Mental health and work participation: Epidemiological survey and register–based studies among the working population in Sweden

Abstract

Abstract Background: From a public health perspective, more research is needed to understand the complexities of work participation and mental health among the working population. Aim: The overall aim was to examine mental health and work participation among men and women in the working population, taking sociodemographic factors, capacity to work, and psychosocial work characteristics into consideration. Methods: Cross-sectional survey data and longitudinal register-based data were analysed. Participants were approximately 8000 working women and men aged ≥18 years. The WHO-5 Mental Well-being Index, the Capacity to Work Index (C2WI), the Job Demand-Control model, and workplace conflicts were used. In study I, Rasch analysis assessed the construct validity of the C2WI. In study II, linear regression was used to assess self-perceived mental well-being and capacity to work. In studies III and IV, logistic regression assessed mental well-being, capacity to work, the Job Demand-Control model, and workplace conflicts as determinants of sustained work participation (SWP). In studies III and IV, moderation analysis was used to examine differences in associations across levels of mental well-being. Results: Higher self-perceived mental well-being was associated with maintained capacity to work, independent of sociodemographic and occupational factors in both women and men. Capacity to work was associated with SWP, whereas the Job Demand–Control model showed no association with SWP, except among women working in passive and high-strain jobs. Absence of workplace conflicts was not associated with SWP, except in cases where women reported conflicts as quite uncommon. The validation of the Capacity to Work Index (C2WI), designed to assess capacity to work among employees experiencing common mental disorders, demonstrated limited construct validity. However, statistical performance improved when assessed in a subgroup with low self-perceived mental well-being. Conclusions: Capacity to work, as measured by the C2WI, emerged as a key determinant for SWP, independent of mental well-being and psychosocial work characteristics. C2WI appears to capture the complexity of work participation and mental health in the working population. These findings underscore the importance of promoting capacity to work through tailored and universal workplace strategies to support sustainable work participation.