Department of Health Sciences, Section of Social Medicine, Work and Health, University Medical Center Groningen, Antonius Deusinglaan, The Netherlands.
J Occup Rehabil. 2011 Jun;21(2):259-74. doi: 10.1007/s10926-010-9261-5.
INTRODUCTION In the past few decades, mental health problems have increasingly contributed to sickness absence and long-term disability. However, little is known about prognostic factors of return to work (RTW) and disability of persons already on sick leave due to mental health problems. Understanding these factors may help to develop effective prevention and intervention strategies to shorten the duration of disability and facilitate RTW. METHOD We reviewed systematically current scientific evidence about prognostic factors for mental health related long term disability, RTW and symptom recovery. Searching PubMed, PsycINFO, Embase, Cinahl and Business Source Premier, we selected articles with a publication date from January 1990 to March 2009, describing longitudinal cohort studies with a follow-up period of at least 1 year. Participants were persons on sick leave or receiving disability benefit at baseline. We assessed the methodological quality of included studies using an established criteria list. Consistent findings in at least two high quality studies were defined as strong evidence and positive findings in one high quality study were defined as limited evidence. RESULTS Out of 796 studies, we included seven articles, all of high methodological quality describing a range of prognostic factors, according to the ICF-model categorized as health-related, personal and external factors. We found strong evidence that older age (>50 years) is associated with continuing disability and longer time to RTW. There is limited evidence for the association of other personal factors (gender, education, history of previous sickness absence, negative recovery expectation, socio-economic status), health related (stress-related and shoulder/back pain, depression/anxiety disorder) and external i.e., job-related factors (unemployment, quality and continuity of occupational care, supervisor behavior) with disability and RTW. We found limited evidence for the association of personal/external factors (education, sole breadwinner, partial/full RTW, changing work tasks) with symptom recovery. CONCLUSION This systematic review identifies a number of prognostic factors, some more or less consistent with findings in related literature (mental health factors, age, history of previous sickness absence, negative recovery expectation, socio-economic status, unemployment, quality and continuity of occupational care), while other prognostic factors (gender, level of education, sole breadwinner, supervisor support) conflict with existing evidence. There is still great need for research on modifiable prognostic factors of continuing disability and RTW among benefit claimants with mental health problems. Recommendations are made as to directions and methodological quality of further research, i.e., prognostic cohort studies.
简介
在过去的几十年中，心理健康问题越来越多地导致人们缺勤和长期残疾。然而，对于已经因心理健康问题而请病假的人重返工作岗位 (RTW) 和残疾的预测因素知之甚少。了解这些因素可能有助于制定有效的预防和干预策略，以缩短残疾时间并促进 RTW。
方法
我们系统地回顾了当前关于心理健康相关长期残疾、RTW 和症状恢复的预测因素的科学证据。我们在 PubMed、PsycINFO、Embase、Cinahl 和 Business Source Premier 中进行了搜索，选择了发表日期为 1990 年 1 月至 2009 年 3 月的文章，描述了至少 1 年随访期的纵向队列研究。参与者为基线时请病假或领取残疾津贴的人员。我们使用既定的标准清单评估纳入研究的方法学质量。至少有两项高质量研究的一致发现被定义为强有力的证据，而一项高质量研究的阳性发现被定义为有限的证据。
结果
在 796 项研究中，我们纳入了 7 篇文章，所有文章的方法学质量都很高，根据 ICF 模型分类为与健康相关、个人和外部因素。我们发现强有力的证据表明，年龄较大（>50 岁）与持续残疾和更长的 RTW 时间相关。其他个人因素（性别、教育程度、以前病假史、负面康复预期、社会经济地位）、健康相关因素（与压力相关和肩部/背部疼痛、抑郁/焦虑障碍）以及外部因素（失业、职业护理的质量和连续性、主管行为）与残疾和 RTW 相关的证据有限。我们发现个人/外部因素（教育程度、唯一养家糊口者、部分/完全 RTW、工作任务的改变）与症状恢复相关的证据有限。
结论
本系统评价确定了一些预测因素，其中一些与相关文献中的发现或多或少一致（心理健康因素、年龄、以前的病假史、负面康复预期、社会经济地位、失业、职业护理的质量和连续性），而其他预测因素（性别、教育程度、唯一养家糊口者、主管支持）与现有证据相冲突。仍然非常需要对患有心理健康问题的福利申领者持续残疾和 RTW 的可改变预测因素进行研究。提出了进一步研究的方向和方法学质量建议，即预后队列研究。
