Understanding depression as a workplace issue: Clarifying employers' attitudes to manage employees with depression

Factors influencing employers' support for employees with acquired brain injuries or mental illness to return to- and stay in work: A qualitative systematic review

BACKGROUND

People with acquired brain injuries (ABIs) often experience residual limitations and co-morbid mental illnesses that restrict work participation. Employers are key in enabling successful return-to-work and job retention.

OBJECTIVE

This review aimed to explore employers' perspectives of factors influencing their support for people with ABIs and/or mental illness to return to- and stay in work. Review questions focused on barriers and facilitators to their support, and contextual characteristics present at the time.

METHODS

Five databases were searched from October 2010 until November 2023 for relevant qualitative studies published in English. Findings from included studies (N = 25) were synthesised using thematic synthesis.

RESULTS

Included studies focused on employees with ABI or mental illness, rather than dually diagnosed ABI and mental illness. Employers' support was influenced by their awareness/knowledge of- and attitudes towards the employee's condition/illness; their skills and experience in supportive strategies; factors related to provision of work accommodations; and stakeholder influence. Similarities and differences in influential factors were observed across the ABI and mental illness literature. Contextual characteristics related to organisational characteristics, cultural taboo, and involvement of certain stakeholders.

CONCLUSIONS

ABI survivors (with and without co-morbid mental illness) and their employers may benefit from specialist support and resources to guide them through the return-to-work process. Further research is needed to investigate employers' knowledge of ABI and mental illness and supportive strategies. Exploration of the influence of other stakeholders, socio-demographic characteristics, and contextual factors on employers' return-to-work and retention support for ABI survivors with co-morbid mental illness is warranted.

An assessment of workplace wellness policies and programs of universities in the Asia-Pacific

BACKGROUND

Universities could positively impact the health and well-being of employees through workplace wellness programs (WWP).

OBJECTIVE

To assess the prevalence of WWP among Asia-Pacific universities, identify gaps and challenges, and solutions to challenges.

METHODS

An online survey was sent to members of the Association of Pacific Rim Universities to assess programs on physical fitness, nutrition/weight, mental health/stress, family support, chronic disease prevention, and safety.

RESULTS

Employees at 28 universities in 13 economies completed the survey on behalf of their university. Most common WWP were paid maternity/paternity leave (89.3% /85.7%), disaster preparedness training (85.7%), fitness challenges (78.6%), written policies regarding discrimination/hate speech (75.0%), and quiet rest areas (71.4%). However, few addressed childcare, breastfeeding support, workplace sexual harassment, tobacco use, or mental health. Programs rarely aligned with the reported goal of increasing employee morale, but instead resulted from government mandates. Many universities offered sporadic, one-off programs but lacked comprehensive, coordinated programming and adequate evaluation procedures. Key challenges were low employee participation, limited budget, and lack of leadership support. This study highlights the need for improved program administration, information dissemination, data collection to evaluate impact, and leadership support.

CONCLUSION

WWP could benefit universities and employees but should be implemented and evaluated as part of a comprehensive campus wellness culture.

A conceptual framework for return to work for clients with major depressive disorder

BACKGROUND

Return to work (RTW) may be a lengthy and complex process for individuals with major depressive disorder (MDD) especially when not well managed. This increases the risk of isolation and loss of routine which negatively influences their mental health. However, for clients with MDD, a comprehensive overview of all the factors that influence RTW based on a model of occupation is lacking.

OBJECTIVE

To develop a conceptual framework to guide an occupation-based process of RTW for clients with MDD, treated in the private sector in South Africa.

METHODS

This paper describes the development of a conceptual framework using literature and thematic synthesis of a qualitative descriptive study based on interviews with eight participants diagnosed with MDD which were linked to constructs of Kielhofner's Model of Human Occupation (MOHO).

RESULTS

Qualitative data from key informant interviews were deductively analysed according to the subsystems of MOHO for waiting to RTW and experience of RTW. The conceptual framework developed included the constructs of Person and Occupational Setting from MOHO as well as the components of Occupational Identity and Competence central to intervention to achieve successful RTW.

CONCLUSION

A successful RTW process for clients with MDD is dependent on the person and the occupational setting. The role of the occupational therapist in the RTW can be facilitated by the occupation-based conceptual framework developed on MOHO.

Quality of life, sense of coherence and occupational balance one year after an occupational therapy intervention for people with depression and anxiety disorders

BACKGROUND

Quality of life (QOL), sense of coherence (SOC) and occupational balance (OB) have been found to increase after rehabilitation among people living with depression and anxiety. However, these aspects have not been investigated over time in participants with different paid work situations, such as being on sick leave or not.

OBJECTIVE

To describe and compare the self-rated QOL, SOC and OB after participation in occupational therapy in three groups of people with depression and anxiety disorders based on their work situation during the study period: continuous sick leave, return to work and continuous work.

METHODS

Forty-seven women and seven men, 19-60 years old with depression and anxiety were followed over time. They completed questionnaires on QOL, SOC and OB on four occasions. Data were analyzed with non-parametric statistics.

RESULTS

No statistically significant differences between the groups were identified. All groups improved in at least one of the studied areas over time: the sick leave group in OB; the return-to-work group in QOL and OB; and the Work group in QOL and SOC.

CONCLUSION

The results indicate variations in QOL, SOC and OB between people with different work situations over time after occupational therapy. Studies with larger samples are, however, warranted.

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.

The Capacity Note: a communication facilitator in the sick leave process of patients with common mental disorders - a qualitative study of user perceptions

OBJECTIVES

To describe the development of a communication facilitator, the Capacity Note, for the sick leave process of patients with common mental disorders (CMDs) in primary care, and to explore users' perceptions of it.

DESIGN

Qualitive study.

SETTING

Primary healthcare in Region Västra Götaland, Sweden.

PARTICIPANTS AND METHODS

The Capacity Note was developed inductively based on data from six qualitative studies of work capacity and CMD and was introduced at primary healthcare centres during 2018-2019. Individual semistructured interviews were performed with 13 informants (8 patients, 2 general practitioners and 3 managers) who had used the Capacity Note at least once. Interviews were audiorecorded and transcribed verbatim and inductive manifest qualitative content analysis was used to analyse the data.

RESULTS

The Capacity Note comprised questions about work situation, work capacity limitations and possible work adjustments. Based on the interviews, four categories relating to its role as a facilitator for communication about work and health were identified: content and format, understanding, legitimacy and action, openness and timing, and time and efficiency. The participants considered the Capacity Note relevant and easy to use, and as having the potential to improve communication about and understanding of the patient's situation. The increased understanding was perceived as contributing to a sense of legitimacy and agency. Achieving these benefits required, according to the participants, openness, an investment of time and using the Capacity Note at the right time in the sick leave process.

CONCLUSION

The Capacity Note was found to be relevant and as having, under the right conditions, the potential to improve communication and facilitate the sick leave process.

'Work is a motivator in life' Strategies in managing work participation among highly educated employees with depression

BACKGROUND

Work participation among employees with depression is hampered due to cognitive impairments. Although studies show higher levels of work disability among people with a lower education, highly educated employees may encounter specific challenges in fulfilling their work role due to the cognitive impairments of depression, as they often perform cognitively demanding jobs. There is little knowledge about their challenges and opportunities with regard to work participation.

OBJECTIVE

To investigate how highly educated employees with depression manage work participation by focusing on their views on opportunities and challenges in fulfilling their work role.

METHODS

Eight individual interviews with highly educated employees with depression were conducted. Transcripts were analysed using qualitative content analysis.

RESULTS

The analysis revealed four categories: struggling with acknowledging depression and disclosure; fear of being stigmatised at work; work is a motivator in life; and striving to fulfil the work role at the expense of private life activities.

CONCLUSIONS

Highly educated employees with depression need guidance regarding the disclosure of information about health issues and work ability. To successfully manage their work role, they need a clear plan with outlined tasks, demands and goals. Healthcare professionals and workplaces should support them in setting limits with regard to work tasks and working hours.