In What Ways Does Health Related Stigma Affect Sustainable Employment and Well-Being at Work? A Systematic Review

Improving Work Participation Outcomes Among Unemployed People with Mental Health Issues/Mental Illness: Feasibility of a Stigma Awareness Intervention

PURPOSE

As stigma is a barrier to work participation of unemployed people with mental health issues/mental illness (MHI), a stigma awareness intervention can be helpful to make informed decisions about disclosing MHI. The aim of this process evaluation was to investigate the feasibility of a stigma awareness intervention, to explore experiences of clients and their employment specialists; and to give recommendations for further implementation.

METHODS

The intervention consisted of a stigma awareness training for employment specialists and a decision aid tool for their clients with (a history of) MHI. For the process evaluation, six process components of the Linnan & Stecklar framework were examined: recruitment, reach, dose delivered, dose received, fidelity and context. Using a mixed-methods design, quantitative and qualitative data were collected and analyzed.

RESULTS

The six components showed the intervention was largely implemented as planned. Questionnaire data showed that 94% of the clients found the tool useful and 87% would recommend it to others. In addition, more than half (54%) indicated the tool had been helpful in their disclosure decision. Qualitative data showed that participants were mainly positive about the intervention. Nevertheless, only a minority of clients and employment specialists had actually discussed the tool together. According to both, the intervention had increased their awareness of workplace stigma and the disclosure dilemma.

CONCLUSION

The implementation of a stigma awareness intervention was feasible and did increase stigma awareness. Experiences with the intervention were mainly positive. When implementing the tool, it is recommended to embed it in the vocational rehabilitation system, so that discussing the disclosure dilemma becomes a routine.

TRAIL REGISTER

The study was retrospectively registered at the Dutch Trial Register (TRN: NL7798, date: 04-06-2019).

Good reasons for bad behavior: a randomized controlled experiment on the impact of narrative reading and writing on empathic concern, perspective-taking, and attitude

Background

Empathic concern and perspective-taking may contribute to avoiding stigmatization of adverse health behavior. Narrative writing has been shown to be effective in promoting perspective-taking and empathy. But since narrative writing is time consuming, we tested in the present study narrative reading as an alternative, more parsimonious approach.

Methods

In a randomized controlled experiment, we compared writing a narrative text about a fictitious person who displays disapproved of health behavior to reading such a text and to a control condition in which participants wrote about an unrelated topic. With a sample of n = 194 participants, we investigated the impact of writing and reading a narrative text on promoting empathic concern and perspective-taking as well as on attitude change.

Results

We found that both writing and reading a narrative text about the fictitious character increased empathic concern, F(1, 191) = 32.85, p < 0.001, part. η2 = 0.15, and perspective-taking, F(1, 191) = 24.76, p < 0.001, part. η2 = 0.12, more strongly than writing about an unrelated topic. Writing and reading a narrative text also resulted in a more positive attitude toward this person, F(1, 191) = 17.63, p < 0.001, part. η2 = 0.08. Simply reading a narrative text was equally efficient as narrative writing with respect to empathic concern, p = 0.581, perspective-taking, p = 0.629, and attitude, p = 0.197.

Conclusion

The finding that narrative reading is as effective as narrative writing suggests that the readers appear to be able to comprehend and engage with the story being told. When narrative reading is as effective as narrative writing, it can succeed with reduced effort in increasing empathic concern, perspective-taking, and attitude. We discuss the benefits of this approach for reducing stigmatization of adverse health behavior.

Effectiveness of a Stigma Awareness Intervention on Reemployment of People with Mental Health Issues/Mental Illness: A Cluster Randomised Controlled Trial

PURPOSE

A barrier for reemployment of people with mental health issues/mental illness (MHI) is workplace stigma and discrimination. In this RCT the effectiveness of a stigma-awareness intervention addressing finding work, retaining work and decisional stress were evaluated.

METHODS

A cluster RCT was conducted in 8 Dutch municipal practices. Randomisation took place at practice level. Participants were unemployed people with MHI, receiving social benefits. The intervention consisted of a decision aid for workplace disclosure for participants and a 2 × 3 h stigma-awareness training for their employment specialists. Primary outcomes were measured at baseline, 3-, 6- and 12-months. Multilevel analyses, containing random intercepts of participants nested in organizations, were conducted to analyse the effects of the intervention.

RESULTS

Participants (N = 153) were randomized to an experimental (n = 76) or control group (n = 77). At six months, significantly more participants of the experimental group (51%) had found work compared to the control group (26%). At twelve months, significantly more participants of the experimental group (49%) had retained work compared to the control group (23%). Intention-to-treat analyses showed that randomization to the experimental group was associated with finding (OR(95%CI) = 7.78(1.33-45.53), p = 0.02) and retaining (OR(95%CI) = 12.15(2.81-52.63), p < 0.01) work more often at twelve months. Analyses showed that the experimental and control group did not differ in decisional stress.

CONCLUSIONS

Our stigma awareness intervention was effective for finding and retaining work. As the percentage of people who found and retained work almost doubled, this suggests that on a societal level, a vast number of unemployed people could be reemployed with a relatively simple intervention.

TRIAL REGISTRATION

The study was retrospectively registered at the Dutch Trial Register (TRN: NL7798, date: 04-06-2019).

Impact of mental disorders during education on work participation: a register-based longitudinal study on young adults with 10 years follow-up

BACKGROUND

Mental disorders are a leading cause of disability and a major threat to work participation in young adults. This register-based longitudinal study aims to investigate the influence of mental disorders on entering and exiting paid employment among young graduates and to explore differences across socioeconomic groups.

METHODS

Register information on sociodemographics (age, sex, migration background) and employment status of 2 346 393 young adults who graduated from secondary vocational (n=1 004 395) and higher vocational education or university (n=1 341 998) in the period 2010-2019 was provided by Statistics Netherlands. This information was enriched with register information on the prescription of nervous system medication for mental disorders in the year before graduation as a proxy for having a mental disorder. Cox proportional hazards regression models were used to estimate the influence of mental disorders on (A) entering paid employment among all graduates and (B) exiting from paid employment among graduates who had entered paid employment.

RESULTS

Individuals with mental disorders were less likely to enter (HR 0.69-0.70) and more likely to exit paid employment (HR 1.41-1.42). Individuals using antipsychotics were the least likely to enter (HR 0.44) and the most likely to exit paid employment (HR 1.82-1.91), followed by those using hypnotics and sedatives. The association between mental disorders and work participation was found across socioeconomic subgroups (ie, educational level, sex and migration background).

DISCUSSION

Young adults with mental disorders are less likely to enter and maintain paid employment. These results ask for prevention of mental disorders and for a more inclusive labour market.

Dutch workers' attitudes towards having a coworker with mental health issues or illness: a latent class analysis

Introduction

Workplace mental health stigma is a major problem as it can lead to adverse occupational outcomes and reduced well-being. Although workplace climate is largely determined by managers and co-workers, the role of co-workers in workplace stigma is understudied. Therefore, the aims are: (1) to examine knowledge and attitudes towards having a coworker with Mental Health Issues or Illness (MHI), especially concerning the desire for social distance, (2) to identify distinct subgroups of workers based on their potential concerns towards having a coworker with MHI, and (3) to characterize these subgroups in terms of knowledge, attitudes, and background characteristics.

Materials and methods

A cross-sectional survey was conducted among a nationally representative internet panel of 1,224 Dutch workers who had paid jobs and did not hold management positions. Descriptive statistics and a three-step approach Latent Class Analysis (LCA) were used to address the research aims.

Results

Concerning the desire for social distance, 41.9% of Dutch workers indicated they did not want to have a close colleague with MHI, and 64.1% did not want to work for a higher-ranking manager who had MHI. In contrast however, most workers did not have negative experiences with interacting with coworkers with MHI (92.6%). Next, five distinct subgroups (SG) of workers were identified: two subgroups with few concerns towards having a coworker with MHI (SG1 and SG2; 51.8% of the respondents), one subgroup with average concerns (SG3; 22.7% of the respondents), and two subgroups with more concerns (SG4 and SG5; 25.6% of the respondents). Four out of five subgroups showed a high tendency towards the desire for social distance. Nevertheless, even in the subgroups with more concerns, (almost) half of the respondents were willing to learn more about how to best deal with coworkers with MHI. No significant differences were found between the subgroups on background characteristics.

Discussion

The high tendency to the desire for social distance seems to contrast with the low number of respondents who personally had negative experiences with workers with MHI in the workplace. This suggests that the tendency to socially exclude this group was not based on their own experience. The finding that a large group of respondents indicated to want to learn more about how to deal with a co-worker with MHI is promising. Destigmatizing interventions in the workplace are needed in order to create more inclusive workplaces to improve sustained employment of people with MHI. These interventions should focus on increasing the knowledge of workers about how to best communicate and deal with coworkers with MHI, they do not need to differentiate in background variables of workers.

Inequalities in the impact of having a chronic disease on entering permanent paid employment: a registry-based 10-year follow-up study

BACKGROUND

This study aimed to investigate among unemployed persons (1) the impact of having a chronic disease on entering paid employment and obtaining a permanent contract and (2) whether these associations differed by educational attainment.

METHODS

Register data from Statistics Netherlands on employment status, contract type, medication and sociodemographic characteristics were linked. Dutch unemployed persons between 18 and 64 years (n=667 002) were followed up for 10 years (2011-2020). Restricted mean survival time analyses (RMSTs) were used to investigate differences in average months until entering paid employment and until obtaining a permanent contract between persons with and without cardiovascular diseases, inflammatory conditions, diabetes, respiratory illness, common mental disorders and psychotic disorders. Interaction terms were included for education.

RESULTS

One-third of the unemployed persons at baseline entered paid employment during follow-up. Persons with chronic diseases spent more months in non-employment compared with persons without chronic diseases (difference ranging from 2.50 months (95% CI 1.97 to 3.03 months) to 10.37 months (95% CI 9.98 to 10.77 months)), especially for persons with higher education. Conditional on entering paid employment, the time until a permanent contract was longer for persons with cardiovascular diseases (4.42 months, 95% CI 1.85 to 6.99 months), inflammatory conditions (4.80 months, 95% CI 2.02 to 7.59 months) and diabetes (8.32 months, 95% CI 4.26 to 12.37 months) than for persons without these diseases. These latter differences were similar across educational attainment.

CONCLUSIONS

Having a chronic disease is a barrier to entering permanent paid employment. The findings underline the need to prevent chronic diseases and promote an inclusive workforce.

Workplace Mental Health Disclosure, Sustainable Employability and Well-Being at Work: A Cross-Sectional Study Among Military Personnel with Mental Illness

Purpose Disclosure of mental illness to a supervisor can have positive (e.g. supervisor support) and negative consequences (e.g. stigma). However, research on the association between disclosure and sustainable employability and well-being at work is scarce. The aim of this study was to investigate the association between the disclosure decision (yes/no), experiences with the decision (positive/negative) and sustainable employment and well-being at work among military personnel with mental illness (N = 323). Methods A cross-sectional questionnaire study was conducted. Descriptive and regression (linear and ordinal) analyses were performed. Comparisons were made between those with positive and negative disclosure experiences. Results Disclosure decision (yes/no) was not significantly associated with any of the measures of sustainable employability and well-being at work. However, positive disclosure experiences were significantly associated with higher scores on almost all measures of sustainable employability and well-being at work. Those with negative disclosure experiences reported significantly more shame (M_pos = 2.42, M_neg = 2.78, p < .05) and discrimination (M_pos = 1.70, M_neg = 2.84, p < .001). Those with a positive disclosure experience, reported significantly more supervisor support (M_pos = 3.20, M_neg = 1.94, p < .001). Conclusion We did not find evidence that the disclosure decision itself is related to measures of sustainable employment and well-being at work. In contrast, how participants had experienced their (non-)disclosure decision was significantly related to almost all measures. This emphasizes the importance of the work environments reactions to disclosure and mental illness in the workplace. Future research and interventions should focus on increasing the likelihood of positive disclosure experiences through creating a more inclusive work environment, with more supervisor support and less stigma.

Mental health issues and illness and substance use disorder (non-)disclosure to a supervisor: a cross-sectional study on beliefs, attitudes and needs of military personnel

OBJECTIVES

Research suggests that military personnel frequently delay disclosing mental health issues and illness (MHI), including substance use disorder, to supervisors. This delay causes missed opportunities for support and workplace accommodations which may help to avoid adverse occupational outcomes. The current study aims to examine disclosure-related beliefs, attitudes and needs, to create a better understanding of personnel's disclosure decision making.

DESIGN

A cross-sectional questionnaire study among military personnel with and without MHI. Beliefs, attitudes and needs regarding the (non-)disclosure decision to a supervisor were examined, including factors associated with (non-)disclosure intentions and decisions. Descriptive and regression (logistic and ordinal) analyses were performed.

SETTING

The study took place within the Dutch military.

PARTICIPANTS

Military personnel with MHI (n=324) and without MHI (n=554) were participated in this study.

OUTCOME MEASURE

(Non-)disclosure intentions and decisions.

RESULTS

Common beliefs and attitudes pro non-disclosure were the preference to solve one's own problems (68.3%), the preference for privacy (58.9%) and a variety of stigma-related concerns. Common beliefs and attitudes pro disclosure were that personnel wanted to be their true authentic selves (93.3%) and the desire to act responsibly towards work colleagues (84.5%). The most reported need for future disclosure (96.8%) was having a supervisor who shows an understanding for MHI. The following factors were associated both with non-disclosure intentions and decisions: higher preference for privacy (OR (95% CI))=(1.99 (1.50 to 2.65)_intention, 2.05 (1.12 to 3.76)_decision) and self-management (OR (95% CI))=(1.64 (1.20 to 2.23)_intention, 1.79 (1.00 to 3.20)_decision), higher stigma-related concerns (OR (95% CI))=(1.76 (1.12 to 2.77)_intention, 2.21 (1.02 to 4.79)_decision) and lower quality of supervisor-employee relationship (OR (95% CI))=(0.25 (0.15 to 0.42)_intention, 0.47 (0.25 to 0.87)_decision).

CONCLUSION

To facilitate (early-)disclosure to a supervisor, creating opportunities for workplace support, interventions should focus on decreasing stigma and discrimination and align with personnels' preference for self-management. Furthermore, training is needed for supervisors on how to recognise, and effectively communicate with, personnel with MHI. Focus should also be on improving supervisor-employee relationships.

"I noticed that when I have a good supervisor, it can make a Lot of difference." A Qualitative Study on Guidance of Employees with a Work Disability to Improve Sustainable Employability

PURPOSE

For employees with a work disability adequate daily guidance from supervisors is key for sustainable employability. Supervisors often lack expertise to guide this group of employees. Mentorwijs (literal translation: Mentorwise) is a training for supervisors to improve the guidance of employees with a work disability. The aim of this study was to investigate the experiences of employees with a work disability regarding: (1) the guidance from their supervisors (who followed the Mentorwijs training), (2) which differences they notice in the guidance due to the Mentorwijs training, and (3) what kind of aspects they consider important in their guidance to achieve sustainable employability.

METHODS

A qualitative study was performed with semi-structured (group) interviews among twenty-one employees with a work disability. Thematic analysis was performed to analyze the data.

RESULTS

Themes that followed from the interviews were: (1) work tasks and conditions can facilitate or hinder sustainable employability: (2) relationships among employees and with supervisors can affect sustainable employability; (3) a desire for new opportunities and challenges; and (4) a need for supervisor skills to facilitate sustainable employability, i.e. appreciation, availability of help, dealing with problems, listening, attitude and communication. According to employees, changes were mainly noticed in supervisor skills.

CONCLUSIONS

Employees with a work disability were very satisfied with the guidance of supervisors who followed the Mentorwijs training. To improve sustainable employability, training of supervisors should focus more on adequate work conditions, providing employees opportunities to learn new work tasks and improving supervisors' skills regarding appreciation, attitude and communication.

The influence of onset of disease on exit from paid employment among workers in The Netherlands: A longitudinal register-based study with 9 years follow-up

OBJECTIVES

This study investigates the influence of onset of disease on exit from paid employment and whether this differs across diseases and sociodemographic groups.

METHODS

Register data from Statistics Netherlands on medication prescription was linked to information on employment status and demographics. Persons who were employed in 2009 and 2010 and who did not use medication for the selected disease in 2009 (N=5 889 036) were followed-up over nine years. Six diseases were identified based on medication prescription in 2010 and 2011: cardiovascular diseases, inflammatory diseases, diabetes mellitus, respiratory diseases, common mental disorders, and psychotic disorders. Four pathways out of paid employment were defined: disability benefits, unemployment, no income, and early retirement. Early exit from paid employment was defined as exiting paid employment before retirement age. Cause-specific Cox proportional hazards regression analyses were performed, with interaction terms for age, sex, and migration background.

RESULTS

Onset of disease increased the likelihood of exit from paid employment, with the strongest associations for psychotic disorders [hazard ratio (HR) 2.88, 95% confidence interval (CI) 2.78-2.98] and common mental disorders (HR 2.00, 95% CI 1.97-2.03). Onset of disease was most strongly associated with disability benefits, followed by unemployment. The influence of common mental and psychotic disorders on disability increased until around middle-age, after which it decreased. The influence of mental health problems on exit from paid employment was stronger for persons with a non-native Dutch background and males.

CONCLUSION

Onset of diseases, especially mental health disorders, is a risk for exiting paid employment before the retirement age. Effective interventions are needed to enhance an inclusive workforce and prevent involuntary loss of paid employment.

Expectations of Mental Illness Disclosure Outcomes in the Work Context: A Cross-Sectional Study Among Dutch Workers

Purpose The decision whether to disclose mental illness at work can have important positive and negative consequences for sustainable employment and well-being. The aim of the study is (1) to examine workers' expectations of outcomes of mental illness disclosure in the workplace and to evaluate their expectations regarding which factors are of influence on these outcomes, (2) to identify distinct subgroups of workers, and (3) to characterize these subgroups in terms of personal, sociodemographic, and work-related characteristics. Methods In this cross-sectional survey study, a sample of 1224 Dutch workers was used. Latent Class Analysis (LCA) was used to identify classes of workers based on expected workplace mental illness outcomes. A three-step approach LCA was chosen to investigate whether the classes differed in characteristics. Results The majority of workers expected predominantly positive outcomes of workplace mental illness disclosure (e.g., being able to be one's authentic self; 82.4%), even though they simultaneously expected disclosure to lead to advancement-related discrimination (e.g., lower chances of contract renewal; or getting a promotion; 68.4% and 57%, respectively). Six distinct subgroups of workers were identified based on expected workplace mental illness disclosure outcomes: two positive classes (50.1%), two negative classes (33.3%), and two classes who indicated not to know what the outcomes would be (16.7%). Significant differences between the classes were found on personal experience, work-related association with mental illness, gender, educational level, and workplace atmosphere. Conclusion The disclosure process is complex, as most workers were optimistic (i.e., expected generally positive outcomes) whilst simultaneously expecting workplace discrimination. Subgroup differences in expectations regarding workplace mental illness disclosure outcomes were found.

Psychometric properties of the Internalized Stigma of Mental Illness (ISMI-10) scale in a Dutch sample of employees with mental illness

BACKGROUND

Internalized stigma can have numerous negative effects on the well-being and employment of people with mental illness. Brief, valid, and reliable measures are needed to get a better understanding of self-stigmatization. The aim of this study is to translate the brief version of the Internalized Stigma of Mental Illness (ISMI-10) scale into a Dutch version and to assess the reliability and validity of this Dutch version in a sample of employees with mental illness.

METHODS

The ISMI-10 was translated into Dutch using the forward-backward translation procedure. The sample consisted of 161 employees with mental illness. Internal consistency was evaluated and the retest reliability was tested with 68 respondents. The construct validity was evaluated by testing convergent and divergent validity.

RESULTS

The Dutch ISMI-10 showed good internal consistency (α = 0.83) and good test-retest reliability (r = 0.73). The Dutch ISMI-10 demonstrated excellent convergent validity; high correlations were found between the Dutch ISMI-10 and hope (r = -0.54), anxiety and depression (r = 0.59), self-esteem (r = -0.56), and empowerment (r = - 0.59). Acceptable divergent validity was indicated; small correlations were found between the Dutch ISMI-10 and the physical functioning subscale (r = -0.27) and the role limitation due to physical problems subscale (r = -0.21), and medium correlations were found between the Dutch ISMI-10 and the general health subscale (r = -0.36).

CONCLUSION

The Dutch ISMI-10 demonstrated adequate psychometric properties for assessing internalized stigma and can be used by researchers in Dutch speaking countries to get a better understanding of self-stigmatization among people with mental illness.

Effectiveness of interventions for improving livelihood outcomes for people with disabilities in low- and middle-income countries: A systematic review

BACKGROUND

People with disabilities-more than a billion people worldwide-are frequently excluded from livelihood opportunities, including employment, social protection, and access to finance. Interventions are therefore needed to improve livelihood outcomes for people with disabilities, such as improving access to financial capital (e.g., social protection), human capital (e.g., health and education/training), social capital (e.g., support) or physical capital (e.g., accessible buildings). However, evidence is lacking as to which approaches should be promoted.

OBJECTIVES

This review examines whether interventions for people with disabilities result in improved livelihood outcomes in low- and middle-income countries (LMIC): acquisition of skills for the workplace, access to the job market, employment in formal and informal sectors, income and earnings from work, access to financial services such as grants and loans, and/or access to social protection programmes.

SEARCH METHODS

The search, up to date as of February 2020, comprised of: (1)an electronic search of databases (MEDLINE, Embase, PsychINFO, CAB Global Health, ERIC, PubMED and CINAHL),(2)screening of all included studies in the instances where reviews were identified,(3)screening reference lists and citations of identified recent papers and reviews, and(4)An electronic search of a range of organisational websites and databases (including ILO, R4D, UNESCO and WHO) using the keyword search for unpublished grey to ensure maximum coverage of unpublished literature, and reduce the potential for publication bias.

SELECTION CRITERIA

We included all studies which reported on impact evaluations of interventions to improve livelihood outcomes for people with disabilities in LMIC.

DATA COLLECTION AND ANALYSIS

We used review management software EPPI Reviewer to screen the search results. A total of 10 studies were identified as meeting the inclusion criteria. We searched for errata for our included publications and found none. Two review authors independently extracted the data from each study report, including for the confidence in study findings appraisal. Data and information were extracted regarding available characteristics of participants, intervention characteristics and control conditions, research design, sample size, risk of bias and outcomes, and results. We found that it was not possible to conduct a meta-analysis, and generate pooled results or compare effect sizes, given the diversity of designs, methodologies, measures, and rigour across studies in this area. As such, we presented out findings narratively.

MAIN RESULTS

Only one of the nine interventions targeted children with disabilities alone, and only two included a mix of age groups (children and adults with disabilities. Most of the interventions targeted adults with disabilities only. Most single impairment group interventions targeted people with physical impairments alone. The research designs of the studies included one randomised controlled trial, one quasi-randomised controlled trial (a randomised, posttest only study using propensity score matching (PSM), one case-control study with PSM, four uncontrolled before and after studies, and three posttest only studies. Our confidence in the overall findings is low to medium on the basis of our appraisal of the studies. Two studies scored medium using our assessment tool, with the remaining eight scoring low on one or more item. All the included studies reported positive impacts on livelihoods outcomes. However, outcomes varied substantially by study, as did the methods used to establish intervention impact, and the quality and reporting of findings.

AUTHORS' CONCLUSIONS

The findings of this review suggest that it may be possible for a variety of programming approaches to improve livelihood outcomes of people with disabilities in LMIC. However, given low confidence in study findings related to methodological limitations in all the included studies, positive findings must be interpreted with caution. Additional rigorous evaluations of livelihoods interventions for people with disabilities in LMIC are needed.

Stigma, Discrimination and Disclosure of the Diagnosis of Multiple Sclerosis in the Workplace: A Systematic Review

The objective of the study was to describe and analyze the stigma, discrimination and the disclosure of the diagnosis of Multiple Sclerosis (MS) in the workplace. The protocol was registered in PROSPERO (CRD42022320437). We systematically searched four scientific databases with key search terms. We included any original peer-reviewed articles reporting the stigma or discrimination experienced at work due to MS or the disclosure of the diagnosis of MS in the workplace. No time limits were set for the search. An appraisal of the individual study quality was performed with the JBI critical appraisal checklist. Overall, 26 studies were deemed to fulfil all the eligibility criteria. The total number of participants in this review was 9571. The prevalence of people with MS who experience some degree of stigma in the workplace can be as high as 79.2%. Those who report greater feelings of discrimination are more likely to be unemployed. The prevalence of employers’ and co-workers’ awareness of the diagnosis varies from 31.7 to 90.2%. The main reason for non-disclosure is the fear of being discriminated against. The psychosocial work environment needs to be taken into consideration as part of public and individual policies to promote the health of patients with MS.

Strengthening supervisor support for employees with common mental health problems: developing a workplace intervention using intervention mapping

Background

This study presents the development of a workplace intervention to strengthen supervisor’s support for employees with common mental health problems (CMHP). CMHP have been increasing over the last years, resulting into negative work outcomes, such as absenteeism or reduced work performance. To date, organisational interventions have been promising in preventing these negative work outcomes, however it is yet unknown in what way the role of workplace stakeholders, in particular supervisors, can be strengthened. This study contributes to the literature of interventions on an organizational level which uses a preventative approach by promoting stay at work among employees with CMHP through supervisor support.

Methods

we applied the intervention mapping (IM) approach, by actively involving workplace stakeholders (employees with CMHP, supervisors and occupational health professionals) through the development process and the use of Integrated model of behaviour prediction for employers. All six steps of IM are followed and thematic analysis was used to analyse interviews and focus groups.

Results

Based on a comprehensive needs assessment, the intervention resulted in an online guideline, with five step-wise themes on how to support employees with CMHP to stay at work (SAW). The guideline addressed the most important and changeable actions using the Integrated model of behaviour prediction. The guideline presents how to signal and address problems in the workplace and find solutions by stimulating autonomy of employees, explore job accommodations and ask for occupational support. In addition, basic conditions on how to create mentally healthy workplaces were presented. Coaching sessions by occupational health professionals, that include practical strategies using the best available evidence, were identified by the stakeholders.

Conclusions

This SAW-Supervisor Guideline-intervention responds to the need of supervisors to be supported in their role, responsibility and ways to support employees with mental health issues, through a behaviour-oriented, preventative approach. Intervention mapping provided a systematic process to identify, structure and prioritize factors of supervisor support, resulting in a novel workplace intervention. The active involvement of workplace stakeholders throughout the process resulted into a well-received intervention. The theoretical framework provided practical ways to induce supportive behaviour of supervisors, bridging theory with practice.

Factors relevant to work participation from the perspective of adults with developmental dyslexia: a systematic review of qualitative studies

Background

This review is focused on workers with developmental dyslexia (DD). In this review DD is considered an expression of neurodiversity, a consequence of a natural variant of the brain. Evidence was synthesized to explore which factors workers with DD consider relevant for their participation in work and whether these factors reflect shifts in the concepts of health and sustainable employability. The factors were classified according to the International Classification of Functioning, Disability and Health (ICF), adapted for occupational health.

Methods

A systematic review of qualitative studies was performed. Two search strings were used to determine the population and the context of work. The factors were classified using a recently proposed rearrangement of the ICF scheme that places participation in a central position and incorporates preliminary lists of work-related environmental factors and personal factors.

Results

Fifty-one factors were found that appeared in 35% or more of the included studies and that were relevant to work participation according to the workers themselves. These factors were dispersed over all ICF categories. In the category Functions and Structures (11 factors), most of the factors had negative connotations. In the category Activities (9 factors), all the factors cause difficulties, except speaking (which is ambiguous). In the category Participation (4 factors), the formal relationships are important for the degree of participation. Overall, more than half of the factors are environmental (18) or personal (9) and they both hinder and facilitate work participation.

Conclusions

The results of this review give an indication for the importance of the biopsychosocial model as a relevant approach for people with a disability in the world of work. This review also adds data for the usefulness of the proposals for the reconsideration of the ICF scheme. The data has not (yet) returned any visible trends revealing that the concept of neurodiversity is common in organizations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13436-x.

Decision (not) to disclose mental health conditions or substance abuse in the work environment: a multiperspective focus group study within the military

OBJECTIVES

Many workers in high-risk occupations, such as soldiers, are exposed to stressors at work, increasing their risk of developing mental health conditions and substance abuse (MHC/SA). Disclosure can lead to both positive (eg, support) and negative (eg, discrimination) work outcomes, and therefore, both disclosure and non-disclosure can affect health, well-being and sustainable employment, making it a complex dilemma. The objective is to study barriers to and facilitators for disclosure in the military from multiple perspectives.

DESIGN

Qualitative focus groups with soldiers with and without MHC/SA and military mental health professionals. Sessions were audiotaped and transcribed verbatim. Content analysis was done using a general inductive approach.

SETTING

The study took place within the Dutch military.

PARTICIPANTS

In total, 46 people participated in 8 homogeneous focus groups, including 3 perspectives: soldiers with MHC/SA (N=20), soldiers without MHC/SA (N=10) and military mental health professionals (N=16).

RESULTS

Five barriers for disclosure were identified (fear of career consequences, fear of social rejection, lack of leadership support, lack of skills to talk about MHC/SA, masculine workplace culture) and three facilitators (anticipated positive consequences of disclosure, leadership support, work-related MHC/SA). Views of the stakeholder groups were highly congruent.

CONCLUSIONS

Almost all barriers (and facilitators) were related to fear for stigma and discrimination. This was acknowledged by all three perspectives, suggesting that stigma and discrimination are considerable barriers to sustainable employment and well-being. Supervisor knowledge, attitudes and behaviour were critical for disclosure, and supervisors thus have a key role in improving health, well-being and sustainable employment for soldiers with MHC/SA. Furthermore, adjustments could be made by the military on a policy level, to take away some of the fears that soldiers have when disclosing MHC/SA.