Determinants of Sickness Absence and Return to Work Among Employees with Common Mental Disorders

A Scoping Review
Purpose: To present an overview of the existing evidence on prognostic factors of (recurrent) sickness absence (SA) and return to work (RTW) among workers with a common mental disorder (CMD). This scoping review provides information about determinants for SA and RTW, which could be used to develop better interventions aimed at the prevention of SA and promotion of RTW among workers with a CMD.
Methods: Relevant articles were identified in PubMed, Embase, PsycINFO, PSYNDEX, and SINGLE up to October 2016. In order to be included, studies should provide insight into prognostic factors of SA or RTW of workers with a CMD. We classified all factors according to the domains of the International Classification of Functioning, Disability and Health.
Results: Our searches identified 2447 possible relevant articles, of which 71 were included for data extraction. There is consistent evidence in ≥3 studies that previous episodes of CMD, higher symptom severity, previous absenteeism, co-morbidity, high job demands, low job control, high job strain, female gender, lower educational level, smoking behavior, and low perceived general health are predictors of SA in people with CMDs. Earlier RTW is consistently predicted by lower symptom severity, having no previous absenteeism, younger age, and positive expectations concerning sick-leave duration or RTW.
Conclusions: The amount of research on determinants for SA and RTW in workers with CMD has increased dramatically in recent years, although most studies are from the Netherlands and Scandinavia. There are some research gaps identified in this scoping review that need further attention in primary and secondary studies. Based on the summary of the evidence, we provide guidance for policy, practice and research.

Source: de Vries, H., Fishta, A., Weikert, B., Sanchez, A. R., & Wegewitz, U. (2017). Journal of Occupational Rehabilitation.
http://dx.doi.org/10.1007/s10926-017-9730-1

Le retour au travail des immigrants victimes de lésions professionnelles

Les embûches de la rencontre interculturelle et la précarité du lien d'emploi
Cet article rapporte une partie des résultats d'une étude exploratoire sur le processus de réadaptation et de retour au travail en contexte de relations interculturelles. Cette étude avait deux objectifs : identifier les stratégies mises de l'avant par les différents acteurs pour faciliter le processus de réadaptation et de retour au travail des travailleurs immigrants et décrire les contraintes, les obstacles et les aides au processus selon la perspective des différents acteurs. Des entrevues semi-dirigées ont ainsi été menées auprès de 47 répondants : cliniciens, agents d'indemnisation et conseillers en réadaptation de la CNESST, employeurs et travailleurs immigrants victimes d'une lésion reconnue et indemnisée. Au-delà des barrières linguistiques et culturelles, deux facteurs nuisent au retour en emploi des travailleurs immigrants : d'une part, la précarité du lien d'emploi freine leurs efforts et mine leur volonté de consolider leur état de santé et, d'autre part, la menace ou la perte réelle du lien d'emploi amène une rupture symbolique dans leur processus d'intégration. Cette rupture est importante pour ceux qui sont surqualifiés pour leur poste, surtout si leur emploi est un passage obligé pour acquérir une expérience de travail au Canada et viser ensuite un emploi à la hauteur de leurs compétences. Le processus de réadaptation peut soit se transformer en un « parcours déshonorant », soit fournir une occasion d'améliorer sa situation sur un marché du travail discriminant. Adapter les programmes à la réalité de ces travailleurs immigrants est possible, mais pose un dilemme moral et éthique : comment motiver les travailleurs à se rétablir tout en explorant un autre créneau d'emploi si leur lien d'emploi risque d'être rompu, alors que les règles relatives au droit de retour au travail prévoient la réintégration de l'emploi prélésionnel ou tout autre poste jugé équivalent ?

Source: Côté, D., Gravel, S., Dubé, J., Gratton, D., & White, B. (2017). Comprendre le processus de réadaptation et de retour au travail. Alterstice, 7(1), 21-38.
https://www.journal.psy.ulaval.ca/ojs/index.php/ARIRI/article/view/Gravel_Alterstice7%281%29

Return to work: A comparison of psychological and physical injury claims

The report examines the similarities and differences between psychological and physical claims. Two main areas are considered: RTW by potential influencing factors, and employees responses and experiences.

Source: https://www.safeworkaustralia.gov.au/doc/return-work-comparison-psychological-and-physical-injury-claims

Pratiques des milieux de travail pour assurer un retour en emploi sain et durable

Au Québec, la Loi sur les accidents du travail et des maladies professionnelles (LATMP) établit que tout travailleur ayant subi une lésion professionnelle qui porte atteinte à son intégrité physique ou psychique a droit à la réadaptation que requiert son état en vue de sa réinsertion sociale et professionnelle. La LATMP prévoit aussi un droit de retour au travail lorsque le travailleur redevient capable d’exercer son métier. Les organisations et les travailleurs sont donc directement concernés par la mise en place de solutions de retour au travail (RaT) adéquates, durables et efficaces. Alors que la littérature récente nous renseigne abondamment sur les principes d’intervention basés sur les données probantes permettant un RaT sain et durable (pratiques exemplaires), les pratiques des milieux de travail à cet égard auprès des travailleurs ayant subi un trouble musculosquelettique (TMS) ont été, à ce jour, peu étudiées. Globalement, la présente étude vise à évaluer les écarts éventuels entre les pratiques exemplaires de RaT, basées sur des données probantes, et les pratiques actuelles des milieux de travail pour, par la suite, proposer des pistes d’amélioration. Plus précisément, les objectifs spécifiques suivants ont été définis : 1) Identifier les pratiques exemplaires de RaT durable et de prévention de l’incapacité prolongée des travailleurs ayant subi un TMS; 2) Décrire les pratiques actuelles de RaT dans quelques organisations québécoises et déterminer les éléments contextuels facilitant leur mise en place; 3) Explorer les écarts entre les pratiques exemplaires recommandées en recherche et les pratiques actuelles des milieux de travail pour ensuite envisager des façons d’améliorer le transfert entre la théorie et la pratique.

Source: http://www.irsst.qc.ca/publications-et-outils/publication/i/100950/n/pratiques-milieux-travail-retour-emploi-sain-durable

Barriers to and facilitators of return to work after sick leave in workers with common mental disorders

Perspectives of workers, mental health professionals, occupational health professionals, general physicians and managers
Common mental disorders (CMDs), such as anxiety, stress and depression, are among the leading causes of disability worldwide and have a major impact in terms of lost productivity and sickness absence. Returning to work is a complex process in which different stakeholders may be involved and have to co-operate.
This report discusses the return-to-work process of workers on sick leave with CMDs, and the barriers and facilitators from a multi-stakeholder perspective, ie workers, managers, mental health professionals, occupational health professionals and general physicians. This research was undertaken by Tilburg University.

Source: https://www.iosh.co.uk/~/media/Documents/Books%20and%20resources/Tilburg%20full%20report%20final.pdf?la=en

Work, organisational practices, and margin of manoeuver during work reintegration

BACKGROUND: Many individuals of working age experience cardiovascular disease and are disabled from work as a result. The majority of research in cardiac work disability has focused on individual biological and psychological factors influencing work disability despite evidence of the importance of social context in work disability. In this article, the focus is on work and organisational features influencing the leeway (margin of manoeuvre) workers are afforded during work reintegration.
METHODS: A qualitative method was used. A large auto manufacturing plant was selected owing to work, organisational, and worker characteristics. Workplace context was assessed through site visits and meetings with stakeholders including occupational health, human resources and union personnel and a review of collective agreement provisions relating to seniority, benefits and accommodation. Worker experience was assessed using a series of in-depth interviews with workers (n = 12) returning to work at the plant following disabling cardiac illness. Data was analysed using qualitative content analysis.
RESULTS: Workers demonstrated variable levels of adjustment to the workplace that could be related to production expectations and work design. Policies and practices around electronic rate monitoring, seniority and accommodation, and disability management practices affected the buffer available to workers to adjust to the workplace.
CONCLUSIONS: Work qualities and organisational resources establish a margin of manoeuver for work reintegration efforts. Practitioners need to inform themselves of the constraints on work accommodation imposed by work organisation and collective agreements. Organisations and labour need to reconsider policies and practices that creates unequal accommodation conditions for disabled workers. Implications for rehabilitation Margin of manoeuvre offers a framework for evaluating and structuring work reintegration programmes. Assessing initial conditions for productivity expectations, context and ways and means to support work reintegration can be integrated with worker perceptions of work ability and possibilities for adaptation to structure and then monitor work reintegration programmes. Margin of manoeuvre can be used to evaluate sustainability of work at the end of rehabilitation. Cause-based workers' compensation schemes, collective agreement provisions, and organisational approaches to non-compensable disability create two tiers of disabled workers and make certain workers more vulnerable to occupational disability.

Source: O'Hagan, F. (2017). Disability and Rehabilitation, 1-10.
https://doi.org/10.1080/09638288.2017.1383520

How do line managers experience and handle the return to work of employees on sick leave due to work-related stress?

A one-year follow-up study
PURPOSE: To examine how line managers experience and manage the return to work process of employees on sick leave due to work-related stress and to identify supportive and inhibiting factors.
MATERIALS AND METHODS: Semi-structured interviews with 15 line managers who have had employees on sick leave due to work-related stress. The grounded theory approach was employed.
RESULTS: Even though managers may accept the overall concept of work-related stress, they focus on personality and individual circumstances when an employee is sick-listed due to work-related stress. The lack of a common understanding of stress creates room for this focus. Line managers experience cross-pressure, discrepancies between strategic and human-relationship perspectives and a lack of organizational support in the return to work process.
CONCLUSION: Organizations should aim to provide support for line managers. Research-based knowledge and guidelines on work-related stress and return to work process are essential, as is the involvement of coworkers. A commonly accepted definition of stress and a systematic risk assessment is also important. Cross-pressure on line managers should be minimized and room for adequate preventive actions should be provided as such an approach could support both the return to work process and the implementation of important interventions in the work environment. Implication for rehabilitation Organizations should aim to provide support for line managers handling the return to work process. Cross-pressure on line managers should be minimized and adequate preventive actions should be provided in relation to the return to work process. Research-based knowledge and guidelines on work-related stress and return to work are essential. A common and formal definition of stress should be emphasized in the workplace.

Source: Ladegaard, Y., Skakon, J., Elrond, A. F., & Netterstrøm, B. (2017). Disability and Rehabilitation, 1-9.
http://dx.doi.org/10.1080/09638288.2017.1370733

Cadre de référence sur le soutien et la réintégration au travail

Vers une approche axée sur la collaboration
Le cadre de référence sur le soutien et la réintégration au travail est destiné à l'ensemble des établissements du réseau de la santé et des services sociaux. Il s'adresse d'abord à la haute direction, particulièrement à la Direction des ressources humaines, des communications et des affaires juridiques, qui est responsable du service de la gestion de la présence au travail. Il s'adresse ensuite à l'ensemble du personnel d'encadrement et des employés des établissements, qui ont tous un rôle à jouer dans le soutien et la réintégration au travail des employés en invalidité.

Source: http://publications.msss.gouv.qc.ca/msss/document-001946/

Legislative change enabling use of early part-time sick leave enhanced return to work and work participation in Finland

Part-time sick leave is used in many countries to enhance return to work, however its effectiveness – especially at the early stage of work disability – is not known. This quasi-experiment utilizing propensity
score matching shows that part-time sick leave, started during the first 12 weeks of work disability, enhances return to work and increases work participation over a 2-year period.

Source: Viikari-Juntura E, Virta LJ, Kausto J, Autti-Rämö I, Martimo K-P, Laaksonen M, Leinonen T, Husgafvel-Pursiainen K, Burdorf A, Solovieva S. (2017). Scand J Work Environ Health.
http://dx.doi.org/10.5271/sjweh.3664

Models of care for the management of persistent musculoskeletal pain and/or depression

Musculoskeletal pain can occur following damage to the muscles, ligaments, tendons, and bones. The three main causes of musculoskeletal pain are unusual or repetitive strain on the system, trauma to a specific area from a fall, sprain or blow, and certain musculoskeletal diseases.1 Many Australians experience musculoskeletal pain, however for a few, this becomes chronic or persistent. 2 Persistent musculoskeletal pain is often associated with depression and anxiety.3 Persistent musculoskeletal pain is a major cause of disability in older age and a major cause of work absence in the working age population. Low back pain is the most common type of persistent musculoskeletal pain.

Source: http://www.iscrr.com.au/__data/assets/pdf_file/0004/1007950/Horizon-Scanning-Brief-July-2017-Models-of-Care-Musculoskeletal-Pain-Depression.pdf

Return to work after mild-to-moderate stroke: work satisfaction and predictive factors

A large proportion of stroke patients are unable to return to work (RTW), although figures vary greatly. A total of 121 mild-to-moderate stroke patients, who had a paid job at the time of their stroke were included (a) to quantify RTW and work satisfaction one-year post-stroke (using the Utrecht Scale for Evaluation of Rehabilitation-Participation) and (b) to determine factors predicting RTW post-stroke, based on stroke-related, personal and neuropsychological variables. Half of the patients were not in work (28%) or were working less (22%) than pre-stroke. Ninety percent of those in fulltime employment post-stroke were satisfied with their occupational situation, against 36% of the unemployed participants. In regards to factors predicting RTW, global cognitive functioning (r = .19, Montreal Cognitive Assessment) and depressive symptoms (r = −.16, Hospital Anxiety and Depression Scale) at two months post-stroke onset were associated with return to work within one year. Only global cognitive functioning was an independent predictor of RTW (11.3% variance, p = .013). Although the explained variance was not that high, neuropsychological factors probably play a pivotal role in returning to work and should be taken into account during rehabilitation after mild and moderate stroke.

Source: van der Kemp, J., Kruithof, W. J., Nijboer, T. C., van Bennekom, C. A., van Heugten, C., & Visser-Meily, J. M. (2017). Neuropsychological Rehabilitation, 1-16.
http://dx.doi.org/10.1080/09602011.2017.1313746

Return to work after work-related stress

A randomized controlled trial of a work-focused cognitive behavioral intervention
In this randomized controlled trial (RCT) study, a work-focused cognitive behavioral therapy (CBT) treatment combined with an optional workplace intervention was associated with faster lasting return to work compared to a control group that received clinical assessment among patients on sick leave due to work-related stress. The intervention group returned to work four weeks faster, which could have substantial financial impact on both the employee and related societal costs.

Source: Dalgaard, V. L., Aschbacher, K., Andersen, J. H., Glasscock, D. J., Willert, M. V., Carstensen, O., & Biering, K. (2017). Scandinavian Journal of Work, Environment & Health.
http://dx.doi.org/10.5271/sjweh.3655

Length of sickness absence and sustained return-to-work in mental disorders and musculoskeletal diseases

A cohort study of public sector employees
This study adds to the scientific evidence on the length of sickness absence until sustained return to work (SRTW) in depression, anxiety disorders, intervertebral disc disorders, and back pain among Finnish public sector employees. Timescales are provided for returning to work in different occupational groups also taking into consideration the persistence of the health problem and comorbid conditions.

Source: Kausto, J., Pentti, J., Oksanen, T., Virta, L. J., Virtanen, M., Kivimäki, M., & Vahtera, J. (2017). Scandinavian Journal of Work, Environment & Health.
http://dx.doi.org/10.5271/sjweh.3643

Work ability in rheumatoid arthritis patients

A register study on the prospective risk of exclusion and probability of returning to work
Objectives: The aim was to study work ability in patients with RA compared with the general population by investigating the rates and risks of long-term sickness absence, unemployment and disability pension, and the chance of returning to work and the changes in these risks over time (1994-2011). Methods: This was a cohort study with up to 17 years of follow-up (mean 6.95 years/person) including 6677 RA patients of working age (identified in the nationwide DANBIO registry) and 56 955 matched controls from the general population. A multi-state model was used to analyse all shifts between the work-related states (long-term sickness absence, unemployment and disability pension, as well as the chance of returning to work) and calculate hazard rates (HRs). Analyses were stratified by disease duration and controlled for socio-demographic factors, physical job exposure and somatic and psychiatric co-morbidities. Results: RA patients had increased risk of long-term sickness absence (e.g. early RA: HR = 4.00, 95% CI: 3.64, 4.30) and disability pension (e.g. established RA: HR = 2.75, 95% CI: 2.54, 2.98) relative to controls. From 1994-99 to 2006-11, a decrease in the effect of established RA was observed [long-term sickness absence: from HR = 2.25 (95% CI: 1.99, 2.54) to 1.63 (95% CI: 1.51, 1.75); and disability pension: from HR = 3.49 (95% CI: 2.83, 4.32) to 2.40 (95% CI: 2.15, 2.69)]. RA patients had a lower chance of returning to work from long-term sickness absence or unemployment (HR = 0.60, HR=0.80), and this did not change over time. Conclusion: RA patients remain at high risk for long-term sickness absence and disability pension, despite a positive development between 1996-99 and 2006-11. Returning to work after sick leave or unemployment remains a challenge for RA patients.

Source: Hansen, S. M., Hetland, M. L., Pedersen, J., Østergaard, M., Rubak, T. S., & Bjorner, J. B. (2017). Rheumatology.
https://doi.org/10.1093/rheumatology/kex064

Relations interculturelles - Comprendre le processus de réadaptation et de retour au travail

Dans le domaine de la santé et de la sécurité du travail (SST), les barrières linguistiques et culturelles sont souvent décrites comme des facteurs de vulnérabilité des travailleurs. Il est rapporté que de telles barrières ont déjà été ou sont encore à l'origine d'erreurs diagnostiques ou de mauvaises évaluations cliniques, compliquant ainsi le processus de réadaptation et de retour au travail. La problématique de la réadaptation et du retour au travail dans le contexte de la rencontre interculturelle est pourtant peu documentée à l'échelle internationale. Il devient impératif de connaître l'expérience et la perspective de chacun des acteurs et de cibler des besoins et des problèmes spécifiques sur lesquels il faudra concentrer les efforts de recherche et de développement. L'objectif général de cette étude vise à déterminer les stratégies mises de l'avant par les différents acteurs pour faciliter le processus de réadaptation et de retour au travail des travailleurs dans le contexte de la rencontre interculturelle. Elle vise à décrire l'expérience et la perspective de chaque partie concernée (travailleurs, cliniciens, conseillers en réadaptation, milieux de travail) pour mieux faire ressortir les contraintes, les obstacles, les facilitateurs et les besoins spécifiques.

Source: http://www.irsst.qc.ca/publications-et-outils/publication/i/100929/n/relations-interculturelles-readaptation-retour-travail

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