The linkage of depressive and anxiety disorders with the expected labor market affiliation (ELMA): a longitudinal multi-state study of Danish employees.

OBJECTIVE: Depressive and anxiety disorders are prevalent among employees in general. Still, knowledge regarding the contribution of these disorders to the dynamics of the labor market in terms of working time, sickness absence, and unemployment is scarce. We aim to quantify the linkage of depressive and anxiety disorders with labor market participation using the expected labor market affiliation method (ELMA), in a large sample of Danish employees. METHODS: We combined three survey waves on occupational health with six high-quality national registers in N = 43,148 Danish employees, of which the 2012 survey contributed 29,665 person years, the 2014 survey 33,043 person years, and the 2016 survey 35,375 person years. We used the new ELMA method to estimate the multi-state transition probabilities and 2-year expected time in work, sickness absence, and unemployment. Depressive and anxiety disorders were assessed by the Major Depression Inventory and the SCL-ANX4 scales, respectively. We adjusted for multiple variables by applying inverse probability weighting in groups of gender and age. RESULTS: Depressive and anxiety disorders among employees link to reduced labor market affiliation by significantly changed transitions probabilities between the labor markets states, viewed as reduced working time by 4-51 days (in two years), increased time in sickness absence by 6-44 days (in two years), and unemployment by 6-12 days (in two years) when compared to employees without depression or anxiety disorders. The results were most pronounced for women employees and for employees with both depression and anxiety disorders. CONCLUSIONS: The study reveals detailed insight into what extent depression and anxiety disorders influence the labor market affiliation, in terms of the complex interrelation between working time, sickness absence, and unemployment. The study emphasizes the importance of preventing and handling depressive and anxiety disorders among employees for strengthening work participation.

Influence at work is a key factor for mental health - but what do contemporary employees in knowledge and relational work mean by "influence at work"?

PURPOSE: Common mental health problems are a substantial burden in many western countries. Studies have pointed out that work related factors can both increase and decrease the risk of developing mental health problems. Influence at work is a key factor relating the psychosocial work environment to employees mental health. However, little is known regarding how contemporary employees experience and understand influence at work. The purpose of this study is to explore this in depth. METHODS: We conducted semi-structured interviews with 59 employees in knowledge and relational work and analysed the data using principles from Interpretative Phenomenological Analysis (IPA). FINDINGS: TWe identified three themes each consisting of two interrelated parts, where the second part describes the consequences of the identified type of influence for employees: 1) work tasks and performance, 2) relations and belonging, 3) identity and becoming. CONCLUSIONS: The interviewed employees had a multifaceted understanding of influence at work and that influence at work mattered to them in different but important ways. Our hope is that managers, employees and consultants will be inspired by the three themes when designing work tasks, organizations and interventions in order to increase the level of influence and thereby help enhance the mental well-being of employees.

The Relational Fit in Organizational Interventions-What Can Organizational Research Learn from Research in Psychotherapy?

There is a growing interest in organizational interventions (OI) aiming to increase employees' well-being. An OI involves changes in the way work is designed, organized, and managed. Studies have shown that an OI's positive results are increased if there is a good fit between context and intervention and between participant and intervention. In this article, we propose that a third fit-the Relational Fit (R-Fit)-also plays an important role in determining an intervention's outcome. The R-Fit consists of factors related to (1) the employees participating in the OI, (2) the intervention facilitator, and (3) the quality of the relation between participants and the intervention facilitator. The concept of the R-Fit is inspired by research in psychotherapy documenting that participant factors, therapist factors, and the quality of the relations explain 40% of the effect of an intervention. We call attention to the importance of systematically evaluating and improving the R-Fit in OIs. This is important to enhance the positive outcomes in OIs and thereby increase both the well-being and productivity of employees. We introduce concrete measures that can be used to study and evaluate the R-Fit. This article is the first to combine knowledge from research in psychotherapy with research on OIs.

Expected Labor Market Affiliation: A New Method Illustrated by Estimating the Impact of Perceived Stress on Time in Work, Sickness Absence and Unemployment of 37,605 Danish Employees.

As detailed data on labor market affiliation become more accessible, new approaches are needed to address the complex patterns of labor market affiliation. We introduce the expected labor market affiliation (ELMA) method by estimating the time-restricted impact of perceived stress on labor market affiliation in a large sample of Danish employees. Data from two national surveys were linked with a national register. A multi-state proportional hazards model was used to calculate ELMA estimates, i.e., the number of days in work, sickness absence, and unemployment during a 4-year follow-up period, stratified by gender and age. Among employees reporting frequent work-related stress, the expected number of working days decreased with age, ranging from 103 days lost among older women to 37 days lost among younger and middle-aged men. Young and middle-aged women reporting frequent work- and personal life-related stress lost 62 and 81 working days, respectively, and had more days of sickness absence (34 days and 42 days). In conclusion, we showed that perceived stress affects the labor market affiliation. The ELMA estimates provide a detailed understanding of the impact of perceived stress on labor market affiliation over time, and may inform policy and practice towards a more healthy and sustainable working life.

Impact of depressive symptoms on worklife expectancy: a longitudinal study on Danish employees.

OBJECTIVE: Depressive symptoms are associated with sickness absence, work disability and unemployment, but little is known about worklife expectancy (WLE). This study investigates the impact of depressive symptoms on the WLE of a large sample of Danish employees. METHODS: We used occupational health survey data of 11 967 Danish employees from 2010 and linked them with register data on salary and transfer payments from 2010 to 2015. Depressive symptoms were self-reported using the Major Depression Inventory. We used multistate data and a life table approach with Cox proportional hazard modelling to estimate the WLE of employees, expressed by time in work, unemployment and sickness absence. Separate analyses were conducted for sex and employees with a voluntary early retirement pension scheme. Using age as time axis, we used inverse probability weights to account for differences in educational level, sector, body mass index, smoking habits and loss of employment during sickness absence. RESULTS: The WLE of employees reporting depressive symptoms was shorter compared with those not reporting depressive symptoms; that is, the expected time in unemployment and sickness absence was longer, while the expected time in work was shorter. The shorter WLE was most pronounced in women; for example, a 40-year-old woman with depressive symptoms can expect 3.3 years less in work, 0.8 years more in unemployment and 0.7 years more in sickness absence. Employees with a voluntary early retirement pension scheme showed an even lower WLE. CONCLUSIONS: Our study showed a meaningful impact of depressive symptoms on the WLE of Danish employees using a multistate framework.

Struggling at work--a qualitative study of working Danes with depressive symptoms.

PURPOSE: Little is known on how employees at work with mental health problems experience their work environment. This study explores how a selected sample of Danish employees with depressive symptoms experience the interaction with their work environment and how they respond to and deal with problems at work. METHODS: From a survey study on work and mental health in Denmark, we invited participants for in-depth interviews. Using grounded theory, we conducted 13 semi structured interviews with employees, at work, experiencing depressive symptoms. FINDINGS: Work was pivotal for the informants who were in an on-going process that we conceptualised as struggling at work. Informants struggled with the negative experiences of work that led to emotional, cognitive and somatic symptoms. Relationships with supervisors and colleagues, work load and work pressure and their self-image as a good worker conditioned the struggle. The informants found themselves unable to change their problematic working situation. This gradually led to different strategies to endure work and take care of one-self. These strategies were as follows: tending to symptoms and altering prospects for their future. The consequence of the on-going struggle was that the informants distanced themselves from their work. CONCLUSIONS: This study provided insight to the process of struggling at work, which the interviewed employees with depressive symptoms experienced. IMPLICATIONS FOR REHABILITATION: Behaviour of supervisors is a key element for employees with depressive symptoms struggling at work. Practitioners and other health and rehabilitation practitioners working with people with depressive symptoms and other mental health problems could inquire about supervisor's behaviour and relation between supervisors and employees. Interventions that targets both the individual employee as well as work environment focused interventions at the organisational level could be beneficial for employees with mental health problems as well as the workplaces.

How do workers with common mental disorders experience a multidisciplinary return-to-work intervention? A qualitative study.

PURPOSE: Long-term sick leave due to common mental disorders (CMD) is an increasing problem in many countries. Recent reviews indicate that return to work (RTW) interventions have limited effect on reducing sickness absence among this group of sick-listed. The aims of this study were to investigate how sick-listed persons with CMD experienced participating in an RTW intervention and how workability assessments and RTW activities influenced their RTW-process, and to examine the working mechanisms of the intervention. The gained knowledge can help improve future RTW intervention design and implementation. METHODS: In-depth interviews were conducted with 17 participants on sick leave due to CMD who participated in an RTW intervention. Interviews were conducted at three time points with each participant. Principles of interpretative phenomenological analyses guided the analysis. RESULTS: The workability assessment consultations and RTW activities such as psychoeducative group sessions and individual sessions with psychologist could result in both motivation and frustration depending on the extent to which the RTW professionals practiced what we have termed an individual approach to the sick-listed person. CONCLUSIONS: The individual approach seems necessary for the realization of the positive potential in the RTW intervention. However, the fact that RTW professionals are both the facilitators and the controllers of the sick-listed persons' RTW process is an inherent paradox in the intervention, which can impede the necessary establishment of a high-quality relationship between the sick-listed persons and RTW professionals.

Meta-synthesis of qualitative research on return to work among employees with common mental disorders.

OBJECTIVES: The purpose of this study was to investigate which opportunities and obstacles employees with common mental disorders (CMD) experience in relation to return to work (RTW) and how they perceive the process of returning to work. In addition, the study explores what characterizes an optimal RTW intervention and points to possible ways to improve future interventions for employees with CMD. METHODS: A systematic literature search was conducted, and eight qualitative studies of medium or high quality published between 1995-2011 were included in this systematic review. The eight studies were synthesized using the meta-ethnographic method. RESULTS: This meta-synthesis found that employees with CMD identify a number of obstacles to and facilitators of returning to work related to their own personality, social support at the workplace, and the social and rehabilitation systems. The employees found it difficult to decide when they were ready to resume work and experienced difficulties implementing RTW solutions at the workplace. CONCLUSIONS: This study reveals that the RTW process should be seen as a continuous and coherent one where experiences of the past and present and anticipation of the future are dynamically interrelated and affect the success or failure of RTW. The meta-synthesis also illuminates insufficient coordination between the social and rehabilitation systems and suggests how an optimal RTW intervention could be designed.