Behavioral determinants as predictors of return to work after long-term sickness absence: an application of the theory of planned behavior

Background The aim of this prospective, longitudinal cohort study was to analyze the association between the three behavioral determinants of the theory of planned behavior (TPB) model-attitude, subjective norm and self-efficacy-and the time to return-to-work (RTW) in employees on long-term sick leave. Methods The study was based on a sample of 926 employees on sickness absence (maximum duration of 12 weeks). The employees filled out a baseline questionnaire and were subsequently followed until the tenth month after listing sick. The TPB-determinants were measured at baseline. Work attitude was measured with a Dutch language version of the Work Involvement Scale. Subjective norm was measured with a self-structured scale reflecting a person's perception of social support and social pressure. Self-efficacy was measured with the three subscales of a standardised Dutch version of the general self-efficacy scale (ALCOS): willingness to expend effort in completing the behavior, persistence in the face of adversity, and willingness to initiate behavior. Cox proportional hazards regression analyses were used to identify behavioral determinants of the time to RTW. Results Median time to RTW was 160 days. In the univariate analysis, all potential prognostic factors were significantly associated (P < 0.15) with time to RTW: work attitude, social support, and the three subscales of self-efficacy. The final multivariate model with time to RTW as the predicted outcome included work attitude, social support and willingness to expend effort in completing the behavior as significant predictive factors. Conclusions This prospective, longitudinal cohort-study showed that work attitude, social support and willingness to expend effort in completing the behavior are significantly associated with a shorter time to RTW in employees on long-term sickness absence. This provides suggestive evidence for the relevance of behavioral characteristics in the prediction of duration of sickness absence. It may be a promising approach to address the behavioral determinants in the development of interventions focusing on RTW in employees on long-term sick leave

The impact of perinatal loss on adjustment to subsequent pregnancy

The current study compared the emotional adjustment of pregnant couples with and without a history of perinatal loss. Thirty-one pregnant women with a history of perinatal loss and 31 pregnant women with an unremarkable reproductive history were assessed between their 10th and 24th week of gestation. Partners were also recruited. Twenty-eight men were in the loss group and 23 men in the comparison group. Couples with a history of loss reported significantly more depressive symptomatology and pregnancy-specific anxiety than couples in the comparison group. Women reported more depressive symptomatology than men. Regression analyses revealed that for the group with a previous loss, depressive symptomatology was significantly associated with self-criticism, interpersonal dependency and number of previous losses. For the comparison group, depressive symptomatology was significantly associated dyadic adjustment. Pregnancy-specific anxiety of women with a previous loss was associated with their belief that their behavior affects fetal health; for women in the comparison group, pregnancy-specific anxiety was associated with the belief that health professionals' behavior affects fetal health. Implications for practice of health care professionals are discussed. The importance of early intervention to reduce distress is highlighted by the finding that alterations in mood are apparent in the early stages of pregnancy for both women and men who have experienced a previous perinatal loss. While carefully reducing personal responsibility for fetal health in women with a previous loss may reduce their pregnancy-specific anxiety, women with an unremarkable obstetrical history may benefit from an approach diminishing their perception of the power that medical staff has on fetal health.Perinatal loss Pregnancy Psychological factors

Work functioning measurement: tools for occupational mental health research

To review the status of work functioning research in workers with common mental disorders (CMDs) and also the work functioning measurement instruments. We distinguish between productivity, work role limitations, quality of work output, and extra effort required to remain productive. Two systematic literature studies; the first to identify articles that measured work functioning in workers with CMDs, and the second to identify work functioning measurement instruments. Work functioning is mostly studied in relation to clinical factors. Instruments with acceptable psychometric properties exist for measuring productivity and work role limitations. Further exploration of work-related determinants of work functioning is needed to develop more work-focused interventions. Existing instruments have to be tested in workers with CMDs. New work functioning instruments are needed to integrate the quality of work output and the effort required to remain productiv

Early healthcare provider communication with patients and their workplace following a lost-time claim for an occupational musculoskeletal injury

One of the key players in the return-to-work (RTW) and work accommodation process is the healthcare provider (HCP). This study examines the association between RTW approximately one month post injury and early, proactive HCP communication with the patient and workplace.In this cross-sectional study 187 Ontario workers completed a telephone survey 17-43 days post injury. All had accepted or pending lost-time claims for back, neck or upper extremity occupational musculoskeletal injuries. Logistic regression was used to analyze the effects of three self-reported items "your HCP told you the date you could RTW," "your HCP advised you on how to prevent re-injury or recurrence," "your HCP made contact with your workplace" on self-reported RTW. Fourteen potential confounders were also tested in the model including sex, age, income, education, occupational classification, worksite size, co-morbidity, psycho-physical work demands, pain, job satisfaction, depression, and time from injury to interview.The HCP giving a patient a RTW date (adjusted OR=3.33, 95% CI=1.62-6.87) and giving a patient guidance on how to prevent recurrence and re-injury (adjusted OR=2.71, 95% CI=1.24-5.95) were positively associated with an early RTW. Contact by the HCP with the workplace was associated with RTW, however, this association became weaker upon adjusting for confounding variables (crude OR=2.11, 95% C1=1.09-4.09; adjusted OR=1.72, 95% CI=0.83-3.58).Our study lends support to the HCP playing an active role early in the RTW process, one that includes direct contact with the workplace and proactive communication with the patient

Return-to-work self-efficacy: development and validation of a scale in claimants with musculoskeletal disorders.

INTRODUCTION We report on the development and validation of a 10-item scale assessing self-efficacy within the return-to-work context, the Return-to-Work Self-Efficacy (RTWSE) scale. METHODS Lost-time claimants completed a telephone survey 1 month (n = 632) and 6 months (n = 446) after a work-related musculoskeletal injury. Exploratory (Varimax and Promax rotation) and confirmatory factor analyses of self-efficacy items were conducted with two separate subsamples at both time points. Construct validity was examined by comparing scale measurements and theoretically derived constructs, and the phase specificity of RTWSE was studied by examining changes in strength of relationships between the RTWSE Subscales and the other constructs at both time measures. RESULTS Factor analyses supported three underlying factors: (1) Obtaining help from supervisor, (2) Coping with pain (3) Obtaining help from co-workers. Internal consistency (alpha) for the three subscales ranged from 0.66 to 0.93. The total variance explained was 68% at 1-month follow-up and 76% at 6-month follow-up. Confirmatory factor analyses had satisfactory fit indices to confirm the initial model. With regard to construct validity: relationships of RTWSE with depressive symptoms, fear-avoidance, pain, and general health, were generally in the hypothesized direction. However, the hypothesis that less advanced stages of change on the Readiness for RTW scale would be associated with lower RTWSE could not be completely confirmed: on all RTWSE subscales, RTWSE decreased significantly for a subset of participants who started working again. Moreover, only Pain RTWSE was significantly associated with RTW status and duration of work disability. With regard to the phase specificity, the strength of association between RTWSE and other constructs was stronger at 6 months post-injury compared to 1 month post-injury. CONCLUSIONS A final 10-item version of the RTWSE has adequate internal consistency and validity to assess the confidence of injured workers to obtain help from supervisor and co-workers and to cope with pain. With regard to phase specificity, stronger associations between RTWSE and other constructs at 6-month follow-up suggest that the association between these psychological constructs consolidates over time after the disruptive event of the injury