Santé mentale

Décembre 2020

Coordination of return-to-work for employees on sick leave due to common mental disorders: facilitators and barriers

Purpose To identify facilitators of and barriers to the coordination of return-to-work between the primary care services, the employee, and the employers from the perspective of coordinators and employees on sick leave due to common mental disorders (CMDs). Methods Descriptive qualitative study. Semi-structured interviews were conducted with eighteen coordinators and nine employees on sick leave due to CMDs. The Consolidated Framework for Implementation Research (CFIR) was used as a starting point for the interview guides and in the thematic analysis of data. Results The results show facilitators and barriers related to the CFIR domains "intervention characteristics," "outer setting," "inner setting," and "characteristics of individuals." Positive attitudes, an open dialogue in a three-party meeting, and a common ground for the sick leave process at the primary care centre facilitated coordination, while an unclear packaging, conflicts at the employee's workplace, and a lack of team-based work were examples of barriers. Conclusions The results indicate a need for the detailed packaging of coordination; formalization of coordinators' qualifications and levels of training; and acknowledgement of the role of organizational factors in the implementation of coordination. This is important to further develop and evaluate the efficacy of coordination. Positive attitudes to coordination, an open dialogue in a three-party meeting, leadership engagement, routines for the return to work (RTW) process at the primary care centre, and collegial alliances were identified as facilitators. An unclear packaging of the intervention, conflicts at the employee's workplace, lack of team-based work, and lack of coordinator training were identified as barriers. A detailed intervention packaging adapted for the specific setting and formalization of coordinators' qualifications and training is necessary for coordination of RTW. Recognizing organizational factors were identified as being important for the implementation of coordination of RTW for persons on sick leave due to CMDs.

Source: Holmlund L, Hellman T, Engblom M, Kwak L, Sandman L, Törnkvist L, Björk Brämberg E, Disability and rehabilitation, p.1-9, 2020 Dec.

Octobre 2020

Logic Models for the therapeutic return-to-work program as adapted for common mental disorders: A guide for health professionals

Purpose Workplace interventions are recommended for workers with common mental disorders, but knowledge of their action mechanisms and operationalization remains limited. The Therapeutic Return-to-Work Program, developed for workers with musculoskeletal disorders, is recommended for common mental disorders. Objective Our objective was to adapt this program's logic models to common mental disorders. Methods A program logic analysis was conducted using a literature review and a two-phase group consensus method. We submitted a preliminary adapted version of the program's logic models and two questionnaires to health professional experts who participated in two group sessions, ultimately to produce the final version of the models. Results We consulted 86 publications. The health professional experts (N = 7) had overall mean agreement scores of respectively 4.10/5 and 3.89/5 for questions on the program's theoretical and operational models. The final version of the logic models adapted for common mental disorders included four specific and 15 intermediate objectives, three main components, one optional component, four key processes, and 44 tasks. Conclusions The adapted logic models for the Therapeutic Return-to-Work Program show the relevance of the original objectives and components for common mental disorders. The next step will involve evaluating its feasibility with other stakeholders (insurers, employers, unions, workers).

Source: Marois E, Durand MJ, Coutu MF, Work, 2020 Oct.

Feasibility evaluation of a return-to-work program for workers with common mental disorders: Stakeholders' perspectives

Purpose This study aimed to evaluate the feasibility of a newly developed return-to-work program for workers with common mental disorders from the perspective of stakeholders (insurers, employers, unions, workers). Methods We used a sequential mixed design. First, we conducted a survey to evaluate the levels of stakeholder agreement with the program's feasibility. Second, we conducted a number of independent, homogeneous-group discussions or individual interviews to deepen stakeholders' reflections and allow co-construction of a shared perspective of the program's feasibility. Results Overall, the stakeholders (insurers (n = 6), employers (n = 7), unions (n = 8), and workers (n = 3)), agreed partly to totally with the feasibility of the specific/intermediate objectives, components/tasks, and duration of the components. They identified obstacles that could hinder program implementation. These obstacles pertained mainly to employers' contexts, e.g., difficulty/impossibility of offering job accommodations. They also proposed facilitators to counteract most of these obstacles. Diverging views were found regarding both the role of union representatives and health professionals in the program, and for the duration of the components. Conclusions Overall, the program was perceived as feasible to implement, provided that the potential factors discussed are taken into account. The next step will be to evaluate its implementation in real practice settings.

Source: Marois E, Coutu MF, Durand MJ, Work, 2020 Oct.

Interventions to improve return to work in depressed people

Purpose Work disability such as sickness absence is common in people with depression. Objectives To evaluate the effectiveness of interventions aimed at reducing work disability in employees with depressive disorders.Methods We searched CENTRAL (The Cochrane Library), MEDLINE, Embase, CINAHL, and PsycINFO until April 4th 2020. We included randomised controlled trials (RCTs) and cluster-RCTs of work-directed and clinical interventions for depressed people that included days of sickness absence or being off work as an outcome. We also analysed the effects on depression and work functioning. Results Two review authors independently extracted the data and rated the certainty of the evidence using GRADE. We used standardised mean differences (SMDs) or risk ratios (RR) with 95% confidence intervals (CI) to pool study results in studies we judged to be sufficiently similar.  MAIN RESULTS: In this update, we added 23 new studies. In total, we included 45 studies with 88 study arms, involving 12,109 participants with either a major depressive disorder or a high level of depressive symptoms. Risk of bias The most common types of bias risk were detection bias (27 studies) and attrition bias (22 studies), both for the outcome of sickness absence. Work-directed interventions Work-directed interventions combined with clinical interventions A combination of a work-directed intervention and a clinical intervention probably reduces days of sickness absence within the first year of follow-up (SMD -0.25, 95% CI -0.38 to -0.12; 9 studies; moderate-certainty evidence). This translates back to 0.5 fewer (95% CI -0.7 to -0.2) sick leave days in the past two weeks or 25 fewer days during one year (95% CI -37.5 to -11.8). The intervention does not lead to fewer persons being off work beyond one year follow-up (RR 0.96, 95% CI 0.85 to 1.09; 2 studies, high-certainty evidence). The intervention may reduce depressive symptoms (SMD -0.25, 95% CI -0.49 to -0.01; 8 studies, low-certainty evidence) and probably has a small effect on work functioning (SMD -0.19, 95% CI -0.42 to 0.06; 5 studies, moderate-certainty evidence) within the first year of follow-up.  Stand alone work-directed interventions A specific work-directed intervention alone may increase the number of sickness absence days compared with work-directed care as usual (SMD 0.39, 95% CI 0.04 to 0.74; 2 studies, low-certainty evidence) but probably does not lead to more people being off work within the first year of follow-up (RR 0.93, 95% CI 0.77 to 1.11; 1 study, moderate-certainty evidence) or beyond (RR 1.00, 95% CI 0.82 to 1.22; 2 studies, moderate-certainty evidence). There is probably no effect on depressive symptoms (SMD -0.10, 95% -0.30 CI to 0.10; 4 studies, moderate-certainty evidence) within the first year of follow-up and there may be no effect on depressive symptoms beyond that time (SMD 0.18, 95% CI -0.13 to 0.49; 1 study, low-certainty evidence). The intervention may also not lead to better work functioning (SMD -0.32, 95% CI -0.90 to 0.26; 1 study, low-certainty evidence) within the first year of follow-up.   Psychological interventions A psychological intervention, either face-to-face, or an E-mental health intervention, with or without professional guidance, may reduce the number of sickness absence days, compared with care as usual (SMD -0.15, 95% CI -0.28 to -0.03; 9 studies, low-certainty evidence). It may also reduce depressive symptoms (SMD -0.30, 95% CI -0.45 to -0.15, 8 studies, low-certainty evidence). We are uncertain whether these psychological interventions improve work ability (SMD -0.15 95% CI -0.46 to 0.57; 1 study; very low-certainty evidence). Psychological intervention combined with antidepressant medication Two studies compared the effect of a psychological intervention combined with antidepressants to antidepressants alone. One study combined psychodynamic therapy with tricyclic antidepressant (TCA) medication and another combined telephone-administered cognitive behavioural therapy (CBT) with a selective serotonin reuptake inhibitor (SSRI). We are uncertain if this intervention reduces the number of sickness absence days (SMD -0.38, 95% CI -0.99 to 0.24; 2 studies, very low-certainty evidence) but found that there may be no effect on depressive symptoms (SMD -0.19, 95% CI -0.50 to 0.12; 2 studies, low-certainty evidence). Antidepressant medication only Three studies compared the effectiveness of SSRI to selective norepinephrine reuptake inhibitor (SNRI) medication on reducing sickness absence and yielded highly inconsistent results. Improved care Overall, interventions to improve care did not lead to fewer days of sickness absence, compared to care as usual (SMD -0.05, 95% CI -0.16 to 0.06; 7 studies, moderate-certainty evidence). However, in studies with a low risk of bias, the intervention probably leads to fewer days of sickness absence in the first year of follow-up (SMD -0.20, 95% CI -0.35 to -0.05; 2 studies; moderate-certainty evidence). Improved care probably leads to fewer depressive symptoms (SMD -0.21, 95% CI -0.35 to -0.07; 7 studies, moderate-certainty evidence) but may possibly lead to a decrease in work-functioning (SMD 0.5, 95% CI 0.34 to 0.66; 1 study; moderate-certainty evidence). Exercise Supervised strength exercise may reduce sickness absence, compared to relaxation (SMD -1.11; 95% CI -1.68 to -0.54; one study, low-certainty evidence). However, aerobic exercise probably is not more effective than relaxation or stretching (SMD -0.06; 95% CI -0.36 to 0.24; 2 studies, moderate-certainty evidence). Both studies found no differences between the two conditions in depressive symptoms.Conclusions A combination of a work-directed intervention and a clinical intervention probably reduces the number of sickness absence days, but at the end of one year or longer follow-up, this does not lead to more people in the intervention group being at work. The intervention may also reduce depressive symptoms and probably increases work functioning more than care as usual. Specific work-directed interventions may not be more effective than usual work-directed care alone. Psychological interventions may reduce the number of sickness absence days, compared with care as usual. Interventions to improve clinical care probably lead to lower sickness absence and lower levels of depression, compared with care as usual. There was no evidence of a difference in effect on sickness absence of one antidepressant medication compared to another. Further research is needed to assess which combination of work-directed and clinical interventions works best.

Source: Nieuwenhuijsen K, Verbeek JH, Neumeyer-Gromen A, Verhoeven AC, Bültmann U, Faber B, The Cochrane database of systematic reviews, Vol. 10, 2020 Oct.

Septembre 2020

Role of a Digital Return-To-Work Solution for Individuals With Common Mental Disorders: Qualitative Study of the Perspectives of Three Stakeholder Groups

Purpose Although effective return-to-work (RTW) interventions are not widely available for individuals with common mental disorders on sick leave, there is potential for transforming such interventions into a digital solution in an effort to make them more widely available. However, little is currently known about the viewpoints of different stakeholder groups, which are critical for successful development and implementation of a digital RTW intervention in health care services. The aim of this study was to examine stakeholder groups' perspectives on the role and legitimacy of a digital RTW solution called mWorks for individuals with common mental disorders who are on sick leave. Methods A purposeful snowball sampling method was utilized to recruit respondents. Semistructured individual and focus group interviews were conducted for stakeholder groups of service users, RTW professionals, and influential managers regarding their experiences, needs, and preferences for mWorks. Content analysis generated themes and categories that constituted the main findings. Results The legitimacy of a digital RTW solution was high among all stakeholder groups since such a tool was perceived to enable service users to take control over their RTW process. This was mainly a product of accessible support and promotion of service user decision making, which had the potential to empower service users. All respondents stressed the importance of fostering a positive user experience with usability and emphasis on service user resources and strengths, as opposed to various limitations and shortcomings. Stakeholder groups highlighted critical content to facilitate RTW, such as the need to clarify a back-to-work plan, accompanied by an accessible RTW network and strategies for handling mental health problems. Implementation challenges primarily involved influential managers' concern of legislation incompatibility with innovative technology, and RTW professionals' concern of the possibility that digital solutions may replace them to a certain extent. Conclusions This formative research emphasizes the importance of shifting power from RTW professionals to service users. mWorks can play a role in mediating service user control over the RTW process, and thereby increase their empowerment. A digital RTW solution may facilitate the circumvention of implementation barriers associated with introducing evidence-based RTW interventions in a traditional RTW context.

Source: Engdahl P, Svedberg P, Lexén A, Bejerholm U, JMIR formative research, Vol. 4(9), p. e15625, 2020 Sep.

Return to Work after Common Mental Disorders: A Qualitative Study Exploring the Expectations of the Involved Stakeholders

Purpose Common mental disorders (CMDs) are risk factors for long-term sickness absence and unemployment. Therefore, return-to-work (RTW) processes have been introduced to facilitate the return of employees. As the success of RTW processes is considered to be determined by the cooperativeness of the involved stakeholders, we aimed to investigate the views of those stakeholders to disclose potentially diverging expectations. Methods Qualitative interviews were conducted (08/2018-04/2019) among five stakeholder groups: returnees with a diagnosed CMD who were eligible for a RTW process; health care professionals nominated by the returnees; supervisors, colleagues and occupational physicians (the latter three groups were not nominated by the returnees). Results In total, 24 returnees, 13 health care professionals, 13 occupational physicians, 9 supervisors and 9 colleagues were interviewed (68 interviews in total). Potentially diverging expectations of the stakeholders related to whether diagnoses need to be disclosed by returnees. Agreement existed in terms of the need for a trustful relationship between employees and occupational physicians to initiate a RTW process early. Conclusions As the understanding of all stakeholders' viewpoints is one of the main factors promoting a successful RTW, we explored the expectations of those involved in the RTW process. One implication of our findings is to strengthen the role of occupational physicians, who could coordinate the return process.

Source: Scharf J, Angerer P, Müting G, Loerbroks A, International journal of environmental research and public health, Vol. 17 (18), 2020 Sep.

Août 2020

Stakeholders' Role and Actions in the Return-to-Work Process of Workers on Sick-Leave Due to Common Mental Disorders: A Scoping Review

Purpose The lack of knowledge regarding the roles and actions of return to work (RTW) stakeholders create confusion and uncertainty about how and when to RTW after experiencing a common mental disorder (CMD). The purpose of this scoping review is to disentangle the various stakeholders' role and actions in the RTW process of workers on sick-leave due to CMDs. The research question is: What is documented in the existing literature regarding the roles and actions of the identified stakeholders involved in the RTW process of workers on sick-leave due to CMDs? Methods In conducting this scoping review, we followed Arksey and O'Malley's (Int J Soc Res Methodol 8:19–32, 2005) methodology, consisting of different stages (e.g., charting the data by categorizing key results). Results 3709 articles were screened for inclusion, 243 of which were included for qualitative synthesis. Several RTW stakeholders (n=11) were identified (e.g., workers on sick leave due to CMDs, managers, union representatives, rehabilitation professionals, insurers, return to work coordinators). RTW stakeholders' roles and actions inter- and intra-system were recommended, either general (e.g., know and understand the perspectives of all RTW stakeholders) or specific to an actor (e.g., the return to work coordinator needs to create and maintain a working alliance between all RTW stakeholders). Furthermore, close to 200 stakeholders' actions, spread out on different RTW phases, were recommended for facilitating the RTW process. Conclusions Eleven RTW stakeholders from the work, heath and insurance systems have been identified, as well as their respective roles and actions. Thanks to these results, RTW stakeholders and policy makers will be able to build practical relationships and collaboration regarding the RTW of workers on sick leave due to CMDs.

Source: Corbière M, Mazaniello-Chézol M, Bastien MF, Wathieu E, Bouchard R, Panaccio A, Guay S, Lecomte T, Journal of Occupational Rehabilitation, Vol. 30(3), p.381-419, 2020 Sep.

Mai 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. Results We identified task, relational and cognitive job crafting strategies that workers had employed after returning to work. Conclusions 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, Vol. 43(2), p.154-158, 2020 Jun.

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.