Henry G. Harder

Prospective study of risk factors for increased suicide ideation and behavior following recent discharge

OBJECTIVE The purpose of this study is to prospectively examine the association between predictors from the three thematic areas - suicidality, personal risk factors and patient care factors - and the occurrence of postdischarge suicide ideation and behavior in recently discharged patients. METHODS The design is a prospective cohort study of all patients admitted to an inner city inpatient psychiatric service with a lifetime history of suicidal behavior and current suicidal ideation. Predictors of suicide ideation at 1, 3 and 6 months following discharge and suicide behavior over the 6 months of follow-up were examined. RESULTS The incidence of death by suicide during the study period was 3.3% [95% confidence interval (CI)=0.9%-8.3%], and 39.4% (95% CI=30.0%-49.5%) of the surviving participants reported self-injury or suicide attempts within 6 months of hospital discharge. Risk factors such as recent suicide attempts, levels of depression, hopelessness and impulsivity were predictive of increased suicide ideation or behavior after discharge from the inpatient service. CONCLUSIONS The high risk of suicide ideation, suicide attempts and suicide demonstrated in these recently discharged patients supports the need to develop selective prevention strategies.

Physician-stakeholder collaboration in Disability Management: A Canadian perspective on guidelines and expectations

Purpose. The physician plays a vital role in Disability Management; unfortunately, there is an apparent lack of clarity with respect to the functions included in this role. The present article reviews the collaborative nature of the physician-stakeholder relationship giving attention to types of expectations, current Canadian guidelines and future challenges. Conclusion. The authors conclude that although challenging and complex, the physicians performance in Disability Management can be optimized through improved communication and collaboration with stakeholders.

The perpetual search for parsimony: Enhancing the epistemological and practical utility of qualitative research findings

BACKGROUND While it appears that the term parsimony has been used in the context of qualitative research and qualitative research methodology, there is a distinct absence of writing that actually explores, seeks to define, understand, critique, apply and/or evaluate the concept in qualitative research literature. AIMS This paper explores a number of issues pertaining to parsimony in qualitative research. It is the hope of the authors that this paper might raise awareness of the hitherto unexplored issues, stimulate some further interest in these and prompt other qualitative researchers to contribute to the ensuing debate. DISCUSSION While there are currently no definitive criteria for determining the parsimony of qualitative research findings, it would be epistemologically inappropriate and philosophically incongruent to import and translate quantitative notions of parsimony. However, the ideas, principles and epistemological functions that parsimony serves can and should be applied to the qualitative paradigm. The authors suggest that more than one type of qualitative parsimony is required. The authors advance the argument that there is a relationship between the degree of parsimony and the elegance, ease of accessibility and straightforwardness (some might say - beauty) of the writing/findings; the level of expertise of the researcher; and the quality of the data collection interview. The authors also assert that there are a number of practices which, when adhered to, can enhance the parsimony of the findings and that here are a number of major implications arising from qualitative findings that lack parsimony.

Disability Management Approach to Job Accommodation for Mental Health Disability

A body of research exists that outlines the personal, social, and economic costs of mental health disability (e.g., Dewa and McDaid 2010, this book; Dewa et al. 2007; WHO 2005). More recently, employers are becoming aware of the financial and human costs of mental health disability in their work sites.

Characteristics of the traumatic stressors experienced by rural first responders

First responders routinely experience work-related events that meet the definition of a traumatic stressor. Despite the high exposure to traumatic events, prevalence rates of posttraumatic stress disorder (PTSD) are relatively low. This discrepancy points to the potential value of identifying factors that distinguish those traumatic stressors that produce ongoing traumatic stress symptoms from those that do not. The present study surveyed 181 first responders from rural settings. A repeated-measures design was used to compare characteristics of traumatic stressors that were or were not associated with ongoing PTSD symptoms. A factor analysis revealed that distressing events were characterized by chaos and resource limitations. Consistent with contemporary models, two mediational analyses revealed that each event characteristic predicted peritraumatic dissociation and posttraumatic cognitions, which in turn predicted PTSD symptoms. Moreover, the effect of each event characteristic on PTSD symptoms was partially mediated by these cognitive processes.

Behavioral Health and Firefighters: An Intervention and Interviews with Canadian Firefighters

ABSTRACT The present study described participatory action research regarding behavioral health of firefighters. At the request of the participant fire department, the Veterans’ Affairs Wellness kit was used to provide wellness information to members. During the intervention, qualitative data from the researcher perspective was collected and subsequently coded to reveal themes about lessons learned during provision of the materials. Following the intervention at the department level, individual interviews were completed with a subsample of members and their spouses. The combined outcomes from these two research phases suggest that wellness interventions for firefighters should be informal, firefighter-specific, focused on programs endorsed by firefighter-related organizations, and supported by management and frontline supervisors. From our data, we suggest that the Veterans’ Affairs Wellness kit should be studied further as a potentially meaningful fire service intervention. Further, we propose that this and other interventions should take into account job aspects identified as important by both members and their spouses.

Workers’ Perspectives on Vocational Rehabilitation Services

The purpose of the present study was to consider the vocational rehabilitation (VR) process from the perspective of VR consumers. To better understand the experiences of workers who were injured on the job and participated in VR rehabilitation services, 27 semistructured interviews were completed; 24 were completed face-to-face and 3 were completed over the phone. The present data suggested five primary themes, including expectations, communication, human factors, psychological factors, and reemployment considerations as the most important areas from the workers’ perspectives. Using these themes, recommendations for VR consultant (VRC) practice may be developed. These recommendations include the demonstration of sincere empathy for the consumer and clear communication that allows the client to feel a part of their VR plan/process. It is also recommended that VRCs evaluate and monitor client expectations, openly address barriers, and provide mental health support whenever requested or required. Finally, additional support during the job development process is recommended. In particular, clients desired ample support and communication during the processes of job assessment, job search, and job placement. Finally, clients desired and valued the use of accommodated employment in situations where accommodations would improve their employment outcomes.

Disability management and organizational culture in Australia and Canada

BACKGROUND Organizational culture has received increasing attention in terms of its influence on workplace health and productivity, yet there has been little research on its relationship with employer-based disability programs. OBJECTIVE This study explored the relationship between disability management and organizational culture in Australian and Canadian organizations. METHODS Thematic analysis was conducted on data from semi-structured interviews with 16 employees, including injured workers, human resource managers and disability managers in two Australian and two Canadian large organizations. RESULTS Seven themes were identified: 1. Consistency between espoused beliefs and artifacts in organization; 2. Genuineness of interest in well-being of injured worker; 3. Level of ongoing support of worker following injury; 4. Communication with injured workers; 5. Level of support from supervisors and co-workers; 6. Promptness in claims processing and covering medical costs and; 7. Focus on wellness and injury prevention. It was found that organizational culture may impact the delivery and perceived value of employer-based disability management programs. CONCLUSIONS Given the potential relationship between organizational culture and disability management, employers should facilitate a positive workplace culture by ensuring consistency among underlying values, espoused values and actual treatment of employees, including injured workers.

Private Health Care Option: Disability Management in Canada

Timely access to health care has become a leading concern for many Canadians. At the center of the debate lies the more volatile issue of whether some diagnostic procedures and surgeries should be completed at private health care facilities rather than through the public system. This article provides review and discussion regarding the risks and benefits involved in the use of private health care options, in particular with respect to musculoskeletal illness/injury. The authors conclude that employers considering the use of privately funded options for employees should evaluate this decision carefully and contemplate seeking advice from legal and ethical experts prior to implementation.

International employee perspectives on disability management

Abstract Purpose: To provide an international analysis of employees’ views of the influence of disability management (DM) on the workplace. Methodology: An international research team with representation from Australia, Canada, China, and Switzerland collected survey data from employees in public and private companies in their respective regions. Due to lack of availability of current measures, a research team-created survey was used and a total of 1201 respondents were collected across the four countries. Analysis: Multiple linear (enter) regression was also employed to predict DM’s influence on job satisfaction, physical health, mental health, workplace morale and reduced sickness absence, from respondents’ perceptions of whether their company provided disability prevention, stay-at-work, and return-to-work initiatives within their organization. One-way ANOVA comparisons were used to examine differences on demographic variables including company status (public versus private), union status (union versus nonunion), and gender. Results: The perceived influence of DM programs was related to perceptions of job satisfaction; whereas, relationships with mental health, physical health, morale, and sickness absence were variable according to type of DM program and whether the response was related to self or others. Difference analyses (ANOVA) revealed significantly more positive perceptions for private and nonunion organizations; no gender effects were found. Conclusions: There is perceived value of DM from the perspective of employees, especially with respect to its value for coworkers. Implications for Rehabilitation Rehabilitation efforts should continue to focus attention on the value of disability management (DM). In particular, DM that is fully committed to the biopsychosocial model would be supported by this research. Employees reported the most value in the psychosocial variables addressed by DM, such that rehabilitation professionals could focus on these valued aspects to improve buy-in from employees. The interest in coworker value may provide another avenue for rehabilitation efforts to increase uptake, by highlighting the value of intervention efforts for employee coworkers. Rehabilitation professionals in union environments may need to be particularly cognizant of the need for encouraging psychosocial and coworker value potentially seen by employees in order to increase acceptance and participation for organizational DM efforts.