Mood, anxiety, and alcohol use disorders and later cause-specific sick leave in young adult employees

Predictors of return to work in people with major depression: Results from a supported employment program in Germany

BACKGROUND

Depression is a common mental disorder and is associated with work disability. For the implementation of evidence-based interventions, such as Individual Placement and Support (IPS) for people with depression in Germany, the aim of this study was to investigate client variables that predict return to work.

METHODS

The sample consisted of 129 participants, initially treated in a psychiatric hospital due to major depression, who participated in IPS as part of a German clinical trial. Baseline demographic (age, sex, education, sickness absence days, employment status), psychiatric (symptom severity, comorbidity, general physical and mental health, disability), and neuropsychological (self-rated deficits, test performance) variables were included. Return to work within one year was predicted using separate and overall binary logistic regression analyses.

RESULTS

A total of 70 participants (56 %) returned to work within the one-year follow-up period. >100 days of sick leave in the year prior to study entry (vs. <100 days) and higher self-rated cognitive deficits were significantly associated with reduced odds of return to work within one year of IPS.

LIMITATIONS

The sample consisted of participants with a relatively good work history who were assigned to IPS by the treatment team, thus, the generalizability of the results is limited.

CONCLUSIONS

People with depression who participate in IPS interventions might benefit from specifically targeting perceived cognitive deficits. Factors associated with prolonged sick leave due to depression and their role in return to work with IPS need further investigation.

Sickness absence among young employees in private and public sectors with a history of depression and anxiety

The aim was to investigate occurrence and duration of sickness absence (SA) among young employees with previous depression/anxiety in private and public sectors. This population-based prospective study included 11,519 Swedish twin individuals of age 19-29 years that were followed regarding SA during 2006-2016. Data on previous depression/anxiety came from two screening surveys in 2005. Data on SA and employment sector were received from national registries. Descriptive statistics and logistic regression were used, also controlling for familial factors. Proportion of employees with SA was significantly higher among those with, as compared to those without, previous depression/anxiety, regardless the employment sector. Individuals with previous depression/anxiety had increased risk for future SA, in both private (OR 2.25, 95% CI 1.90-2.66) and public sectors (OR 2.10, 95% CI 1.73-2.54). Familial factors played a role in the association among employees in the private sector. A higher proportion of long-term SA was observed among employees with previous depression/anxiety in the private as compared to the public sector. To conclude, previous depression/anxiety tends to increase risk for SA among young employees in both employment sectors, whereas long-term SA seemed to be more prevalent among those in the private as compared to the public sector.

Do Differences in Drinking Attitudes and Alcohol-Related Problems Explain Differences in Sick Leave? A Multilevel Analysis of 95 Work Units Within 14 Companies From the WIRUS Study

Background

Systematic reviews have shown a strong relationship between alcohol consumption and sick leave. The effect of alcohol consumption on sick leave may, however, vary according to the work environment. While attitudes toward drinking may impact sick leave, there is little research on the contribution of drinking attitudes to sick leave. Moreover, alcohol-related problems and drinking attitudes may be influenced by the broader sociocultural contexts of the organizational units where people work.

Objectives

This study aimed to explore the relationship of alcohol-related problems and drinking attitudes with sick leave while considering the nesting of employees within working units within companies.

Method

Data from the WIRUS (Workplace Interventions preventing Risky alcohol Use and Sick leave) study were linked to company-registered sick leave data for 2,560 employees from 95 different work units in public (n = 9) and private companies (n = 5) in Norway. Three-level (employee, work unit, and company) negative binomial regression models were estimated to explore the 12-month prospective association of alcohol-related problems and drinking attitudes with four measures of sick leave (one-day, short-term, long-term, and overall sick leave days). Models were adjusted for gender, age, cohabitation status, educational attainment, work position, and employment sector.

Results

We observed higher variation of one-day, short-term, and overall sick leave days between companies than between work units within companies (15, 12, and 30% vs. 0, 5, and 8%, respectively). However, neither alcohol-related problems nor drinking attitudes were associated with sick leave and, thus, those variations in sick leave were not explained by alcohol-related problems or drinking attitudes.

Conclusion

Our findings suggest company-level differences are more important than within company differences when explaining differences in sick leave. While alcohol-related problems or drinking attitudes were not associated with sick leave, future studies may need to explore the role of company policies, practices, or social norms in variations in sick leave rates.

Psychiatric disorders diagnosed in adolescence and subsequent long-term exclusion from education, employment or training: longitudinal national birth cohort study

BACKGROUND

Long-term 'not in education, employment or training' (NEET) status is an important indicator of youth marginalisation.

AIMS

To carry out a comprehensive overview of the associations between different psychiatric illnesses and long-term NEET status.

METHOD

We used the register-based 1987 Finnish Birth Cohort study, which includes all live births in Finland during that year. The analyses comprised 55 273 individuals after exclusions for intellectual disability, death or emigration. We predicted that psychiatric disorders, diagnosed by specialist services between 1998 and 2007 when the cohort were 10-20 years of age, would be associated with subsequent long-term NEET (defined as NEET for at least 5 years between 2008 and 2015, when they were 20-28 years of age).

RESULTS

In total, 1438 individuals (2.6%) were long-term NEET during follow-up and the associations between long-term NEET and the 11 diagnostic categories we studied were statistically significant (P < 0.001). In multivariate models we included sociodemographic characteristics and upper secondary education as covariates, and the highest effect sizes, measured by odds ratios (OR) with 95% confidence intervals (CI), were found for psychosis (OR = 12.0, 95% CI 9.5-15.2) and autism spectrum disorder (OR = 17.3, 95% CI 11.5-26.0). If individuals had not successfully completed this education, 70.6% of those with autism spectrum disorder and 48.4% of those with psychosis were later long-term NEET.

CONCLUSIONS

Adolescents who receive treatment for psychiatric disorders, particularly autism spectrum disorder or psychosis, need support to access education and employment. This could help to prevent marginalisation in early adulthood.

A systematic review and meta-analysis uncovering the relationship between alcohol consumption and sickness absence. When type of design, data, and sickness absence make a difference

AIM

Earlier research has revealed a strong relationship between alcohol use and sickness absence. The aim of this review was to explore and uncover this relationship by looking at differences in type of design (cross-sectional vs. longitudinal), type of data (self-reported vs. registered data), and type of sickness absence (long-term vs. short term).

METHOD

Six databases were searched through June 2020. Observational and experimental studies from 1980 to 2020, in English or Scandinavian languages reporting the results of the association between alcohol consumption and sickness absence among working population were included. Quality assessment, and statistical analysis focusing on differences in the likelihood of sickness absence on subgroup levels were performed on each association, not on each study. Differences in the likelihood of sickness absence were analyzed by means of meta-analysis. PROSPERO registration number: CRD42018112078.

RESULTS

Fifty-nine studies (58% longitudinal) including 439,209 employees (min. 43, max. 77,746) from 15 countries were included. Most associations indicating positive and statistically significant results were based on longitudinal data (70%) and confirmed the strong/causal relationship between alcohol use and sickness absence. The meta-analysis included eight studies (ten samples). The increased risk for sickness absence was likely to be found in cross-sectional studies (OR: 8.28, 95% CI: 6.33-10.81), studies using self-reported absence data (OR: 5.16, 95% CI: 3.16-8.45), and those reporting short-term sickness absence (OR: 4.84, 95% CI: 2.73-8.60).

CONCLUSION

This review supports, but also challenges earlier evidence on the association between alcohol use and sickness absence. Certain types of design, data, and types of sickness absence may produce large effects. Hence, to investigate the actual association between alcohol and sickness absence, research should produce and review longitudinal designed studies using registry data and do subgroup analyses that cover and explain variability of this association.

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.

Changes in drinking as predictors of changes in sickness absence: a case-crossover study

Background

We investigated whether changes in alcohol use predict changes in the risk of sickness absence in a case-crossover design.

Methods

Finnish public sector employees were surveyed in 2000, 2004 and 2008 on alcohol use and covariates. Heavy drinking was defined as either a weekly intake that exceeded recommendations (12 units for women; 23 for men) or having an extreme drinking session. The responses were linked to national sickness absence registers. We analysed the within-person relative risk of change in the risk of sickness absence in relation to change in drinking. Case period refers to being sickness absent within 1 year of the survey and control period refers to not being sickness absent within 1 year of the survey.

Results

Periods of heavy drinking were associated with increased odds of self-certified short-term (1–3 days) sickness absence (multivariable-adjusted OR 1.21, 95% CI 1.07 to 1.38 for all participants; 1.62, 95% CI 1.19 to 2.21 for men and 1.15, 95% CI 1.00 to 1.33 for women). A higher risk of short-term sickness absence was also observed after increase in drinking (OR=1.27, 95% CI 1.07 to 1.52) and a lower risk was observed after decrease in drinking (OR=0.83, 95% CI 0.69 to 1.00). Both increase (OR=1.38, 95% CI 1.21 to 1.57) and decrease (OR=1.27, 95% CI 1.19 to 1.43) in drinking were associated with increased risk of long-term (>9 days) medically certified all-cause sickness absence.

Conclusion

Increase in drinking was related to increases in short-term and long-term sickness absences. Men and employees with a low socioeconomic position in particular seemed to be at risk.

Working in dissonance: experiences of work instability in workers with common mental disorders

BACKGROUND

Common mental disorders have a negative impact on work functioning, but less is known about the process when the functioning starts to destabilize. This study explores experiences of work instability in workers with common mental disorders.

METHODS

A grounded theory study using a theoretical sampling frame, individual in-depth interviews and a constant comparative analysis conducted by a multidisciplinary research team. The sample involved 27 workers with common mental disorders, currently working full or part time, or being on sick leave not more than 6 months. They were women and men of different ages, representing different occupations and illness severity.

RESULTS

A general process of work instability was conceptualized by the core category Working in dissonance: captured in a bubble inside the work stream. The workers described that their ordinary fluency at work was disturbed. They distanced themselves from other people at and outside work, which helped them to regain their flow but simultaneously made them feel isolated. Four categories described sub-processes of the dissonance: Working out of rhythm, Working in discomfort, Working disconnected and Working in a no man's land.

CONCLUSIONS

The experience of work instability in CMDs was conceptualized as "working in dissonance", suggesting a multifaceted dissonance at work, characterized by a sense of being caught up, as if in a bubble. Focusing on how the worker can re-enter their flow at work when experiencing dissonance is a new approach to explore in occupational and clinical settings.