Returning to Work after Sickness Absence due to Common Mental Disorders: Results from an 18-Month Follow-Up Study in Germany
Federal Institute for Occupational Safety and Health Berlin, Germany, Germany
One aim of this study is to investigate the return to work (RTW) process after sickness absence(s) due to common mental disorders at the intersection of the healthcare system and the workplace. In Germany, evidence is still lacking in terms of work-related, disease-related and personal factors that predict a successful and sustainable RTW.
The prospective cohort study was conducted in two psychosomatic rehabilitation facilities (N = 117) and two psychiatric clinics (N = 169). It consists of patients between 18 and 60 years of age, part- or full-time workers with a diagnosed common mental disorder, who will be followed-up for 18 months after clinical treatment. The participants will be questioned via telephone at the end of their clinical treatment, after six, 12 and 18 months. The baseline CATI interviews were realised between August 2016 and October 2017. Outcome measures include the duration until RTW and the time to full RTW.
The study sample consists of 286 individuals. Their median age was 50 years (IQR: 43, 54), 47 % were female, and 30 % had a degree from university or university of applied sciences. Preliminary results show that after six months, 269 of initially 286 participants (94 %) could be reached. Further findings after six months show that 241 participants (90 %) returned to their organisation. The latest overall dropout rate is 8 %, and at the end of September 2018, N = 185 (65 %) already completed all four telephone interviews. Results of survival analyses and other regression models regarding prognostic factors of a successful and sustainable RTW will become available in spring 2019 and will be presented at the conference.
Findings of this study will help to gain a better understanding of a successful and sustainable RTW to promote the prevention of mental disorders.
Factor Associated To Time To Return To Work Among Workers With Mental Disorders In São Paulo, Brazil
1National Social Security Institute (INSS - Brazil), São Paulo, Brazil; 2Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; 3WAF Informática, São Paulo, Brazil; 4School of Public Health, University of São Paulo, São Paulo, Brazil
Introduction Mental disorders are the third leading cause for grant sickness social security benefit in Brazil. Those workers have longer time to return to work (RTW) comparing to other disabilities. This study aims to analyse factors associated to RTW after an episode of sickness absence due to mental disorders (MD). Methods A longitudinal study was conducted in São Paulo city, Brazil, during 2014–2016. Included 204 workers requiring sickness social security benefit due to MD. At baseline, participants fill questionnaires about sociodemographic, health risk behaviours, work characteristics, health conditions and social security history. They were followed for 365 days after the first day of sickness absence. Survival analysis (Kaplan-Meier curve and Cox regression) were performed to identify factors influencing the first RTW. Result The group was composed mostly by women (71.1%), people aged under 40 (67.6%) education equal or higher 12 years (80.4%) and diagnosed as depressed (52.9%). Many worked in customer service jobs (44.1%), reported effort-reward imbalance at work (57.4%) and high overcommitment (74.2%). The average time for RTW was approximately six months among the 63.0% who tried to resume their work activities. Factors associated to return to work within one year after sick leave were: aged between 30–39 years (HR 1.76; 95% CI: 1.08 to 2.79), 12 or more years of education (HR 1.87; 95% CI: 1.10 to 3.17), low alcohol intake (HR 2.65; 95% CI: 1.75 to 4.02) and low level of anxiety symptoms at baseline (HR 0.17; 95% CI: 0.04 to 0.74) – when analysis were adjusted by sex and job title. Discussion Sociodemographic characteristics, risk health behaviours and medical conditions at baseline were associated to RTW after sick leave due to MD. Further studies, with larger sample, are needed to improve estimates and discussion focused in interventions to early RTW in public and private sectors. Financial support: CNPq grant 442051/2014–0.
What are the Recommended Characteristics of an Effective Return-to-Work Intervention for Workers with both a Common Mental Disorder and a Personality Disorder?
1Universite de Sherbrooke, Canada; 2CAPRIT, CR-CSIS Research Center, Longueuil, Canada
Objectives: It is now recognized that to facilitate a return to work (RTW) after a common mental disorder (CMD), interventions cannot focus solely on workers’ health, but should also include service coordination and work accommodations. However, little is known to date about how these principles apply to workers with both a personality disorder (PD) and a CMD. Yet CMD comorbidity with PDs is highly prevalent and associated with increased risk of work absence. The first phase of our project aimed to define the adaptations needed to a work rehabilitation program based on best practices, to promote the RTW of this worker sub-group.
Methods: Semi-structured interviews were conducted with seven experts thoroughly familiar with the PD-related intervention in a work absence context. The interview concerned the program’s alignment with PD patients’ needs and the applicable precautions and contra-indications. Thematic data analysis was performed and inter-subject points of convergence were identified.
Results: Three needed adaptations were identified. (1) Initial evaluation: clarify early on the relational dysfunctions that interfere with the RTW and obtain the worker’s explicit consent to make them an intervention target. (2) Coordination: during the various stages of rehabilitation, negotiate with the worker which information will be shared with partners and who will be responsible for doing so (worker or clinician). (3) Work accommodations: proceed with caution when direct interventions in the workplace are necessary, due to their potential, negative effects that can hinder sustainable RTW.
Conclusion: The RTW intervention for CMD-PD cases requires adapting the intervention recommended for CMD-cases only. The next phases will involve revising the CMD-only RTW program to incorporate the adaptations proposed by the experts while reconciling them with the constraints of clinical settings. This should help practitioners deliver services truly adapted to the needs of many workers off work for a CMD-PD.
Gradual Return to Work Trajectories among Employees with Mental Health Problems: The i-STEP Project
1Tilburg University, the Netherlands; 2HumanTotalCare, the Netherlands
A gradual return to work (RTW) after a period of mental health related sickness absence is becoming increasingly common in various European countries. However, the effect of a gradual RTW on sustainable work resumption remains debated. It seems likely that gradual RTW follows different trajectories for different employees, and that not every trajectory is beneficial for sustainable RTW. We investigate (1) which gradual RTW trajectories can be identified, (2) what characterizes these different trajectories in terms of the employee and work environment, (3) how different trajectories are related to sustainable work resumption.
For this project, we use longitudinal, retrospective absence data from a large Dutch occupational health service (HumanTotalCare). A cohort of workers who were absent due to a mental health problem in the period 2014-2017 was drawn from the absence registry. Employees in this cohort worked in various sectors, for companies of varying sizes. We performed latent transition analyses to investigate which RTW trajectories can be identified.
In total, 9494 employees were included in the analyses. On average, employees returned in five steps (M = 5.45, SD = 4.44). Preliminary results revealed five trajectories of RTW: relatively fast RTW with small fluctuation chance, relatively slow RTW with small fluctuation chance, relatively fast RTW with considerable fluctuation chance, relatively slow RTW with considerable fluctuation chance, and immediate RTW (further results expected in November 2018).
The implications of our findings for practice will be discussed in focus groups with different stakeholders, including employees, employers, occupational physicians and psychologists (results expected in February 2018). The knowledge generated in this project can contribute to improved RTW support, tailored to specific individuals and organizations. This may increase the chances of sustainable RTW and reduce costs for all stakeholders. The project is financed by IOSH (Institution of Occupational Safety and Health).
The Impact of Self-Efficacy in the Return-To-Work Process of Employees With Common Mental Disorders. A Latent Class Growth Analysis
1Tranzo, Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands;; 2Department of Human Resource Studies, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
One of the factors that has been shown to be predictive of return to work (RTW) in employees with common mental disorders (CMD) is self-efficacy. However, little is known about the development of self-efficacy during the RTW process, which could inform the care process and promote better patient-centered outcomes. Therefore, we investigate (1) which trajectories of RTW-self-efficacy can be identified and (2) what characterizes these trajectories in terms of personal, work-related and health related factors.
We used longitudinal data from employees that had been absent due to CMD. Self-efficacy was measured with the RTW self-efficacy scale for employees with mental health problems. The final sample, consisted of 95 sick-listed employees. Baseline data at first day of sick leave and the 3-, 6- and 12-months follow-up were used to identify trajectories of RTW self-efficacy by means of latent class growth analysis.
The preliminary results reveal four trajectories of RTW self-efficacy during the RTW process: one class with constant high scores on self-efficacy during the entire period (high trajectory), one class with constant low scores (low trajectory), one class with low scores at the beginning and high scores after 12 months (high increase) and one class with moderate scores at the beginning and high scores at the last point in time (moderate increase). The characteristics of the different classes will be available end of 2018.
These four classes delineate the heterogeneity of the development of self-efficacy in the RTW process. Insights into the different trajectories can contribute to promote better RTW support by informing intervention design and advance the current knowledge on patterns and development of self-efficacy. This may enhance the chances of sustainable RTW and help to reduce the costs related to workers being absent due to CMD.
Knowledge Transfer and Exchange in Work and Health to Reach Workplace Audiences
1Institute for Work & Health, Canada; 2University of Waterloo
Introduction: Workplace injury and illness can be burdensome for individual workers, workplaces, medical systems, insurance systems and society as a whole. The notion of research to practice is important in work and health research. Knowledge transfer and exchange (KTE) is the practice of generation, synthesis, and dissemination of research. The objective of this presentation is to synthesize the literature describing KTE activities relevant to workplace health and safety programs and interventions.
Methods: A rapid review of the literature was completed. Search strategies, developed using terms for knowledge transfer and occupational health and safety, were run in six electronic databases (Medline, Embase, ERIC, Social Sciences, Web of Science, and Business Source Premier). References of relevant documents and hand-searching complimented the search. Documents that described a KTE approach for workplaces were reviewed. KTE approach data were extracted and synthesized according to a framework by Lavis (2003) (What, To whom, By Whom, How, and With what effect) as well as conceptual guidance.
Results: Literature searches revealed 34 documents that described 23 different KTE approaches designed to reach workplaces. The KTE approaches addressed workplace and intermediary audiences. KTE methods and outcomes varied greatly according to the context. However there were common elements including: targeting workers as a key audience, involving researchers in dissemination, and using multiple dissemination methods. Dissemination methods consistently included direct interaction but also often featured printed materials. Many KTE approaches were guided by conceptual frameworks. However no single conceptual framework was predominant.
Conclusion: Common elements related to audience, activities and impact were found in the literature that can help to guide future KTE approaches. Including workers as an audience and researchers as disseminators in a multi-faceted approach along with in-person meetings and printed material are important aspects of KTE for work and health. Conceptual guidance was context dependent.