Avril 2020

Interventions for common mental disorders in the occupational health service: a systematic review with a narrative synthesis

Purpose Common mental disorders (CMD) are leading causes of decreased workability in Sweden and worldwide. Effective interventions to prevent or treat such disorders are important for public health. Objective To synthesize the research literature regarding occupational health service (OHS) interventions targeting prevention or reduction of CMD among employees. The effect on workability (sickness absence, return-to-work and self-reported workability) and on CMD symptoms was evaluated in a narrative analysis. Data Sources The literature search was performed in four electronic databases in two searches, in 2014 and in 2017. Population studies investigating employees at risk or diagnosed with CMD, as well as preventive workplace intervention targeting mental health. Intervention studies where the recruitment or the intervention was delivered by the OHS or OHS personnel were included. Control individuals or groups who did not receive the target intervention. Outcome all types of outcomes concerning sickness absence and psychological health were included. Study quality was assessed using a Swedish AMSTAR-based checklist, and results from studies with low or medium risk of bias were narratively synthesized based on effect or absence thereof. Results Thirty-three studies were included and assessed for risk of bias. Twenty-one studies had low or medium risk of bias. In 18 studies, rehabilitation interventions were evaluated, 11 studies concerned interventions targeting employees at risk for developing CMD and four studies investigated preventive interventions. Work-focused cognitive behavioral therapy and problem-solving skill interventions decreased time to first return-to-work among employees on sick leave for CMD in comparison with treatment-as-usual. However, effect on return to full-time work was not consistent, and these interventions did not consistently improve CMD symptoms. Selective interventions targeting employees at risk of CMD and preventive interventions for employees were heterogeneous, so replication of these studies is necessary to evaluate effect. Limitations Other workplace interventions outside the OHS may have been missed by our search. There was considerable heterogeneity in the included studies, and most studies were investigating measures targeting the individual worker. Interventions at the workplace/organizational level were less common. Conclusions Return-to-work and improvement of CMD symptoms are poorly correlated and should be addressed simultaneously in future interventions. Further, interventions for CMD administered through the occupational health service require further study. Rehabilitative and preventive strategies should be evaluated with scientifically robust methods, to examine the effectiveness of such interventions.

Source: Axén I, Björk Brämberg E, Vaez M, Lundin A, Bergström G, International archives of occupational and environmental health, 2020 Apr.

Mars 2020

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

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

Source: Nielsen K, Yarker J, International Journal of Rehabilitation Research, 2020 Feb. 

Identifying return to work trajectories among employees on sick leave due to mental health problems using latent class transition analysis

Purpose To develop effective return to work (RTW) interventions for employees on sick leave due to mental health problems (MHPs), a better understanding of individual variation in the RTW process is needed. We investigated which RTW trajectories can be identified among employees with MHPs in terms of RTW duration and relapse occurrence during the RTW process. Additionally, we examined how different RTW trajectories can be described in terms of personal and work characteristics. Methods Longitudinal sickness absence registry data were collected retrospectively from the largest Dutch occupational health service. Quantitative RTW information as well as personal and work characteristics were extracted. In total, 9517 employees with a sickness absence due to MHPs were included in the analyses (62 938 data points; RTW durations from 29 to 730 days). Results A latent class transition analysis revealed five distinct RTW trajectories, namely (1) fast RTW with little chance of relapse, (2) slow RTW with little chance of relapse, (3) fast RTW with considerable chance of relapse, (4) slow RTW with considerable chance of relapse and (5) very fast RTW with very small chance of relapse. Differences between employees in the slower and faster trajectories were observed regarding gender, age, type of MHP, organisation sector and organisation size but not regarding part-time work. Conclusions RTW trajectories among employees with MHPs showed large individual variability and differed on personal and work characteristics. Knowledge on different RTW trajectories and their characteristics contributes to the development of personalised RTW treatments, tailored to specific individuals and organisations.

Source: Spronken M, Brouwers EPM, Vermunt JK, Arends I, Oerlemans WGM, van der Klink JJL, Joosen MCW, BMJ Open, Vol. 10 (2), 2020 Feb.

Février 2020

Mental health problem or workplace problem or something else: what contributes to work perception? 

Purpose Work perception is an important predictor for work ability and, therefore, of interest for rehabilitation. Until now it is unclear to which extent different psychological aspects explain work perception. This study investigates in which way workplace problems on the one hand, and mental health and coping on the other hand, contribute to work perception. Methods A heterogeneous sample of 384 persons in working age with and without mental health problems was recruited. Participants gave self-reports on workplace problems, mental health problems, work-coping, work-anxiety, and work perception. Results Persons with mental health problems and workplace problems (M + W) perceive the highest degree of work demands, followed by persons with workplace problems but without mental health problems (NM + W). Work-anxiety appeared as the strongest factor explaining perception of high work demands, whereas general mental health problems did not contribute significantly to variance explanation. Conclusions Persons with specific mental health problems in terms of work-anxiety may be expected to perceive higher work demands. They may be detected when asking for work perception, e.g., within the frame of return-to-work interventions in rehabilitation, or in occupational health settings by mental hazard analysis. Work perception is an important predictor for work ability. Work-anxiety plays a key role for work perception. Thus, work perception and work anxiety should be explored in the diagnostic phase of rehabilitation treatments. Work-anxiety should be considered not only in rehabilitation diagnostics and interventions in clinical settings, but considered in preventive activities at work: Self-ratings on work-anxiety and work perception (instead of general wellbeing) may be included in assessments for workplace exploration, or mental hazard analysis. They give hints concerning concrete work-related health problems.

Source: Muschalla B, Henning A, Haake TW, Cornetz K, Olbrich D, Disability & Rehabilitation, Vol. 42 (4), p.502-509, 2020 Feb. 

Number of Previous Absences Is a Predictor of Sustained Attendance After Return-to-Work in Workers with Absence due to Common Mental Disorders: A Cohort 3-year Study

Purpose This study evaluated the relationship of the number of previous episodes due to common mental disorders (CMDs) with long-term outcomes and sustainability of attendance after return-to-work (RTW). Methods Participants were assigned to the following three groups: workers having one (Group 1), two (Group 2), and three or more (Group 3) previous episodes. Outcomes were a recurrent absence and the sustainability rate of attendance after RTW. Results The sustainability rate in Group 1 was significantly higher than that in Group 3 throughout the observation period. The sustainability rates for Group 2 were significantly higher than for Group 3 at 30 and 36 months. Conclusions The number of previous episodes was shown to affect sustainability of attendance after RTW due to CMDs, indicating that repeated previous absences are a significant prognostic factor.

Source: Masayoshi M, Hiroyoshi A, Chieko M, Journal of Occupational & Environmental Medicine, Vol. 62 (2), p.108-112, 2020 Feb. 

Managing employees' depression from the employees', co-workers' and employers' perspectives

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

Source: Thisted CN, Labriola M, Vinther Nielsen C, Kristiansen ST, Strøm J, Bjerrum MB, Disability & Rehabilitation, Vol. 42 (4), p.445-459, 2020 Feb.

Work-directed rehabilitation or physical activity to support work ability and mental health in common mental disorders: a pilot randomized controlled trial

Purpose To evaluate feasibility and potential effectiveness of work-directed rehabilitation in people with common mental disorders. Design Pilot randomized controlled trial. Setting Primary healthcare, Sweden. Subjects Working adults (n=42) of mean age 46.2 ± 11.1 years with depression or anxiety disorder. Interventions Eight weeks of work-directed rehabilitation (n=21) or physical activity (n=21). Work-directed rehabilitation included sessions with a physiotherapist and/or an occupational therapist, to develop strategies to cope better at work. Physical activity included a planning session and access to a local gym. Main measures Feasibility: attendance, discontinuation and adverse events. Measurements were the Work Ability Index, the Global Assessment of Functioning, the Montgomery–Asberg Depression Rating Scale, the Beck Anxiety Inventory and the World Health Organization—Five Well-Being Index. Results Attendance to rehabilitation sessions was 88% (n=147/167) and discontinuation rate was 14% (n=3/21). No serious adverse events were reported. Within both groups, there was a significant improvement in Work Ability Index score (mean change: 3.6 (95% confidence interval (CI): 0.45, 6.7) in work-directed rehabilitation and 3.9 (95% CI: 0.9, 7.0) in physical activity) with no significant difference between groups. For the other outcomes, significant improvements were found within but not between groups. Per-protocol analysis showed a trend toward the antidepressant effect of work-directed rehabilitation compared to physical activity (mean difference in depression score −3.1 (95% CI: −6.8, 0.4), P=0.075). Conclusions Work-directed rehabilitation was feasible to persons with common mental disorders and improved their work ability and mental health. Comparable improvements were seen in the physical activity group. Suggested modifications for a larger trial include adding a treatment-as-usual control.

Source : Danielsson L, Waern M, Hensing G, Holmgren K, Clinical Rehabilitation, Vol. 34 (2), p.170-181, 2020 Feb. 

Return to Work for Mental Ill-Health: A Scoping Review Exploring the Impact and Role of Return-to-Work Coordinators

Purpose This scoping review was completed to explore the role and impact of having a return-to-work (RTW) coordinator when dealing with individuals with common mental ill-health conditions. Methods Peer reviewed articles published in English between 2000 and 2018 were considered. Our research team reviewed all articles to determine if an analytic focus on RTW coordinator and mental ill-health was present; consensus on inclusion was reached for all articles. Data were extracted for all relevant articles and synthesized for outcomes of interest. Results Our search of six databases yielded 1798 unique articles; 5 articles were found to be relevant. The searched yielded only quantitative studies. Of those, we found that studies grouped mental ill-health conditions together, did not consider quality of life, and used different titles to describe RTW coordinators. Included articles described roles of RTW coordinators but did not include information on their strategies and actions. Included articles suggest that RTW interventions for mental ill-health that utilize a RTW coordinator may result in delayed time to RTW. Conclusions Our limited findings suggest that interventions for mental ill-health that employ RTW coordinators may be more time consuming than conventional approaches and may not increase RTW rate or worker's self-efficacy for RTW. Research on this topic with long-term outcomes and varied research designs (including qualitative) is needed, as well as studies that clearly define RTW coordinator roles and strategies, delineate results by mental health condition, and address the impact of RTW coordinators on workers' quality of life.

Source: MacEachen E, McDonald E, Neiterman E, McKnight E, Malachowski C, Crouch M, Varatharajan S, Dali N, Giau E, Journal of Occupationnal Rehabilitation, 2020 Jan. 

Janvier 2020

A short work-directed rehabilitation to promote work capacity while depressed and anxious: a qualitative study of workers' experiences

Purpose Most people with common mental disorders are working despite symptoms. This study explores individuals' experiences of a work-directed rehabilitation, provided by occupational therapists and physiotherapists, aiming to promote work capacity in persons with common mental disorders. Methods A qualitative content analysis was used, and 11 women and 8 men with depression or anxiety disorder were interviewed. They were 25-66 years old, had different occupations and were working full or part-time. Results The participants experienced a process interpreted as Increasing belief in one's capacity through supported reflection and practice. This theme reflects the shifting between "reflecting" and "doing" through rehabilitation and the growing hope for change. The increasing belief in one's capacity was developed through three stages, comprised of the categories To be supported by a professional, To realise things about oneself and To try new strategies for change. Conclusions Strategies suggested by occupational therapists and physiotherapists have the potential to promote work capacity in people who are working while depressed and anxious. The results may deepen the understanding among rehabilitation professionals about the importance of a person-centred approach to people with common mental disorders, and to combine reflection and practical exercises to support the development of work-related strategies. Implications for rehabilitation Work-directed rehabilitation provided by occupational therapists and/or physiotherapists is beneficial to people with common mental disorders. Rehabilitation professionals should focus on facilitating self-efficacy among people with common mental disorders. An individualised person-centred approach seems important in order to initiate change.

Source: Lork K, Holmgren K, Danielsson L, Disability and Rehabilitation, p. 1-10, 2019 Dec.