A conceptual framework for return to work for clients with major depressive disorder.

BACKGROUND: Return to work (RTW) may be a lengthy and complex process for individuals with major depressive disorder (MDD) especially when not well managed. This increases the risk of isolation and loss of routine which negatively influences their mental health. However, for clients with MDD, a comprehensive overview of all the factors that influence RTW based on a model of occupation is lacking. OBJECTIVE: To develop a conceptual framework to guide an occupation-based process of RTW for clients with MDD, treated in the private sector in South Africa. METHODS: This paper describes the development of a conceptual framework using literature and thematic synthesis of a qualitative descriptive study based on interviews with eight participants diagnosed with MDD which were linked to constructs of Kielhofner's Model of Human Occupation (MOHO). RESULTS: Qualitative data from key informant interviews were deductively analysed according to the subsystems of MOHO for waiting to RTW and experience of RTW. The conceptual framework developed included the constructs of Person and Occupational Setting from MOHO as well as the components of Occupational Identity and Competence central to intervention to achieve successful RTW. CONCLUSION: A successful RTW process for clients with MDD is dependent on the person and the occupational setting. The role of the occupational therapist in the RTW can be facilitated by the occupation-based conceptual framework developed on MOHO.

Validity and reliability of the HIV Disability Questionnaire for people living with HIV in South Africa.

This study determined the measurement properties of the HIV Disability Questionnaire (HDQ) on a sample of people living with HIV (PLWHIV) to validate this assessment in a resource-limited environment. A quantitative, descriptive, cross-sectional research design was used with PLWHIV on antiretroviral therapy (ART) for six months or more. Participants completed the HDQ, World Health Organisation Disability Assessment Scale (WHODAS 2.0) and the Medical Outcomes Study - Social Support Survey (MOS-SSS). Disability presence, severity and episodic scores on the HDQ were tested against the WHODAS 2.0 and MOS-SSS to determine convergent and divergent construct validity and internal consistency. Results for the HDQ were compared to four other populations from high-income countries. Of the sample of 498 participants, 68% were female, the median age was 41 years and 19% had a median of one concurrent health condition. Median HDQ scores were 24.63 for disability presence, 10.14 for disability severity and 15.94 for the episodic scale. Moderate correlations confirmed 92.8% of convergent a priori hypotheses, while 85.7% of divergent a priori hypotheses were accepted. Cronbach's alpha for the HDQ scales ranged from 0.89 to 0.84. Results from the HDQ differed from those determined in Canada, Ireland, the United States and the United Kingdom, with presence and severity scores for the South African sample being lower. Episodic scores were higher, which may be related to the socio-economic context. The HDQ is reliable and valid for disability determination and may be used as a rehabilitation outcome measure for PLWHIV in South Africa.