Having mental health problems but not sickness absent: factors of importance among privately employed

Abstract Background Knowledge is scarce on individuals who are experiencing mental health problems but who have low or no sickness absence (SA). The aim of this study was to identify individual-level characteristics, including sociodemographic factors, morbidity, and lifestyle, among privately employed individuals with previous depression/anxiety but no SA during follow-up. Methods This prospective cohort study included 750 twin individuals born in Sweden in 1959-1986, employed in the private sector and with a history of depression/anxiety. Depending on the birth year, the twins were invited to participate in two different health-screening surveys in 2005, when study participants were aged 19-20 or 20-30, respectively. Survey data were used to evaluate depression and anxiety, self-rated health, stressful life events, emotional neglect, level of physical activity, and alcohol use. Study participants were prospectively followed regarding SA occurrence between 2006 and 2018. Data on SA, sociodemographic factors, outpatient healthcare use, and use of prescribed antidepressants were obtained from the Swedish national registries. Descriptive statistics will be reported with further analyses for the presentation. Results Preliminary results showed that despite previous depression or anxiety, 35% of women and 52% of men were not on SA during the follow-up period. Those who had no SA during follow-up were more likely to have higher education >12 years (49%), experienced fewer stressful life events (43%) and emotional neglect (56%), had better self-rated health (95%), along with a lower use of antidepressants (11%) and outpatient healthcare (88%), as compared with those on SA (33%, 65%, 66%, 90%, 17%, and 98%, respectively). Conclusions Higher education, being male, fewer life adversities, good self-rated health and low use of antidepressants and outpatient healthcare were individual-level factors of importance for those with previous depression or anxiety and no incident SA during follow-up. Key messages Individuals with previous depression/anxiety, but not sickness absent, were more likely to have higher education, be male, and have lower morbidity, as compared to individuals on sickness absence. Identification of factors that prevent sickness absence among those with mental health problems may potentially be used to improve sickness absence prevention strategies.


Background:
Research suggest migrants are at higher risk of mental health (MH) disorders in the post-partum (PP), while they have less access to care. However, MH need and care have been studied separately, descendants have been, mostly, excluded and migrants, studied as a homogeneous group. We aim to assess differences in MH care use between Danish-born, migrants and descendants in the PP after a MH need is identified; and to characterize migrants at lowest risk of accessing MH care.

Methods:
This retrospective cohort study includes 45571 women who gave birth from 2002 to 2018 in Denmark and had a MH need identified by a nurse in the PP program. MH care use, from delivery to two years PP, was retrieved from national registries and includes contacts with the general practitioner, psychologist, psychiatrist, emergency room, hospitalization, and medication expedition.

Conclusions:
There is a gap in PP MH care between Danish-born women, who show higher and earlier access to care, and migrants and descendants. Refugee background, length of residency and origin impact migrant's MH care use and should be considered.

Key messages:
Unmet need for MH care is higher for migrants and descendants than for Danish-born in the postpartum. MH care use differ among migrants and tailored strategies of care provision could be beneficial.

Background:
Knowledge is scarce on individuals who are experiencing mental health problems but who have low or no sickness absence (SA). The aim of this study was to identify individuallevel characteristics, including sociodemographic factors, morbidity, and lifestyle, among privately employed individuals with previous depression/anxiety but no SA during follow-up.

Methods:
This prospective cohort study included 750 twin individuals born in Sweden in 1959-1986, employed in the private sector and with a history of depression/anxiety. Depending on the birth year, the twins were invited to participate in two different health-screening surveys in 2005, when study participants were aged 19-20 or 20-30, respectively. Survey data were used to evaluate depression and anxiety, self-rated health, stressful life events, emotional neglect, level of physical activity, and alcohol use. Study participants were prospectively followed regarding SA occurrence between 2006 and 2018. Data on SA, sociodemographic factors, outpatient healthcare use, and use of prescribed antidepressants were obtained from the Swedish national registries. Descriptive statistics will be reported with further analyses for the presentation.

Introduction:
Jobs characterized by low to moderate job demands and high job resources are associated with better work outcomes among healthy workers, yet it remains unclear whether this is the case for workers with depression. This study examined whether depression moderates the relationship between job demands, job resources, and maintaining employment.

Methods:
Data from the longitudinal population-based Lifelines cohort study were matched with register data on employment status from Statistics Netherlands (n = 55,950). The two-way interaction between job demands and depression and the three-way interaction between job demands, job resources and depression were examined in a zero-inflated Poisson regression model with path 1 including a binary employment outcome and path 2 a count variable including months out of employment.

Results:
The interaction effect of job demands and depression on being employed was significant (b = -0.22, 95% CI: -0.44; 0.01), showing that workers without depression were more likely to be employed whereas workers with depression were less likely to be employed if they had high job demands. The three-way interaction between job demands, job resources, and depression was significant for months out of employment (b = 0.15, 95% CI: 0.01; 0.29), indicating that workers with depression had more months out of employment when reporting high job demands and high job resources compared to workers without depression.

Discussion:
Although increasing resources to prevent negative work outcomes may be beneficial for workers without depression, this approach might be limited for the vulnerable subgroup of workers with depression. Key messages: While job demands are associated with a higher likelihood of employment during follow-up for workers without depression, this is not the case for workers with depression. Job resources do not help workers with depression who face high job demands.

Background:
Public mental health (PMH) services address social determinants of mental health, such as poverty, poor housing, and job insecurity. Austerity and welfare reform in the UK has led to cuts to social and welfare support, increasing poor mental health and widening inequalities, exacerbated by COVID-19. State health services lack capacity to tackle social issues that contribute to a large proportion of expressed mental health need. Co-locating PMH services within community spaces is a potential solution to increase early access and improve quality of services. Using a realist evaluation, we sought to develop the theory on how community co-location affects PMH outcomes, who this works best for, and how this is impacted by the context of delivery.

Methods:
We collected data from service-users and service-providers at six case study sites across England, UK, using interviews (n = 62), four focus groups (n = 40) and two stakeholder workshops (n = 19).

Results:
We identified four overarching theories. First, community providers do not operate under the same limits as state services allowing them the flexibility and time to build trust and ongoing relationships with service users. Second, the ethos and culture of services is to empower users to access help and be independent. Third, accessing support from a shared local space allows a coordinated and holistic response reducing barriers such as distance, cost, and anxiety. Four, as they are recreational services and spaces for access by all with no predefined/required level of need they are better at promoting wellbeing and primary prevention.

Conclusions:
Community co-location of PMH services can strengthen the overall mental health system by widening reach to people vulnerable to poor mental health and enabling earlier intervention on associated social determinants. This has potential to reduce mental health inequalities and demand on the state health system. Key messages: Community co-location of PMH services can provide early and holistic support for complex social issues. There is potential to support the state health system by alleviating demand for help with 'non-health' issues.
15th European Public Health Conference 2022