Andrea Gragnano

Common Psychosocial Factors Predicting Return to Work After Common Mental Disorders, Cardiovascular Diseases, and Cancers: A Review of Reviews Supporting a Cross-Disease Approach

Purpose This systematic review aimed at identifying the common psychosocial factors that facilitate or hinder the return to work (RTW) after a sick leave due to common mental disorders (CMDs), cardiovascular diseases (CVDs), or cancers (CAs). Methods We conducted a review of reviews searching 13 databases from 1994 to 2016 for peer-reviewed, quantitative, cohort studies investigating factors influencing RTW after a CMD, CVD, or CA. Then, for each disease we identified additional cohort studies published after the date of the latest review included. Data were extracted following a three steps best-evidence synthesis method: the extraction of results about each predictor from studies within each single review and in the additional papers; the synthesis of results across the reviews and additional papers investigating the same disease; and the synthesis of results across the diseases. Results The search strategy identified 1029 unique records from which 27 reviews and 75 additional studies underwent comprehensive review. 14 reviews and 32 additional cohort studies met eligibility criteria. Specific predictors of RTW with different levels of evidence are provided for each disease. We found four common facilitators of RTW (job control, work ability, perceived good health and high socioeconomic status), and six barriers of RTW (job strain, anxiety, depression, comorbidity, older age and low education). Conclusion This is the first review to systematically analyze commonalities in RTW after CMDs, CVDs, or CAs. The common factors identified indicate that the RTW process presents many similarities across various diseases, thus supporting the validity of a cross-disease approach.

How Can Supervisors Contribute to the Return to Work of Employees Who have Experienced Depression

Background In Western countries, work disability due to depression is a widespread problem that generates enormous costs. Objective The goal of this study was to determine the types and prevalence of supervisor contributions during the different phases of the return-to-work (RTW) process (before and during the sick-leave absence, and during the RTW preparations) of employees diagnosed with depression. Moreover, we sought to determine which contributions actually facilitate employees’ RTW, and to identify the work accommodations most frequently implemented by supervisors at the actual time of their employee’s RTW. Methods Telephone interviews were conducted in Québec (Canada) with 74 supervisors working with employees who were already back at work or still on sick leave due to depression. A sub-sample of 46 supervisors who had already taken measures to facilitate their employees’ RTW was questioned about the work accommodations implemented. Results Most of the supervisors got along well with their employees before their sick leave and 72% stayed in contact with them during their leave. Nearly 90% of the supervisors encouraged their employees to focus primarily on their recovery before their RTW, but 43% pressured their employees to RTW as soon as possible. Cox regression analyses performed for the entire sample revealed that “the supervisors’ intention to take measures to facilitate their employees’ RTW” was the only significant predictor of the RTW at the time of the interview. The Kaplan–Meier survival curve showed that 50% of the employees were expected to RTW within the first 8 months of absence. Four of the most frequently implemented work accommodations were actions directly involving the supervisor (i.e. providing assistance, feedback, recognition, and emotional support to the employee). Conclusions This study shed light on the less explored point of view of the supervisor involved in the RTW process of employees post-depression. It highlighted the most frequent and effective supervisor contributions to the process. These results can be used to develop concrete action plans for training supervisors to contribute to the sustainable RTW of employees on sick leave due to depression.

Adjustment Between Work Demands and Health Needs: Development of the Work-Health Balance Questionnaire

Purpose: This study presented the construct of Work–Health Balance (WHB) and the design and validation of the Work–Health Balance Questionnaire (WHBq). More and more workers have a long-standing health problem or disability (LSHPD). The management of health needs and work demands is crucial for the quality of working life and work retention of these workers. However, no instrument exists measuring this process. The WHBq assesses key factors in the process of adjusting between health needs and work demands. Method: We tested the reliability and validity of 38 items with cross-sectional data from a sample of 321 Italian workers (mean age = 45 ± 11 years) using exploratory factor analysis (EFA), Rasch analyses, and the correlations with other relevant variables. Results: The instrument ultimately consisted of 17 items that reliably measured three factors: work–health incompatibility, health climate, and external support. These dimensions were associated with well-being in the workplace, dysfunctional behaviors at work, and general psychological health. A higher level on the WHB index was associated with lower levels of presenteeism, emotional exhaustion, workaholism, and psychological distress and with higher levels of job satisfaction and work engagement, supporting the construct validity of the instrument. Conclusion: The WHBq shows good psychometric characteristics and strong and theoretically consistent relationships with important and well-known variables. These results make the WHBq a promising tool in the study and management of health of employees, especially for the work continuation of employees returning to work with LSHPD.

Does the return to work have a negative impact on the lifestyle of cardiovascular patients? Comments on the ICAROS results

Dear Editor,Although cardiovascular disease (CVD) is most prevalent in theelderly, it often affects patients in their productive years prior toretirement age (65–70 years) [1]. In this case, almost always,medical and rehabilitative support has the objective to promotethe return to work (RTW) [2]. Previous studies have focused onvariables that can affect a more rapid and satisfactory RTW, andthese studies concluded that the RTW after CVD is a complex andmultidimensional process that is more influenced by psychosocialfactors (e.g., depression, work strain, job satisfaction, and workplacejustice) than by the patients clinical status (e.g., left ventricularejection fraction) [3,4]. The RTW after a cardiovascular event is noteasy [5], and observational studies have reported that workers withCVD show increased rates of absenteeism and disability periodscompared with workers without CVD [6]. There is an abundance ofscientific literature demonstrating that lifestyle interventions inpatients with CAD can reduce the risk of new events, improve thesurvival and the quality of life [7,8]. Nevertheless, the influence ofwork on healthy lifestyle is relatively unknown and adverse jobconditions, characterized by high job strain, might increase thelikelihood of co-occurring health risk behaviors [9].Wethusanalyzed the data collected with the Italian survey on CardiacRehabilitation and Secondary prevention after cardiac revascular-ization (ICAROS) to verify patient adherence to a healthy lifestyle.ICAROS has already been described elsewhere [8,10].Inbrief,itisaprospective, longitudinal, multicenter registry with on-line datacollection that evaluates the achievement and maintenance ofrecommended lifestyle targets and risk control after completing acomprehensive inpatient or outpatient cardiac rehabilitation pro-gram aftercardiac revascularization. The lifestyle data collectionwasperformed by trained investigators at discharge from the CardiacRehabilitation program, as well as 6 months and 1 year later, using abrief questionnaire that analyzed smoking habits (smoking vs. nosmoking), diet (the consumption frequency of vegetables, fruit, fish,olive oil and cheese/butter was evaluated to obtain a Mediterraneandiet score, which was then categorized into good or bad diet), andphysical activity (never/rarely vs. ≥30 min/session of moderateintensity exercise per 3 times/week) [8,10]. The ethical committeefor each center approved the protocol, and informed consent wasobtained from each patient. To obtain a balanced sample for thisresearch,accordingtothecurrentincreasein meanretirementageinItaly, we extracted only working age patients (b70) from the ICAROSdatabase, and we divided them into two groups: workers and non-workers before CVD. Using these categories, we selected 789 of 1272patients; demographic and lifestyle profiles of the study populationsare reported in Table 1.Inoursample,thenumberofworkingpeopledecreasedovertime.Atthe moment of the index event workers were 51.5% of the studypopulation:6and12 monthsaftertheendofthesupervisedCRprogrampatient with a profitable work were 47 and 38.9%, respectively. Thus,9.6% of those that were working before CVD did not return to work6 months after discharge, and 17.3% of those that returned to work lefttheir jobs within the first 12 months after discharge.We performed 3 logistic regressions to assess the influence ofwork on smoking behavior, dietary habits and physical activity,controlling for the effects of time after discharge, other lifestylehabits, intervention type, age and sex (Table 2 ).The logistic regressionused to predict smoking behavior revealedthat the odds for smoking was 1.84 (95% CI = 1.13–2.99) timesgreater for workers compared with non-workers. Nevertheless, sex(male odds ratio (OR) = 2.75; 95% CI = 1.25–6.03) and, weakly, age(OR = 0.97; 95% CI = 0.94–0.99) also affected smoking behavior.The return to work did not have an effect on dietary habits andphysical activity. However, our data suggested that these lifestylebehaviors were linked. Indeed, bad dietary habits increased theprobability of smoking (OR = 1.81; 95% CI = 1.23–2.66), smokingbehavior decreased the probability of adopting a healthy diet(OR = 0.62; 95% CI = 0.39–1.00) and adopting a healthy dietincreased the probability of being physically active (≥3times/week), with an odds ratio of 1.98 (95% CI = 1.56–2.40).Our data highlighted three important aspects related to thereturn to work and lifestyle modification that, to the best of ourknowledge, were previously unexplored. First, a considerable groupof CVD patients returned to work but then, within the first yeardecided to retire; second, patients that returned to work had anincreased risk of not quitting. Finally patients with a defectivecontrol of one lifestyle risk factors are at higher risk for adoption ofan additional unhealthy lifestyle. Because the return to work for CVDpatients is psychologically stressful [4,6], it might be postulated thatsome patients decide to retire and that other patients resumesmoking after the RTW as a result of maladaptive coping strategies.In conclusion, this ancillary analysis of ICAROS highlights theimportance of considering in patients with CAD not only the RTWbut also their level of functioning once they are back at work [10].Inparticular, one question raised here is whether it is possible tobalance work life with a healthy lifestyle or if the RTW leads tosmoking and other unhealthy behaviors. From this perspective, wethink that our data open an interesting field of research and a newrole for cardiac rehabilitation.