Negotiating Safety: Facilitation of Return to Work for Individuals Employed in High-Risk Occupations.

PURPOSE: Return-to-work (RTW) after absence due to a mental illness is a largely understudied area, especially in industries already struggling with retention like those posing unique and high risks for public or personal safety (i.e., pilots, police officers, and health professionals), otherwise known as safety-sensitive sectors. The goal of this paper is to examine how RTW coordinators work with individuals who took a leave of absence for mental illness in safety-sensitive occupations and navigate the RTW process. METHODS: Qualitative methodology was utilized to explore the experiences of 47 RTW coordinators who had worked with individuals employed in safety-sensitive industries. The participants were recruited across Canada using convenience sampling to participate in semi-structured interviews. The interviews were transcribed, anonymized, uploaded to NVIVO 11, and coded using inductive thematic analysis. RESULTS: Our analysis shows that despite the presumed rigidity of occupational health and safety standards for safety-sensitive positions, the notion of "safety" becomes ambiguous in navigating RTW processes, and concerns about safety are often interpreted as the potential risk workers may pose to themselves, other individuals, or the workplace image. Institutional constraints of safety-sensitive jobs shape the ability of RTW coordinators to advocate on behalf of the workers, ultimately placing the workers at a disadvantage by prioritizing safety concerns for organizations over employees' needs. CONCLUSION: It is important to consider how to protect workers in safety-sensitive occupations during the RTW process after absence due to a mental illness to ensure effective integration to the workplace.

A Standpoint Approach to Return-to-Work Coordination: Understanding Union Roles.

Purpose This study examined how the participation of union representatives impacted return-to-work (RTW) processes, and explored key activities undertaken by union representatives involved in return-to-work coordination. Methods Forty-seven RTW coordinators (RTWCs) participated in in-depth, semi-structured interviews in 2018 as part of a cross-Canadian study investigating their strategies for managing challenges in the RTW process. The study included RTWCs from a variety of organisation types, including unionized organizations. Audio-recordings were transcribed, coded, and analysed using constant case comparison and deviant case analysis leading to the development of findings themes. Results Our findings highlight the role of union representatives in RTW processes and how their activities are seen by other parties involved with work accommodation. First, we describe Union RTWC's administrative functions and the extent of their involvement in RTW accommodation negotiations. Second, we examine how Union and Non-union RTWCs framed the same RTW processes differently, according to their own accountabilities. Finally, we identify the positive ways that union participation figured into the RTW process, including playing a role in identifying viable modified work and serving as a trusted party to help reluctant workers engage with RTW plans. Conclusions We introduce a standpoint perspective to shed light on how Union and Non-union RTWCs approached accommodation issues and consider acknowledgement of power relations as a starting point for managing divergent interests.

The Integrated Health Hub (IHH) Model: The Evolution of a Community Based Primary Care and Mental Health Centre.

There is increasing demand for comprehensive community healthcare that integrates community mental health and primary care services. The Canadian Mental Health Association-Durham Branch provides an example of how the Integrated Health Hub (IHH) Model evolved organically to meet this need. The Framework Method was used to analyze interviews and focus groups with 29 participants. Results reveal five key domains critical to the development of the IHH Model (1) Communication; (2) Hub 'Nuances'; (3) Leadership; (4) Staff; and (5) Challenges. These findings provide insights for other community mental health organizations wishing to provide comprehensive integrated community healthcare services.

Correction to: The Integrated Health Hub (IHH) Model: The Evolution of a Community Based Primary Care and Mental Health Centre.

The original version of this article unfortunately contained a mistake in the co-author name. The co-author name should be Stephanie Skopyk instead it was published incorrectly as Stephanie Skoypk.

Interventions for Women With Substance Abuse Issues: A Scoping Review.

OBJECTIVE: The aim of this scoping review was to describe the characteristics and features of substance abuse interventions for women in North America and discuss the findings from an occupational perspective. METHOD: A scoping review was conducted to examine North American peer-reviewed literature published between 2001 and 2014. Four databases were searched using terms related to intervention, substance abuse, and women only. Descriptive statistics of categorical groupings were used to describe the data sources and characteristics and features of the interventions. RESULTS: Forty-two articles met the inclusion criteria, with the majority citing a harm-reduction approach and using multifaceted interventions with various targets for change. CONCLUSION: Substance abuse interventions for women are typically multifaceted and follow a harm-reduction philosophy. Further research into the efficacy of interventions that more specifically target occupation beyond substance use is needed.

The Sociopolitical Context of Canada's National Standard for Psychological Health and Safety in the Workplace: Navigating Policy Implementation.

In January 2013, Canada introduced the National Standard for Psychological Health and Safety in the Workplace. This paper describes how the standard, which is the first of its kind internationally, came to be the instrument of choice within the current Canadian sociopolitical climate. A key consideration was that the policy tool had to be packaged in a manner that would be accessible and relevant across all workplaces and across all provinces and territories. This paper explores possibilities for future regulation of the standard.

Meta-analyses with industry involvement are massively published and report no caveats for antidepressants.

OBJECTIVES: To identify the impact of industry involvement in the publication and interpretation of meta-analyses of antidepressant trials in depression. STUDY DESIGN AND SETTING: Using MEDLINE, we identified all meta-analyses evaluating antidepressants for depression published in January 2007-March 2014. We extracted data pertaining to author affiliations, conflicts of interest, and whether the conclusion of the abstract included negative statements on whether the antidepressant(s) were effective or safe. RESULTS: We identified 185 eligible meta-analyses. Fifty-four meta-analyses (29%) had authors who were employees of the assessed drug manufacturer, and 147 (79%) had some industry link (sponsorship or authors who were industry employees and/or had conflicts of interest). Only 58 meta-analyses (31%) had negative statements in the concluding statement of the abstract. Meta-analyses including an author who were employees of the manufacturer of the assessed drug were 22-fold less likely to have negative statements about the drug than other meta-analyses [1/54 (2%) vs. 57/131 (44%); P < 0.001]. CONCLUSION: There is a massive production of meta-analyses of antidepressants for depression authored by or linked to the industry, and they almost never report any caveats about antidepressants in their abstracts. Our findings add a note of caution for meta-analyses with ties to the manufacturers of the assessed products.

Measures of patients' expectations about recovery: a systematic review.

INTRODUCTION: Patients' expectations regarding their prognosis has been shown to affect recovery. We completed a systematic review to identify measures that assess patients' expectations of recovery. METHODS: Eligible studies explored the association between patients' expectations of recovery, and return to work or claim resolution. We searched electronic databases (MEDLINE and PSYCInfo) from inception to June 21, 2014, bibliographies of eligible studies, relevant systematic reviews and our personal files. Reviewers determined study eligibility and study quality, and completed data extraction. RESULTS: Of 14,509 unique citations, 46 studies were eligible with majority of the studies (n = 27; 59 %) rated as low quality, primarily due to substantial missing data and inappropriate adjustment for age, gender and illness severity in their regression models. We identified 5 measures and 41 individual items assessing recovery expectations. Three of seven (43 %) studies using a measure to assess recovery expectations reported psychometric properties, with only one reporting both reliability and construct validity. Only two measures (Expectations of Recovery Scale and the Work-related Recovery Expectations Questionnaire) were externally validated in different populations. Overall, 44 (96 %) studies found that patient recovery expectations was a significant predictor of return to work or sick leave/disability claim resolution. CONCLUSIONS: Very few studies assessing recovery expectations use a psychometrically valid measure. Current evidence suggests that patients with lower recovery expectations are less likely to resolve their disability claim or return to work versus patients with higher recovery expectations. Further validation of existing measures for assessing patient recovery expectations, or development of a new measure that addresses the limitations of existing ones, is required.

Measures of Symptom Exaggeration for Mental Health Disorders: A Systematic Review.

Introduction .- Measures that help detect exaggeration of symptoms can be valuable for informing more accurate diagnoses and aid in treatment and case management. We completed a systematic review to identify measures that assess symptom exaggeration in mental health disorders. Methods .- Eligible studies assessed exaggeration of symptoms with a psychometrically validated measure in patients presenting with a mental health disorder. We searched MEDLINE and PsycINFO from inception to June 2013 for relevant studies. To determine study eligibility, reviewers screened title and abstracts of identified citations, and reviewed full texts of all potentially eligible citations. Data extractors completed data abstraction of eligible studies. Results .- Of 8435 unique citations, 105 studies consisting of 112 cohorts were eligible, and we identified 36 unique, validated measures assessing exaggeration of symptoms. The most frequently used measures were symptom validity indicators embedded in the Minnesota Multiphasic Personality Inventory (MMPI-2) (n=48, 46%), the Structured Interview of Reported Symptoms (SIRS) (n=12, 11%), and the Personality Assessment Inventory (PAI) (n=11, 10%). Most studies (n=96; 91%) failed to test reliability of their measure of symptom exaggeration. The symptom validity indicators in the MMPI/MMPI-2 and the SIRS both showed moderate to high internal consistency, range 0.47 to 0.85 and 0.48 to 0.95, respectively. Conclusions .- Multiple measures assessing symptom exaggeration have been used in patients with mental health disorders. The symptom validity indicators of the MMPI/MMPI-2 are the most widely used measures to assess symptom exaggeration. Assessment and reporting of reliability is poor across studies; we require further assessment of psychometric properties for existing measures of symptom exaggeration.

Workplace antistigma initiatives: a scoping study.

OBJECTIVE: The purpose of this scoping study was to identify and describe the principles and characteristics embedded in workplace mental health antistigma initiatives. Research in this area is diffuse and not well synthesized. Therefore, a scoping study is useful in generating a breadth of coverage and identifying all relevant literature on the topic regardless of study design. Results will inform evaluation strategies and can be used to distinguish the effectiveness of particular elements in future research. METHODS: The "York Framework," a five-stage methodological design (with an optional sixth stage) was used as the structure for this study. Eleven peer-reviewed and gray-literature databases were searched (2000-2011), and an extensive Internet review was also conducted. Two reviewers independently reviewed all abstracts to determine study selection. A data chart consisting of key issues and themes was utilized to extract data from the included studies. Preliminary results were used to inform a stakeholder consultation with seven international experts. RESULTS: Twenty-two antistigma interventions were included in the study. Most of the initiatives have appeared in the past four years and across geographic boundaries, reflecting the growing international interest in mental health in the workplace. A large proportion of the interventions utilize educational approaches to reducing stigma, and a substantial number target military personnel. CONCLUSIONS: Stronger evidence for effective practices needs to be established through the use of standardized workplace-specific interventions, reliable and valid evaluation tools, and overall enhanced scientific rigor.