Santé mentale

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.

Octobre 2023

Purpose The incidence of sick leave due to stress-related disorders such as exhaustion disorder (ED) is high in many economically developed countries. Meanwhile, knowledge about facilitating return to work during clinical interventions for ED patients is still limited. The current study aimed to investigate if improvements in exhaustion symptoms, insomnia, perfectionistic behaviors, psychological flexibility, and perceived work ability during treatment of ED were associated with subsequent sick leave in the year following treatment. Methods Using a cohort of 880 ED patients who had participated in a multimodal intervention based on Cognitive Behavior Therapy, we estimated the association between one standard deviation (SD) improvement in treatment-related variables and the rate of net days of sick leave one-year following treatment. Results Our results showed that improvements in all treatment-related variables were associated with lower sick leave rates one year following treatment. Improvements in exhaustion symptoms (rate ratio (RR): 0.70 [95% CI 0.66; 0.75]) and self-perceived work ability (RR 0.56 [95% CI 0.50; 0.63]) showed the strongest associations to subsequent sick leave. Conclusions These findings suggest that interventions focusing on exhaustion symptoms, insomnia, perfectionistic behaviors, psychological flexibility, and perceived work ability can have a meaningful impact on ED patients' subsequent sick leave.

Septembre 2023

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.

Purpose Nurses are engaged in an unpredictable and dynamic work environment where they are exposed to events that may cause or contribute to physical and/or psychological injuries. Operational stress injury (OSI) may lead to an extended time away from work or nurses leaving the profession altogether. A deliberate focus on the workplace reintegration phase of the mental health recovery process may lead to the increased retention of nurses in their profession. Prior to the creation and implementation of potential solutions to address workplace reintegration, it is imperative to explore the experiences and perceptions of nurses affected by OSI. This qualitative study aims to investigate the experiences and perceptions of nurses (N = 7) employed within a Canadian provincial healthcare system who have attempted workplace reintegration after being off of work with an OSI. Methods Nurses were recruited via social media, unit emails, and word of mouth. Data were collected through recorded semi-structured interviews conducted over videoconferencing. Once transcribed, the data were thematically analyzed using an inductive approach. Results The resulting themes included (1) heroes to zeros, (2) changing the status quo, (3) connection is key, and (4) post-traumatic growth: advocacy and altruism. Study participants indicated both that nursing culture and a cumulation of events contributed to a need for a leave of absence from work and that a formalized process was desired by nurses to assist in returning to work. Conclusions The development, implementation, and exploration of innovative policies, procedures, and initiatives to bridge the gap from clinical interventions to workplace reintegration are needed for nurses experiencing OSI. Further research is also needed regarding mental health impacts and appropriate resources to support nurses in their workplace reintegration process after experiencing psychological and/or physical injury.

© Jones C; Juby B; Spencer S; Smith-MacDonald L; O'Greysik E; Vincent M; Mooney C; Bright KS; Sevigny PR; Burback L; Greenshaw A; Carleton RN; Savage R; Hayward J; Zhang Y; Cao B; Bremault-Phillips S. International Journal of Environmental Research & Public Health [Electronic Resource]. 20(17), 2023 08 28.

Purpose Stress-related disorders have become a major challenge for society and are associated with rising levels of sick leave. The provision of support to facilitate the return to work (RTW) for this patient group is of great importance. The aim of the present study was to evaluate whether a new systematic procedure with collaboration between general practitioners (GPs), rehabilitation coordinators (RCs) and employers could reduce sick leave days for this patient group. Method Employed patients with stress-related diagnoses seeking care at primary health care centres (PHCCs) were included in either the intervention group (n = 54), following the systematic intervention procedure, or the control group (n = 58), receiving treatment as usual (TAU). The intervention included a) a training day for participant GPs and RCs, b) a standardised procedure for GPs and RCs to follow after training, c) the opportunity to receive clinical advice from specialist physicians in the research group. Outcome measures for RTW were sick leave days. Results The median number of registered gross sick leave days was lower for the control group at six, 12 and 24 months after inclusion, but the difference was not statistically significant. The control group had significantly fewer net sick leave days at three months (p = 0.03) at six months (p = 0.00) and at 12-months follow-up (p = 0.01). At 24 months, this difference was no longer significant. Conclusions The PRIMA intervention, which applied a standardized procedure for employer involvement in the rehabilitation process for patients with stress-related disorders, actually increased time to RTW compared to TAU. However, at 24 months, the benefit of TAU could no longer be confirmed.

Major depressive disorder (MDD) and other mental health issues pose a substantial burden on the workforce. Approximately half a million Canadians will not be at work in any week because of a mental health disorder, and more than twice that number will work at a reduced level of productivity (presenteeism). Although it is important to determine whether work plays a role in a mental health condition, at initial presentation, patients should be diagnosed and treated per appropriate clinical guidelines. However, it is also important for patient care to determine the various causes or triggers including work-related factors. Clearly identifying the stressors associated with the mental health disorder can help clinicians to assess functional limitations, develop an appropriate care plan, and interact more effectively with worker's compensation and disability programs, as well as employers. There is currently no widely accepted tool to definitively identify MDD as work-related, but the presence of certain patient and work characteristics may help. This paper seeks to review the evidence specific to depression in the workplace, and provide practical tips to help clinicians to identify and treat work-related MDD, as well as navigate disability issues.

Purpose Common mental disorders (CMDs) are currently a major cause of long-term sick leave, with women being most affected. Using the Theory of Planned Behaviour (TPB), we aimed to describe the development and psychometric evaluation of a new questionnaire to measure women's beliefs about return to work (RTW) after long-term sick leave for CMDs. Methods Data were collected in central Sweden from women on long-term sick leave (2- 24 months) for CMDs. The questionnaire was developed by conducting an elicitation study with 20 women and included both direct and indirect measures. Subsequently, 282 women participated in a psychometric evaluation and 35 of them in a test-retest procedure. Psychometric properties were evaluated by determining reliability (internal consistency [Cronbach's alpha] and test-retest stability [intraclass correlation coefficient]), construct validity (exploratory factor analysis) and content validity. Results The development resulted in 60 questionnaire items. Content validity assessment showed that the women overall found it easy to complete the questionnaire. Reliability analyses showed satisfactory results for both direct and indirect measures, with a few exceptions. Factor analyses of the indirect scales showed that items were generally in line with the TPB, but that items related to life as a whole/personal life and items related to work were separated into two different factors. Conclusion The questionnaire, called the RTW Beliefs Questionnaire, showed promising results and can among women with CMDs be considered useful, especially the scales for direct measures. This questionnaire gives opportunity to identify new potential predictors for RTW.

Août 2023

Purpose Burnout is a work-related mental health problem that often causes long-term sickness absence. Return-to-work (RTW) interventions for burned-out sick-listed employees aim to prevent long-term work disability. This systematic review addresses two questions: (1) Which interventions for burned-out sick-listed employees have been studied?; (2) What is the effect of these interventions on RTW? Methods We performed a systematic literature review and searched PubMed, Cochrane Central Register of Controlled Trials, Embase, CINAHL and Web of Science from 1 January 2000 to 31 December 2022. We searched for articles of interventions for burned-out sick-listed employees. We conducted the review in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Outcome was RTW. Results We identified 2160 articles after removal of all duplicates. Eight studies met inclusion criteria. RTW outcomes were number of sick-leave days, sick-leave rates, median period of RTW and worked hours per week. Five studies described person-directed interventions, one described a workplace-directed intervention, one described a combination of both intervention types and one study described all three types of intervention. Only the workplace-directed intervention showed a significant improvement in RTW compared with the comparator group: at 18-month follow-up, 89% of the intervention group had returned to work compared with 73% of the comparator group. Conclusion Only a limited number of studies have explored interventions specifically focused on burned-out sick-listed employees and the effect on RTW. Due to heterogeneity and moderate to high risk of bias of these studies, no firm conclusions can be drawn on the described interventions and their effect on RTW.

Purpose The study objective was to design a new theoretically driven multidimensional scale for the use in the empirical measurement of stigmatizing attitudes towards persons with mental illness within the return-to-work process as this integral part of vocational reintegration has been widely neglected by scholars so far. Methods Therefore, we developed and validated a 21-item instrument to comprehensively measure the three-factorial structure of stigmatizing attitudes (affect, cognition, behavior) across two studies (overall N = 251). Results In both studies the new scale proved to be highly internally consistent, and its proposed three-factor structure was equally supported across the two studies. Convergent and discriminant validity were demonstrated by moderate and high correlations or zero correlations with pertinent measures. Furthermore, construct validity of the new scale was supported by significant positive associations with relevant personality characteristics within stigma research. Conclusion The WMISS is the first instrument to measure mental health stigma specifically within the return-to-work-process and demonstrates strong psychometric properties. Inclusion of this scale in future research can help facilitate understanding of mental illness stigma within the occupational sector and assist with targeted intervention development.

Purpose To explore how stakeholders in depression care view intersectoral collaboration and work participation for workers with depression. Methods Design: Focus group study applying reflexive thematic analysis using a salutogenic perspective. Setting and subjects: We conducted seven focus group interviews in six different regions in Norway with 39 participants (28 women); three groups consisted of general practitioners (GPs), two of psychologists and psychiatrists and two of social welfare workers and employers (of which one group also included GPs). Results Stakeholders considered work participation salutary for most workers with depression, given the right conditions (e.g. manageable work accommodations and accepting and inclusive workplaces). They also highlighted work as an integral source of meaningfulness to many workers with depression. Early collaborative efforts and encouraging sick-listed workers to stay connected to the workplace were considered important to avoid long and passive sickness absences. Furthermore, stakeholders' views illuminated why intersectoral collaboration matters in depression care; individual stakeholders have limited information about a worker's situation, but through collaboration and shared insight, especially in in-person collaborative meetings, they (and the worker) can gain a shared understanding of the situation, thereby enabling more optimal support. Ensuring adequate information flow for optimal and timely follow-up of workers was also emphasized. Conclusion Stakeholders highlighted the salutary properties of work participation for workers with depression under the right conditions. Intersectoral collaboration could support these conditions by sharing insight and knowledge, building a shared understanding of the worker's situation, assuring proper information flow, and ensuring early and timely follow-up of the worker.

Purpose Sick-listed workers with depression are at higher risk of long-term, recurrent sickness absence and work disability, suggesting reduced likelihood of sustainable return to work (SRTW). Though likelihood of RTW has been associated with education level, less is known about the association over time, post-RTW. We aimed to investigate associations between educational level and SRTW among long-term sick-listed workers with depression. Methods Nationwide cohort study, based on linked data from Norwegian health and population registries, including all inhabitants of Norway aged 20-64 years on long-term sick leave with a depression diagnosis given in general practice between 1 January 2009 and 10 April 2011 (n=13.624, 63.7% women). Exposure was the highest attained education level (five groups). Three outcome measures for SRTW were used, with 0 days, <=30 days and <=90 days of accumulated sickness absence post-RTW during a 2-year follow-up. Associations between exposure and outcomes were estimated in gender-stratified generalised linear models, adjusting for sociodemographic factors and duration of sick leave. Results Higher-educated workers had a higher likelihood of SRTW 0, SRTW <=30 and SRTW <=90 than the lowest-educated groups in the crude models. Among men, this association was mainly explained when adjusting for occupation. Among women, the highest educated group had a higher likelihood of SRTW 0 (RR=1.45, 95% CI 1.23 to 1.71) and SRTW <=30 and SRTW <=90 in the fully adjusted models. Conclusion An educational gradient in SRTW was mainly explained by occupation among men but not among women. These findings suggest gendered differences in associations between education level and SRTW, which could inform interventions aiming to promote equal opportunities for SRTW.

Juillet 2023

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.

Juin 2023

Purpose During the COVID-19 pandemic, changes in working life occurred, even in Sweden, where there was no general lockdown. The aim of this study was to examine how the COVID-19 pandemic was perceived as affecting the hindering and enabling factors among young employees with CMD to remain at or return to work, here as investigated from the perspective of young employees and managers. Methods A qualitative design was applied with semistructured interviews with 23 managers and 25 young employees (20-29 years old). The interviews were recorded and transcribed verbatim, and the parts of the interviews related to the aim of this article were analysed using conventional content analysis. Results The hindering factors were changed working conditions, decreased well-being when spending more time at home, and uncertainty. The enabling factors were decreased demands, increased balance, and well-functioning work processes. For managers it is important to be aware of warning signals indicating blurred boundaries between work and private life, to create and maintain well-functioning communication, and leave room for recovery. Conclusion The hindering and enabling factors can be described as two sides of the same coin. Changes in the working conditions during the pandemic led to difficulties for both young employees and managers when the margins of maneuver were insufficient.

Purpose To study whether early and enhanced cooperation within the primary care centres (PCC) combined with workplace cooperation via a person-centred employer dialogue meeting can reduce days on sick leave compared with usual care manager contact for patients on sick leave because of common mental disorders (CMD). Secondary aim: to study lapse of CMD symptoms, perceived Work Ability Index (WAI) and quality of life (QoL) during 12 months. Methods Design: Pragmatic cluster randomised controlled trial, randomisation at PCC level. Setting: 28 PCCs in Region Vastra Gotaland, Sweden, with care manager organisation. Participants: 30 PCCs were invited, 28 (93%) accepted invitation (14 intervention, 14 control) and recruited 341 patients newly sick-listed because of CMD (n=185 at intervention, n=156 at control PCCs). Intervention: Complex intervention consisting of (1) early cooperation among general practitioner (GP), care manager and a rehabilitation coordinator, plus (2) a person-centred dialogue meeting between patient and employer within 3 months. Control group: regular contact with care manager. Main outcome measures: 12 months net and gross number of sick leave days at group level. Secondary outcomes: 12 months depression, anxiety, stress symptoms, perceived WAI and QoL (EuroQoL-5 Dimensional, EQ-5D). Results No significant differences were found between intervention and control groups concerning days of sick leave (intervention net days of sick leave mean 102.48 (SE 13.76) vs control 96.29 (SE 12.38) p=0.73), return to work (HR 0.881, 95% CI 0.688 to 1.128), or CMD symptoms, WAI or EQ-5D after 12 months. Conclusions It is not possible to speed up CMD patients' return to work or to reduce sick leave time by early and enhanced coordination among GP, care manager and a rehabilitation coordinator, combined with early workplace contact over and above what 'usual' care manager contact during 3 months provides.

Purpose Nurses are exposed to potentially psychologically traumatic events which can lead to operational stress injuries (OSI). Workplace reintegration after an OSI can be challenging, especially with repeated exposure to potentially traumatic scenarios and workplace demands. A workplace reintegration program (RP) originally developed for police officers may be of benefit for nurses returning to work after an OSI. The purpose of this study is to investigate the perceived need for an RP for nurses, and its potential contextualization and implementation in the nursing context using an implementation science approach. Methods This mixed-methods study collected data via questionnaires and focus groups from acute care nurses in Canada (N = 19). Data analysis was conducted using descriptive statistics, thematic analysis, and an organizational readiness assessment. Results Study participants indicated that formalized processes were rarely used to support nurses returning to work after time off due to mental health challenges. Themes included (1) "The Perfect Storm": the current state of return-to-work, (2) Integral Needs, and (3) A Break in the Clouds: hope for health. Conclusions Exploration of innovative programs such as the RP may provide additional support to nurses affected by OSIs. Further research is needed regarding workplace reintegration for nurses, and contextualization and evaluation of the RP.

Purpose Sick leave due to long-term stress is increasing in Finland and other Western countries. Occupational therapists might contribute to the prevention of and/or recovery from stress-related exhaustion. Aims/objectives: To describe what is known about occupational therapy for stress-related exhaustion. Methods A five-step scoping review included papers published in six databases from 2000 to 2022. Extracted data was summarized to show the occupational therapy contribution within the literature. Results There were 29 papers meeting the inclusion criteria, of which a limited number described preventive interventions. Most articles described recovery-oriented occupational therapy with group interventions. The occupational therapists contributed with prevention measures, mostly targeting recovery in multi-professional interventions in terms of stress reduction or return-to-work. Conclusions Occupational therapy involving stress management both prevents stress and supports recovery from stress-related exhaustion. Occupational therapists internationally use craft, nature activities or gardening as stress management measures. Occupational therapy appears to be a potential treatment option for stress-related exhaustion internationally in conditions that could also work in Finland, for example in occupational healthcare.

Mai 2023

Purpose Depression and anxiety disorders are the most common cause for disability retirement among people of middle age. The following social disintegration can have an additional detrimental effect on subjects' psychological well-being, which further reduces their chances for recovery. Long-term disability could be avoidable in many cases as depression and anxiety disorders don't have an etiology that makes permanent loss of function inevitable. This prospective cohort study tests the long-term effects of an intervention addressed at these young disablement retirees. Methods Forty-one subjects each in the experimental and control group were followed-up on over a period of 24 months. Results The intervention had positive effects on psychological well-being. More subjects returned to work than controls. The effects were still present at one year follow-up. Conclusion These findings show that an individually tailored return-to-work intervention is a useful, sustainable and economically advantageous therapeutic tool to get out of disability retirement due to mental illness even after all other therapeutic tools have failed.

Purpose To demonstrate proof-of-concept for a chatbot-led digital lifestyle medicine program in aiding rehabilitation for return-to-work. Methods Design: Retrospective cohort study with pre-post measures. Setting: Community setting, Australia. Participants: 78 adult participants (mean age 46 years, 32% female) with an active workers' compensation claim. Interventions: A 6-week digital lifestyle medicine program led by an artificially intelligent virtual health coach and weekly telehealth calls with a health coach. Main outcome measures: Adherence (% program completions) and engagement (% of daily and weekly sessions completed), changes in depression, anxiety and distress (K10), psychological wellbeing (WHO-5), return-to-work confidence and anxiety and change in work status. Results Sixty participants completed the program (72%), with improvements in psychological distress (p=<.001, r=.47), depression (p <.001, r=.55), anxiety (<.001, r=.46) and wellbeing (p <.001, r=.62) were noted, as well as increased confidence about returning to work (p=<.001, r=.51) and improved work status (p=<.001). Anxiety about returning to work remained unchanged. Participants completed an average of 73% of daily virtual coach sessions and 95% of telehealth coaching sessions. Conclusions Artificial intelligence technology may be able to provide a practical, supportive and low-cost intervention to improve psychosocial outcomes among individuals on an active workers' compensation claim. Further, controlled research is needed to confirm these findings.

Purpose Work-directed interventions that include problem-solving can reduce the number of sickness absence days. The effect of combining a problem-solving intervention with involvement of the employer is currently being tested in primary care in Sweden for employees on sickness absence due to common mental disorders (PROSA trial). The current study is part of the PROSA trial and has a two-fold aim: 1) to explore the experiences of participating in a problem-solving intervention with workplace involvement aimed at reducing sickness absence in employees with common mental disorders, delivered in Swedish primary health care, and 2) to identify facilitators of and barriers to participate in the intervention. Both aims targeted rehabilitation coordinators, employees on sickness absence, and first-line managers. Methods Data were collected from semi-structured interviews with participants from the PROSA intervention group; rehabilitation coordinators (n = 8), employees (n = 13), and first-line managers (n = 8). Content analysis was used to analyse the data and the Consolidated Framework for Implementation Research was used to group the data according to four contextual domains. One theme describing the participation experiences was established for each domain. Facilitators and barriers for each domain and stakeholder group were identified. Results The stakeholders experienced the intervention as supportive in identifying problems and solutions and enabling a dialogue between them. However, the intervention was considered demanding and good relationships between the stakeholders were needed. Facilitating factors were the manual and work sheets which the coordinators were provided with, and the manager being involved early in the return-to-work process. Barriers were the number of on-site meetings, disagreements and conflicts between employees and first-line managers, and symptom severity. Conclusions Seeing the workplace as an integral part of the intervention by always conducting a three-part meeting enabled a dialogue that can be used to identify and address disagreements, to explain CMD symptoms, and how these can be handled at the workplace. We suggest allocating time towards developing good relationships, provide RCs with training in handling disagreements, and additional knowledge about factors in the employee's psychosocial work environment that can impair or promote health to increase the RCs ability to support the employee and manager.

Purpose The research on return to work for workers with common mental disorders has primarily focused on the pre‐return journey. Relapses and recurrent sick leaves are prevalent and call for research on how we can support workers stay and thrive at work after long‐term sickness absence due to common mental disorders. Methods In the present study, we used Longitudinal Interpretative Phenomenological Analysis to explore the experiences of returned workers' post‐return journey and the barriers and facilitators to staying and thriving at work. We conducted monthly semistructured interviews with seven returned workers over a period of 4 months. Results We identified three post‐return trajectories: the thrivers, the survivors and the exiteers. We identified 10 higher order themes and 13 subthemes that influenced these trajectories. At the individual level, wanting to make a valuable contribution and job crafting facilitated a sustainable return. At the group level, we identified social support as a facilitator. At the leader level, line managers making work adjustments and recognising workers as valuable were important, whereas a lack of understanding and conflicts with senior management posed as barriers. At the overarching level, the media influenced organisational values. Conclusion Our findings have important implications for how organisations can facilitate a whole systems approach to support returned workers and prevent sickness absence reoccurrence and job loss.

Purpose The workplace is a vital setting to support positive mental health. Mental health conditions in the workforce contribute to decreased work engagement and participation. There is existing literature on return-to-work (RTW) interventions for individuals with work-related mental health conditions, however, there lacks consensus on their effectiveness. Therefore, the primary aim of this systematic review was to synthesize the literature and evaluate the effectiveness of return-to-work interventions on return-to-work rates, quality of life, and psychological wellbeing for individuals with work-related mental health conditions. Methods Selected articles were organized and identified using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and the Population/Intervention/Comparison/Outcome (PICO) framework. Quality assessment of the included studies was completed using the Critical Appraisal Skills Programme randomized controlled trials checklist and the Joanna Briggs Institute quasi-experimental studies checklist. A random effects meta-analysis model was performed using DerSimonian-Laird weighting to calculate standard mean difference and risk ratios to assess the impact of RTW interventions on return-to-work rates, absenteeism, stress symptoms, depression symptoms, and quality of life. Results A total of 28 out of 26,153 articles met the inclusion criteria. Diagnoses for participants in the studies ranged from work-related stress to work-related PTSD following exposure to a psychologically traumatizing event in the workplace. No significant differences were found for the meta-analyses examining return-to-work rates, absenteeism, depression, stress, and quality of life. The most effective interventions were found to be a multi-domain intervention (67% of participants RTW full time) and a health-focused intervention (85% RTW rate). Conclusions Future research may consider establishing effective interventions to develop programs or policies supporting the RTW of employees and promote mental well-being among employees experiencing work-related mental health conditions.

Avril 2023

Purpose Public safety personnel (PSP) perform work that puts them at greater risk of psychological injury than the general public. PSP who subsequently develop posttraumatic stress disorder (PTSD) or other mental health conditions may need to take time off of work and use the workers compensation system. Very little is known about the experiences of PSP making this type of claim in Ontario to the Workplace Safety and Insurance Board (WSIB), or which healthcare professionals (HCP) PSP access as part of the treatment and return to work (RTW) process. This study captures the experiences of Ontario PSP in their RTW journeys, including with employers, WSIB, and HCPs. Methods A survey-based study was conducted, using email and social media platforms to distribute the survey to PSP across Ontario. Quantitative data were summarized using means and frequencies, and open text results were analyzed using qualitative framework analysis. Results 145 survey respondents met the inclusion criteria for the study. On a scale out of 5, PSP rated their experience with WSIB and employer support as poor on their first RTW attempt with an average rating of 2.93 and 2.46 respectively. The top three HCPs accessed by PSP were psychologists (61%), occupational therapists (OT; 60%) and general practitioners (GP; 44%). Respondents identified the cultural competence of HCPs in understanding their work demands and work culture as very important. Conclusions To improve RTW experiences for PSP who make a workers compensation claim for a psychological injury, an increase in HCP cultural competence related to PSP work is indicated, as well as improved RTW processes and workplace support.

Purpose Quality of life (QOL), sense of coherence (SOC) and occupational balance (OB) have been found to increase after rehabilitation among people living with depression and anxiety. However, these aspects have not been investigated over time in participants with different paid work situations, such as being on sick leave or not. Objective: To describe and compare the self-rated QOL, SOC and OB after participation in occupational therapy in three groups of people with depression and anxiety disorders based on their work situation during the study period: continuous sick leave, returned to work and continuous work. Methods Forty-seven women and seven men, 19–60 years old with depression and anxiety were followed over time. They completed questionnaires on QOL, SOC and OB on four occasions. Data were analyzed with non-parametric statistics. Results No statistically significant differences between the groups were identified. All groups improved in at least one of the studied areas over time: the sick leave group in OB; the return-to-work group in QOL and OB; and the Work group in QOL and SOC. Conclusions The results indicate variations in QOL SOC and OB between people with different work situations over time after occupational therapy. Studies with larger samples are, however, warranted.

Mars 2023

Purpose Knowledge about predictors of return to work (RTW) in people on sick leave with common mental disorders (CMDs) may inform the development of effective vocational rehabilitation interventions for this target group. In this study, we investigated predictors of RTW at 6 and 12 months in people on sick leave with depression, anxiety disorders or stress-related disorders. Methods We have performed a secondary analysis, utilizing data from two RCTs that evaluated the efficacy of an integrated health care and vocational rehabilitation intervention. Data were obtained from mental health assessments, questionnaires and registers. Using Cox regression analysis, the relationship between baseline variables and RTW was analysed at 6 and 12 months after randomization within the group of CMD as a whole and within the subgroups of depression, anxiety and stress-related disorders. Results Symptom burden and employment status at baseline predicted RTW in the CMD group (n = 1245) and in the three diagnostic subgroups at both time points. RTW self-efficacy predicted RTW in the depression group but not in the anxiety or stress subgroups. Conclusion Many predictors of RTW were similar over time and, to some extent, across the CMD subgroups. Findings highlight the need not only to take health-related and psychological factors into account when developing vocational rehabilitation interventions but also to consider workplace strategies and options for support.

Purpose To (1) examine the time to first full return-to-work (RTW), and (2) investigate whether psychosocial work factors and work-home interference are associated with time to first full RTW after sick leave due to common mental disorders (CMDs). Methods The cohort study comprised 162 employees on sick leave due to CMDs participating in a two-armed cluster-randomised controlled trial in Sweden. Baseline data consisted of a web-based questionnaire and follow-up data of repeated text messages every fourth week for 12 months. The time to first full RTW was estimated using the Kaplan-Meier Estimator. Parametric Weibull survival models with interval-censored outcomes were used to determine associations between psychosocial work factors and work-home interference with time to first full RTW. In a post hoc analysis, time-interval differences in associations for 0- <= 6- versus > 6-12 months were tested. Results During the 12-month follow-up, n = 131 (80.9%) reported a first full RTW. The median time to this RTW was 16 weeks (95% CI 12; 20). High psychological job demands, high emotional job demands, high work-to-home interference (WHI), and low social job support were independently associated with a longer time to first full RTW. Time-interval differences were found for job control and emotional job demands. Conclusions Psychosocial work demands and WHI are associated with a longer time to RTW after sick leave due to CMDs. Work organisations and rehabilitation practices should include accommodations for high psychological and emotional job demands during RTW, as well as pay attention to the risk of spill-over of high job demands into employees' private lives.

Février 2023

Purpose Victims of workplace bullying represent a group characterised by severe negative health complaints at risk of losing their foothold in working life. To date, very few studies have investigated the effect of psychological treatment of the health-related problems often facing victims of bullying. The aim was to investigate if victims of workplace bullying suffering from common mental disorders (CMD) benefit from clinical treatment for their mental health problems at an outpatient clinic treating patients using Metacognitive or Cognitive Behavioural Therapy with work-focus. Criteria were symptom reduction and change in workplace participation. Comparisons were made between the victims of workplace bullying with CMD, a wait-list control group consisting of patients who had also been exposed to bullying yet now awaiting treatment, and other patients not exposed to bullying. Methods The sample comprised of 405 patients from an outpatient clinic in Norway. The study used a naturalistic observational design and data was collected pre-treatment and post-treatment. Results The results showed the treatment to be effective in symptom reduction for victims of bullying to a similar degree as patients otherwise not exposed to bullying. Even more, victims receiving treatment had a larger improvement compared to the wait-list control group (p < 0.001). Yet, among patients on sick leave pre-treatment, fewer victims of bullying were fully working by the end of treatment compared to the patients not exposed to workplace bullying. Conclusion The findings provide ground for optimism for this treatment as an efficient way of dealing with the aftermath of workplace bullying.

Purpose People with depression and anxiety disorder may experience occupational performance issues (OPIs). Further knowledge about these issues longitudinally and about potential differences between people is valuable. Aim: To explore experienced OPIs longitudinally in a sample living with depression and/or anxiety disorder participating in occupational therapy and varying in terms of their work situation. Methods The Canadian occupational performance measure (COPM) was completed by 54 participants with depression and/or anxiety at four measure-points from baseline to one-year after participation in occupational therapy. The participants constituted three groups: continuously on sick leave (SL), returned to work within a year and continuing working. Descriptive and non-parametric analysis was used. Results Participants in all groups identified OPIs in all occupational areas in the COPM. All groups increased their occupational performance and satisfaction with their occupational performance in the area socialisation. Each group also made improvements in relation to other occupational areas, varying between the groups. Conclusions OPIs and improvements were identified among the participants regardless of them being on SL, returning to work or working. The diverse nature of OPIs and improvements in the clients indicate the relevance of occupational therapy.

Purpose Common mental disorders (CMDs) are currently a major cause of long-term sick leave, with women being most affected. Using the Theory of Planned Behaviour (TPB), we aimed to describe the development and psychometric evaluation of a new questionnaire to measure women's beliefs about return to work (RTW) after long-term sick leave for CMDs. Methods Data were collected in central Sweden from women on long-term sick leave (2- 24 months) for CMDs. The questionnaire was developed by conducting an elicitation study with 20 women and included both direct and indirect measures. Subsequently, 282 women participated in a psychometric evaluation and 35 of them in a test-retest procedure. Psychometric properties were evaluated by determining reliability (internal consistency [Cronbach's alpha] and test-retest stability [intraclass correlation coefficient]), construct validity (exploratory factor analysis) and content validity. Results The development resulted in 60 questionnaire items. Content validity assessment showed that the women overall found it easy to complete the questionnaire. Reliability analyses showed satisfactory results for both direct and indirect measures, with a few exceptions. Factor analyses of the indirect scales showed that items were generally in line with the TPB, but that items related to life as a whole/personal life and items related to work were separated into two different factors. Conclusion The questionnaire, called the RTW Beliefs Questionnaire, showed promising results and can among women with CMDs be considered useful, especially the scales for direct measures. This questionnaire gives opportunity to identify new potential predictors for RTW.

Purpose Integration of vocational rehabilitation and mental healthcare has shown some effect on work participation at 1-year follow-up after sick leave with depression and anxiety. Methods We aimed to study the effect on work and health outcomes at 2-year follow-up, why we performed a randomized trial was conducted to study the effectiveness of integrated intervention (INT) compared to service as usual (SAU) and best practice mental healthcare (MHC). Results We included 631 participants, and at 24-month follow-up, we detected no differences in effect between INT and SAU. Compared to MHC, INT showed faster return-to-work (RTW) rates (p = 0.044) and a higher number of weeks in work (p = 0.024). No symptom differences were observed between the groups at 24 months. Conclusion In conclusion, compared to SAU, INT was associated with a slightly higher work rate reaching borderline statistical significance at 12-month follow-up and lower stress levels at 6-month follow-up. The disappearance of relative effect between 12 and 24 months may be explained by the fact that the intervention lasted less than 12 months or by delayed spontaneous remission in the SAU group after 12 months. Despite the lack of effect at long-term follow-up, INT still performed slightly better than SAU overall. Moderate implementation difficulties, may partly explain the absence of the hypothesized effect. Integrated intervention, as implemented in this trial, showed some positive effects on mid-term vocational status and short-term stress symptom levels. However, these effects were not sustained beyond the duration of the intervention.

Purpose This study examines the feasibility and acceptability of an AI-led digital mental health intervention in a Workers' Compensation (WC) program, Wysa for Return to Work. Methods Self-reported demographic data and responses to psychosocial screening questions were analyzed alongside participants' app usage through which four key outcomes were measured: recruitment rate, onboarding rate, retention, and engagement. Results The data demonstrated a high need for psychosocial interventions among injured workers, especially women, young adults, and those with high severity injuries. Those with more psychosocial risk factors had a higher rate of onboarding, retention, and engagement, and those with severe injuries had higher retention. Conclusions Our study concluded that Wysa for Return to Work, the AI-led digital mental health intervention that delivers a recovery program using a digital conversational agent, is feasible and acceptable for a return-to-work population.

Janvier 2023

Purpose Service users and other stakeholders have had few opportunities to influence the design of their mental health and return-to-work services. Likewise, digital solutions often fail to align with stakeholders' needs and preferences, negatively impacting their utility. mWorks is a co-design initiative to create a digital return-to-work solution for persons with common mental disorders that is acceptable and engaging for those receiving and delivering the intervention. This study aimed to describe stakeholder perceptions and the involvement of a design process during the prototype development of mWorks. Methods A co-design approach was used during the iterative development of mWorks. Overall, 86 stakeholders were recruited using a combination of purposeful and convenience sampling. Five stakeholder groups represented service users with experience of sick leave and common mental disorders (n=25), return-to-work professionals (n=19), employers (n=1), digital design and system developers (n=4), and members of the public (n=37). Multiple data sources were gathered using 7 iterations, from March 2018 to November 2020. The rich material was organized and analyzed using content analysis to generate themes and categories that represented this study's findings. Results The themes revealed the importance of mWorks in empowering service users with a personal digital support solution that engages them back in work. The categories highlighted that mWorks needs to be a self-management tool that enables service users to self-manage as a supplement to traditional return-to-work services. It was also important that content features helped to reshape a positive self-narrative, with a focus on service users' strengths and resources to break the downward spiral of ill health during sick leave. Additional crucial features included helping service users mobilize their own strategies to cope with thoughts and feelings and formulate goals and a plan for their work return. Once testing of the alpha and beta prototypes began, user engagement became the main focus for greater usability. It is critical to facilitate the comprehension and purpose of mWorks, offer clear guidance, and enhance motivational and goal-setting strategies. Conclusions Stakeholders' experience-based knowledge asserted that mWorks needs to empower service users by providing them with a personal support tool. To enhance return-to-work prospects, users must be engaged in a meaningful manner while focusing on their strengths and resources.

Purpose Health affects work absenteeism and productivity of workers, making it a relevant marker of an individual's professional development. The aims of this article were to investigate whether changes in the main cause of the sick leaves and the presence of mental health illnesses are associated with return to work with readaptation. Methods A historical cohort study was carried out with non-work-related illnesses suffered by statutory workers of university campuses in a medium-sized city in the state of Sao Paulo, Brazil. Two exposures were measured: (a) changes, throughout medical examinations, in the International Classification of Diseases (ICD-10) chapter regarding the main condition for the sick leave; and (b) having at least one episode of sick leave due to mental illness, with or without change in the ICD-10 chapter over the follow-up period. The outcome was defined as return to work with adapted conditions. The causal model was established a priori and tested using a multiple logistic regression (MLR) model considering the effects of several confounding factors, and then compared with the same estimators obtained using Targeted Machine Learning. Results Among workers in adapted conditions, 64% were health professionals, 34% had had changes in the ICD-10 chapter throughout the series of sick leaves, and 62% had diagnoses of mental health issues. In addition, they worked for less time at the university and were absent for longer periods. Having had a change in the illness condition reduced the chance of returning to work in another function by more than 30%, whereas having had at least one absence because of a cause related to mental and behavioral disorders more than doubled the chance of not returning to work in the same activity as before. Conclusion These results were independent of the analysis technique used, which allows concluding that there were no advantages in the use of targeted maximum likelihood estimation (TMLE), given its difficulties in access, use, and assumptions.

Purpose Sustainable return to work remains challenging for workers returning after long-term sick leave due to common mental disorders (CMDs): stress, anxiety and depression. Line managers play a significant role in supporting returned workers. Therefore, the purpose of this qualitative study was to examine the supportive behaviors of line managers in supporting returned workers. Methods The authors conducted a longitudinal study with up to three semi-structured interviews with 20 line managers with experience managing returned workers. In these interviews, the authors asked questions about the supportive behaviors line managers enacted to support workers and the role of the context. The authors conducted reflexive thematic analysis. Results The analyses revealed five key strategies, including managing workload, flexible working time arrangements, location of work, mental health check-ups and long-term support. The interviewed line managers reported their own lived experiences and that being aware of the limitations of their role, together with training and support from senior management and human resources (HR), enabled them to provide appropriate support. Conclusions Practical implications: The five strategies and the barriers and facilitators to implementing these may enable HR to develop policies and procedures to support line managers, including training of line managers. Originality/value: This is the first study in the UK on line managers' behaviors to support workers who have returned to work after a period of long-term sickness absence due to CMDs. The identification of such behaviors is paramount to developing organizational policies and practices. The question, however, remains whether employees see these behaviors as effective.

Décembre 2022

Purpose Sick leave caused by common mental health disorders (CMD) is becoming more prevalent. For most people, work is essential for good mental and physical health. It is necessary to provide treatments that facilitate return to work (RTW) and a reduction of symptoms. A qualitative study can contribute to an understanding of what makes an intervention successful. The aim of this study was to investigate how individuals who are on sick leave because of CMD perceive and handle their symptoms and their work, after completing metacognitive therapy and work-focused interventions. Methods Semi-structured interviews were conducted with 23 participants after they had completed therapy. Thematic analysis was used to analyse the data. Results Through both therapy and the process of RTW, the participants had gained increased awareness and understanding of their mental health problems and the relationship between those problems and work. Together with the sense that they were in charge of their own process of RTW, this helped to improve their self-confidence. An important part of the process was the change to new strategies and the rejection of older maladaptive ones, in relation to both mental health and work. Being open about their mental illness in the workplace could lead to support but also to the opposite, and therefore not an option for everyone. After treatment, most had returned to work and gained a more positive outlook on the future, but some had less confidence in their ability to deal with future symptoms and workplace issues. Conclusions Achieving improved self-confidence and adopting new strategies, which enabled them to change how they related to their mental problems and how they addressed their problems at work, seemed to have increased their self-efficacy. Active involvement in therapy and at work was also important, both for the process and as a way of increasing self-efficacy. This gave them renewed belief in themselves and in their ability to handle their work at present and in the future. Despite this being a manualized treatment, the participants' experience was that it was adapted to each individual, something they regarded as important.

Purpose Considering worker's perspective, the purpose of this study was twofold: (1) to document the meaning of the experience of recognition in the return to work (RTW) process of work after a sick leave due to a common mental disorder (CMD) and (2) to investigate the phenomenon of recognition for workers in the process of RTW after a sick leave due to a CMD, by evaluating the presence or absence of marks of recognition from salient RTW stakeholders stemming from different systems. Methods The Relational Caring Inquiry phenomenological method was used to explore the meaning of recognition during the return-to-work process and marks of recognition in a group of 20 workers who returned to their employment after a sick leave due to a CMD. In depth individual interviews were conducted with each participant. Results The definition of recognition that emerged from workers experiencing the RTW process is related to the behaviours and attitudes of various stakeholders, stemming from the work, health, insurance and social systems that allow them to feel appreciated, valued and respected, throughout the RTW process. Recognition was most often described as showing support, trust, respect for recovery and pace, and providing positive feedback. Conclusion The findings from this study could serve as guidelines in organizations regarding the RTW process, and in particular clarifying the roles and actions that different stakeholders could take in the workplace to stimulate expressions of meaningful recognition.

Purpose To discuss the impact of depression on work and how depression-related sick leave duration could be a potential indicator and outcome for measuring functionality in depression. Methods Our review was based on a literature search and expert opinion that emerged during a virtual meeting of European psychiatrists that was convened to discuss this topic. Results Current evidence demonstrates that depression-related sick leave duration is influenced by multiple disease-, patient- and work-related factors, together with societal attitudes towards depression and socioeconomic conditions. A wide variety of pharmacological and non-pharmacological treatments and work-based interventions are effective in reducing depression-related sick leave duration and/or facilitating return to work. Recent real-world evidence showed that patients treated with antidepressant monotherapy appear to recover their working life faster than those receiving combination therapy. Although depression-related sick leave duration was found to correlate with severity of depressive symptoms, it cannot be used alone as a viable marker for disease severity. Conclusions Given its multifactorial nature, depression-related sick leave duration is not on its own a viable outcome measure of depression severity but could be used as a secondary outcome alongside more formal severity measures and may also represent a useful measure of functionality in depression.

© Volz HP; Bartecku E; Bartova L; Bessa J; De Berardis D; Dragasek J; Kozhuharov H; Ladea M; Lazary J; Roca M; Usov G; Wichniak A; Godman B; Kasper S. International Journal of Psychiatry in Clinical Practice. 26(4):406-416, 2022 Nov.

Purpose We attempted to score data extracted from written medical records containing assessment results using natural language processing, and to clarify the relationship between duration of sick leave and the use of emotional words among return-to-work (RTW) program users on sick leave due to mental health problems. Method Participants were users of an RTW program. We extracted textual data from their electronic medical records, and gave all words a score based on the following two considerations: positivity score (the degree of positive emotion a word has) and emotion score with respect to seven emotions (sadness, anxiety, anger, disgust, trust, surprise, and joy), with the score for each emotion measured for each word. We analyzed relationships between duration of sick leave and each score. Results Forty-two users participated. The results showed that high positive scores (β = −0.42, p < 0.00) and high sadness scores (β = −0.60, p < 0.00) were related to a shorter duration of sick leave, and high anger score (β = 0.52, p < 0.00) was related to a longer duration of sick leave. Conclusion Professional assessments based on occupational therapy and natural language processing of medical records may predict the appropriate timing of RTW.

Novembre 2022

Purpose Common mental disorders (CMDs) are a major cause of sick leave. Return-to-work (RTW) interventions providing mechanisms that support the participation and collaboration of the different stakeholders appear promising in these circumstances. The Therapeutic Return-to-Work (TRW) Program offers such mechanisms designed to enable affected workers to fully reintegrate into their jobs on a sustainable basis. This study evaluated the feasibility of implementing this program for workers with CMDs, within a specialized mental health hospital. Methods The study was conducted using a multiple case design and three main data sources: (1) the worker's medical file, (2) the log completed by the clinicians, and (3) individual interviews with stakeholders. Data were analyzed using a qualitative approach. Results Twelve workers between 32 and 60 years old, mostly women with complex mental health profiles working in large enterprises, participated in this study. Three main observations were made regarding the TRW Program implementation: (1) eight cases were characterized by complete or virtually complete implementation; (2) no explanatory factor could be identified for the different implementation levels; (3) eight cases achieved RTW success (RTW to the original job or another job), which appears partially attributable to the high level of program implementation. Conclusions The TRW Program seems highly promising for supporting the return to work of workers with CMDs. However, studies identifying the factors likely to influence the implementation process in different health service contexts and specifying the scope and nature of the program's actual impact on RTW outcomes should be conducted before larger-scale implementation takes place.

Purpose This study aimed to investigate the relationships between demographic covariates, vocational rehabilitation (VR) services, and employment outcomes of individuals with anxiety disorders. The specific research question for the current study investigate demographic variables and vocational rehabilitation services as predictors of competitive employment outcomes. Methods Data for the present study were extracted from the most recent United States Rehabilitation Service Administration 2018 Case Service Report (RSA-911) data. A purposeful selection, multivariate logistic regression analysis was conducted to examine the case service report data of 9266 individuals with anxiety disorders who received vocational rehabilitation services based on their demographic variables and receipt of VR services. Results The results indicated that African Americans and Latinx, people who have completed high school or more, people who do not receive disability-related benefits, and those who received more vocational rehabilitation services were more likely to be gainfully employed. In addition, receipt of financial support for life crises and occupational credentials (i.e., other services and maintenance services) and vocational rehabilitation counseling and guidance services were significant predictors of employment outcomes. Conversely, receipt of supported employment and transition services were negatively associated with employment outcome. Conclusions In the present study, we identified VR services that can improve and risk factors that can impede employment outcomes of people with anxiety disorders. We also identified medical, psychosocial, and vocational interventions that can lessen the effect of anxiety disorders on physical and mental health functioning.

Purpose Burnout literature has primarily studied determinants and rehabilitation. Remarkably, ways to enable qualitative return to work after burnout are considered considerably less and were studied here. Specifically, building on the Job Demands-Resources model and Effort-Recovery model, this study investigated determinants of the quality of return to work. Methods Hierarchical regression analyses were conducted to evaluate the quality of reintegration among 786 workers who were surveyed about their return to work after a burnout episode. Results Restarting work at a new employer and especially getting supervisor support appeared beneficial, whereas remaining burnout symptoms, stressors in one's private environment and – mostly – neuroticism hampered the quality of return to work. Given the high prevalence and important costs burnout entails, primary prevention alone proves insufficient. Conclusions Current study findings inform on how to optimize the quality of reintegration in the workplace after a burnout episode, demonstrating that supportive managers and inclusive workplaces (i.e., open to hire applicants with a burnout history) are important levers for qualitative return to work, next to ensuring workers are not (so much) impaired by their burnout rest symptoms. Reintegration trajectories after burnout should not only be evaluated by sick leave duration but also by the clients' subjective experience of quality of return to work. Rehabilitation professionals should ensure clients prepare return to work early so they return timely and are not (so much) impaired by their burnout rest symptoms. Rehabilitation professionals should propose reorientation towards a new employer in case of irreversible work ability problems at the current workplace. The clients' current work situation should allow for sufficient supervisor social support. Also stressors in private life (like divorce) and personality characteristics (like neuroticism) should be considered as they may hamper quality of return to work.

Purpose Supervisors play an important role in supporting employees to return to work following sickness absence due to common mental disorders; stress, anxiety and depression, however, employees may not always feel supported. We examined employees’ perceptions of their supervisors’ attitudes and behaviours pre, during and following sickness absence due to common mental disorders, placing a particular focus on post-return. Methods In a qualitative study, using purposeful sampling, we recruited and interviewed 39 returned employees up to four times. Results We identified three types of supervisor behaviours: the compassionate, the indifferent and the demeaning. Compassionate supervisors possessed empathy and communication skills, worked collaboratively to identify appropriate work adjustments and provided ongoing support and adjustment. Indifferent supervisors lacked the skills and motivation to support returning employees. They did what was required according to organisational policies. Demeaning supervisors lacked understanding and displayed stigmatising behaviour. Conclusion The results extend our understanding of how supervisors may support returned employees in two ways: First, our results identified three distinct sets of supervisor behaviours. Second, the results indicate that it is important to understand return to work as lasting years where employees are best supported by supervisors making adjustments that fit the needs of returned employees on an ongoing basis.

Purpose Major depression is one of the leading causes of disability and limited capacity to work. Neuropsychological impairment is a common symptom in acute and remitted major depression and is associated with poor psychosocial functioning. This scoping review aimed to identify research on the role of neuropsychological functioning in outcomes of vocational rehabilitation programs in individuals with depression. Methods We report on the conduct of this pre-registered (https://osf.io/5yrnf) scoping review in accordance with PRISMA-ScR guidelines. PubMed and PsychInfo were systematically searched for English or German research articles published between 1990 and September 2021 that studied objective neuropsychological tests as predictors of vocational rehabilitation interventions and included participants with depression. Results The systematic literature search yielded no studies that specifically targeted subjects with major depression. However, eight articles published since 2016 were included in the review, analyzing data from five trials that evaluated the effectiveness of supported employment in North America and Europe in severe mental illnesses. An estimated 31% of the total number of participants included ( n = 3,533) had major depression. Using a variety of cognitive tests and covariates, seven articles found that neuropsychological functioning - especially global cognition scores, verbal and visual learning and memory - significantly predicted vocational outcomes of rehabilitation programs. Conclusion Despite a lack of studies specifically targeting major depressive disorder, the identified literature suggests that higher baseline neuropsychological functioning predicts better vocational outcomes of supported employment programs in individuals with depression. In clinical practice, additional neuropsychological modules during return-to-work interventions might be helpful for vocational outcomes of such programs.

Octobre 2022

Purpose Return to work (RTW) may be a lengthy and complex process for individuals with major depressive disorder (MDD) especially when not well managed. This increases the risk of isolation and loss of routine which negatively influences their mental health. However, for clients with MDD, a comprehensive overview of all the factors that influence RTW based on a model of occupation, is lacking. Objective: To develop a conceptual framework to guide an occupation-based process of RTW for clients with MDD, treated in the private sector in South Africa. Methods This paper describes the development of a conceptual framework using literature and thematic synthesis of a qualitative descriptive study based on interviews with eight participants diagnosed with MDD which were linked to constructs of Kielhofner's Model of Human Occupation (MOHO). Results Qualitative data from key informant interviews were deductively analysed according to the subsystems of MOHO for waiting to RTW and experience of RTW. The conceptual framework developed included the constructs of Person and Occupational Setting from MOHO as well as the components of Occupational Identity and Competence central to intervention to achieve successful RTW. Conclusion A successful RTW process for clients with MDD is dependent on the person and the occupational setting. The role of the occupational therapist in the RTW can be facilitated by the occupation-based conceptual framework developed on MOHO.

Purpose The objective was to (i) assess the long-term cost-effectiveness of acceptance and commitment therapy (ACT), a workplace dialog intervention (WDI), and ACT+WDI compared to treatment as usual (TAU) for common mental disorders and (ii) investigate any differences in cost-effectiveness between diagnostic groups. Methods An economic evaluation from the healthcare and limited welfare perspectives was conducted alongside a randomized clinical trial with a two-year follow-up period. Persons with common mental disorders receiving sickness benefits were invited to the trial. We used registry data for cost analysis alongside participant data collected during the trial and the reduction in sickness absence days as treatment effect. A total of 264 participants with a diagnosis of depression, anxiety, or stress-induced exhaustion disorder participated in a two-year follow-up of a four-arm trial: ACT (N=74), WDI (N=60), ACT+WDI (N=70), and TAU (N=60). Results For all patients in general, there were no statistically significant differences between interventions in terms of costs or effect. The subgroup analyses suggested that from a healthcare perspective, ACT was a cost-effective option for depression or anxiety disorders and ACT+WDI for stress-induced exhaustion disorder. With a two-year time horizon, the probability of WDI to be cost-saving in terms of sickness benefits costs was 80% compared with TAU. Conclusions ACT had a high probability of cost-effectiveness from a healthcare perspective for employees on sick leave due to depression or anxiety disorders. For participants with stress-induced exhaustion disorder, adding WDI to ACT seems to reduce healthcare costs, while WDI as a stand-alone intervention seems to reduce welfare costs.

Purpose To investigate if attitudes to depression were associated with the public's opinion of depression as a valid reason of SA. Methods The study population (n = 2413) originated from a web-based panel of citizens. The survey included a short vignette describing a person with symptoms of depression and the person's work tasks, followed by a question on recommendation of SA. Negative attitudes were measured by the Depression Stigma Scale. Logistic regressions were used to estimate the odds ratios (OR) for the likelihood of not recommending SA, controlling for individual and work-related co-variates. Results The crude association between negative attitudes and not recommending SA was OR 2.15 (95% CI, 1.76-2.62). In the fully adjusted model the OR was 1.76 (95% CI, 1.40 -2.21) for not recommending SA. Conclusions Participants with negative attitudes to depression were more likely to not consider depression as a valid reason of sickness absence. The study supports theories on layered stigma; attitudes from one arena are related to other arenas. Future studies are needed to confirm our findings.

Purpose The number of sick days taken from work due to depression is steadily rising. A successful return to work (RTW) is essential for sustainable reintegration. This study aims to identify factors to optimize RTW and to investigate approaches for sustainable RTW (sRTW) after depressive episodes. Methods Semi-structured expert interviews with senior occupational physicians (OPs, N = 5) served to develop two surveys among OPs (N = 180) and employees after depressive episode (N = 192). Predictors of RTW rating, workplace-based RTW interventions and sRTW interventions were analyzed using multiple hierarchical regression, chi-square difference and t-tests. Results For OPs, employee training on mental illness prevention was found to be the strongest predictor of overall RTW rating, whereas understanding and appreciation in conversations and stigmatization were strongest predictors of overall RTW rating by the employees. Compared to the employees, OPs reported significantly more availability of workplace-based interventions. To prevent relapse, the employees prioritized sufficient time and financial security during the RTW process more than OPs. Conclusions The study identified facilitating and hindering factors that can inform further research and practice to improve RTW after depressive episodes. To redress the awareness gap about the availability of workplace-based interventions, regular contact between OPs and employees is crucial. Several factors were considered to be of varying importance for relapse prevention by the two groups. Multiple perceptions and needs ought to be taken into account during RTW.

Purpose Mood and adjustment disorders are two major causes of long-term sick leave among employees, leading to large social losses. Therefore, a return to work (RTW) intervention was attempted, targeting patients with mood and adjustment disorders. This study aimed to investigate the outcome of an interdisciplinary RTW intervention including occupational therapy implemented within the Japanese healthcare framework. Methods An interdisciplinary RTW intervention including occupational therapy was conducted five times a week for approximately three months, targeting individuals with mood and adjustment disorders who took a leave of absence. Their mental symptoms, cognitive functioning, job performance, temperament, social adaptation, psychosocial state, and readiness to RTW before and after the intervention were evaluated. Full-time RTW ratios at 3, 6, 12, 18, and 24 months from baseline were followed up and compared with those of prior studies. Results A total of 30 individuals completed the intervention. After the intervention, participants' psychological symptoms, cognitive function, vocational aptitude, temperament, social adaptation, psychosocial state, and readiness to RTW improved (p<=0.001-0.0279). The ratios of RTW at 3, 6, 12, 18, and 24 months from the baseline were 6.7%, 46.7% , 73.3% , 77.8% , and 82.6% , respectively, reflecting a higher pattern than prior reports. Conclusions The interdisciplinary RTW intervention including occupational therapy has the potential to improve not only depressive symptoms but also cognitive functioning, job performance, social adaptation, and readiness to RTW. They can also raise RTW ratios.

Septembre 2022

Purpose Victims of workplace bullying represent a group characterised by severe negative health complaints at risk of losing their foothold in working life. To date, very few studies have investigated the effect of psychological treatment of the health-related problems often facing victims of bullying.The aim was to investigate if victims of workplace bullying suffering from common mental disorders (CMD) benefit from clinical treatment for their mental help problems at an outpatient clinic treating patients using Metacognitive or Cognitive Behavioural Therapy with work-focus. Methods Criteria were symptom reduction and change in workplace participation. Comparisons were made between the victims of workplace bullying with CMD, a wait-list control group consisting of patients who had also been exposed to bullying yet now awaiting treatment, and other patients not exposed to bullying.The sample comprised of 405 patients from an outpatient clinic in Norway. The study used a naturalistic observational design and data was collected pre-treatment and post-treatment. Results The results showed the treatment to be effective in symptom reduction for victims of bullying to a similar degree as patients otherwise not exposed to bullying. Even more, victims receiving treatment had a larger improvement compared to the wait-list control group (p < 0.001). Conclusion Yet, among patients on sick leave pre-treatment, fewer victims of bullying were fully working by the end of treatment compared to the patients not exposed to workplace bullying.The findings provide ground for optimism for this treatment as an efficient way of dealing with the aftermath of workplace bullying.

Purpose Mental health professionals are becoming increasingly involved in the process of employment rehabilitation of persons with psychiatric disabilities. However, few studies address the attitudes of these professionals toward the employability of those with mental illness. The aim of this research was to identify differences in the attitudes of medical and non‐medical mental health professionals, as well as to detect any association between attitude scores and the type of professional. Methods A sample of 140 employees from public and third sector mental health organizations answered a questionnaire using a scale measuring their attitudes and views on the employability of people with psychiatric disabilities. The psychometric characteristics of the scale are provided together with the variations detected in the professionals’ attitudes. Results This research shows that significant differences in the attitudes between medical and non‐medical mental health employees exist and that there is a need for the implementation of educational programs that may help to improve the attitudes of medical professionals toward the employability of people with mental illness. Conclusion This research indicates the importance of improving the professionals’ attitudes to support people attempting to return to work.

Juillet 2022

Purpose Common mental disorders in combination with work-related stress are widespread in the western world, not least in Sweden. Various interactive factors, primarily work-related, have impact on the return to work process, for example; a supportive communicative function between the person on sick leave and the employer may facilitate this process. The aim was to investigate experiences of being part of a collaborative care model including a person-centered dialogue meeting with the employer and with a rehabilitation coordinator as the moderator. Methods A qualitative design based on individual interviews with 13 persons diagnosed with common mental disorders who participated in an extensive collaborative care model, called the Co-Work-Care model. Persons were recruited as a heterogeneous sample with respect to age, gender, work background, and time since the intervention. All interviews were analyzed with Systematic Text Condensation. Results Five codes synthesized the results: 1) A feeling of being taken care of, 2) Collaboration within the team was perceived as supportive, 3) An active and sensitive listener, 4) Structure and planning in the dialogue meeting, 5) The person-centered dialogue meeting was supportive and provided increased understanding. Conclusions Participants experienced the close collaborative contact with the care manager and the rehabilitation coordinator as highly valuable for their rehabilitation process. Participants valued a well-structured dialogue meeting that included initial planning and a thorough communication involving the patient, the employer, and coordinator. Further, participants appreciated having an active role during the meeting, also empowering the return to work process.

Purpose Common mental disorders are associated with long‐term sick leave, especially among women. There is a lack of theory‐based research regarding the impact of personal factors on return to work and psychological well‐being. Therefore, the aim of this study was to examine whether return‐to‐work beliefs and perceived health were predictors of return to work and psychological well‐being among women during or after long‐term sick leave for common mental disorders, based on the Theory of Planned Behaviour. Methods This was a prospective cohort study with a 1‐year follow‐up. At baseline, women (n = 282) had been on full‐ or part‐time sick leave for common mental disorders for 2–24 months. Data were collected in October 2019–January 2020 and October 2020–January 2021 in Sweden. The Social Insurance Agency identified the women at baseline. The Return‐To‐Work Beliefs Questionnaire, EuroQol Visual Analogue Scale and General Health Questionnaire‐12 were used. Multiple logistic and linear regression analyses were conducted. The women were divided into two groups: full‐time sick leave or part‐time sick leave at baseline. Results The results showed that stronger return‐to‐work intention significantly predicted return to work among women on full‐time sick leave at baseline. No significant predictors of return to work were found among women on part‐time sick leave at baseline. Psychological well‐being was predicted by stronger social pressure to return to work (full‐time group) and a more positive attitude toward returning to work and better perceived health (part‐time group). Conclusion We concluded that the Theory of Planned Behaviour can be useful for understanding return to work among women on full‐time sick leave, and what underlies psychological well‐being in both groups. However, return to work and psychological well‐being were predicted by different factors, indicating that a multifactorial approach should be used in supporting women to return to work after long‐term sick leave for common mental disorders.

Juin 2022

Purpose Depression highly impairs function and reduces quality of life. Therefore, both symptomatic and functional recovery are important treatment goals. Depression consists of several cognitive, somatic, and affective symptom factors that differently affect function. However, it is unclear whether changes in these domains predict return to work (RTW) after treatment. Methods Data were collected during treatment from patients on full or partial sick leave reporting depression symptoms (N = 300) at an out-patient clinic. Information on work status was assessed pre- and post-treatment and at 6 months follow-up. Multiple logistic regression was used to investigate if residualized changes in symptom factors predicted full RTW, controlling for gender, education level, and age. Results Changes (as symptom improvement) in the cognitive, somatic, and affective factor scores each significantly predicted full RTW post-treatment and at follow-up for patients on full and partial sick leave, even after controlling for gender, education level, and age. The change in the somatic factor explained the largest proportion of variance for full work post-treatment in patients on full sick-leave, while change in the cognitive factor explained most unique variance for patients on graded sick leave. Discussion The sample consisted of a majority of women with a relatively high level of education. This study should be replicated in more heterogeneous samples. Conclusion Changes in depression symptom domains are significant predictors for RTW work post-treatment. The change in the somatic factor explained the largest proportion of variance in patients on full sick leave and thus may particularly influence RTW after treatment.

Purpose The objective of this scoping review was to provide an overview of existing health questionnaires utilised by health care providers and affiliated researchers. It reviewed their effectiveness and suitability to detect mental distress endured by injured workers engaged in the return to work process. Methods A scoping review methodology was conducted using the Arksey and O'Malley framework which examined peer-reviewed articles published between 2000 and March 2020 comprising health questionnaires. Database searches included Medline, CINAHL, EMBASE and PsycINFO combining specific MeSH terms and key words. Results The full search identified 3168 articles. Following full screening a total of 164 articles reviewed the use of health questionnaires and specific criteria to determine their suitability. Most of the health questionnaires reviewed were used as screening measures for identifying both work and non-work-related psychological hazards. However, they were found to be limited in their application when considering all potential predictors of delayed return to work such as poor or stressful interactions with stakeholders, financial stress and the injured workers experience of the RTW process. Conclusion Earlier identification of mental distress using an optimal MHSQ followed by appropriate intervention will reduce the risk of psychological injury becoming cumulative on a physical workplace injury. Without such complications, early return to work can be achieved with significant cost saving to the economy.

Purpose To assess the feasibility and acceptability of conducting a trial of the clinical effectiveness and cost-effectiveness of a new case-management intervention to facilitate the return to work of health care workers, on sick leave, having a common mental disorder (CMD). Methods A mixed methods feasibility study. Results Systematic review examined 40 articles and 2 guidelines. Forty-nine National Health Service Occupational Health (OH) providers completed a usual care survey. We trained six OH nurses as case managers and established six recruitment sites. Forty-two out of 1938 staff on sick leave with a CMD were screened for eligibility, and 24 participants were recruited. Out of them, 94% were female. Eleven participants received the intervention and 13 received usual care. Engagement with most intervention components was excellent. Return-to-work self-efficacy improved more in the intervention group than in the usual care group. Qualitative feedback showed the intervention was acceptable. Conclusions The intervention was acceptable, feasible and low cost to deliver, but it was not considered feasible to recommend a large-scale effectiveness trial unless an effective method could be devised to improve the early OH referral of staff sick with CMD. Alternatively, the intervention could be trialled as a new stand-alone OH intervention initiated at the time of usual OH referral.

© Parsons V; Juszczyk D; Gilworth G; Ntani G; Henderson M; Smedley J; McCrone P; Hatch SL; Shannon R; Coggon D; Molokhia M; Griffiths A; Walker-Bone K; Madan I. Journal of Public Health. 2022 May 30.

Purpose Health professions are ranked among the most stressful occupations and have a much higher likelihood of absenteeism from work. Methods In this paper, we present findings from four health professional case studies in our Healthy Professional Worker partnership, involving surveys with 1860 respondents and 163 interviews with nurses, physicians, midwives, and dentists conducted between December 2020 and April 2021. Results We found that the pathway from mental health experiences through to the decision to take a leave of absence and return to work differed between the health professions and that both gender and leadership matter greatly. Conclusions There is a need to de-stigmatize mental health issues and encourage greater awareness and support from supervisors and colleagues. Leadership can play an important role in mitigating mental health issues, and as such investment in both leadership training and mentorship are important first steps in acting upon our research findings.

Purpose Mental illnesses are among the most common diseases worldwide. Cases of inability to work caused by mental illness are frequent and the related economic burden is immense. A successful reintegration into their work environment of those patients who were on sick leave due to a mental illness is an important prognostic factor for the further course of the disease and helps reducing financial consequences. It was the aim of the present review to give an overview of the status quo of return-to-work interventions in the international literature. Results Main themes of interventions addressing return to work of persons with mental illnesses are the provision of psychotherapeutic support with or without combining these approaches with work directed interventions. Personal contact of employees, mental healthcare staff and supervisors may be helpful with regard to facilitating return to work. Discussion Current return to work interventions are mostly elaborate, extensive and expensive without convincing results regarding work related outcome parameters. A variety of reasons might be responsible for this finding, including heterogeneity of outcomes, a poor definition of return-to-work-interventions and the complexity of the issue (involving multiple stakeholders).

Purpose Identify ethical issues that arise in the coordination of return-to-work (RTW) among employees on sick leave due to common mental disorders (CMDs). Methods 41 semi-structured individual interviews and one focus group interview with stakeholders (n = 46) involved in RTW: employees on sick leave due to CMDs, coordinators and physicians at primary health care centres, managers, representatives of the Swedish social insurance agency and occupational health services. A six-step thematic analysis focused on the ethical values and norms related to autonomy, privacy, resources and organization, and professional values. Results Five themes were identified: (1) autonomous decision-making versus the risk of taking over, (2) employee rights versus restrictions to self-determination, (3) respect for employee privacy versus stakeholders' interests, (4) risk of unequal inclusion due to insufficient organizational structure and resources, (5) risk of unequal support due to unclear professional roles and responsibilities. Conclusion The main ethical issues are the risks of unequal access to and unequal support for the coordination of RTW. For the fair and equal provision of coordination, it is necessary to be transparent on how to prioritize the coordination of RTW for different patient groups, provide clarity about the coordinator's professional role, and facilitate ongoing boundary work between stakeholders. Implications for rehabilitation: Unfair and arbitrary criteria for inclusion to the coordination of RTW implicate risks of unequal access for the employee on sick leave due to CMDs.Unclear professional roles and responsibilities among stakeholders in the coordination of RTW implicate risks of unequal support for the employee on sick leave due to CMDs.Coordination of RTW should be transparently prioritized on policy and organisational levels to secure fair and equal inclusion. The coordinator's professional role should be clearly defined to facilitate boundary work between stakeholders and improve the competence around the coordination of RTW.

Purpose Common mental disorders (CMD) are major causes of sick leave and have huge negative impacts on psychosocial well-being and to overall society. The return to work (RTW) process involves various welfare sectors, but often lack collaboration across these sectors and may cause uneven RTW processes. This study reports from an intervention aimed to increase collaboration between the mental health care system (MHCS) and the social insurance sector (SIS). The intervention consisted of two phases: (a) a development phase building on a participatory approach and (b) an implementation phase. Interprofessional meetings, evaluation workshops and joint consultations with workers from SIS and MHCS, and patients, comprised the key components of the intervention. The study explores how the collaborative process is experienced during the implementation phase with a focus on how collaboration maintains and challenges professional identities. Methods A qualitative design was employed consisting of individual interviews (n20), focus group discussions (4), and observations of interactions between Patients with CMDs, case managers from SIS, and professionals working in MHCS. Results Patients with CMDs felt supported and did not feel pushed to RTW prematurely. SIS and MHCS professionals reported that they were not sufficiently prepared and it was not clear who was responsible for which tasks. MHCS professionals experienced that their professional identities were in conflict with the aim of the intervention whereas SIS professionals found that the intervention improved their poor reputation. Conclusions The results suggest that a higher level of participation in the intervention design and implementation process can improve a clear and transparent role distribution between professionals in MHCS and SIS. Implications for rehabilitation: Collaboration across sectors is key to successful Return-to-work after sickness-related absence. Professional identities are challenged in collaborative interventions as different agendas are at play. Collaboration is most likely to be successful when engaging involved professions to decide goals and methods which are compatible with local work procedures.

Purpose Sickness absence and rehabilitation processes can be challenging for an individual. At a time of generally reduced capacity, the individual must comprehend and navigate through several options. The aim of this study was to investigate the prerequisites for support, knowledge and information related to decision making experienced by people on sickness absence due to common mental disorders. Methods A qualitative explorative approach was used. Face-to-face interviews took place with 11 sick-listed individuals with common mental disorders. Patients were recruited from different sources in the western part of Sweden, such as primary health care centres, patient organizations and via social media. Data analysis was performed using manifest content analysis, meaning that the analysis was kept close to the original text, and on a low level of interpretation and abstraction. Results The analysis revealed three themes that described experiences of decision making during the sick leave and rehabilitation process: Ambiguous roles challenge possibilities for moving on; Uncertain knowledge base weakens self-management; and Perceived barriers and enablers for ending sick leave. Conclusions Our findings suggest that alternatives need to be found that address sickness absence and rehabilitation processes from a complex perspective. Collaboration between stakeholders as well as shared decision making should be considered when the time for return to work is discussed with sick-listed individuals. Other factors in the context of the individual must also be considered. Current knowledge on strategies to improve health/well-being while being in the sick leave process need to be elaborated, communicated and adapted to each individuals' unique situation, including clarifying rights, obligations and opportunities during the sick-leave process.

Mai 2022

Purpose Return-to-work (RTW) perceptions and attitudes are predictive for future work participation in workers with mental health issues. To identify what RTW perceptions and attitudes occupational health professionals recognize in sick-listed unemployed workers with mental health issues and how these perceptions and attitudes can be systematically assessed. Methods Four focus group sessions, each involving five-six different occupational health professionals, were held. The audio records were transcribed verbatim and coded by two researchers independently. A thematic analysis was conducted. Results Professionals recognized RTW perceptions and attitudes in sick-listed unemployed workers with mental health issues. These perceptions and attitudes were described as characteristics of three modes in a process regarding RTW: the passive, ambivalent and active RTW mode. A passive RTW mode includes perceptions about not being able to work and an expectant attitude. The ambivalent RTW mode is characterized by uncertainty and ambivalence regarding RTW with a desire for occupational support. Workers in an active RTW mode have positive RTW perceptions and show job search behavior. A main theme was the flexible nature of RTW attitudes and perceptions, with workers switching between the passive, ambivalent and active RTW modes. For the assessment of the RTW mode, the professionals preferred personal contact, possibly with support of a tool. This enables them to ask specific questions and to observe non-verbal signs. Conclusion Recurring assessments of the RTW mode can be helpful in identifying unemployed workers with mental health issues at risk of long-term sickness absence and for starting targeted RTW interventions.

Purpose Common mental disorders have a severe impact on society and individuals; rates of unemployment and disability pensions are high. Knowing which factors facilitate or hinder people's return to work is important when designing effective vocational rehabilitation interventions. Methods We conducted secondary analyses on data from 289 participants with depression or anxiety included in the Individual Placement and Support modified for people with mood and anxiety disorders (IPS-MA) trial. Associations of baseline characteristics and employment or education after 24 months were tested in univariate logistic regression analyses, variables with a p-value below 0.1 were included in multivariate analyses. Results In the univariate analyses, self-reported level of functioning (p = 0.032), higher age (p = 0.070), and higher level of readiness to change (p = 0.001) were associated with the outcome and included in the multivariate analysis. Only age (p = 0.030) and readiness to change (p = 0.003) remained significantly associated with return to work or education after 24 months in the multivariate analysis. Conclusion Higher age and lower readiness to change were associated with a lower chance of having returned to work or education. Factors modifying the effect of higher age should be identified, just as vocational rehabilitation should focus on improving factors related to people's readiness to change.

Purpose Collaborative care with a care manager in primary care improves care. Objective: To study whether care manager support leads to improved work ability, decreased job strain and reduced time of sick leave among primary care patients with depression. Methods A clinical effectiveness study of care managers for depression patients seeking care in primary care was conducted in a RCT 2014 -2016. Patients in the intervention group were assigned a care manager. In the 12-month follow-up, patients with employment (n = 269; intervention n = 142, control n = 127) were studied concerning work ability, job strain and sick leave. Results An association was shown between reduction of depressive symptoms and improved work ability for the entire group. At 12-month follow-up a statistically significant difference of reduction of depressive symptoms was seen between the groups (MADRS-S: intervention 10.8 vs control 13.1, p = 0.05) as well as increased quality of life (EQ-5D: intervention 0.77 vs control 0.70, p = 0.04). In the intervention group, a concordance was found between the patient's prediction of return to work and the actual return to work (91%for intervention and 68 %for control group, p = 0.047). Conclusions Compared to usual care, the care manager does not seem to further improve perception of work ability, job strain or perception of social support per se among the patients despite a long-term effect on depression symptoms. The lack of a long-term effect regarding these aspects may be due to the fact that care manager support was only provided during the first three months.

Purpose Traditional approaches to vocational rehabilitation tend to focus on improving worker skills and competencies rather than addressing barriers and inequities in existing workplace structures. The purpose of this scoping review is to provide an overview of current demand-side employment interventions that are aimed at building inclusive hiring and retention practices for persons living with common mental disorders (CMD). Methods Using the method advanced by Arksey and O'Malley (2005), and furthered by Levac et al., (2010), we carried out a scoping review to identify the range and breadth of literature exploring demand-side employment interventions for individuals with CMD. One rater screened titles and abstracts and two independent raters evaluated full-text articles against a set of inclusion/exclusion criteria. A descriptive analysis was conducted to highlight the state of the literature in this area. Results A total of 10 articles were retrieved, including six empirical papers and four theoretical papers. Three broad themes were extracted from the literature: (1) Workplaces as a determinant of worker health; (2) Unique interventions are needed for different work sectors; and (3) Individualistic perspectives embedded in demand-side interventions. Conclusions Demand-side employment interventions hold promise for building employer capacity to hire and retain people with CMD. There is a need for innovative approaches to engage workplace stakeholders in developing and evaluating innovative solutions to build inclusive workplaces.

Avril 2022

urpose Stress-related disorders are common, associated with substantial individual suffering, and place a large economic burden on society. While treatment appears to be able to reduce symptoms, evidence of interventions to improve vocational outcomes is flimsy. Lack of integration of vocational rehabilitation and healthcare services has been suspected to be a major potential barrier in return-to-work (RTW) processes; therefore, we aimed to test the effectiveness of such integration. Methods We randomized participants who were on sick leave for ≥ 4 weeks with a stress-related disorder. They were allocated to (i) service as usual (SAU), (ii) improved mental healthcare (MHC), or (iii) integrated interventions (INT). The primary outcome was RTW rates measured at 12 months. Secondary outcome were RTW rates measured at 6 months, proportion in work at 12 months, and levels of stress, anxiety, depression, and functioning at 6 months. Results We included 666 participants. On the primary outcome and almost all other vocational outcomes, SAU was superior to both INT and MHC. MHC and INT did not differ on any vocational outcome. On several symptom scales, MHC showed lower values than SAU, whilst INT did not differ from the two other groups. Conclusion Both the INT and the MHC intervention lowered RTW rates compared with SAU, and thereby yielded a worse outcome. However, the MHC group showed a tendency towards having lower symptom levels compared with those in the SAU group; accordingly, the SAU group is not unequivocally superior. MHC and INT showed no general differences.

Purpose Mental distress is often endured by injured workers participating in the rehabilitation or return to work process following a physical injury. Delays in detecting the onset and treating mental distress can lead to a diverse range of cognitive and behavioural changes that may precipitate psychological distress such as anxiety, depression, and posttraumatic stress. The objective of this scoping review was to provide an overview of existing health questionnaires utilised by health care providers and affiliated researchers. It reviewed their effectiveness and suitability to detect mental distress endured by injured workers engaged in the return to work process. Methods A scoping review methodology was conducted using the Arksey and O'Malley framework which examined peer-reviewed articles published between 2000 and March 2020 comprising health questionnaires. Database searches included Medline, CINAHL, EMBASE and PsycINFO combining specific MeSH terms and key words. Results The full search identified 3168 articles. Following full screening a total of 164 articles reviewed the use of health questionnaires and specific criteria to determine their suitability. Most of the health questionnaires reviewed were used as screening measures for identifying both work and non-work-related psychological hazards. However, they were found to be limited in their application when considering all potential predictors of delayed return to work such as poor or stressful interactions with stakeholders, financial stress and the injured workers experience of the RTW process. Conclusion Earlier identification of mental distress using an optimal MHSQ followed by appropriate intervention will reduce the risk of psychological injury becoming cumulative on a physical workplace injury. Without such complications, early return to work can be achieved with significant cost saving to the economy.

Purpose The cost of mental ill health in the EU-28 nations has been estimated at approximately 4.1% of the total gross domestic products (GDP). Improved rates of return to sustainable employment among people who are sick-listed due to mental ill health would decrease spending on welfare benefits. The present cohort study provides statistical information that may be helpful in the design and prioritizing of efforts aimed at reducing the burden of sickness absence due to mental ill health among employees in the general working population of Denmark. Our primary aim was to estimate odds of being i) deceased or recipient of health related welfare benefits and ii) recipient non-health related welfare benefits, compared to being alive and self-reliant at 1, 3 and 5 years after first visit to a jobs and benefits office due to mental health related sickness absence, as a function of industrial sector and job group skill level at baseline. A secondary aim was to analyze these odds as a function of baseline age, gender, type of mental ill health, family type and employment status. Methods The study population consisted of 20-54 year-old persons on long-term sickness absence due to mental health problems in 21 Danish municipalities in 2010-2012 (N = 19,660). Odds ratios were estimated by use of multinomial logistic regression. The outcomes were ascertained through national registers. Results We did not find any statistically significant association between baseline industrial sector or job group skill level and welfare dependency at follow-up. In the secondary analyses, the estimated odds of health and non-health related welfare dependencies at follow-up tended to increase with unemployment, age, being single and being on sick leave due to self-reported anxiety or depression versus stress/burnout at baseline. Conclusions The present study does not support that industry and job group skill level predict welfare dependency after health related sickness absence, after adjustment for relevant covariates, in the general population of Denmark. It suggests, however, that the vulnerability lies in population groups characterized by unemployment, older age, being single and being on sick leave due to self-reported anxiety or depression versus stress/burnout.

Mars 2022

Purpose People with depression and anxiety disorder may experience occupational performance issues (OPIs). Further knowledge about these issues longitudinally and about potential differences between people is valuable. Aim: To explore experienced OPIs longitudinally in a sample living with depression and/or anxiety disorder participating in occupational therapy and varying in terms of their work situation. Methods The Canadian occupational performance measure (COPM) was completed by 54 participants with depression and/or anxiety at four measure-points from baseline to one-year after participation in occupational therapy. The participants constituted three groups: continuously on sick leave (SL), returned to work within a year and continuing working. Descriptive and non-parametric analysis was used. Results Participants in all groups identified OPIs in all occupational areas in the COPM. All groups increased their occupational performance and satisfaction with their occupational performance in the area socialisation. Each group also made improvements in relation to other occupational areas, varying between the groups. Conclusions OPIs and improvements were identified among the participants regardless of them being on SL, returning to work or working. The diverse nature of OPIs and improvements in the clients indicate the relevance of occupational therapy.

Purpose This study was conducted to estimate the risk of return to work for people who experience symptoms of depression based on the pool of prospective data. Methods All online articles on PubMed and Scopus which were accessible before November 2019 were searched. The odd ratios of each of the studies were pooled together to obtain an overall odd ratio. The pool of studies was with random effects. The following analysis was performed, analysis based on depression symptoms scale, type of disease, and duration of follow-up. The two other aspects were examined in the analysis, one being the bias in the publication of studies and the other being the level of heterogeneity that was examined. Results Thirty-five studies were selected for the meta-analysis. The pooled odds ratio indicates that the odd of return to work in people with depressive symptoms is 31% lower than in those without depressive symptoms. The funnel plot shows that there is asymmetry. Egger test result was significant (P < 0.001) and there is publication bias. Conclusion Depression symptoms after sick leave due to physical illness is a risk factor for not returning to work.

Purpose Sick leave due to common mental disorders (CMDs) is a public health problem in several countries, including Sweden. Given that symptom relief does not necessarily correspond to return to work, health care interventions focusing on factors that have proven important to influence the return to work process, such as self-efficacy, are warranted. Self-efficacy is also a central concept in person-centered care.The aim of this study is to evaluate the effects of a person-centered eHealth intervention for patients on sick leave due to CMDs. Methods A randomized controlled trial of 209 patients allocated to either a control group (107/209, 51.2%) or an intervention group (102/209, 48.8%) was conducted. The control group received usual care, whereas the intervention group received usual care with the addition of a person-centered eHealth intervention. The intervention was built on person-centered care principles and consisted of telephone support and a web-based platform. The primary outcome was a composite score of changes in general self-efficacy (GSE) and level of sick leave at the 6-month follow-up. An intention-to-treat analysis included all participants, and a per-protocol analysis consisted of those using both the telephone support and the web-based platform. Results At the 3-month follow-up, in the intention-to-treat analysis, more patients in the intervention group improved on the composite score than those in the control group (20/102, 19.6%, vs 10/107, 9.3%; odds ratio [OR] 2.37, 95% CI 1.05-5.34; P=.04). At the 6-month follow-up, the difference was no longer significant between the groups (31/100, 31%, vs 25/107, 23.4%; OR 1.47, 95% CI 0.80-2.73; P=.22). In the per-protocol analysis, a significant difference was observed between the intervention and control groups at the 3-month follow-up (18/85, 21.2%, vs 10/107, 9.3%; OR 2.6, 95% CI 1.13-6.00; P=.02) but not at 6 months (30/84, 35.7%, vs 25/107, 23.4%; OR 1.8, 95% CI 0.97-3.43; P=.06). Changes in GSE drove the effects in the composite score, but the intervention did not affect the level of sick leave. Conclusions A person-centered eHealth intervention for patients on sick leave due to CMDs improved GSE but did not affect the level of sick leave.

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.

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

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.

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.

Using intervention mapping to develop evidence-based toolkits that support workers on long-term sick leave and their managers.

Associations between improvements in psychological variables and subsequent sick leave among persons receiving a multimodal intervention for exhaustion disorder.

Using intervention mapping to develop evidence-based toolkits that support workers on long-term sick leave and their managers.

"Collapsing into Darkness": An Exploratory Qualitative Thematic Analysis of the Experience of Workplace Reintegration among Nurses with Operational Stress Injuries.

Does employer involvement in primary health care enhance return to work for patients with stress-related mental disorders? a cluster randomized controlled trial.

Practical pathway for the management of depression in the workplace: a Canadian perspective.

Development and psychometric evaluation of a theory-based questionnaire measuring women's return-to-work beliefs after long-term sick leave for common mental disorders.

Return-to-work interventions for sick-listed employees with burnout: a systematic review.

How to measure mental illness stigma at work: development and validation of the workplace mental illness stigma scale.

Stakeholder views on work participation for workers with depression and intersectoral collaboration in depression care: a focus group study with a salutogenic perspective.

Level of education and sustainable return to work among long-term sick-listed workers with depression: a register-based cohort study (The Norwegian GP-DEP Study).

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

Hindering and enabling factors for young employees with common mental disorder to remain at or return to work affected by the Covid-19 pandemic - a qualitative interview study with young employees and managers.

Rehabilitation cooperation and person-centred dialogue meeting for patients sick-listed for common mental disorders: 12 months follow-up of sick leave days, symptoms of depression, anxiety, stress and work ability

How Do We Keep our Heads above Water? An Embedded Mixed-Methods Study Exploring Implementation of a Workplace Reintegration Program for Nurses Affected by Operational Stress Injury.

Occupational therapy and stress-related exhaustion - a scoping review.

Effectiveness of a return to work intervention after occupational disability retirement due to depression and anxiety.

A digital lifestyle program for psychological distress, wellbeing and return-to-work: a proof-of-concept study.

Experiences of participating in a problem-solving intervention with workplace involvement in Swedish primary health care: a qualitative study from rehabilitation coordinator's, employee's, and manager's perspectives.

Thrivers, survivors or exiteers: A longitudinal, interpretative phenomenological analysis of the post‐return‐to‐work journeys for workers with common mental disorders.

Evaluating the Effectiveness of Return-to-Work Interventions for Individuals with Work-Related Mental Health Conditions: A Systematic Review and Meta-Analysis.

Return to Work Experiences of Ontario Public Safety Personnel with Work-Related Psychological Injuries.

Quality of life, sense of coherence and occupational balance one year after an occupational therapy intervention for people with depression and anxiety disorders.

Predictors of return to work for people on sick leave with depression, anxiety and stress: secondary analysis from a randomized controlled trial.

Are psychosocial work factors and work-home interference associated with time to first full return-to-work after sick leave due to common mental disorders?

Healing the wounds of workplace bullying: Evaluating mental health and workplace participation among victims seeking treatment for common mental disorders.

Occupational performance issues in a longitudinal perspective in people with depression and/or anxiety on sick leave, returning to work or working.

Development and psychometric evaluation of a theory-based questionnaire measuring women's return-to-work beliefs after long-term sick leave for common mental disorders.

Integrated Mental Healthcare and Vocational Rehabilitation for People on Sick Leave with Anxiety or Depression: 24-Month Follow-up of the Randomized IBBIS Trial.

Evaluating a Digital Mental Health Intervention (Wysa) for Workers' Compensation Claimants: Pilot Feasibility Study.

Co-design Process of a Digital Return-to-Work Solution for People With Common Mental Disorders: Stakeholder Perception Study.

The impact of disease changes and mental health illness on readapted return to work after repeated sick leaves among Brazilian public university employees.

What can I do for you? Line managers' behaviors to support return to work for workers with common mental disorders.

Work after mental-health-related absence: a qualitative study of perceived change after a combination of metacognitive therapy and work-focused interventions.

Recognition During the Return-to-Work Process in Workers with Common Mental Disorders.

Sick leave duration as a potential marker of functionality and disease severity in depression.

Relationship between emotional words in electronic medical records and leave periods of users of a return-to-work program with depression.

Return to Work for People with Common Mental Disorders: Insights into the Implementation of a Collaborative Program in a Specialized Mental Health Hospital.

Demographic Covariates, Vocational Rehabilitation Services, and Employment Outcomes of Working-Age Adults with Anxiety Disorders: A Multivariate Logistic Regression Analysis.

Successful return to work after burnout: an evaluation of job, person- and private-related burnout determinants as determinants of return-to-work quality after sick leave for burnout.

Employees’ experience of supervisor behaviour – a support or a hindrance on their return-to-work journey with a CMD? A qualitative study.

Neuropsychological predictors of vocational rehabilitation outcomes in individuals with major depression: A scoping review.

A conceptual framework for return to work for clients with major depressive disorder.

Economic evaluation of return-to-work interventions for mental disorder-related sickness absence: two years follow-up of a randomized clinical trial.

Association of stigmatizing attitudes with people's opinion of depression as a valid reason for sickness absence: A Swedish vignette study.

Sustainable return to work after depression - A comparative study among occupational physicians and affected employees.

Outcomes of an interdisciplinary return to work intervention including occupational therapy for mood and adjustment disorders: A single-arm clinical trial.

Healing the wounds of workplace bullying: Evaluating mental health and workplace participation among victims seeking treatment for common mental disorders.

The attitudes of mental health professionals on the employability of people with mental illness: A different view limiting employment rehabilitation.

Experiences of patients with common mental disorders concerning team-based primary care and a person-centered dialogue meeting: An intervention to promote return to work

Predictors of return to work and psychological well‐being among women during/after long‐term sick leave due to common mental disorders ‐ a prospective cohort study based on the theory of planned behaviour

Changes in depression domains as predictors of return to work in common mental disorders.

Health screening questionnaires used in the management of mental distress acquired during an injured worker's return to work: A scoping review.

Developing and testing a case-management intervention to support the return to work of health care workers with common mental health disorders.

The pathway from mental health, leaves of absence, and return to work of health professionals: Gender and leadership matter.

Return-to-work interventions for persons/employees with mental illnesses.

Ethical aspects of the coordination of return-to-work among employees on sick leave due to common mental disorders: a qualitative study.

Cross-sectorial collaboration in return to work interventions: perspectives from patients, mental health care professionals and case managers in the social insurance sector.

Capability to make well-founded decisions: an interview study of people with experience of sickness absence who have common mental disorders.

Identification of the return-to-work mode in unemployed workers with mental health issues: A focus group study among occupational health professionals.

Predictors of Return to Work for People with Anxiety or Depression Participating in a Randomized Trial Investigating the Effect of a Supported Employment Intervention.

Long-term effect of a care manager on work ability for patients with depression -the PRIM-CARE RCT.

Demand-side Employment Interventions for Individuals with Common Mental Disorders: a Scoping Review.

Integrating vocational rehabilitation and mental healthcare to improve the return-to-work process for people on sick leave with stress-related disorders: results from a randomized trial.

Health screening questionnaires used in the management of mental distress acquired during an injured worker's return to work: A scoping review.

Do baseline industry and job group skill level predict welfare dependency at 1, 3 and 5 years after mental health related sickness absence? A Danish cohort study.

Occupational performance issues in a longitudinal perspective in people with depression and/or anxiety on sick leave, returning to work or working.

Depression symptoms reducing return to work: A Meta-analysis of Prospective studies.

Effects of a Person-Centered eHealth Intervention for Patients on Sick Leave Due to Common Mental Disorders (PROMISE Study): Open Randomized Controlled Trial.