The research team, led by Lisa Björk of the University of Gothenburg and the Institute of Stress Medicine in Region Västra Götaland, together with Jenny Hultquist, Gunnel Hensing and Monica Bertilsson, set out to test a deceptively simple assumption. Because sickness absence due to common mental disorders is known to be unevenly distributed across the Swedish labour market, with higher levels in the public sector, in service industries where people are the main object of work, and in female-dominated occupations, the researchers reasoned that managers in different industries might encounter and interpret reduced work capacity in fundamentally different ways. A hospital ward manager, constantly observing the social and emotional demands of patient care, might notice different impairments than a manager of software engineers whose work revolves around data and cognitive output.

To investigate this, the team analysed survey responses from 1,819 Swedish managers who reported having had at least one employee with depression or an anxiety disorder during the previous two years. The data were collected between September and December 2017 as part of the New Ways – Mental Health at Work research programme, within the project Managers’ Perspective – A Missing Piece, and approved by the Regional Ethics Review Board in Gothenburg. Participants were recruited through the Swedish Citizen Panel at the SOM Institute at the University of Gothenburg and through the HELIX Competence Centre at Linköping University, achieving a total response rate of 71 percent. Of the managers included in the final analysis, 927, or 51 percent, had experienced one staff member with depression or anxiety, while 892, or 49 percent, had experienced several.

The methodological design is one of the study’s notable strengths. Rather than relying on a single definition of industry, the researchers applied three separate classification schemes, each grounded in a different logic. The first categorised organisations by ownership, distinguishing governmental, county council and municipal employers from private companies and not-for-profit organisations. The second classified industries by their main work object, following a long tradition in occupational sociology that divides work into tasks centred on data, things or people. The third, most fine-grained scheme combined work object with the gender composition of the industry, yielding categories such as male-dominated industries handling things, gender-mixed industries spanning all three objects, and female-dominated industries handling people, namely education and health and social care.

The exposure findings were clear and consistent across all three classifications. Managers in municipalities and counties, in industries where people are the main work object, and specifically in health and social care and education, were significantly more likely to have experienced several employees with depression and anxiety. In health and social care and education, 57 percent of managers reported multiple affected staff members, followed by public administration at 52 percent, labour-intensive services at 48 percent, knowledge-intensive services at 45 percent, machinery operations at 42 percent, and goods and energy production at just 38 percent. When classified by ownership, private companies stood out with only 42 percent of managers reporting several affected employees, compared with 56 to 57 percent elsewhere. By work object, industries centred on data showed the lowest multiple-exposure rate at 40 percent.

These patterns align closely with earlier register-based research showing that psychotropic drug prescriptions, psychiatric care, sickness absence and disability pensions due to depression and anxiety are all more prominent in female-dominated industries. Two systematic reviews cited by the authors suggest a causal link between detrimental psychosocial work environments and depression and burnout, with negative consequences affecting women and men working in such environments in similar ways. The implication is sobering: more women may be affected not because of inherent vulnerability, but because they disproportionately work in settings where job insecurity, high demands, high workload, low job control and low reward are common.

Yet the study’s second, and arguably more surprising, finding concerns how managers rated the effects of those disorders on work capacity. Using a nine-item instrument derived from a validated measure of work capacity in workers with common mental disorders, the researchers aggregated responses into two indices: task-oriented work capacity, capturing abilities such as prioritising among work tasks, and relational work capacity, capturing abilities such as interacting with other people. The indices showed good internal consistency, with Cronbach’s alpha values of 0.81 and 0.70 respectively. Three separate multivariate analyses of covariance, one for each industry classification and each controlling for organisational size and the manager’s span of control, found no statistically significant effect of industry on these ratings. The effect sizes were vanishingly small, with partial eta-squared values ranging from 0.002 to 0.006.

The authors propose three possible explanations for this null result, each carrying important implications. The first, which they ultimately consider unlikely, is that depression and anxiety may genuinely affect work capacity in similar ways across industries, perhaps because automation and digitalisation have aligned work tasks across sectors. The second concerns the measurement instrument itself: the division into task-oriented and relational components may be too fine-tuned for managers, who may hold a more general conception of reduced work capacity without being able to pinpoint specific problematic aspects. The third explanation centres on the inherent complexity of work capacity as a phenomenon. Physicians in clinical studies have long reported that assessing work capacity is difficult because of individual variation in symptoms and symptom management, and patients themselves often struggle to articulate their limitations, which is why communication tools such as the Capacity Note in Swedish primary health care have been developed to help patients find a more precise language for their experiences.

The study also raises the possibility of underreporting in male-dominated sectors. Managers depend heavily on employee disclosure, and workers frequently avoid disclosing mental health problems for fear of stigmatisation. Previous qualitative work has found that masculine workplace cultures built on ideals of strength and endurance can hamper disclosure, and a separate Swedish study showed that male managers hold significantly more negative attitudes toward depression than their female counterparts. Together, these findings suggest that common mental disorders may be underestimated in industries dominated by men, though the authors caution that this assumption requires confirmation in future studies. Notably, even in the full study population of 3,358 managers, 73 percent reported none or only one affected employee in the previous two years, underscoring that encountering these conditions remains a relatively rare experience for most managers.

The practical takeaway is unexpectedly liberating for organisations designing support programmes. Had the findings confirmed industry differences, tailored training for managers in different sectors would have been warranted. Instead, the uniformity of ratings across the labour market suggests that support for managers dealing with employees’ depression and anxiety does not need to be customised by industry. What matters is that managers everywhere receive the support they need to reduce work-related risk factors, assist affected employees and help those on sick leave return to work. The authors also point to a specific professional role: occupational therapists, with their expertise in assessing individual functionality, teaching coping strategies and adapting work environments and tasks, are well positioned to provide that support to both employees and managers. As common mental disorders continue to shape working life, this study suggests the challenge is shared across every sector, and so is the solution.

Subject of Research: Industry differences in managers' experiences and ratings of work capacity in employees with depression and anxiety

Article Title: Managers’ experiences of work capacity in employees with depression and anxiety

Article References: Björk, L., Hultquist, J., Hensing, G., & Bertilsson, M. (2025). Managers’ experiences of work capacity in employees with depression and anxiety. Scandinavian Journal of Occupational Therapy, 32(1), Article 2570900. https://doi.org/10.1080/11038128.2025.2570900

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2570900

Keywords: common mental disorders, depression, anxiety, work capacity, managers, occupational health, sickness absence, gender composition, Swedish labour market, psychosocial work environment, occupational therapy, workplace mental health

The research, published in SSM – Population Health, was conducted by Joachim Gerich of the University of Linz and colleagues at the Federal Institute for Occupational Safety and Health in Germany. Rather than asking workers retrospectively how many days they had dragged themselves into the office while unwell, a method prone to memory distortion, the team deployed a factorial survey experiment. More than 3,500 employees, drawn as a follow-up to the nationally representative BIBB/BAuA Employment Survey 2024, each evaluated ten hypothetical scenarios in which they woke up feeling unwell. The scenarios systematically varied symptoms, body temperature, infectiousness, workload, team dynamics, attendance pressure, weekday and even weather, and respondents chose between calling in sick, going to work on-site, or working remotely if their job allowed it.

The results were striking in their clarity. Body temperature emerged as the dominant predictor of attendance behavior, accounting for by far the largest share of explained variance. At a mildly elevated 37.5 degrees Celsius, the probability of attending work on-site dropped by roughly 15 percentage points compared with normal temperature. At 38.3 degrees Celsius, a genuine fever, the probability collapsed by 54 percentage points. Strong cold symptoms, such as feeling weak and exhausted with a severe headache, reduced the likelihood of working by about 12 percentage points. No other situational factor came close to this explanatory power, confirming the classical model of Steers and Rhodes from 1978, which posits that ill-health acts as the central gatekeeper of attendance decisions.

But the study’s most consequential finding concerns what happens when the feverish employee has a laptop and a home office. Among respondents with a remote work option, a fever of 38.3 degrees still pushed 66 percent toward sick leave, but 28 percent chose to work from home and a stubborn 7 percent even went to the physical workplace. At the milder temperature of 37.5 degrees, remote workers were actually more likely to work from home than to call in sick. This pattern supports the theoretical argument of Fiorini that the availability of remote work raises the threshold of illness severity at which employees perceive themselves as sick enough to rest. In effect, the home office has become a middle path that absorbs many of the mild and moderate illness episodes that would once have ended in either full attendance or full absence.

The experiment also illuminated how contextual pressures operate only within a specific window of ambiguity. Attendance pressure from supervisors, the fear of overburdening colleagues, team cohesion and infectiousness all significantly shaped decisions, but their effects were concentrated at normal or moderately elevated temperatures, where the right course of action is genuinely unclear. When symptoms were very mild or very severe, these factors faded into irrelevance, echoing a hierarchical model of decision-making in which people skip deliberative stages when the answer seems obvious. Notably, high attendance pressure increased on-site presenteeism but left virtual presenteeism untouched, suggesting that managerial pressure operates primarily by pulling bodies into buildings rather than by extracting work in general.

Social dynamics within teams proved more influential than individual workload. When respondents imagined that their absence would significantly increase their colleagues’ workload, they became markedly more likely to work while ill, both on-site and remotely. Conversely, when they faced working alongside colleagues they did not get along with, the probability of calling in sick rose. Interestingly, the much-discussed Monday effect, the tendency for absence rates to spike at the start of the week in observational data, vanished entirely in the experimental setting, lending weight to the argument that Monday absences largely reflect illnesses that begin over the weekend rather than motivational shirking.

Perhaps the most sobering result is how persistent presenteeism remains even under objectively severe conditions. Across the full sample, the overall probability of working in some form, whether on-site or remotely, still reached 30 percent at a body temperature of 38.3 degrees Celsius. Men were slightly more prone to this than women, showing 32 percent presenteeism at high fever compared with 28 percent for women, and men with remote options favored virtual presenteeism while women more often chose the on-site route. Given that standard medical advice for acute febrile illness is rest and recovery, the authors caution that this persistence may deliver short-term productivity at the cost of long-term health depletion, a trade-off documented in prior research linking working while ill to serious cardiovascular events.

The motivational analysis added a revealing psychological layer. Respondents who chose to work despite illness rated their reasons on a scale, and the pattern shifted with severity. Inner convictions and principles were rated as the most important motive overall, followed by concern for the well-being of others and the accumulation of unfinished work. Crucially, as body temperature rose, those who still worked attached escalating importance to self-oriented and avoidance-oriented motives: protecting their reputation, advancing their career, avoiding unpleasant conversations, and preventing work from piling up. Prosocial concern for others, by contrast, remained flat across temperature levels. In other words, the sicker people were, the more their decision to work reflected personal disposition and identity rather than genuine consideration for colleagues or customers.

The study’s design carries both strengths and limits. The factorial survey approach, with its D-efficient orthogonal design and random assignment of scenarios, allows causal inference about situational effects that retrospective surveys cannot provide, and the preregistered analysis strengthens confidence in the findings. Yet hypothetical vignettes measure stated intentions rather than actual behavior, and the scenarios focused on acute cold-like illness, so the conclusions may not extend to chronic conditions, mental health problems or episodic diseases where working through symptoms can sometimes be adaptive. Factors such as organizational culture, leadership style and caregiving responsibilities also lay outside the experimental frame.

The implications for occupational and public health are nonetheless significant. Remote work appears to reduce outright absence in some situations, but it also seems to normalize working through mild illness and to blur the boundary between recovery and labor. As flexible arrangements become a permanent fixture of working life, organizations may need to make explicit that a moderately elevated temperature is a signal to rest, not an invitation to log in from the sofa. The German data suggest that without such norms, the flexibility that protects teams from infection and eases the daily commute may simultaneously erode the recovery time on which long-term health and productivity ultimately depend.

Subject of Research: Situational factors influencing sickness presenteeism and virtual versus on-site work attendance decisions among German employees

Article Title: The situational contingency of virtual and on-site workplace attendance decisions in Germany: a vignette-based approach

Article References: Gerich, J., Herdegen, N., Koch, A., Kroczek, M., Kugler, P., Meyer, S.-C., Perleberg, M., & Späth, J. (2026). The situational contingency of virtual and on-site workplace attendance decisions in Germany: a vignette-based approach. SSM – Population Health, Article 101979. https://doi.org/10.1016/j.ssmph.2026.101979

Image Credits: AI Generated

DOI: 10.1016/j.ssmph.2026.101979

Keywords: sickness presenteeism, remote work, attendance decisions, factorial survey, body temperature, occupational health, Germany, workplace behavior, virtual presenteeism, sickness absence, team cohesion, attendance pressure

The trial, led by Fiona Starke of the Federal Institute for Occupational Safety and Health in Berlin together with colleagues at Maastricht University and a network of German psychiatric clinics, evaluated a program called RTW-PIA, short for Return to work-Psychiatrische Institutsambulanz. The intervention was designed to fill a well-recognized gap: in Germany, aftercare programs aimed at maintaining recovery and minimizing relapse among employees moving from psychiatric outpatient treatment back to their jobs are scarce. RTW-PIA combined medical and psychotherapeutic care with work-oriented components over an eighteen-month period, making it a genuinely multimodal approach rather than a single-focus therapy.

To test the program rigorously, the researchers conducted a multicenter randomized controlled trial embedded in psychiatric outpatient clinics. They enrolled 484 employees who were on sick leave with a diagnosed mental disorder. Half of the participants, 240 in total, were randomly assigned to receive RTW-PIA in addition to usual care, while the remaining 244 received care as usual alone. Randomization of this kind ensures that differences in outcomes between the groups can be attributed to the intervention itself rather than to pre-existing differences in illness severity, motivation, or workplace circumstances.

The primary outcome was what the researchers call sustainable return to work, defined in a deliberately demanding way. A participant counted as achieving sustainable return to work only if, after fully returning to work, they accumulated no more than six weeks of additional sickness absence during the following twelve months. This definition matters because simply going back to work once is not the same as staying there; relapse and renewed absence are common among people with recurrent mental health conditions. Outcomes were measured at baseline and then at six, twelve, eighteen, and twenty-four months, giving the team a long observation window.

When the intention-to-treat analysis was complete, the headline finding was negative. Employees who received the intensified aftercare were not significantly more likely to achieve sustainable return to work than those receiving usual care. The odds ratio was 1.38 with a 95 percent confidence interval running from 0.89 to 2.12, an interval that crosses the threshold of statistical significance. In practical terms, the point estimate hinted at a possible advantage for the intervention group, but the data could not rule out that the true effect was absent or even slightly unfavorable.

The secondary outcomes told a similar story. The researchers examined measures such as return-to-work self-efficacy and work ability, and here again no significant differences emerged between the groups. What they did observe, however, was a consistent pattern of slight improvements favoring RTW-PIA across these measures. That consistency is worth noting: while none of the individual effects reached statistical significance, the direction of the results was uniform, which sometimes suggests that a real but modest effect may be diluted in an averaged analysis of a heterogeneous population.

The team took methodological rigor seriously. They complemented the primary intention-to-treat analysis with prespecified sensitivity analyses, including per-protocol and complete-case approaches, and these analyses led to the same conclusion as the main result. Latent growth curve models were used alongside logistic regression to track how outcomes changed over time, and missing data were handled under a missing-at-random assumption. The trial was also prospectively registered in the German Clinical Trials Register on September 1, 2021, before the first participant was enrolled, and ethical approval was obtained from the Ethics Committee at Hanover Medical School.

The most interesting findings emerged from the subgroup and moderator analyses. In diagnostic subgroup sensitivity analyses, employees with recurrent depressive disorders showed significant improvements in several secondary outcomes when they received the intensified aftercare. Prespecified exploratory moderator analyses suggested potential benefits for two further groups: employees without a recognized degree of disability, and those reporting low social support at work. After the researchers applied multiplicity adjustment to guard against false-positive findings, only recurrent depressive disorder still moderated the treatment effect, specifically on work ability. These patterns remain hypotheses rather than proven effects, and the authors are careful to state that they need to be tested in independent samples.

Why might an eighteen-month multimodal program fail to move the needle on sustainable return to work overall? The answer likely lies in the complexity of the problem itself. Returning to work after a mental disorder involves the interplay of clinical recovery, workplace conditions, social support, insurance and disability status, and individual circumstances that no single intervention can fully address. The moderator findings support this interpretation: employees who lacked workplace social support, who did not carry a formal disability designation, or who struggled with recurrent depression may represent subgroups where the added clinical and work-oriented components could genuinely tip the balance, while for others usual care may already suffice or other barriers may dominate.

The authors conclude that, on average, RTW-PIA did not significantly improve sustainable return to work or secondary outcomes, and they direct future research toward two priorities: testing the identified subgroup hypotheses in independent samples and studying how such an intervention could be implemented in practice. The trial was funded by the Innovation Fund of the Federal Joint Committee, Germany’s key health care decision-making body, between January 2021 and June 2025, with the funder having no role in the design, analysis, or interpretation. For a health system searching for ways to keep people with mental illness attached to the labor market, the study is a reminder that well-intentioned, resource-intensive aftercare is not automatically effective, but also that carefully designed subgroup research may yet reveal who benefits most and how support should be targeted.

Subject of Research: Effectiveness of intensified clinical aftercare for sustainable return to work among employees on sick leave with mental disorders

Article Title: Intensified return to work clinical aftercare for sick-listed employees with diagnosed mental disorders in Germany: effects of a multicentre randomized controlled trial

Article References: Starke, F., Zimmermann, J., Sikora, A., Houkes, I., Schulz, A., Stegmann, R., Seufert, L., Schmitz, E., Buntrock, C., Szycik, G. R., Borgolte, A., Unger, H.-P., Schumacher, J. O., Stark, H., Schneller, C., Unterschemmann, S.-L., de Rijk, A., & Wegewitz, U. (2026). Intensified return to work clinical aftercare for sick-listed employees with diagnosed mental disorders in Germany: effects of a multicentre randomized controlled trial. BMC Psychiatry. https://doi.org/10.1186/s12888-026-08639-0

Image Credits: AI Generated

DOI: 10.1186/s12888-026-08639-0

Keywords: return to work, mental disorders, aftercare, randomized controlled trial, sickness absence, recurrent depression, work ability, occupational health, psychiatric rehabilitation, Germany, sustainable employment, clinical trial

The research team searched Medline, PsycINFO and Web of Science from their inception to December 2025, ultimately identifying 24 studies comprising 26 W-CBT treatment conditions and a combined total of 3,279 participants. All included studies involved working-age adults on sickness absence due to mild to moderate depression or anxiety, or stress-related conditions such as adjustment disorder and burnout. The studies came primarily from European welfare states, with the Netherlands contributing seven trials, Denmark five and Norway four, alongside two each from Germany, Sweden and the United States and one each from Canada and Japan. Seventeen of the studies were randomized controlled trials, while seven used non-randomized or pre-post designs.

What distinguishes W-CBT from conventional CBT is the deliberate integration of work participation throughout treatment. Therapists help patients restructure work-related beliefs, design behavioural experiments, undertake graded exposure to work demands and systematically solve practical workplace problems. In roughly a third of the included studies, the intervention also involved direct contact with a workplace representative. The interventions were delivered individually in 75 percent of the studies, mostly by psychologists, with a median of about eight sessions. Follow-up assessments, available for most treatment conditions, extended to a median of 8.5 months after treatment ended.

The headline clinical result is striking. Within treatment groups, psychiatric symptoms improved with a mean standardized effect size of g = 1.04 from pre- to post-treatment, a large effect by conventional benchmarks, and the improvement was essentially maintained at follow-up, with g = 1.09. Between-group comparisons told a more modest story: W-CBT outperformed control conditions with a small post-treatment effect of g = 0.28, which shrank to g = 0.11 at follow-up. Importantly, significant advantages over control conditions emerged only against waitlist controls, not against treatment as usual or other active CBT-based interventions, a pattern consistent with the broader psychotherapy literature in which effect sizes diminish as comparison conditions become more stringent.

The work-related findings are perhaps the most consequential for policy. At the end of treatment, 56 percent of participants had returned to work, rising to 87 percent at follow-up. Between-group analyses showed that participants receiving W-CBT had a significantly higher likelihood of full return to work than controls, with a pooled risk ratio of 1.23 at post-treatment and 1.15 at follow-up, both statistically significant. Self-reported work functioning also improved substantially within groups, and intriguingly, the follow-up effect size of 1.25 exceeded the post-treatment value of 0.97. This temporal pattern suggests that functional recovery lags behind symptom reduction, echoing prior evidence that people often return to full performance well after their clinical symptoms remit.

Moderator analyses offered partial support for the theoretical foundation of W-CBT. For within-group symptom outcomes, higher scores on both the CBT content subscale and the work-focused content subscale were associated with larger effects, as were a greater number of treatment sessions, indicating a dose-response relationship. More recent publication year and country of origin were also significant. Notably, therapist profession, treatment format, study setting, type of mental disorder and the presence of a formal workplace intervention did not significantly moderate outcomes, an encouraging signal that W-CBT can be delivered flexibly across professional groups and healthcare settings without losing effectiveness.

Beneath the encouraging headline numbers, however, the review uncovers a serious methodological problem that the authors argue threatens the validity of the entire return-to-work evidence base. Outcomes such as days of sickness absence or time to return to work are bounded at zero, heavily skewed and frequently zero-inflated, yet many primary studies analyzed them with statistical methods that assume normally distributed data. The authors show that in several studies the reported means and standard deviations implied impossible values, such as negative numbers of sick days. When bounded, skewed outcomes are pushed through ordinary linear models, the resulting estimates, confidence intervals and p-values can be invalid, and predictions can be nonsensical.

Time-to-event outcomes fared little better. Seven studies reported hazard ratios from Cox proportional hazards models, and the pooled effect was HR = 1.15, with a confidence interval crossing unity. The authors emphasize that hazard ratios are problematic for meta-analysis because they are non-collapsible, carry built-in selection bias, are sensitive to effect modification by covariates and depend on the length of follow-up, all of which undermine comparability across studies. They suggest alternatives such as risk differences or risk ratios, and point to modern tools like ordered beta regression for bounded data, while acknowledging that such models are difficult to integrate into conventional meta-analysis without access to individual participant data, which none of the included studies openly shared.

The reviewers also graded the methodological rigour of the field using the psychotherapy outcome study methodology rating scale, finding a median score of 16.5 out of a possible 44, well below the scores of around 22 reported in standard CBT effectiveness trials for depression and anxiety. Risk-of-bias assessments using the Cochrane RoB 2 tool found that only about a third of the randomized trials had low risk of bias, while most non-randomized studies rated as high or critical risk. Publication bias analyses, including robust Bayesian model-averaging, provided strong evidence for the genuine symptom-reducing effect of W-CBT and only weak evidence of bias, lending credibility to the core findings despite these weaknesses.

The public health stakes are considerable. Common mental disorders affect roughly one in six adults in Europe each year, and cross-national survey data indicate that around 30 percent of adults meet criteria for a mental disorder in their lifetime. Sickness absence due to these conditions is often prolonged and recurrent, and delayed or incomplete return to work can set people on a path toward labour market marginalization. The authors conclude that W-CBT is associated with meaningful symptom improvement and an increased likelihood of returning to work, and that it aligns naturally with primary care and occupational health services in many European countries. Their prescription for the field is twofold: continued development of interventions that integrate mental health treatment with work-focused strategies, and a decisive upgrade in how return-to-work outcomes are defined, measured and statistically modeled, in line with emerging core outcome sets. Without that methodological repair, they warn, the evidence supporting one of the most promising tools against work disability will remain harder to trust than it should be.

Subject of Research: Work-focused cognitive behavioural therapy for common mental disorders and its effects on psychiatric symptoms and return-to-work outcomes

Article Title: Work-focused cognitive behavioural therapy for common mental disorders: a systematic review and meta-analysis

Article References: Finnes, A., Johansson, M., Bernhardtz, R., & Öst, L.-G. (2026). Work-focused cognitive behavioural therapy for common mental disorders: a systematic review and meta-analysis. BMC Psychology, 14(1), Article 1374. https://doi.org/10.1186/s40359-026-05648-2

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05648-2

Keywords: work-focused CBT, common mental disorders, return to work, sickness absence, depression, anxiety, meta-analysis, systematic review, occupational health, psychotherapy, hazard ratios, work disability