Institute of Psychiatry, Kings College London, Department of Psychological Medicine, Weston Education Centre, UK.
J R Soc Med. 2011 May;104(5):198-207. doi: 10.1258/jrsm.2011.100231.
Psychiatric disorders are now the most common reason for long-term sickness absence. The associated loss in productivity and the payment of disability benefits places a substantial burden on the economies of many developed countries. The occupational dysfunction associated with psychiatric disorders can also lead to poverty and social isolation. As a result the area of work and psychiatric disorders is a high priority for policymakers. There are two main agendas: for many researchers and clinicians the focus is on the need to overcome stigma and ensure people with severe psychiatric disorders have meaningful work; however the public health agenda predominantly relates to the more common disorders such as depression and anxiety, which contribute a greater burden of disability benefits and pensions. In this review we attempt to address this second agenda. The relatively sparse evidence available reveals a complex field with significant interplay between medical, psychological social and cultural factors. Sick leave can be a 'process' as well as an 'event'. In this review we propose a staged model where different risk and protective factors contribute to the onset of psychiatric disorders in the working population, the onset of short-term sickness absence, and the transition from short- to long-term absence. We also examine strategies to manage psychiatric disorder in the workforce with a view towards returning the employee to work. Our aim in this review is to highlight the complexity of the area, to stimulate debate and to identify important gaps in knowledge where further research might benefit both patients and wider society.
精神障碍现在是导致长期病假的最常见原因。与精神障碍相关的生产力损失和残疾福利支出给许多发达国家的经济带来了巨大负担。与精神障碍相关的职业功能障碍也可能导致贫困和社会孤立。因此，工作和精神障碍领域是政策制定者的高度优先事项。有两个主要议程：对于许多研究人员和临床医生来说，重点是需要克服污名化，确保患有严重精神障碍的人有有意义的工作；然而，公共卫生议程主要涉及更常见的疾病，如抑郁症和焦虑症，这些疾病导致残疾福利和养老金的负担更大。在这篇综述中，我们试图解决第二个议程。现有的相对稀缺证据揭示了一个复杂的领域，其中医学、心理、社会和文化因素之间存在着显著的相互作用。病假既可以是一个“过程”，也可以是一个“事件”。在这篇综述中，我们提出了一个阶段模型，其中不同的风险和保护因素导致工作人群中精神障碍的发作、短期病假的发作以及从短期到长期病假的过渡。我们还研究了在劳动力中管理精神障碍的策略，以期使员工重返工作岗位。我们在这篇综述中的目的是强调该领域的复杂性，激发辩论，并确定知识的重要差距，在这些差距中，进一步的研究可能会使患者和更广泛的社会受益。
