The impact of common mental disorders on the work functioning of nurses and allied health professionals: A systematic review

Abstract

Objective

This study aims to inventory aspects of work functioning of nurses and allied health professionals that are affected by common mental disorders.

Design

A systematic review of psychological and occupational health literature was performed.

Data sources

A sensitive systematic literature search based on index terms and text words was conducted in four electronic databases: PubMed, PsycINFO, Embase, and Cinahl. The literature search was limited to journal articles published between 1998 and 2008, written in English, German, or Dutch.

Review methods

For inclusion, studies had to examine a relationship between common mental disorders and a measure of work functioning in nurses or allied health professionals. No restrictions on study design were handled. Methodological quality was assessed for each study. The data were categorized into themes, for which the strength of evidence was assessed using six levels of evidence.

Results

Sixteen of 2792 studies met the inclusion criteria, of which 13 had a cross-sectional design, 1 was a vignette study, and 2 were narrative reviews. In all studies, the subjects were nurses. The retrieved aspects of sub-optimal work functioning due to common mental disorders were merged into 15 themes. Strong evidence was found for five themes: general errors, medication errors, near misses, patient safety, and patient satisfaction. Moderate evidence was found that common mental disorders are associated with complex motor skills and with general performance; while evidence for an association between common mental disorders and needle stick injuries was inconclusive. Seven themes had only narrative evidence: interpersonal behaviour, energy, focus on goals and responsibility, work speed, avoiding work while on the job, coping with emotions, and motivation.

Conclusion

Common mental disorders were found to be associated with various impairments in work functioning in nurses, these include task-related, intrapersonal and interpersonal aspects of work. In particular, strong evidence was found for an association between common mental disorders and general errors, medication errors, near errors, patient safety, and patient satisfaction. These results provide input for preventive actions to improve both health and work functioning in health care workers.

Introduction

Work and mental health are in constant interplay. Work can be therapeutic and plays an important role in a person's life; it is a dominant, time consuming, and rewarding activity, and thus a primary source for income, identity and mental health (Tsang and Chiu, 2000). However, work and mental health can impact each other in a negative way as well. Unfavourable working conditions can impair the mental health of employees by causing mental health complaints such as stress, mild depression, and anxiety disorders, often referred to as common mental disorders (CMDs) (Wieclaw et al., 2008). In addition, mental health problems caused by work or other conditions can negatively impact work CMDs can entail impaired work functioning when being at work, as much as absenteeism from work (Hilton et al., 2008, Lerner and Henke, 2008, Bonde, 2008). In the past, absenteeism, its causes and remedies have been studied extensively. More recently, occupational health professionals, work psychologists, and human resource professionals are paying greater attention to the work of employees who are not absent but do suffer from health problems (Aronsson and Gustafsson, 2005, Burton et al., 1999, Lerner et al., 2004). If concrete aspects of work functioning impairments due to CMDs are identified, early detection of employees with CMDs and work functioning problems would be possible, as well as early interventions. This literature review is intended to determine the range of relevant aspects of work functioning that may be impaired by CMDs.

To describe concrete aspects of impaired work functioning, we have chosen to focus on specific occupational groups in the healthcare sector. This review specifically studies nurses, as they are one of the largest occupational groups in this sector. Allied health professionals working in hospitals are also included in this review, as their tasks and work environment are similar to that of nurses in many aspects. By focussing on these occupations too, we hope to find more information on the effect of CMDs on medical actions performed by hospital personal other than doctors. In these occupational groups we can distinguish two risks: first, the increased risk of the onset of CMDs and second, the risk of serious consequences of impaired work functioning for others such as patients. Regarding the first risk, it is noticeable that in the healthcare sector, and in particular for nurses, the incidence of mental health problems is very high (Wieclaw et al., 2006). In a study by Wieclaw et al. (2006), the relative risk for depression in nurses was 3.5 (CI: 1.3–9.6) compared to workers outside the human service professions. The relative risk was highest for nurses compared to other human service workers and also compared to other healthcare workers. A possible explanation for this high prevalence may be high job demands, high emotional demands, a lack of autonomy and of social support that characterise the work of nurses (Gershon et al., 2007). These are known risk factors for developing mental health complaints (Stansfeld and Candy, 2006). The second risk, serious consequences of impaired work performance, is also known to be present in nursing (Suzuki et al., 2004). Impaired work functioning can directly affect the health of nurses and their patients. Examples of these effects are needle stick injuries and drug administration errors (Suzuki et al., 2004).

We decided to comprehensively analyse the effect of CMDs on work and chose not to focus solely on the performed actions, or ‘output’ of the work (e.g. has the nurse given the right pain killer to her patient, at the right time, and with the right dose). We also wanted to take into account all preceding components of this action, the process of work, as it is an essential component of work performance (Crombie and Davies, 1998, Sonnentag and Frese, 2002). The process of work can be defined as the behaviour exerted to reach work outcomes; thus, what a person is doing at work and how the person is doing it (Sonnentag and Frese, 2002). Regarding the process of pain medication administration, for instance, we may want to know whether the nurse checked the patient's file for necessary information, whether the nurse double checked the medication dose, but also whether the nurse put the patient at ease when administering the medication. By considering work functioning in its entirety, both process and output, a broader and more complete picture is attained of the behaviour of the worker. In the case of impaired functioning, this insight helps to signal the exact impairments and to intervene effectively. Apart from the distinction between work process and work output, we are interested in both the quality and quantity of work performance. In earlier studies, impaired work functioning is most often quantified and expressed in economic terms, such as cost to employers and lost productive time (Schultz and Edington, 2007, Stewart et al., 2003), or number of days attending work when unwell (Aronsson et al., 2000). The quality dimension of work has been addressed to a lesser extent, although there are a few examples in which studies focus on errors or accidents (Suzuki et al., 2004, Chambers et al., 1998, Haslam et al., 2005).

Our research question is: what is the effect of CMDs on work functioning of nurses and allied health professionals working in hospitals? To gain insight into the range of relevant aspects of work functioning that are impaired by CMDs, we review information on the output and process of work, as well as quality and quantity aspects.