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

Mental Health Stigma in the Workplace and its Association with Possible Actions of Managers to Prevent Sickness Absence of Employees with Mental Health Problems in the Swedish Private Sector: a Video Vignette Study

PURPOSE

Mental health problems (MHPs) are subjected to workplace stigma and can deteriorate into common mental disorders (CMDs) and sickness absence (SA). Research has shown that personal stigmatizing attitudes limit managers' efforts towards employees with MHPs, but knowledge is lacking regarding stigma in social contexts (contextual stigma) and different types of possible preventive actions. This study investigates personal stigmatizing attitudes and three contextual stigma layers (employee, collegial, organizational) and different types of possible actions to prevent SA of employees with MHPs.

METHOD

Survey data of 2769 Swedish managers working in the private sector were analysed. Personal stigmatizing attitudes were measured with the managerial stigma towards employee depression scale and supplemented with four additional items capturing contextual stigma. Managers watched video vignettes and assessed which preventive actions (n  = 20) were possible to use in their organization. A sum score was calculated reflecting the 'number of actions'. Principal component analysis revealed three action types: adapt tasks and setting, involve experts, and social support. A score reflecting the 'possibilities to implement actions' was calculated for each type. Multiple linear regression analyses were conducted with the four stigma layers as independent variables for each of the three action variables.

RESULTS

Personal stigmatizing attitudes and contextual stigma were significantly associated with both 'number of actions' and 'possibilities for implementing actions' relating to all action types. Patterns of associations with contextual stigma were significant but varied between the different action types.

CONCLUSION

This study substantiated the role of personal stigmatizing attitudes and contextual stigma in relation to possible actions of managers to prevent SA of employees with MHPs. The results emphasize the role of contextual stigma. Implications for practice and research are discussed.

The significance of managers' knowledge of common mental disorders on managerial stigma towards employee depression: a cross-sectional study in Sweden

BACKGROUND

Common mental disorders (CMD) such as depression, anxiety and stress-related disorders have increased in the working-age population in many countries but are still often associated with social stigma in workplaces. Managers have a key role in supporting employees with impaired health. Identifying factors that can improve stigmatizing attitudes among managers towards CMD is crucial. The aim of this study was to investigate managers' knowledge of CMD on managerial stigma; more specifically knowledge aquired through training and education and through occupational and personal experience of CMD on low managerial stigma towards employee depression.

METHODS

Data from a web-based survey conducted in 2017 among 3038 managers in Sweden were used. Managers' attitudes towards employee depression were measured using the Swedish version of the Managerial Stigma towards Employee Depression questionnaire. Binary logistic regression analysis, with adjustments for work setting and managerial experience, was conducted for associations between sources of knowledge of CMD and low managerial stigma.

RESULTS

With regard to knowledge acquired through training, medical training on CMD was significantly associated with a higher probability for low managerial stigma towards employee depression after adjustments (odds ratio [OR], 1.95; 95% confidence interval [CI], 1.26-3.01), whereas no significant associations were found between knowledge acquired through managerial training on CMD or level of formal education and low managerial stigma. With regard to knowledge acquired through professional and personal experience, occupational experience of treating people with CMD was significantly associated with a higher probability for low managerial stigma (OR, 2.03; 95% CI, 1.40-2.94) as was occupational experience of employees with CMD (1 employee: OR, 1.31; 95% CI, 1.04-1.66); >1 employee, OR 1.35 (CI 1.05-1.73). Personal experience of CMD was significantly associated with low managerial stigma (OR, 1.98; 95% CI, 1.60-2.46).

CONCLUSIONS

Managers' knowledge and understanding of CMD may increase the probability of a low level of managerial stigma towards employees with depression. Managers' professional and/or personal experiences of CMD were important sources of knowledge in relation to a low level of stigmatizing attitudes. Organizations should encourage the use of managers' experience-based knowledge of CMD in addition to training on CMD to reduce managerial stigma.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Managers' experience of causes and prevention of sick leave among young employees with Common Mental Disorders (CMDs)-A qualitative interview study with a gender perspective

BACKGROUND

Young adults entering the workforce have an almost 40% greater risk of work-related mental health problems than other working age groups. Common mental disorders (CMDs) constitute the majority of such mental health problems. Managers are crucial in promoting a good psychosocial work environment and preventing sick leave. The study aims to explore managers' experience of 1) causes of sick leave in the personal and work-life of young employees with CMDs, and 2) prevention of such sick leave. A gender perspective is applied to examine managers' experience of causes and prevention of sick leave in relation to male and female employees and male and female-dominated occupations.

MATERIAL AND METHODS

A qualitative design was applied and 23 semi-structured interviews were conducted with Swedish managers experienced in supervising young employees with CMDs. The interviews were analysed with conventional content analysis and the managers' experience of similarities and differences between young female and male employees and occupations were explored through reflective notes.

RESULTS

Four main categories and eight subcategories describe the managers' experience of the causes of sick leave due to CMD among young employees. The main categories are: 1) entering work life when already worn-out, 2) struggling with too high expectations at work, 3) having a challenging personal life, and 4) being unable to manage specific occupational challenges and demands. Gender differences were found in six subcategories regarding, e.g., work demands and problems in personal relationships. One main category and three subcategories describe how this type of sick leave might be prevented, with managers emphasizing the need to ease the transition into work life. Gender differences in the prevention of sick leave were found in one subcategory regarding communication about workers' health and problems at work.

CONCLUSION

Our findings show that gender norms and the expectations of young men and women are factors of importance in managers' experience of the development and prevention of CMDs. These results can inform their preventive work and their supervision and introduction of newly-employed young adults.

Effects of a multi-component alcohol prevention program in the workplace on hazardous alcohol use among employees

BACKGROUND

The workplace can be affected negatively by hazardous alcohol use, and intervening at an early stage remains a challenge. Recently, a multi-component alcohol prevention program, Alcohol Policy and Managers' skills Training (hereafter, 'APMaT'), was delivered at the organizational level. In a previous outcome evaluation, APMaT appeared to be effective at the managerial level. The current study takes a step further by aiming to evaluate the effectiveness of APMaT in decreasing the alcohol risk level among employees.

METHODS

Data from 853 employees (control: n = 586; intervention: n = 267) were gathered through a cluster-randomized study. To analyze changes in the odds of hazardous alcohol use among employees, multilevel logistic regression was applied using group (control vs. intervention), time (baseline vs. 12-month follow-up), and the multiplicative interaction term (group × time) as the main predictors. The intervention effect was further adjusted for sociodemographic characteristics and policy awareness.

RESULTS

No statistically significant difference was observed in the odds of hazardous alcohol use, although employees in the intervention group showed a larger decrease compared to the control group. This remained even after adjusting for several factors, including the sociodemographic factors and policy awareness.

CONCLUSIONS

The findings are insufficient to determine the effectiveness of APMaT at the employee level at the current stage of the evaluation. Future studies should strive to identify issues with implementation processes in workplace-based alcohol interventions.

TRIAL REGISTRATION

The trial was retrospectively registered on 11/10/2019; ISCRTN ID: ISRCTN17250048.

Managers' sick leave recommendations for employees with common mental disorders: a cross-sectional video vignette study

BACKGROUND

To better understand the initial phases of sickness absence due to common mental disorders (CMD), the aim of the present video vignette study was to test the following three hypotheses: (1) Managers who have negative attitudes towards employees with CMD will not recommend sick leave. (2) Managers with experience of CMD recommend sick leave to a significantly higher extent than managers lacking this experience. (3) Managers with previous experience of recommending sick leave for people with CMD will recommend sick leave to a significantly higher extent also based on the vignettes.

METHODS

An online survey, including a CMD-labelled video vignette, was sent to 4737 Swedish managers (71% participated, n  = 3358). For aims (1) and (2), a study sample consisting of 2714 managers was used. For aim (3), due to the design of the survey questions, a subsample (n  = 1740) was used.

RESULTS

There was no significant association between negative attitudes towards employee depression and managers' recommendation of employee sick leave with the vignette case. The bivariate analysis showed that personal experience of CMD was associated with managers' recommendation of employee sick leave. In the adjusted regression model, it became non-significant. Previous experience of recommending sick leave to one employee and to several employees was associated with recommending sick leave, also when adjusting for gender, level of education, years of managerial experience, and management training on CMDs CONCLUSIONS: The likelihood of a manager recommending sick leave after watching a CMD-labelled video vignette was higher if the manager had previous experience of this situation in real life. This study highlights the importance of including managerial behaviours and attitudes to better understand sick leave among employees with CMD.

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

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

How Managers Find Out About Common Mental Disorders Among Their Employees

OBJECTIVE

To explore how managers find out about common mental disorders (CMDs) among employees and associations with managers' work- and knowledge-related characteristics and attitude to CMDs.

METHODS

Data from an online survey in 2017 with Swedish managers (n = 1810) were used. Different ways managers find out about CMDs were measured, and multivariate logistic regression analysis was conducted for associations with manager characteristics.

RESULTS

Few managers found out about CMDs themselves; another source was more common, for example, employees' self-disclosure. Managers' overseeing fewer subordinates and those with a negative attitude to depression were more likely to find out about CMDs themselves. The significance of mental health training and education could not be established.

CONCLUSION

Managers' awareness about employees' CMDs mainly came about through employees' self-disclosure. Managers' attitudes and work conditions were related to the way of finding out.

Acting the part: how social and organisational factors shape managers' actions towards employees with repeated short-term sickness absence

Purpose

The aim of the study was to understand the social and organisational factors in the workplace that shape managers' actions and attitudes towards workers with repeated short-term sickness absence.

Design/methodology/approach

This was a qualitative interview study. Semi-structured interviews were conducted with 19 managers at 15 different workplaces. The analysis had an abductive approach, using thematic analysis which focused on the latent content of managers attitudes towards employees with repeated short-term sickness absence.

Findings

Results indicate that the managers' views of people on short-term sick leave shift and move through several phases, which was analysed as they were acts in a play, where their given roles are prescribing which actions to take given the available resources for acting these parts. These acts depict an increasingly controlling attitude, where the sick leave is ultimately seen as an individual problem best managed by repressive tactics.

Originality/value

Role theory offers the possibility to analyse managers' attitudes and behaviours by considering the workplace and the manager-employee relationship as regulated by norms and organisational factors.

Enhanced Capacity to Act: Managers' Perspectives When Participating in a Dialogue-Based Workplace Intervention for Employee Return to Work

Purpose To explore if and how a dialogue-based workplace intervention with a convergence dialogue meeting can support a return to work process from the managers' perspective. Methods Individual interviews were conducted with 16 managers (10 women and 6 men) who had an employee on sick leave because of stress-induced exhaustion disorder. The manager and employee participated in a dialogue-based workplace intervention with a convergence dialogue meeting that was guided by a healthcare rehabilitation coordinator. The intervention aimed to facilitate dialogue and find concrete solutions to enable return to work. The interviews were analyzed by the Grounded Theory method. Results A theoretical model was developed with the core category enhancing managerial capacity to act in a complex return to work process, where the managers strengthened their agential capacity in three levels (categories). These levels were building competence, making adjustments, and sharing responsibility with the employee. The managers also learned to navigate in multiple systems and by balancing demands, control and support for the employee and themselves. An added value was that the managers began to take preventive measures with other employees. When sick leave was caused only by personal or social issues (not work), workplace actions or interventions were difficult to find. Conclusions From the managers' perspective, dialogue-based workplace interventions with a convergence dialogue meeting and support from a rehabilitation coordinator can strengthen managerial competence and capacity to act in a complex return to work process.

Gender differences in managers' attitudes towards employees with depression: a cross-sectional study in Sweden

BACKGROUND

Depression is prevalent among employees and a major reason for sickness absence. First-line managers' attitudes towards employees with depression might influence return to work and the scant literature indicates gender differences in attitudes. The objective of this study was to investigate gender differences in managers' attitudes to employees with depression.

METHODS

A cross-sectional study was conducted among 4737 Swedish managers in 2017 (response rate 71%, n = 3358). Attitudes towards depression were measured with the instrument "Managerial stigma towards employees with depression" (12 items). The response patterns of women and men, the level of stigma and the direction of the gender differences were investigated with independent t tests and binary logistic regression analyses with covariates.

RESULTS

The likelihood of reporting high negative attitudes (score ≥ 36) was lower among women than men (odds ratio, 1.64; 95% confidence interval, 1.28-2.10) after adjusting for age, level of education, work sector, distribution of women and men among the staff, current workplace experience in management, lifetime experience in management, managerial position and presence of staff members at the current workplace who had depression and/or anxiety disorders.

CONCLUSIONS

Based on these findings, a gender-sensitive approach is suggested for future interventions to improve managers' attitudes towards employees with depression and other mental disorders.