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Cost-effectiveness analyses of new cancer treatments in real-world settings (e.g., post-clinical trials) inform healthcare decision makers about their healthcare investments for patient populations. The results of these analyses are often, though not always, presented with statistical uncertainty. This paper identifies five ways to characterize statistical uncertainty: (1) a 95% confidence interval (CI) for the incremental cost-effectiveness ratio (ICER); (2) a 95% CI for the incremental net benefit (INB); (3) an INB by willingness-to-pay (WTP) plot; (4) a cost-effectiveness acceptability curve (CEAC); and (5) a cost-effectiveness scatterplot. It also explores their usage in 22 articles previously identified by a rapid review of real-world cost effectiveness of novel cancer treatments. Seventy-seven percent of these articles presented uncertainty results. The majority those papers (59%) used administrative data to inform their analyses while the remaining were conducted using models. Cost-effectiveness scatterplots were the most commonly used method (34.3%), with 40% indicating high levels of statistical uncertainty, suggesting the possibility of a qualitatively different result from the estimate given. Understanding the necessity for and the meaning of uncertainty in real-world cost-effectiveness analysis will strengthen knowledge translation efforts to improve patient outcomes in an efficient manner.

Since the 1980s, college students in the U.S. have self-reported a decline in their physical and emotional health. With these conditions compounded by the COVID-19 pandemic and its physical distancing restrictions, higher education institutions have an increased responsibility to establish strategic interventions and health-promoting programs for their students. Research collaborations between public health professionals and environmental designers have highlighted the benefits of environmental factors, such as wildlife, street trees, and public parks, on mental health. This pilot project aims to build upon the transdisciplinary dialogue between ecology, design, and public health by examining the social benefits of grazing lawnscape management, which is the practice of using herbivorous livestock to manage turfgrass areas. Through the design of an accessible central campus grazing space for a flock of 25 sheep and use of online questionnaires, a smartphone-based single-item survey, and open-ended feedback given via social media, the UC Davis Sheepmower Project addresses three primary questions: (1) Are there differences in self-reported stress levels and well-being between people who did not watch grazing sheep (no sheepmower group) compared with those who did watch grazing sheep (sheepmower group)? (2) Does holding sheep grazing events create opportunities for education about well-being and engagement with the campus community? (3) Can this type of urban grazing installation ultimately contribute to the overall identity of a college campus? Web-based questionnaire results indicate there is no significant difference in self-reported stress levels between the two groups; however, the moment-in-time smartphone-based single item question suggests that the presence of sheep provides temporary, noticeable relief and enhanced mood for those who observe the animals. Reflections posted on social media suggested that participants found the sheep grazing events fostered feelings of community and placemaking within the campus identity. However, the questionnaire sample indicated the grazing events did not have a significant effect on participants' sense of place or overall campus identity. This transdisciplinary effort breaks down traditionally siloed approaches to human and environmental health and is an example of a whole-systems approach to developing innovative solutions and encouraging applied collective action.

Acts of violence are the fifth leading cause of nonfatal occupational injuries in the United States. Experiencing a traumatic event at work can have serious mental health consequences, including the development of posttraumatic stress disorder (PTSD). This study aimed to quantify the prevalence of PTSD caused by workplace violence (WPV) in a statewide workers' compensation system and compare the outcomes and treatment of WPV cases versus those caused by other traumatic events. Using a retrospective cohort study design, workers who reported PTSD as the primary reason for a workers' compensation claim and had no coexisting physical injuries were found in California during 2009-2018. A total of 3,772 PTSD cases were identified, 48.9% of which were attributed to WPV. Demographic risk factors associated with WPV PTSD included lower income, younger age, female gender, and employment in retail or finance, p < .001-p = .007. For individuals who returned to work, claims due to WPV resulted in longer medically approved time away from work than non-WPV causes (Mdn = 132.5 days vs. Mdn = 91 days, respectively), p < .001. Three of the top 10 most frequently prescribed medications were administered against evidence-based guidelines. This study found that many treatments prescribed to PTSD patients are based on insufficient evidence, and the provision of existing empirically supported treatments is needed, particularly in generalized populations. The findings support the need for additional recognition of the cause of workplace PTSD to facilitate appropriate referrals to WPV or PTSD specialists to support return-to-work efforts.

Cost-effectiveness analysis (CE Analysis) provides evidence about the incremental gains in patient outcomes costs from new treatments and interventions in cancer care. The utilization of "real-world" data allows these analyses to better reflect differences in costs and effects for actual patient populations with comorbidities and a range of ages as opposed to randomized controlled trials, which use a restricted population. This rapid review was done through PubMed and Google Scholar in July 2022. Relevant articles were summarized and data extracted to summarize changes in costs (in 2022 CAD) and effectiveness in cancer care once funded by the Canadian government payer system. We conducted statistical analyses to examine the differences between means and medians of costs, effects, and incremental cost effectiveness ratios (ICERs). Twenty-two studies were selected for review. Of those, the majority performed a CE Analysis on cancer drugs. Real-world cancer drug studies had significantly higher costs and effects than non-drug therapies. Studies that utilized a model to project longer time-horizons saw significantly smaller ICER values for the treatments they examined. Further, differences in drug costs increased over time. This review highlights the importance of performing real-world CE Analysis on cancer treatments to better understand their costs and impacts on a general patient population.

Cost-effectiveness analysis, the most common type of economic evaluation, estimates a new option's additional outcome in relation to its extra costs. This is crucial to study within the clinical setting because funding for new treatments and interventions is often linked to whether there is evidence showing they are a good use of resources. This article describes how to analyze a cost-effectiveness dataset using the framework of a net benefit regression. The process of creating estimates and characterizing uncertainty is demonstrated using a hypothetical dataset. The results are explained and illustrated using graphs commonly employed in cost-effectiveness analyses. We conclude with a call to action for researchers to do more person-level cost-effectiveness analysis to produce evidence of the value of new treatments and interventions. Researchers can utilize cost-effectiveness analysis to compare new and existing treatment mechanisms.

BackgroundSmoking among patients diagnosed with cancer poses important health and financial challenges including reduced effectiveness of expensive cancer therapies. This study explores the value of smoking cessation programs (SCPs) for patients already diagnosed with cancer. It also identifies conditions under which SPCs may be wise investments.MethodsUsing a simplified decision analytic model combined with insights from a literature review, we explored the cost-effectiveness of SCPs.ResultsThe findings provide insights about the potential impact of cessation probabilities among cancer patients in SCPs and the potential impact of SCPs on cancer patients' lives.ConclusionThe evidence suggests that there is good reason to believe that SCPs are an economically attractive way to improve outcomes for cancer patients when SCPs are offered in conjunction with standard cancer care.

BackgroundThe reopening of college and university campuses was seen as presenting a high risk for transmission of COVID-19. Thus, these institutions faced with a new public health challenge never heretofore faced on this scale. To magnify the problem, they needed to rapidly develop and implement re-opening plans in an environment filled with uncertainty and for a population that was significantly less likely to observe COVID-19 mitigation behaviors. In response, within three weeks of opening, as part of its COVID-19 public health strategy, a West Coast university created and trained a public health workforce comprised of 282 undergraduates tasked with encouraging compliance with COVID-19 mitigating healthy behaviors.Main objectivesThis paper describes the use and outcomes of a practicum framework to quickly create a university-based public health workforce. It addresses two questions: (1) Using a practicum framework, what are important considerations in designing and building a public health workforce for a university campus? and (2) What are the benefits to the workforce in terms of public health education and professional growth?MethodsProgram administrative data were used to describe the workforce and their learning outcomes.ResultsThe majority of students indicated that through the practicum, they learned new skills/developed new attitudes (71.7%) and became aware of their own strengths and opportunities for professional growth (73.7%). The types of new skills and attitudes learned included communication (49.2%), conflict management (20.4%), time management (7.5%), and open-mindedness/less judgmental attitude (14.6%). In terms of public health, they gained an understanding of infectious disease prevention (40.9%) that is multi-disciplinary (20.5%), and involves a community effort (36.8%).ConclusionsThese findings demonstrate an effective way of rapidly addressing public health concerns that allowed for on the job training and opportunities for young adults to learn and grow. The practicum framework allowed the expeditious development of a public health workforce that ensured a fit between student interests and the role. This led to high retention with the majority of students continuing into the winter quarter. Only 5% of students reported not being satisfied with their position. None of the students contracted job-related COVID-19. The role gave students a sense of purpose during the pandemic's uncertain times that helped to protect them from the negative effects of stress. The practicum structure and support fostered a safe environment in which students were able to feel part of the larger community while gaining valuable work experience and skills and serve their community.

BackgroundDepression is the greatest contributor to worldwide disability. The purpose of this study was to understand the influence of antidepressant and psychotherapy treatment adherence on future work leaves for patients with major depressive disorder.MethodsPatients with a newly diagnosed major depressive disorder (n = 26,256) were identified in IBM® Watson™ MarketScan® medical and disability claims databases. Antidepressant and psychotherapy adherence metrics were evaluated in the acute phase of treatment, defined as the 114 days following the depression diagnosis. Multiple variable Cox proportional hazards regression models evaluated the influence of antidepressant and/or psychotherapy adherence on future injury or illness work leaves.ResultsThe majority of work leaves in the 2-year follow-up period occurred in the acute phase of treatment (71.2%). Among patients without a work leave in the acute phase and who received antidepressants and/or psychotherapy (n = 19,994), those who were adherent to antidepressant or psychotherapy treatment in the acute phase had a 16% (HR = 0.84, 95% CI = 0.77-0.91) reduced risk of a future work leave compared to treatment non-adherent patients. Patients who were non-adherent or adherent to antidepressant treatment had a 22% (HR = 1.22, 95% CI = 1.11-1.35) and 13% (HR = 1.13, 95% CI = 1.01-1.27) greater risk of a future work leave, respectively, than patients not receiving antidepressant treatment. Conversely, patients who were non-adherent or adherent to psychotherapy treatment had a 9% (HR = 0.91, 95% CI = 0.81-1.02) and 28% (HR = 0.72, 95% CI = 0.64-0.82) reduced risk of a future work leave, respectively, than patients not receiving psychotherapy treatment.ConclusionsThis analysis suggests that treatment adherence may reduce the likelihood of a future work leave for patients with newly diagnosed major depressive disorder. Psychotherapy appears more effective than antidepressants in reducing the risk of a future work leave.

ObjectivesTo examine the influence of depression and/or anxiety on work leaves and the impact of work leaves on experiencing a new-onset depression and/or anxiety disorder.MethodsIBM's MarketScan® research databases were linked to investigate depressive and anxiety disorders in workers with a work leave due to an injury or non-mental health illness (n = 467,930) and without a work leave (n = 2,764,447).ResultsThe odds of a work leave within a year were 2.10 times higher (95%CI: 2.08-2.13) in individuals with depression and/or anxiety compared to those without. The odds of developing a new-onset depression and/or anxiety within a year was 4.21 times higher (95% CI: 4.14-4.27) in individuals with a work leave compared to those without.ConclusionDepression and anxiety are both risk factors for and subsequent outcomes of injuries or illnesses that require a work leave.

BackgroundStigma can be a barrier for workers experiencing a mental illness to access accommodations at work. However, work accommodations may be necessary to maintain a worker's ability to work. Therefore, it may be important to develop effective interventions to address workplace stigma.ObjectiveTo determine (1) what proportion of workers would probably disclose their mental health issue to their manager, (2) what are the motivating factors for the decision of whether or not to disclose, and (3) what would potentially change the disclosure decision?MethodsA link to a Web-based questionnaire was sent to a nationally representative sample of 1671 Dutch adults over 18 years of age. The response rate was 74%. We focused on the 892 respondents who indicated they were either employed for pay or looking for employment, not in management positions, and never experienced a mental health issue. This group comprised 73% of the total sample. They were asked if they would disclose their mental health issue to their manager. For what reasons would they disclose/not disclose the issue? And, what could change their decision?ResultsWe found that almost 75% of workers would disclose to their managers. The perceived relationship with their managers and feelings of responsibility to their workplaces were important contributors to the decision. A large minority of workers would not tell, preferring to deal with their issues alone. In addition, a significant proportion of workers would choose not to disclose fearing negative consequences.ConclusionOur results indicate that the majority of these Dutch workers would disclose a mental health issue to their managers. The relationship with the manager plays a central role. The advice from a trusted individual and the experiences of colleagues are also significant factors in the disclosure decision.

Mental health courts were created to help criminal defendants who have a mental illness that significantly contributes to their criminal offense. The purpose of this systematic literature review is to assess the current evidence to address the question, "How effective are mental health courts in reducing recidivism and police contact?" Systematic literature searches of eight electronic databases were performed. A total of 2590 unique citations were identified. Of these, 20 studies were included in the final analysis. The results of this systematic review suggest there is some evidence to show that mental health courts help to reduce recidivism rates, but the effect on police contact is less clear. Results also suggest case managers or access to vocational and housing services may be important components of effective mental health courts.

BackgroundEconomic evaluations commonly accompany trials of new treatments or interventions; however, regression methods and their corresponding advantages for the analysis of cost-effectiveness data are not widely appreciated.MethodsTo illustrate regression-based economic evaluation, we review a cost-effectiveness analysis conducted by the Canadian Cancer Trials Group's Committee on Economic Analysis and implement net benefit regression.ResultsNet benefit regression offers a simple option for cost-effectiveness analyses of person-level data. By placing economic evaluation in a regression framework, regression-based techniques can facilitate the analysis and provide simple solutions to commonly encountered challenges (e.g., the need to adjust for potential confounders, identify key patient subgroups, and/or summarize "challenging" findings, like when a more effective regimen has the potential to be cost-saving).ConclusionsEconomic evaluations of patient-level data (e.g., from a clinical trial) can use net benefit regression to facilitate analysis and enhance results.

ObjectiveHeterogeneity of depression experiences has led to suggestions that interventions focus on depression symptom combinations rather than depression severity alone. Our analyses explore the question, "What is the relationship between different combinations of depression symptoms and work productivity losses?"MethodsThese analyses use a population-based sample of 2219 working adults. Using the PHQ-8 items, cluster analysis methods were used to identify depression symptom clusters. The Work Limitations Questionnaire's four work productivity loss dimensions were regressed on the identified depression symptoms clusters.ResultsThe symptoms clusters of workers with mild to moderate depression had significant but similar work productivity losses. However, the symptom combinations within these clusters of workers varied.ConclusionTo create effective work accommodations, attention should focus on the combinations of depression symptoms and specific job characteristics rather than severity alone.

ContextDespite the high prevalence of work disability due to common mental disorders (CMD), no information exists on the rates and predictors of recurrence in a United States population.ObjectiveTo estimate recurrent work disability statistics and evaluate factors associated with recurrence due to CMDs including adjustment, anxiety, bipolar, and depressive disorders.MethodsRecurrent work disability statistics were calculated using a nationwide database of disability claims. For the CMDs, univariate and multiple variable analyses were used to examine demographic factors and comorbidities associated with the time to recurrence.ResultsOf the CMDs, cases with bipolar (n = 3,017) and depressive disorders (n = 20,058) had the highest recurrence densities, 98.7 and 70.9 per 1000 person-years, respectively. These rates were more than three times higher than recurrence rates for other chronic disorders (e.g., diabetes, asthma; n = 105,558) and non-chronic disorders (e.g., injury, acute illnesses; n = 153,786). Individuals with CMD were also more likely to have a subsequent disability distinct from their mental health condition. Risk factors for recurrent CMD disability included being younger, being an hourly employee, living in a geographic area with more college graduates, having more previous psychiatric visits, having a previous work leave, and the type of work industry.ConclusionsResults indicate that CMD patients may benefit from additional care and disability management both during and after their work absence to help prevent subsequent CMD and non-CMD related leaves.

PurposePeople with mental illnesses are at a significantly greater risk of police arrest than the general population. This pattern of arrests has been associated with a phenomenon referred to as the criminalization of mental illness such that people with mental illnesses are inappropriately diverted to the criminal justice system rather than to treatment. To decrease arrests of people with mental illnesses experiencing a crisis, pre-booking diversion programs have been developed to intervene at the point of police contact. This systematic literature review examines the state of knowledge regarding the effectiveness of police-based pre-booking diversion programs by addressing the question, "What is the evidence for the effectiveness of police-based pre-booking diversion programs in reducing arrests (i.e., reducing criminalization) of people with mental illnesses?"MethodsSystematic literature searches of seven databases were performed during May 2017. The searches sought to identify studies that examined the effectiveness of pre-booking diversion programs in decreasing arrests. A multi-phase screening process was completed independently by two pairs of reviewers as well as a risk of bias review.ResultsA total of 2,750 unique citations were identified. Of these, 4 met the inclusion/exclusion criteria; all were from the US. Three of the studies examined the effectiveness of Crisis Intervention Teams and one study looked at a mobile crisis program. Two of the studies were at moderate risk of bias and two at high risk.ConclusionsThis review indicates that this line of inquiry is still developing. There are a number of gaps yet to be filled. The current evidence for the effectiveness of police-based pre-booking diversion programs in reducing arrests (i.e., reducing criminalization) of people with mental illnesses is limited. However, these studies indicate there is moderate evidence that these programs increase linkages to mental health services.

BackgroundThere has been increasing interest in examining the relationship between physician wellbeing and quality of patient care. However, few reviews have specifically focused on resident burnout and quality of patient care. The purpose of this systematic literature review of the current scientific literature is to address the question, "How does resident burnout affect the quality of healthcare related to the dimensions of acceptability and safety?"MethodsThis systematic literature review uses a multi-step screening process of publicly available peer-reviewed studies from five electronic databases: (1) Medline Current, (2) Medline In-process, (3) PsycINFO, (4) Embase, and (5) Web of Science.ResultsThe electronic literature search resulted in the identification of 4638 unique citations. Of these, 10 articles were included in the review. Studies were assessed for risk of bias. Of the 10 studies that met the inclusion criteria, eight were conducted in the US, one in The Netherlands, and one in Mexico. Eight of the 10 studies focused on patient safety. The results of these included studies suggest there is moderate evidence that burnout is associated with patient safety (i.e., resident self-perceived medical errors and sub-optimal care). There is less evidence that specific dimensions of burnout are related to acceptability (i.e., quality of care, communication with patients).ConclusionsThe results of this systematic literature review suggest a relationship between patient safety and burnout. These results potentially have important implications for the medical training milieu because residents are still in training and at the same time are asked to teach students. The results also indicate a need for more evidence-based interventions that support continued research examining quality of care measures, especially as they relate to acceptability.

ObjectivesThis study reviews the current state of the published peer-reviewed literature related to physician burnout and two quality of care dimensions. The purpose of this systematic literature review is to address the question, 'How does physician burnout affect the quality of healthcare related to the dimensions of acceptability and safety?'DesignUsing a multiphase screening process, this systematic literature review is based on publically available peer-reviewed studies published between 2002 and 2017. Six electronic databases were searched: (1) MEDLINE Current, (2) MEDLINE In-process, (3) MEDLINE Epub Ahead of Print, (4) PsycINFO, (5) Embase and (6) Web of Science.SettingPhysicians practicing in civilian settings.ParticipantsPracticing physicians who have completed training.Primary and secondary outcome measuresQuality of healthcare related to acceptability (ie, patient satisfaction, physician communication and physician attitudes) and safety (ie, minimising risks or harm to patients).Results4114 unique citations were identified. Of these, 12 articles were included in the review. Two studies were rated as having high risk of bias and 10 as having moderate risk. Four studies were conducted in North America, four in Europe, one in the Middle East and three in East Asia. Results of this systematic literature review suggest there is moderate evidence that burnout is associated with safety-related quality of care. Because of the variability in the way patient acceptability-related quality of care was measured and the inconsistency in study findings, the evidence supporting the relationship between burnout and patient acceptability-related quality of care is less strong.ConclusionsThe focus on direct care-related quality highlights additional ways that physician burnout affects the healthcare system. These studies can help to inform decisions about how to improve patient care by addressing physician burnout. Continued work looking at the relationship between dimensions of acceptability-related quality of care measures and burnout is needed to advance the field.

BackgroundMental health courts were created to help criminal defendants who have a mental illness that significantly contributes to their criminal offense. Despite the increasing number of mental health courts around the world, data about their effectiveness have only begun to emerge in the past decade. The purpose of this systematic literature review is to assess the current evidence on the effectiveness of mental health courts. Specifically, this review will address the question, "How effective are mental health courts in reducing recidivism and police contact?"Methods/designEight electronic databases will be searched, specifically PsycINFO, Medline, Medline In-Process, Embase, Web of Science, CINAHL, Social Work Abstracts, and Criminal Justice Abstracts. A multi-phase screening process will be used to identify relevant search hits. Articles that pass the three-stage screening process will then be assessed for risk of bias and have their reference lists hand searched. Full-text articles that are rated to have low to moderate risk of bias will be summarized into two tables, one containing a brief description of the study and the other reporting the results of relevant outcomes measured.DiscussionBy synthesizing the results of the studies, this systematic review will help illuminate gaps in the literature, direct future research, and inform policy makers.Systematic review registrationPROSPERO CRD42016036084.

ObjectiveBecause health care resources are constrained, decision-making processes often require clarifying the potential costs and savings associated with different options. This involves calculating a program's costs. The chosen costing perspective defines the costs to be considered and can ultimately influence decisions. Yet reviews of the literature suggest little attention has been paid to the perspective in economic evaluations. This article's purpose is to explore how the costing perspective can affect cost estimates.MethodAs a vehicle for our discussion, we use service use data for clients enrolled in 6 Ontario early psychosis intervention programs. Governmental and nongovernmental payer costing perspectives are considered. We examine annual costs associated with early psychosis intervention clients enrolled for ≤12 months versus those enrolled for >12 months. This also allows for an assessment of the impact that choice of time horizon can make on the results.ResultsThe difference in total between group cost for hospital, emergency room, and physicians is $2499; the >12-month group has relatively higher mean costs. When all governmental and nongovernmental costs are considered, there is a mean between-group cost difference of $1272, with lower mean costs for the >12-month group.ConclusionsAlthough the Ministry of Health bears a large proportion of costs, other governmental agencies and the private sector can incur a sizeable share. This example demonstrates the potential importance of including other cost perspectives with the hospital sector in analyses as well as the impact of time horizon on cost estimates.

ObjectiveThere has been an increasing number of employer best practice guidelines (BPGs) for the return to work (RTW) from mental disorder-related disability leave. This systematic review addresses 2 questions: 1) What is the quality of the development and recommendations of these BPGs? and 2) What are the areas of agreement and discrepancy among the identified guidelines related to the RTW from mental illness-related disability leave?MethodA systematic literature search was performed using publically available grey literature and best practice portals. It focused on the RTW of workers with medically certified disability leave related to mental disorders. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) was used to assess the quality of the development and recommendations of these BPGs.ResultsA total of 58 unique documents were identified for screening. After screening, 5 BPGs were appraised using AGREE II; 3 BPGs were included in the final set. There were no discrepancies among the 3, although they were from different countries. They all agreed there should be: 1) well-described organizational policies and procedures for the roles and responsibilities of all stakeholders, 2) a disability leave plan, and 3) work accommodations. In addition, one guideline suggested supervisor training and mental health literacy training for all staff.ConclusionAlthough there were no discrepancies among the 3 BPGs, they emphasized different aspects of RTW and could be considered to be complementary. Together, they provide important guidance for those seeking to understand employer best practices for mental illness-related disability.

PurposeThe purpose of this exploratory and descriptive study is to contribute to the sparse return-to-work literature on head and neck cancer (HNC) survivors. Interview participants were asked to reflect upon their work-related experience with cancer by answering two specific questions: (1) What advice would you give someone who has been newly diagnosed with head and neck cancer? (2) What advice would you give to employers of these people?MethodsData were gathered through 10 individual semi-structured in-depth interviews with HNC clinic patients at a regional cancer center's head and neck clinic in Ontario, Canada. A constant comparative method of theme development was used. Codes identified in and derived from the data were discussed by research team members until consensus was reached. Codes with similar characteristics were grouped together and used to develop overarching themes.ResultsWork-related advice for peers focused on personal self-care and interactions within workplaces. Work-related advice to employers focused on demonstrating basic human values as well as the importance of communication.DiscussionThe study results suggest HNC clinic patients should be proactive with employers and help to set reasonable expectations and provide a realistic plan for work to be successfully completed. HNC clinic patients should develop communication skills to effectively disclose their cancer and treatment to employers.ConclusionsIn this exploratory study, HNC clinic patients' advice was solution-focused underscoring the importance of self-care and pro-active communication and planning with employers. Employers were advised to demonstrate core human values throughout all phases of the work disability episode beginning at diagnosis.

ObjectiveThis article estimates the decrease in workplace productivity losses associated with removal of three types of barriers to mental health service use among workers with depression.MethodsA model of productivity losses based on the results of a population-based survey of Canadian workers was used to estimate the impact of three types of barriers to mental health service use among workers with depression.ResultsRemoving the service need recognition barrier is associated with a 33% decrease in work productivity losses. There is a 49% decrease when all three barriers are removed.ConclusionsOur results suggest recognizing the need for treatment is only one barrier to service use; attitudinal and structural barriers should also be considered. The greatest decrease in productivity losses is observed with the removal of all three barriers.

ObjectivesThis paper reviews the current state of the published peer-reviewed literature related to return-to-work (RTW) interventions that incorporate work-related problem-solving skills for workers with sickness absences related to mental disorders. It addresses the question: What is the evidence for the effectiveness of these RTW interventions?DesignUsing a multiphase screening process, this systematic literature review was based on publically available peer-reviewed studies. Five electronic databases were searched: (1) Medline Current, (2) Medline In-process, (3) PsycINFO, (4) Econlit and (5) Web of Science.SettingThe focus was on RTW interventions for workers with medically certified sickness absences related to mental disorders.ParticipantsWorkers with medically certified sickness absences related to mental disorders.InterventionsRTW intervention included work-focused problem-solving skills.Primary and secondary outcome measuresRTW rates and length of sickness absences.ResultsThere were 4709 unique citations identified. Of these, eight articles representing a total of six studies were included in the review. In terms of bias avoidance, two of the six studies were rated as excellent, two as good and two as weak. Five studies were from the Netherlands; one was from Norway. There was variability among the studies with regard to RTW findings. Two of three studies reported significant differences in RTW rates between the intervention and control groups. One of six studies observed a significant difference in sickness absence duration between intervention and control groups.ConclusionsThere is limited evidence that combinations of interventions that include work-related problem-solving skills are effective in RTW outcomes. The evidence could be strengthened if future studies included more detailed examinations of intervention adherence and changes in problem-solving skills. Future studies should also examine the long-term effects of problem-solving skills on sickness absence recurrence and work productivity.

ObjectiveMedical certification is one of the basic administrative mechanisms used by social policies aimed at income protection. The assessment of work disability is central to the income protection application. Yet, there is evidence suggesting that determining work disability related to mental disorders is challenging. Although essential to the disability application process, few studies have looked at physician and other clinician experiences with the process. However, this type of information is critical to developing processes to support providers who participate in the assessments. This purpose of this paper is to explore the experiences of physicians and other clinicians assessing public long-term work disability related to mental disorders.MethodsThis is an exploratory and descriptive study using qualitative methods. Clinician input was gathered through focus groups and individual in-depth interviews. Verbatim transcripts were analyzed to identify recurrent and significant themes that arose during the focus groups and individual interviews.ResultsMany of the experiences that the clinicians in this sample discussed related to the difficulty of trying to fill the roles of advocate and medical expert as well as the challenge of determining the impact of functional capacity and work ability. The findings also highlight the current gap in knowledge about the factors that affect successful functioning in general and at work in particular.ConclusionsGiven the challenges created by the current state of knowledge, it may be useful to consider a category of "partial disability". In addition, the fact that work disability depends on the interaction between the experience of the mental disorder and specific job requirements and the fact that people applying for public long-term disability are not working, it might be helpful to offer a clear description and guidelines of the meaning of work ability.

BackgroundInterest in the impact of burnout on physicians has been growing because of the possible burden this may have on health care systems. The objective of this study is to estimate the cost of burnout on early retirement and reduction in clinical hours of practicing physicians in Canada.MethodsUsing an economic model, the costs related to early retirement and reduction in clinical hours of physicians were compared for those who were experiencing burnout against a scenario in which they did not experience burnout. The January 2012 Canadian Medical Association Masterfile was used to determine the number of practicing physicians. Transition probabilities were estimated using 2007-2008 Canadian Physician Health Survey and 2007 National Physician Survey data. Adjustments were also applied to outcome estimates based on ratio of actual to planned retirement and reduction in clinical hours.ResultsThe total cost of burnout for all physicians practicing in Canada is estimated to be $213.1 million ($185.2 million due to early retirement and $27.9 million due to reduced clinical hours). Family physicians accounted for 58.8% of the burnout costs, followed by surgeons for 24.6% and other specialists for 16.6%.ConclusionThe cost of burnout associated with early retirement and reduction in clinical hours is substantial and a significant proportion of practicing physicians experience symptoms of burnout. As health systems struggle with human resource shortages and expanding waiting times, this estimate sheds light on the extent to which the burden could be potentially decreased through prevention and promotion activities to address burnout among physicians.

BackgroundInterest in the well-being of physicians has increased because of their contributions to the healthcare system quality. There is growing recognition that physicians are exposed to workplace factors that increase the risk of work stress. Long-term exposure to high work stress can result in burnout. Reports from around the world suggest that about one-third to one-half of physicians experience burnout. Understanding the outcomes associated with burnout is critical to understanding its affects on the healthcare system. Productivity outcomes are among those that could have the most immediate effects on the healthcare system. This systematic literature review is one of the first to explore the evidence for the types of physician productivity outcomes associated with physician burnout. It answers the question, "How does burnout affect physician productivity?"MethodsA systematic search was performed of: Medline Current, Medline in process, PsycInfo, Embase and Web of Science. The search period covered 2002 to 2012. The searches identified articles about practicing physicians working in civilian settings. Articles that primarily looked only at residents or medical students were excluded. Productivity was captured by hours worked, patients seen, sick leave, leaving the profession, retirement, workload and presenteeism. Studies also were excluded if: (1) the study sample was not comprised of at least 50% physicians, (2) the study did not examine the relationship between burnout and productivity or (3) a validated measure of burnout was not used.ResultsThe search identified 870 unique citations; 5 met the inclusion/exclusion criteria. This review indicates that globally there is recognition of the potential impact of physician burnout on productivity. Productivity was examined using: number of sick leave days, work ability, intent to either continue practicing or change jobs. The majority of the studies indicate there is a negative relationship between burnout and productivity. However, there is variation depending on the type of productivity outcome examined.ConclusionsThere is evidence that burnout is associated with decreased productivity. However, this line of inquiry is still developing. A number of gaps are yet to be filled including understanding how to quantify the changes in productivity related to burnout.

BackgroundOver the past decade, growing attention has been given to the mental health of workers. One way to examine the mental health of workers is to look at the incidence rates of mental illness-related sickness absence. There is a scarcity of literature in which the incidence rates of mental illness-related sickness absence among different countries have been considered together. The purpose of this systematic literature review is to address the question: Are there similarities and differences in the incidence rates of mental disorder-related sickness absence among and within OECD identified Social Democratic, Liberal and Latin American country categories? In this paper, we seek to identify differences and similarities in the literature rather than to explain them. With this review, we lay the groundwork for and point to areas for future research as well as to raise questions regarding reasons for the differences and similarities.MethodsA systematic literature search of the following databases were performed: Medline Current, Medline In-process, PsycINFO, Econlit and Web of Science. The search period covered 2002-2013. The systematic literature search focused on working adults between 18-65 years old who had not retired and who had mental and/or substance abuse disorders. Intervention studies were excluded. The search focused on medically certified sickness absences.ResultsA total of 3,818 unique citations were identified. Of these, 10 studies met the inclusion/exclusion criteria; six were from Social Democratic countries. Their quality ranged from good to excellent. There was variation in the incidence rates reported by the studies from the Social Democratic, Liberal and Latin American countries in this review.ConclusionsThe results of this systematic review suggest that this is an emerging area of inquiry that needs to continue to grow. Priority areas to support growth include cross jurisdictional collaboration and development of a typology characterizing the benefit generosity and work integration policies of sickness absence schemes. Finally, the literature should be updated to reflect changes in sickness absence benefit schemes over time.

ObjectiveTo explore basic requirements for a stigma program to produce sufficient savings to pay for itself (that is, break even).MethodsA simple economic model was developed to compare reductions in total short-term disability (SDIS) cost relative to a stigma program's costs. A 2-way sensitivity analysis is used to illustrate conditions under which this break-even scenario occurs.ResultsUsing estimates from the literature for the SDIS costs, this analysis shows that a stigma program can provide value added even if there is no reduction in the length of an SDIS leave. To break even, a stigma program with no reduction in the length of an SDIS leave would need to prevent at least 2.5 SDIS claims in an organization of 1000 workers. Similarly, a stigma program can break even with no reduction in the number of SDIS claims if it is able to reduce SDIS episodes by at least 7 days in an organization of 1000 employees.ConclusionsModelling results, such as those presented in our paper, provide information to help occupational health payers become prudent buyers in the mental health market place. While in most cases, the required reductions seem modest, the real test of both the model and the program occurs once a stigma program is piloted and evaluated in a real-world setting.

ObjectivesThe purpose of this systematic literature review is to examine the current state of knowledge regarding the return-to-work outcomes of sickness absences related to mental disorders that increase costs borne by employers. We address two questions: (1) Based on the existing literature, from the employer's perspective, what are the relevant economic return-to-work outcomes for sickness absences related to mental disorders? and (2) From the employer's economic perspective, are there gaps in knowledge about the relevant return-to-work outcomes for sickness absences related to mental disorders?SettingThe included studies used administrative data from either an employer, insurer or occupational healthcare provider.ParticipantsStudies included working adults between 18 and 65 years old who had a sickness absence related to a mental disorder.Primary and secondary outcome measuresThe studies considered two general return-to-work outcome categories: (1) outcomes focusing on return-to-work and (2) outcomes focusing on sickness absence recurrence.ResultsA total of 3820 unique citations were identified. Of these, 10 studies were identified whose quality ranged from good to excellent. Half of the identified studies came from one country. The studies considered two characteristics of sickness absence: (1) whether and how long it took for a worker to return-to-work and (2) sickness absence recurrence. None of the studies examined return-to-work outcomes related to work reintegration.ConclusionsThe existing literature suggests that along with the incidence of sickness absence related to mental disorders, the length of sickness absence episodes and sickness absence recurrence (ie, number and time between) should be areas of concern. However, there also seems to be gaps in the literature regarding the work reintegration process and its associated costs.

BackgroundIn adult correctional facilities, correctional officers (COs) are responsible for the safety and security of the facility in addition to aiding in offender rehabilitation and preventing recidivism. COs experience higher rates of job stress and burnout that stem from organizational stressors, leading to negative outcomes for not only the CO but the organization as well. Effective interventions could aim at targeting organizational stressors in order to reduce these negative outcomes as well as COs' job stress and burnout. This paper fills a gap in the organizational stress literature among COs by systematically reviewing the relationship between organizational stressors and CO stress and burnout in adult correctional facilities. In doing so, the present review identifies areas that organizational interventions can target in order to reduce CO job stress and burnout.MethodsA systematic search of the literature was conducted using Medline, PsycINFO, Criminal Justice Abstracts, and Sociological Abstracts. All retrieved articles were independently screened based on criteria developed a priori. All included articles underwent quality assessment. Organizational stressors were categorized according to Cooper and Marshall's (1976) model of job stress.ResultsThe systematic review yielded 8 studies that met all inclusion and quality assessment criteria. The five categories of organizational stressors among correctional officers are: stressors intrinsic to the job, role in the organization, rewards at work, supervisory relationships at work and the organizational structure and climate. The organizational structure and climate was demonstrated to have the most consistent relationship with CO job stress and burnout.ConclusionsThe results of this review indicate that the organizational structure and climate of correctional institutions has the most consistent relationship with COs' job stress and burnout. Limitations of the studies reviewed include the cross-sectional design and the use of varying measures for organizational stressors. The results of this review indicate that interventions should aim to improve the organizational structure and climate of the correctional facility by improving communication between management and COs.

BackgroundThe extant literature suggests that poorly defined job roles make it difficult for peer support workers to be successful, and hinder their integration into multi-disciplinary workplace teams. This article uses data gathered as part of a participatory evaluation of a peer support program at a psychiatric tertiary care facility to specify the work that peers do.MethodsData were gathered through interviews, focus groups, and activity logs and were analyzed using a modified grounded theory approach.ResultsPeers engage in direct work with clients and in indirect work that supports their work with clients. The main types of direct work are advocacy, connecting to resources, experiential sharing, building community, relationship building, group facilitation, skill building/mentoring/goal setting, and socialization/self-esteem building. The main types of indirect work are group planning and development, administration, team communication, supervision/training, receiving support, education/awareness building, and information gathering and verification. In addition, peers also do work aimed at building relationships with staff and work aimed at legitimizing the peer role. Experience, approach, presence, role modeling, collaboration, challenge, and compromise can be seen as the tangible enactments of peers' philosophy of work.ConclusionsCandidates for positions as peer support workers require more than experience with mental health and/or addiction problems. The job description provided in this article may not be appropriate for all settings, but it will contribute to a better understanding of the peer support worker position, the skills required, and the types of expectations that could define successful fulfillment of the role.

BackgroundThe prevalence of type II diabetes among individuals suffering from schizophrenia or schizoaffective disorders is more than double that of the general population. By 2005, North American professional medical associations of Psychiatry, Diabetes, and Endocrinology responded by recommending continuous metabolic monitoring for this population to control complications from obesity and diabetes. However, these recommendations do not identify the types of effective treatment for people with schizophrenia who have type II diabetes. To fill this gap, this systematic evidence review identifies effective lifestyle interventions that enhance quality care in individuals who are suffering from type II diabetes and schizophrenia or other schizoaffective disorders.MethodsA systematic search from Medline, CINAHL, PsycINFO, and ISI Web of Science was conducted. Of the 1810 unique papers that were retrieved, four met the inclusion/exclusion criteria and were analyzed.ResultsThe results indicate that diabetes education is effective when it incorporates diet and exercise components, while using a design that addresses challenges such as cognition, motivation, and weight gain that may result from antipsychotics.ConclusionsThis paper begins to point to effective interventions that will improve type II diabetes management for people with schizophrenia or other schizoaffective disorders.

BackgroundPosttraumatic stress disorder acquired at work can be debilitating both for workers and their employers. The disorder can result in increased sick leave, reduced productivity, and even unemployment. Furthermore, workers are especially unlikely to return to their previous place of employment after a traumatic incident at work because of the traumatic memories and symptoms of avoidance that typically accompany the disorder. Therefore, intervening in work-related PTSD becomes especially important in order to get workers back to the workplace.MethodsA systematic literature search was conducted using Medline, PsycINFO, Embase, and Web of Science. The articles were independently screened based on inclusion and exclusion criteria, followed by a quality assessment of all included articles.ResultsThe systematic search identified seven articles for inclusion in the review. These consisted of six research articles and one systematic review. The review focused specifically on interventions using real exposure techniques for anxiety disorders in the workplace. In the research articles addressed in the current review, study populations included police officers, public transportation workers, and employees injured at work. The studies examined the effectiveness of EMDR, cognitive-behavioural techniques, and an integrative therapy approach called brief eclectic psychotherapy. Interestingly, 2 of the 6 research articles addressed add-on treatments for workplace PTSD, which were designed to treat workers with PTSD who failed to respond to traditional evidence-based psychotherapy.ConclusionsResults of the current review suggest that work-related interventions show promise as effective strategies for promoting return to work in employees who acquired PTSD in the workplace. Further research is needed in this area to determine how different occupational groups with specific types of traumatic exposure might respond differently to work-tailored treatments.