Jac J. L. van der Klink

The performance of the K10, K6 and GHQ-12 to screen for present state DSM-IV disorders among disability claimants

BackgroundScreening for mental disorders among disability claimants is important, since mental disorders seem to be seriously under-recognized in this population. However, performance of potentially suitable scales is unknown. We aimed to evaluate the psychometric properties of three scales, the 10- and 6-item Kessler Psychological Distress Scale (K10, K6) and the 12-item General Health Questionnaire (GHQ-12), to predict present state mental disorders, classified according to the Diagnostic and Statistical Manual of Mental Disorders, 4thEdition (DSM-IV) among disability claimants.MethodsAll scales were completed by a representative sample of persons claiming disability benefit after two years sickness absence (n=293). All diagnoses, both somatic and mental, were included. The gold standard was the Composite International Diagnostic Interview (CIDI 3.0) to diagnose present state DSM-IV disorder. Cronbach’s α, sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and the areas under the Receiver Operating Characteristic curve (AUC) were calculated.ResultsCronbach’s alpha’s were 0.919 (K10), 0.882 (K6) and 0.906 (GHQ-12). The optimal cut-off scores were 24 (K10), 14 ( K6) and 20 (GHQ-12). The PPV and the NPV for the optimal cut point of the K10 was 0.53 and 0.89, for the K6 0.51 and 0.87, and for the GHQ-12 0.50 and 0.82. The AUC’s for 30-day cases were 0.806 (K10; 95% CI 0.749-0.862), 0.796 (K6; 95% CI 0.737-0.854) and 0.695 (GHQ-12; 95% CI 0.626-0.765).ConclusionsThe K10 and K6 are reliable and valid scales to screen for present state DSM-IV mental disorder. The optimal cut-off scores are 24 (K10) and 14 (K6). The GHQ-12 (optimal cut-off score: 20) is outperformed by the K10 and K6, which are to be preferred above the GHQ-12. The scores on separate items of the K10 and K6 can be used in disability assessment settings as an agenda for an in-depth follow-up clinical interview to ascertain the presence of present state mental disorder.

Exploring the return-to-work process for workers partially returned to work and partially on long-term sick leave due to common mental disorders: a qualitative study

Purpose. We conducted a qualitative study into the return-to-work process of workers partially on sick leave due to common mental disorders. Our objectives were to describe the barriers to a full return to work, solutions, communicating to the working environment and the aim of a full return to work, all as perceived by the workers. Method. Workers who had partially returned to work and were partially on long-term sick leave due to a stress-related, anxiety or depressive disorder were eligible for this study. Fourteen workers were interviewed and the interviews were transcribed verbatim and coded. Results. The perceived main barriers were: inability to set limits, recognise exhaustion and to control cognitions and behaviour such as perfectionism. A general pattern in the process was that all workers perceived barriers to a full return to work; most workers were able to mention solutions; all workers aimed for a full return to work, and after some time all workers were met with sufficient understanding and social support from their supervisor and health care professional. However, hardly any worker intended to implement or utilise the solutions at the workplace, except the structural adaptations of the work demands. Conclusions. The pattern we found suggests a critical intention–behaviour gap between solutions and intentions for a full return to work and its implementation at work. This implies that we should develop new interventions that focus on helping workers and their environment to bridge this gap.

Predictors for Work Participation in Individuals with an Autism Spectrum Disorder: A Systematic Review

Introduction Research shows that only about 25% of people with autism are employed. Method We conducted a systematic review on factors facilitating or hindering work participation of people with autism in longitudinal studies. An extensive search in biomedical and psychological databases yielded 204 articles and 18 satisfied all inclusion criteria. We assessed the methodological quality of included studies using an established criteria list. Results Seventeen factors were identified and categorized as disease-related factors, personal factors or external factors. Limited cognitive ability was the only significant predictor consistently found for work outcome. Functional independence and institutionalization were both reported by one study to be significantly related to work outcome. Inconsistent findings or non significant findings were reported for the other fourteen factors. Conclusion These findings emphasize the need for more high quality cohort studies focussing on work participation as the main outcome among people with Autism.

Sickness absence and full return to work after cancer : 2-year follow-up of register data for different cancer sites

Objective: Cancer survival has improved in recent years, but data on return to work (RTW) after cancer are sparsely published. Therefore, this study analysed RTW after cancer.

Gender and age differences in the recurrence of sickness absence due to common mental disorders: a longitudinal study

BackgroundCommon mental disorders (CMDs) are an important cause of sickness absence and long-term work disability. Although CMDs are known to have high recurrence rates, little is known about the recurrence of sickness absence due to CMDs. The aim of this study was to investigate the recurrence of sickness absence due to CMDs, including distress, adjustment disorders, depressive disorders and anxiety disorders, according to age, in male and female employees in the Netherlands.MethodsData on sickness absence episodes due to CMDs were obtained for 137,172 employees working in the Dutch Post and Telecommunication companies between 2001 and 2007. The incidence density (ID) and recurrence density (RD) of sickness absence due to CMDs was calculated per 1000 person-years in men and women in the age-groups of < 35 years, 35-44 years, 45-54 years, and ≥ 55 years.ResultsThe ID of one episode of CMDs sickness absence was 25.0 per 1000 person-years, and the RD was 76.7 per 1000 person-years. Sickness absence due to psychiatric disorders (anxiety and depression) does not have a higher recurrence density of sickness absence due to any CMDs as compared to stress-related disorders (distress and adjustment disorders): 81.6 versus 76.0 per 1000 person-years. The ID of sickness absence due to CMDs was higher in women than in men, but the RD was similar. Recurrences were more frequent in women < 35 years and in women between 35 and 44 years of age. We observed no differences between age groups in men. Recurrences among employees with recurrent episodes occurred within 3 years in 90% of cases and the median time-to-onset of recurrence was 11 (10-13) months in men and 10 (9-12) months in women.ConclusionsEmployees who have been absent from work due to CMDs are at increased risk of recurrent sickness absence due to CMDs and should be monitored after they return to work. The RD was similar in men and in women. In women < 45 years the RD was higher than in women ≥ 45 years. In men no age differences were observed.

Towards a sustainable healthy working life: associations between chronological age, functional age and work outcomes

BACKGROUND The aims of this study were: (i) to determine the relation between chronological and functional age; (ii) to examine the association between chronological age and work outcomes; and (iii) to examine the association between functional age and work outcomes. An overview of the most reported work outcomes is outlined. METHODS Chronological age refers to the calendar age; functional age was measured with perceived health status (SF-36) and the presence of a chronic health condition. Perspectives on experienced problems, barriers, facilitators and support needs due to ageing and the Work Ability Index were gathered out as work outcomes. RESULTS The association of chronological and functional age of workers aged ≥45 years (n = 2971) on work outcomes were significant but small, except for the presence of a chronic health condition. The presence of a chronic health condition was not related to chronological age. Older workers (60-64 years) reported better scores on social functioning, mental health and vitality compared with workers aged 45-59 years. Most reported problems due to ageing were energy decline, muscle function decline, concentration lapses and memory deterioration. Experienced barriers were concentration, work pace problems and mobility; facilitators were support from colleagues, informal relations at work and supervisors. Individual agreement had to be met to continue working life. CONCLUSIONS This study confirmed that both chronological and functional age were associated with a decrease in work outcomes. Workers >60 years did not experience more problems and barriers compared with workers between 45 and 49 years of age.

Prevention of recurrent sickness absence among employees with common mental disorders: design of a cluster-randomised controlled trial with cost-benefit and effectiveness evaluation

BackgroundCommon mental disorders, such as depression, anxiety disorder, and adjustment disorder, have emerged as a major public and occupational health problem in many countries. These disorders can have severe consequences such as absenteeism and work disability. Different interventions have been developed to improve the return-to-work of employees with common mental disorders, but still a large proportion of employees experiences health and work problems after their return-to-work. For this reason, the SHARP-at work intervention is developed to prevent a relapse of sickness absence among employees who have returned to work after a period of sickness absence because of common mental disorders. We aim to evaluate the effectiveness, cost-benefit and process of the intervention compared to care as usual.Methods/DesignThe study is designed as a cluster-randomised controlled trial with randomisation at the level of the occupational physician. Employees who have returned to work after a period of sickness absence because of a common mental disorder are included in the study. Employees in the intervention group will receive the SHARP-at work intervention. The intervention focusses on active guidance of employees by occupational physicians during the first weeks of work after sickness absence. Employees in the control group will receive care as usual. Outcomes will be assessed at baseline and at 3, 6, and 12 months follow-up. The primary outcome is cumulative recurrent sickness absence days. Secondary outcome measures are mental health, work functioning, and coping. Adherence to the protocol, communication between stakeholders, and satisfaction with the treatment are the process measures assessed in both study groups. Cost-benefit is calculated from a societal perspective. Finally, prognostic factors for a relapse of sickness absence are investigated.DiscussionThis study goes beyond return-to-work by focussing on the prevention of recurrent sickness absence. The study incorporates not only outcomes on sickness absence and mental health but also on health-related work functioning. The results of this study can contribute to a further development of practice guidelines and the promotion of sustainable work participation.Trial registrationNTR1963

Predictors of recurrent sickness absence among workers having returned to work after sickness absence due to common mental disorders

OBJECTIVE The aim of this study was to investigate whether sociodemographic, disease-related, personal, and work-related factors - measured at baseline - are predictors of recurrent sickness absence (SA) at 6 and 12 months follow-up among workers who returned to work after SA due to common mental disorders (CMD). METHODS Based on a cluster-randomized controlled trial, this prospective study comprised 158 participants, aged 18-63 years, with partial or full return to work (RTW) and an occupational physician-diagnosed CMD. Data on predictors were collected with questionnaires and administrative data. Outcome was the incidence of recurrent SA (ie, decreased work for ≥30% of contract hours due to all-cause SA regardless of partial or full RTW) at 6 and 12 months follow-up. Longitudinal logistic regression analysis with backward elimination was used. RESULTS We found that company size >100 [odds ratio (OR) 2.59, 95% confidence interval (95% CI) 1.40-4.80] and conflicts with the supervisor (OR 2.21, 95% CI 1.21-4.04) were predictive of recurrent SA. Having ≥1 chronic diseases decreased the risk of recurrent SA (OR 0.54, 95% CI 0.30-0.96). CONCLUSIONS Two work- and one disease-related factor predicted the incidence of recurrent SA among workers with CMD. Healthcare providers can use these findings to detect and help workers who have returned to work and are at higher risk for recurrent SA. Furthermore, future interventions to prevent recurrent SA could focus on supervisor conflicts.

The development and validation of two prediction models to identify employees at risk of high sickness absence

BACKGROUND Sickness absence (SA) is a public health risk marker for morbidity and mortality. The aim of this study was to develop and validate prediction models to identify employees at risk of high SA. METHODS Two prediction models were developed using self-rated health (SRH) and prior SA as predictors. SRH was measured by the categories excellent, good, fair and poor in a convenience sample of 535 hospital employees. Prior SA was retrieved from the employers register. The predictive performance of the models was assessed by logistic regression analysis with high (≥ 90 th percentile) vs. non-high (<90th percentile) SA days and SA episodes as outcome variables and by using bootstrapping techniques to validate the models. RESULTS The overall performance as reflected in the Nagelkerkes pseudo R(2) was 11.7% for the model identifying employees with high SA days and 31.8% for the model identifying employees with high SA episodes. The discriminative ability, represented by the area (AUC) under the receiver operating characteristic (ROC), was 0.729 (95% CI 0.667-0.809) for the model identifying employees with high SA days and 0.831 (95% CI 0.784-0.877) for the model identifying employees with high SA episodes. The Hosmer-Lemeshow test showed acceptable calibration for both models. CONCLUSIONS The prediction models identified employees at risk of high SA, but need further external validation in other settings and working populations before applying them in public and occupational health research and care.

Effectiveness of an exposure-based return-to-work program for workers on sick leave due to common mental disorders: a cluster-randomized controlled trial

OBJECTIVES In case of long-term sick leave, gradually increasing workload appears to be an effective component of work-directed interventions to reduce sick leave due to common mental disorders (CMD). CMD are defined as stress-related, adjustment, anxiety, or depressive disorders. We developed an exposure-based return-to-work (RTW-E) intervention and evaluated the effect on time-to-full return to work (RTW) among workers who were on sick leave due to CMD in comparison to those treated with care-as-usual (CAU). CAU is guideline-directed and consists of problem-solving strategies and graded activities. METHODS Using a two-armed cluster-randomized trial, we randomized 56 occupational physicians (OP). Of these, 35 OP treated 160 workers at the start of their sick leave; 75 workers received RTW-E and 85 workers received CAU. These workers were followed over a 12-month follow-up period. The time-to-full RTW lasting ≥28 days without recurrence was the primary outcome measure. To evaluate differences between groups, we used intention-to-treat and multilevel Coxs regression analysis. RESULTS The median time-to-full RTW differed significantly between groups [hazard ratio (HR) 0.55; 95% confidence interval (95% CI) 0.33-0.89]. The workers receiving RTW-E (209 days; 95% CI 62-256) had a prolonged time-to-full RTW compared to workers receiving CAU (153 days; 95% CI 128-178). CONCLUSIONS Workers on sick leave due to CMD treated with RTW-E showed a prolonged time-to-full RTW compared to those treated with CAU. We recommend that OP do not apply RTW-E but continue counseling workers on sick leave due to CMD according to CAU.