Factors related to COVID-19 vaccine hesitancy in Denmark: A national study in the autumn of 2021.

AIMS: The novelty of the COVID-19 pandemic and fast-developed vaccines may increase concerns about the safety and effectiveness of the COVID-19 vaccine and thereby influence vaccine hesitancy. The aims of this study were to examine (a) the main reasons for COVID-19 vaccine hesitancy and (b) factors associated with COVID-19 vaccine hesitancy. METHODS: A nationwide survey was conducted in the autumn of 2021 when most Danes had received at least one dose of a COVID-19 vaccine. The sample (N=13,570) was based on a random selection of individuals (⩾15 years), and data were collected via self-administered mailed questionnaires (digital and physical). The participants were asked whether they had been vaccinated against COVID-19, and if they had not, they were asked about their reasons for vaccine hesitancy. Logistic regression models were used to determine factors associated with vaccine hesitancy. RESULTS: In all, 5,384 (39.7%) individuals completed the questionnaire. The main reasons for vaccine hesitancy were worries about adverse effects (57.6%) and the belief that natural immunity is better than vaccination (43.8%). Factors associated with vaccine hesitancy included female sex, younger age, being divorced, a country of origin other than Denmark, lower educational level, being unemployed, previously infected with COVID-19 and being worried to a greater extent about oneself and others getting infected. Mental health indicators were not associated with vaccine hesitancy. CONCLUSIONS: COVID-19 vaccine hesitancy is likely to pose a challenge for population immunity. To reduce vaccine hesitancy and increase vaccination uptake, future vaccination programmes should focus on specific socio-demographic subgroups identified in this study.

Labor force participation during COVID-19 and risk of depression: a Danish register study.

BACKGROUND: COVID-19 caused economic insecurity for businesses and their employees. Understanding effects of changes in labor force participation on depression risk during economic recession is fundamental for early diagnosis. The study evaluates if changes in labor force participation are associated with depression risk during COVID-19 in Denmark. METHODS: A register-based longitudinal study of Danes aged 25-67 years without depression 2 years prior to baseline defined as February 2020. An eight-level categorical variable on stable or changing labor force participation was defined from monthly employment percentage gradients in the Danish Register-based Evaluation and Marginalization Database from February 2020. The cohort was followed until 31 December 2020 for depressions overall and mild-, moderate- and severe depression. Sex-stratified cox regression models with hazard ratios (HR) and 95% confidence intervals (95% CI) were performed accounting for important confounders. RESULTS: In total, 1 619 240 (50.3%) men of mean age 45.6 years and 1 598 587 (49.7%) women of mean age 45.9 years were included. Becoming unemployed implied an increased HR of depression in men (HR 2.02; 95% CI 1.94-2.10) and women (2.19; 2.12-2.26) compared to a steady-state full-time employment. Being outside the labor force or employed part-time implied an elevated HR in men (3.02; 2.82-3.23 and 2.41; 2.35-2.48) and women (3.13; 2.30-3.31 and 2.30; 2.26-2.35), respectively, compared to a steady-state full-time employment. CONCLUSIONS: Changes in labor force participation were associated with higher risk of depression relative to a steady-state full-time employment particularly among individuals with low labor force participation during COVID-19.

A multicomponent psychosocial intervention among people with early-stage dementia involving physical exercise, cognitive stimulation therapy, psychoeducation and counselling: Results from a mixed-methods study.

BACKGROUND: There is increasing awareness of the benefits of both physical and psychosocial interventions to empower and benefit people with dementia and their caregivers. However, the potential additional benefits of combining physical and psychosocial interventions have only been sparsely explored. The aim of this pilot study was to investigate the acceptability and potential impact of a multicomponent intervention comprising physical exercise, cognitive stimulation therapy (CST), psychoeducation and counselling for people with early-stage dementia. DESIGN: A 15-week multicomponent group-based intervention was offered to people with early-stage dementia in Denmark (N = 44). A mixed-methods design combining interviews, observations, tests of cognitive and physical functioning and an interviewer-assisted questionnaire on quality of life was applied to (1) investigate acceptability of the intervention, including whether people with dementia and their caregivers found the intervention meaningful and (2) to explore and assess changes in participants' physical and cognitive functioning and quality of life. The study was conducted between June 2018 and August 2019. RESULTS: The pilot study demonstrated that the multicomponent intervention was acceptable for people with early-stage dementia and their caregivers. Test results did not show significant changes in measures of participants' physical and cognitive functioning or quality of life. However, qualitative data revealed that participants perceived the intervention as meaningful and found that it had a positive influence on their physical and social well-being. In addition, interaction and support from peers and staff members was considered important and rewarding. CONCLUSION: This multicomponent intervention constitutes a meaningful and beneficial activity for people with early-stage dementia and their caregivers. It provides an opportunity to engage in social interactions with peers and experience professional support. The study also underlines the importance of providing prolonged and sustainable interventions for people with dementia to maintain personal and social benefits.

Onset of workplace sexual harassment and subsequent depressive symptoms and incident depressive disorder in the Danish workforce.

BACKGROUND: We studied onset of workplace sexual harassment and subsequent risk of depressive symptoms and depressive disorder. METHODS: We examined 9,981 individuals who participated in the Work Environment and Health in Denmark survey in 2012 and 2014 and 6,647 individuals who also participated in 2016, all unexposed to sexual harassment in 2012. Depressive symptoms and disorder were assessed with the Major Depression Inventory. Using linear regression, we estimated the associations between onset of sexual harassment in the 12 months preceding the 2014 survey and depressive symptoms in 2014 and 2016, respectively. Using logistic regression, we estimated risk of incident depressive disorder in 2014. RESULTS: Onset of sexual harassment was associated with elevated depressive symptoms in 2014, both for harassment by non-workplace personnel (e.g., patients, estimate (B): 1.61, 95% CI: 0.51-2.72, p = 0.004) and workplace personnel (e.g., supervisors, B: 3.85, 95% CI: 2.51-5.20, p < 0.001), after adjustment for depressive symptoms in 2012. Harassment by workplace personnel was further associated with elevated depressive symptoms in 2016 after adjustment for symptoms in 2012, but not after adjustment for symptoms in 2014. Harassment by workplace personnel was associated with incident depressive disorder in 2014 (odds ratio: 5.26, 95% CI: 2.68-10.31, p < 0.001). LIMITATIONS: Depressive symptoms and disorder were assessed with a validated self-administered rating scale but not a clinical diagnostic interview. Participants reporting harassment in 2014 had elevated depressive symptoms already in 2012 requiring future investigation. CONCLUSIONS: Exposure to sexual harassments at the workplace may be a contributing factor in the aetiology of depressive symptoms and disorder.

Exploring Perceptions of Continuity of Care Among People With Long-Term Mental Disorders in Denmark.

Continuity of mental health care is central to improve the treatment and rehabilitation of people with mental disorders. While most studies on continuity of care fail to take the perspectives of service users into account, the aim of this study was to explore the perceived meanings of continuity of care among people with long-term mental disorders. Fifteen service users participated in semi-structured in-depth interviews. We used template analysis to guide the analysis. The main transversal themes of continuity were "Navigating the system" and "Connecting to people and everyday life." While the first theme related to the participants' experiences of their interaction with the mental health care system, the latter related to their hopes and perceived opportunities for a good life as desired outcomes of mental health care. We conclude that efforts to improve continuity of mental health care should be tailored to the priorities of service users.

Workplace sexual harassment and depressive symptoms: a cross-sectional multilevel analysis comparing harassment from clients or customers to harassment from other employees amongst 7603 Danish employees from 1041 organizations.

BACKGROUND: Previous research has reported that sexual harassment can lead to reduced mental health. Few studies have focused on sexual harassment conducted by clients or customers, which might occur in person-related occupations such as eldercare work, social work or customer service work. This study examined the cross-sectional association between sexual harassment by clients or customers and depressive symptoms. We also examined if this association was different compared to sexual harassment conducted by a colleague, supervisor or subordinate. Further, we investigated if psychosocial workplace initiatives modified the association between sexual harassment by clients or customers and level of depressive symptoms. METHODS: We used data from the Work Environment and Health in Denmark cohort study (WEHD) and the Work Environment Activities in Danish Workplaces Study (WEADW) collected in 2012. WEHD is based on a random sample of employed individuals aged 18-64. In WEADW, organizational supervisors or employee representatives provided information on workplace characteristics. By combining WEHD and WEADW we included self-reported information on working conditions and health from 7603 employees and supervisors in 1041 organizations within 5 occupations. Data were analyzed using multilevel regression and analyses adjusted for gender, age, occupation and socioeconomic position. RESULTS: Exposure to workplace sexual harassment from clients or customers was statistically significantly associated with a higher level of depressive symptoms (2.05; 95% CI: 0.98-3.12) compared to no exposure. Employees harassed by colleagues, supervisors or subordinates had a higher mean level of depressive symptoms (2.45; 95% CI: 0.57-4.34) than employees harassed by clients or customers. We observed no statistically significant interactions between harassment from clients and customers and any of the examined psychosocial workplace initiatives (all p > 0.05). CONCLUSIONS: The association between sexual harassment and depressive symptoms differed for employees harassed by clients or customers and those harassed by colleagues, supervisors or subordinates. The results underline the importance of investigating sexual harassment from clients or customers and sexual harassment by colleagues, supervisors or subordinates as distinct types of harassment. We found no modification of the association between sexual harassment by clients or customers and depressive symptoms by any of the examined psychosocial workplace initiatives.

Sexual harassment in care work - Dilemmas and consequences: A qualitative investigation.

BACKGROUND: Care workers are often exposed to sexual harassment from patients. Research shows that such exposure may have detrimental effects on mental health of the care workers. Inappropriate sexual behaviour from patients is a particular challenge for formal and informal care workers alike. There is a scarceness of studies investigating the experience and the handling of sexual harassment from patients. OBJECTIVES: To investigate the experience and handling of sexual harassment from patients in care work. DESIGN: The study follows an explorative qualitative approach based on group interviews (n=19) with 39 care workers. SETTINGS: Ten workplaces participated in the study, including hospitals, nursing homes, community health centres, rehabilitations care centres, and psychiatric residential facilities. PARTICIPANTS: We conducted group interviews with care workers (employees), managers, shop stewards and/or safety representatives. The majority of the interviewees were trained nurses. RESULTS: The interviews revealed that sexual harassment is a complex and multifaceted phenomenon. The care workers often separated between intentional and unintentional behaviours initiated by cognitively impaired patients. Thus, they often refrain from using the term harassment, because it implies that the actions were intentional. However, the interviews revealed that, in practice, this separation was very difficult, and that sexual harassment often creates a range of dilemmas in the daily work. At the same time, sexual harassment is a taboo. The managers, shop stewards and safety representatives in this study were often not aware of the frequency and the impact of the episodes had on the care workers. The workplaces participating in this study, rarely had guidelines or policies for managing and/or preventing sexual harassment or inappropriate sexual behaviours, but often responded to episodes in an ad hoc and case-by-case manner. CONCLUSION: The term sexual harassment might not be appropriate in the context of care work, because many patients who display inappropriate behaviours are cognitively impaired. While the interviews revealed that there is no universally accepted term, it might be more prudent to avoid the term harassment and refer it to as sexual behaviours. Considering the demographic development with a rising number of elderly and the increase in various forms of dementia, the management of inappropriate sexual behaviour by patients will be even more pressing in the future. It is time to address the prevention of sexual harassment and the management of patients' sexuality as an explicit part of the professional organisational culture of care work.

Effects of a randomized controlled intervention trial on return to work and health care utilization after long-term sickness absence.

BACKGROUND: The aim of the RCT study was to investigate if the effect of a multidisciplinary intervention on return to work (RTW) and health care utilization differed by participants' self-reported health status at baseline, defined by a) level of somatic symptoms, b) health anxiety and c) self-reported general health. METHODS: A total of 443 individuals were randomized to the intervention (n = 301) or the control group (n = 142) and responded to a questionnaire measuring health status at baseline. Participants were followed in registries measuring RTW and health care utilization. Relative risk (RR) and odds ratio (OR) were used as measures of associations. Results were adjusted for gender, age, educational level, work ability and previous sick leave. RESULTS: Among all responders we found no effect of the intervention on RTW. Among participants with low health anxiety, the one-year probability of RTW was lower in the intervention than in the control group (RR = 0.79 95 % CI 0.68-0.93), but for those with high health anxiety there was no difference between the groups (RR = 1.15 95 % CI 0.84-1.57). Neither general health nor somatic symptoms modified the effect of the intervention on RTW. The intervention had no effect on health care utilization. CONCLUSIONS: The multidisciplinary intervention did not facilitate RTW or decrease health care utilization compared to ordinary case management in subgroups with multiple somatic symptoms, health anxiety or low self-rated health. However, the intervention resulted in a reduced chance of RTW among participants with low health anxiety levels. TRIAL REGISTRATION: ISRCTN43004323 , and ISRCTN51445682.

Effort-reward imbalance at work and the risk of antidepressant treatment in the Danish workforce.

BACKGROUND: Previous studies have shown that high effort-reward imbalance (ERI) at work is a risk factor for the onset of self-reported depressive symptoms. In this study, we examined whether ERI predicts risk of treatment with antidepressant medication in a representative sample of the Danish workforce. METHODS: We linked survey data on ERI and covariates of 4541 participants from the Danish Work Environment Cohort Study 2000 with the Danish National Prescription Registry that includes all legally purchased prescription drugs at pharmacies in Denmark since 1995. Participants with a history of antidepressant treatment or with self-reported depressive symptoms at baseline were excluded. Using Cox proportional hazard analyses we examined the prospective association between ERI at baseline and incident antidepressant treatment while adjusting for potential confounders. Time of follow-up was 5 years. RESULTS: A total of 309 (6.8%) participants started antidepressant treatment during follow-up. Exposure to ERI at baseline was not related to risk of antidepressant treatment (hazard ratio: 0.91, 95% CI=0.81-1.03 after adjustment for potential confounders). LIMITATIONS: The use of antidepressant treatment as an indicator for onset of depression might have led to misclassification, because (a) antidepressants are also used to treat other conditions than depression and (b) a considerable proportion of individuals with depression are not treated with antidepressants. CONCLUSIONS: ERI did not predict incident antidepressant treatment, contradicting previous findings on ERI and self-reported depression. To clarify the association of ERI with risk of depression, we recommend further prospective studies using non-self-reported measures of ERI, clinical assessments of depression, or both.

Implementation of the Danish return-to-work program: process evaluation of a trial in 21 Danish municipalities.

OBJECTIVES: The aim of this study was to evaluate the implementation of the Danish national return-to-work (RTW) program in 21 Danish municipalities. METHODS: We conducted a structured process evaluation on (i) reach and recruitment, (ii) fidelity, (iii) dose-delivered, (iv) dose-received, and (v) context by formulating 29 implementation criteria and analyzing qualitative and quantitative data from administrative records, interviews, field notes, and questionnaires. RESULTS: All municipalities integrated the basic features of the RTW program into the existing framework of the sickness benefit management system to an acceptable degree, ie, establishment of RTW teams, participation of RTW team members in the training courses, and following the general procedures of the program. However, the level of implementation varied considerably between the municipalities, particularly with respect to fidelity (defined as implementation consistent with the principles of the interdisciplinary RTW process). Five municipalities had high and eight had low fidelity scores. Similar large differences were found with regard to dose-delivered, particularly in the quality of cooperation with beneficiaries, employers, and general practitioners. Only 50% of the first consultations with the RTW coordinator were conducted in time. Among participants who were employed when their sickness absence period started, only 9% had at least one meeting with their workplace. CONCLUSION: It was feasible to implement the basic features of the Danish RTW program, however, large variations existed between municipalities. Establishment of well-functioning interdisciplinary RTW teams might require more time and resources, while ensuring early assessment and more frequent cooperation with employers might need more general adjustments in the Danish sickness benefit system.

Stability of return to work after a coordinated and tailored intervention for sickness absence compensation beneficiaries with mental health problems: results of a two-year follow-up study.

PURPOSE: Mental health problems (MHPs) are increasingly common as reasons for long-term sickness absence. However, the knowledge of how to promote a stable return to work (RTW) after sickness absence due to MHPs is limited. The purpose of this study was to assess the effects of a multidisciplinary, coordinated and tailored RTW-intervention in terms of stability of RTW, cumulative sickness absence and labour market status after 2 years among sickness absence compensation beneficiaries with MHPs. METHODS: In a quasi-randomised, controlled trial, we followed recipients of the intervention (n = 88) and of conventional case management (n = 80) for 2 years to compare their risk of recurrent sickness absence and unemployment after RTW, their cumulative sickness absence and their labour market status after 2 years. RESULTS: We found no statistically significant intervention effect in terms of the risk of recurrent sickness absence or unemployment. Intervention recipients had more cumulated sickness absence in year one (mean difference = 58 days; p < 0.01) and year two (mean difference = 36 days; p = 0.03), and fewer were self-supported at the end of follow-up (52% versus 69%; p = 0.02). CONCLUSION: The intervention showed no benefits in terms of improved stability of RTW, reduced sickness absence or improved labour market status after 2 years when compared to conventional case management. IMPLICATIONS FOR REHABILITATION: Evidence for effective return-to-work (RTW) interventions for people with mental health problems is limited, as most research to date has been done in the context of musculoskeletal disorders. A complex, multidisciplinary intervention, detached from the workplace, does not appear to improve the stability of RTW and may actually lead to more sickness absence days and less self-support when compared to conventional case management of sickness absence beneficiaries in Denmark. A stronger focus on cooperation with social insurance officers and employers may produce better results.

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.

A multisite randomized controlled trial on time to self-support among sickness absence beneficiaries. The Danish national return-to-work programme.

BACKGROUND: In 2010, the Danish Government launched the Danish national return-to-work (RTW) programme to reduce sickness absence and promote labour market attainment. Multidisciplinary teams delivered the RTW programme, which comprised a coordinated, tailored and multidisciplinary effort (CTM) for sickness absence beneficiaries at high risk for exclusion from the labour market. The aim of this article was to evaluate the effectiveness of the RTW programme on self-support. METHODS: Beneficiaries from three municipalities (denoted M1, M2 and M3) participated in a randomized controlled trial. We randomly assigned beneficiaries to CTM (M1: n = 598; M2: n = 459; M3: n = 331) or to ordinary sickness absence management (OSM) (M1: n = 393; M2: n = 324; M3: n = 95). We used the Cox proportional hazards model to estimate hazard ratios (HR) comparing rates of becoming self-supporting between beneficiaries receiving CTM and OSM. RESULTS: In M2, beneficiaries from employment receiving CTM became self-supporting faster compared with beneficiaries receiving OSM (HR = 1.32, 95% CI: 1.08-1.61). In M3, beneficiaries receiving CTM became self-supporting slower than beneficiaries receiving OSM (HR = 0.72, 95% CI: 0.54-0.95). In M1, we found no difference between the two groups (HR = 0.99, 95% CI: 0.84-1.17). CONCLUSION: The effect of the CTM programme on return to self-support differed substantially across the three participating municipalities. Thus, generalizing the study results to other Danish municipalities is not warranted. TRIAL REGISTRATION: ISRCTN43004323.

Effect of the Danish return-to-work program on long-term sickness absence: results from a randomized controlled trial in three municipalities.

OBJECTIVES: The aim of this study was to evaluate the effect of the Danish return-to-work (RTW) program on long-term sickness absence in a randomized controlled trial in three municipalities. METHODS: The intervention group comprised 1948 participants while the control group comprised 1157 participant receiving ordinary sickness benefit management (OSM). Study participants were working-age adults receiving long-term (≥8 weeks or more) benefits, included regardless of reason for sickness absence or employment status. Each beneficiary was followed-up for a maximum period of 52 weeks. Cox proportional hazards model was used to estimate hazard ratios (HR) for return to work (RTW) with 95% confidence intervals (95% CI). RESULTS: The intervention effect differed significantly between the municipalities (P=0.00005). In one municipality (M2) the intervention resulted in a statistically significant increased rate of recovery from long-term sickness absence (HR 1.51, 95% CI 1.31-1.74). In the other two municipalities, the intervention did not show a statistically significant effect (HR M11.12, 95% CI 0.97-1.29, and HR M30.80, 95% CI 0.63-1.03, respectively). Adjustment for a series of possible confounders only marginally altered the estimated HR. CONCLUSION: The effect of the intervention differed substantially between the three municipalities, indicating that that contextual factors are of major importance for success or failure of this complex intervention.

Effort-reward imbalance at work and risk of long-term sickness absence in the Danish workforce.

OBJECTIVE: To examine whether effort-reward imbalance (ERI) at work predicts onset of register-based long-term sickness absence (LTSA) in a representative sample of the Danish workforce. METHODS: We measured effort, reward, ERI, and covariates with self-administered questionnaires in a sample of 4775 employees. LTSA during 12-months of follow-up was assessed with a national register. We calculated hazard ratios (HRs) with Cox proportional hazard models. RESULTS: The HR of LTSA for a one-SD increase in ERI was 1.03 (95% confidence interval [CI], 0.93-1.15) in the most-adjusted model. For effort, the HR for a one-SD increase was 0.95 (95% CI, 0.85-1.06) and for reward the HR for a one-SD decrease was 1.14 (95% CI, 1.03-1.26). CONCLUSIONS: ERI was not associated with onset of LTSA. Low reward, however, predicted LTSA.

Effectiveness of a coordinated and tailored return-to-work intervention for sickness absence beneficiaries with mental health problems.

PURPOSE: Sickness absence and exclusion from the labour market due to mental health problems (MHPs) is a growing concern in many countries. Knowledge about effective return-to-work (RTW) intervention models is still limited, but a multidisciplinary, coordinated and tailored approach has shown promising results in the context of musculoskeletal disorders. The purpose of this study was to assess the effectiveness of this approach as implemented among sickness absence beneficiaries with MHPs. METHODS: In a quasi-randomised, controlled trial, we assessed the intervention's effect in terms of time to RTW and labour market status after 1 year. We used two different analytical strategies to compare time to RTW between participants receiving the intervention (n = 88) and those receiving conventional case management (n = 80): (1) a traditional multivariable regression analysis controlling for measured confounding, and (2) an instrumental variable (IV) analysis controlling for unmeasured confounding. RESULTS: The two analytical approaches provided similar results in terms of a longer time to RTW among recipients of the intervention (HR = 0.50; 95 % CI 0.34-0.75), although the estimate provided by the IV-analysis was non-significant (HR = 0.70; 95 % CI 0.23-2.12). After 1 year, more recipients of the intervention than of conventional case management were receiving sickness absence benefits (p = 0.031). CONCLUSION: The intervention delayed RTW compared to conventional case management, after accounting for measured confounding. The delayed RTW may be due to either implementation or program failure, or both. It may also reflect the complexity of retaining employees with mental health problems in the workplace.

Encounters between workers sick-listed with common mental disorders and return-to-work stakeholders. Does workers' gender matter?

INTRODUCTION: The aims of this paper were to examine how disabled workers assess encounters with return-to-work (RTW) stakeholders during sickness absence due to common mental disorders (CMD) and to investigate gender differences in these assessments. METHOD: Data on contact with and assessment of encounters with RTW-stakeholders were obtained from a questionnaire investigation (N = 226). The participants were recruited from employees applying for sickness benefits due to CMD from the Municipality of Copenhagen. RESULTS: High support was most often reported from the personal and health system, especially from the psychologists (83%), while encounters with social insurance officers were least often reported to be highly supportive (16%). Colleagues were more often reported to be highly supportive (49%) than supervisors (30%). Gender differences were found both in contact with and assessments of encounters. Women were less likely to participate in a sickness absence interview with the employer, to receive care from a psychiatrist, and also assessed the encounter with the supervisor as less supportive and respectful. Gender differences remained statistically significant after controlling for several covariates, including depressive symptoms. CONCLUSION: The study findings strongly indicate that further attention needs to be directed towards improving the workers' relationship with supervisors and social insurance officers. Findings apply in particular to women.

Sleep disturbances and fatigue: independent predictors of sickness absence? A prospective study among 6538 employees.

BACKGROUND: Although sleep disturbances and fatigue are common conditions, frequently shown to be associated with sickness absence, only a few studies have prospectively investigated their independent effects on sickness absence, while adjusting for depressive symptoms. This study aims (i) to examine whether sleep disturbances and fatigue are independently related to the onset of register-based sickness absence of ≥ 3 weeks during a 1-year follow-up in a representative sample of the Danish workforce and (ii) to determine if possible associations are gender-specific. METHODS: Data were used from the Danish Work Environment Cohort Study and linked with sickness absence data from the Danish National Register of Social Transfer Payments. A total of 6538 employees, 3178 men and 3360 women, were included in the analyses. RESULTS: Sleep disturbances predicted risk of sickness absence after adjustment for covariates, but lost statistical significance after further adjustment for depressive symptoms. Fatigue among men predicted risk of sickness absence [Hazard ratio (HR) = 1.25, 95% confidence intervals (CI) 1.00-1.56] after adjustment for covariates, depressive symptoms and sleep disturbances. CONCLUSION: Sleep disturbances in both genders and fatigue in women did not predict sickness absence after depressive symptoms were taken into account. In men, fatigue was significantly related to future sickness absence, also when adjusted for depressive symptoms and sleep disturbances. Further prospective studies are needed to explore the pathways from fatigue to sickness absence in more detail. The study suggests that early detection and treatment of fatigue in men should be high on the stakeholder's agenda.

Healing a vulnerable self: exploring return to work for women with mental health problems.

Mental health problems (MHPs) such as stress and depression are among the leading causes of work disability. In this article we explore how women with MHPs experience sickness absence and subsequent return to work. We conducted 16 semistructured interviews and employed constructivist grounded theory for the analysis. We found that whereas sickness absence constituted a major threat to positive self-images, the experience had potential as a personal growth experience: Although some women felt handicapped, others became stronger and more self-confident. The core of the experience was not the return to work but a process of healing a vulnerable self--the ability both to refocus attention from symptoms to other life goals and to maintain or reconstruct a positive self-image. Supportive health care and acknowledgment from others facilitated the healing process.