Long-term follow-up study of work status among patients with work-related mental disorders referred to departments of occupational medicine in Denmark

OBJECTIVES: To describe the 5 year work status in patients referred for suspected work-related common mental disorders. To develop a prognostic model.DESIGN: Register-based nationwide longitudinal follow-up study.SETTING: All departments of occupational medicine in Denmark.PARTICIPANTS: 17 822 patients aged 18-67 years, seen for the first time at a Department of Occupational Medicine in Denmark from 2000 to 2013 and diagnosed with stress, depression, post-traumatic stress disorder, anxiety or other mental disorders.INTERVENTIONS: All patients were seen for diagnostic assessment and causal evaluation of the work-relatedness of their disorders. Some departments offered patients with stress disorders psychological treatment, which, however, was not organised according to patient selection or type of treatment.PRIMARY AND SECONDARY OUTCOME MEASURES: Register data were collected for 5 year periods before and after the patients' first assessment at a department. Weekly percentages of patients are presented according to work status. The outcome in the prognostic model was a high Work Participation Score (ie, working&gt;75% of potential work weeks/year) at 5 year follow-up.RESULTS: For all subgroups of patients, a high proportion were working (&gt;75%) 1-5 years before assessment, and all experienced a large reduction in work status at time of assessment. At 1 year follow-up, almost 60% of patients with stress were working, whereas in the other patient subgroups, less than 40% were working. In the following years, practically no increase was observed in the percentage of patients working in any of the subgroups. Based on these 5 year follow-up data, we developed a work participation model with only moderate discrimination and calibration.CONCLUSIONS: In Denmark, not all return to previous work status 5 years after a referral due to a suspected work-related common mental disorder. We developed a prognostic model with only moderate discrimination and calibration for long-term work participation after suggested work-related common mental disorders.</p

Why Being ‘Stressed’ Is ‘Desserts’ in Reverse—The Effect of Acute Psychosocial Stress on Food Pleasure and Food Choice

The link between acute stress, food pleasure and eating behavior in humans by employing measures of individual reward mechanisms has not been investigated as of yet. Having these insights is key to understanding why many people experience a change in eating behavior when experiencing stress. Thirty-five Danes (mean age 21.71 years) underwent a stress-inducing and relaxation-inducing task based on a randomized cross-over study design. Both tasks were combined with the Leeds Food Preference Questionnaire, to investigate the effect of stress on specific measures of food reward. Furthermore, participants chose a snack, as a covert measure of actual food choice. The study found no effect on explicit liking, explicit wanting or relative preference. For implicit wanting, an effect was detected on high-fat sweet foods, with increasing scores for the stress-induced condition. Moreover, 54% chose a different snack following the stress-inducing condition. Interestingly, 14% chose to change their snack choice to no snack at all. Results suggest acute psychosocial stress can increase cravings for highly palatable foods for some, while for others an experience of loss of appetite prevails. Overall, this study points to a further understanding of why consumers have issues with making healthy food choices, ultimately affecting public health too

Sick at work and future sickness absence:a prospective study of two measures of sickness presence

AbstractBackgroundSickness presence (SP), or going to work despite being ill, is a common way of practicing sickness absence (SA). However, its consequences for long-term SA are poorly understood, and there is no consensus on how to measure SP. This study aims to examine the consequences of SP on long-term sickness absence (&gt;14 days) using two different measures.MethodsData from a Danish public human service organization were analyzed, with approximately 2400 employees answering questionnaires in November 2019, yielding a response rate of 50%. Information on SA, work environment, self-reported health, SP episodes, and sociodemographic information were included in negative binomial regression models. The outcome variable was prospective episodes of SA (&gt;14 days) taken from the SA register of the organization. Two different ways of measuring SP were used: a traditional measure of overall SP frequency and a measure of going to work with specific symptoms (fever, cold, headache, musculoskeletal pain).ResultsParticipants who reported SP frequency of more than 10 times during the last 6 months had a two-fold risk of long-term SA (IRR: 2.19 (95%CI 1.09-4.58)) in the follow-up period. This risk remained significant even after adjusting for work environment factors, sociodemographic factors, self-rated health, and spells of sickness absence in the previous year. Going to work with fever (IR: 1.43) or cold (IR: 1.48) was also associated with long-term SA in the follow-up period.ConclusionsSP may negatively impact employees’ health status and increase long-term sickness absence. Health professionals should be aware of the negative consequences of focusing solely on reducing short-term sickness absence especially if they inadvertently encourage employees to substitute sickness presence for sickness absence.Key messages• Going to work despite having ill health is common but may have adverse health consequences and lead to long-term sickness absence.• Focusing narrowly on reducing short-term sickness absence might be a bad idea for public health. Employees might feel encouraged to go ill to work which could increase future sick leave

Developing prognostic models for health care utilization in patients with work-related mental health problems

Abstract Background The long-term prognosis for employees with work-related mental health problems is unclear. We aim to describe long-term trends in health care utilization (HCU) and develop multivariable prognostic models for long-term mental health care utilization. Methods From the Danish Occupational Medicine Cohort we included mental health patients (N = 17,822) assessed from 2000 to 2013 at Departments of Occupational Medicine. Outcomes were general health (general practitioner, somatic hospital) and mental health (psychiatrist/psychologist, psychiatric hospital) HCU obtained from registries five years before/after assessment. The 10-year period was divided into phases relative to assessment: 5 − 3 years before, 2 years before/after, and 3–5 years after. We developed gender-stratified Lasso-penalized multivariable prognostic models for HCU 3–5 years after assessment assessing both calibration and discrimination. Results Prevalent HCU for general practitioner, psychiatrist/psychologist and psychiatric hospital services was relatively stable 5 − 3 years prior to assessment, then rising during the 2 years before/after. At 3–5 years after assessment prevalent general practitioner HCU declined to previous levels, while prevalent HCU for psychologist/psychiatrist and psychiatric hospital services remained elevated compared to previous levels during years 5 − 3. Prognostic models for long-term psychologist/psychiatrist and psychiatric hospital HCU indicated acceptable calibration and modest discrimination. Conclusions Prevalent HCU rose two years before/after assessment and remained elevated for psychiatrist/psychologist and psychiatric hospital HCU 3–5 years after. Gender-stratified prognostic models were developed for long-term mental health HCU, but discrimination and calibration should be further improved before out-of-sample application for personal prognosis. Trial registration The study was registered at clinicaltrials.gov (Identifier: NCT04459793) prior to analyses