Santé mentale

Avril 2023

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

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

Mars 2023

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

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

Février 2023

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

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

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

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

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

Janvier 2023

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

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

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

Décembre 2022

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

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

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

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

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

Novembre 2022

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

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

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

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

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

Octobre 2022

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

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

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

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

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

Septembre 2022

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

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

Juillet 2022

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

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

Juin 2022

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

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

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

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

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

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

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

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

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

Mai 2022

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

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

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

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

Avril 2022

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

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

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

Mars 2022

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

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

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

Février 2022

Purpose Major depressive disorder (MDD) affects a person's function of daily activities, including work participation. Such functional impairments often persist even when other symptoms of MDD are remitted. Increasing evidence highlights the health-promoting effects of returning to work (RTW) in various diseases. However, limited data are available regarding the impact of return to work on functional recovery in MDD. We explored the association between RTW and functional improvements in people with MDD using a large nationally representative database and a 3-year follow-up. Methods Data of people with an MDD diagnosis were selected from the Taiwan Data Bank of Persons with disability for the period between July 11, 2012, and October 31, 2018. We included 4038 adults aged 18-64 years. The World Health Organization Disability Assessment Schedule 2.0 was used for functional assessment. The association between RTW and functional improvements was investigated using a multivariable regression analysis adjusted for confounding variables. Results Women aged ≥ 45 years with a lower education level were vulnerable to prolonged unemployment. RTW was significantly associated with better functional improvements in cognition, mobility, self-care, getting along, life activity, and participation than unemployment. Conclusions RTW was positively associated with functional improvements in patients with MDD. A referral system targeting re-employment may be suggested during MDD treatment, especially for individuals at risk of prolonged unemployment.

Purpose To support the return to work following common mental disorders knowing which factors influence the return to work is important. We aimed to identify factors predicting return to work for people on sick leave with disorders like stress, anxiety, and depression. Methods A systematic review and meta-analyses were conducted regarding return to work at any time point, < 3 months, 3-12 months, and > 12 months of sick leave, respectively, and diagnostic subgroups. Results The meta-analyses included 29 studies. Predictors decreasing return to work probability at any time point were higher age, being male, neuroticism and openness, previous sickness absence, and higher symptom scores. Predictors increasing return to work probability were positive return to work expectations, high return to work- and general self-efficacy, conscientiousness, and high workability index. Return to work within < 3 months of sick leave was associated with positive return to work expectations. Return to work after > 12 months was increased by higher education. Higher age was associated with decreased return to work probability after > 12 months. No significant predictors were found in diagnostic subgroups. Conclusion Results are overall consistent with earlier reviews. Future studies should focus on specific time points, diagnostic subgroups, and work-related factors.

Purpose In Germany, return to work (RTW) after inpatient treatment for common mental disorders (CMDs) is a complex process at the intersection of the mental healthcare system and the workplace. This study examined (1) the time to first and full RTW and (2) associated factors among employees receiving inpatient treatment for CMDs. Methods In this prospective cohort study, employees receiving inpatient psychiatric or medical rehabilitation treatment for CMDs were interviewed by phone during their last week before discharge. Follow-up interviews were conducted after 6, 12, and 18 months. Health-, personal, and work-related factors were used from baseline measurement. Parametric survival analysis was conducted to identify factors associated with time to first and full RTW. Results A total of N = 269 participants who stayed at a psychiatric clinic or a medical rehabilitation facility were included. Almost all participants (n = 252, 94%) from both treatment settings reported a first RTW and a full RTW. The time to first and full RTW was shortest among participants from medical rehabilitation (both median 6 days) and longer among participants from psychiatric treatment (median 17 days to first RTW and 73 days to full RTW). While only health-related and personal factors were associated with time to first RTW, leadership quality and needed individual RTW support were associated with time to full RTW. Conclusions More attention to work accommodation needs for RTW in clinical practice and coordinated actions towards RTW in collaboration with key RTW stakeholders in the workplace may support a timely RTW.

Purpose Occupational therapists support workers who have experienced a mental health issue in their return-to-work process, but can also support the maintenance of long-term healthy participation. Little scientific literature exists to understand this emerging role. Aim: To describe occupational therapists' interventions with respect to enabling workers to maintain their mental health. Methods Using a descriptive qualitative design, interviews were conducted with 19 occupational therapists working in socioprofessional rehabilitation. Results Occupational therapists reported to implemente 31 interventions, devided in eight categories. These interventions were mainly focused on the workers themselves; those involving the environment were less developed. Conclusions The interventions described with specificity offer concrete levers that occupational therapists can use in their practice. However, research is needed to evaluate the effectiveness of these interventions.

Janvier 2022

Purpose The aim of this study was to investigate an integrated mental healthcare and vocational rehabilitation intervention to improve and hasten the process of return-to-work of people on sick leave with anxiety and depression. Methods In this three-arm, randomised trial, participants were assigned to (1) integrated intervention (INT), (2) improved mental healthcare (MHC) or (3) service as usual (SAU). The primary outcome was time to return-to-work measured at 12-month follow-up. The secondary outcomes were time to return-to-work measured at 6-month follow-up; levels of anxiety, depression, stress symptoms, and social and occupational functioning at 6 months; and return-to-work measured as proportion in work at 12 months. Results 631 individuals were randomised. INT yielded a higher proportion in work compared with both MHC (56.2% vs 43.7%, p=0.012) and SAU (56.2% vs 45%, p=0.029) at 12-month follow-up. We found no differences in return-to-work in terms of sick leave duration at either 6-month or 12-month follow-up, with the latter being the primary outcome. No differences in anxiety, depression or functioning between INT, MHC and SAU were identified, but INT and MHC showed lower scores on Cohen's Perceived Stress Scale compared with SAU at 12-month follow-up. Conclusions Although INT did not hasten the process of return-to-work, it yielded better outcome with regard to proportion in work compared with MHC and SAU. The findings suggest that INT compared with SAU is associated with a few, minor health benefits. Overall, INT yielded slightly better vocational and health outcomes, but the clinical significance of the health advantage is questionable.

Octobre 2021

Purpose Although common mental disorders (CMDs) highly impact individuals and society, a knowledge gap exists on how sickness absence can be prevented in workers with CMDs. This study explores: (1) workers’ perceived causes of sickness absence; (2) perceived return to work (RTW) barriers and facilitators; and (3) differences between workers with short, medium and long-term sickness absence. Methods A longitudinal qualitative study was conducted involving 34 workers with CMDs. Semi-structured interviews were held at two time-points during their RTW process. The 68 interviews were audio-taped, transcribed and thematically analyzed to explore workers’ perspective on sickness absence causes, RTW barriers and facilitators, and compare data across the three sub-groups of workers. Results Workers reported various causes for their absence, including: (1) high work pressure; (2) poor work relationships; (3) unhelpful thoughts and feelings, e.g. lacking self-insight; and (4) ineffective coping behaviors. According to workers, RTW was facilitated by work adjustments, fulfilling relationships with supervisors, and adequate occupational health guidance. Workers with short-term leave more often reported favorable work conditions, and proactive coping behavior. In contrast, the long-term group reported reactive coping behavior and dissatisfaction with their work. Conclusion Supporting workers with CMDs in gaining self-awareness and regaining control, discussing the value of their work, and creating work conditions that enable workers to do valuable work, seem central for successful RTW and might prevent sickness absence. Supervisors play a key role in enabling workers to do valuable work and further research should focus on how supervisors can be supported in this task.

Août 2021

Purpose There is an evident discrepancy between need and provision of evidence-based return-to-work (RTW) interventions in existing mental health services. Online dissemination of evidence-based interventions is presumed to reduce this gap. However, there is almost no knowledge available on perceived acceptability of digital RTW interventions among service users, which are factors that might influence the development and implementation of future interventions. The aim of this study was to develop knowledge of service user acceptability of mWorks, a proposed digital RTW solution. Methods Participants (n = 18) with experience of common mental disorder and sick leave were recruited with a purposive snowball sampling method. Semi-structured interviews (n = 12) and one focus group interview (n = 6) were conducted. A deductive thematic analysis was performed according to the Theoretical Framework of Acceptability. Results Digital RTW interventions were perceived as acceptable and aligned with participant value. Participants expressed positive attitudes toward having access to support, regardless of time and place. A certain ambiguity between a decline in social interactions and opportunities to RTW in a safe space was reported. Participants were confident in their ability to use digital RTW solutions, but reported the need to reduce stressful elements of using smartphones. Overly demanding digital solutions, i.e. ones requiring high cognitive effort, were described as burdensome. Conclusions For digital RTW solutions to be acceptable, they need to complement traditional services by providing accessible and person-centred support throughout the RTW process. They should be designed to reduce the need for cognitive effort. Future research should explore how to balance user autonomy with other support components in digital interventions.

Purpose Most people with common mental disorders are working despite symptoms. This study explores individuals' experiences of a work-directed rehabilitation, provided by occupational therapists and physiotherapists, aiming to promote work capacity in persons with common mental disorders. Methods A qualitative content analysis was used, and 11 women and 8 men with depression or anxiety disorder were interviewed. They were 25-66 years old, had different occupations and were working full or part-time. Results The participants experienced a process interpreted as Increasing belief in one's capacity through supported reflection and practice. This theme reflects the shifting between "reflecting" and "doing" through rehabilitation and the growing hope for change. The increasing belief in one's capacity was developed through three stages, comprised of the categories To be supported by a professional, To realise things about oneself and To try new strategies for change. Conclusions Strategies suggested by occupational therapists and physiotherapists have the potential to promote work capacity in people who are working while depressed and anxious. The results may deepen the understanding among rehabilitation professionals about the importance of a person-centred approach to people with common mental disorders, and to combine reflection and practical exercises to support the development of work-related strategies.Implications for rehabilitationWork-directed rehabilitation provided by occupational therapists and/or physiotherapists is beneficial to people with common mental disorders.Rehabilitation professionals should focus on facilitating self-efficacy among people with common mental disorders.An individualised person-centred approach seems important in order to initiate change.

Juillet 2021

Purpose Lack of mental health literacy among rehabilitation professionals and employers in the return-to-work of persons with mental health problems resulted in the development of a three-day group training program, the Support to Employers from rehabilitation Actors about Mental health (SEAM) intervention. Objective: To evaluate the impact of SEAM on rehabilitation professionals' knowledge and beliefs, attitudes, and supporting behaviors towards people with mental health problems and employers as part of the return-to-work process. Methods In this longitudinal study, 94 rehabilitation professionals were included. Data were collected prior to (T1), immediately after (T2) and 6 months after SEAM training (T3) using knowledge and attitude scales and a questionnaire on supporting behaviors. SEAM includes training in Mental Health First Aid, presentations and discussions on current research on work and mental health, and strategies and communication guidelines to use when meeting service users and employers as part of the return-to-work of persons with mental health problems. SEAM also includes a homepage with targeted employer information. Data were analyzed using non-parametric statistics. Results SEAM significantly increased rehabilitation professionals' knowledge of mental health (T1-T2: z = -2.037, p = 0.042; T2-T3: z = -5.093, p = 0.001), and improved their attitudes towards persons with mental health problems (T1-T2: z = 4.984, p = 0.001). Professionals (50-60%) also estimated that they had increased their use of supporting strategies towards service users and employers.Conclusions The study suggests that SEAM can increase mental health literacy among rehabilitation professionals and lead to a greater focus on service users' resources and work ability, as well as on employers' support needs

Purpose Work participation among employees with depression is hampered due to cognitive impairments. Although studies show higher levels of work disability among people with a lower education, highly educated employees may encounter specific challenges in fulfilling their work role due to the cognitive impairments of depression, as they often perform cognitively demanding jobs. There is little knowledge about their challenges and opportunities with regard to work participation. Objective: To investigate how highly educated employees with depression manage work participation by focusing on their views on opportunities and challenges in fulfilling their work role. Methods Eight individual interviews with highly educated employees with depression were conducted. Transcripts were analysed using qualitative content analysis. Results The analysis revealed four categories: struggling with acknowledging depression and disclosure; fear of being stigmatised at work; work is a motivator in life; and striving to fulfil the work role at the expense of private life activities. Conclusions Highly educated employees with depression need guidance regarding the disclosure of information about health issues and work ability. To successfully manage their work role, they need a clear plan with outlined tasks, demands and goals. Healthcare professionals and workplaces should support them in setting limits with regard to work tasks and working hours.

Purpose Depression is one of the major causes for sick leave and loss of productivity at work. Many studies have investigated return to work (RTW) interventions for people with common mental disorders. However, a paucity of studies has targeted depressive symptoms in the workplace, as well as work productivity. This study presents preliminary results on a novel group intervention based on cognitive behavioral principles in order to optimize sustainable RTW, by reducing clinical symptoms (anxiety and depression) and improving work productivity. Methods This pilot study followed a quasi-experimental design, with participants randomly receiving the group intervention (N = 19) or only receiving usual services (N = 11, control group). The group intervention called Healthy Minds for Sustainable RTW consists of eight sessions based on cognitive behavioral therapy principles and techniques. Outcome measures on depressive and anxiety symptoms and work productivity were administered at baseline (i.e. the start of return-to-work or gradual RTW), as well 2 months later (post-intervention), and at 6-month follow-up. Results The results did not show a time × group interaction for symptoms of depression or anxiety (p = 0.07). Those who received the group intervention however did see a within-group reduction in anxiety and depressive symptoms over time, clinically significant for the group intervention only. A significant time × group interaction for work productivity was found, with those in the intervention group improving over time compared to the control condition. Conclusion Although replication is needed, these results suggest that a brief group cognitive-behavioral intervention specifically tailored to work-related issues is promising. Future studies are warranted, particularly with larger samples and remote webconferencing delivery.

Juin 2021

Purpose The problem of illnesses, sick leave and the necessary return to work and permanence at work has been determining the development of different protocols and professional rehabilitation programs in different countries. We sought to identify articles that address programs for professional rehabilitation and the return to work of people laid off due to mental health problems, and to verify the results of professional rehabilitation programs and the follow-up processes for such return. Methods A systematic review was performed according to the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA). The serial search of the articles was carried out in the electronic databases: Web of Science, MEDLINE/PubMed and Scopus. The variations in the descriptors served to find a greater range of significant results for the research. Results In total, 2,306 articles were found. Another two articles that met the inclusion criteria were located through manual searches, adding up to a total of 2,308. Applying the exclusion criteria resulted in a final data set of 47 peer-reviewed articles. Conclusions The issues involving return to work and permanence in work were complex and multifaceted in the research articles studied. Recovery from Common Mental Disorders (CMDs) is a major cause of long-term sick leave and the granting of disability benefits. Many people with these diagnoses remain employed; however, further studies are needed with women, workers with fragile relationships, and immigrants.

Purpose To explore if and how a dialogue-based workplace intervention with a convergence dialogue meeting can support a return to work process from the managers' perspective. Methods Individual interviews were conducted with 16 managers (10 women and 6 men) who had an employee on sick leave because of stress-induced exhaustion disorder. The manager and employee participated in a dialogue-based workplace intervention with a convergence dialogue meeting that was guided by a healthcare rehabilitation coordinator. The intervention aimed to facilitate dialogue and find concrete solutions to enable return to work. The interviews were analyzed by the Grounded Theory method. Results A theoretical model was developed with the core category enhancing managerial capacity to act in a complex return to work process, where the managers strengthened their agential capacity in three levels (categories). These levels were building competence, making adjustments, and sharing responsibility with the employee. The managers also learned to navigate in multiple systems and by balancing demands, control and support for the employee and themselves. An added value was that the managers began to take preventive measures with other employees. When sick leave was caused only by personal or social issues (not work), workplace actions or interventions were difficult to find. Conclusions From the managers' perspective, dialogue-based workplace interventions with a convergence dialogue meeting and support from a rehabilitation coordinator can strengthen managerial competence and capacity to act in a complex return to work process.

Purpose To disentangle the key steps of the return to work (RTW) process and offer clearer recovery-focused and sustainable RTW for people on sick leave due to common mental disorders (CMDs). Methods This participatory research involves two large Canadian organizations. In each organization, we established an advisory committee composed of RTW stakeholders. We collected information in semi-structured interviews from RTW stakeholders ( n = 26) with each member of the advisory committee in each organization, as well as with employees who had recently experienced CMDs. The interviews examined the RTW process for employees on sick leave due to CMDs as well as RTW stakeholders' perceptions of barriers and facilitators. A thematic approach was used to synthesize the data, following which, results were discussed with the two advisory committees to identify solutions considering key RTW steps. Results Ten common key steps within the three RTW phases emerged from the semi-structured interviews with RTW stakeholders and discussions with the two advisory committees: 1) At the beginning of sickness absence and involvement of disability management team (phase 1), we found 3 steps (e.g., taking charge of the file), 2) during the involvement in treatment rehabilitation with health professionals and preparation of the RTW (phase 2), 4 steps (e.g., RTW preparation), and finally 3) the RTW and follow-up (phase 3) consists of 3 steps (e.g., gradual RTW). Conclusion A participatory study involving RTW stakeholders helped identify 10 common key steps within three phases to support RTW sustainability of people with CMDs. Future research will need to address how RTW coordinators intervene in the RTW process of employees with CMDs within these steps.IMPLICATIONS FOR REHABILITATIONRehabilitation professionals will benefit from a detailed description of the RTW process (10 steps spread out over 3 RTW phases), allowing them to standardize it while adopting a personalized approach for the employee on sick leave.Rehabilitation professionals are informed of stakeholders' role and actions required in the RTW process; as such the communication between RTW stakeholders should be improved.RTW coordinators will be able to tailor more precisely their intervention, considering the detailed RTW process and RTW stakeholders' role and actions, and thus will become the pivot occupational health specialists for the RTW process.

Purpose An increasing number of patients are on sick leave because of common mental disorders (CMD), with or without antidepressant therapy. There is a lack of long-term follow-up studies in the primary care context, where most of the patients are treated. The importance of identifying potential factors associated with work ability for CMD patients is increasingly in focus. Objective: To investigate the associations between using antidepressants, sick leave duration, reported work ability and psychological symptoms among patients with CMD during a two-year observation period in the primary care context. Methods Longitudinal observational cohort study at 28 Primary Care Centers in Region Västra Götaland, Sweden, including 182 patients with an employment and on sick leave for CMD. The following outcomes were assessed: work ability measured with WAI, depressive symptoms with MADRS-S, anxiety symptoms with BAI, fatigue symptoms with KEDS, quality of life with EQ-5D, and days of sick leave. The data were compared between the groups that used and did not use antidepressants, during the 24-months observation period. Results Work ability and health-related quality of life increased over time in both groups. A steeper decrease of depressive symptoms, anxiety symptoms as well as an increased health-related quality of life at 3, 6 and 12 months was found in the group without antidepressants, although both groups levelled off at 24 months. In both groups, a higher work ability at baseline was associated with less two-year sick leave. Conclusion Our study indicates that a high work ability at baseline has a strong association with a lower total net and gross sick leave duration during the entire two-year follow-up period for patients with CMD in primary health care, irrespective of use of antidepressants. Using WAI in primary health care could therefore be helpful in predicting return to work. Use of antidepressants during the CMD episode could indicate initially a more pronounced overall symptom pattern, motivating introduction of antidepressants, rather than prolonging the sick leave period.

Purpose Common mental disorders present the main reason for registered sick leave in Sweden today, and women are at a higher risk of such sick leave than men. The aim of this paper is to explore how employees on sick leave for common mental disorders experience interventions and rehabilitation activities during return-to-work, as well as to explore similarities and differences between the experiences of the interviewed women and men. Methods A qualitative design was applied with semi-structured focus group interviews. Seven focus groups were conducted with a total of 28 participants (13 women and 15 men). The focus group discussions were audiotaped and transcribed verbatim, and data analyzed with conventional content analysis. Similarities and differences in the women's and men's experiences were written down in reflective notes during all steps of the analysis. Results The results comprise of one main category, "To be met with respect and recognition", and subcategories at two levels. Both similarities and differences emerged in how women and men sick-listed because of common mental disorders experienced return-to-work interventions and rehabilitation activities. It was important for both women and men to be met with respect and recognition, which was essential to all forms of help that the participants discussed during the focus group interviews. Women expressed a need for home-related interventions, whereas men expressed a need for organizational interventions to counter feelings of resignation at work. Women could also more easily understand their mental health condition as compared with men. Conclusion A key implication of this study is that research on interventions and rehabilitation activities during return-to-work among employees on sick leave for common mental disorders should consider whether the findings are relevant equally to both women and men. Similarly, return-to-work professionals may need to consider possible differences among women and men on sick leave for common mental disorders, and to further customize offered interventions and rehabilitation activities. Doing so may help enhance the effectiveness of such interventions.

Mai 2021

Purpose Return to work self-efficacy (RTW-SE) is a strong predictor of return to work (RTW) in employees with mental health problems (MHPs). However, little is known about the development of RTW-SE during the RTW process. In this study, we aimed to identify RTW-SE trajectories in the year following sick leave in employees with MHPs and provided a description of the trajectories in terms of personal and work characteristics, and RTW status. Methods This multi-wave study included 111 employees with MHPs. RTW-SE was measured at baseline, and at 3, 6, and 12 months follow-up with the RTW-SE scale for employees with MHPs. Results Latent class growth analysis revealed six trajectories. In three trajectories employees had increasing RTW-SE scores, namely (class 1) low start, moderate increase, (class 3) moderate start, small increase and (class 5) moderate start, steep increase. The other trajectories were defined by (class 2) persistently high, (class 6) persistently low, and (class 4) decreasing RTW-SE scores over time. Employees across the various trajectories differed significantly with respect to RTW status, and personal and work characteristics measured at baseline, including age, gender, and type of MHP. Less favorable trajectories (class 4 and 6) were characterized by higher age, a higher prevalence of anxiety disorder and lower RTW rates. The most favorable trajectory (class 2) was characterized by a higher proportion of stress-related disorders and less major depression diagnoses. Conclusions Large heterogeneity exists in terms of RTW-SE trajectories in employees with MHPs and significant differences were found across the trajectories regarding personal and work characteristics, and RTW status. Insights into RTW-SE trajectories and their attributes are important to advance more effective and personalized RTW treatment for employees with MHPs.

Purpose This study aims to analyse factors that influence return to work (RTW) among workers on sickness absence due to mental disorders. Methods A longitudinal study conducted between 2014-2017 in São Paulo, Brazil. The 385 participants answered a questionnaire including sociodemographics, habits/lifestyle, job characteristics and clinical information. Survival analysis were performed to identify factors influencing the RTW. Results Most of participants were females (74.5%), worked in jobs dealing with public (44.2%) and were depressed (52.4%). RTW occurred for 68.3% participants over 1-year follow-up. Mean duration of absence was 163.83 days. The risk profile for remaining absent was heavy smokers, be abstainer, obese, deal with the public, perceived great effort at work and low self-efficacy. Conclusions These findings can contribute in discussion about disability prevention and interventions to assure mental health care for workers.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Functional status and return to work in people with major depression: a 3-year national follow-up study.

Predictors of return to work for people on sick leave with common mental disorders: a systematic review and meta-analysis.

Employees Receiving Inpatient Treatment for Common Mental Disorders in Germany: Factors Associated with Time to First and Full Return to Work.

Habiliter les travailleurs à préserver leur santé mentale: Que font les ergothérapeutes?

Integrating vocational rehabilitation and mental healthcare to improve the return-to-work process for people on sick leave with depression or anxiety: results from a three-arm, parallel randomised trial.

Barriers and Facilitators for Return to Work from the Perspective of Workers with Common Mental Disorders with Short, Medium and Long-Term Sickness Absence: A Longitudinal Qualitative Study

Acceptability of a digital return-to-work intervention for common mental disorders: a qualitative study on service user perspectives.

A short work-directed rehabilitation to promote work capacity while depressed and anxious: a qualitative study of workers' experiences.

Changes in rehabilitation actors' mental health literacy and support to employers: An evaluation of the SEAM intervention.

'Work is a motivator in life' Strategies in managing work participation among highly educated employees with depression.

Healthy Minds: Group Cognitive-Behavioral Intervention for Sustainable Return to Work After a Sick Leave Due to Depression.

Mental health: Professional rehabilitation and the return to work - A systematic review.

Enhanced Capacity to Act: Managers' Perspectives When Participating in a Dialogue-Based Workplace Intervention for Employee Return to Work.

Developing a collaborative and sustainable return to work program for employees with common mental disorders: a participatory research with public and private organizations.

Associations between antidepressant therapy, work ability, and sick leave for patients with common mental disorders within a two-year perspective - A longitudinal observational cohort study in Swedish primary care.

Experiences of interventions and rehabilitation activities in connection with return-to-work from a gender perspective. A focus group study among employees on sick leave for common mental disorders.

Identifying Return to Work Self-Efficacy Trajectories in Employees with Mental Health Problems.

Return to Work after a Disabling Mental Disorder: Predictors from a Brazilian Longitudinal Study.