Long-term Work Disability Research Articles

M131. RETURN TO LABOUR MARKET IN SCHIZOPHRENIA AND OTHER PSYCHOSES – THE NORTHERN FINLAND BIRTH COHORT 1966

BackgroundPeople with psychotic disorders typically have the poorest rate of employment compared to other mental disorders. However, the chances of returning back to labour market and work after long-term work disability is unclear. Aim of this study was to study proportion of persons who can return to labour market after they have received disability pension. We also aim to study potential predictors for return to work.MethodsThe study was based on the Northern Finland Birth Cohort 1966 (NFBC1966) (N=12 058) which is an unselected, general population-based sample. NFBC1966 offers us a unique way to examine return to labour market and its predictors in general population sample with true prospectively collected data with 50-years follow-up. Different national registers were utilized in the study (information about psychiatric diagnoses and occupational outcomes). Occupational outcomes until end of the 2016 were measured by information about disability pension, disability benefits and employment contracts. The sample included 232 schizophrenia patients, 208 persons with other psychosis and 1927 persons with non-psychotic psychiatric disorder diagnosed until the end of 2016. There is also large amount of predictor data (for occupational outcomes) collected since birth until recent years.ResultsOf the 141 (61%) persons with schizophrenia who had been on disability pension due to psychiatric reason, disability pensions of 16 (11%) persons had ended due to return to labour market. Of the 74 (32%) persons in the other psychosis subgroup and 180 (9%) in the non-psychotic psychiatric disorder subgroup who had been on disability pension due to psychiatric reason, corresponding numbers of pension’s ending due to return to labour market were 18 (24%) and 56 (31%), respectively. Disability pensions of 14 (10%) persons in schizophrenia group, 3 (4%) persons in other psychosis subgroup and 4 (2%) persons in non-psychotic psychiatric disorder subgroup had ended due to death. Disability pensions of 111 (79%) persons in schizophrenia group, 53 (72%) persons in other psychosis subgroup and 120 (67%) persons in non-psychotic psychiatric disorder subgroup were still running. Later, also sociodemographic information, psychiatric and somatic comorbidity and age at the onset of disease as predictors for the good occupational outcome (i.e. return to work) will be analysed and presented.DiscussionOur results indicate that having schizophrenia diagnosis often means relatively poor occupational outcome compared to other psychiatric disorders and ending up on disability pension. Besides of that some people with psychosis manage to maintain their working ability, some people also manage to return to labour market after being on disability pension. Finding the predictors for returning back to labour force in long-time follow-up can help us to cut off the long-term disability periods and support people back to work in the future.

Promoting resilience in work rehabilitation: development of a transdiagnostic intervention

Purpose The aim of this study was to develop an operationalized transdiagnostic resilience-based intervention for workers at risk of long-term work disability. Methods A sequential mixed method design was used. Expert clinicians (n = 10) first answered a questionnaire including closed and open-ended questions on the clarity, applicability, relevance and exhaustiveness of a preliminary resilience intervention developed from evidenced-informed resilience factors to prompt reflection. Second, proposals from the questionnaire were discussed at a consensus group meeting with the same experts, yielding a final and improved intervention. Third, semi-structured interviews with work-disabled workers (n = 6) explored the intervention’s acceptability to them. Thematic analysis of the verbatim was performed. Results Experts identified 15 statements on clarity, applicability, relevance or exhaustiveness in the questionnaire that did not achieve consensus and generated 41 modification proposals. The consensus group adopted 15 modifications. The adapted intervention was well-accepted by the workers who had completed a work rehabilitation program. They perceived the intervention as positive, relevant, coherent, useful and consistent with their values. Conclusion A new transdiagnostic resilience intervention in work rehabilitation is available and was on exploratory basis seen acceptable by workers. Next step would be to validate it at a larger scale with more workers and other stakeholders. IMPLICATIONS FOR REHABILITATION Promoting workers resilience in work rehabilitation fosters a holistic approach in clinical practice. Resilience interventions should be integrated into work rehabilitation programs. A new transdiagnostic resilience intervention designed to complement current work rehabilitation programs is available.

Sleep disturbance and work-related mental strain: A national prospective cohort study of the prediction of subsequent long-term sickness absence, disability pension and mortality

Aims: Sleep disturbances and work-related mental strain are linked to increased sickness absence and disability pension (DP), but we have no information on synergy effects. The aim of this study was to examine the combined (and separate) association of the two predictors with subsequent long-term work disability and mortality. Methods: A total of 45,498 participants aged 16–64 years were interviewed in the Swedish Surveys of Living Conditions between 1997 and 2013, and were followed up on long-term sickness absence (LTSA; >90 days/year), DP and mortality via national registers until 2016. Crude and multivariable Cox analyses were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Results: For LTSA, the HRs for sleep disturbances and work-related mental strain were 1.6 (95% CI 1.5–1.7) and 1.3 (95% CI 1.2–1.4), respectively. For DP, the HRs were 2.0 (95% CI 1.8–2.2) and 1.4 (95% CI 1.2–1.5). Mortality was only predicted by sleep disturbances (HR=1.2, 95% CI 1.1–1.4). No synergy effect was seen. Conclusions: Work-related mental strain and, in particular, sleep disturbances were associated with a higher risk of subsequent LTSA and DP, but without synergy effects. Sleep disturbances were also associated with mortality. Exposure to interventions tackling sleep disturbance and prevention of workplace stress may reduce work disability.

Shared liability to pain, common mental disorders, and long-term work disability differs among women and men

Knowledge of factors involved in the associations between pain, common mental disorders, and future work incapacity is still scarce. The aim of this study was to examine the overlap between genetic and environmental factors contributing to depression/anxiety, pain, and future long-term sickness absence (SA) and disability pension (DP) among women and men. The study sample included 47,995 twins born in Sweden 1935 to 1985. Information on self-reported depression/anxiety and back, neck, and shoulder pain was obtained from surveys conducted 1998 to 2002 and 2004 to 2005. Data on long-term SA (>365 days) and DP due to mental and/or musculoskeletal disorders until 2013 were obtained from the National Social Insurance Agency. Shared genetic and environmental influences on depression/anxiety, pain, and SA/DP were estimated by applying structural equation modeling. The prevalence of depression/anxiety was 27% and 14% among women and men, for pain 24% and 19%, and for SA/DP due to mental and musculoskeletal diagnoses 7% and 4%, respectively. Multivariate biometric analyses revealed different patterns of covariation between the 3 phenotypes among women and men. For women, a latent-shared liability to all 3 phenotypes could be identified, mainly attributable to genetic factors (66%). For men, no shared underlying liability was observed. The variation in SA/DP was explained by genetic factors in common with depression/anxiety by 27% and in common with pain by 9%. Common mental disorders, pain, and SA/DP tend to covariate in different ways among women and men. The results may have clinical implications as strategies preventing SA/DP may be different among women and men.

Sociodemographic, labour market marginalisation and medical characteristics as risk factors for reinfarction and mortality within 1 year after a first acute myocardial infarction: a register-based cohort study of a working age population in Sweden

ObjectivesResearch covering a wide range of risk factors related to the prognosis during the first year after an acute myocardial infarction (AMI) is insufficient. This study aimed to investigate whether...

Effects of sickness absence on disability pension risk: Finnish register study of two native groups

Abstract Background Sickness absence and disability pension have a close connection and both describe the health of working-aged populations. The aim of this paper was to study if Swedish and Finnish speakers differ in the risk of disability pension after first-time sickness absence. This may reveal new aspects how to support health and work ability promotion activities. Methods The longitudinal register data used come from Statistics Finland. They consist of random samples of 5 % of all Finnish speakers and 20 % of all Swedish speakers, observed throughout the period 1989-2010. The analyses concerned non-retired individuals aged 16-60 years who were under risk of first-time sickness absence that extended 10 days. Discrete-time hazard models were estimated to both language groups to evaluate how first-time sickness absence, time since absence, length of absence, and various socio-economic control variables affected the disability pension risk. Results The disability pension risk was extremely high immediately after the sickness absence receipt and remained elevated thereafter approximately 20 times higher as compared to non-recipients. A strong interrelation between first-time sickness absence and the risk of subsequent disability pension was found for both language groups and the risk was persistent in the very long term. The risk pattern looked similar to both Swedish and Finnish speakers and we did not observe any differences between women and men. Conclusions Paid sickness absence is illustrative of strong health selection and a notable risk for reduced work ability even in the more distant future. The currently implemented policies in Finland, which require statements about rehabilitation plans soon after individuals have entered a sickness spell, can be considered beneficial for both the individual and society. Comparison of the language groups shows that the disability pension process after sickness absence is operating similarly to both groups. Key messages Sickness absence requiring medical certificate is an indicator of possible long-term work disability. Timing of rehabilitation process during the sickness absence is critical.

Patients with rheumatoid arthritis facing sick leave or work disability meet varying regulations: a study among rheumatologists and patients from 44 European countries

ObjectivesTo describe and explore differences in formal regulations around sick leave and work disability (WD) for patients with rheumatoid arthritis (RA), as well as perceptions by rheumatologists and patients on...

The effect of smoking cessation on work disability risk: a longitudinal study analysing observational data as non-randomized nested pseudo-trials.

BackgroundSmoking increases disability risk, but the extent to which smoking cessation reduces the risk of work disability is unclear. We used non-randomized nested pseudo-trials to estimate the benefits of smoking cessation for preventing work disability.MethodsWe analysed longitudinal data on smoking status and work disability [long-term sickness absence (≥90 days) or disability pension] from two independent prospective cohort studies—the Finnish Public Sector study (FPS) (n = 7393) and the Health and Social Support study (HeSSup) (n = 2701)—as ‘nested pseudo-trials’. All the 10 094 participants were smokers at Time 1 and free of long-term work disability at Time 2. We compared the work disability risk after Time 2 of the participants who smoked at Time 1 and Time 2 with that of those who quit smoking between these times.ResultsOf the participants in pseudo-trials, 2964 quit smoking between Times 1 and 2. During the mean follow-up of 4.8 to 8.6 years after Time 2, there were 2197 incident cases of work disability across the trials. Quitting smoking was associated with a reduced risk of any work disability [summary hazard ratio = 0.89, 95% confidence interval (CI) 0.81–0.98]. The hazard ratio for the association between quitting smoking and permanent disability pension (928 cases) was of similar magnitude, but less precisely estimated (0.91, 95% CI 0.81–1.02). Among the participants with high scores on the work disability risk score (top third), smoking cessation reduced the risk of disability pension by three percentage points. Among those with a low risk score (bottom third), smoking cessation reduced the risk by half a percentage point.ConclusionsOur results suggest an approximately 10% hazard reduction of work disability as a result of quitting smoking.

Does increasing physical activity reduce the excess risk of work disability among overweight individuals?

Objectives We examined the extent to which an increase in physical activity would reduce the excess risk of work disability among overweight and obese people (body mass index ≥ 25kg/m 2). Methods We used counterfactual modelling approaches to analyze longitudinal data from two Finnish prospective cohort studies (total N=38 744). Weight, height and physical activity were obtained from surveys and assessed twice and linked to electronic records of two indicators of long-term work disability (≥90-day sickness absence and disability pension) for a 7-year follow-up after the latter survey. The models were adjusted for age, sex, socioeconomic status, smoking, and alcohol consumption. Results The confounder-adjusted hazard ratio (HR) of long-term sickness absence for overweight compared to normal-weight participants was 1.43 [95% confidence interval (CI) 1.35-1.53]. An increase in physical activity among overweight compared to normal-weight individuals was estimated to reduce this HR to 1.40 (95% CI 1.31-1.48). In pseudo-trial analysis including only the persistently overweight, initially physically inactive participants, the HR for long-term sickness absence was 0.82 (95% CI 0.70-0.94) for individuals with increased physical activity compared to those who remained physically inactive. The results for disability pension as an outcome were similar. Conclusions These findings suggest that the excess risk of work disability among overweight individuals would drop by 3-4% if they increased their average physical activity to the average level of normal-weight people. However, overweight individuals who are physically inactive would reduce their risk of work disability by about 20% by becoming physically active.

Innovations in Occupational Health Care Delivery Can Prevent Entry into Permanent Disability: 8-Year Follow-up of the Washington State Centers for Occupational Health and Education.

Background:Long-term work disability is known to have an adverse effect on the nation’s labor force participation rate. To reduce long-term work disability, the Washington State Department of Labor and Industries established a quality improvement initiative that created 2 pilot Centers of Occupational Health and Education (COHE).Objectives:To document the level of work disability in a sample of injured workers with musculoskeletal injuries and to examine (8-y) work disability outcomes associated with the COHE health care model.Research Design:Prospective nonrandomized intervention study with nonequivalent comparison group using difference-in-difference regression models.Subjects:Intervention group represents 18,790 workers with musculoskeletal injuries treated by COHE providers. Comparison group represents 20,992 workers with similar injuries treated within the COHE catchment area by non-COHE providers.Measures:Long-term disability outcomes include: (1) on disability 5 years after injury; (2) received a state pension for total permanent disability; (3) received total disability income support through the Social Security Disability Insurance program; or (4) a combined measure including any one of the 3 prior measures.Results:COHE patients had a 30% reduction in the risk of experiencing long-term work disability (odds ratio=0.70, P=0.02). The disability rate (disability days per 1000 persons) over the 8-year follow-up for the intervention and comparison groups, respectively, was 49,476 disability days and 75,832 disability days.Conclusions:Preventing long-term work disability is possible by reorganizing the delivery of occupational health care to support effective secondary prevention in the first 3 months following injury. Such interventions may have promising beneficial effects on reversing the nation’s progressively worsening labor force participation rate.

Predictors of employment in young adults with psychiatric work disability.

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. 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. 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. 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.

Determinants of work disability following lumbar spine decompression surgery.

Scientific knowledge about risk factors for work disability in terms of long-term sickness absence and disability pension following lumbar spine decompression surgery remains insufficient. This study aimed to investigate the associations between socio-demographic, work-related, and medical characteristics with subsequent long-term sickness absence (>90 days) and disability pension for individuals who underwent lumbar spine decompression surgery. A prospective cohort study of all individuals aged 19-60 years with diagnosed dorsopathies, who underwent lumbar spine decompression surgery 2008-10 in Sweden ( n=7373) was performed. Univariate and multivariate hazard ratios with 95% confidence intervals regarding long-term sickness absence and disability pension with a 3-year follow-up period were estimated by Cox proportional regression. Low educational level, being a non-European immigrant and preoperative sickness absence were risk factors for both long-term sickness absence and disability pension (hazard ratios: 1.2-3.8). Female sex was a risk factor for long-term sickness absence (hazard ratios: 1.3) whereas age >44 years and being a Nordic immigrant were risk factors for disability pension (hazard ratios: 1.9-2.6). Medical factors as common mental disorders, other mental disorders, prescribed psychiatric medication and somatic comorbidity were risk factors for both long-term sickness absence and disability pension (hazard ratios: 1.2-3.4). A simultaneous lumbar fusion surgery and high preoperative pain severity were risk factors for long-term sickness absence (hazard ratios 1.2-1.8). To prevent long-term work disability after lumbar spine decompression surgery, specific focus is required on older and female patients, those with mental or somatic comorbidities, high levels of preoperative pain or sickness absence, with a simultaneous lumbar fusion surgery, a low educational level or a non-European immigrant background.

Development and Implementation of a Mental Health Work Rehabilitation Program: Results of a Developmental Evaluation.

Purpose Long-term work disability due to common mental disorders (CMDs) is a growing problem. Yet optimal interventions remain unclear and little is known about implementation challenges in everyday practice. This study aimed to support and evaluate, in real time, the development and implementation of a work rehabilitation program (WRP) designed to promote post-CMD return-to-work (RTW). Methods A 2-year developmental evaluation was performed using a participatory approach. At program outset, the researchers held five work meetings to revise the program's logic model and discuss its underlying change theory with clinicians. Data collection tools used throughout the study period were structured charts of activities conducted with workers (n = 41); in-depth interviews with program clinicians and managers (n = 9); and participant observation during work meetings. Quantitative data were analyzed using descriptive statistics. Qualitative data underwent thematic analysis using a processual approach. Results Three types of activity were developed and implemented: individual and group interventions targeting workers, and joint activities targeting partners (physicians, employers, others). While worker-targeted activities were generally implemented as planned, joint activities were sporadic. Analysis of the implementation process revealed five challenges faced by clinicians. Determinants included clinicians, host organization, sociopolitical context and resources provided by the evaluation. Conclusion The program studied is original in that it is based on the best available scientific knowledge, yet adapted to contextual particularities. The identified implementation challenges highlight the need for greater importance to be placed on the external, non-program context to ensure sustainable implementation in everyday practice.

Trends in diagnosis-specific work disability before and after ischaemic heart disease: a nationwide population-based cohort study in Sweden

ObjectivesWe examined trends of diagnosis-specific work disability before and after ischaemic heart disease (IHD).DesignParticipants were followed 4 years before and 4 years after an IHD event for diagnosis-specific work disability...

Assessing factors associated with long-term work disability after cancer in Belgium: a population-based cohort study using competing risks analysis with a 7-year follow-up

ObjectivesThe number of workers with cancer has dramatically increasing worldwide. One of the main priorities is to preserve their quality of life and the sustainability of social security systems. We...

Characteristics of individuals receiving disability benefits in the Netherlands and predictors of leaving the disability benefit scheme: a retrospective cohort study with five-year follow-up

BackgroundToday, work disability is one of the greatest social and labour market challenges for policy makers in most OECD countries, where on average, about 6% of the working-age population relies on disability benefits. Understanding of factors associated with long-term work disability may be helpful to identify groups of individuals at risk for disability benefit entitlement or continuing eligibility, and to develop effective interventions for these groups. The purpose of this study is to provide insight into the main diagnoses of workers who qualify for disability benefits and how these diagnoses differ in age, gender and education. Using a five-year follow-up, we examined the duration of disability benefits and how durations differ among individuals with various characteristics.MethodsWe performed a cohort study of 31,733 individuals receiving disability benefits from the Dutch Social Security Institute (SSI) with a five-year follow-up. Data were collected from SSI databases. Information about disorders was assessed by an insurance physician upon benefit application. These data were used to test for significant relationships among socio-demographics, main diagnoses and comorbidity, and disability benefit entitlement and continuing eligibility.ResultsMental disorders were the most frequent diagnosis for individuals claiming work disability. Diagnoses differed among age groups and education categories. Mental disorders were the main diagnosis for work disability for younger and more highly educated individuals, and physical disorders (generally musculoskeletal, cardiovascular and cancer) were the main diagnosis for older and less educated individuals. In 82% of the claims, the duration of disability benefit was five years or more after approval. Outflow was lowest for individuals with (multiple) mental disorders and those with comorbidity of mental and physical disorders, and highest for individuals with (multiple) physical disorders.ConclusionsThe main diagnosis for persons entitled to disability benefits was mental health problems, especially for young women. In a five-year follow-up, claim duration for disability benefits was long lasting for most claimants.

Predictors of Return to Work 6 Months After the End of Treatment in Patients with Common Mental Disorders: A Cohort Study

Purpose Common mental disorders (CMDs) account for a large portion of sickness absence. Even after attending return to work (RTW) interventions, many patients with a CMD remain on sick leave. To identify people at risk of long-term work disability, more needs to be known about factors that predict RTW after treatment. Methods This was a prospective cohort study that followed 106 former patients at an RTW outpatient clinic for CMDs for 6 months after the end of treatment. Changes in work participation and mental health status between the end of treatment and the 6-month follow-up were analysed. Changes in work participation were used to identify patients with successful RTW. Patient characteristics and end-of-treatment measures of mental health status, work ability, generalized self-efficacy and expectations of future work ability, and changes in clinical outcome measures during treatment were included in logistic regression analyses to identify predictors of RTW at the 6-month follow-up. Results In the final model, high occupational status and higher work ability at the end of treatment predicted successful RTW at the 6-month follow-up. Further analyses showed that if the expectancy of future work ability improved or remained positive from before to the end of treatment, this was also strongly associated with RTW at the 6-month follow-up. Conclusions Among patients treated for CMDs, those with a low occupational status and who report lower work ability at the end of treatment are at risk of long-term disability.

Are the early predictors of long-term work absence following injury time dependent? Results from the Prospective Outcomes of Injury Study

ObjectivesFew studies examine the influence of early predictors of work absence beyond 12 months following injury or the time-dependent relative importance of these factors. This study aimed to identify the...

Prognostic Factors for Permanent Work Disability in Patients With Rheumatoid Arthritis Who Received Combination Therapy of Conventional Synthetic Disease-Modifying Antirheumatic Drugs: A Retrospective Cohort Study.

There is limited information about the factors related with the development of long-term permanent work disability (PWD) in rheumatoid arthritis (RA) treated with a combination of conventional synthetic disease-modifying antirheumatic drugs (cs-DMARDs). The aim of this study was to evaluate incidence and factors associated with the development of PWD in RA treated with combination therapy using conventional synthetic cs-DMARDs. We assessed in multivariate models the effect of clinical and demographic factors in the development of PWD in a long-term retrospective cohort of 180 workers with RA who were treated with a combination of cs-DMARDs. Incidence rates of PWD were 2.2% at 1 year, 7.7% at 5 years, 24.9% at 10 years, 34.9% at 15 years, and 45% at 20 years. In the adjusted Cox regression analysis, factors associated with PWD development were the first failure with combination of cs-DMARDs (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.05-5.46; P = 0.03), poor functioning at time of cohort onset (HR, 2.2; 95% CI, 1.05-4.70; P = 0.03), and requirement for joint replacement (HR, 3.3; 95% CI, 1.28-8.79; P = 0.01). Around 25% of workers with combination therapy with cs-DMARDs developed PWD in 10 years following the diagnosis of RA. Some factors increase the risk of disability. Permanent work disability generates a relevant society burden and increases health care costs. Therefore, indicators predicting failure of combination therapies with cs-DMARDs might provide clinicians of useful tools for modifying treatments avoiding the disease progression.

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.