Predictors of employment in young adults with psychiatric work disability

AIM: Mental disorders are the leading cause of work disability among young adults in the industrialized world. Factors predicting employment after long-term psychiatric work disability are largely unknown. METHODS: We linked personal and clinical information from the benefit applications and medical certificates of 1163 young adults (18-34 years) with a new-onset fixed-term psychiatric disability pension in 2008 with employment records between 2005 and 2013. The outcomes were starting employment during and being employed at the end of follow-up. RESULTS: Of the participants, 48% had been employed during and 22% were employed at the end of follow-up. Sustained employment history, university education (master's degree) and no recorded psychological symptoms in childhood were associated with both subsequent employment outcomes. Women and participants under 25 years were more likely to start employment. Depression and other mental disorders (vs psychotic diagnose) and having no comorbid mental disorders or substance abuse were associated with employment at the end of follow-up. CONCLUSIONS: Sustained employment history, university education and no recorded psychological symptoms during childhood predict a return to employment among young adults after a fixed-term psychiatric work disability pension. Pro-active interventions in psychological problems during childhood could enhance employment after a period of work disability

Do predictors of return to work and recurrence of work disability due to mental disorders vary by age? A cohort study

BACKGROUND: The extent to which predictors of return to work (RTW) and recurrence of work disability episodes vary by age group is not well understood. METHODS: We examined the associations of sociodemographic and clinical factors with RTW and recurrence after mental-disorder-related work disability episodes in a cohort of 10,496 Finnish public sector employees. Disability records were derived from national disability registers between 2005 and 2011. Effect modification by age was examined in age groups of 21-34, 35-50 and >50 years. RESULTS: A total of 16,551 disability episodes from mental disorders were recorded. The likelihood of RTW was elevated in age group 21-34 (hazard ratio (HR) = 1.36, 95% confidence interval (CI) = 1.28-1.46) and 35-50 years (HR = 1.22, 95% CI = 1.18-1.26) compared to age group >50 years. The risk of a recurrent episode of work disability was higher in age groups >50 (HR = 1.29, 95% CI = 1.09-1.52) and 35-50 years (HR = 1.20, 95% CI = 1.03-1.41) compared to the youngest age group. Employees with depressive disorders were less likely to RTW than employees with neurotic, stress-related and somatoform disorders, and this difference increased with age. Low education was associated with increased risk of recurrent work disability episode in age groups of 50 years or younger, while no such association was observed in age group >50 years. CONCLUSIONS: The importance of depressive symptoms over neurotic, stress-related and somatoform disorders as predictors of delayed RTW increases with age, whereas educational differences in the recurrence of an episode diminish by age

'Return to Work' Coordinator Model and Work Participation of Employees: A Natural Intervention Study in Finland

Purpose Employers increasingly use 'return to work' (RTW) coordinators to support work ability and extend working careers, particularly among employees with reduced work ability. We examined whether applying this model was associated with changes in employee sickness absence and disability retirements. Methods We used data from the Finnish Public Sector study from 2009 until 2015. Employees where the model was introduced in 2012 constituted the cases (n = 4120, one municipality) and employees where the model was not in use during the follow-up, represented the controls (n = 5600, two municipalities). We analysed risk of disability retirement in 2013-2015 and risk of sickness absence after (2013-2015) vs. before (2009-2011) intervention by case-control status. Results The incidence of disability retirement after the intervention was lower in cases compared to controls both in the total population (hazard ratio HR = 0.49, 95% CI 0.30-0.79) and in the subgroup of participants with reduced work ability (HR = 0.34, 95% CI 0.12-0.99). The risk of sickness absence increased from pre-intervention to post-intervention period both among cases and controls although the relative increase was greater among cases (RRpost- vs. pre-intervention = 1.26, 95% CI 1.14-1.40) than controls (RRpost- vs. pre-intervention = 1.03, 95% CI 0.97-1.08). In the group of employees with reduced work ability, no difference in sickness absence trends between cases and controls was observed. Conclusions These findings suggest that RTW-coordinator model may increase employee sickness absence, but decrease the risk of disability retirement, i.e., permanent exclusion from the labour market

Psychotherapeutic and vocational interventions among young adults with work disability due to mental disorders in Finland.

BACKROUND: Little is known about treatment and rehabilitation received and planned among young adults with work disability due to a mental disorder. AIMS: To examine the implemented psychotherapeutic and vocational interventions and treatment plans among young adults with work disability due to a mental disorder. MATERIAL AND METHODS: Data were collected from medical records of young Finnish adults aged 18-34 with a long-term work disability history due to a mental disorder (N = 1163). The participant characteristics associated with four types of interventions were analyzed using log-binomial regression analysis. RESULTS: In total, 34% had participated in a psychotherapeutic intervention. Of the non-students, 26% had participated in vocational intervention. For 46% of the non-students, neither type of intervention was planned. Both implemented and planned psychotherapeutic interventions were associated with female sex, high education, attachment to employment, and absence of substance abuse. Low education and childhood adversity were associated with implemented vocational interventions and absence of substance abuse with planned vocational interventions. CONCLUSION AND SIGNIFICANCE: There is an unmet need for psychotherapeutic interventions among men, among those with lower socio-economic status, and among those with poor attachment to labor market. In addition, there is a lack of vocational interventions for those with high education. People with substance abuse are largely excluded from both types of interventions

Predictors of Depression and Musculoskeletal Disorder Related Work Disability Among Young, Middle-Aged, and Aging Employees

OBJECTIVE: The aim of this study was to investigate the level and predictors of work disability in different age groups. METHODS: We followed young (18 to 34 years), middle-aged (35 to 50 years), and aging (>50 years) employees (n¼70,417) for 7 years (2005 to 2011) for all-cause and cause-specific work disability (sickness absence and disability pension). Using negative binomial regression, we obtained both relative risk estimates and absolute rates, that is, days of work disability per person-year. RESULTS: The greatest relative difference in all-cause, and specifically depression-related work disability, was between young women and young men, and between employees with low versus high levels of education. Aging employees with a low education and chronic somatic disease had the highest levels of musculoskeletal disorder related work disability. CONCLUSIONS: The predictors of work disability vary by age and diagnosis. These results help target age-specific measures for the prevention of permanent work disability

Gezond reorganiseren. Hoe te reorganiseren met behoud van welbevinden van medewerkers?

Reorganisaties zijn niet meer weg te denken uit onze hedendaagse economie. Iedere medewerker krijgt vroeg of laat met een reorganisatie te maken, in welke vorm dan ook. Door te reorganiseren proberen organisaties hun prestaties te vergroten. Het is een manier om zich voor te bereiden op of aan te passen aan een veranderende omgeving. Een reorganisatie is een organisatieverandering die ingrijpender is dan een ‘alledaagse verandering’ en die ten minste een sector of een volledige organisatie aantast. Het gaat om meer dan alleen veranderingen in werkwijzen (1). Reorganisaties zijn een grote uitdaging voor werkgevers en medewerkers. Veranderingen worden doorgevoerd terwijl tegelijkertijd ook het dagelijks werk gewoon door moet gaan

Joint action on mental health at the workplace : situation analysis and recommendation for action

The thematic “Mental Health at Workplaces” is part of the “Joint Action on Mental Health and Well-being”, an initiative which sits within the framework of the 2 nd European Health Programme of the European Commission and the Member States of the EU in the period 2013 to 2016. The main aim of this joint action project is to ‘develop an action framework to support enterprises in adopting policies and practices which prevent mental ill-health and strengthen positive mental health’. This objective will be achieved by working with the representatives of eleven participating member states and their relevant stakeholders. The member states involved are Austria, Croatia, Finland, France, Germany, Hungary, Ireland, Iceland, Malta, Netherlands and Slovenia. The planned action will focus not on practices at enterprise level but on how the various stakeholders (apart from enterprises) can put in place a framework and supportive infrastructure which encourages enterprises to adopt initiatives that supports employees with mental health problems and promotes a positive corporate culture that prevents mental health at work

Longitudinal Metabolome-Wide Signals Prior to the Appearance of a First Islet Autoantibody in Children Participating in the TEDDY Study

Children at increased genetic risk for type 1 diabetes (T1D) after environmental exposures may develop pancreatic islet autoantibodies (IA) at a very young age. Metabolic profile changes over time may imply responses to exposures and signal development of the first IA. Our present research in The Environmental Determinants of Diabetes in the Young (TEDDY) study aimed to identify metabolome-wide signals preceding the first IA against GAD (GADA-first) or against insulin (IAA-first). We profiled metabolomes by mass spectrometry from children's plasma at 3-month intervals after birth until appearance of the first IA. A trajectory analysis discovered each first IA preceded by reduced amino acid proline and branched-chain amino acids (BCAAs), respectively. With independent time point analysis following birth, we discovered dehydroascorbic acid (DHAA) contributing to the risk of each first IA, and γ-aminobutyric acid (GABAs) associated with the first autoantibody against insulin (IAA-first). Methionine and alanine, compounds produced in BCAA metabolism and fatty acids, also preceded IA at different time points. Unsaturated triglycerides and phosphatidylethanolamines decreased in abundance before appearance of either autoantibody. Our findings suggest that IAA-first and GADA-first are heralded by different patterns of DHAA, GABA, multiple amino acids, and fatty acids, which may be important to primary prevention of T1D