobilisation for return-to-work after sick leave due to common mental disorders can promote interprofessional and organisational strategies for facilitating the return-to-work process. This study aimed to explore the facilitators of and barriers to return-to-work after common mental disorders. This exploration considered the perspectives of employees and managers and the realms of work and private life. METHODS A qualitative approach was used with data from 27 semi-structured telephone interviews. The strategic sample consisted of employees who returned to work after sick leave due to common mental disorders (n = 17) and managers responsible for their return-to-work process (n = 10). Thematic analysis conducted in a six-step process was used to generate themes in the interview data. RESULTS The analysis generated three main themes with subthemes, illustrating experiences of barriers to and facilitators of return-to-work positioned in the employees' private and work contexts: (1) Getting along: managing personal difficulties in everyday life; (2) Belonging: experiencing social connectedness and support in work and private life; and (3) Organisational support: fostering a supportive work environment. The results contribute to a comprehensive understanding of the return-to-work process, including the challenges individuals face at work and in private life. CONCLUSIONS The study suggests that return-to-work after sick leave due to CMDs is a dynamic and ongoing process embedded in social, organisational, and societal environments. The results highlight avenues for an interprofessional approach and organisational learning to support employees and managers, including space for the employee to recover during the workday. TRIAL REGISTRATION This study recruited employees from a two-armed cluster-randomised controlled trial evaluating a problem-solving intervention for reducing sick leave among employees sick-listed due to common mental disorders (reg. NCT3346395).
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Affiliation(s)
- Lisa Holmlund
- Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, SE-171 77, Stockholm, Box 210, Sweden.
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Fack 23 200, SE-141 83, Stockholm, Huddinge, Sweden.
| | - Helena Tinnerholm Ljungberg
- Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, SE-171 77, Stockholm, Box 210, Sweden
| | - Ute Bültmann
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Elisabeth Björk Brämberg
- Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, SE-171 77, Stockholm, Box 210, Sweden
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, SE-405 30, Gothenburg, Box 100, Sweden
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Waldmann T, Riedl L, Brieger P, Lang A, Blank D, Kohl M, Brucks A, Bühner M, Hamann J, Kilian R. The cost-utility of a return-to-work intervention in comparison to routine care for patients with mental disorders in Germany: Results from the RETURN project. Eur Psychiatry 2023; 66:e55. [PMID: 37486071 PMCID: PMC10486254 DOI: 10.1192/j.eurpsy.2023.2427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Only two-thirds of patients admitted to psychiatric wards return to their previous jobs. Return-to-work interventions in Germany are investigated for their effectiveness, but information regarding cost-effectiveness is lacking. This study investigates the cost-utility of a return-to-work intervention for patients with mental disorders compared to treatment as usual (TAU). METHODS We used data from a cluster-randomised controlled trial including 166 patients from 28 inpatient psychiatric wards providing data at 6- and 12-month follow-ups. Health and social care service use was measured with the Client Sociodemographic and Service Receipt Inventory. Quality of life was measured with the EQ-5D-3L questionnaire. Cost-utility analysis was performed by calculating additional costs per one additional QALY (Quality-Adjusted Life Years) gained by receiving the support of return-to-work experts, in comparison to TAU. RESULTS No significant cost or QALY difference between the intervention and control groups has been detected. The return-to-work intervention cannot be identified as cost-effective in comparison to TAU. CONCLUSIONS The employment of return-to-work experts could not reach the threshold of providing good value for money. TAU, therefore, seems to be sufficient support for the target group.
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Affiliation(s)
- Tamara Waldmann
- Department of Psychiatry and Psychotherapy II,
University of Ulm and BKH Günzburg, Günzburg,
Germany
| | - Lina Riedl
- Department of Psychiatry and Psychotherapy of Technical,
University of Munich, München,
Germany
| | - Peter Brieger
- Kbo-Isar-Amper Clinic, Academic Teaching Hospital
of Ludwig-Maximilians University, Munich,
Germany
| | - Anne Lang
- Kbo-Isar-Amper Clinic, Academic Teaching Hospital
of Ludwig-Maximilians University, Munich,
Germany
| | - Daniela Blank
- Kbo-Isar-Amper Clinic, Academic Teaching Hospital
of Ludwig-Maximilians University, Munich,
Germany
| | - Monika Kohl
- Department of Psychiatry and Psychotherapy of Technical,
University of Munich, München,
Germany
| | - Adele Brucks
- Department of Psychiatry and Psychotherapy of Technical,
University of Munich, München,
Germany
| | - Markus Bühner
- Department of Psychology, Ludwig-Maximilians
University, Munich, Germany
| | - Johannes Hamann
- Department of Psychiatry and Psychotherapy of Technical,
University of Munich, München,
Germany
- Bezirksklinikum Mainkofen,
Deggendorf, Germany
| | - Reinhold Kilian
- Department of Psychiatry and Psychotherapy II,
University of Ulm and BKH Günzburg, Günzburg,
Germany
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Starke F, Sikora A, Stegmann R, Knebel L, Buntrock C, de Rijk A, Houkes I, Szycik GR, Unger HP, Schumacher JO, Stark H, Hauth I, Holzapfel C, Borgolte A, Schneller C, Unterschemmann SL, Paetow W, Jung AL, Berking M, Zimmermann J, Wegewitz U. Evaluating a multimodal, clinical and work-directed intervention (RTW-PIA) to support sustainable return to work among employees with mental disorders: study protocol of a multicentre, randomised controlled trial. BMC Psychiatry 2023; 23:380. [PMID: 37254157 DOI: 10.1186/s12888-023-04753-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/05/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Mental disorders (MDs) are one of the leading causes for workforce sickness absence and disability worldwide. The burden, costs and challenges are enormous for the individuals concerned, employers and society at large. Although most MDs are characterised by a high risk of relapse after treatment or by chronic courses, interventions that link medical-psychotherapeutic approaches with work-directed components to facilitate a sustainable return to work (RTW) are rare. This protocol describes the design of a study to evaluate the (cost-)effectiveness and implementation process of a multimodal, clinical and work-directed intervention, called RTW-PIA, aimed at employees with MDs to achieve sustainable RTW in Germany. METHODS The study consists of an effectiveness, a health-economic and a process evaluation, designed as a two-armed, multicentre, randomised controlled trial, conducted in German psychiatric outpatient clinics. Sick-listed employees with MDs will receive either the 18-month RTW-PIA treatment in conjunction with care as usual, or care as usual only. RTW-PIA consists of a face-to-face individual RTW support, RTW aftercare group meetings, and web-based aftercare. Assessments will be conducted at baseline and 6, 12, 18 and 24 months after completion of baseline survey. The primary outcome is the employees´ achievement of sustainable RTW, defined as reporting less than six weeks of working days missed out due to sickness absence within 12 months after first RTW. Secondary outcomes include health-related quality of life, mental functioning, RTW self-efficacy, overall job satisfaction, severity of mental illness and work ability. The health-economic evaluation will be conducted from a societal and public health care perspective, as well as from the employer's perspective in a cost-benefit analysis. The design will be supplemented by a qualitative effect evaluation using pre- and post-interviews, and a multimethod process evaluation examining various predefined key process indicators from different stakeholder perspectives. DISCUSSION By applying a comprehensive, multimethodological evaluation design, this study captures various facets of RTW-PIA. In case of promising results for sustainable RTW, RTW-PIA may be integrated into standard care within German psychiatric outpatient clinics. TRIAL REGISTRATION The study was prospectively registered with the German Clinical Trials Register ( DRKS00026232 , 1 September 2021).
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Affiliation(s)
- Fiona Starke
- Division 3 Work and Health, Unit 3.5 Evidence-based Occupational Health, Workplace Health Management, Federal Institute for Occupational Safety and Health (BAuA), Nöldnerstr. 40-42, Berlin, 10317, Germany.
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands.
| | - Alexandra Sikora
- Division 3 Work and Health, Unit 3.5 Evidence-based Occupational Health, Workplace Health Management, Federal Institute for Occupational Safety and Health (BAuA), Nöldnerstr. 40-42, Berlin, 10317, Germany
| | - Ralf Stegmann
- Division 3 Work and Health, Unit 3.5 Evidence-based Occupational Health, Workplace Health Management, Federal Institute for Occupational Safety and Health (BAuA), Nöldnerstr. 40-42, Berlin, 10317, Germany
| | - Leonie Knebel
- Division 3 Work and Health, Unit 3.5 Evidence-based Occupational Health, Workplace Health Management, Federal Institute for Occupational Safety and Health (BAuA), Nöldnerstr. 40-42, Berlin, 10317, Germany
| | - Claudia Buntrock
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto-Von-Guericke University Magdeburg (OVGU), Leipziger Str. 44, 39120, Magdeburg, Germany
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Nägelsbachstr. 25a, 91052, Erlangen, Germany
| | - Angelique de Rijk
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
| | - Inge Houkes
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
| | - Gregor R Szycik
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hanover Medical School, Podbielskistr. 162, Hanover, OE7110, Germany
| | - Hans-Peter Unger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Centre for Mental Health, Asklepios Clinic Harburg, Eißendorfer Pferdeweg 52, Hamburg, 21075, Germany
| | - Jan Ole Schumacher
- Department of Psychiatry, Psychotherapy and Psychosomatics, Centre for Mental Health, Asklepios Clinic Harburg, Eißendorfer Pferdeweg 52, Hamburg, 21075, Germany
| | - Heiko Stark
- Department of Psychiatry, Burghof-Clinic, Ritterstr. 19, 31737, Rinteln, Germany
| | - Iris Hauth
- Department of Psychiatry, Psychotherapy and Psychosomatics, Alexian St. Joseph-Hospital Berlin-Weissensee, Gartenstr. 1, 13088, Berlin, Germany
| | | | - Anna Borgolte
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hanover Medical School, Podbielskistr. 162, Hanover, OE7110, Germany
| | - Carlotta Schneller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Alexian St. Joseph-Hospital Berlin-Weissensee, Gartenstr. 1, 13088, Berlin, Germany
| | | | - Wiebke Paetow
- Department of Psychiatry, Psychotherapy and Psychosomatics, Centre for Mental Health, Asklepios Clinic Harburg, Eißendorfer Pferdeweg 52, Hamburg, 21075, Germany
| | - Anna Lena Jung
- Clinic Wittgenstein, Sählingsstr. 60, 57319, Bad Berleburg, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Nägelsbachstr. 25a, 91052, Erlangen, Germany
| | - Johannes Zimmermann
- Department of Psychology, University of Kassel, Holländische Str. 36-38, 34127, Kassel, Germany
| | - Uta Wegewitz
- Division 3 Work and Health, Unit 3.5 Evidence-based Occupational Health, Workplace Health Management, Federal Institute for Occupational Safety and Health (BAuA), Nöldnerstr. 40-42, Berlin, 10317, Germany
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Holmlund L, Bültmann U, Bergström G, Warnqvist A, Björk Brämberg E. Are psychosocial work factors and work-home interference associated with time to first full return-to-work after sick leave due to common mental disorders? Int Arch Occup Environ Health 2023; 96:747-755. [PMID: 36964790 DOI: 10.1007/s00420-023-01970-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 03/11/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVE To (1) examine the time to first full return-to-work (RTW), and (2) investigate whether psychosocial work factors and work-home interference are associated with time to first full RTW after sick leave due to common mental disorders (CMDs). METHODS The cohort study comprised 162 employees on sick leave due to CMDs participating in a two-armed cluster-randomised controlled trial in Sweden. Baseline data consisted of a web-based questionnaire and follow-up data of repeated text messages every fourth week for 12 months. The time to first full RTW was estimated using the Kaplan-Meier Estimator. Parametric Weibull survival models with interval-censored outcomes were used to determine associations between psychosocial work factors and work-home interference with time to first full RTW. In a post hoc analysis, time-interval differences in associations for 0- ≤ 6- versus > 6-12 months were tested. RESULTS During the 12-month follow-up, n = 131 (80.9%) reported a first full RTW. The median time to this RTW was 16 weeks (95% CI 12; 20). High psychological job demands, high emotional job demands, high work-to-home interference (WHI), and low social job support were independently associated with a longer time to first full RTW. Time-interval differences were found for job control and emotional job demands. CONCLUSIONS Psychosocial work demands and WHI are associated with a longer time to RTW after sick leave due to CMDs. Work organisations and rehabilitation practices should include accommodations for high psychological and emotional job demands during RTW, as well as pay attention to the risk of spill-over of high job demands into employees' private lives.
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Affiliation(s)
- Lisa Holmlund
- Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, P.O.Box 210, 171 77, Stockholm, Sweden.
| | - Ute Bültmann
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gunnar Bergström
- Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, P.O.Box 210, 171 77, Stockholm, Sweden
- Department of Occupational Health Sciences and Psychology, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
| | - Anna Warnqvist
- Institute of Environmental Medicine, Division of Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Elisabeth Björk Brämberg
- Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, P.O.Box 210, 171 77, Stockholm, Sweden
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