Is manager support related to workplace productivity for people with depression: a secondary analysis of a cross-sectional survey from 15 countries

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.

Effects of mental health status during adolescence on primary care costs in adulthood across three British cohorts

PURPOSE

This study examines the association between mental health problems in adolescence and general practice (GP) costs during adulthood up to age 50 in the UK.

METHODS

We conducted secondary analyses of three British birth cohorts (individuals born in single weeks in 1946, 1958 and 1970). Data for the three cohorts were analysed separately. All respondents who participated in the cohort studies were included. Adolescent mental health status was assessed in each cohort using the Rutter scale (or, for one cohort, a forerunner of that scale) completed in interviews with parents and teachers when cohort members were aged around 16. Presence and severity of conduct and emotional problems were modelled as independent variables in two-part regression models in which the dependent variable was costs of GP services from data collection sweeps up to mid-adulthood. All analyses were adjusted for covariates (cognitive ability, mother's education, housing tenure, father's social class and childhood physical disability).

RESULTS

Adolescent conduct and emotional problems, particularly when coexisting, were associated with relatively high GP costs in adulthood up to age 50. Associations were generally stronger in females than males.

CONCLUSION

Associations between adolescent mental health problems and annual GP cost were evident decades later, to age 50, suggesting that there could be significant future savings to healthcare budgets if rates of adolescent conduct and emotional problems could be reduced.

TRIAL REGISTRATION

Not applicable.

Promoting labour market inclusion of the chronically ill: a scoping review of Scandinavian countries' efforts

OBJECTIVES

This article is a scoping review of efforts in labour market inclusion of the chronically ill in the Scandinavian countries, a research area that has received much political as well as research attention in recent years. The aim of the review was to identify promising strategies and the need for further research.

METHODS

Six electronic databases were searched for literature published between 2015 and 2020. We included peer-reviewed articles that studied the effect of measures, aimed at the workplace or at the individual, that are intended to increase participation. Our search resulted in 2718 articles; our screening procedures resulted in 47 included articles.

RESULTS

Among the included studies, musculoskeletal problems (17 articles) and mental health problems (29 articles) were the most frequent chronic conditions. Multimodal occupational rehabilitation programmes directed towards the individual employee were the most frequent interventions (30 articles). Return to work (24 articles) and sickness absence (12 articles) were the most common outcomes. About half (25 articles) of the included studies reported a positive impact of the intervention on work inclusion of the chronically ill.

CONCLUSIONS

Our review found little evidence of how government programmes directed towards the supply side of the labour market succeed in including the chronically ill. Our review further indicated that multidisciplinary workplace interventions have a substantial effect. We also identified a significant lack of research on the effect of various governmental policies and programmes, including local health, work and welfare services, and limited coordination and cooperation between health and work services professions.

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.

"Should I Tell My Leader or Not?"-Health-Oriented Leadership and Stigma as Antecedents of Employees' Mental Health Information Disclosure Intentions at Work

OBJECTIVE

To investigate how health-oriented leadership and stigma facilitate or impede employees' disclosure intentions to leaders.

METHODS

In two studies-an experimental vignette (n = 73) and a cross-sectional study (n = 220)-we manipulated or measured health-oriented leadership, transformational leadership, and organizational stigma and compared different reasons for disclosure (mental health problems and severe error) to separate general and specific disclosure decisions.

RESULTS

Health-oriented leadership fostered disclosure above and beyond transformational leadership. High organizational stigma was associated with lower disclosure. Health-oriented leadership had a stronger effect on disclosing mental problems than on disclosing a severe error and slightly mitigated the negative relationship between stigma and disclosure in study 1. Findings were not influenced by employees' current mental health status.

CONCLUSIONS

Our findings highlight the importance of health-oriented leadership as a facilitator and organizational stigma as a barrier to disclosure intentions.

"Should I Further Engage in Staff Care?": Employees' Disclosure, Leaders' Skills and Goal Conflict as Antecedents of Health-Oriented Leadership

Leaders play a crucial role in employees' health and job satisfaction. When employees show early warning signs that their physical or mental health is at risk, leaders' responsibility gains even more importance. Recent health-specific leadership approaches (health-oriented leadership; HoL) emphasize the importance of leaders ability to perceive employees' warning signals (staff care awareness) to take appropriate action (staff care behavior). However, little is known about the factors facilitating or hindering the transfer from leaders' awareness to concrete behaviors. In an experimental study (N = 91), we examined and manipulated antecedents of staff care behavior: (a) employees' disclosure, (b) leaders' HoL skills, and (c) leaders' goal conflict in a 2 × 2 × 2 mixed factorial design. Employees' disclosure and leaders' skills were positively related to staff care behavior. Leaders' goal conflict was not directly related to staff care behavior but had an indirect effect and diminished the positive relationship between disclosure and staff care behavior. The findings deepen the theoretical understanding of the HoL concept. By studying the influence of employees' disclosure on staff care behavior, our study complements a follower-centered perspective. We provide practical recommendations for workplace health promotion and how leaders' staff care behavior can be fostered.

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.

Health-oriented leadership: Antecedents of leaders’ awareness regarding warning signals of emerging depression and burnout

Due to growing demands, there is an increase in depression and burnout causing sickness absence and early retirement. Detecting depression and burnout at an early stage is a crucial task for leaders to allow for early support and prevent more severe illnesses. Within the health-oriented leadership concept, awareness is the ability to recognize followers’ warning signals as a potential health risk. Although it is widely accepted that awareness is a precondition to taking appropriate action, it is yet unclear to what extent leaders recognize the warning signals of followers and which factors facilitate or impede awareness. In an experimental study ( N = 54) and a survey study ( N = 215) we examined antecedents of awareness in followers and leaders: (a) clarity of displayed warning signals in followers, (b) leaders’ stressors, (c) leaders’ autonomy. Even under favorable conditions, only about half of the leaders recognized warning signals as a health risk. Leaders showed lower awareness during times of high stress and low autonomy and when followers displayed less clear warning signals. Autonomy moderated the effect of stress (workload) on awareness, but there was no buffering effect as expected. The findings deepen the theoretical understanding of awareness and suggest that leaders need to know how their awareness may be impeded. We provide practical recommendations for human resource management on how leaders’ awareness can be fostered.

The Economic Burden Associated with Depressive Symptoms among Middle-Aged and Elderly People with Chronic Diseases in China

Coexisting physical diseases and depressive symptoms exacerbate morbidity and disability, but their incremental economic burden remains unclear. We used cross-sectional data from the China Health and Retirement Longitudinal Study (CHARLS) survey in 2018 to estimate the economic burden associated with depressive symptoms among middle-aged and elderly people with chronic diseases. A multivariable regression model was used to assess the annual health care utilization, expenditures, and productivity loss of depressive symptoms among people with 12 common chronic diseases. We found that depressive symptoms were associated with higher incremental economic burdens, as the total health care costs increased by 3.1% to 85.0% and annual productivity loss increased by 1.6% to 90.1%. Those with cancer or malignant tumors had the largest economic burden associated with depressive symptoms, with CNY 17,273.7 additional annual health care costs and a loss of CNY 2196.2 due to additional annual productivity loss. The effect of depressive symptoms on the economic burden of patients with chronic conditions did not increase by the number of chronic conditions. Considering the high economic burden associated with depressive symptoms among patients with chronic conditions, it is important to consider the mental health of patients in chronic disease treatment and management.

Line managers' hiring intentions regarding people with mental health problems: a cross-sectional study on workplace stigma

OBJECTIVES

Stigma may negatively affect line managers' intention to hire people with mental health problems (MHP). This study aims to evaluate line managers' knowledge and attitudes concerning job applicants with MHP, and to assess which factors are associated with the intention (not) to hire an applicant with MHP.

METHODS

A sample of Dutch line managers (N=670) filled out a questionnaire on their knowledge, attitudes and experiences concerning applicants/employees with MHP. Descriptive analyses and multiple regression analyses were used.

RESULTS

The majority (64%) was reluctant to hire a job applicant with MHP, despite the fact that only 7% had negative and 52% had positive personal experiences with such employees. Thirty per cent were reluctant to hire an applicant if they knew the applicant had past MHP. Associated with higher reluctance to hire an applicant with MHP were the concerns that it will lead to long-term sickness absence (β (95% CI)=0.39 (0.23 to 0.55)), that the employee cannot handle the work (β (95% CI)=0.16 (0.00 to 0.33)) that one cannot count on the employee (β (95% CI)=0.41 (0.23 to 0.58)) and higher manager education level (β (95% CI)=0.25 (0.05 to 0.44)). Conversely, associated with positive hiring intentions was being in favour of diversity and/or inclusive enterprise (β(95% CI)=-0.64 (-0.87 to -0.41)).

CONCLUSIONS

As the majority of managers were reluctant to hire applicants with MHP, and even 30% were reluctant to hire applicants who had past MHP, these findings have major implications for social inclusion in the Netherlands, where about 75% of employees would disclose MHP at work.

Exploring the Relationship between Innovative Work Behavior, Job Anxiety, Workplace Ostracism, and Workplace Incivility: Empirical Evidence from Small and Medium Sized Enterprises (SMEs)

The aim of this study is to explore the relationship between workplace ostracism (WO), workplace incivility (WI), and innovative work behavior (IWB), using job anxiety as a mediating variable. Building on the conservation of resource (COR) theory, this study proposes a theoretical framework. In this framework, workplace ostracism and workplace incivility are theorized to strengthen innovative work behavior, directly and indirectly, through job anxiety. Data were collected from the workers of small and medium sized enterprise (SME) entrepreneurs located in Pakistan. To estimate the proposed relationships in the conceptual model, we used structural equation modeling (SEM) through AMOS-21. The outcomes of this study confirmed that workplace ostracism and workplace incivility had a negative impact on innovative work behavior. It was also confirmed that job anxiety mediates in the relationship between workplace ostracism, workplace incivility, job anxiety, and innovative work behavior. At the end of the study, we thoroughly discussed the conclusions, practical implications, limitations, and future research directions of the study.

Economic analyses of mental health and substance use interventions in the workplace: a systematic literature review and narrative synthesis

Mental illness and substance use disorders in the workplace have been increasingly recognised as a problem in most countries; however, evidence is scarce on which solutions provide the highest return on investment. We searched academic and grey literature databases and additional sources for studies that included a workplace intervention for mental health or substance abuse, or both, and that did an economic analysis. We analysed the papers we found to identify the highest yielding and most cost-effective interventions by disorder. On the basis of 56 studies, we found moderate strength of evidence that cognitive behavioural therapy is cost-saving (and in some cases cost-effective) to address depression. We observed strong evidence that regular and active involvement of occupational health professionals is cost-saving and cost-effective in reducing sick leave related to mental health and in encouraging return to work. We identified moderate evidence that coverage for pharmacotherapy and brief counselling for smoking cessation are both cost-saving and cost-effective. Addressing mental health and substance misuse in the workplace improves workers' wellbeing and productivity, and benefits employers' bottom line (ie, profit). Future economic analyses would benefit from the consideration of subgroup analyses, examination of longer follow-ups, inclusion of statistical and sensitivity analyses and discussion around uncertainty, and consideration of potential for bias.

Associations between the depressive symptoms, subjective cognitive function, and presenteeism of Japanese adult workers: a cross-sectional survey study

Background

Presenteeism has attracted much attention in the research into mental health. However, how cognitive complaints and depressive symptoms affect presenteeism remains unknown. Therefore, this study examined the correlation between subjective cognitive impairment, depressive symptoms, and work limitations.

Methods

We collected data from 477 adult workers in Japan. We evaluated subjective cognitive function using the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA), depressive symptoms with the Patient Health Questionnaire 9 (PHQ-9), and work limitations with the Work Limitations Questionnaire 8 (WLQ-8). The relations between depressive symptoms, cognitive complaints, and work limitations were examined using Spearman’s rank correlations and multiple regression analysis. It was hypothesized that cognitive complaints would mediate the effects of depressive symptoms on work productivity loss, which was tested using path analysis.

Results

The results indicated that cognitive complaints were significantly correlated with work limitations and depressive symptoms. Multiple regression analysis, using the WLQ-8 productivity loss score as the dependent variable, revealed that COBRA and PHQ-9 scores were significant predictors of work productivity loss. We performed path analysis using PHQ-9, COBRA, and WLQ-8 productivity loss scores and created a path diagram, which revealed that the direct effects of both depressive symptoms and cognitive dysfunction on work productivity loss were statistically significant. Moreover, depressive symptoms indirectly affected work productivity loss through subjective cognitive impairment. There was no significant interaction effect between depressive symptoms and cognitive complaints.

Conclusions

Our results suggest that work limitations may be predicted by not only depressive symptoms but also cognitive complaints. Moreover, subjective cognitive impairment may mediate the effect of depressive symptoms on presenteeism among adult workers.

Sustainable Work Performance: The Roles of Workplace Violence and Occupational Stress

The purpose of this study is to analyze the relationships between workplace violence, occupational stress, and sustainable work performance. Multiple dimensions of workplace violence (harassment, mobbing, ostracism, and stalking) were used in this study. A questionnaire survey was used, composed of 48 items with a 5-point Likert scale (1, strongly disagree, to 5, strongly agree). Data were collected from 15 hospitals in the vicinity of Karachi, Lahore, and Islamabad, Pakistan. The target population of this study consisted of doctors, nurses, and paramedical staff. We distributed 500 questionnaires among the target population. In total, 345 usable questionnaires were returned, resulting in a response rate of 69%. Partial least squares structural equation modeling was used to test the direct and indirect effects. The results of this study highlight that in both direct and indirect relationships, workplace violence negatively influences sustainable work performance. The findings of this study are as follows: First, harassment reduces employee morale, which consistently lessens employees' work performance. Second, mobbing at the workplace reduces productivity, increases levels of stress, anxiety, depression, and irritability, and increases low work engagement, work absences, and work destruction. Third, ostracism at the workplace reduces motivation among workers and organizations, which reduces work efficiency. Work performance is undermined due to stalking at the workplace because it creates a bad image and brings toxicity among colleagues and peers. Fourth, occupational stress is considered a stigma among employees who are facing stress at the workplace. We can conclude that if employees are happy and healthy, they can be their most productive. So, organizations need to construct a culture where employees can be at their best and shine.

Positioning Depression as a Critical Factor in Creating a Toxic Workplace Environment for Diminishing Worker Productivity

This study determined how a toxic workplace environment can influence worker productivity, directly and indirectly, using work depression as a mediating variable. A toxic workplace environment with multiple dimensions (harassment, bullying, ostracism, and incivility) was used in this study. We used a questionnaire survey approach to evaluate the data. A total of 53 items were used in the questionnaire with a five-point Likert scale. The data were collected from 23 branches of five Chinese banks in the vicinity of Shanghai. The authors distributed 250 questionnaires among targeted employees (senior managers, middle managers, and administrative staff) and received 186 filled questionnaires, among which six were incomplete. Thus, the completed sample size of the research was 180, and the overall response rate was 72%. To estimate the proposed relationships in the research model, we used partial least-squares structural equation modeling (PLS-SEM 3.2). The outcomes of this study indicate that for direct and indirect relationships, a toxic workplace environment negatively influences worker productivity. Moreover, the outcomes of this study also show that work depression negatively impacts worker productivity. The study concludes with a discussion, limitations, and future research directions.