Predictors of impaired work functioning in employees with major depression in remission

Disparities in program enrollment and employment outcomes for veterans with psychiatric and co-occurring substance use disorders referred or enrolled for VHA vocational rehabilitation

Introduction

The purpose of the study was to investigate factors that influence vocational rehabilitation program enrollment and employment at discharge of veterans with psychiatric and co-occurring alcohol and other substance use disorders enrolled at a veteran health administration (VHA) medical center.

Methods

A sample of 2,550 veteran patients referred for VHA vocational rehabilitation between 2016 and 2021 were examined for the current study. The current study was classified as quality improvement/assurance, thus resulting in exempt research by the U.S. Department of Veteran Affairs Institutional Review Board.

Results

Veterans with active alcohol use disorders (AUDs) and co-occurring depression, anxiety, post-traumatic stress disorder, or bipolar disorders were less likely to be enrolled for vocational rehabilitation program services compared to those without these co-occurring diagnoses. Veterans with AUD (active & in-remission status combined into one category) and a diagnosis of anxiety were less likely to be employed at discharge compared to veterans with AUDs and no anxiety diagnosis (anxiety diagnosis - 3.5% vs. no anxiety diagnosis - 5.8%).

Discussion

VHA vocational rehabilitation can be an effective intervention to assist veterans in reintegrating back into the community. Yet, there appears to be some disparities in the program enrollment and employment at discharge, depending on the nature of the psychiatric diagnosis. Investigating the factors contributing (mediating or moderating) to these discrepancies are needed. Although it appears access is not the issue in being referred for vocational rehabilitation services, other factors are likely contributing to program entry.

Self-Other Balance in Context: A Quiet Ego May Be Meaningful and Adaptive in Latinx/Hispanic Cultures and Work Settings

Quiet ego is a relatively novel, increasingly studied, multi-dimensional concept characterized by a compassionate, interdependent worldview and an adaptive balance between self-interest and concern for others. Quiet ego has been associated with a range of characteristics that can promote relationship quality, responding effectively in the face of challenges, and greater well-being. However, it is currently unknown to what extent quiet ego translates across cultures and settings. The present research leverages cultural and organizational theories to evaluate the conceptual and structural validity of quiet ego for Latinx/Hispanic individuals in the U.S. and to examine relationships among quiet ego, work supervisor relationship quality, and goals in the workplace. Employed college student participants (n = 831; nLatinx/Hispanic = 305) completed an online survey, and collected data were subjected to confirmatory factor analysis and path analysis. Findings confirmed the overall structural model of quiet ego with four primary dimensions (perspective taking, inclusive identity, detached awareness, and growth-mindedness) and indicated that this structure did not differ between Latinx/Hispanic and non-Latinx/Hispanic subsamples. Further, results cohered with the proposed model suggesting that quiet ego might facilitate relationship quality with a workplace supervisor, which, in turn could foster balanced, intrinsically motivating perceptions that one's work goals benefit both oneself and others (mutual gain motivation). The study suggests that quiet ego may be a construct with meaning and utility in Latinx/Hispanic populations and in employment settings. However, further research is needed, and specific suggestions for future study are discussed.

Association between baseline cognitive symptoms and the subsequent presenteeism and global function in patients with major depressive disorder

Cognitive symptoms in major depressive disorder (MDD) contribute to impaired functional abilities and work productivity, particularly presenteeism. We investigated the association between baseline cognitive symptoms and subsequent presenteeism, and global functional impairment in Japanese patients with MDD from PERFORM-J (Prospective Epidemiological Research on Functioning Outcomes Related to Major Depressive Disorder in Japan) - a 6-month, multicenter, epidemiological study data. A total of 518 patients initiating antidepressant monotherapy (first-line or switched from another drug) were enrolled. Assessments include Perceived Deficits Questionnaire - Depression (PDQ-D) for cognitive complaints, Sheehan Disability Scale (SDS) for global function (analysed n = 318), and Work Productivity and Activity Impairment Questionnaire for presenteeism (analysed n = 122). A strong association between changes in presenteeism and changes in SDS scores (r: total = 0.636; work/school = 0.686) was observed. After adjusting for sociodemographic and MDD-related factors, patients without cognitive complaints at baseline showed lower odds of impaired presenteeism at 6 months versus patients with cognitive complaints (0.243, 95% CI: 0.079 to 0.747, p = 0.014) and also in patients with first episode of MDD against with recurrent MDD (0.327 (95% CI: 0.136 to 0.787). Similarly, patients without cognitive complaints had healthier global functioning (lower mean SDS total score) than patients with cognitive complaints (8.3 vs 11.2; 95% CI, -5.189 to -0.578; p = 0.014). First depressive episode (lower risk of presenteeism), being male, and low baseline SDS total score (better global functioning) were also associated with improved outcomes. These results highlight the potential value of baseline PDQ-D scores in predicting subsequent workplace and global functioning in patients undergoing treatment for MDD.

In pursuit of full recovery in major depressive disorder

Many individuals with major depression disorder (MDD) who achieve remission of depressive symptoms, do not perceive themselves as fully recovered. This study explores whether clinical remission is related to functional remission and to patient's perception of recovery, as well as, which factors are associated with their functional and subjective remission. 148 patients with MDD in partial clinical remission were included. Demographics and clinical variables were collected through semi-structured interviews. Objective cognition was evaluated through a neuropsychological battery and subjective cognition through a specific questionnaire. The patient's psychosocial functioning and the perception of their remission were also assessed. Apart from descriptive analysis, Pearson correlations and backward stepwise regression models explored the relationship between demographic, clinical, and cognitive factors with patients' functional and self-perceived remission. From the whole sample, 57 patients (38.5%) were considered to achieve full clinical remission, 38 patients (25.7%) showed functional remission, and 55 patients (37.2%) perceived themselves as remitted. Depressive symptoms and objective and subjective executive function were the factors associated with psychosocial functioning. Besides, depressive symptoms, objective and subjective attention, and subjective executive function were the significant explanatory variables for self-perception of remission. The concept of full recovery from an episode of MDD should not only include the clinician's perspective but also the patient's psychosocial functioning along with their self-perceived remission. As residual depressive symptoms and cognition (objective and subjective) are factors with great contribution to a full recovery, clinicians should specifically address them when choosing therapeutic strategies.

Do chronic diseases moderate the association between psychosocial working conditions and work exit? Longitudinal results from 55 950 Dutch workers

BACKGROUND

This study aims to examine whether the presence of chronic diseases or multimorbidity moderates the associations between psychosocial working conditions and work exit through unemployment, work disability or early retirement.

METHODS

Data from Lifelines (n=55 950), a prospective population-based cohort study, were enriched with monthly information on employment status from Statistics Netherlands. Working conditions were measured with the Copenhagen Psychosocial Questionnaire. Work exit was defined as unemployment, work disability and early retirement. Participants were classified as having no chronic disease, one chronic disease or multimorbidity. Cause-specific Cox proportional hazard regression models, adjusted for age, gender, education and partnership status, were used to analyse associations between working conditions and work exit. Interaction terms were used to examine moderation by chronic disease status.

RESULTS

Higher social support decreased the risk for unemployment, work disability and early retirement. Higher meaning of work decreased the risk of unemployment, and more possibilities for development decreased the risk for work disability. Chronic disease status did generally not moderate associations between working conditions and work exit. Only among workers without a chronic disease, more possibilities for development was associated with a lower risk for unemployment (HR: 0.89; 95% CI: 0.85 to 0.94).

CONCLUSION

While efforts to retain workers with chronic diseases in the labour market should continue, favourable psychosocial working conditions are important for all workers.

Strengthening supervisor support for employees with common mental health problems: developing a workplace intervention using intervention mapping

Background

This study presents the development of a workplace intervention to strengthen supervisor’s support for employees with common mental health problems (CMHP). CMHP have been increasing over the last years, resulting into negative work outcomes, such as absenteeism or reduced work performance. To date, organisational interventions have been promising in preventing these negative work outcomes, however it is yet unknown in what way the role of workplace stakeholders, in particular supervisors, can be strengthened. This study contributes to the literature of interventions on an organizational level which uses a preventative approach by promoting stay at work among employees with CMHP through supervisor support.

Methods

we applied the intervention mapping (IM) approach, by actively involving workplace stakeholders (employees with CMHP, supervisors and occupational health professionals) through the development process and the use of Integrated model of behaviour prediction for employers. All six steps of IM are followed and thematic analysis was used to analyse interviews and focus groups.

Results

Based on a comprehensive needs assessment, the intervention resulted in an online guideline, with five step-wise themes on how to support employees with CMHP to stay at work (SAW). The guideline addressed the most important and changeable actions using the Integrated model of behaviour prediction. The guideline presents how to signal and address problems in the workplace and find solutions by stimulating autonomy of employees, explore job accommodations and ask for occupational support. In addition, basic conditions on how to create mentally healthy workplaces were presented. Coaching sessions by occupational health professionals, that include practical strategies using the best available evidence, were identified by the stakeholders.

Conclusions

This SAW-Supervisor Guideline-intervention responds to the need of supervisors to be supported in their role, responsibility and ways to support employees with mental health issues, through a behaviour-oriented, preventative approach. Intervention mapping provided a systematic process to identify, structure and prioritize factors of supervisor support, resulting in a novel workplace intervention. The active involvement of workplace stakeholders throughout the process resulted into a well-received intervention. The theoretical framework provided practical ways to induce supportive behaviour of supervisors, bridging theory with practice.

The effectiveness of repeated intravenous ketamine on subjective and objective psychosocial function in patients with treatment-resistant depression and suicidal ideation

BACKGROUND

Ketamine has rapid and robust antidepressant effects in adults with treatment-resistant depression (TRD), while its effects on functional outcomes have not been sufficiently evaluated. The aim was to evaluate the efficacy of ketamine treatment on both subjective and objective functioning, and to explore whether improvements in depressive symptom and cognition mediated changes in functioning.

METHODS

Adults (n=111) with TRD and/or suicidality received six infusions of ketamine (0.5mg/kg, thrice-weekly). Depression symptoms were assessed with the Montgomery-Asberg Depression Rating Scale (MADRS) at baseline, day 13 and day 26. Cognitive domains, including processing speed, working memory, visual learning and verbal learning were measured with the MATRICS Consensus Cognitive Battery, and subjective and objective functioning were measured with the Sheehan Disability Scale (SDS) and the Global Assessment of Functioning (GAF) at the same time-points.

RESULTS

Significant improvement was observed in SDS total score (effect size [ES]=-1.563) and GAF score (ES=1.700) during the 26-day observation. Results from path analysis indicated that reductions of the total MADRS score and improvements in processing speed aggregately significantly mediated the reductions of SDS total score (total indirect effect coef=-3.993, 95%CI [-4.9, -3.2], direct effect coef=-1.374, 95%CI [-2.4, -0.4]) as well as the increases of GAF score (total indirect effect coef=6.022, 95%CI [4.5, 7.8], direct effect coef=3.987, 95%CI [2.1, 5.8]).

CONCLUSION

Six infusions of ketamine was associated with improvements in functional outcomes in adults with TRD and/or suicidality. Depressive symptoms severity and processing speed performance were significant partial mediators of objective and subjective functioning improvements.

Put your feet up: The impact of personality traits, job pressure, and social support on the need for recovery after work

The need for recovery after work (NFR) is an important warning of work-related fatigue. NFR is linked to prolonged work-related efforts and depletion of resources, creating a need for temporary respite from work demands. The aim of the current study was to investigate the relationships between NFR and the five-factor model (FFM), comprising the personality traits of emotional stability (ES), extraversion (E), agreeableness (A), conscientiousness (C), and openness to experience (O). Perceived job pressure and perceived social support were included as mediators. The study was conducted using structural equation modelling (SEM) on cross-sectional data from a sample of 681 participants from several work sectors (N females = 376, N males = 305; M age = 46.9 years; SD = 11.1). The results showed that NFR was affected both directly and indirectly by FFM traits. High ES and high O contributed directly to reduced and increased NFR, respectively. High perceived social support contributed to reduced NFR, while high perceived job pressure contributed to increased NFR. High ES contributed indirectly to reduced NFR through perceived job pressure and social support, high O contributed indirectly to increased NFR through perceived social support, and high E contributed indirectly to increased NFR through perceived job pressure. A and C were not related to NFR. The findings demonstrate that personality traits, especially ES, are firmly related to NFR and highlight the importance of incorporating personality factors into studies of work environmental factors on NFR.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-02950-1.

The Role of the Employer in Supporting Work Participation of Workers with Disabilities: A Systematic Literature Review Using an Interdisciplinary Approach

Purpose There is growing awareness that the employer plays an important role in preventing early labor market exit of workers with poor health. This systematic review aims to explore the employer characteristics associated with work participation of workers with disabilities. An interdisciplinary approach was used to capture relevant characteristics at all organizational levels. Methods To identify relevant longitudinal observational studies, a systematic literature search was conducted in PubMed, Web of Science, PsycINFO and EconLit. Three key concepts were central to the search: (a) employer characteristics, (b) work participation, including continued employment, return to work and long-term work disability, and (c) chronic diseases. Results The search strategy resulted in 4456 articles. In total 50 articles met the inclusion criteria. We found 14 determinants clustered in four domains: work accommodations, social support, organizational culture and company characteristics. On supervisor level, strong evidence was found for an association between work accommodations and continued employment and return to work. Moderate evidence was found for an association between social support and return to work. On higher organizational level, weak evidence was found for an association between organizational culture and return to work. Inconsistent evidence was found for an association between company characteristics and the three work outcomes. Conclusions Our review indicates the importance of different employer efforts for work participation of workers with disabilities. Workplace programs aimed at facilitating work accommodations and supervisor support can contribute to the prevention of early labor market exit of workers with poor health. Further research is needed on the influence of organizational culture and company characteristics on work participation.

The Longitudinal Relationship Between Speech Recognition in Noise, Need for Recovery After Work, Job Demand, and Job Control Over a Period of 5 Years

OBJECTIVE

Hearing impairment may lead to an increased need to recover from fatigue and distress after a day of work. Also, hearing impairment may negatively affect the balance between workload and control over it (job demand and job control). The uptake of hearing solutions may have a positive effect on these outcomes. We aimed to assess the longitudinal relationship between change in speech recognition in noise and changes in need for recovery after work and job demand and job control, and the influence of hearing solutions on these relationships over a period of 5 years. Research questions (RQs) were as follows: (1) Is a 5-year change in speech recognition in noise associated with a change in need for recovery after work over that same 5-year period?; (2) Is a 5-year change in speech recognition in noise associated with a change in job demand and job control over that same 5-year period?; (3) What is the effect of hearing solution uptake in the 5-year period on the change in these outcomes in that same 5-year period?

METHOD

Data of the Netherlands Longitudinal Study on Hearing, collected between 2006 and January 2019, were divided into two 5-year follow-up intervals: T0 (baseline) to T1 (5-year follow-up) and T1 (5-year follow-up) to T2 (10-year follow-up). An online digit-triplet in noise test was used to assess speech recognition in noise. Online questionnaires on demographic, socioeconomic, and work-related characteristics were administered. For RQ1-RQ2, the study sample included adults working ≥12 hours per week, with at least two consecutive measurements (n = 783). For RQ3, employees who had not yet obtained hearing solutions at baseline, but who would be eligible based on a speech reception threshold in noise ≥ -5.5 dB signal-to-noise ratio (SNR), were included (n = 147). Longitudinal linear regression analyses using mixed models were performed to assess RQ1-RQ3.

RESULTS

After adjusting for baseline values, 5-year change in speech recognition in noise showed a statistically significant association with 5-year change in need for recovery. A worsening of 1 dB SNR in speech recognition in noise in an individual was associated with an increase of 0.72 units in need for recovery (scale range 0 to 100). A 5-year change in speech recognition in noise was not significantly associated with a 5-year change in job demand or job control. The uptake of hearing solutions in the 5-year period did not have a significant effect on change in need for recovery in that same 5-year period.

CONCLUSION

The significant longitudinal association between 5-year worsening in speech recognition in noise and increase in need for recovery over the same time period strengthens the evidence for the importance of early detection of a worsening in speech recognition in noise to identify employees with an increase in need for recovery. The absence of an effect of the uptake of a hearing solution on need for recovery indicates that additional alternative interventions may be needed to foster beneficial use of hearing solutions as well as to mitigate the increased need for recovery in case of worsening speech recognition in noise.

Efficacy of ketamine and esketamine on functional outcomes in treatment-resistant depression: A systematic review

BACKGROUND

In recent years, ketamine and esketamine treatment have demonstrated rapid antidepressant effects in adults with treatment-resistant depression (TRD). Hitherto, relatively few studies have reported the effect of ketamine/esketamine treatment on functional outcomes (e.g., psychosocial functioning, workplace functioning). Herein, we review and synthesize extant literature reporting functional outcomes with ketamine/esketamine treatment in adults with TRD.

METHODS

A systematic review of clinical studies reporting subjective or objective ratings of general functioning as primary or secondary outcomes was performed.

RESULTS

Four randomized-controlled trials, one open-label clinical study and one case series reported on the efficacy of ketamine/esketamine on subjective measures of general functioning. Overall, mixed results were reported with respect to the effect across disparate functional measures (e.g., Sheehan Disability Scale [SDS]) using ketamine/esketamine. A single study demonstrated a significant decrease (i.e., improvement) in SDS total scores in TRD with esketamine treatment; most studies, however, did not report on functional outcomes and have functional outcomes as a (co)-primary outcome measure.

LIMITATIONS

Clinical studies that were included evaluated work- or social-related disability as a secondary outcome using subjective rating scales.

CONCLUSION

Functional outcomes in adults with TRD receiving ketamine/esketamine was insufficiently characterized. Available evidence indicates that improvements in general psychosocial functioning is apparent. The association, if any, between symptomatic improvement and functional improvement in TRD, as well as the temporality to improve functioning, are future research vistas.

Workers' Decisions to Disclose a Mental Health Issue to Managers and the Consequences

Background: Stigma can be a barrier to accessing effective interventions and work accommodations for mental illnesses. Fear of stigma's concomitant prejudice and discrimination can inhibit workers from asking for help. Thus, it may be important to develop effective interventions addressing workplace stigma. To identify important targets for these interventions, this study addresses three questions: (1) what proportion of workers experiencing mental health issues disclosed their mental health issue to their managers, (2) what factors did they identify as contributing to their disclosure decisions, and (3) what were the consequences of their decisions? Methods: The dataset is comprised of responses from respondents who were randomly drawn from a nationally representative sample of working Dutch adults who completed a web-based survey in February 2018. Respondents indicating they either had or have mental health issues were asked three sets of questions focusing on: (1) Did you disclose your mental health issue to you manager? (2) For what reasons did you disclose/not disclose the issue? (3) What were the consequences of your disclosure decision? Results: About 73% of respondents with lived experience with mental health issues told their managers about their mental health issue. The structure of the survey questions identified four groups of workers who either: (1) disclosed and had a positive experience (64.2%), (2) disclosed and had a negative experience (9.0%), (3) did not disclose and had a positive experience (22.6%), or (4) did not disclose and had a negative experience (4.2%). Conclusion: Our results reflect workers' diverse preferences for disclosing their mental health issues to their managers. Understanding both the factors that contributed to the decision to disclose and the consequences of disclosure decisions could help to better target workplace educational programs and interventions to address workplace stigma. Our findings suggest that addressing workplace stigma may not be as straightforward as requiring all employees to receive anti-stigma education. Rather, education should support workers to make the appropriate disclosure decision based on their workplace contexts. Future research is needed to understand the optimal ways for workers struggling with mental health issues to ask and receive help if they need it.

Predicting improvement of work ability in modalities of short- and long-term psychotherapy: The differential impact of reflective ability and other aspects of patient suitability

OBJECTIVES

We investigated how patients' psychological capacities to engage in psychotherapy predict changes in work ability in short- and long-term psychotherapy.

METHODS

A cohort study of 326 patients, aged 20-46 years and suffering from mood and anxiety disorders, treated by short-term solution-focused, short-term psychodynamic, or long-term psychodynamic psychotherapy, followed-up for 5 years. The Suitability for Psychotherapy Scale, assessed at baseline, was the predictor. Outcomes were assessed at baseline and at six follow-up occasions using the Work Ability Index as the primary indicator.

RESULTS

Patients with good pretreatment psychological suitability for psychotherapy, good reflective ability in particular, improved more than patients with poor suitability in short-term psychodynamic psychotherapy. Comparisons between therapy groups showed poorer suitability to predict more improvement in solution-focused and in long-term psychodynamic psychotherapy than in short-term psychodynamic psychotherapy.

CONCLUSION

Patients' psychological suitability for psychotherapy has a different impact on work ability in different therapy modalities and durations.

Job crafting as a work adjustment strategy for workers returning after long-term sickness absence due to common mental disorders

The purpose of this qualitative study was to examine the way workers with common mental disorders use job crafting to adjust their work to their levels of functioning after returning from long-term sick leave. Thirty-eight workers who had returned within the last 24 months from sickness absence due to common mental disorders were interviewed using semistructured interviews. Questions were asked about how they job crafted to match their changed needs for work functioning post return. To interpret the results, we coded the data according to the Wrzesniewski and Dutton typology of job crafting and conducted thematic analysis. We identified task, relational and cognitive job crafting strategies that workers had employed after returning to work. Our findings have important implications for how managers and organizations can support workers to make adjustments that enable them to stay and thrive at work with reduced work functioning.

Interventions to improve return to work in depressed people

BACKGROUND

Work disability such as sickness absence is common in people with depression.

OBJECTIVES

To evaluate the effectiveness of interventions aimed at reducing work disability in employees with depressive disorders.

SEARCH METHODS

We searched CENTRAL (The Cochrane Library), MEDLINE, Embase, CINAHL, and PsycINFO until April 4th 2020.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) and cluster-RCTs of work-directed and clinical interventions for depressed people that included days of sickness absence or being off work as an outcome. We also analysed the effects on depression and work functioning.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted the data and rated the certainty of the evidence using GRADE. We used standardised mean differences (SMDs) or risk ratios (RR) with 95% confidence intervals (CI) to pool study results in studies we judged to be sufficiently similar.  MAIN RESULTS: In this update, we added 23 new studies. In total, we included 45 studies with 88 study arms, involving 12,109 participants with either a major depressive disorder or a high level of depressive symptoms. Risk of bias The most common types of bias risk were detection bias (27 studies) and attrition bias (22 studies), both for the outcome of sickness absence. Work-directed interventions Work-directed interventions combined with clinical interventions A combination of a work-directed intervention and a clinical intervention probably reduces days of sickness absence within the first year of follow-up (SMD -0.25, 95% CI -0.38 to -0.12; 9 studies; moderate-certainty evidence). This translates back to 0.5 fewer (95% CI -0.7 to -0.2) sick leave days in the past two weeks or 25 fewer days during one year (95% CI -37.5 to -11.8). The intervention does not lead to fewer persons being off work beyond one year follow-up (RR 0.96, 95% CI 0.85 to 1.09; 2 studies, high-certainty evidence). The intervention may reduce depressive symptoms (SMD -0.25, 95% CI -0.49 to -0.01; 8 studies, low-certainty evidence) and probably has a small effect on work functioning (SMD -0.19, 95% CI -0.42 to 0.06; 5 studies, moderate-certainty evidence) within the first year of follow-up.  Stand alone work-directed interventions A specific work-directed intervention alone may increase the number of sickness absence days compared with work-directed care as usual (SMD 0.39, 95% CI 0.04 to 0.74; 2 studies, low-certainty evidence) but probably does not lead to more people being off work within the first year of follow-up (RR 0.93, 95% CI 0.77 to 1.11; 1 study, moderate-certainty evidence) or beyond (RR 1.00, 95% CI 0.82 to 1.22; 2 studies, moderate-certainty evidence). There is probably no effect on depressive symptoms (SMD -0.10, 95% -0.30 CI to 0.10; 4 studies, moderate-certainty evidence) within the first year of follow-up and there may be no effect on depressive symptoms beyond that time (SMD 0.18, 95% CI -0.13 to 0.49; 1 study, low-certainty evidence). The intervention may also not lead to better work functioning (SMD -0.32, 95% CI -0.90 to 0.26; 1 study, low-certainty evidence) within the first year of follow-up.   Psychological interventions A psychological intervention, either face-to-face, or an E-mental health intervention, with or without professional guidance, may reduce the number of sickness absence days, compared with care as usual (SMD -0.15, 95% CI -0.28 to -0.03; 9 studies, low-certainty evidence). It may also reduce depressive symptoms (SMD -0.30, 95% CI -0.45 to -0.15, 8 studies, low-certainty evidence). We are uncertain whether these psychological interventions improve work ability (SMD -0.15 95% CI -0.46 to 0.57; 1 study; very low-certainty evidence). Psychological intervention combined with antidepressant medication Two studies compared the effect of a psychological intervention combined with antidepressants to antidepressants alone. One study combined psychodynamic therapy with tricyclic antidepressant (TCA) medication and another combined telephone-administered cognitive behavioural therapy (CBT) with a selective serotonin reuptake inhibitor (SSRI). We are uncertain if this intervention reduces the number of sickness absence days (SMD -0.38, 95% CI -0.99 to 0.24; 2 studies, very low-certainty evidence) but found that there may be no effect on depressive symptoms (SMD -0.19, 95% CI -0.50 to 0.12; 2 studies, low-certainty evidence). Antidepressant medication only Three studies compared the effectiveness of SSRI to selective norepinephrine reuptake inhibitor (SNRI) medication on reducing sickness absence and yielded highly inconsistent results. Improved care Overall, interventions to improve care did not lead to fewer days of sickness absence, compared to care as usual (SMD -0.05, 95% CI -0.16 to 0.06; 7 studies, moderate-certainty evidence). However, in studies with a low risk of bias, the intervention probably leads to fewer days of sickness absence in the first year of follow-up (SMD -0.20, 95% CI -0.35 to -0.05; 2 studies; moderate-certainty evidence). Improved care probably leads to fewer depressive symptoms (SMD -0.21, 95% CI -0.35 to -0.07; 7 studies, moderate-certainty evidence) but may possibly lead to a decrease in work-functioning (SMD 0.5, 95% CI 0.34 to 0.66; 1 study; moderate-certainty evidence). Exercise Supervised strength exercise may reduce sickness absence, compared to relaxation (SMD -1.11; 95% CI -1.68 to -0.54; one study, low-certainty evidence). However, aerobic exercise probably is not more effective than relaxation or stretching (SMD -0.06; 95% CI -0.36 to 0.24; 2 studies, moderate-certainty evidence). Both studies found no differences between the two conditions in depressive symptoms.

AUTHORS' CONCLUSIONS

A combination of a work-directed intervention and a clinical intervention probably reduces the number of sickness absence days, but at the end of one year or longer follow-up, this does not lead to more people in the intervention group being at work. The intervention may also reduce depressive symptoms and probably increases work functioning more than care as usual. Specific work-directed interventions may not be more effective than usual work-directed care alone. Psychological interventions may reduce the number of sickness absence days, compared with care as usual. Interventions to improve clinical care probably lead to lower sickness absence and lower levels of depression, compared with care as usual. There was no evidence of a difference in effect on sickness absence of one antidepressant medication compared to another. Further research is needed to assess which combination of work-directed and clinical interventions works best.

Personality disorder increases risk of low quality of life among women with mental state disorders

BACKGROUND

Limited data are available examining the relationship between mental state disorders (mood, anxiety, substance use, eating disorders), their co-occurrence with personality disorder (PD), and quality of life among women. We aimed to investigate these relationships in a sample of women from the community.

METHOD

Women from the Geelong Osteoporosis Study (n = 717) were administered the Structured Clinical Interview for DSM-IV (SCID-I/NP and SCID-II) and the World Health Organisation Quality of Life scale (WHOQOL-BREF). Weight and height were measured and lifestyle and demographic factors were self-reported. Logistic regression models (odds ratios with 95% confidence intervals) were undertaken to investigate associations among groups (mental state disorders, co-occurring mental state disorders with PD, and controls) and the WHOQOL-BREF domains (physical, psychological, social, and environmental health) while testing for potential confounding.

RESULTS

Results indicated that mental state disorders were associated with increased risk of low quality of life in physical, psychological, social, but not environmental domains, compared to controls. This risk was increased among women with co-occurring PD across all domains compared to both controls and those with mental state disorders.

CONCLUSION

These findings add evidence suggesting poor quality of life is experienced by those with mental state disorders, and that this is worsened by the experience of co-occurring PD.

Prognostic Factors for Staying at Work for Partially Sick-Listed Workers with Subjective Health Complaints: A Prospective Cohort Study

Examination of prognostic factors for staying at work for long-term sick-listed workers with subjective health complaints (SHC) who partially work in a paid job, and to evaluate whether these factors are comparable with those of workers with other disorders. We used data of 86 partially sick-listed workers with SHC (57 females, 29 males, mean age 47.1 years) and 433 with other disorders (227 females, 206 males, mean age 50.9 years), from an existing prospective cohort study consisting of 2593 workers aged 18–65 years and registered as sick-listed with different health complaints or disorders for at least 84 weeks in the database of the Dutch Social Security Institute. We performed univariable logistic regression analyses (p ≤ 0.157) for all independent variables with the dependent variable staying at work for the workers with SHC. We then performed multivariable logistic regression analyses with forward selection (p ≤ 0.157) and combined the remaining factors in a final, multivariable model (p ≤ 0.05), which we also used for logistic regression analysis in the workers with other disorders. The following factors were significant prognostic factors for staying at work for workers with SHC: full work disability benefits (odds ratio (OR) 0.07, 95% confidence interval (95% CI) 0.01–0.64), good mental health (OR 1.08, 95% CI 1.02–1.14), positive expectations for staying at work (OR 6.49, 95% CI 2.00–21.09), previous absenteeism for the same health complaint (OR 0.31, 95% CI 0.10–0.96) and good coping strategies (OR 1.13, 95% CI 1.04–1.23). For workers with other disorders, full work disability benefits, good mental health and positive expectations for staying at work were also prognostic factors for staying at work. Individual and policy factors seem to be important for staying at work of sick-listed workers with SHC and those with other disorders alike, but several biopsychosocial factors are particularly important for workers with SHC.

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.

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.

Factors influencing the need for recovery in employees with hearing loss: a cross-sectional study of health administrative data

Objective

Need for recovery is a predictor of work stress and health problems, but its underlying factors are not yet well understood. We aimed to identify hearing-related, work-related, and personal factors influencing need for recovery in hearing-impaired employees.

Methods

We retrospectively identified hearing-impaired employees (N = 294) that were referred to the Amsterdam University Medical Center between 2004 and 2019. Routinely obtained healthcare data were used, including a survey and hearing assessments. A directed acyclic graph was constructed, revealing the hypothesized structure of factors influencing need for recovery as well as the minimal set of factors needed for multiple regression analysis.

Results

Four variables were included in the regression analysis. In total, 46.1% of the variance in need for recovery was explained by the factors feeling that something should change at work (B = 19.01, p < 0.001), self-perceived listening effort (B = 1.84, p < 0.001), personal adaptations scale score (B = − 0.34, p < .001), and having a moderate/poor general health condition (B = 20.06, p < 0.001). Although degree of hearing loss was associated with self-perceived listening effort, the direct association between degree of hearing loss and need for recovery was not significant.

Conclusions

The results suggest that the way employees perceive their hearing loss and how they cope with it directly influence need for recovery, rather than their measured degree of hearing loss. Additionally, general health condition was found to be an independent factor for need for recovery. The results should be confirmed by future, longitudinal research.

Redefining Therapeutic Outcomes of Depression Treatment

Responses to evidence-based interventions for depression are divergent: Some patients benefit more than others during treatment and some do not benefit at all or even deteriorate. Tailoring interventions to the individual may improve outcomes. However, such personalization of evidence-based treatment in depression requires investigation of individual outcomes and the individual trajectories towards these outcomes. This theoretical paper provides a critical reflection on individual outcomes of depression treatment. First, it is argued that outcomes should be broadened, from a focus on mainly depressive symptomatology to recovery in different domains. It is acknowledged that recovery from depression reflects a personal journey that differs from person to person. Second, outcome measures should be lengthened beyond the acute treatment phase, taking a lifetime perspective on depression. The challenge then is to discover which trajectories of what measures during what interventions result in personalized sustainable recovery and for whom. Routine outcome monitoring systems may be used to inform this quest towards assessment of personalized sustainable therapeutic outcomes. Adaptations to broaden and lengthen measurements in routine outcome monitoring systems are proposed to identify predictors of personalized sustainable recovery. Routine outcome monitoring systems may eventually be used to implement personalized treatments for depression that result in personalized sustainable recovery.

Maladaptive Personality Traits and 10-Year Course of Psychiatric and Medical Symptoms and Functional Impairment Following Trauma

Background

Personality is a major predictor of many mental and physical disorders, but its contributions to illness course are understudied.

Purpose

The current study aimed to explore whether personality is associated with a course of psychiatric and medical illness over 10 years following trauma.

Methods

World Trade Center (WTC) responders (N = 532) completed the personality inventory for DSM-5, which measures both broad domains and narrow facets. Responders' mental and physical health was assessed in the decade following the WTC disaster during annual monitoring visits at a WTC Health Program clinic. Multilevel modeling was used in an exploratory manner to chart the course of health and functioning, and examine associations of maladaptive personality domains and facets with intercepts (initial illness) and slopes (course) of illness trajectories.

Results

Three maladaptive personality domains-negative affectivity, detachment and psychoticism-were uniquely associated with initial posttraumatic stress disorder (PTSD); detachment and psychoticism were also associated with initial functional impairment. Five facets-emotional lability, anhedonia, callousness, distractibility and perceptual dysregulation-were uniquely associated with initial mental and physical health and functional impairment. Anxiousness and depressivity facets were associated with worse initial levels of psychiatric outcomes only. With regard to illness trajectory, callousness and perceptual dysregulation were associated with the increase in PTSD symptoms. Anxiousness was associated with greater persistence of respiratory symptoms.

Conclusions

Several personality domains and facets were associated with initial levels and long-term course of illness and functional impairment in a traumatized population. Results inform the role of maladaptive personality in the development and maintenance of chronic mental-physical comorbidity. Personality might constitute a transdiagnostic prognostic and treatment target.

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.

One-year trajectories of mental health and work outcomes post return to work in patients with common mental disorders

BACKGROUND

We investigated one-year trajectories of symptom recovery, work functioning and the return to work percentage (RTW%) among patients with common mental disorders (CMDs).

METHODS

Data were used from a cluster-randomised controlled trial evaluating a problem-solving intervention for CMD patients (N = 158) who had returned to work. Information on anxiety and depressive symptoms, work functioning and RTW% was collected at baseline and 3, 6 and 12 months follow-up. Latent class growth analyses were used to identify trajectories for the four outcomes and investigate how these trajectories clustered in higher order latent classes. Additionally, we investigated the relation between patient characteristics and class membership.

RESULTS

We identified four trajectories for all four outcomes and derived three higher order latent classes: slow recovery (42% [66/158]) (high anxiety and depressive symptoms, moderate to low work functioning and fast RTW); fast recovery (25% [40/158]) (low anxiety and depressive symptoms, high work functioning and fast RTW); and gradual recovery (33% [52/158] (decreasing anxiety and depressive symptoms, increasing or low work functioning and fast RTW). Participants with a higher work engagement and readiness to stay at work were more likely to belong to the fast recovery class.

LIMITATIONS

Due to the relatively small sample size, some trajectories consisted of few participants. Symptom severity was self-reported.

CONCLUSIONS

Many CMD patients experience high levels of mental health symptoms and work functioning problems during the year post RTW. Creating realistic recovery expectations (for both patients and their environments) could be important for successful and sustainable recovery and work participation.

Cross-Cultural Adaptation of the Work Rehabilitation Questionnaire (WORQ) to French: A Valid and Reliable Instrument to Assess Work Functioning

Purpose The Work Rehabilitation Questionnaire (WORQ) is a patient-reported instrument to assess work related functioning in vocational rehabilitation (VR) and work, based on the International Classification of Functioning, Disability and Health (ICF) core set for VR. The objective of this study was to cross-culturally adapt WORQ to French and to evaluate its psychometric properties. Methods The cross-cultural adaptation followed a dual-panel approach. Psychometrics was examined in one VR-centre in the French speaking part of Switzerland. Test-retest reliability was analyzed with intraclass correlation coefficient (ICC), internal consistency was assessed with Cronbach's alpha. Construct validity was determined by convergence to the self-reported general functioning scale and the Hospital Anxiety and Depression Scales (HADS). The association of patient's return-to-work expectation within 6-months and having a case manager was examined. The usability of WORQ-French was tested in 10 VR patients. Results Eighty-nine patients with musculoskeletal injuries were included. WORQ-French showed excellent internal consistency (0.968) and a high test-retest reliability (0.935). WORQ-French was positively associated with self-reported general functioning (r = 0.662) and both HADS scales (r = 0.56-0.57). Neither the patient's return-to-work expectation nor having a case manager were significantly correlated with WORQ-French. Usability in terms of understandability of questions and response options was found to be good. Seven patients rated the length of WORQ-French as good, while two found the instrument a little too long and one found it too long. Conclusions WORQ French is a valid, reliable, and easy to administer instrument to assess self-reported work functioning given our study setting and sample characteristics.

Analysis of HAM-D scores and working ability in an observational study of Japanese patients with major depressive disorder and painful physical symptoms treated with duloxetine or SSRI monotherapy

OBJECTIVE

To investigate the relationship between Hamilton Depression Rating Scale (HAM-D) score and psychiatrists' judgment of working ability in patients with major depressive disorder (MDD) and painful physical symptoms.

METHODS

This was a prospective, observational, 12-week study in patients who received duloxetine or a selective serotonin reuptake inhibitor. Patients were ≥20 years old, resided in Japan, and had at least moderate depression (Quick Inventory of Depressive Symptomatology ≥16) and at least moderate painful physical symptoms (Brief Pain Inventory-Short Form average pain ≥3). The main outcome in this post-hoc analysis was the HAM-D17 cutoff best corresponding with patients' working ability according to the investigator's judgment. Area under the receiver-operator curve was used to determine the time point with the strongest relationship between HAM-D17 and working ability. The optimal HAM-D17 cutoff was determined based on the maximum of sensitivity (true positive rate) minus ([1 minus specificity] [true negative rate]). For the evaluation of binary data, a mixed effects model with repeated measures analysis was used.

RESULTS

For the estimation of the HAM-D17 cutoff, the area under the receiver-operator curve was maximal at 12 weeks, when a HAM-D17 score of 6 resulted in the best correspondence with working ability in the combined study population. At 12 weeks, a HAM-D17 score of 6 also resulted in the maximum predictive ability in each of the two treatment groups separately. For predicted working ability at 12 weeks, 52.7% of duloxetine-treated patients achieved the HAM-D17 cutoff of ≤6, whereas 48.5% of SSRIs-treated patients achieved HAM-D17 ≤6 (P=0.477).

CONCLUSION

In this study of patients with major depressive disorder and painful physical symptoms, a HAM-D17 score ≤6 corresponded best with patients' working ability. This finding is consistent with previous studies showing that a HAM-D17 cutoff of ≤7 may overestimate functional recovery from MDD.

Work-Anxiety Rather Than Cognitive Performance Contributes to Workability Decisions in Patients With Mental Disorders

BACKGROUND

Mental workability decisions must be based on information on person's symptom load, cognitive performance, and workplace conditions. This investigation explores in which way these factors contribute to workability in persons with common mental disorders (CMDs).

METHODS

One thousand five hundred seventy CMD-patients underwent multimodal medical diagnostic. Participants filled in questionnaires on work-phobic-anxiety and general mental symptom load. They were also investigated concerning their cognitive performance. Sick leave duration, workplace problems, and subjective workability were assessed. Physicians' decision on the persons' workability (fit or unfit for work) was given 5 weeks later.

RESULTS

Negative workability perception, long previous sick leave duration, and high work phobic anxiety explained unfitness for work, whereas general symptom load and general cognitive performance did not.

CONCLUSION

Work-directed diagnostics and interventions must address work-phobic anxiety and subjective workability perception.

Efficacy of antidepressants on measures of workplace functioning in major depressive disorder: A systematic review

INTRODUCTION

Work-related disability and productivity loss in Major Depressive Disorder (MDD) are critical determinants of patient quality of life and contribute significantly to the human and economic costs of MDD. Notwithstanding the return to work and pre-morbid levels of functioning as a critical therapeutic objective among individuals with MDD, it is unclear whether antidepressant treatment significantly and reliably improves measures of workplace functioning. Herein, we investigate to what extent antidepressant treatment improves workplace functioning among adults with MDD.

METHODS

We conducted a systematic review of randomized, double-blind, placebo-controlled or active comparator clinical trials primarily or secondarily investigating the efficacy of antidepressant agents on subjective ratings of workplace functioning and/or measures of work absence.

RESULTS

Thirteen placebo-controlled and four active comparator clinical trials reported on the efficacy of agomelatine, bupropion, desvenlafaxine, duloxetine, fluoxetine, levomilnacipran, paroxetine, sertraline, venlafaxine, or vortioxetine on subjective measures of workplace impairment. Overall, antidepressant treatment improved standardized measures of workplace functioning (e.g., Sheehan Disability Scale-work item). One placebo-controlled trial of agomelatine and one clinical trial comparing the efficacy of vortioxetine to that of venlafaxine had mixed results on measures of work absence.

LIMITATIONS

Included interventional trials evaluated work-related disability as a secondary outcome using subjective rating scales.

CONCLUSION

Extant data suggest that antidepressant treatment improves workplace outcomes in MDD. The capability of antidepressants in improving measures of workplace functioning should be considered in cost-benefit analyses to better inform cost-modelling studies pertaining to antidepressant therapy.

Prediction of occupational disability from psychological and neuropsychological evidence in forensic context

Within the fields of psychiatry, psychology, and neuropsychology, medical examiners are often tasked with providing an opinion about an injured individual's health prognosis and likelihood of returning to work. Traditionally, examiners have conducted such assessments by employing clinical intuition, expert knowledge, and judgment. More recently, however, an accumulation of research on factors predictive of disability has allowed examiners to provide prognostications using specific empirically supported evidence. This paper integrates current evidence for four common clinical issues encountered in forensic assessments-musculoskeletal pain, depression, Posttraumatic Stress Disorder, and traumatic brain injury. It discusses an evidence-informed, cross-diagnostic and multifactorial model of predicting disability that is emerging from the literature synthesis, along with recommendations for best forensic assessment practice.