What are they returning to? Psychosocial work environment as a predictor of returning to work among employees in treatment for common mental disorders: A prospective observational pre-post study

Practical pathway for the management of depression in the workplace: a Canadian perspective

Major depressive disorder (MDD) and other mental health issues pose a substantial burden on the workforce. Approximately half a million Canadians will not be at work in any week because of a mental health disorder, and more than twice that number will work at a reduced level of productivity (presenteeism). Although it is important to determine whether work plays a role in a mental health condition, at initial presentation, patients should be diagnosed and treated per appropriate clinical guidelines. However, it is also important for patient care to determine the various causes or triggers including work-related factors. Clearly identifying the stressors associated with the mental health disorder can help clinicians to assess functional limitations, develop an appropriate care plan, and interact more effectively with worker's compensation and disability programs, as well as employers. There is currently no widely accepted tool to definitively identify MDD as work-related, but the presence of certain patient and work characteristics may help. This paper seeks to review the evidence specific to depression in the workplace, and provide practical tips to help clinicians to identify and treat work-related MDD, as well as navigate disability issues.

Level of education and sustainable return to work among long-term sick-listed workers with depression: a register-based cohort study (The Norwegian GP-DEP Study)

OBJECTIVES

Sick-listed workers with depression are at higher risk of long-term, recurrent sickness absence and work disability, suggesting reduced likelihood of sustainable return to work (SRTW). Though likelihood of RTW has been associated with education level, less is known about the association over time, post-RTW. We aimed to investigate associations between educational level and SRTW among long-term sick-listed workers with depression.

METHODS

Nationwide cohort study, based on linked data from Norwegian health and population registries, including all inhabitants of Norway aged 20-64 years on long-term sick leave with a depression diagnosis given in general practice between 1 January 2009 and 10 April 2011 (n=13.624, 63.7% women). Exposure was the highest attained education level (five groups). Three outcome measures for SRTW were used, with 0 days, ≤30 days and ≤90 days of accumulated sickness absence post-RTW during a 2-year follow-up. Associations between exposure and outcomes were estimated in gender-stratified generalised linear models, adjusting for sociodemographic factors and duration of sick leave.

RESULTS

Higher-educated workers had a higher likelihood of SRTW 0, SRTW ≤30 and SRTW ≤90 than the lowest-educated groups in the crude models. Among men, this association was mainly explained when adjusting for occupation. Among women, the highest educated group had a higher likelihood of SRTW 0 (RR=1.45, 95% CI 1.23 to 1.71) and SRTW ≤30 and SRTW ≤90 in the fully adjusted models.

CONCLUSIONS

An educational gradient in SRTW was mainly explained by occupation among men but not among women. These findings suggest gendered differences in associations between education level and SRTW, which could inform interventions aiming to promote equal opportunities for SRTW.

Supporting employees with mental illness and reducing mental illness-related stigma in the workplace: an expert survey

An expert survey was designed to support the development of a workplace-based multi-country intervention tackling depression, anxiety, and mental illness-related stigma in small- and medium-sized enterprises (SMEs). Academic experts and representatives of SME organisations, specific sector organisations, labour or advocacy groups, and occupational health organisations, were contacted across eight European countries and Australia. The survey comprised closed and open text questions to assess expert opinion about interventions for employees with mental health difficulties, interventions supporting their managers, and anti-stigma interventions. The survey was available in six languages. The online platform Qualtrics was used for data collection. Quantitative data was analysed through descriptive statistics and qualitative data was analysed through thematic analysis. Sixty-five of 146 experts responded, representing a 42% response rate. Results showed only 26.2% of experts agreed that employees could speak openly about mental health issues, and 81.5% of experts indicated a large or medium unmet need for support for employees with mental health issues. Psychoeducational materials, face-to-face workshops and interventions based on cognitive behavioural therapy were ranked most likely to be taken up by employees. Experts rated as most useful for managers' guidelines on how to act if an employee has mental health issues (67.7%). The greatest number of experts indicated workshops of people with lived experience of mental illness (80.0%) and awareness campaigns (78.5%) were most required to tackle stigma. Responses were consistent between experts from different countries and areas of expertise. Experts in this multinational survey assessed that interventions supporting mental health in the workplace and tackling stigma are greatly needed. A multicomponent intervention with a wide range of materials and tools is supported.

Influence of social support on return to work after total hip or total knee arthroplasty: a prospective multicentre cohort study

OBJECTIVES

There is strong evidence that social support is an important determinant of return to work (RTW). Little is known about the role of social support in RTW after total hip or knee arthroplasty (THA/TKA). Objective was to examine the influence of preoperative and postoperative perceived social support on RTW status 6 months postoperatively.

DESIGN

A prospective multicentre cohort study was conducted.

SETTING

Orthopaedic departments of four Dutch medical centres; a tertiary university hospital, two large teaching hospitals and a general hospital.

PARTICIPANTS

Patients planned to undergo THA/TKA, aged 18-63 and employed preoperatively were included.

MAIN OUTCOME MEASURES

Questionnaires were filled out preoperatively and 3 and 6 months postoperatively and included questions to assess patients' perceived social support targeting three sources of social support: from home (friends, family), from work (coworkers, supervisors) and from healthcare (occupational physician, general practitioner, other caregivers). Control variables included age, gender, education, type of arthroplasty and comorbidities. RTW was defined as having fully returned to work 6 months postoperatively. Univariate and multivariate logistic regression analyses were conducted.

RESULTS

Enrolled were 190 patients (n=77 THA, n=113 TKA, median age was 56 years, 56% women). The majority returned to work (64%). Preoperatively, social support from the occupational physician was associated with RTW (OR 2.53, 95% CI 1.15 to 5.54). Postoperatively, social support from the occupational physician (OR 3.04, 95% CI 1.43 to 6.47) and the supervisor (OR 2.56, 95% CI 1.08 to 6.06) was associated with RTW.

CONCLUSIONS

This study underscores the importance of work-related social support originating from the occupational physician and supervisor in facilitating RTW after primary THA/TKA, both preoperatively and postoperatively. Further research is needed to confirm our results and to understand the facilitating role of social support in RTW, as arthroplasty is being performed on a younger population for whom work participation is critical.

The influence of work environment relationships on mental health of Brazilian seamstresses

BACKGROUND

The work environment is a place in which different kinds of interpersonal relationships are developed and can contribute positively or negatively to productivity and to workers' well-being. Discussion on this topic may contribute to building more coping strategies to fight against gender inequality and the emotional repercussions of these conditions.

OBJECTIVE

This is a cross-sectional study that investigated the possible influence of work environment relationships on the mental health of Brazilian seamstresses.

METHODS

The participants were seamstresses from four clothing factories in a city in the southwest of Brazil. For data collection, we used the Social Support Perception at Work Scale; Self-Report Questionnaire; Alcohol, Smoking and Substance Involvement Screening Test; and a focus group. The quantitative data were statistically analyzed, and data from the focus groups were analyzed using content analysis.

RESULTS

Interpersonal relationships at work were mentioned as sources of conflict and stress but also as emotional and material social support providers. In the sample studied, these relationships did not influence directly the development of mental health disorders.

CONCLUSIONS

Study results suggest that a low level of education is an important factor that increases the vulnerability of these women to the precariousness of work, and, consequently to developing mental health symptoms or aggravating previous mental health distress. However, emotional and material support from peers likely protects these workers' mental health.

The Psychosocial Work Environment and Perceived Stress among Seniors with Physically Demanding Jobs: The SeniorWorkingLife Study

Background: Poor psychosocial work conditions are known to foster negative health consequences. While the existing literature on this topic focus mainly on white-collar workers, the influence of different aspects of the psychosocial work environment in physically demanding jobs remain understudied. Likewise, senior workers represent a population of the workforce at increased risk of adverse health outcomes and premature exit from the labour market. This study investigates the association between psychosocial work factors and perceived stress among the senior work force. Methods: Utilizing cross-sectional findings, this study reports associations between psychosocial factors (organizational justice, cooperation and collegial support, decision latitude, clarity of tasks, and quality of leadership) and the outcome of perceived stress quantified by Cohen’s Perceived Stress Scale (CPSS). Currently employed senior workers with physically demanding jobs were included in the analyses (n = 3386). Associations were modeled using general linear models with weights to make the estimates representative. Results: For all individually adjusted psychosocial variables, the category of “good” was consistently associated with lower stress scores compared to the categories of both “moderate” and “poor” (all p < 0.0001). Likewise, in the mutually adjusted analysis, the category of “good” was statistically different from “poor” for all included variables, while the category of “moderate” remained different from “poor” for “clarity of tasks”, “cooperation and collegial support”, and “decision latitude”. Conclusions: Among senior workers with physically demanding jobs, poor ratings of organizational factors related to the psychosocial work environment are consistently associated with high stress scores. Blue-collar occupations focusing primarily on physical risk factors are recommended to increase awareness on psychosocial aspects that may be relevant to the local work environment.

Work-life balance predicted work ability two years later: a cohort study of employees in the Swedish energy and water sector

Background

Work-life balance (WLB) is the extent to which individual’s multiple life roles and demands carry over between each role. WLB can be divided into work interference with personal life (WIPL) and personal life interference with work (PLIW). This study aimed to investigate longitudinal associations between WIPL, PLIW and work ability outcomes.

Methods

In this cohort study, 224 employees in the energy and water sector in Sweden were followed-up over 2 years. Three questions derived from the Work Ability Index were used for measuring work ability outcome: current work ability compared with lifetime best; work ability regarding physical; and mental demands. Logistic regression models were used to analyse longitudinal associations between work ability and WIPL and WIPL respectively, controlling for workplace (company), position at work, experience of leadership quality, demographics, and work ability.

Results

Work ability compared to lifetime best were associated with WIPL in the adjusted logistic regression models (odds ratio (OR) 1.77, 95% confidence interval (CI) 1.15–2.73), and PLIW (OR 3.34, 95% CI 1.66–6.74). Work ability regarding physical demands was associated with WIPL (OR 1.60, 95% CI 1.07–2.40). Work ability regarding mental demands was associated with WIPL (OR 1.59, 95% CI 1.03–2.44) and PLIW (OR 2.88, 95% CI 1.31–6.32).

Conclusion

In this two-year longitudinal study, lower WIPL predicted good/excellent overall work ability compared with lifetime best, higher work ability regarding physical and mental demands, and lower PLIW predicted good/excellent overall work ability compared with lifetime best and higher work ability regarding and mental demands.

Perceived job strain among Swedish occupational therapists with less than 10 years of work experience

BACKGROUND

Occupational therapists with less than 10 years of work experience have been shown to be at higher risk of work-related stress. There is a need for further research on the level of job strain they perceive.

AIMS

To investigate the perceived level of job strain among Swedish occupational therapists with less than 10 years of work experience and differences between groups who have worked for 0-5 years and 6-10 years.

MATERIAL AND METHODS

In this cross-sectional study, a web-based survey was sent to 345 occupational therapists with less than 10 years of work experience, with 252 responding. Data was collected using the Swedish Demand-Control-Support Questionnaire and questions on job strain and sociodemographics.

RESULTS

The participants scored 19.68 points on the control scale and 20.01 points on the support scale, indicating high levels of control and support, and 13.33 points on the demand scale (high demand ≤ 14 points). Twelve percent worked in high strain jobs. Most (75%) worked in low strain and active jobs.

CONCLUSIONS AND SIGNIFICANCE

The participants reported low levels of job strain. However, to prevent mental health problems, employers need to identify those in active jobs to ensure that they have time to exercise control over their work situation.

Work ethics and societal norms influence sick leave and return to work: tales of transformation

PURPOSE

This study's purpose was to explore how people on sick leave manage societal norms and values related to work, and how these influence their perspectives of themselves throughout the rehabilitation process.

MATERIALS AND METHODS

This was a longitudinal interview study with a narrative approach, comprising 38 interviews with 11 individuals on long-term sick leave. Data collection was conducted in two phases and analysed iteratively through content analysis.

RESULTS

The results suggest that work ethics and societal norms influence individuals' views of themselves and the sick leave and rehabilitation process. Conforming one's personal values to the work norm can create internal conflicts and cause feelings of shame for not being able to live up to the established norm. The strong work norm may create unrealistic expectations, which in some cases may result in constraining the return to work process.

CONCLUSION

To transform a sick leave narrative into a positive one, societal norms and their influence on identity needs to be recognised. Stakeholders involved in the process can contribute to a positive transformation by not only supporting return to work, but also to acknowledge and help people manage their self-image as having a disability that limits their ability to work.IMPLICATIONS FOR REHABILITATIONStakeholders involved in the sick leave and rehabilitation process need to support sick listed individuals by acknowledging and helping people manage their self-image.Full RTW is not always the best option from a quality of life and wellbeing perspective.Treatment and support from stakeholders should be viewed as meaningful and legitimate, even if it does not lead to RTW.