Workplace support and the return-to-work process for patients with stress-related mental disorder

Abstract

Background: Sick leave with psychiatric diagnoses has increased markedly in Sweden over the past two decades, with stress-related mental disorders now accounting for around 20% of all ongoing cases. A similar trend is observed across other OECD countries. As these conditions have major consequences at individual, employer and societal levels, increased understanding of factors that facilitate return to work (RTW) is essential. Aim: The overarching aim of this thesis was to explore work-related changes and workplace adjustments during the RTW process among individuals with stress-related mental disorders, and to examine the role of workplace support in facilitating RTW. Method: Study I examined work-related changes at a seven-year follow-up among patients diagnosed with exhaustion disorder (ED) (n = 217). Study II, a qualitative study, explored perceived facilitators of RTW among ED patients (n = 20). Study III compared the duration of sick leave between a structured employer-involvement procedure and treatment as usual (n = 112). Study IV linked self reported workplace adjustments from a national survey (n = 1,412) to registered sick-leave days at 6 and 18 months. Results: The results show that most individuals reported work-related changes in their RTW process, including changing workplace or work tasks. Women reduced their working hours to a greater extent than men. A holistic approach involving organisational preparedness, supportive leadership and tailored adjustments was viewed as essential for RTW. The structured intervention involving employer contact did not shorten sick-leave duration. Self-reported adjustments provided by the employer were associated with fewer sick-leave days. Conclusion: Most participants on sick-leave with stress-related mental disorders make some form of work-related change or adjustment during RTW. Experiences from ED patients point to the potential value of a broader RTW perspective, considering organisational conditions and managerial support. Women more often tended to reduce their working hours, which may indicate a need to consider gender aspects in RTW planning. The intervention did not result in shorter sick-leave durations, which may indicate limited effectiveness; however, the potential impact of contextual factors on implementation of the intervention should also be considered.