Research Article: What are they returning to? Psychosocial work environment as a predictor of returning to work among employees in treatment for common mental disorders: A prospective observational pre–post study

Date Published: April 24, 2019

Publisher: Public Library of Science

Author(s): Bjørn Lau, Olga Shiryaeva, Torleif Ruud, Mattias Victor, Astrid M. Kamperman.


Long-term sick leave and disabilities due to common mental disorders are challenging for society, employers, and individuals. Hence, we wanted to investigate whether psychosocial work environments experienced by employees undergoing treatment for such disorders was associated with return to work.

At the start of treatment, 164 patients responded to questionnaires concerning their psychosocial work environment (the Job Demand–Control–Support model and the Effort–Reward Imbalance model), symptoms (The Clinical Outcomes in Routine Evaluation Outcome Measure) and ability to work (Work Ability Index). In addition, the respondents reported whether they were working or on sick leave at the start and end of their courses of treatment. Their therapists provided information about diagnoses.

Return to work was associated with control of decisions, support from colleagues, esteem, and job promotion opportunities as measured at the start of treatment. In multivariate analyses, control over decisions and job promotion opportunities continued to predict return to work when adjusted for symptoms, current work ability, and expected future work ability.

The working conditions that predicted return to work are considered to facilitate work performance and to be sources of motivation, job satisfaction, and job commitment. Consequently, it is important to examine whether this patient group has a favorable working environment and consider changes in the workplace if the environment is not favorable.

Partial Text

Common mental disorders (CMDs), such as anxiety and depression, are found in a sizable proportion of people on long-term sickness and disability benefits in many Western countries [1–3]. However, participation in work was shown to have positive effects on mental health and well-being, especially under favorable workplace conditions and with good management [4]. Therefore, it is important to know why some employees with CMDs lose a potentially positive force in their lives by going on long-term sick leave or disability benefits, while others remain at work or return to work (RTW) after a period of sickness absence.

The study was approved by the Regional Committee for Medical and Health Research Ethics, South East Norway (case number 2010/494), and the Lovisenberg Hospital management (case number 03–2010 LDS). The study was conducted according to the principles of the Helsinki Declaration and informed consent was obtained from all patients included in the study.

As shown in Table 1, 117 (71%) of the sample successfully returned to work. More women received treatment and about half of the sample were married or cohabiting. The average age was 38.2 years (standard deviation [SD] = 10.4 years). In terms of education, 69% graduated from college or university. Most patients were diagnosed with CMDs (anxiety, depression, or adjustment disorders). In a series of logistic regression analyses (not shown here), no differences were found between the variables listed in Table 1, i.e., age, sex, marital status, education, or diagnosis, when these were entered as independent variables to predict RTW (successful versus failed RTW).

In this study, we hypothesized that work-related demand dimensions (quantitative demands, decision demands, learning demands, and effort) would be negatively associated with RTW, while alleged job-related resources like autonomy (control of decisions and control of work pacing), support (support from superior and support from colleagues), esteem, job promotion, and job security would be positively associated with RTW. However, the results showed that successful RTW was only predicted by perceived control of decisions, support from colleagues, esteem, and career opportunities measured at the start of treatment. These results were supported by analyses comparing average values between those who successfully returned to work with those who did not, and by logistic regression analyses where working environment variables predicted a successful RTW.