Work limitations and employer adjustments for employees with chronic illness

How do immunocompromised people experience the changes in their working lives during the COVID-19 pandemic? Results from a mixed-methods study in Germany

Background and aims

The COVID-19 pandemic has a major impact on many areas of life, including many people's job situations. Not everyone is affected in the same way - people with chronic conditions may experience increased mental stress and social problems. In this study, we focus on immunocompromised people (ICP), who are at high risk for a severe course of COVID-19. Our aim was to investigate the level of social participation during the pandemic, focusing on how ICPs perceive changes in their working lives.

Methods

We applied a mixed-methods concurrent triangulation design with qualitative interviews (N = 13) and a quantitative cross-sectional survey with N = 179 participants. This approach allowed us to gain deep insights into the experience of occupational-social participation.

Results

Qualitative results show that working from home during the COVID-19 pandemic was seen as a relief by many, as medical necessities could be integrated more easily into everyday life. Understanding and consideration of their professional social network were essential for all respondents. Our interview data hint at an influence of the family situation (e.g., having children) and the relationship of the ICP to coworkers on the perception of changes to their work environment. The quantitative results indicate an interaction between mental health and employment status on social participation, with employment reducing the negative impact of poorer mental health on social participation after adjusting for sociodemographic variables.

Conclusions

Our results indicate changes necessary to integrate people with chronic conditions into working life, even under pandemic conditions. This includes the possibility of flexible working hours and compliance with hygiene measures at the workplace.

Employees with mental disorders seeking support from the workers compensation system - experiences from Denmark

BACKGROUND

In Europe it is commonly accepted that psychosocial hazards may influence the mental health of employees. However, mental disorders such as depression are generally not acknowledged as an occupational disease covered by the workers compensation system. Studies indicate that workers compensation claim processes may affect employee's health negatively due to a demanding case process. If filing a workers' compensation claim can harm the employees' health, it is highly relevant to pay attention to employees with mental health claims, as they are most likely vulnerable and face a very low chance of compensation.

OBJECTIVE

This study investigates how employees with work-related mental disorders experience the process of seeking workers compensation from the Danish Workers' Compensation System.

METHOD

Interview (N = 13) and questionnaire (N = 436) data from claimants were analysed.

RESULTS

Analysis showed that even though many employees wished for the claim to influence the conditions at the workplace, there seemed to be a lack of preventive health and safety initiatives in the workplaces. Central stakeholders such as health and safety representatives were often not involved. Management involvement was often experienced negatively, and the Danish Working Environment Authority rarely conducted workplace inspections. Employees experienced inadequate information about the workers' compensation process and experienced a lack of coordination between stakeholders.

CONCLUSION

A more supportive and coordinated approach in the Workers' Compensation System is recommendable. The processes in the system could be evaluated using the Social Insurance Literacy concept, to ensure sufficient support of the claimants and reduce potential harmful aspects of the process.

Swedish managers' experience-based understanding of the Capacity to work in employees with Common Mental Disorders: a Focus Group Study

PURPOSE

Understanding of the capacity to work among employees with common mental disorders (CMDs) is important, but contemporary knowledge on this issue lacks the managers' perspective. The aim of this study was to explore and describe managers' experience-based understanding of capacity to work in employees with CMD.

METHODS

A qualitative focus group study was designed. Managers with experience in supporting employees with CMD were recruited via organizations and networks. Eight focus group interviews with 31 participants took place.

RESULTS

The analysis resulted in five categories. (1) Capacity to mentally focus on work tasks decreases or disappears, with negative consequences for work output. (2) Capacity to commit to continuous and coherent task changes, making tasks that span longer periods of time difficult. (3) Capacity to independently adapt to the needs of the situation decreases, and employees need more guidance and instructions than usual. (4) Capacity to keep up professional appearances is reduced, and the employees struggle with the professional role. (5) Ability to interact socially and professionally decreases, which potentially causes conflicts at the workplace.

CONCLUSIONS

This study adds managers' perspective to the increasing knowledge on how capacity to work is influenced by CMDs. Managers understand CMDs in employees as changed, reducing the capacities needed for occupational functioning. A deeper understanding of reduced capacity to work is needed to adapt workplaces, and our findings can facilitate work accommodations for employees with CMDs.

Association of stigmatizing attitudes with people’s opinion of depression as a valid reason for sickness absence: A Swedish vignette study

BACKGROUND: Depression is a common cause of sickness absence (SA) and also highly associated with stigma. Few studies have addressed the role of stigma in relation to SA. OBJECTIVE: To investigate if attitudes to depression were associated with the public’s opinion of depression as a valid reason of SA. METHODS: The study population (n = 2413) originated from a web-based panel of citizens. The survey included a short vignette describing a person with symptoms of depression and the person’s work tasks, followed by a question on recommendation of SA. Negative attitudes were measured by the Depression Stigma Scale. Logistic regressions were used to estimate the odds ratios (OR) for the likelihood of not recommending SA, controlling for individual and work-related co-variates. RESULTS: The crude association between negative attitudes and not recommending SA was OR 2.15 (95% CI, 1.76–2.62). In the fully adjusted model the OR was 1.76 (95% CI, 1.40 –2.21) for not recommending SA. CONCLUSIONS: Participants with negative attitudes to depression were more likely to not consider depression as a valid reason of sickness absence. The study supports theories on layered stigma; attitudes from one arena are related to other arenas. Future studies are needed to confirm our findings.

Sickness Presenteeism in the Aftermath of COVID-19: Is Presenteeism Remote-Work Behavior the New (Ab)normal?

Due to the confinement imposed by the COVID-19 pandemic situation, companies adopted remote work more than ever. The rapid rise of remote work also affected local life and many employers introduced or extended their telework activities because of the associated advantages. However, despite the evident positive benefits, some employees were pressured to work remotely while ill. This evidence brought new challenges to the presenteeism literature. This article investigates how individual, economic/societal, and organizational/sectorial/supervisory-related variables can moderate the role of a contagious disease, such as the COVID-19, in explaining presenteeism behavior. Moreover, the current research presents a multi-level conceptual model (i.e., organizational, individual, supervisory factors) to describe how a new construct of remote-work presenteeism behavior mediates the relationship between different post pandemic health conditions (e.g., allergies, back pain, depression, anxiety) and future cumulative negative consequences. The authors suggested that the widespread pervasive adoption of remote work because of COVID-19 has important implications for the presenteeism literature and opens avenues for further research.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Employer perspectives concerning the self-management support needs of workers with long-term health conditions

Purpose

Long-term health conditions are a significant occupational and global burden and can undermine people's ability to work. Workplace support for self-management of long-term conditions has the potential to minimise adverse work effects, by enhancing health and work outcomes. No data exist about employers' views concerning supporting workers with long-term conditions to self-manage.

Design/methodology/approach

The exploration of employers' views involved recruiting 15 participants with responsibilities for workplace health, well-being and safety responsibilities, who participated in a semi-structured interview about self-management and support. Data were analysed using a qualitative six-stage thematic analysis technique.

Findings

Self-management support is not purposely provided to workers with long-term conditions. Support in any form rests on workers disclosing a condition and on their relationship with their line-manager. While employers have considerable control over people's ability to self-manage, they consider that workers are responsible for self-management at work. Stigma, work demands and line-manager behaviours are potential obstacles to workers' self-management and support.

Practical implications

Workplace discussions about self-managing long-term conditions at work should be encouraged and opened up, to improve health and work outcomes and aligned with return-to-work and rehabilitation approaches. A wider biopsychosocial culture could help ensure workplaces are regarded as settings in which long-term conditions can be self-managed.

Originality/value

This study highlights that employer self-management support is not provided to workers with long-term conditions in a purposeful way. Workplace support depends on an employer knowing what needs to be supported which, in turn, depends on aspects of disclosure, stigma, work demands and line management.

[Cognitive and emotional disorders in patients with migraine and signs of leukoencephalopathy]

OBJECTIVE

To identify cognitive and emotional disorders and their correlation with neuroimaging parameters in patients with chronic migraine.

MATERIAL AND METHODS

We examined 50 patients (8 men and 42 women, mean age 41.9±11.9 years) with migraine, including 31 with chronic migraine, and signs of leukoencephalopathy according to magnetic resonance imaging (MRI). A control group comprised 40 healthy individuals (13 men and 27 women) aged 20 to 64 years (mean 42.6±12.0 years). A number of tests for neuropsychological examination and assessment of the emotional state, including a 12-word test, literal and categorical associations, Benton Test, the Montreal cognitive scale (MOCA), the Hospital Depression Scale, the Beck Depression Scale, the Center for Epidemiological Research scale, the Hospital Anxiety Scale and the Spielberger-Khanin scale, were administered at baseline and after 3 and 6 month of preventive therapy.

RESULTS

Patients with migraine had lower scores (p=0.004) on MOCA, memorization of 12 words (p=0.0003), test for literal (p=0.001) and categorical associations (p=0.0002) compared with the control group. No significant correlations were found between the volume of white matter lesions according to MRI and the severity of cognitive impairment. An inverse correlation of average strength was noted (correlation coefficient R=-0.41) between the number of days with headache per month and the MOCA score (p<0.05). In patients with migraine, signs of depression were found on the Hospital Depression Scale (p=0.04), Beck Depression Scale (p=0.003), the Center for Epidemiological Research scale (p=0.0001), and increased anxiety on the Hospital Anxiety Scale (p=0.0001) and the Spielberger-Khanin scale (p=0.0001). A significant relationship was found between the degree of depression and the MOCA score (p=0.007). The frequency of headaches decreased from 19.4±2.9 to 12.6±4.4 days per month (p<0.05).

CONCLUSION

There were a significant decrease of emotional disorders and improvement of cognitive functions compared with baseline scores during the 6 month therapy. Preventive treatment of migraine and concomitant emotional disorders seems to be the most effective way to improve cognitive functions.

The Compensatory Protective Effects of Social Support at Work in Presenteeism During the Coronavirus Disease Pandemic

The present study investigated the lasting effects of sickness presenteeism on well-being and innovative job performance in the demanding Chinese work context compounded with the precarities of the post-pandemic business environment. Adopting the conservation of resources (COR) theory perspective, especially its proposition of compensation of resources, we incorporated social resources at work (supervisory support and collegial support) as joint moderators in the presenteeism–outcomes relationship. We employed a panel design in which all variables were measured twice with 6 months in between. Data were obtained from 323 Chinese employees working in diverse industries in Taiwan. We found that after controlling for the baseline level of well-being, presenteeism did not have a lasting effect on employees' exhaustion. However, presenteeism did have a negative lasting effect on employees' innovative behavior 6 months later. Moreover, we found a significant three-way interaction of presenteeism, supervisory support, and collegial support on employees' innovative job performance, after controlling for the baseline level of performance. Specifically, when working under illness, employees displayed the best innovative performance with high levels of both supervisory and collegial support, the worst performance with both support being low, and the intermediate when any one of the support being high. This can be taken as the preliminary evidence to support the COR proposition of resource caravans, showing that supervisory support and collegial support compensated for each other as critical resources in alleviating the impact of working under sickness on employees' innovative performance. Theoretical implications of the findings are discussed, taking into account the macro-cultural context of the East Asian Confucian societies. We also reflected on the managerial implications of the lasting damages of sickness presenteeism and benefits of mobilizing social resources on employees' well-being and performance.

Identification of work accommodations and interventions associated with work productivity in adults with migraine: A scoping review

OBJECTIVE

To identify factors associated with work productivity in adults with migraine, and accommodations or interventions to improve productivity or the workplace environment for them.

METHODS

We conducted a scoping review by searching MEDLINE, Embase, PsycINFO, Cumulative Index of Nursing and Allied Heath Literature, and Web of Science from their inception to 14 October 2019 for studies of any design that assessed workplace productivity in adults with migraine.

RESULTS

We included 26 articles describing 24 studies after screening 4139 records. Five prospective cohort studies showed that education on managing migraine in the workplace was associated with an increase in productivity of 29-36%. Two studies showed that migraine education and management in the workplace were associated with increased productivity (absenteeism decreased by 50% in one study). One prospective cohort study showed that occupational health referrals were associated with more than 50% reduction in absenteeism. Autonomy, social support, and job satisfaction were positively associated with productivity, while quantitative demands, emotional demands, job instability, and non-conducive work environment triggers are negatively associated with productivity in workers with migraine.

CONCLUSION

Despite migraine being the second leading cause of disability worldwide, there is a paucity of strong data on migraine-related work factors associated with productivity.Registration: None (scoping review).

Gender differences in managers' attitudes towards employees with depression: a cross-sectional study in Sweden

BACKGROUND

Depression is prevalent among employees and a major reason for sickness absence. First-line managers' attitudes towards employees with depression might influence return to work and the scant literature indicates gender differences in attitudes. The objective of this study was to investigate gender differences in managers' attitudes to employees with depression.

METHODS

A cross-sectional study was conducted among 4737 Swedish managers in 2017 (response rate 71%, n = 3358). Attitudes towards depression were measured with the instrument "Managerial stigma towards employees with depression" (12 items). The response patterns of women and men, the level of stigma and the direction of the gender differences were investigated with independent t tests and binary logistic regression analyses with covariates.

RESULTS

The likelihood of reporting high negative attitudes (score ≥ 36) was lower among women than men (odds ratio, 1.64; 95% confidence interval, 1.28-2.10) after adjusting for age, level of education, work sector, distribution of women and men among the staff, current workplace experience in management, lifetime experience in management, managerial position and presence of staff members at the current workplace who had depression and/or anxiety disorders.

CONCLUSIONS

Based on these findings, a gender-sensitive approach is suggested for future interventions to improve managers' attitudes towards employees with depression and other mental disorders.

Work limitations due to neck-shoulder pain and physical work demands in older workers: cross-sectional study

PURPOSE

Many older workers are working despite having neck-shoulder pain (NSP), which may give rise to work limitations due to pain, especially among those with high physical work demands. This study investigated the joint association of neck-shoulder pain intensity and physical work demands with work limitations among older workers.

METHODS

In SeniorWorkingLife, workers ≥ 50 years (n = 11,800) replied to questions about NSP intensity, work limitations due to pain, and physical activity demands at work. The odds ratio for having a higher level of work limitations due to pain in relation to neck-shoulder pain intensity and physical work demands were modeled using logistic regression controlled for various confounders.

RESULTS

The results showed that the neck-shoulder pain intensity was associated with work limitations in a dose-response fashion (p < 0.0001). Importantly, a significant interaction existed between neck-shoulder pain intensity and physical activity at work (p < 0.0001), e.g., 77% of workers with high pain and high work demands experienced work limitations due to the pain.

CONCLUSION

Higher neck-shoulder pain intensity and higher physical work demands-and particularly in combination-were associated with higher odds of work limitation due to pain among older workers. Thus, it seems especially important to accommodate work demands through a better work environment for these groups of workers.

Early Age of Migraine Onset is Independently Related to Cognitive Decline and Symptoms of Depression Affect Quality of Life

Background

People with migraine experience cognitive decline more often than healthy controls, resulting in a significant functional impact. Early identifying influencing factors that contribute to cognitive decline in migraineurs is crucial for timely intervention. Although migraine may onset early in childhood and early onset migraine is related to significant disability, there is no research investigating the association between the age of migraine onset and migraineurs’ cognitive decline. Therefore we aim to explore possible factors that correlate to the cognitive function of migraineurs, especially focus on age of migraine onset.

Methods

531 patients with migraine were included. Data on demographics and headache-related characteristics were collected and evaluated using face-to-face interviews and questionnaires. We used the Montreal Cognitive Assessment scale to assess cognitive function. In addition, we analyzed independent correlations between cognitive decline and the age of migraine onset in patients with migraine. And all patients completed the Headache Impact Test-6 to evaluate their quality of life.

Results

Migraineurs with cognitive decline showed significant differences from those without in age (OR=1.26, P<0.0001), years of education (OR=0.89, P=0.0182), the intensity of headache (OR=1.03, P=0.0217), age of onset (OR=0.92, P<0.0001) and anxiety scores (OR=1.09, P=0.0235). Furthermore, there was no interaction in the age of onset between subgroups. Multivariate linear regression analyses of HIT-6 scores showed that the intensity of headache (β=0.18, P<0.0001) and depression scores (β=0.26, P=0.0009) had independent effects on decreased quality of life.

Conclusion

Our findings suggest that younger age of migraine onset is independently related to migraineurs’ cognitive decline, and migraine accompanying anxiety symptoms significantly related to decreased quality of life in migraineurs.

Managing the (In)visibility of Chronic Illness at Work: Dialogism, Parody, and Reported Speech

Interactionally, the workplace may be dilemmatic for a person with "invisible" chronic illness. Risks of stigmatization exist if they disclose their condition to colleagues. Meanwhile, not disclosing threatens well-being and entitlements. Using Bakhtin's dialogism as a theoretical framework, we explored these social aspects of illness: inductively analyzing narratives from 20 participants with multiple sclerosis (MS). Capitalizing on concepts from dialogical and conversation analysis, links between (in)visibility, knowledge, and belief were examined with respect to symptoms and co-worker judgment. Perceived medical legitimacy creates a core social dilemma. At the intersection of genre and action, participants systematically used parody to subvert the traditional workplace hierarchy. "Oh-prefaced" direct reported speech (OPDRS) was deployed to exaggerate workplace interactions, undermining managers/colleagues who misattributed (in)visible symptoms. Parodic OPDRS index emotive interactional dilemmas. As subversions of organizational power, OPDRS denote those very areas where employees feel disempowered. Sensitivity to OPDRS can provide diagnostic support and complement evaluation frameworks.

Tortoise or hare? Supporting the chronotope preference of employees with fluctuating chronic illness symptoms

OBJECTIVE

Our aim is to understand how to facilitate the job retention of employees with chronic illness. We focus on multiple sclerosis (MS) as a criterion chronic illness.

DESIGN

An opportunity sample of 20 individuals of working age (13 female; 7 male) were recruited who had been in paid employment for over 28 months with a concurrent diagnosis of MS. Participants took part in one of three focus groups with a topic guide comprising keywords: work, coping, performance, support, future, expectations, sharing and symptoms. Data were analysed using dialogical analysis.

MAIN OUTCOME MEASURES

As a qualitative study, no outcome measure was used. However, the specific focus of interest was to search for differential patterns of 'timespace' - chronotope - that people with chronic illness utilise to manage their condition in the workplace.

RESULTS

Participants oriented to two distinct chronotope types: unsustainable epic (characterised by condensed time) and temporary idyll (characterized by condensed space). Perceived managerial discretion was identified as possibly influencing participants' chronotope preference.

CONCLUSION

Identifying chronotope preference has practical implications for health psychologists and related professionals who provide and advise on support to facilitate people with chronic illness to thrive in the workplace.

What Persons with Chronic Health Conditions Need to Maintain or Return to Work-Results of an Online-Survey in Seven European Countries

Chronic health conditions represent the major share of the disease burden in Europe and have a significant impact on work. This study aims to: (1) identify factors that have a negative or positive impact on the work lives of persons with chronic health conditions; (2) explore the needs of these persons to maintain a job or return to work and (3) compare these results with respect to these persons' occupational status. An online survey was performed in seven European countries. Open-ended survey questions were analyzed using qualitative methods. In total, 487 participants with six chronic health conditions participated. The majority of participants named work-related aspects (such as career development, stress at the workplace, work structure and schedule as well as workload), support of others and attitudes of others as being the factors positively and negatively impact their work lives the most. Our study shed light on the importance of changing the attitudes of supervisors and co-workers to counteract stigmatization of persons with chronic health conditions in the workplace. In conclusion, this study provides a basis for developing new strategies of integration and reintegration at work for persons with chronic health conditions in European countries.

Psychosocial working conditions as determinants of asthma self-management at work: A systematic review

OBJECTIVE

Asthma exerts a considerable impact on patients and their employers. While adequate self-management is able to improve patients' prognosis, its actual implementation in everyday life may depend on contextual factors. We aimed to review the literature on the potential determinants of asthma self-management at the workplace.

DATA SOURCES

We systematically searched Medline and PsycINFO using terms related to the key concepts of interest (i.e., adult asthma, working conditions, and self-management).

STUDY SELECTION

We included original studies published in peer-reviewed journals in English or German since 1992 addressing any type of asthma self-management behavior as the outcome and any type of working condition as the determinant.

RESULTS

Upon implementation of a multi-stage selection process, seven articles were included. As those studies showed considerable methodological heterogeneity, a qualitative analysis was applied. A first study identified three different adaptation profiles among employees with asthma with implications for self-management behavior. Another study suggested that concerns about taking time off from work may be associated with the utilization of emergency ambulance services for asthma. Five studies among workers with various chronic illnesses addressed determinants of self-disclosure, coping with acute symptoms (e.g., medication use at work), and the potential effect of practical and emotional support from line managers or colleagues on self-management.

CONCLUSION

Our review indicates that the evidence for a potential link of occupational factors with asthma self-management at work is relatively sparse. Future research should take a more comprehensive approach by considering multiple types of working conditions and asthma self-management behaviors simultaneously.

Clinical description of attack-related cognitive symptoms in migraine: A systematic review

Introduction

Cognitive symptoms have been described during migraine attacks since the Roman era; while being neglected throughout the centuries, they are relevant contributors to migraine-related disability.

Objective

To determine whether cognitive symptoms are included in clinical series describing migraine attack phenomenology, and which symptoms occur in each attack phase.

Method

Systematic review of existing data on clinical descriptions of migraine attacks, focusing on cognitive symptomatology. Data were organized and analyzed qualitatively, due to methodological differences between studies.

Results

Twenty-four articles were reviewed, with a total sample of 7007 patients, including 82.9% females with an average age of 39.2 years. Twenty one (75%) studies analyzed one phase of the attack (eight prodromes, five auras, one between aura and pain, three headaches and three postdromes), the remaining studied more than one phase. Cognitive complaints were the most frequent symptom of the prodromic (30%) and headache (38%) phases, while fatigue (70%) dominated the resolution phase. Not enough data is available to estimate the frequency of cognitive symptoms during the aura.

Discussion

Cognitive symptoms are described in all phases of the migraine attack phenomenology in published clinical series of migraine. Their characteristics appear to be different in each attack phase, although methodological limitations prevent generalization of this finding.

Impact on Employee Productivity From Presenteeism and Absenteeism: Evidence From a Multinational Firm in Sri Lanka

OBJECTIVE

This study examines the effects of 13 psychological and physical health conditions on work productivity.

METHODS

One hundred fifty-two staff at the headquarters of a Sri Lankan multinational firm completed a questionnaire asking whether they experienced 13 health conditions common in workplaces, and about their related absenteeism and presenteeism.

RESULTS

Most respondents (85.5%) reported absenteeism, presenteeism, or both. Among those reporting a health condition, 57.6% reported losing days due to absenteeism, and 69.5% reported losing additional days to presenteeism. Among those caring for a sick adult or child, 57.3% reported losing days due to absenteeism, and 36.5% reported losing additional days due to presenteeism. Overall productivity loss was 10.43 days each year, 3.95% of employee capacity, equating to about Sri Lanka Rupees 8 million (US$54,421) for all headquarters employees.

CONCLUSIONS

The health conditions' effects on productivity significantly increased employee costs.

Working with Persistent Pain: An Exploration of Strategies Utilised to Stay Productive at Work

Purpose Maintaining productive employment for people with persistent pain conditions is challenging. This study aims to explore supports-work and non-work- used by employees to assist them in maintaining productive employment. Methods An exploratory, mixed-methods study comprising a questionnaire battery followed by semi-structured interviews to collect in-depth qualitative data was undertaken. The questionnaires measured descriptive variables used to select participants for interviews based on maximum heterogeneity sampling. Thirty-five semi-structured interviews were undertaken (14 males; 21 females). The interview schedule covered: employment situation, workplace challenges, workplace supports, coping strategies, motivations, future employment options and any other resources utilised. Inductive content analysis was undertaken using a grounded theory approach to systematically explore the data. Results Three key themes were identified: barriers to working productively, enablers to working productively, disclosing my condition at work. A key determinant of maintaining productive employment was a supportive employer. In addition, flexibility in the work organisation was also pivotal in maintaining sustainable, productive employment. An important issue emerged with regard to disclosure of one's condition to an employer. For some, this was a significant barrier to employment. Conclusions To ensure sustainable employment is attainable for those with persistent pain conditions, a good match is required between an employee and their work. Workplace accommodations may assist with improving job fit but this requires disclosure of a condition to an employer. Weighing up the risks and benefits of disclosure is difficult, and may be assisted by knowledge of available supports to assist with maintaining ongoing employment.

Workers with a chronic disease and work disability. Problems and solutions

The prevalence of chronic diseases in the age group 18-65 years is high. Cardiometabolic conditions and musculoskeletal diseases are the most frequent chronic diseases. Depending on disease and comorbidity, the employment rates are considerably lower than for healthy individuals. Chronically ill workers may have problems in meeting job demands, they may experience physical, cognitive or sensory limitations, have fatigue or pain complaints or other disease symptoms. Psychological distress, depressive feelings, feelings of shame or guilt, lack of coping or communicative skills, and non-supportive colleagues and supervisors may add to work-related problems. The ICF Model (International Classification of Functioning, Disability and Health) of the WHO offers a framework for understanding and considering health-related problems at work and finding solutions. Interventions to prevent problems in functioning, sickness absence and work disability may focus on the worker, the workplace, or health care. Multidisciplinary vocational rehabilitation, exercise therapy, cognitive behavioural interventions, workplace interventions and empowerment are interventions with at least some evidence of effectiveness. Future policy could focus more on promotion of workers' health and future research should include the interests and motivations of employers concerning disability management, skills of line managers, the feasibility of interventions to prevent work disability and the context sensitivity of study outcomes.

Work adjustments in a representative sample of employees with a chronic disease in the Netherlands

PURPOSE

The aims of this study are: (1) to describe the prevalence of needed and implemented work adjustments in a representative sample of Dutch employees with a chronic disease; and (2) to assess the effects of needed and implemented work adjustments on sick leave.

METHODS

The prevalence of work adjustments was assessed in employees with a chronic disease, aged between 15 and 65 years (n = 7,687) from the 2007 Netherlands Working Conditions Survey (NWCS). Of these, N = 2,631 employees participated in the Netherlands Working Conditions Cohort Study (NWCCS) measurements in 2008 and 2009. The NWCCS data were used to investigate the effects of work adjustments on sick leave. All data were self-reported. A repeated measures ANOVA was performed to analyse differences in sick leave in 2007, 2008 and 2009 between employees with and without a need for work adjustments, for those who reported an implemented work adjustment and those who did not.

RESULTS

In 2007, the prevalence of implemented work adjustments among Dutch employees with a chronic disease was 22 %, while 30 % reported the need of a work adjustment. In employees with and without a need for work adjustments in 2007, a work adjustment in 2008 was significantly associated with a decrease in sick leave from 2007 to 2009.

CONCLUSION

The need for work adjustments is higher than the implementation of work adjustments. Work adjustments should be considered more often for employees with chronic diseases, because implementation of a work adjustment is associated with a decrease in sick leave.

Prognostic factors for successful work functioning in the general working population

PURPOSE

To help workers to stay at work in a healthy productive and sustainable way and for the development of interventions to improve work functioning, it is important to have insight in prognostic factors for successful work functioning. The aim of this study is to identify prognostic factors for successful work functioning in a general working population.

METHODS

A longitudinal study (3 months follow-up) was conducted among the working population (N = 98). Work functioning was assessed with the Work Role Functioning Questionnaire 2.0 (WRFQ). The total score was categorized as follows: 0-90; >90 ≤95; and >95-100 (defined as 'successful work functioning'). Ordinal logistic regression analyses were performed to examine bivariate relationships between potential prognostic factors and the dependent variable (successful work functioning) to identify potential prognostic factors for the multivariate models (p < 0.10). A stepwise approach was used to introduce the variables in the multiple ordinal regression analyses.

RESULTS

Baseline work functioning and work ability were significant prognostic factors for successful work functioning at 3 months follow-up. No prospective associations were identified for psychological job demands and supervisor social support with successful work functioning.

CONCLUSION

To our knowledge this is the first longitudinal study to identify prognostic factors for successful work functioning in the general working population. High work ability is predictive for future successful work functioning, independent of baseline work functioning.

Return to work and cancer: the Australian experience

PURPOSE

Research suggests that for many cancer survivors, returning to work has a range of benefits. However, considerable barriers have been identified as influencing the quality of return to work outcomes. This study explored the perspectives of Australian cancer survivors, managers and employee assistance program (EAP) professionals to gain an understanding of the return to work process and factors that affect the experience.

METHODS

Focus groups and interviews were conducted with cancer survivors (n = 15), managers (n = 12), and EAP professionals / psychologists (n = 4) from public and private sectors. Thematic analysis was used to analyse the data to identify common and unique themes from the three participant groups.

RESULTS

A range of drivers were identified including maintaining normality and regaining identity, which could act positively or negatively depending on survivors' coping ability and self awareness. Analysis revealed communication difficulties in the workplace that impact on emotional and practical support. Negotiating an employee's return is complex, influenced by the level of consultation with the employee and use of an ad hoc or structured process. Direct and indirect ways of supporting employees with cancer were identified, as was the need for colleague and manager support.

CONCLUSION

This study supports previous research findings of the impact of cancer on work, and reveals managers' lack of knowledge on how to respond appropriately. The process of returning to work is complex, influenced by employees' and managers' attitudes, communication skills and coping abilities. Areas for workplace interventions to optimise support for the cancer survivor are described.

Clinging to any bit of joy: urban, ethnically diverse, impoverished women's descriptions of anxiety and depression

Depression and anxiety are mental health issues that disproportionately affect women. This study sought to capture perceptions of anxiety and depression in 3 urban, ethnically diverse, underserved, and impoverished neighborhoods. Using community-based participatory research, in the context of long-term partnerships between a department of nursing and these neighborhoods, the researchers recruited 61 women aged 18 to 69 years. Data were collected via 6 homogeneous focus groups composed of Black, Hispanic, and White women, respectively. The women identified themes pertaining to the manifestations and effects of anxiety and depression as well as unique coping strategies.

Work Limitations and Their Relationship to Morbidity Burden among Academic Health Center Employees with Diabetes

The objective of this study was to determine the prevalence of work limitations and their relationship to morbidity burden among academic health center employees with diabetes. Employees with diabetes were surveyed via Internet and mail using the Work Limitations Questionnaire. Morbidity burden was measured using the Adjusted Clinical Groups methodology. Seventy-two percent of the employees with diabetes had a work limitation. Adjusted odds ratios for overall, physical, time, and output limitations were 1.81, 2.27, 2.13, and 2.14, respectively. Morbidity burden level is an indicator of work limitations in employees with diabetes and can be used to identify employees who may benefit from specialized services aimed at addressing their work limitations associated with diabetes.

Workers with health problems: three perspectives on functioning at work

PURPOSE

Our aims were (i) to explore why it is that one worker with a health problem is able to stay at work while the other is not, (ii) to identify signals for decreased functioning at work, and (iii) to explore if and how this can be measured.

METHOD

We conducted three focus groups: with workers with a health problem, occupational physicians, and human resources managers/supervisors.

RESULTS

Individual differences in coping strategies, motivation, believes, attitudes, and values were mentioned. All three groups reported that the supervisor is the key figure in the functioning at work of workers with health problems. The supervisor can facilitate the work accommodation of workers and help optimizing functioning at work. The identified signals might contribute to the development of an instrument. Conditions for use were suggested, i.e. a "safe" setting.

CONCLUSIONS

This focus group study provided insight in why it is that one worker is able to stay at work while the other is not, according to the opinions of three different groups. Although all three groups reported that the supervisor is the key figure in the functioning at work of workers with health problems, there are differences between how the three stakeholders perceive the situation.

Workplace support for employees with cancer

Objective

The aim of the present study was to survey human resources personnel about how their northeastern Ontario workplaces assist employees with cancer.

Study Design and Setting

This cross-sectional study was conducted from December 2007 to April 2008. Surveys were sent to 255 workplaces in northeastern Ontario with 25 or more employees, and 101 workplaces responded (39.6% response rate). Logistic regression modelling was used to identify factors associated with more or less workplace support. More or less workplace support was defined by provision of paid time to employees with medical appointments and an offer of a return-to-work meeting and reduced hours for employees with cancer. Factors considered in the model included organization size, geographic location (urban, rural), and workplace type (private sector, public sector).

Results

Most of the human resources staff who completed the surveys were women (67.4%), and respondents ranged in age from 25 to 70 years (mean: 45.30 ± 8.10 years). Respondents reported working for organizations that ranged in size from 25 to more than 9000 employees. In the logistic regression model, large organization size [odds ratio (or): 6.97; 95% confidence interval (ci): 1.34 to 36.2] and public sector (or: 4.98; 95% ci: 1.16 to 21.3) were associated with employer assistance. Public sector employers provided assistance at a rate 5 times that of private sector employers, and large organizations (>50 employees) provided assistance at a rate 7 times that of smaller organizations.

Conclusions

In the population studied, employees with cancer benefit from working in larger and public sector organizations. The data suggest a need for further support for employees with cancer in some other organizations.

Characteristics of suitable work from the perspective of patients with fibromyalgia

OBJECTIVES

The evaluation of work ability of patients with FM is difficult. Our aim was to investigate the characteristics of suitable work from the perspective of patients with FM.

METHODS

Interviews with patients yielded statements about characteristics of suitable work. Patients individually sorted these statements according to similarity. Hierarchical cluster analysis was applied to these sortings.

RESULTS

The hierarchical structure included 74 characteristics of suitable work. The 10 clusters at the lowest level included (i) recovery opportunities, (ii) pace of work, (iii) not too high workload, (iv) keeping energy for home and free time, (v) match between work and capabilities, (vi) development opportunities, (vii) understanding from colleagues, (viii) help from colleagues, (ix) support from management and (x) work agreements with management.

CONCLUSIONS

According to patients with FM, suitable work is paced in such a way that one can perform the job well and with satisfaction while keeping energy for home and free time and having acknowledgement and help from management and colleagues. The brief suitable work checklist that is provided can help patients with FM to negotiate with employers and job professionals to improve the match between job demands and capabilities.

Facilitating job retention for chronically ill employees: perspectives of line managers and human resource managers

BACKGROUND

Chronic diseases are a leading contributor to work disability and job loss in Europe. Recent EU policies aim to improve job retention among chronically ill employees. Disability and occupational health researchers argue that this requires a coordinated and pro-active approach at the workplace by occupational health professionals, line managers (LMs) and human resource managers (HRM). Little is known about the perspectives of LMs an HRM on what is needed to facilitate job retention among chronically ill employees. The aim of this qualitative study was to explore and compare the perspectives of Dutch LMs and HRM on this issue.

METHODS

Concept mapping methodology was used to elicit and map statements (ideas) from 10 LMs and 17 HRM about what is needed to ensure continued employment for chronically ill employees. Study participants were recruited through a higher education and an occupational health services organization.

RESULTS

Participants generated 35 statements. Each group (LMs and HRM) sorted these statements into six thematic clusters. LMs and HRM identified four similar clusters: LMs and HRM must be knowledgeable about the impact of chronic disease on the employee; employees must accept responsibility for work retention; work adaptations must be implemented; and clear company policy. Thematic clusters identified only by LMs were: good manager/employee cooperation and knowledge transfer within the company. Unique clusters identified by HRM were: company culture and organizational support.

CONCLUSIONS

There were both similarities and differences between the views of LMs and HRM on what may facilitate job retention for chronically ill employees. LMs perceived manager/employee cooperation as the most important mechanism for enabling continued employment for these employees. HRM perceived organizational policy and culture as the most important mechanism. The findings provide information about topics that occupational health researchers and planners should address in developing job retention programs for chronically ill workers.

Impact of chronic rhinosinusitis on work productivity through one-year follow-up after balloon dilation of the ethmoid infundibulum

BACKGROUND

Although multiple clinical trials have demonstrated that balloon dilation of sinus ostia in patients diagnosed with chronic rhinosinusitis (CRS) results in sustained symptomatic improvement, less data are available to measure the effects of sinusitis on worker productivity. The objective of our research was to analyze work and activity impairment before and after transantral, endoscopically-guided balloon dilation of the maxillary sinus ostia and ethmoid infundibulum.

METHODS

Subjects diagnosed with CRS and computed tomography (CT) evidence of disease in the maxillary sinuses alone, or maxillary and anterior ethmoid sinuses, completed the Work Productivity and Activity Impairment (WPAI) questionnaire and the Work Limitation Questionnaire (WLQ) before treatment and at 3, 6, and 12 months postprocedure.

RESULTS

A total of 56 subjects were enrolled and 53 completed the 1-year follow-up. The lost productivity composite score computed from the WLQ improved by 73% (9.0 to 2.4; p < 0.0001) at 1-year follow-up whereas lost productivity at work as measured by the WPAI improved by approximately 76% (38.3 to 9.2; p < 0.0001) 12 months after treatment.

CONCLUSION

These results indicate that sinus-related health problems impose a substantial burden on work productivity and physical/mental activity levels. Treatment of CRS by dilating the maxillary sinus ostium and ethmoid infundibulum can significantly improve quality of life (QOL) and work productivity.

Low mood and employment: when affective disorders are intertwined with the workplace--a UK perspective

Working is undoubtedly an important aspect of western life. As well as structuring time, it provides financial security, meaning, identity and social participation, and has a beneficial effect on long-term physical and mental well-being. Despite this, people with mental health conditions have the lowest employment rate of any disabled group, although many of them want to work and work is highly beneficial for their physical and mental health. Existing research on mental health problems and employment outcomes have tended to focus on interventions for people with severe mental illness. Little research exists on the relationship between affective disorders, mainly depression and anxiety, and employment. This review focuses on studies conducted in the UK. Its conclusion is that there is no single rigorous investigation to test the relationship between common mental disorders and vocational outcomes.

The influence of employer support on employee management of chronic health conditions at work

INTRODUCTION

This study examined the relationship between employer support, self-efficacy and self-management of chronic illness at work.

METHOD

772 employees reporting musculoskeletal pain (n = 230), arthritis and rheumatism (n = 132), asthma (n = 129), depression and anxiety (n = 121), heart disease (n = 80) and diabetes(n = 80) completed a questionnaire distributed across four large organizations. A modified version of the Self-Efficacy to Manage Symptoms Scale and the Self-Management Behaviors Scale were used. Support from line manager and occupational health were assessed.

RESULTS

Structural equation modelling analyses revealed that line managers support was directly related to employees' self-management of symptoms and medication at work. All three self-efficacy measures (beliefs about the ability to make adjustments,take medication and manage symptoms at work) partially mediated the relationship between line manager support and the use of medication at work. Self-efficacy beliefs in taking medication and making work adjustments also partially mediated the relationship between line manager support and self-management of symptoms at work. In contrast, there were no direct relationship between occupational health support and two self-management behaviors. Self-efficacy beliefs about making adjustments at work fully mediated the relationship between support from occupational health and self-management behaviors.

CONCLUSIONS

Employer support in developing both symptom-related and work-related self-efficacy for medication adherence and symptom management is important for those working with a chronic illness.

Supporting more able students on the autism spectrum: college and beyond

In the 1990's a surge of children were diagnosed with autism spectrum disorders (ASDs) and are now approaching college age. Through early diagnosis and intervention many of these children are now able to consider post secondary education. However, these students will need specific interventions and supports in order to be successful. This article reviews the nosology of ASDs, the legal basis for providing accommodations to students on the autism spectrum, and the incidence and prevalence of ASDs. The authors provide specific recommendations regarding the academic, independent living, social, vocational and counseling needs of college students who are on the autism spectrum. With a carefully planned transition, appropriate accommodations, and support, ASD students can be successful academically and socially in college.

Employee health and presenteeism: a systematic review

INTRODUCTION

Many employers focus on their large and easily measured cost of health care, yet until recently they have ignored the impact of health on productivity. Studies of some chronic conditions and some health risk factors suggest that costs of lost productivity exceed costs of medical care. This review will examine the literature to explore the link between employee health and on-the-job productivity, also known as presenteeism.

METHODS

Searches of Medline, CINAHL and PubMed were conducted in October 2006, with no starting date limitation with "presenteeism" or "work limitations" as keywords. A total of 113 studies were found using this method. Each study was evaluated based on the strength of the study design, statistical analyses, outcome measurement, and controlling of confounding variables.

RESULTS

Literature on presenteeism has investigated its link with a large number of health risks and health conditions ranging from exercise and weight to allergies and irritable bowel syndrome. As expected, the research on some topic areas is stronger than others.

CONCLUSIONS

Based on the research reviewed here, it can be said with confidence that health conditions such as allergies and arthritis are associated with presenteeism. Moreover, health risks traditionally measured by a health risk appraisal (HRA), especially physical activity and body weight, also show an association with presenteeism. The next step for researchers is to tease out the impact of individual health risks or combinations of risks and health conditions on this important outcome measure.

Work factors related to psychological and health-related distress among employees with chronic illnesses

OBJECTIVE

This study examined specific psychosocial factors associated with psychological and health-related distress amongst employees reporting different chronic illnesses.

METHODS

The sample consisted of 1029 employees managing either musculoskeletal pain (n=324), arthritis and rheumatism (n=192), asthma (n=174), depression and anxiety (n=152), heart disease (n=96) or diabetes (n=91). Information on psychological distress, work limitations, illness management, disclosure, absence, presenteeism, support and demographic factors were obtained through self-administered questionnaires.

RESULTS

Both low psychological well-being and high health-related distress were associated with an increase in work limitations (beta=0.20, SE=.03; and beta=0.19, SE=.01, respectively), poorer management of illness symptoms at work (beta=-0.17, SE=.12; and beta=-0.13, SE=.02), high presentieesm (beta=0.19, SE=.25; and beta=0.14, SE=.05) and low workplace support (beta=-0.05, SE=.22; and beta=-0.12, SE=.05). Health-related distress was additionally associated with disclosure of illness at work (beta=0.18, SE=.08) and long-term sickness absence (beta=0.10, SE=.06).

CONCLUSIONS

To enable individuals to effectively manage both their illness and their work without serious repercussions, it is important for both healthcare professionals and employers alike, to improve the well-being of workers with chronic illness by supporting and facilitating their efforts to over-come health-related limitations at work.

Interventions to improve employment outcomes for workers who experience mental illness

OBJECTIVE

To review employment interventions for individuals who experience mental illness.

METHOD

I reviewed employment interventions described in the mental health, disability, and rehabilitation literature for the period 1990 to 2005 and organized these interventions into a framework.

RESULTS

The framework develops 7 distinct individual-level employment interventions as well as interventions directed at the employer and at workplace organization. It also considers factors that will affect access to these interventions. Although there is a sense of optimism about the potential of these interventions, research in the area is limited.

CONCLUSION

Physicians who are knowledgeable about the nature and scope of employment interventions for individuals with mental illness are in a good position to effect positive change in the work lives of the individuals they serve.

Cancer survivorship and work: symptoms, supervisor response, co-worker disclosure and work adjustment

INTRODUCTION

Recent improvements in cancer treatment have not only increased cancer survivorship but also peoples' ability to work during and following treatment. However, the impact that both diagnosis and treatment has on cancer survivors' ability to fully engage in paid work is not yet entirely understood. This study aims to explore the role of symptoms, work adjustments and cancer disclosure to supervisors and co-workers on working during primary cancer treatment and return to work following treatment.

METHOD

328 cancer survivors responded to a 33 item questionnaire that assessed cancer-specific variables e.g. type and treatment, symptoms experienced during and following treatment, disclosure of cancer and adjustments and supports available at work. Multivariate logistic regressions were run to determine the association of symptoms, disclosure and work adjustments and working during treatment and returning to work following treatment.

RESULTS

The findings indicate that opportunities to work flexibly (OR = 2.43, CI 1.21-4.02), disclosure to colleagues (OR = 3.03, CI 1.28-8.19), difficulties managing fatigue (OR = 2.08, CI 1.22-3.85), and paid time off to attend all medical appointments (OR = .4, CI .30-.87) were associated with continuing to work during treatment. Correlates of return to work included difficulties managing fatigue (OR = 1.49, CI 1.42-6.18), managing the stress of cancer (OR = 2.80, 1.05-5.34), managing physical changes associated with cancer (OR = .46, CI .13-.95), received advice from their doctor about work (OR = 1.47, CI 1.09-2.84) and return to work meeting with employer (OR 1.99, 1.2-5.09).

CONCLUSIONS

This study highlights the importance of symptom management in cancer survivors who work and the potential impact of workplace adjustments on the ability of cancer survivors to navigate in the world of work.