Work and mental complaints: are response outcome expectancies more important than work conditions and number of subjective health complaints?

Purpose Investigate the relative effect of response outcome expectancies, work conditions, and number of subjective health complaints (SHC) on anxiety and depression in Norwegian employees. Learned response outcome expectancies are important contributors to health. Individual differences in the expectancy to cope with workplace and general life demands may be important for how work conditions influence health. Method A survey was conducted among 1746 municipal employees (mean age 44.1, SD = 11.5, 81.5 % female), as part of a randomized controlled trial. This cross-sectional study used baseline data. Multiple logistic regression analysis was performed. Outcome variables were anxiety and depression; response outcome expectancies, work conditions, and number of SHC were independent variables. Results A high number of SHC was a significant factor in explaining anxiety (OR 1.26), depression (OR 1.22) and comorbid anxiety and depression (OR 1.31). A high degree of no and/or negative response outcome expectancies was a significant factor in explaining depression (OR 1.19) and comorbid anxiety and depression (OR 1.28). The variance accounted for in the full models was 14 % for anxiety, 23 % for depression, and 41 % for comorbid anxiety and depression. Conclusion A high number of SHC, and a high degree of no and/or negative response outcome expectancies were associated with anxiety and depression. The strongest association was found for number of SHC. However, previous studies indicate that it may not be possible to prevent the occurrence of SHC. We suggest that workplace interventions targeting anxiety and depression could focus on influencing and altering employees’ response outcome expectancies.publishedVersio

Work and Mental Complaints: Are Response Outcome Expectancies More Important Than Work Conditions and Number of Subjective Health Complaints?

Purpose Investigate the relative effect of response outcome expectancies, work conditions, and number of subjective health complaints (SHC) on anxiety and depression in Norwegian employees. Learned response outcome expectancies are important contributors to health. Individual differences in the expectancy to cope with workplace and general life demands may be important for how work conditions influence health. Method A survey was conducted among 1746 municipal employees (mean age 44.1, SD = 11.5, 81.5 % female), as part of a randomized controlled trial. This cross-sectional study used baseline data. Multiple logistic regression analysis was performed. Outcome variables were anxiety and depression; response outcome expectancies, work conditions, and number of SHC were independent variables. Results A high number of SHC was a significant factor in explaining anxiety (OR 1.26), depression (OR 1.22) and comorbid anxiety and depression (OR 1.31). A high degree of no and/or negative response outcome expectancies was a significant factor in explaining depression (OR 1.19) and comorbid anxiety and depression (OR 1.28). The variance accounted for in the full models was 14 % for anxiety, 23 % for depression, and 41 % for comorbid anxiety and depression. Conclusion A high number of SHC, and a high degree of no and/or negative response outcome expectancies were associated with anxiety and depression. The strongest association was found for number of SHC. However, previous studies indicate that it may not be possible to prevent the occurrence of SHC. We suggest that workplace interventions targeting anxiety and depression could focus on influencing and altering employees’ response outcome expectancies

Workplace Inclusion of People With Health Issues, Immigrants, and Unemployed Youths—A Qualitative Study of Norwegian Leaders’ Experiences

Aim: To explore leaders’ perceptions and experiences of facilitators and barriers for successful workplace inclusion of immigrants, unemployed youths, and people who are outside the labor market due to health issues. Methods: Semi-structured individual interviews with 16 leaders who actively engaged in inclusion work, representing different occupations, were conducted. Systematic Text Condensation was used to structure the analysis. Results: The participating leaders emphasized that job match, including their perception of workers’ motivation, respect for workplace policies, and the availability of appropriate accommodation at the workplace, facilitated work inclusion. An active public support system providing professional and financial support to workers and leaders was also an important facilitating factor. The leaders emphasized that their perception of workers’ lack of motivation for the job was the most important barrier in their own hiring and inclusion engagement. Successful inclusion depended on all workers acknowledging responsibility for and contributing to an inclusive work environment. Being open and willing to discuss challenges was an important part of making the inclusion work. In addition, leadership qualities, such as empathy, patience, and a non-judgmental attitude, appeared as a hallmark among these leaders who actively engaged in inclusion work. Conclusion: Workplace inclusion of this population of marginalized people was facilitated by job match, mutual respect, commitment, and trust, as well as financial and practical support from the public support system. Leaders’ inclusion practices were furthermore affected by personal attitudes and perceptions of social responsibility. Even so, successful workplace inclusion was presented as a two-way street. Leaders have the main responsibility in initiating a respectful and trusting relationship, but both the worker and the leader needs to contribute to make the relationship thrive.Workplace Inclusion of People With Health Issues, Immigrants, and Unemployed Youths—A Qualitative Study of Norwegian Leaders’ ExperiencespublishedVersio

Workplace Inclusion of Potentially Marginalized Groups: A Cluster Randomized Controlled Trial of the atWork Intervention

Study design: A cluster randomized controlled trial. Aim: The main aim of this study was to investigate possible differences between the modified atWork intervention (MAW) and the original atWork intervention (OAW) in workplace inclusion. atWork is an intervention using the workplace as an arena to normalize and debunk myths regarding common health complaints. Methods: Employees working in 93 Norwegian kindergartens were eligible participants. Kindergartens were randomly allocated to two different health promoting interventions (MAW n = 406 employees, OAW n = 438 employees) in a concealed process. There was no blinding to group allocation. The outcome was workplace inclusion of persons with different health or social challenges, measured by the Workplace Inclusion Questionnaire. MAW targeted musculoskeletal and mental health complaints and consisted of two sessions for everyone at the workplace and two additional sessions for managers and workplace representatives. OAW targeted musculoskeletal complaints and consisted of three sessions for everyone at the workplace, in addition to peer support. Results: There were no significant differences in change on workplace inclusion between the MAW and the OAW after the interventions. However, participants in the MAW group were more willing to include the cases describing an older worker, a previous drug addict, and a person with minority background after the intervention, and participants in the OAW group were more willing to include the cases describing a person with a spine fracture and a person with ADHD after the intervention. Conclusions: Both interventions showed a positive effect on workplace inclusion, but there were no between-group differences. Trial registration: Clinicaltrials.gov: NCT02396797. Registered March 23th, 2015

Stop Sexual Harassment: A study protocol for a cluster randomised controlled trial in secondary schools in Norway

Background: Sexual- and gendered harassment are normalised in many peer groups, yet their associations with mental health concerns among adolescents are well-established. School based interventions that prevent and reduce sexual and gendered harassment among younger adolescents are scarce. For schools, protecting pupils from harassment may be challenging if the behaviour is trivialised among the pupils themselves. In the current study, the school intervention “Stop Sexual Harassment” was therefore developed to help teachers and pupils detect, address and stop sexual and gendered harassment among pupils ages 13–15 in Norwegian secondary schools. Methods: In this study the effectiveness of “Stop Sexual Harassment” is evaluated via a cluster randomised controlled trial among pupils and teachers at 38 secondary schools. Schools were randomised into intervention and control groups. Primary outcomes are sexual and gendered harassment victimisation and perpetration, which will be assessed by the administration of questionnaires to pupils and teachers at baseline, and 2-, and 7-months follow-up. A process evaluation of the intervention implementation will be conducted through focus group interviews with pupils and teachers to gain insight about their experiences with the program components and implementation of the intervention. Discussion: If the intervention yields positive effects, large-scale implementation of the program may be offered for secondary schools. The program may thus reduce sexual and gendered harassment among young adolescents.Stop Sexual Harassment: A study protocol for a cluster randomised controlled trial in secondary schools in NorwaypublishedVersio

Comparing two interdisciplinary occupational rehabilitation programs for employees on sick leave: a mixed-method design study protocol

Background Musculoskeletal disorders (MSDs) and common mental disorders (CMDs) are the most frequent reasons for long-term sick leave and work disability. Occupational rehabilitation programs are used to help employees return to work (RTW). However, knowledge regarding the effect of these programs is scarce, and even less is known about which programs are best suited for which patients. This study aims to compare the RTW results of two interdisciplinary occupational rehabilitation programs in Norway, as well as to examine the delivery and reception of the two programs and explore the active mechanisms of the participants’ RTW processes. Methods/design We will use a mixed-method convergent design to study the main outcome. Approximately 600 participants will be included in the study. Eligible study participants will be aged 18–60 years old and have been on sick leave due to MSDs, CMDs, or both for at least 6 weeks. Interdisciplinary teams at both participating clinics will deliver complex occupational rehabilitation programs. The inpatient rehabilitation program has a duration of 4 weeks and is full time. The outpatient program has a duration of 3 months and involves weekly sessions. The primary outcome is RTW. Secondary outcomes are differences in the incremental cost for an averted sick leave day, cost utility/benefit, and differences between the programs regarding improvements in known modifiable obstacles to RTW. Subgroup analyses are planned. The researchers will be blinded to the intervention groups when analyzing the quantitative RTW data. Discussion This study aims to provide new insights regarding occupational rehabilitation interventions, treatment targets, and outcomes for different subgroups of sick-listed employees and to inform discussions on the active working mechanisms of occupational rehabilitation and the influence of context in the return-to-work process.publishedVersio

Protocol for the SEED-trial: Supported Employment and preventing Early Disability

Background: Early withdrawal or exclusion from the labor market leads to significant personal and societal costs. In Norway, the increasing numbers of young adults receiving disability pension is a growing problem. While a large body of research demonstrates positive effects of Supported Employment (SE) in patients with severe mental illness, no studies have yet investigated the effectiveness of SE in young adults with a range of social and health conditions who are receiving benefits. Methods/design: The SEED-trial is a randomized controlled trial (RCT) comparing traditional vocational rehabilitation (TVR) to SE in 124 unemployed individuals between the ages of 18-29 who are receiving benefits due to various social- or health-related problems. The primary outcome is labor market participation during the first year after enrollment. Secondary outcomes include physical and mental health, health behaviors, and well-being, collected at baseline, 6, and 12 months. A cost-benefit analysis will also be conducted. Discussion: The SEED-trial is the first RCT to compare SE to TVR in this important and vulnerable group, at risk of being excluded from working life at an early age

Sick Leave and Subjective Health Complaints

The aims of this thesis were to identify risk factors for high levels of sick leave and investigate what – if anything – can be done to reduce sick leave. What is the role of “subjective health complaints”, coping, and psychosocial work factors in relation to sick leave, and to what extent do these factors and the sick leave relate to quality of life? Are there any interventions with a documented effect on sick leave in the literature? Is it possible to influence sick leave through an intervention tailored to target the risk factors for sick leave including both psychological and physiological health factors? Finally, the aim was to identify and describe employees with a high level of sick leave. “Subjective health complaints” are complaints without known pathology or where the pathological findings are less than expected. Such complaints are the cause of more than 50% of the sick leave in Norway. Musculoskeletal complaints are one subgroup of subjective health complaints and are responsible for nearly half of the sick leave. Low back pain is the most common diagnosis in this group. Employees in the health sector are the work group with most sick leave and highest recruitment to disability pension. In Paper 1 employees in two nursing homes for the elderly were assessed for subjective health complaints as well as for health related quality of life. In addition, personal and work factors were monitored. High levels of subjective health complaints did relate to low quality of life. High expectancies of being able to cope and low work demands were associated to high quality of life; and low coping expectancies and high work demands were associated to low quality of life. Since low back pain is the most common reason for sick leave and a frequent complaint among the employees in the nursing homes, the literature for work place interventions targeted at low back pain was searched. In Paper 2 the results from this systematic literature review of controlled work place interventions are presented. We identified 31 publications that satisfied our quality criteria. The inclusion criteria were: controlled intervention, work setting, and assessment of at least one of the four main outcome measures: sick leave, costs, new episodes of low back pain, and pain. All studies were scored on methodological quality. Physical exercise and comprehensive multidisciplinary interventions were the only interventions with a documented effect on low back pain. Physical exercise to prevent low back pain and comprehensive multidisciplinary interventions to treat employees with low back pain were effective in reducing sick leave, costs, and preventing recurrence of low back pain. In Paper 3 the effects of an intervention tailored to target the risk factors for sick leave including both psychological and physiological health factors related to sick leave are presented. Employees in one of the nursing homes from Paper 1 were invited to participate in an “Integrated Health Programme” consisting of physical exercise, health information, and stress management, in a randomised controlled study. The intervention group (n = 19) was allowed time off from work to participate in the intervention twice weekly for 9 months. The control group (n = 21) was offered the same “Integrated Health Programme” after the study was finished. The intervention had no significant effect on sick leave. Sick leave more than doubled in both groups during the intervention period. The intervention group reported less neck complaints compared to the control group, otherwise there were no effects on subjective health complaints. On the other hand, there were large positive subjective effects in the intervention group. The intervention group reported significant improvement in their experience of their own health, physical fitness, muscle pain, stress management, maintenance of health, and work situation. Still, this did not change the scores on health related quality of life. This may relate to the fact that the scores were about average for the group as a whole. Finally, in Paper 4, the distribution of sick leave in a population of power plant employees was described. A group of 10% of the employees was responsible for 82% of the sick leave, with an average number of 44 days of sick leave in the group of employees with much sick leave and 1 day in the group with low level of sick leave. The employees with much sick leave were characterised by high levels of subjective health complaints, low education, low coping, heavy manual work, and many health risk factors such as smoking, low job satisfaction, high reports of job stress, poor quality of sleep, and low level of physical activity. With sick leave among the employees distributed like this, demonstrating effect on sick leave of an intervention including all employees will be difficult. The conclusion from the thesis is that a minor part of the employees had the major part of the sick leave. The employees with much sick leave were characterised by having high levels of subjective health complaints, an unhealthy life style, low coping, a reduced quality of life, and low socioeconomic status. Subjective health complaints were important for daily life functioning. High coping and low job demands were associated with high quality of life. Physical exercise interventions at the work place had a documented effect on sick leave. A work place intervention including physical exercise was not effective in reducing sick leave and subjective health complaints, but had large subjective effects. The potential for reducing sick leave is small when targeting all employees in an organisation and this may explain why so few of the interventions aiming to reduce sick leave, including the one in this thesis, are effective