Mastery Matters: The impact of self-efficacy and work-focused therapy on return to work among employees with common mental disorders

Introduction Common mental disorders (CMD) such as depression, anxiety and adjustment disorder are highly prevalent and constitute a major cause of (long-term) sick leave. Considering the negative consequences of long-term sick leave it is important that effective return to work (RTW) interventions are implemented for workers with CMD. Evidence about effective interventions and their mechanisms of change is still limited, especially with respect to mental health care (MHC) interventions. This dissertation evaluated the effectiveness of a MHC intervention on RTW and studied the (mediating) role of RTW self-efficacy (RTW-SE) in the RTW process of workers with CMD. RTW-SE refers to the confidence employees have in their abilities to return to the workplace and perform their job successfully. Role of self-efficacy in the RTW process A RTW-SE measure was developed and validated among employees on sick leave (n=2214). Results showed that the RTW-SE scale was a reliable and valid instrument. In addition, results from descriptive and multilevel-analysis among 168 employees on sick leave with CMD showed that RTW-SE increased over time in a cuvelinear and generally wave-like pattern before full RTW occurred. Full RTW did occur on average when participants scored between 3.8-4.5 (on a scale from 1-6). Moreover, this dissertation is the first to show that increased RTW-SE predicts faster full RTW, irrespective of baseline self-efficacy levels. Therefore, we recommend the use of theoretical models that include self-efficacy for the design and evaluation of RTW interventions. In addition, self-efficacy scores may be used in practice to monitor RTW-readiness and offer tailored RTW-solutions. Work-focused therapy Because of the limited impact of regular MHC on RTW we developed a new intervention provided by psychotherapists: work-focused cognitive behavioural therapy (W-CBT). W-CBT uses work as an early and integral part of clinical treatment, following a graded exposure perspective. This intervention was compared with regular CBT among 168 employees on sick leave with CMD (major depression was excluded). W-CBT showed to be a (cost) effective method to promote faster RTW (65 days earlier), without negative side effects on recovery of CMD symptoms and irrespective of baseline symptom severity. Low self-efficacious employees who received W-CBT showed faster partial RTW, but did not benefit from W-CBT in terms of full RTW. Contrary to our expectations the effectiveness of W-CBT on RTW could not be explained by stronger increases of RW-SE in W-CBT. Main challenges regarding RTW interventions for workers with CMD are to unravel mediating factors or effective intervention elements and tailor RTW interventions to the needs of low self-efficacious and major depressed workers.Although enhancing RTW-SE is important for RTW, W-CBT must have affected other factors besides RTW-SE that further enhanced RTW chances. Future research may test our hypothesis that the effectiveness of W-CBT may be related to the therapeutic conditions that stimulated optimal creation and implementation of tailored gradual RTW plans. To conclude, this dissertation has provided valuable insights in the RTW process and practical tools that may be used to enhance the effectiveness of RTW interventions for workers with CMD

Mastery Matters : The impact of self-efficacy and work-focused therapy on return to work among employees with common mental disorders

Introduction Common mental disorders (CMD) such as depression, anxiety and adjustment disorder are highly prevalent and constitute a major cause of (long-term) sick leave. Considering the negative consequences of long-term sick leave it is important that effective return to work (RTW) interventions are implemented for workers with CMD. Evidence about effective interventions and their mechanisms of change is still limited, especially with respect to mental health care (MHC) interventions. This dissertation evaluated the effectiveness of a MHC intervention on RTW and studied the (mediating) role of RTW self-efficacy (RTW-SE) in the RTW process of workers with CMD. RTW-SE refers to the confidence employees have in their abilities to return to the workplace and perform their job successfully. Role of self-efficacy in the RTW process A RTW-SE measure was developed and validated among employees on sick leave (n=2214). Results showed that the RTW-SE scale was a reliable and valid instrument. In addition, results from descriptive and multilevel-analysis among 168 employees on sick leave with CMD showed that RTW-SE increased over time in a cuvelinear and generally wave-like pattern before full RTW occurred. Full RTW did occur on average when participants scored between 3.8-4.5 (on a scale from 1-6). Moreover, this dissertation is the first to show that increased RTW-SE predicts faster full RTW, irrespective of baseline self-efficacy levels. Therefore, we recommend the use of theoretical models that include self-efficacy for the design and evaluation of RTW interventions. In addition, self-efficacy scores may be used in practice to monitor RTW-readiness and offer tailored RTW-solutions. Work-focused therapy Because of the limited impact of regular MHC on RTW we developed a new intervention provided by psychotherapists: work-focused cognitive behavioural therapy (W-CBT). W-CBT uses work as an early and integral part of clinical treatment, following a graded exposure perspective. This intervention was compared with regular CBT among 168 employees on sick leave with CMD (major depression was excluded). W-CBT showed to be a (cost) effective method to promote faster RTW (65 days earlier), without negative side effects on recovery of CMD symptoms and irrespective of baseline symptom severity. Low self-efficacious employees who received W-CBT showed faster partial RTW, but did not benefit from W-CBT in terms of full RTW. Contrary to our expectations the effectiveness of W-CBT on RTW could not be explained by stronger increases of RW-SE in W-CBT. Main challenges regarding RTW interventions for workers with CMD are to unravel mediating factors or effective intervention elements and tailor RTW interventions to the needs of low self-efficacious and major depressed workers.Although enhancing RTW-SE is important for RTW, W-CBT must have affected other factors besides RTW-SE that further enhanced RTW chances. Future research may test our hypothesis that the effectiveness of W-CBT may be related to the therapeutic conditions that stimulated optimal creation and implementation of tailored gradual RTW plans. To conclude, this dissertation has provided valuable insights in the RTW process and practical tools that may be used to enhance the effectiveness of RTW interventions for workers with CMD

Perceived impeding factors for return-to-work after long-term sickness absence due to major depressive disorder: a concept mapping approach

Contains fulltext : 136495.pdf (publisher's version ) (Open Access)OBJECTIVE: The purpose of the present study was to explore various stakeholder perspectives regarding factors that impede return-to-work (RTW) after long-term sickness absence related to major depressive disorder (MDD). METHODS: Concept mapping was used to explore employees', supervisors' and occupational physicians' perspectives on these impeding factors. RESULTS: Nine perceived themes, grouped in three meta-clusters were found that might impede RTW: Person, (personality / coping problems, symptoms of depression and comorbid (health) problems, employee feels misunderstood, and resuming work too soon), Work (troublesome work situation, too little support at work, and too little guidance at work) and Healthcare (insufficient mental healthcare and insufficient care from occupational physician). All stakeholders regarded personality/coping problems and symptoms of depression as the most important impeding theme. In addition, supervisors emphasized the importance of mental healthcare underestimating the importance of the work environment, while occupational physicians stressed the importance of the lack of safety and support in the work environment. CONCLUSIONS: In addition to the reduction of symptoms, more attention is needed on coping with depressive symptoms and personality problems in the work environment support in the work environment and for RTW in mental healthcare, to prevent long term sickness absence

How to combat burnout: A review of insights and directions for the future

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My love, my life, my everything: Work-home interaction among small entrepreneurs

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All day and all of the night: The relative contribution of two dimensions of workaholism to well-being in self-employed workers

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Predictive value of work-related self-efficacy change on RTW for employees with common mental disorders

To improve interventions that aim to promote return to work (RTW) of workers with common mental disorders (CMD), insight into modifiable predictors of RTW is needed. This study tested the predictive value of self-efficacy change for RTW in addition to preintervention levels of self-efficacy. RTW self-efficacy was measured 5 times within 9 months among 168 clients of a mental healthcare organisation who were on sick leave due to CMD. Self-efficacy parameters were modelled with multilevel analyses and added as predictors into a Cox regression analysis. Results showed that both high baseline self-efficacy and self-efficacy increase until full RTW were predictive of a shorter duration until full RTW. Both self-efficacy parameters remained significant predictors of RTW when controlled for several relevant covariates and within subgroups of employees with either high or low preintervention self-efficacy levels. This is the first study that demonstrated the prognostic value of self-efficacy change, over and above the influence of psychological symptoms, for RTW among employees with CMD. By showing that RTW self-efficacy increase predicted a shorter duration until full RTW, this study points to the relevance of enhancing RTW self-efficacy in occupational or mental health interventions for employees with CMD. Efforts to improve self-efficacy appear valuable both for people with relatively low and high baseline self-efficacy