How Do Work-Related Mental Health Issues Affect Long-Term Employment?

What you need to know

• Most patients with suspected work-related mental disorders were working 1-5 years after assessment, but some remained out of work, especially those with PTSD or depression.
• Younger age, not being on sick leave at assessment, and high previous work participation were associated with better work outcomes 5 years later.
• The study developed prognostic models to predict long-term work participation, but they were only moderately successful and require further refinement.

Background and Purpose

Mental health issues related to work, such as stress, depression, and anxiety, can significantly impact a person’s ability to maintain employment. In Denmark, when a doctor suspects that a patient’s mental health problem may be work-related, they can refer the patient to a department of occupational medicine for further evaluation. This study aimed to examine what happens to these patients in terms of their work status over the long term - specifically, 5 years after their initial assessment. The researchers also wanted to develop a way to predict which patients might be at higher risk of losing their connection to the job market in the long run.

Study Design and Participants

This was a large-scale study that looked at data from all departments of occupational medicine across Denmark. It included 17,822 patients aged 18-67 who were seen for the first time at one of these departments between 2000 and 2013. All of these patients had been diagnosed with mental health issues that were thought to be potentially related to their work, such as stress, depression, post-traumatic stress disorder (PTSD), or anxiety.

The researchers collected information about these patients from various national registries in Denmark. These registries provided detailed data on things like employment status, education level, use of healthcare services, and receipt of social benefits. This information was gathered for each patient for the 5 years before and 5 years after their first visit to the occupational medicine department.

Key Findings

Work Status Over Time

The study found that most patients had a strong connection to the job market in the years leading up to their assessment at the occupational medicine department. This suggests that, for the most part, these were individuals who had been generally healthy and able to work until they developed their mental health issues.

After the assessment, there was a significant drop in the percentage of patients who were working. However, the patterns varied depending on the specific mental health diagnosis:

• For patients with stress disorders, about 60% were back at work one year after the assessment. This percentage remained relatively stable over the next four years.
• For patients with other mental health diagnoses (like depression or PTSD), less than 40% were working one year after the assessment. Again, this percentage didn’t change much over the following years.

Importantly, for all groups, the percentage of patients working 5 years after the assessment was lower than it had been before the onset of their mental health issues.

Factors Associated with Better Work Outcomes

The researchers developed statistical models to try to predict which patients would have better work outcomes 5 years after their assessment. They found that several factors were associated with a higher likelihood of maintaining employment:

• Younger age
• Not being on sick leave at the time of the assessment
• Having a history of strong work participation before the mental health issues arose
• Having a higher level of education
• Being in a managerial or professional occupation
• Having a stress disorder diagnosis (as opposed to depression or PTSD)
• Being assessed in more recent years (2010-2013 vs. 2000-2004)

However, it’s important to note that while these factors were associated with better outcomes, the predictive power of the models was only moderate. This means they couldn’t reliably predict outcomes for individual patients, but could give some general indications at a population level.

Implications and Future Directions

This study provides valuable insights into the long-term employment outcomes of people with suspected work-related mental health issues. It highlights that while many people do return to work, a significant proportion continue to struggle with employment years after their initial assessment. This underscores the need for effective interventions and support systems to help these individuals maintain their connection to the job market.

The findings also suggest that early intervention may be crucial, as those who were not on sick leave at the time of assessment had better long-term outcomes. Additionally, the fact that outcomes were somewhat better for patients assessed in more recent years might indicate that changes in treatment approaches or workplace policies are having a positive effect, though more research would be needed to confirm this.

The moderate success of the predictive models developed in this study indicates that more work is needed to create tools that can reliably identify patients at high risk of long-term employment difficulties. Such tools could help healthcare providers and occupational health specialists target their interventions more effectively.

Conclusions

Work-related mental health issues can have long-lasting effects on a person’s employment status. While many patients do return to work, a significant number continue to face challenges years after their initial assessment. Factors like age, education level, and the specific type of mental health diagnosis can influence long-term outcomes. However, predicting individual outcomes remains challenging, highlighting the complex nature of these issues and the need for personalized, long-term support strategies.

This study underscores the importance of addressing work-related mental health issues promptly and effectively, not just for the immediate well-being of the individuals affected, but also for their long-term ability to participate in the workforce. It also points to the need for further research to develop more effective interventions and better tools for identifying those at highest risk of long-term employment difficulties.