Perspectives of unemployed workers with mental health problems: barriers to and solutions for return to work

Purpose: To evaluate the barriers to and solutions for return to work (RTW) from the perspective of unemployed workers who were sick-listed due to mental health problems.

Methods: We conducted semi-structured interviews with 25 sick-listed unemployed workers with mental health problems. Qualitative data analysis was performed, using a process of identifying, coding, and categorising the patterns in data.

Results: All workers experienced multiple problems in different domains of life related to their disease, personal circumstances (e.g., divorced, debts) and their environment (e.g., labour market problems, issues with the Social Security Agency). Workers differed in the way they perceived their RTW process and in the extent to which they were able to envision and implement the solutions for RTW, thus resulting in three types of workers’ attitudes towards their own RTW process: (1) “frozen”; (2) “insightful though passive”; and (3) “action mode”.

Conclusions: We conclude that the sick-listed unemployed workers with mental health problems have to deal with multiple problems, of which medical problems are only a part. These workers need help aimed at their coping methods according to one of the three types of workers’ characteristics. Moreover, they need specific help organising and structuring their problems, getting their life back on track, and finding employment.

• Implications for Rehabilitation

• Unemployed workers with mental health problems face considerable challenges which impede their return to work. Evaluating the workers’ attitude may provide useful information on their own return-to-work process.

• In many cases, workers indicate a need for coaching to help them with problem-solving, planning, gaining structure, getting their life back on track, and finding employment.

• Rehabilitation professionals should tailor RTW interventions to the needs of these workers, aimed at their specific problems and taking into account the workers’ coping methods according to one of three types of workers’ attitudes towards their own RTW process.

     

Associations between socio-demographic factors,encounters with healthcare professionals and perceived ability to return to work in people sick-listed due to heart failure in Sweden: a cross-sectional study

Purpose: The aim of this study was to investigate associations between socio-demographic factors, experiences of positive/negative encounters with healthcare professionals, and the encounters' impact on the ability to return to work in a population of people on sick leave due to heart failure. Methods: This was a cross-sectional study. Data were collected from two official registries in Sweden and from a postal questionnaire. In all, 590 people with heart failure responded to the questionnaire. Associations between variables were calculated with bivariate correlation analyses and logistic regression analyses. Results: For people on sick leave due to heart failure, positive encounters with healthcare professionals are associated with being Swedish-born, female gender, and high income. People with high income are more likely to be supported back to work by positive encounters with healthcare professionals. To perceive that healthcare professionals believe in person's ability to return to work can be facilitating. Conclusions: Women, people who are not foreign-born, and people with high income are more likely to perceive encounters with healthcare professionals as positive. Healthcare professionals who work with rehabilitation for people with heart failure need to be aware of social inequalities and that being on sick leave is a process of change.

• Implications for Rehabilitation

• A failing heart limits everyday life implying risk for long-term sick leave. Even though there are rehabilitation programs for people with heart failure, vocational rehabilitation is often over-looked. The knowledge about factors associated with sick leave due to heart failure is scarce.

• Experiences of positive encounters with healthcare professionals were associated with being Swedish-born, female gender, and high income. People with high income were more likely to be supported back to work by positive encounters with healthcare professionals.

• Healthcare professionals who work with rehabilitation for people with heart failure can support patients with heart failure by showing them confidence and trust. However, they need to be aware that sick leave implies a process of change.

     

Quality of life and maintenance of improvements after early multimodal rehabilitation: a 5-year follow-up

Purpose. There is a paucity of long-term evaluations on rehabilitation of musculoskeletal disorders, e.g., neck, shoulder or back pain. The aim of this study was to assess quality of life and the effect of early multimodal rehabilitation on 91 patients with musculoskeletal pain and disability at a 5-year follow-up.

Method. The follow-up assessment, which included questions on pain, function, quality of life, perceived health, sick leave and psychosomatic symptoms, was performed 5 years after the assessment of baseline status.

Results. Improvements in pain, perceived health and psychosomatic symptoms were maintained at the 5-year follow-up. In addition, improvements in function, quality of life, and level of acceptable pain were significant in comparison to baseline. At the time of the baseline assessment all patients were on sick leave (13% were on partial sick leave). At the 5-year follow-up, 58% of the patients were at work part or full time. The results show that those working differed significantly from those not working at the 5-year follow-up on almost all variables, indicating that those working enjoy better health. The most salient prognostic factors for return to work were perceived health and educational level at the time of the baseline evaluation.

Conclusions. These results show that treatment improved quality of life and the effects were basically maintained at 5 years. Work capacity as reflected in return to work increased greatly (81%) at a 1-year follow-up and was substantial (58%) at the 5-year follow-up. Moreover, perceived health and educational levels were important prognostic factors. Finally, the fact that patients working reported better health underscores the probable importance of return to work. Our results imply that it may be feasible to obtain long-term benefits from such a primary care-based intervention.     

Quality of life and maintenance of improvements after early multimodal rehabilitation: A 5-year follow-up

Purpose.?There is a paucity of long-term evaluations on rehabilitation of musculoskeletal disorders, e.g., neck, shoulder or back pain. The aim of this study was to assess quality of life and the effect of early multimodal rehabilitation on 91 patients with musculoskeletal pain and disability at a 5-year follow-up.

Method.?The follow-up assessment, which included questions on pain, function, quality of life, perceived health, sick leave and psychosomatic symptoms, was performed 5 years after the assessment of baseline status.

Results.?Improvements in pain, perceived health and psychosomatic symptoms were maintained at the 5-year follow-up. In addition, improvements in function, quality of life, and level of acceptable pain were significant in comparison to baseline. At the time of the baseline assessment all patients were on sick leave (13% were on partial sick leave). At the 5-year follow-up, 58% of the patients were at work part or full time. The results show that those working differed significantly from those not working at the 5-year follow-up on almost all variables, indicating that those working enjoy better health. The most salient prognostic factors for return to work were perceived health and educational level at the time of the baseline evaluation.

Conclusions.?These results show that treatment improved quality of life and the effects were basically maintained at 5 years. Work capacity as reflected in return to work increased greatly (81%) at a 1-year follow-up and was substantial (58%) at the 5-year follow-up. Moreover, perceived health and educational levels were important prognostic factors. Finally, the fact that patients working reported better health underscores the probable importance of return to work. Our results imply that it may be feasible to obtain long-term benefits from such a primary care-based intervention.     

Exploring activity limitations and sick leave among patients with spinal pain participating in multidisciplinary rehabilitation

Purpose.?To describe limitations in 12 activities at baseline, after multidisciplinary rehabilitation and at a 6-month follow-up for patients with spinal pain and, further, to investigate whether low limitation in any of the activities or in the mean score at baseline might predict increased working time at follow-up.

Method.?A prospective cohort study of 302 patients, 22- to 63-years old, who participated in multidisciplinary rehabilitation because of chronic neck, thoracic and/or lumbar pain. Data from the Disability Rating Index questionnaire were obtained at baseline, after the 4-week rehabilitation programme, and at the 6-month follow-up. Two subgroups are described: patients who at baseline (1) worked full-time or (2) were on part- or full-time sick leave.

Results.?The degree of limitation in the 12 activities (items) showed large variations in median scores (7–91). Both subgroups showed significant improvements in most activities after rehabilitation, which remained at the follow-up. Nevertheless, in the sick-leave group, patients who had increased their working time at follow-up (62%) were still very limited in running, heavy work, and lifting heavy objects. In logistic regressions, low limitation in standing bent over a sink at baseline was the only single activity that predicted increased working time at the follow-up: odds ratio (OR) 1.93 (95% CI 1.1–3.5). OR for the mean score was 1.8 (1.0–3.3).

Conclusion.?A profile of the separate activities demonstrates the large variation in the degree of limitation, which is concealed in a mean score. The single items can be useful when evaluating interventions. However, to predict increased working time after rehabilitation, the mean score, as well as the activity standing bent over a sink, proved useful.     

慢性失眠患者失眠程度、抑郁情绪与生活质量的相关性

目的 通过探讨慢性失眠患者失眠严重程度、抑郁情绪与生活质量的相关性,评估影响患者生活质量的主要因素.方法 连续收集126例成年慢性失眠患者,根据失眠严重程度指数量表(ISI)得分分为亚临床、中度、重度失眠三组,根据贝克抑郁问卷(BDI)得分分为伴和不伴抑郁两组,用SF-36健康调查量表(SF-36)评分,分别对生活质量进行比较.结果 失眠程度重的患者SF-36(除机体疼痛外)得分低(P<0.01);伴有抑郁情绪的患者SF-36(除机体疼痛外)得分低(P<0.05);相关性分析得出ISI得分与SF-36(除机体疼痛外)得分呈负相关(P<0.05),BDI得分与SF-36得分呈显著负相关(P<0.01);控制BDI变量偏相关分析,ISI得分与SF-36(生理功能、生理职能、总体健康、活力和生理健康)得分呈负相关(P<0.05);控制ISI变量偏相关分析,BDI得分与SF-36得分(除生理机能和机体疼痛外)呈显著负相关(P<0.01).结论 慢性失眠患者失眠严重程度与生活质量相关,但与慢性失眠相关的抑郁情绪起到主要作用,这提示慢性失眠治疗中应注重改善患者情绪问题.     

The prevalence of migraine in patients with bipolar and unipolar affective disorders

There is a well-known association between migraine and affective disorders, but the information is sparse concerning the prevalence of migraine in subgroups of the affective disorders. The present study was undertaken to investigate the prevalence of migraine in unipolar depressive, bipolar I and bipolar II disorders. Patients with major affective disorders (n = 62), consecutively admitted to an open psychiatric ward, were examined with a semi-structured interview based on DSM-IV diagnostic criteria, combined with separate criteria for affective temperaments. Diagnosis of unipolar and bipolar I disorders followed the DSM-IV criteria, while bipolar II disorder encompassed patients with either discrete hypomanic episodes or a cyclothymic temperament. Migraine was diagnosed according to IHS-criteria. Symptoms of migraine were found to be common in these patients, both in those with unipolar depression (46% prevalence of migraine) and in those with bipolar disorders (44% prevalence). Among the bipolar patients there was, however, a striking difference between the two diagnostic subgroups, with a prevalence of 77% in the bipolar II group compared with 14% in the bipolar I group (P = 0.001). These results support the contention that bipolar I and II are biologically separate disorders and point to the possibility of using the association of bipolar II disorder with migraine to study both the pathophysiology and the genetics of this affective disorder.     

The relationship between involvement in activities and quality of life for people with severe and enduring mental illness

A number of authors have indicated that people who have greater and more satisfactory social activity tend to report that they have higher life satisfaction. This study was concerned with examining the relationship between involvement in activities and self-reported quality of life for people with severe and enduring mental illness. It is part of a larger study of quality of life for this client group. A random sample of 92 respondents was drawn from the population of people who met the criteria for severe and enduring mental illness in a Health Board in Northern Ireland. Data were gathered using a reliable and valid interview schedule based on a quality of life profile developed for the larger study. The findings indicated that over half of the respondents (56.5%, n=52) had no structured activity in their everyday life and there was a low level of participation in 14 listed activities of living. The respondents also reported a low level of self-reported quality of life. There was also a weak, but statistically significant, correlation between involvement in activities and self-reported quality of life. However, a moderate positive statistically significant correlation was found to exist between satisfaction with involvement in activities and self-reported quality of life. The implications for the care of people who are experiencing severe and enduring mental illness within and outside the United Kingdom are discussed.     

Early identification of work-related stress predicted sickness absence in employed women with musculoskeletal or mental disorders: a prospective,longitudinal study in a primary health care setting

Purpose: The objectives were to identify work-related stress, and to analyse whether or not work-related stress served to predict sick-leave in a population of employed women who saw a doctor due to musculoskeletal or mental disorder at primary health care centres. Methods: This prospective study was based on data collected with the Work Stress Questionnaire (WSQ) at baseline 2008 and at follow-up 2009 in the primary health care centres in western Sweden. A total of 198 women participated. Results: High perceived stress owing to indistinct organization and conflicts at baseline increased the risk for sick-leave 8 days or longer at follow-up. The adjusted relative risk (RR) was 2.50 (1.14–5.49). The combination of high stress perception owing to indistinct organization and high stress perception owing to individual demands and commitment increased the risk for sickness absence of 8 days or longer with an adjusted RR of 4.34 (1.72–10.99). Conclusions: Work-related stress predicted sick-leave during the follow-up at 12 months. The WSQ seemed to be useful in identifying women at risk of future sick-leave. Thus, it can be recommended to introduce questions and questionnaires on work-related stress in primary health care settings to early identify women with the need for preventive measures in order to decrease risk for sick-leave due to work-related stress.

Implications for Rehabilitation

• Early identification of work-related stress is important to prevent long-term sick-leave

• Especially to identify stress due to the combination of both indistinct work organization and individual work commitment is essential.

• It can be recommended to introduce questions and questionnaires on work-related stress in primary health care settings to early identify women with the need for preventive measures in order to decrease risk for sick-leave due to work-related stress.

     

Health,work, and personal-related predictors of time to return to work among employees with mental health problems

Purpose: To identify health-, personal- and work-related factors predictive of return to work (RTW) in employees sick-listed due to common mental health problems, such as, stress, depression, burnout, and anxiety. Methods: We distributed a baseline questionnaire to employees applying for sickness absence benefits at a large Danish welfare Department (n?=?721). A total of 298 employees returned the questionnaire containing information on possible predictors of RTW. We followed up all baseline responders for a maximum of one year in a national registry of social transfer payments, including sickness absence benefits. Results: At baseline, about 9% of respondents had quit their job, 10% were dismissed and the remaining 82% were still working for the same employer. The mean time to RTW, measured from the first day of absence, was 25 weeks (median?=?21) and at the end of follow-up (52 weeks) 85% had returned to work. In the fitted Cox model we found that fulfilling the DSM-IV criteria for depression predicted a longer time to RTW (HR: 0.61, CI: 0.45–0.84), whereas a better self-rated health predicted a shorter time to RTW (HR: 1.18, CI: 1.03–1.34). Employees working in the municipal (HR: 0.62, CI: 0.41–0.94) and private sector (HR: 0.65, CI: 0.44–0.96) returned to work slower compared to employees working in the governmental sector. Gender, education, cohabitation, size of workplace, low-back and upper-neck pain and employment at baseline did not predict RTW. Conclusion: Our results indicate that time to RTW is determined by both health- and work-related factors.

Implications for Rehabilitation

• Common mental health problems are one of the leading causes for sickness absence and work disability

• Return to work after sickness absence is not solely determined by improvements in health but is also affect by individual and work related factors

• This study showed that self-rated health, occupational sector and depression are predictors of time to return to work in employees with mental health problems

     

Return to work and quality of life in severely injured patients

Background. Little is known about the long-term consequences of severe injuries in terms of return to productivity and quality of life.

Methods. In this study we focused on the return to work status and quality of life in 53 severely injured patients (AIS/ISS ≥ 16, mean ISS 24, range 16 - 54), mean age 37 years, one to two years after the injury. Questions were asked concerning employment in the past and at present. Quality of life was measured by means of the Sickness Impact Profile (SIP) questionnaire. Injury-related parameters were analysed in order to study their relation with disablement.

Results. Of those patients who survived their injuries, 87% had resumed their former work. Only 10% of the patients received disability benefits. A mean SIP-total score of 6.7 was found, the mean SIP-physical score was 5.9 and the mean SIP-psychosocial score was 6.9. “No disability” (SIP score ≤ 3) was found in 55% of the patients, whereas 11% of the patients reported “severe disability” (SIP score ≥ 20). Age was a significant predictor of disablement (odds ratio 1.07). The Injury Severity Score (ISS), the length of hospital stay and the number of diagnoses did not predict disablement.

Conclusions. Although the results were obtained in a relatively small sample size, the return to work rate in the surviving severely injured patients appears to be excellent. The quality of life is good; the majority of patients are not disabled. Age (and not the ISS) seems to be a significant predictor of disablement.     

Return to work and quality of life in severely injured patients

Background. Little is known about the long-term consequences of severe injuries in terms of return to productivity and quality of life.

Methods. In this study we focused on the return to work status and quality of life in 53 severely injured patients (AIS/ISS ≥ 16, mean ISS 24, range 16 – 54), mean age 37 years, one to two years after the injury. Questions were asked concerning employment in the past and at present. Quality of life was measured by means of the Sickness Impact Profile (SIP) questionnaire. Injury-related parameters were analysed in order to study their relation with disablement.

Results. Of those patients who survived their injuries, 87% had resumed their former work. Only 10% of the patients received disability benefits. A mean SIP-total score of 6.7 was found, the mean SIP-physical score was 5.9 and the mean SIP-psychosocial score was 6.9. “No disability” (SIP score ≤ 3) was found in 55% of the patients, whereas 11% of the patients reported “severe disability” (SIP score ≥ 20). Age was a significant predictor of disablement (odds ratio 1.07). The Injury Severity Score (ISS), the length of hospital stay and the number of diagnoses did not predict disablement.

Conclusions. Although the results were obtained in a relatively small sample size, the return to work rate in the surviving severely injured patients appears to be excellent. The quality of life is good; the majority of patients are not disabled. Age (and not the ISS) seems to be a significant predictor of disablement.     

类风湿关节炎患者焦虑抑郁情绪及其与生活质量的相关性

目的观察类风湿关节炎(RA)患者焦虑抑郁情绪及其与主要症状体征、生活质量(QOL)的相关性,探讨RA患者抑郁情绪的机制。方法采用焦虑自评量表(SAS)和抑郁自评量表(SDS)、主要症状体征积分、生活质量量表对100例RA患者进行观察并做相关分析。结果(1)100例RA患者中,SAS标准分为(46.33±7.69),有焦虑症状者为37%;SDS标准分为(51.36±9.10),抑郁情绪的发生率为53%;两者均高于正常人;(2)SAS标准分与关节疼痛、关节压痛、关节重着、症状体征总积分呈正相关;SDS标准分与食欲减退、少气懒言、倦怠乏力、关节重着、症状体征总积分呈正相关,两者均与年龄、病程无关。(3)SAS、SDS标准分均与生理功能、社会功能、心理功能、健康自我认识能力及生活质量总积分呈正相关。结论类风湿关节炎患者存在一定程度的焦虑抑郁情绪,以抑郁情绪为主,RA患者的焦虑、抑郁情绪与病情及生活质量存在一定的相关性,提示其发生机制与生活质量下降有关。     

强迫症患者生活质量与其症状严重程度相关性研究

目的探讨强迫症患者的生活质量与其临床症状严重程度的相关性。方法对61例强迫症患者采用耶鲁布朗强迫症量表评估强迫症状,生活质量量表评估生活质量,并进行相关分析。结果强迫症的强迫思维分和强迫总分与其生活质量的身体方面、心理方面、社会方面、尽职的能力、自我健康意识及生活质量量表总分呈显著负相关。强迫症的强迫行为分与其生活质量的身体方面、社会方面、尽职的能力及生活质量量表总分呈显著负相关,而与心理方面、自我健康意识无明显相关。结论强迫症患者生活质量与强迫思维和强迫行为均显著性相关,且与强迫思维更为密切相关。