External context in individual placement and support implementation: a scoping review with abductive thematic analysis

BACKGROUND

Context including the external context may considerably affect the adoption, implementation, sustainment, and scale-up of evidence-based practices. We investigated external contextual features by conducting a scoping review of empirical research regarding the implementation of an evidence-based psychiatric or mental health vocational rehabilitation service called Individual Placement and Support (IPS).

METHODS

The protocol for the scoping review was registered with the Open Science Framework. We used the methodology by Joanna Briggs Institute for conducting the scoping review and reported it according to the PRISMA-ScR checklist. We searched 12 databases for research regarding 'Individual Placement and Support' or 'Evidence-Based Supported Employment'. We retained peer-reviewed empirical studies investigating external contextual factors and their impact on IPS implementation outcomes. We extracted data from the eligible articles and conducted descriptive and thematic analyses.

RESULTS

Fifty-nine original research papers met our eligibility requirements and were retained after reviewing 1124 titles and abstracts and 119 full texts. The analysis generated two main themes: (1) external contextual determinants of service delivery and (2) external systems influencing the evidence-to-practice process. The first main theme encompassed policies and laws, financing, and administratively instituted support resources, and organizational arrangements associated with external stakeholders that may facilitate or hinder the local implementation. The second main theme comprised strategies and actions used by different stakeholders to facilitate implementation locally or scale-up efforts at a system level.

DISCUSSION

Our scoping review illustrates the important role that external contextual factors play and how they may facilitate or hinder the implementation and scale-up of the IPS model across mental health services in different countries. Consideration of these factors by decision-makers in mental health and welfare services, planners, providers, and practitioners is likely to facilitate the development of effective strategies for bridging the evidence-practice gap in implementing the EBPs. Finally, the scoping review identified gaps in knowledge and offered suggestions for future research.

TRIAL REGISTRATION

Open Science Framework.

Trajectories of hospitalizations after age-based statutory retirement

Retirement years are ideally spent in good health. We aimed to produce new information using person-oriented methods by identifying groups of statutory retirees who did or did not achieve this objective and the factors that distinguish these groups from each other. Our particular focus was on the years directly after the transition into retirement, and the pre-retirement factors that explained the development of health, using a more severe health-related outcome-hospitalization. We studied the retirement, hospitalizations, education, and work characteristics of former employees of the City of Helsinki, Finland (N = 6569), from complete registers. We used group-based trajectory models and identified groups of constant low, constant high, decreasing, and temporarily occurring hospitalizations, and one group of increasing hospitalizations among women and two groups of earlier and later increasing hospitalizations among men. Multinomial regression models showed that among women, belonging to groups with less favourable health was associated with secondary education, older age at retirement, and reduced working hours. Education and work characteristics before retirement both contribute to the development of health, as indicated by hospitalizations directly after retirement. Our findings show that socioeconomic inequalities in health are persistent and should also be addressed after transition into retirement.

Trajectories of CVD medication after statutory retirement: contributions of pre-retirement sociodemographic, work and health-related factors: a register study in Finland

BACKGROUND

Cardiovascular diseases (CVDs) are prevalent in older people, but few studies focus on developmental patterns in CVD medication directly after transition to statutory retirement. We thus aimed to identify trajectories of CVD medication after retirement, and their sociodemographic, work and health-related determinants.

METHODS

We used complete register data of former employees of the City of Helsinki, Finland. All who reached their statutory retirement in 2000-2013, with five-year follow-up data (n = 6,505, 73% women), were included. Trajectories of CVD medication were identified with group-based trajectory modelling using data from Finnish Social Insurance Institution's reimbursement register. Sociodemographic, work and health-related determinants of trajectory group membership were analysed using multinomial logistic regression.

RESULTS

Six trajectories of CVD medication were distinguished: "constant low" (35%), "late increase" (6%), "early increase" (5%), "constant high" (39%), "high and decreasing " (8%), and "low and decreasing" (7%). The majority (74%) of the retirees fell into the "constant low" and "constant high" categories. Lower occupational class and increased pre-retirement sickness absence were associated with the "constant high" trajectory. Further, those with lower educational attainment were more prone to be in the "early increase" trajectory.

CONCLUSIONS

Individuals in lower socioeconomic positions or with a higher number of pre-retirement sickness absence may be considered at higher risk and might benefit from early interventions, e.g. lifestyle interventions and interventions targeting working conditions, or more frequent monitoring.

Working conditions and mental health functioning among young public sector employees

Background: The associations between adverse working conditions and mental disorders are well established. However, associations between adverse working conditions and poor mental health functioning is a less explored area. This study examines these associations among younger public sector employees of the City of Helsinki, Finland. Methods: We use data from the Young Helsinki Health Study with a representative sample of the employees of the City of Helsinki, aged 19-39 years (n=4 217). Mental health functioning was measured with mental composite summary of the Short Form 36. Working conditions included factors related to both the psychosocial (job control and job demands) and the physical work environment (physical workload). To examine the associations, we used logistic regression models with adjustments for socio-demographics, other working conditions and health-related covariates. Results: After adjustment for sociodemographic characteristics, poor health, health behaviours and other occupational exposures, high job demands (OR=1.69; 95% CI=1.45-1.97) and low job control (OR=1.65; 95% CI=1.40-1.94) were associated with poor mental health functioning. High physical workload was not associated with the outcome (OR=0.87; 95% CI=0.72-1.05) after the adjustments. Conclusions: Adverse psychosocial working conditions were associated with mental health functioning, whereas physical working conditions were not. As impaired functioning is likely to cause health-related lost productivity and can lead to work disability, further research and interventions with a balanced approach focusing on both psychosocial working conditions and mental health functioning are recommended.

Intervention targeted at physicians' treatment of musculoskeletal disorders and sickness certification: an interrupted time series analysis

OBJECTIVE

An intervention was carried out at the occupational healthcare services (OHS) of the City of Helsinki beginning in 2016. We investigated the association between the intervention and employee sick leaves using interrupted time series analysis.

DESIGN

Register-based cohort study with a quasi-experimental study design.

SETTING

Employees of the City of Helsinki.

PARTICIPANTS

We analysed individual-level register-based data on all employees who were employed by the city for any length of time between 2013 and 2018 (a total 86 970 employees and 3 014 075 sick leave days). Sick leave days and periods that were OHS-based constituted the intervention time series and the rest of the sick leave days and periods contributed to the comparison time series.

INTERVENTION

Recommendations provided to physicians on managing pain and prescribing sick leave for low back, shoulder and elbow pain.

OUTCOME MEASURES

Number of sick leave days per month and sick leave periods per year.

RESULTS

For all sick leave days prescribed at OHS, there was no immediate change in sick leave days, whereas a gradual change showing decreasing number of OHS-based sick leave days was detected. On average, the intervention was estimated to have saved 2.5 sick leave days per year per employee. For other sick leave days, there was an immediate increase in the level of sick leave days after the intervention and a subsequent gradual trend showing decreasing number of sick leave days.

CONCLUSIONS

The intervention may have reduced employee sick leaves and therefore it is possible that it had led to direct cost savings. However, further evidence for causal inferences is needed.

Working conditions and antidepressant medication use: A prospective study among 18 to 39-year-old municipal employees

This study aimed to examine the associations of perceived physical and mental working conditions with subsequent antidepressant medication purchases among 18-39-year-old municipal employees. Survey data collected in 2017 among employees of the City of Helsinki (n=5897, response rate 51.5%) were linked to register data on psychotropic medication purchases (82% gave permission to register linkage). The analysis included 3570 women and 972 men. We used three single-item measures of working conditions: perceived mental and physical strenuousness of work, and time spent in physical work. Covariates included age, gender, marital status, employment status, body mass index, smoking, alcohol use and previous medication. Cox regression analysis was used to calculate hazard ratios (HR) for the first antidepressant medication (ATC class N06A) purchase during a one-year follow-up. Those with mentally strenuous work (HR 1.85) as well as those spending more than four hours in physical work per workday (HR 1.60) had an statistically significantly increased risk of antidepressant medication use when adjusting for age and gender. Further adjustments for covariates attenuated these associations, which however remained statistically significant. Improving working conditions to avoid excess mental and physical workload is likely to be beneficial for preventing mental health problems already among younger employees.

Physical working conditions and subsequent sickness absence: a record linkage follow-up study among 19-39-year-old municipal employees

Purpose

Physical work exposures are associated with sickness absence among older employees. We aimed to examine if they similarly contribute to all-cause sickness absence during early and mid-careers.

Methods

We used questionnaire data on physical work exposures linked to register data on sickness absence from 3542 municipal employees aged 19–39 years. Follow-up for the number of sickness absence days was 12 months. Exposures to physical workload, occupational environmental hazards, and sedentary work were divided into quartiles. In addition, duration of daily exposure to heavy work was included. Negative binomial regression models were used.

Results

Higher exposure to physical workload or hazardous exposures was associated with a higher number of sickness absence days. The age and gender adjusted rate ratios for sickness absence days among the participants whose exposure to physical workload was in the highest exposure quartile were 2.1 (95% CI 1.8‒2.5) compared with those whose exposure was in the lowest quartile. In addition, rate ratios for sickness absence days among participants who reported that they do heavy physical work 1.1‒2.0 h, 2.1‒4.0 h or over 4 h daily were 1.6 (1.3‒1.9), 1.5 (1.3‒1.8) and 1.7 (1.5‒2.1), respectively, compared with those who reported not doing physical work. Further adjustment for lifestyle factors or health characteristics attenuated the associations only slightly.

Conclusion

Exposure to physically demanding work is associated with a higher number of sickness absence days among municipal employees below 40 years of age. Physical working conditions should be considered when aiming to support later work ability.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00420-021-01791-y.

Seeing an occupational health psychologist reduces sickness absence due to mental disorders: A quasi-experimental study

Mental health problems are a major public health and work-life issue. We examined in a quasi-experimental design whether occupational health psychologist (OHP) appointment reduces subsequent sickness absence (SA) due to mental disorders among younger Finnish employees. The present study was conducted among 18-39-year-old employees of the City of Helsinki using register data from the City of Helsinki and the Social lnsurance Institution of Finland. We examined differences in SA days due to mental disorders (ICD-10, F-diagnosed sickness allowances) between those treated (at least one OHP appointment for work ability support) and the comparison group (no OHP appointment) during a one-year follow-up. The full sample (n = 2286, 84% women) consisted of employees with SA due to a diagnosed mental disorder during 2008-2017. To account for the systematic differences between the treatment and comparison groups, the included participants were matched according to age, sex, occupational class, education, previous SA, occupational health primary care visits and psychotropic medication. The weighted matched sample included 1351 participants. In the weighted matched sample, the mean of SA days due to mental disorders was 11.4 (95% CI, 6.4-16.5) for those treated (n = 238) and 20.2 (95% CI, 17.0-23.4) for the comparison group (p < 0.01) during the follow-up year. The corresponding figures in the full sample were (11.1, 6.7-15.4) days for those treated (n = 288) and (18.9, 16.7-21.1) days for the comparison group (p < 0.01). This quasi-experimental study suggests that seeing an OHP to support work ability reduces SA due to mental disorders.

Frequent short sickness absence, occupational health service utilisation and long-term sickness absence due to mental disorders among young employees

Objectives

We examined whether frequent short-term sickness absence (FSTSA) and primary care use in occupational health service (OHS) were associated with medically-certified long-term sickness absence (LTSA) due to mental disorders among young employees.

Methods

We used record-linkage data covering the young employees (< 35 years) of the City of Helsinki, Finland (n = 8,282) from 2010 to 2014. The outcome was LTSA due to mental disorders. Cox regression models were fitted.

Results

FSTSAs were associated with subsequent LTSA. Also OHS use predicted LTSA due to mental disorders; however, this association was not found for those with prior FSTSA.

Conclusions

Both FSTSA and primary care use indicate subsequent LTSA independently, and together these indicators identify a larger proportion of individuals at risk of LTSA due to mental disorders.

Does seeing a psychologist reduce sickness absence due to mental disorders? A quasi-experiment

Background

Mental ill-health in young adults is a major public health and work-life problem. We examined in a quasi-experimental design whether occupational psychologist appointment can reduce subsequent sickness absence due to mental disorders among young Finnish employees.

Methods

The present study was conducted among 18-39-year-old employees of the City of Helsinki using register data from the City of Helsinki and the Social lnsurance Institution of Finland. We used Wald test to compare the differences in sickness absence days due to mental disorders (ICD-10, F-diagnosed) between those treated (occupational psychologist appointment for work ability support) and the non-treated (no psychologist appointment) during a one year follow-up. The full sample (n = 2156, 84% women) consisted of employees with mental disorder diagnosed sickness absence during 2009-2014. To account for the systematic differences between the treated and non-treated, the participants were matched according to their characteristics (age, sex, occupational class, education, previous sickness absence and psychotropic medication). The matched sample included 886 participants. We excluded those with treatment before the treatment screening time (± 3 months to the end of sickness absence period), non-treated with treatment during the follow-up and those that could not be matched (lack of common support).

Results

In the full sample, the mean of sickness absence days due to mental disorders was 17.7 (95% CI, 11.4, 24.1) days for those treated (n = 240) and 23.2 (95% CI, 20.5, 25.9) days for non-treated (n = 1916), difference being non-significant. The corresponding figures in the matched sample were (16.8, 95% CI, 9.5-24.1) for those treated (n = 195) and (27.8, 95% CI, 22.6-32.9) for non-treated (n = 691), difference being statistically significant (p = 0.02).

Conclusions

This quasi-experiment suggests that seeing an occupational psychologist to support work ability may be reduce mental health related sickness absence.

Key messages

We showed that supporting work ability at an early stage may prevent sickness absence due to mental disorders. More efforts to provide early stage support for maintaining work ability may prove useful in reducing sickness absence rates in younger employees.

Socioeconomic Differences in Occupational Health Service Utilization and Sickness Absence Due to Mental Disorders: A Register-Based Retrospective Cohort Study

Occupational health service (OHS) is the main provider of primary care services for the working population in Finland. We investigated whether socioeconomic differences in the utilization of OHS predict sickness absence (SA) due to mental disorders. We used register linkage data covering the employees of the City of Helsinki aged 18-34 years (N = 6545) and 35-54 years (N = 15,296) from 2009 to 2014. The outcome was medically certified long-term (over 11 days) SA due to mental disorders. Cox regression analyses were performed to obtain hazard ratios (HR) and their 95% confidence intervals (CIs). Employees with low socioeconomic position (SEP) used OHS more frequently. The number of OHS visits independently predicted SA due to mental disorders. HRs were 1.59 (95% CI 1.35, 1.86) for those with frequent visits and 1.73 (95% CI 1.30, 2.29) for those with a clustered visit pattern among 18-34 year old employees; and 1.46 (95% CI 1.18, 1.81) and 1.41 (95% CI 1.14, 1.74) among 35-54 year old employees, respectively. In both age groups, lower education and routine non-manual worker position indicated the highest probability of SA. Low SEP predicts both high OHS utilization and subsequent SA due to mental disorders. Medical records may be used to accurately predict future SA, and the results indicate that preventive measures should be targeted particularly to younger employees with lower SEP.

Association between socioeconomic position and occupational health service utilisation trajectories among young municipal employees in Finland

OBJECTIVES

To identify groups of municipal employees between the ages of 20 and 34 years with distinct utilisation trajectories of primary care services provided by occupational health service (OHS), measured as the annual number of OHS visits, and to identify demographic and socioeconomic risk factors that distinguish employees in the high utilisation trajectory group(s).

METHODS

The present study is a retrospective register-based cohort study. All municipal employees of the City of Helsinki, Finland, aged 20-34 in the Helsinki Health Study, recruited from 2004 to 2013, with follow-up data for 4 years were included in the study (n=9762). The outcome measure was group-based trajectories of OHS utilisation, identified with a group-based trajectory analysis. The demographic and socioeconomic variables used to predict the outcome were age, first language, educational level and occupational class. The analyses were stratified by gender.

RESULTS

A large proportion of the young employees do not use OHS. Trajectory groups of 'No visits' (50%), 'Low/increasing' (18%), 'Low/decreasing' (22%) and 'High/recurrent' (10%) use were identified. We found occupational class differences in OHS utilisation patterns showing that lower occupational classes had a higher propensity for 'High/recurrent' OHS utilisation for both genders.

CONCLUSIONS

Preventive measures should be targeted particularly to the trajectory groups of 'Low/increasing' and 'High/recurrent' in order to intervene early. In addition, OHS utilisation should be closely monitored among the two lowest occupational classes. More research with longitudinal OHS data is needed.

Effectiveness of internet-delivered cognitive behavioural therapy in reducing sickness absence among young employees with depressive symptoms: study protocol for a large-scale pragmatic randomised controlled trial

INTRODUCTION

Depression is a highly prevalent condition with typical onset in early adulthood. Internet-delivered cognitive behavioural therapy (iCBT) is a promising cost-effective and more widely available alternative to face-to-face CBT. However, it is not known whether it can reduce sickness absence in employees showing depressive symptoms. The randomised controlled trial component of the DAQI (Depression and sickness absence in young adults: a quasi-experimental trial and web-based treatment intervention) project aims to investigate if iCBT is effective in reducing sickness absence compared with care as usual (CAU) among young employees with depressive symptoms in primary care provided in an occupational health setting.

METHODS AND ANALYSIS

This study will use a randomised controlled single-centre service-based trial of an existing iCBT programme (Mental Hub iCBT for Depression) to evaluate whether or not this treatment can reduce the number of sickness absence days in public sector employees aged 18-34 years who present at the occupational health service with mild depressive symptoms (score ≥9 on the Beck Depression Inventory-IA). Control participants will be offered CAU, with no constraints regarding the range of treatments. The active condition will consist of seven weekly modules of iCBT, with support from a web therapist. Primary outcome will be participants' all-cause sickness absence as indicated in employer's and national administrative records up to 6 months from study entry. Secondary outcomes relating to long-term sickness absence (over 11 calendar days) for mental and musculoskeletal disorders and psychotropic medication use will be obtained from the Finnish Social Insurance Institution's administrative records; and short sickness absence spells (up to 11 calendar days) will be extracted from employer's records. Analyses will be conducted on an intention-to-treat basis.

ETHICS AND DISSEMINATION

The Coordinating Ethics Committee of the Hospital District of Helsinki and Uusimaa has approved the study (HUS/974/2019). The results will be published in peer-reviewed scientific journals and in publications for lay audience.

TRIAL REGISTRATION NUMBER

ISRCTN10877837.

Educational attainment, labour market position and mental ill health as pathways from adversities in adolescence to disability pension in early adulthood: A Finnish cohort study using register data

BACKGROUND

We investigated whether social adversities (parents' receipt of income support and care placement) in adolescence were associated with the receipt of work disability pension (DP) in early adulthood. A further aim was to examine whether and to what extent individual educational attainment, labour market position and mental disorders during the period of transition to adulthood operate as underlying mechanisms in this relationship.

METHODS

This was a nationwide cohort study of a 60% representative sample of Finnish young adults born between 1983 and 1985 with no prior DP at entry to the study ( N=116,788). Data from several nationwide registers were used with a follow-up time from 2004 to 2010. The age range of the cohort was 19-21 years at the beginning of the follow-up period. Hazards ratios (HRs) with 95% confidence intervals (CIs) were calculated using a Cox regression. Mediation analyses for educational attainment, labour market position and purchases of psychotropic drugs were performed.

RESULTS

A total of 1597 (1.37%) people were granted a DP during the follow-up period of 687,429 years at risk. After adjustment for mediators, the HR (95% CI) of DP for those whose parents had received income support was 1.36 (1.21-1.53) for men and 1.21 (1.07-1.36) for women. The corresponding figures for those with a history of care placement were 1.23 (1.00-1.51) and 1.58 (1.29-1.92), respectively.

CONCLUSIONS

Social adversities in adolescence increase the risk of DP in early adulthood. The intergenerational social determination of disability could be addressed through interventions promoting mental health and improving educational and employment opportunities for young people.