Workplace mental health disability leave recurs sooner than physical health leave, CAMH study shows

Most workers who take a mental health leave from their jobs do not have another disability leave for at least two years, according to a new study from CAMH. In contrast, most who have had a physical health disability leave have almost four years before a second episode.

Mental health disability leaves cost approximately $51 billion a year in Canada in health care and work disruption costs, and those with a previous episode are at higher risk of having another one.

"If we understand the timing of a repeated episode, as well as who is at risk of having a recurrence, we can develop more effective prevention programs to help people stay at work," says Dr. Carolyn Dewa, study lead and head of CAMH's Centre for Research on Employment and Workplace Health. The study was published in the June issue of the Journal of Occupational and Environmental Medicine.

For their study, Dr. Dewa and colleagues looked at the records of a Canadian company with 13,000 employees from 2003 to 2006. Among this group, 3,593 employees had one or more disability leaves during this period. An episode was at least five continuous days off work related to a medical diagnosis.

Among all workers, 72 per cent who had a disability leave were still at work after a year. Those who were more likely to have a second episode sooner included women, maintenance workers and those with disrupted marriages.

"It's important to be aware that although workers who have had one mental health disability leave are at risk of having a recurrence, it doesn't happen immediately," added Dr. Dewa. "These workers want to be back at work, but unfortunately, sometimes supports to help maintain their health are not available." It is important to do return-to-work planning to help employees transition back after a leave. Workplace resources can be very valuable in sustaining worker well-being and help them remain on the job longer.

It is a complex task to untangle the reasons why mental health disability leave recurs sooner than those for physical health. It is possible the workers in the study had not fully recovered when they returned, because some aspects of their illness were overlooked, the researchers point out.

"The workers' major symptoms may have subsided, but their ability to work may still be impaired due to memory loss or inability to focus," says Dr. Dewa. "The return-to-work forms that physicians fill out don't always ask about a person's functional abilities at work, just about medical symptoms. And workers may attribute symptoms such as memory loss or lack of focus to aging."

If a workers' ability to do their job is impaired, it could create resentment among their colleagues -- and there is growing evidence to suggest social support, both within and outside the workplace, is important to prevent psychiatric disorders. This may explain, for example, why those with disrupted marriages relapsed sooner. Past research also shows a link between low social support and depression in women.

Finding the right balance of providing social support without intruding too much or violating a person's privacy is challenging, but possible, says Dr. Dewa. "Occupational health staff can provide support or just check in with workers who have had a previous disability leave. People like it when you genuinely care about the answer to, 'How are you?'"