Cultivating Resilience Among Perinatal Care Providers During the Covid-19 Pandemic.

The Covid-19 pandemic has further illuminated the already existing need for methods of building resilience in perinatal caregivers. Using a scoping review approach, literature was examined to identify evidence-based models of resilience building in a cohort of perinatal clinicians. Research published between January 2015 and 2020 was evaluated using PubMed, CINAHL, EMBASE, and PsycINFO databases. Of the initial 3399 records reviewed, 2 qualitative studies met the inclusion criteria. Given the deleterious effects of Covid-19 on perinatal care providers, and in light of the paucity of available studies, personnel, time, and funding should be allocated for research to address these issues.

Restoring confidence in return to work: A qualitative study of the experiences of persons with exhaustion disorder after a dialogue-based workplace intervention.

BACKGROUND: Stress-induced exhaustion disorder (SED) is a primary cause for sickness absence among persons with mental health disorders in Sweden. Interventions involving the workplace, and supporting communication between the employee and the supervisor, are proposed to facilitate return to work (RTW). The aim of this study was to explore experiences of persons with SED who participated in a dialogue-based workplace intervention with a convergence dialogue meeting performed by a rehabilitation coordinator. METHODS: A qualitative design based on group interviews with 15 persons with SED who participated in a 24-week multimodal rehabilitation program was used. The interviews were analyzed with the methodology of grounded theory. RESULTS: The analysis resulted in a theoretical model where the core category, restoring confidence on common ground, represented a health promoting process that included three phases: emotional entrance, supportive guidance, and empowering change. The health promoting process was represented in participant experiences of personal progress and safety in RTW. CONCLUSIONS: The intervention built on a health-promoting pedagogy, supported by continuous guidance from a rehabilitation coordinator and structured convergence dialogue meetings that enhanced common communication and collaboration with the supervisor and others involved in the RTW process. The intervention balanced relationships, transferred knowledge, and changed attitudes about SED among supervisors and colleagues in the workplace. The inclusion of a rehabilitation coordinator in the intervention was beneficial by enhancing RTW and bridging the gaps between healthcare, the workplace, and other organizational structures. In addition, the intervention contributed to a positive re-orientation towards successful RTW instead of an endpoint of employment. In a prolonged process, a dialogue-based workplace intervention with convergence dialogue meetings and a rehabilitation coordinator may support sustainable RTW for persons with SED.

Effects of a work stress intervention on healthcare use and treatment compared to treatment as usual: a randomised controlled trial in Swedish primary healthcare.

BACKGROUND: Work stress is an increasing burden in society. Identifying early symptoms of work stress in primary healthcare (PHC) could result in earlier and better-targeted care. The Work Stress Questionnaire (WSQ) was developed in PHC for this task. We aimed to evaluate whether the use of the WSQ, in combination with physicians' feedback, resulted in differences in healthcare visits and treatment compared to treatment as usual (TAU) in patients reporting high stress. Our hypothesis was that patients receiving the intervention would generate more visits to rehabilitation providers during follow-up compared to TAU. METHODS: A two-armed randomised controlled trial was conducted at seven primary healthcare centres (PHCCs) in Region Västra Götaland, Sweden. One group received the WSQ intervention, and the controls received TAU. Employed, not sick-listed persons aged 18-64 years who sought care for mental or physical health complaints at the PHCCs participated. Register data on healthcare visits and treatments 12 months prior to inclusion and 12 months after were obtained and analysed with Fisher's exact test together with questionnaire data (WSQ and background features). RESULTS: A total of 271 participants were included in the study, 132 intervention and 139 controls. Visits to psychologists/psychotherapists were higher among intervention participants with high stress (20%, n = 87) during follow-up compared to corresponding controls (7%, n = 97) (p < 0.05). Collaborative care measures were more common among the stressed intervention participants (23%) post-inclusion compared to the stressed controls (11%) (p < 0.05). The amount of received cognitive behavioural therapy (CBT) was higher among the stressed intervention group (16%) than among controls (10%) during follow-up. CONCLUSIONS: The intervention group that used the WSQ with physicians' feedback had an increased number of rehabilitative measures and treatment more in line with established guidelines compared to treatment as usual. Findings of the study indicate that the WSQ can assist in identifying work stress in primary healthcare and contribute to physicians' recommendations of suitable rehabilitative measures at an earlier stage compared to treatment as usual. TRIAL REGISTRATION: ClinicalTrials.gov. Identifier: NCT02480855 . Registered 20 May 2015.

Need for recovery in relation to effort from work and health in four occupations.

OBJECTIVE: To examine three levels of need for recovery (NFR) after work in relation to effort from work demands, demand compensatory strategies, effort-moderating or -reversing resources, and health including health behaviors. A further purpose was to examine occupational characteristics determining NFR. METHODS: 5000 engineers, carpenters, nurses, and home care nurses were invited to participate. NFR k-means clusters were calculated from 1289 participants. The effect from three levels of NFR regarding demands, compensatory strategies, resources at work, health, and health behaviors was examined using analysis of variance (ANOVA) and post hoc analysis. Prevalence ratios (PRs) of suboptimal health for three levels of NFR were calculated using Poisson regression. Linear stepwise multiple regression predictors explaining NFR were examined also occupation wise. RESULTS: NFR centroids at 5.8/33, 13.1/33, and 21.0/33 points were identified. ANOVA showed corresponding effects from NFR levels on work demands and compensatory strategies. The inversed proportion concerned levels of resources at work. Only the low NFR cluster negated regular health effects. The other two cluster groups also repeatedly worked while ill and presented PRs concerning health effects from 1.9 to 3.9 when compared to the low NFR group. Making good quality work, recovery opportunities, and thinking of work when off work were the most important predictors of NFR among 1289 participants with also occupation-wise interpretable profiles. CONCLUSIONS: Three levels of NFR meant corresponding levels of work demands, work-demand compensatory strategies, and unfavorable health behaviors. An inversed proportion of resources related to the same levels of NFR. Low NFR meant no regular health effects which could guide limit values regarding salutary NFR. Important predictors of NFR were resources making a good quality work, recovery opportunities, and reversely effort from rumination when off work. Occupation-wise predictors could guide interventions.

The Role of Leisure-Time Physical Activity in the Change of Work-Related Stress (ERI) over Time.

BACKGROUND: Every second employee in Europe complains about work-related stress. Occupational stress due to an imbalance between efforts spent and rewards gained (effort-reward imbalance = ERI) is well investigated and it is associated with mental and physical health. A common guess is that leisure-time physical activity (LTPA) has beneficial effects on work-related stress. Yet, evidence in support of this assumption is weak, especially regarding ERI-stress. Longitudinal studies investigating the role of LTPA on ERI are missing. Therefore, this study aims to investigate the effect of LTPA on work-related stress by ERI over time. METHODS: 3961 socially insured employees that were born in 1959 or 1965 and working in the first (t1: 2011) and second wave (t2: 2014) of the lidA-study were included. Work-related stress was measured by ERI, LTPA by the self-rated weekly frequency of physical activities. Besides the direct effect, a moderating effect of LTPA on ERI over time was tested in the multiple linear regression analysis. RESULTS: The ERI at t1 was strongly associated with ERI at t2. While LTPA had no direct effect on ERI(t2), it was a significant moderator of ERI from t1 to t2: The higher the frequency of LTPA, the lower ERI was over time. This interaction of LTPA with ERI remained after adjustment for socio-demographic factors. CONCLUSIONS: The long-term moderating effect of LTPA on ERI is in agreement with former investigations on the role of LTPA on work-related stress, generally, and on its cross-sectional effect on ERI-stress, specifically. Some of Hill's criteria of a causal association in epidemiology (biological gradient, temporality, consistency) support our findings. As LTPA has also been shown to exert a protective effect on health outcomes that are associated with ERI, the moderation of ERI by LTPA could partly explain this protective effect. Future observational and interventional studies are required to support our results over more than two age groups and study times.

Dynamics of stress generation and reduction in the nursing team at an oncology center. / Dinâmica de geração e dissipação do estresse na equipe de enfermagem num centro de oncologia.

OBJECTIVE: to represent the dynamics of stress generation, accumulation and reduction in the nursing team at an oncology therapy center. METHOD: a mathematical simulation model of system dynamics was developed based on data collection in loco. The model served to test the impact of three policies aimed at reducing stress in the team, namely i) increase in the service load; ii) increase in the size of shift teams and iii) reduction of service hours per bed. RESULTS: the model showed that the policy of increasing the size of the team obtained the best results, with the absenteeism index stabilizing at 8%; staff at leave also stabilizing at 4-5 people per month, as well as accumulated stress reduced to baseline levels. CONCLUSION: measures to monitor physical and emotional demands, hiring staff, better technical training for so-called stressful activities, and a better distribution of tasks can be effective in reducing absenteeism rates and improving the quality of life of these workers.

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.

Dinâmica de geração e dissipação do estresse na equipe de enfermagem num centro de oncologia / Dynamics of stress generation and reduction in the nursing team at an oncology center / Dinámica de generación y disipación del estrés en el equipo de enfermería en un centro de oncología

Objetivo: representar a dinâmica de geração, acumulação e dissipação do estresse na equipe de enfermagem em um centro de terapia oncológica. Método: um modelo de simulação matemático de dinâmica de sistemas foi desenvolvido com base na coleta de dados in loco. O modelo serviu para testar o impacto de três políticas direcionadas a reduzir o estresse na equipe: i) incremento na carga de atendimento; ii) incremento do tamanho das equipes de turno e iii) redução de horas de atendimento por leito. Resultados: o modelo demonstrou que a política de incremento de tamanho da equipe obteve os melhores resultados, sintetizados com o índice de absenteísmo, estabilizando-se em 8%; pessoal afastado também se estabilizando em 4-5 pessoas por mês, bem como o estresse acumulado reduzido aos níveis do cenário base. Conclusão: as medidas no sentido de acompanhamento das demandas físicas e emocionais, a contratação de pessoal, um melhor treinamento técnico para as atividades ditas estressantes e uma melhor distribuição de tarefas podem ser eficazes na redução dos índices de absenteísmo e melhorar a qualidade de vida desses trabalhadores.

Objective: to represent the dynamics of stress generation, accumulation and reduction in the nursing team at an oncology therapy center. Method: a mathematical simulation model of system dynamics was developed based on data collection in loco. The model served to test the impact of three policies aimed at reducing stress in the team, namely i) increase in the service load; ii) increase in the size of shift teams and iii) reduction of service hours per bed. Results: the model showed that the policy of increasing the size of the team obtained the best results, with the absenteeism index stabilizing at 8%; staff at leave also stabilizing at 4-5 people per month, as well as accumulated stress reduced to baseline levels. Conclusion: measures to monitor physical and emotional demands, hiring staff, better technical training for so-called stressful activities, and a better distribution of tasks can be effective in reducing absenteeism rates and improving the quality of life of these workers.

Objetivo: representar la dinámica de generación, acumulación y disipación del estrés en el equipo de enfermería en un centro de terapia oncológica. Método: un modelo de simulación matemático de dinámica de sistemas fue desarrollado basado en la recolección de datos in loco. El modelo sirvió para testar el impacto de tres políticas dirigidas a reducir el estrés en el equipo: i) incremento en la carga de atendimiento; ii) incremento del tamaño de los equipos de turno y iii) reducción de horas de atendimiento por lecho. Resultados: el modelo demostró que la política de incremento de tamaño del equipo obtuvo los mejores resultados, sintetizados con el índice de ausentismo estabilizándose en 8%; personal alejado también estabilizándose en 4-5 personas por mes, así como el estrés acumulado reducido a los niveles del escenario base. Conclusión: las medidas en el sentido de acompañamiento de las demandas físicas y emocionales, la contratación de personal, mejor entrenamiento técnico para actividades llamadas estresantes y una mejor distribución de tareas pueden ser eficaces en la reducción de los índices de ausentismo y mejorar la calidad de vida de esos trabajadores.

Improving Chinese Teachers' Stress Coping Ability through Group Sandplay.

Teachers are burdened by high work pressure, suggesting the need for an effective stress coping system to support them. The present study evaluated the effectiveness of coping strategies currently utilized by teachers and explored the potential contribution of group sandplay to coping. The study was led by a group of experienced therapists and sandplay practitioners. Two hundred teachers served as participants, equally divided into two groups: An experimental sandplay group (EG) and control group. Both groups received a 3-hour tutorial on the psychological pressure at work, reactions to it, and physical/mental symptoms resulting from overwhelming pressure, and were introduced to the working principles and process of sandplay. EG participants then engaged in group sandplay for three consecutive days. The Simplified Coping Style Questionnaire was used as an objective measure of participants' coping styles. Therapists' and practitioners' observations were used as subjective information, including the scenes and themes created by participants, individual performance during sandplay activities, and feedback regarding changes to stress coping strategies. We compared participants' pre-and post-test stress coping strategies. The results revealed a significant improvement in the EG sample at the shift from passive coping (pre-test M = 1.94, 95% CI [1.83-2.05]; post-test M = 0.96, 95% CI [0.92-1.00]) to active coping (pre-test M = 1.76, 95% CI [1.69-1.83]; post-test M = 2.41, 95% CI [2.29-2.53]). Overall, our findings support the conclusion that group sandplay effectively improved Chinese teachers' overall stress coping abilities.

An active transition from offshore work to family life: Activities that may impact recovery.

BACKGROUND: Night shift workers, particularly those working offshore, take a long time to recover from their shifts. The activities that shift workers, such as offshore employees, pursue during their leisure time can influence the process of recovery from work-related fatigue, but little is known about these leisure time activities. OBJECTIVE: To explore what leisure time activities are pursued that may be relevant to recovery for offshore employees. METHODS: Sixty-one offshore working family men-20 night shift, 16 swing shift, and 25 day shift workers-reported on six predefined activities for 14 days following their offshore tours. Generalized estimating equations analysis was used to explore trends in the data. RESULTS: From the start of the free period, almost all participants were involved in household chores and childcare; these activities declined over the 14 days. Throughout the study period, participants actively pursued social, volunteer, and leisure time physical activities. Work-related activities were pursued by half of the participants at some time during the 14 days. Night and swing shift workers were more physically active than day workers throughout the first 14 days of the free period. CONCLUSIONS: The transition from offshore work to family life can be characterised as active. The activities engaged in by this sample of employees are likely to promote their recovery.

Monitoring of need for recovery and prolonged fatigue within the working population: Evaluation of reliability and agreement over time.

BACKGROUND: Need for recovery (NFR) and prolonged fatigue are two important concepts for monitoring short- and long-term outcomes of psychological job demands within employees. For effective monitoring it is, however, important to gain insight in the reproducibility of the instruments that are used. OBJECTIVE: The objective was to assess reproducibility of the NFR scale and Checklist Individual Strength (CIS), measuring NFR and prolonged fatigue respectively, in the working population. METHODS: Longitudinal data from the Maastricht Cohort Study (MCS) study was used, capturing 12,140 employees from 45 different companies at baseline. A 'working' and 'returning to work' sample was conceived for different intervals; 4-month, 1-year, and 2-year. RESULTS: Reliability, assessed with the interclass correlation, was high within employees with a stable work environment for the NFR scale (0.78) and CIS (0.75). The smallest detectable change, assessing the agreement, was 41.20 for the NFR scale and 31.10 for the CIS. CONCLUSIONS: Reliability was satisfactory for both the NFR scale and CIS. The agreement of both scales to detect a changes within employees was, however, less optimal. It is, therefore, suggested that, ideally, both instruments are placed within a broader range of instruments to effectively monitor the outcomes of psychological job demands.

Return to work after work-related stress: a randomized controlled trial of a work-focused cognitive behavioral intervention.

Objectives This study aimed to evaluate the effect of a stress management intervention (SMI) on lasting return to work (RTW) among patients with work-related stress complaints. Methods Sickness benefit departments from three local municipalities referred patients on sick leave with work-related adjustment disorders or mild depression to the Department of Occupational Medicine, Regional Hospital West Jutland. A 2× randomization procedure allocated patients into one of three groups: intervention (N=58), control A (which received a clinical assessment; N=56), or control B (no assessment; N=49). Treatment comprised individual work-focused cognitive behavioral therapy (CBT) with an optional workplace intervention. The outcome was time until lasting RTW (16 and 44 weeks follow-up) using register data. Results Median number of weeks until lasting RTW was 15, 19, and 32 for the intervention group, control A, and control B respectively. However, for group B, clinical assessment was not part of the inclusion process, which may have introduced selection bias. In the fully-adjusted Cox regression model, the intervention group exhibited significantly faster lasting RTW at 44 weeks; hazard ratio (HR) 1.57 [95% confidence interval (95% CI) 1.01-2.44] relative to control group A, with a non-significant trend evident at 16 weeks; HR 1.70 (95% CI 0.94-3.10), when controlling for age, gender, occupation, sick leave during previous year, full or partial sick leave, and diagnosis. Unadjusted analyses remained directionally consistent but were reduced to marginal significance. Conclusions There was a tendency towards faster lasting RTW in the intervention group compared to control A, which received clinical assessment, in all analyses. The intervention group returned to work about 4 weeks earlier than control A, which could translate into substantial financial gains.

Reintegro laboral en trabajadores con problemas de salud mental: la perspectiva de los tratantes / Return to work in workers with mental health problems: attendants perspective

ANTECEDENTES: En los últimos años se ha observado un aumento en la prevalência de problemas mentales de origen laboral, incrementando significativamente el promedio anual de días de trabajo perdidos por reposo. Con respecto al posterior reintegro, la evidencia es categórica en afirmar la importancia de que este sea un proceso exitoso para la prevención de recaídas del trabajador. Asimismo, se constata que a nivel latinoamericano es casi inexistente la literatura e investigación en torno a intervenciones para el retorno laboral. OBJETIVO: Estudiar las condiciones de diagnóstico, intervención y retorno al trabajo que han mostrado efectividad desde la perspectiva y experiencias de tratantes de una mutualidad respecto de la intervención para el reintegro al trabajo en individuos con problemas de salud mental de origen laboral. MÉTODO: Se diseñó una investigación exploratoria-descriptiva, empleando metodología cualitativa. Se utilizaron grupos focales y entrevistas a seis psicólogos, tres psiquiatras y cuatro terapeutas ocupacionales que ejercen sus labores profesionales en una mutual en Chile. RESULTADOS: A partir de un análisis descriptivo, empleando el procedimiento de codificación abierta propuesto por el modelo de Teoría Fundamentada, emergieron cinco categorías centrales y dos fenómenos transversales: La comunicación tripartita y el proceso orientado al reintegro laboral. Ambos hacen referencia tanto al proceso de intervención para el retorno al trabajo como a los actores involucrados en este, ya sea de la mutualidad como también del contexto laboral inmediato de los trabajadores.

BACKGROUND: In recent years there has been an increase in the prevalence of work-related mental problems, significantly increasing the average annual working days lost because of leave sick. With respect to the later return-to-work, the evidence is categorical in affirming the importance of the successful of this process for the relapse prevention. Furthermore, we note that throughout Latin America the literature and research on interventions to return-to-work is almost absent. OBJECTIVE: To study the conditions of diagnosis, intervention and return to work that have shown effectiveness from the perspectives and experiences of professionals from a mutuality regarding the intervention to return to work in individuals with problems of mental health of occupational origin. METHOD: An exploratory-descriptive research was designed using qualitative methodology. Focus groups and interviews to six psychologists, three psychiatrists and four occupational therapists were used. RESULTS: From a descriptive analysis using the procedure of open coding proposed by the Grounded Theory model, five core categories and two transverse phenomena emerged: The tripartite communication and the process oriented by the return to work. The two refer to the process of intervention to return to work as the actors involved in this, whether mutuality or the workers' immediate labor context.

Afecciones de salud mental y el proceso de retorno al trabajo: una revisión sistemática / Mental health illness and the return to work process: a systematic review

Antecedentes: Para el tratamiento de las afecciones de salud mental relacionadas con el trabajo se requiere considerar como parte del tratamiento a los agentes laborales causales de la patología y el proceso de retorno al trabajo. Un diseño adecuado de intervenciones psicoterapéuticas en el ámbito ocupacional requiere la consideración de las últimas investigaciones en estas materias. Objetivo: Describir las investigaciones recientes cuyo objetivo sea el estudio del retorno al trabajo en afecciones de salud mental relacionadas con el trabajo. Método: Mediante una revisión de la literatura publicada entre los años 2008 a 2012, se caracterizaron las principales líneas de investigación del tratamiento y reintegro laboral de pacientes con afecciones de salud mental relacionadas al trabajo. Resultados: Sobre 63 artículos seleccionados, se identificó que los países europeos lideraron la investigación, destacando entre ellos Holanda. El 80% de los estudios abordan el proceso de retorno laboral. La mayoría de los diseños de investigación no son de tipo cuantitativo, descriptivo y longitudinal, y están enfocados en: a) producir indicadores para pronosticar factores protectores del tratamiento y, b) generar indicadores de alerta para la relación terapia y reintegro al trabajo. La terapia cognitivo-conductual y los tratamientos entregados en el lugar de trabajo, comandadas por terapeutas (sin profesión específica), psicólogos y psiquiatras son las formas de intervención preferidas. El rol del supervisor de retorno al trabajo es una figura nueva, usualmente poco considerada en el tratamiento estándar. Conclusiones: El estudio del vínculo entre el tratamiento clínico y el proceso del reintegro al trabajo en afecciones de salud mental abre una nueva ventana local para la investigación en salud ocupacional.

Background: It is generally accepted that mental health illnesses require treatment for the patient’s recovery. But if such illness is work-related, standard clinical treatment alone could be insufficient. Thus, should work-related issues and the return to work process considered as part of a standard treatment. Objective: To describe scientific research whose aim is the return to work process in workrelated mental illness. Methods: A literature review from 2008 to 2012 was conducted to describe research trends in mental health work-related treatment, and the return-to-work process. Results: 63 papers met requirements. Research is mainly done in Europe, led by Holland. 80% of articles are focused on the return to work process. Most of the research done is quantitative, descriptive and longitudinal, focused on a) generating parameters to forecast treatment’s positive outcomes and, b) to determine warning indicators for the therapy - return to work relationship. Cognitive - behavioural therapy and workplace interventions are the preferred methods, led by therapists (without specific occupation), psychologists and psychiatrists. The return-to-work supervisor role is a new element, slightly considered in standard clinical treatment. Conclusions: This work places the clinical treatment - return-to-work relationship as its subject, opening a new local research trend in occupational health.