Academic journal article Scandinavian Journal of Work, Environment & Health

Meta-Synthesis of Qualitative Research on Return to Work among Employees with Common Mental Disorders

Academic journal article Scandinavian Journal of Work, Environment & Health

Meta-Synthesis of Qualitative Research on Return to Work among Employees with Common Mental Disorders

Article excerpt

Andersen MF, Nielsen KM, Brinkmann S. Meta-synthesis of qualitative research on return to work among employees with common mental disorders. Scand J Work Environ Health. 2012;38(2):93-104. doi:10.5271/sjweh.3257

Objectives The purpose of this study was to investigate which opportunities and obstacles employees with common mental disorders (CMD) experience in relation to return to work (RTW) and how they perceive the process of returning to work. In addition, the study explores what characterizes an optimal RTW intervention and points to possible ways to improve future interventions for employees with CMD.

Methods A systematic literature search was conducted, and eight qualitative studies of medium or high quality published between 1995-201 1 were included in this systematic review. The eight studies were synthesized using the meta-ethnographic method.

Results This meta-synthesis found that employees with CMD identify a number of obstacles to and facilitators of returning to work related to their own personality, social support at the workplace, and the social and rehabilitation systems. The employees found it difficult to decide when they were ready to resume work and experienced difficulties implementing RTW solutions at the workplace.

Conclusions This study reveals that the RTW process should be seen as a continuous and coherent one where experiences of the past and present and anticipation of the future are dynamically interrelated and affect the success or failure of RTW. The meta-synthesis also illuminates insufficient coordination between the social and rehabilitation systems and suggests how an optimal RTW intervention could be designed.

Key terms back to work; meta-ethnography; mental health; mental illness; rehabilitation; review; RTW; sick leave; social support; work accommodation.

Long-term sick leave due to common mental disorders (CMD) such as depression, anxiety, and stress-related disorders is an increasing problem in many countries (1-5). Long-term sick leave is a major risk factor for early withdrawal from the labor market (6), and only 50% of those off work for >6 months due to poor mental health return to work (7). CMD make up an increasing percentage of claims for disability benefits (8), and a number of studies show a strong correlation between depression and disability pension (4, 8-10) and also between anxiety and disability pension (8). Not only is CMD-related sick leave and withdrawal from the labor market costly for society and workplaces due to compensation costs and lost productivity (11), being off work also frequently has negative consequences for the individual as work is socially highly valued and beneficial to self-respect, identity, health, and general well-being (12).

To reduce both the human, societal, and economic consequences related to long-term sick leave and withdrawal from the labor market due to CMD, a better understanding of the factors that facilitate or complicate return to work (RTW) for employees with CMD is warranted.

Previous research has found RTW to be a complex and multi-factorial process (13). Quantitative research shows that the medical seriousness of the disorder, work-related factors, personal factors, national compensation policies, and the structure of the healthcare system determine whether sick leave results in return to or withdrawal from the labor market (7, 13-18). While quantitative studies are useful for investigating general predictors for RTW and the effects of RTW interventions, they are not suitable for capturing the complex processes characterizing RTW. Qualitative research can help expand our understanding of the RTW process (19) and is particularly suited to examine the complex dimensions and practices of RTW (20).

The meta-synthesis method is an obvious research method to extract and integrate results from various qualitative studies (21-23). We therefore conducted a systematic meta-synthesis of qualitative research to investigate how people with CMD themselves experience the RTW process and which obstacles and opportunities they identify in relation to RTW. …

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