Employees with mental disorders seeking support from the workers compensation system - experiences from Denmark.

BACKGROUND: In Europe it is commonly accepted that psychosocial hazards may influence the mental health of employees. However, mental disorders such as depression are generally not acknowledged as an occupational disease covered by the workers compensation system. Studies indicate that workers compensation claim processes may affect employee's health negatively due to a demanding case process. If filing a workers' compensation claim can harm the employees' health, it is highly relevant to pay attention to employees with mental health claims, as they are most likely vulnerable and face a very low chance of compensation. OBJECTIVE: This study investigates how employees with work-related mental disorders experience the process of seeking workers compensation from the Danish Workers' Compensation System. METHOD: Interview (N = 13) and questionnaire (N = 436) data from claimants were analysed. RESULTS: Analysis showed that even though many employees wished for the claim to influence the conditions at the workplace, there seemed to be a lack of preventive health and safety initiatives in the workplaces. Central stakeholders such as health and safety representatives were often not involved. Management involvement was often experienced negatively, and the Danish Working Environment Authority rarely conducted workplace inspections. Employees experienced inadequate information about the workers' compensation process and experienced a lack of coordination between stakeholders. CONCLUSION: A more supportive and coordinated approach in the Workers' Compensation System is recommendable. The processes in the system could be evaluated using the Social Insurance Literacy concept, to ensure sufficient support of the claimants and reduce potential harmful aspects of the process.

Work-unit organizational changes and risk of cardiovascular disease: a prospective study of public healthcare employees in Denmark.

PURPOSE: The impact of organizational change at work on cardiovascular disease (CVD) among employees is poorly understood. We examined the longitudinal associations between different types of work-unit organizational changes and risk of CVD among employees. METHODS: We used multilevel mixed-effects parametric survival models to assess the risk of incident ischemic heart disease and stroke (72 events) during 2014 according to organizational changes in 2013 among 14,788 employees working in the same work unit from January through December 2013. We excluded employees with pre-existing CVD events between 2009 and 2013. Data on organizational changes defined as mergers, split-ups, relocations, change in management, employee layoffs, and budget cuts were obtained from work-unit managers (59% response). RESULTS: There was an excess risk of CVD in the year following change in management (HR 2.04, 95% CI 1.10-3.78) and employee layoff (HR 2.44, 95% CI 1.29-4.59) in the work unit relative to no change. Exposure to any organizational change also suggested increased risk of CVD (HR 1.48, 95% CI 0.91-2.43). Including perceived stress as mediator in the regression models attenuated the point risk estimates only slightly, indicating no important mediation through this psychosocial factor. CONCLUSIONS: Work-unit organizational change may be associated with excess risk of incident CVD among the employees relative to stable workplaces.

Work-unit organisational changes and subsequent prescriptions for psychotropic medication: a longitudinal study among public healthcare employees.

OBJECTIVES: We examined exposure to different types of organisational changes at work as risk factors for subsequent prescription for psychotropic medication among employees. METHODS: The study population included 15 038 public healthcare employees nested within 1284 work units in the Capital Region of Denmark. Multilevel mixed-effects parametric survival models were developed to examine time to prescription for psychotropic medications (anxiolytics/hypnotics/sedatives/antidepressants) during the 12-month interval following exposure to organisational changes relative to no change from January to December 2013. Data on work-unit level organisational changes (including mergers, split-ups, relocation, change in management, employee lay-offs and budget cuts) were collected from work-unit managers (59% response). RESULTS: Any organisational change versus no change was associated with a higher risk of psychotropic prescription (HR: 1.14, 95% CI: 1.02 to 1.26), especially change in management (HR: 1.23, 95% CI: 1.07 to 1.41). Splitting the 12-month follow-up period into two halves yielded particularly high rates of psychotropic prescription in the latter half of the follow-up, for example, any change (HR: 1.25, 95% CI: 1.11 to 1.41), change in management (HR: 1.42, 95% CI: 1.22 to 1.65), mergers (HR: 1.26, 95% CI: 1.06 to 1.50), employee lay-off (HR: 1.23, 95% CI: 1.03 to 1.46) and budget cuts (HR: 1.13, 95% CI: 1.00 to 1.41). The associations did not vary by sex. CONCLUSIONS: Organisational changes in the workplace, especially change in management, may be associated with increased risk of psychotropic prescription among employees regardless of sex.

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.

Cross-Cultural Adaptation, Reliability and Validity of the Danish Version of the Readiness for Return to Work Instrument.

The objective of the present study was to translate and validate the Canadian Readiness for Return To Work instrument (RRTW-CA) into a Danish version (RRTWDK) by testing its test-retest and internal consistency reliability and its structural and construct validity. Cross-cultural adaptation of the six-staged RRTW-CA instrument was performed in a standardised, systematic five-step-procedure; forward translation, panel synthesis of the translation, back translation, consolidation and revision by researchers, and finally pre-testing. This RRTW-DK beta-version was tested for its psychometric properties by intra-class correlation coefficient and standard error of measurement (n = 114), Cronbach's alpha (n = 471), confirmatory factor analyses (n = 373), and Spearman's rank correlation coefficient (n = 436) in sickness beneficiaries from a municipal employment agency and hospital wards. The original RRTW-CA stage structure could not be confirmed in the RRTWDK. The psychometric properties were thus inconclusive. The RRTW-DK cannot be recommended for use in the current version as the RRTW construct is questionable. The RRTW construct needs further exploration, preferably in a population that is homogeneous with regard to cause of sickness, disability duration and age.

Longitudinal associations between organizational change, work-unit social capital, and employee exit from the work unit among public healthcare workers: a mediation analysis.

Objectives Organizational changes are associated with higher rates of subsequent employee exit from the workplace, but the mediating role of social capital is unknown. We examined the associations between organizational changes and subsequent employee exit from the work unit and mediation through social capital. Methods Throughout 2013, 14 059 healthcare employees worked in the Capital Region of Denmark. Data on work-unit changes (yes/no) from July‒December 2013 were collected via a survey distributed to all managers (merger, split-up, relocation, change of management, employee layoff, budget cuts). Eight employee-reported items assessing social capital were aggregated into work-unit measures (quartiles: low-high). Data on employee exit from the work unit in 2014 were obtained from company registries. Results We found a somewhat higher rate of employee exit from the work unit after changes versus no changes [hazard ratio (HR) 1.10, 95% confidence interval (CI) 1.01-1.19] and an inverse dose‒response relationship between social capital and employee-exit rates (low versus high: HR 1.65, 95% CI 1.46-1.86). We also showed a higher risk of low social capital in work units exposed to changes [low versus high: odds ratio (OR) 2.04, 95% CI 1.86-2.23]. Accounting for potential mediation through social capital seemed slightly to reduce the association between changes and employee-exit rates (HR 1.07, 95% CI 0.98-1.16 versus HR 1.10). Conclusions Work-unit organizational changes prospectively predict lower work-unit social capital, and lower social capital is associated with higher employee-exit rates. Detection of weak indications of mediation through social capital, if any, were limited by inconsistent associations between changes and employee exit from the work unit.

Dual impact of organisational change on subsequent exit from work unit and sickness absence: a longitudinal study among public healthcare employees.

OBJECTIVES: We investigated work-unit exit, total and long-term sickness absence following organisational change among public healthcare employees. METHODS: The study population comprised employees from the Capital Region of Denmark (n=14 388). Data on reorganisation at the work-unit level (merger, demerger, relocation, change of management, employee layoff or budget cut) between July and December 2013 were obtained via surveys distributed to the managers of each work unit. Individual-level data on work-unit exit, total and long-term sickness absence (≥29 days) in 2014 were obtained from company registries. For exposure to any, each type or number of reorganisations (1, 2 or ≥3), the HRs and 95% CIs for subsequent work-unit exit were estimated by Cox regression, and the risk for total and long-term sickness absence were estimated by zero-inflated Poisson regression. RESULTS: Reorganisation was associated with subsequent work-unit exit (HR 1.10, 95% CI 1.01 to 1.19) in the year after reorganisation. This association was specifically important for exposure to ≥3 types of changes (HR 1.52, 95% CI 1.30 to 1.79), merger (HR 1.29, 95% CI 1.12 to 1.49), demerger (HR 1.41, 95% CI 1.16 to 1.71) or change of management (HR 1.24, 95% CI 1.11 to 1.38). Among the employees remaining in the work unit, reorganisation was also associated with more events of long-term sickness absence (OR 1.15, 95% CI 1.00 to 1.33), which was particularly important for merger (OR 1.31, 95% CI 1.00 to 1.72) and employee layoff (OR 1.31, 95% CI 1.08 to 1.59). CONCLUSIONS: Specific types of reorganisation seem to have a dual impact on subsequent work-unit exit and sickness absence in the year after change.

Do managers experience more stress than employees? Results from the Intervention Project on Absence and Well-being (IPAW) study among Danish managers and their employees.

OBJECTIVE: To examine whether managers' perceived stress and work strain is higher than perceived stress and work strain among employees. METHODS AND PARTICIPANTS: The study is based on questionnaire responses from 2052 respondents (128 managers and 1924 employees) at 48 worksites. Bi-variate and multivariate analyses were used to explain possible differences in stress levels and related mediators. RESULTS: Managers experienced higher demands, higher level of conflicts, and lower degree of social support from peers. They tended to experience significantly lower emotional stress, whereas this trend was insignificant with regards to behavioural, somatic and cognitive stress. The difference was partly explained by higher scores in the psychosocial work environment factors; job satisfaction, perceived management quality from their managers, influence, degrees of freedom at work, possibilities for development and meaning of work. For behavioural stress, 41% of the difference was explained by the preventive factors, 20% for somatic stress, 39% for emotional stress and 56% for cognitive stress. CONCLUSIONS: This study indicates that the preventive psychosocial factors explain parts of the managers' lower stress level. These results contradict the lay perception of managers being under higher pressure and experiencing more stress than employees. Interventions aiming at reducing employee stress levels, especially regarding behavioural and cognitive stress, could benefit from focussing on psychosocial work environment exposures such as skill discretion, meaning of work, psychological demands, information flow and management quality.

Psychosocial work environment of hospital workers: validation of a comprehensive assessment scale.

BACKGROUND: Studies have shown that adverse workplace factors can increase the risk of ill-health in hospital workers, but more comprehensive measures of the psychosocial work environment are needed. OBJECTIVES: To test a comprehensive and theory-based psychosocial work environment questionnaire and analyze associations with mental health in a sample of Danish hospital workers. DESIGN AND PARTICIPANTS: Questionnaire-based cross-sectional study with 343 female employees from a large Danish hospital, including patient care workers (nurses, nurse assistants, midwives) and laboratory technicians. METHODS: The psychosocial work environment was measured with 14 scales from the Copenhagen psychosocial questionnaire, version I, covering three main areas: demands at work, work organization and interpersonal relations at work. We further measured self-rated mental health and sociodemographic and employment characteristics of the participants. Cronbach's alphas, analyses of covariance, one-sample t-tests, partial correlations and linear regression models were used to analyze data. RESULTS: Of the 14 work psychosocial workplace scales 12 showed a satisfactory internal consistency (alpha>0.70). Patient care workers had more quantitative, emotional and cognitive demands (all p-values <0.001), higher work pace (p<0.001) and more role conflicts (p=0.01) than laboratory technicians, but also better work organization, including more influence at work, better possibilities for development and a higher meaning of work (all p-values <0.001). Both patient care workers and laboratory technicians had substantially higher scores on the demand scales and lower scores on the influence at work scale than the general Danish working population. Further analyses showed that high levels of demands at work and low levels of work organization and problematic interpersonal relations at work were associated with lower self-rated mental health. CONCLUSION: The Copenhagen psychosocial questionnaire is a suitable instrument to measure the psychosocial work environment of hospital workers. The comprehensive assessment of the psychosocial work environment helps tailoring interventions to the specific needs of different occupational groups.