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NEW WAYS a research program to identify, treat and support - - PowerPoint PPT Presentation

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NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY NEW WAYS a research program to identify, treat and support individuals with common mental disorders to remain in work NEW WAYS JULY 2017 NEW WAYS SOCIAL MEDICINE AND

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NEW WAYS

a research program to

identify, treat and support

individuals with common mental disorders to remain in work

NEW WAYS JULY 2017

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

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SLIDE 2

Overall aims of New Ways

  • to develop methods grounded in theory and tested in practice for

early identification, treatment and support to persons with common mental disorders (CMD) and reduced work capacity to remain in work

  • to perform research both at the individual and organisational

level targeting patients as well as their context e.g. their work environment

  • to go upstream and build capacity at work places in order to

promote mental health and prevent reduced work capacity

  • to reduce risk for marginalisation from work life in persons with

CMD

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

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SLIDE 3

Theoretical background

  • Work understood as a social activity contributing with structures,

meaning and income is important for mental health and wellbeing.

– High risk for long term sick-leave and permanent marginalisation from work

  • Person-environment-occupational model (PEOM)
  • Complexity

– to diagnose, to assess function and work capacity, to support RTW – A process perspective on sickness absence and rehabilitation – Situational assessments due to fluctuating experiences of capacity

  • Agent perspective

– Promote self-management, active coping and empowerment

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

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Modified person-environment-occupational model (PEOM)

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

Law et al 1996

Environment Activity Person

Work capacity

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SLIDE 5

Common mental disorders and work

  • a process perspective

CMD at work Reduced mental health and capacity to work CMD off work Sickness absence Return to work

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

Outside work Well managed disorder

Hensing 2015

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Empirical background

  • CMD are common in the working population
  • The correlation between specific diagnoses and functional and work

capacity is low

  • Not much research compared to MSD
  • Higher risk to become sick-listed if the person has a CMD
  • Higher risk for slow return to work
  • Higher risk for recurrent sickness absence
  • Few studies

– Recent reviews point out the need for more research

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

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Distribution of costs for economic support for those with sickness or functional limitations

23 416 50 026 25 915 19 709

Million SEK (per year in 2014)

Sickness benefit Acitivity benefit Assistance Other

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY Försäkringskassan 2015

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New Ways organisation

Steering committee

Gunnel Hensing (Principal Investigator), Robin Fornazar (Project Coordinator), Kristina Holmgren, Maria Larsson, Lisa Björk

Work Stream 1 Work Stream 2 Work Stream 3 Reference group

Gunnar Ahlborg, Stefan Bergman, Cecilia Björkelund, Lotta Dellve Eva Hellquist, Ingibjörg Jonsdottir, Christina Möller, Lena Wängnerud

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

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SLIDE 9

New Ways

Work stream 1

Health literacy

Social inequity in access to care

Aim: Increase knowledge of inequity in access to health care due to CMD

Development of a decision support

Aim: Increase health literacy and promote healthy decisions and behaviour among persons off sick due to CMD

Work stream 2

Primary Health Care

TIDAS

Aim: Evaluate if a structured use of the Work Stress Questionnaire can prevent sickness absence

PRIM-NET

Aim: Evaluate if treatment of depression in the PHC context can be improved by the use of computerized CBT

MADRS-S integrated

Aim: Evaluate in the PHC context if monitoring and self- evaluation can improve depressive symptoms

GP-3Q

Aim: Develop an easy-to-use tool that will be used for screening of rehabiliation needs in the PHC

PRIMA

Aim: Develop and evaluate an intervention to RTW among patients with stress-related mental health problems

CapNote

Aim: Evaluate if systematic use of the capacity note by patients, physicians and employers affects return to work

Work stream 3

Work life

Depression stigma at work

Aim: Increase knowledge in of attitudes towards CMD and of its connection to gender at work places

Manager's perspective - a missing piece

Aim:Study managers' knowledge, attitudes towards and challenges in the work with employees with CMD

WIS-CMD

Aim: Develop and test a work instability scale for depression

C2WI

Aim: Develop the Capacity to Work Index , a questionnaire investigating CMD-related work capacity

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Grant SEK Years

FORTE

  • Research program (Dnr. 2013-2216)

18 000 000 6

  • Junior researcher (Dnr. 2014-0936)

3 680 000 4

  • Network (Dnr. 2014-2681)

100 000 1

  • Project (Dnr. 2015-00703)

3 530 000 4

  • Project (Dnr. 2016-07419)

3 453 000 4 AFA Insurance

  • Project (Dnr. 2015-0378)

2 958 000 3 Region Västra Götaland

  • PhD student

3 654 557 4

  • Researcher

215 007 1

  • Project (Dnr. VGFOUGSB-576081)

104 100 1

  • Project (Dnr. VGFOUREG-594071)

878 099 1

  • Project (Dnr. VGFOUREG-588531)

988 696 1 TOTAL 37 561 459

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

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Collaborators

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY The Center for Research and Development & Institute of Stress Medicine

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Work stream 1

Health literacy

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

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Work stream 1

Health literacy

Social inequity in access to care

Aim: Increase knowledge of inequity in access to health care due to CMD

Development of a decision support

Aim: Increase health literacy and promote healthy decisions and behaviour among persons off sick due to CMD

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Social inequity in access to care

Background

  • Many persons with CMD have an unmet need for care
  • Access to care is related to social position

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

63% 17% 20%

Do not request care Request care, receive treatment Request care, do not receive treatment

Persons with meetable need for mental health care (n=462) Sweden, Forsell 2006

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Aims

  • Investigate barriers to mental health care for persons with CMD
  • Investigate the relation between barriers to care and social inequity based on gender, class

and ethnicity and the intersection of those structures

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

Study 1 Quantitative Cross Sectional Study 2 Quantitative Longitudinal Study 3-4 Qualitative

Is there an association between unmet needs and the intersection of gender and class? Is there an association between unmet needs, the intersection of gender and class and future marginalization? Focus groups to explore ”how” the intersection works in everyday life of persons with CMD

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An intersectional perspective

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

Gender Ethnicity Class

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Development of a decision support

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

Background

There is a need of support and guidance in the process off sick-leave and return to work.

(Mårtensson & Hensing 2012)

User Centered Design (UCD) has previously been shown to increase the usability of the product being developed.

Overall aim

To promote and strengthen the possibility to make informed decisions regarding health and sickness absence among persons’ off sick due to CMD

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NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

Process

Systematically* develop a web-based support based

  • n needs and information from persons with current

experience of CMD and sickness absence. With UCD and input from experts we will develop and revise prototypes in iterations until we reach a final product: webpage and/or mobile phone application.

Design

  • UCD involving participators from phase 1 with

web-designers and a coordinator in a design group

  • Create a prototype and get input from

researchers, other experts and a test group

  • Revise prototypes until a decision of a final

product is taken by the steering committee

  • Launch the web-based support in collaboration

with stakeholders that will take over responsibility

  • f maintenance an updates

Inventory

  • Semi-structured interviews/focus groups (n=35)
  • Conducted within themes of experience of the sick-

listing process, needs and information of support and possibilities to take actions to prevent sick-listing

  • Current experience of CMD and sickness absence,

18-65 years old

  • Variation in length of sick-listing (<90 days), country of

birth, gender, age, educational level

  • Thematic analysis method

Phase 1 Evaluation

  • Testing made by ”real” users
  • ne year after launching the

web-based support

  • Survey and web-analytics
  • Further improvements

Phase 2 Phase 3

*inspired by Elwyn et al (2011) & Elf et al. (2013)

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Research questions

1. What needs concerning support, knowledge and information are important to persons with CMD in relation to prevention, understanding and promotion within the process of sickness absence and return to work? 2. How do persons with current experience of sickness absence due to CMD suggest the contents and structure of a web-based support to be in relation to prevention, understanding and promotion within the process of sickness absence and return to work? 3. How has the web-based support been used by “real” users and what do they think of its relevance and usefulness in relation to the process of sickness absence and return to work?

Opportunities

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

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SLIDE 20

Work stream 2

Primary health care

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

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Work stream 2

Primary Health Care

TIDAS

Aim: Evaluate if a structured use of the Work Stress Questionnaire can prevent sickness absence

PRIM-NET

Aim: Evaluate if treatment of depression in the PHC context can be improved by the use of computerized CBT

MADRS-S integrated

Aim: Evaluate in the PHC context if monitoring and self- evaluation can improve depressive symptoms

GP-3Q

Aim: Develop an easy-to-use tool that will be used for screening of rehabilitation needs in the PHC

PRIMA

Aim: Develop and evaluate an intervention to RTW among patients with stress-related mental health problems

CapNote

Aim: Evaluate if systematic use of the capacity note by patients, physicians and employers affects return to work

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TIDAS

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

Early identification of people at risk for sick-leave due to work-related stress – A randomized controlled study of people with mental disorders and physical complaints consulting primary health care

Aim

To evaluate if a systematic use of the WSQ, combined with feedback at consultation, can serve as a method for healthcare professionals in primary health care centers to prevent or reduce sickness absence over a 12 months follow-up.

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Design

  • A randomized controlled study of people with mental disorders and physical

complaints consulting primary health care

  • Sick-leave days
  • The use of medicines
  • Healthcare treatment
  • Process evaluation
  • Focus group study to explore GPs’ perception
  • Questionnaire on feasibility, attitudes and readiness

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

Identify the target group Study information and informed consent

INTERVENTION 1) Patient fills in the WSQ 2) GP gives feedback at the consultation 3) Patient and GP discuss measures and referrals Follow-up 1) Sick-leave 2) Treatment 3) Prescription of medicine CONTROL 1) Patient receives treatment as usual 2) Patient fills in the WSQ, and receives no feedback

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TIDAS 2015–2018

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

Data collection 2015–2016

  • Baseline
  • Follow-up 3,

6, 12 months Process evaluation 2015–2016

  • Focus groups

discussions

  • Questionnaire

Registered follow-up 2016–2017

  • MiDAS
  • Vega
  • Drug register

Analyses and publications

  • Paper 1, 2016
  • Paper 2, 2017
  • Paper 3, 2017
  • Paper 4, 2018
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PRIM-NET

Background

  • Internet-delivered psychological treatments are becoming well

established

  • Previously studies based on volontary patients (efficacy) and not in

regular health care (effectiveness)

Aim

Evaluate if treatment of depression by internet-based CBT is effective and works in a regular health care setting

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

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Design

  • Patients with depression (18+, n=90) recruited from 18 primary health care

(PHC) centers between 2010 and 2012

  • Follow-up using BDI-II, MADRS-S, and BAI
  • Intervention = ICBT with Depressionshjälpen*, Control = TAU

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY *Developed by Psykologpartners W&W AB

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Results

  • No difference between ICBT and TAU during 0, 3 and 9 month follow-up
  • Both treatments were effective as treatment for depression in a PHC setting
  • No distinguishing factors found for those who did not respond (50 %) to treatment
  • Positive attitudes to work with ICBT among PHC therapists

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

Implication

Reach more patients

  • Flexibility for patients
  • Therapists become available for persons who

need regular treatment

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MADRS-S Integrated

Background Most people in Sweden with mild to moderate depression are treated within primary health care. However, the follow-up is often unstructured and we do not know much if a structured follow-up can affect depression, work ability and quality of life. Aim To study if repeated and structured follow-ups with the self- assessment instrument MADRS-S* lead to increased work ability, quality of life, reduced time until return to work and depression among persons with mild to moderate depression.

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

*Montgomery Åsberg Depression Rating Scale-Self (MADRS-S)

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Design

  • Physicians randomised to control or intervention

– Control = TAU – Intervention = TAU + education in utilisation of MADRS-S + 4 patient centred consultations with patients

  • Following the curve of depression will make the patient improve
  • Patients followed from baseline to 3, 6 and 12 months follow-ups using the same

questionnaire

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

Randomization

FOLLOW-UP

  • 3, 6 and 12

months

  • Depression

reduction

  • Questionnaire

INTERVENTION

  • TAU
  • MADRS-S at 4

consultations

  • Questionnaire

4 STUDIES 1) Depression reduction and QoL*

(quantitative)

2) Effects on function and sick-listing

(quantitative)

3) Patients’ perception of using MADRS-S

(qualitative)

4) Differences between PHCC* in identifying depression

(qualitative)

CONTROL

  • TAU
  • Questionnaire

*Quality of Life (QoL), Primary Health Care Centres (PHCC)

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Designed by Pressfoto - Freepik.com

Expected results

  • Patients randomised to physicians using MADRS-S as an integrated tool

in structured follow-ups will recover from depression faster than controls.

  • Also, the work ability and quality of life is expected to be improved and the

patients will return to work quicker in patients to intervention physicians.

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

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GP-3Q – a new decision support for physicians

  • Limited knowledge about the physicians’ role and practice

in the sickness certification process

(Söderberg et al 2010)

  • Physicians find it difficult

– to determine if there is reduced capacity to work – to make a long-term prognosis

(Alexandersson et al 2013)

  • There is today no validated tool for physicians that can

support the evaluation of whether a person would benefit from occupational rehabilitation or not

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY SAHLGRENSKA ACADEMY THE

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Literature review Knowledge in the research group Interview study Modified Delphi study

GP-3Q

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY SAHLGRENSKA ACADEMY THE

“Bottom-up” approach Pragmatic trial Evaluation

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SLIDE 33

Possibilities/Outcomes

  • Fewer sickness absence days
  • Improved patient values
  • Facilitating physicians’ work with sickness absence

matters

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY SAHLGRENSKA ACADEMY THE

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SLIDE 34

Background Despite the fact that primary care centres are key actors for the rehabilitation of patients with stress related mental disorders, they lack of prerequisites for working with workplace-

  • riented measures. There are several intervention studies available in this area, but few

have been conducted in the primary care setting. Aim The aim of the PRIMA project is to develop and evaluate a model for return to work (RTW) for patients with stress-related exhaustion disorder, which is well adapted to the Swedish primary care setting and includes the workplace. We will investigate: 1) whether the intervention has an effect on the patients' RTW pattern over time; 2) what mechanisms at organizational and individual level are involved; 3) organizational and individual level circumstances that are necessary for these mechanisms to be triggered.

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

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SLIDE 35

Randomization

FOLLOW-UP

  • 6, 12, 18 and 24

months after sick- listing

  • Register data

(MiDAS) on sick- listing INTERVENTION

  • 15 PHCC
  • Education
  • Process support

4 STUDIES 1) Short-term effects on RTW (quantitative) 2) Long-term effects on RTW (quantitative) 3) Mechanisms behind a successful intervention (mixed methods) 4) Methodological learnings (qualitative) CONTROL

  • Matched PHCC
  • TAU

Design

  • The intervention will be conducted on 15 different primary health care centers

(PHCC) that will be matched with a control group

  • The intervention is to implement a new routine for physicians and rehab-

coordinators and consists of a education and process support

– Focus on workplace-oriented and person tailored therapies for CMD patients but also on collaboration between stake holders in the RTW process

  • RTW for 500 patients will be analysed by using self-reported and registry data

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

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Expected results

  • Patients at PHC with successful implementation will on average RTW earlier than in

control PHC

  • Variations between groups (e.g. according to gender and age) in results on RTW will

be found

  • The variations will be found at both organisational and individual level

Relevance and usefulness

  • The knowledge of the hypothetically variations will be used to tailor a model for

Swedish circumstances

  • Primarily, positive effects on the patients’ health, the workload on health care staffs

and decrease costs for the society are expected

  • Secondarily, there is an expectation of effects on persons working at person-oriented

work-places. Women are over-represented at these work-places and equalising gender differences in sickness absence are then expected

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

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SLIDE 37

Background

  • Physicians need more information of work life
  • Employers lack knowledge on how CMD affect work functioning
  • Patients tend to reduce their activities over time in sickness absence

Aims 1) Evaluate if systematic use of the capacity note by GPs in PHCC will reduce time to RTW 2) Evaluate how the capacity note was received by the intervention participants (patients, GPs, supervisors)

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY SAHLGRENSKA ACADEMY

CapNote

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Design

  • RCT at primary health care centers (PHCC) in Region Västra Götaland
  • GPs (not PHCC) randomized into intervention or control (TAU)
  • Inclusion criteria: physician decides there is a need for sick-listing the patient
  • Intervention

– Filling in the capacity note regarding information of work situation, psychological symptoms and its impact on work ability during the first GP consultation – Patient contact the supervisor for a discussion based on the capacity note. Further, they discuss short or long term adjustments of the work situation in respect to health status – Further discussion of treatment or occupational rehabilitation during the second consultation

  • Data and outcomes

– RTW (number and proportion who RTW and days until RTW) – Follow-up after 6, 12 and 18 months (register data) – The patients’, GPs’ and supervisors’ experiences using capacity notes collect (questionnaire data)

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY SAHLGRENSKA ACADEMY

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Expectations

  • Using capacity notes will empower the patient and enhance the patient agency
  • The communication between patient, GP and supervisor is promoted at an early

stage.

  • Less days until RTW in intervention group compared to control group

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY SAHLGRENSKA ACADEMY

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SLIDE 40

Work stream 3

Work life

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

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SLIDE 41

Work stream 3

Work life

Depression stigma at work

Aim: Increase knowledge in of attitudes towards CMD and

  • f its connection to gender at work places

Manager's perspective - a missing piece

Aim: Study managers' knowledge, attitudes towards and challenges in the work with employees with CMD

WIS-CMD

Aim: Develop and test a work instability scale for depression

C2WI

Aim: Develop the Capacity to Work Index, a questionnaire investigating CMD-related work capacity

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SLIDE 42

Stigmatizing attitudes towards depression

Mechanisms between stigma and health: 1. Resources (work, status, performance) 2. Social isolation (due to others and own behaviour) 3. Psychological and behavioural response (self-stigma, initiative to work, delayed care seeking, alcohol, drugs, diet & exercise) 4. Stress

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

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SLIDE 43

Data collection

LORE Citizenship panel (Laboratory of Opinion Research)

  • One of the largest University owned web-panels globally
  • Study-group

– n=3175 volunteers – Gender, age, health, education, work situation, occupational position, attitudes towards political issues, i.e. taxes, inequity, immigrants, political affiliation (latest election)

  • Response rate 60-70%

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

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SLIDE 44

Ongoing studies

1. Public attitudes towards sickness absence in depressed people 2. Political affiliation as a predictor of stigmatic attitudes towards depression. 3. Attitudes towards sickness absence in depressed people – the relevance of gendered structures

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

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SLIDE 45

Manager’s perspective – a missing piece

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

  • Prejudice against mental health problems
  • Sceptical about the thruthfulness in mental health problems
  • Finds mental health problems more problematic
  • Lacking knowledge
  • Difficulties understanding the decreased work capacity
  • Difficulties with work adjustments
  • Lacking formal support and resources

Hauck 2009,Canada Munir 2009, England Tjulin 2010, Sweden Lemieux 2011,Canada Johnston 2014, Australia Evans-Lacko 2014, Europe

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SLIDE 46

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

88% knows

  • f low mood and sadness

as symptoms But only: 33% forgetfulness 47% indecisiveness 57% concentration difficulties Work places lacks knowledge

IDEA: Evans-Lacko & Knapp 2014

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SLIDE 47

Aim

To investigate Swedish supervisors’ attitudes to and knowledge

  • f CMD and related work capacity.

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

A web-based survey to 5000 Swedish supervisors investigating:

  • attitudes to depression
  • knowledge of CMD-related

work capacity

  • use of work accommodations

for employees with CMD

  • supervisors’ recommendations
  • f sickness absence in video

vignettes of CMD cases.

A focus group study with approximately 40 supervisors exploring:

a) supervisors’ know-how and perceived challenges to support workers with CMD b) Supervisors’ experience- based understanding of how the capacity to work is affected by CMD

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SLIDE 48

WIS-CMD

Work instability scale – common mental disorders

  • Work instability ”a state in which the consequences of a mismatch

between an individual’s functional and/or cognitive abilities and demands of their job can threaten continuing employment if not resolved” (Gilworth et al., 2006)

  • As process in CMD - how? Fluctuating? Gradually declining? What are

signs of instability in relation to work capacity?

Capacity Demands

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

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SLIDE 49

(Gilworth,Tennant m fl, 2003, 2006, 2012)

1) Experiences of work instability in persons with CMD 2) Draft of the scale, with item pool based on the lived experiences Psychometrics 3) face validity 4) content validity 5) reliability 6) clinical "gold standard" assessment 7) Adjustments, condensation of scale, final version Predictive validity Does WIS-CMD predict sickleave? Application of the scale Does the intervention XX have an effect on work instability?

Aim To explore experiences of changed capacity to work and to develop and test a work instability scale for common mental disorders

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

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SLIDE 50

Preliminary content in qualitative study

  • Change of energy/energy-shift

– ”Moving in syrup”, must force/channel the energy into narrow focus – Able to achieve enough results, but crashes at home – Phase of feeling on overdrive, ”spinning”

  • Changed perceptions/awareness

– Hypersensitive, emotional, unable to shut off from impressions – Numb, difficult attuning to one’s own and others’ needs – Unable to keep focus/hold one thought into the next work task – If channelled focus is disturbed, the task fails

  • Changed relations

– Withdraws from/burdened by interacting and breaks – Can appreciate social events, but on certain conditions – Easiliy annoyed and irritated by others – More difficult to understand what other people mean

  • Changed role of function/job identity

– Maintain a facade, denial of declining abilities – The professional facade also a shelter, gives space

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SLIDE 51

Remain in work or become sick-listed – what factors decide the outcome?

At work

  • Affected by CMD

Sick-listed

  • Affected by CMD

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

C2WI A project to develop the Capacity to Work Index

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SLIDE 52

Aim

Why do some persons with CMD continue to work while others become sick-listed? And is it more difficult to remain in work if your work involves taking care of other human beings?

Design

  • 1. Develop items that can fit in the C2WI based on earlier qualitative

findings from our group.

  • 2. Test the user friendliness, validity and reliability of the C2WI
  • 3. Perform a large scale questionnaire study in a sample of the working

population and follow up their sickness absence to answer the aim.

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

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SLIDE 53

Expectations

  • The development of a specific index to measure CMD related

work capacity in epidemiological studies

  • New knowledge on individual, work related and social factors

that promote remain in work for persons with CMD

  • New knowledge regarding risk factors of occupations with high

levels of human encounters in relation to sickness absence due to CMD

NEW WAYS SOCIAL MEDICINE AND EPIDEMIOLOGY THE SAHLGRENSKA ACADEMY

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SLIDE 54

Gunnel Hensing

Principal Investigator +46 76 618 68 62 gunnel.hensing@gu.se

epso.gu.se/newways

Robin Fornazar

Project Coordinator +46 76 618 32 22 robin.fornazar@gu.se