AWARD. Monica Bertilsson, researcher at EPSO (Section for Epidemiology and Social Medicine) has received the Lennmalm Award from the Swedish Society of Medicine for her research on sickness insurance medicine. She has been awarded the prize for her thesis work, motivated by the fact that her research enables problems within sickness insurance medicine to be identified, named and consequently discussed in practice.
“As a young, new researcher it’s a type of testimonial that I’m doing interesting and good research that’s useful for society and the healthcare sector,” says Monica Bertilsson.
Her research deals with mental illness, work capacity and sick leave. In her thesis that she defended in 2013, she explored the return to work after a period of sick leave – i.e. persons’ experiences of being put back on sick leave regardless of the reason for this. The thesis showed that the risk of it taking a long time to return to work was twice as high amongst participants who stated they had mental health problems than with individuals who did not. Mental health problems were also shown to be linked to a higher risk of being on sick leave the following year.
“This shows that the healthcare sector – particularly primary healthcare – must be aware of mental health problems amongst all patients in the early stages of sick leave. This is to avoid long-lasting illness, not just amongst the patients who state themselves that they have mental health problems,” says Monica Bertilsson.
In two qualitative studies, she also researched the “work capacity” phenomenon in people with depression and anxiety. These were the first two studies of their kind.
In one of the studies, Monica Bertilsson carried out focus group discussions, that involved people with depression and anxiety arriving straight after work to each other about working while having mental health problems. The result showed that a feeling of alienation – no longer feeling at home in their own working life – set in
“They felt shut out, mechanical and that they couldn’t rely upon their own efforts – that things easily went wrong. They described how they managed to carry on working thanks to a “façade”. At the same time they felt vulnerable and insecure – they could be exposed at any moment and, behind this façade, was someone who could hardly cope with their job,” says Monica Bertilsson.
The most difficult work tasks were those that involved other people such as customers, pupils or colleagues.
“When you interact with others, you need to constantly adapt, interpret the small signals. This needs a mental ‘presence’ that participants believed they didn’t have. They also described how they traded their private life for their work – they stopped doing activities in their free time to be able to conserve energy to be able to do their jobs”.
In the second study, healthcare workers with experience of working with this type of patient were interviewed.
“They were shocked at how the patients they met were still at work, but couldn’t manage their day-to-day lives at home. This was something that relatives had to take charge of,” says Monica Bertilsson
One important finding was that work capacity is more than just being able to do your work tasks. For people with depression and anxiety, it may be incredibly difficult to contribute and participate in the social side of work, something which can take place during coffee breaks, after work drinks, team activities at the start of the (business) year or the traditional Christmas party.
“There’s a clear expectation to contribute socially, so those who don’t participate can become isolated. But the question is: how should society and social insurance handle a lack of participation in the social side of work life, or deal with that people with depression and anxiety appear to allocate their inability to the ‘wrong’ place – that’s to say outside of work. Is this part of work ability or not? Does this constitute the right to sick leave?” Monica Bertilsson asks herself, and declares these to be difficult questions,
“If we are to reduce the instances of illness due to mental health problems, maybe we need to think about the concept of ‘work ability’ and what it should include”.
Since finishing her PhD, Monica Bertilsson has divided her time between research and teaching within the Public Health Science program. She is participating in a new research program, “New Ways” at the Section for Epidemiology and Social Medicine.
“It’s about increasing knowledge about identifying, treating and supporting people who have depression and anxiety, so they can maintain their ability to work and reduce the need for sick leave”.
In January 2016, Monica Bertilsson plans to begin her post-doctoral studies. There she will investigate managers’ attitudes and knowledge of depression and anxiety, work ability and sick leave.
“The workplace and the role of the manager are essential when it comes to work ability and sick leave. But when it comes to mental health problems, there are currently very few research studies that discuss managers’ knowledge and competence. This is something I want to dive into and research”.
The award ceremony will take place at the Swedish Society of Medicine’s annual gala on Tuesday November 17, 2015.
