Factors Associated With Time to Achieve Employment Through Occupational Support Programs in Patients With Mood Disorders: 1 Year Naturalistic Study

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.

Effects of a rework program in a university hospital and predictors of work restoration and maintenance in the participants

During sickness absence, it appears necessary for psychiatric patients suffering from depression or bipolar disorder to undergo a psychiatric rehabilitation called the rework program that aids in work restoration and maintenance. However, few studies have investigated the effects of such a program and predictors of work restoration and maintenance in the participants. Here, we aimed to investigate the effects of a rework program as well as to examine whether cognitive function and mental state at the end of the rework program predict the probability of work restoration and maintenance and whether the frequency of rework program participation predicts successful work restoration and maintenance. The rework program included both patients absent from work and unemployed patients. Patients completed assessments including Trail Making Test Type B (TMT-B), the Wisconsin Card Sorting Test, and the Social Adaptation Self-Evaluation Scale just before graduating from the rework program. Simultaneously, their depressive state was assessed using the Hamilton Depression Rating scale. The patients were divided into the job group, comprising 94 patients who were able to restore their work or get a new job, and the non-job group, comprising 34 patients who were not able to do so. We found that the program was more effective in patients absent from work than in unemployed patients, TMT-B could predict work restoration and maintenance, and the frequency of rework program participation could predict work restoration but not work maintenance. Based on the findings, we propose "Yamashita's criterion" where a TMT-B completion time of 70 s is the cut-off point for work restoration. The present findings may provide useful evidence that could aid in the further development of rework program(s).