At the sources of one's well-being: early rehabilitation for employees with symptoms of distress

Interventions for common mental disorders in the occupational health service: a systematic review with a narrative synthesis

Introduction

Common mental disorders (CMD) are leading causes of decreased workability in Sweden and worldwide. Effective interventions to prevent or treat such disorders are important for public health.

Objective

To synthesize the research literature regarding occupational health service (OHS) interventions targeting prevention or reduction of CMD among employees. The effect on workability (sickness absence, return-to-work and self-reported workability) and on CMD symptoms was evaluated in a narrative analysis.

Data sources

The literature search was performed in four electronic databases in two searches, in 2014 and in 2017.

Eligibility criteria (using PICO)

Population: studies investigating employees at risk or diagnosed with CMD, as well as preventive workplace intervention targeting mental health. Intervention: studies where the recruitment or the intervention was delivered by the OHS or OHS personnel were included. Control: individuals or groups who did not receive the target intervention. Outcome: all types of outcomes concerning sickness absence and psychological health were included.

Study quality was assessed using a Swedish AMSTAR-based checklist, and results from studies with low or medium risk of bias were narratively synthesized based on effect or absence thereof.

Results

Thirty-three studies were included and assessed for risk of bias. Twenty-one studies had low or medium risk of bias. In 18 studies, rehabilitation interventions were evaluated, 11 studies concerned interventions targeting employees at risk for developing CMD and four studies investigated preventive interventions. Work-focused cognitive behavioral therapy and problem-solving skill interventions decreased time to first return-to-work among employees on sick leave for CMD in comparison with treatment-as-usual. However, effect on return to full-time work was not consistent, and these interventions did not consistently improve CMD symptoms. Selective interventions targeting employees at risk of CMD and preventive interventions for employees were heterogeneous, so replication of these studies is necessary to evaluate effect.

Limitations

Other workplace interventions outside the OHS may have been missed by our search. There was considerable heterogeneity in the included studies, and most studies were investigating measures targeting the individual worker. Interventions at the workplace/organizational level were less common.

Conclusions and implication of key findings

Return-to-work and improvement of CMD symptoms are poorly correlated and should be addressed simultaneously in future interventions. Further, interventions for CMD administered through the occupational health service require further study. Rehabilitative and preventive strategies should be evaluated with scientifically robust methods, to examine the effectiveness of such interventions.

A Systematic Review on the Research Progress and Evolving Trends of Occupational Health and Safety Management: A Bibliometric Analysis of Mapping Knowledge Domains

Background: Effective occupational health and safety management (OHSM) is important to employee health, enterprise sustainability, and social stability. However, scientific research into OHSM lags behind practice, and contextualizing OHSM research from the perspective of its historical evolution is urgently required.

Methods: The mapping of knowledge domains, based on bibliometric analysis, was adopted to classify 4,852 journal articles related to OHSM listed in the core database of Web of Science and published between 1900 and 2018.

Results and Conclusions: Risk assessment/management at the organizational level were found to have always been research hotspots, and the relationship between safety culture/atmosphere, sickness absence, and safety performance, among other factors, have become core research topics in the field in recent years. Research at the individual level has gradually evolved from an early focus on physiological problems such as work-related musculoskeletal disorders and low back pain, further toward issues such as occupational stress, mental health, and quality of life. In addition, the results of clustering analysis based on high-frequency keywords indicated six aspects of OHSM: OHSM mode and method; OHSM systems and standards; OHS risk assessment and management; OHSM and safety culture; mental health and quality of life; and specific disease management. Future development trends in OHSM research are described providing theoretical and practical reference for further study.

Mindfulness-Based IARA Model® Proves Effective to Reduce Stress and Anxiety in Health Care Professionals. A Six-Month Follow-Up Study

Changes in the health care environment, together with specific work-related stressors and the consequences on workers’ health and performance, have led to the implementation of prevention strategies. Among the different approaches, those which are mindfulness-based have been institutionally recommended with an indication provided as to their effectiveness in the management of stress. The aim of the present study was to analyze the efficacy of the mindfulness-based IARA Model^® (an Italian acronym translatable into meeting, compliance, responsibility, autonomy) in order to ameliorate perceived stress, anxiety and enhance emotional regulation among health care professionals (HCPs; i.e., doctors, nurses, and healthcare assistants). Four hundred and ninety-seven HCPs, 215 (57.2%) of which were women, were randomly assigned to a mindfulness-based training or control group and agreed to complete questionnaires on emotion regulation difficulties (DERS), anxiety, and perceived stress. Results showed that HCPs who attended the IARA training, compared to the control group, had better emotional regulation, anxiety and stress indices after 6 months from the end of the intervention. Furthermore, the results confirmed the positive relationship between emotional regulation, perceived stress and anxiety. The present study contributes to literature by extending the effectiveness of IARA in improving emotional regulation and well-being in non-clinical samples. Moreover, the study provides support for the idea that some specific emotional regulation processes can be implicated in perceived stress and anxiety. From the application point of view, companies should invest more in stress management intervention, monitoring and training, in order to develop worker skills, emotional self-awareness, and relational resources.

A Cognitive Behavioural Intervention Programme to Improve Psychological Well-Being

Psychosocial risk factors have increased in today's work environment, and they threaten work ability. Good workplace atmosphere, psychosocial support, the ability to cope with stress, and skills and knowledge are all connected to more successful coping. Faster changes in the work environment and an increased workload can lead to a chain of fatigue and illness. The aim of this study was to evaluate a cognitive behavioural intervention as an early rehabilitation strategy to improve employees' well-being, in intervention group N446 and in control group N116. The well-being measures used were the Bergen Burnout Inventory (BBI 15), Utrecht Work Engagement Scale (UWES), and depression and stress screening questions. Data were obtained by a self-report survey at baseline and at a nine-month follow-up. Differences were analysed within and between groups. The results suggest that cognitive behavioural intervention as an early rehabilitation programme will increase employees' well-being measured by BBI 15, UWES, and depression and stress screening questions. In the intervention group, the total BBI 15 score (p < 0.01) and each of the three subdimensions of burnout (exhaustion, cynicism, and sense of inadequacy) decreased at follow-up. Mental health issues are the commonest reasons for sick leave and early retirement. We need ways to prevent these issues.

Effects of a nine-month occupational intervention on health-related quality of life

The aim of this study was to evaluate the effectiveness of vocationally outpatient oriented rehabilitation on an intervention group, compared with a control group that did not take part in the intervention. The groups were compared for health-related quality of life (HRQoL) by the quantitative indicator RAND 36. Data were obtained by a self-report at baseline and at nine months follow-up. Differences between base-line and follow-up were analyzed within group and between the groups. The study population consisted of 751 municipal employees aged between 26 and 64 years; an intervention with 463 women and 115 men ( n = 578), and a control group with 138 women and 35 men ( n = 173). In this study we focused on those who had answered to all questions in RAND 36, thus 581 remained. Of these, 388 were in the intervention group (mean age 49.0 years) and 110 in the control group (mean age 48.4 years). Intervention was based on cognitive behavioral therapy. Participants in the 9-month outpatient intervention group showed statistically significant increase in all eight RAND 36 areas. Most improvement was seen in the psychosocial functioning index ( p = 0.002). Although there were no statistically significant changes in RAND 36 components in the control group, difference in changes between groups were seen in energy and fatigue ( p < 0.001), social functioning ( p = 0.032) and general health perceptions 0.027 in favor of the intervention group. The results suggest that a cognitive behavioral intervention as an early rehabilitation program is effective in increasing employees’ quality of life, as measured by RAND 36.