J. J. L. van der Klink

Trends in the incidence of sickness absence due to common mental disorders between 2001 and 2007 in the Netherlands

BACKGROUND Mental disorders are an important public health problem because of their prevalence and the probability of long-term work disability. The incidence of sickness absence with mental disorders has increased between 1985 and 2000, but little is known about trends in recent years. This study investigated the incidence of sickness absence due to common mental disorders in the Netherlands from 2001 to 2007. METHODS Observational study in about 1 million employees, working in various economic sectors, representative for the Dutch workforce. Sickness absence episodes were medically certified by an occupational physician utmost in the fifth week of absence. The 12-month incidence of medically certified sickness absence was calculated for each year by dividing incident episodes by the number of employees. Sick days due to common mental disorders were computed as percentage of the total number of medically certified sick days. RESULTS The 12-month incidence of sickness absence due to common mental disorders was 2.2% in 2001, increased to 2.7% in 2004 and decreased thereafter to 2.0% in 2007. The percentage of sick days due to common mental disorders was highest in the education sector (39%) followed by financial services (31%) and health care (30%). CONCLUSIONS In the Netherlands, the incidence of sickness absence with common mental disorders was highest in 2004 and has decreased since then probably because of changes in sick leave compensation, economic market position and company policies.

Development and validation of the Diagnostic Interview Adjustment Disorder (DIAD)

Adjustment disorders (ADs) are under‐researched due to the absence of a reliable and valid diagnostic tool. This paper describes the development and content/construct validation of a fully structured interview for the diagnosis of AD, the Diagnostic Interview Adjustment Disorder (DIAD). We developed the DIAD by partly adjusting and operationalizing DSM‐IV criteria. Eleven experts were consulted on the content of the DIAD. In addition, the DIAD was administered by trained lay interviewers to a representative sample of disability claimants (n = 323). To assess construct validity of the DIAD, we explored the associations between the AD classification by the DIAD and summary scores of the Kessler Psychological Distress 10‐item Scale (K10) and the World Health Organization Disability Assessment Schedule (WHODAS) by linear regression. Expert agreement on content of the DIAD was moderate to good. The prevalence of AD using the DIAD with revised criteria for the diagnosis AD was 7.4%. The associations of AD by the DIAD with average sum scores on the K10 and the WHODAS supported construct validity of the DIAD. The results provide a first indication that the DIAD is a valid instrument to diagnose AD. Further studies on reliability and on other aspects of validity are needed. Copyright

Characteristics of zero-absenteeism in hospital care

BACKGROUND Literature on sickness presenteeism is emerging, but still little is known about employees who are never absent from work due to injuries or illness. Insight into the determinants and characteristics of such zero-absentees may provide clues for preventing sickness absence. AIMS To investigate the characteristics of zero-absentees, defined as employees without sickness absence over a period of 5 years. METHODS A mixed-method qualitative study comprising semi-structured interviews and focus groups for which Azjen and Fishbeins theory of planned behaviour was used as a framework. Zero-absentees working in hospital care were invited for semi-structured interviews until saturation was reached. The results of semi-structured interviews were validated in two focus groups. RESULTS Of 1053 hospital employees, 47 were zero-absentees of whom 31 (66%) agreed to participate in the study. After 16 semi-structured interviews, no new insights or information were gathered from the interviews. The remaining 15 employees were invited to two (n = 8 and n = 7) focus groups. Personal attitudes and self-efficacy were more important in zero-absenteeism than social pressures of managers, colleagues or patients. Zero-absentees were found to be intrinsically motivated to try attending work when ill. CONCLUSIONS In the present study population of hospital employees, we found indications that zero-absenteeism and sickness presenteeism might be different types of work attendance. Managers should realize that zero-absentees are driven by intrinsic motivation rather than social pressures to attend work.

Bevorderen van de duurzame inzetbaarheid van de oudere werknemer. Langer werken gaat niet vanzelf

SamenvattingDe participatie in arbeid van mensen boven de 45 jaar neemt toe en de verwachting is dat deze tendens zich nog zal voortzetten. Van werknemers wordt steeds meer verwacht dat zij doorwerken tot het bereiken van de pensioengerechtigde leeftijd. Om inzicht te krijgen in de factoren die van invloed zijn op duurzame inzetbaarheid van deze groep is in 2008 een vragenlijstonderzoek uitgevoerd onder 3008 werknemers van 45 jaar en ouder. Doel van het onderzoek was om te inventariseren welke factoren de inzetbaarheid van oudere werknemers positief of negatief beïnvloeden en te bepalen hoe de inzetbaarheid van deze werknemers kan worden vergroot.Uit de resultaten blijkt dat 42% van de respondenten (gezondheids)problemen ervaart door het ouder worden en dat 37% een chronische aandoening rapporteert. Door deze problemen ervaart meer dan de helft van de werknemers moeilijkheden bij het uitvoeren van werk, met risicos voor de toekomstige inzetbaarheid. Een actief beleid gericht op duurzame inzetbaarheid lijkt noodzakelijk gezien de gerapporteerde participatieproblemen.

De limbische verklaring: wat zijn de voordelen?

SamenvattingWij waarderen de uitvoerige reactie van collega Klaver op ons artikel ‘Dilemma voor de bedrijfsarts; Onbegrepen psychische klachten, voortmodderen of verwijzen?’. In feite is zijn reactie een systematische bespreking van het artikel in het licht van de limbische verklaring.

Dilemma voor de bedrijfsarts: Verwijzing verplicht?

SamenvattingDe commercieel directeur van arbodienst Mercurius heeft samen met de vakmanager bedrijfsgeneeskunde, de leidinggevende van de bedrijfsartsen, een commercieel werkplan 2002 opgesteld. Naast de vaste elementen daarin, zoals het aantal te realiseren declarabele uren per medewerker, en de resultaatsafhankelijke bonus voor medewerkers die nieuwe klanten aandragen of anderszins extra presteren, zijn er ook nieuwe elementen. Een daarvan is gebaseerd op de reeds afgesloten en nog af te sluiten contracten met zogenaamde tweedelijns arbo-instellingen.Met twee van deze instellingen is het contract al rond. Het betreft de landelijke organisatie Fit-At-Work, gespecialiseerd in de aanpak van klachten aan het bewegingsapparaat, en de snelgroeiende instelling die naar de naam Master Mind luistert, en die een succesvol protocol voor de behandeling van psychische problematiek heeft ontwikkeld dat door getrainde psychotherapeuten aan de man wordt gebracht.

High prevalence of early onset mental disorders among long-term disability claimants

Abstract Purpose: To provide information on prevalence, comorbidity, age-of-onset and severity of mental disorders among persons claiming disability after long-term sickness absence. Method: Cross-sectional analysis of a cohort of Dutch disability claimants (n = 346). Composite International Diagnostic Interview (CIDI) 3.0 was used to generate DSM-IV classifications of mental disorder, age-of-onset and severity; registry data were used on demographics and ICD-10 classifications of somatic disorder. Results: The mean age of respondents was 49.8 (range 22–64). The most prevalent broad categories of mental disorders were mood and anxiety disorder with a 12-month prevalence of 28.6% and 32.9%, respectively. Mood and most anxiety disorders had ages of onset in adolescence and early adulthood. The phobias start at school age. Of all respondents, 33.7% had ≥1 12-month mental disorder. Co-occurrence of substance use disorders, phobias and depression/anxiety disorders is frequent. Urogenital and gastrointestinal diseases, and cancer coincide with 12-month mental disorder in 66.7%, 53.9% and 51.7% of cases, respectively. More than two out of three specific mental disorders are serious in terms of disability and days out of working role. Conclusions: Disability claimants constitute a vulnerable population with a high prevalence of serious mental disorder, substantial comorbidity and ages-of-onset in early working careers. More research is needed to help prevent long-term sickness absence and disability of claimants with mental health problems. Implications for Rehabilitation This study shows common mental disorders, such as mood and anxiety disorders, to be highly prevalent among persons claiming disability benefit after long-term sickness absence, to have early onsets and to often co-occur with somatic disorders. Professionals in primary and occupational health care should assess need for treatment of workers at risk, while at the same time being careful not to medicalize normal life problems. Insurance physicians assessing disability benefit claims should identify factors that caused claimants to call in sick and start interventions to promote return to work.

Beroepsbevolking vertoont krimp noch vergrijzing

SamenvattingWie de media volgt, zal zich zorgen maken. Naast de kredietcrisis, met een verondersteld tijdelijk karakter, komt een tweede dreiging op ons af, namelijk één van meer permanente aard, de vergrijzing. Die vergrijzing beperkt zich niet tot het oudere segment van de bevolking, maar zou zich ook voltrekken binnen de beroepsbevolking. Op geleide van nieuwsberichten doemt

Dilemma voor de bedrijfsarts: Frauduleuze handelingen: straffen of behandelen?

SamenvattingFrans van Itteren, 49 jaar oud, is bijstandsmaatschappelijk werker bij de sociale dienst van de Gemeente Uiterwaarden. Als ambtenaar van deze middelgrote geürbaniseerde plattelandsgemeente vervult hij een uitvoerende rol voor die inwoners die onder de voorzieningen van de Algemene Bijstandswet vallen. Tot voor kort was hij ook lid van de dienstcommissie, en hij behartigde daarbinnen de portefeuille arbobeleid. In die hoedanigheid heeft hij frequent overleg met de arbodienst gevoerd. Zowel de bedrijfsarts die al negen jaar voor deze gemeente optreedt, als de arboadviseur, beiden werkzaam bij de regionale arbodienst Hercules, hebben hem daarbij als een integer en idealistisch mens leren kennen.

The capability set for work - correlates of sustainable employability in workers with multiple sclerosis

BackgroundThe aim of this study was to examine whether work capabilities differ between workers with Multiple Sclerosis (MS) and workers from the general population. The second aim was to investigate whether the capability set was related to work and health outcomes.MethodsA total of 163 workers with MS from the MS@Work study and 163 workers from the general population were matched for gender, age, educational level and working hours. All participants completed online questionnaires on demographics, health and work functioning. The Capability Set for Work Questionnaire was used to explore whether a set of seven work values is considered valuable (A), is enabled in the work context (B), and can be achieved by the individual (C). When all three criteria are met a work value can be considered part of the individual’s ‘capability set’.ResultsGroup differences and relationships with work and health outcomes were examined. Despite lower physical work functioning (U = 4250, p = 0.001), lower work ability (U = 10591, p = 0.006) and worse self-reported health (U = 9091, p ≤ 0.001) workers with MS had a larger capability set (U = 9649, p ≤ 0.001) than the general population. In workers with MS, a larger capability set was associated with better flexible work functioning (r = 0.30), work ability (r = 0.25), self-rated health (r = 0.25); and with less absenteeism (r = − 0.26), presenteeism (r = − 0.31), cognitive/neuropsychiatric impairment (r = − 0.35), depression (r = − 0.43), anxiety (r = − 0.31) and fatigue (r = − 0.34).ConclusionsWorkers with MS have a larger capability set than workers from the general population. In workers with MS a larger capability set was associated with better work and health outcomes.Trial registrationThis observational study is registered under NL43098.008.12: ‘Voorspellers van arbeidsparticipatie bij mensen met relapsing-remitting Multiple Sclerose’. The study is registered at the Dutch CCMO register (https://www.toetsingonline.nl). This study is approved by the METC Brabant, 12 February 2014. First participants are enrolled 1st of March 2014.