Mental health and related disability among workers: a population-based study

Three-year course of clinical high-risk symptoms for psychosis in the community: a latent class analysis

AIMS

Clinical high-risk for psychosis (CHR-P) states exhibit diverse clinical presentations, prompting a shift towards broader outcome assessments beyond psychosis manifestation. To elucidate more uniform clinical profiles and their trajectories, we investigated CHR-P profiles in a community sample.

METHODS

Participants (N = 829; baseline age: 16-40 years) comprised individuals from a Swiss community sample who were followed up over roughly 3 years. latent class analysis was applied to CHR-P symptom data at baseline and follow-up, and classes were examined for demographic and clinical differences, as well as stability over time.

RESULTS

Similar three-class solutions were yielded for both time points. Class 1 was mainly characterized by subtle, subjectively experienced disturbances in mental processes, including thinking, speech and perception (basic symptoms [BSs]). Class 2 was characterized by subthreshold positive psychotic symptoms (i.e., mild delusions or hallucinations) indicative of an ultra-high risk for psychosis. Class 3, the largest group (comprising over 90% of participants), exhibited the lowest probability of experiencing any psychosis-related symptoms (CHR-P symptoms). Classes 1 and 2 included more participants with functional impairment and psychiatric morbidity. Class 3 participants had a low probability of having functional deficits or mental disorders at both time points, suggesting that Class 3 was the healthiest group and that their mental health and functioning remained stable throughout the study period. While 91% of Baseline Class 3 participants remained in their class over time, most Baseline Classes 1 (74%) and Class 2 (88%) participants moved to Follow-up Class 3.

CONCLUSIONS

Despite some temporal fluctuations, CHR-P symptoms within community samples cluster into distinct subgroups, reflecting varying levels of symptom severity and risk profiles. This clustering highlights the largely distinct nature of BSs and attenuated positive symptoms within the community. The association of Classes 1 and 2 with Axis-I disorders and functional deficits emphasizes the clinical significance of CHR-P symptoms. These findings highlight the need for personalized preventive measures targeting specific risk profiles in community-based populations.

Comparing mental health and well-being of US undergraduate and graduate students during the early stages of the COVID-19 pandemic

Objective: This study explored how COVID-related mental health and well-being varied between undergraduate and graduate students. Relationships with physical health behaviors were also examined. Participants: Undergraduate (n = 897) and graduate (n = 314) students were recruited from three US universities between mid-April and late-May 2020. Methods: Participants in this cross-sectional survey self-reported perceived stress, financial stress, resilience, repetitive negative thinking, mood, anxiety, diet, sleep, and physical activity using validated instruments. Results: Undergraduate students reported more perceived stress, more repetitive negative thinking, less positive mood, and less support from professors than graduate students. Perceived stress, repetitive negative thinking, negative mood, and anxiety increased among all students (p < .05 for all). Correlations between mental health outcomes and physical health behaviors were weak to moderate (r = .08 to .49). Conclusions: College students, particularly undergraduates, perceived negative mental health impacts during COVID. Creative approaches for meeting student needs are necessary.

Effectiveness of Internet-based cognitive behavioural therapy for employees with depression: a systematic review and meta-analysis

Objectives. The effectiveness of Internet interventions for employees with depressive disorder remains controversial. We summarized all available evidence exploring the role of Internet interventions in reducing employees' depressive symptoms. Methods. This study was a comprehensive systematic review and meta-analysis that included acceptability and preliminary feasibility studies. We excluded programme descriptions, discussion articles and study protocols. We followed the PRISMA guidelines and searched MEDLINE, EMBASE, PsycINFO, the Cochrane Library and Web of Science from database inception to May 2021 for articles published in English. We extracted data concerning demographics, intervention format, including Internet interventions, control group conditions and outcome measures. We used a random-effects model and calculated Hedges' g values for the scores of employees receiving Internet interventions versus control conditions. This systematic review is registered as INPLASY202160082. Results. Data from 19 studies were included. These 19 studies included 5898 participants (2813 participants received Internet interventions, 3085 participants were in control groups). Conclusions. The findings suggest that Internet interventions can be effective in improving depression in employees. However, more randomized controlled trials are needed to provide better evidence regarding Internet interventions for employees with depression, and robust studies are needed to observe the effectiveness of Internet interventions.

Depression symptoms reducing return to work: a meta-analysis of prospective studies

Objectives. This study was conducted to estimate the risk of return to work for people who experience symptoms of depression based on the pool of prospective data. Methods. All online articles in PubMed and Scopus which were accessible before November 2019 were searched. The odds ratios of each of the studies were pooled together to obtain an overall odds ratio. The pool of studies was with random effects. The analysis was performed based on the depression symptoms scale, type of disease and duration of follow-up. Two other aspects were examined in the analysis, one being the bias in the publication of studies and the other being the level of heterogeneity that was examined. Results. Thirty-five studies were selected for the meta-analysis. The pooled odds ratio indicates that the odds of return to work in people with depressive symptoms is 31% lower than in those without depressive symptoms. The funnel plot shows that there is asymmetry. The Egger test result was significant (p < 0.001) and there is publication bias. Conclusion. Depression symptoms after sick leave due to physical illness is a risk factor for not returning to work.

Breakfast skipping alone and in interaction with inflammatory based quality of diet increases the risk of higher scores of psychological problems profile in a large sample of Iranian adults

The authors investigate the association of breakfast skipping and its interaction with a dietary inflammatory index (DII) with the severity of psychological disorders. A total of 2876 Iranian general adults were enrolled in this cross-sectional study. Psychological problems profile score was calculated using the regression method in the framework of factor analysis based on depression, anxiety and psychological distress. The higher scores indicate more severity of mental problem. The frequency of breakfast eating in a week was assessed. Dietary intakes were assessed using a food-frequency questionnaire and twenty-seven items were included in the calculation of DII. In the crude model, individuals who ate breakfast seldom had the highest odds for having worse psychological problems profile (OR 3⋅59; 95 % CI 2⋅52, 5⋅11). Adjustment for various confounders did not change the associations (OR 3⋅35; 95 % CI 2⋅11, 5⋅32). In the adjusted multinomial logistic regression model, participants with high DII (>median) who skipped breakfast had highest risk of being in the higher tertiles of psychological problems profile compared with those who had low DII (<median) and ate breakfast (OR 6⋅67; 95 % CI 3⋅45, 12⋅90). Similar results were observed in women and men regarding the impact of breakfast skipping alone and interaction with DII on scores of psychological problems profile. Breakfast skipping is associated with higher risk of psychological problems. Similar findings were obtained in the stratified analysis by sex. Our findings confirmed that the DII and breakfast skipping are associated with mental health, interactionally. Further longitudinal studies are needed to confirm the true link between breakfast skipping and psychological problems.

Toward Effective Work Accommodations for Depression: Examining the Relationship Between Different Combinations of Depression Symptoms and Work Productivity Losses

OBJECTIVE

Heterogeneity of depression experiences has led to suggestions that interventions focus on depression symptom combinations rather than depression severity alone. Our analyses explore the question, "What is the relationship between different combinations of depression symptoms and work productivity losses?"

METHODS

These analyses use a population-based sample of 2219 working adults. Using the PHQ-8 items, cluster analysis methods were used to identify depression symptom clusters. The Work Limitations Questionnaire's four work productivity loss dimensions were regressed on the identified depression symptoms clusters.

RESULTS

The symptoms clusters of workers with mild to moderate depression had significant but similar work productivity losses. However, the symptom combinations within these clusters of workers varied.

CONCLUSION

To create effective work accommodations, attention should focus on the combinations of depression symptoms and specific job characteristics rather than severity alone.

Associations of psychosis-risk symptoms with quality of life and self-rated health in the Community

BACKGROUND

Understanding factors related to poor quality of life (QoL) and self-rated health (SRH) in clinical high-risk (CHR) for psychosis is important for both research and clinical applications. We investigated the associations of both constructs with CHR symptoms, axis-I disorders, and sociodemographic variables in a community sample.

METHODS

In total, 2683 (baseline) and 829 (3-year follow-up) individuals of the Swiss Canton of Bern (age-at-baseline: 16-40 years) were interviewed by telephone regarding CHR symptoms, using the Schizophrenia Proneness Instrument for basic symptoms, the Structured Interview for Psychosis-Risk Syndromes for ultra-high risk (UHR) symptoms, the Mini-International Neuropsychiatric Interview for current axis-I disorders, the Brief Multidimensional Life Satisfaction Scale for QoL, and the 3-level EQ-5D for SRH.

RESULTS

In cross-sectional structural equation modelling, lower SRH was exclusively significantly associated with higher age, male gender, lower education, and somatoform disorders. Poor QoL was exclusively associated only with eating disorders. In addition, both strongly interrelated constructs were each associated with affective, and anxiety disorders, UHR and, more strongly, basic symptoms. Prospectively, lower SRH was predicted by lower education and anxiety disorders at baseline, while poorer QoL was predicted by affective disorders at baseline.

CONCLUSIONS

When present, CHR, in particular basic symptoms are already distressful for individuals of the community and associated with poorer subjective QoL and health. Therefore, the symptoms are clinically relevant by themselves, even when criteria for a CHR state are not fulfilled. Yet, unlike affective and anxiety disorders, CHR symptoms seem to have no long-term influence on QoL and SRH.

Depressive Symptomatology, Presenteeism Productivity, and Quality of Life: A Moderated Mediation Model

: In this study, we intend to test if presenteeism productivity influences the relationship between depressive symptoms and quality of life and also if this relation is conditional upon levels of information processing speed. Data were collected from 231 participants who completed a neuropsychological test and self-reported measures. Results revealed a significant indirect effect and a significant moderation effect. The association between depressive symptoms and presenteeism productivity was moderated by information processing speed only in their medium and high levels. Our findings suggest that individuals with higher levels of processing speed may have more difficulty in focusing on work without being distracted by health problems. The present investigation has made a significant contribution to the existing literature about cognitive function and productivity in workers with depressive symptomatology and its effects on their quality of life.

Feeling better at work! Mental health self-management strategies for workers with depressive and anxiety symptoms

BACKGROUND

The aim of this study was to identify self-management strategies that can be used in a workplace setting by workers living with depression and anxiety.

METHODS

A two-round Delphi study was conducted among three panels of experts: (1) employees living with anxiety or depression (n = 31); (2) managers of employees living with anxiety or depression (n = 12); and (3) researchers with expertise in workplace mental health (n = 15). Participants had to indicate whether each of 60 self-management strategies was applicable at work, and how useful each was for managing their symptoms while working. They could also reformulate or add strategies that were then evaluated in the second round.

RESULTS

A total of 60 existing and new self-management strategies were retained following the two rounds. Most useful strategies refer to the ability to set boundaries, maintain work-life balance, identify sources of stress and create positive relationships with supervisor and colleagues. Panels differed in their assessment of the usefulness of strategies focusing on employees' empowerment.

LIMITATIONS

Most participants were from Canada, limiting the generalizability of the results.

CONCLUSION

The self-management strategies identified in this study should be included in programs focusing on mental health at work and disseminated to employees living with depression and anxiety. Managers should take employee's perspective into account when searching for solutions to help them. Future research should use an inductive approach to identify strategies that are specifically related to the workplace setting. Quantitative studies are also needed to evaluate the effect of such strategies on work functioning.

Association of derived patterns of musculoskeletal disorders with psychological problems: a latent class analysis

Background

Musculoskeletal symptoms often occur in more than one anatomical site. The present study aimed to define specific patterns of multisite musculoskeletal disorders and examine how these patterns are related to common psychological problems.

Methods

Using the data from an interview-based health survey of 358 samples of the industrial manufacturing male employees, we derived major patterns of musculoskeletal complaints using latent class analysis and investigated its association with psychological problems score extracted from depression, anxiety, and stress measured by Depression/Anxiety/Stress Scale (DASS-21). Musculoskeletal disorders were assessed by Nordic Musculoskeletal Questionnaire (NMQ). The statistical analysis was carried out by Mplus 8.

Results

Complaints in the lower back (42.1%) and neck (30.7%) had the highest prevalence, and in the hip (15.0%) and ankle (12.2%) the lowest. Three major patterns of musculoskeletal disorders were extracted using latent class analysis. Class 1 (12.9%) was characterized by a high rate of complaints in upper musculoskeletal sites, such as the neck, shoulder, and joints; class 2 (38.2%) was identified by a higher rate of complaints in the lower and upper back; and class 3 (48.9%) was marked by low rates of complaints in all musculoskeletal sites. After adjustment for confounding variables and specifying class 3 as the reference, it turned out that there was a statistically significant association between the psychological problems score and the chance of being in class 1 (OR = 2.47, 95% CI 1.66–3.68), but not a significant association with the chance of being in class 2 (OR = 1.51, 95% CI 0.83–2.72).

Conclusion

Musculoskeletal disorders can be summarized in the latent class-derived patterns in the adult study population and provide additional prognostics. Common psychological problems are significantly associated with the type of musculoskeletal disorder patterns. The findings in this study could be useful for dealing with prevention and treatment programs.

Occupational factors associated with major depressive disorder: A Brazilian population-based study

BACKGROUND

There have been very few studies exploring the occupational risk factors for major depressive disorder (MDD) in the working populations in Latin America. The aim of this study was to explore the associations between a large set of occupational factors and MDD in the Brazilian working population.

METHODS

The study was based on the cross-sectional data from the Brazilian National Health Survey, 2013. 60,202 people were interviewed (response rate: 91.9%). Among them, 36,442 were working, 19,450 men and 16,992 women. MDD was measured using the diagnostic algorithm (DSM-IV criteria) of the PHQ-9. Occupational factors included job characteristics, working time factors, psychosocial work stressors and physico-chemical exposures. Logistic regression models were performed and adjusted for sociodemographic factors. All analyses were conducted using weighted and stratified data by gender.

RESULTS

The following occupational factors were associated with a higher risk of MDD: working part time (≤20 h a week) and stress at work for both genders, workplace violence, intense physical activity, exposure to noise and chemicals among women, and prolonged exposure to sun among men. Associations of stress and violence at work with MDD were particularly strong.

LIMITATIONS

Cross-sectional study design, healthy worker effect and reporting bias may have impacted the results.

CONCLUSIONS

This study, one of the first studies among the Brazilian working population, showed that psychosocial work stressors were the strongest risk factors for MDD. Physico-chemical exposures deserve more attention in association with MDD. Prevention policies oriented toward the work environment may help to prevent depression at the workplace.

Association between the dietary inflammatory index and common mental health disorders profile scores

BACKGROUND & AIMS

The association between diet and mental health disorders might be mediated by inflammatory properties of the diet. We evaluated the association between the dietary inflammatory index (DII) and the risk of a worsened mental health disorders profile.

METHODS

A total of 3363 Iranian adults were included in this cross-sectional study. A mental health disorders profile score was calculated using regression analysis, within the framework of factor analysis, based on anxiety, depression and psychological distress, with a higher scores indicating greater severity of mental problems. Dietary intakes were assessed using a validated dish-based food frequency questionnaire (DFQ). Twenty-seven macro- and micro-nutrients, onions, tea and caffeine were included in the calculation of DII. Each of them received a score based on their inflammatory ability, thus, a greater DII indicated a more pro-inflammatory diet. The odds of being in the highest tertile of mental health disorders profile across the tertiles of DII was assessed using multinomial logistic regression.

RESULTS

Either in the crude or fully-adjusted multinomial logistic regression models, participants in the lowest tertile of DII had a lower risk for being in the top tertile of mental health disorders profile (adjusted model: OR: 0.45; 95% CI: 0.33, 0.60; P trend<0.001). In a stratified analysis by sex, similar findings were observed in both genders, although there was only a trend for the associations to be significant in men (men: OR: 0.53; 95% CI: 0.31, 0.90; P trend = 0.070; women: OR: 0.40; 95% CI: 0.27, 0.58; P trend<0.0001).

CONCLUSIONS

Our findings suggest a direct association between the pro-inflammatory properties of the diet and an increased risk of higher mental health disorders profile scores. Prospective dietary intervention studies and observational prospective cohorts are required to confirm these findings.

Association of stressful life events and psychological problems profile: Results from a large-scale cross-sectional study among Iranian industrial employees using Bayesian quantile structural equation model

Objectives: The current study aimed at evaluating the major domains of stressful life events and their association with psychological problems profile in a large sample of Iranian industrial manufacturing employees. Methods: In a cross-sectional study, 3,063 participants were randomly selected from 16,000 employees working in a big industrial company in Isfahan, Iran. Three common psychological problems i.e. depression, anxiety and psychological distress were evaluated using Persian validated version of Hospital Anxiety and Depression Scale (HADS) and 12-item General Health Questionnaire (GHQ-12), respectively. Self-perceived frequency and intensity of stressful life events were measured by stressful life event (SLE) questionnaire. Bayesian quantile structural equation model in R free statistical software (version 3.4) was used for evaluating the association of stressful life events and levels of psychological problems profile. Results: Using factor analysis, two major domains i.e. socioeconomic and personal stressors were derived from 11 life stressors and a unified measure i.e. psychological problem profile was extracted from three common psychological problems. Financial and daily life stressors had the highest and sexual problems showed lowest intensity. Quantile structural equation model revealed that the psychological problems profile scores had stronger association with personal (β: ranging from 0.45, 1.87) than socioeconomics stressors (β: ranging from 0.11, 0.27). The association of socioeconomic stressors was fairly uniform across quantiles of psychological problems scores, while personal stressors showed stronger association in higher quantiles, meaning that employees with higher mental health problems more experienced personal stressors. Conclusions: Life stressors particularly personal showed direct association with intensity of psychological problems in manufacturing employees. Life stressors are more perceived by employees with higher intensity of psychological problems. The results of current study can be useful in planning occupational health programs in order to improve psychological health and job productivity.

The influence of dietary patterns and stressful life events on psychological problems in a large sample of Iranian industrial employees: Structural equations modeling approach

BACKGROUND

Psychological problems affect many employees and their job performance. Although, the association of diet and stress, as modifiable risk factors, with psychological problems have been investigated separately, however their simultaneous impacts have not been studied. The present study aimed at reinvestigating the association of major dietary patterns and stressful life events with intensity of psychological problems in a large sample of Iranian industrial employees.

METHODS

In a cross-sectional study, 3063 employees in an industrial unit in Isfahan, Iran were investigated. Psychological problems profile as a latent construct was extracted from three common psychological problems; depression, anxiety and psychological distress. Depression and anxiety were measured by Persian validated version of Hospital Anxiety and Depression Scale (HADS) and psychological distress by the 12 items General Health Questionnaires (GHQ). Major dietary patterns were derived from a validated short form of semi-quantitative Food Frequency Questionnaire (FFQ) using explanatory factor analysis. Stressful life events dimensions were extracted based on factor analysis, from self-perceived frequency and intensity of Stressful Life Events (SLE) questionnaire. Associations of the obtained factors were investigated in a latent structural modeling framework.

RESULTS

Three dietary patterns i.e. western, traditional and healthy and two stressors dimensions including personal life and socioeconomics were extracted. Greater adherence to healthy diet was protectively associated with psychological problems profile scores (β = -0.54; 95% CI: -0.74, -0.34). Adherence to western (β = 0.23; 95% CI: 0.02, 0.45) and Iranian traditional (β = 0.48; 95% CI: 0.28, 0.68) dietary patterns were positively associated with higher psychological problems scores in employees. But after adjustment for life stressors only adherence to a healthy diet remained significantly associated with psychological problems profile (β = -0.43; 95% CI: -0.59, -0.27). Also, personal life stressors (β = 0.81; 95% CI: 0.63, 0.99) and socioeconomics stressors (β = 0.12; 95% CI: 0.08, 0.16) had significantly direct association with psychological problems profile scores.

LIMITATIONS

Variables assessment by self-reported questionnaires, not affording causality because of cross sectional design, not adjusting the nutrients intake in association analyses, relatively small sample size of women.

CONCLUSIONS

Life stressors particularly personal stressors have negative direct association with psychological health of employees. Adherence to a healthy diet can be related to improvement of psychological health in employees. The results can be useful in occupational health planning in order to improve mental health and job productivity.

Functioning mediates help-seeking for mental problems in the general population

Aims:

Absent or delayed help-seeking is considered to aggravate the immense personal and societal burden caused by mental disorders. Therefore, we cross-sectionally examined rates and clinical and sociodemographic moderators of early help-seeking for current clinician-assessed non-psychotic mental problems/disorders in the community.

Methods:

Altogether, 2683 individuals of the Swiss Canton Bern (16–40 years old, response rate 63.4%) were interviewed by telephone for current axis-I problems/disorders using the Mini-International Neuropsychiatric Interview, for psychosocial functioning using the Social and Occupational Functioning Assessment Scale, and for help-seeking for mental problems.

Results:

In total, 1122 (41.8%) reported mental problems. Of these, 769 (68.5%) affirmed any one screening question and 353 (31.5%) fulfilled criteria for any current axis-I disorder, and 396 (35.3%) reported any lifetime help-seeking (28.3% sought help in the past and 7.0% were in current treatment). In path analyses, current help-seeking was associated mainly by type and number of mental problems/disorders mediated by functional impairment, in addition to older age, no current partner, and past treatment.

Conclusion:

Our cross-sectional data indicate a gap in help-seeking for mental problems/disorders. The relationship between number of mental problems/disorders and help-seeking mediated by functional impairment confirm that individuals commonly do not seek help until problems are severe enough to cause problems in occupational and psychosocial functioning, driving the already immense costs of mental disorders. Thus, campaigns promoting early help-seeking, including early diagnostic clarification of and support for subthreshold mental problems in terms of an indicated prevention, should focus on psychosocial functioning, aside from signs of mental illness.

Prevalence and clinical relevance of interview-assessed psychosis-risk symptoms in the young adult community

BACKGROUND

An efficient indicated prevention of psychotic disorders requires valid risk criteria that work in both clinical and community samples. Yet, ultra-high risk and basic symptom criteria were recently recommended for use in clinical samples only. Their use in the community was discouraged for lack of knowledge about their prevalence, clinical relevance and risk factors in non-clinical, community settings when validly assessed with the same instruments used in the clinic.

METHODS

Using semi-structured telephone interviews with established psychosis-risk instruments, we studied the prevalence of psychosis-risk symptoms and criteria, their clinical relevance (using presence of a non-psychotic mental disorder or of functional deficits as proxy measures) and their risk factors in a random, representative young adult community sample (N=2683; age 16-40 years; response rate: 63.4%).

RESULTS

The point-prevalence of psychosis-risk symptoms was 13.8%. As these mostly occurred too infrequent to meet frequency requirements of psychosis-risk criteria, only 2.4% of participants met psychosis-risk criteria. A stepwise relationship underlay the association of ultra-high risk and basic symptoms with proxy measures of clinical relevance, this being most significant when both occurred together. In line with models of their formation, basic symptoms were selectively associated with age, ultra-high risk symptoms with traumatic events and lifetime substance misuse.

CONCLUSIONS

Psychosis-risk criteria were uncommon, indicating little risk of falsely labelling individuals from the community at-risk for psychosis. Besides, both psychosis-risk symptoms and criteria seem to possess sufficient clinical relevance to warrant their broader attention in clinical practice, especially if ultra-high risk and basic symptoms occur together.

Une intervention cognitive comportementale de groupe pour prévenir les rechutes chez les employés en processus de retour au travail à la suite d’une dépression : protocole et faisabilité

La dépression est une des causes d’absence maladie (ou arrêt maladie) les plus fréquentes en milieu organisationnel. Plusieurs études se sont intéressées aux facteurs individuels, organisationnels, et ceux relatifs aux interventions qui peuvent prédire le retour au travail des personnes ayant vécu une dépression. Toutefois, peu d’études s’intéressent à la prévention des rechutes de dépression à la suite d’un retour au travail, alors que plus de la moitié des personnes ayant vécu une première dépression est à risque de faire une rechute dans un délai assez court.

Objectif Cet article présente le protocole de recherche relatif à une intervention de groupe novatrice, d’orientation cognitive comportementale, en vue d’optimiser la santé mentale des employés lors de leur retour au travail et ainsi diminuer d’éventuelles rechutes. Nous visons aussi à présenter la faisabilité de cette approche.

Méthode L’étude consiste en un essai pilote randomisé avec groupe contrôle dont la moitié des participants (n= 25) suit l’intervention de groupe et l’autre moitié (n = 25) reçoit les services/interventions usuels. Les bases théoriques et empiriques soutenant l’intervention proposée ainsi qu’une description de l’intervention et des objectifs de l’étude sont ici présentées.

RésultatsNous décrirons succinctement les propos tenus par les participants des deux premières cohortes concernant leur appréciation à l’égard de l’intervention de groupe.

ConclusionEnfin, les retombées d’une telle intervention seront aussi évoquées.

Health and Stress Management and Mental-health Disability Claims

This study examines the associations between health and stress management (HSM) practices and mental-health disability claims. Data from the Salveo study was collected during 2009-2012 within 60 workplaces nested in 37 companies located in Canada (Quebec) and insured by a large insurance company. In each company, 1 h interviews were conducted with human resources managers in order to obtain data on 63 HSM practices. Companies and workplaces were sorted into the low-claims and high-claims groups according to the median rate of the population of the insurer's corporate clients. Logistic regression adjusted for design effect and multidimensional scaling was used to analyse the data. After controlling for company size and economic sector, task design, demands control, gratifications, physical activity and work-family balance were associated with low mental-health disability claims rates. Further analyses revealed three company profiles that were qualified as laissez-faire, integrated and partially integrated approaches to HSM. Of the three, the integrated profile was associated with low mental-health disability claims rates. The results of this study provide evidence-based guidance for a better control of mental-health disability claims. Copyright © 2015 John Wiley & Sons, Ltd.

World Health Organization disability assessment schedule 2.0: An international systematic review

PURPOSE

This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criteria for evaluating relevant international scientific literature. The aims were to establish the extent of international dissemination and use of WHODAS 2.0 and analyze psychometric research on its various translations and adaptations. In particular, we wanted to highlight which psychometric features have been investigated, focusing on the factor structure, reliability, and validity of this instrument.

METHOD

Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a search for publications focused on "whodas" using the ProQuest, PubMed, and Google Scholar electronic databases.

RESULTS

We identified 810 studies from 94 countries published between 1999 and 2015. WHODAS 2.0 has been translated into 47 languages and dialects and used in 27 areas of research (40% in psychiatry).

CONCLUSIONS

The growing number of studies indicates increasing interest in the WHODAS 2.0 for assessing individual functioning and disability in different settings and individual health conditions. The WHODAS 2.0 shows strong correlations with several other measures of activity limitations; probably due to the fact that it shares the same disability latent variable with them. Implications for Rehabilitation WHODAS 2.0 seems to be a valid, reliable self-report instrument for the assessment of disability. The increasing interest in use of the WHODAS 2.0 extends to rehabilitation and life sciences rather than being limited to psychiatry. WHODAS 2.0 is suitable for assessing health status and disability in a variety of settings and populations. A critical issue for rehabilitation is that a single "minimal clinically important .difference" score for the WHODAS 2.0 has not yet been established.

Effects of Social Determinants on Chinese Immigrant Food Service Workers' Work Performance and Injuries: Mental Health as a Mediator

OBJECTIVE

The effects of social discrimination, job concerns, and social support on worker mental health and the influence of mental health on occupational health outcomes have been documented intermittently. We propose an integrated, theory-driven model to distinguish the impact of social determinants on work performance and injuries and the mediating effects of mental health problems.

METHODS

The US Chinese immigrant food service workers (N = 194) completed a multimeasure interview; we tested the integrated model using structural equation modeling.

RESULTS

Mental health problems, which were associated with decreased work performance and increased injuries, also mediated relationships between job/employment concerns and both work performance and injuries but did not mediate the influences of discrimination and social support.

CONCLUSIONS

This research reveals mechanisms by which social determinants influence immigrant worker health, pointing to complementary strategies for reducing occupational health disparities.

Protocol for the atWork trial: a randomised controlled trial of a workplace intervention targeting subjective health complaints

Background

Subjective health complaints, such as musculoskeletal and mental health complaints, have a high prevalence in the general population, and account for a large proportion of sick leave in Norway. It may be difficult to prevent the occurrence of subjective health complaints, but it may be possible to influence employees’ perception and management of these complaints, which in turn may have impact on sick leave and return to work after sick leave. Long term sick leave has many negative health and social consequences, and it is important to gain knowledge about effective interventions to prevent and reduce long term sick leave.

Methods/Design

This study is a cluster randomised controlled trial to evaluate the effect of the modified atWork intervention, targeting non-specific musculoskeletal complaints and mental health complaints. This intervention will be compared to the original atWork intervention targeting only non-specific musculoskeletal complaints. Kindergartens in Norway are invited to participate in the study and will be randomly assigned to one of the two interventions. Estimated sample size is 100 kindergartens, with a total of approximately 1100 employees. Primary outcome is sick leave at unit level, measured using register data from the Norwegian Labour and Welfare Administration. One kindergarten equals one unit, regardless of number of employees. Secondary outcomes will be measured at the individual level and include coping, health, job satisfaction, social support, and workplace inclusion, collected through questionnaires distributed at baseline and at 12 months follow up. All employees in the included kindergartens are eligible for participating in the survey.

Discussion

The effect evaluation of the modified atWork intervention is a large and comprehensive project, providing evidence-based information on prevention of long-term sick leave, which may be of considerable benefit both from a societal, organisational, and individual perspective.

Trial registration

Clinicaltrials.gov: NCT02396797. Registered March 23th, 2015.

Association between serum vitamin D and depressive symptoms among female workers in the manufacturing industry

Background

Vitamin D has been known to maintain the body’s balance of calcium and phosphorus as well as skeletal health. There has been increasing emphasis on the importance of vitamin D as recent studies have been reporting the specific functions of vitamin D in the cerebral nervous system and the association between the level of serum vitamin D and depressive symptoms. However, there is currently a paucity of research investigating the association between serum vitamin D and depressive symptoms in Korean subjects. Consequently, this study has aimed to determine the level of serum vitamin D and explore the association between serum vitamin D and depressive symptoms in Korean female workers.

Method

A medical examination, questionnaire, anthropometric measurements, and a blood test were conducted between February 3 and March 7, 2014 in 1054 subjects among female workers in the manufacturing industry who underwent physical examinations in a university hospital. From this data, we identified the level of serum vitamin D and investigated the association between serum vitamin D deficiency and depressive symptoms.

Results

The average serum vitamin D level of the 1054 subjects was 9.07 ± 3.25 ng/mL, and the number of subjects in the serum vitamin D deficiency group with less than 10 ng/mL was 721 (68.4 %). The odds ratio of the depressive symptom group with a CES-D score of 16 or above being in the deficiency group with a serum vitamin D level less than 10 ng/mL was found to be 1.55 (95 % CI = 1.15–2.07).

Conclusion

68.4 % of female workers in the manufacturing industry were in the deficiency group with serum vitamin D levels less than 10 ng/mL. Additionally, we identified an association between serum vitamin D deficiency and depressive symptoms. In the future, if serum vitamin D deficiency is checked regularly in workers, we expect to achieve better outcomes in managing their depressive symptoms.

Union perceptions of factors related to the return to work of employees with depression

PURPOSE

Between 30 and 60% of the societal cost of depression is due to losses related to decreased work productivity. To date, only a few studies have focused on union perspectives related to factors influencing the return-to-work of employees absent due to depression, despite evidence of the importance of these perspectives. The purpose of this study is to develop a better understanding of union perspectives on the factors surrounding the return-to-work of employees who were absent from work due to depression.

METHODS

In this qualitative study, conducted in Canada (Québec), 23 individuals (union representatives and peer workers) from the three largest unions (mixed industries) in Quebec took part in one of three focus groups.

RESULTS

Fourteen emerging themes (e.g., work environment, attitudes toward depression) were distributed over five categories of stakeholders involved in the return-to-work of employees on sick leave (i.e., employers and immediate supervisors, co-workers, employees on sick leave due to depression, general physicians, and unions). We observed four major cross-cutting themes that arose beyond these five categories: (1) organizational culture in which mental health issues and human aspects of work are central, (2) support and follow-up during the work absence and the return-to-work, (3) lack of resources to assist the employee in the return-to-work, and (4) stakeholders' prejudices and discomfort regarding depression.

CONCLUSIONS

Our results clarify the factors, from a union perspective, that may facilitate or hinder the return-to-work of employees absent from work due to depression.

The multilevel determinants of workers' mental health: results from the SALVEO study

PURPOSE

This study examined the contribution of work, non-work and individual factors on workers' symptoms of psychological distress, depression and emotional exhaustion based on the multilevel determinants of workers' mental health model.

METHODS

Data from the SALVEO Study were collected in 2009-2012 from a sample of 1,954 employees nested in 63 workplaces in the province of Quebec (Canada). Multilevel regression models were used to analyse the data.

RESULTS

Altogether, variables explain 32.2 % of psychological distress, 48.4 % of depression and 48.8 % of emotional exhaustion. Mental health outcomes varied slightly between workplaces and skill utilisation, physical and psychological demands, abusive supervision, interpersonal conflicts and job insecurity are related to the outcomes. Living in couple, having young children at home, family-to-work conflict, work-to-family conflict, strained marital and parental relations, and social support outside the workplace associated with the outcomes. Most of the individual characteristics also correlated with the three outcomes. Importantly, non-work and individual factors modulated the number and type of work factors related to the three outcomes.

CONCLUSION

The results of this study suggest expanding perspectives on occupational mental health that fully recognise the complexity of workers' mental health determinants.

Receiving workplace mental health accommodations and the outcome of mental disorders in employees with a depressive and/or anxiety disorder

OBJECTIVES

To investigate the association between receiving workplace accommodations and the 1-year risk of mood/anxiety disorders.

METHODS

A general population sample of employees in Alberta, Canada, with a prior or current mental disorder (N = 715) was observed for 1 year. Mental disorders were determined on the basis of the Diagnostic and Statistical Manual, 4th revision, criteria.

RESULTS

In participants who needed but did not receive any accommodations, 30.8% had a mood/anxiety disorder 1 year later. Receiving needed accommodations was associated with a lowered risk of 24.5%. Logistic regression showed that the percentage of having accommodation needs met was significantly associated with the risk of a mental disorder 1 year later (odds ratio = 0.27; 95% confidence interval = 0.11 to 0.65).

CONCLUSIONS

Receiving needed accommodations was associated with better outcomes for mental disorders. Studies are needed to confirm the effectiveness of specific accommodations for enhancing the prognosis of mood/anxiety disorders.

Long-term results of a web-based guided self-help intervention for employees with depressive symptoms: randomized controlled trial

Background

Depressive disorders are highly prevalent in the working population and are associated with excessive costs. The evidence for effective worker-directed interventions for employees with depressive symptoms is limited. Treating employees with depressive symptoms via the Internet before they report sick from work could be beneficial and cost saving.

Objective

In this study, we tested the effectiveness over the period of 1 year of a Web-based guided self-help intervention, called Happy@Work, for employees with depressive symptoms who were not on sick leave.

Methods

A two-arm randomized controlled trial comparing a worker-directed, Web-based, guided self-help intervention to care as usual (CAU) was carried out. We recruited employees from 6 companies via the company’s Intranet and by putting up posters. The inclusion criteria were elevated depressive symptoms as measured by a score ≥16 on the Center for Epidemiologic Studies Depression scale (CES-D) and not being on sick leave. The intervention contained 6 lessons and consisted of problem-solving treatment and cognitive therapy. Participants were asked to submit weekly assignments via the website after completion of a lesson and they received feedback from a coach via the website. Self-report questionnaires on depressive symptoms (CES-D; primary outcome), burnout (Maslach Burnout Inventory, MBI), work performance (Health and Work Performance Questionnaire, HPQ), duration of absenteeism, and anxiety (Hospital Anxiety and Depression Scale, HADS; secondary outcomes), were completed at baseline, posttreatment, and at 6-, and 12-month follow-up. Several subgroup and per-protocol analyses were performed.

Results

A total of 231 employees were randomized to either the intervention group (n=116) or to CAU (n=115). Completion of assessments varied between 54%-74%. Improvement in depressive symptoms between baseline and posttreatment was shown in all participants and these effects sustained over time. However, there were no differences between the 2 groups (adjusted regression coefficient=0.46, 95% CI –2.11 to 3.03, P=.72; Cohen’s d=0.05). Differences between groups were also not significant for the secondary outcomes. No subgroups were identified to show differences between the groups, nor did we find a between-group effect in the per-protocol analyses.

Conclusions

This study showed that a worker-directed, Web-based, guided self-help intervention was not more effective than CAU in reducing depressive symptoms among employees with depressive symptoms who were not on sick leave over the period of 1 year. An intervention for this specific target group might not be necessary because the recovery in the CAU group was comparable to the intervention group and sustained over a 12-month period.

Trial Registration

Nederlands Trial Register (NTR): NTR2993; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2993 (Archived by WebCite at http://www.webcitation.org/6PL9pFC0n).

The mental vitality @ work study: effectiveness of a mental module for workers' health surveillance for nurses and allied health care professionals on their help-seeking behavior

OBJECTIVES

To study the effectiveness of a mental module for workers' health surveillance for health care workers.

METHODS

Nurses and allied health care professionals from one organization were cluster-randomized at ward level to an intervention or control group. The intervention included screening for work functioning impairments and mental health complaints. Positively screened workers were invited to visit their occupational physician. Outcome measures, including help-seeking behavior, work functioning, and mental health, were assessed at baseline, 3-month follow-up, and 6-month follow-up.

RESULTS

An effect of study-group × time interaction on help-seeking behavior was found (P = 0.02). Workers in the intervention group showed less work functioning impairments over time than the control group (P = 0.04).

CONCLUSION

The module can be used to stimulate help seeking from the occupational physician and to improve functioning in workers with mild to moderate work functioning, mental health complaints, or both.

TRIAL NUMBER

NTR2786.

Short-term effects of a web-based guided self-help intervention for employees with depressive symptoms: randomized controlled trial

Background

Depressive disorders are highly prevalent in the working population and are associated with excessive costs. The evidence for effective worker-directed interventions for employees with depressive symptoms is limited. Treating employees with depressive symptoms before sick leave via the Internet could be beneficial and cost saving.

Objective

In this study, we developed and tested the effectiveness of a Web-based guided self-help course for employees with depressive symptoms. We report on the posttreatment effectiveness of the intervention.

Methods

This study is a two-arm randomized controlled trial comparing a Web-based guided self-help course to care as usual (CAU). We recruited employees from 6 different companies via the companies’ intranet and posters. The main inclusion criterion was elevated depressive symptoms as measured by a score of ≥16 on the Center for Epidemiological Studies Depression scale (CES-D). The intervention (Happy@Work) was based on problem-solving treatment and cognitive therapy and consisted of 6 weekly lessons. Participants were asked to submit their weekly assignment via the website after completion. They subsequently received feedback from a coach via the website. Self-report questionnaires on depressive symptoms (CES-D; primary outcome), anxiety measured by the Hospital Anxiety and Depression Scale (HADS), burnout measured by the Maslach Burnout Inventory (MBI), and work performance measured by the Health and Work Performance Questionnaire (HPQ; secondary outcomes) were completed at baseline and at posttreatment.

Results

A total of 231 employees were randomized to either the intervention group (n=116) or CAU (n=115).The posttreatment assessment was completed by 171 (74.0%) participants. Both the intervention and the CAU group showed significant improvements in the primary outcome of depressive symptoms, but no differences between the conditions was found (d=0.16, 95% CI –0.10 to 0.41, P=.29). Significant but small effects in favor of the intervention group were found for anxiety symptoms (d=0.16, 95% CI –0.09 to 0.42, P=.04) and exhaustion (d=0.17, 95% CI –0.09 to 0.43, P=.02).

Conclusions

This study showed that a Web-based guided self-help course for employees with depressive symptoms was not more effective in reducing depressive symptoms among employees than CAU. Large improvements in depressive symptoms in the CAU group were unforeseen and potential explanations are discussed.

Prevention of recurrent sickness absence in workers with common mental disorders: results of a cluster-randomised controlled trial

OBJECTIVES

Workers with common mental disorders (CMDs) frequently experience recurrent sickness absence but interventions to prevent this are lacking. The goal of this study was to evaluate the effectiveness of the Stimulating Healthy participation And Relapse Prevention at work intervention in preventing recurrent sickness absence in workers who returned to work after sickness absence due to CMDs.

METHODS

We performed a cluster-randomised controlled trial with 3 months, 6 months and 12 months follow-up. Treatment providers were randomised to either a 2-day training in the Stimulating Healthy participation And Relapse Prevention at work intervention, that is, a problem-solving intervention, or usual care. Primary outcome measures were the incidence of recurrent sickness absence and time to recurrent sickness absence. Secondary outcome measures were mental health complaints, work functioning and coping behaviour.

RESULTS

80 participants were randomised in the intervention group and 78 in the control group. The adjusted OR for the incidence of recurrent sickness absence was 0.40 (95% CI 0.20 to 0.81) and the adjusted HR for time to recurrent sickness absence was 0.53 (95% CI 0.33 to 0.86) for the intervention group compared with care as usual.

CONCLUSIONS

This study demonstrates the 12-month effectiveness of a problem-solving intervention for reducing recurrent sickness absence in workers with CMDs and emphasises the importance of continuous attention in the post return to work phase for workers who have been on sickness absence due to CMDs.

Impact of social discrimination, job concerns, and social support on Filipino immigrant worker mental health and substance use

BACKGROUND

The personal and social impact of mental health problems and substance use on workforce participation is costly. Social determinants of health contribute significantly to health disparities beyond effects associated with work. Guided by a theory-driven model, we identified pathways by which social determinants shape immigrant worker health.

METHOD

Associations between known social determinants of mental health problems and substance use (social discrimination, job and employment concerns, and social support) were examined using structural equation modeling in a sample of 1,397 immigrants from the Filipino American Community Epidemiological Study.

RESULTS

Social discrimination and low social support were associated with mental health problems and substance use (P < 0.05). Job and employment concerns were associated with mental health problems, but not substance use.

CONCLUSIONS

The integration of social factors into occupational health research is needed, along with prevention efforts designed for foreign-born ethnic minority workers.

Economic evaluation of a problem solving intervention to prevent recurrent sickness absence in workers with common mental disorders

Objectives

Workers with common mental disorders (CMDs) frequently experience recurrent sickness absence but scientifically evaluated interventions to prevent recurrences are lacking. The objectives of this study are to evaluate the cost-effectiveness and cost-benefit of a problem solving intervention aimed at preventing recurrent sickness absence in workers with CMDs compared to care as usual.

Methods

An economic evaluation was conducted alongside a cluster-randomised controlled trial with 12 months follow-up. Treatment providers were randomised to either a 2-day training in the SHARP-at work intervention, i.e. a problem solving intervention, or care as usual. Effect outcomes were the incidence of recurrent sickness absence and time to recurrent sickness absence. Self-reported health care utilisation was measured by questionnaires. A cost-effectiveness analysis (CEA) from the societal perspective and a cost-benefit analysis (CBA) from the employer’s perspective were conducted.

Results

The CEA showed that the SHARP-at work intervention was more effective but also more expensive than care as usual. The CBA revealed that employer’s occupational health care costs were significantly higher in the intervention group compared to care as usual. Overall, the SHARP-at work intervention showed no economic benefit compared to care as usual.

Conclusions

As implementation of the SHARP-at work intervention might require additional investments, health care policy makers need to decide if these investments are worthwhile considering the results that can be accomplished in reducing recurrent sickness absence.

The relationship between depressive symptoms among female workers and job stress and sleep quality

OBJECTIVE

Recently, workers' mental health has become important focus in the field of occupational health management. Depression is a psychiatric illness with a high prevalence. The association between job stress and depressive symptoms has been demonstrated in many studies. Recently, studies about the association between sleep quality and depressive symptoms have been reported, but there has been no large-scaled study in Korean female workers. Therefore, this study was designed to investigate the relationship between job stress and sleep quality, and depressive symptoms in female workers.

METHODS

From Mar 2011 to Aug 2011, 4,833 female workers in the manufacturing, finance, and service fields at 16 workplaces in Yeungnam province participated in this study, conducted in combination with a worksite-based health checkup initiated by the National Health Insurance Service (NHIS). In this study, a questionnaire survey was carried out using the Korean Occupational Stress Scale-Short Form(KOSS-SF), Pittsburgh Sleep Quality Index(PSQI) and Center for Epidemiological Studies-Depression Scale(CES-D). The collected data was entered in the system and analyzed using the PASW (version 18.0) program. A correlation analysis, cross analysis, multivariate logistic regression analysis, and hierarchical multiple regression analysis were conducted.

RESULTS

Among the 4,883 subjects, 978 subjects (20.0%) were in the depression group. Job stress(OR=3.58, 95% CI=3.06-4.21) and sleep quality(OR=3.81, 95% CI=3.18-4.56) were strongly associated with depressive symptoms. Hierarchical multiple regression analysis revealed that job stress displayed explanatory powers of 15.6% on depression while sleep quality displayed explanatory powers of 16.2%, showing that job stress and sleep quality had a closer relationship with depressive symptoms, compared to the other factors. The multivariate logistic regression analysis yielded odds ratios between the 7 subscales of job stress and depressive symptoms in the range of 1.30-2.72 and the odds ratio for the lack of reward was the highest(OR=2.72, 95% CI=2.32-3.19). In the partial correlation analysis between each of the 7 subscales of sleep quality (PSQI) and depressive symptoms, the correlation coefficient of subjective sleep quality and daytime dysfunction were 0.352 and 0.362, respectively.

CONCLUSION

This study showed that the depressive symptoms of female workers are closely related to their job stress and sleep quality. In particular, the lack of reward and subjective sleep factors are the greatest contributors to depression. In the future, a large-scale study should be performed to augment the current study and to reflect all age groups in a balanced manner. The findings on job stress, sleep, and depression can be utilized as source data to establish standards for mental health management of the ever increasing numbers of female members of the workplace.

Web-based guided self-help for employees with depressive symptoms (Happy@Work): design of a randomized controlled trial

BACKGROUND

Depressive disorders are highly prevalent in the working population and are associated with excessive costs for both society and companies. Effective treatment for employees with depressive symptoms in occupational health care is limited. The purpose of this study is to investigate the effectiveness and cost-effectiveness of an indicated preventive web-based guided self-help course for employees with depressive symptoms.

METHODS

The study is a two-arm randomized controlled trial comparing a web-based guided self-help course with care-as-usual. The self-help course consists of 6 weekly lessons. Weekly support will be provided by a coach via the website. Subjects in the care-as-usual group do not receive any treatment in addition to regular care. 200 white collar workers from several national and international companies in the Netherlands will be recruited via different methods such as banners on the company's intranet, pamphlets and posters. Subjects will be included when they: have elevated depressive symptoms (score ≥16 on the Center for Epidemiologic Studies Depression scale), are 18 years of age or older, have access to the Internet and can be contacted via e-mail. Exclusion criteria are: partial or full work absenteeism, a legal labor dispute with the employer and receiving treatment from the company's occupational health care at study entrance.The primary outcome is depressive symptoms. Secondary outcomes include work absenteeism, work performance, burnout, anxiety, quality of life, health care use and production losses. Outcome data will be collected at 8 weeks, 6 months, and 12 months after baseline. Analyses will be based on the intention-to-treat principle. The cost-effectiveness analyses will be performed from a societal and a company's perspective. A process evaluation will be conducted alongside the study.

DISCUSSION

This study evaluates the effectiveness and cost-effectiveness of a web-based guided self-help course for employees with depressive symptoms. This study could stimulate the use of e-mental health interventions in the worksite setting.

TRIAL REGISTRATION

Nederlands Trial Register (NTR): TC2993.

The association of treatment of depressive episodes and work productivity

OBJECTIVE

About one-third of the annual $51 billion cost of mental illnesses is related to productivity losses. However, few studies have examined the association of treatment and productivity. The purpose of our research is to examine the association of depression and its treatment and work productivity.

METHODS

Our analyses used data from 2737 adults aged between 18 and 65 years who participated in a large-scale community survey of employed and recently employed people in Alberta. Using the World Health Organization's Health and Work Performance Questionnaire, a productivity variable was created to capture high productivity (above the 75th percentile). We used regression methods to examine the association of mental disorders and their treatment and productivity, controlling for demographic factors and job characteristics.

RESULTS

In the sample, about 8.5% experienced a depressive episode in the past year. The regression results indicated that people who had a severe depressive episode were significantly less likely to be highly productive. Compared with people who had a moderate or severe depressive episode who did not have treatment, those who did have treatment were significantly more likely to be highly productive. However, about one-half of workers with a moderate or severe depressive episode did not receive treatment.

CONCLUSIONS

Our results corroborate those in the literature that indicate mental disorders are significantly associated with decreased work productivity. In addition, these findings indicate that treatment for these disorders is significantly associated with productivity. Our results also highlight the low proportion of workers with a mental disorder who receive treatment.

Factors associated with disability and depressive symptoms among individuals with diabetes: a community study in Quebec

BACKGROUND

The prevalence of diabetes in Canada is increasing. Multiple factors have been identified in the development of disability in diabetic patients, but the interaction of those risk factors is not clear.

OBJECTIVE

The purpose of this paper was to assess the association between diabetes severity, health behavior, socioeconomic status, social support, depression, and disability simultaneously in a population-based study of individuals with diabetes in Quebec, Canada.

METHOD

Random digit dialing was used to select a sample of 2,003 adults with self-reported diabetes in Quebec. Health status was assessed by the World Health Organization Disability Assessment Schedule II and the CDC Healthy Days Measures. The Patient Health Questionnaire (PHQ-9) was used to assess depression. Potential risk factors included diabetes severity, social support, socioeconomic status, and health behavior factors. Structural equation models were used to identify risk factors that contributed to both depressive symptoms and disability.

RESULTS

The prevalence of major and minor depression was 8.7% and 10.9%, respectively, while the prevalence of severe disability was 6.7%. Diabetes severity and health behavior factors were associated with both depression and disability. Social support was associated with depression for women but not for men.

DISCUSSION

Our results suggest a complex interaction between health behavior factors, diabetes severity, social support, depression, and disability. Behavioral factors and diabetes-specific factors might have a direct effect on both depression and physical functioning.

Does job strain interact with psychosocial factors outside of the workplace in relation to the risk of major depression? The Canadian National Population Health Survey

OBJECTIVES

To investigate whether job strain interacts with psychosocial factors outside of the workplace in relation to the risk of major depression and to examine the roles of psychosocial factors outside of the workplace in the relationship between job strain and the risk of major depression.

METHODS

Data from the longitudinal cohort of the Canadian National Population Health Survey (NPHS) were used. Major depressive episode (MDE) in the past 12 months was assessed by the Composite International Diagnostic Interview-Short Form. Participants who were working and who were between the ages of 18 and 64 years old in 2000/2001 (n = 6,008) were followed to 2006/2007. MDE that occurred from 1994/1995 to 2000/2001 were excluded from the analysis.

RESULTS

High job strain, negative life events, chronic stress and childhood traumatic events were associated with the increased risk of MDE. There was no evidence that job strain interacted with psychosocial factors outside of the workplace in relation to the risk of MDE. The incidence proportion in participants who reported having exposed to none of the stressors, one type of stressor, two types of stressors and three or more types of stressors was 2.6, 4.3, 6.6 and 14.2%, respectively. The odds of developing MDE in participants who were exposed to three or four types of stressors was more than four times higher than the reference group.

CONCLUSION

MDE may be facilitated by simultaneous exposure to various stressors. There is a dose-response relationship between the risk of MDE and the number of stressors.

A systematic review of functioning in vocational rehabilitation using the International Classification of Functioning, Disability and Health

BACKGROUND

Vocational rehabilitation (VR) is aimed at engaging or re-engaging individuals with work participation and employment. The International Classification of Functioning, Disability and Health (ICF) by the World Health Organization can be operationalized in the context of VR. The objective of this study is to review the literature to identify outcomes or measures being used in VR using a systematic review methodology and link those measures to the ICF.

METHODS

We applied a structured search strategy using multiple databases. Items or constructs of the measures or outcomes identified were linked to the ICF by two trained individuals.

RESULTS

We have identified 648 measures which contained 10,582 concepts that were linked to the ICF which resulted in 87 second-level ICF categories. Out of the 87 categories, 31 (35.6%) were related to body functions, 43 (49.4%) were related to activities and participation, and 13 (14.9%) were related to environmental factors. No category was related to body structures.

CONCLUSIONS

Our review found great diversity in the ICF contents of the measures used in different VR settings and study populations, which indicates the complexity of VR. This systematic review has provided a list of ICF categories which could be considered towards a successful VR.

Identification of relevant ICF categories in vocational rehabilitation: a cross sectional study evaluating the clinical perspective

INTRODUCTION

Vocational rehabilitation (VR) emphasizes a need for medical support, rehabilitation and biopsychosocial approach to enable individuals to successfully participate in the workforce. Optimal rehabilitation management relies on an in-depth knowledge of the typical spectrum of problems encountered of patients in VR. The International Classification of Functioning, Disability and Health (ICF) is based on a universal conceptual model and provides a holistic view of functioning of the lived experience of people such as those undergoing VR. The objectives of this study are to describe the functioning and health of persons undergoing VR and to identify the most common problems around work and in VR using the ICF as the reference framework.

METHODS

An empirical cross-sectional multicenter study was conducted using convenience sampling from March 2009 to March 2010. Data were collected using a Case Record Form rated by health professionals which was based on an extended version of the ICF Checklist containing 292 ICF categories and sociodemographic information.

RESULTS

152 patients with various health conditions participated. We identified categories from all four ICF components: 24 for body functions, six for body structures, 45 for activities and participation, and 25 for environmental factors.

CONCLUSIONS

Our study identified a multitude of ICF categories that describe functioning domains and which represent the complexity of VR. Such a comprehensive approach in assessing patients in VR may help to understand and customize the process of VR in the clinical setting and to enhance multidisciplinary communication.

An international expert survey on functioning in vocational rehabilitation using the International Classification of Functioning, Disability and Health

BACKGROUND

Vocational rehabilitation (VR) is a key process in work disability (WD) management which aims to engage or re-engage individuals to work and employment. The International Classification of Functioning, Disability and Health (ICF) by the World Health Organization (WHO) can be interfaced with VR but there is a lack of evidence of what ICF contents experts in the field consider. The objective of this study is to survey the experts in the VR field with regard to what factors are considered important to patients participating in VR using the ICF as the language to summarize the results.

METHODS

An internet-based survey was conducted with experts from six WHO Regions (Africa, the Americas, Eastern Mediterranean, Europe, South-East Asia, and Western Pacific). Experts were asked six open-ended questions on factors that are important in VR. Each question was related to a component of the ICF (body functions, body structures, activities and, environmental factors, and personal factors). Responses were linked to the ICF.

RESULTS

Using a modified stratified randomized sampling, 201 experts were sent the survey and 151 experts responded (75% response rate). We identified 101 ICF categories: 22 (21.8%) for body functions, 13 (12.9%) for body structures, 36 (35.6%) for activities and participation, and 30 (29.7%) for environmental factors.

CONCLUSIONS

There was a multitude of ICF functioning domains according to the respondents which indicates the complexity of VR. This expert survey has provided a list of ICF categories which could be considered in VR.

Mental health in the workforce: an occupational psychiatric study

BACKGROUND

Prevalence of mental disorders at work is commonly reported on the subclinical level. Data on clinical caseness as to ICD-10 among employees is scarce.

AIMS

(i) To establish the prevalence of psychiatric morbidity in the Danish workforce in large enterprises based on a self-report measure. (ii) To verify the screening results by use of a structured diagnostic interview. (iii) To analyze associations with demographics and work- and health-related characteristics.

METHODS

A two-phase design study was carried out in three Danish counties. Ten large enterprises within private and public sectors participated. A questionnaire was administrated to 1,500 employees. The Present State Examination (PSE) interview was conducted with selected respondents according to their scores on Symptom Checklist 90-revised (SCL-90R) and CAGE.

RESULTS

Nine hundred and seventy six (65%) employees responded. A large proportion (28.6%) was identified as sub-cases and 77 as cases as to ICD-10. Absenteeism and work dissatisfaction were associated with ICD-10 diagnoses.

CONCLUSIONS

Common mental disorders caseness as to ICD-10 provides evidence for the clinical nature of occupational mental health phenomena. There were strong associations between some demographic and work- and health-related factors.

Psychopathology, defence mechanisms, and the psychosocial work environment

BACKGROUND

The body of evidence verifies the predictive value of certain work characteristics for mental health problems and that various levels of adaptation mechanisms are employed when dealing with adversity. Data on the relationships between employees' mental health status, their perceptions of work, and their psychological defences are scarce.

AIMS

To examine the role that personal defences play in the relationship between psychiatric symptoms among working people and their working environment.

METHODS

Nine hundred and seventy six employees (mean age = 42.4 years, SD = 11.3) participated in a questionnaire study that included the Defence Style Questionnaire, the Symptom Checklist 90 revised, and the Copenhagen Psychosocial Questionnaire .

RESULTS

Data showed that greater maturity of psychological defences was associated with higher level of psychological functioning and there were strong associations between presence of psychopathology and the three defence clusters.

RESULT

s indicated a strong positive correlation between the mature defence style and the perception of a satisfactory workplace. There was no interaction between psychopathology and defences in relation to work environment.

CONCLUSION

Psychopathology and defences were significantly associated with work conditions, which could suggest that adaptation mechanisms and psychopathology are two independent forms of adjustment to the rapidly changing world of work.

Work functioning in persons with depressive and anxiety disorders: the role of specific psychopathological characteristics

BACKGROUND

Depressive and anxiety disorders affect work functioning and cause high labour costs.

AIMS

To examine and compare psychopathological characteristics of depressive and anxiety disorders in their effect on work functioning.

METHOD

In 1876 working participants of the Netherlands Study of Depression and Anxiety (NESDA) associations of presence, severity, comorbidity, duration and type of DSM-IV anxiety and depressive disorders with both absenteeism (<2 weeks and >2 weeks) and work performance (reduced and impaired) were assessed.

RESULTS

People with current depressive disorders had 7.10 times greater odds for the risk of >2 weeks work-absence and 5.67 greater odds for the risk of impaired work performance, while persons with current anxiety disorders had 1.84 and 2.13 greater odds for the risk of >2 weeks absence and impaired work performance, respectively. Even when persons were recovered from depressive and anxiety disorders, they still had a higher risk of poor work functioning. Persons with comorbidity, chronic depressive disorder, a generalized anxiety disorder, and more severity of both anxiety and depressive disorder had higher odds for the risk of absenteeism and decreased work performance.

CONCLUSION

Anxiety disorders have significant negative impact on work functioning, although smaller than the effect of depressive disorders. Comorbidity, severity, type and duration of the disorder, differentiate the risk of poor work functioning.

Prevention of recurrent sickness absence among employees with common mental disorders: design of a cluster-randomised controlled trial with cost-benefit and effectiveness evaluation

Background

Common mental disorders, such as depression, anxiety disorder, and adjustment disorder, have emerged as a major public and occupational health problem in many countries. These disorders can have severe consequences such as absenteeism and work disability. Different interventions have been developed to improve the return-to-work of employees with common mental disorders, but still a large proportion of employees experiences health and work problems after their return-to-work. For this reason, the SHARP-at work intervention is developed to prevent a relapse of sickness absence among employees who have returned to work after a period of sickness absence because of common mental disorders. We aim to evaluate the effectiveness, cost-benefit and process of the intervention compared to care as usual.

Methods/Design

The study is designed as a cluster-randomised controlled trial with randomisation at the level of the occupational physician. Employees who have returned to work after a period of sickness absence because of a common mental disorder are included in the study. Employees in the intervention group will receive the SHARP-at work intervention. The intervention focusses on active guidance of employees by occupational physicians during the first weeks of work after sickness absence. Employees in the control group will receive care as usual. Outcomes will be assessed at baseline and at 3, 6, and 12 months follow-up. The primary outcome is cumulative recurrent sickness absence days. Secondary outcome measures are mental health, work functioning, and coping. Adherence to the protocol, communication between stakeholders, and satisfaction with the treatment are the process measures assessed in both study groups. Cost-benefit is calculated from a societal perspective. Finally, prognostic factors for a relapse of sickness absence are investigated.

Discussion

This study goes beyond return-to-work by focussing on the prevention of recurrent sickness absence. The study incorporates not only outcomes on sickness absence and mental health but also on health-related work functioning. The results of this study can contribute to a further development of practice guidelines and the promotion of sustainable work participation.

Trial registration

NTR1963

Feasibility and diagnostic validity of the M-3 checklist: a brief, self-rated screen for depressive, bipolar, anxiety, and post-traumatic stress disorders in primary care

PURPOSE

Mood and anxiety disorders are the most common psychiatric conditions seen in primary care, yet they remain underdetected and undertreated. Screening tools can improve detection, but available instruments are limited by the number of disorders assessed. We wanted to assess the feasibility and diagnostic validity of the My Mood Monitor (M-3) checklist, a new, 1-page, patient-rated, 27-item tool developed to screen for multiple psychiatric disorders in primary care.

METHODS

We enrolled a sample of 647 consecutive participants aged 18 years and older who were seeking primary care at an academic family medicine clinic between July 2007 and February 2008. We used a 2-step scoring procedure to make screening more efficient. The main outcomes measured were the sensitivity and specificity of the M-3 for major depression, bipolar disorder, any anxiety disorder, and post-traumatic stress disorder (PTSD), a specific type of anxiety disorder. Using a split sample technique, analysis proceeded from determination of optimal screening thresholds to assessment of the psychometric properties of the self-report instrument using the determined thresholds. We used the Mini International Neuropsychiatric Interview as the diagnostic standard. Feasibility was assessed with patient and physician exit questionnaires.

RESULTS

The depression module had a sensitivity of 0.84 and a specificity of 0.80. The bipolar module had a sensitivity of 0.88, and a specificity of 0.70. The anxiety module had a sensitivity of 0.82 and a specificity of 0.78, and the PTSD module had a sensitivity of 0.88 and a specificity of 0.76. As a screen for any psychiatric disorder, sensitivity was 0.83 and specificity was 0.76. Patients took less than 5 minutes to complete the M-3 in the waiting room, and less than 1% reported not having time to complete it. Eighty-three percent of clinicians reviewed the checklist in 30 or fewer seconds, and 80% thought it was helpful in reviewing patients' emotional health.

CONCLUSIONS

The M-3 demonstrates utility as a valid, efficient, and feasible tool for screening multiple common psychiatric illnesses, including bipolar disorder and PTSD, in primary care. Its diagnostic accuracy equals that of currently used single-disorder screens and has the additional benefit of being combined into a 1-page tool. The M-3 potentially can reduce missed psychiatric diagnoses and facilitate proper treatment of identified cases.

Training GP's to use a minimal intervention for stress-related mental disorders with sick leave (MISS): Effects on performance: Results of the MISS project; a cluster-randomised controlled trial [ISRCTN43779641]

OBJECTIVE

To study the effects of a brief patient-stress management training on the performance of general practitioners (GPs).

METHODS

After training in the Minimal Intervention for Stress-related mental disorders with Sick leave (MISS), the performance of 24 GPs was compared with the usual care provided by 22 GPs. Outcome measures in this intervention were: assignment of a diagnosis, taking an activating approach and monitoring the symptoms.

RESULTS

Twenty-three GPs completed the training. Outcomes showed that the training added to a psychosocial diagnosis. Other skills (using a questionnaire to make a diagnosis, handing out information leaflets and monitoring the symptoms) were to some extent improved by the training.

CONCLUSION

The result indicates limited adherence of GPs to the MISS. Only a few components of the training were actually applied after the training, and there is still ample room for improvement.

PRACTICE IMPLICATIONS

More than the current 11h of training are probably needed to change the behaviour of GPs in general. Within educational programmes more attention should be given to the implementation of new behaviour, particularly when it concerns the treatment of patients with stress-related problems.

A theoretical model for understanding mental health, substance use, and work performance among Asian immigrants

Mental illness and substance use disorders are prevalent among workers. Each year businesses lose billions of dollars to decreased work performance associated with these issues. This article discusses a theoretical model that depicts relationships between social discrimination, job concerns, and social support and workers' mental health problems and substance use and work performance. The focus is Asian immigrant workers, a population underrepresented in the literature. This model serves to assist occupational health nurses in the practice and research arenas better understand the complexities of mental health problems and substance use among Asian immigrant workers. Occupational health nurses are in a prime position to recognize, identify, and respond to at-risk workers. Examples of areas that might be considered by occupational health nurses when using this model are included.

A Theoretical Model for Understanding Mental Health, Substance Use, and Work Performance among Asian Immigrants

Mental illness and substance use disorders are prevalent among workers. Each year businesses lose billions of dollars to decreased work performance associated with these issues. This article discusses a theoretical model that depicts relationships between social discrimination, job concerns, and social support and workers' mental health problems and substance use and work performance. The focus is Asian immigrant workers, a population underrepresented in the literature. This model serves to assist occupational health nurses in the practice and research arenas better understand the complexities of mental health problems and substance use among Asian immigrant workers. Occupational health nurses are in a prime position to recognize, identify, and respond to at-risk workers. Examples of areas that might be considered by occupational health nurses when using this model are included.