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Little is known on how employees at work with mental health problems experience their work environment. This study explores how a selected sample of Danish employees with depressive symptoms experience the interaction with their work environment and how they respond to and deal with problems at work.From a survey study on work and mental health in Denmark, we invited participants for in-depth interviews. Using grounded theory, we conducted 13 semi structured interviews with employees, at work, experiencing depressive symptoms.Work was pivotal for the informants who were in an on-going process that we conceptualised as struggling at work. Informants struggled with the negative experiences of work that led to emotional, cognitive and somatic symptoms. Relationships with supervisors and colleagues, work load and work pressure and their self-image as a good worker conditioned the struggle. The informants found themselves unable to change their problematic working situation. This gradually led to different strategies to endure work and take care of one-self. These strategies were as follows: tending to symptoms and altering prospects for their future. The consequence of the on-going struggle was that the informants distanced themselves from their work.This study provided insight to the process of struggling at work, which the interviewed employees with depressive symptoms experienced.Behaviour of supervisors is a key element for employees with depressive symptoms struggling at work. Practitioners and other health and rehabilitation practitioners working with people with depressive symptoms and other mental health problems could inquire about supervisor's behaviour and relation between supervisors and employees. Interventions that targets both the individual employee as well as work environment focused interventions at the organisational level could be beneficial for employees with mental health problems as well as the workplaces.

Background Depression increases the risk of disability pension and represents a health related strain that pushes people out of the labour market. Although early voluntary retirement is an important alternative to disability pension, few studies have examined whether depressive symptoms incur early voluntary retirement. This study examined whether depressive symptoms and changes in depressive symptoms over time were associated with early retirement intentions. Methods We used a cross-sectional (n = 4041) and a prospective (n = 2444) population from a longitudinal study on employees of the Danish eldercare sector. Depressive symptoms were measured by the Major Depression Inventory and the impact of different levels of depressive symptoms (severe, moderately severe, moderate, mild and none) and changes in depressive symptoms (worsened, improved, unaffected) on early retirement intentions were analysed with multinomial logistic regression. Results In the cross-sectional analysis all levels of depressive symptoms were significantly associated with retirement intentions before the age of 62 years. Similar associations were found prospectively. Depressive symptoms and worsened depressive symptoms in the two year period from baseline to follow-up were also significantly associated with early retirement intentions before age 62. The prospective associations lost statistical significance when controlling for early retirement intentions at baseline. Conclusions The whole spectrum of depressive symptoms represents a health related strain that can incur intentions to retire early by early voluntary retirement. In order to change the intentions to retire early, the work related consequences of depressive symptoms should be addressed as early in the treatment process as possible.

OBJECTIVES: Mental health problems are strong predictors of long-term sickness absence (LTSA). In this study, we investigated whether organizational justice at work - fairness in resolving conflicts and distributing work - prevents risk of LTSA among employees with depressive symptoms.METHODS: In a longitudinal study with five waves of data collection, we examined a cohort of 1034 employees with depressive symptoms. Depressive symptoms and organizational justice were assessed by self-administered questionnaires and information on LTSA was derived from a national register. Using Poisson regression analyses, we calculated rate ratios (RR) for the prospective association of organizational justice and change in organizational justice with time to onset of LTSA. All analyses were sex stratified.RESULTS: Among men, intermediate levels of organizational justice were statistically significantly associated with a decreased risk of subsequent LTSA after adjustment for covariates [RR 0.49, 95% confidence interval (95% CI) 0.26-0.91]. There was also a decreased risk for men with high levels of organizational justice although these estimates did not reach statistical significance after adjustment (RR 0.47, 95% CI 0.20-1.10). We found no such results for women. In both sexes, neither favorable nor adverse changes in organizational justice were statistically significantly associated with the risk of LTSA.CONCLUSIONS: This study shows that organizational justice may have a protective effect on the risk of LTSA among men with depressive symptoms. A protective effect of favorable changes in organizational justice was not found.

The objective of this study was to investigate whether work unit-levels of psychosocial working conditions modify the effect of depressive symptoms on risk of long-term sickness absence (LTSA).A total of 5,416 Danish female eldercare workers from 309 work units were surveyed using questionnaires assessing depressive symptoms and psychosocial working conditions. LTSA was derived from a national register. We aggregated scores of psychosocial working conditions to the work unit-level and conducted multi-level Poisson regression analyses.Depressive symptoms, but not psychosocial working conditions, predicted LTSA. Psychosocial working conditions did not statistically significantly modify the effect of depressive symptoms on LTSA.Psychosocial working conditions did not modify the effect of depressive symptoms on LTSA. The results, however, need to be interpreted with caution, as we cannot rule out lack of exposure contrast and non-differential misclassification of the exposure.

Background Depression has a high point and life time prevalence and is a major cause of reduced work ability and long-term sickness absence (LTSA). Less is known of the extent to which non-clinical depressive symptoms are related to the risk of LTSA. The aim of this study was to investigate how non-clinical and clinical depressive symptoms are prospectively associated to subsequent LTSA. Methods In a cohort study of 6985 female employees from the Danish eldercare sector depressive symptoms were measured by the Major Depression Inventory (MDI) and scores (0–50) were divided into groups of 0–4, 5–9, 10–14, 15–19, ≥ 20 points and clinical depression. Data was linked to a national register with information on LTSA (≥ 3 weeks). Hazard ratios (HR) for LTSA during a 1-year follow-up were calculated by Cox's proportional hazards model. Results Compared to the reference group (0–4) the HR was stronger for each subsequent group: MDI scores of 5–9: HR = 1.07 (95% CI: 0.93–1.24); 10–14: 1.38 (1.15–1.66); 15–19: 1.54 (1.20–1.98); ≥ 20: 1.96 (1.45–2.64); clinical depression: 2.32 (1.59–3.38); after adjustment for previous LTSA, age, family status, smoking, leisure time physical activity, BMI, and occupational group. Limitations Missing information on the cause of sickness absence and prevalent somatic illness. Conclusion A clear dose–response relationship exists between increasing depressive symptoms and risk of LTSA. The adverse effect of non-clinical depressive symptoms on LTSA already manifests itself at relatively low scores. Clinical relevance: this study illustrates the valuable information of considering the whole continuum of depressive symptoms.