Sustainable return to work after depression – a comparative study among occupational physicians and affected employees Introduction: The number of sick days taken from work due to depression is steadily rising. A successful return to work (WE) is essential for sustainable reintegration. This study aims to identify factors to optimise WE and to investigate approaches for a sustainable WE after a depressive episode. Methods: Semi-structured expert interviews with senior occupational physicians (BÄ, n = 5) served to develop two surveys among BÄ (n = 180) and employees after a depressive episode (n = 192). Predictors of WE rating, workplace-based WE interventions and sustainable WE interventions were analysed using multiple hierarchical regression, chi-square difference and t-tests. Results: For BÄ, employee training on mental illness prevention was found to be the strongest predictor of overall WE rating, whereas understanding and appreciation in conversations and stigmatisation were the strongest predictors of overall WE rating by the employees. Compared to the employees, BÄ reported significantly more availability of workplace-based interventions. To prevent relapse, the employees prioritised sufficient time and financial security during the WE process more than BÄ. Conclusions: The study identified facilitating and hindering factors that can inform further research and practice to improve WE after depressive episodes. To redress the awareness gap about the availability of workplacebased interventions, regular contact between BÄ and employees is crucial. Several factors were considered to be of varying importance for relapse prevention by the two groups. Multiple perceptions and needs ought to be taken into account when planning the WE. Keywords: depression – return to work – sick leave – workplace – occupational medicine

IntroductionThe number of sick days taken from work due to depression is steadily rising. A successful return to work (RTW) is essential for sustainable reintegration. This study aims to identify factors to optimize RTW and to investigate approaches for sustainable RTW (sRTW) after depressive episodes.MethodsSemi-structured expert interviews with senior occupational physicians (OPs, N = 5) served to develop two surveys among OPs (N = 180) and employees after depressive episode (N = 192). Predictors of RTW rating, workplace-based RTW interventions and sRTW interventions were analyzed using multiple hierarchical regression, chi-square difference and t-tests.ResultsFor OPs, employee training on mental illness prevention was found to be the strongest predictor of overall RTW rating, whereas understanding and appreciation in conversations and stigmatization were strongest predictors of overall RTW rating by the employees. Compared to the employees, OPs reported significantly more availability of workplace-based interventions. To prevent relapse, the employees prioritized sufficient time and financial security during the RTW process more than OPs.ConclusionsThe study identified facilitating and hindering factors that can inform further research and practice to improve RTW after depressive episodes. To redress the awareness gap about the availability of workplace-based interventions, regular contact between OPs and employees is crucial. Several factors were considered to be of varying importance for relapse prevention by the two groups. Multiple perceptions and needs ought to be taken into account during RTW.