Psychosocial factors and colleagues’ perceptions of return-to-work opportunities for workers with a psychiatric disorder: a Japanese population-based study

Predictors of the successful return to work for individuals with psychiatric disorders have often focused on workplace psychosocial factors as well as individual health conditions [1‐4]. Sick leave and withdrawal from the labor market related to mental health has increased the financial burden on society and workplaces through compensation costs and lost productivity [5]. To reduce the economic consequences associated with long-term sick leave and withdrawal from the labor market, a better understanding of the factors that facilitate or complicate return to work for employees with psychiatric diseases is necessary and appropriate [4].

Social support is known to be important for workers, particularly those with a psychiatric disease who are wishing to return to work [1, 3, 6]. Support from colleagues is essential for implementing any necessary measures to reduce work hours, responsibilities, and workloads of employees in this regard. Expectations and actual experiences of the social support available may, however, influence the feelings, thoughts, and behavior of employees with a psychiatric disorder who wish to return to work [4, 7‐10]. Despite this fact, research investigating colleague’s perceptions of psychiatric disorders has generally been limited, especially in Japan.

Identifying specific psychosocial factors that may negatively affect colleagues’ perceptions is clearly important as it can facilitate the successful return to work of employees with a psychiatric disorder. The present study aimed, therefore, to examine potential associations between psychosocial factors and colleagues’ negative perceptions in a Japanese working population by means of an internet-based survey.

In total, 3,710 individuals (1,855 males and 1,855 females) participated in the study and their background characteristics are shown in Table 1. Slightly more than half the participants (52.2%) reported that their workplace climate could not provide a work opportunity for an employee with limited work capacity due to a psychiatric disorder and/or treatment side effects. One-fifth of participants reported a previous experience of having worked with a person with a psychiatric disorder.

Table 2 describes statistical associations between psychosocial factors and colleagues’ negative perception. A relatively high proportion of participants who reported they had low workplace social support, low levels of job control, no previous experience working with an employee with a psychiatric disorder, worked in a small company, were blue-collar workers, or had low educational level reported that their workplace climate could not provide a working opportunity for an employee with limited work capacity owing to symptoms related to a psychiatric disorder and the side effects of treatment for those psychiatric disorders.

Table 3 describes the results of the multiple logistic regression analyses of associations between psychosocial factors and colleagues’ negative perceptions. Colleagues’ negative perceptions were associated with lower workplace social support when compared with high workplace social support (middle tertile: Odds Ratio [OR]: 1.26, 95% Confidence Interval [CI]: 1.12–1.40; low tertile: OR: 1.45, 95% CI: 1.32–1.58; p for trend < 0.01); lower job control when compared with high job control (middle tertile: OR: 1.22, 95% CI: 1.06–1.38; low tertile: OR: 1.64, 95% CI: 1.46–1.81; p for trend < 0.01); not having experience of working with an employee with a psychiatric disorder when compared with having previous experience (OR: 1.74, 95% CI: 1.60–1.88); smaller company size when compared with companies of more than 300 employees (50–299: OR: 1.25, 95% CI: 1.12–1.38; <50 employees: OR: 1.51, 95% CI: 1.37–1.66; p for trend <0.01); white- or blue-collar occupations when compared with managers (white-collar: OR: 1.14, 95% CI: 0.95–1.34; blue-collar: OR: 1.20, 95% CI: 0.99–1.43); and, low educational level (technical college or junior college: OR: 1.09, 95% CI: 0.97–1.22; junior high school or high school: OR: 1.16, 95% CI: 1.04–1.30; p for trend <0.01). The participant’s employment contract was not significantly associated with colleagues’ negative perception.

A sensitivity analysis conducted separately by gender found similar results to when sex was entered into the model as a variable, and confirmed the linear associations between colleagues’ negative perceptions and age, psychosocial factors, experience working with an employee with a psychiatric disorder, company size, and educational level.

Cronbach’s alpha coefficients were 0.84 for job demand, 0.75 for job control, 0.84 for supervisor support, 0.83 for coworker support, and 0.87 for total workplace social support.

This study investigated associations between psychosocial factors and negative perceptions of colleagues in Japan’s working-age population. Several potential determinants of colleagues’ negative perception were identified, with around half of all participants reporting a negative perception of employment opportunities for a potential colleague with limited work capacity due to a psychiatric disorder or related treatment. Being female, older age, having lower levels of workplace social support and job control, not having previous experience working with an employee with a psychiatric disorder, smaller company size, and lower educational level were independently associated with colleagues’ negative perceptions.

A statistically significant association was demonstrated between adverse workplace-based psychosocial factors (low workplace support and low job control) and colleagues’ negative attitudes toward a coworker with a psychiatric disease. Previous studies have shown that psychosocial factors including workplace social support and job control are important contributors to the organizational climate in Japanese workplaces [12]. Similarly, adverse working environments (low workplace social support and low job control) may also be inversely associated with successful return to work of employees with a psychiatric disorder [21]. Supervisor and coworker support are known to be important determinates of workplace mental health [22] and have also been demonstrated as a predictor for the successful return to work of employees with a psychiatric disorder [1, 3, 6]. Moreover, adverse job characteristics may lead to a general reduction in the helping of others in the workplace [23]; while suboptimal workplace-based social support may also limit interpersonal helping behavior [24]. Some research suggests that employees who do not feel well-supported by their organizations tend to reciprocate by showing less engagement in interpersonal helping behavior, when compared with those who report higher levels of organizational support [25‐28]. Colleagues’ attitudes toward coworkers with a psychiatric disorder may mediate the association between psychosocial factors and successful return to work.

Given these facts, it is reasonable to hypothesize that age reflects an individual’s historical background, and therefore, may play an important contextual role in their reaction to colleagues experiencing a psychiatric disorder. In this study, we found that older age was associated with more negative attitudes towards (hypothetical) psychiatric disorders in the workplace. This finding was consistent with previous studies that reported an association between older age and negative attitudes toward psychiatric disorders [29‐32]. After the guidelines for workplace mental health were promulgated in Japan during the year 2000, it is generally believed that workplace activities to reduce stigma and discrimination towards people with psychiatric disorders have been relatively effective in this country [33]. As a result, younger people may have a more positive impression of colleagues with a psychiatric disorder than their older colleagues. As such, it would be useful if the attitudes of these groups are explored in future research, to help develop a greater understanding of how negative attitudes could be more effectively addressed in the less positive sub-groups.

Stigma toward psychiatric disorders in the workplace may comprise an obstacle to a successful return to work [34‐36]. Corrigan and colleagues, for example, previously identified three strategies for challenging stigmatizing attitudes and prejudice towards psychiatric disorders, as follows: protest, education, and contact [37]. “Contact” reasons that the less contact an individual has with someone who has experienced psychiatric disorders, the more stigmatizing they will be, although the relationship is correlational; that is it may equally be the case that those who hold less stigmatizing attitudes towards psychiatric disorders are happier to have contact with individuals experiencing psychiatric disorders in this regard. In the workplace, previous experience of working with someone with a psychiatric disorder might reduce the stigmatizing negative perception of a future colleague, similarly encumbered.

In Japan, it is reasonable to assume that small and medium-sized companies may have insufficient human resources for mental health activities when compared with large companies. For example, government statistics suggest that when compared with 100% of large companies, less than 60% of small and medium-sized companies were able to conduct preventive activities to address mental health issues [38]. In addition, another Japanese study found that smaller companies may be less likely to have flexible working systems such as a half-day working hours, a dedicated return to work system, or paid sick leave to accommodate attending regular hospital visits; when compared to larger companies [39]. It is important to note that Japanese companies with 50 or more employees are required by the Occupational Health and Safety Law to employ an occupational health physician. Therefore, this lack of physician supervision may be one reason why workers in smaller Japanese companies are more likely to have negative perceptions of individuals with mental health issues in the workplace.

A limitation of the present study was firstly that the study population was recruited through a web-based survey company, and it might be expected that individuals who can access the internet can also seek information more easily and might take healthy behaviors more seriously [40]. Our results may therefore not be completely generalizable to those without internet access, or to other countries and settings. Secondly, the present study was also cross-sectional, meaning that no causal relationships could be determined. To clarify potential causal relationships between psychosocial factors and colleagues’ negative perception, a further interventional study should be conducted. Thirdly, regarding "previous experience of working with an employee with a psychiatric disorder," we could not confirm the actual medical diagnosis of someone who participants judged that their work capacity was limited due to symptoms related to psychiatric disorders such as depression and schizophrenia and the side effects of their treatment. Participants in the current study might, therefore, have misjudged the conditions of their co-workers. Fourth, we did not specify the symptoms in the questionnaire, and we did not ask the participants how they knew someone had symptoms related to a psychiatric disorder or the side effects of its treatment. The interpretations of “symptoms” may, therefore, vary from participant to participant. Finally, while the present study investigated colleagues’ negative perception, participants were not followed up, meaning that we were unable to determine any subsequent changes in perceptions. This may be a relevant consideration for future investigations.

Overall, our findings suggest that psychosocial factors may affect colleagues’ perceptions of individuals with a psychiatric disorder returning to work in Japan. Greater consideration of psychosocial factors in the workplace may be necessary to facilitate people with a psychiatric disorder successfully returning to work in Japan, as elsewhere.