Santé mentale

Avril 2021

Is the "Brainwork Intervention" effective in reducing sick leave for non-permanent workers with psychological problems? Results of a controlled clinical trial

Purpose Both the presence of psychological problems and the absence of an employment contract are related to long-term sickness absence, prolonged work disability and unemployment. Studies researching the effectiveness of return-to-work interventions on these non-permanent workers, including unemployed and temporary agency workers and workers with an expired fixed-term contract, are lagging behind. Therefore, a return-to-work intervention called "Brainwork" was developed. The aim of this study was to assess the effectiveness of the 'Brainwork Intervention' in reducing the duration of sick leave compared to usual care over a 12-month follow-up. Methods In a multicenter controlled clinical trial, using a quasi-randomization procedure, we compared the Brainwork Intervention (n = 164) to usual care (n = 156). The primary outcome was the duration of sick leave. Secondary outcomes were the duration of sick leave starting from Social Security Agency transfer; the proportion of workers returned to work; the number of hours of paid employment during the follow-up period; the degree of worker participation; the level of psychological complaints; and the self-efficacy for return to work. Protocol adherence (Brainwork Intervention) was considered sufficient when at least three of the five protocol steps were followed. Cox regressions, linear and ordinal regression, and Mixed Model analyses were performed. Results All 320 participants were analyzed. The Brainwork Intervention resulted in a non-significant reduction of the duration of sick leave compared to usual care (269 days versus 296 days; HR = 1.29; 95% CI 0.94-1.76; p = 0.11). For those working (46%) during the 12-month follow-up, the mean number of hours of paid employment was non-significantly higher in the usual care group (682 h versus 493 h; p = 0.053). No significant differences were found for other secondary outcomes. Protocol adherence was 10%. Conclusions The Brainwork Intervention as performed with a low protocol adherence did not result in a significant reduction of the duration of sick leave compared to usual care. It remains unclear what the results would have been if the Brainwork Intervention had been executed according to protocol.

Source: Audhoe SS, Hoving JL, Zijlstra BJH, Frings-Dresen MHW, Nieuwenhuijsen K, BMC public health, 2021 Apr 09; Vol. 21 (1), pp. 698

Mars 2021

Resilience building for mood disorders: Theoretical introduction and the achievements of the Re-Work program in Japan

Purpose Mood disorders are common, tend to recur, cause sickness absence, and lead to economic loss. Since past experiences of mood disorder episodes often increase future vulnerability, it is imperative to assist those mood disorder patients who want to resume working to build resilience to prevent relapse. Paralleling efforts in the West, a resilience-building program utilizing the principles of the Illness Management and Recovery program was first developed in Japan in 1997. The purpose of this survey is to introduce the concept and theory behind the Re-Work program and to review studies that report on program assessment, content, effects and associated factors, and prognosis of participants. Methods A literature search performed with PubMed and Igaku chuou zasshi (Ichushi) identified 30 relevant studies. Results One of these reported on a tool developed to assess readiness for returning to work. Concerning program content, a group therapy setting and cognitive behavioral therapy were found to be effective. Physical exercise and relaxation techniques may be useful as secondary program components. Conclusion Several studies report on program effects, but there may be factors that limit these effects. The prognosis for relapse prevention after the resumption of work may be better for Re-Work program participants than for a control group. Further research in this area is needed to confirm program effectiveness and related factors.

Source: Arima H, Akiyama T, de Moura PA, Bernick P, Sakai Y, Ozaki Y, Matsumoto S, Ohki Y, Igarashi Y, Tachimori H, Yamaguchi S, Asian journal of psychiatry, 2021 Feb 17; Vol. 58, pp. 102580

Psychiatrists' Experience of Vocational Rehabilitation for Patients with Mental Illness

Purpose The aim of this study was to explore psychiatrists' experience of vocational rehabilitation for patients with mental illness. Methods The study employed a qualitative design to explore psychiatrists' experience of vocational rehabilitation. Ten psychiatrists, five women and five men, 33-62 years of age (median 40), were interviewed. All of them worked with patients at Sahlgrenska University Hospital. The interviews were analyzed using inductive thematic analysis. All participants considered vocational rehabilitation to be of great importance for patients' well-being and health. Results The results were characterized by two opposite experiences: frustration and agency, these were the two main themes in the analysis. All narratives embraced both experiences, but some reflected more frustration and others more agency. Conclusion In order for the psychiatrist to master the assignment, there is a need for further training and supervision. The psychiatrist's role, as well as other professional roles within the team, requires clarification, and the support from rehabilitation coordinators and occupational therapists should be enhanced. There is a need for improved cooperation with external actors.

Source: Wallentin Å, Kinberg E, Strand J, Sand P, The Psychiatric quarterly, 2021 Mar 04

Seizing and realizing the opportunity: A salutogenic perspective on rehabilitation after burnout

Purpose Most research on burnout has focused on its antecedents, correlates, and consequences. However, little empirical attention has been paid to what constitutes successful rehabilitation after burnout, especially among young employees. The present study empirically examined resources supporting successful rehabilitation after burnout among young employees (between 18 and 35 years of age) from a salutogenic perspective. Methods Interpretative phenomenological analysis was used as a methodological framework to explain the experiences of young employees underlying their rehabilitation after burnout. Results The analysis showed that the rehabilitation process comprises four phases: 1) facing the crisis; 2) addressing the root causes; 3) seizing and achieving the opportunity; and 4) staying at work. Essential overarching resources facilitating successful recovery after burnout included receiving social support from family, friends, and colleagues, as well as having a feeling of control over the rehabilitation process. Participants learned to be aware of potential pitfalls that could trigger burnout symptoms, while having confidence in their ability to prevent burnout from reoccurring. These continuous learning processes were experienced as a prerequisite to remain at work. Conclusions Receiving social support and experiencing a feeling of control over the rehabilitation process appear to be key resources in facilitating a stable, meaningful return to work after burnout.

Source: Pijpker R, Vaandrager L, Veen EJ, Koelen MA, Work, 2021 Feb 16

Evidence for the Cost-Effectiveness of Return-to-Work Interventions for Mental Illness Related Sickness Absences: A Systematic Literature Review

Purpose The purpose of this systematic literature review (SLR) is to examine the state of knowledge about the cost-effectiveness of return-to-work (RTW) interventions targeted at workers with medically certified sickness absences related to mental disorders. Our SLR addresses the question, "What is the evidence for the cost-effectiveness of RTW interventions for mental illness related sickness absences?" Methods This SLR used a reviewer pair multi-phase screening of publically available peer-reviewed studies published between 2002 and 2019. Five electronic databases were searched: (1) MEDLINE 1946-Present, (2) MEDLINE: Epub-Ahead of Print and In-Process, (3) PsycINFO, (4) Econlit, and (5) Web of Science. Results 6138 unique citations were identified. Ten articles were included in the review. Eight of the ten studies were conducted in the Netherlands, one in Sweden, and one in Canada. Results of this SLR suggest there is evidence that RTW interventions for workers with medically certified sickness absences can be cost-effective. Conclusions Although this SLR's results suggest that economic evaluations of RTW interventions can be cost-effective, the use of economic evaluations for studies of these program types is in its infancy. Some jurisdictions (e.g., the Netherlands) seem to have recognized the need for economic evaluations. However, more research is needed in different disability system contexts. Furthermore, use of the standard economic evaluation approaches for healthcare interventions may limit the usefulness of results if the end-user is an employer or non-health organization. This may present the opportunity to introduce newer approaches that include work-related measures of effectiveness and analytical approaches.

Source: Dewa CS, Hoch JS, Loong D, Trojanowski L, Bonato S, Journal of occupational rehabilitation, 2021 Mar; Vol. 31 (1), pp. 26-40

Are return to work beliefs, psychological well-being and perceived health related to return-to-work intentions among women on long-term sick leave for common mental disorders? A cross-sectional study based on the theory of planned behaviour.

Purpose Long-term sick leave due to common mental disorders (CMDs) is a great burden in society today, especially among women. A strong intention to return to work (RTW) as well as symptom relief may facilitate RTW in this group. However, there is a lack of knowledge regarding what constitutes a strong intention. The Theory of Planned Behaviour is well-suited to identifying underlying beliefs about intentions to perform a behaviour. By including psychological well-being and perceived health, a more comprehensive picture of determinants of RTW intention might be achieved. Thus, the aim of the present study was to identify associations between RTW beliefs, psychological well-being, perceived health and RTW intentions among women on long-term sick leave due to CMDs, and to do so based on the Theory of Planned Behaviour. Methods The study was cross-sectional. Between October 2019 and January 2020, 282 women on long-term sick leave (> 2 months) due to CMDs were included in the study. The questionnaires for data collection were: "RTW Beliefs Questionnaire", the "General Health Questionnaire -12" and the "EuroQol Visual Analogue Scale". Standard multiple regression analysis was performed both with and without adjustment for potential confounders. Results The results showed that a more positive attitude towards RTW, stronger social pressure to RTW, higher perceived control over RTW and higher psychological well-being were associated with stronger RTW intention. The adjusted analysis eliminated the importance of psychological well-being for RTW intention, but showed that women who reported that their employer had taken actions to facilitate their RTW had stronger RTW intention. Conclusion The RTW beliefs, derived from the Theory of Planned Behaviour, were all important for a strong RTW intention, while psychological well-being and perceived health showed weaker associations. Furthermore, having an employer that take actions for facilitating RTW was associated with stronger RTW intentions. Though some caution is warranted regarding the representativeness of the sample, the results do improve our understanding of some important determinants of RTW intention among women on long-term sick leave for CMDs.

Source: Hedlund Å, Kristofferzon ML, Boman E, Nilsson A, BMC public health, 2021 Mar 19; Vol. 21 (1), pp. 535

Février 2021

An overlooked concept? Intention to return to work among individuals on sick leave due to common mental disorders: A scoping review

Purpose Intention to return to work (RTW) is an important predictor of actual RTW among individuals on sick leave in general. However, it is not known whether this is also the case for individuals with common mental disorders (CMDs). Because CMDs are a leading cause of disability worldwide, the RTW process is often more complex and sick leave periods are longer than for other diagnoses. Thus, it is important to focus solely on this group. The purpose of this scoping review was to summarise studies targeting individuals' RTW intention and its importance for actual RTW after sick leave due to CMDs. Methods Studies relevant for the aim were identified by a structured searching in three electronic databases (PubMed, CINAHL and PsycINFO) from their inception until the end of June 2020, as well as grey literature and reference lists of included articles. To cover all aspects of "intention", close concepts such as "expectation" and "willingness" were searched for as well. Results After the selection process, 10 original research papers were included in the review: eight quantitative and two qualitative. Nine of the studies used the concept "expectation" and one "intention". There was also a lack of consistency in measurements across studies. However, they showed that intention (expectation) was a significant predictor of actual RTW. Conclusion The conclusion is that RTW intention among individuals after sick leave due to CMDs has been narrowly investigated, with a lack of consistency in measurements. Future research should use behavioural-psychological theories to cover the concept "intention" in a more comprehensive and consistent manner.

Source: Hedlund Å, Health & social care in the community, 2021 Jan 28

A systematic review into the effectiveness of occupational therapy for improving function and participation in activities of everyday life in adults with a diagnosis of depression

Purpose Depression is a common mental health disorder, the symptoms of which can disrupt functioning and lead to reduced participation in everyday activities.  Occupational therapy is routinely provided for people with such difficulties; however, the evidence underpinning this intervention for depression has yet to be systematically assessed. Methods A systematic review of the effectiveness of occupational therapy for people with a diagnosis of depression, using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) was undertaken. Seven databases were searched using terms for depression combined with terms associated with occupational therapy. Due to heterogeneity in study design and outcome measures, a best evidence synthesis was undertaken as an alternative to meta-analysis. Results Of 1962 articles identified, 63 full texts were assessed and six met the inclusion criteria. Studies were carried out in Canada, Germany, the Netherlands, Taiwan and the United Kingdom. There was strong evidence for the effectiveness of occupational therapy return-to-work interventions for improving depression symptomology, limited evidence for occupational therapy lifestyle interventions for reducing anxiety and suicidal ideation, and limited evidence for improving work participation.  No studies evaluated individualised client-centred occupational therapy, highlighting a gap in research.Incomplete reporting within studies and heterogeneity prevented meta-analysis.  English language restrictions were applied. Conclusions Whilst overall the evidence base for occupational therapy for depression is limited, strong evidence was found for the effectiveness of occupational therapy return-to-work interventions, which is important given the costs associated with mental ill-health and work absence. Further research is needed to strengthen the evidence base.

Source: Christie L, Inman J, Davys D, Cook PA, Journal of affective disorders, 2021 Mar 01; Vol. 282, pp. 962-973

Janvier 2021

Beliefs About Return to Work Among Women During/After Long-Term Sick Leave for Common Mental Disorders: A Qualitative Study Based on the Theory of Planned Behaviour

Purpose Long-term sick leave due to common mental disorders (CMDs) is an increasing problem, especially among women. To help these women return to work (RTW) sustainably, we need to know more about their own beliefs about RTW. One applicable theory is the theory of planned behaviour (TPB). Thus, the present study aimed to describe, based on the TPB, women's beliefs about RTW during or after long-term sick leave for a CMD. Methods A qualitative approach was used. Twenty women were included during a long-term sick leave period due to a CMD. A deductive content analysis was conducted using predetermined factors from the TPB: behavioural beliefs (advantages-disadvantages of RTW), normative beliefs (supporters and non-supporters of RTW), and control beliefs (facilitators of-barriers to RTW). Results The women believed that RTW would give them meaning and balance in life, but also that it would be challenging to maintain balance after RTW. They believed they had several supporters of RTW, but that the support was sometimes perceived as stressful rather than encouraging. Furthermore, individual adaptation and high demands were the most mentioned facilitator and barrier, respectively. Workplace conditions and personal strategies were thought to be important aspects. Conclusions By using the TPB, the present study was able to offer new findings on women's beliefs about RTW after long-term sick leave for a CMD. Based on the findings, we suggest that various RTW stakeholders should focus on striving to provide the tasks and work pace women need so they can maintain their professional competence and sense of meaning.

Source: Hedlund Å, Boman E, Kristofferzon ML, Nilsson A, Journal of occupational rehabilitation, 2021 Jan 25

Do work- and home-related demands and resources differ between women and men during return-to-work? A focus group study among employees with common mental disorders

Background Common mental disorders present the main reason for registered sick leave in Sweden today, and women are at a higher risk of such sick leave than men. The aim of our study was to explore how the experiences of work- and home-related demands as well as resources influence return-to-work among employees sick-listed for common mental disorders in Sweden. Specifically, we aimed to explore similarities and differences in patterns of experiences among women and men.Methods A qualitative design with semi-structured focus group interviews was applied. One pilot interview and six additional focus groups, with a total of 28 participants, were conducted. The focus group discussions were audiotaped and transcribed verbatim. Data was analyzed with conventional content analysis.Results The analysis resulted in four main categories and eight sub-categories. While the study aim was to explore aspects of work and home, additional considerations related to internal demands and involved actors were also found. The main and sub-categories were "Home-related demands and resources" (sub-categories: "Not on sick leave for home-related demands", "Feeling responsible for relationships and the well-being of others", "An affected economy" and "Finding energizing activities and creating routines"), "Work-related demands and resources" (sub-categories: "Encountering tough emotions and an over-bearing feeling of responsibility at work", "Continued work-related demands create un-certainty about the future", "Loss of boundaries" and "(Desired) support from managers and colleagues"), "Internal demands and resources" and "Demands and resources linked to involved actors". The experiences described among women and men were similar in some categories while patterns of experiences differed in others.Conclusions Home-related demands and resources influence return-to-work among women and men sick-listed for common mental disorders in Sweden, also when work-related demands are experienced as the main reason for the sick leave period. Furthermore, several of these aspects were described differently among women and men, which highlights the need to consider possible gender differences in relation to return-to-work, while maintaining attention to individual variations.

Source: Nybergh L, Bergström G, Hellman T, BMC public health, 2020 Dec 17; Vol. 20 (1), pp. 1914.

The experiences of care managers and rehabilitation coordinators of a primary care intervention to promote return to work for patients with common mental disorders: a qualitative study

Background In an earlier study, PRIM-CARE RCT, a care manager implementation at the primary care centre showed improved return to work and reduced sick leave for patients with CMD. To further improve return to work, the project Co-Work-Care added a person-centered dialogue meeting between the patient, the employer and the rehabilitation coordinator, preceded by an increased collaboration between care manager, rehabilitation coordinator and GP. In this first qualitative study of the Co-Work-Care project, we explored how care managers and rehabilitation coordinators experienced the Co-Work-Care model. The purpose of this study was to explore care managers' and rehabilitation coordinators' perceptions and experiences of a close collaboration and the use of the person-centred dialogue meeting. Methods From an ongoing RCT with 20 primary care centres, care managers (CMs) (n = 13) and rehabilitation coordinators (RCs) (n = 12) participated in a qualitative study with focus groups. The study was conducted in the primary health care in a Swedish region. The data was analysed with Systematic Text Condensation by Malterud. Results Seven codes describing the participants' experiences of the Co-Work-Care model were identified: 1) The importance of collaboration at the primary care centre, 2) Collaboration and division of roles between the RC and the CM, 3) Collaboration with the General practitioner (GP), 4) The person-centred dialogue meeting, 5) Initiating the person-centred dialogue meeting, 6) The person-centred dialogue meeting to improve collaboration with the employer, and 7) The person-centred dialogue meeting to teach about the return to work process. Conclusion The increased collaboration within the Co-Work-Care model created a common picture and understanding of the patient's situation. The person-centred dialogue meeting in the rehabilitation process became a bridge between the employer and the patient.

Source: Petersson EL, Törnbom K, Hange D, Nejati S, Jerlock M, Wikberg C, Björkelund C, Svenningsson I, BMC family practice, 2020 Dec 18; Vol. 21 (1), pp. 272.