Conference Agenda

Precarious workers and vulnarable groups
Friday, 07/Jun/2019:
11:00am - 12:30pm

Session Chair: Ellen MacEachen
Session Chair: Astrid Velasquez Sanchez
Location: Room 97


Work-related mental disorders in the workplace and in the Workers Compensation System

Yun Ladegaard, Janne Skakon, Bo Netterstrøm

University of Copenhagen, Denmark

Background Challenges in the psychosocial work environment are key issues in the current labour market. Psychosocial risks, such as work-related stress and workplace violence, are widely recognized as major challenges to occupational health and safety. Current study focuses on work-related mental disorders such as stress-related disorders, depression and PTSD. How are these work-related mental disorders handled at the workplace respectively in the Workers’ Compensation System?

Methods The project applied a variety of methodological approaches, thus data consisted of expert and stakeholder interviews (N=23) and patient interviews (N=23), analyzing interview data from a grounded theory approach, respectively questionnaire responses from employees with workers compensation claims of mental disorders (N=436), analyzing data with Chi2 tests.

Results From the employee perspective, a workers compensation claim of a mental disorder, was most often submitted with the aim of initiating prevention in the work environment, to spare colleagues of similar negative experiences and demands. However employees often reported that both the workplace and Workers’ Compensation System took an isolated approach at the individual. Changes in the work environment and workplace inspections were rarely detected by the employee. Managers were frequently experienced negatively by the employee while health-and-safety or union representatives were often experienced as uninvolved. Further, many employees received inadequate information from the Workers’ Compensation System and found compensation schemes difficult to fill out. Workers’ compensation claims could be an obstacle for RTW.

Conclusions Strengthened interactions between the legislative/insurance and workplace systems are needed to enable information about psychosocial hazards to be used systematically to prevent work-related mental disorders. Workers’ compensation claims might be a valuable source in this matter. Employees with work-related mental disorders should not be advised against filing compensation claims solely in concern for their health, but there are room for improvement in the Workers’ Compensation System

Work Motivation And Employment Outcomes In People With Severe Mental Illness

Miljana Vukadin1, Frederieke G. Schaafsma1, Sandra J. Vlaar1, Jooske T. Van Busschbach2, Peter M. Van de Ven1, Harry W.C. Michon3, Johannes R. Anema1

1Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands, The; 2University of Groningen, University Medical Center Groningen; 3Trimbos Institute, The Netherlands Institute of Mental Health and Addiction

Purpose: To explore associations between self-reported work motivation and employment outcomes in people with severe mental illness (SMI), who expressed a wish to work and were enrolled in Individual Placement and Support (IPS) or a traditional vocational rehabilitation (TVR) program, and to assess whether associations between work motivation and employment outcomes differ between the two programs.

Methods: Data of 151 study participants, collected from a randomised controlled trial with a 30-month follow-up period, were used for a secondary data analysis. Cox regression and multiple linear regression analyses were performed to analyse the association between work motivation and time until job obtainment and job duration.

Results: No direct association was found between work motivation at baseline and time until job obtainment (HR = 1.37, 95% CI 0.48-3.32, p = 0.48) and (log-transformed) job duration (B = -0.99, 95% CI -2.59-0.61, p = 0.22, R-squared = 0.05). These associations did not differ between IPS and TVR. However, corrected for program, age modified the association between work motivation and time until job obtainment (p = 0.01): in younger people (17-33 years) higher work motivation was associated with shorter time until job obtainment (HR = 3.50, 95% CI 1.12 - 10.93, p = 0.03), whereas no such association was found in older people (HR = 0.29, 95% CI 0.06-1.38, p = 0.12).

Conclusions: Results suggest that work motivation is an ambiguous factor with regard to employment outcomes in people with SMI. Assessing work motivation, however, could be relevant for younger people who are enrolled in a vocational rehabilitation program.

A Systematic Review and Meta-Analysis of Observational Studies Identifies the Prevalence of Workplace Violence Among Physicians

Amin Yazdani5, Behdin Nowrouzi-Kia1, Emily Chai2, Koyo Usuba1, Behnam Nowrouzi-Kia3, Jennifer Casole4

1Laurentian University, Canada; 2University of Toronto, Canada; 3McMaster University, Canada; 4Loretto College, Canada; 5Conestoga College and the University of Waterloo

Objectives: The objective of this systematic review was to identify the types of workplace violence (WPV) present in the work environment of doctors. Moreover, a meta-analysis was completed to estimate the prevalence of WPV among doctors.
Methods: Primary papers on workplace violence in medicine were identified through a literature search in four health databases (Ovid Medline, Embase, PsychoINFO and CINAHL). The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for the mapping and identification of records. To assess the studies included in our review, we used the Critical Appraisal Skills Programme cohort review checklist. All analyses were performed in R 3.4.3 and “metafor” package was used for the meta-analysis of proportions. The risk of bias was examined using the Cochrane Collaboration ‘risk of bias’ assessment tool across six domains.
Results: Thirteen articles were reviewed from a total of 2,154. Our systematic review outlined factors of physician WPV as following: (1) remote healthcare areas, (2) understaffed shifts, (3) mental/emotional stress of patients/visitors, (4) insufficient security, (5) cultural differences, and (5) lacking preventative measures.
Conclusions: The impact of WPV on healthcare institutions is profound and far-reaching. Thus, steps must be taken to promote an organizational culture where there are measures to protect and promote the well-being of doctors. Our recommendations are to encourage policy amendments that may begin to alleviate the negative impacts of WPV against physicians.

The Brainwork Intervention for Precarious Workers with Psychological Problems: Effect on Sickness Absence

Selwin S. Audhoe1, Karen Nieuwenhuijsen2, Jan L. Hoving2, Monique H.W. Frings-Dresen2

1Research Center for Insurance Medicine; 2Amsterdam UMC, University of Amsterdam, The Netherlands

Background Precarious workers are unemployed and temporary agency workers and workers with an expired fixed-term contract. Once these workers are on sick leave due to psychological problems, they are at high risk for prolonged work disability. The Brainwork intervention offers them a customized program attuned to their psychological and psychosocial problems. The components of the intervention, provided by vocational rehabilitation agencies and mental health institutions/professionals, can include an exercise program, vocational training, gym membership, and psychological interventions. The protocol further commended short lead times, ensuring timely telephone and face-to-face contacts of workers with professionals.

Objective The aim of this study was to assess the effect of the Brainwork intervention, compared to usual care, on sick leave over a 12-month follow-up.

Methods In a controlled clinical trial, using a quasi-randomization procedure, we compared the Brainwork Intervention (n = 164) to usual care (n = 156). The primary outcome was duration of sick leave, differences between the groups were tested using Cox regression analysis. Protocol adherence (Brainwork Intervention) was considered sufficient when at least three of the five protocol steps were followed within the pre-specified timeframe.

Results At six months, the Brainwork Intervention resulted in a non-significant reduction of the duration of sick leave compared to usual care (171 days versus 185 days; HR = 1.34; 95% CI 0.91−1.97; p = 0.14). Protocol adherence was low, 10% of the workers received the program according to the pre-specified timeline and 32% did not receive the intervention at all.

ConclusionsThe Brainwork Intervention, as implemented, did not result in a significant reduction of the duration of sick leave compared to usual care at six months, the 12-months follow up data will be analyzed by the end of 2018.

Indicators of Opioid Misuse Among Workers' Compensation Claimants

Sheilah Hogg-Johnson1, Nancy Carnide2, Hyunmi Lee2, Andrea Furlan3, Pierre Cote4, Mieke Koehoorn5

1Institute for Work & Health, Canadian Memorial Chiropractic College, University of Toronto; 2Institute for Work & Health; 3Institute for Work & Health, Toronto Rehabilitation Institute, University of Toronto; 4University of Ontario Institute of Technology, Canadian Memorial Chiropractic College; 5University of British Columber

Background & Objectives: Several studies have reported an association between opioid use and prolonged work disability among workers’ compensation (WC) claimants. Other potential risks associated with opioids include addiction and overdose. Our objective was to derive indicators of potential opioid misuse among WC claimants using a population-based network of prescription dispensing records.

Methods: Historical cohort of WorkSafeBC low back pain (LBP) claimants 1998 to 2009 with 1+ opioid prescriptions in the year following injury. Data were provided by Population Data BC. Prescription records for opioids dispensed within one year of injury included dispense date, drug identification number, drug strength, quantity, and days supply. Indicators of potential opioid misuse included: average daily morphine equivalent dose > 120 mg/day and TROUP misuse score (range 0-16) combining indicators of days supply, # of prescribers and # of pharmacies (Sullivan et al Pain 2010;150(2):332-339).

Results: Of 97,124 LBP claimants, 37,695 (39%) had 1+ opioid prescription in year after injury. Average daily MED > 120 mg/day was observed for 311 (0.8%). The TROUP misuse score was categorized as: no misuse (scores 0-1), possible misuse (scores 2-4) and probable misuse (score 5-16) with 35,053 (93.1%), 2096 (5.6%) and 490 (1.3%) claimants respectively. There were 542 (1.7%) claimants with 5+ opioid prescribers within a six-month window and 212 (0.7%) using 5+ pharmacies within a 28-day window. The proportion of probable misuse was steady year to year, but possible misuse increased from 4.9% in 1998 to 6.7% in 2009.

Conclusions: A small proportion of claimants displayed dispensing patterns suggestive of misuse. There are limitations to indicators based on dispensing patterns as it is difficult to obtain valid estimates of addiction. Nevertheless, indicators of misuse derived from administrative data may have some value as a screening tool. Based on this study, it appears that prevalence of misuse is low.

How Likely Are Icelandic Employers To Hire Individuals With Decreased Workability And Does Attitude Affect This Decision?

Jonina Waagfjord

VIRK Vocational Rehabilitation Fund, Iceland

Background: It has been well established that work is beneficial for people´s health and well-being. As the workforce ages, dealing with disability will become more of an issue than it is today, and employers play a crucial role in hiring, managing and retaining these employees.

Objective: The aim of this study is to examine how likely employers, participating in an ongoing return-to-work (RTW)-project with VIRK Vocational Rehabilitation Fund, are to hire individuals with decreased workability and if attitude affects the decision. The study is part of a larger study conducted by the Icelandic Ministry of Welfare in cooperation with VIRK, examining Icelandic employer´s perceived barriers and enablers to employment of individuals with decreased workability. The results will support preparation of a new governmental policy aiming to improve labour market participation of individuals with decreased workability.

Method: Cross-sectional survey using an electronically administered questionnaire. 589 (45% response rate) employers participated with 57% of them randomly sampled and 43% a convenience sample of employers associated with VIRK VR and the Directorate of Labour.

Results: Employers with prior experience of hiring were significantly more likely to hire again within the next two years and increased numbers of hiring, and size of the company, increased this probability. This was also true for companies connected with VIRK VR and they were also significantly more likely to have a RTW-plan, to stay in contact with and to accommodate returning employees (i.e. changing worktime and work duties, adjusting work environment, reposition to another job). These employers also demonstrated significantly more positive attitudes in relation to absenteeism, job flexibility and invited more diversity.

Conclusion: Results emphasise the importance of formal education to and interaction with employers, by special employment counsellors employed in the RTW-project, resulting in more positive attitude and increased willingness to hire individuals with decreased workability.