The relationship between specific occupational health care (OHC) pathways and subsequent work disability following an initial mental health-related sickness absence (SA) is poorly understood. This study aimed to predict long-term SA outcomes by modeling the timing and composition of OHC pathways among employees absent due to mood disorders or anxiety. We conducted a register‑based observational cohort study using structured occupational health records from a major Finnish OHC provider (2015–2023, N = 35 385). Following a 12‑month washout period, the first mental health-related SA (ICD‑10 F30–F48) occurring in 2016–2021 was defined as the index episode. The OHC pathways were characterized within a 3-month window. XGBoost was employed to predict 24‑month recurrence of mental health-related SA and cumulative SA days using care pathway features and socio‑demographic variables. Model interpretability was assessed using Shapley Additive Explanations (SHAP) values. SA patterns emerged as the most potent predictors of long‑term outcomes. The accumulation of absence days, particularly between days 61 and 90, and internal recurrence within the index period markedly increased the predicted risk of future mental health-related SA. In contrast, specific OHC pathway elements and the timing of clinical contacts contributed less to overall model performance. Our findings suggest that long‑term work disability risk is most strongly predicted by indicators of condition severity rather than the specific composition of early OHC interventions. To improve outcomes, timely identification of workers whose recovery trajectories deviate from expected norms may allow more targeted and sustained support for work ability.
Liver transplantation (LT) restores survival and quality of life in patients with end-stage liver disease, yet return-to-work (RTW) remains challenging. Employment status before transplantation is a major predictor of post-LT reintegration, but socio-professional factors are rarely assessed during the pre-transplant period, particularly in the post-COVID era. We retrospectively included all adult LT candidates, aged 18–64 years and eligible to work, who performed elective pre-transplant evaluation at Rennes University Hospital between June 2022 and December 2023. Retired patients were excluded. We aimed to investigate the socio-professional aspects of working age liver transplant candidates and characterize their socio-professional trajectory one year after LT. Socio-demographic, medical, and occupational data were collected at baseline and one-year post-LT. Working patients were defined as those engaged in income-generating activity. Logistic regression was used to identify factors associated with employment before and after LT. Among 141 LT candidates (65
This study investigates the predictive value of the newly identified factors Beliefs about working with health problems and Support at work for patients on sick leave due to common mental disorders. The aim was to explore the validity of the two factors in a new sample, investigating the factor structure, reliability and construct validity. Further the predictive value was assessed from pre-to post-treatment and at 6- and 12-months follow-up using sick leave data from national registries. The study had a longitudinal design conducting secondary analyses with data from a randomised controlled trial (N = 236). The patients filled out self-report questionnaires and sick leave data were collected from national registries. The principal component factor analysis identified the two factors, Beliefs about working with health problems and Support at work, with strong internal consistency α = 0.79 and 0.85 respectively. At pre-to post-treatment both factors separately predicted number of days on sick leave. Beliefs about working with health problems also predicted number of days on sick leave from post-treatment to 6- and 12-months follow-up. These findings highlight key predictors for return to work. Beliefs about working with health problems is especially important, predicting up to 12-months post-treatment. These factors can easily be assessed and addressed in therapy and increased focus may help more patients return to work.
This process evaluation examined the implementation of a problem-solving intervention with workplace involvement (PSI-WPI) for employees with common mental disorders, developed to reduce sickness absence. The aim was to understand factors influencing the “problem-solving in primary care” (PROSA) effect evaluation, which showed no significant difference in sickness absence days between PSI-WPI and care-as-usual (CAU). PSI-WPI included a five-step process typically delivered over three sessions by primary care rehabilitation coordinators. Process outcomes assessed were reach, dose delivered, dose received, fidelity and dose response. Data came from questionnaires, medical records, and registry data. Kruskal–Wallis tests assessed associations between number of PSI-WPI sessions and sickness absence days. A post hoc analysis explored characteristics of employees receiving no, one or ≥ three PSI-WPI sessions. PSI-WPI coordinators reported slightly more face-to-face sessions and three-part meetings, whereas CAU coordinators reported more telephone sessions. Coordinator support was received by 85
Workplace accommodations play a critical role in promoting equitable employment outcomes for people with disabilities (PWDs), yet the accommodation request process remains complex and emotionally charged. Drawing on Social Cognitive Theory (SCT) and Social Cognitive Career Theory (SCCT), this study examined how negative affect influences workplace accommodation request intention through self-efficacy and outcome expectancy. A cross-sectional survey was administered to 725 employed adults with disabilities across the United States. Structural equation modeling (SEM) was conducted to test direct and indirect relationships among negative affect, accommodation-related self-efficacy, outcome expectancy, and request intention. Negative affect did not directly predict the intention to make an accommodation request. However, negative affect significantly reduced both self-efficacy and outcome expectancy. Self-efficacy, in turn, was a strong positive predictor of request intention, suggesting a mediating mechanism through which emotional experiences influence behavioral intentions. Contrary to prior literature, outcome expectancy did not significantly predict request intention in the final structural model. Multi-group analyses revealed no statistically significant differences in path coefficients between visible and invisible disabilities or between majority and minority racial groups, although variations in coefficient magnitudes warrant further investigation. Findings extend SCT and SCCT applications to disability employment by clarifying the affective–cognitive mechanisms underlying accommodation decision-making. The results underscore the central role of self-efficacy in mitigating the adverse effects of negative affect and highlight the need for interventions that strengthen self-evaluative beliefs during emotionally salient workplace interactions.
To (1) examine health- and work-related outcomes among partners of cancer survivors and (2) explore associated factors of these outcomes. In the STEPS prospective cohort study 225 employed partners of cancer survivors in the Netherlands completed questionnaires at baseline, and after 6 and 12 months, on work participation, health-related quality of life (HRQoL), and medical, lifestyle, health, and work factors. Generalized estimating equations and time-lagged regression analyses were used to examine changes over time and associations with measured factors. Partners worked on average 31.1 h/week at baseline, which remained stable over the 12-month follow-up. Employment status (i.e., whether participants were employed versus not) slightly declined from 91 to 86
The 2018 United Network for Organ Sharing (UNOS) heart allocation policy change has substantially altered left ventricular assist device (LVAD) bridge duration before heart transplantation. Whether prolonged durable mechanical circulatory support is associated with impaired post-transplant employment, including return to work (RTW) among previously employed patients, remains uncertain. We performed a retrospective cohort study of 9473 adult LVAD-bridged heart transplant recipients (2010–2023) using the UNOS/Scientific Registry of Transplant Recipients (SRTR) database. The primary outcome was post-transplant employment at 1 year. A key secondary outcome was RTW among patients employed at the time of listing. Bridge duration was categorized as < 6, 6–12, 12–24, and > 24 months. Multivariable logistic regression adjusted for demographic, socioeconomic, and clinical factors. Median bridge duration was 12.4 months (IQR 6.3–23.8); 21.2
Cancer survivors experience challenges in establishing sustained employability, i.e., return to work and work retention. We evaluated the effectiveness of a stages-of-change-based work participation program (STEPS) to support sustained employability in cancer survivors. A two-armed randomized controlled trial was conducted among employees diagnosed with cancer 3–18 months earlier. Participants completed questionnaires pre-randomization, and at 6- and 12-month of follow-up (T1 and T2). Mixed-effects modeling compared STEPS with usual care on working hours (sustained employability) and secondary outcomes. Of 239 included participants, 123 were randomly assigned to STEPS and 116 to usual care. There were no meaningful differences in weekly working hours between the STEPS and control groups during follow-up. However, strict STEPS protocol adherence was related to working fewer hours per week across T1 and T2 (− 3.6, 95
Many people diagnosed with cancer are of working age and experience challenges returning to and retaining—paid work. Existing interventions to support return to work have shown mixed effectiveness, and their cost-effectiveness is often unknown. The STEPS work participation program, based on the Stages of Change, aims to support employed cancer survivors in work resumption and retention. This study evaluated its cost-effectiveness compared to usual care. An economic evaluation was conducted alongside a 12-month multi-center randomized controlled trial in the Netherlands. Employed cancer survivors were randomized to STEPS (n = 123) or usual care (n = 116). Quality-adjusted life years (QALYs) were estimated using the EQ-5D-5L questionnaire. Costs were assessed from a societal perspective. Analyses followed the intention-to-treat principle, were conducted using seemingly unrelated regression adjusted for baseline utility and costs, with uncertainty assessed using bootstrapping. Participants in the STEPS group accrued marginally more QALYs than those receiving usual care (adjusted mean difference: 0.004; 95
Employment plays a central role in social inclusion and individual well-being. Yet people living with chronic illnesses or disabilities continue to face substantial structural and workplace barriers to gaining and sustaining employment. There is a pressing need for empirical research that examines these issues. In this study, we aim to analyse the barriers to accessing and maintaining employment of people with chronic illnesses despite the existence of inclusive employment policies designed to promote their effective labour market participation. This study investigates the employment experiences of 98 Spanish adults diagnosed with immune-mediated inflammatory diseases (IMIDs). A mixed-methods approach was used, combining quantitative survey analysis with qualitative data. The findings reveal that chronic pain, cognitive impairment, and inadequate workplace adjustments severely affect individuals’ work performance and stability. Participants described physical and psychological exhaustion, limited understanding from co-workers, and declining employability behaviours as key challenges to sustaining employment. Structural barriers, such as rigid schedules and insufficient job adaptations, further exacerbate exclusion. Overall, the results underscore how current workplace systems remain poorly equipped to accommodate the fluctuating and invisible nature of chronic illnesses, undermining true employment inclusion. These findings highlight the urgent need to rethink prevailing assumptions in employment policy and organisational practice. To ensure genuine inclusion of workers with chronic illnesses or disabilities, employers and policymakers should promote the co-creation of flexible work arrangements, adapt job design and workflows, and raise awareness of invisible and fluctuating conditions. Such actions are crucial to achieving sustainable and equitable labour market participation.
Chronic low back pain (CLBP) is a leading cause of work-related disability with limited benefit from biomedical treatments. Multidisciplinary approaches, including cognitive-behavioral therapy (CBT) show promise, but outcomes may depend on readiness to change. The Transtheoretical Model may help identify who benefits most, yet its relevance for return-to-work (RTW) outcomes in CLBP remains underexplored. This secondary analysis of a randomized controlled trial examined whether readiness to change, measured by the Pain Stages of Change Questionnaire (PSOCQ), was associated with back pain intensity and disability, and whether it predicted RTW 12 months after a multidisciplinary intervention for CLBP. 414 participants on long-term sick leave due to CLBP were randomized to either: brief intervention (BI), BI + CBT, BI + seal oil, or BI + soy oil. Baseline measures included PSOCQ, pain intensity, and Oswestry Disability Index. RTW was assessed via registry data at 12 months. Hierarchal regression showed that higher precontemplation scores were significantly associated with greater baseline back pain and disability, while higher maintenance scores were linked to less back pain. In the CBT group, logistic regression revealed that higher precontemplation scores significantly predicted a 63
Injured workers often navigate healthcare services funded by multiple payers with distinct eligibility and funding rules. In Australia, general practitioner (GP) care is subsidised through the publicly funded health insurance system (Medicare). Injured workers may also access care funded by the workers’ compensation system for work-related conditions. Consequently, injured workers may be required to navigate two healthcare funding systems simultaneously. This study examined injured workers’ experiences of GP care across both systems to inform improved patient care and system reform. Twelve participants with work-related musculoskeletal injuries were recruited. Data were analysed using reflexive thematic analysis, following an inductive approach to coding and identifying key themes. Three themes were identified: (1) “Navigating dual care funding systems”, where participants described challenges accessing care across workers’ compensation and Medicare; (2) “Workers’ compensation systemic strains on care”, where systemic pressures within workers’ compensation affected workers’ access to and GPs’ delivery of care; and (3) “GPs’ management of workers’ compensation-related tasks”, where care experiences varied depending on how individual GPs approached workers’ compensation-related tasks. Workers described significant challenges arising from system fragmentation, administrative demands, and variability in GPs ‘willingness to engage with the workers’ compensation process. These experiences shaped access, continuity, and quality of care received. Workers preferred whole-person care, often changing GPs when their regular GP refused to engage with the workers’ compensation system. Strengthening coordination between funding systems, streamlining administrative processes, and improving GP training could improve the care experiences. These findings highlight the system-level reforms prioritising patient experience.
Return to work (RTW) is a key outcome of occupational rehabilitation, but physical recovery alone does not determine it. While prolonged treatment duration is a known barrier to RTW, the extent to which modifiable psychological resources mitigate this effect remains unclear. Therefore, this study aimed to examine whether self-efficacy and self-esteem are associated with RTW and whether self-esteem buffers the adverse effect of prolonged treatment duration. Five-year panel data (2018–2022) from the Panel Study of Workers’ Compensation Insurance, including 14,607 observations, were analyzed. RTW was operationalized as current work participation at each survey wave based on the official PSWCI economic activity status classification. Generalized estimating equations with a logit link were used to examine main and interaction effects. A Random Forest model was used to assess predictive performance and variable importance. Self-efficacy (OR = 2.020, p < .001) and self-esteem (OR = 1.519, p = .001) significantly predicted RTW, with self-efficacy showing the strongest effect. Longer treatment duration was associated with reduced probability of RTW (OR = 0.615, p < .001). A significant interaction indicated that self-esteem attenuated the adverse effect of prolonged treatment (OR = 1.098, p = .017). The Random Forest model demonstrated strong predictive performance (AUC = 0.818), with self-efficacy and self-esteem as the top-ranked predictors. Psychological resources are important for RTW following occupational injury. Self-efficacy and self-esteem were positively associated with RTW, and self-esteem additionally buffered the adverse effect of prolonged treatment duration. These findings support rehabilitation strategies that prioritize modifiable psychological factors to enhance sustainable work reintegration.
Prostate cancer is the most common cancer amongst men, yet how its treatment affects work participation remains poorly understood. This systematic review synthesised quantitative evidence on work participation following prostate cancer treatment, comparing treatments and identifying associated factors and evidence gaps. Five databases (MEDLINE, Embase, PsycINFO, CINAHL, Google Scholar) were searched (May 2025) for English-language, peer-reviewed articles reporting treatment-specific work outcomes amongst men with prostate cancer. The review followed PRISMA and was registered with PROSPERO (CRD420251061347). Risk of bias was assessed using Joanna Briggs Institute tools, and certainty of evidence using GRADE. Twenty-eight articles (24 studies, 39,966 men) were included. Most were cohort (n = 15) or cross-sectional (n = 6) studies; 15 compared ≥ 2 treatments. Median time to return to work (RTW) ranged from 14 to 56 days. Amongst low risk of bias studies reporting adjusted estimates, RTW was faster (adjusted hazard ratio 2.13, 95
Differentiated thyroid cancer (DTC) predominantly affects individuals of working age and is characterized by excellent long-term survival. However, occupational recovery after treatment has received limited and fragmented attention in the literature. The objective is to systematically review the available evidence on return to work and employment-related outcomes among survivors of differentiated thyroid cancer. PubMed/MEDLINE, Scopus, and Web of Science Core Collection were searched from database inception to December 2025 in accordance with PRISMA guidelines. Observational and qualitative studies reporting work- or employment-related outcomes in adult DTC survivors were included. Given the substantial heterogeneity of study designs and outcome measures, a narrative synthesis was performed. Twenty-three studies met the inclusion criteria. Although many DTC survivors returned to work relatively early, incomplete occupational recovery was frequently reported, including reduced working hours, prolonged sick leave, income loss, or long-term employment difficulties. Work-related outcomes varied widely across studies and were influenced by nononcological factors such as fatigue, psychological distress, and sociodemographic characteristics. Importantly, several studies highlighted a mismatch between actual return to work and readiness to return to work, indicating that work resumption often occurred before full functional and psychological recovery. Despite excellent oncological outcomes, survivors of differentiated thyroid cancer may experience persistent challenges in employment. Return to work should be regarded as a multidimensional process rather than a binary outcome, highlighting the need for standardized assessment and targeted vocational support in survivorship care.
Employment is a key social determinant of health, yet people with disabilities (PWDs) face persistent disparities in vocational rehabilitation (VR) services and outcomes. Federally funded Vocational Rehabilitation (VR) programs serve individuals whose disabilities create barriers to competitive integrated employment, yet service allocation and outcomes vary widely across socioeconomic contexts. Understanding how cumulative socioeconomic disadvantage shapes VR service delivery and employment outcomes is essential for advancing equity. Using Rehabilitation Service Administration (RSA-9/11) data (n = 182,266), machine learning methods, including principal component analysis (PCA), were applied to develop a Socioeconomic Vulnerability Index, which was then used to examine associations with VR service delivery and employment outcomes. Results revealed that higher vulnerability was linked to increased likelihood of receiving basic support services but lower odds of career-oriented services. Higher vulnerability index scores correlated with higher expenditures (+ 246) yet substantially lower wages (−3.13/hour). Findings suggest that an intake‑level vulnerability screening tool could support risk stratification and more targeted, equity‑focused VR service planning.
Work accommodations can facilitate return to work (RTW), but little is known about work accommodation needs and practices among employees with common mental disorders (CMDs). This study examines (1) needed work accommodations for RTW, (2) received work accommodations during RTW, and (3) the longitudinal relationships between received work accommodations and both depressive symptoms and work ability after RTW. Data were collected in two German longitudinal studies among employees with CMDs on long-term sickness absence: (I) an observational cohort study (F2385; N = 286; 30-month follow-up); and (II) a randomized controlled trial (RTW-PIA; N = 424; 24-month follow-up). Needed and received work accommodations were described and compared. Multiple regression analyses were conducted to examine the longitudinal relationships between received work accommodations and both depressive symptoms and work ability after RTW. Before RTW, 91–99
To compare rates of return to work (RTW), at 18 months post-injury/infection, between workers with an absence from work due to COVID-19 and those with non-COVID injuries and illnesses, and to examine if RTW differences are explained by different factors in the RTW process. Telephone interviews were conducted among 18,000 workers with accepted lost-time workers’ compensation claims 18 months after their claim acceptance: 607 with work-related COVID-19 infections (oversampled) and 393 with other work-related injuries/illnesses. Potential outcome mediation models examined factors at the individual, workplace, healthcare provider, and system level involved in differences in RTW between workers with COVID-19 and non-COVID-19 claims, adjusting for a range of confounders. At 18 months post-injury, approximately 13 more workers with COVID-19 infections were at work, per 100 workers, compared to those with other injuries or illnesses. Differences in self-rated health, experiencing financial difficulties, and disagreement with the workers’ compensation agency, explained between 12 and 21
Workers’ compensation claims processes may exacerbate mental health symptoms for individuals with work-related mental health conditions (WR-MHCs). This study examined associations between mental health outcomes and contemporaneous claim status. Data of this cohort study were drawn from 153 general practice patients with WR-MHCs providing 422 observations, enrolled in the IMPRovE trial across Australia. Workers’ compensation claim status (accepted, rejected, being assessed, or no claim), working status, and mental health outcomes (Depression Anxiety Stress Scale–21 (DASS-21) and Short-form health survey) were assessed via 3-monthly surveys. Mixed-effects linear regression models were used to assess the relationship between claim status and outcomes, adjusting for intervention status, working status, time-point, state, clinic size, location, age, and gender. On the DASS-21, patients with a claim application being assessed reported significantly poorer overall mental health outcomes than those with accepted claims (e.g. stress: β = 5.73, 95
