Santé mentale

Septembre 2025

Purpose The aim was to evaluate the effectiveness of a problem-solving intervention with workplace involvement (PSI-WPI) added to care as usual (CAU) in reducing sickness absence days among employees with common mental disorders compared to CAU alone in Swedish primary health care on a monthly basis over 18-months follow-up. Methods We conducted a cluster-randomised controlled trial including 197 employees blinded to allocation (85 PSI-WPI and 112 CAU). As sickness absence data was skewed and over-dispersed, generalised estimating equations was used to enable a comparison between the intervention and control group for each month of the follow-up period. Results The median number of sickness absence days over the 18-month follow-up was 78 days, inter-quartile range (IQR) 18-196 for employees receiving PSI-WPI and 64 days, IQR 18-161 for employees receiving CAU. The time x group generalised estimating equations analysis showed no statistically significant difference in sickness absence days per month. Conclusion The addition of a PSI-WPI to CAU was not more effective in reducing sickness absence days. This may be explained by the primary health care context, lack of specialisation in occupational health and the Swedish social insurance system with specific time limits.

Juillet-août 2025

Purpose Assessing fitness for work among employees with mental health disorders presents significant challenges. While it is fundamentally assumed that employees must be capable of adequately fulfilling their job responsibilities, occupational health professionals frequently encounter difficulties in making such determinations. This study aims to elucidate the factors considered by occupational physicians, particularly those specializing in psychiatry when evaluating the work eligibility of employees experiencing mental health issues. Methods We analyzed a subset of occupational physician interview records collected over a 14.5-year period at a higher education institution. A total of 1,381 interviews involving 184 individuals were included. For two groups, employees currently working and those on leave, we used the occupational physician's decision as the dependent variable. A generalized linear mixed model (GLMM) was employed to estimate the odds ratios (ORs) of factors associated with the physician's decision to recommend sick leave versus continued work without leave. Results Among employees currently working, factors associated with the occupational physician's decision to recommend sick leave rather than continued work included other occupations (OR [95% CI] = 5.43 [1.16, 25.42]), reduced sense of sleep quality (OR [95% CI] = 4.22 [1.07, 16.67]), and loss of appetite (OR [95% CI] = 6.81 [1.36, 34.2]). Among employees on sick leave, the only factor associated with a return-to-work decision, as opposed to continued sick leave, was the total duration of prior sick leave (in months) (OR [95% CI] = 0.94 [0.91, 0.96]). Conclusions The present study revealed that occupational physicians specializing in psychiatry place significant emphasis on lifestyle factors such as sleep and appetite when assessing fitness for work. When occupational physicians assessed fitness to return to work for employees on sick leave, they focused on the duration of the leave, which could serve as a potential risk factor for relapse.

Purpose Common mental disorders (CMD) are one of the main causes for work absenteeism. While traditional cognitive behavioural therapy is effective for symptom reduction, its impact on return to work is less pronounced. Work-focused therapy for those with CMD has shown positive results on return to work, but availability of such treatment is scarce. Objective: To investigate a transdiagnostic work-focused Internet Delivered Cognitive Behavioural Therapy (W-ICBT) intervention. Further, to investigate its feasibility in terms of use and adherence, including the participants experience of perceived effects, for outpatients on sick leave with diagnoses of depression and/or anxiety. Method We conducted a naturalistic feasibility study using a convergent, mixed-methods pre-post design. Outcomes included adherence and use of the treatment, return to work, work related self-efficacy, symptoms of depression and anxiety, quality of life and the experience of participants through qualitative interviews. Results 19 patients were screened, 15 included and 11 completed the 12-week treatment. Degree of sick leave was reduced from 79 % to 32 % for the completer sample (g = 0.95, p = .003), with statistically significant results on self-efficacy (g = 1.05 p = .005), depression (g = 0.81, p = .024), quality of life (g = 1.20, p = .002). No significant changes were observed on measures of anxiety and impairment of daily living. These results were supported by the findings from the qualitative interviews. Conclusion W-ICBT appears to be a promising approach to reducing work absenteeism and warrants further research.

Purpose & methods In our qualitative study, we interviewed 45 Canadian teachers about mental health issues, taking a leave of absence, and their subsequent return to work. Results We found that doctors, supportive principals, supportive colleagues, supportive human resource departments, supportive school boards, and the teaching unions were facilitators for taking a leave, while stigma, unsupportive administration, preparation, and the process of taking a leave were barriers. In returning to work, principals and administrators, and preparation to return were cited as barriers, while colleagues, principals and administrators, doctors, unions and a change in work were facilitators. We interpret these findings through a synthesized framework combining Allegro and Veerman's theory of sickness absence and D'Amato and Zijsrtra's theory of work resumption, highlighting individual, organizational, and societal factors shaping leave and return decisions. Conclusions With the high cost of teacher absences and critical staffing shortages, we discuss the impacts of these facilitators and barriers and make recommendations for practice for a healthy teaching workforce.

Purpose Exhaustion disorder (ED) is a prevalent cause of sick leave in Sweden, and support from employers appears to facilitate return to work (RTW). The aim of this study was to explore and highlight what patients diagnosed with ED thought would have been beneficial for their RTW, on the individual level, on the workplace level and at the organisational level. Methods Twenty patients were invited to participate in an interview conducted seven years after they sought care. The semi-structured interviews were transcribed verbatim and analysed using inductive content analysis. Results The analysis revealed an overarching theme "A need for a holistic view of the RTW process" and three main categories emerged: "The importance of a well-prepared organisation", "What characterises a good leader?" and "Meeting the needs of each employee". Important findings were that adjustments are warranted on an organisational level. Leadership qualities such as having a supportive approach and authority to make changes were highlighted. On an individual level, influence on their work situation and tailored adjustments was essential. For most patients change of work situation, such as change of workplace, work tasks and reduced working hours were necessary. Conclusion To facilitate RTW for patients with ED, it is essential to have a holistic approach that recognises necessary organisational changes, management support and individually tailored adjustments.

Juin 2025

Purpose The literature provides contradictory information on the effect of cognitive behavioural therapy (CBT) interventions on return to work (RTW) for patients on sick leave due to work-related stress. We compared the cumulative number of sick leave weeks between a cohort of patients who received a CBT-based stress management intervention in the period 2011-2018 (N = 331) and a cohort of patients from 2010 to 2011 (N = 221) who did not receive the intervention. We also compared time until sustainable RTW (3 consecutive months of no sick registrations) between the cohorts. Methods Registry data on sickness absence were obtained from the national DREAM register (Danish Public Transfer Payments Database). The cumulative time of registered sick leave in DREAM until first sustainable period of RTW was visualized using Kaplan-Meier plots. A Cox proportional hazard model was used to compare the effectiveness of the intervention relative to the comparison cohort and was reported as hazard rate ratio. Results The intervention cohort's cumulated number of weeks in DREAM across the total period from 0 to 36 months (median 29 range 26-32) was lower than that of the comparison cohort (median 40 range 34-52), (P = 0.005), corresponding to a 14% (95% CI 0.04-0.24) reduction. For RTW, a hazard ratio rate of 1.25 (95% CI 1.02-1.54) favouring the intervention group was found (P = 0.034). Conclusion The CBT stress management intervention significantly reduced the amount of sick leave and reduced the time until sustainable RTW for the intervention cohort compared to the comparison cohort.

Purpose Achieving and sustaining employment is a critical concern for individuals with mental health disorders, and vocational rehabilitation (VR) may be beneficial. However, existing reviews focus on a wide range of mental illnesses. This systematic review and meta-analysis evaluated the effectiveness of VR for individuals with affective disorders in improving depressive symptoms, competitive employment, absence duration, and quality of life compared to usual care. Methods Randomized controlled trials which recruited adults aged 18-65 with depressive disorders or bipolar disorders were included. A random-effects meta-analysis was conducted where applicable. Ten databases were systematically searched from inception to November 2023. Grey literature was searched on ProQuest and Google Scholar. The search was updated on March 22, 2024. Results Thirteen articles describing nine studies (n = 1869 participants) were included; no study involved individuals with bipolar disorders. VR reduced depressive symptoms post-intervention and at short-term follow-up compared to usual care but not at long-term follow-up. Competitive employment, absence duration, and quality of life showed no significant differences. Conclusion Moderate-quality evidence supports VR's effectiveness in reducing depressive symptoms. Future research should focus on VR for bipolar disorders and incorporate workplace support to improve vocational and quality-of-life outcomes.

Purpose Common mental disorders (CMDs) are significant causes of work disability. Low socioeconomic status (SES) is a known risk factor for CMDs and work disability, one possible reason being poorer treatment adherence. We aimed to study the realization of pharmacological treatment and antidepressant adherence in patients with CMDs 3 years before and 3 years after being granted a disability pension (DP) and the role of SES in this. We also studied whether antidepressant adherence is associated with return to work (RTW) after a temporary DP. Methods Information on all persons granted a DP due to CMD between 2010 and 2012 in Finland (n = 12,388) was retrieved from national registers, which included medical, socioeconomic, and sociodemographic information of the subjects. We used the PRE2DUP method to estimate drug use periods and regression analyses to study associations between SES, taking medications, and RTW. Results Prevalence of taking antidepressants increased towards the DP grant and decreased thereafter, but 14.6% of subjects did not take antidepressants or antipsychotics at all during the study period. Of SES factors, only income was positively associated with antidepressant adherence, lasting over a year. Antidepressant adherence was not associated with RTW. Conclusions An alarming result was the absence of recommended medication in fewer than every seventh patient estimated to be disabled due to pharmacologically treatable psychiatric disorders. Contrary to expectations, SES had only a minor predictive role in antidepressant adherence in this patient group. Contrary to taking antidepressants, rehabilitation was associated with RTW. The results adduced the importance of CMD treatment optimization regardless of SES.

© Leppanen H; Kampman O; Autio R; Tanskanen A; Taipale H; Karolaakso T; Rissanen P; Nappila T; Pirkola S. European Psychiatry: the Journal of the Association of European Psychiatrists. 68(1):e79, 2025 Jun 13.

Mai 2025

Purpose This study investigates the vocational recovery and return-to-work (RTW) experiences of individuals with common mental disorders (CMDs) within disability-based insurance systems, assessing alignment with the Connectedness, Hope, Identity, Meaning, and Empowerment (CHIME) model. 'Disability-based' refers to systems where eligibility depends on the presence of a health condition regardless of its cause, operating through social insurance in European countries and life insurance in Australia. Methods Through a qualitative scoping review under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) framework we reviewed qualitative peer-reviewed studies on RTW for people with CMDs from five electronic databases and mapped findings to CHIME dimensions noting unclassifiable content. Results Analysis of 11 studies revealed complex RTW processes for individuals with CMDs within disability-based insurance systems, emphasising the importance of CHIME dimensions. Key findings identified the necessity of supportive relationships and structured rehabilitation services for successful vocational recovery. Conclusion Results identify the need for a recovery-oriented approach in occupational rehabilitation for individuals with CMDs. This emphasises the importance of supportive environments that foster empowerment, meaningful engagement, and identity reconstruction in the RTW process. Further research should explore these aspects within the Australian context to develop more effective person-centred rehabilitation models.

Purpose Mood disorders and stress-related disorders are the two leading causes of long-term employee absenteeism and cause significant social losses. Therefore, strengthening the support systems is essential to help employees return to work. This study aimed to investigate the outcomes of a return to work (RTW) rehabilitation program and to explore factors associated with RTW and continued employment. Methods A five-times-a-week RTW intervention was implemented for three to four months for people on leave who had been diagnosed with a mood or stress-related disorder. RTW rates within one year of completing the program and RTW retention rates one year after returning to work were examined to explore factors associated with RTW and employment retention. Results Of the 47 participants, 41 completed the RTW intervention, 35 returned to work (85.4%) within one year after the intervention, and 29 were still working one-year post their RTW (82.9%). The non-RTW group had a lower attendance rate for the program and showed an increase in anxious temperament. Additionally, compared to the RTW group, the non-RTW group showed significantly lower interpersonal relationship scores and decreased finger dexterity in the post-program evaluation, which may be associated with difficulties in returning to work. There was little improvement in cognitive function in the RTW non-continuation group, with a disrupted rhythm of life, depression, panic, and non-assertive self-expression. Conclusion The RTW intervention demonstrated effectiveness for treating patients with mood and stress-related disorders. Future studies should investigate comparative trials with a control group while also increasing the sample size.

Purpose Released Veterans with mental health conditions are three times more likely than civilians to experience limitations in work reintegration. Various tools have been developed to assess barriers impacting the return-to-work (RTW) process for Veterans transitioning to civilian life. The Barriers to Employment and Coping Efficacy Scales for Veterans (BECES-V) was designed to assess perceived barriers and self-efficacy among Veterans as they reintegrate the workplace following a prolonged absence. Methods This study offers a preliminary validation of the BECES-V tool, specifically investigating: the dimensions of RTW obstacles while considering the literature and employing concept mapping procedure, the salient RTW obstacles experienced by Veterans with mental health conditions transitioning from military to civilian workplaces in Canada and the USA, and the strongest dimensions of RTW obstacles and self-efficacy, using logistic regression analyses. The study involved 92 Veterans who completed the BECES-V. Results Health-related limitations and adaptability difficulties were salient in both countries; self-efficacy to overcome work-life balance difficulties, as well as mental health and military stigmatization, emerged as the strongest predictors of RTW. Conclusion Utilizing BECES-V may help identify Veterans at increased risk for prolonged RTW, allowing rehabilitation professionals to address individualized obstacles and self-efficacy for successful RTW.

Purpose Burnout is a leading cause of prolonged sick leave and workforce withdrawal, with high relapse rates after return to work (RTW). Despite its classification as an occupational phenomenon, RTW interventions for burnout to date predominantly focus on individual recovery, often neglecting workplace-directed strategies. This study aimed to develop a multi-stakeholder RTW intervention, integrating both individual and organizational components through a participatory, iterative design process. Methods Using a Design Thinking approach structured within the Double Diamond framework, this study employed a co-creation methodology to engage employees, supervisors, HR professionals, occupational health practitioners, and other RTW experts in the development of a comprehensive RTW intervention. The process unfolded through iterative cycles of stakeholder engagement, prototyping, and refinement. Formative usability testing was conducted to assess feasibility, practicality, and alignment with workplace needs. Results The intervention included three key components: (1) a neutral RTW facilitator role and corresponding training program for facilitators supporting employees and supervisors; (2) a structured step-by-step RTW process with distinct pre- and post-RTW phases; and (3) a supporting toolbox incorporating conversation cards and a digital tool for progress monitoring. Conclusion This study highlights the feasibility of a multi-stakeholder, design-driven approach to RTW intervention development. By aligning the intervention with real-world needs through participatory design, the intervention holds the promise for reducing relapse and supporting sustainable RTW. Future research should evaluate its effectiveness in real-world implementation and its impact on long-term work retention.

Purpose A stepped care approach, beginning with a low-intensity e-Health program followed by a high-intensity Participatory Approach led by a return-to-work (RTW) coordinator is a promising intervention to promote RTW of employees on sick leave with distress. As this approach is new, determinants of its successful implementation remain unknown. This study aimed to identify the potential facilitators and barriers for a stepped care approach to promote RTW of employees with distress, from the perspective of employees, employers, and occupational physicians. Methods A qualitative study was performed consisting of individual semi-structured interviews with 10 employees, 5 supervisors, and two focus groups with 15 occupational physicians. The verbatim transcripts were inductively thematically coded. The Consolidated Framework for Implementation Research (CFIR) was applied to classify themes within its domains. Results Themes were constructed belonging to either the implementation or the content of the stepped care approach, falling within the CFIR domains "innovation," "outer setting," "inner setting," and "characteristics of the individual." From all three stakeholder groups, identified facilitators were the tailored program, enabling task adjustments, and the RTW coordinator to stimulate a good communicative relationship between employee and supervisor. Barriers identified were the timing of the stepped care approach, integrating the approach in the current RTW system, and low digital skills. Conclusion Both facilitators and barriers were found for the implementation of the stepped care approach. This underlines the importance of an adaptive implementation strategy that takes into account workplace dynamics and tailored approaches to support the stakeholder groups' needs.

Purpose In Norway's welfare system, General Practitioners (GPs) issue sickness certificates (SCs) to document patient's inability to work. These documents serve a dual role as medical evidence and as a basis for social welfare decisions. The language used in SCs can shape how non-medical stakeholders perceive a patient's work capacity. This study examines how SC language constructs narratives of work ability, focusing on how it portrays patients' limitations and prospects for recovery. Methods We conducted a qualitative discourse analysis of 155 SCs written by Norwegian GPs for patients under 35 years old with common mental health conditions. We focused on certificates issued around week 39 of the patient's sick leave. Using discourse analysis techniques, we examined linguistic features that convey the patient's work capacity and functional limitations. Results SCs predominantly emphasized incapacity and the necessity of work absence through discursive choices such as definitive language, amplified descriptions, and rhetorical strategies reinforcing limitations. Recovery potential was presented with tentative language, reflecting uncertainty in prognosis, while the temporal dimension of treatment was frequently framed as a barrier to returning to work. Additionally, the use of specialized terminology, generalized label, and elliptical constructions placed a significant interpretative burden on non-medical readers. Furthermore, SCs largely lacked explicit recommendations for workplace accommodations or interdisciplinary collaboration, limiting their utility in facilitating structured return-to-work strategies. Conclusions Time constraints, administrative pressures, and the dual roles of GPs as clinicians and bureaucrats shape the entire production of SCs. In turn, these discursive choices often reinforce narratives of incapacity. Enhancing SC relevance through structural modifications and interdisciplinary collaboration, including employer involvement in evaluating workplace accommodations, could improve welfare assessments and support tailored reintegration strategies. Positioning SCs as collaborative tools - rather than standalone assessments - may better align clinical evaluations with workplace realities and foster shared accountability for recovery and return-to-work efforts. SCs seem to place a disproportionate burden on GPs to translate medical conditions into work-related recommendations, often without the support or expertise required for such interdisciplinary evaluations.

Purpose The Danish return-to-work (RTW) program was a coordinated, tailored and multidisciplinary intervention aimed at improving sickness benefit management at municipal jobs and benefits offices in Denmark. Objective: To estimate long-term effects of the Danish RTW program for participants with mental ill health. Methods The study population consisted of 8655 20-54 year-old citizens in 21 Danish municipalities who were sick-listed due to self-reported mental health problems (anxiety (4%), depression (47%), stress/ burnout (37%), or other (12%)) in 2010-2012. Of these, 5252 received the intervention while 3403 (the control group) received ordinary case management. Multinomial logistic regression was used to estimate odds ratios (intervention vs. control) for health and non-health related welfare dependency at a 1, 3 and 5-year follow-up in national registers. Results We did not find effects on the odds of receiving health related welfare benefits at 1 (OR = 0.90, 99% CI: 0.78-1.05), 3 (1.00, 0.85-1.17) and 5 years (0.98, 0.85-1.14). We did also not find effects on the odds of receiving non-health related welfare benefits at 1 (1.11, 0.95-1.29) and 3 years (0.94, 0.81-1.09), but found an effect at the 5-year follow-up OR = 0.81 (0.69-0.96). Conclusion For persons with mental ill health at baseline, a structured RTW program reduced the risk of unemployment at 5-year follow-up, suggesting an impact on a process that can only be measured after several years. The intervention did not have long-term effects on the odds of receiving health related welfare benefits.

Purpose Growing mental health treatment access disparities elevate the urgency for identifying and implementing innovative approaches for delivering evidence-supported interventions. Work-related cognitive behavioral therapy (WCBT), a technology-assisted CBT (t-CBT) designed to address social anxiety and employment outcomes among job seekers at vocational service centers and for delivery by vocational service professionals, offers a promising way to increase access to needed mental health care. This qualitative study, guided by the Organizational Transformation Model (OTM), explored factors related to WCBT's implementation at two Jewish Vocational Services (JVS) Human Service sites in Detroit, MI and Los Angeles County, CA. Methods Twenty-seven staff-stakeholders across the two JVS sites completed in-depth, semi-structured interviews focused on their experiences with WCBT over the four-year study period. Results Thematic analysis identified five core codes that most broadly captured participants' perceptions of WCBT implementation and the factors influencing implementation, including: (1) Need, (2) Buy-in and engagement, (3) Communication, (4) Sustainability concerns, and (5) Implementation facilitators. Conclusions Core codes aligned with OTM factors related to impetus to transform, improvement initiatives, integration across boundaries, alignment from top to bottom, and leadership. Findings identify implementation strategies likely to optimize uptake and sustainability of WCBT within JVS sites that can be tested in a larger, multi-site implementation trial.

Avril 2025

Purpose Studies focusing on the return for young employees are scarce. The aim of this study was to investigate the return to work process after a period of sick leave due to common mental disorders among young male and female employees, with a specific focus on promoting and hindering factors. A gender perspective was applied to examine potential patterns of similarities and differences in the study participants' experiences. Methods A qualitative approach with an applied gender perspective was used to capture both young employees' and managers' experiences of the return to work process. The data consisted of interviews with 12 young male and 13 young female employees (aged 20-29) and 23 interviews with managers with experience of supervising at least one young employee during return to work. An inductive, conventional content analysis was conducted. Results The analysis resulted in three main categories and five subcategories describing hindering and promoting factors in young employees' return to work processes. The main and subcategories were (1) "Coordinating, planning, and timing the return to work process" (with subcategories "Lack of coordination and support from key stakeholders", "The importance of a return to work plan and follow-up", and "The timing of the return to work"); (2) "Gaining sufficient support and having personal resources" (with subcategories: "Level and quality of support in the work environment", and "Resources and obstacles on a personal level"); and (3) "Poor match between the young employees' capabilities and the work demands or working conditions". Conclusion The study participants identified similar factors that promoted and hindered the return to work process. Young employees need more support from employers and various welfare agencies. Managers need to know more about the return to work process and the responsibility of involved stakeholders. No expressed gender differences were identified.

Purpose Increasing numbers of people are unable to work due to mental illness and this is an increasing problem on both a personal and societal level. In Germany, a workplace integration management system (BEM) has been legally required since 2004 to support return to work (RTW). However, its uptake and success, especially regarding mental illnesses, is still unclear. This study was conducted to identify the current state of RTW after episodes of mental illnesses from the perspective of workplace integration managers and explore potential barriers and facilitators that influence the course and outcome of the BEM process. Methods Semi-structured interviews with BEM managers (N = 14) from the greater Munich area were performed and analyzed using Thematic Analysis. Results In their work, BEM managers tend to find themselves in a field of tension between the personal concerns of returning employees and the employer's business interests. They experience mistrust and lack of openness on the part of the returnees, while employers show little willingness to fully invest in the process. Lack of or incorrect information about BEM and on mental illness seems to promote these disruptive factors, as well as others. Conclusion Broad education on BEM appears to be a promising means to reduce fear among returnees and to better reach the processes potential. In addition, a more open approach to mental illness could simplify the process for all involved.

Février 2025

Purpose Owing to the ongoing global mental health crisis, providing support for employees returning to work after a mental health leave has become a crucial issue. This study aimed to preliminarily examine the efficacy of a functional assertiveness training program incorporating acceptance and commitment therapy (ACT) in a pilot study involving individuals who had taken a leave of absence due to mental health problems. As part of the program, eight group sessions were offered to these individuals in a group format while they attended an outpatient psychiatric clinic. Methods The effectiveness of the program was assessed in terms of mindfulness, psychological flexibility, functional assertiveness, and difficulty in returning to work. A total of 29 participants took part in the program, and 28 participants completed it. A paired t-test and effect size analysis (Cohen's d) were conducted using data from 26 participants; two participants were excluded from the analysis due to post-test data was not collected. Results The results showed an increase in participants' mindfulness (observing, non-reactivity and non-judging), psychological flexibility, and functional assertiveness increased and their sense of difficulty in returning to work (especially difficulties arising from workplace relationships) decreased after the intervention. Conclusion Although the lack of a control group makes it difficult to draw definitive conclusions, the results suggest that a functional assertiveness training program incorporating ACT may be beneficial for employees on leave due to mental health issues in returning to work.

Purpose A main goal during the return to work (RTW) process after a long-term sickness absence due to common mental disorders (CMDs), is to restore and maintain employees' work ability to enable their sustained work participation. This study jointly examined employees' work ability ratings and experiences during their RTW process with CMDs. Methods In a mixed methods follow-up study of N = 286 participants, work ability was quantitatively assessed with the Work Ability Score (WAS, range 0-10) at baseline (week before clinical discharge) and after 6, 12, 18, and 30 months. In a sub-sample, the qualitative work ability experiences of N = 32 participants were analysed at 6 and 12 months, and were jointly evaluated with the quantitative data. Results The mean WAS increased during the first 18 months of follow-up. Three groups of qualitative work ability experiences emerged: Employees with (1) poor work ability (WAS 0-3), who did not RTW yet and described great difficulties in coping with everyday life, (2) moderate work ability (WAS 4-6), who mainly did RTW, but still showed a certain level of fragility, and (3) good to very good work ability (WAS 7-10), who mainly returned to work and reported many individual and work accommodations to maintain their work ability. Conclusion The present study provides new insights into different aspects of work ability experiences, especially during the later RTW phases, where restoring and maintaining work ability is essential for a sustained work participation. This knowledge may help RTW stakeholders to better tailor support during the RTW process.

Purpose Common mental disorders (CMDs) are highly prevalent in workplace settings, and have become a significant public health challenge. This study aims to assess the effectiveness of PRATICAdr, a web application facilitated by a Return-to-Work Coordinator (RTW-C), with a focus on reducing sick leave duration and preventing relapse in individuals with CMDs. Methods PRATICAdr, designed to enhance collaboration among Return-to-Work (RTW) stakeholders and provide systematic support throughout the RTW process, was evaluated in a quasi-experimental study. Survival analyses were used to compare sick leave durations and relapses between the experimental group (PRATICAdr with RTW-C), and control groups (RTW-C only). Both conditions had equal distribution of 50% from large public health organizations (n = 35) and 50% from a large private financial organization (n = 35). Mixed linear models were used to observe changes in clinical symptoms over time, especially for the experimental group. Results The experimental group demonstrated significantly shorter sick leave durations and fewer relapses compared to the control group. Notably, the average absence duration was close to 3 months shorter in the experimental group. This difference was found when the RTW-C intervention (rehabilitation care) began 2 months after the onset of sick leave. Relapses occurred only in the control group (13.2%). The absence of relapses in the experimental group is noteworthy, along with the significant decrease in depressive and anxious symptoms over time. Conclusions The findings suggest that incorporating PRATICAdr into RTW-C intervention can lead to substantial cost savings by facilitating coordination among stakeholders and guiding the RTW process with validated tools. Initiation of RTW-C intervention alongside PRATICAdr within the first month of absence is recommended for optimal health and work outcomes.

Purpose Sick leave and ill health due to stress are significant concerns today and negatively affect the individual, the organisations, and the community. High demands, multitasking, and inexplicit boundaries between different occupations contribute to an explanation. However, research shows that more qualitative studies are needed to better understand this issue and how to promote health in the working population. The study aims to explore participants' experiences of maintaining or regaining occupational health in their everyday life, including paid work, several years after sick leave. Methods Nine semi-structured interviews were conducted and analysed using inductive content analysis. The analysis resulted in one major theme and three categories describing the current experiences handling their everyday life and work situations. Results The result showed that returning to work and maintaining occupational health after sick leave due to occupational ill health calls for "flex-ability". The term describes that individuals need to be open to change and adapt to new challenges at work and in everyday life. Conclusion The findings highlight the importance of health-promotive organisations where the individual factor is more considered. Furthermore, a broader view of health-promotive work in society where work is included in everyday life, instead of divided into and outside of work, is needed.

Purpose Depressive disorders can negatively impact work life sustainability for affected individuals. Little is known about depression care trajectories and their association with sustainable return to work (SRTW) after long-term sick leave. This study aimed to identify depression care trajectories during the first three months of sick leave among long-term sick-listed workers with depression and investigate their associations with SRTW. Methods Design: Nationwide cohort study using linked data from Norwegian health and population registries. Study population: All inhabitants of Norway aged 20-64 from 1 January 2009 to 1 April 2011, who were diagnosed with depression in general practice, and had reached three months consecutive sick leave (n = 13 624, 63.7% women). Exposure: Depression care trajectories during the first three months of initial sick leave, identified using group-based multi-trajectory modeling. Types of depression care included were general practitioner (GP) consults, GP longer consults and/or talking therapy, antidepressant medication (MED), and specialized mental healthcare. Outcome: SRTW, measured by accumulated all-cause sickness absence days during two-year follow-up after initial sick leave, with cutoffs at 0, <= 30, and <= 90 days. Analysis: Gender stratified generalized linear models, used to investigate the associations between depression care trajectories and SRTW, adjusting for sociodemographic factors and sick leave duration. Results Four depression care trajectory groups were identified: "GP 12 weeks" (37.2%), "GP 2 weeks" (18.6%), "GP & MED 12 weeks" (40.0%), and "Specialist, GP & MED 12 weeks" (8.7%). The "GP 12 weeks" group (reference) had the highest proportion attaining SRTW for both genders. Men in the "GP 2 weeks" group had a 12-14% lower likelihood for SRTW compared to the reference. Women in the "Specialist,GP & MED 12 weeks 12 weeks" group had a 19- 23% lower likelihood for SRTW compared to the reference. Conclusion The association between depression care trajectories and SRTW varies by gender. However, trajectories involving follow-up by the GP, including both standard and longer consults and/or talking therapy over 12 weeks, showed the highest likelihood of SRTW for both genders. Enhancing GP resources could improve SRTW outcomes by allowing more frequent and longer consultations or talking therapy.

Janvier 2025

Purpose More than 50% of people receiving long-term sickness benefits in Denmark have a common mental illness. At the same time, a significant treatment gap exists where less than 30% receive sufficient care for their mental illness. Methods The trial was designed as an investigator-initiated, randomized, two-group parallel superiority trial. Nine hundred participants with a common mental illness were randomly assigned into two groups: (1) IBBIS II, consisting of integrated mental health care and vocational rehabilitation, or (2) service as usual (SAU), at two sites in Denmark. The primary outcome was the difference between the two groups in time to return to work (RTW) at 12 months. Results There was no difference between the integrated IBBIS II intervention and SAU in time from baseline to RTW at the 12-month follow-up (Hazard ratio (HR) = 1.16 (95% CI 0.99-1.37), p = 0.07), but there was a tendency that the IBBIS II group had worse outcomes on several exploratory employment measures, including time to return to work at 6-month follow-up (HR = 1.36 (95% CI 1.03-1.55), p = 0.02), and number of weeks in work at 12-month follow-up (incidence rate ratio = 1.14 (95% CI 1.04-1.27), p = 0.008). Conclusion The integrated employment and health intervention (IBBIS II) was not more effective than SAU in any of the included vocational outcomes and may even have been inferior to SAU on certain outcome measures. Based on these results, it is not recommended that the IBBIS II intervention is widely implemented in countries with service as usual comparable with Denmark.

Purpose Mental disorders are a major public health challenge, and their prevalence is globally increasing. They substantially affect work ability, quality of life, and the number of years of disability. A new model for referring psychiatric patients to occupational health services (OHS) aims to improve the continuity of care and to promote the early return to work (RTW) of workers with diagnosed mental health conditions. The purpose of this qualitative implementation study was to identify the facilitators of and barriers to implementing the new model. Methods We used the Quality Implementation Framework and the Consolidated Framework for Implementation Research (CFIR) as theoretical frameworks. We interviewed the developers of the model and the psychiatrists and occupational health physicians who deliver it. We invited forty participants to join the study, 17 of whom consented. We conducted nine semi-structured group and individual interviews. Data analysis consisted of analysing the sessions, systematically coding the transcribed texts according to the main domains of CFIR, thematic analysis, and identifying the overarching themes and context-related mechanisms. Results We identified three overarching themes crucially related to the implementation of the model: uncertainty about the scope and boundaries of the cooperation in the model, ambiguity about the size of the target group, and the existing sociocultural and self-stigma related to mental illness. Shared belief in the importance and the positive effects of the model and trust in the developers were the main facilitators of the implementation of the model. The main barriers were the limited availability of the e-referral system between the psychiatrists and OHS, uncertainty regarding the number of eligible patients, and the low number of actual referrals during implementation. Conclusion Collaborative models in mental health care should accommodate various stakeholders from different sectors involved in the treatment and rehabilitation of workers with diagnosed mental health conditions. Helping health care workers contact possible cooperation partners and knowing how to address important individual, workplace-related and sociocultural factors such as stigma may strengthen collaboration between different sectors and stakeholders in mental health care. Future studies should focus on the multi-actor feasibility of the new collaborative models and include the patients' perspective.

Décembre 2024

Purpose The objective of this study is twofold: (1) to better understand the Return-to-Work (RTW) process of employees on sick leave due to burnout by evaluating RTW obstacles and self-efficacy to overcome them, and (2) to investigate strategies implemented for maintaining employment following burnout. Method Fifty-one participants completed the online questionnaire titled "Return-to-Work Obstacles and Self-Efficacy Scale (ROSES)", and two focus groups were conducted with employees returning to work after experiencing burnout. Results All the ROSES dimensions emerged as potential obstacles to returning to work after burnout. Several were particularly challenging to overcome, such as Fears of a relapse, Cognitive difficulties, and Loss of motivation to RTW. Qualitative analysis of verbatim from focus groups identified eight categories of strategies for overcoming these obstacles, such as Work involvement regulation strategies, Identity and anxiety regulation strategies, Seeking care and support from professionals, and Cognitive and metacognitive strategies, among the most often mentioned. Conclusion These findings pave the way for a more detailed analysis of the perceived obstacles individuals face during their RTW after burnout. Furthermore, the identification of strategies to overcome these obstacles may prove beneficial not only for the sustainable RTW of individuals, but also for the professionals who support them.

Purpose Literature on the effectiveness of occupational therapy mental health interventions in return-to-work (RTW) is limited, presenting challenges in implementing appropriate strategies. This scoping review aims to synthesize empirical evidence on the effectiveness of mental health interventions on RTW. Methods The search strategy across databases, including Medline, Embase, CINAHL, Web of Science, APA PsycINFO, and Cochrane Library, yielded over 1430 articles, of which seven met the eligibility criteria. Results Three main intervention types were identified from the review: work performance/function intervention, vocational rehabilitation, and nature-based rehabilitation. Conclusion This study will help select effective interventions for RTW and expand on the existing knowledge base.

Novembre 2024

Purpose Problem-solving interventions with workplace involvement (PSI-WPI) have been shown to reduce sick leave and increase return to work in an occupational health services context. However, many employees struggle with reduced work functioning, anxiety-, and depressive symptoms up to 12 months after a sick leave episode, and it is unclear if the intervention affects outcomes other than sick leave. The aim of this study is to investigate if a PSI-WPI added to care as usual (CAU) is superior to CAU with respect to self-reported sick leave, psychological symptoms, work ability, work performance, and health after RTW when provided in primary care. Methods Employed individuals aged 18-59 years on sick leave (2 to 12 weeks) diagnosed by a physician at a primary care center with mild to moderate depression, anxiety, or adjustment disorder were enrolled in a two-armed cluster-randomised trial evaluating the effectiveness of a PSI-WPI. Multiple outcomes were recorded at baseline, six months, 12 months, and every fourth week during the study period. Outcomes were categorised into psychological symptoms, health, work ability, work performance, and self-reported sick leave. Data were analysed using MANOVA, GEE (Generalized Estimating Equations), and cox regression. Results One hundred ninety-nine individuals responded to the invitation to participate; one participant withdrew, one was excluded as the employment ended, nine did not answer the baseline survey, and three were removed from the analysis due to missing data. The analysis included 81 subjects who received the intervention and 104 subjects who received the control. Baseline characteristics were similar across both groups. No differences between the groups were found among either variables except one. There was a significant difference between the groups in self-rated health (EQ5D) in favour of the CAU group from baseline to six-month follow-up, with a mean difference of -8.44 (-14.84, -2.04). Conclusions A problem-solving intervention with workplace involvement added to CAU did not result in statistically significant reductions in outcomes. Further research is needed to understand why problem-solving interventions appear to have an effect on sick leave in an occupational health services context and not in a primary care context.

Purpose Stakeholders from the mental health care sector and the social security sector are often involved in the implementation of vocational rehabilitation (VR) interventions, so-called coordinated or integrated program, as clients need support from both fields. Collaboration of the involved stakeholders from both sectors is therefore important. In this study, a review was performed to provide an overview of the barriers and facilitators for collaboration during the implementation of coordinated or integrated vocational rehabilitation interventions. Methods A systematic review (PROSPERO ID CRD42023404823) was performed in the databases of Medline PubMed (n = 11.511), Web of Science (n = 4821), and PSYCINFO (n = 368). We used the AI-driven tool ASReview to support the screening process, conducted by two researchers independently. A thematic content analysis was performed to analyse the reported barriers and facilitators. Appraisal of the quality of included studies was conducted using Critical Appraisal Skills Programme (CASP). Results We included 105 of the 11,873 identified articles for full text screening, of which 26 were included for final analysis. Six themes of barriers and facilitators were found: attitude and beliefs, engagement and trust, governance and structure, practical issues, professionals involved, and client-centeredness. We found a reporting quality between 8 and 20, based on CASP. Conclusion We found that a positive attitude towards and belief of those involved in collaboration during coordinated of integrated VR interventions can enhance collaboration. Moreover, a negative attitude or lack of trust, most often found among mental health professionals, hindered collaboration. Collaboration between stakeholders from different sectors could be increased by improving positive attitudes and mutual trust and increasing knowledge about each other's expertise. Also sharing success stories, co-location of professionals, and having a clear governance were found to be a factor in collaborations' success.

Octobre 2024

Purpose Common mental disorders are common reasons for long-term sick leave, especially among women. Return to work is often complex and unsuccessful, why more knowledge is needed regarding women's health and psychological well-being in the return-to-work process. Therefore, the aim was to describe women's health and psychological well-being in the return-to-work process, from women's and first-line managers' perspectives. Methods Individual interviews were conducted with 17 women and 16 first-line managers. Qualitative content analysis was performed based on the content areas "Women's health (i.e. overall well-being, both physical and psychological) throughout the whole RTW process" and "Women's psychological well-being (happiness, meaning and a sense of being significant) at work after work resumption" Themes and categories were created. Results Women and managers had similar descriptions, i.e. that women's health and psychological well-being depend on the individual characteristics of women themselves, their private life, work and other stakeholders. However, women described relational work tasks (e.g. meeting patients) as beneficial for health, and highlighted small stressors in the work environment, which the managers did not. Having work that was compatible with private life, being in good health, having stimulating work tasks and strengthening relationships at work were important for the women's psychological well-being. Conclusions Based on women's and first-line managers experiences, promotion of women's health and psychological well-being during the return-to-work process requires individually adapted assessments and actions involving women's entire life situation. First-line managers should know that relational work tasks (e.g., meeting patients) can be beneficial for women's health as well as that minor stressor in the work environment can put their health at risk.

Septembre 2024

Purpose The rise in the number of people on sick leave for common mental disorders is a growing concern, both from a societal and individual perspective. One common suggestion to improve the return-to-work process is increased cooperation between the relevant parties, including at least the employer, the social insurance agency and health care. This suggestion is often made on the presumption that all parties share the common goal of reintegrating the patient-employee back into the workplace. Methods In this paper we investigate this presumption by mapping out the ethical frameworks of these three key actors in any return-to-work process. Results We show that although the goals of these actors often, and to a large extent, overlap there are potential differences and tensions between their respective goals. Further, we emphasise that there may be other limitations to an actor's participation in the process. In particular the health care system is required to respect patient autonomy and confidentiality. There is also an inherent tension in the dual roles of health care professionals as therapists and expert witnesses in work ability assessment. Conclusion In conclusion, there are potential tensions between the key actors in the return-to-work process. These tensions need to be addressed in order to enable an increased cooperation between actors and to facilitate the development of a feasible plan of action for all parties, including the employee.

Août 2024

Purpose In two randomized controlled trials (RCT) we tested the efficacy of a novel integrated vocational rehabilitation and mental healthcare intervention, coined INT, for sickness absentees with common mental disorders. The aim was to improve vocational outcomes compared to Service As Usual (SAU). Contrary to expectations, the delivered intervention caused worse outcomes within some diagnostic groups and some benefits in others. In this phase 4 study, we examined the effectiveness of the intervention in real-world practice. Method In this prospective intervention study, we allocated adult sickness absentees with either depression, anxiety, or adjustment disorder to receive INT in a real-world setting in a Danish Municipality. We compared the vocational outcomes of this group to a matched group who received INT as a part of the RCTs, after randomization to the intervention group herein. Primary outcome was return to work at any point within 12 months. Results In the real-world group, 151 participants received INT during 2019. From the randomized trials, 302 matched participants who received INT between 2016-2018 were included. On the primary outcome - return to work within 12 months - the real-word group fared worse (48.3 vs 64.6 %, OR 0.54 [95%CI: 0.37-0.79], p = 0.001). Across most other vocational outcomes, a similar pattern of statistically significant poorer outcomes in the real-world group was observed: Lower number of weeks in work and lower proportion in work at 12 months (42.3% vs. 58.3% (p = 0.002)). Conclusions The real-word group showed significantly worse vocational outcomes. Like in many other studies of complex interventions, implementation was difficult in the original randomized trials and perhaps even more difficult in the less structured real-world setting. Since the intervention was less effective for some groups compared to SAU in the original trial, this negative effect may be even more pronounced in a real-world setting.

Juillet 2024

Purpose Employees who experience sickness absence (SA) due to common mental disorders (CMD) are at increased risk of recurrent sickness absence (RSA). This systematic literature review examines the factors at different levels in the work and non-work context that increase or decrease the likelihood of RSA due to CMD. The resulting knowledge enables more accurate identification of employees at risk of RSA. Methods We conducted a search in June 2023 using the following databases: PubMed, PsycInfo, Web of Science, Cumulative Index to Nursing & Allied Health Literature (Cinahl), Embase and Business Source Ultimate (BSU). Inclusion criteria were as follows: (self-)employees, CMD, related factors, RSA. The quality of the studies was assessed using the Mixed Methods Appraisal Tool (MMAT). The Individual, Group, Leader, Organisation and Overarching/social context (IGLOO) model were used to cluster the found factors and these factors were graded by evidence grading. Results Nineteen quantitative and one qualitative studies of mainly high and some moderate quality were included in this review. A total of 78 factors were found. These factors were grouped according to the IGLOO levels and merged in 17 key factors. After evidence grading, we found that mainly low socioeconomic status (SES) and the type of previous SA (short-term SA and SA due to CMD) are predictors of an increased risk of RSA. Conclusions Having a low SES and previous experience of SA (short term, or due to CMD) are factors that predict the chance of RSA, implying the need for prolonged support from occupational health professionals after the employee has returned to work.

Purpose Depression is a common mental disorder and is associated with work disability. For the implementation of evidence-based interventions, such as Individual Placement and Support (IPS) for people with depression in Germany, the aim of this study was to investigate client variables that predict return to work. Methods The sample consisted of 129 participants, initially treated in a psychiatric hospital due to major depression, who participated in IPS as part of a German clinical trial. Baseline demographic (age, sex, education, sickness absence days, employment status), psychiatric (symptom severity, comorbidity, general physical and mental health, disability), and neuropsychological (self-rated deficits, test performance) variables were included. Return to work within one year was predicted using separate and overall binary logistic regression analyses. Results A total of 70 participants (56%) returned to work within the one-year follow-up period. >100days of sick leave in the year prior to study entry (vs. <100days) and higher self-rated cognitive deficits were significantly associated with reduced odds of return to work within one year of IPS. Limitations: The sample consisted of participants with a relatively good work history who were assigned to IPS by the treatment team, thus, the generalizability of the results is limited. Conclusions People with depression who participate in IPS interventions might benefit from specifically targeting perceived cognitive deficits. Factors associated with prolonged sick leave due to depression and their role in return to work with IPS need further investigation.

Purpose Stress-induced exhaustion disorder (SED) is the most common reason for long-term sick leave in Sweden and the recovery process may be long and troublesome. This study explores the symptoms of burnout, depression and anxiety among patients with SED 10 years after termination of a multimodal rehabilitation program. Another aim of the study was to investigate work situation, work functioning, and any remaining exhaustion and sleeping disorders among those who were gainfully employed at the 10-year follow-up. Methods This longitudinal study included 107 patients (91 women and 16 men), who had been diagnosed with SED 10 years prior to the study. After establishing the diagnosis they all underwent and completed an multimodal rehabilitation program. Data on symptoms of burnout, anxiety and depression were collected before and after the multimodal rehabilitation program, and at follow-ups after additional 1 year and an additional 10 years. At the 10-year follow-up, work situation, work functioning, and symptoms of exhaustion and sleep disorders were assessed in those who were gainfully employed (89 patients). Results Symptoms of burnout, anxiety, and depression remained stable from the 1- to the 10-year follow-up after completed rehabilitation. Among participants who were gainfully employed, 73% had changed workplaces, and 31.5% had reduced their working hours. Common reasons for these changes were lack of energy or because they had chosen to prioritise their lives differently. Work functioning was rated as moderate, one third self-reported SED to some extent, and one fifth reported moderate-to-severe insomnia. Conclusion A relatively large proportion of former patients with SED have residual health problems 10 years after rehabilitation and some have not been able to return to full-time work. Preventive and early rehabilitative interventions with adjustments and measures at the organisational level are probably needed to achieve a more sustainable working life.

Juin 2024

Purpose Return to work often requires collaboration between different stakeholders. Rehabilitation coordination is a resource in coordinating efforts during sick leave to facilitate return to work. The purpose of the present study was to describe how people at risk for sick leave or on sick leave with mental health problems experienced rehabilitation coordination. Methods The study had a qualitative approach using qualitative content analysis as described by Graneheim and Lundman. Eleven semi-structured interviews were conducted with persons at risk for sick leave or on sick leave due to mental health problems and with experience of rehabilitation coordination. Results The participants experience of rehabilitation coordination were described by the overarching theme Building a bridge with many bricks between the person and society. The theme was formed by four categories and eleven subcategories reflecting the complex context of rehabilitation coordination. The categories were Collaboration in a new setting, Unburdened within certain limits, The way back to work is a joint project and Recognising challenges beyond the person. Conclusions People with mental health problems experienced rehabilitation coordination as a meaningful link between healthcare and work. However, rehabilitation coordination needs to be more recognised within healthcare to increase accessibility. It seems important that interventions are directed not only towards the person, but also include the workplace for a sustainable return to work.

Purpose Rehabilitation coordinators have gradually been introduced into Swedish psychiatric care to support individuals on sick leave to return-to-work or enter work. Aim: To explore healthcare professionals' perspectives on the contributions a rehabilitation coordinator can make to patients in psychiatric care. Methods A descriptive qualitative design was used, and data were collected through interviews. Twelve healthcare professionals in psychiatric care participated in individual semi-structured interviews. Data were analysed using thematic analysis. Results An overarching theme evolved: "The rehabilitation coordinator promotes security and reduces stress in the vocational rehabilitation process", based on two themes: (1) "Adaptations and support based on the patient's needs" and (2) "Rehabilitation coordinator efforts as relevant for care". The themes, in turn, consist of six subthemes. Conclusions This study showed that healthcare professionals perceived employment as important for patients' health and well-being. Therefore, the rehabilitation coordination efforts were not only seen as beneficial for addressing patients' challenges and needs in managing the vocational rehabilitation process but also as an integral part of the patient's care.

Purpose This study explores how the goals of collaboration in the return-to-work (RTW) process for people with common mental disorders are described by the stakeholders involved, and how they experience stakeholders' roles and responsibilities in relation to these goals. Methods Interviews were conducted with 41 participants from three Swedish regions. Nine of the participants were workers, six employer representatives, four occupational health professionals, four social insurance officers, 18 RTW coordinators and five physicians. Thematic analysis was conducted. Results Three main themes and overarching goals when collaborating on RTW were identified. In the first theme, 'creating an informative environment', all stakeholders emphasised clear roles and responsibilities. The second theme, 'striving for consensus in an environment of negotiations', addressed negotiations about when and how to collaborate, on what and with whom, and reveal different views on stakeholders' goals, roles and responsibilities in collaboration. The third theme identified goals for 'creating a supportive environment' for both workers and other stakeholders. Coordinators are found to have an important role in achieving a supportive environment, and in neutralising power imbalances between workers and their employers and social insurance officers. Conclusions Competing goals and priorities were identified as hindering successful collaboration, contributing to a spectrum of complex versus easy RTW collaboration. This study suggests some basic conditions for achieving a collaborative arena that is neutral in terms of power balance, where all stakeholders can share their views.

Purpose Recent research has emphasized that return to work (RTW) is a dynamic, gradual and often uneven process with a great degree of individual variation. This study aimed to identify RTW trajectories of Swedish employees on sick-leave due to common mental disorders (CMDs). The second aim was to explore which demographic, employment, health-related and work environment characteristics predicted RTW trajectory membership. Methods Data comes from two 2-armed cluster-randomized controlled trials (RCT) with a 12-month follow-up. A participative problem-solving intervention aimed to reduce sick-leave was compared to care as usual (CAU) involving any kind of work-directed interventions. Participants on sick-leave due to CMDs at baseline (N = 197) formed the study sample. Latent growth mixture modeling and logistic regression were the main analytical approaches. Results Five distinct RTW trajectories of Swedish employees were identified: Early RTW (N = 65), Delayed RTW (N = 50), Late RTW (N = 39), Struggling RTW (N = 21) and No RTW (N = 22). RTW trajectories differed consistently with regard to previous sick-leave duration and social support at work. More unique predictors of RTW trajectories included gender, rewards at work, work performance impairment due to health problems, home-to-work interference and stress-related exhaustion disorder. Conclusion The study may have important clinical implications for identifying patients belonging to a particular RTW trajectory. Knowledge on the modifiable work environment factors that differentiated between the RTW trajectories could be useful for designing effective workplace interventions, tailored to particular needs of employees with CMDs. However, in a first step, the results need to be replicated.

Purpose Few studies have focused on identifying distinctive strategies implemented for overcoming return-to-work (RTW) barriers perceived by people with common mental disorders (CMDs), and their impact on RTW. The study aimed to document the strategies used by occupational therapists to overcome RTW obstacles identified by people with CMDs, and to explore the impact of these strategies on employees' self-efficacy. Method Ten workers followed by three occupational therapists were recruited for this study. Based on the participants' ROSES scores, the occupational therapists identified in a logbook the dimensions to be worked on and the strategies they implemented for each dimension. Data was analyzed with the use of thematic analysis and descriptive statistics. Results Three dimensions of the ROSES were most frequently targeted by the occupational therapists: job demands, fear of relapse and difficult relation with the immediate supervisor. The main strategies used to overcome these obstacles were work-oriented and Cognitive Behavioral Therapy-based interventions. Most of the participants have increased their self-efficacy for RTW after using these strategies. Eighty percent of the participants returned to work at the end of the study. Conclusion The use of work-oriented and CBT-based interventions by occupational therapists appears to be useful in improving participants' self-efficacy and promoting their return to work.

Mai 2024

Purpose Healthcare systems and health professionals are facing a litany of stressors that have been compounded by the pandemic, and consequently, this has further perpetuated suboptimal mental health and burnout in nursing. The purpose of this paper is to report select findings from a larger, national study exploring gendered experiences of mental health, leave of absence (LOA), and return to work from the perspectives of nurses and key stakeholders. Methods Given the breadth of the data, this paper will focus exclusively on the qualitative results from 53 frontline Canadian nurses who were purposively recruited for their workplace insight. Results This paper focuses on the substantive theme of "Breaking Point," in which nurses articulated a multiplicity of stress points at the individual, organizational, and societal levels that amplified burnout and accelerated mental health LOA from the workplace. Conclusions These findings exemplify the complexities that underlie nurses' mental health and burnout and highlight the urgent need for multipronged individual, organizational, and structural interventions. Robust and timely interventions are needed to restore the health of the nursing profession and sustain its future.

Purpose To evaluate the body of evidence of the effects of work-directed interventions on return-to-work for people on sick leave due to common mental disorders (i.e., mild to moderate depression, anxiety, adjustment disorders and reactions to severe stress). Methods The systematic review was conducted in accordance with an a priori developed and registered protocol (Prospero CRD42021235586). The certainty of evidence was assessed by two independent reviewers using the Grading of Recommendations, Assessment, Development and Evaluations. We reviewed 14,794 records published between 2015 and 2021. Of these, eight RCTs published in eleven articles were included in the analysis. Population: Working age adults (18 to 64 years), on sick leave due to mild to moderate depression, anxiety, adjustment disorders or reactions to severe stress. Intervention: Work-directed interventions. Comparator: No comparator, Standard care, or other measures. Outcome: return to work, number of days on sick leave, income. Results Overall, the effects of work-focused CBT and work-focused team-based support on RTW resulted in increased or faster return-to-work compared with standard care or no intervention (low certainty of evidence). The effects of Individual Placement and Support showed no difference in RTW compared with standard care (very low certainty of evidence). Conclusion Interventions involving the workplace could increase the probability of RTW. Areas in need of improvement in the included studies, for example methodological issues, are discussed. Further, suggestions are made for improving methodological rigor when conducting large scale trials.

Purpose Public safety personnel (PSP) are frequently exposed to psychological trauma through their work. Evidence shows that worker's compensation claims for work-related psychological injuries are on the rise for PSP. Occupational therapists increasingly provide return to work (RTW) services for this population. Objective: To explore the therapeutic practices and personal experiences of occupational therapists working with PSP who have work-related psychological injuries. Methods These mixed methods descriptive study included a chart review of available occupational therapy client records from 2016 to 2020 for PSP with work-related psychological injuries from two Ontario companies. Additionally, a web-based self-report survey for Ontario occupational therapists providing RTW services to this same population was available from November 1, 2021 to June 1, 2022. Results The chart review included 31 client records and the online survey was completed by 49 Ontario occupational therapists. Therapists commonly provided services in clients' homes, workplaces, and communities, and focused on functional activities. The evidence base drawn on by therapists was not always occupation-based. Barriers to RTW included challenges with interprofessional collaboration, stigma, and the COVID-19 pandemic. Conclusion Occupational therapists are commonly working with PSP with work-related psychological injuries and have the opportunity to contribute to the evidence base for occupational approaches to RTW.

Purpose Low socioeconomic status (SES) is a risk factor for work disability due to common mental disorders (CMDs), one possible reason being inequal use of services. Psychotherapy is an evidence-based treatment for CMDs. This study examines socioeconomic and sociodemographic differences in psychotherapy attendance and an association of psychotherapy duration with return to work (RTW). Methods The study subjects (N = 12,263) were all Finnish citizens granted a disability pension (DP) due to CMDs in 2010-2012. Numbers of psychotherapy sessions (maximum 200) were collected from the nine-year interval around the DP grant. Socioeconomic and sociodemographic differences in psychotherapy duration (dependent variable) among DP recipients were studied using multinomial logistic regression models, likewise, the association between psychotherapy duration and RTW (dependent variable) among temporary DP recipients was examined. Results Higher SES, female gender, and younger age were positively associated with attending longer psychotherapies and surpassing the early treatment termination level (>10 sessions). Attending 11-60 psychotherapy sessions was positively associated with full RTW and partial RTW, whereas longer psychotherapies were not. Early termination was positively associated with partial RTW only. Conclusion This study demonstrates varying tendencies among CMD patients from different backgrounds to attend long rehabilitative psychotherapies, which may create inequalities in RTW.

Purpose Nurses experience elevated rates of operational stress injuries (OSIs). This can necessitate taking leave from work and subsequently engaging in a workplace reintegration process. An unsuccessful process can have long term impacts on a nurse's career, affecting the individual, their family, and broader community, while contributing to nursing shortages. A knowledge gap regarding the workplace reintegration of nurses experiencing mental health challenges, impedes the development and implementation of initiatives that might increase the success of nurses reintegrating into the workplace. This scoping review explored the existing literature concerning workplace reintegration for nurses experiencing OSIs. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) reporting guidelines were utilized. Three key search terms across six databases were employed followed by a qualitative content analysis of the resulting literature. Results Eight documents were included. The literature exhibited high heterogeneity in objectives, content, and article types. The content analysis revealed five themes: (1) recognizing stigma, (2) elements of successful workplace reintegration, (3) considerations for military nurses, (4) considerations for nurses with substance use disorders, and (5) gaps in the existing literature. Conclusion A paucity of programs, policies, procedures, and research exists regarding workplace reintegration for nurses facing mental health challenges. It is imperative to recognize that nurses may experience OSIs, necessitating mental health support, time off work, and operationally/culturally-specific assistance in returning to work. Innovative and evidence-based approaches to workplace reintegration are needed to enhance the retention of a skilled, experienced, compassionate, and healthy nursing workforce.

Avril 2024

Purpose Best practice guidelines for the recovery and return to work (RTW) of people with mental disorders recommend access to the services of an interdisciplinary team combining pharmacological, psychological and work rehabilitation interventions. In the Canadian context, primary healthcare services are responsible for providing these services for people with common mental disorders, such as depressive or anxiety disorders. However, not everyone has easy access to these recommended primary healthcare services, and previous studies suggest that multiple personal, practice-related and organizational factors can influence the patient's journey. Moreover, previous studies documented that family physicians often work in silos and lack the knowledge and time needed to effectively manage by themselves patients' occupational health. Thus, the care and service trajectories of these patients are often suboptimal and can have important consequences on the person's recovery and RTW. Our study aimed to gain a better understanding of the patient journeys and the factors influencing their access to and experience with primary healthcare services while they were on sick leave due to a common mental disorder. Methods A descriptive qualitative research design was used to understand and describe these factors. Conventional content analysis was used to analyze the verbatim. Results Five themes describe the main factors that influenced the patient's journey of the 14 participants of this study: (1) the fragmented interventions provided by family physicians; (2) patients' autonomy in managing their own care; (3) the attitude and case management provided by the insurer, (4) the employer's openness and understanding and (5) the match between the person's needs and their access to psychosocial and rehabilitation services. Conclusion Our findings highlight important gaps in the collaborative practices surrounding the management of mental health-related sick leave, the coordination of primary healthcare services and the access to work rehabilitation services. Occupational therapists and other professionals can support family physicians in managing sick leaves, strengthen interprofessional and intersectoral collaboration and ensure that patients receive needed services in a timelier manner no matter their insurance coverage or financial needs. Patients or public contribution: This study aimed at looking into the perspective of people who have lived or are currently experiencing a sick leave related to a mental health disorder to highlight the factors which they feel hindered their recovery and RTW. Additionally, two patient partners were involved in this study and are now engaged in the dissemination of the research results and the pursuit of our team research programme to improve services delivered to this population.

Purpose Major depressive disorder (MDD) is a prevalent psychological mood disorder that can disrupt one's functioning and result in decreased engagement in daily activities. Psychotherapy, in different approaches, is a common approach for individuals experiencing MDD. Nevertheless, a literature review of the research supporting the effectiveness of psychotherapeutic interventions in patients with MDD-impacted areas of their daily occupations, such as back to work, cognitive deficits, and well-being, has not been conducted. Methods A literature review was carried out to evaluate the effectiveness of psychotherapy on daily occupations for individuals diagnosed with MDD. Due to variations in study design and outcome measures, a best evidence synthesis was carried out instead of a meta-analysis. Results Forty-one identified articles were fully assessed in total. These studies were conducted in various countries so that a global approach could be considered comprehensive. The findings showed strong evidence supporting the effectiveness of psychotherapy on return-to-work interventions in improving depressive symptoms. There was limited evidence for the effectiveness of psychotherapy on lifestyle interventions in reducing anxiety and suicidal ideation, as well as limited evidence for enhancing work participation. Notably, there were no studies evaluating individualized client-centered psychotherapy interactions with occupations, revealing a research gap. Challenges such as incomplete reporting within studies and study heterogeneity prevented a meta-analysis. Conclusions While the overall evidence base for the effectiveness of psychotherapy for MDD in treating functionality is limited, the findings provide strong support for the efficacy of occupational therapy return-to-work interventions. This is particularly important given the economic costs associated with mental health issues and work-related absences. Further research is required to strengthen the existing evidence base.

Purpose Return-to-work (RTW) after absence due to a mental illness is a largely understudied area, especially in industries already struggling with retention like those posing unique and high risks for public or personal safety (i.e., pilots, police officers, and health professionals), otherwise known as safety-sensitive sectors. The goal of this paper is to examine how RTW coordinators work with individuals who took a leave of absence for mental illness in safety-sensitive occupations and navigate the RTW process. Methods Qualitative methodology was utilized to explore the experiences of 47 RTW coordinators who had worked with individuals employed in safety-sensitive industries. The participants were recruited across Canada using convenience sampling to participate in semi-structured interviews. The interviews were transcribed, anonymized, uploaded to NVIVO 11, and coded using inductive thematic analysis. Results Our analysis shows that despite the presumed rigidity of occupational health and safety standards for safety-sensitive positions, the notion of "safety" becomes ambiguous in navigating RTW processes, and concerns about safety are often interpreted as the potential risk workers may pose to themselves, other individuals, or the workplace image. Institutional constraints of safety-sensitive jobs shape the ability of RTW coordinators to advocate on behalf of the workers, ultimately placing the workers at a disadvantage by prioritizing safety concerns for organizations over employees' needs. Conclusion It is important to consider how to protect workers in safety-sensitive occupations during the RTW process after absence due to a mental illness to ensure effective integration to the workplace.

Mars 2024

Purpose Psychiatric disorders are increasing globally. Especially when these disorders affect working people, this places a financial burden on society due to long-term sick leave, the incapacity to work and the inability to earn and pay taxes. General practitioners (GPs) are often the first health professionals to be consulted by those suffering from mental health disorders. This study investigated the experiences of GPs regarding their patients with mental health disorders and identified factors that are important for a successful return to work. Methods This qualitative study used semi-structured interviews to explore the opinions of GPs (n = 12) working in Munich, Germany, or its metropolitan area. The interviews were audio-recorded, transcribed, and analyzed using the reflexive thematic analysis method. Results GPs think of themselves as important players in the rehabilitation process of patients with mental health disorders. In their daily routine, they face many obstacles to ensure the best treatment and outcome for their patients. They also suffer from poor collaboration with other stakeholders, such as psychiatric hospitals, therapists or employers. They indicate that the mental health disorder of each patient is unique, including the barriers to and possibilities of a successful return to work. Additionally, the workplace appears to play a crucial role in the success rate of re-entry into work. It can exacerbate the course of mental health disorders or support recovery. Fear, shame and stigmatization of the patients are personal factors responsible for prolonged sick leave. Conclusion We conclude that GPs believe that they can have a major impact on the rehabilitation of patients with mental health disorders. As such, special focus should be placed on supporting them in this context.

Février 2024

Purpose Incorporating multiple perspectives and contexts in knowledge mobilisation for return-to-work after sick leave due to common mental disorders can promote interprofessional and organisational strategies for facilitating the return-to-work process. This study aimed to explore the facilitators of and barriers to return-to-work after common mental disorders. This exploration considered the perspectives of employees and managers and the realms of work and private life. Methods A qualitative approach was used with data from 27 semi-structured telephone interviews. The strategic sample consisted of employees who returned to work after sick leave due to common mental disorders (n = 17) and managers responsible for their return-to-work process (n = 10). Thematic analysis conducted in a six-step process was used to generate themes in the interview data. Results The analysis generated three main themes with subthemes, illustrating experiences of barriers to and facilitators of return-to-work positioned in the employees' private and work contexts: (1) Getting along: managing personal difficulties in everyday life; (2) Belonging: experiencing social connectedness and support in work and private life; and (3) Organisational support: fostering a supportive work environment. The results contribute to a comprehensive understanding of the return-to-work process, including the challenges individuals face at work and in private life. Conclusions The study suggests that return-to-work after sick leave due to CMDs is a dynamic and ongoing process embedded in social, organisational, and societal environments. The results highlight avenues for an interprofessional approach and organisational learning to support employees and managers, including space for the employee to recover during the workday.

Purpose This study aims to explore ethical challenges potentially arising from a problem-solving intervention with workplace involvement (PSI-WPI) in primary health care (with first-line manager involvement) for employees on sickness absence due to common mental disorders. Methods A qualitative design guided by the theoretical framework for systematic identification of ethical aspects of healthcare technologies. Semi-structured interviews were performed with coordinators (n = 6), employees (n = 13), and first-line managers (n = 8). Reflexive thematic analysis was used to analyse and interpret themes. Results A main theme was identified "the workplace and healthcare hold different organizational value logics" and four sub-themes: "the PSI-WPI challenged the organizational goals and values of the workplace and healthcare", "the PSI-WPI challenged organizational values on fairness", "the PSI-WPI challenged the professional roles of first-line managers and rehabilitation coordinators" and "the PSI-WPI introduced a need for the employee to juggle the employee and patient roles". Conclusion Different organizational value logics, values, and goals can introduce ethical challenges. We advise clarifying stakeholders' roles and preparing employees and managers for the return to work process by providing sufficient information. The ethical challenges and suggested measures to minimize them, should be considered when planning return to work interventions that involve several stakeholders.

Janvier 2024

Purpose Posttraumatic stress injury (PTSI) is a term used to describe a range of psychiatric difficulties which arise following exposure to a psychologically traumatic event. The impact of being diagnosed with multiple psychiatric conditions on the return-to-work (RTW) outcomes of individuals with PTSI has not been adequately researched. The current study examined whether the presence of two or more psychiatric conditions occurring simultaneously is predictive of RTW outcomes in workers with PTSI. Methods A population-based cohort design was conducted using archival data from injured workers admitted to a PTSI rehabilitation program. Differences in RTW outcomes and demographic, administrative, and clinical variables were compared between individuals with single and multiple psychiatric diagnoses. A range of variables were entered into a multivariable logistic regression model predicting RTW. Results The final logistic regression model indicated workers had higher odds of RTW if they had a single psychiatric diagnosis (Adjusted Odds Ratio (AOR) 2.20), non-elevated scores on a measure of traumatic stress (AOR 1.85), and reported higher self-perceived readiness to RTW (AOR 1.24). Conclusion Being diagnosed with multiple psychiatric conditions appears to be associated with more negative RTW outcomes following PTSI rehabilitation.

© Krebs BK; Rachor GS; Yamamoto SS; Dick BD; Brown CA; Asmundson GJG; Straube S; Els C; Jackson TD; Brémault-Phillips S; Voaklander D; Stastny J; Berry T; Gross DP. Journal of Vocational Rehabilitation. Jan2024, p1-15.

Décembre 2023

Purpose Little is known about the effects of routine mental health care on return-to-work (RTW) outcomes. This systematic review aimed to summarize and evaluate the effects of clinical representative psychotherapy on RTW among patients with a common mental disorder (CMD), treated within public mental health care. Method A systematic search was conducted using PubMed, PsycINFO, Embase, and SveMED+. Primary outcomes were RTW, sick leave status, or= self-reported work functioning. Studies limited to specific treatments and/or specific patient groups were excluded. Results Out of 1,422 records, only one article met the preregistered inclusion criteria. After broadening of criteria, a total of nine studies were included. Six were randomized controlled trials (RCT), two were register-based studies, and one was a quasi-experimental study. Descriptions of treatment duration and intensity of usual care were rarely specified but ranged from a few sessions to 3 years of psychotherapy. In the RCTs, two studies favored the intervention, one favored routine care, and three found no difference between conditions. Choice of outcomes differed greatly and included RTW rates (full or partial), number of days until RTW, change in sick leave status, and net days/months of work absence. Time points for outcome assessment also varied greatly from 3 months to 5 years after treatment. Conclusion There is inconclusive evidence to establish to what extent routine mental healthcare is associated with improved RTW outcomes for patients with CMD. There is a need for more and better clinical trials and naturalistic studies detailing the content of routine treatment and its effect on RTW.

Purpose Common mental disorders (CMD) are highly prevalent among sick-listed precarious workers and often lead to long-term sickness-absence, work disability and unemployment. This study aimed to identify predictors of a longer time until return to work (RTW) and prolonged duration of sickness absence in sick-listed precarious workers with CMD. Methods We conducted a secondary Cox regression analysis using existing data from two Dutch randomized controlled trials and one cohort study among sick-listed precarious workers with CMD (N = 681). Age, gender, baseline employment status, study allocation, severity of psychological symptoms and RTW self-efficacy were evaluated for their predictive value on time until sustainable (>= 28 days) RTW and duration of sickness absence during 12-month follow-up. In this study, time until sustainable RTW and duration of sickness absence are distinct dependent variables, because they are not mutually exclusive. Results Age above 50 years (HR 0.57, 95% CI 0.39-0.82), severe psychological symptoms (HR 0.64, 95% CI 0.43-0.93), unemployment (HR 0.19 95% CI 0.11-0.33) and loss of employment contract during sickness absence (HR 0.25, 95% CI 0.14-0.47) were predictive of a longer time until RTW. Male gender (HR 0.77, 95% CI 0.62-0.97), severe psychological symptoms (HR 0.64, 95% CI 0.46-0.87), unemployment (HR 0.47, 95% CI 0.27-0.84) and loss of employment contract (HR 0.48, 95% CI 0.26-0.90) predicted a prolonged duration of sickness absence. Conclusions Unemployment at the moment of sick-listing, loss of employment contract during sickness absence, and severe psychological symptoms are predictors of both a longer time until RTW and prolonged duration of sickness absence among sick-listed precarious workers with CMD. This knowledge assists occupational health and mental health professionals in the early identification of workers at risk of long-term sickness absence, enabling them to arrange targeted occupational rehabilitation support and mental health care.

Purpose Public safety personnel (PSP) are frequently exposed to psychological trauma through their work. Evidence shows that worker's compensation claims for work-related psychological injuries are on the rise for PSP. Occupational therapists increasingly provide return to work (RTW) services for this population. Objective: To explore the therapeutic practices and personal experiences of occupational therapists working with PSP who have work-related psychological injuries. Methods This mixed methods descriptive study included a chart review of available occupational therapy client records from 2016 to 2020 for PSP with work-related psychological injuries from two Ontario companies. Additionally, a web-based self-report survey for Ontario occupational therapists providing RTW services to this same population was available from November 1, 2021 to June 1, 2022. Results The chart review included 31 client records and the online survey was completed by 49 Ontario occupational therapists. Therapists commonly provided services in clients' homes, workplaces, and communities, and focused on functional activities. The evidence base drawn on by therapists was not always occupation-based. Barriers to RTW included challenges with interprofessional collaboration stigma, and the COVID-19 pandemic. Conclusions Occupational therapists are commonly working with PSP with work-related psychological injuries and have the opportunity to contribute to the evidence base for occupational approaches to RTW.

Novembre 2023

Purpose Targets of workplace bullying tend to develop severe mental health complaints, having increased risk of sick leave and expulsion from the workplace. Hence, these individuals are likely to be overrepresented among patients seeking treatment for common mental disorders (CMD). This study investigated the prevalence of exposure to workplace bullying in a patient group seeking treatment for CMD. Further we explored if exposed and non-exposed patients differed on clinical and work-related characteristics. Methods The sample comprised of 675 patients from an outpatient clinic in Norway and consisted of 70% women and had a mean age of 39 (SD = 10.5) years. The study had a cross-sectional design and differences between the patient groups were analysed using chi-square, Mann-Whitney U-tests and independent sample t-tests. Results The prevalence of exposure to bullying was 25.8%. The patients exposed to bullying reported significantly more major depressive disorders (MDDs) measured with the MINI psychiatric interview, higher levels of depressive symptoms, anxiety symptoms, subjective health complaints, alcohol use, and lower resilience as measured with questionnaires. Twice as many were on full-time sick leave, reported lower work ability, lower return to work self-efficacy, and lower job satisfaction. A majority preferred another job than the one they have today over returning to their current employment. Conclusion Victims of workplace bullying are a vulnerable group at risk of expulsion from working life, being overrepresented among patients seeking mental health treatment for CMD. One in four patients represented with such experience have higher levels of psychological symptoms and are more often diagnosed with depression as compared to other patients. Thus, this is a problem that should be addressed in clinical settings. If not addressed there is an increased risk of sick leave and permanent exclusion from working life.

Purpose Return-to-work (RTW) resources for persons with mental health disorders are limited and costs are typically shared by several stakeholders in society. Occupational therapists (OT) provide RTW interventions for this target group, however, increased knowledge of health, and employment effects, as well as costs are needed to better inform decision makers in their prioritisations. Objectives: To identify and summarise evidence of cost-effectiveness of RTW interventions for persons with mental health disorders which OTs provide. Methods A systematic search was applied and resulted in 358 articles. After screening, nine articles met inclusion criteria and were reviewed. Quality assessment was conducted using the economic evaluation tool by Joanna Briggs Institute. Results Supported employment, Individual Placement and Support was cost-effective in several contexts while three studies showed larger effects and higher costs. An OT intervention added to treatment for major depression was indicated to be cost-beneficial and an advanced supported employment was cost-saving. The methodological quality varied considerably between studies. Conclusions The results of the included studies are promising, however, to further strengthen the economic perspective in OT RTW interventions, the need for conducting more and methodologically robust economic evaluations is crucial in future studies.

Purpose It is unclear what constitutes Work Focused Cognitive Behaviour Therapy (W-CBT). This review sought to define W-CBT and ascertain its effectiveness at facilitating return to work (RTW) for people experiencing mental health conditions. Methods A systematic review and narrative synthesis were undertaken. Five databases were searched (Medline, ProQuest, PsychInfo, Scopus, and Web of Science). English publications with an intervention combining CBT with RTW were selected. Quality checklists from the Joanna Briggs Institute were applied. Results Searching yielded 16,863 results. 23 moderate-to-high quality studies from 25 articles were included (13 experimentally designed studies, 3 pilots/case studies and 7 reviews). Results indicated W-CBT is effective at facilitating RTW for mild-to-moderate mental health conditions. Conclusion For a program to be labelled W-CBT it is recommended it is (1) a stand-alone intervention; (2) delivered with an understanding RTW is the goal; and, (3) the CBT components are always framed by matters, subjects and contexts related to work.

Purpose Managing long-term sickness absence is challenging in countries where employers and managers have the main responsibility to provide return to work support, particularly for workers with poor mental health. Whilst long-term sick leave and return to work frameworks and guidance exist for employers, there are currently no structured return to work protocols for employers or for their workers encompassing best practice strategies to support a positive and timely return to work outcome. Objective: To utilise the intervention mapping (IM) protocol as a framework to develop return to work toolkits that are underpinned by relevant behaviour change theory targeting mental health to promote a positive return to work experiensce for workers on long-term sick leave. Methods This paper provides a worked example of intervention mapping (IM) to develop an intervention through a six-step process to combine theory and evidence in the development of two toolkits - one designed for managers and one to be used by workers on long-term sick leave. As part of this process, collaborative planning techniques were used to develop the intervention. A planning group was set up, through which researchers would work alongside employer, worker, and mental health professional representatives to develop the toolkits. Additionally, feedback on the toolkits were sought from the target populations of workers and managers and from wider employer stakeholders (e.g., human resource specialists). The implementation and evaluation of the toolkits as a workplace intervention were also planned. Results Two toolkits were designed following the six steps of intervention mapping. Feedback from the planning group (n = 5; psychologist, psychiatrist, person with previous experience of poor mental health, employer and charity worker) and participants (n = 14; employers = 3, wellbeing director = 1; human resources = 2, managers = 2, employees with previous experience of poor mental health = 5) target populations indicated that the toolkits were acceptable and much needed. Conclusions Using IM allowed the development of an evidence-based practical intervention, whilst incorporating the views of all the impacted stakeholder groups. The feasibility and acceptability of the toolkits and their supporting intervention components, implementation process and methods of assessment will be evaluated in a feasibility pilot randomised controlled trial.

Septembre 2025

Is a Problem-Solving Intervention with Workplace Involvement for Employees on Sickness Absence Due to Common Mental Disorders More Effective, than Care as Usual, in Reducing Sickness Absence Days?

Juillet-août 2025

Occupational Health Physicians' Perspectives on Factors Influencing Return-to-Work Decisions for Employees With Mental Health Disorders: A Retrospective Observational Study.

Work-focused therapy in an internet-based CBT format - A mixed methods feasibility study.

Facilitators and Barriers to Mental Health Leaves and Return to Work Among Canadian Teachers.

Facilitating Return to Work through a Broader Perspective on Vocational Rehabilitation: Insights from Patients with Stress-Related Disorders.

Juin 2025

Effect of Cognitive Behavioural Stress Management on Return-to-Work Amongst Sick-Listed Employees.

Effectiveness of vocational rehabilitation interventions on depression and work-related outcomes among adults with affective disorders: a systematic review and meta-analysis.

Socioeconomic status, antidepressant use, and return to work after disability due to common mental disorders.

Mai 2025

Return-to-work experiences of individuals with common mental disorders within disability-based insurance systems explored within a mental health recovery framework: a scoping review.

Return-to-work support program outcomes for people on leave due to mood and stress-related disorders.

Preliminary validation of the Barriers to Employment and Coping Efficacy Scales for Veterans with a mental health condition (BECES-V) - assessing barriers and self-efficacy to returning to work.

Designing a Multi-Stakeholder Intervention for Return to Work After Burnout. A Participatory Approach.

Facilitators and Barriers for a Stepped Care Approach to Promote Return to Work of Employees with Distress: A Multi-perspective Qualitative Study.

Legitimizing incapacity: discursive choices in Norwegian sickness certificates.

Long-term follow-up of participants with mental ill health in the Danish return-to-work program: A secondary analysis of a controlled trial.

Multiple Stakeholder Perspectives of Implementing Work-Related Cognitive Behavioral Therapy (WCBT) in Vocational Service Settings: A Qualitative Exploration of Intervention Acceptability and Sustainability.

Avril 2025

The return to work after sick leave due to common mental disorders among young employees: a qualitative interview study with young employees and managers.

Return to work after sick leave due to mental illness - a qualitative study on the perspective of workplace integration managers.

Février 2025

Functional assertiveness with acceptance and commitment therapy for employees returning to work: a preliminary investigation

Work Ability during the Return to Work Process: Results from a Mixed Methods Follow-Up Study Among Employees with Common Mental Disorders.

Web-enhanced return-to-work coordination for employees with common mental disorders: reduction of sick leave duration and relapse.

Flex-ability - a key concept to promote occupational health in everyday life beyond sick leave.

Depression care trajectories and sustainable return to work among long-term sick-listed workers: a register-based study (The Norwegian GP-DEP Study).

Janvier 2025

Integrated mental health care and vocational rehabilitation intervention to improve return to work rates for people on sick leave due to common mental and functional disorders (IBBIS-II) - results from a randomized clinical trial.

Referring psychiatric patients to occupational health services for earlier return to work - a qualitative implementation study of barriers and facilitators.

Décembre 2024

Obstacles, Self-Efficacy, and Strategies for Returning to Work after Experiencing Burnout: Paving the Path to Sustainable Reintegration.

Effectiveness of Occupational Therapy Mental Health Interventions in a Return-to-Work Context: A Scoping Review.

Novembre 2024

The effectiveness of a problem-solving intervention with workplace involvement on self-reported sick leave, psychological symptoms and work ability: a cluster randomised clinical trial.

Barriers and facilitators of collaboration during the implementation of vocational rehabilitation interventions: a systematic review.

Octobre 2024

Women's health and psychological well-being in the return-to-work process after long-term sick leave for common mental disorders: women's and first-line managers' perspectives.

Septembre 2024

Cooperation in Return-to-work Interventions for Common Mental Disorders: An Ideal Theory Analysis of Actors, Goals, and Ethical Obstacles.

Août 2024

The Danish Ibbis Trials for Sickness Absentees with Common Mental Disorders: A Phase 4 Prospective Study Comparing Randomized Trial and Real-World Data.

Juillet 2024

Factors Related to the Recurrence of Sickness Absence Due to Common Mental Health Disorders: A Systematic Review

Predictors of return to work in people with major depression: Results from a supported employment program in Germany

Symptoms, work situation and work functioning 10 years after rehabilitation of stress-induced exhaustion disorder

Juin 2024

Experiences of rehabilitation coordination among people on sick leave with mental health problems.

Healthcare professionals' perceptions of the contributions of rehabilitation coordinators to patients in Swedish psychiatric care: a qualitative descriptive study.

Collaboration in the return-to-work process after sick leave due to common mental disorders: a qualitative study of stakeholders' views on goals and roles.

Return to Work Trajectories of Swedish Employees on Sick-Leave Due to Common Mental Disorders.

Strategies used by Occupational Therapists to overcome return-to-work obstacles perceived by workers with common mental disorders.

Mai 2024

"I feel broken": Chronicling burnout, mental health, and the limits of individual resilience in nursing.

Effects of work-directed interventions on return-to-work in people on sick-leave for to common mental disorders - a systematic review.

Occupational Therapy and Public Safety Personnel: Return to Work Practices and Experiences.

Socioeconomic status, psychotherapy duration, and return to work from disability due to common mental disorders.

Workplace Reintegration Programs, Policies, and Procedures for Nurses Experiencing Operational Stress Injury: A Scoping Literature Review.

Avril 2024

Factors affecting patients' journey with primary healthcare services during mental health-related sick leave.

Exploring the Effects of Major Depressive Disorder on Daily Occupations and the Impact of Psychotherapy: A Literature Review.

Negotiating Safety: Facilitation of Return to Work for Individuals Employed in High-Risk Occupations.

Mars 2024

Returning-to-work after mental health-associated sick leave: a qualitative interview study exploring the experiences of general practitioners in Germany.

Février 2024

Navigating work and life- a qualitative exploration of managers' and employees' views of return-to-work after sick leave due to common mental disorders.

Ethical challenges from a problem-solving intervention with workplace involvement: a qualitative study among employees with common mental disorders, first-line managers, and rehabilitation coordinators.

Janvier 2024

Multiple psychiatric diagnoses and return-to-work following posttraumatic stress injury rehabilitation.

Décembre 2023

Examination of the knowledge gap of return-to-work outcomes in routine outpatient treatment for common mental disorders: a systematic review.

Predictors of time until return to work and duration of sickness absence in sick-listed precarious workers with common mental disorders: a secondary data-analysis of two trials and one cohort study.

Occupational Therapy and Public Safety Personnel: Return to Work Practices and Experiences.

Novembre 2023

Clinical Characteristics of Patients Seeking Treatment for Common Mental Disorders Presenting With Workplace Bullying Experiences.

Cost-effectiveness of occupational therapy return-to-work interventions for people with mental health disorders: A systematic review.

Defining work-focused cognitive behavioural therapy (W-CBT) and whether it is effective at facilitating return to work for people experiencing mental health conditions: A systematic review and narrative synthesis.