Work participation and mental health at work – The ADAPT research project

Background

Mental health problems, such as depression and anxiety, are common among working people. According to the World Health Organization, around 25–30% of people aged 18–65 in the EU/EEA experience such problems in any given year. In Sweden, mental health problems are a common cause of sick leave and a significant risk factor for reduced work capacity. At the same time, many people continue to work despite their symptoms, but the factors that determine who can remain in work are unclear. Possible explanations include individual differences in the need for sick leave, depending on symptom severity, whether the person receives treatment, and how effective they perceive it to be, as well as differences in job duties and working environment. The relationship between symptom severity, treatment, and work capacity is defined by a dynamic interaction. However, more research is needed to understand this complex interaction, both to reduce the number of sick leave cases and to prevent long-term sickness absence. 

Purpose

The project aimed to investigate factors that may explain differences in work participation, particularly with regard to mental health, mental work capacity, and psychosocial work characteristics, among working individuals in Sweden.

Method

The ADAPT project utilized a new instrument to measure work capacity, which was developed with a focus on investigating why work capacity is affected, specifically in individuals with mental health problems. The instrument was part of a web-based survey that also included questions about sociodemographic characteristics, general health, mental well-being, psychosocial work characteristics, and treatment. 

To measure work participation, survey responses were linked to register data on sick leave episodes exceeding 14 days during a one-year follow-up period.

Results

Cross-sectional analyses showed that:

- Low mental well-being and more strained work capacity were more common among women, especially in the younger age group (18–34 years). 

- Poor self-rated health was strongly associated with more strained work capacity in both women and men. The lower the mental well-being, the more strained one's work capacity was perceived to be. This association remained even when adjusted for sociodemographic characteristics, general health, and occupational position.

Prospective analyses showed that: 

- Gender, age, less strained mental work capacity, and a higher occupational position increased the likelihood of sustained work participation during the follow-up period among both women and men.

- Among women, mental well-being played a particularly important role in increasing the likelihood of sustained work participation. Women in managerial positions were also more likely to remain in work. These associations were not evident among men.

- We also investigated whether the association between sustained work participation and mental work capacity differed depending on the level of mental well-being. Such a pattern was observed among men, but not among women.

- No significant association was found between psychosocial work characteristics (e.g. the balance between job demands and control, or the occurrence of conflicts at work) and sustained work participation.

The researchers emphasize that due to the design of the study, the results cannot prove causal relationships. Nevertheless, they provide valuable insight into potential underlying patterns that may influence sustained work participation. This information is valuable for both further research and employers who wish to implement preventive strategies and enhance their employees' ability to remain in work.

Collaboration and funding

The project is a collaboration between researchers in public health science, work science, and sociology. It is funded by AFA Insurance and the Swedish Social Insurance Agency.