# Occupational Health Physicians’ Perspectives on Factors Influencing Return-to-Work Decisions for Employees With Mental Health Disorders: A Retrospective Observational Study

## TL;DR

This study explores how occupational physicians decide whether employees with mental health issues can return to work, focusing on factors like sleep and appetite.

## Contribution

The study identifies specific lifestyle and leave duration factors influencing return-to-work decisions for mental health disorders.

## Key findings

- Poor sleep quality and loss of appetite increase the likelihood of recommending sick leave for working employees.
- Longer sick leave duration decreases the chance of recommending a return to work for employees on leave.
- Occupational physicians consider lifestyle factors more than job type when assessing mental health-related work eligibility.

## Abstract

Introduction

Assessing fitness for work among employees with mental health disorders presents significant challenges. While it is fundamentally assumed that employees must be capable of adequately fulfilling their job responsibilities, occupational health professionals frequently encounter difficulties in making such determinations. This study aims to elucidate the factors considered by occupational physicians, particularly those specializing in psychiatry when evaluating the work eligibility of employees experiencing mental health issues.

Methods

We analyzed a subset of occupational physician interview records collected over a 14.5-year period at a higher education institution. A total of 1,381 interviews involving 184 individuals were included. For two groups, employees currently working and those on leave, we used the occupational physician’s decision as the dependent variable. A generalized linear mixed model (GLMM) was employed to estimate the odds ratios (ORs) of factors associated with the physician’s decision to recommend sick leave versus continued work without leave.

Results

Among employees currently working, factors associated with the occupational physician’s decision to recommend sick leave rather than continued work included other occupations (OR [95% CI] = 5.43 [1.16, 25.42]), reduced sense of sleep quality (OR [95% CI] = 4.22 [1.07, 16.67]), and loss of appetite (OR [95% CI] = 6.81 [1.36, 34.2]). Among employees on sick leave, the only factor associated with a return-to-work decision, as opposed to continued sick leave, was the total duration of prior sick leave (in months) (OR [95% CI] = 0.94 [0.91, 0.96]).

Conclusions

The present study revealed that occupational physicians specializing in psychiatry place significant emphasis on lifestyle factors such as sleep and appetite when assessing fitness for work. When occupational physicians assessed fitness to return to work for employees on sick leave, they focused on the duration of the leave, which could serve as a potential risk factor for relapse.