Building blocks for return to work after sick leave due to depression

Major depressive disorder (MDD) has a high prevalence among the working population and is well known to have adverse effects on employees work performance. This thesis examines the effectiveness of an occupational therapy intervention on return to work and predictors of impaired work functioning. Using qualitative studies it also assessed perceived promoting and impeding factors, and cultural differences on return to work. The aim of the occupational therapy intervention, developed at the Academic Medical Centre in Amsterdam, was to improve early return to work and the ability to cope with work place stress. The addition of this new intervention to treatment as usual, did not improve an early return to work, but did improve return to work in good health. However, employees who reached a substantial return to work, i.e. 90% based on their original contract hours, still showed impaired work functioning. Personality characteristics were the strongest predictor of this impaired work functioning. With regard to the return to work process stakeholders involved - employees, supervisors and occupational physicians - generated 60 factors that promote and 60 factors that impede return to work. In both studies, these are grouped in factors pertaining to the employee’s personal, work and healthcare environment. Comparing promoting factors in The Netherlands with those in Suriname, identified three main cultural differences, pertaining to the employee’s needs, the supervisor’s tasks and the importance of social networks. Previous studies reveal the need for a multifactorial approach to the RTW process. A guideline based on promoting and impeding factors may support this approach. Studies also underline the importance of good cooperation between stakeholders and the importance of additional support for employees vulnerable to impaired work functioning