Giny Norder

Predictors of Recurrent Sickness Absence Due to Depressive Disorders - A Delphi Approach Involving Scientists and Physicians

Background Depression is a common and highly recurrent mental disorder that is accompanied by poor functioning at home and at work. Not all depressed employees report sick and little is known about variables associated with sickness absence (SA) due to depression. Recurrent SA due to depression tends to marginalize employees from the workforce and exclude them from social participation. Therefore, this study sought group consensus on factors predicting recurrent SA due to depression. Methodology/principal findings 23 scientists in the field of work and mental health and 23 physicians with expertise in assessing work disability were invited for a Delphi study. Sixty-seven factors retrieved from the literature were scored for their impact on the recurrence of SA due to depression, range 1 (no impact) to 10 (very high impact) in two Delphi rounds. The third Delphi round addressed the assessability and modifiability of elected predictors. Group consensus was defined as 75% agreement. In the first round (response 78%), group consensus was reached on a high impact of 13 factors on recurrent SA due to depression. The second round (response 79%) added another 8 factors with high impact on recurrent SA due to depression. The panelists were of the opinion that stressful life and work events, age at first diagnosis, duration of the last depressive episode, anxiety, lifetime number of depressive episodes, and psychological work demands were readily assessable in consultation with patients. Furthermore, work factors, particularly decision latitude, psychological job demands, and commitment to work, were recognized as modifiable. Conclusions/significance Although results have to be validated with further quantitative research, physicians may identify employees at risk of recurrent SA due to depression and may support them to adjust their work aimed at increasing commitment to work and preventing future SA due to depression.

Recovery and recurrence of mental sickness absence among production and office workers in the industrial sector

BACKGROUND Manual workers in the public sector have previously been found to be at risk of mental sickness absence (SA). As the impact of mental illness differs across economic sectors, this study investigated mental SA in the industrial sector, differentiating between office and production workers. METHODS Ten-year observational cohort study including 14 369 (8164 production and 6205 office) workers with a total of 101 118 person years. SA data were retrieved from an occupational health register. Mental SA episodes were medically certified as emotional disturbances [10th version of the International Classification of Diseases (ICD-10 R45)] or mental and behavioural disorders (ICD-10 F00-F99). The first mental SA episode since baseline was called index mental SA. Recurrences were defined as any mental SA episode occurring >28 days after recovery from index mental SA. RESULTS The incidence of mental SA was higher in production workers than in office workers, but office workers needed longer time to recover from mental SA. Mental SA recurred as frequently in production workers as in office workers. The median time to recurrence was 15.9 months and tangibly shorter in office workers (14.9 months) than in production workers (16.7 months). Production and office workers aged >55 years were at increased risk of recurrent mental SA within 12 months of recovery from index mental SA. CONCLUSIONS The incidence of mental SA was higher in production workers than in office workers, whereas recurrence rates did not differ between them. Occupational health providers should pay special attention to older workers as they are at increased risk of recurrent mental SA.

Beyond return to work from sickness absence due to mental disorders: 5-year longitudinal study of employment status among production workers

Background: Mental disorders are increasing and account for one-third of all disability benefits in OECD countries. This study investigated the work status after mental sickness absence (SA). Methods: Five-year longitudinal cohort study of 6678 male production workers. Work status, work schedule and work hours/week were retrieved from employer records in five years following RTW from mental SA. Longitudinal analysis was done with linear and logistic generalized estimating equations estimating relative risks (RRs) and odds ratios (ORs), respectively, controlled for age, marital status and occupational grade. Results: In total, 4613 (69%) workers had complete data and were included in the analyses; 552 of them had experienced mental SA. In the years following mental SA, 102 (18%) workers left employment compared to 384 (9%) workers without mental SA. In the first year after mental SA, workers left employment at their own request and in later years they were dismissed because of poor work functioning. After mental SA, workers more often (RR = 2.93; 95% CI 1.83–4.03) reduced their work hours/week than those without mental SA, whereas the odds of changing work schedule did not differ between them (OR = 1.02; 95% CI 0.84–1.24). Conclusions: After mental SA, workers left employment or reduced work hours/week more often than those without mental SA. The results suggest that changes in employment status are more common after SA caused by mental disorders as compared with somatic disorders.

Time to recurrence of mental health-related absence from work.

BACKGROUND It is unclear when occupational health providers should re-evaluate workers after mental health-related absences from work. AIMS To investigate the time to recurrence of mental health-related absences, stratified by International Classification of Diseases-Tenth Revision (ICD-10) diagnostic categories. METHODS A 10-year observational study of workers employed at a steel mill. Sickness absence data were retrieved from an occupational health register. Mental health-related absences were defined as absence due to emotional disturbance or mental and behavioural disorders. The first mental health-related absence since baseline was called the index episode. Recurrences were defined as mental health-related absences occurring >28 days after recovery from the index episode. The frequency of recurrent mental health-related absence was assessed by the recurrence density (RD) per 1000 person-years. The time to recurrent mental health-related absence was investigated by Kaplan-Meier survival analysis. RESULTS Of 15461 workers, 391 had recurrent mental health-related absences. RD was 30.5, 34.3, 29.9 and 37.7 per 1000 person-years after index episodes due to emotional disturbance, mood disorders, neurotic disorders and other psychiatric disorders, respectively. RDs did not differ across ICD-10 diagnostic categories. The median time to recurrent mental health-related absence was 15.2 months [95% confidence interval (CI) 12.6-17.7] and was shortest for mood disorders (5.2, 95% CI 1.4-8.9 months) and specific psychiatric disorders (5.3, 95% CI 1.0-13.1 months). CONCLUSIONS Based on this observational study, we suggest that occupational and primary health care providers consider reviewing the mental health status of workers 6 months after recovery from mental health-related absence.

Validering van een prognostisch model voor de duur van verzuim bij psychische klachten

SamenvattingHet aantal medewerkers dat zich ziek meldt met psychische stoornissen, zoals depressie, angst en aanpassingsstoornissen, wordt steeds groter. Psychische stoornissen zijn de oorzaak van een aanzienlijk deel van het langdurige ziekteverzuim en zijn de belangrijkste reden voor een WIA-uitkering onder medewerkers jonger dan 55 jaar.1 Prognostische modellen die de duur van ziekteverzuim ten gevolge van psychische klachten voorspellen, kunnen bedrijfsartsen helpen medewerkers met een hoog risico op langdurig ziekteverzuim al in een vroeg stadium te identificeren en te verwijzen naar een behandeling of interventie gericht op het verminderen van de verzuimduur.