Managers' attitudes to depression and the association with their rating of how work capacity is affected in employees with common mental disorders.

OBJECTIVE: This explorative, cross-sectional study assessed the association between managers' attitudes to employee depression and their rating of how common mental disorders (CMDs) affect employee work capacity. RESULTS: A principal component analysis was performed for the nine variables concerning managers' rating of how CMDs can affect work capacity among employees. The analysis resulted in two factors: task-oriented- and relational work capacity. The result of the multivariate analysis of covariance showed a p value of 0.014 (Pillai's trace) indicating a statistically significant association between managers' attitudes towards employee depression and managers' rating of how CMDs affect work capacity. The association was significant for both factors as indicated by the p value of 0.024 for task-oriented work capacity and the p value of 0.007 for relational work capacity. The R2 value was 0.022 for task-oriented work capacity and 0.017 for relational work capacity. We assumed that negative attitudes towards employee depression would be associated with a perception of decreased work capacity among employees with CMDs. The results showed a significant association; however, the effect (~ 2%) was small. Further studies of manager's attitudes and other possible determinants of managers' rating of CMD-related work capacity are needed to better understand these factors.

Does employer involvement in primary health care enhance return to work for patients with stress-related mental disorders? a cluster randomized controlled trial.

BACKGROUND: Stress-related disorders have become a major challenge for society and are associated with rising levels of sick leave. The provision of support to facilitate the return to work (RTW) for this patient group is of great importance. The aim of the present study was to evaluate whether a new systematic procedure with collaboration between general practitioners (GPs), rehabilitation coordinators (RCs) and employers could reduce sick leave days for this patient group. METHOD: Employed patients with stress-related diagnoses seeking care at primary health care centres (PHCCs) were included in either the intervention group (n = 54), following the systematic intervention procedure, or the control group (n = 58), receiving treatment as usual (TAU). The intervention included a) a training day for participant GPs and RCs, b) a standardised procedure for GPs and RCs to follow after training, c) the opportunity to receive clinical advice from specialist physicians in the research group. Outcome measures for RTW were sick leave days. RESULTS: The median number of registered gross sick leave days was lower for the control group at six, 12 and 24 months after inclusion, but the difference was not statistically significant. The control group had significantly fewer net sick leave days at three months (p = 0.03) at six months (p = 0.00) and at 12-months follow-up (p = 0.01). At 24 months, this difference was no longer significant. CONCLUSIONS: The PRIMA intervention, which applied a standardized procedure for employer involvement in the rehabilitation process for patients with stress-related disorders, actually increased time to RTW compared to TAU. However, at 24 months, the benefit of TAU could no longer be confirmed. The study was registered on 16/01/2017 (ClinicalTrials.gov, NCT03022760).

Under pressure - The working situation of Swedish healthcare managers during the first wave of COVID-19.

Introduction: The aim of this study is to provide insight into the psychosocial work situation of hospital managers during the first wave of the COVID-19 pandemic. Methods: Mixed-effect modelling was used on survey data on job demands, job resources, job motivation, and work-life balance among over 500 managers working in 55 departments of a large Swedish university hospital in 2019 and 2020. Responses from 6011 employees were then used to stratify the analysis for COVID-19 exposure. Inductive content analysis was applied to open-ended questions on the managers' views on organisational prerequisites during the onset of the pandemic. Results: The proportion of managers reporting difficulties with role clarity, quantitative demands, decision-making authority, and emotional support, time for recovery at work, motivation deficits, or problems with work-life balance clearly increased during the first wave of the pandemic. The proportion of managers reporting negative responses was higher in departments with high COVID-19 exposure. The qualitative analysis shows that overall governance in terms of clear, fair, and well-communicated routines, resource allocation, and division of responsibilities constituted an important framework for managerial during the crisis. First-line managers also require a mandate to re-organize their roles and their teams to successfully adapt to the situation. Organisational and social support was also important resources. Discussion: This is the first study investigating healthcare managers' work situation during the first wave of the COVID-19 pandemic in a Swedish context. As expected, it indicates an increasingly strained work situation during the crisis, but it also provides findings on organisational prerequisites that allow healthcare managers to cope with stressful situations. In line with previous research on organisational resilience, the study provides suggestions for how higher-level managers can act in order to provide front-line managers with the organisational prerequisites they need to adapt, learn and develop successfully during times of unpredictability, insecurity, and rapid change in order to offer the best possible support to health care workers.

Occupational trajectories of working conditions in Sweden: Development trends in the workforce, 1997-2015.

OBJECTIVE: This study aimed to explore the development of working conditions within and between occupations in the Swedish labor market from 1997 to 2015 and whether any polarization in working conditions concurrently occurred between occupations. METHODS: Cross-sectional data from ten waves of the Swedish Work Environment Surveys (1997-2015) were used and an aggregated occupational-level dataset was created using the Swedish Standard Classification of Occupations. To capture the patterns of change in working conditions over time (ie, growth), growth curve modeling was used to identify the starting points for 89 occupations (intercepts) as well as both the shape (functional form) and rate of growth (slope) over time. RESULTS: The Swedish labor market was stable overall, with some small, mainly positive, changes in job demands and resources. Different occupations developed in divergent directions, but there was no evidence of polarization. CONCLUSIONS: The findings indicate that macro-level stability can hide highly heterogeneous patterns of change among different occupational groups. This type of analysis, taking context into account, could be valuable for decision makers intending to improve the work environment.

Process Evaluation of an Operational-Level Job Stress Intervention Aimed at Decreasing Sickness Absence among Public Sector Employees in Sweden.

Work-related sickness absence carries large societal costs, and interventions aimed at decreasing sickness absence need to be performed in an effective way. This study evaluated the implementation process of an operational-level job stress intervention, implemented between 2017 and 2018 in the public sector, by assessing the extent to which the allocated resources reached the intended target group, if the planned measures could be expected to address the relevant work environmental challenges, and if the planned measures were implemented. Data were collected from applications for funding in the intervention (n = 154), structured interviews (n = 20), and register data on sickness absence (n = 2912) and working conditions (n = 1477). Thematic analysis was used to classify the level of the work environmental challenges, the level and perspective of the suggested measures, and the "measure-to-challenge correspondence". Overall, participating workplaces (n = 71) had both higher sickness absence (p = 0.01) and worse reported working conditions compared to their corresponding reference groups. A measure-to-challenge correspondence was seen in 42% of the measures, and individual-level measures were mostly suggested for organisational-level work environment challenges. Almost all planned measures (94%) were ultimately implemented. When performing operational-level interventions, managers and their human resource partners need support in designing measures that address the work environmental challenges at their workplace.

Can Working Conditions and Employees' Mental Health Be Improved via Job Stress Interventions Designed and Implemented by Line Managers and Human Resources on an Operational Level?

Organisational-level interventions are recommended for decreasing sickness absence, but knowledge of the optimal design and implementation of such interventions is scarce. We collected data on working conditions, motivation, health, employee turnover, and sickness absence among participants in a large-scale organisational-level intervention comprising measures designed and implemented by line managers and their human resources partners (i.e., operational-level). Information regarding the process, including the implementation of measures, was retrieved from a separate process evaluation, and the intervention effects were investigated using mixed-effects models. Data from reference groups were used to separate the intervention effect from the effects of other concurrent changes at the workplace. Overall, working conditions and motivation improved during the study for both the intervention and reference groups, but an intervention effect was only seen for two of 13 evaluated survey items: clearness of objectives (p = 0.02) and motivation (p = 0.06). No changes were seen in employees' perceived health, and there were no overall intervention effects on employee turnover or sickness absence. When using operational-level workplace interventions to improve working conditions and employees' health, efforts must be made to achieve a high measure-to-challenge correspondence; that is, the implemented measures must be a good match to the problems that they are intended to address.

Involving the employer to enhance return to work among patients with stress-related mental disorders - study protocol of a cluster randomized controlled trial in Swedish primary health care.

BACKGROUND: Work-related stress has become a major challenge for social security and health care systems, employers and employees across Europe. In Sweden, sickness absence particularly due to stress-related disorders has increased excessively in recent years, and the issue of how to improve sustainable return to work in affected employees is high up on the political agenda. The literature on interventions for return to work in patients with common mental disorders is still inconclusive. This randomized controlled trial (RCT) aims to contribute with knowledge about how physicians and rehabilitation coordinators in primary health care can involve the employer in the rehabilitation of patients with stress-related disorders. The objective is to evaluate whether the early involvement of the patient's employer can reduce the time for return to work compared to treatment as usual. A process study will complete the RCT with information about what prerequisites primary health caregivers need to succeed with this endeavor. METHODS: Twenty-two primary care centers were randomized to either intervention or control group. At the intervention centers, physicians and rehabilitation coordinators underwent training, providing them with both knowledge and practical tools to involve the employer in rehabilitation. At the patient level, employed patients with an ICD-10 F43 diagnosis were eligible for participation (n=132). Difference in proportion of patients on full- or part-time sick leave at three, six and 12 months after inclusion will be investigated. Register data, logbooks and interviews with coordinators and physicians at both intervention and control centers will be used for process evaluation. DISCUSSION: Although the issue of how to tackle work-related stress can be recognized all across Europe, Sweden face an urgent need to curb the disproportional increase of stress-related disorders in the sick-leave statistics. Since physicians are limited by time constraints, the rehabilitation coordinator may be a helpful resource to take this contact. The current study will contribute to knowledge about how this collaboration can be organized to facilitate employer involvement and reduce time to return to work among patients suffering from work related stress. TRIAL REGISTRATION: Registered on 1 November 2016, ClinicalTrials.gov, NCT03022760 .