Troubles mentaux : quelles conséquences sur le maintien dans l'emploi ?

Environ 12 % des femmes et 6 % des hommes âgés de 30 à 55 ans, qui travaillent en 2006, déclarent souffrir au moins d'un trouble mental (trouble anxieux généralisé ou épisode dépressif caractérisé). Parmi ces personnes, plus de 20 % invoquent une limitation d'activité, environ 45 % indiquent souffrir d'une maladie chronique et près de la moitié se considèrent en mauvaise santé.
Ces données statistiques sont issues de l'enquête Santé et itinéraire professionnel (SIP), réalisée conjointement par la DREES et la DARES, en 2006 et 2010.
Les personnes déclarant souffrir de troubles mentaux ont sensiblement moins de chances de garder une activité professionnelle que celles qui n'en ont pas signalé. En effet, 86 % des femmes et 82 % des hommes porteurs de ces troubles ont conservé une activité professionnelle en 2010, contre respectivement 92 % et 93 % des personnes n'en déclarant pas.
Les troubles anxieux généralisés affectent la trajectoire professionnelle des hommes, mais pas celle des femmes. Ce sont les limitations d'activité déclarées qui augmentent le plus le risque de ne pas garder son emploi.
Le rôle propre de la santé mentale (en regard des poids respectifs de l'état de santé général et des comportements à risque) reste, cependant, à apprécier, car les caractéristiques individuelles et professionnelles ont traditionnellement une incidence sur le maintien dans l'emploi.
Ainsi, parmi les variables socio-économiques, l'âge au-delà de 50 ans, la présence d'enfants et le travail à temps partiel (chez les femmes), le niveau de diplôme ainsi que la profession et la catégorie socioprofessionnelle (chez les hommes) ont un effet significatif sur la capacité des personnes à conserver un emploi.


Exploring factors facilitating adults with spinal cord injury rejoining the workforce

A pilot study
BACKGROUND: Return-to-work (RTW) rates after spinal cord injury (SCI) in the USA are very low and are continuing to decline. Previous research has attempted to identify factors facilitating RTW; however, the phenomenon of RTW involves many personal factors and predicting RTW success remains difficult.
PURPOSE: The purpose of this pilot study was to explore the factors facilitating adults with SCI rejoining the workforce in an urban area in order to identify items that may be emphasized in the rehabilitation process.
METHODS: The study was completed using qualitative methods. Four adults who had acquired a traumatic SCI in adulthood and were currently employed participated. Their experiences in RTW after injury were collected via semi-structured interviews and photography of assistive devices.
RESULTS: The most common facilitating factor was motivation, with family and rehabilitation professionals serving as extrinsic motivators. Other facilitators were resources and perceived benefits.
CONCLUSIONS: Motivation and resources were important facilitators, including rehabilitation professional's personal influence and therapies, and resource assistance from state agencies. The results indicate that practitioners can play an important role in influencing RTW, and resources from state agencies are helpful when individuals know how to access and utilize them. Implications for Rehabilitation Assistive technology supports successful return to work after SCI. Motivation strongly influences return to work after SCI and can be influenced by rehabilitation professionals, family and community members. Patients should be well informed about how to access assistance programs such as vocational rehabilitation.

Source: Wilbanks SR, Ivankova NV. Disabil. Rehabil. 2014.

Systematic review of return to work after mild traumatic brain injury

Results of the International Collaboration on Mild Traumatic Brain Injury Prognosis
OBJECTIVE: To synthesize the best available evidence on return to work (RTW) after mild traumatic brain injury (MTBI). DATA SOURCES: MEDLINE and other databases were searched (2001-2012) with terms including "craniocerebral trauma" and "employment." Reference lists of eligible articles were also searched. STUDY SELECTION: Controlled trials and cohort and case-control studies were selected according to predefined criteria. Studies had to assess RTW or employment outcomes in at least 30 MTBI cases. DATA EXTRACTION: Eligible studies were critically appraised using a modification of the Scottish Intercollegiate Guidelines Network criteria. Two reviewers independently reviewed and extracted data from accepted studies into evidence tables. DATA SYNTHESIS: Evidence was synthesized qualitatively according to modified Scottish Intercollegiate Guidelines Network criteria and prioritized according to design as exploratory or confirmatory. After 77,914 records were screened, 299 articles were found eligible and reviewed; 101 (34%) of these with a low risk of bias were accepted as scientifically admissible, and 4 of these had RTW or employment outcomes. This evidence is preliminary and suggests that most workers RTW within 3 to 6 months after MTBI; MTBI is not a significant risk factor for long-term work disability; and predictors of delayed RTW include a lower level of education (<11y of formal education), nausea or vomiting on hospital admission, extracranial injuries, severe head/bodily pain early after injury, and limited job independence and decision-making latitude. CONCLUSIONS: Our findings are based on preliminary evidence with varied patient characteristics and MTBI definitions, thus limiting firm conclusions. More well-designed studies are required to understand RTW and sustained employment after MTBI in the longer term (≥2y post-MTBI).

Source: Cancelliere C, Kristman VL, Cassidy JD, Hincapié CA, Côté P, Boyle E, Carroll LJ, Stålnacke BM, Nygren-de Boussard C, Borg J. Arch. Phys. Med. Rehabil. 2014; 95(3S): S201-S209.

Assessing work ability

A cross-sectional study of interrater agreement between disability claimants, treating physicians, and medical experts
Objectives It is unclear to what extent assessments of work ability differ between disability claimants, their treating physicians, and multidisciplinary medical expert teams.
Methods We compared assessments of work ability for consecutive disability claimants referred to a multidisciplinary assessment center in Switzerland over a 4-year period. Assessments were made for the last job (LJ) prior to claiming a disability benefit and an alternative job (AJ) thought to suit the claimant's physical and mental abilities. Mean differences (MD) in percentage work ability between assessments from claimants, physicians, and experts were then estimated in a linear regression model.
Results The 3562 claims made during the study period were mostly due to musculoskeletal and depressive disorders. Assessments differed little between claimants and physicians [LJ MD 1.3% (95% confidence interval [95% CI] 0.5–2.2%); AJ MD 11% (95% CI 10–12%)]. Experts on average assessed a claimant's work ability higher than either the claimant or physician, particularly in the AJ [MD between expert and claimant 57% (95% CI 56–58%) and between expert and physician 46% (95% CI 45–48%)].
Conclusions Assessments of work ability differed substantially between experts in multidisciplinary medical teams and both claimants and their treating physicians. A careful evaluation of the disability assessment process is needed in an effort to reduce disagreement between expert teams and treating physicians and so improve acceptance of the process.

Source: Dell-Kuster S, Lauper S, Koehler J, Zwimpfer J, Altermatt B, Zwimpfer T, Zwimpfer L, Young J, Bucher HC, Nordmann AJ, Scand J Work Environ Health, 2014.

Estimating the Net Benefit of a Specialized Return-to-Work Program for Workers on Short-Term Disability Related to a Mental Disorder

An Example Exploring Investment in Collaborative Care
Objective: This article estimates the net benefit for a company incorporating a collaborative care model into its return-to-work program for workers on short-term disability related to a mental disorder.
Methods: Employing a simple decision model, the net benefit and uncertainty were explored.
Results: The breakeven point occurs when the average short-term disability episode is reduced by at least 7 days. In addition, 85% of the time, benefits could outweigh costs.
Conclusions: Model results and sensitivity analyses indicate that organizational benefits can be greater than the costs of incorporating a collaborative care model into a return-to-work program for workers on short-term disability related to a mental disorder. The results also demonstrate how the probability of a program's effectiveness and the magnitude of its effectiveness are key factors that determine whether the benefits of a program outweigh its costs.

Source: Dewa, Carolyn S. Hoch, Jeffrey S. Journal of Occupational & Environmental Medicine: June 2014 - Volume 56 - Issue 6 - p 628–631.

Functional and occupational characteristics predictive of a return to work within 18 months after stroke in Japan

Implications for rehabilitation
Objective: This study examined clinical, functional, and occupational factors associated with return to work within 18 months after stroke, specifically focusing on the impact of higher cortical dysfunction on return to work in the chronic phase. Methods: This prospective cohort study in 21 hospitals specializing in clinical and occupational health recruited consecutive working-age inpatients receiving acute care for their first stroke (n = 351). A unified database was used to extract patient information from hospital records at the time of admission, discharge, and follow-up at 18 months post-stroke. Cox proportional hazard regression analysis was conducted to determine clinical, functional, and occupational factors influencing return to work within 18 months. Results: Of 351 registered stroke patients (280 males, 71 females, mean age ± SD, 55.3 ± 7.2 years) who met inclusion criteria, 250 responded to the follow-up survey and 101 were lost to follow-up. Half (51 %) succeeded in returning to work during the 18-month follow-up after stroke onset. After adjusting for age, gender, and Barthel index at initial rehabilitation, the following factors were identified as significant predictors of a return to work: white-collar versus blue-collar occupation (hazard ratio (HR) 1.5; 95 % confidence interval (CI) 1.1-2.2), no aphasia (HR 3.0; 95 % CI 1.5-5.9), no attention dysfunction (HR 2.0; 95 % CI 1.0-4.0), and walking ability (HR 3.1; 95 % CI 1.3-7.1).Conclusions: This study indicated the importance of tailored rehabilitation to alleviate the impact of higher cortical dysfunction and to support return to work by stroke survivors.

Source: Tanaka H; Toyonaga T; Hashimoto H, International Archives Of Occupational And Environmental Health, 2014 May; Vol. 87 (4), p. 445-453.

Unintended consequences

The social context of cancer survivors and work
Purpose: This article describes the ways in which socioeconomic characteristics and workplace contexts shape the unintended consequences that cancer survivors can experience as they return to work. The study was conducted in an employment setting where there is a major focus on productivity and economic growth in the business sector. Methods: Five focus groups (N = 33 participants) were conducted in 2012 in Singapore. Questions were directed at obtaining information related to the meaning of a job and reactions to return to work as a cancer survivor completes primary cancer treatment. A thematic analysis using a two-staged analytical process was conducted to identify (1) work-related challenges faced by survivors as a result of the interplay between their self-identity as someone with a critical illness and organizational structure, and (2) unintended social consequences (USCs) related to the interaction between the workplace and cancer survivor. Results: Eight emerging themes of work-related challenges and unintended consequences were categorized. Fear of losing out by compromising one's expectation, downplaying illness to avoid being a burden to others, working harder to meet expectations, and passive acceptance to perceived discrimination. Unintended consequences were also observed in relation to policies, procedures, and economic factors in the context of a heightened economically driven social climate. Conclusions: This study contributes to the understanding of how cancer survivors perceive their work situation. These findings can inform health care providers, employers, and policy makers regarding the challenges faced by cancer survivors as they return to the workplace in a culture of a rapidly growing emphasis on economic concerns. Implications For Cancer Survivorship: These findings offer a new perspective on the complexities that can occur when cancer survivors interact with their workplace. Awareness of the existence and types of unintended consequences in this context can help provide a more comprehensive understanding of the cancer survivor and work interface.

Source: Mak AK; Chaidaroon S; Fan G; Thalib F, Journal Of Cancer Survivorship: Research And Practice, 2014 Jun; Vol. 8 (2), p. 269-81.

Barriers to Change in Depressive Symptoms Following Multidisciplinary Rehabilitation for Whiplash

The Role of Perceived Injustice
Objective: Depressive symptoms complicate patients' recovery following musculoskeletal injury. There is strong evidence to support the utility of multidisciplinary approaches for treating comorbid pain and depressive symptoms. Despite this, a significant proportion of patients may not experience meaningful reductions in depressive symptoms following intervention. The purpose of this study was to identify barriers to change in depressive symptom during multidisciplinary rehabilitation for patients with whiplash injuries.
Methods: 53 patients with clinically meaningful levels of depressive symptoms prior to participating in a standardized multidisciplinary rehabilitation program participated in this study. Patients completed self-report measures of depressive symptoms, demographic factors, pain intensity, disability, post-traumatic stress symptoms, pain catastrophizing and self-efficacy upon commencement and completion of the rehabilitation program. Analyses examined whether pre-treatment variables predicted change in depressive symptoms over treatment and the maintenance of clinically meaningful levels of depressive symptoms at post-treatment.
Results: Duration of work absence and perceived injustice were significant unique predictors of percent change in depressive symptoms in a linear regression analysis. Perceived injustice was the only significant unique predictor of the presence of clinically meaningful levels of depressive symptoms at post-treatment in a logistic regression analysis.
Conclusions: The results suggest that the identification of patients with high levels of perceived injustice and implementation of targeted interventions for these patients might contribute to greater improvements in their depressive symptomatology.

Source: Scott W, Trost Z, Milioto M, Sullivan MJ. Clin. J. Pain. 2014.

The Role of Stress in Absenteeism

Cortisol Responsiveness among Patients on Long-Term Sick Leave
Objective: This study aimed to (1) See whether increased or decreased variation relate to subjective reports of common somatic and psychological symptoms for a population on long-term sick leave; and (2) See if this pattern in variation is correlated with autonomic activation and psychological appraisal.Methods: Our participants (n?=?87) were referred to a 3.5-week return-to-work rehabilitation program, and had been on paid sick leave >8 weeks due to musculoskeletal pain, fatigue and/or common mental disorders. An extensive survey was completed, addressing socio-demographics, somatic and psychological complaints. In addition, a physician and a psychologist examined the participants, determining baseline heart rate, medication use and SCID-I diagnoses. During the 3.5-week program, the participants completed the Trier Social Stress Test for Groups. Participants wore heart rate monitors and filled out Visual Analogue Scales during the TSST-G.Results: Our participants presented a low cortisol variation, with mixed model analyses showing a maximal increase in free saliva cortisol of 26% (95% CI, 0.21-0.32). Simultaneously, the increase in heart rate and Visual Analogue Scales was substantial, indicating autonomic and psychological activation consistent with intense stress from the Trier Social Stress Test for Groups. Conclusions: The current findings are the first description of a blunted cortisol response in a heterogeneous group of patients on long-term sick leave. The results suggest lack of cortisol reactivity as a possible biological link involved in the pathway between stress, sustained activation and long-term sick leave.

Source: Jacobsen HB; Bjørngaard JH; Hara KW; Borchgrevink PC; Woodhouse A; Landrø NI; Harris A; Stiles TC, Plos One, 2014 May 02; Vol. 9 (5).

People with mental illness returning to work

A qualitative evaluation of a Norwegian project
Objective: Several studies demonstrate the need for a unified effort by the Norwegian Labour and Welfare Administration (NAV) and health services to support people with mental illness who wish to return to work and simultaneously receive treatment. The aim of the present qualitative evaluation study is to develop a deeper understanding of the participants' experiences of being involved in the NAV project called “Work, Substance Abuse and Mental Health”, which helps service recipients to combine work and treatment. Methods: The study involved the use of qualitative research interviews. Seven NAV project participants completed an interview and their data were analysed using qualitative content analysis. Results: The results suggest that this project is effective from both a salutogenic perspective and a recovery-oriented perspective. Increased lust for life as a result of diverse forms of support and a flexible personalized service with rapid intervention was identified. The results also show phenomena that contributed to stagnation and life longings, or a decrease in quality of life. Conclusion: The success of the project depends on the NAV office. Future research should investigate cooperation between therapists and NAV advisers, participants' ambivalence, and explore other factors important for relationship building.

Source: Mikkelsgård, Karin Alice; Granerud, Arild; Høye, Sevald; Scandinavian Journal of Occupational Therapy, 2014 May; 21 (3): 172-80.

Quality of Working Life Issues of Employees with a Chronic Physical Disease

A Systematic Review
Purpose: To assess issues that contribute to the Quality of Working Life (QWL) of employees with a chronic physical disease. Methods: A systematic literature search was conducted using the databases PubMed, PsycINFO and EMBASE. Experiences and perceptions during the working life of employees with a chronic physical disease were extracted and synthesized into issues that contributed to their QWL. We organized these synthesized QWL issues into higher order themes and categories with qualitative data analysis software. Results: From a total of 4,044 articles identified by the search, 61 articles were included. Data extraction and data synthesis resulted in an overview of 73 QWL issues that were classified into 30 themes. The following five categories of themes were identified: (1) job characteristics with issues such as job flexibility and work-site access; (2) the social structure and environment containing issues about disclosure, discrimination, misunderstanding, and awareness by employers or colleagues; (3) organizational characteristics with issues such as requesting work accommodations; (4) individual work perceptions including issues about enjoyment and evaluating work or life priorities; and (5) effect of the disease and treatment including issues about cognitive and physical health and work ability. Conclusion: This systematic review offers an extensive overview of issues that might contribute to the QWL of employees with a chronic physical disease. This overview may function as a starting point for occupational support, such as monitoring and evaluating the QWL of employees with a chronic physical disease during return-to-work and work continuation processes.

Source: de Jong M; de Boer AG; Tamminga SJ; Frings-Dresen MH, Journal Of Occupational Rehabilitation, 2014, May 16.

Decrease social inequalities return-to-work

Development and design of a randomised controlled trial among women with breast cancer
Abstract: Background Despite the improvement in the care management, women cancer patients who are still in employment find themselves for the most part obliged to stop working while they are having treatment. Their return-to-work probability is impacted by numerous psychosocial factors. The objective is to describe the development and the content of an intervention aimed to facilitate the return to work of female breast cancer patients and in particular the women in the most precarious situations through early active individualised psychosocial support (APAPI). Methods: The intervention proposed is made up of 4 interviews with a psychologist at the hospital, distributed over the year according to the diagnosis and conducted on the same day as a conventional follow-up consultation, then a consultation with a specialist job retention physician. We expect, in the first instance, that this intervention will reduce the social inequalities of the return-to-work rate at 12 months. The EPICES score will enable the population to be broken down according to the level of social precariousness. The other expected results are the reduction of the social inequalities in the quality of the return to work at 18 and 24 months and the disparities between the individual and collective resources of the patients. This intervention is assessed in the context of a controlled and randomised multi-centre study. The patients eligible are women aged between 18 and 55 years with a unilateral breast cancer with local extension exclusively, having received surgery followed by adjuvant chemotherapy, in employment at the time of the diagnosis and dealt with by one of the 2 investigating centres. Discussion: It is essential to assess this type of intervention before envisaging its generalisation. The study set in place will enable us to measure the impact of this intervention aiming to facilitate the return to work of breast cancer patients, in particular for those who suffer from social fragility, compared with the standard care.

Source: Vidor, Clémence; Leroyer, Ariane; Christophe, Véronique; Seillier, Mélanie; Foncel, Jérome; Van de Maële, Justine; Bonneterre, Jacques; Fantoni, Sophie. BMC Cancer. 2014, Vol. 14 Issue 1, p1-20.

Absence from work and return to work in people with back pain

A systematic review and meta-analysis
Background: A considerable proportion of work absence is attributed to back pain, however prospective studies in working populations with back pain are variable in setting and design, and a quantitative summary of current evidence is lacking.Objective: To investigate the extent to which differences in setting, country, sampling procedures and methods for data collection are responsible for variation in estimates of work absence and return to work.Methods: Systematic searches of seven bibliographic databases. Inclusion criteria were: adults in paid employment, with back pain, work absence or return to work during follow-up had been reported. Random effects meta-analysis and meta-regression analysis was carried out to provide summary estimates of work absence and return to work rates.Results: 45 studies were identified for inclusion in the review; 34 were included in the meta-analysis. The pooled estimate for the occurrence of work absence in workers with back pain was 15.5% (95% CI 9.8% to 23.6%, n=17 studies, I(2) 98.1%) in studies with follow-up periods of ≤6 months. The pooled estimate for the proportion of people with back pain returning to work was 68.2% (95% CI 54.8% to 79.1%, n=13, I(2) 99.2%), 85.6% (95% CI 78.2% to 90.7%, n=13, I(2) 98.7%) and 93.3% (95% CI 84.0% to 94.7%, n=10, I(2) 99%), at 1 month, 1-6 months and ≥6 months, respectively. Differences in setting, risk of participation bias and method of assessing work absence explained some of the heterogeneity.Conclusions: Pooled estimates suggest high return to work rates, with wide variation in estimates of return to work only partly explained by a priori defined study-level variables. The estimated 32% not back at work at 1 month are at a crucial point for intervention to prevent long term work absence.

Source: Wynne-Jones G; Cowen J; Jordan JL; Uthman O; Main CJ; Glozier N; van der Windt D, Occupational And Environmental Medicine, 2014 Jun; Vol. 71 (6), p. 448-456.

Prognostic Factors for Return to Work, Sickness Benefits, and Transitions Between These States

A 4-year Follow-up After Work-Related Rehabilitation
Purpose The aim of this study was to examine if age, gender, medical diagnosis, occupation, and previous sick leave predicted different probabilities for being at work and for registered sickness benefits, and differences in the transitions between any of these states, for individuals that had participated in an interdisciplinary work-related rehabilitation program. Methods 584 individuals on long-term sickness benefits (mean 9.3 months, SD = 3.4) were followed with official register data over a 4-year period after a rehabilitation program. 66 % were female, and mean age was 44 years (SD = 9.3). The majority had a mental (47 %) or a musculoskeletal (46 %) diagnosis. 7 % had other diagnoses. Proportional hazards regression models were used to analyze prognostic factors for the probability of being on, and the intensity of transitions between, any of the following seven states during follow-up; working, partial sick leave, full sick leave, medical rehabilitation, vocational rehabilitation, partial disability pension (DP), and full DP. Results In a fully adjusted model; women, those with diagnoses other than mental and musculoskeletal, blue-collar workers, and those with previous long-term sick leave, had a lower probability for being at work and a higher probability for full DP during follow-up. DP was also associated with high age. Mental diagnoses gave higher probability for being on full sick leave, but not for transitions to full sick leave. Regression models based on transition intensities showed that risk factors for entering a given state (work or receiving sickness benefits) were slightly different from risk factors for leaving the same state. Conclusions The probabilities for working and for receiving sickness benefits and DP were dependent on gender, diagnoses, type of work and previous history of sick leave, as expected. The use of novel statistical methods to analyze factors predicting transition intensities have improved our understanding of how the processes to and from work, and to and from sickness benefits may differ between groups. Further research is required to understand more about differences in prognosis for return to work after intensive work-related rehabilitation efforts.

Source: Oyeflaten I; Lie SA; Ihlebæk CM; Eriksen HR, Journal Of Occupational Rehabilitation, 2014 Jun; Vol. 24 (2), p. 199-212.

Does part-time sick leave help individuals with mental disorders recover lost work capacity?

Purpose: This paper aims to answer the question whether combining sick leave with some hours of work can help employees diagnosed with a mental disorder (MD) increase their probability of returning to work. Given the available data, this paper analyzes the impact of part-time sick leave (PTSL) on the probability of fully recovering lost work capacity for employees diagnosed with an MD. Methods: The effects of PTSL on the probability of fully recovering lost work capacity are estimated by a discrete choice one-factor model using data on a nationally representative sample extracted from the register of the National Agency of Social Insurance in Sweden and supplemented with information from questionnaires. All individuals in the sample were 20-64 years old and started a sickness spell of at least 15 days between 1 and 16 February 2001. We selected all employed individuals diagnosed with an MD, with a final sample of 629 individuals. Results: The results show that PTSL is associated with a low likelihood of full recovery, yet the timing of the assignment is important. PTSL's effect is relatively low (0.015) when it is assigned in the beginning of the spell but relatively high (0.387), and statistically significant, when assigned after 60 days of full-time sick leave (FTSL). This suggests efficiency improvements from assigning employees with an MD diagnosis, when possible, to PTSL. Conclusions The employment gains will be enhanced if employees with an MD diagnosis are encouraged to return to work part-time after 60 days or more of FTSL.

Source: Andrén D, Journal Of Occupational Rehabilitation, 2014 Jun; Vol. 24 (2), p. 344-60.

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