Inger Plaisier

Work functioning in persons with depressive and anxiety disorders: The role of specific psychopathological characteristics

BACKGROUND Depressive and anxiety disorders affect work functioning and cause high labour costs. AIMS To examine and compare psychopathological characteristics of depressive and anxiety disorders in their effect on work functioning. METHOD In 1876 working participants of the Netherlands Study of Depression and Anxiety (NESDA) associations of presence, severity, comorbidity, duration and type of DSM-IV anxiety and depressive disorders with both absenteeism (<2 weeks and >2 weeks) and work performance (reduced and impaired) were assessed. RESULTS People with current depressive disorders had 7.10 times greater odds for the risk of >2 weeks work-absence and 5.67 greater odds for the risk of impaired work performance, while persons with current anxiety disorders had 1.84 and 2.13 greater odds for the risk of >2 weeks absence and impaired work performance, respectively. Even when persons were recovered from depressive and anxiety disorders, they still had a higher risk of poor work functioning. Persons with comorbidity, chronic depressive disorder, a generalized anxiety disorder, and more severity of both anxiety and depressive disorder had higher odds for the risk of absenteeism and decreased work performance. CONCLUSION Anxiety disorders have significant negative impact on work functioning, although smaller than the effect of depressive disorders. Comorbidity, severity, type and duration of the disorder, differentiate the risk of poor work functioning.

The effect of social roles on mental health: A matter of quantity or quality?

The effect of social roles (partner, parent, worker) on mental health may depend on the total number or the quality of the individual occupied social roles. With longitudinal data from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), the effect of the number and quality of occupied social roles on mental health over three years was examined among 2471 men and women aged 25-55 years without mental disorders at baseline. Mental health was assessed using 3-year change in the SF-36 mental health scale as well as using the 3-year incidence of anxiety and depressive disorders defined by DSM-III criteria. The quality of social roles was assessed by the GQSB (Groningen Questionnaire Social Behavior). The number of social roles had no significant effect on the risk of developing depressive and anxiety disorders, but particularly the partner-role had a significant positive effect on mental health (beta of mental health=1.19, p=0.01; HR of incident disorders=0.75, 95% CI:0.51-1.00, p=0.05). A good quality of each of the three social roles was associated with higher levels of mental health and lower risks of incident disorders over 3 years. More than the number of social roles, knowledge about social role quality might provide opportunities for prevention of depressive and anxiety disorders.

Job strain as a risk factor for clinical depression: systematic review and meta-analysis with additional individual participant data.

Background Adverse psychosocial working environments characterized by job strain (the combination of high demands and low control at work) are associated with an increased risk of depressive symptoms among employees, but evidence on clinically diagnosed depression is scarce. We examined job strain as a risk factor for clinical depression. Method We identified published cohort studies from a systematic literature search in PubMed and PsycNET and obtained 14 cohort studies with unpublished individual-level data from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium. Summary estimates of the association were obtained using random-effects models. Individual-level data analyses were based on a pre-published study protocol. Results We included six published studies with a total of 27 461 individuals and 914 incident cases of clinical depression. From unpublished datasets we included 120 221 individuals and 982 first episodes of hospital-treated clinical depression. Job strain was associated with an increased risk of clinical depression in both published [relative risk (RR) = 1.77, 95% confidence interval (CI) 1.47–2.13] and unpublished datasets (RR = 1.27, 95% CI 1.04–1.55). Further individual participant analyses showed a similar association across sociodemographic subgroups and after excluding individuals with baseline somatic disease. The association was unchanged when excluding individuals with baseline depressive symptoms (RR = 1.25, 95% CI 0.94–1.65), but attenuated on adjustment for a continuous depressive symptoms score (RR = 1.03, 95% CI 0.81–1.32). Conclusions Job strain may precipitate clinical depression among employees. Future intervention studies should test whether job strain is a modifiable risk factor for depression.

Depressive and anxiety disorders on-the-job: the importance of job characteristics for good work functioning in persons with depressive and anxiety disorders.

This study examines the importance of job characteristics on absence and on-the-job performance in a large group of employees with diagnosed depressive and anxiety disorders. In a sample of 1522 employees (1129 persons with and 393 persons without psychopathology) participating in Netherlands Study of Depression and Anxiety (NESDA, n=2981) we examined associations between job characteristics and work functioning (absenteeism and work performance) in multinominal logistic regression models. Job characteristics were working hours, psychosocial working conditions and occupational status. As expected, depressed and anxious patients were at significantly elevated risk for absenteeism and poor work performance. In analyses adjusted for psychopathology, absenteeism and poor performance were significantly lower among persons reporting high job support, high job control, less working hours, self-employed and high skilled jobs. Associations were comparable between persons with and without psychopathology. High job support, high job control and reduced working hours were partially related to work functioning in both workers with- and without-psychopathology. Since depressed and anxious employees are at a substantially increased risk for absenteeism and poor work performance, strategies that improve job support and feelings of control at work may be especially helpful to prevent poor work functioning in this at-risk group of employees.

Developments in home-care use. Policy and changing community-based care use by independent community-dwelling adults in the Netherlands

Reforms have recently been introduced in the Dutch care system in order to constrain the rising expenditure on long-term care. In this study we examined changes in community-based care use between 2004 and 2011 and changes in the explanatory effects of its determinants (health, personal and facilitating factors) that may result from these reforms. The study drew on care use registration data linked to data from national health surveys and income data from the tax authorities. Changes in community-based care use determined by health, personal and facilitating factors between 2004 and 2011 were studied. Changes in determinants were investigated by incorporating time-interaction terms of each determinant in logistic regression models. The main findings show among other things that the use of community-based care did not increase between 2004 and 2011 if allowances made for the increase in the number of (elderly) older people. The role of income and household composition has changed the most (and to a lesser extent the role of age and physical impairments). Care use decreased among individuals with high incomes and increased among single persons. The changes in community-based care use and in the role of income and household composition could be due to changes in eligibility for care, in which the applicants personal situation is given a more prominent role alongside health considerations.

The impact of conscientiousness, mastery, and work circumstances on subsequent absenteeism in employees with and without affective disorders.

BackgroundHigh numbers of employees are coping with affective disorders. At the same time, ambitiousness, achievement striving and a strong sense of personal control and responsibility are personality characteristics that are nowadays regarded as key to good work functioning, whereas social work circumstances tend to be neglected. However, it is largely unkown how personality characteristics and work circumstances affect work functioning when facing an affective disorder. Given the high burden of affective disorders on occupational health, we investigate these issues in the context of affective disorders and absenteeism from work. The principal aim of this paper is to examine whether particular personality characteristics that reflect self-governance (conscientiousness and mastery) and work circumstances (demands, control, support) influence the impact of affective disorders on long-term absenteeism (>10 working days).MethodsBaseline and 1-year follow-up data from 1249 participants in the Netherlands Study of Depression and Anxiety (NESDA) in 2004–2006 was employed. Multivariate logistic regression analyses were performed, including interaction effects between depressive, anxiety, and comorbid disorders and personality and work circumstances.ResultsIn general, mastery and conscientiousness increased nor diminished odds of subsequent long-term absenteeism, whereas higher job support significantly decreased these odds. Interaction effects showed that the impact of affective disorders on absenteeism was stronger for highly conscientious employees and for employees who experienced high job demands.ConclusionsAffective disorders may particularly severely affect work functioning of employees who are highly conscientious or face high psychological job demands. Adjusting working conditions to their individual needs may prevent excessive work absence.