Work and common psychiatric disorders.
01 May 2011-Journal of the Royal Society of Medicine (SAGE Publications)-Vol. 104, Iss: 5, pp 198-207
TL;DR: A staged model where different risk and protective factors contribute to the onset of psychiatric disorders in the working population, the onsetof short-term sickness absence, and the transition from short- to long-term absence is proposed.
Abstract: Psychiatric disorders are now the most common reason for long-term sickness absence. The associated loss in productivity and the payment of disability benefits places a substantial burden on the economies of many developed countries. The occupational dysfunction associated with psychiatric disorders can also lead to poverty and social isolation. As a result the area of work and psychiatric disorders is a high priority for policymakers. There are two main agendas: for many researchers and clinicians the focus is on the need to overcome stigma and ensure people with severe psychiatric disorders have meaningful work; however the public health agenda predominantly relates to the more common disorders such as depression and anxiety, which contribute a greater burden of disability benefits and pensions. In this review we attempt to address this second agenda. The relatively sparse evidence available reveals a complex field with significant interplay between medical, psychological social and cultural factors. Sick leave can be a 'process' as well as an 'event'. In this review we propose a staged model where different risk and protective factors contribute to the onset of psychiatric disorders in the working population, the onset of short-term sickness absence, and the transition from short- to long-term absence. We also examine strategies to manage psychiatric disorder in the workforce with a view towards returning the employee to work. Our aim in this review is to highlight the complexity of the area, to stimulate debate and to identify important gaps in knowledge where further research might benefit both patients and wider society.
Citations
More filters
TL;DR: The first comprehensive systematic meta-review of the evidence linking work to the development of common mental health problems, specifically depression, anxiety and/or work-related stress is conducted to consider how the risk factors identified may relate to each other.
Abstract: It has been suggested that certain types of work may increase the risk of common mental disorders, but the exact nature of the relationship has been contentious. The aim of this paper is to conduct the first comprehensive systematic meta-review of the evidence linking work to the development of common mental health problems, specifically depression, anxiety and/or work-related stress and to consider how the risk factors identified may relate to each other. MEDLINE, PsychInfo, Embase, the Cochrane Collaboration and grey literature databases were systematically searched for review articles that examined work-based risk factors for common mental health problems. All included reviews were subjected to a quality appraisal. 37 review studies were identified, of which 7 were at least moderate quality. 3 broad categories of work-related factors were identified to explain how work may contribute to the development of depression and/or anxiety: imbalanced job design, occupational uncertainty and lack of value and respect in the workplace. Within these broad categories, there was moderate level evidence from multiple prospective studies that high job demands, low job control, high effort-reward imbalance, low relational justice, low procedural justice, role stress, bullying and low social support in the workplace are associated with a greater risk of developing common mental health problems. While methodological limitations continue to preclude more definitive statements on causation between work and mental disorders, there is now a range of promising targets for individual and organisational-level interventions aimed at minimising mental health problems in the workplace.
412 citations
TL;DR: Overall, these findings demonstrate there are empirically supported interventions that workplaces can utilize to aid in the prevention of common mental illness as well as facilitating the recovery of employees diagnosed with depression and/or anxiety.
Abstract: Depression and anxiety disorders are the leading cause of sickness absence and long-term work incapacity in most developed countries. The present study aimed to carry out a systematic meta-review examining the effectiveness of workplace mental health interventions, defined as any intervention that a workplace may either initiate or facilitate that aims to prevent, treat or rehabilitate a worker with a diagnosis of depression, anxiety or both. Relevant reviews were identified via a detailed systematic search of academic and grey literature databases. All articles were subjected to a rigorous quality appraisal using the AMSTAR assessment. Of the 5179 articles identified, 140 studies met the inclusion criteria, of which 20 were deemed to be of moderate or high quality. Together, these reviews analysed 481 primary research studies. Moderate evidence was identified for two primary prevention interventions; enhancing employee control and promoting physical activity. Stronger evidence was found for CBT-based stress management although less evidence was found for other secondary prevention interventions, such as counselling. Strong evidence was also found against the routine use of debriefing following trauma. Tertiary interventions with a specific focus on work, such as exposure therapy and CBT-based and problem-focused return-to-work programmes, had a strong evidence base for improving symptomology and a moderate evidence base for improving occupational outcomes. Overall, these findings demonstrate there are empirically supported interventions that workplaces can utilize to aid in the prevention of common mental illness as well as facilitating the recovery of employees diagnosed with depression and/or anxiety.
307 citations
Cites background from "Work and common psychiatric disorde..."
...Despite the size and importance of the problem, there is remarkably limited consensus about the occupational effectiveness of various mental health interventions (Henderson et al. 2011)....
[...]
...To date, much of the focus on workplace mental health has centred around the concept of ‘work stress’ and the role work may have in precipitating mental ill health (Henderson et al. 2011)....
[...]
TL;DR: Individual placement and support is an effective intervention across a variety of settings and economic conditions and is more than twice as likely to lead to competitive employment when compared with traditional vocational rehabilitation.
Abstract: Background
Individual placement and support (IPS) is a vocational rehabilitation programme that was developed in the USA to improve employment outcomes for people with severe mental illness. Its ability to be generalised to other countries and its effectiveness in varying economic conditions remains to be ascertained.
Aims
To investigate whether IPS is effective across international settings and in different economic conditions.
Method
A systematic review and meta-analysis of randomised controlled trials comparing IPS with traditional vocational services was undertaken; 17 studies, as well as 2 follow-up studies, were included. Meta-regressions were carried out to examine whether IPS effectiveness varied according to geographic location, unemployment rates or gross domestic product (GDP) growth.
Results
The overall pooled risk ratio for competitive employment using IPS compared with traditional vocational rehabilitation was 2.40 (95% CI 1.99–2.90). Meta-regressions indicated that neither geographic area nor unemployment rates affected the overall effectiveness of IPS. Even when a country's GDP growth was less than 2% IPS was significantly more effective than traditional vocational training, and its benefits remained evident over 2 years.
Conclusions
Individual placement and support is an effective intervention across a variety of settings and economic conditions and is more than twice as likely to lead to competitive employment when compared with traditional vocational rehabilitation.
257 citations
TL;DR: The findings suggest that the impact of depression in the workplace is considerable across all countries, both in absolute monetary terms and in relation to proportion of country GDP.
Abstract: Purpose
Depression is a leading cause of disability worldwide. Research suggests that by far, the greatest contributor to the overall economic impact of depression is loss in productivity; however, there is very little research on the costs of depression outside of Western high-income countries. Thus, this study examines the impact of depression on workplace productivity across eight diverse countries.
228 citations
Cites background from "Work and common psychiatric disorde..."
...Among all medical conditions, depression may have the greatest negative impact on time management and productivity [3, 4]....
[...]
TL;DR: The available evidence supports the proposition that work can be beneficial for an employee’s well-being, particularly if good-quality supervision is present and there are favourable workplace conditions.
Abstract: Objective:The literature on mental health in the workplace largely focuses on the negative impacts of work and how work may contribute to the development of mental disorders. The potential mental health benefits of employment have received less attention.Method:A systematic search of reviews or meta-analyses that consider the benefits of work in regards to mental health was undertaken using academic databases. All relevant reviews were subjected to a quality appraisal.Results:Eleven reviews were identified as meeting the inclusion criteria, with four deemed to be of at least moderate quality. The available evidence supports the proposition that work can be beneficial for an employee’s well-being, particularly if good-quality supervision is present and there are favourable workplace conditions. The benefits of work are most apparent when compared with the well-documented detrimental mental health effects of unemployment.Conclusions:The potential positive effects of good work and the role work can play in f...
212 citations
References
More filters
Book•
26 Apr 1990TL;DR: In this article, a strategy for redesigning jobs to reduce unnecessary stress and improve productivity and job satisfaction is proposed, which is based on the concept of job redesigning and re-designing.
Abstract: Suggests a strategy for redesigning jobs to reduce unnecessary stress and improve productivity and job satisfaction.
8,329 citations
TL;DR: The effort-reward imbalance model is proposed to assess adverse health effects of stressful experience at work: reciprocity of exchange in occupational life where high-cost/low-gain conditions are considered particularly stressful.
Abstract: In addition to the person-environment fit model (J. R. French, R. D. Caplan, & R. V. Harrison, 1982) and the demand-control model (R. A. Karasek & T. Theorell, 1990), a third theoretical concept is proposed to assess adverse health effects of stressful experience at work: the effort-reward imbalance model. The focus of this model is on reciprocity of exchange in occupational life where high-cost/low-gain conditions are considered particularly stressful. Variables measuring low reward in terms of low status control (e.g., lack of promotion prospects, job insecurity) in association with high extrinsic (e.g., work pressure) or intrinsic (personal coping pattern, e.g., high need for control) effort independently predict new cardiovascular events in a prospective study on blue-collar men. Furthermore, these variables partly explain prevalence of cardiovascular risk factors (hypertension, atherogenic lipids) in 2 independent studies. Studying adverse health effects of high-effort/low-reward conditions seems well justified, especially in view of recent developments of the labor market.
4,550 citations
TL;DR: This meta-analysis provides robust consistent evidence that high demands and low decision latitude and (combinations of) high efforts and low rewards are prospective risk factors for common mental disorders and suggests that the psychosocial work environment is important for mental health.
Abstract: Objectives To clarify the associations between psychosocial work stressors and mental ill health, a meta-analysis of psychosocial work stressors and common mental disorders was undertaken using longitudinal studies identified through a systematic literature review.
Methods The review used a standardized search strategy and strict inclusion and quality criteria in seven databases in 1994–2005. Papers were identified from 24 939 citations covering social determinants of health, 50 relevant papers were identified, 38 fulfilled inclusion criteria, and 11 were suitable for a meta-analysis. The Comprehensive Meta-analysis Programme was used for decision authority, decision latitude, psychological demands, and work social support, components of the job-strain and iso-strain models, and the combination of effort and reward that makes up the effort–reward imbalance model and job insecurity. Cochran’s Q statistic assessed the heterogeneity of the results, and the I2 statistic determined any inconsistency between studies.
Results Job strain, low decision latitude, low social support, high psychological demands, effort–reward imbalance, and high job insecurity predicted common mental disorders despite the heterogeneity for psychological demands and social support among men. The strongest effects were found for job strain and effort–reward imbalance.
Conclusions This meta-analysis provides robust consistent evidence that (combinations of) high demands and low decision latitude and (combinations of) high efforts and low rewards are prospective risk factors for common mental disorders and suggests that the psychosocial work environment is important for mental health. The associations are not merely explained by response bias. The impact of work stressors on common mental disorders differs for women and men.
1,646 citations
Book•
[...]
01 Jan 1982
TL;DR: In 2020, the employment rate went down slightly for those aged 20 to 59 compared with 2018, while women's employment rate remained almost unchanged as discussed by the authors, and the employment rates among mothers of families with underage children rose from 77.2 to 79.2 per cent.
Abstract: In 2020, the employment rate went down slightly for those aged 20 to 59 compared with 2018. Men’s employment rate fell and women's employment rate remained almost unchanged. The employment rate among mothers of families with underage children rose from 77.2 to 79.2 per cent. The employment rate went up most among those mothers whose youngest child was aged under three. The employment rate fell most among men without children aged under 18. These data derive from Statistics Finland’s table release Labour Force Survey 2020, families and work.
1,577 citations
TL;DR: Cognitive-behavioral interventions are more effective than the other intervention types and are most pronounced on the following outcome categories: complaints, psychologic resources and responses, and perceived quality of work life.
Abstract: In this quantitative meta-analysis is sought to determine the effectiveness of occupational stress-reducing interventions and the populations for which such interventions are most beneficial. 48 experimental studies were included in the analysis. Four intervention types were distinguished: cognitive-behavioural interventions, relaxation techniques, multimodal programs, and organisation-focused interventions. A small but significant overall effect was found. A moderate effect was found for cognitive-behavioural interventions and multimodal interventions, and a small effect was found for relaxation techniques. The effect size for organization-focused interventions was nonsignificant. Effects were most pronounced on the following outcome categories: complaints, psychologic resources and responses, and perceived quality of work life. The conclusion of the study was that stress management interventions are effective. Cognitive-behavioural interventions are more effective than the other intervention types.
918 citations