Navigating work and life- a qualitative exploration of managers' and employees' views of return-to-work after sick leave due to common mental disorders

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).

Part-time work and sickness absence - an organization-level analysis

BACKGROUND

Absenteeism is consistently higher in public than in private organizations, as is the use of part-time employment. The aim of this study is to identify whether there is a relationship between part-time work and sickness absence at the organizational level.

METHODS

The data is a six-year panel for the full population of Norwegian municipalities (N = 422), linking objective register data on both part-time employment and sickness absence. Using OLS regression with fixed effects for municipality and time, we estimate the statistical effects of the municipalities' use of part-time work on sickness absence.

RESULTS

The bivariate correlation between percentage position at the municipal level and percentage sickness absence is positive and significant (Pearson's r = .25, sig LE 0.01). When controlling for fixed effects for municipality and time, as well as municipality economy, municipality size, ratio of female employees in the municipality and characteristics of the general population, the multivariate regression coefficient is still positive but insignificant (coefficient = 1.56, robust standard error = 1.31).

CONCLUSIONS

The main findings are that the organizations' use of part-time work is unrelated to sickness absence indicating that organizations with extensive use of part-time work do not experience higher levels of absenteeism than those having less extensive use of part-time employees.

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?

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.

Sick leave duration as a potential marker of functionality and disease severity in depression

Objective: To discuss the impact of depression on work and how depression-related sick leave duration could be a potential indicator and outcome for measuring functionality in depression.Methods: Our review was based on a literature search and expert opinion that emerged during a virtual meeting of European psychiatrists that was convened to discuss this topic.Results: Current evidence demonstrates that depression-related sick leave duration is influenced by multiple disease-, patient- and work-related factors, together with societal attitudes towards depression and socioeconomic conditions. A wide variety of pharmacological and non-pharmacological treatments and work-based interventions are effective in reducing depression-related sick leave duration and/or facilitating return to work. Recent real-world evidence showed that patients treated with antidepressant monotherapy appear to recover their working life faster than those receiving combination therapy. Although depression-related sick leave duration was found to correlate with severity of depressive symptoms, it cannot be used alone as a viable marker for disease severity.Conclusions: Given its multifactorial nature, depression-related sick leave duration is not on its own a viable outcome measure of depression severity but could be used as a secondary outcome alongside more formal severity measures and may also represent a useful measure of functionality in depression. Key pointsDepression in the working population and depression-related sick leave have a profound economic impact on societyDepression-related sick leave duration is influenced by multiple disease-, patient- and work-related factors, together with societal attitudes towards depression and socioeconomic conditionsA wide variety of pharmacological and non-pharmacological treatments and work-based interventions have been shown to be effective in reducing depression-related sick leave duration and/or facilitating return to workIn terms of pharmacological intervention, recent real-world evidence has shown that patients treated with antidepressant monotherapy are able to recover their working life faster than those treated with combination therapyAlthough depression-related sick leave duration has been shown to correlate with severity of depressive symptoms, it is not a viable outcome measure of depression severity on its own, but could be used as secondary outcome alongside more formal clinician- and patient-rated severity measuresDepression-related sick leave duration may, however, represent a viable outcome for measuring functionality in depression.

Functional status and return to work in people with major depression: a 3-year national follow-up study

PURPOSE

Major depressive disorder (MDD) affects a person's function of daily activities, including work participation. Such functional impairments often persist even when other symptoms of MDD are remitted. Increasing evidence highlights the health-promoting effects of returning to work (RTW) in various diseases. However, limited data are available regarding the impact of return to work on functional recovery in MDD. We explored the association between RTW and functional improvements in people with MDD using a large nationally representative database and a 3-year follow-up.

METHODS

Data of people with an MDD diagnosis were selected from the Taiwan Data Bank of Persons with disability for the period between July 11, 2012, and October 31, 2018. We included 4038 adults aged 18-64 years. The World Health Organization Disability Assessment Schedule 2.0 was used for functional assessment. The association between RTW and functional improvements was investigated using a multivariable regression analysis adjusted for confounding variables.

RESULTS

Women aged ≥ 45 years with a lower education level were vulnerable to prolonged unemployment. RTW was significantly associated with better functional improvements in cognition, mobility, self-care, getting along, life activity, and participation than unemployment.

CONCLUSIONS

RTW was positively associated with functional improvements in patients with MDD. A referral system targeting re-employment may be suggested during MDD treatment, especially for individuals at risk of prolonged unemployment.

Do baseline industry and job group skill level predict welfare dependency at 1, 3 and 5 years after mental health related sickness absence? A Danish cohort study

Background

The cost of mental ill health in the EU-28 nations has been estimated at approximately 4.1% of the total gross domestic products (GDP). Improved rates of return to sustainable employment among people who are sick-listed due to mental ill health would decrease spending on welfare benefits. The present cohort study provides statistical information that may be helpful in the design and prioritizing of efforts aimed at reducing the burden of sickness absence due to mental ill health among employees in the general working population of Denmark. Our primary aim was to estimate odds of being i) deceased or recipient of health related welfare benefits and ii) recipient non-health related welfare benefits, compared to being alive and self-reliant at 1, 3 and 5 years after first visit to a jobs and benefits office due to mental health related sickness absence, as a function of industrial sector and job group skill level at baseline. A secondary aim was to analyze these odds as a function of baseline age, gender, type of mental ill health, family type and employment status.

Methods

The study population consisted of 20–54 year-old persons on long-term sickness absence due to mental health problems in 21 Danish municipalities in 2010–2012 (N = 19,660). Odds ratios were estimated by use of multinomial logistic regression. The outcomes were ascertained through national registers.

Results

We did not find any statistically significant association between baseline industrial sector or job group skill level and welfare dependency at follow-up. In the secondary analyses, the estimated odds of health and non-health related welfare dependencies at follow-up tended to increase with unemployment, age, being single and being on sick leave due to self-reported anxiety or depression versus stress/burnout at baseline.

Conclusions

The present study does not support that industry and job group skill level predict welfare dependency after health related sickness absence, after adjustment for relevant covariates, in the general population of Denmark. It suggests, however, that the vulnerability lies in population groups characterized by unemployment, older age, being single and being on sick leave due to self-reported anxiety or depression versus stress/burnout.

Mental health: Professional rehabilitation and the return to work - A systematic review

BACKGROUND

The problem of illnesses, sick leave and the necessary return to work and permanence at work has been determining the development of different protocols and professional rehabilitation programs in different countries.

OBJECTIVE

We sought to identify articles that address programs for professional rehabilitation and the return to work of people laid off due to mental health problems, and to verify the results of professional rehabilitation programs and the follow-up processes for such return.

METHOD

A systematic review was performed according to the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA). The serial search of the articles was carried out in the electronic databases: Web of Science, MEDLINE/PubMed and Scopus. The variations in the descriptors served to find a greater range of significant results for the research.

RESULTS

In total, 2,306 articles were found. Another two articles that met the inclusion criteria were located through manual searches, adding up to a total of 2,308. Applying the exclusion criteria resulted in a final data set of 47 peer-reviewed articles.

CONCLUSIONS

The issues involving return to work and permanence in work were complex and multifaceted in the research articles studied. Recovery from Common Mental Disorders (CMDs) is a major cause of long-term sick leave and the granting of disability benefits. Many people with these diagnoses remain employed; however, further studies are needed with women, workers with fragile relationships, and immigrants.

Depression symptoms and risk of sick leave: a systematic review and meta-analysis

OBJECTIVES

Depression symptoms are one of the most common psychiatric disorders and affect all aspects of life. The impact of depression symptoms on sick leave in the working population is a major issue that requires a more comprehensive examination.

METHODS

This systematic review used the PRISMA method to identify eligible studies (n = 15). Subsequently, the association between depression symptoms and sick leave was examined and several important subgroup analyses were performed.

RESULTS

Depression symptoms were associated with sick leave, with an overall risk ratio (RR) of 1.52 [95% confidence interval (95% CI) 1.34-1.73]. In men, the result displayed RR 2.19 (95% CI 1.17-4.09) and in women, the result showed RR 1.54 (95% CI 1.35-1.76). Additional subgroup analyses that account for methodological differences across studies based on the method of assessing depression symptoms and sick leave showed that this association was consistent.

CONCLUSION

Depression symptoms are associated with sick leave. Given that sick leave can have an economic and social burden, more attention to depression symptoms is necessary.

Stakeholders' Role and Actions in the Return-to-Work Process of Workers on Sick-Leave Due to Common Mental Disorders: A Scoping Review

The lack of knowledge regarding the roles and actions of return to work (RTW) stakeholders create confusion and uncertainty about how and when to RTW after experiencing a common mental disorder (CMD). Purpose The purpose of this scoping review is to disentangle the various stakeholders' role and actions in the RTW process of workers on sick-leave due to CMDs. The research question is: What is documented in the existing literature regarding the roles and actions of the identified stakeholders involved in the RTW process of workers on sick-leave due to CMDs? Methods In conducting this scoping review, we followed Arksey and O'Malley's (Int J Soc Res Methodol 8:19-32, 2005) methodology, consisting of different stages (e.g., charting the data by categorizing key results). Results 3709 articles were screened for inclusion, 243 of which were included for qualitative synthesis. Several RTW stakeholders (n=11) were identified (e.g., workers on sick leave due to CMDs, managers, union representatives, rehabilitation professionals, insurers, return to work coordinators). RTW stakeholders' roles and actions inter- and intra-system were recommended, either general (e.g., know and understand the perspectives of all RTW stakeholders) or specific to an actor (e.g., the return to work coordinator needs to create and maintain a working alliance between all RTW stakeholders). Furthermore, close to 200 stakeholders' actions, spread out on different RTW phases, were recommended for facilitating the RTW process. Conclusions Eleven RTW stakeholders from the work, heath and insurance systems have been identified, as well as their respective roles and actions. Thanks to these results, RTW stakeholders and policy makers will be able to build practical relationships and collaboration regarding the RTW of workers on sick leave due to CMDs.

Social security benefits for mental and behavioral disorders among workers in Piaui, Brazil, in 2014

Background

The characteristics of social security benefits changed over time as a function of modifications in the patterns of work organization. This process gave rise to new social vulnerabilities which include aspects visibly related to occupational health, as is the case of mental and behavioral disorders.

Objective

To describe temporary social security benefits granted by the National Social Security Institute (INSS) to workers with mental and behavioral disorders in Piaui, Brazil, in 2014.

Methods

Cross-sectional, descriptive and retrospective study based on INSS data collected in November 2015 relative to 2014.

Results

1,473 benefits were granted along the analyzed period, 50.4% of which corresponded to male workers. Most beneficiaries resided in the state capital and had urban jobs. Mood disorders accounted for 47.7% of sick leaves. The mean duration of benefits was 112.6 days. There was significant difference in the duration of benefits according to their type (p<0.012), urban versus rural jobs (p<0.015) and sex (p=0.010).

Conclusion

Mood disorders were the most frequent reason for sick leaves due to mental and behavioral disorders and the affected workers were granted social security benefits. The duration of leaves significantly differed as a function of the type of benefits, urban versus rural jobs and sex.

Integration of a Return-to-Work Module in Cognitive Behavioral Therapy in Patients With Major Depressive Disorder and Long-Term Sick Leave-A Feasibility Study

OBJECTIVE

Major depressive disorder (MDD) has a negative impact on individuals ability to work, and is often associated with long phases of sick leave. Consequently, interventions facilitating return to work in patients with MDD gained increased attention during last decades. We here report results of a feasibility study where a "return-to-work" (RTW) module published by Lagerveld and colleagues in the Netherlands was integrated in cognitive behavioral therapy in depressed patients with long-term sick leaves in Germany. Our study aimed to answer the following questions: Is RTW accepted by patients and therapists? Do RTW interventions lead to return-to-work? Do depressive symptoms improve?

METHODS

Twenty patients with MDD (15 female; mean age, 45 ± 9 years) were included. Patients received cognitive-behavioral therapy with an integrated, standardized return-to-work module (W-CBT). Psychometric measurements included Beck Depression Inventory (BDI-2) and work ability index (WAI). Further, time until return-to-work was measured, and acceptability of W-CBT was assessed using visual analog scales and open questions.

RESULTS

Mean sick leave days in depressed patients were 127 ± 97, and 75% of patients were sick leave for more than 6 weeks. After treatment, 11/20 patients had returned to their former occupation (55%), 5/20 were in occupational re-deployment or started a new job (25%), and 3/20 patients were still on sick leave (2/20; 10%) or received a pension (1/20; 5%). One patient dropped out. BDI-2 sum score improved from 23 ± 8 to 8 ± 5 (p < 0.001), and WAI improved from 28 ± 6 to 39 ± 7 (p < 0.001). Acceptability of W-CBT in patients and therapists was high.

CONCLUSION

We here demonstrate feasibility and acceptability of an RTW module integrated in standard cognitive behavioral therapy. W-CBT leads to improvement of work ability, paralleled by improvement of depressive symptoms. Despite the limitations of this uncontrolled study, the results propose that W-CBT may be feasible in the treatment of depressed patients with long sick leaves and justify a controlled trial evaluating the efficacy of W-CBT.

Gender difference in sickness absence: Do managers evaluate men and women differently with regard to the appropriateness of sickness absence?

Aims: Women have much higher rates of sickness absence than men, but the causes of the difference are not well understood. This study examines whether managers have more lenient attitudes towards women's than towards men's absence, as this might contribute to higher rates of sickness absence among women. Differences between managers and other employees are also assessed. Methods: Vignettes were used to measure attitudes towards the legitimacy of sickness absence. The vignettes consisted of brief case descriptions of individuals considering asking their physicians for sick leave, with information about the medical condition (mainly taken from the descriptions in ICPC-2), occupation and gender. Respondents judged how appropriate sickness absence was in each case. Quota sampling was used, and the effective sample size was 899 managers and 1396 other employees, with each respondent evaluating either four or six vignettes. Generalised ordinal logistic regression was used. Results: The gender of the vignette person had no effect on the managers' evaluations of the appropriateness of sickness absence. Irrespective of the gender of the vignette person, however, managers were generally more restrictive than non-managers. Conclusions: Different attitudes on the part of managers towards sickness absence in men and women do not seem to contribute to gender differences in sickness absence, but managers are generally more restrictive compared to non-managerial employees.

The association between having a coordinator and return to work: the rapid-return-to-work cohort study

OBJECTIVES

The aim of this study was to assess if the reported provision of a coordinator was associated with time to first return to work (RTW) and first full RTW among sick-listed employees who participated in different rapid-RTW programmes in Norway.

DESIGN

The study was designed as a cohort study.

SETTING

Rapid-RTW programmes financed by the regional health authority in hospitals and Norwegian Labour and Welfare Administration in Norway.

PARTICIPANTS

The sample included employees on full-time sick leave (n=326) who participated in rapid-RTW programmes (n=43), who provided information about the coordination of the services they received. The median age was 46 years (minimum-maximum 21-67) and 71% were female. The most common reported diagnoses were musculoskeletal (57%) and mental health disorders (14%).

INTERVENTIONS

The employees received different types of individually tailored RTW programmes all aimed at a rapid RTW; occupational rehabilitation (64%), treatment for medical or psychological issues, including assessment, and surgery (26%), and follow-up and work clarification services (10%). It was common to be provided with a coordinator (73%).

PRIMARY AND SECONDARY OUTCOME MEASURES

Outcomes were measured as time to first RTW (graded and 100%) and first full RTW (100%).

RESULTS

Employees provided with a coordinator returned to work later than employees who did not have a coordinator; a median (95% CI) of 128 (80 to 176) days vs 61 (43 to 79) days for first RTW, respectively. This difference did not remain statistically significant in the adjusted regression analysis. For full RTW, there was no statistically significant difference between employees provided with a coordinator versus those who were not.

CONCLUSIONS

The model of coordination, provided in the Norwegian rapid-RTW programmes was not associated with a more rapid RTW for sick-listed employees. Rethinking how RTW coordination should be organised could be wise in future programme development.

Transtornos de ansiedade como causa de afastamentos laborais

Resumo Introdução: transtornos mentais e comportamentais (TMC) estão entre as principais causas de perda de dias de trabalho. Os transtornos de ansiedade são a segunda causa dos afastamentos laborais. Objetivo: identificar e analisar as evidências disponíveis na literatura sobre afastamentos do trabalho por transtornos de ansiedade. Métodos: revisão integrativa da literatura, sem limite de ano de publicação, com descritores controlados, realizada nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs), Medical Literature Analysis and Retrieval System Online (Medline) e Base de Dados em Enfermagem (BDENF). Resultados: a seleção final consistiu em 13 artigos, sendo o mais antigo publicado em 2006 e o mais recente em 2016. Os afastamentos por transtornos de ansiedade tiveram como principais fatores de risco as condições e ambiente de trabalho, com impacto negativo, tanto para a saúde do trabalhador como para o empregador. Discussão: as evidências apontam para uma alta prevalência dos transtornos ansiosos como causa de afastamentos do trabalho e da alta demanda de custos elevados com auxílio-doença. Conhecer o perfil de adoecimento do trabalhador contribui para identificar os fatores de risco para TMC e auxilia na proposição de estratégias de intervenção direcionadas a reduzir o afastamento laboral.

Early intervention with cognitive behavioral therapy reduces sick leave duration in people with adjustment, anxiety and depressive disorders

Background: Early intervention in workers diagnosed with mental disorders is associated with a lower incidence of relapse and shorter sick leave. However, no studies have been carried out on the effect of early intervention using an evidence-based therapy, Cognitive Behavioral Therapy (CBT), on people with sick leave.Aims: The objectives of the present study are to study whether the type of intervention (early or late) will affect the total duration of the sick leave, the partial duration of the sick leave, the duration of the psychotherapy and the time until return to work after the psychotherapy ends. The sample was composed of 167 participants who were on sick leave for adjustment disorders, anxiety disorders or depressive disorder.Results: The participants who had early intervention with CBT had a significantly shorter duration of total sick leave and partial sick leave, and a shorter time until returning to work after the psychotherapy ended than those who had late intervention. There were no statistically differences in the duration or efficacy of the psychotherapy.Conclusion: We can suggest that providing early access to CBT significantly reduces the length of sick leave in patients with mental disorders.

Comparing time off work after work-related mental health conditions across Australian workers' compensation systems: a retrospective cohort study

Workers' compensation claims (WCC) due to mental health conditions (MHC) are the most expensive due to often lengthy periods off work. This retrospective cohort study aims to determine the factors associated with work time loss in Australian workers with accepted WCCs for MHCs, and investigate whether jurisdiction in which a claim is made affects work time loss, using administrative claims data between January 2010 and June 2011. Cox regression analysis showed that worker age, industry, occupation and type of MHC were associated with work time loss. Workers with depressive disorders had longer time loss than those with stress-related conditions. Workers from South Australia, Comcare and Victoria had the longest durations of work time loss, while Australian Capital Territory and Tasmania had shorter durations. Future research should investigate policy variations that could explain the differences in time spent on compensation between jurisdictions.

Common Psychosocial Factors Predicting Return to Work After Common Mental Disorders, Cardiovascular Diseases, and Cancers: A Review of Reviews Supporting a Cross-Disease Approach

Purpose This systematic review aimed at identifying the common psychosocial factors that facilitate or hinder the return to work (RTW) after a sick leave due to common mental disorders (CMDs), cardiovascular diseases (CVDs), or cancers (CAs). Methods We conducted a review of reviews searching 13 databases from 1994 to 2016 for peer-reviewed, quantitative, cohort studies investigating factors influencing RTW after a CMD, CVD, or CA. Then, for each disease we identified additional cohort studies published after the date of the latest review included. Data were extracted following a three steps best-evidence synthesis method: the extraction of results about each predictor from studies within each single review and in the additional papers; the synthesis of results across the reviews and additional papers investigating the same disease; and the synthesis of results across the diseases. Results The search strategy identified 1029 unique records from which 27 reviews and 75 additional studies underwent comprehensive review. 14 reviews and 32 additional cohort studies met eligibility criteria. Specific predictors of RTW with different levels of evidence are provided for each disease. We found four common facilitators of RTW (job control, work ability, perceived good health and high socioeconomic status), and six barriers of RTW (job strain, anxiety, depression, comorbidity, older age and low education). Conclusion This is the first review to systematically analyze commonalities in RTW after CMDs, CVDs, or CAs. The common factors identified indicate that the RTW process presents many similarities across various diseases, thus supporting the validity of a cross-disease approach.

Reducing the time until psychotherapy initiation reduces sick leave duration in participants diagnosed with anxiety and mood disorders

BACKGROUND

Sick leave in patients with a mental disorder is characterized by having a long duration. Studies suggest that the time until a patient on sick leave for a common mental health disorder initiates evaluation and treatment by a healthcare professional is an important factor in the duration of the sick leave. However, in these studies, the intervention was not performed by a mental health specialist. The aim of this study was to find out whether the length of sick leave was associated with the time before initiating psychotherapy, age, time until returning to work after psychotherapy ends, and duration of psychotherapy. In a further analysis, we examined whether the model composed of age, duration of psychotherapy, and time before initiating psychotherapy predicted the length of sick leave.

METHOD

The sample consisted of 2,423 participants, 64.1% (n = 1,554) women and 35.9% (n = 869) men, who were on sick leave for anxiety disorders or depressive disorder.

RESULTS

The total duration of the sick leave of participants diagnosed with depression and anxiety was positively associated with the time before beginning psychotherapy. Time before beginning psychotherapy predicted the length of sick leave when the variables age and duration of psychotherapy were controlled.

CONCLUSION

It is necessary to reduce the time until beginning psychotherapy in people on sick leave for common mental disorders.

Job demands and decision control predicted return to work: the rapid-RTW cohort study

Background

In order to help workers with long-term sickness absence return to work (RTW), it is important to understand factors that either impede or facilitate employee’s reintegration into the labour force. The aim of this study was therefore to examine the impact of psychological work characteristics on time-to first RTW in sick listed employees in Norway.

Methods

The study was designed as a cohort study of 543 employees participating in 50 different RTW programmes. The Job Content Questionnaire (JCQ) was used to gather information on the psychological work conditions. The participants were followed for up to 18 months after they started treatment in the RTW programme. Survival analyses were used to investigate the association between psychological work conditions and time-to first RTW.

Results

Having high psychological job demands (HR = .654; 95% CI: .513–.832) and low decision control (HR = 1.297; 95% CI: 1.010–1.666) were both independent predictors of delayed RTW. Employees in low-strain jobs (low demands/high control) (HR = 1.811; 95% CI: 1.287–2.549) and passive jobs (low demands/low control) (HR = 1.599; 95% CI: 1.107–2.309), returned to work earlier compared to employees in high-strain jobs (high demands/low control). No difference was found for active jobs (high demands/high control).

Conclusion

This study revealed that high psychological demands, low control, and being in a high strain job reduced the probability of early RTW in sick listed employees. RTW programmes should therefore increase the focus on these issues.

Absenteeism due to mental health problems and systems for return to work: an internet-based unmatched case-control study

PURPOSE

The aim of this study was to investigate the risk factors for absenteeism due to mental health problems with regard to company characteristics and systems for return to work in Japan.

METHODS

This was an Internet-based unmatched case-control study. Two hundred and fifty-eight workers who experienced over 28 days of sick leave due to mental health problems (cases) and 258 workers who have not taken sick leave (controls) were recruited. Company characteristics and the awareness and presence of systems for return to work were analysed as indicators of absenteeism.

RESULTS

A total of 501 workers were included in the analysis. Females were less likely to experience absenteeism when adjustments were made for both the awareness and presence of systems [odds ratio (OR) = 0.51 and 0.41, respectively]. Large companies showed an increased risk of having absentee workers than small companies. The awareness of a gradual resumption system and the presence of a sick pay system were related to absenteeism (OR = 2.75 and 2.40, respectively).

CONCLUSIONS

The awareness and presence of systems for return to work are related to the long-term absenteeism. The predictors of sex and company size are also related to the experience of the long-term absenteeism. To understand the effect of systems for return to work on absenteeism due to mental problems, further studies are needed.

Entwicklung eines Inventars für Job-Coping und -Rückkehrintention (JoCoRi)

Zusammenfassung. Ein großer Anteil der Erwerbstätigen ist aufgrund gesundheitlicher Einschränkungen einmalig oder mehrfach in seiner Berufsbiografie längere Zeit arbeitsunfähig. Auf Grundlage etablierter psychologischer Konstrukte und empirischer Befunde wurde ein spezifisch arbeitsbezogenes Inventar für Job-Coping und Rückkehrintention (JoCoRi) entwickelt. Der Selbsteinschätzungsfragebogen wurde an drei unabhängigen Stichproben (N = 243, N = 337, N = 111) von Rehabilitationspatienten aus Psychosomatik, Orthopädie, Kardiologie und Neurologie geprüft. Faktorenanalytische Ergebnisse der ersten Stichprobe bestätigen eine mehrfaktorielle Struktur. Das Inventar enthält 30 Items in 7 Skalen: 1. Arbeitsbezogene Rückkehrintention und -planung, 2. Arbeitsbezogene Selbstwirksamkeitserwartung, 3. Arbeitsbezogene Selbstberuhigung und Selbstinstruktion, 4. Arbeitsbezogene externale Kontrollüberzeugung, 5. Aktives Coping am Arbeitsplatz, 6. Bedeutung der Arbeit, 7. Kontrollüberzeugung bzgl. der Arbeitsaufnahme. Die Varianzaufklärung liegt bei 68 %. 25 Items haben Hauptladungen > .60. Interne Konsistenzen und Trennschärfen sind überwiegend zufriedenstellend. Die Modellgüte der konfirmatorischen Faktorenanalyse ist überzeugend. Das Modell ist in einer unabhängigen Stichprobe stabil (N = 337). Die Skalen wurden mit inhaltlich analogen Globalkonstrukten validiert. Die mehrfaktorielle Struktur kann in der zweiten Stichprobe repliziert werden. Eine längsschnittliche Analyse der dritten Stichprobe prüft die prädiktive Validität der Rückkehrintentionsskala; sie wird hinsichtlich Arbeitsunfähigkeitsdauer und Arbeitsfähigkeitsstatus bestätigt.

Effect of an intervention to enhance guideline adherence of occupational physicians on return-to-work self-efficacy in workers sick-listed with common mental disorders

Background

Since a higher level of self-efficacy in common mental disorders is associated with earlier return-to-work (RTW), it is important to know if work related self-efficacy can be increased by occupational health care. The primary aim of this study was to evaluate whether an intervention to enhance guideline adherence of occupational physicians lead to an increase in RTW self-efficacy in workers three months later. The secondary aim was to evaluate whether the intervention modified the association between RTW self-efficacy and return-to-work three months later.

Methods

A total of 66 occupational physicians participated in the study. They were randomized into two groups; the intervention group received a training, the control group did not. The training aimed to enhance adherence to a mental health guideline that contained strategies that are supposed to enhance RTW self-efficacy. In 128 sick-listed workers guided by these occupational physicians, RTW self-efficacy, RTW, and personal, health-related and work-related variables were measured at baseline and three months later. Generalized linear mixed models analysis and linear mixed models analysis were used for the evaluations.

Results

In workers whose occupational physicians had received the training RTW self-efficacy increased significantly more than in workers whose occupational physicians had participated in the control group (t = −2.626, p ≤ .05). Higher baseline RTW self-efficacy scores were significantly more often associated with full RTW than with no RTW three months later (OR 2.20, 95 % CI 1.18–4.07), but the intervention did not affect this association.

Conclusions

This study showed that a training to enhance guideline adherence of occupational physicians leads to increased RTW self-efficacy in workers sick-listed with common mental disorders during the first months of sickness absence in a real-life occupational health care setting. This insight is helpful for optimizing the recovery and RTW process, and for understanding the role of RTW self-efficacy in this process.

Trial registration

ISRCTN86605310

The presence of a depressive episode predicts lower return to work rate after myocardial infarction

CONTEXT

No studies have evaluated whether the presence of a depressive episode is associated with an increased risk of not returning to work following myocardial infarction (MI).

OBJECTIVES

To examine the prospective associations between depressive episode and anxiety disorders with return to work (RTW) after MI at 3 and 12 months based on International Classification of Diseases, 10th Revision.

DESIGN

Prospective cohort study.

SETTING

Four hospitals in the North of The Netherlands.

PARTICIPANTS

From a sample of patients hospitalized for MI (n=487), we selected those who had a paid job at the time of the MI (N=200).

MAIN EXPOSURE MEASURES

Presence of a depressive episode and presence of any anxiety disorder during the first 3 months post-MI.

MAIN OUTCOME MEASURES

RTW at 12 months post-MI.

RESULTS

Of the patients with work prior to MI, 75% had returned to work at 12 months. The presence of a depressive episode during the first 3 months (prevalence: 19.4%) was a significant predictor of no RTW at 12 months post-MI, also after controlling for confounders [odds ratio (OR) 3.48; 95% confidence interval (CI): 1.45-8.37]. The presence of an anxiety disorder (prevalence: 11.9%) had a borderline significant association with no RTW as well. This association remained after controlling for confounders (OR 2.90; 95% CI: 1.00-6.38) but diminished when controlling for depression.

CONCLUSIONS

The presence of a depressive episode was associated with an increased risk of no RTW in MI patients. The association between anxiety and risk of no RTW could in part be explained by the presence of depression. Further studies may address the possibility of countering the effect of depression by effective treatment.

Pattern and predictors of sick leave among users of antidepressants: a Danish retrospective register-based cohort study

OBJECTIVES

Depression is associated with work absenteeism, reduced productivity, and significant personal and societal economic burden. We describe patterns and determinants of sick leave among working Danish antidepressant users.

METHODS

Persons starting antidepressant treatment (January 1, 2004 through December 31, 2005) were identified from a representative 25% sample of the Danish population by linking Danish national registries. Inclusion criteria were age 18-64 years, being in the workforce the week prior to the first antidepressant prescription (index prescription, IP), and no antidepressant prescription in the year prior to the IP. Only sick leaves >2 weeks are centrally registered in Denmark and could be assessed. Cox regression analyses identified predictors of sick leave during the year following the IP, based on previous history of sick leave and clinical and socio-demographic baseline characteristics.

RESULTS

In the cohort of 25,908 (59.7% women), sick leave prevalence increased from 37.5% (year prior to IP) to 45.3% (year after the IP); 30.7% were on sick leave for >8 weeks. Incidence peaked (35.5% of individuals) the week after the IP. Of persons with sick leave in the year before the IP, 62.7% were on sick leave the first week after the IP, vs 5.7% of those without previous sick leave. Predictors associated with increased risk of sick leave among those without previous sick leave were unemployment, female gender, age 25-54 years, couples with children, and vocational and higher intermediate education (including e.g. teachers and nurses).

LIMITATIONS

Reasons for sick leave, sick leaves of less than 14 days and the indications for antidepressant treatment were unknown.

CONCLUSIONS

Sick leave was prevalent in persons starting new antidepressant use, often lasting >8 weeks. Previous sick leave was the strongest predictor of subsequent sick leave.

The combination of work organizational climate and individual work commitment predicts return to work in women but not in men

OBJECTIVE

To analyze if the combination of organizational climate and work commitment can predict return to work (RTW).

METHODS

This prospective Swedish study was based on 2285 participants, 19 to 64 years old, consecutively selected from the employed population, newly sick-listed for more than 14 days. Data were collected in 2008 through postal questionnaire and from register data.

RESULTS

Among women, the combination of good organizational climate and fair work commitment predicted an early RTW with an adjusted relative risk of 2.05 (1.32 to 3.18). Among men, none of the adjusted variables or combinations of variables was found significantly to predict RTW.

CONCLUSIONS

This study demonstrated the importance of integrative effects of organizational climate and individual work commitment on RTW among women. These factors did not predict RTW in men. More research is needed to understand the RTW process among men.

Return to work perceptions and actual return to work in workers with common mental disorders

INTRODUCTION

Return to work (RTW) perceptions have been found to predict actual RTW of workers with common mental disorders. This study aims to (1) assess the relative value of RTW self-efficacy (RTW-SE) and RTW expectation in predicting actual RTW and (2) explore the role of mental health symptoms, work characteristics and their interaction as determinants of these RTW perceptions at baseline and over time.

METHODS

Workers (N = 179) with common mental disorders were included at the start of their sick leave and followed-up at 3, 6, 9, and 12 months. RTW self-efficacy, RTW expectation, mental health and RTW were assessed by self-report. Kaplan-Meier survival analysis was used to test the predictive value of RTW-SE and RTW expectation against the actual RTW. Linear regression was used to study the associations of mental health symptoms, work characteristics and their interaction with RTW-SE at baseline. Mental health symptoms in relation to RTW-SE over the first 6 months were analyzed using Linear Mixed Models.

RESULTS

Compared to RTW expectation, differences in RTW-SE were more predictive of actual RTW. At baseline, lower fatigue, depressive symptoms, and work pace- and load were associated with higher RTW-SE. Decreasing levels of fatigue and depressive symptoms over time were associated with parallel improvements in RTW-SE. Workers with high work pace and workload at baseline showed lower levels of RTW-SE at all time points.

CONCLUSIONS

We recommend the use of the RTW-SE scale to detect workers with common mental disorders at risk of a late RTW. Work characteristics and changes in mental health symptoms were associated with RTW-SE over time.

Mental health symptoms as prognostic risk markers of all-cause and psychiatric sickness absence in office workers

BACKGROUND

To investigate mental health symptoms as prognostic risk markers of all-cause and psychiatric sickness absence (SA).

METHODS

Mental health symptoms were measured in 1137 office workers with the Four-Dimensional Symptom Questionnaire (4DSQ), including scales for distress, depression, anxiety and somatization. The total number of SA days was accumulated prospectively on the individual level and high SA was defined as ≥30 SA days during 1-year follow-up. Psychiatric SA was also tallied on the individual level during 1-year follow-up. Baseline 4DSQ scores were associated with high all-cause SA and psychiatric SA by logistic regression analysis. The Hosmer-Lemeshow test and calibration slope were used to assess the accuracy of predictions by 4DSQ scores. The ability of 4DSQ scores to discriminate high-risk from low-risk employees was estimated by the area under the receiver operating characteristic curve.

RESULTS

Six hundred thirty-three office workers (56%) participated in the study. All 4DSQ scales were prospectively associated with high all-cause SA and with psychiatric SA. Distress and somatization scores showed acceptable calibration, but failed to discriminate between office workers with and without high all-cause SA. The distress scale did show adequate calibration (calibration slope = 0.95) and discrimination (area under the receiver operating characteristic curve = 0.71) for psychiatric SA.

CONCLUSION

Distress was a valid prognostic risk marker for identifying office workers at work, but at risk of future psychiatric SA. Further research is necessary to investigate the prognostic performance of distress as risk marker of psychiatric SA in other working populations and to determine cut-off points for distress.

The performance of the K10, K6 and GHQ-12 to screen for present state DSM-IV disorders among disability claimants

BACKGROUND

Screening for mental disorders among disability claimants is important, since mental disorders seem to be seriously under-recognized in this population. However, performance of potentially suitable scales is unknown. We aimed to evaluate the psychometric properties of three scales, the 10- and 6-item Kessler Psychological Distress Scale (K10, K6) and the 12-item General Health Questionnaire (GHQ-12), to predict present state mental disorders, classified according to the Diagnostic and Statistical Manual of Mental Disorders, 4thEdition (DSM-IV) among disability claimants.

METHODS

All scales were completed by a representative sample of persons claiming disability benefit after two years sickness absence (n=293). All diagnoses, both somatic and mental, were included. The gold standard was the Composite International Diagnostic Interview (CIDI 3.0) to diagnose present state DSM-IV disorder. Cronbach's α, sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and the areas under the Receiver Operating Characteristic curve (AUC) were calculated.

RESULTS

Cronbach's alpha's were 0.919 (K10), 0.882 (K6) and 0.906 (GHQ-12). The optimal cut-off scores were 24 (K10), 14 ( K6) and 20 (GHQ-12). The PPV and the NPV for the optimal cut point of the K10 was 0.53 and 0.89, for the K6 0.51 and 0.87, and for the GHQ-12 0.50 and 0.82. The AUC's for 30-day cases were 0.806 (K10; 95% CI 0.749-0.862), 0.796 (K6; 95% CI 0.737-0.854) and 0.695 (GHQ-12; 95% CI 0.626-0.765).

CONCLUSIONS

The K10 and K6 are reliable and valid scales to screen for present state DSM-IV mental disorder. The optimal cut-off scores are 24 (K10) and 14 (K6). The GHQ-12 (optimal cut-off score: 20) is outperformed by the K10 and K6, which are to be preferred above the GHQ-12. The scores on separate items of the K10 and K6 can be used in disability assessment settings as an agenda for an in-depth follow-up clinical interview to ascertain the presence of present state mental disorder.

The performance of the K10, K6 and GHQ-12 to screen for present state DSM-IV disorders among disability claimants

BACKGROUND

Screening for mental disorders among disability claimants is important, since mental disorders seem to be seriously under-recognized in this population. However, performance of potentially suitable scales is unknown. We aimed to evaluate the psychometric properties of three scales, the 10- and 6-item Kessler Psychological Distress Scale (K10, K6) and the 12-item General Health Questionnaire (GHQ-12), to predict present state mental disorders, classified according to the Diagnostic and Statistical Manual of Mental Disorders, 4thEdition (DSM-IV) among disability claimants.

METHODS

All scales were completed by a representative sample of persons claiming disability benefit after two years sickness absence (n=293). All diagnoses, both somatic and mental, were included. The gold standard was the Composite International Diagnostic Interview (CIDI 3.0) to diagnose present state DSM-IV disorder. Cronbach's α, sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and the areas under the Receiver Operating Characteristic curve (AUC) were calculated.

RESULTS

Cronbach's alpha's were 0.919 (K10), 0.882 (K6) and 0.906 (GHQ-12). The optimal cut-off scores were 24 (K10), 14 ( K6) and 20 (GHQ-12). The PPV and the NPV for the optimal cut point of the K10 was 0.53 and 0.89, for the K6 0.51 and 0.87, and for the GHQ-12 0.50 and 0.82. The AUC's for 30-day cases were 0.806 (K10; 95% CI 0.749-0.862), 0.796 (K6; 95% CI 0.737-0.854) and 0.695 (GHQ-12; 95% CI 0.626-0.765).

CONCLUSIONS

The K10 and K6 are reliable and valid scales to screen for present state DSM-IV mental disorder. The optimal cut-off scores are 24 (K10) and 14 (K6). The GHQ-12 (optimal cut-off score: 20) is outperformed by the K10 and K6, which are to be preferred above the GHQ-12. The scores on separate items of the K10 and K6 can be used in disability assessment settings as an agenda for an in-depth follow-up clinical interview to ascertain the presence of present state mental disorder.

Let's get back to work: survival analysis on the return-to-work after depression

PURPOSE

Absence from work due to mental disorders is substantial. Additionally, long-term absence from work is associated with a reduced probability of return-to-work (RTW). Major depressive disorder (MDD) is a prevalent condition in Dutch occupational health care settings. An early estimate of the prognosis regarding RTW in patients with MDD could serve both as a point of departure for the identification of high-risk cases and as an instrument to monitor the course of the disorder and of RTW. In the current study, we aimed to assess the added value of health-related quality of life (HRQoL) and severity of depression to predict the time to RTW.

PATIENTS AND METHODS

Data were derived from a prospective longitudinal study aimed to evaluate the cost effectiveness of a collaborative care treatment in sick-listed workers with MDD. We included demographic, job-related, and health-related variables. Severity of depression was measured using the Patient Health Questionnaire Depression Scale-9 (PHQ-9). HRQoL was measured using two generic preference-based instruments, the EuroQol 5-Dimension (EQ-5D™) and the Medical Outcomes Study Short Form Health Survey (SF-36). A survival model was constructed by applying different survival functions to assess the best fit for the data. Additionally, survival analyses were performed to assess the added value of the two HRQoL measures and depression severity for predicting RTW.

RESULTS

Females and older patients had a longer time to RTW. The same was true for patients with a full-time job and patients with more decision latitude. Patients in a management position and patients with more social support had a shorter time to RTW. Severity of depression was not predictive for the time to RTW. HRQoL measured by the SF-36 was a significant predictor for the time to RTW.

CONCLUSION

HRQoL emerged as a significant predictor for the time to RTW. However, severity of depression was not predictive for the time to RTW. These results suggest the importance of assessing HRQoL in addition to severity of disease to assess functionality.