Santé mentale

Avril 2025

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

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

Février 2025

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

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

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

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

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

Janvier 2025

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

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

Décembre 2024

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

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

Novembre 2024

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

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

Octobre 2024

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

Septembre 2024

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

Août 2024

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

Juillet 2024

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

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

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

Juin 2024

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

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

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

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

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

Mai 2024

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

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

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

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

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

Avril 2024

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

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

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

Mars 2024

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

Février 2024

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

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

Janvier 2024

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

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

Décembre 2023

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

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

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

Novembre 2023

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

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

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

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

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 2025

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

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

Février 2025

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

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

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

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

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

Janvier 2025

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

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

Décembre 2024

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

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

Novembre 2024

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

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

Octobre 2024

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

Septembre 2024

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

Août 2024

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

Juillet 2024

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

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

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

Juin 2024

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

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

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

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

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

Mai 2024

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

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

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

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

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

Avril 2024

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

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

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

Mars 2024

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

Février 2024

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

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

Janvier 2024

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

Décembre 2023

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

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

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

Novembre 2023

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

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

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

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

Octobre 2023

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

Septembre 2023

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.

Août 2023

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).

Juillet 2023

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

Juin 2023

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.