Work Accommodations Research Articles

30-month work participation trajectories of employees returning to work with common mental disorders

Abstract Background Promoting a sustainable return to work (RTW) and work participation (WP) for employees with common mental disorders (CMDs) is a crucial challenge for mental healthcare, organisations, and society at large. To date, work-related factors have only very rarely been examined within RTW trajectory studies. The present study aims to examine 30-month WP trajectories and associated individual, health- and work-related factors of employees on sickness absence due to CMDs in Germany. Methods In a prospective cohort study with N = 259 participants, five measurements were conducted at baseline (during the last week of inpatient treatment), and 6, 12, 18 and 30 months later. WP was defined as the proportion of weeks being present at work between two measurement points (self-reported). WP trajectories over 30 months were estimated with Latent Class Growth Analysis (LCGA), and were described according to associated individual, health- and work-related factors. Results We extracted four trajectory classes: Class 1 ‘slowly increasing WP’ (19.6%) with a slow but constantly increasing WP over time, and finally reaching nearly 60% of WP; Class 2 ‘high maintaining WP’ (30.3%) with a maintaining high WP of over 80% after RTW until 30 months; Class 3 ‘highest maintaining WP’ (34.7%) with the highest maintaining WP throughout follow-up and reaching nearly 100% WP after RTW; and Class 4 ‘decreasing WP’ (15.4%) with a positive development of WP until 12 months, reaching of about 90% WP, but then decreasing below 60% WP until 30 months. Participants with persistent high WP (Classes 2 and 3, 65.0%) reported better individual-, health- and work-related characteristics at baseline, and more realized work accommodations during RTW. Conclusions For the majority of the employees, returning to work resulted in sustainable WP during the 30 months study period. However, about one third of the employees should be given more attention in their complete RTW process from treatment to workplace support. Key messages • Sustainable work participation after returning to work with common mental disorders is a long and complex journey. • Employees with a better individual, health- and work-related situation at baseline seem to be more likely to achieve a sustainable work participation.

Employees’ work ability during returning to work with common mental disorders: a mixed methods study

Abstract Background A main goal during the return to work (RTW) process after a long-term sickness absence due to common mental disorders (CMDs), is to restore and maintain an employees’ work ability to enable sustained work participation. To date, surprisingly little research has examined the concept of work ability during the RTW process with CMDs. To better understand how to restore employees’ work ability during RTW with CMDs, both quantitative and qualitative research is needed. The goal of this mixed methods study is to expand the understanding of restoring work ability during the RTW process with CMDs. Methods In this mixed methods follow-up study of N = 286 participants, work ability was quantitatively assessed with the Work Ability Score (WAS, range 0-10) at five measurement points (0, 6, 12, 18 and 30 months) during 30 months of follow-up. In a sub-sample, the qualitative work ability experiences of N = 32 participants were jointly analysed with their quantitative work ability ratings at 6 and 12 months. Results In the joint analysis, three groups of qualitative work ability experiences together with their respective quantitative work ability ratings emerged: Employees with (1) poor work ability (WAS 0-3), who did not RTW yet and described great difficulties in coping with everyday life; (2) moderate work ability (WAS 4-6), who mainly did RTW, but still showed a certain level of fragility; and (3) good to very good work ability (WAS 7-10), who mainly returned within 12 months and reported many individual and work accommodations to restore and maintain their work ability. Conclusions The joint evaluation of work ability ratings and experiences allowed a deeper understanding of restoring work ability during the RTW process. This knowledge may help occupational health professionals and other key RTW stakeholders to provide more tailored support during the RTW process and to promote a sustainable RTW for employees with CMDs. Key messages • Restoring and maintaining the work ability of employees with common mental disorders during the return to work process is crucial for their sustained work participation. • Achieving a good to very good work ability helps returning employees with common mental disorders to ‘stay and thrive’ at work again.

Development of a vocational rehabilitation intervention to support return-to-work and well-being following major trauma: a person-based approach

ObjectivesMajor trauma centres (MTCs) save lives but rehabilitation to support return-to-work (RTW) is lacking. This paper describes development of a vocational rehabilitation intervention (the ROWTATE intervention) to support RTW following...

Predictors of receiving work accommodations among employed breast cancer survivors with adult and child dependents at home.

211 Background: Many cancer survivors experience challenges returning to work, yet there is limited knowledge about factors that influence receiving accommodations in their jobs (e.g., flexible work hours and reduced workloads), which could affect the ability to maintain employment In the current study, we analyze if having adult and/or child dependents at home is associated with receiving accommodations and if this association is modified by occupational factors (e.g., having taken a work leave, job tenure). Methods: We analyzed self-reported, cross-sectional survey data from the PinkWorks Study consisting of 150 female breast cancer survivors. Participants were ≥18 years of age, fluent in English, had completed treatment within the past 36 months, and were working ≥ 20 hours per week both at the time of their cancer diagnosis and currently. Univariate and multiple Logistic Regressions were performed to identify job, personal, and demographic correlates with receipt of work accommodations (yes=67, no=87). Structural Equation Modelling will be performed to identify direct and indirect effects with the outcome. Results: About half of the participants were granted work accommodations. In multivariate logistic regression, we observed suggestive evidence that receiving accommodations was associated with having adult dependents at home compared to those without dependents and, identifying as Caucasian compared to non-Caucasian (aOR=1.69 CI 0.76-3.72, p=0.20; aOR=3.12 CI 0.91-10.87, p=0.07; respectively). In stratified analyses by having taken a leave from work or not, the association with adult dependents at home and receipt of work accommodations reached statistical significance among those who worked continuously (aOR=4.85, CI 1.15-20.44, p=0.03). However, for those who had taken a leave, job tenure of ≥5 years was associated with receipt of accommodations compared to those with <5 years of employment at their current job (aOR = 9.68, CI 2.00-46.91, p=0.005). The suggestive finding of a disparity by race in the full sample was maintained in both strata. Conclusions: We observed that receipt of work accommodations varied whether or not a leave of absence was taken. Additional analyses will be presented regarding other potential work-related influences on receipt of accommodations such as employer size, job type (i.e., clerical vs managerial). Familiarity of physicians with potential needs for workplace accommodations can help survivors maintain employment and subsequent quality of life. Interpretation of findings from these analyses is limited by the cross-sectional design and small sample sizes in this exploratory study.

The meaning and feasibility of engaging in physical activity while being employed in people with mild to moderate disability due to multiple sclerosis: a qualitative study

Purpose To understand the perceptions of the meaning and feasibility of physical activity (PA) while employed for people with multiple sclerosis (pwMS). Materials and methods A qualitative design, using individual in-depth interviews of 26 employed pwMS with mild to moderate disability. The interviews were analysed using systematic text condensation in a phenomenological hermeneutic framework informed by a pattern theory of self. A systematic and dynamic process was used to develop categories of the most salient content and meaning. Results Three categories were developed: (1) Meaningfulness of PA for work, (2) Balancing daily life, PA, and work when energy is low, and (3) Leisure PA during work hours is beneficial but challenging to implement. The findings highlight that PA can be perceived meaningful for health, function, life balance, identity, their perceived abilities, possibilities, and challenges in relation to work, all influencing self-perception. The participants perceived the feasibility of PA to be influenced by work, private life, and work-life balance, particularly highlighting physical function, organisational structures and arrangements, and social and normative practices to be important. An arrangement of implementing leisure PA during working hours was recognised as a beneficial work accommodation when it was perceived feasible and accepted. Conclusion Employed pwMS may perceive PA as meaningful for their health, function, and work, influencing self-perception and perceived work capabilities. Its feasibility may be influenced by individual, environmental, and/or social aspects. Thus, individualised work adjustments to facilitate PA, like accommodating for leisure PA during work hours, can ultimately facilitate both PA and employment.

Patients’ Perspective on Provider Consideration of Work Accommodations during Pregnancy

Patients’ Perspective on Provider Consideration of Work Accommodations during Pregnancy

Systematic review and tools appraisal of prognostic factors of return to work in workers on sick leave due to musculoskeletal and common mental disorders.

With the overall objective of providing implication for clinical and research practices regarding the identification and measurement of modifiable predicting factors for return to work (RTW) in people with musculoskeletal disorders (MSDs) and common mental disorders (CMDs), this study 1) systematically examined and synthetized the research evidence available in the literature on the topic, and 2) critically evaluated the tools used to measure each identified factor. A systematic search of prognostic studies was conducted, considering four groups of keywords: 1) population (i.e., MSDs or CMDs), 2) study design (prospective), 3) modifiable factors, 4) outcomes of interest (i.e., RTW). Studies showing high risk of bias were eliminated. Tools used to measure prognostic factors were assessed using psychometric and usability criteria. From the 78 studies that met inclusion criteria, 19 (for MSDs) and 5 (for CMDs) factors reaching moderate or strong evidence were extracted. These factors included work accommodations, RTW expectations, job demands (physical), job demands (psychological), job strain, work ability, RTW self-efficacy, expectations of recovery, locus of control, referred pain (back pain), activities as assessed with disability questionnaires, pain catastrophizing, coping strategies, fears, illness behaviours, mental vitality, a positive health change, sleep quality, and participation. Measurement tools ranged from single-item tools to multi-item standardized questionnaires or subscales. The former generally showed low psychometric properties but excellent usability, whereas the later showed good to excellent psychometric properties and variable usability. The rigorous approach to the selection of eligible studies allowed the identification of a relatively small set of prognostic factors, but with a higher level of certainty. For each factor, the present tool assessment allows an informed choice to balance psychometric and usability criteria.

Generalizability of a Musculoskeletal Therapist Electronic Health Record for Modelling Outcomes to Work-Related Musculoskeletal Disorders.

Electronic Health Records (EHRs) can contain vast amounts of clinical information that could be reused in modelling outcomes of work-related musculoskeletal disorders (WMSDs). Determining the generalizability of an EHR dataset is an important step in determining the appropriateness of its reuse. The study aims to describe the EHR dataset used by occupational musculoskeletal therapists and determine whether the EHR dataset is generalizable to the Australian workers' population and injury characteristics seen in workers' compensation claims. Variables were considered if they were associated with outcomes of WMSDs and variables data were available. Completeness and external validity assessment analysed frequency distributions, percentage of records and confidence intervals. There were 48,434 patient care plans across 10 industries from 2014 to 2021. The EHR collects information related to clinical interventions, health and psychosocial factors, job demands, work accommodations as well as workplace culture, which have all been shown to be valuable variables in determining outcomes to WMSDs. Distributions of age, duration of employment, gender and region of birth were mostly similar to the Australian workforce. Upper limb WMSDs were higher in the EHR compared to workers' compensation claims and diagnoses were similar. The study shows the EHR has strong potential to be used for further research into WMSDs as it has a similar population to the Australian workforce, manufacturing industry and workers' compensation claims. It contains many variables that may be relevant in modelling outcomes to WMSDs that are not typically available in existing datasets.

Exploring the Changing Landscape of the HR Role in Managing and Addressing the Unique Challenges Faced by Frontline Workers during Covid-19 Pandemic

Exploring the Changing Landscape of the HR Role in Managing and Addressing the Unique Challenges Faced by Frontline Workers during Covid-19 Pandemic

A National Survey of Pregnancy and Parenthood among Nephrology Trainees: A Focus on Nephrology Fellowship.

National and international policies on parental leave for physician trainees are inconsistent. Physician trainees, including nephrology fellows, may be at higher risk of pregnancy complications. Physician trainees face barriers in meeting their breastfeeding goals and in finding childcare due to nontraditional work hours with extended or unpredictable shifts. Here, we examine awareness of current policies in United States (US) nephrology fellowship programs regarding parental leave, pregnancy/breastfeeding accommodations, and fellows' perspectives on family planning. An anonymous, on-line survey of US nephrology fellows was undertaken from June 9 to August, 24, 2023. One hundred twenty nephrology fellows submitted the survey. A majority of fellow respondents were unaware of parental leave policies of their training programs (63%), Accreditation Council for Graduate Medical Education (ACGME) (75%), and/or American Board of Medical Specialties(ABMS) (75%). Forty two percent were unaware of the duration of parental leave at their program. Nearly 45% of all respondents were unsure if their program limited night shifts or shifts greater than 24 hours for pregnant trainees. Forty three percent reported they were unsure of lactation accommodations, and 40% were unsure of access to subsidized childcare. When fellows received work accommodations for pregnancy or parenthood, their work obligations were largely covered by co-fellows (60%) or attendings (38%). Over 60% of fellows agreed or strongly agreed that they would avoid a pregnancy in fellowship due to concern they would have to extend their training. Of the 40 fellows who chose to pursue pregnancy or parenthood during medical training, 75% did not change their career plans as a result. Most nephrology fellows were unaware of parental leave policies and pregnancy/lactation accommodations. While the topic itself has a broad impact to all physician trainees, there is need for improved awareness about national and local program policies among trainees across individual nephrology programs.

Chronic Health Conditions and Longitudinal Employment in Survivors of Childhood Cancer

Employment is an important factor in quality of life and provides social and economic support. Longitudinal data on employment and associations with chronic health conditions for adult survivors of childhood cancer are lacking. To evaluate longitudinal trends in employment among survivors of childhood cancer. Retrospective cohort study of 5-year cancer survivors diagnosed at age 20 years or younger between 1970 and 1986 enrolled in the multi-institutional Childhood Cancer Survivor Study (CCSS). Sex-stratified employment status at baseline (2002 to 2004) and follow-up (2014 to 2016) was compared with general population rates from the Behavioral Risk Factor Surveillance System cohort. Data were analyzed from July 2021 to June 2022. Cancer therapy and preexisting and newly developed chronic health conditions. Standardized prevalence ratios of employment (full-time or part-time, health-related unemployment, unemployed, not in labor force) among adult (aged ≥25 years) survivors between baseline and follow-up compared with the general population. Longitudinal assessment of negative employment transitions (full-time to part-time or unemployed at follow-up). Female participants (3076 participants at baseline; 2852 at follow-up) were a median (range) age of 33 (25-53) years at baseline and 42 (27-65) years at follow-up; male participants (3196 participants at baseline; 2557 at follow-up) were 33 (25-54) and 43 (28-64) years, respectively. The prevalence of full-time or part-time employment at baseline and follow-up was 2215 of 3076 (71.3%) and 1933 of 2852 (64.8%) for female participants and 2753 of 3196 (85.3%) and 2079 of 2557 (77.3%) for male participants, respectively, with declining standardized prevalence ratios over time (female participant baseline, 1.01; 95% CI, 0.98-1.03; follow-up, 0.94; 95% CI, 0.90-0.98; P < .001; male participant baseline, 0.96; 95% CI, 0.94-0.97; follow-up, 0.92; 95% CI, 0.89-0.95; P = .02). While the prevalence of health-related unemployment increased (female participants, 11.6% to 17.2%; male participants, 8.1% to 17.1%), the standardized prevalence ratio remained higher than the general population and declined over time (female participant baseline, 3.78; 95% CI, 3.37-4.23; follow-up, 2.23; 95% CI, 1.97-2.51; P < .001; male participant baseline, 3.12; 95% CI, 2.71-3.60; follow-up, 2.61; 95% CI, 2.24-3.03; P = .002). Among survivors employed full-time at baseline (1488 female participants; 1933 male participants), 285 female participants (19.2%) and 248 male participants (12.8%) experienced a negative employment transition (median [range] follow-up, 11.5 [9.4-13.8] years). Higher numbers and grades of chronic health conditions were significantly associated with these transitions. In this retrospective analysis of adult survivors of childhood cancer, significant declines in employment and increases in health-related unemployment among cancer survivors compared with the general population were identified. A substantial portion of survivors in the midcareer age range fell out of the workforce. Awareness among clinicians, caregivers, and employers may facilitate clinical counseling and occupational provisions for supportive work accommodations.

The Impact of COVID-19 on the Employment of People With Multiple Sclerosis: A Multiple Methods Study.

The COVID-19 pandemic led to approximately half of the working population in the United Kingdom being unable to work temporarily. This study aims to understand the employment needs and experiences of people with multiple sclerosis (MS) in the UK during this period. Multiple methods were used, including an online survey and follow-up interviews with people with MS who were employed prior to the start of the pandemic restrictions in March 2020. The online survey was completed by 101 eligible participants and we interviewed 15 of them for qualitative data in the follow-up. Survey data indicated that the work experience of people with MS improved during the pandemic because they were allowed to work from home. However, participants experienced increased feelings of anxiety and loneliness. From the interviews, we extracted 5 themes: (1) the benefits of working from home; (2) the challenges of working during the COVID-19 pandemic; (3) the relevance of managers; (4) returning to "normal"; and (5) the need for vocational support. The pandemic showed that MS symptom management was improved by work flexibility (eg, working from home, breaks, flexible working hours); for people with MS, these accommodations improved both their ability to work and their self-perceived productivity. Future research should explore the support needs of people with MS who work remotely and determine whether pandemic-influenced work accommodations are sustainable over time.

Experiences of workers with long-term disabilities on employer support throughout the RTW process in The Netherlands: a qualitative study

Purpose The aim of this qualitative study was to explore ways that employer support influenced successful return to work (RTW) in workers with disabilities. Methods We conducted a semi-structured interview study among 27 workers with disabilities in the Netherlands who received a partial disability benefit two years after sick leave and who continued working in paid (part-time) employment after a period of long-term sickness absence (> 2 years). We analyzed data by means of thematic analysis. Results We identified four types of employer support that were experienced as factors of successful RTW: 1. Supervisor accessibility; 2. Supervisor engagement; 3. Supervisor strategies; and 4. Supervisor-initiated work accommodations. More specifically, during the preparations for RTW phase, the supervisor’s active role involved having a positive and open attitude toward facilitating RTW; during the initial RTW phase, the supervisor’s role involved being creative in finding solutions for work accommodations; and during the sustained RTW phase, the supervisor’s role included helping workers who still needed changes in their work situations. Conclusion The elements of successful employer support reveals that the pressure on the shoulders of the supervisor is high. Future research should further investigate whether supervisors need more phase-specific training from their organization.

Financial hardship after cancer: revision of a conceptual model and development of patient-reported outcome measures.

Aim: This qualitative study refined a conceptual model of financial hardship and developed measures corresponding to model constructs. Methods: Eighteen women with breast cancer recruited through a comprehensive cancer center completed interviews. A qualitative framework analysis was conducted of the interviews. Results: Participants experienced varying levels of financial hardship. Protective factors included good health insurance, work accommodations and social support. Participants worried about cancer care costs and employment. Programs for alleviating financial hardship had high administrative burdens. Four preliminary financial hardship measures were developed: coping, impacts, depression and worry. Conclusion: Reducing administrative barriers to benefits could reduce financial hardship after cancer. More research is needed on the effects of out-of-network/formulary care and denials of coverage and to validate the measures.

Developing a Work Accommodation Operating Model for Workplaces and Work Ability Support Services

Abstract Purpose Workplace accommodation can help employees with disabilities remain employed or access employment rather than leave the labor force. However, the workplace accommodation process is still poorly understood and documented. Aim The aim of this study was to develop a national operating model to make workplace accommodation interactive and procedural for workplaces and work ability support services and lower the threshold to making accommodations. Methods The collaborative development process was carried out by a multiprofessional expert team with eleven workplaces in the private and public sectors in Finland. The design of this study was conceptual and developmental. The development process of the operating model consisted of four phases: the orientation phase, the joint planning phase, the implementation advancement phase, and the instilling phase. Results The operating model has six stages: 1) identifying needs, 2) gathering knowledge, 3) exploring alternatives, 4) selecting solutions, 5) implementing solutions, and 6) monitoring and evaluating. The model defines the actions, roles, and responsibilities for each phase. To help implement the model, we published an information package, a guide, a planning formula, and a video animation in Finnish and Swedish. Conclusion The operating model is a tool that workplaces and work ability support services can use to help working-aged people remain employed or access employment. Future studies should determine the workplace-specific functionality of this model using implementation research.

The Strategies Used to Balance Health and Work Across the Solid Organ Transplantation Trajectory.

Introduction: Workers who undergo solid organ transplantation report frequent conflicts between the unpredictable demands of their health condition and the rigid requirements of their employer and of health services. The present study aimed to describe the self-management strategies adopted by workers while staying at work before transplantation and during sustainable return-to-work posttransplantation. Methods: Fifteen employed kidney, liver, and lung transplant recipients were recruited from 2 large urban university health centers in Montreal, Canada. Three focus groups were held, and thematic analysis was performed. Findings: Seven strategies were identified: responding promptly and consistently to fatigue-related needs, planning ahead with immediate supervisors while remaining strategic about when to disclose transplantation, requesting work accommodations, requesting flexibility in healthcare provision, consulting physicians about work-related issues, informing co-workers about work limitations and immunosuppression and asking not to be treated differently in the workplace. Conclusion: Access to work accommodations, support from physicians and flexibility in treatment and appointment schedules supported workers' ability to manage their health while staying at work before and after undergoing solid organ transplantation. In light of findings, it may be useful for healthcare professionals to address workers' concerns about work limitations and work accommodation implementation, especially when the illness-management burden increases before transplantation and during posttransplantation sick leave. Future studies could describe the strategies used by other important stakeholders when attempting to provide support to workers.

Predictors of job tenure for people with a severe mental illness, enrolled in supported employment programs.

Different predictors of job tenure for people with a severe mental illness (SMI) have been documented. Conflicting results may be explained by the choice of indicators to measure job tenure. This study aimed to assess the contribution of employment specialist competencies working in supported employment programs, client variables, and work accommodations, in determining job tenure in the regular labor market. A longitudinal study was conducted over 6 months, including people with SMI (n = 209) registered in 24 Canadian supported employment programs. Multivariable modeling analyses were performed. Overall, 67% (n = 140) of the sample were employed at the 6-month follow-up. Multilevel analyses showed that shorter duration of unemployment (i.e., the number of weeks worked), employment specialist knowledge, and working alliance were the strongest predictors of job tenure for people with SMI. With respect to the number of hours worked per week, diagnosis, executive functions, social functioning, work accommodations, and employment specialist skills were the strongest predictors of job tenure for people with SMI, with 57% of variance explained. Understanding the various predictors of job tenure can assist employment specialists in providing better interventions for the work integration of people with SMI. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Non-pharmacological treatment of Attention Deficit Disorder with or without Hyperactivity (ADHD). Overview and report of the first international symposium on the non-pharmacological management of ADHD

Attention Deficit Disorder with or without Hyperactivity (ADHD is a neurodevelopmental disorder which affects the day-to-day functioning of children and adults with this condition. Pharmacological treatment can reduce the symptoms associated with ADHD, but it has some limitations. The objective of this symposium is to determine the effects of non-pharmacological approaches on ADHD symptoms. Results indicate that the following intervention are promising approaches: cognitive behavioral therapy (CBT), mindfulness-based interventions (MBI), yoga, cognitive and metacognitive intervention, neurofeedback and parental training programs. Current research advocates multimodal approaches in conjunction with school or work accommodations integrating innovative technologies.

An Italian Survey and Focus Groups on Fibromyalgia Impairment: Impact on Work and Possible Reasonable Accommodations.

Fibromyalgia symptoms affect the sufferers' working life; however, through reasonable accommodations in workplaces, they can continue to work satisfactorily. There are no Italian studies on factors that facilitate or hinder fibromyalgia-affected people's working life. Our objective was to explore, in a pre-pandemic setting, the quality of working life of fibromyalgia sufferers and reasonable accommodations to improve it. Quantitative and qualitative methods were applied; a survey-questionnaire, participatory-developed, was online-administered to a sample of self-reported FM sufferers (N = 1176). Then, two Focus Groups (FGs), involving 15 fibromyalgia-affected women, were held. Data were analyzed by a thematic analysis approach. Among survey-respondents, 20% were unemployed and only 14% went to work gladly. Variability of pain (84%) and fatigue (90%) were the most perceived reasons for difficulties at work. Negative relationships at work were reported by most participants. The FGs' discussions addressed different strategies for overcoming the main obstacle of "not being believed by colleagues and employers" and reasonable accommodations. However, a negative hopeless attitude towards the solution of problems at work was also apparent. Different critical issues in the workplace emerged from the survey and the FGs. Coordinated actions, according to a transdisciplinary approach, are needed to manage fibromyalgia-induced difficulties in the workplace.

Factors influencing employers' support for employees with acquired brain injuries or mental illness to return to- and stay in work: A qualitative systematic review.

People with acquired brain injuries (ABIs) often experience residual limitations and co-morbid mental illnesses that restrict work participation. Employers are key in enabling successful return-to-work and job retention. This review aimed to explore employers' perspectives of factors influencing their support for people with ABIs and/or mental illness to return to- and stay in work. Review questions focused on barriers and facilitators to their support, and contextual characteristics present at the time. Five databases were searched from October 2010 until November 2023 for relevant qualitative studies published in English. Findings from included studies (N = 25) were synthesised using thematic synthesis. Included studies focused on employees with ABI or mental illness, rather than dually diagnosed ABI and mental illness. Employers' support was influenced by their awareness/knowledge of- and attitudes towards the employee's condition/illness; their skills and experience in supportive strategies; factors related to provision of work accommodations; and stakeholder influence. Similarities and differences in influential factors were observed across the ABI and mental illness literature. Contextual characteristics related to organisational characteristics, cultural taboo, and involvement of certain stakeholders. ABI survivors (with and without co-morbid mental illness) and their employers may benefit from specialist support and resources to guide them through the return-to-work process. Further research is needed to investigate employers' knowledge of ABI and mental illness and supportive strategies. Exploration of the influence of other stakeholders, socio-demographic characteristics, and contextual factors on employers' return-to-work and retention support for ABI survivors with co-morbid mental illness is warranted.