Factors Associated with Long-Term Sickness Absence Due to Mental Disorders: A Cohort Study of 7.112 Patients during the Spanish Economic Crisis

Sickness absence around contact with outpatient mental health care services - differences between migrants and non-migrants: a Norwegian register study

BACKGROUND

Mental disorders are a leading cause of sickness absence. Some groups of migrants are at higher risk of both mental disorder and sickness absence. Yet, research on sickness absence in relation to mental disorders among migrants is limited. This study investigates differences in sickness absence in the twelve-month period around contact with outpatient mental health services between non-migrants and various migrant groups with different length of stays. It also considers whether these differences are similar for men and women.

METHODS

Using linked Norwegian register data, we followed 146,785 individuals, aged 18-66 years, who had attended outpatient mental health services and who had, or had recently had, a stable workforce attachment. The number of days of sickness absence was calculated for the 12-month period surrounding contact with outpatient mental health services. We applied logistic regression and zero-truncated negative binomial regression to assess differences in any sickness absence and number of days of absence between non-migrants and migrants, including refugees and non-refugees. We included interaction terms between migrant category and sex.

RESULTS

Refugee men and other migrant men from countries outside the European Economic Area (EEA) had a higher probability of any sickness absence in the period surrounding contact with outpatient mental health services than their non-migrant counterparts. Women from EEA countries with stays of less than 15 years had a lower probability than non-migrant women. Additionally, refugees, both men and women, with 6-14 years in Norway had more days of absence while EEA migrants had fewer days than their non-migrant counterparts.

CONCLUSIONS

Refugee men and other non-EEA migrant men appear to have higher sickness absence than non-migrant men around the time of contact with services. This finding does not apply to women. Several probable reasons for this are discussed, though further research is required to understand why. Targeted strategies to reduce sickness absence and support the return to work for refugees and other non-EEA migrant men are needed. Barriers to timely help-seeking should also be addressed.

How does Gender Influence Sustainable Return to Work Following Prolonged Work Disability? An Interpretive Description Study

PURPOSE

A sustainable return to work (S-RTW) following prolonged work disability poses different challenges, depending on gender. This article provides a synthesis of gender differences in the issues and factors influencing the S-RTW of workers following such a disability.

METHODS

Using an interpretive description method, an integrative review was conducted of the literature on gender differences in S-RTW issues and factors associated with four major causes of work disability. The initial review concerned the 2000-2016 literature; it was subsequently updated for November 2016-March 2020. To explore and contextualise the results, four focus groups were held with stakeholders representing the workplace, insurance, and healthcare systems and workers. Qualitative thematic analysis was performed.

RESULTS

A total of 47 articles were reviewed, and 35 stakeholders participated in the focus groups. The prevailing traditional gender roles were found to have a major gender-specific influence on the attitudes, behaviours, processes and outcomes associated with S-RTW. These differences related to the (1) cumulative workload, (2) work engagement, and (3) expressed and addressed needs.

CONCLUSIONS

The results highlight the importance of taking into account both professional and personal aspects when integrating gender issues into the assessment of workers' needs and subsequently into interventions.

The Impact of Economic Recessions on Depression, Anxiety, and Trauma-Related Disorders and Illness Outcomes-A Scoping Review

In the wake of a global economic recession secondary to the COVID-19 pandemic, this scoping review seeks to summarize the current quantitative research on the impact of economic recessions on depression, anxiety, traumatic disorders, self-harm, and suicide. Seven research databases (PsycINFO, MEDLINE, Embase, Web of Science: Core Collection, National Library of Medicine PubMed, PubMed Central, and Google Scholar) were searched for keywords returning 3412 preliminary results published since 2008 in Organisation for Economic Coordination and Development (OECD)nations. These were screened by both authors for inclusion/exclusion criteria resulting in 127 included articles. Articles included were quantitative studies in OECD countries assessing select mental disorders (depression, anxiety, and trauma-/stress-related disorders) and illness outcomes (self-harm and suicide) during periods of economic recession. Articles were limited to publication from 2008 to 2020, available online in English, and utilizing outcome measures specific to the disorders and outcomes specified above. A significant relationship was found between periods of economic recession and increased depressive symptoms, self-harming behaviour, and suicide during and following periods of recession. Results suggest that existing models for mental health support and strategies for suicide prevention may be less effective than they are in non-recession times. It may be prudent to focus public education and medical treatments on raising awareness and access to supports for populations at higher risk, including those vulnerable to the impacts of job or income loss due to low socioeconomic status preceding the recession or high levels of financial strain, those supporting others financially, approaching retirement, and those in countries with limited social safety nets. Policy makers should be aware of the potential protective nature of unemployment safeguards and labour program investment in mitigating these negative impacts. Limited or inconclusive data were found on the relationship with traumatic disorders and symptoms of anxiety. In addition, research has focused primarily on the working-age adult population with limited data available on children, adolescents, and older adults, leaving room for further research in these areas.

The impact of economic crisis on mortality due to mental health illnesses

BACKGROUND

The financial crisis affected several aspects of health. The aim of this study is to explore the impact of the crisis on mortality of mental illnesses in Greece and the socioeconomic determinants of mortality trends.

METHODS

Mortality data of 2000-16 were analyzed and sex-and-age-standardized death rates (SDRs) were calculated. The Average Annual Percent Change (AAPC) before and after the time point of slope change was computed. The crisis impact on SDRs was explored with interrupted time series analyses and standardized rate ratios (SRRs). The correlation of mortality with socioeconomic and healthcare-related variables was investigated with correlation and regression analyses.

RESULTS

A significant change in SDR trend was observed after 2012. The AAPC reversed from -2.9% to 94.5%, while the SRR was calculated at 6.1 (5.5-6.7). Income reduction, unemployment rise and health budget cuts were found to be significantly correlated with mortality rise.

CONCLUSIONS

Financial crisis had a significant impact on mortality due to mental illnesses, especially in females and elderly. The findings indicate that mortality increase is more driven by socioeconomic and healthcare-related factors that affect access to appropriate healthcare than by morbidity trends. The findings have implications in planning interventions to provide appropriate healthcare to patients living with mental illness.

Resilience building for mood disorders: Theoretical introduction and the achievements of the Re-Work program in Japan

Mood disorders are common, tend to recur, cause sickness absence, and lead to economic loss. Since past experiences of mood disorder episodes often increase future vulnerability, it is imperative to assist those mood disorder patients who want to resume working to build resilience to prevent relapse. Paralleling efforts in the West, a resilience-building program utilizing the principles of the Illness Management and Recovery program was first developed in Japan in 1997. The purpose of this survey is to introduce the concept and theory behind the Re-Work program and to review studies that report on program assessment, content, effects and associated factors, and prognosis of participants. A literature search performed with PubMed and Igaku chuou zasshi (Ichushi) identified 30 relevant studies. One of these reported on a tool developed to assess readiness for returning to work. Concerning program content, a group therapy setting and cognitive behavioral therapy were found to be effective. Physical exercise and relaxation techniques may be useful as secondary program components. Several studies report on program effects, but there may be factors that limit these effects. The prognosis for relapse prevention after the resumption of work may be better for Re-Work program participants than for a control group. Further research in this area is needed to confirm program effectiveness and related factors.

Analysis of Consultation Demand in a Mental Health Centre during the Recent Economic Recession

The economic recession that recently affected most European countries has led to a worsening of the mental health situation in the general population and an associated rise in outpatient psychiatric care. The aim of this study was to analyse the socio-demographic, clinical and assistential features of the demand for specialist mental health attention. A descriptive and analytical study was conducted in the period 2011-2015 (N = 1252). The principal relations among variables were analysed by an χ² test, followed by a Z test with Bonferroni's correction. For a global perspective a Multiple Correspondence Analysis was performed. 2 The most frequent disorders were adjustment, anxiety and mood disorders, and in addition there were a large number of patients without diagnosis. The percentage of unemployed or inactive patients was high, as it was for those with a low academic level. The younger patients were more prone to have adjustment disorders, especially among the unemployed ones, while anxiety disorders were more frequent in the patients with jobs. A close association seems to exist between unemployment, low academic level and mental health problems. The high demand for mental health attention reveals a clear need to optimize the utilization of specialized care in mental health.

Potential Work Time Lost Due to Sickness Absence and Presence Among Japanese Workers

OBJECTIVE

The current study aimed to quantify the overall sickness absence and sickness presence in five Japanese companies.

METHODS

Two indicators were calculated: worktime lost rates and average working days lost per employee per annum.

RESULTS

In total, 1.1% of working days per annum were lost due to sick leave. The average number of annual sick-leave days per employee was 2.58. Sickness presence accounted for a total worktime loss of 6.55% and an average of 15.36 work days lost per employee per annum. Overall, employees lost 7.65% of their total working days, or an average of 17.92 days were lost per employee per annum, due to sickness leave and sickness presence combined.

CONCLUSION

Sickness-absence rate among Japanese workers is quite lower than other countries; however, sickness presence is more critical than absenteeism, which is in line with other countries.

The Relationship between Self-Employed Workers' Entrepreneurial Attitude and Health Status

In the new work environment, self-employment as a formula and entrepreneurship as an attitude have gained prominence as a means to foster a more competitive economy and increase employment opportunities. Having an entrepreneurial attitude, in addition to being positive on a work level, can also have positive effects on the health of the entrepreneur. The objective of this study is to analyze the relationship between an entrepreneurial attitude and its influence on the general health of Spanish self-employed workers who possess these skills, compared to those who lack them. A cross-sectional descriptive study was carried out through random sampling of 1148 self-employed professionals throughout Spain from 21 different economic sectors. The results show the existence of a negative relationship between entrepreneurial attitude and age, that is to say, an entrepreneurial attitude decreases with age. With the sex variable, women show less entrepreneurial attitude and with mental health, decreased mental health was shown in those with a greater entrepreneurial attitude. On the other hand, there is a positive linearity between a positive attitude and the social function of the state of health.

Work Disability Trajectories Among Individuals with a Sick-Leave Spell Due to Depressive Episode ≥ 21 Days: A Prospective Cohort Study with 13-Month Follow Up

Background Despite the increasing pattern of sick leave associated with depression in western countries, little is known about future work disability patterns among such sickness absentees. Aim To identify work disability (sick leave and disability pension) trajectories after the 21st day of a sick-leave spell due to depressive episode, and to investigate sociodemographic and morbidity characteristics of individuals in different trajectory groups. Methods This is a prospective cohort study using Swedish nationwide register data. We studied future work disability days (mean net days of sick leave and disability pension per month) among all individuals with a new sick-leave spell due to depressive episode (ICD-10 F32) ≥ 21 days during the first 6 months of 2010 (n = 10,327). Using group-based trajectory modeling, we identified work disability trajectories for the following 13 months. BIC value, group sizes, and average group probability were used to determine number of trajectories. Sociodemographic and morbidity characteristics were compared by χ² tests. Results We identified six trajectories of work disability: "decrease to 0 after 4 months" (43% of the cohort); "decrease to 0 after 9 months" (22%); "constant high" (11%); "decrease, then high increase" (9%); "slow decrease" (9%); and "decrease, then low increase" (6%). Those in the groups "constant high" and "decrease then high increase" were older and had the highest proportion with sick leave the year before. Conclusion A majority of the cohort (65%) had no work disability by the end of follow up. Sociodemographic and morbidity characteristics differed between trajectory groups among people on sick leave due to a depressive episode.

Determinants of Sickness Absence and Return to Work Among Employees with Common Mental Disorders: A Scoping Review

Purpose To present an overview of the existing evidence on prognostic factors of (recurrent) sickness absence (SA) and return to work (RTW) among workers with a common mental disorder (CMD). This scoping review provides information about determinants for SA and RTW, which could be used to develop better interventions aimed at the prevention of SA and promotion of RTW among workers with a CMD. Methods Relevant articles were identified in PubMed, Embase, PsycINFO, PSYNDEX, and SINGLE up to October 2016. In order to be included, studies should provide insight into prognostic factors of SA or RTW of workers with a CMD. We classified all factors according to the domains of the International Classification of Functioning, Disability and Health. Results Our searches identified 2447 possible relevant articles, of which 71 were included for data extraction. There is consistent evidence in ≥3 studies that previous episodes of CMD, higher symptom severity, previous absenteeism, co-morbidity, high job demands, low job control, high job strain, female gender, lower educational level, smoking behavior, and low perceived general health are predictors of SA in people with CMDs. Earlier RTW is consistently predicted by lower symptom severity, having no previous absenteeism, younger age, and positive expectations concerning sick-leave duration or RTW. Conclusions The amount of research on determinants for SA and RTW in workers with CMD has increased dramatically in recent years, although most studies are from the Netherlands and Scandinavia. There are some research gaps identified in this scoping review that need further attention in primary and secondary studies. Based on the summary of the evidence, we provide guidance for policy, practice and research.

The effect of long-term sickness absence on coworkers in the same work unit

After workers take long-term sickness absence due to mental disorders (LTSA-MD), the occupational stress of the coworkers in the same work unit might be affected. The aims of this study were to evaluate the effect of the incident of LTSA-MD on the coworkers' occupational stress. A retrospective cohort study of 16,032 public servants was conducted. The Brief Job Stress Questionnaire (BJSQ) was used, which was administered in 2011 and 2012. To analyze the amount of change in occupational stress, the difference between the scores of the BJSQ scales in 2011 and 2012 was calculated. After adjusting for the baseline BJSQ scales, sex, age, total number of workers, and social support, analysis of covariance of the difference between the BJSQ scales' scores showed that job stressors and stress responses worsened among the coworkers after the incident of LTSA-MD. Social support did not change among the coworkers. This study indicates that an incident of LTSA-MD in the same work unit adversely affects the coworkers' occupational stress. Focusing on the coworkers' mental state after an incident of LTSA-MD in the same work unit and an early intervention strategy are needed to prevent secondary mental illness and sickness absence in the coworkers.

Has the Spanish economic crisis affected the duration of sickness absence episodes?

The global economic crisis has had particularly intense effects on the Spanish labor market. We investigated whether the duration of non-work related sickness absence (SA) episodes in salaried workers had experienced any changes before and after the crisis started. This was a repeated cross-sectional analysis conducted in a dynamic cohort in 2006 and 2010. Database was provided by eight mutual insurance companies, covering 983,108 workers and 451,801 SA episodes. Descriptive analysis and crude, bivariate and multivariate analyses using Cox proportional hazards modeling were performed, to quantify the changes in duration of SA episodes between 2006 and 2010, stratified by sex. There was a higher number of episodes in 2010 for both sexes, but especially for women. Unadjusted median duration in men was similar for both years, while for women it was shorter in 2010. Final multivariate models show a greater risk of longer episode duration for men in 2010 (HR 0.95; 95% CI, 0.95-0.95), but a shorter one for women (HR 1.07; 95% CI, 1.07-1.07). Once the economic crisis started affecting the Spanish labor market, the number of SA episodes in women equalized with those in men. There was a decrease of episodes in the youngest age groups, in the construction and in temporary contracts. The relative ranking of leading diagnoses was similar in both years with an increase in infectious, nervous system and respiratory diseases and in mental disorder episodes for both sexes, but especially for women. The risk of longer episode duration was greater in 2010 among men, but smaller in women.