Return-To-Work after mental illness: A qualitative study on factors promoting the reintegration into work

Return-To-Work after mental illness: A qualitative study on factors promoting the reintegration into work | 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 Return-To-Work after mental illness: A qualitative study on factors promoting the reintegration into work Sabrina Braunwarth, Martin Lange This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3994464/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Mental illnesses have increased significantly in the past years and have a significant impact on individuals and work. Return-to-work (RTW) processes facilitate employees' return to work, help them regain workability, and prevent early retirement and long-term incapacity for work. However, the current state of evidence regarding RTW in the context of mental illness is not sufficient. The study aimed to identify (1) promoters and inhibitors of vocational rehabilitation from the patient's perspective, (2) potential differences in respondents' perceptions of various contextual factors, and (3) the relevance of professional, social, or economic influences on RTW acceptance. Methods : The qualitative design used semi-standardized interviews. In total, eight people affected by mental illness were interviewed, of which seven were included in the thematic analysis. The interviews were conducted by the same person, either in person or by telephone. We used MaxQDA to develop a coding scheme in iterative revisions. Two additional independent individuals checked the final coding tree and data analysis. Results : We identified, among other aspects, relationships with coworkers and supervisors, open communication about illness, or contact with peers as promotors of successful RTW. Inhibitors were triggers at the workplace, conflicts with supervisors, performance pressure, and a lack of understanding. Social support through family and daily routines were considered critical contextual factors. The constant justification of the illness or financial worries, e.g., were perceived as onerous. The exchange with peers and the role of stakeholders were revealed to be critical for a positive perception of the RTW process. Conclusion : Our study showed that the return to work after or during a mental illness is a complex part of therapy. Work itself is an essential part of recovery after mental illness that can provide stability for those affected and minimize risk factors and remissions. This, in turn, assigns workplaces the role of a support system, including team members, supervisors, and daily routines and tasks. Our results underline that there is a collective responsibility for all stakeholders. return-to-work mental illness vocational therapy determinants workplace health Background Digitalization, globalization, and demographics are critical drivers of workplace transitions (1), especially in industrialized countries. In addition, the COVID-19 pandemic accelerated these developments and presented companies and employees with significant changes, especially regarding the digitalization of work (2). Regarding employee health, some of these changes are beneficial, such as increased acceptance of home-based remote work or reduced sick days due to reduced social contacts (3). In contrast, others reveal possible adverse effects, for example, if remote work from home causes “anxiety and stress if it leads to an increase in job demands (work overload, time pressure, cognitive and emotional demands)” (4) or a fading of boundaries between leisure and working time (5). The adverse effects of these workplace changes are of particular interest as they pose a serious risk to employees` mental health (6). Prevalence of and reasons for mental illness in the workplace context Mental illnesses are “health conditions involving changes in emotion, thinking or behavior (or a combination of these). Mental illnesses can be associated with distress and problems functioning in social, work or family activities “ (7) and are strongly associated with long-term sickness absence (8). In Germany, approximately 28%, or about 18 million adults, are affected by mental disorders each year (9). At the same time, the volume of work incapacity due to corresponding diagnoses has increased by 70% over the past decade, and the duration per sickness-related absence has risen on average per case from 27.3 days in 2006 to 39.2 days in 2021 (10). Employees with a diagnosed mental illness have accounted for the majority of additions to the reduced earning capacity pension for several years, which corresponded to 42% in 2021 (11). Various reasons cause mental illness, such as work itself, for example, qualitative and quantitative overload, emotional stress, difficulties with social relationships at work, low level of decision-making autonomy, and a deadline or performance pressure (12). These stressors can cumulate or intensify in a spiral over time, which in turn may lead to mental illnesses ADDIN CitaviPlaceholder{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} (12). In addition, job loss or long-term sick leave absence from work can represent a further stress-associated aspect (13). Conversely, various studies point out that participation in working life represents a crucial psychosocial treatment factor for those affected by mental illness (14). Return-to-Work programs in the workplace context Return-to-Work (RTW) programs have been introduced to facilitate employees' return after a long-term sickness absence. In Germany, since 2004, employers have been legally obligated to offer employees occupational integration management after a single or repeated illness with a cumulated sick leave duration of six weeks. According to § 167 SGB IX (Social Code Book IX), RTW programs aim to maintain or restore an employee`s workability and to prevent renewed absence in the long term (15). The benefits of RTW, for example, are keeping the employee integrated into the workplace, maintaining an income while going through the process of reintegration, and, on the company’s side, continuing the employee’s contribution at work while reducing the compensation costs (16) Factors promoting the acceptance of RTW RTW programs are highly individualized and data-sensitive processes that rely on various factors, particularly the employee's expectations of the RTW process and a well-developed self-efficacy expectation (17). Factors that facilitate acceptance rates can be found in the organizational and personal context. Aspects that generally have a positive effect on the success of RTW include an intact partnership (Beiderwieden, 2001, p. 193), completed vocational training before the start of rehabilitation (Gruber et al., 2019, pp. 153 - 154), high work-related self-efficacy (Meschnig et al., 2018, p. 154) or social support (Köster et al., 2007, p. 9). An older age, female sex, a high degree of disability as well as burdens due to pain and chronification (17), an unemployed status, or a lower level of internal control are associated with less acceptance and success rates with RTW programs (18). So far, individual contextual factors have played a more critical role in scientific research than organizational aspects. Regarding mental illness, the influence that the choice of the RTW program has on the success of reintegration is particularly emphasized. One aspect that various researchers consider particularly beneficial is returning the patients to a regular job and conducting on-site vocational rehabilitation measures. Furthermore, the relevance of workability, willingness to participate, work environment, disease progression, and work attitude of the RTW expert in charge play a vital role (Blank et al., 2021, p. 123). From an employee’s perspective, a study identified aspects such as excessive workloads, interpersonal conflicts in the workplace, the lack of a contact person in the transition phase, and the failure to hold a return-to-work interview as unfavorable, while good support from the company and clinic seem to be positive aspects in the process of RTW (Mernyi et al., 2018, pp. 201–203). As described, the relevance of RTW for employers as well as employees is still rising. The success of the individual program relies on an employee’s consent and willingness to participate. To date, evidence does not appear to be sufficient regarding the reintegration of those affected by mental disorders into working life in the long term. Against this background, the aims of the study were (1) to identify promoters and inhibitors of vocational rehabilitation from the patient's perspective and (2) to find out whether there are differences in respondents' perceptions in the presence of various contextual factors, and thus (3) whether professional, social or economic influences play a role in RTW acceptance in addition to personal aspects. Research Design and Materials Design Considering the high degree of individualization, strict data protection regulations, and the sensitivity of RTW programs, a qualitative survey method in the form of a semi-standardized interview was used (19, 20). We applied the COREQ (Consolidated criteria for reporting qualitative research; Additional file 1) guidelines to reach a comprehensive and transparent reporting standard (21). The ethics committee retrospectively approved the study (Ethic Approval No. 022024IST233) since a publication was not planned initially. Sample and Recruitment Due to the European General Data Protection Regulations (GDPR, 2016/679), a non-probabilistic sampling method was used to select participants (22). Recruitment was carried out through face-to-face information and information material during vocational therapy sessions in November and December 2021. Some test subjects were recruited via the therapy facility where the interviewer was employed. They knew her from the treatment setting but not in a private setting. In addition, the human resources departments of various companies and an integration service were used as an interface for approaching employees or clients who fit the profile of those to be interviewed. Contacts from hospital and training settings were also addressed and were not personally known to the interviewer. Due to RTW programs' high degree of individualization, a sample size calculation a priori was weighed regarding a targeted saturation (23). Finally, ten participants were deducted by rules of thumb, ranging from three to ten participants at a minimum level (23). SB approached a total of eight potential interview partners. For data protection reasons, the exact number of intermediaries from integration services and HR departments approached is not known. However, at least three people were asked to participate based on the resulting interviews. Eight of the people asked agreed to take part in the study. Reasons for refusing or dropping out were “no time,” “no interest,” and “no interest or worries talking about work and health status.” After eight conducted interviews, data saturation was reviewed by both authors and evaluated as appropriate. Inclusion criteria were a working age between 15 and 65 years, having one or more ICD-10 GM Version 2023 Chapter V diagnoses ADDIN CitaviPlaceholder{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} (24), and meeting the eligibility requirements for vocational rehabilitation. Individuals who suffered from acute perceptual or reality disorders at the interview and did not meet the requirements for vocational rehabilitation were excluded. Setting and Data Collection Information material was handed out during recruitment, including the GDPR policy and informed consent, which was agreed to by all participants. Participants could choose between two methods of data collection: face-to-face interviews in a quiet room specially designed for client interviews in the treatment facility or telephone interviews. The face-to-face interview was chosen by one of the interviewees. The other seven participants chose the interview by telephone. All interviews were recorded with an audio-only recording device (mibao Voice Recorder V100). The speaker function was used during the telephone interviews to allow the recording. An interview guide was developed by the authors and pilot-tested independently by each author (see Additional file 2). The semi-standardized interview guideline asked about aspects such as the personal importance of work for the individual, regular everyday tasks, and positive or negative influences on the course of the disease itself. Also, factors that promote or inhibit RTW programs in general were considered. All interviews were conducted by the same person (SB), who is qualified as a vocational therapy specialist with extensive training in patient communication. ML supported the conceptualization of the research approach and preparation of the study. Each interview was then prepared carefully to avoid interruptions or cancellations. All interviews were conducted once per interviewee. No interruptions or disturbances were recorded. Interviews were planned to take 20 to 40 minutes each. Some interviews were considerably longer due to the wide-ranging narrations of the interviewee’s experiences. To build trust and due to the relevance of some of the information mentioned in passing for the course of the disease, these explanations were allowed only to a limited extent. The average time per interview was 39,23 (Min: 28,21; Max: 54,04). Data Analysis and Syntheses Transcription of the interview recordings was semi-automated using AmberScript software (Version of 2021), with correction of the text file for native dialects or inarticulateness (25). Final transcripts were not returned to interviewees for comment or correction. The thematic analysis approach was selected to explore themes after data collection and evaluate large amounts of text data (26). This approach is widely accepted and used (27, 28). The program MaxQDA (Version 2020) was used for coding and analysis according to this scheme. Topic categories were formed, to which the text passages previously classified as relevant were assigned. This initially resulted in superordinate clusters, which were further subdivided. Both authors repeated this process several times, resulting in a condensation of the groups through multiple revisions. The subcodes were then linked to the main categories and structured according to their relevance to the research question to be interpreted against this background. To increase objectivity and interrater reliability, the coding was performed by two additional independent individuals (MK, NE). The derived themes, including the coding tree, are summarized in Additional file 3. Results Descriptive Results The final sample included seven employees with an average age of 54,13 years (see Table 1). The interview data of one person was excluded from the analysis due to the possibility of acute reality and perception disorders. Most of the Interviewees (5/7) suffered from more than one type of psychiatric diagnosis. Those who could name the period of their incapacity stated that they had been on sick leave for at least six months (at a stretch or cumulatively) due to their psychiatric complaints. Although all interviewees would have been legally entitled to vocational rehabilitation measures, only three participated. There was no corresponding provision for two people, one interviewee did not answer this clearly, and another was about to take up a measure. Table 1 Characteristics of Interviewees Age Male Female 35 – 44 years 0 1 45 – 54 years 1 1 55 – 64 years 2 2 Total 3 4 Measures for participation in working life Has occurred 3 Has not occurred 3 No clear answer 1 Total 7 Diagnosis (multiple diagnoses possible) n Depressive disorder/episode 6 Panic attacks 2 Others* 1 Number of psychiatric diagnoses n One 2 More than one 5 Partnership status n Living in partnership 6 Living alone 1 Highest school degree n High School diploma 6 Higher education degree 1 *Post-traumatic stress disorder, generalized anxiety disorder, bipolar disorder, adjustment disorder, persistent personality change, acute stress reaction each mentioned one time Promotors and Inhibitors The interviewees named various aspects as critical parts of the success of RTW processes. These can be categorized as influential factors on the mental situation, relevant factors for reintegration, and factors for organizational change regarding mental illness. Most interviewees (4/7) mentioned promoting aspects of the work environment, particularly relationships with coworkers or the possibility of talking about illness at work. Further, adapting the workplace to the needs of the person affected due to illness was one of the main success factors for RTW, as well as good communication between employer and patient or understanding and openness by colleagues. The contact with other psychiatric patients was reported as a positive impact. Another necessary factor was the continuance of outpatient therapy after the period of incapacity to work. It did not matter whether the respondents had previously been in inpatient treatment or not. The time the patients had to wait for a place on a treatment program was an inhibitor for a successful recovery or RTW. Other inhibiting factors of the RTW process were conflicts with the employer, triggers at the workplace, and coping with changes in job performance. The participants also described their handling of changes, e.g., in their performance due to the illness, and the feeling that they repeatedly had to justify their coping strategies and the consequences of the mental crisis in their professional and private lives as stressful (see Table 2). Detailed results are summarized in Additional file 4. Table 2 Promoting and inhibiting factors for RTW processes. Promoters Frequency of mention (n) Good relationships and contacts in the working environment 4 Openness/open communication about illness in the workplace 3 Workplace adapted to patients' health situation 3 Communication and willingness to talk to the employer 3 Integration into outpatient psychotherapy 3 Contact with other psychiatric patients 3 Inhibitors Frequency of mention Triggers at Workplace 3 Conflicts with the supervisor 3 Performance pressure 2 Dealing with changes due to illness 2 Lack of understanding and interest in the work 2 Feeling the need to justify oneself 2 Maintaining the (behavioral) changes in the long term 2 Negative experiences with social security institutions 2 Influence Concerning personal or contextual factors of the social environment, the critical factors for a favorable development concerning mental health and, therefore, the ability to work seemed to be in contact with other affected persons, support in the circle of family and friends, personal development, and occupation with possible aids as well as structure and tasks or occupation in everyday life. Interviewees also mentioned sports activities and exercising in general to positively impact their mental health. Furthermore, the ability to express personal needs had an essential impact on the success of RTW measures. Negative influences resulted from the feeling of having to justify the illness to family and friends repeatedly, difficulties in personally dealing with the mental situation and maintaining behavioral changes over the long term, as well as financial worries, influences from the pandemic, pressures from social demands and obligations, and concerns about society's reaction to one's illness. Perception of contextual factors Perceptions of relevant factors for the RTW process vary with a recent previous separation from the partner, among other factors. Their relationships in the workplace, as well as communication, appreciation, and support, also made a significant difference in whether they perceived the company's influences as positive or negative. The relevance of the workplace also differed depending on whether the interviewees had a specific daily structure and defined tasks besides work. The relevance of stakeholders in the support systems is also considered, especially if the experience with them was negative. Respondents who have had no positive experiences with the relevant people hardly believe them to have any influence on their RTW process. The exchange with other patients significantly affected the perception of the process. Interviewees who maintained contact with fellow patients cited this as an essential tool for changing perspectives in certain areas and an opportunity to recall resources learned in the therapy process. Discussion Principal Findings The study aimed to point out factors that promote or inhibit the process of RTW from the perspective of psychiatric patients, finding professional, social, or economic aspects that influence these measures and the respondents’ perception of various context factors. Our results underline that the work environment for the interviewees has not only an influence on their work routine but is of high importance for their well-being and the RTW process. In particular, social aspects such as relationships with colleagues, communication, and acceptance of their illness among other employees and superiors were essential factors contributing to recovery and the RTW process. Other relevant findings were the continuance of outpatient treatment, the exchange with peers, and social support by family and friends. Social stigmatization and a lack of acceptance were identified as critical inhibitors, followed by a lack of information and poor management by the social insurance case manager. Finally, respondents perceived the relevance of contact with peers and the role of stakeholders in social insurance differently (29). One of our study's most salient findings is that most barriers to RTW processes remain individual but are mostly linked to work environment-related aspects such as high job demands, lack of communication, and a culture that accepts illness and prohibits stigmatization. This, in turn, puts the focus of RTW measures on the individual, the employer, and the workplace environment. While most RTW interventions address the individual primarily through behavior-oriented therapy (e.g., occupational therapy, stress management programs, inpatient or outpatient rehabilitation) (30), only a few interventions combine individual therapy elements with workplace-related measures (31). Despite varying legal requirements and general data protection regulations, this aspect underlines that recommended RTW processes include colleagues and superiors during RTW phases in a cooperative manner (32) Maintaining stability can be considered a foundation of RTW processes of mental illnesses (33), which was also revealed by our results. In the context of work, stability can be understood as the extent of match between a patient’s “functional (in)capacity and the work demands […] and its impact on job retention” (34). Further, it is vital for patients with mental disorders to feel connected to their work, experience a certain work rhythm, and feel comfortable with the work itself. Behavioral concepts view stability as individuals consistently engaging in the same patterns of behavior (35). These daily work routines lower the risk of worsening symptoms and reduce remissions with mental disorders (36). The two understandings have far-reaching implications that include an assessment of the actual functional capacity and needs of the employee and the specific determination of work routines. To offer social support, supervisors and close team members must be included in these daily routines, which requires empowerment and training. The role of supervisors was also evaluated as beneficial regarding the RTW processes. However, the specific designation, the tasks of the manager, and the expectations of the employees remain complex and unclear. As part of the RTW process, they have the task of controlling the load according to the functional capacity of the patients. However, they also support the implementation and management of the RTW process. This starts, e.g., with welcoming the employee back after the illness and frequently checking whether they can perform the assigned tasks (e.g., capacity, pace) (37). Supervisors should be educated on the RTW process and relevant work-related disease impacts to ensure the employee's well-being and individual workload management (38). The definition of the role and action in the RTW process applies to supervisors and other stakeholders, such as institutions of the support system. Interviewees referred to a lack of knowledge and poor communication with and between, e.g., job centers, statutory health insurance, or German pension insurance (German: Deutsche Rentenversicherung). Communication is essential and timely urgent, as patients sometimes depend on income, transitional allowance, or other important social benefits. Ineffective communication or significant delays in commitment can increase psychological stress and promote relapses or remissions. Clarity and consistency within RTW stakeholders’ roles are important facilitators of an effective RTW process with mental illness (29, 39). Even though the aims of this study did not directly address it, the interviewees mentioned the need for greater theming and education regarding mental illness as well as a change in the increasing pace and pressure within society. These aspects are fundamental as they have a relevant influence on the recovery and stabilization of patients (40, 41). Strengths and Limitations Clear strengths of our study are empirical data on the highly sensitive context of RTW and the in-depth patient perspective in the context of mental illness. Empirical evidence from qualitative studies regarding psychiatric patients and RTW processes is relatively small. Our results offer relevant directions and practical implications for future interventions and research in RTW. Most importantly, participants were recruited through their vocational therapy sessions. Therefore, the participants were not employed at the same organization, which increases the generalizability of the results and minimizes biases towards employers and organizational confounders. The interviewer's personal and close communication style could be considered a strength or a bias. The context of the mental illness itself, as well as the sensitivity of the personal information, requires the trust of the interviewees. The interviewer's therapeutic experience and external position outside the interviewee’s employer promoted that trust substantially as this implies a particular ability and integrity (42). As our results underlined the comprehensive nature of RTW processes in the context of mental illness and its determinants, the sole perspective of patients can be considered limited. To fully understand the RTW process and mental illness, stakeholders such as case managers, workplace health coordinators, employers, colleagues, and other healthcare professionals would add important information (43). Further data sources, such as observations, supervision, or quantitative data, could contribute to modeling the entirety of the RTW process. Other sources of data might lead to different results as the interviewees experienced mental illness affecting the ability to recall the events appropriately, as one of the characteristics of these illnesses is a clinically significant disturbance of cognition (44). Implications for Occupational Health Practice Practical implications can be derived on the one hand for the patients and on the other hand for the workplace. Effective RTW processes can be seen as an essential cornerstone for patients as work is a central aspect of recovery from mental illness. Patients must learn and apply resilience and coping strategies to avoid relapses and minimize risk factors. Since behavior-oriented therapy strategies are sometimes lengthy, connections to external stakeholders must be ensured. Thus, it seems necessary to involve external stakeholders (e.g., case managers from German pension insurance) in the RTW process or to bring them into the workplace as needed. The workplaces’ RTW coordinators or managers can implement such interface management. On the company's part, our results show a much more significant range of tasks and responsibilities, as the social environment significantly influences the recovery process and, in addition to private aspects, represents a central support system. Developing action competence or health-oriented leadership skills is another facilitator companies should foster through specific training measures. Depending on the company's size, fostering a network with stakeholders early to build up these structures and competencies as early as possible and continuously could be helpful. Overall, all stakeholders need to accept that mental illnesses are diverse and complex and that the course of therapy can be highly individual under certain circumstances. Future Research The results of this study point out various future research directions. First, further investigations need to be made into facilitating factors of efficient RTW processes, and the gathered data should be compared with existing evidence to identify potential gaps. These investigations should focus on transitions from different therapy phases and interface-related barriers. Second, a limitation of our study was the mere patient perspective, which should be accompanied by qualitative data from other stakeholders such as employers, managers, and case managers. This way, interface-related aspects (e.g., communication, information delivery, waiting time) could be identified, evaluated, and implemented into practices. Further, the supervisors or managers should be interviewed explicitly about their experiences and needs to manage employees during RTW processes. Lastly, next to qualitative data, quantitative data is necessary to evaluate the impact of mediation and moderating roles of the identified factors. The inclusion of international perspectives and the comparison to that could broaden a mere national perspective and identify gaps or potentials. Conclusions Our study showed that the return to work after or during a mental illness is a complex part of therapy. Work itself is an integral part of recovery after mental illness that can provide stability and meaning for those affected and minimize risk factors and remissions. This, in turn, assigns workplaces the role of a support system, including team members, supervisors, and daily routines and tasks. Our results contribute to the growing body of evidence of RTW processes in the context of mental illness and underline that all stakeholders share a collective responsibility. Abbreviations RTW … Return to work Declarations Ethics approval and consent to participate: This study was approved by the Ethics Committee of the IST University of Applied Science retrospectively (Ethic Approval No. 022024IST233) since the motivation to publish was derived during the research project, which was initially a Master’s thesis. All interviewees were informed and agreed to participate before data collection. Consent for publication: We declare that all interviewees have given their written consent to publish anonymized data. Data availability statement: Data will be available to the corresponding author upon request. Competing interests: There are no competing interests. Funding: This research received no external funding. Author contribution: All authors contributed equally to the study design, writing, proofreading, modifications, and reviews. Acknowledgements: The authors thank Marcel Kroth and Nils Eggers for reviewing the study’s results and coding them to determine interrater reliability. Author information: Prof. Dr. Martin Lange has taught at the IST University of Applied Science since 2018. His work focuses on workplace prevention, health promotion, return-to-work, and workplace health management. He is on the scientific advisory board of the Institute of Workplace Health Promotion, chair of the Federal Workplace Health Management Association (BBGM e.V.), and a member of the German Network for Healthcare Research (DNVF e.V.). Sabrina Braunwarth completed her Master's in 2022 at the IST University of Applied Sciences. As a physiotherapist specializing in treating neurological and psychiatric patients, she focuses mainly on aspects of her client's participation, including in a professional context. Accordingly, she has concentrated on occupational health management as part of her studies and sees her further research interests in this field. Applying Research to Occupational Health Practice The results of this study identified vital determinants for a successful RTW process for patients with mental illness. This includes good relationships with coworkers and supervisors, the integration of RTW at work with outpatient therapy, and the possibility of talking about the disease. Triggers at work conflicts with supervisors, or performance pressure could hinder the RTW process. Besides the individual situation, the workplace becomes integral to recovery as it offers stability and a daily routine. Workplaces should acknowledge that role and responsibility. Further, workplaces should consider educating supervisors, building up a network of stakeholders, and aspiring to a communication-friendly culture and openness. Researchers and politicians should investigate the impact of regulations that promote interprofessional collaboration between stakeholders (e.g., employers, case managers, and social insurance). References Eichhorst W, Buhlmann F. Die Zukunft der Arbeit und der Wandel der Arbeitswelt. Bonn: Forschungsinstitut zur Zukunft der Arbeit (IZA); 2015. IZA Standpunkte 77 [cited 2023 Feb 23]. Available from: URL: https://docs.iza.org/sp77.pdf. Digital Transformation in the Age of COVID-19: BUILDING RESILIENCE AND BRIDGING DIVIDES. Paris; 2020. Digital Economy Outlook 2020 Supplement [cited 2023 Aug 16]. Available from: URL: https://www.oecd.org/digital/digital-economy-outlook-covid.pdf. The New Normal? The World of Work after the Coronavirus Pandemic. Berlin; 2021 [cited 2023 Aug 16]. 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Gühne U, Stein J, Schwarzbach M, Riedel-Heller SG. Der Stellenwert von Arbeit und beruflicher Beschäftigung in der Behandlung psychisch kranker Menschen: Eine qualitative Studie. Psychother Psych Med 2017 [cited 2021 Sep 1]; 67(11):457–64. Available from: URL: https://eref.thieme.de/print/section/1439-1058_2017_11/10.1055-s-0043-104855.pdf. Sikora A, Schulz IL, Schröder UB, Stegmann R. Betriebliches Eingliederungsmanagement (BEM) - Ein individueller, systematischer und lebendiger Prozess; 2021. Return to Work. Hamilton; 2022. Available from: URL: https://www.ccohs.ca/oshanswers/psychosocial/rtw/rtw_program.pdf. Cancelliere C, Donovan J, Stochkendahl MJ, Biscardi M, Ammendolia C, Myburgh C et al. Factors affecting return to work after injury or illness: best evidence synthesis of systematic reviews. Chiropr Man Therap 2016; 24(1). Available from: URL: https://chiromt.biomedcentral.com/counter/pdf/10.1186/s12998-016-0113-z.pdf. Schmidt C, Flach TH, Begerow B. Einfluss psychosozialer Faktoren auf die Wiedereingliederung in Arbeit: Institut für Qualitätssicherung in Prävention und Rehabilitation (iqpr) GmbH der Sporthochschule Köln; 2011 [cited 2023 Mar 8]. Available from: URL: https://www.iqpr.de/iqprweb/public/dokumente/forschung/abgeschl_projekte/Abschlussbericht_DRV1.pdf. Karl Krajic, Cornelia Reiter, Eva Wimmer, Jörg Flecker. Qualitative Erhebungs- und Auswertungsmethoden zur Umsetzung qualitativ hochwertiger Evaluationen – Beitrag zum Baukastensystem für Evaluationen im Präventionsbereich der AUVA; 2016. Hussy W, Schreier M, Echterhoff G. Forschungsmethoden in Psychologie und Sozialwissenschaften: Für Bachelor. Berlin, Heidelberg: Springer; 2010. (Springer-Lehrbuch). Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007; 19(6):349–57. Hultsch DF, MacDonald SW, Hunter MA, Maitland SB, Dixon RA. Sampling and generalisability in developmental research: Comparison of random and convenience samples of older adults. International Journal of Behavioral Development 2002; 26(4):345–59. Sim J, Saunders B, Waterfield J, Kingstone T. Can sample size in qualitative research be determined a priori? International Journal of Social Research Methodology 2018; 21(5). Available from: URL: file:///C:/Users/Sabrina/Downloads/Sim2018Cansamplesizeinqualitativeresearchbedeterminedapriori1.pdf. Chapter V: Mental and behavioural disorders (F00-F99); 2019 [cited 2023 Nov 26]. Available from: URL: https://icd.who.int/browse10/2019/en#/V. Institut für Psychologie Freiburg. Regeln für die Transkription; 2012 [cited 2023 Aug 18]. Available from: URL: https://www.psychologie.uni-freiburg.de/studium.lehre/klin-master/skripte/Vergangene_Semester/qualitative-methoden-in-den-rehabilitations-und-gesundheitswissenschaften-SS2012/Regeln%20fuer%20die%20Transkription. Nowell LS, Norris JM, White DE, Moules NJ. Thematic Analysis. International Journal of Qualitative Methods 2017; 16(1). Available from: URL: https://journals.sagepub.com/doi/pdf/10.1177/1609406917733847. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology 2006; 3(2). Available from: URL: https://www.researchgate.net/profile/Virginia-Braun/publication/235356393_Using_thematic_analysis_in_psychology/links/00b7d52c9e6303d840000000/Using-thematic-analysis-in-psychology.pdf. Niekler A. Automatisierte Verfahren für die Themenanalyse nachrichtenorientierter Textquellen; 2016. Corbière M, Mazaniello-Chézol M, Bastien M-F, Wathieu E, Bouchard R, Panaccio A et al. Stakeholders' Role and Actions in the Return-to-Work Process of Workers on Sick-Leave Due to Common Mental Disorders: A Scoping Review. J Occup Rehabil 2020; 30(3):381–419. Tingulstad A, Meneses-Echavez J, Evensen LH, Bjerk M, Berg RC. Effectiveness of work-related interventions for return to work in people on sick leave: a systematic review and meta-analysis of randomized controlled trials. Syst Rev 2022; 11(1):192. Skagseth M, Fimland MS, Rise MB, Johnsen R, Borchgrevink PC, Aasdahl L. Effectiveness of adding a workplace intervention to an inpatient multimodal occupational rehabilitation program: A randomized clinical trial. Scand J Work Environ Health 2020; 46(4):356–63. Dunstan DA, Mortelmans K, Tjulin Å, MacEachen E. The Role of Co-Workers in the Return-to-Work Process. Int. J. Disabil. Manag. 2015; 10. Bundesanstalt für Arbeitsschutz und Arbeitsmedizin. Die Rückkehr gemeinsam gestalten; 2021. Gilworth G, Carey A, Eyres S, Sloan J, Rainford B, Bodenham D et al. Screening for job loss: development of a work instability scale for traumatic brain injury. Brain Inj 2006; 20(8):835–43. He-Yueya J, Buck B, Campbell A, Choudhury T, Kane JM, Ben-Zeev D et al. Assessing the relationship between routine and schizophrenia symptoms with passively sensed measures of behavioral stability. NPJ Schizophr 2020; 6(1):35. Charzyńska K, Kucharska K, Mortimer A. Does employment promote the process of recovery from schizophrenia? A review of the existing evidence. Int J Occup Med Environ Health 2015; 28(3):407–18. Nastasia I, Coutu M-F, Rives R, Dubé J, Gaspard S, Quilicot A. Role and Responsibilities of Supervisors in the Sustainable Return to Work of Workers Following a Work-Related Musculoskeletal Disorder. J Occup Rehabil 2021; 31(1):107–18. Jansen J, Boot CRL, Alma MA, Brouwer S. Exploring Employer Perspectives on Their Supportive Role in Accommodating Workers with Disabilities to Promote Sustainable RTW: A Qualitative Study. J Occup Rehabil 2022; 32(1):1–12. Martin MHT, Nielsen MBD, Petersen SMA, Jakobsen LM, Rugulies R. Implementation of a coordinated and tailored return-to-work intervention for employees with mental health problems. J Occup Rehabil 2012; 22(3):427–36. Cohrdes C, Hapke U, Nübel J, Thom J. Erkennen - Bewerten - Handeln. Schwerpunktbericht zur psychischen Gesundheit der Bevölkerung in Deutschland. Teil 1 – Erwachsenenalter. Robert Koch-Institut; 2022. Rössler W. The stigma of mental disorders: A millennia-long history of social exclusion and prejudices. EMBO Rep 2016; 17(9):1250–3. Gencsoy M. Impact of interview style on trust, and risk perception Melissa Gencsoy 1 Faculty of Behavioural Management and Social Science Psychology of Conflict, Risk and Safety First Supervisor: Dr. Steven J. Watson Second Supervisor: Dr. Miriam S. D. Oostinga Impact of interview style on perceived trust in the interviewer and the effect on risk perception. Enschede: Universiity of Twente; 2020. Charmaz K, Belgrave LL. Qualitative Interviewing and Grounded Theory Analysis. In: Gubrium J, Holstein J, Marvasti A, McKinney K, editors. The SAGE Handbook of Interview Research: The Complexity of the Craft. 2455 Teller Road, Thousand Oaks California 91320 United States: SAGE Publications, Inc; 2012. p. 347–66. Conijn JM, van der Ark LA, Spinhoven P. Satisficing in Mental Health Care Patients: The Effect of Cognitive Symptoms on Self-Report Data Quality. Assessment 2020; 27(1):178–93. Additional Declarations No competing interests reported. Supplementary Files Additionalfile1COREQChecklist.pdf Additionalfile2Interviewguide.pdf Additionalfile3CodingTree.pdf Additionalfile4Results.pdf Cite Share Download PDF Status: Posted Version 1 posted 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. 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In addition, the COVID-19 pandemic accelerated these developments and presented companies and employees with significant changes, especially regarding the digitalization of work (2). Regarding employee health, some of these changes are beneficial, such as increased acceptance of home-based remote work or reduced sick days due to reduced social contacts (3). In contrast, others reveal possible adverse effects, for example, if remote work from home causes \u0026ldquo;anxiety and stress if it leads to an increase in job demands (work overload, time pressure, cognitive and emotional demands)\u0026rdquo; \u0026nbsp;(4) or a fading of boundaries between leisure and working time (5). The adverse effects of these workplace changes are of particular interest as they pose a serious risk to employees` mental health (6).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePrevalence of and reasons for mental illness in the workplace context\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eMental illnesses are \u0026ldquo;health conditions involving changes in emotion, thinking or behavior (or a combination of these). Mental illnesses can be associated with distress and problems functioning in social, work or family activities \u0026ldquo; (7) and are strongly associated with long-term sickness absence (8). In Germany, approximately 28%, or about 18 million adults, are affected by mental disorders each year (9). At the same time, the volume of work incapacity due to corresponding diagnoses has increased by 70% over the past decade, and the duration per sickness-related absence has risen on average per case from 27.3 days in 2006 to 39.2 days in 2021 (10). Employees with a diagnosed mental illness have accounted for the majority of additions to the reduced earning capacity pension for several years, which corresponded to 42% in 2021 (11). Various reasons cause mental illness, such as work itself, for example, qualitative and quantitative overload, emotional stress, difficulties with social relationships at work, low level of decision-making autonomy, and a deadline or performance pressure (12). These stressors can cumulate or intensify in a spiral over time, which in turn may lead to mental illnesses\n \u003c!--[if supportFields]\u003e\u003cspan style='mso-element:field-begin'\u003e\u003c/span\u003eADDIN CitaviPlaceholder{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}\u003cspan style='mso-element:field-separator'\u003e\u003c/span\u003e\u003c![endif]--\u003e(12). In addition, job loss or long-term sick leave absence from work can represent a further stress-associated aspect (13). Conversely, various studies point out that participation in working life represents a crucial psychosocial treatment factor for those affected by mental illness (14).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eReturn-to-Work programs in the workplace context\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eReturn-to-Work (RTW) programs have been introduced to facilitate employees\u0026apos; return after a long-term sickness absence. In Germany, since 2004, employers have been legally obligated to offer employees occupational integration management after a single or repeated illness with a cumulated sick leave duration of six weeks. According to \u0026sect; 167 SGB IX (Social Code Book IX), RTW programs aim to maintain or restore an employee`s workability and to prevent renewed absence in the long term (15). The benefits of RTW, for example, are keeping the employee integrated into the workplace, maintaining an income while going through the process of reintegration, and, on the company\u0026rsquo;s side, continuing the employee\u0026rsquo;s contribution at work while reducing the compensation costs (16)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFactors promoting the acceptance of RTW\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eRTW programs are highly individualized and data-sensitive processes that rely on various factors, particularly the employee\u0026apos;s expectations of the RTW process and a well-developed self-efficacy expectation (17). Factors that facilitate acceptance rates can be found in the organizational and personal context. Aspects that generally have a positive effect on the success of RTW include an intact partnership (Beiderwieden, 2001, p. 193), completed vocational training before the start of rehabilitation (Gruber et al., 2019, pp. 153 - 154), high work-related self-efficacy (Meschnig et al., 2018, p. 154) or social support (K\u0026ouml;ster et al., 2007, p. 9). An older age, female sex, a high degree of disability as well as burdens due to pain and chronification (17), an unemployed status, or a lower level of internal control are associated with less acceptance and success rates with RTW programs (18). So far, individual contextual factors have played a more critical role in scientific research than organizational aspects.\u003c/p\u003e\n\u003cp\u003eRegarding mental illness, the influence that the choice of the RTW program has on the success of reintegration is particularly emphasized. One aspect that various researchers consider particularly beneficial is returning the patients to a regular job and conducting on-site vocational rehabilitation measures. Furthermore, the relevance of workability, willingness to participate, work environment, disease progression, and work attitude of the RTW expert in charge play a vital role\u0026nbsp;(Blank et al., 2021, p.\u0026nbsp;123). From an employee\u0026rsquo;s perspective, a study identified aspects such as excessive workloads, interpersonal conflicts in the workplace, the lack of a contact person in the transition phase, and the failure to hold a return-to-work interview as unfavorable, while good support from the company and clinic seem to be positive aspects in the process of RTW\u0026nbsp;(Mernyi et al., 2018, pp. 201\u0026ndash;203).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs described, the relevance of RTW for employers as well as employees is still rising. The success of the individual program relies on an employee\u0026rsquo;s consent and willingness to participate. To date, evidence does not appear to be sufficient regarding the reintegration of those affected by mental disorders into working life in the long term. Against this background, the aims of the study were (1) to identify promoters and inhibitors of vocational rehabilitation from the patient\u0026apos;s perspective and (2) to find out whether there are differences in respondents\u0026apos; perceptions in the presence of various contextual factors, and thus (3) whether professional, social or economic influences play a role in RTW acceptance in addition to personal aspects.\u003c/p\u003e"},{"header":"Research Design and Materials","content":"\u003cp\u003e\u003cstrong\u003eDesign\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsidering the high degree of individualization, strict data protection regulations, and the sensitivity of RTW programs, a qualitative survey method in the form of a semi-standardized interview was used (19, 20). We applied the COREQ (Consolidated criteria for reporting qualitative research; Additional file 1) guidelines to reach a comprehensive and transparent reporting standard (21). The ethics committee retrospectively approved the study (Ethic Approval No. 022024IST233) since a publication was not planned initially.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample and Recruitment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDue to the European General Data Protection Regulations (GDPR, 2016/679), a non-probabilistic sampling method was used to select participants (22). Recruitment was carried out through face-to-face information and information material during vocational therapy sessions in November and December 2021. Some test subjects were recruited via the therapy facility where the interviewer was employed. They knew her from the treatment setting but not in a private setting. In addition, the human resources departments of various companies and an integration service were used as an interface for approaching employees or clients who fit the profile of those to be interviewed. Contacts from hospital and training settings were also addressed and were not personally known to the interviewer.\u003c/p\u003e\n\u003cp\u003eDue to RTW programs\u0026apos; high degree of individualization, a sample size calculation a priori was weighed regarding a targeted saturation (23). Finally, ten participants were deducted by rules of thumb, ranging from three to ten participants at a minimum level (23). SB approached a total of eight potential interview partners. For data protection reasons, the exact number of intermediaries from integration services and HR departments approached is not known. However, at least three people were asked to participate based on the resulting interviews. Eight of the people asked agreed to take part in the study. Reasons for refusing or dropping out were \u0026ldquo;no time,\u0026rdquo; \u0026ldquo;no interest,\u0026rdquo; and \u0026ldquo;no interest or worries talking about work and health status.\u0026rdquo; After eight conducted interviews, data saturation was reviewed by both authors and evaluated as appropriate.\u003c/p\u003e\n\u003cp\u003eInclusion criteria were a working age between 15 and 65 years, having one or more ICD-10 GM Version 2023 Chapter V diagnoses\n \u003c!--[if supportFields]\u003e\u003cspan style='mso-element:field-begin'\u003e\u003c/span\u003eADDIN CitaviPlaceholder{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}\u003cspan style='mso-element:field-separator'\u003e\u003c/span\u003e\u003c![endif]--\u003e(24), and meeting the eligibility requirements for vocational rehabilitation. Individuals who suffered from acute perceptual or reality disorders at the interview and did not meet the requirements for vocational rehabilitation were excluded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSetting and Data Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformation material was handed out during recruitment, including the GDPR policy and informed consent, which was agreed to by all participants. Participants could choose between two methods of data collection: face-to-face interviews in a quiet room specially designed for client interviews in the treatment facility or telephone interviews. The face-to-face interview was chosen by one of the interviewees. The other seven participants chose the interview by telephone. All interviews were recorded with an audio-only recording device (mibao Voice Recorder V100). The speaker function was used during the telephone interviews to allow the recording.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAn interview guide was developed by the authors and pilot-tested independently by each author (see Additional file 2). The semi-standardized interview guideline asked about aspects such as the personal importance of work for the individual, regular everyday tasks, and positive or negative influences on the course of the disease itself. Also, factors that promote or inhibit RTW programs in general were considered.\u003c/p\u003e\n\u003cp\u003eAll interviews were conducted by the same person (SB), who is qualified as a vocational therapy specialist with extensive training in patient communication. ML supported the conceptualization of the research approach and preparation of the study. Each interview was then prepared carefully to avoid interruptions or cancellations. All interviews were conducted once per interviewee. No interruptions or disturbances were recorded. Interviews were planned to take 20 to 40 minutes each. Some interviews were considerably longer due to the wide-ranging narrations of the interviewee\u0026rsquo;s experiences. To build trust and due to the relevance of some of the information mentioned in passing for the course of the disease, these explanations were allowed only to a limited extent. The average time per interview was 39,23 (Min: 28,21; Max: 54,04).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis and Syntheses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTranscription of the interview recordings was semi-automated using AmberScript software (Version of 2021), with correction of the text file for native dialects or inarticulateness (25). Final transcripts were not returned to interviewees for comment or correction.\u003c/p\u003e\n\u003cp\u003eThe thematic analysis approach was selected to explore themes after data collection and evaluate large amounts of text data (26). This approach is widely accepted and used (27, 28). The program MaxQDA (Version 2020) was used for coding and analysis according to this scheme. Topic categories were formed, to which the text passages previously classified as relevant were assigned. This initially resulted in superordinate clusters, which were further subdivided. Both authors repeated this process several times, resulting in a condensation of the groups through multiple revisions. The subcodes were then linked to the main categories and structured according to their relevance to the research question to be interpreted against this background. To increase objectivity and interrater reliability, the coding was performed by two additional independent individuals (MK, NE). The derived themes, including the coding tree, are summarized in Additional file 3.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eDescriptive Results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe final sample included seven employees with an average age of 54,13 years (see Table 1). The interview data of one person was excluded from the analysis due to the possibility of acute reality and perception disorders. Most of the Interviewees (5/7) suffered from more than one type of psychiatric diagnosis. Those who could name the period of their incapacity stated that they had been on sick leave for at least six months (at a stretch or cumulatively) due to their psychiatric complaints. Although all interviewees would have been legally entitled to vocational rehabilitation measures, only three participated. There was no corresponding provision for two people, one interviewee did not answer this clearly, and another was about to take up a measure.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCharacteristics of Interviewees\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.08818635607321%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.455906821963396%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.455906821963396%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.08818635607321%\"\u003e\n \u003cp\u003e35 \u0026ndash; 44 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.455906821963396%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.455906821963396%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.08818635607321%\"\u003e\n \u003cp\u003e45 \u0026ndash; 54 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.455906821963396%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.455906821963396%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.08818635607321%\"\u003e\n \u003cp\u003e55 \u0026ndash; 64 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.455906821963396%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.455906821963396%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.08818635607321%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.455906821963396%\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.455906821963396%\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.08818635607321%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMeasures for participation in working life\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.91181364392679%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.08818635607321%\"\u003e\n \u003cp\u003eHas occurred\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.91181364392679%\" colspan=\"2\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.08818635607321%\"\u003e\n \u003cp\u003eHas not occurred\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.91181364392679%\" colspan=\"2\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.08818635607321%\"\u003e\n \u003cp\u003eNo clear answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.91181364392679%\" colspan=\"2\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.08818635607321%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.91181364392679%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.08818635607321%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiagnosis (multiple diagnoses possible)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.91181364392679%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.08818635607321%\"\u003e\n \u003cp\u003eDepressive disorder/episode\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.91181364392679%\" colspan=\"2\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.08818635607321%\"\u003e\n \u003cp\u003ePanic attacks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.91181364392679%\" colspan=\"2\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.08818635607321%\"\u003e\n \u003cp\u003eOthers*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.91181364392679%\" colspan=\"2\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.08818635607321%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of psychiatric diagnoses\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.91181364392679%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.08818635607321%\"\u003e\n \u003cp\u003eOne\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.91181364392679%\" colspan=\"2\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.08818635607321%\"\u003e\n \u003cp\u003eMore than one\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.91181364392679%\" colspan=\"2\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.08818635607321%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePartnership status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.91181364392679%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.08818635607321%\"\u003e\n \u003cp\u003eLiving in partnership\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.91181364392679%\" colspan=\"2\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.08818635607321%\"\u003e\n \u003cp\u003eLiving alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.91181364392679%\" colspan=\"2\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.08818635607321%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHighest school degree\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.91181364392679%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.08818635607321%\"\u003e\n \u003cp\u003eHigh School diploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.91181364392679%\" colspan=\"2\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.08818635607321%\"\u003e\n \u003cp\u003eHigher education degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.91181364392679%\" colspan=\"2\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Post-traumatic stress disorder, generalized anxiety disorder, bipolar disorder, adjustment disorder, persistent personality change, acute stress reaction each mentioned one time\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePromotors and Inhibitors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe interviewees named various aspects as critical parts of the success of RTW processes. These can be categorized as influential factors on the mental situation, relevant factors for reintegration, and factors for organizational change regarding mental illness. Most interviewees (4/7) mentioned promoting aspects of the work environment, particularly relationships with coworkers or the possibility of talking about illness at work. Further, adapting the workplace to the needs of the person affected due to illness was one of the main success factors for RTW, as well as good communication between employer and patient or understanding and openness by colleagues. The contact with other psychiatric patients was reported as a positive impact. Another necessary factor was the continuance of outpatient therapy after the period of incapacity to work. It did not matter whether the respondents had previously been in inpatient treatment or not.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe time the patients had to wait for a place on a treatment program was an inhibitor for a successful recovery or RTW. Other inhibiting factors of the RTW process were conflicts with the employer, triggers at the workplace, and coping with changes in job performance. The participants also described their handling of changes, e.g., in their performance due to the illness, and the feeling that they repeatedly had to justify their coping strategies and the consequences of the mental crisis in their professional and private lives as stressful (see Table 2). Detailed results are summarized in Additional file 4.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePromoting and inhibiting factors for RTW processes.\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.39267886855241%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePromoters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.607321131447584%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency of mention (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.39267886855241%\"\u003e\n \u003cp\u003eGood relationships and contacts in the working environment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.607321131447584%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.39267886855241%\"\u003e\n \u003cp\u003eOpenness/open communication about illness in the workplace\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.607321131447584%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.39267886855241%\"\u003e\n \u003cp\u003eWorkplace adapted to patients\u0026apos; health situation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.607321131447584%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.39267886855241%\"\u003e\n \u003cp\u003eCommunication and willingness to talk to the employer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.607321131447584%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.39267886855241%\"\u003e\n \u003cp\u003eIntegration into outpatient psychotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.607321131447584%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.39267886855241%\"\u003e\n \u003cp\u003eContact with other psychiatric patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.607321131447584%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.39267886855241%\"\u003e\n \u003cp\u003e\u003cstrong\u003eInhibitors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.607321131447584%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency of mention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.39267886855241%\"\u003e\n \u003cp\u003eTriggers at Workplace\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.607321131447584%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.39267886855241%\"\u003e\n \u003cp\u003eConflicts with the supervisor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.607321131447584%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.39267886855241%\"\u003e\n \u003cp\u003ePerformance pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.607321131447584%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.39267886855241%\"\u003e\n \u003cp\u003eDealing with changes due to illness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.607321131447584%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.39267886855241%\"\u003e\n \u003cp\u003eLack of understanding and interest in the work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.607321131447584%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.39267886855241%\"\u003e\n \u003cp\u003eFeeling the need to justify oneself\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.607321131447584%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.39267886855241%\"\u003e\n \u003cp\u003eMaintaining the (behavioral) changes in the long term\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.607321131447584%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.39267886855241%\"\u003e\n \u003cp\u003eNegative experiences with social security institutions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.607321131447584%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eInfluence\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConcerning personal or contextual factors of the social environment, the critical factors for a favorable development concerning mental health and, therefore, the ability to work seemed to be in contact with other affected persons, support in the circle of family and friends, personal development, and occupation with possible aids as well as structure and tasks or occupation in everyday life. Interviewees also mentioned sports activities and exercising in general to positively impact their mental health. Furthermore, the ability to express personal needs had an essential impact on the success of RTW measures.\u003c/p\u003e\n\u003cp\u003eNegative influences resulted from the feeling of having to justify the illness to family and friends repeatedly, difficulties in personally dealing with the mental situation and maintaining behavioral changes over the long term, as well as financial worries, influences from the pandemic, pressures from social demands and obligations, and concerns about society\u0026apos;s reaction to one\u0026apos;s illness.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerception of contextual factors\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePerceptions of relevant factors for the RTW process vary with a recent previous separation from the partner, among other factors. Their relationships in the workplace, as well as communication, appreciation, and support, also made a significant difference in whether they perceived the company\u0026apos;s influences as positive or negative. The relevance of the workplace also differed depending on whether the interviewees had a specific daily structure and defined tasks besides work.\u003c/p\u003e\n\u003cp\u003eThe relevance of stakeholders in the support systems is also considered, especially if the experience with them was negative. Respondents who have had no positive experiences with the relevant people hardly believe them to have any influence on their RTW process.\u003c/p\u003e\n\u003cp\u003eThe exchange with other patients significantly affected the perception of the process. Interviewees who maintained contact with fellow patients cited this as an essential tool for changing perspectives in certain areas and an opportunity to recall resources learned in the therapy process.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cstrong\u003ePrincipal Findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study aimed to point out factors that promote or inhibit the process of RTW from the perspective of psychiatric patients, finding professional, social, or economic aspects that influence these measures and the respondents\u0026rsquo; perception of various context factors. Our results underline that the work environment for the interviewees has not only an influence on their work routine but is of high importance for their well-being and the RTW process. In particular, social aspects such as relationships with colleagues, communication, and acceptance of their illness among other employees and superiors were essential factors contributing to recovery and the RTW process. Other relevant findings were the continuance of outpatient treatment, the exchange with peers, and social support by family and friends. Social stigmatization and a lack of acceptance were identified as critical inhibitors, followed by a lack of information and poor management by the social insurance case manager. Finally, respondents perceived the relevance of contact with peers and the role of stakeholders in social insurance differently (29).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOne of our study\u0026apos;s most salient findings is that most barriers to RTW processes remain individual but are mostly linked to work environment-related aspects such as high job demands, lack of communication, and a culture that accepts illness and prohibits stigmatization. This, in turn, puts the focus of RTW measures on the individual, the employer, and the workplace environment. While most RTW interventions address the individual primarily through behavior-oriented therapy (e.g., occupational therapy, stress management programs, inpatient or outpatient rehabilitation) (30), only a few interventions combine individual therapy elements with workplace-related measures (31). Despite varying legal requirements and general data protection regulations, this aspect underlines that recommended RTW processes include colleagues and superiors during RTW phases in a cooperative manner (32)\u003c/p\u003e\n\u003cp\u003eMaintaining stability can be considered a foundation of RTW processes of mental illnesses (33), which was also revealed by our results. In the context of work, stability can be understood as the extent of match between a patient\u0026rsquo;s \u0026ldquo;functional (in)capacity and the work demands [\u0026hellip;] and its impact on job retention\u0026rdquo; (34). Further, it is vital for patients with mental disorders to feel connected to their work, experience a certain work rhythm, and feel comfortable with the work itself. Behavioral concepts view stability as individuals consistently engaging in the same patterns of behavior (35). These daily work routines lower the risk of worsening symptoms and reduce remissions with mental disorders (36). The two understandings have far-reaching implications that include an assessment of the actual functional capacity and needs of the employee and the specific determination of work routines. To offer social support, supervisors and close team members must be included in these daily routines, which requires empowerment and training.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe role of supervisors was also evaluated as beneficial regarding the RTW processes. However, the specific designation, the tasks of the manager, and the expectations of the employees remain complex and unclear. As part of the RTW process, they have the task of controlling the load according to the functional capacity of the patients. However, they also support the implementation and management of the RTW process. This starts, e.g., with welcoming the employee back after the illness and frequently checking whether they can perform the assigned tasks (e.g., capacity, pace) (37). Supervisors should be educated on the RTW process and relevant work-related disease impacts to ensure the employee\u0026apos;s well-being and individual workload management (38).\u003c/p\u003e\n\u003cp\u003eThe definition of the role and action in the RTW process applies to supervisors and other stakeholders, such as institutions of the support system. Interviewees referred to a lack of knowledge and poor communication with and between, e.g., job centers, statutory health insurance, or German pension insurance (German: Deutsche Rentenversicherung). Communication is essential and timely urgent, as patients sometimes depend on income, transitional allowance, or other important social benefits. Ineffective communication or significant delays in commitment can increase psychological stress and promote relapses or remissions. Clarity and consistency within RTW stakeholders\u0026rsquo; roles are important facilitators of an effective RTW process with mental illness (29, 39).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEven though the aims of this study did not directly address it, the interviewees mentioned the need for greater theming and education regarding mental illness as well as a change in the increasing pace and pressure within society. These aspects are fundamental as they have a relevant influence on the recovery and stabilization of patients (40, 41).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths and Limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClear strengths of our study are empirical data on the highly sensitive context of RTW and the in-depth patient perspective in the context of mental illness. Empirical evidence from qualitative studies regarding psychiatric patients and RTW processes is relatively small. Our results offer relevant directions and practical implications for future interventions and research in RTW. Most importantly, participants were recruited through their vocational therapy sessions. Therefore, the participants were not employed at the same organization, which increases the generalizability of the results and minimizes biases towards employers and organizational confounders.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe interviewer\u0026apos;s personal and close communication style could be considered a strength or a bias. The context of the mental illness itself, as well as the sensitivity of the personal information, requires the trust of the interviewees. The interviewer\u0026apos;s therapeutic experience and external position outside the interviewee\u0026rsquo;s employer promoted that trust substantially as this implies a particular ability and integrity (42).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs our results underlined the comprehensive nature of RTW processes in the context of mental illness and its determinants, the sole perspective of patients can be considered limited. To fully understand the RTW process and mental illness, stakeholders such as case managers, workplace health coordinators, employers, colleagues, and other healthcare professionals would add important information (43). Further data sources, such as observations, supervision, or quantitative data, could contribute to modeling the entirety of the RTW process. Other sources of data might lead to different results as the interviewees experienced mental illness affecting the ability to recall the events appropriately, as one of the characteristics of these illnesses is a clinically significant disturbance of cognition (44).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplications for Occupational Health Practice\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePractical implications can be derived on the one hand for the patients and on the other hand for the workplace. Effective RTW processes can be seen as an essential cornerstone for patients as work is a central aspect of recovery from mental illness. Patients must learn and apply resilience and coping strategies to avoid relapses and minimize risk factors. Since behavior-oriented therapy strategies are sometimes lengthy, connections to external stakeholders must be ensured. Thus, it seems necessary to involve external stakeholders (e.g., case managers from German pension insurance) in the RTW process or to bring them into the workplace as needed. The workplaces\u0026rsquo; RTW coordinators or managers can implement such interface management.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOn the company\u0026apos;s part, our results show a much more significant range of tasks and responsibilities, as the social environment significantly influences the recovery process and, in addition to private aspects, represents a central support system. Developing action competence or health-oriented leadership skills is another facilitator companies should foster through specific training measures. Depending on the company\u0026apos;s size, fostering a network with stakeholders early to build up these structures and competencies as early as possible and continuously could be helpful. Overall, all stakeholders need to accept that mental illnesses are diverse and complex and that the course of therapy can be highly individual under certain circumstances.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFuture Research\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of this study point out various future research directions. First, further investigations need to be made into facilitating factors of efficient RTW processes, and the gathered data should be compared with existing evidence to identify potential gaps. These investigations should focus on transitions from different therapy phases and interface-related barriers. Second, a limitation of our study was the mere patient perspective, which should be accompanied by qualitative data from other stakeholders such as employers, managers, and case managers. This way, interface-related aspects (e.g., communication, information delivery, waiting time) could be identified, evaluated, and implemented into practices. Further, the supervisors or managers should be interviewed explicitly about their experiences and needs to manage employees during RTW processes. Lastly, next to qualitative data, quantitative data is necessary to evaluate the impact of mediation and moderating roles of the identified factors. The inclusion of international perspectives and the comparison to that could broaden a mere national perspective and identify gaps or potentials.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOur study showed that the return to work after or during a mental illness is a complex part of therapy. Work itself is an integral part of recovery after mental illness that can provide stability and meaning for those affected and minimize risk factors and remissions. This, in turn, assigns workplaces the role of a support system, including team members, supervisors, and daily routines and tasks. Our results contribute to the growing body of evidence of RTW processes in the context of mental illness and underline that all stakeholders share a collective responsibility.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eRTW \u0026hellip; Return to work\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThis study was approved by the Ethics Committee of the IST University of Applied Science retrospectively (Ethic Approval No. 022024IST233) since the motivation to publish was derived during the research project, which was initially a Master\u0026rsquo;s thesis. All interviewees were informed and agreed to participate before data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eWe declare that all interviewees have given their written consent to publish anonymized data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement:\u003c/strong\u003e Data will be available to the corresponding author upon request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThere are no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contribution:\u003c/strong\u003e All authors contributed equally to the study design, writing, proofreading, modifications, and reviews. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e The authors thank Marcel Kroth and Nils Eggers for reviewing the study\u0026rsquo;s results and coding them to determine interrater reliability.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information:\u003c/strong\u003e\u0026nbsp; Prof. Dr. Martin Lange has taught at the IST University of Applied Science since 2018. His work focuses on workplace prevention, health promotion, return-to-work, and workplace health management. He is on the scientific advisory board of the Institute of Workplace Health Promotion, chair of the Federal Workplace Health Management Association (BBGM e.V.), and a member of the German Network for Healthcare Research (DNVF e.V.). Sabrina Braunwarth completed her Master\u0026apos;s in 2022 at the IST University of Applied Sciences. As a physiotherapist specializing in treating neurological and psychiatric patients, she focuses mainly on aspects of her client\u0026apos;s participation, including in a professional context. Accordingly, she has concentrated on occupational health management as part of her studies and sees her further research interests in this field.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eApplying Research to Occupational Health Practice\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of this study identified vital determinants for a successful RTW process for patients with mental illness. This includes good relationships with coworkers and supervisors, the integration of RTW at work with outpatient therapy, and the possibility of talking about the disease. Triggers at work conflicts with supervisors, or performance pressure could hinder the RTW process. Besides the individual situation, the workplace becomes integral to recovery as it offers stability and a daily routine.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWorkplaces should acknowledge that role and responsibility. Further, workplaces should consider educating supervisors, building up a network of stakeholders, and aspiring to a communication-friendly culture and openness. Researchers and politicians should investigate the impact of regulations that promote interprofessional collaboration between stakeholders (e.g., employers, case managers, and social insurance).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eEichhorst W, Buhlmann F. Die Zukunft der Arbeit und der Wandel der Arbeitswelt. Bonn: Forschungsinstitut zur Zukunft der Arbeit (IZA); 2015. IZA Standpunkte 77 [cited 2023 Feb 23]. Available from: URL: https://docs.iza.org/sp77.pdf.\u003c/li\u003e\n\u003cli\u003eDigital Transformation in the Age of COVID-19: BUILDING RESILIENCE AND BRIDGING DIVIDES. Paris; 2020. Digital Economy Outlook 2020 Supplement [cited 2023 Aug 16]. Available from: URL: https://www.oecd.org/digital/digital-economy-outlook-covid.pdf.\u003c/li\u003e\n\u003cli\u003eThe New Normal? 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Einfluss psychosozialer Faktoren auf die Wiedereingliederung in Arbeit: Institut f\u0026uuml;r Qualit\u0026auml;tssicherung in Pr\u0026auml;vention und Rehabilitation (iqpr) GmbH der Sporthochschule K\u0026ouml;ln; 2011 [cited 2023 Mar 8]. Available from: URL: https://www.iqpr.de/iqprweb/public/dokumente/forschung/abgeschl_projekte/Abschlussbericht_DRV1.pdf.\u003c/li\u003e\n\u003cli\u003eKarl Krajic, Cornelia Reiter, Eva Wimmer, J\u0026ouml;rg Flecker. Qualitative Erhebungs- und Auswertungsmethoden zur Umsetzung qualitativ hochwertiger Evaluationen \u0026ndash; Beitrag zum Baukastensystem f\u0026uuml;r Evaluationen im Pr\u0026auml;ventionsbereich der AUVA; 2016.\u003c/li\u003e\n\u003cli\u003eHussy W, Schreier M, Echterhoff G. Forschungsmethoden in Psychologie und Sozialwissenschaften: F\u0026uuml;r Bachelor. Berlin, Heidelberg: Springer; 2010. (Springer-Lehrbuch).\u003c/li\u003e\n\u003cli\u003eTong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007; 19(6):349\u0026ndash;57.\u003c/li\u003e\n\u003cli\u003eHultsch DF, MacDonald SW, Hunter MA, Maitland SB, Dixon RA. Sampling and generalisability in developmental research: Comparison of random and convenience samples of older adults. International Journal of Behavioral Development 2002; 26(4):345\u0026ndash;59.\u003c/li\u003e\n\u003cli\u003eSim J, Saunders B, Waterfield J, Kingstone T. Can sample size in qualitative research be determined a priori? International Journal of Social Research Methodology 2018; 21(5). Available from: URL: file:///C:/Users/Sabrina/Downloads/Sim2018Cansamplesizeinqualitativeresearchbedeterminedapriori1.pdf.\u003c/li\u003e\n\u003cli\u003eChapter V: Mental and behavioural disorders (F00-F99); 2019 [cited 2023 Nov 26]. Available from: URL: https://icd.who.int/browse10/2019/en#/V.\u003c/li\u003e\n\u003cli\u003eInstitut f\u0026uuml;r Psychologie Freiburg. Regeln f\u0026uuml;r die Transkription; 2012 [cited 2023 Aug 18]. Available from: URL: https://www.psychologie.uni-freiburg.de/studium.lehre/klin-master/skripte/Vergangene_Semester/qualitative-methoden-in-den-rehabilitations-und-gesundheitswissenschaften-SS2012/Regeln%20fuer%20die%20Transkription.\u003c/li\u003e\n\u003cli\u003eNowell LS, Norris JM, White DE, Moules NJ. Thematic Analysis. International Journal of Qualitative Methods 2017; 16(1). Available from: URL: https://journals.sagepub.com/doi/pdf/10.1177/1609406917733847.\u003c/li\u003e\n\u003cli\u003eBraun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology 2006; 3(2). Available from: URL: https://www.researchgate.net/profile/Virginia-Braun/publication/235356393_Using_thematic_analysis_in_psychology/links/00b7d52c9e6303d840000000/Using-thematic-analysis-in-psychology.pdf.\u003c/li\u003e\n\u003cli\u003eNiekler A. Automatisierte Verfahren f\u0026uuml;r die Themenanalyse nachrichtenorientierter Textquellen; 2016.\u003c/li\u003e\n\u003cli\u003eCorbi\u0026egrave;re M, Mazaniello-Ch\u0026eacute;zol M, Bastien M-F, Wathieu E, Bouchard R, Panaccio A et al. Stakeholders\u0026apos; Role and Actions in the Return-to-Work Process of Workers on Sick-Leave Due to Common Mental Disorders: A Scoping Review. J Occup Rehabil 2020; 30(3):381\u0026ndash;419.\u003c/li\u003e\n\u003cli\u003eTingulstad A, Meneses-Echavez J, Evensen LH, Bjerk M, Berg RC. Effectiveness of work-related interventions for return to work in people on sick leave: a systematic review and meta-analysis of randomized controlled trials. Syst Rev 2022; 11(1):192.\u003c/li\u003e\n\u003cli\u003eSkagseth M, Fimland MS, Rise MB, Johnsen R, Borchgrevink PC, Aasdahl L. Effectiveness of adding a workplace intervention to an inpatient multimodal occupational rehabilitation program: A randomized clinical trial. Scand J Work Environ Health 2020; 46(4):356\u0026ndash;63.\u003c/li\u003e\n\u003cli\u003eDunstan DA, Mortelmans K, Tjulin \u0026Aring;, MacEachen E. The Role of Co-Workers in the Return-to-Work Process. Int. J. Disabil. Manag. 2015; 10.\u003c/li\u003e\n\u003cli\u003eBundesanstalt f\u0026uuml;r Arbeitsschutz und Arbeitsmedizin. Die R\u0026uuml;ckkehr gemeinsam gestalten; 2021.\u003c/li\u003e\n\u003cli\u003eGilworth G, Carey A, Eyres S, Sloan J, Rainford B, Bodenham D et al. Screening for job loss: development of a work instability scale for traumatic brain injury. Brain Inj 2006; 20(8):835\u0026ndash;43.\u003c/li\u003e\n\u003cli\u003eHe-Yueya J, Buck B, Campbell A, Choudhury T, Kane JM, Ben-Zeev D et al. Assessing the relationship between routine and schizophrenia symptoms with passively sensed measures of behavioral stability. NPJ Schizophr 2020; 6(1):35.\u003c/li\u003e\n\u003cli\u003eCharzyńska K, Kucharska K, Mortimer A. Does employment promote the process of recovery from schizophrenia? A review of the existing evidence. Int J Occup Med Environ Health 2015; 28(3):407\u0026ndash;18.\u003c/li\u003e\n\u003cli\u003eNastasia I, Coutu M-F, Rives R, Dub\u0026eacute; J, Gaspard S, Quilicot A. Role and Responsibilities of Supervisors in the Sustainable Return to Work of Workers Following a Work-Related Musculoskeletal Disorder. J Occup Rehabil 2021; 31(1):107\u0026ndash;18.\u003c/li\u003e\n\u003cli\u003eJansen J, Boot CRL, Alma MA, Brouwer S. Exploring Employer Perspectives on Their Supportive Role in Accommodating Workers with Disabilities to Promote Sustainable RTW: A Qualitative Study. J Occup Rehabil 2022; 32(1):1\u0026ndash;12.\u003c/li\u003e\n\u003cli\u003eMartin MHT, Nielsen MBD, Petersen SMA, Jakobsen LM, Rugulies R. Implementation of a coordinated and tailored return-to-work intervention for employees with mental health problems. J Occup Rehabil 2012; 22(3):427\u0026ndash;36.\u003c/li\u003e\n\u003cli\u003eCohrdes C, Hapke U, N\u0026uuml;bel J, Thom J. Erkennen - Bewerten - Handeln. Schwerpunktbericht zur psychischen Gesundheit der Bev\u0026ouml;lkerung in Deutschland. Teil 1 \u0026ndash; Erwachsenenalter. Robert Koch-Institut; 2022.\u003c/li\u003e\n\u003cli\u003eR\u0026ouml;ssler W. The stigma of mental disorders: A millennia-long history of social exclusion and prejudices. EMBO Rep 2016; 17(9):1250\u0026ndash;3.\u003c/li\u003e\n\u003cli\u003eGencsoy M. Impact of interview style on trust, and risk perception Melissa Gencsoy 1 Faculty of Behavioural Management and Social Science Psychology of Conflict, Risk and Safety First Supervisor: Dr. Steven J. Watson Second Supervisor: Dr. Miriam S. D. Oostinga Impact of interview style on perceived trust in the interviewer and the effect on risk perception. Enschede: Universiity of Twente; 2020.\u003c/li\u003e\n\u003cli\u003eCharmaz K, Belgrave LL. Qualitative Interviewing and Grounded Theory Analysis. In: Gubrium J, Holstein J, Marvasti A, McKinney K, editors. The SAGE Handbook of Interview Research: The Complexity of the Craft. 2455 Teller Road, Thousand Oaks California 91320 United States: SAGE Publications, Inc; 2012. p. 347\u0026ndash;66.\u003c/li\u003e\n\u003cli\u003eConijn JM, van der Ark LA, Spinhoven P. Satisficing in Mental Health Care Patients: The Effect of Cognitive Symptoms on Self-Report Data Quality. Assessment 2020; 27(1):178\u0026ndash;93.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"return-to-work, mental illness, vocational therapy, determinants, workplace health","lastPublishedDoi":"10.21203/rs.3.rs-3994464/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3994464/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Mental illnesses have increased significantly in the past years and have a significant impact on individuals and work. Return-to-work (RTW) processes facilitate employees' return to work, help them regain workability, and prevent early retirement and long-term incapacity for work. However, the current state of evidence regarding RTW in the context of mental illness is not sufficient. The study aimed to identify (1) promoters and inhibitors of vocational rehabilitation from the patient's perspective, (2) potential differences in respondents' perceptions of various contextual factors, and (3) the relevance of professional, social, or economic influences on RTW acceptance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: The qualitative design used semi-standardized interviews. In total, eight people affected by mental illness were interviewed, of which seven were included in the thematic analysis. The interviews were conducted by the same person, either in person or by telephone. We used MaxQDA to develop a coding scheme in iterative revisions. Two additional independent individuals checked the final coding tree and data analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: We identified, among other aspects, relationships with coworkers and supervisors, open communication about illness, or contact with peers as promotors of successful RTW. Inhibitors were triggers at the workplace, conflicts with supervisors, performance pressure, and a lack of understanding. Social support through family and daily routines were considered critical contextual factors. The constant justification of the illness or financial worries, e.g., were perceived as onerous. The exchange with peers and the role of stakeholders were revealed to be critical for a positive perception of the RTW process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Our study showed that the return to work after or during a mental illness is a complex part of therapy. Work itself is an essential part of recovery after mental illness that can provide stability for those affected and minimize risk factors and remissions. This, in turn, assigns workplaces the role of a support system, including team members, supervisors, and daily routines and tasks. Our results underline that there is a collective responsibility for all stakeholders.\u003c/p\u003e","manuscriptTitle":"Return-To-Work after mental illness: A qualitative study on factors promoting the reintegration into work","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-12 06:11:39","doi":"10.21203/rs.3.rs-3994464/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4f1d5c66-c312-49f6-8238-32e8d42896ec","owner":[],"postedDate":"March 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-01T11:51:27+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-12 06:11:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3994464","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3994464","identity":"rs-3994464","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}