The association between team climate at work and mental health in the Finnish Health 2000 Study.

OBJECTIVES: Depression, anxiety and alcohol use disorders are common mental health problems in the working population. However, the team climate at work related to these disorders has not been studied using standardised interview methods and it is not known whether poor team climate predicts antidepressant use. This study investigated whether team climate at work was associated with DSM-IV depressive, anxiety and alcohol use disorders and subsequent antidepressant medication in a random sample of Finnish employees. METHODS: The nationally representative sample comprised 3347 employees aged 30-64 years. Team climate was measured with a self-assessment scale. Diagnoses of depressive, anxiety and alcohol use disorders were based on the Composite International Diagnostic Interview. Data on the purchase of antidepressant medication in a 3-year follow-up period were collected from a nationwide pharmaceutical register of the Social Insurance Institution. RESULTS: In the risk factor adjusted models, poor team climate at work was significantly associated with depressive disorders (OR 1.61, 95% CI 1.10 to 2.36) but not with alcohol use disorders. The significance of the association between team climate and anxiety disorders disappeared when the model was adjusted for job control and job demands. Poor team climate also predicted antidepressant medication (OR 1.53, 95% CI 1.02 to 2.30). CONCLUSION: A poor team climate at work is associated with depressive disorders and subsequent antidepressant use.

The effectiveness of vocationally oriented multidisciplinary intervention on sickness absence and early retirement among employees at risk: an observational study.

OBJECTIVE: To study the effect of a preventive vocationally oriented intervention on rates of sickness absence and disability pension in employees considered to be at risk of future work disability. DESIGN: An observational register-based study of public sector employees. SUBJECTS: 2236 intervention programme participants and 8944 matched controls were followed up for 8 years. METHODS: Multidisciplinary intervention was carried out at rehabilitation institutions. Data on demographics and sickness absences were obtained from employers' records and information about health at baseline, participation in the intervention and subsequent disability pension from national registers. RESULTS: Before the intervention participants had 17% more annual sick leave days and a 23% higher rate of absence spells lasting >21 days than controls. In the intervention year and 3 subsequent years, the sickness absence rate among participants reduced to that observed among controls but thereafter increased to the pre-intervention level (p for curvilinear trend <0.001 for absence days and 0.03 for absence spells). The association between the intervention and future disability pension was non-proportional among participants. Compared to controls, risk among participants was lower in the first 4 years of follow-up but thereafter returned to the previous higher level. The temporary decline in sickness absence attributable to the intervention totalled 6673 absence days per 1000 employees and the cumulative reduction in disability was 56.4 years. These direct health benefits may not fully cover the costs of the intervention. CONCLUSION: The risk of work disability can be temporarily reduced in employees at risk by means of a vocationally oriented multidisciplinary intervention programme.

Effects of multidisciplinary inpatient rehabilitation for chronic back or neck pain: a register-linkage study of sickness absences and analgesic purchases in an occupational cohort.

OBJECTIVE: To determine the effects of multidisciplinary in-patient rehabilitation for chronic back or neck pain on sickness absences and analgesic purchases. DESIGN: A prospective observational study. SETTING: 10 towns in Finland. PARTICIPANTS: 34 838 local government employees, including 418 participants in rehabilitation for chronic back pain and 195 participants in rehabilitation for chronic neck pain between 1994 and 2002. MAIN OUTCOME MEASURES: The annual rates of short (1-3 days), long (>3 days), and very long (>21 days) sickness absences and the defined daily doses (DDD) of prescribed analgesics. RESULTS: The rate of very long (>21 days) sickness absence among the chronic back pain rehabilitees was 3.03-fold (95% CI 2.55 to 3.60) compared to the non-rehabilitees in the year before rehabilitation. This ratio declined to 1.88 (95% CI 1.65 to 2.37) three years after rehabilitation. No further decline in the rate of very long sickness absence was observed in the subsequent years. For chronic neck pain rehabilitees, no evidence of the effectiveness of rehabilitation on sickness absence was found. In relation to consumption of analgesics, the mean rate of DDDs declined among the back and neck pain rehabilitees after rehabilitation compared to the non-rehabilitees. CONCLUSIONS: Multidisciplinary in-patient rehabilitation for chronic back pain may decrease the risk of very long sickness absence for three years. In relation to rehabilitation for chronic neck pain, no changes in sickness absences were found.