Disabling mental illness in workers: a concept analysis in occupational mental health

Disabling mental illness in workers: a concept analysis in occupational mental health | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Disabling mental illness in workers: a concept analysis in occupational mental health Angela dos Santos Silva, Francisco Mayron Morais Soares, Elton Brás Camargo Júnior, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9182548/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Disabling mental illness represents a growing concern at the intersection of mental health and occupational health. Conceptual clarity is needed to better understand its determinants and consequences in workers’ lives. Methods A concept analysis was conducted using the Walker and Avant framework, supported by an integrative literature review performed in four databases (LILACS, Scopus, PubMed/MEDLINE, and Web of Science). Sixteen studies were included and analyzed to identify antecedents, defining attributes, consequences, and empirical referents of the concept. Results Disabling mental illness is characterized by persistent functional impairment, enduring psychological symptoms, recurrent work absences, and difficulty in occupational and social reintegration. Antecedents include harmful work environments, lack of organizational support, high psychological demands, and pre-existing psychosocial vulnerabilities. Consequences involve dependence on social security benefits, early retirement, social exclusion, and chronicity of the clinical condition. Conclusions The concept of disabling mental illness reflects a multifactorial phenomenon resulting from the interaction between work conditions, psychosocial vulnerabilities, and mental health outcomes. Conceptual clarification may support early identification, guide nursing interventions, and inform occupational mental health policies. Absenteeism Mental Disorders Mental Health Occupational Health Sick Leave Figures Figure 1 Figure 2 1. Background Mental disorders constitute a considerable and growing burden on global public health, with direct consequences for individuals' quality of life and broader socioeconomic functioning. Their impact on occupational performance is well documented, as they are recognized contributors to workplace absenteeism, diminished productivity, and increased reliance on disability benefits [ 1 ]. At the global level, the World Health Organization (WHO) identifies depression as one of the primary causes of disability, with a disproportionate prevalence among women of productive age [ 2 , 3 ]. In the Brazilian context, data from the Ministry of Social Security [ 4 ] indicate that mental and behavioral disorders rank among the leading causes of work absenteeism and social security benefit claims, generating substantial social and economic costs. Nursing professionals represent a particularly vulnerable group to occupational psychological distress, given the high emotional demands, heavy workloads, and constant exposure to human suffering inherent to the profession. Evidence from a systematic review and meta-analysis [ 5 ] encompassing more than 288,000 nurses across 32 countries indicates that burnout within this workforce is associated with compromised patient safety, reduced quality of care, and decreased patient satisfaction, underscoring the systemic consequences of psychological distress beyond the individual level. Although the relevance of mental illness is widely recognized, the concept of disabling mental illness still lacks a consolidated definition in the scientific literature. It is used diversely across clinical, social security, and occupational contexts. This terminological variability contributes to conceptual overlap with related constructs, such as psychosocial disability, work-related mental incapacity, and chronic mental illness with functional impairment. The term has been employed to describe psychological conditions that significantly impair an individual’s functional capacity, interfering with daily activities, work performance, and social interactions. This condition may manifest as persistent limitations in domains such as self-care, productivity, employment, and social participation [ 6 ]. The complexity of disabling mental illness lies in both the variety of diagnoses involved, such as depression, anxiety, mood disorders, substance use disorders, and stress-related disorders, and the interaction of multiple biological, psychological, and social factors that influence its development and outcomes. The concept appears to relate to the extent and persistence of functional limitation associated with mental health conditions. The literature has emphasized the relevance of the work environment as a precipitating or aggravating element of these conditions, especially under adverse circumstances such as work overload, low social support, long working hours, and job insecurity [ 2 , 7 ]. In Brazil's Social Security Administration and forensic practice, the concept is associated with work incapacity resulting from mental and behavioral disorders, based on clinical and functional criteria [ 8 ]. However, this institutional use does not necessarily correspond to a conceptual definition of the phenomenon, as it reflects regulatory and administrative classifications. In healthcare practice, the term is often applied to situations of persistent psychological suffering that compromise functional and social performance, even in the absence of a standardized conceptual framework. Some studies use the term more broadly to refer to mental conditions that lead to prolonged work absences, reduced productivity, and difficulties in social reintegration [ 7 ]. In this context, concept analysis represents an essential methodological strategy for clarifying ambiguous or imprecise expressions in the literature and clinical practice. In nursing, this approach strengthens the disciplinary field by refining technical language and the theoretical foundations of health interventions, distinguishing essential attributes from contextual or institutional responses. Operationalizing complex phenomena such as disabling mental illness supports the development of nursing diagnoses, public policies, and evidence-based care practices [ 9 ]. Despite its increasing use, the concept of disabling mental illness remains theoretically underdeveloped. Conceptual clarification is therefore necessary to advance public policy formulation, strengthen mental health care, and guide the development of psychosocial rehabilitation strategies, particularly in supporting nursing assessment, clinical reasoning, and intervention planning in situations involving functional impairment. Based on the method proposed by Walker and Avant [ 10 ], this study aims to clarify the concept of disabling mental illness in the context of mental health and work by identifying its attributes, uses, antecedents, consequences, and empirical referents. 2. Material and Methods 2.1 Study Design This theoretical study uses concept analysis [ 10 ] to examine a concept's structure and function, aiding understanding of phenomena in a specific area knowledge. This model is operationalized through eight stages: selection of the concept; determination of the purpose of the analysis; identification of all possible uses of the concept; determination of defining attributes; presentation of a model case; presentation of additional cases; identification of antecedents and consequences of the concept; and definition of empirical referents [ 10 ]. The term selected for analysis was disabling mental illness, given the author’s familiarity with the topic of mental and occupational health and the need for a better conceptual delimitation in the literature. Subsequently, the possible uses of this concept were identified. To achieve this, a search was conducted in scientific databases using an integrative literature review, a rigorous and well-defined method commonly employed in evidence-based practice. The review followed the steps of problem identification and development of the guiding question; literature search with application of inclusion and exclusion criteria; data collection using a prestructured instrument; data analysis; and presentation of the review [ 11 , 12 ]. The reporting of the literature search and study selection process was informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to enhance transparency and completeness. The completed PRISMA checklist is provided as supplementary material. This review was not prospectively registered. To formulate the research question, the PCC mnemonic (Population, Concept, and Context) was used. Accordingly, the elements were defined as follows: P – category of workers; C – mental illness with functional incapacity; C – occupational health. Based on this framework, the following questions were constructed: What is the concept of disabling mental illness? What are its uses, attributes, antecedents, and consequences? The articles retrieved from the databases were evaluated by the principal investigator through the screening of titles and abstracts, using a free web-based single-version review program called Rayyan Qatar Computing Research Institute [ 13 ]. Full-text reading of the selected articles was then carried out, followed by manual reference checking of the included papers, which did not yield any additional studies. 2.2 Study Period and Setting The literature search was conducted between May and June 2025 in the following electronic databases: LILACS, Elsevier’s Scopus (SCOPUS), National Library of Medicine (MEDLINE via PubMed), and Web of Science. The descriptors employed were drawn from the Medical Subject Headings (MeSH), Health Sciences Descriptors (DeCS), and free terms, combined using Boolean operators (AND/OR). The search strategy was adapted according to the specificities of each database; however, the combinations among descriptors were maintained, and no restrictions were applied regarding publication date or language. The search syntaxes are presented in Table 1 . Table 1 Search strategies used in each database. Database Search equation LILACS (("Transtornos Mentais" OR "Saúde Mental" OR "sofrimento psíquico" OR "adoecimento mental")) AND (("Incapacidade" OR "Invalidez" OR "Capacidade de Trabalho" OR "incapacidade funcional" OR "adoecimento mental incapacitante" OR "afastamento do trabalho")) PUBMED ("Mental Disorders"[MeSH Terms] OR "Mental Health"[MeSH Terms] OR "Psychiatric Illness" OR "Mental Illness" OR "psychological distress") AND ("Disability Evaluation"[MeSH Terms] OR "Work Capacity Evaluation"[MeSH Terms] OR "Sick Leave"[MeSH Terms] OR "Workplace Disability" OR "Functional Impairment" OR "Work Disability") AND ("chronic mental illness" OR "disabling mental illness" OR "psychosocial disability" OR "incapacitating mental disorder" OR "mental illness and work absence" OR "mental health related disability") Web of Science TS=("mental disorder" OR "mental illness" OR "psychiatric disorder" OR "psychological distress") AND TS=("work disability" OR "functional impairment" OR "psychosocial disability" OR "disability due to mental illness" OR "incapacitating mental disorder") AND TS=("chronic mental illness" OR "mental health related disability" OR "mental illness and work absence") SCOPUS TITLE-ABS-KEY ("mental disorder" OR "mental illness" OR "psychiatric illness" OR "psychological distress") AND TITLE-ABS-KEY ("work disability" OR "functional impairment" OR "psychosocial disability" OR "incapacitating mental illness" OR "disabling mental illness") AND TITLE-ABS-KEY ("chronic mental illness" OR "sick leave" OR "mental illness and work" OR "mental health disability") 2.3 Population and Sample A total of 982 studies were identified in the initial search. These records were exported to the Rayyan software for screening and duplicate removal, resulting in 905 documents. After reading the titles and abstracts, 70 articles remained for full-text review. Following full-text screening and application of inclusion and exclusion criteria, 16 studies were selected to comprise the final sample of this study. The selection was carried out by a nurse researcher specialized in mental health. 2.4 Inclusion and exclusion criteria The inclusion criteria were full-text publications freely available in electronic format; peer-reviewed scientific articles; no restrictions regarding language or publication period; and direct alignment with the study objective. The exclusion criteria comprised duplicate records, abstracts, letters to the editor, opinion articles, studies unrelated to the proposed topic, correspondences, book reviews, book chapters, theses and dissertations, undergraduate monographs, and final course papers. 2.5 Data Analysis After selecting the 16 included articles, an analytical reading and extraction of conceptual data were performed using a customized instrument developed in Microsoft Excel®, containing the following information: study title, objective, design, year of publication, country, language, defining attributes, antecedents, and consequences related to the concept. The subsequent step involved thematic categorization, identifying recurring expressions and ideas associated with the concept, and grouping them by similarities in meaning. This process aimed to distinguish essential conceptual attributes from contextual, institutional, or outcome-related elements. Comparative analysis across studies enabled the identification of convergences and divergences in the uses of the concept, distinguishing among clinical, occupational, and sociopolitical emphases. This analytical distinction helped define concepts more precisely, rather than simply grouping and describing them. These findings supported the definition of the attributes, antecedents, and consequences presented in the results. It is worth noting that antecedents are events that precede the concept and serve as precursors to its occurrence, whereas consequences are events that follow the concept and result from the presence of its defining attributes [ 14 ]. Subsequently, a model case and a contrary case were described. To meet the theoretical requirements of concept analysis, additional cases were examined to sharpen conceptual boundaries. The defining attributes of the concept were then established, revealing its essential characteristics. A model case was presented alongside borderline, related, contrary, and invented cases to show how the concept manifests in different ways. Antecedents and consequences were identified, and empirical referents were defined, enabling the concept to be operationalized and recognized in practice. It should be emphasized that the presentation of results, in line with the aim of this study, is descriptive in nature, oriented toward conceptual refinement and theoretical clarification, and guided by the discussion of the steps selected for the concept analysis of disabling mental illness, in accordance with the stages of the adopted framework. 3. Results A total of 982 studies were identified in the initial search. The material was exported to the Rayyan software, after which study screening was conducted using inclusion and exclusion criteria, resulting in a final sample of 16 studies. The selection process is detailed in the PRISMA flow diagram in Fig. 1, which presents the identification, screening, eligibility, and inclusion stages of the integrative review studies. Analytical reading of the 16 studies made it possible to identify three thematic categories that synthesize the main meanings attributed to the term disabling mental illness: (1) the functional dimension, encompassing elements related to loss of performance and autonomy, persistent psychological symptoms, and difficulty returning to work activities; (2) the organizational dimension, which includes factors related to the work environment, such as work overload, high emotional demands, institutional violence, and lack of social or organizational support; and (3) the social dimension, which comprises social exclusion, dependence on social security benefits, and stigma associated with illness. These dimensions are analytical groupings and do not necessarily reflect the essential attributes of the concept. Comparative analysis among the studies revealed that while publications with a clinical focus emphasize functional and emotional impairments, social security studies highlight work incapacity and legal criteria for leave, and sociopolitical works address illness as an outcome of structural working conditions. This triangulation reinforces the multifactorial nature of the concept and supports the distinction between conceptual attributes and contextual or institutional responses, guiding the construction of its essential attributes, antecedents, and consequences. The analysis revealed multiple uses of the concept of disabling mental illness. In the clinical and care field, the term is used to describe conditions of psychological distress involving significant functional impairment [ 15 – 20 ]. In social security and forensic contexts, it appears associated with work incapacity that underlies benefits such as sickness allowance or disability retirement [ 16 , 17 , 21 – 24 ]. These uses reflect application contexts rather than defining characteristics of the concept. It was also identified in epidemiological studies, which measure the prevalence of work absences due to mental disorders [ 15 , 18 , 25 – 28 ]. Finally, in sociopolitical approaches, the concept is used to denounce harmful working conditions and to advocate for public policies aimed at psychosocial reintegration and rehabilitation [ 16 , 17 , 22 , 29 , 30 ]. To understand this phenomenon, antecedents, essential attributes, and consequences were identified and organized according to the Walker and Avant [ 10 ] method through analytical reading and systematic categorization. The attributes reflect manifestations intrinsic to the conceptual expression of disabling mental illness, while consequences represent downstream social and institutional outcomes, distinguishing them from contextual conditions or antecedent factors (Fig. 2 ). Disabling mental illness emerges at the intersection between the fields of mental health and occupational health, reflecting the complexity of the psychosocial and functional effects of mental disorders on individuals’ work and social lives. The most frequently cited antecedents of disabling mental illness were harmful work environments (13 studies), including exhaustive working hours, work overload, productivity pressure, interpersonal conflicts, and institutional violence; lack of organizational and social support (11 studies); previous history of mental suffering (10 studies); and high psychological demands in the workplace (9 studies). In addition, stigma and discrimination related to mental disorders were highlighted, as well as various social vulnerabilities, such as low educational attainment, precarious income, and job insecurity. These psychosocial and contextual factors play a role in triggering the illness, highlighting how labor and structural conditions contribute to the development of mental disorders with functional and disabling effects. As such, they were interpreted as antecedents to the concept rather than part of its essential definition. The essential attributes of disabling mental illness refer to the manifestations that define its functionally limiting nature. The most prominent is persistent functional impairment, identified in 10 studies, characterized by difficulty maintaining performance in daily, occupational, and social activities, with compromise of cognitive, emotional, and relational skills. Enduring psychological symptoms, such as anxiety, depression, intense emotional distress, and chronic stress, were also recurrent (9 studies), along with frequent and prolonged work absences (8 studies), reduced productivity and work capacity (7 studies), and difficulty in social and/or occupational reintegration (6 studies), even after clinical improvement. These attributes reflect the intensity and persistence of the concept's impact on quality of life, occupational performance, and social inclusion, conferring upon it a truly disabling nature that extends beyond diagnostic labels or administrative classifications. The consequences of disabling mental illness reveal a chain of adverse outcomes affecting both individuals and society. Such outcomes are consequences of the concept's presence and should not be confused with its defining attributes. Notably, these include dependence on social security benefits, such as sickness allowance and disability retirement, followed by permanent withdrawal from work or early retirement, and social and professional exclusion, marked by the loss of the social role associated with work. The chronicity of psychological symptoms is also observed, with the persistence of suffering even under treatment, as well as social isolation and difficulty in reentering the labor market, forming a cycle of marginalization. These developments reinforce the disabling nature of mental illness by compromising professional identity, social participation, and prospects for functional and occupational recovery. To illustrate the practical application and limits of the analyzed concept, particularly regarding the presence of its defining attributes, antecedents, and consequences, cases were constructed within the selected theoretical framework, including model, contrary, borderline, and related cases to strengthen conceptual boundaries. The model case exemplifies the concept of disabling mental illness in its fullest expression, incorporating all essential attributes: “Ms. M.M., 38 years old, is a social worker at an urban center and works in a shelter service for people in situations of vulnerability. Over the past two years, she began facing high emotional demands associated with resource scarcity, work overload, understaffing, and continuous exposure to traumatic stories. Over time, Ms. M.M. started to present symptoms of anxiety and depression, such as insomnia, extreme fatigue, crying spells, and a constant sense of failure. Despite seeking medical help, the symptoms intensified, compromising her concentration, interpersonal relationships, and job performance. After successive episodes of sick leave, she was granted a sickness allowance due to recurrent depressive disorder. The process of returning to work proved unsuccessful because of the lack of institutional support, worsening of her clinical condition, and feelings of professional uselessness. Ms. M.M. was subsequently permanently removed from work and referred for disability retirement. She currently continues mental health follow-up but faces social isolation, loss of professional identity, and difficulty reintegrating into social and productive activities”. Ms. M.M.'s case fully embodies the concept of disabling mental illness as defined through this analysis. All essential attributes of the concept are present, including persistent functional impairment, enduring psychological symptoms, frequent work absences, reduced productivity and work capacity, and difficulty in social and occupational reintegration. In addition, the case highlights critical antecedents, including a harmful work environment (overload, resource scarcity), a lack of institutional support, and high emotional demands. It also presents consequences such as permanent work withdrawal, dependence on social security benefits, social isolation, and loss of professional identity, fulfilling its didactic and methodological role by materializing the findings of the concept analysis in a concrete, though fictional situation. The contrary case is used to contrast and delineate the concept, emphasizing its boundaries and conceptual distinctions: Mr. J.J., 27 years old, is a systems analyst working in a hybrid mode. After the end of a relationship, he began to experience mild symptoms of sadness, insomnia, and loss of appetite. Acknowledging the emotional impact, he sought psychological support, attended several psychotherapy sessions, and made adjustments to his self-care routine. He continued performing his professional duties normally, with slight fluctuations in productivity for about a week. By the end of the month, he reported significant improvement, regaining emotional well-being and his usual professional performance. He never needed to take sick leave nor exhibited any relevant functional impairment. This contrary case illustrates a situational psychological distress that does not meet the defining attributes of disabling mental illness. Although the character experienced mild symptoms of sadness, insomnia, and temporary reduction in productivity, these effects were transient, did not persistently compromise his functionality, and did not require work absence. He sought support, responded positively to the intervention, and maintained his occupational and social performance, all of which are incompatible with the concept's chronic, dysfunctional, and limiting nature. This distinction shows that not all psychological suffering constitutes a disabling mental illness. As demonstrated by the analyzed studies, the concept presupposes the persistence of psychological symptoms, significant functional impairment, and a prolonged impact on the individual’s occupational and social life. In the contrary case, these conditions are absent, reinforcing the importance of differentiating common psychological distress from conditions that truly require work leave and prolonged intervention. Thus, the contrary case helps refine the boundaries of the concept, clarifying that the isolated presence of emotional symptoms, without functional impairment, does not characterize disabling mental illness. This differentiation is essential to prevent overdiagnosis, unwarranted stigmatization, or excessive medicalization of expected emotional experiences in response to life events. Borderline cases represent situations in which some defining attributes are present without full conceptual expression, while related cases encompass adjacent phenomena that share certain characteristics without constituting the concept itself. This distinction reinforces conceptual boundaries and prevents conflation between disabling mental illness and other forms of psychological distress or functional impairment. Ms. M.F., 45 years old, is a nurse working in a public emergency department. Over the course of six months, she began experiencing intense psychological distress associated with high workload, night shifts, and recurrent exposure to critical incidents. She reported symptoms of anxiety, emotional exhaustion, irritability, and difficulty concentrating. Her productivity declined, and she required two short periods of sick leave totaling three weeks. During this time, she expressed feelings of professional inadequacy and considered requesting long-term leave. After organizational adjustments were implemented, including temporary reduction of shifts, peer support, and structured psychological follow-up, her symptoms gradually improved. Within four months, she resumed full professional responsibilities without further absences. Although she continues to experience occasional stress, she maintains functional stability and occupational performance. Ms. M.F.'s case approximates the concept of disabling mental illness, presenting several defining attributes, including significant psychological distress, temporary functional impairment, reduced productivity, and work absences. However, the impairment lacks the persistence, chronicity, and sustained difficulty in occupational reintegration that characterize the full conceptual expression of the concept. Given that the functional decline proved reversible and responsive to institutional and psychosocial interventions, this case approximates but does not fully embody disabling mental illness, particularly in its enduring and structurally limiting dimension. While borderline cases approach the concept by containing most of its defining attributes, related cases represent distinct but adjacent phenomena with their own conceptual identity, as illustrated by the following example from the field of mental health nursing. Ms. A.M., 54 years old, is a psychiatric nurse working in a community mental health center. Over several years of continuous exposure to patients experiencing severe trauma and chronic psychiatric conditions, she began to report emotional exhaustion, reduced empathy, and feelings of detachment from patients’ suffering. She describes difficulty sleeping and occasional irritability after intense workdays. Although she feels emotionally drained, she continues to perform her clinical duties competently, maintains therapeutic relationships, and fulfills her professional responsibilities. She has not required sick leave, does not exhibit persistent functional impairment in her daily life, and remains socially and occupationally engaged. This related case corresponds to compassion fatigue, a recognized phenomenon in nursing practice that shares contextual proximity with disabling mental illness through exposure to high emotional demands and sustained psychological strain. Yet it does not fulfill the defining attributes identified in this analysis, as it lacks persistent functional impairment, recurrent work absences, and a trajectory toward occupational exclusion or institutional dependence. As a related case, compassion fatigue belongs to the broader constellation of work-related mental health phenomena while remaining conceptually distinct from disabling mental illness, which requires enduring functional limitation and sustained disruption of occupational and social roles beyond emotional strain alone. The empirical referents of the concept of disabling mental illness correspond to observable indicators that enable its identification and application in professional practice. Among the main indicators are the granting of social security benefits for mental disorders, such as sickness allowance and disability retirement [ 3 , 26 ], and the use of validated clinical instruments, such as the WHODAS 2.0 (World Health Organization Disability Assessment Schedule), which assesses the degree of functional disability [ 31 ]. Other empirical indicators include the frequency of work absences due to mental disorders, the recurrence of psychological symptoms refractory to treatment, and difficulties in reintegration into work or social life [ 4 , 7 , 24 ]. These operational elements are essential for recognizing and managing the phenomenon in clinical practice and public policy. It is worth noting that frequent work absences constitute a manifestation of persistent functional impairment as a defining attribute; however, their measurement through absence records or administrative data serves as an empirical referent rather than a defining characteristic of the concept. Therefore, disabling mental illness is understood as a state of chronic psychological suffering characterized primarily by persistent functional impairment rather than by the presence of a specific diagnostic category or institutional outcome. This impairment manifests through enduring mental symptoms, recurrent work absences, and sustained difficulties in professional and social reintegration. This phenomenon emerges from the interaction between harmful working conditions, lack of institutional support, and pre-existing psychosocial vulnerabilities, resulting in dependence on social security benefits, social exclusion, and chronicity of the clinical condition. It represents a process that transcends an isolated psychiatric diagnosis, expressing the interface between mental health, functionality, and work organization. 4. Discussion The concept analysis conducted in this study enabled an in-depth exploration of disabling mental illness, highlighting its complexity and relevance within the field of workers’ mental health. The findings indicate that this concept is characterized by multiple interconnected dimensions involving subjective, clinical, functional, and social aspects. However, the analysis also allowed for the distinction between essential conceptual attributes and contextual conditions surrounding the phenomenon. The prevalence of antecedents such as harmful work environments, lack of organizational support, and a prior history of mental suffering reinforces this complexity and underscores the need for integrated approaches. In the context of contemporary work, emotional and cognitive demands, job insecurity, and precarious working conditions have been widely recognized as sources of chronic stress and psychological illness. Studies [ 15 , 16 , 22 ] have demonstrated that workplace suffering cannot be dissociated from the social and institutional contexts in which it occurs. The analysis revealed an overlap between social and occupational factors as determinants of the illness process that leads to long-term functional impairment, while indicating that these factors operate primarily as antecedents rather than as defining attributes of the concept. The most frequently cited attributes, such as persistent functional impairment, enduring psychological symptoms, frequent work absences, and difficulty in reintegration, offer a robust characterization of the concept. Together, these elements support the conceptualization of disabling mental illness as a chronic, process-oriented phenomenon defined by persistent functional limitation, transcending both episodic mental disorder and diagnostic categorization alone. The analysis of consequences reveals a concerning pattern: dependence on social security benefits, early retirement, and social and occupational exclusion are frequently reported outcomes. These consequences were distinguished from essential attributes as part of the theoretical delimitation of the concept, yet they underscore that disabling mental illness extends beyond individual health, compromising active participation in society. Even after clinical improvement, individuals continue to face substantial obstacles to social and occupational reintegration, a process further hindered by persistent stigma and inadequate psychosocial support [ 18 , 19 ]. This reality carries essential implications for Nursing and Public Health. The conceptual clarification proposed in this study provides a stronger foundation for care practices, allowing for the early identification of cases of potentially disabling illness and the implementation of more targeted interventions. By clarifying conceptual boundaries, this analysis supports clinical reasoning grounded in functionality, trajectory, and context, transcending the limitations of diagnostic labels alone. Moreover, it contributes to the development of public policies and clinical guidelines that consider not only diagnosis but also individuals' functioning and social context, and advances nursing theory by offering a more precise conceptual framework for assessing functional impairment associated with mental health conditions. It is therefore essential to recognize disabling mental illness as a phenomenon requiring intersectoral responses that integrate health, labor, and social security systems. Nursing, due to its relational and holistic nature, occupies a privileged position to lead this expanded care process within the Brazilian Psychosocial Care Network (RAPS), particularly in identifying early functional decline, monitoring impairment trajectories, and supporting return-to-work processes. Thus, this analysis advances the nursing disciplinary field by refining the theoretical delimitation of disabling mental illness and distinguishing it from adjacent constructs such as work incapacity, psychosocial disability, and chronic mental illness with functional limitation, offering a conceptual foundation for clinical, forensic, and policy-oriented action in the context of the growing challenge of mental illness in the workplace This study has two main limitations. First, relying on published literature means that the conceptualization reflects reported uses of the term, which may be shaped by institutional or policy-driven definitions. Second, as a qualitative method, concept analysis is subject to the author's interpretive bias, despite the systematization and analytical rigor applied throughout the process. 5. Conclusion The concept analysis of disabling mental illness made it possible to identify the essential attributes, antecedents, and consequences that characterize this phenomenon as multifactorial, with a significant impact on individuals’ functional, social, and occupational lives. Based on the review of the 16 included studies, it became evident that the concept encompasses elements such as persistent functional impairment, enduring psychological symptoms, recurrent work absences, and difficulties in work reintegration, all related to adverse work environments, lack of institutional support, and social vulnerabilities. The analysis also enabled a distinction between the defining attributes of the concept and the contextual or institutional outcomes associated with it. This study refines the concept of disabling mental illness by positioning functional impairment and its trajectory as central elements, moving beyond diagnostic labels and administrative classifications. In doing so, it strengthens nursing's technical-scientific language and provides a theoretical foundation for more accurate clinical and forensic reasoning. The study further advances nursing theory by distinguishing disabling mental illness from adjacent constructs such as work incapacity, psychosocial disability, and chronic mental illness with functional limitation, with direct implications for clinical practice, care management, and public policy in workers' mental health. Future research should focus on the empirical validation of the identified attributes and the development of instruments for the early identification and monitoring of disabling mental illness, including further exploration of borderline and related phenomena to support operationalization in clinical practice. Additionally, intersectoral articulation among health, social security, and labor systems is essential to address the challenges posed by this phenomenon and to promote interventions that ensure dignity, functionality, and social inclusion for affected individuals This concept analysis contributes to mental health nursing practice by clarifying the defining attributes of disabling mental illness and positioning persistent functional impairment as its central feature. This refinement enables nurses to distinguish disabling trajectories from transient psychological distress and adjacent occupational phenomena, supporting early identification of sustained functional decline and the planning of targeted psychosocial rehabilitation and return-to-work interventions. By strengthening theoretical clarity, this analysis also informs the development of structured assessment approaches and promotes more consistent, evidence-informed care in workplace and community settings. Abbreviations DeCS: Health Sciences Descriptors LILACS: Latin American and Caribbean Health Sciences Literature MEDLINE: Medical Literature Analysis and Retrieval System Online MeSH: Medical Subject Headings RAPS: Psychosocial Care Network WHO: World Health Organization WHODAS 2.0: World Health Organization Disability Assessment Schedule 2.0 Declarations Ethics approval and consent to participate As this is a theoretical study based exclusively on the analysis of scientific publications available for public consultation, submission to a Research Ethics Committee was not required. Consent for publication The authors have nothing to report. Availability of data and materials The authors confirm that the data supporting the findings of this study are available within the article. Competing interests The authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors' contributions ASS: Conceptualization, Methodology, Investigation, Writing - Original draft preparation. FMMS: Writing - Review & Editing. EBCJ: Writing - Review & Editing. MNFF: Supervision, Writing - Review & Editing. Acknowledgments This study was supported by the Fundação de Amparo à Pesquisa e ao Desenvolvimento Científico e Tecnológico do Maranhão (FAPEMA) – Research Foundation for Scientific and Technological Development of Maranhão, Brazil. References Henderson M, Harvey SB, Øverland S, Mykletun A, Hotopf M. Work and common psychiatric disorders. J R Soc Med. 2011;104(5):198–207. https://doi.org/10.1258/jrsm.2011.100 . World Health Organization. Depression and other common mental disorders: global health estimates [Internet]. Geneva: WHO. 2017 [cited 2026 Jan 14]. Available from: https://www.who.int/publications/i/item/depression-global-health-estimates World mental health report: transforming mental health for all [Internet]. Geneva: WHO. 2022 [cited 2026 Jan 14]. 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Occup Environ Med. 2017;74(4):301–10. 10.1136/oemed-2016-104015 . Brazil. Ministério da Previdência Social. Manual técnico de perícia médica previdenciária. Brasília: Ministério da Previdência Social; 2018. [cited 2026 Jan 10]. Available from: https://www.ampid.org.br/v1/wp-content/uploads/2018/06/ManualT%C3%A9cnicoPer%C3%ADciaM%C3%A9dicaPrevidenci%C3%A1ria_alterado637.pdf Sousa LMM, Firmino CF, Carteiro DMH, Frade F, Marques JM, Antunes AV. Concept analysis: concepts, methods and applications in nursing. Rev Investig Enferm. 2018;25(2):9–19. [cited 2026 Jan 15]. Available from: https://www.sinaisvitais.pt/images/stories/Rie/RIE25_s2.pdf Walker LO, Avant KC. Strategies for theory construction in nursing. 6th ed. Boston: Pearson; 2019. Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs. 2005;52(5):546–53. https://doi.org/10.1111/j.1365-2648.2005.03621 . Stillwell SB, Fineout-Overholt E, Melnyk BM, Williamson KM. Evidence-based practice, step by step: searching for the evidence. Am J Nurs. 2010;110(5):41–7. https://doi.org/10.1097/01.NAJ.0000372071.24134.7e . Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan: a web and mobile app for systematic reviews. Syst Rev. 2016;5:210. 10.1186/s13643-016-0384-4 . Fernandes MGM, Nóbrega MML, Garcia TR, Macêdo-Costa KNF. Conceptual analysis: methodological considerations. Rev Bras Enferm. 2011;64(6):1150–6. https://doi.org/10.1590/S0034-71672011000600024 . Ansoleaga E, Garrido P, Domínguez C, Castillo S, Lucero C, Tomicic A, et al. Return to work enablers for workers with work-related mental illness. Rev Med Chil. 2015;143(1):85–95. http://dx.doi.org/10.4067/S0034-98872015000100011 . Bastos MLA, Carvalho TGS, Ferreira MJM. Global burden of mental illness in agents fighting endemics. Cad Saude Publica. 2022;38(2):e00157921. https://doi.org/10.1590/0102311X00157921 . Fonseca RMC, Carlotto MS. Mental health and work leave in judiciary workers in the state of Rio Grande do Sul. Psicol Pesq. 2011;5(2):117–25. https://doi.org/10.24879/201100500200332 . Gruber AG, Hamada AKC, Cassol MEG, Goldim MPS. Absence from work for mental disorders in southern Brazil between 2009 and 2018. Rev Saude Publ Parana. 2021;4(4):17–28. https://doi.org/10.32811/25954482-2021v4n4p17 . Lundqvist J, Lindberg MS, Brattmyr M, Havnen A, Aasdahl L, Solem S, et al. Work disability status following routine mental health treatment: a Norwegian registry-based cohort study. BMC Health Serv Res. 2025;25:787. 10.1186/s12913-025-12856-w . Stangeland F, Sveinsdottir V, Ree E. From outsider to participant: a qualitative study about attaining and retaining work among persons with mental illness. BMC Public Health. 2024;24:3346. https://doi.org/10.1186/s12889-024-20667-7 . Falavigna A, Carlotto MS. Time trends of sick leave at work by mental and behavioral disorders of nurses (1998–2008). Psicol Organ Trab. 2013;13(3):363–372. [cited 2026 Jan 20]. Available from: http://pepsic.bvsalud.org/scielo.php?script=sci_arttext&pid=S1984-66572013000300012&lng=pt&tlng=pt Guimarães LAM, Neto AL, Massuda Júnior J. Workers’ mental health integrated intervention in a police corporation of Campo Grande, MS, Brazil. Rev Bras Saude Ocup. 2020;45:e8. http://dx.doi.org/10.1590/2317-6369000018618 . Knutsen RH, Nielsen MB, Lunde L, Skare O, Johannessen HA. Impact of psychosocial work factors on risk of medically certified sick leave due to common mental disorders: a nationwide prospective cohort study of Norwegian home care workers. BMC Public Health. 2024;24:773. https://doi.org/10.1186/s12889-024-18299-y . Silva-Junior JS, Fischer FM. Long-term sickness absence due to mental disorders is associated with individual features and psychosocial work conditions. PLoS ONE. 2014;9(12):e115885. https://doi.org/10.1371/journal.pone.0115885 . Leino-Arjas P, Seitsamo J, Nygård C, Prakash KC, Neupane S. Process of work disability: from determinants of sickness absence trajectories to disability retirement in a long-term follow-up of municipal employees. Int J Environ Res Public Health. 2021;18:2614. https://doi.org/10.3390/ijerph18052614 . Miranda FAN, Carvalho GRP, Fernandes RL, Silva MB, Sabino MGG. Mental health, work and retirement: a focus on mental alienation. Rev Bras Enferm. 2009;62(5):711–6. https://doi.org/10.1590/S0034-71672009000500010 . Neves RF, Nunes MO, Magalhães L. Interactions among stakeholders involved in return to work after sick leave due to mental disorders: a meta-ethnography. Cad Saude Publica. 2015;31(11):2275–90. http://dx.doi.org/10.1590/0102-311X00029215 . Cornelius LR, Van der Klink JJL, Groothoff JW, Brouwer S. Prognostic factors of long-term disability due to mental disorders: a systematic review. J Occup Rehabil. 2011;21:259–74. https://doi.org/10.1007/s10926-010-9261-5 . Magnago TSBS, Prochnow A, Urbanetto JS, Greco PBT, Beltrame M, Luz EMF. Relationship between work ability in nursing and minor psychological disorders. Texto Contexto Enferm. 2015;24(2):362–70. https://doi.org/10.1590/0104-07072015002580013 . Frantz A, Toropova A, Axén I, Bergström G, Finnes A, Bramberg EB. Predictors of sickness absence among employees with common mental disorders in Sweden: a longitudinal study. BMC Public Health. 2025;25:428. https://doi.org/10.1186/s12889-025-21563-4 . World Health Organization. Measuring health and disability: manual for WHO Disability Assessment Schedule (WHODAS 2.0). Geneva: WHO. 2010. [cited 2026 Jan 19]. Available from: https://www.who.int/publications/i/item/measuring-health-and-disability-manual-for-who-disability-assessment-schedule-(-whodas-2.0 ). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 05 May, 2026 Reviewers agreed at journal 23 Apr, 2026 Reviewers invited by journal 15 Apr, 2026 Editor invited by journal 23 Mar, 2026 Editor assigned by journal 23 Mar, 2026 Submission checks completed at journal 23 Mar, 2026 First submitted to journal 20 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9182548","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":625790955,"identity":"adeb8545-8b50-431d-8ca9-7677d92d81c7","order_by":0,"name":"Angela dos Santos Silva","email":"","orcid":"","institution":"Federal University of Maranhão","correspondingAuthor":false,"prefix":"","firstName":"Angela","middleName":"dos Santos","lastName":"Silva","suffix":""},{"id":625790956,"identity":"4ed0a4eb-3e89-4ea8-ba27-28eb2e85ef57","order_by":1,"name":"Francisco Mayron Morais Soares","email":"","orcid":"","institution":"Federal University of Maranhão","correspondingAuthor":false,"prefix":"","firstName":"Francisco","middleName":"Mayron Morais","lastName":"Soares","suffix":""},{"id":625790957,"identity":"fded8f3a-91e2-4083-8ec0-eb782e87d7d4","order_by":2,"name":"Elton Brás Camargo Júnior","email":"","orcid":"","institution":"Universidade de Rio Verde","correspondingAuthor":false,"prefix":"","firstName":"Elton","middleName":"Brás Camargo","lastName":"Júnior","suffix":""},{"id":625790958,"identity":"2aedebf8-2dbf-4b37-9128-c78357e7c43e","order_by":3,"name":"Maria Neyrian de Fátima Fernandes","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA70lEQVRIiWNgGAWjYLCCBCh9gKGCgR9Is5Gi5QyDZANRWuCAsY0ILebsPWYfHtTcYdBtP/vwwM95hyV02w+wPa7Ao8Wy54zxjIRjzxjMzqQbHOzddljC7EwCu+EZPFoMbuQYMySwHWYwO5DGcIB32+E6swMJbCDX4dZy/w1Qyz+glvPPGA7+nQO05fwDAlpu8BgzJLYBtdxIYzjM2wDUcoOQLWfSihkS+w7zmN14xnBY5lg6UMvDdkO8Wo4f3sz449thObPzacwf39RYAx2WfOwhPi0MDBwGIJIHSYQRvwYGBvYHBBSMglEwCkbBiAcAwQ1UDwYFm+EAAAAASUVORK5CYII=","orcid":"","institution":"Federal University of Maranhão","correspondingAuthor":true,"prefix":"","firstName":"Maria","middleName":"Neyrian de Fátima","lastName":"Fernandes","suffix":""}],"badges":[],"createdAt":"2026-03-21 01:53:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9182548/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9182548/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107706521,"identity":"f1df0e27-b7d6-4a0a-8f38-1b4ff912c206","added_by":"auto","created_at":"2026-04-24 09:18:14","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":49883,"visible":true,"origin":"","legend":"\u003cp\u003ePrisma flow diagram of study inclusion\u003c/p\u003e\n\u003cp\u003eSource: Page et al. (2021).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9182548/v1/9be71f3276f2b3cf8a44183a.png"},{"id":107574588,"identity":"6928befe-da45-48cd-9dd9-be3004c84205","added_by":"auto","created_at":"2026-04-22 19:39:41","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":83308,"visible":true,"origin":"","legend":"\u003cp\u003eConceptual model of disabling mental illness.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNote\u003c/em\u003e – 1: Anseolaga \u003cem\u003eet al., \u003c/em\u003e(2015); 2: Bastos, Carvalho \u0026amp; Ferreira (2022); 3: Fonseca \u0026amp; Carlotto (2011); 4: Gruber \u003cem\u003eet al.,\u003c/em\u003e (2021); 5: Lundqvist \u003cem\u003eet al\u003c/em\u003e., (2025); 6: Stangeland, Sveinsdottir \u0026amp; Ree (2024); 7: Falavigna \u0026amp; Carlotto (2013); 8: Guimarães, Neto \u0026amp; Massuda Júnior (2020); 9: Knutsen, Nielsen, Lunde, Skare \u0026amp; Johannessen (2024); 10: Silva-Junior \u0026amp; Fischer (2014); 11: Leino-Arjas, Seitsamo, Nygard, Prakash \u0026amp; Neupane (2021); 12: Miranda, Carvalho, Fernandes, Silva \u0026amp; Sabino (2009); 13: Neves, Nunes \u0026amp; Magalhães (2015); 14: Cornelius, Van der Klink, Groothoff \u0026amp; Brouwer (2011); 15: Magnago, Prochnow, Urbanetto, Greco, Beltrame \u0026amp; Luz (2015); 16: Frantz, Toropova, Axén, Bergstrom, Finnes \u0026amp; Bramberg (2025).\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9182548/v1/6278558244191103983a0d89.png"},{"id":107709240,"identity":"84dc9fbb-d11d-4929-8dbe-23cadbb65add","added_by":"auto","created_at":"2026-04-24 09:35:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":315182,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9182548/v1/88a2e8c5-2d36-4eb7-8211-4b21d42c97a2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Disabling mental illness in workers: a concept analysis in occupational mental health","fulltext":[{"header":"1. Background","content":"\u003cp\u003eMental disorders constitute a considerable and growing burden on global public health, with direct consequences for individuals' quality of life and broader socioeconomic functioning. Their impact on occupational performance is well documented, as they are recognized contributors to workplace absenteeism, diminished productivity, and increased reliance on disability benefits [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. At the global level, the World Health Organization (WHO) identifies depression as one of the primary causes of disability, with a disproportionate prevalence among women of productive age [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In the Brazilian context, data from the Ministry of Social Security [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] indicate that mental and behavioral disorders rank among the leading causes of work absenteeism and social security benefit claims, generating substantial social and economic costs.\u003c/p\u003e \u003cp\u003eNursing professionals represent a particularly vulnerable group to occupational psychological distress, given the high emotional demands, heavy workloads, and constant exposure to human suffering inherent to the profession. Evidence from a systematic review and meta-analysis [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] encompassing more than 288,000 nurses across 32 countries indicates that burnout within this workforce is associated with compromised patient safety, reduced quality of care, and decreased patient satisfaction, underscoring the systemic consequences of psychological distress beyond the individual level.\u003c/p\u003e \u003cp\u003eAlthough the relevance of mental illness is widely recognized, the concept of disabling mental illness still lacks a consolidated definition in the scientific literature. It is used diversely across clinical, social security, and occupational contexts. This terminological variability contributes to conceptual overlap with related constructs, such as psychosocial disability, work-related mental incapacity, and chronic mental illness with functional impairment. The term has been employed to describe psychological conditions that significantly impair an individual\u0026rsquo;s functional capacity, interfering with daily activities, work performance, and social interactions. This condition may manifest as persistent limitations in domains such as self-care, productivity, employment, and social participation [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe complexity of disabling mental illness lies in both the variety of diagnoses involved, such as depression, anxiety, mood disorders, substance use disorders, and stress-related disorders, and the interaction of multiple biological, psychological, and social factors that influence its development and outcomes. The concept appears to relate to the extent and persistence of functional limitation associated with mental health conditions. The literature has emphasized the relevance of the work environment as a precipitating or aggravating element of these conditions, especially under adverse circumstances such as work overload, low social support, long working hours, and job insecurity [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Brazil's Social Security Administration and forensic practice, the concept is associated with work incapacity resulting from mental and behavioral disorders, based on clinical and functional criteria [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, this institutional use does not necessarily correspond to a conceptual definition of the phenomenon, as it reflects regulatory and administrative classifications. In healthcare practice, the term is often applied to situations of persistent psychological suffering that compromise functional and social performance, even in the absence of a standardized conceptual framework. Some studies use the term more broadly to refer to mental conditions that lead to prolonged work absences, reduced productivity, and difficulties in social reintegration [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this context, concept analysis represents an essential methodological strategy for clarifying ambiguous or imprecise expressions in the literature and clinical practice. In nursing, this approach strengthens the disciplinary field by refining technical language and the theoretical foundations of health interventions, distinguishing essential attributes from contextual or institutional responses. Operationalizing complex phenomena such as disabling mental illness supports the development of nursing diagnoses, public policies, and evidence-based care practices [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite its increasing use, the concept of disabling mental illness remains theoretically underdeveloped. Conceptual clarification is therefore necessary to advance public policy formulation, strengthen mental health care, and guide the development of psychosocial rehabilitation strategies, particularly in supporting nursing assessment, clinical reasoning, and intervention planning in situations involving functional impairment. Based on the method proposed by Walker and Avant [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], this study aims to clarify the concept of disabling mental illness in the context of mental health and work by identifying its attributes, uses, antecedents, consequences, and empirical referents.\u003c/p\u003e"},{"header":"2. Material and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study Design\u003c/h2\u003e \u003cp\u003eThis theoretical study uses concept analysis [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] to examine a concept's structure and function, aiding understanding of phenomena in a specific area knowledge. This model is operationalized through eight stages: selection of the concept; determination of the purpose of the analysis; identification of all possible uses of the concept; determination of defining attributes; presentation of a model case; presentation of additional cases; identification of antecedents and consequences of the concept; and definition of empirical referents [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe term selected for analysis was disabling mental illness, given the author\u0026rsquo;s familiarity with the topic of mental and occupational health and the need for a better conceptual delimitation in the literature.\u003c/p\u003e \u003cp\u003eSubsequently, the possible uses of this concept were identified. To achieve this, a search was conducted in scientific databases using an integrative literature review, a rigorous and well-defined method commonly employed in evidence-based practice. The review followed the steps of problem identification and development of the guiding question; literature search with application of inclusion and exclusion criteria; data collection using a prestructured instrument; data analysis; and presentation of the review [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe reporting of the literature search and study selection process was informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to enhance transparency and completeness. The completed PRISMA checklist is provided as supplementary material. This review was not prospectively registered.\u003c/p\u003e \u003cp\u003eTo formulate the research question, the PCC mnemonic (Population, Concept, and Context) was used. Accordingly, the elements were defined as follows: P \u0026ndash; category of workers; C \u0026ndash; mental illness with functional incapacity; C \u0026ndash; occupational health. Based on this framework, the following questions were constructed: What is the concept of disabling mental illness? What are its uses, attributes, antecedents, and consequences?\u003c/p\u003e \u003cp\u003eThe articles retrieved from the databases were evaluated by the principal investigator through the screening of titles and abstracts, using a free web-based single-version review program called Rayyan Qatar Computing Research Institute [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Full-text reading of the selected articles was then carried out, followed by manual reference checking of the included papers, which did not yield any additional studies.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Study Period and Setting\u003c/h2\u003e \u003cp\u003eThe literature search was conducted between May and June 2025 in the following electronic databases: LILACS, Elsevier\u0026rsquo;s Scopus (SCOPUS), National Library of Medicine (MEDLINE via PubMed), and Web of Science. The descriptors employed were drawn from the Medical Subject Headings (MeSH), Health Sciences Descriptors (DeCS), and free terms, combined using Boolean operators (AND/OR). The search strategy was adapted according to the specificities of each database; however, the combinations among descriptors were maintained, and no restrictions were applied regarding publication date or language. The search syntaxes are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSearch strategies used in each database.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDatabase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSearch equation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLILACS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e((\"Transtornos Mentais\" OR \"Sa\u0026uacute;de Mental\" OR \"sofrimento ps\u0026iacute;quico\" OR \"adoecimento mental\")) AND ((\"Incapacidade\" OR \"Invalidez\" OR \"Capacidade de Trabalho\" OR \"incapacidade funcional\" OR \"adoecimento mental incapacitante\" OR \"afastamento do trabalho\"))\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePUBMED\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(\"Mental Disorders\"[MeSH Terms] OR \"Mental Health\"[MeSH Terms] OR \"Psychiatric Illness\" OR \"Mental Illness\" OR \"psychological distress\")\u003c/p\u003e \u003cp\u003eAND (\"Disability Evaluation\"[MeSH Terms] OR \"Work Capacity Evaluation\"[MeSH Terms] OR \"Sick Leave\"[MeSH Terms] OR \"Workplace Disability\" OR \"Functional Impairment\" OR \"Work Disability\") AND (\"chronic mental illness\" OR \"disabling mental illness\" OR \"psychosocial disability\" OR \"incapacitating mental disorder\" OR \"mental illness and work absence\" OR \"mental health related disability\")\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeb of Science\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTS=(\"mental disorder\" OR \"mental illness\" OR \"psychiatric disorder\" OR \"psychological distress\") AND TS=(\"work disability\" OR \"functional impairment\" OR \"psychosocial disability\" OR \"disability due to mental illness\" OR \"incapacitating mental disorder\") AND TS=(\"chronic mental illness\" OR \"mental health related disability\" OR \"mental illness and work absence\")\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSCOPUS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTITLE-ABS-KEY (\"mental disorder\" OR \"mental illness\" OR \"psychiatric illness\" OR \"psychological distress\") AND TITLE-ABS-KEY (\"work disability\" OR \"functional impairment\" OR \"psychosocial disability\" OR \"incapacitating mental illness\" OR \"disabling mental illness\") AND TITLE-ABS-KEY (\"chronic mental illness\" OR \"sick leave\" OR \"mental illness and work\" OR \"mental health disability\")\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Population and Sample\u003c/h2\u003e \u003cp\u003eA total of 982 studies were identified in the initial search. These records were exported to the Rayyan software for screening and duplicate removal, resulting in 905 documents. After reading the titles and abstracts, 70 articles remained for full-text review. Following full-text screening and application of inclusion and exclusion criteria, 16 studies were selected to comprise the final sample of this study. The selection was carried out by a nurse researcher specialized in mental health.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Inclusion and exclusion criteria\u003c/h2\u003e \u003cp\u003eThe inclusion criteria were full-text publications freely available in electronic format; peer-reviewed scientific articles; no restrictions regarding language or publication period; and direct alignment with the study objective. The exclusion criteria comprised duplicate records, abstracts, letters to the editor, opinion articles, studies unrelated to the proposed topic, correspondences, book reviews, book chapters, theses and dissertations, undergraduate monographs, and final course papers.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Data Analysis\u003c/h2\u003e \u003cp\u003eAfter selecting the 16 included articles, an analytical reading and extraction of conceptual data were performed using a customized instrument developed in Microsoft Excel\u0026reg;, containing the following information: study title, objective, design, year of publication, country, language, defining attributes, antecedents, and consequences related to the concept.\u003c/p\u003e \u003cp\u003eThe subsequent step involved thematic categorization, identifying recurring expressions and ideas associated with the concept, and grouping them by similarities in meaning. This process aimed to distinguish essential conceptual attributes from contextual, institutional, or outcome-related elements.\u003c/p\u003e \u003cp\u003eComparative analysis across studies enabled the identification of convergences and divergences in the uses of the concept, distinguishing among clinical, occupational, and sociopolitical emphases. This analytical distinction helped define concepts more precisely, rather than simply grouping and describing them. These findings supported the definition of the attributes, antecedents, and consequences presented in the results.\u003c/p\u003e \u003cp\u003eIt is worth noting that antecedents are events that precede the concept and serve as precursors to its occurrence, whereas consequences are events that follow the concept and result from the presence of its defining attributes [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSubsequently, a model case and a contrary case were described. To meet the theoretical requirements of concept analysis, additional cases were examined to sharpen conceptual boundaries. The defining attributes of the concept were then established, revealing its essential characteristics. A model case was presented alongside borderline, related, contrary, and invented cases to show how the concept manifests in different ways. Antecedents and consequences were identified, and empirical referents were defined, enabling the concept to be operationalized and recognized in practice.\u003c/p\u003e \u003cp\u003eIt should be emphasized that the presentation of results, in line with the aim of this study, is descriptive in nature, oriented toward conceptual refinement and theoretical clarification, and guided by the discussion of the steps selected for the concept analysis of disabling mental illness, in accordance with the stages of the adopted framework.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eA total of 982 studies were identified in the initial search. The material was exported to the Rayyan software, after which study screening was conducted using inclusion and exclusion criteria, resulting in a final sample of 16 studies. The selection process is detailed in the PRISMA flow diagram in Fig.\u0026nbsp;1, which presents the identification, screening, eligibility, and inclusion stages of the integrative review studies.\u003c/p\u003e\u003cp\u003eAnalytical reading of the 16 studies made it possible to identify three thematic categories that synthesize the main meanings attributed to the term disabling mental illness: (1) the functional dimension, encompassing elements related to loss of performance and autonomy, persistent psychological symptoms, and difficulty returning to work activities; (2) the organizational dimension, which includes factors related to the work environment, such as work overload, high emotional demands, institutional violence, and lack of social or organizational support; and (3) the social dimension, which comprises social exclusion, dependence on social security benefits, and stigma associated with illness. These dimensions are analytical groupings and do not necessarily reflect the essential attributes of the concept.\u003c/p\u003e \u003cp\u003eComparative analysis among the studies revealed that while publications with a clinical focus emphasize functional and emotional impairments, social security studies highlight work incapacity and legal criteria for leave, and sociopolitical works address illness as an outcome of structural working conditions. This triangulation reinforces the multifactorial nature of the concept and supports the distinction between conceptual attributes and contextual or institutional responses, guiding the construction of its essential attributes, antecedents, and consequences.\u003c/p\u003e \u003cp\u003eThe analysis revealed multiple uses of the concept of disabling mental illness. In the clinical and care field, the term is used to describe conditions of psychological distress involving significant functional impairment [\u003cspan additionalcitationids=\"CR16 CR17 CR18 CR19\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In social security and forensic contexts, it appears associated with work incapacity that underlies benefits such as sickness allowance or disability retirement [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan additionalcitationids=\"CR22 CR23\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. These uses reflect application contexts rather than defining characteristics of the concept.\u003c/p\u003e \u003cp\u003eIt was also identified in epidemiological studies, which measure the prevalence of work absences due to mental disorders [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan additionalcitationids=\"CR26 CR27\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Finally, in sociopolitical approaches, the concept is used to denounce harmful working conditions and to advocate for public policies aimed at psychosocial reintegration and rehabilitation [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo understand this phenomenon, antecedents, essential attributes, and consequences were identified and organized according to the Walker and Avant [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] method through analytical reading and systematic categorization. The attributes reflect manifestations intrinsic to the conceptual expression of disabling mental illness, while consequences represent downstream social and institutional outcomes, distinguishing them from contextual conditions or antecedent factors (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eDisabling mental illness emerges at the intersection between the fields of mental health and occupational health, reflecting the complexity of the psychosocial and functional effects of mental disorders on individuals\u0026rsquo; work and social lives.\u003c/p\u003e \u003cp\u003eThe most frequently cited antecedents of disabling mental illness were harmful work environments (13 studies), including exhaustive working hours, work overload, productivity pressure, interpersonal conflicts, and institutional violence; lack of organizational and social support (11 studies); previous history of mental suffering (10 studies); and high psychological demands in the workplace (9 studies). In addition, stigma and discrimination related to mental disorders were highlighted, as well as various social vulnerabilities, such as low educational attainment, precarious income, and job insecurity. These psychosocial and contextual factors play a role in triggering the illness, highlighting how labor and structural conditions contribute to the development of mental disorders with functional and disabling effects. As such, they were interpreted as antecedents to the concept rather than part of its essential definition.\u003c/p\u003e \u003cp\u003eThe essential attributes of disabling mental illness refer to the manifestations that define its functionally limiting nature. The most prominent is persistent functional impairment, identified in 10 studies, characterized by difficulty maintaining performance in daily, occupational, and social activities, with compromise of cognitive, emotional, and relational skills. Enduring psychological symptoms, such as anxiety, depression, intense emotional distress, and chronic stress, were also recurrent (9 studies), along with frequent and prolonged work absences (8 studies), reduced productivity and work capacity (7 studies), and difficulty in social and/or occupational reintegration (6 studies), even after clinical improvement. These attributes reflect the intensity and persistence of the concept's impact on quality of life, occupational performance, and social inclusion, conferring upon it a truly disabling nature that extends beyond diagnostic labels or administrative classifications.\u003c/p\u003e \u003cp\u003eThe consequences of disabling mental illness reveal a chain of adverse outcomes affecting both individuals and society. Such outcomes are consequences of the concept's presence and should not be confused with its defining attributes. Notably, these include dependence on social security benefits, such as sickness allowance and disability retirement, followed by permanent withdrawal from work or early retirement, and social and professional exclusion, marked by the loss of the social role associated with work.\u003c/p\u003e \u003cp\u003eThe chronicity of psychological symptoms is also observed, with the persistence of suffering even under treatment, as well as social isolation and difficulty in reentering the labor market, forming a cycle of marginalization. These developments reinforce the disabling nature of mental illness by compromising professional identity, social participation, and prospects for functional and occupational recovery.\u003c/p\u003e \u003cp\u003eTo illustrate the practical application and limits of the analyzed concept, particularly regarding the presence of its defining attributes, antecedents, and consequences, cases were constructed within the selected theoretical framework, including model, contrary, borderline, and related cases to strengthen conceptual boundaries. The model case exemplifies the concept of disabling mental illness in its fullest expression, incorporating all essential attributes:\u003c/p\u003e \u003cp\u003e\u0026ldquo;Ms. M.M., 38 years old, is a social worker at an urban center and works in a shelter service for people in situations of vulnerability. Over the past two years, she began facing high emotional demands associated with resource scarcity, work overload, understaffing, and continuous exposure to traumatic stories. Over time, Ms. M.M. started to present symptoms of anxiety and depression, such as insomnia, extreme fatigue, crying spells, and a constant sense of failure. Despite seeking medical help, the symptoms intensified, compromising her concentration, interpersonal relationships, and job performance. After successive episodes of sick leave, she was granted a sickness allowance due to recurrent depressive disorder. The process of returning to work proved unsuccessful because of the lack of institutional support, worsening of her clinical condition, and feelings of professional uselessness. Ms. M.M. was subsequently permanently removed from work and referred for disability retirement. She currently continues mental health follow-up but faces social isolation, loss of professional identity, and difficulty reintegrating into social and productive activities\u0026rdquo;.\u003c/p\u003e \u003cp\u003eMs. M.M.'s case fully embodies the concept of disabling mental illness as defined through this analysis. All essential attributes of the concept are present, including persistent functional impairment, enduring psychological symptoms, frequent work absences, reduced productivity and work capacity, and difficulty in social and occupational reintegration.\u003c/p\u003e \u003cp\u003eIn addition, the case highlights critical antecedents, including a harmful work environment (overload, resource scarcity), a lack of institutional support, and high emotional demands. It also presents consequences such as permanent work withdrawal, dependence on social security benefits, social isolation, and loss of professional identity, fulfilling its didactic and methodological role by materializing the findings of the concept analysis in a concrete, though fictional situation.\u003c/p\u003e \u003cp\u003eThe contrary case is used to contrast and delineate the concept, emphasizing its boundaries and conceptual distinctions:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eMr. J.J., 27 years old, is a systems analyst working in a hybrid mode. After the end of a relationship, he began to experience mild symptoms of sadness, insomnia, and loss of appetite. Acknowledging the emotional impact, he sought psychological support, attended several psychotherapy sessions, and made adjustments to his self-care routine. He continued performing his professional duties normally, with slight fluctuations in productivity for about a week. By the end of the month, he reported significant improvement, regaining emotional well-being and his usual professional performance. He never needed to take sick leave nor exhibited any relevant functional impairment.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThis contrary case illustrates a situational psychological distress that does not meet the defining attributes of disabling mental illness. Although the character experienced mild symptoms of sadness, insomnia, and temporary reduction in productivity, these effects were transient, did not persistently compromise his functionality, and did not require work absence. He sought support, responded positively to the intervention, and maintained his occupational and social performance, all of which are incompatible with the concept's chronic, dysfunctional, and limiting nature.\u003c/p\u003e \u003cp\u003eThis distinction shows that not all psychological suffering constitutes a disabling mental illness. As demonstrated by the analyzed studies, the concept presupposes the persistence of psychological symptoms, significant functional impairment, and a prolonged impact on the individual\u0026rsquo;s occupational and social life. In the contrary case, these conditions are absent, reinforcing the importance of differentiating common psychological distress from conditions that truly require work leave and prolonged intervention.\u003c/p\u003e \u003cp\u003eThus, the contrary case helps refine the boundaries of the concept, clarifying that the isolated presence of emotional symptoms, without functional impairment, does not characterize disabling mental illness. This differentiation is essential to prevent overdiagnosis, unwarranted stigmatization, or excessive medicalization of expected emotional experiences in response to life events.\u003c/p\u003e \u003cp\u003eBorderline cases represent situations in which some defining attributes are present without full conceptual expression, while related cases encompass adjacent phenomena that share certain characteristics without constituting the concept itself. This distinction reinforces conceptual boundaries and prevents conflation between disabling mental illness and other forms of psychological distress or functional impairment.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eMs. M.F., 45 years old, is a nurse working in a public emergency department. Over the course of six months, she began experiencing intense psychological distress associated with high workload, night shifts, and recurrent exposure to critical incidents. She reported symptoms of anxiety, emotional exhaustion, irritability, and difficulty concentrating. Her productivity declined, and she required two short periods of sick leave totaling three weeks. During this time, she expressed feelings of professional inadequacy and considered requesting long-term leave. After organizational adjustments were implemented, including temporary reduction of shifts, peer support, and structured psychological follow-up, her symptoms gradually improved. Within four months, she resumed full professional responsibilities without further absences. Although she continues to experience occasional stress, she maintains functional stability and occupational performance.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eMs. M.F.'s case approximates the concept of disabling mental illness, presenting several defining attributes, including significant psychological distress, temporary functional impairment, reduced productivity, and work absences. However, the impairment lacks the persistence, chronicity, and sustained difficulty in occupational reintegration that characterize the full conceptual expression of the concept. Given that the functional decline proved reversible and responsive to institutional and psychosocial interventions, this case approximates but does not fully embody disabling mental illness, particularly in its enduring and structurally limiting dimension.\u003c/p\u003e \u003cp\u003eWhile borderline cases approach the concept by containing most of its defining attributes, related cases represent distinct but adjacent phenomena with their own conceptual identity, as illustrated by the following example from the field of mental health nursing.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eMs. A.M., 54 years old, is a psychiatric nurse working in a community mental health center. Over several years of continuous exposure to patients experiencing severe trauma and chronic psychiatric conditions, she began to report emotional exhaustion, reduced empathy, and feelings of detachment from patients\u0026rsquo; suffering. She describes difficulty sleeping and occasional irritability after intense workdays. Although she feels emotionally drained, she continues to perform her clinical duties competently, maintains therapeutic relationships, and fulfills her professional responsibilities. She has not required sick leave, does not exhibit persistent functional impairment in her daily life, and remains socially and occupationally engaged.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThis related case corresponds to compassion fatigue, a recognized phenomenon in nursing practice that shares contextual proximity with disabling mental illness through exposure to high emotional demands and sustained psychological strain. Yet it does not fulfill the defining attributes identified in this analysis, as it lacks persistent functional impairment, recurrent work absences, and a trajectory toward occupational exclusion or institutional dependence. As a related case, compassion fatigue belongs to the broader constellation of work-related mental health phenomena while remaining conceptually distinct from disabling mental illness, which requires enduring functional limitation and sustained disruption of occupational and social roles beyond emotional strain alone.\u003c/p\u003e \u003cp\u003eThe empirical referents of the concept of disabling mental illness correspond to observable indicators that enable its identification and application in professional practice. Among the main indicators are the granting of social security benefits for mental disorders, such as sickness allowance and disability retirement [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], and the use of validated clinical instruments, such as the WHODAS 2.0 (World Health Organization Disability Assessment Schedule), which assesses the degree of functional disability [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Other empirical indicators include the frequency of work absences due to mental disorders, the recurrence of psychological symptoms refractory to treatment, and difficulties in reintegration into work or social life [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. These operational elements are essential for recognizing and managing the phenomenon in clinical practice and public policy.\u003c/p\u003e \u003cp\u003eIt is worth noting that frequent work absences constitute a manifestation of persistent functional impairment as a defining attribute; however, their measurement through absence records or administrative data serves as an empirical referent rather than a defining characteristic of the concept.\u003c/p\u003e \u003cp\u003eTherefore, disabling mental illness is understood as a state of chronic psychological suffering characterized primarily by persistent functional impairment rather than by the presence of a specific diagnostic category or institutional outcome. This impairment manifests through enduring mental symptoms, recurrent work absences, and sustained difficulties in professional and social reintegration. This phenomenon emerges from the interaction between harmful working conditions, lack of institutional support, and pre-existing psychosocial vulnerabilities, resulting in dependence on social security benefits, social exclusion, and chronicity of the clinical condition. It represents a process that transcends an isolated psychiatric diagnosis, expressing the interface between mental health, functionality, and work organization.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe concept analysis conducted in this study enabled an in-depth exploration of disabling mental illness, highlighting its complexity and relevance within the field of workers\u0026rsquo; mental health. The findings indicate that this concept is characterized by multiple interconnected dimensions involving subjective, clinical, functional, and social aspects. However, the analysis also allowed for the distinction between essential conceptual attributes and contextual conditions surrounding the phenomenon. The prevalence of antecedents such as harmful work environments, lack of organizational support, and a prior history of mental suffering reinforces this complexity and underscores the need for integrated approaches.\u003c/p\u003e \u003cp\u003eIn the context of contemporary work, emotional and cognitive demands, job insecurity, and precarious working conditions have been widely recognized as sources of chronic stress and psychological illness. Studies [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] have demonstrated that workplace suffering cannot be dissociated from the social and institutional contexts in which it occurs. The analysis revealed an overlap between social and occupational factors as determinants of the illness process that leads to long-term functional impairment, while indicating that these factors operate primarily as antecedents rather than as defining attributes of the concept.\u003c/p\u003e \u003cp\u003eThe most frequently cited attributes, such as persistent functional impairment, enduring psychological symptoms, frequent work absences, and difficulty in reintegration, offer a robust characterization of the concept. Together, these elements support the conceptualization of disabling mental illness as a chronic, process-oriented phenomenon defined by persistent functional limitation, transcending both episodic mental disorder and diagnostic categorization alone.\u003c/p\u003e \u003cp\u003eThe analysis of consequences reveals a concerning pattern: dependence on social security benefits, early retirement, and social and occupational exclusion are frequently reported outcomes. These consequences were distinguished from essential attributes as part of the theoretical delimitation of the concept, yet they underscore that disabling mental illness extends beyond individual health, compromising active participation in society. Even after clinical improvement, individuals continue to face substantial obstacles to social and occupational reintegration, a process further hindered by persistent stigma and inadequate psychosocial support [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis reality carries essential implications for Nursing and Public Health. The conceptual clarification proposed in this study provides a stronger foundation for care practices, allowing for the early identification of cases of potentially disabling illness and the implementation of more targeted interventions. By clarifying conceptual boundaries, this analysis supports clinical reasoning grounded in functionality, trajectory, and context, transcending the limitations of diagnostic labels alone.\u003c/p\u003e \u003cp\u003eMoreover, it contributes to the development of public policies and clinical guidelines that consider not only diagnosis but also individuals' functioning and social context, and advances nursing theory by offering a more precise conceptual framework for assessing functional impairment associated with mental health conditions.\u003c/p\u003e \u003cp\u003eIt is therefore essential to recognize disabling mental illness as a phenomenon requiring intersectoral responses that integrate health, labor, and social security systems. Nursing, due to its relational and holistic nature, occupies a privileged position to lead this expanded care process within the Brazilian Psychosocial Care Network (RAPS), particularly in identifying early functional decline, monitoring impairment trajectories, and supporting return-to-work processes.\u003c/p\u003e \u003cp\u003eThus, this analysis advances the nursing disciplinary field by refining the theoretical delimitation of disabling mental illness and distinguishing it from adjacent constructs such as work incapacity, psychosocial disability, and chronic mental illness with functional limitation, offering a conceptual foundation for clinical, forensic, and policy-oriented action in the context of the growing challenge of mental illness in the workplace\u003c/p\u003e \u003cp\u003eThis study has two main limitations. First, relying on published literature means that the conceptualization reflects reported uses of the term, which may be shaped by institutional or policy-driven definitions. Second, as a qualitative method, concept analysis is subject to the author's interpretive bias, despite the systematization and analytical rigor applied throughout the process.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThe concept analysis of disabling mental illness made it possible to identify the essential attributes, antecedents, and consequences that characterize this phenomenon as multifactorial, with a significant impact on individuals\u0026rsquo; functional, social, and occupational lives. Based on the review of the 16 included studies, it became evident that the concept encompasses elements such as persistent functional impairment, enduring psychological symptoms, recurrent work absences, and difficulties in work reintegration, all related to adverse work environments, lack of institutional support, and social vulnerabilities. The analysis also enabled a distinction between the defining attributes of the concept and the contextual or institutional outcomes associated with it.\u003c/p\u003e \u003cp\u003eThis study refines the concept of disabling mental illness by positioning functional impairment and its trajectory as central elements, moving beyond diagnostic labels and administrative classifications. In doing so, it strengthens nursing's technical-scientific language and provides a theoretical foundation for more accurate clinical and forensic reasoning. The study further advances nursing theory by distinguishing disabling mental illness from adjacent constructs such as work incapacity, psychosocial disability, and chronic mental illness with functional limitation, with direct implications for clinical practice, care management, and public policy in workers' mental health.\u003c/p\u003e \u003cp\u003eFuture research should focus on the empirical validation of the identified attributes and the development of instruments for the early identification and monitoring of disabling mental illness, including further exploration of borderline and related phenomena to support operationalization in clinical practice. Additionally, intersectoral articulation among health, social security, and labor systems is essential to address the challenges posed by this phenomenon and to promote interventions that ensure dignity, functionality, and social inclusion for affected individuals\u003c/p\u003e \u003cp\u003eThis concept analysis contributes to mental health nursing practice by clarifying the defining attributes of disabling mental illness and positioning persistent functional impairment as its central feature. This refinement enables nurses to distinguish disabling trajectories from transient psychological distress and adjacent occupational phenomena, supporting early identification of sustained functional decline and the planning of targeted psychosocial rehabilitation and return-to-work interventions. By strengthening theoretical clarity, this analysis also informs the development of structured assessment approaches and promotes more consistent, evidence-informed care in workplace and community settings.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eDeCS: Health Sciences Descriptors\u003c/p\u003e\n\u003cp\u003eLILACS: Latin American and Caribbean Health Sciences Literature\u003c/p\u003e\n\u003cp\u003eMEDLINE: Medical Literature Analysis and Retrieval System Online\u003c/p\u003e\n\u003cp\u003eMeSH: Medical Subject Headings\u003c/p\u003e\n\u003cp\u003eRAPS: Psychosocial Care Network\u003c/p\u003e\n\u003cp\u003eWHO: World Health Organization\u003c/p\u003e\n\u003cp\u003eWHODAS 2.0: World Health Organization Disability Assessment Schedule 2.0\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs this is a theoretical study based exclusively on the analysis of scientific publications available for public consultation, submission to a Research Ethics Committee was not required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have nothing to report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors confirm that the data supporting the findings of this study are available within the article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eASS: Conceptualization, Methodology, Investigation, Writing - Original draft preparation. FMMS: Writing - Review \u0026amp; Editing. EBCJ: Writing - Review \u0026amp; Editing. MNFF: Supervision, Writing - Review \u0026amp; Editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Funda\u0026ccedil;\u0026atilde;o de Amparo \u0026agrave; Pesquisa e ao Desenvolvimento Cient\u0026iacute;fico e Tecnol\u0026oacute;gico do Maranh\u0026atilde;o (FAPEMA) \u0026ndash; Research Foundation for Scientific and Technological Development of Maranh\u0026atilde;o, Brazil.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHenderson M, Harvey SB, \u0026Oslash;verland S, Mykletun A, Hotopf M. Work and common psychiatric disorders. 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Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/measuring-health-and-disability-manual-for-who-disability-assessment-schedule-(-whodas-2.0\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/measuring-health-and-disability-manual-for-who-disability-assessment-schedule-(-whodas-2.0\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Absenteeism, Mental Disorders, Mental Health, Occupational Health, Sick Leave","lastPublishedDoi":"10.21203/rs.3.rs-9182548/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9182548/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eDisabling mental illness represents a growing concern at the intersection of mental health and occupational health. Conceptual clarity is needed to better understand its determinants and consequences in workers\u0026rsquo; lives.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA concept analysis was conducted using the Walker and Avant framework, supported by an integrative literature review performed in four databases (LILACS, Scopus, PubMed/MEDLINE, and Web of Science). Sixteen studies were included and analyzed to identify antecedents, defining attributes, consequences, and empirical referents of the concept.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eDisabling mental illness is characterized by persistent functional impairment, enduring psychological symptoms, recurrent work absences, and difficulty in occupational and social reintegration. Antecedents include harmful work environments, lack of organizational support, high psychological demands, and pre-existing psychosocial vulnerabilities. Consequences involve dependence on social security benefits, early retirement, social exclusion, and chronicity of the clinical condition.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe concept of disabling mental illness reflects a multifactorial phenomenon resulting from the interaction between work conditions, psychosocial vulnerabilities, and mental health outcomes. Conceptual clarification may support early identification, guide nursing interventions, and inform occupational mental health policies.\u003c/p\u003e","manuscriptTitle":"Disabling mental illness in workers: a concept analysis in occupational mental health","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-22 19:39:22","doi":"10.21203/rs.3.rs-9182548/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-05T08:53:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"288800477719928858801138758988886013407","date":"2026-04-23T05:56:57+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-15T05:11:18+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-23T16:46:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-23T12:06:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-23T12:05:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2026-03-21T01:37:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"143d7dbb-150b-4ebf-bec9-4cf8b5bb87ce","owner":[],"postedDate":"April 22nd, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-05T08:53:24+00:00","index":67,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-22T19:39:22+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-22 19:39:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9182548","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9182548","identity":"rs-9182548","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}