Interactions among stakehoklders involved in return to work after sick leave due to mental disorders: a meta-ethnography

Mental disorders cause impact in the work environment. Investigations of interaction among stakeholders who are involved in the return to work are scarce. Meta-ethnography serves to synthesize qualitative studies by means of ongoing interpretation and comparison of the ideas presented in the articles. The goal of this study is to present a meta-ethnography of the interactions among the stakeholders involved in the return to work process after leave of absence due to mental disorders. It aims: (1) to investigate the interactions among stakeholders involved in return to work; (2) to identify enablers or obstacles for the return to work. The database search found 619 articles, 16 of which met the inclusion criteria. Analysis of the articles revealed six second-order concepts that resulted in two syntheses. The first is about performance ethos in the return to work, and the second shows return to work as a catalyst of new life styles. Models that favor the worker’s performance ethos, as well as a perspective oriented by psychosocial aspects may enable return to work practices after leave of absence due to mental disorders.

Return to Work; Mental Disorders; Occupational Health; Qualitative Research

Authorship

Robson da Fonseca Neves

Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil. Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil. Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil.

Departamento de Fisioterapia, Universidade Federal da Paraíba, João Pessoa, Brasil. Departamento de Fisioterapia, Universidade Federal da Paraíba, João Pessoa, Brasil. Departamento de Fisioterapia, Universidade Federal da Paraíba, João Pessoa, Brasil.

Mônica de Oliveira Nunes

Lilian Magalhães

School of Occupational Therapy & Occupational Science Field, University of Western Ontario, London, Canada. School of Occupational Therapy & Occupational Science Field, University of Western Ontario, London, Canada. School of Occupational Therapy & Occupational Science Field, University of Western Ontario, London, Canada.

Correspondence
R. F. Neves. Rua Maneol Nóbrega Filho 20, casa 12, Cabedelo, PB 58102-290, Brasil. robsonfisioba@gmail.com

Contributors

R. F. Neves participated in the design of the project that originated the article, data analysis and interpretation, writing of the article, and approved the final version to be published. M. O. Nunes advised the broader project from which this article is derived, made the critical review of the academic content, and approved the final version to be published. L. Magalhães participated in the design and guided the investigation that led to this article, conducted the academic content critical review process, and approved the final version to be published.

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Figures | Tables

Figures (2)
Tables (1)

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Figure 1
Flowchart of the search, eligibility and inclusion process.

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Figure 2
Search process: keywords and keyword combinations.

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Table 1
Description of the selected articles and first-order concepts.

Figure 1 Flowchart of the search, eligibility and inclusion process.

Figure 2 Search process: keywords and keyword combinations.

Table 1 Description of the selected articles and first-order concepts.

Authors (country)	Aims	Participants	Data collection	Method of analysis	First-order concepts
Holmgren & Dahlin Ivanoff ¹⁸18. Holmgren K, Dahlin Ivanoff S. Women on sickness absence: views of possibilities and obstacles for returning to work. A focus group study. Disabil Rehabil 2004; 26:213-22. (Sweden)	Understanding how women on sick leave due to work-related stress perceive and describe possibilities and obstacles for the return to work	20 women on sick leave of less than 6 months due to work-related stress	Focus group	Method described in an abridged way citing Krueger (1998)	Management of the workload; Ideal type of a successful employee; Beliefs of others about the worker performance in return to work; Relational values at the workplace; Role of management levels; Relationships between employee and employer
Caveen et al. ³⁰30. Caveen M, Dewa C, Goering P. The influence of organizational factors on return-to-work outcomes. Can J Community Ment Health 2006; 25:121-42. (Canada)	Understanding the differences in the work environment, particularly the practices for the management of incapacity, and reflecting about how these differences may contribute for the return to work outcome variations	Occupational health nurses, incapacity case managers, assisting physicians or directors or members of the human resources team	Multiple-case studies combining quantitative and qualitative methods, focus groups and interviews	Categorization, thematization and triangulation as proposed by Miles & Huberman (1994)	Perceptions of the supervisor about the return to work; Public commitment of the managers with the return to work; Accommodation in the return to work; Mediation in the return to work; Mistrust about return to work
Saint-Arnaud et al. ²⁴24. Saint-Arnaud L, Saint-Jean M, Damasse J. Towards an enhanced understanding of factors involved in the return-to-work process of employees absent due to mental health problems. Can J Commun Ment Health 2006; 25:303-15. (Canada)	The aim of the study was to better understand the factors involved in the return to the labor market of individuals on leave of absence from work due to mental health disorder	25 women and 12 men who were on leave of absence from work due to a mental health problem between 1998-2001	Interviews	Thematic content analysis according to L’Écuyer (1990) and Bardin (1993)	Beliefs of others about performance of the worker who return to work; Relational values at the workplace; Negative image of the worker by coworkers; Role of management levels; Relationship between employee and employer; Health practitioner support for the return to work; Mistrust about return to work
Oostrom et al. ³²32. Oostrom SH, Anema JR, Terluin B, Venema A, Vet HCW, Mechelen W. Development of a workplace intervention for sick-listed employees with stress-related mental disorders: intervention mapping as a useful tool. BMC Health Serv Res 2007; 7:1-13. (The Netherlands)	Describe the “protocol of participative intervention at the workplace” adjustment process” for workers in sick leave due to mental disorders-related stress	Employees recently on sick leave due to mental disorders, supervisors, and occupational health professionals	Interview associated with focus group	Map of interventions according to Bartholomew et al. (2001)	Perceptions of the supervisor about the return to work; Role of management levels; Qualities of the return to work mediator
Verdonk et al. ²¹21. Verdonk P, de Rijk A, Klinge I, de Vries A. Sickness absence as an interactive process: gendered experiences of young, highly educated women with mental health problems. Patient Educ Couns 2008; 73:300-6. (The Netherlands)	To investigate how women play their roles at work, during sick leave and after their return to work	13 women with work-related psychological stress	Individual interview	Grounded theory	Workload management; Ideal type of a successful employee; Beliefs of others about the worker’s performance on the return to work; Moral considerations about the worker on return to work; Negative image of the worker by coworkers; Role of management levels; Importance of health professionals’ expertise
Cowls & Galloway ²⁸28. Cowls J, Galloway E. Understanding how traumatic re-enactment impacts the workplace: assisting clients’ successful return to work. Work 2009; 33: 401-11. (Canada)	To investigate how traumatic reconstruction may influence the work of an individual who suffered trauma out of the work environment, and also to investigate which return to work interventions are valued by clients with a history of trauma	25 workers in sick leave diagnosed with depression, anxiety and post-traumatic stress disorder	Semi-structured interview conducted over the phone	Grounded theory	Perceptions of the supervisor about the return to work; Health practitioner support for the return to work; Mediation for the return to work; Support for relapses; Cognitive approaches for the return to work; Coping strategies on the return to work
Pittam et al. ²⁵25. Pittam G, Boyce M, Secker J, Lockett H, Samele C. Employment advice in primary care: a realistic evaluation. Health Soc Care Community 2010; 18:598-606. (United Kingdom)	To investigate stakeholder perceptions on the impact of the Richmond Fellowship service	22 clients of the service; 4 general practitioners; 4 job advice experts	Semi-structures interview combined with focus group	Method described in an abridged way citing Pawson & Tilley (1997)	Beliefs of others about the worker’s performance on the return to work; Relationship between employee and employer; Role of the mediator on the return to work; Action of management levels on the return to work; Qualities of the mediator on the return to work
Lemieux et al. ²³23. Lemieux P, Durand M-J, Hong QN. Supervisors’ perception of the factors influencing the return to work of workers with common mental disorders. J Occup Rehabil 2011; 21:293-303. (Canada)	To document the perception of supervisors about the factors that facilitate or hamper the return to work of workers with mental disorders	11 supervisors who were accountable for leading the return to work of one or more workers with mental disorders	Semi-structured interview	Content analysis	Beliefs of others about the worker’s performance on the return to work; Perceptions of the supervisor about the return to work; Relational values at the work place; Unpleasant behavior on return to work; Role of management levels; Action of management levels on the return to work; Relationship between employee and employer; Health professionals expertise; Mediation for the return to work; Role of the mediator on the return to work
Noordik et al. ¹³13. Noordik E, Nieuwenhuijsen K, Varekamp I, van der Klink JJ, van Dijk FJ. Exploring the return-to-work process for workers partially returned to work and partially on long-term sick leave due to common mental disorders: a qualitative study. Disabil Rehabil 2011; 33:1625-35. (The Netherlands)	To describe the barriers for the return to work according to the workers’ perception	10 women and 4 men diagnosed with mental disorders who returned to work with 80% of the working hours	Semi-structured interview	Grounded theory	Workload management; Perceptions of the supervisor about the return to work; Moral considerations about the worker on return to work; Relational values at the work place; Role of management levels; Mistrust about return to work; Relationship between employee and employer; Health practitioner support for the return to work; Qualities of the mediator on the return to work
Olivier et al. ²⁶26. Olivier M, Perez C, Behr S. Trabalhadores afastados por transtornos mentais e de comportamento: o retorno ao ambiente de trabalho e suas consequências na vida laboral e pessoal de alguns bancários. Revista de Administração Contemporânea 2011; 15:993-1015. (Brazil)	To identify and describe the consequences of the occupational life of workers on the return to work after a sick leave period	12 women and 10 men in sick leave between 2006-2008	Semi-structured interview; Self-report (self- narrative)	Content analysis	Perceptions of the supervisor about the return to work; Relational values at the work place; Family and expanded network support; Rejection of the worker with mental disorders
Hatchard et al. ²²22. Hatchard K, Henderson J, Stanton S. Workers’ perspectives on self-directing mainstream return to work following acute mental illness: reflections on partnerships. Work 2012; 43:43-52. (Canada)	To assess the barriers and enablers affecting the self-referral of the worker on return to work after acute mental disorders	4 women and 1 man with mood disorder, post-traumatic stress disorder, and depression	Semi-structured interview	Interpretative phenomenological analysis	Perceptions of the supervisor about the return to work; Relational values at the work place; Health practitioner support for the return to work; Warm reception on return to work; Skepticism of coworkers; Trust in the coworkers; Family and expanded network support
Hees et al. ²⁷27. Hees HL, Nieuwenhuijsen K, Koeter MWJ, Bültmann U, Schene AH. Towards a new definition of return-to-work outcomes in common mental disorders from a multi-stakeholder perspective. PLoS One 2012; 7:1-7. (The Netherlands)	To identify the perspectives of the main stakeholders interested in what makes return to work successful after sick leave due to mental disorders	Workers in on sick leave, supervisors, occupational health doctors, and investigators	Focus group; Semi-structured interview over the phone	Combined quantitative and qualitative analysis, and content analysis	Perceptions of the supervisor about the return to work; Relational values at the work place; Positive beliefs of the supervisor about the worker who returns to work
Muijzer et al. ³¹31. Muijzer A, Brouwer S, Geertzen JH, Groothoff JW. Exploring factors relevant in the assessment of the return-to-work process of employees on long-term sickness absence due to a depressive disorder: a focus group study. BMC Public Health 2012; 12:103. (The Netherlands)	To investigate the relevant factors for the return to work by discussing incapacity benefit request after return to work	Labor specialists, Dutch Securities Institute	Focus group	Information not provided	Relationship between employee and employer
Nielsen et al. ¹⁹19. Nielsen MBD, Rugulies R, Hjortkjaer C, Bültmann U, Christensen U. Healing a vulnerable self: exploring return to work for women with mental health problems. Qual Health Res 2013; 23:302-12. (Denmark)	To investigate the experience of sick leave and subsequent return to work of women with mental disorders	16 women in sick leave who had requested benefit due to mental disorders	Semi-structured interview	Grounded theory	Workload management; Beliefs of others about the worker’s performance on the return to work; Perceptions of the supervisor about the return to work; Health practitioner support for the return to work
Vries et al. ²⁹29. Vries G, Hees HL, Koeter MWJ, Lagerveld SE, Schene AH. Perceived impeding factors for return-to-work after long-term sickness absence due to major depressive disorder: a concept mapping approach. PLoS One 2014; 9:1-10. (The Netherlands)	To expand the knowledge about modifiable personal and environmental factors preventing return to work after extended sick leave due to major depressive disorder	Supervisors, occupational health doctors, employees on sick leave	Discussion group	Concept mapping	Negative perception of worker by the supervisor; Beliefs about the personality of the worker who returns to work; Beliefs of others about the worker’s performance on the return to work
Corbière et al. ²⁰20. Corbière M, Renard M, St-Arnaud L, Coutu MF, Negrini A, Sauvé G, et al. Union perceptions of factors related to the return to work of employees with depression. J Occup Rehabil 2015; 25:335-47. (Canada)	To expand the understanding of return to work-related factors of workers on sick leave due to depression, under de perspective of union representatives	12 men and 11 women who are union representatives experienced in following up on the return to work	Focus groups	Theme analysis	Workload management; Beliefs of others about the worker’s performance on the return to work; Moral considerations about the worker on return to work; Perceptions of the supervisor about the return to work; Relational values at the work place; Role of management levels; Warm reception; Unpleasant behavior; Relationship between employee and employer; Health practitioner support for the return to work; Role of the mediator on the return to work

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Interactions among stakehoklders involved in return to work after sick leave due to mental disorders: a meta-ethnography

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[1] Correspondence
R. F. Neves. Rua Maneol Nóbrega Filho 20, casa 12, Cabedelo, PB 58102-290, Brasil. robsonfisioba@gmail.com