A problem-solving intervention among employees with mental health problems : effects, predictors and experiences

Background Common mental disorders affect approximately 17.6% of the working population each year. Although many employees with these conditions are working, they face a greater risk of sickness absence compared to employees with musculoskeletal disorders. Sickness absence also tends to be longer among this group, while also at higher risk of having recurring episodes. Over recent decades, sickness absence due to common mental disorders has increased both in incidence and proportion of total sickness absence cases, the latter particularly among longer cases. Here, reactions to stress and adjustment disorders represent the greatest increase. Interventions that combine individual treatment with workplace-focused components have shown promising effects in reducing sickness absence due to common mental disorders and improve return to work. However, little is known about the effectiveness of such interventions in Swedish primary healthcare, where many employees with common mental disorders seek support. It is also not known who benefits from such interventions. Given that many affected employees continue to work, employers play an important role in supporting working while having mental health problems. Understanding employees' experiences as well as managers' perspectives of this process could assist the understanding of conditions that are conducive to working while having mental health problems. Addressing these knowledge gaps are important, not only from a preventive perspective, but also in relation to sustainable return to work. Methods In Study I, a two-armed cluster-randomized controlled trial was conducted to test the effectiveness of a problem-solving intervention with workplace involvement on reducing sickness absence days among employees with common mental disorders. In total, 9 rehabilitation coordinators in Swedish primary healthcare were trained and delivered the intervention to 85 participants in the intervention group, while 10 rehabilitation coordinators provided care as usual to 112 participants in the control group. Additionally, a questionnaire on sociodemographic, health-related, and work-related factors was administered at baseline. General estimating equation was applied to evaluate the effectiveness of the intervention on monthly mean net sickness absence days. For Study II, to determine the association between baseline variables and cumulative net sickness absence days during 18 months follow-up, all participants from Study I (n=197) were treated as one group and variables from the baseline questionnaire were added to a model in two steps: firstly, univariable analysis were conducted to determine which variables to add to a multivariable model, secondly variables from the univariable analysis were added in blocks of sociodemographic, health-, and work-related variables applying backwards elimination. For Study III, semi- structured individual interviews were conducted with private-sector employees (n=18) at risk of sickness absence due to common mental disorders on promoting and hindering factors for working while having symptoms of mental health problems. For Study IV, semi-structured individual interviews were conducted with first-line (n=11) and senior managers (n=7) at the same companies to gain insight into their conditions for, and experiences of, managing mental health problems at the workplace. For Studies III and IV, interviews were transcribed verbatim and analysed using reflexive thematic analysis. Results Main results indicate that there was no statistically significant difference in net sickness absence days between the problem-solving intervention with workplace involvement and care as usual. Rating low work ability in relation to physical demands and high psychological job demands at baseline was associated with a higher rate of sickness absence days during the 18-month follow-up period. Being more certain of returning to work within three months was associated with lower rate of sickness absence days. Promoting and hindering factors for working while having mental health problems were described within the themes influence of life stage on working while having mental health problems; managing mental health problems in the social and organizational context; and preserving one's identity and agency when working while having mental health problems. For first-line and senior managers, managing mental health problems was described through a process of preventing, identifying, acting and accommodating within the themes: Ambivalence regarding the processes of preventing mental health problems at the workplace; Going out and listening on a Tuesday morning - identifying mental health problems; "I'm stuck" - struggling with managerial actions; and "Exploring alternatives" - work accommodation or changing job. Conclusions The problem-solving intervention with workplace involvement did not reduce sickness absence. Future interventions may work better if aimed at employees with greater needs-for example, those facing high physical or psychological demands-rather than those already confident about returning to work. Tracking intermediate outcomes like problem-solving skills might clarify whether interventions work as intended. To support employees who are working while having mental health problems, several factors matter: a supportive, respectful team climate that encourages open communication; active, informed managerial support, including guidance on resources and workplace adjustments; commitment from higher management to prioritize mental health and allocate resources. Workplace support for employees who are working while having mental health problems could probably benefit from a multilevel approach that considers individual, group, leader, and organizational factors. List of scientific papers I. Karlsson I, Frantz A, Axén I, Bergström G, Bültmann U, Finnes A, Holmgren K, Kwak L, Björk Brämberg E. Is a Problem-Solving Intervention with Workplace Involvement for Employees on Sickness Absence Due to Common Mental Disorders More Effective, than Care as Usual, in Reducing Sickness Absence Days? Results of a Cluster-Randomised Controlled Trial in Primary Health Care. J Occup Rehabil. 2024 Aug 7. Epub ahead of print. PMID: 39110387. https://doi.org/10.1007/s10926-024-10229-4 II. Frantz A, Toropova A, Axén I, Bergström G, Finnes A, Björk Brämberg E. Predictors of sickness absence among employees with common mental disorders in Sweden- a longitudinal study. BMC Public Health. 2025 Feb 3;25(1):428. doi: 10.1186/s12889-025-21563-4. PMID: 39901173; PMCID: PMC11792670. https://doi.org/10.1186/s12889-025-21563-4 III. Frantz A, Axén I, Bergström G, Finnes A, Björk Brämberg E. Swedish private-sector employees' experiences of promoting and hindering factors for working while having mental health problems: A qualitative study. PLoS One. 21(2):e0342773. doi: 10.1371/journal.pone.0342773 https://doi.org/10.1371/journal.pone.0342773 IV. Frantz A, Bertilsson M, Finnes A, Widar L, Björk Brämberg E. Managing mental health problems at the workplace: a qualitative study of first-line and senior managers' experiences and conditions [Manuscript]