Work Characteristics and Return to Work in Long-Term Sick-Listed Employees with Depressive Symptoms

Sick leave duration as a potential marker of functionality and disease severity in depression

Objective: To discuss the impact of depression on work and how depression-related sick leave duration could be a potential indicator and outcome for measuring functionality in depression.Methods: Our review was based on a literature search and expert opinion that emerged during a virtual meeting of European psychiatrists that was convened to discuss this topic.Results: Current evidence demonstrates that depression-related sick leave duration is influenced by multiple disease-, patient- and work-related factors, together with societal attitudes towards depression and socioeconomic conditions. A wide variety of pharmacological and non-pharmacological treatments and work-based interventions are effective in reducing depression-related sick leave duration and/or facilitating return to work. Recent real-world evidence showed that patients treated with antidepressant monotherapy appear to recover their working life faster than those receiving combination therapy. Although depression-related sick leave duration was found to correlate with severity of depressive symptoms, it cannot be used alone as a viable marker for disease severity.Conclusions: Given its multifactorial nature, depression-related sick leave duration is not on its own a viable outcome measure of depression severity but could be used as a secondary outcome alongside more formal severity measures and may also represent a useful measure of functionality in depression. Key pointsDepression in the working population and depression-related sick leave have a profound economic impact on societyDepression-related sick leave duration is influenced by multiple disease-, patient- and work-related factors, together with societal attitudes towards depression and socioeconomic conditionsA wide variety of pharmacological and non-pharmacological treatments and work-based interventions have been shown to be effective in reducing depression-related sick leave duration and/or facilitating return to workIn terms of pharmacological intervention, recent real-world evidence has shown that patients treated with antidepressant monotherapy are able to recover their working life faster than those treated with combination therapyAlthough depression-related sick leave duration has been shown to correlate with severity of depressive symptoms, it is not a viable outcome measure of depression severity on its own, but could be used as secondary outcome alongside more formal clinician- and patient-rated severity measuresDepression-related sick leave duration may, however, represent a viable outcome for measuring functionality in depression.

Self-Efficacy Beliefs of Employees with Mental Disorders or Musculoskeletal Diseases after Sickness-Related Absence: Validation of the German Version of the Return-to-Work Self-Efficacy Scale

Return-to-work self-efficacy (RTW-SE) is an important predictor of the duration until employees return to work after a sickness-related absence. The aim of the present validation study was to investigate the psychometric properties of the German RTW-SE scale. Data were obtained from three independent samples of employees who were in outpatient care due to mental disorders or musculoskeletal diseases (n₁ = 301, n₂ = 103, n₃ = 104). Confirmatory factor analyses showed an inadequate fit for a one-factor solution and an acceptable fit for a two-factor model that distinguished by item-wording direction. To test whether the two factors represent substantively different dimensions of the construct or rather a statistical item-wording effect, two subscales were formed based on item-wording direction. As the subscales were not differentially associated with external measures, the one-factor solution may be considered appropriate. The scale showed good to excellent internal consistency values over time and across samples, had low retest reliability indices, and indicated construct validity based on moderate to high associations with cognitive and disease-related variables. The results further demonstrated the scale's sensitivity to change. The RTW-SE baseline score predicted physical performance and pain-related psychological impairment after orthopedic rehabilitation. In multiple regression analysis, RTW-SE remained a significant predictor of pain-related psychological impairment but not physical performance, partially demonstrating the predictive validity of the scale. The German version of the RTW-SE scale demonstrated satisfactory results regarding its validity and reliability.

Predictors of return to work for people on sick leave with common mental disorders: a systematic review and meta-analysis

PURPOSE

To support the return to work following common mental disorders knowing which factors influence the return to work is important. We aimed to identify factors predicting return to work for people on sick leave with disorders like stress, anxiety, and depression.

METHODS

A systematic review and meta-analyses were conducted regarding return to work at any time point, < 3 months, 3-12 months, and > 12 months of sick leave, respectively, and diagnostic subgroups.

RESULTS

The meta-analyses included 29 studies. Predictors decreasing return to work probability at any time point were higher age, being male, neuroticism and openness, previous sickness absence, and higher symptom scores. Predictors increasing return to work probability were positive return to work expectations, high return to work- and general self-efficacy, conscientiousness, and high workability index. Return to work within < 3 months of sick leave was associated with positive return to work expectations. Return to work after > 12 months was increased by higher education. Higher age was associated with decreased return to work probability after > 12 months. No significant predictors were found in diagnostic subgroups.

CONCLUSION

Results are overall consistent with earlier reviews. Future studies should focus on specific time points, diagnostic subgroups, and work-related factors.

PROSPERO REGISTRATION ID

CRD42018073396.

A Systematic Search and Review of Questionnaires Measuring Individual psychosocial Factors Predicting Return to Work After Musculoskeletal and Common Mental Disorders

Purpose Individual psychosocial factors are crucial in the return to work (RTW) process of workers with musculoskeletal disorders (MSDs) and common mental disorders (CMDs). However, the quality and validity of the questionnaires used to measure these factors have rarely been investigated. The present systematic search and literature review aims at identifying, categorizing, and evaluating the questionnaires (measurement tools) used to measure individual psychosocial factors related to the perception of the personal condition and motivation to RTW that are predictive of successful RTW among workers with MSDs or CMDs. Methods Through a systematic search on PubMed, Web of Science, and PsycINFO library databases and grey literature, we identified the individual psychosocial factors predictive of successful RTW among these workers. Then, we retrieved the questionnaires used to measure these factors. Finally, we searched for articles validating these questionnaires to describe them exhaustively from a psychometric and practical point of view. Results: The review included 76 studies from an initial pool of 2263 articles. Three common significant predictors of RTW after MSDs and CMDs emerged (i.e., RTW expectations, RTW self-efficacy, and work ability), two significant predictors of RTW after MSDs only (i.e., work involvement and the self-perceived connection between health and job), and two significant predictors of RTW after CMDs only (i.e., optimism and pessimism). We analyzed 30 questionnaires, including eight multiple-item scales and 22 single-item measures. Based on their psychometric and practical properties, we evaluated one of the eight multiple-item scales as questionable and five as excellent. Conclusions: With some exceptions (i.e., self-efficacy), the tools used to measure individual psychosocial factors show moderate to considerable room for improvement.

Stakeholders' Role and Actions in the Return-to-Work Process of Workers on Sick-Leave Due to Common Mental Disorders: A Scoping Review

The lack of knowledge regarding the roles and actions of return to work (RTW) stakeholders create confusion and uncertainty about how and when to RTW after experiencing a common mental disorder (CMD). Purpose The purpose of this scoping review is to disentangle the various stakeholders' role and actions in the RTW process of workers on sick-leave due to CMDs. The research question is: What is documented in the existing literature regarding the roles and actions of the identified stakeholders involved in the RTW process of workers on sick-leave due to CMDs? Methods In conducting this scoping review, we followed Arksey and O'Malley's (Int J Soc Res Methodol 8:19-32, 2005) methodology, consisting of different stages (e.g., charting the data by categorizing key results). Results 3709 articles were screened for inclusion, 243 of which were included for qualitative synthesis. Several RTW stakeholders (n=11) were identified (e.g., workers on sick leave due to CMDs, managers, union representatives, rehabilitation professionals, insurers, return to work coordinators). RTW stakeholders' roles and actions inter- and intra-system were recommended, either general (e.g., know and understand the perspectives of all RTW stakeholders) or specific to an actor (e.g., the return to work coordinator needs to create and maintain a working alliance between all RTW stakeholders). Furthermore, close to 200 stakeholders' actions, spread out on different RTW phases, were recommended for facilitating the RTW process. Conclusions Eleven RTW stakeholders from the work, heath and insurance systems have been identified, as well as their respective roles and actions. Thanks to these results, RTW stakeholders and policy makers will be able to build practical relationships and collaboration regarding the RTW of workers on sick leave due to CMDs.

Managing employees' depression from the employees', co-workers' and employers' perspectives. An integrative review

Purpose: To synthesize evidence on factors promoting or hindering work participation (WP) of employees with depression from the employees', co-workers' and employers' perspectives, as well as an additional focus on the influence of the employee's occupation.Methods: An integrative review was conducted. Pre-defined eligibility criteria guided study selection. Articles were critically appraised using tools developed by Joanna Briggs and Mixed Methods Appraisal Tool. Findings were analysed and synthesised using qualitative inductive content analysis.Results: Seventeen studies were included: 12 quantitative studies, three qualitative studies and two mixed methods studies. From these, 144 findings were extracted and combined into six categories from which two syntheses were developed. One synthesis demonstrated that employees, co-workers and employers hold different perspectives on rehabilitation stakeholders' responsibilities hindering WP. The other synthesis revealed that WP is influenced by interactions between individual and occupational factors.Conclusions: Sufficient treatment from health professionals promotes WP. Employees' fear of stigmatization hinders WP. Co-workers and employers find that open communication is important, however, employers are concerned about entering employees' private sphere. When managing employees with depression, employers intervene at the individual level. There is a need for structural interventions to promote WP among employees with depression.Implications for RehabilitationThe responsibilities of rehabilitation stakeholders should be clarified to promote collaboration.Structural workplace interventions should be initiated to supplement individual level interventions.Workplace interventions may focus on more open communication and awareness towards mental illness.Interactions between the occupational factors and individual factors should be carefully considered.

Measuring Work Ability with Its Antecedents: Evaluation of the Work Ability Survey

Purpose The revised version of the Work Ability Survey (WAS-R) assesses work ability on several sub-scales at the intersection of personal and organizational capacity, thus adding to the measurement of work ability by integrating the holistic model. It, therefore, improves on two features of the current standard measurement tool of work ability, the Work Ability Index (WAI): (1) a ceiling effect and (2) limited detail due to a focus on physical health and personal capacity. Method In two samples (n ₁ = 1093, n ₂ = 359), psychometric properties and the structure of the WAS-R were analyzed. To evaluate construct validity, inter-correlations of the WAS-R and WAI, sickness absence, expected and desired retirement age, and post-retirement work intention were calculated. Results The WAS-R was found to be distributed closer to normality than the WAI. The structural analyses yielded acceptable results for the hypothesized model. The WAS-R was adequately correlated with the WAI, negatively with sickness absence, and positively with desired retirement age. Conclusions The WAS-R extends the measurement of work ability, reflecting organizations' work demands. Its broad sub-scales lead to high acceptance of the results within the participating companies. In particular, the organizational capacity scales can be used to guide interventions aiming at organizational characteristics to improve work ability.

Person-related factors associated with work participation in employees with health problems: a systematic review

PURPOSE

The objective of this systematic review was to explore and provide systematically assessed information about the association between person-related factors and work participation of people with health problems. The research question was: what is the association between selected person-related factors and work participation of workers with health problems?

METHODS

A systematic review was carried out in PubMed and PsycINFO to search for original papers published between January 2007 and February 2017. The risk of bias of the studies included was assessed using quality assessment tools from the Joanna Briggs Institute. The quality of evidence was assessed using the GRADE framework for prognostic studies.

RESULTS

In total, 113 studies were included, all of which addressed the association between person-related factors and work participation. The factors positively associated with work participation were positive expectations regarding recovery or return to work, optimism, self-efficacy, motivation, feelings of control, and perceived health. The factors negatively associated with work participation were fear-avoidance beliefs, perceived work-relatedness of the health problem, and catastrophizing. Different coping strategies had a negative or a positive relationship with work participation.

CONCLUSIONS

The results of this review provide more insight into the associations between different cognitions and perceptions and work participation. The results of this study suggest that person-related factors should be considered by occupational- and insurance physicians when they diagnose, evaluate or provide treatment to employees. Further research is required to determine how these physicians could obtain and apply such information and whether its application leads to a better quality of care.

Förderung berufsbezogener Ziele in der psychosomatischen Rehabilitation durch Mentales Kontrastieren und Wenn-Dann-Pläne

Zusammenfassung. Theoretischer Hintergrund: In der medizinischen Rehabilitation besteht ein Bedarf an Interventionen zur Förderung von Arbeitsmotivation. Mental Contrasting with Implementation Intentions (MCII) hat sich als Methode zur Unterstützung von Zielverfolgung, -bindung und -erreichung etabliert. Die vorliegende Studie untersuchte die Frage: Kann MCII berufsbezogene Ziele fördern? Methode: Patient_innen der psychosomatischen Rehabilitation nahmen an einer berufsbezogenen MCII-Intervention teil (IG; n = 100). Die Kontrollgruppe (KG; n = 100) erhielt eine MBOR-Behandlung ohne MCII-Intervention. Verwendet wurden Fragebogen zu Symptomen, Behandlungszufriedenheit sowie Therapiezielen. Ergebnisse: Patient_innen der IG nannten im Vergleich zur KG etwa zweimal häufiger Ziele mit Berufsbezug (OR = 2.292, 95 % KI [1.049, 5.004]). Nach der Intervention schätzten Patient_innen die Wahrscheinlichkeit der Zielerreichung positiver ein und hatten häufiger einen Zielerreichungsplan. Sie waren zufriedener mit ihrem Behandlungsergebnis. Schlussfolgerungen: Durch MCII priorisierten Patient_innen berufsbezogene Ziele. Die Intervention stellt eine zeit- und kostenökonomische Methode dar, um die Motivation zur Rückkehr ins Erwerbsleben in den Fokus der Reha-Maßnahme zu rücken.

The Magnitude of Occupational Class Differences in Sickness Absence: 15-Year Trends among Young and Middle-Aged Municipal Employees

Background: Our aim was to examine the magnitude of relative occupational class differences in sickness absence (SA) days over a 15-year period among female and male municipal employees in two age-groups. Methods: 18-34 and 35-59-year-old employees of the City of Helsinki from 2002 to 2016 were included in our data (n = ~37,500 per year). Occupational class was classified into four groups. The magnitude of relative occupational class differences in SA was studied using the relative index of inequality (RII). Results: The relative occupational class differences were larger among older than younger employees; the largest differences were among 35-59-year-old men. Among women in both age-groups the relative class differences remained stable during 2002-2016. Among younger and older men, the differences were larger during the beginning of study period than in the end. Among women in both age-groups the RII values were between 2.19 (95% confidence intervals (CI) 1.98, 2.42) and 3.60 (95% CI 3.28, 3.95). The corresponding differences varied from 3.74 (95% CI 3.13, 4.48) to 1.68 (95% CI 1.44, 1.97) among younger and from 6.43 (95% CI 5.85, 7.06) to 3.31 (95% CI 2.98, 3.68) among older men.

CONCLUSIONS

Relative occupational class differences were persistent among employees irrespective of age group and gender. Preventive measures should be started at young age.