Prognostic factors for recovery following the diagnosis of a work-related mental health condition: A systematic review
Many factors influence patient recovery from work-related mental health conditions. General practitioners (GPs) play a central role in both managing the personal recovery plan for these patients and in monitoring their progress towards recovery. However, there is no current advice to GPs about which factors adversely affect recovery in patients following a diagnosis of a work-related mental health condition. We, therefore, aimed to identify the factors that can adversely affect recovery in patients with work-related mental health conditions.
A systematic review using a keyword search of electronic databases was undertaken from database inception to April 2017. Studies were excluded if they were not in English or included mental health conditions other than anxiety, depression, posttraumatic stress disorder, acute stress disorder or adjustment disorder, and if they did not report on patient recovery outcomes (inferred from delayed return to work or personal recovery). Identified titles, abstracts and full texts were reviewed by two reviewers. Conflicting reviews were resolved through discussion or by an adjudicator. The quality of body of evidence was assessed using GRADE: Grading of Recommendations, Assessment, Development and Evaluations.
Of 1610 studies identified in the literature, 13 were eligible for inclusion in the analysis and these were collectively given a GRADE rating of High. Factors that are associated with affecting recovery, include medical factors (e.g. chronic pain, higher-degree of severity of the mental health conditions), health behaviours and attitudes (e.g. drug and alcohol dependence, attitude to return-to-work), employment/workplace factors (e.g. job stress, harassment as a precursor to the mental health condition) and personal factors (e.g. age >40 years, life stressors).
Many factors can adversely affect recovery in patients with a work-related mental health condition. GPs can consider these factors during management and follow-up of patients to assist in preventing delayed recovery or return to work. However, these factors should not be used to indicate compensable status. The findings from this review have informed the development of an evidence-based clinical practice guideline on the diagnosis and management of work-related mental health conditions in general practice.