Employees Receiving Inpatient Treatment for Common Mental Disorders in Germany:Factors Associated with Time to First and Full Return to Work

Purpose In Germany, return to work (RTW) after inpatient treatment for common mental disorders (CMDs) is a complex process at the intersection of the mental healthcare system and the workplace. This study examined (1) the time to first and full RTW and (2) associated factors among employees receiving inpatient treatment for CMDs. Methods In this prospective cohort study, employees receiving inpatient psychiatric or medical rehabilitation treatment for CMDs were interviewed by phone during their last week before discharge. Follow-up interviews were conducted after 6, 12, and 18 months. Health-, personal, and work-related factors were used from baseline measurement. Parametric survival analysis was conducted to identify factors associated with time to first and full RTW. Results A total of N = 269 participants who stayed at a psychiatric clinic or a medical rehabilitation facility were included. Almost all participants (n = 252, 94%) from both treatment settings reported a first RTW and a full RTW. The time to first and full RTW was shortest among participants from medical rehabilitation (both median 6 days) and longer among participants from psychiatric treatment (median 17 days to first RTW and 73 days to full RTW). While only health-related and personal factors were associated with time to first RTW, leadership quality and needed individual RTW support were associated with time to full RTW. Conclusions More attention to work accommodation needs for RTW in clinical practice and coordinated actions towards RTW in collaboration with key RTW stakeholders in the workplace may support a timely RTW. Clinical Registration Number DRKS00010903, retrospectively registered. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10926-021-09985-4

Verbreitung des betrieblichen Eingliederungsmanagements: Sind Gesundheitsorientierung und soziale Ressourcen bedeutsamer als Betriebsgröße? Ergebnisse der BIBB/BAuA-Erwerbstätigenbefragung 2018

Ziele und Methoden: Auf Grundlage der repräsentativen BIBB/BAuA-Erwerbstätigenbefragung 2018 wird analysiert, ob die Verbreitung des betrieblichen Eingliederungsmanagements (BEM) mit ausgewählten strukturellen Merkmalen von Betrieben sowie Variablen aus dem Bereich sozialer Ressourcen zusammenhängt. Ein Zusammenhang mit Merkmalen, die auf eine betriebliche Priorisierung von Gesundheit und Sozialem hinweisen, wird angenommen. Zusätzlich werden die gleichen Variablen in Bezug auf die Inanspruchnahme von BEM betrachtet, ergänzt um personenbezogene Merkmale. Ergebnisse: Rund vierzig Prozent der langzeiterkrankten Beschäftigten bekamen ein BEM angeboten, wovon fast siebzig Prozent das Angebot angenommen haben. BEM wurde eher in Betrieben angeboten, in denen Beschäftigten Maßnahmen der betrieblichen Gesundheitsförderung (BGF) bekannt waren, in denen häufig Lob und Anerkennung durch Vorgesetzte erfolgte, in denen sich häufig ein Gemeinschaftsgefühl am Arbeitsplatz fand und ein Betriebs- oder Personalrat vorhanden war. In kleineren Betrieben sowie in Dienstleistungs- und Handwerksbetrieben wurde das BEM-Angebot häufiger angenommen als in größeren Betrieben, im öffentlichen Dienst und in Betrieben der Industrie. Von den personenbezogenen Merkmalen wies nur eine längere Arbeitsunfähigkeit einen Zusammenhang mit der Inanspruchnahme auf. Schlussfolgerungen: Die Zusammenhänge mit BGF und wertschätzendem Vorgesetztenverhalten legen den Schluss nahe, dass Betriebe, in denen gute und gesundheitsförderliche Arbeit einen höheren Stellenwert hat, eher die gesetzlichen Anforderungen zum BEM umsetzen. Gleichzeitig wäre es auch denkbar, dass ein umgekehrter Effekt vorliegt, und Betriebe die Einführung eines BEM aufgrund aufgetretener Fälle zum Anlass der Überprüfung ihres sonstigen Engagements für die Gesundheit der Beschäftigten genommen haben.Aims: The aim of the present study was to examine whether the prevalence of the operational integration management programme in Germany (BEM) is associated with selected structural characteristics of companies and variables from the field of social resources. Methods: The study was based on the representative 2018 BIBB/BAuA employment survey. An assumption was made of the existence of an association between BEM and characteristics of companies, indicating a prioritisation of health and social resources. Furthermore, the same variables were considered with the acceptance of BEM, complemented by person-related characteristics. Results: About forty percent of employees on long-term sick leave were offered BEM, of which about seventy percent accepted the offer. BEM was more likely to be offered in companies where employees were aware of workplace health promotion (WHP) measures, where supervisors often gave praise and recognition, where there was often a sense of community in the workplace, and where there was a works or staff council. In smaller companies, in service and craft enterprises, the BEM offer was accepted more frequently than in larger companies, the public sector, and in companies in the industry. Of the personal characteristics, only a longer incapacity to work was associated with the acceptance of BEM. Conclusions: The association with WHP and appreciative supervisor behaviour suggest that companies in which good and health-promoting work is given higher priority are more likely to implement the legal requirements for BEM. At the same time, it is also conceivable that the opposite effect exists and that companies have taken the introduction of BEM as an opportunity to review their other commitment to the health of their employees because of the cases that have occurred

Determinants of Sickness Absence and Return to Work Among Employees with Common Mental Disorders:A Scoping Review

Purpose To present an overview of the existing evidence on prognostic factors of (recurrent) sickness absence (SA) and return to work (RTW) among workers with a common mental disorder (CMD). This scoping review provides information about determinants for SA and RTW, which could be used to develop better interventions aimed at the prevention of SA and promotion of RTW among workers with a CMD. Methods Relevant articles were identified in PubMed, Embase, PsycINFO, PSYNDEX, and SINGLE up to October 2016. In order to be included, studies should provide insight into prognostic factors of SA or RTW of workers with a CMD. We classified all factors according to the domains of the International Classification of Functioning, Disability and Health. Results Our searches identified 2447 possible relevant articles, of which 71 were included for data extraction. There is consistent evidence in >= 3 studies that previous episodes of CMD, higher symptom severity, previous absenteeism, co-morbidity, high job demands, low job control, high job strain, female gender, lower educational level, smoking behavior, and low perceived general health are predictors of SA in people with CMDs. Earlier RTW is consistently predicted by lower symptom severity, having no previous absenteeism, younger age, and positive expectations concerning sick-leave duration or RTW. Conclusions The amount of research on determinants for SA and RTW in workers with CMD has increased dramatically in recent years, although most studies are from the Netherlands and Scandinavia. There are some research gaps identified in this scoping review that need further attention in primary and secondary studies. Based on the summary of the evidence, we provide guidance for policy, practice and research

The Current Practice of Gradual Return to Work in Germany: A Qualitative Study Protocol

(1) Background: The increase in working age and long-term illnesses is a challenge for society to maintain the health of employees and to support their work participation. In many countries, such as Germany, a gradual return to work (GRTW) is used frequently to support returning employees, but little is known about its facilitators and obstacles. This protocol aims to provide an overview of the national state of the art in workplace adjustments during return to work and to outline the design of a qualitative study examining current GRTW practices in Germany. (2) Methods: Our qualitative study will examine the current implementation of GRTW by means of 32 narrative interviews and 10 group discussions from different perspectives. Therefore, we will ask returning employees as well as organisational stakeholders and external experts about their experiences with GRTW and attitudes towards the measure. The verbal data obtained will be analysed using the documentary method of interpretation. (3) Discussion: This study will reveal facilitating and hindering factors for the implementation of GRTW in Germany. The findings of the study may contribute to an improved implementation of GRTW not only in Germany

Resuming the discussion of AMSTAR: What can (should) be made better?

Abstract Background Evidence syntheses, and in particular systematic reviews (SRs), have become one of the cornerstones of evidence-based health care. The Assessment of Multiple Systematic Reviews (AMSTAR) tool has become the most widely used tool for investigating the methodological quality of SRs and is currently undergoing revision. The objective of this paper is to present insights, challenges and potential solutions from the point of view of a group of assessors, while referring to earlier methodological discussions and debates with respect to AMSTAR. Discussion One major drawback of AMSTAR is that it relies heavily on reporting quality rather than on methodological quality. This can be found in several items. Furthermore, it should be acknowledged that there are now new methods and procedures that did not exist when AMSTAR was developed. For example, the note to item 1 should now refer to the International Prospective Register of Ongoing Systematic Reviews (PROSPERO). Furthermore, item 3 should consider the definition of hand-searching, as the process of reviewing conference proceedings using the search function (e.g. in Microsoft Word or in a PDF file) does not meet the definition set out by the Cochrane Collaboration. Moreover, methods for assessing the quality of the body of evidence have evolved since AMSTAR was developed and should be incorporated into a revised AMSTAR tool. Summary Potential solutions are presented for each AMSTAR item with the aim of allowing a more thorough assessment of SRs. As the AMSTAR tool is currently undergoing further development, our paper hopes to add to preceding discussions and papers regarding this tool and stimulate further discussion

How is AMSTAR applied by authors – a call for better reporting

Abstract Background The assessment of multiple systematic reviews (AMSTAR) tool is widely used for investigating the methodological quality of systematic reviews (SR). Originally, AMSTAR was developed for SRs of randomized controlled trials (RCTs). Its applicability to SRs of other study designs remains unclear. Our objectives were to: 1) analyze how AMSTAR is applied by authors and (2) analyze whether the authors pay attention to the original purpose of AMSTAR and for what it has been validated. Methods We searched MEDLINE (via PubMed) from inception through October 2016 to identify studies that applied AMSTAR. Full-text studies were sought for all retrieved hits and screened by one reviewer. A second reviewer verified the excluded studies (liberal acceleration). Data were extracted into structured tables by one reviewer and were checked by a second reviewer. Discrepancies at any stage were resolved by consensus or by consulting a third person. We analyzed the data descriptively as frequencies or medians and interquartile ranges (IQRs). Associations were quantified using the risk ratio (RR), with 95% confidence intervals. Results We identified 247 studies. They included a median of 17 reviews (interquartile range (IQR): 8 to 47) per study. AMSTAR was modified in 23% (57/247) of studies. In most studies, an AMSTAR score was calculated (200/247; 81%). Methods for calculating an AMSTAR score varied, with summing up all yes answers (yes = 1) being the most frequent option (102/200; 51%). More than one third of the authors failed to report how the AMSTAR score was obtained (71/200; 36%). In a subgroup analysis, we compared overviews of reviews (n = 154) with the methodological publications (n = 93). The overviews of reviews were much less likely to mention both limitations with respect to study designs (if other studies other than RCTs were included in the reviews) (RR 0.27, 95% CI 0.09 to 0.75) and overall score (RR 0.08, 95% CI 0.02 to 0.35). Conclusions Authors, peer reviewers, and editors should pay more attention to the correct use and reporting of assessment tools in evidence synthesis. Authors of overviews of reviews should ensure to have a methodological expert in their review team

Inter-rater reliability of AMSTAR is dependent on the pair of reviewers

Abstract Background Inter-rater reliability (IRR) is mainly assessed based on only two reviewers of unknown expertise. The aim of this paper is to examine differences in the IRR of the Assessment of Multiple Systematic Reviews (AMSTAR) and R(evised)-AMSTAR depending on the pair of reviewers. Methods Five reviewers independently applied AMSTAR and R-AMSTAR to 16 systematic reviews (eight Cochrane reviews and eight non-Cochrane reviews) from the field of occupational health. Responses were dichotomized and reliability measures were calculated by applying Holsti’s method (r) and Cohen’s kappa (κ) to all potential pairs of reviewers. Given that five reviewers participated in the study, there were ten possible pairs of reviewers. Results Inter-rater reliability varied for AMSTAR between r = 0.82 and r = 0.98 (median r = 0.88) using Holsti’s method and κ = 0.41 and κ = 0.69 (median κ = 0.52) using Cohen’s kappa and for R-AMSTAR between r = 0.77 and r = 0.89 (median r = 0.82) and κ = 0.32 and κ = 0.67 (median κ = 0.45) depending on the pair of reviewers. The same pair of reviewers yielded the highest IRR for both instruments. Pairwise Cohen’s kappa reliability measures showed a moderate correlation between AMSTAR and R-AMSTAR (Spearman’s ρ =0.50). The mean inter-rater reliability for AMSTAR was highest for item 1 (κ = 1.00) and item 5 (κ = 0.78), while lowest values were found for items 3, 8, 9 and 11, which showed only fair agreement. Conclusions Inter-rater reliability varies widely depending on the pair of reviewers. There may be some shortcomings associated with conducting reliability studies with only two reviewers. Further studies should include additional reviewers and should probably also take account of their level of expertise

Measuring test-retest reliability (TRR) of AMSTAR provides moderate to perfect agreement – a contribution to the discussion of the importance of TRR in relation to the psychometric properties of assessment tools

Background!#!Systematic Reviews (SRs) can build the groundwork for evidence-based health care decision-making. A sound methodological quality of SRs is crucial. AMSTAR (A Measurement Tool to Assess Systematic Reviews) is a widely used tool developed to assess the methodological quality of SRs of randomized controlled trials (RCTs). Research shows that AMSTAR seems to be valid and reliable in terms of interrater reliability (IRR), but the test retest reliability (TRR) of AMSTAR has never been investigated. In our study we investigated the TRR of AMSTAR to evaluate the importance of its measurement and contribute to the discussion of the measurement properties of AMSTAR and other quality assessment tools.!##!Methods!#!Seven raters at three institutions independently assessed the methodological quality of SRs in the field of occupational health with AMSTAR. Between the first and second ratings was a timespan of approximately two years. Answers were dichotomized, and we calculated the TRR of all raters and AMSTAR items using Gwet's AC1 coefficient. To investigate the impact of variation in the ratings over time, we obtained summary scores for each review.!##!Results!#!AMSTAR item 4 (Was the status of publication used as an inclusion criterion?) provided the lowest median TRR of 0.53 (moderate agreement). Perfect agreement of all reviewers was detected for AMSTAR-item 1 with a Gwet's AC1 of 1, which represented perfect agreement. The median TRR of the single raters varied between 0.69 (substantial agreement) and 0.89 (almost perfect agreement). Variation of two or more points in yes-scored AMSTAR items was observed in 65% (73/112) of all assessments.!##!Conclusions!#!The high variation between the first and second AMSTAR ratings suggests that consideration of the TRR is important when evaluating the psychometric properties of AMSTAR.. However, more evidence is needed to investigate this neglected issue of measurement properties. Our results may initiate discussion of the importance of considering the TRR of assessment tools. A further examination of the TRR of AMSTAR, as well as other recently established rating tools such as AMSTAR 2 and ROBIS (Risk Of Bias In Systematic reviews), would be useful

Additional file 2: of Inter-rater reliability of AMSTAR is dependent on the pair of reviewers

Appendix 2: overview of included systematic reviews. (DOCX 17 kb