Introduction
Methods
The German Mental Healthcare System
Study Design and Setting
Outcomes
Health-, Personal and Work-Related Factors
Health-Related Factors
Personal Factors
Work-Related Factors
Work Accommodation Needs
Covariates
Statistical Analysis
Results
Sample Characteristics
Total sample (N = 269) | Psychiatric setting (n = 157) | Rehabilitation setting (n = 112) | |||||||
---|---|---|---|---|---|---|---|---|---|
N (%) or mean (SD) | Median timea to first RTW | Median timea to full RTW | N (%) or mean (SD) | Median timea to first RTW | Median timea to full RTW | N (%) or mean (SD) | Median timea to first RTW | Median timea to full RTW | |
Treatment setting | |||||||||
Psychiatric | 157 (58.4) | 17*** | 73*** | ||||||
Rehabilitation | 112 (41.6) | 6 | 6 | ||||||
Gradual RTW during re-entry | |||||||||
No | 122 (45.4) | 6*** | 6*** | 39 (24.8) | 13 | 13 | 83 (74.1) | 4** | 4*** |
Yes | 147 (54.6) | 17 | 74 | 118 (75.2) | 19 | 80 | 29 (25.9) | 11 | 55 |
Sociodemographics | |||||||||
Age [years] | 48.2 (8.3) | 46.9 (8.6) | 50.2 (7.7) | ||||||
Sex | |||||||||
Female | 126 (46.8) | 12 | 34 | 71 (45.2) | 19 | 74 | 55 (49.1) | 6 | 6* |
Male | 143 (53.2) | 17 | 52 | 86 (54.8) | 17 | 73 | 57 (50.9) | 6 | 6 |
Socioeconomic status [3–21] | 14.3 (3.4) | 14.8 (3.5) | 13.7 (3.3) | ||||||
Health-related factors | |||||||||
Previous sickness absence duration [weeks] | 5.6 (7.7) | 6.5 (7.5) | 4.3 (7.8) | ||||||
Treatment duration [weeks] | 6.6 (1.8) | 7.6 (1.6) | 5.2 (0.8) | ||||||
Previous sickness absence and treatment duration [weeks] | 12.2 (8.1) | 14.1 (7.7) | 9.6 (7.8) | ||||||
Self-rated health | |||||||||
Good | 206 (76.6) | 11*** | 34*** | 114 (72.6) | 17*** | 59*** | 92 (82.1) | 6* | 6** |
Poor | 63 (23.4) | 31 | 80 | 43 (27.4) | 39 | 115 | 20 (17.9) | 6 | 13 |
Depressive symptoms [0–24] | 7.7 (4.6) | 8.1 (4.6) | 7.0 (4.6) | ||||||
First medical diagnosis | |||||||||
Depression or anxiety disorder | 228 (84.8) | 17*** | 52*** | 157 (100) | 17 | 73 | 71 (63.4) | 6 | 6 |
Adjustment disorder | 41 (15.2) | 6 | 6 | 0 | – | – | 41 (36.6) | 6 | 6 |
Medical treatment | |||||||||
No | 164 (61.0) | 11*** | 34* | 86 (54.8) | 17** | 66* | 78 (69.6) | 6 | 6 |
Yes | 105 (39.0) | 17 | 55 | 71 (45.2) | 24 | 80 | 34 (30.4) | 6 | 7 |
Work-relatedness of disorder [1–5] | 3.8 (1.1) | 3.9 (1.0) | 3.6 (1.1) | ||||||
Personal factors | |||||||||
RTW expectation | |||||||||
Positive | 226 (84.0) | 11*** | 32*** | 123 (78.3) | 17*** | 59*** | 103 (92.0) | 5*** | 6*** |
Negative | 43 (16.0) | 118 | 192 | 34 (21.7) | 124 | 192 | 9 (8.0) | 48 | 137 |
RTW-SE [1–6] | 4.2 (1.1) | 4.0 (1.1) | 4.6 (1.0) | ||||||
High | 120 (44.6) | 6*** | 13*** | 51 (32.5) | 15*** | 38*** | 69 (61.6) | 6 | 6** |
Low | 149 (55.4) | 17 | 73 | 106 (67.5) | 24 | 80 | 43 (38.4) | 6 | 12 |
Work ability [0–10] | 5.3 (2.2) | 4.7 (2.1) | 6.2 (2.0) | ||||||
Work-related factors | |||||||||
Company size | |||||||||
Small | 83 (30.9) | 6* | 34* | 41 (26.1) | 17 | 59 | 42 (37.5) | 5 | 6 |
Large | 186 (69.1) | 17 | 52 | 116 (73.9) | 17 | 73 | 70 (62.5) | 6 | 6 |
Enterprise sector | |||||||||
Private | 187 (69.5) | 17 | 47 | 116 (73.9) | 21* | 73 | 71 (63.4) | 6 | 6 |
Public | 82 (30.5) | 11 | 32 | 41 (26.1) | 17 | 73 | 41 (36.6) | 6 | 7 |
Shiftwork | |||||||||
No | 203 (75.5) | 17 | 52 | 130 (82.8) | 17 | 73 | 73 (65.2) | 6 | 6 |
Yes | 66 (24.5) | 7 | 27 | 27 (17.2) | 17 | 73 | 39 (34.8) | 6 | 6 |
Civil servant | |||||||||
No | 251 (93.3) | 13 | 45* | 146 (93.0) | 17 | 70* | 105 (93.8) | 6 | 6 |
Yes | 18 (6.7) | 20 | 90 | 11 (7.0) | 27 | 206 | 7 (6.2) | 6 | 34 |
Quantitative demands [0–100] | 65.2 (16.9) | 67.4 (17.2) | 62.2 (16.0) | ||||||
Work-privacy conflict [0–100] | 61.9 (24.7) | 64.1 (25.3) | 58.7 (23.6) | ||||||
Influence at work [0–100] | 38.5 (18.0) | 38.7 (17.7) | 38.2 (18.6) | ||||||
Degrees of freedom at work [0–100] | 51.9 (20.9) | 53.1 (20.4) | 50.3 (21.6) | ||||||
Meaning of work [0–100] | 72.4 (18.3) | 69.7 (17.5) | 76.3 (18.9) | ||||||
Quality of leadership [0–100] | 46.0 (22.4) | 44.8 (22.4) | 47.6 (22.4) | ||||||
Social support [0–100] | 53.8 (19.2) | 52.5 (19.1) | 55.7 (19.3) | ||||||
Sense of community [0–100] | 66.6 (19.7) | 66.9 (19.4) | 66.2 (20.2) | ||||||
Mobbing [1–5] | 2.3 (1.1) | 2.2 (1.1) | 2.3 (1.0) | ||||||
Work accommodation needs | |||||||||
Gradual RTW needed | |||||||||
No | 140 (52.0) | 6*** | 6*** | 55 (35.0) | 17 | 31* | 85 (75.9) | 6 | 6*** |
Yes | 129 (48.0) | 18 | 73 | 102 (65.0) | 20 | 80 | 27 (24.1) | 6 | 54 |
Workload reduction needed | |||||||||
No | 187 (69.5) | 12 | 38 | 106 (67.5) | 17 | 67 | 81 (72.3) | 5 | 6 |
Yes | 82 (30.5) | 17 | 54 | 51 (32.5) | 24 | 73 | 31 (27.7) | 6 | 12 |
Individual RTW support needed | |||||||||
No | 233 (86.6) | 11** | 34*** | 128 (81.5) | 17 | 70 | 105 (93.8) | 6 | 6* |
Yes | 36 (13.4) | 31 | 89 | 29 (18.5) | 31 | 94 | 7 (6.2) | 32 | 89 |
Change of workplace needed | |||||||||
No | 243 (90.3) | 12* | 45* | 140 (89.2) | 17 | 67 | 103 (92.0) | 5* | 6 |
Yes | 26 (9.7) | 32 | 105 | 17 (10.8) | 76 | 118 | 9 (8.0) | 17 | 34 |
Time to First and Full RTW
Health-, Personal, and Work-Related Factors Associated with Time to First and Full RTW
Total samplea | Psychiatric settingb | Rehabilitation settingb,c | |||||||
---|---|---|---|---|---|---|---|---|---|
Coef. | 95% CI | P value | Coef. | 95% CI | P value | Coef. | 95% CI | P value | |
Model ‘time to first RTW’ | |||||||||
Previous sickness absence and treatment duration | 0.05 | 0.04;0.07 | 0.000 | 0.05 | 0.03;0.07 | 0.000 | 0.07 | 0.03;0.10 | 0.000 |
Self-rated health (good) | − 0.36 | − 0.73;0.01 | 0.056 | − 0.52 | − 0.90;− 0.14 | 0.007 | − 0.39 | − 1.11;0.34 | 0.294 |
Depressive symptoms | 0.04 | 0.00;0.01 | 0.028 | 0.06 | 0.02;0.10 | 0.003 | 0.02 | − 0.03;0.08 | 0.372 |
RTW-SE (high) | − 0.23 | − 0.52;0.07 | 0.135 | − 0.49 | − .085;− 0.13 | 0.008 | 0.07 | − 0.48;0.08 | 0.794 |
RTW expectation (positive) | − 1.00 | − 1.40;− 0.60 | 0.000 | − 0.99 | − 1.39;− 0.59 | 0.000 | − 1.51 | − 2.50;− 0.52 | 0.003 |
Quality of leadership | − 0.00 | − 0.01;0.00 | 0.438 | − 0.01 | − 0.01;0.00 | 0.269 | − 0.00 | − 0.02;0.01 | 0.867 |
Social support | 0.00 | − 0.01;0.01 | 0.903 | 0.00 | − 0.01;0.01 | 0.836 | 0.00 | − 0.02;0.02 | 0.869 |
Individual RTW support needed (yes) | 0.29 | − 0.10;0.67 | 0.144 | 0.35 | − 0.04;0.73 | 0.078 | 0.35 | − 0.65;1.34 | 0.496 |
Constant | 2.43 | 1.05;3.81 | 0.001 | 2.48 | 0.61;4.35 | 0.009 | 1.87 | − 0.74;4.47 | 0.160 |
Sigma (ln) | 0.04 | − 0.06;0.14 | 0.444 | − 0.08 | − 0.22;0.07 | 0.322 | 0.15 | 0.02;0.29 | 0.027 |
Number of observations | 263 | 153 | 110 | ||||||
AIC | 813.58 | 453.94 | 371.67 | ||||||
BIC | 867.17 | 496.37 | 406.78 | ||||||
Model ‘time to full RTW’ | |||||||||
Previous sickness absence and treatment duration | 0.08 | 0.06;0.10 | 0.000 | 0.04 | 0.02;0.07 | 0.001 | 0.12 | 0.09;0.16 | 0.000 |
Self-rated health (good) | − 0.22 | − 0.64;0.20 | 0.299 | − 0.27 | − 0.69;0.15 | 0.214 | − 0.53 | − 1.32;0.26 | 0.188 |
Depressive symptoms | 0.01 | − 0.03;0.05 | 0.582 | 0.01 | − 0.04;0.05 | 0.706 | − 0.01 | − 0.07;0.05 | 0.739 |
RTW-SE (high) | − 0.59 | − 0.93;− 0.25 | 0.001 | − 0.79 | − 1.17;− 0.41 | 0.000 | − 0.28 | − 0.89;0.32 | 0.362 |
RTW expectation (positive) | − 1.14 | − 1.60;− 0.67 | 0.000 | − 1.06 | − 1.53;− 0.059 | 0.000 | − 1.07 | − 2.16;0.03 | 0.056 |
Quality of leadership | − 0.01 | − 0.02;− 0.00 | 0.048 | − 0.01 | − 0.02;0.00 | 0.288 | − 0.00 | − 0.02;0.01 | 0.650 |
Social support | 0.00 | − 0.01;0.01 | 0.701 | − 0.01 | − 0.02;0.01 | 0.373 | 0.00 | − 0.02;0.02 | 0.815 |
Individual RTW support needed (yes) | 0.66 | 0.22;1.10 | 0.004 | 0.47 | 0.03;0.92 | 0.038 | 1.37 | 0.26;2.47 | 0.015 |
Constant | 4.07 | 2.55;5.60 | 0.000 | 5.31 | 3.44;7.18 | 0.000 | 2.23 | − 0.62;5.09 | 0.125 |
Sigma (ln) | 0.18 | 0.10;0.27 | 0.000 | 0.03 | − 0.11;0.15 | 0.732 | 0.24 | 0.10;0.38 | 0.001 |
Number of observations | 263 | 153 | 110 | ||||||
AIC | 855.97 | 465.18 | 386.76 | ||||||
BIC | 909.55 | 507.61 | 421.87 |
Time to first RTW | Time to full RTW | |||||
---|---|---|---|---|---|---|
Total sample | Psychiatric setting | Rehabilitation setting | Total sample | Psychiatric setting | Rehabilitation setting | |
Univariable analysisa | ||||||
Sociodemographics | ||||||
Age | ||||||
Sex (male) | ||||||
Socioeconomic status | o | |||||
Health-related factors | ||||||
Previous sickness absence and treatment duration | o | o | o | o | o | o |
Self-rated health (good) | • | • | • | • | • | |
Depressive symptoms | o | o | o | o | ||
First medical diagnosis (adjustment) | • | • | ||||
Medical treatment (yes) | o | o | o | |||
Work-relatedness of disorder | o | o | o | o | ||
Personal factors | ||||||
RTW expectation (positive) | • | • | • | • | • | • |
RTW-SE (high) | • | • | • | • | • | |
Work ability | • | • | • | • | • | |
Work-related factors | ||||||
Company size (large) | o | o | ||||
Enterprise sector (private) | ||||||
Shiftwork (yes) | ||||||
Civil servant (yes) | o | o | ||||
Quantitative demands | o | o | ||||
Work-privacy conflict | o | o | o | o | ||
Influence at work | ||||||
Degrees of freedom at work | ||||||
Meaning of work | • | • | • | |||
Quality of leadership | • | • | ||||
Social support | • | • | • | • | ||
Sense of community | • | • | • | |||
Mobbing | o | o | o | |||
Work accommodation needs | ||||||
Gradual RTW needed (yes) | o | o | o | o | o | o |
Workload reduction needed (yes) | o | o | ||||
Individual RTW support needed (yes) | o | o | o | o | ||
Change of workplace needed (yes) | o | o | o | o | ||
Multivariable analysisa | ||||||
Previous sickness absence and treatment duration | o | o | o | o | o | o |
Self-rated health (good) | • | |||||
Depressive symptoms | o | o | ||||
RTW-SE (high) | • | • | • | |||
RTW expectation (positive) | • | • | • | • | • | |
Quality of leadership | • | |||||
Social support | ||||||
Individual RTW support needed (yes) | o | o | o |