Introduction
Characteristics disease | Nature of symptoms | Prognosis | Treatment available? | Risk of dying? |
---|---|---|---|---|
Depression | Psychological | Recurrences | Yes | Yes |
Osteoarthritis | Physical | Progressive | No | No |
Cardiovascular disease | Psychological and physical | Progressive/recurrences | Yes | Yes |
Methods
Design
Mixed Method Approach
Quantitative Method
Sample
Measures
Analyses
Qualitative Method
Sample
Interviews
Analyses
Results
Sample Characteristics
Population characteristics | D (n = 35) | C (n = 44) | O (n = 120) | DCO (n = 57) |
---|---|---|---|---|
Female gender, n (%) | 23 (66) | 16 (36) | 74 (62) | 36 (63) |
Age (2002/2003) (years), mean (SD) | 58.2 (2.1) | 58.4 (2.2) | 58.4 (1.9) | 58.2 (2.1) |
Intermediate or higher education, n (%) | 21 (60) | 22 (50) | 66 (55) | 28 (49) |
Having a partner, n (%) | 27 (77) | 40 (91) | 109 (91) | 44 (64) |
Having a partner with paid work, n (%) | 15 (58) | 16 (44) | 48 (46) | 14 (33) |
Very good or good self-rated health, n (%) | 17 (49) | 22 (50) | 68 (57) | 14 (24) |
No functional limitations, n (%) | 17 (49) | 35 (80) | 73 (61) | 20 (36) |
Comorbiditya, n (%) | 28 (80) | 26 (59) | 77 (64) | 43 (75) |
Neuroticism (0–30), mean (SD) | 10.6 (7.1) | 5.5 (5.2) | 6.0 (5.0) | 12.0 (7.6) |
Social inadequacy (0–20), mean (SD) | 6.7 (4.9) | 4.5 (4.4) | 5.7 (5.0) | 7.8 (5.5) |
Mastery (5–25), mean (SD) | 15.7 (3.4) | 18.6 (3.1) | 18.4 (2.9) | 14.7 (3.9) |
Self-esteem (5–20), mean (SD) | 13.7 (2.6) | 15.8 (2.2) | 15.4 (2.0) | 13.1 (2.7) |
Satisfied with income level, n (%) | 22 (63) | 24 (56) | 84 (70) | 27 (47) |
Satisfied with living standard, n (%) | 21 (60) | 30 (70) | 88 (73) | 25 (44) |
Subgroup with paid work at baseline (2002/2003)*, n (%) | 14 (40) | 24 (55) | 60 (50) | 15 (26) |
Occupational skills, mean (SD) | 2.9 (1.0) | 2.9 (0.9) | 2.8 (1.2) | 3.1 (1.0) |
Occupational prestige level, mean (SD) | 42.6 (14.6) | 41.5 (13.3) | 39.3 (16.4) | 42.2 (17.0) |
Number of hours work/week, mean (SD) | 24.9 (12.1) | 30.2 (16.9) | 30.0 (15.7) | 26.1 (16.8) |
High physical work demands, n (%) | 10 (83) | 15 (71) | 43 (75) | 8 (53) |
High psychosocial work demands, n (%) | 4 (11) | 6 (14) | 22 (18) | 7 (12) |
Low psychosocial resources at work, n (%) | 11 (31) | 18 (41) | 52 (43) | 13 (23) |
Response in 2005–2006, n (%) | 33 (94) | 43 (98) | 112 (93) | 55 (96) |
Having paid work (2005–2006), n (%) | 6 (18) | 19 (44) | 38 (34) | 9 (16) |
Characteristics | D (n = 4) | C (n = 5) | O (n = 5) |
---|---|---|---|
Gender male/female | 1/3 | 4/1 | 2/3 |
Age (years) | 47–57 | 55–63 | 56–64 |
At work yes/no | 4/0 | 3/2 | 2/3 |
Duration of exit from paid work | All working at present | 2–4 years | 2 months–4 years |
Factors Important for Participation in Paid Work for D, C, O, and DCO
Predictors | D (n = 35) | C (n = 44) | O (n = 120) | DCO (n = 57) | Predictors | D (n = 35) | C (n = 44) | O (n = 120) | DCO (n = 57) | ||
---|---|---|---|---|---|---|---|---|---|---|---|
Female gender | B |
*
| −1.16 | −1.75 | −0.92 | No functional limitations | B |
*
| −1.25 | −0.63 | −0.08 |
SE | 0.70 | 0.44 | 0.75 | SE | 0.87 | 0.43 | 0.80 | ||||
HR | 0.31 | 0.17 | 0.40 | HR | 0.29 | 0.53 | 0.93 | ||||
Age (years) | B | 0.24 | −0.32 | −0.31 | −0.09 | Very good or good self rated health | B | 0.92 | 0.65 | 0.77 | 0.94 |
SE | 0.23 | 0.11 | 0.43 | −0.22 | SE | 0.95 | 0.62 | 0.42 | 0.76 | ||
HR | 1.26 | 1.11 | 1.53 | 0.80 | HR | 2.50 | 1.92 | 2.17 | 2.56 | ||
Intermediate or higher education | B |
*
| 0.11 | 0.43 | −0.22 | Comorbidity | B |
*
| −0.99 | −0.31 | −1.22 |
SE | 0.61 | 0.41 | 0.74 | SE | 0.64 | 0.42 | 0.78 | ||||
HR | 1.11 | 1.53 | 0.80 | HR | 0.37 | 0.74 | 0.29 | ||||
Having a partner | B | −0.56 | −0.26 | −0.17 | −0.82 | Neuroticism | B | −0.15 | −0.02 | −0.14 | −0.09 |
SE | 0.98 | 1.05 | 0.76 | 0.75 | SE | 0.10 | 0.06 | 0.05 | 0.06 | ||
HR | 0.57 | 0.77 | 0.85 | 0.44 | HR | 0.12 | 0.98 | 0.87 | 0.92 | ||
Paid job (2002/2003) | B | 2.74 | 3.99 | 3.07 | 3.25 | Social inadequacy | B | −0.28 | 0.02 | −0.09 | −0.07 |
SE | 1.17 | 1.13 | 0.59 | 0.93 | SE | 0.86 | 0.07 | 0.04 | 0.08 | ||
HR | 15.60 | 54.00 | 21.46 | 25.90 | HR | 0.11 | 1.02 | 0.92 | 0.93 | ||
Partner with paid work (2002–2003) | B |
*
| 2.11 | 1.70 | −0.05 | Mastery | B | 0.06 | 0.08 | 0.22 | 0.08 |
SE | 0.78 | 0.47 | 0.94 | SE | 0.14 | 0.10 | 0.09 | 0.10 | |||
HR | 8.25 | 5.45 | 0.95 | HR | 1.06 | 1.08 | 1.24 | 1.08 | |||
Satisfied with income level | B | 1.39 | 0.63 | 0.50 | −0.13 | Self esteem | B | −0.10 | 0.11 | 0.15 | 0.33 |
SE | 1.16 | 0.63 | 0.45 | 0.74 | SE | 0.16 | 0.15 | 0.11 | 0.19 | ||
HR | 4.00 | 1.87 | 1.64 | 0.88 | HR | 0.90 | 1.12 | 1.16 | 1.40 | ||
Satisfied with income and living standard | B | 1.54 | 0.88 | 0.31 | 0.61 | ||||||
SE | 1.16 | 0.71 | 0.46 | 0.74 | |||||||
HR | 4.64 | 2.41 | 1.36 | 1.84 |
Predictors | D (n = 13) | C (n = 24) | O (n = 55) | DCO (n = 12) | Predictors | D (n = 13) | C (n = 24) | O (n = 55) | DCO (n = 12) | ||
---|---|---|---|---|---|---|---|---|---|---|---|
Subgroup with paid work at baseline only | |||||||||||
Number of hours work per week | B | −0.07 | 0.02 | 0.04 | 0.00 | High physical work demands | B | −0.69 | −20.80 | −1.41 | 1.67 |
SE | 0.06 | 0.03 | 0.02 | 0.04 | SE | 1.58 | 16,409 | 0.84 | 1.35 | ||
HR | 0.93 | 1.02 | 1.04 | 1.00 | HR | 0.50 | 0.00 | 0.24 | 5.33 | ||
Occupational skills level | B | 0.14 | 0.41 | 0.47 | −1.05 | High psychosocial work demands | B | 0,69 | 0.65 | 0.09 | −22.12 |
SE | 0.63 | 0.55 | 0.28 | 0.78 | SE | 1,22 | 1.22 | 0.59 | 17,975 | ||
HR | 1.16 | 1.51 | 1.60 | 0.35 | HR | 2,00 | 1.92 | 1.09 | 0.00 | ||
Occupational prestige level | B | −0.01 | 0.06 | 0.04 | −0.08 | Low psychosocial resources at work | B | −1.54 | −20.51 | 0.22 | 0.41 |
SE | 0.04 | 0.04 | 0.02 | 0.05 | SE | 1.41 | 16,409 | 0.82 | 1.55 | ||
HR | 0.99 | 1.06 | 1.04 | 0.92 | HR | 0.21 | 0.00 | 1.25 | 1.50 |
Pooled estimate | X2 test H0: X
2 < 7.8 (DF = 3) |
t test H0:-1.96 < T<1.96 | Odds ratio | 95 % CI | |
---|---|---|---|---|---|
Female gendera
| −1.45 | 1.16 | −4.39
|
0.23
|
0.12–0.45
|
Age (years) | −0.21 | 5.68 | −2.71
|
0.81
|
0.70–0.94
|
Intermediate or higher education | 0.32 | 1.83 | 1.07 | Ns | |
Having a partner | −0.43 | 0.32 | −0.99 | Ns | |
Partner with paid worka
| 1.49 | 3.58 |
4.19
|
4.42
|
3.70–15.77
|
Financial economic variables | |||||
Paid work in 2002/2003 | 3.16 | 0.91 |
7.44
|
23.52
|
10.61–56.01
|
Satisfied with income level | 0.48 | 1.34 | 1.51 | Ns | |
Satisfied with income and living standard | 0.59 | 1.20 | 1.80 | Ns | |
Functional limitations | |||||
No functional limitationsa
| −0.62 | 0.99 | −1.80 | Ns | |
Health | |||||
Very good or good self-rated health | 0.79 | 0.10 |
2.62
|
2.19
|
1.22–3.95
|
Comorbidityb
| −0.63 | 1.51 | −1.98
|
0.53
|
0.29–0.99
|
Personality | |||||
Neuroticism | −0.10 | 2.57 | −3.11
|
0.91
|
0.85–0.96
|
Social inadequacy | −0.07 | 3.26 | −2.16
|
0.93
|
0.88–0.99
|
Mastery | 0.13 | 1.88 |
2.49
|
1.13
|
1.03–1.25
|
Self esteem | 0.12 | 3.28 | 1.69 | 1.12 | 0.98–1.29 |
Workers at baseline only | |||||
Number of hours work per week | 0.02 | 3.43 | 1.49 | Ns | |
Occupational skills level | 0.30 | 3.48 | 1.35 | Ns | |
Occupational prestige level | 0.03 | 6.22 | 1.55 | Ns | |
High physical work demandsa
| −0.58 | 1.58 | −0.89 | Ns | |
High psychosocial work demandsa
| 0.27 | 0.32 | 0.56 | Ns | |
Low psychosocial resources at worka
| −0.12 | 1.31 | −0.18 | Ns |
Demographic Variables
Health-Related Characteristics
“I can work, I want to work, for sure, and my disease is not really a limitation to work. I can only be my own limitation to work, in my head, when I do recognize my limits, when I do too much, when I start doing things I should not do.” (Cardiovascular disease; woman, 62 years old)
“Well, yes, and I try to eat healthy, and of course not to load (my joints) like an idiot, so you do things in a way to make sure you can continue as long as possible.” (Osteoarthritis; woman, 56 years old)
Work Characteristics
“I have not produced much over there, but no one was watching me anyway, so there were days I could not really accomplish much. But uhm, well, I have told them, also my supervisor, and he understood it.” (Depression; woman, 55 years)
“If I am a little tired, I will need to take a short break. I just need to do things a little differently and I want to have some buffer to compensate for that.” (Osteoarthritis; woman, 64 years)
“I was 100 % work disabled, and I was having a lot of troubles with my back, and uhm, well, from my back in particular, and uhm, then I searched for work adjustments, for an adjusted work place, together with the occupational physician.” (Osteoarthritis; man, 56 years old)
The Importance of Work
“I need to work to help my family; with my salary I can support 10 family members” (Cardiovascular disease; woman, 49 years)
“More the feeling of being part of it [work]. I enjoy it [work], well, it is nice, when you have the feeling, while walking around, that colleagues are having fun because of me, or with me, than I feel I contribute, that feeling, that is important.” (Depression; man, 48 years)
“(…) and to be part of the chain, that you will be missed when you are not there.” (Cardiovascular disease; woman, 49 years)
“Work is very important for me. (…) otherwise I would have been worried about my heart every day. Now I can say, come on, stop worrying and go to work.” (Cardiovascular disease; man, 56 years)
“I needed to hold on, continue work, and imagine what if I would lose my job. My job was my basis, it was my identity, really important” (Depression; man, 57 years)
“Work is my primary need in life” (Depression; woman, 47 years)
“The most, most, very most important thing is, to me, as I suffer from depressive symptoms, negative thoughts, etcetera, to distract my senses. Because the moment I am busy with something, well, than I do not have time to worry about things, because other things request my attention.” (Depression; woman, 56 years)
Work Adjustments
“No. Well, my boss considered me, how shall I put this, a nuisance. Because it was a boss that ignored rules and such, and yes, I explained my rights, and he just told me it was not gonna happen, whether I liked it or not. Nothing I could do about it.” (Osteoarthritis; man, 58 years)
Work Participation
“So, actually, it would be great to stay at home with him (retired husband), but well, that is financially not really feasible” (Osteoarthritis; woman, 55 years)
“Well uhmm, the way the law (for work disability) is constructed, it’s very unfair” (Osteoarthritis; man, 58 years)
“Well, I felt I had to perform again, that I had to show again… so there I went again, with a bucket full of stress.” (Depression; woman, 47 years)
“It’s a great employer, and my director supported me a lot, although she is really busy, but I know she wanted to give me this chance.” (Depression; woman, 59 years)