Social security system Sickness absence management*

Transcription

1 Mental health and work Sustainable return to work and work functioning Ute Bültmann Community & Occupational Medicine University Medical Center Groningen Groningen, The Netherlands International Research Conference, The Norwegian Research Council Oslo, Norway, September 23th, 2013 This presentation Human and economic burden of mental health problems in the workplace A fundamental question for work disability prevention Directions and questions for future research Social security system Occupational Health Care Social Insurance Sickness absence management* Working Time Return to work Working Report sick 2 years Assessment Unemployed Part-time work and part-time unemployed / disability pension Disability pension Employer and Occupational Physician as gatekeepers for entrance in social insurance arrangements Responsibilities for employer AND employee Checked afterwards by Social Insurance Institute ( sanctions possible) *Gatekeeper Improvement Act, 2002

2 Sickness absence management Paradigm shift in the system Week 0-6 Week 6 Week 8 Week 13 Week Week 52 Week Week 104 Compensation (incapacity, disability) Start sickness absence Problem analysis by OP Plan for RTW by employer and employee Report of sickness absence to Social Insurance Institute RTW process / sickness absence management First year evaluation of RTW process Continuation of RTW process Start of disability pension Work disability pensions and sickness absence Actions towards RTW by employer, employee and OP Participation (capacity, ability) Gatekeeper Improvement Act, 2002 Paradigm shift in the system Not all mental health problems are the same Compensation (incapacity, disability) Work disability pensions and sickness absence Alongside legislative changes, actions on the Participation (capacity, ability) professional level, towards RTW and work disability prevention Convergence on different levels! mild moderate severe distress, adjustment disorders depressive symptoms, depressive & anxiety disorder

3 High burden of mental health problems Mental health problems at work Unipolar depressive disorders contribute substantially to years lived with disability Impact on labor market participation Sickness absence & work disability In northern EU, 1 in every 3 new work disability benefit recipients disabled for work due to mental health problems projected to be the leading cause of burden of disease in 2030 High cost implications: sickness absence, work disability benefits & at-work productivity loss WHO Report on Mental Health: new understanding, new hope, 2001; WHO Global Burden of Disease Report, 2004 OECD, 2011; Lagerveld et al., 2010; Bültmann et al., 2008, 2006; Lerner & Henke, 2008, Den Hollander et al., 2006 How to design and evaluate interventions to sustain RTW in workers with mental health problems?

4 Return to work Who returns to work and when? mo 6 mo 12 mo 24 mo distress, adjustment disorder depression, anxiety Younger employees returned to work earlier than older employees Employees with low socio-economic position (SEP) returned to work earlier employees with high SEP Note: Full RTW = resuming work with equal earnings Data: Occupational Health Service (OHS), approx. 1 million workers N=40,762 medically certified sickness absence episodes of 3 weeks N=33,317 episodes, median time to RTW = 90 days N=7,445 episodes, median time to RTW = 251 days Roelen et al., 2012 in emotional disturbance, neurotic, somatoform and stress-related disorders, BUT NOT in mood disorders Roelen et al., 2012 Process of return to work 8 qualitative studies from 4 countries Obstacles and facilitators in RTW process Personality factors Social support at work Social and rehabilitation systems Employees found it difficult to decide when they were ready to resume work and experienced difficulties implementing RTW solutions at the workplace Andersen et al., 2012

5 Recurrences of sickness absence Recurrences of sickness absence Background: Little is known about recurrence of sickness absence due to common mental disorders (CMD) Method: OHS database of N=137,172 employees from Post & Telecommunication 7-year follow-up of employees with first sickness absence due to CMD s Results: Of 9,904 employees with first absence due to CMD s, 19% experienced a recurrence of sickness absence due to CMD s after RTW Median time until recurrence 8 to 11 months Koopmans et al., 2010 Koopmans et al., 2010 Predictors of recurrent sickness absence Delphi approach Expert group consensus (75% agreement) 23 scientists (8 NL, 7 EU, 7 North America) 23 OP s and medical insurance advisors 2 Delphi rounds: IMPACT 3 rd Delphi round: ASSESSABILITY & MODIFIABILITY Norder et al., 2012 Predictors of recurrent sickness absence Consensus 21 factors identified for recurrent SA due to depression - high impact of clinical picture, though difficult / not to modify (11 out of 21 factors) - work variables modifiable 7 factors readily assessable in consultation stressful life and work events, age at first diagnosis, duration of last depressive episode, anxiety symptoms, lifetime number of depressive episodes, psychological work demands Norder et al., 2012

6 Functioning at work RTW healthy RTW Sustainability is our challenge! What needs to be done to sustain RTW for workers with MHP s? Not able to function at full capacity Estimated productivity loss at work 4 hrs/week ($36 billion US) Reducing recurrences Improving functioning at work? Large burden arises from lost productivity at work Work & Workplace? Social relationships? Health care system? Social security system? Lerner et al., 2010; Lerner & Henke, 2008; Eaton et al., 2008; Bültmann et al., 2007; Adler et al., 2006; Stewart et al., 2003 Needs of people with mental health problems Medical What needs to to be to sustain RTW for workers What needs to towith be MHP? to sustain RTW for workers with MHP? Rehabilitation Community Family WHO report 2001 Mental Health: new understanding, new hope

7 Intervention studies Workplace in interventions Intervention Outcome Sickness absence reduction Return to work Symptom reduction Pharmaceutical - + Activating intervention (graded activity, PST-problem solving) Cognitive-behavioral therapy (symptom focus) Cognitive-behavioral therapy (work focus/workplace based) Participatory workplace intervention (incl. RTW coordinator, supervisor) Note: Interventions cover a range of mental health problems / stigma & discrimination work problems work accomodations workplace support supervisor involvement functioning at work context for sustained RTW? Taimela, 2013; Arends et al, 2012; Furlan et al., 2012; Pomaki et al., 2012; Nieuwenhuijsen et al., 2008; Corbiere & Shen, 2006 SHARP-at work intervention SHARP-at work intervention Aim sustained RTW, relapse prevention in employees who have returned to work Intervention extension of Dutch OP guideline for managing mental health problems focus: active guidance of workers by OP (application of skills at work) Aim sustained RTW, relapse prevention in employees who have returned to work Intervention extension of Dutch OP guideline for managing mental health problems focus: active guidance of workers by OP (application of skills at work) specific attention: work problems + supervisor involvement Arends et al., 2010 Arends et al., 2010

8 SHARP-at work: intervention SHARP-at work: evaluation SHARP - strengthening of problem solving capacities by: treatment by OP prevent new failure to cope effectively Effect and economic evaluation reduced recurrent sickness absence days improved (mental) health status and work functioning (WRFQ) 1. Inventory of problems at work 2. Brainstorming about solutions 3. Writing down solutions 4. Discussing solutions with supervisor & making an action plan 5. Evaluating implementation of solutions new stressors gradual return to work + applying solutions Process evaluation (occupational physician, worker, supervisor) attitudes, appraisals, readiness for change, activities recruitment, reach, fidelity, dose delivered, dose received, context OP OP Intervention training Start intervention BL W OP End intervention 1-2 mo 3 mo S W OP S Arends et al., 2010 Incidence of recurrent sickness absence Time to recurrent sickness absence 0-3 months 3-6 months 6-12 months yes no yes no yes no Median (IQR): SHARP: 365 ( ) SHARP 11% 89% 21% 79% 34% 66% N=80 N=75 N=72 CAU 22% 78% 39% 61% 47% 53% N=78 N=76 N=74 N=71 N=74 CAU: 253 ( ) adjusted HR = 0.53 (95% CI ) OR = 0.40, 95% CI (adjusted for age, sex, educational level, baseline sickness absence days, mental health complaints) Continuous attention! Arends et al., submitted Arends et al., submitted

9 Arends et al., submitted Process: Participant s response Process: Occupational physicians Arends et al., submitted

10 Directions for future intervention research Need for more comprehensive interventions in MHP s Need to disentangle what works & what not Need to conduct outcome- & process evaluations Need to look at sustained RTW in workers with MHP s! What is successful RTW? Employees Sustainability Job satisfaction Work-home balance Mental functioning Occupational physicians, supervisors Sustainability At-work functioning Current RTW outcomes may not adequately reflect key stakeholder perspectives! Hees et al., 2012 How to measure work functioning? Systematic review Important: systematic reviews of measurement properties Critical appraisal & comparison of measurement properties Review tool to evaluate methodological quality & content of studies on measurement properties 5 validation studies on 5 instruments in CMD population origin: US, CA, AUS, Turkey; internal consistency, test-retest, hypotheses testing, responsiveness, structural validity validation studies poor to fair methodological quality evidence of measurement properties limited * COSMIN checklist - Mokkink et al., 2010 a-c; Terwee et al., 2009; Mokkink et al., 2006 Abma et al., 2012

11 Systematic review PROBLEMS Information on some measurement properties is lacking (measurement error, content validity, cross-cultural validity) Small sample size, no a-priori hypotheses, inadequate and inconsistent reporting of findings Directions and questions for future measurement research Need to conduct methodologically sound validation studies in workers with mental health problems Need for responsiveness studies in intervention research NO EVIDENCE-BASED decisions and recommendations can be made for the use of health-related work functioning instruments in workers with common mental disorders Abma et al., 2012 What is optimal functioning at work? SHARP-at work: work functioning Take home messages 1. Need to pay attention to MHP s in WDP 2. Need for more comprehensive interventions 3. Focus on measurement of sustained RTW From an intervention and measurement perspective great research opportunities & implications for practice! Arends et al., submitted; Abma et al., 2013, 2012

12 Thank you very much for your attention!