IGLOO: A Framework for Return to Work Among Workers with Mental Health Problems

  • Karina NielsenEmail author
  • Joanna Yarker
  • Fehmidah Munir
  • Ute Bültmann
Living reference work entry
Part of the Handbook Series in Occupational Health Sciences book series (HDBSOHS, volume 1)


It is important for society and for organizations to support workers returning to work following mental health-related absence. Recent evidence points to an increase in mental health problems among the general population, with approximately 38.2% of the EU population suffering from a mental disorder each year (European Commission 2008, 2016). Of those who take a period of sick leave, 55% of workers make unsuccessful attempts to return to work (RTW), and 68% of those who do return have less responsibility and are paid less than before (Matrix Insight 2013). A number of challenges have been reported by workers following a period of long-term sickness absence; however current research has been somewhat limited by a focus on the initial return and a siloed approach where work and non-work contexts are considered separately.

In this book chapter, we apply the IGLOO (individual, group, leader, organizational and overarching contextual factors that may support sustainable RTW) model (Nielsen et al. 2018). In doing so, we focus on the sickness absence before return to work and consider the factors that could support return to work following long-term sickness absence. We provide an overview of the resources that may facilitate return to work among workers who are on sick leave with mental health problems. Based on the IGLOO framework, we identify and discuss resources, i.e., factors that facilitate return to work at five levels: the individual (e.g., beliefs about being able to manage a successful return to work, health behaviors), the group (work groups, friends, and family), the leader (line managers and healthcare provides who take the lead in supporting workers return), the organizational (Human Resource policies and external organizations such a charities), and the overarching context (social security systems). We discuss these resources that pertain to the work context but also the non-work context and highlight the importance of understanding how resources apply at different levels. We argue that there is a need to understand how societal factors, such as legislation, culture, and national policies, impact return to work outcomes. We propose a holistic approach that focuses on integrating the resources in and outside work and is needed to facilitate successful and sustainable return to work for workers with mental health problems.


Return to work Multi-level interventions Sickness absenteeism Mental health 


  1. Aas RW, Ellingsen KL, Lindøe P, Möller A (2008) Leadership qualities in the return to work process: a content analysis. J Occup Rehabil 18(4):335–346PubMedCrossRefPubMedCentralGoogle Scholar
  2. Andersen MF, Nielsen K, Brinkmann S (2014) How do workers with common mental disorders experience a multidisciplinary return-to-work intervention? A qualitative study. J Occup Rehabil 24(4):709–724PubMedPubMedCentralCrossRefGoogle Scholar
  3. Appelbaum E, Bailey T, Berg P, Kalleberg AL (2001) Do high performance work systems pay off? In: Vallas SP (ed) The transformation of work. Emerald Group, Oxford, pp 85–107CrossRefGoogle Scholar
  4. Arnold KA (2017) Transformational leadership and employee psychological well-being: a review and directions for future research. J Occup Health Psychol 22(3):381–396PubMedCrossRefPubMedCentralGoogle Scholar
  5. Bandura A (1986) The explanatory and predictive scope of self-efficacy theory. J Social Clin Psychol 4:359–373CrossRefGoogle Scholar
  6. Collie A, Lane TJ, Hassani-Mahmooei B, Thompson J, McLeod C (2016) Does time off work after injury vary by jurisdiction? A comparative study of eight Australian workers’ compensation systems. BMJ Open 6(5):e010910. Scholar
  7. Corbière M, Samson E, Negrini A, St-Arnaud L, Durand MJ, Coutu MF, Lecomte T (2016) Factors perceived by employees regarding their sick leave due to depression. Disabil Rehabil 38(6):511–519PubMedCrossRefPubMedCentralGoogle Scholar
  8. Cowls J, Galloway E (2009) Understanding how traumatic re-enactment impacts the workplace: assisting clients’ successful return to work. Work 33(4):401–411PubMedCrossRefPubMedCentralGoogle Scholar
  9. Day A, Nielsen K (2017) What does our organization do to help our well-being? Creating healthy workplaces and workers. In: Chmiel N, Fraccaroli F, Sverke M (eds) An introduction of work and organizational psychology. Wiley Blackwell, Sussex: UK. pp 295–314CrossRefGoogle Scholar
  10. de Vries G, Hees H, Koeter MW, Lagerveld SE, Schene AH (2014) Perceived impeding factors for return-to-work after long-term sickness absence due to major depressive disorder: a concept mapping approach. PLoS One 9(1):e85038PubMedPubMedCentralCrossRefGoogle Scholar
  11. de Vries H, Fishta A, Weikert RSA, Wegewitz U (2018) Determinants of sickness absence and return to work among employees with common mental disorders: a scoping review. J Occup Rehabil 28(3):393–417CrossRefGoogle Scholar
  12. Dibben P, Wood G, O’Hara R (2018) Do return to work interventions for workers with disabilities and health conditions achieve employment outcomes and are they cost effective? A systematic narrative review. Empl Relat 40(6):999–1014CrossRefGoogle Scholar
  13. Dunstan DA, MacEachen E (2013) Bearing the brunt: Co-workers’ experiences of work reintegration processes. J Occup Rehabil 23:44–54CrossRefGoogle Scholar
  14. Ekberg K, Wåhlin C, Persson J, Bernfort L, Öberg B (2015) Early and late return to work after sick leave: predictors in a cohort of sick-listed individuals with common mental disorders. J Occup Rehabil 25(3):627–637PubMedCrossRefPubMedCentralGoogle Scholar
  15. Ekbladh E, Sandqvist J (2015) Psychosocial factors’ influence on work ability of people experiencing sick leave resulting from common mental disorders. Occup Ther Ment Health 31(3):283–297CrossRefGoogle Scholar
  16. Ervasti J, Joensuu M, Pentti J, Oksanen T, Ahola K, Vahtera J, Kivimäki M, Virtanen M (2017) Prognostic factors for return to work after depression-related work disability: A systematic review and meta-analysis. J Psychiatr Res 95:28–36CrossRefGoogle Scholar
  17. EU-OSHA (2014) Psychosocial risks in Europe: prevalence and strategies for prevention. Publications Office of the European Union, LuxembourgGoogle Scholar
  18. European Commission (2008) EU high-level conference “Together for mental health and well-being” – European pact for mental health and well-being. Retrieved from:
  19. European Commission (2010) Why socio-economic inequalities increase? Facts and policy responses in Europe. Directorate-general for research socio-economic sciences and humanities. Retrieved from:
  20. European Commission (2016) European framework for action on mental health and wellbeing. Retrieved from:
  21. Halbesleben JRB, Neveu JP, Paustian-Underdahl SC, Westman M (2014) Getting to the “COR”: understanding the role of resources in conservation of resources theory. J Manag 40(5):1334–1364Google Scholar
  22. Harms PD, Credé M, Tynan M, Leon M, Jeung W (2017) Leadership and stress: a meta-analytic review. Leadersh Q 28(1):178–194CrossRefGoogle Scholar
  23. Harnois G, Gabriel P, World Health Organization (2000) Mental health and work: impact, issues and good practices. WHO, GenevaGoogle Scholar
  24. Hees HL, Nieuwenhuijsen K, Koeter MW, Bültmann U, Schene AH, Botbol M (2012) Towards a new definition of return-to-work outcomes in common mental disorders from a multi-stakeholder perspective. PLoS One, 7:e39947PubMedPubMedCentralCrossRefGoogle Scholar
  25. Hobfoll SE (1989) Conservation of resources: a new attempt at conceptualizing stress. Am Psychol 44(3):513–524PubMedCrossRefPubMedCentralGoogle Scholar
  26. Holmgren K, Ivanoff SD (2004) Women on sickness absence—views of possibilities and obstacles for returning to work. A focus group study. Disabil Rehabil 26(4):213–222PubMedCrossRefPubMedCentralGoogle Scholar
  27. Huijs JJ, Koppes LL, Taris TW, Blonk RW (2012) Differences in predictors of return to work among long-term sick-listed employees with different selfreported reasons for sick leave. J of Occup Rehabil 22:301–311PubMedCrossRefPubMedCentralGoogle Scholar
  28. Inceoglu I, Thomas G, Chu C, Plans D, Gerbasi A (2018) Leadership behavior and employee well-being: an integrated review and a future research agenda. Leadersh Q 29(1):179–202CrossRefGoogle Scholar
  29. Jansson I, Perseius K, Gunnarsson AB, Bjorklund A (2014) Work and everyday activities: experiences from two interventions addressing people with common mental disorders. Scand J Occup Ther 21(4):295–304PubMedCrossRefPubMedCentralGoogle Scholar
  30. Lagerveld SE, Bultmann U, Franche RL, van Dijk FJ, Vlasveld MC, van der Feltz-Cornelis CM, Nieuwenhuijsen K (2010) Factors associated with work participation and work functioning in depressed workers: a systematic review. J Occup Rehabil 20(3):275–292PubMedPubMedCentralCrossRefGoogle Scholar
  31. Leventhal H, Benyamini Y, Brownlee S, Diefenbach M, Leventhal EA, Patrick-Miller L, Robitaille C (1997) Illness representations: theoretical foundations. In: Petrie KJ, Weinman JA (eds) Perceptions of health and illness: current research and applications. Harwood Academic Publishers, Amsterdam, pp 19–45Google Scholar
  32. Loisel P, Buchbinder R, Hazard R, Keller R, Scheel I, Tulder MV et al (2005) Prevention of work disability due to musculoskeletal disorders: the challenge of implementing evidence. J Occup Rehabil 15(4):507–524PubMedCrossRefPubMedCentralGoogle Scholar
  33. Løvvik C, Øverland S, Hysing M, Broadbent E, Reme SE (2014a) Association between illness perceptions and return-to-work expectations in workers with common mental health symptoms. J Occup Rehabil 24(1):160–170PubMedCrossRefPubMedCentralGoogle Scholar
  34. Løvvik C, Shaw W, Øverland S, Reme SE (2014b) Expectations and illness perceptions as predictors of benefit recipiency among workers with common mental disorders: secondary analysis from a randomised controlled trial. BMJ Open 4(3):e004321PubMedPubMedCentralCrossRefGoogle Scholar
  35. MacEachen E, Varatharajan S, Du B, Bartel E, Ekberg K (2018) The uneven foci of work disability research across cause-based and comprehensive social security systems. Int J Health Serv 20731418809857. Scholar
  36. Macpherson RA, Lane TJ, Collie A, McLeod CB (2018) Age, sex, and the changing disability burden of compensated work-related musculoskeletal disorders in Canada and Australia. BMC Public Health 18(1):758. Scholar
  37. Madsen IE, Nyberg ST, Hanson LM, Ferrie JE, Ahola K, Alfredsson L, ... Chastang JF (2017) Job strain as a risk factor for clinical depression: systematic review and meta-analysis with additional individual participant data. Psychol Med 47(8):1342–1356PubMedPubMedCentralCrossRefGoogle Scholar
  38. Matrix Insight (2013) Economic analysis of workplace mental health promotion and mental disorder prevention programmes and of their potential contribution to EU health, social and economic policy objectives, Matrix Insight, Research commissioned by the European Agency for Health and ConsumersGoogle Scholar
  39. Melkevik O, Clausen T, Pedersen J, Garde AH, Holtermann A, Rugulies R (2018) Comorbid symptoms of depression and musculoskeletal pain and risk of long term sickness absence. BMC Public Health 18(1):981PubMedPubMedCentralCrossRefGoogle Scholar
  40. Montano D, Reeske A, Franke F, Hüffmeier J (2017) Leadership, followers’ mental health and job performance in organizations: a comprehensive meta-analysis from an occupational health perspective. J Organ Behav 38(3):327–350CrossRefGoogle Scholar
  41. Munir F, Yarker J, Hicks B, Donaldson-Feilder E (2012) Returning employees back to work: developing a measure for supervisors to support return to work (SSRW). J Occup Rehabil 22(2):196–208PubMedCrossRefPubMedCentralGoogle Scholar
  42. Negrini A, Corbière M, Lecomte T, Coutu MF, Nieuwenhuijsen K, St-Arnaud L, ... Berbiche D (2018) How can supervisors contribute to the return to work of employees who have experienced depression? J Occup Rehabil 28(2):279–288CrossRefGoogle Scholar
  43. Netterstrøm B, Friebel L, Ladegaard Y (2013) Effects of a multidisciplinary stress treatment programme on patient return to work rate and symptom reduction: results from a randomised, wait-list controlled trial. Psychother Psychosom 82(3):177–186PubMedCrossRefPubMedCentralGoogle Scholar
  44. Nielsen MBD, Rugulies R, Hjortkjaer C, Bültmann U, Christensen U (2013) Healing a vulnerable self: exploring return to work for women with mental health problems. Qual Health Res 23(3):302–312PubMedCrossRefPubMedCentralGoogle Scholar
  45. Nielsen K, Nielsen MB, Ogbonnaya C, Känsälä M, Saari E, Isaksson K (2017) Workplace resources to improve both employee well-being and performance: a systematic review and meta-analysis. Work Stress 31(2):101–120CrossRefGoogle Scholar
  46. Nielsen K, Yarker J, Munir F, Bültmann U (2018) IGLOO: an integrated framework for sustainable return to work in workers with common mental disorders. Work Stress 32(4):1–18CrossRefGoogle Scholar
  47. Nieuwenhuijsen K, Verbeek JHAM, De Boer AGEM, Blonk RWB, Van Dijk FJH (2004) Supervisory behaviour as a predictor of return to work in employees absent from work due to mental health problems. Occup Environ Med 61(10):817–823PubMedPubMedCentralCrossRefGoogle Scholar
  48. Nigatu YT, Liu Y, Uppal M, Mckinney S, Rao S, Gillis K, Wang J (2016) Interventions for enhancing return to work in individuals with a common mental illness: systematic review and meta-analysis of randomized controlled trials. Psychol Med 46(16):3263–3274PubMedCrossRefPubMedCentralGoogle Scholar
  49. Nigatu YT, Liu Y, Uppal M, McKinney S, Gillis K, Rao S, Wang JL (2017) Prognostic factors for return to work of employees with common mental disorders: a meta-analysis of cohort studies. Soc Psychiatry Psychiatr Epidemiol 52(10):1205–1215PubMedCrossRefPubMedCentralGoogle Scholar
  50. Noordik E, Nieuwenhuijsen K, Varekamp I, van der Klink JJ, van Dijk F (2011) Exploring the return-to-work process for workers partially returned to work and partially on long-term sick leave due to common mental disorders: a qualitative study. Disabil Rehabil 33(17–18):1625–1635PubMedCrossRefPubMedCentralGoogle Scholar
  51. Norder G, Bültmann U, Hoedeman R, Bruin JD, van der Klink JJ, Roelen CA (2015) Recovery and recurrence of mental sickness absence among production and office workers in the industrial sector. Europ J Public Health 25:419–423PubMedCrossRefPubMedCentralGoogle Scholar
  52. Norrmen G, Svardsudd K, Andersson DK (2010) The association of patient’s family, leisure time, and work situation with sickness certification in primary care in Sweden. Scand J Prim Health Care 28(2):76–81PubMedPubMedCentralCrossRefGoogle Scholar
  53. OECD (2014) Making mental health count: the social and economic costs of neglecting mental health care. OECD health policy studies. OECD Publishing, ParisGoogle Scholar
  54. Olsen IB, Øverland S, Reme SE, Løvvik C (2015) Exploring work-related causal attributions of common mental disorders. J Occup Rehabil 25(3):493–505PubMedCrossRefPubMedCentralGoogle Scholar
  55. Paul KI, Moser K (2009) Unemployment impairs mental health: meta-analyses. J Vocat Behav 74(3):264–282CrossRefGoogle Scholar
  56. Prang K, Bohensky M, Smith P, Collie A (2016) Return to work outcomes for workers with mental health conditions: a retrospective cohort study. Injury 47(1):257–265PubMedCrossRefPubMedCentralGoogle Scholar
  57. Reavley NJ, Ross A, Killackey EJ, Jorm AF (2012) Development of guidelines to assist organisations to support employees returning to work after an episode of anxiety, depression or a related disorder: a Delphi consensus study with Australian professionals and consumers. BMC Psychiatry 12(1):135PubMedPubMedCentralCrossRefGoogle Scholar
  58. Saint-Arnaud L, Saint-Jean M, Demasse J (2006) Towards an enhanced understanding of factors involved in the return- to-work process of employees absent due to mental health problems. Can J Commun Ment Health 25(2):303–315CrossRefGoogle Scholar
  59. Salkever DS, Shinogle JA, Goldman H (2003) Return to work and claim duration for workers with long-term mental disabilities: impacts of mental health coverage, fringe benefits, and disability management. Ment Health Serv Res 5(3):173–186PubMedCrossRefPubMedCentralGoogle Scholar
  60. Schuch FB, Vancampfort D, Richards J, Rosenbaum S, Ward PB, Stubbs B (2016) Exercise as a treatment for depression: a meta-analysis adjusting for publication bias. J Psychiatr Res 77:42–51PubMedCrossRefPubMedCentralGoogle Scholar
  61. Skakon J, Nielsen K, Borg V, Guzman J (2010) Are leaders’ well-being, behaviours and style associated with the affective well-being of their employees? A systematic review of three decades of research. Work Stress 24(2):107–139CrossRefGoogle Scholar
  62. Stansfeld S, Candy B (2006) Psychosocial work environment and mental health—a meta-analytic review. Scand J Work Environ Health 32:443–462PubMedCrossRefPubMedCentralGoogle Scholar
  63. Sturesson M, Edlund C, Falkdal AH, Bernspång B (2014) Healthcare encounters and return to work: a qualitative study on sick-listed patients’ experiences. Prim Health Care Res Dev 15(4):464–475PubMedCrossRefPubMedCentralGoogle Scholar
  64. Tajfel H (ed) (2010) Social identity and intergroup relations. Cambridge University Press, CambridgeGoogle Scholar
  65. Tajfel H, Turner JC (1979) An integrative theory of intergroup conflict. In: Austin WG, Worchel S (eds) The social psychology of intergroup relations. Brooks/Cole, Monterey, pp 7–24Google Scholar
  66. van Rhenen W, Schaufeli WB, van Dijk FJH, Blonk RWB (2008) Coping and sickness absence. Int Arch Occup Environ Health 81(4):461–472PubMedCrossRefPubMedCentralGoogle Scholar
  67. Whiteford HA, Ferrari AJ, Degenhardt L et al (2015) The global burden of mental, neurological and substance use disorders: an analysis from the global burden of disease study 2010. PLoS One 10:e0116820PubMedPubMedCentralCrossRefGoogle Scholar
  68. Wittchen HU, Jacobi F, Rehm J, Gustavsson A, Svensson M, Jönsson B, … & Fratiglioni L (2011) The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 21(9):655–679Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Karina Nielsen
    • 1
    Email author
  • Joanna Yarker
    • 2
  • Fehmidah Munir
    • 3
  • Ute Bültmann
    • 4
  1. 1.Institute for Work PsychologyUniversity of SheffieldSheffieldUK
  2. 2.BirkbeckUniversity of LondonLondonUK
  3. 3.Loughborough UniversityLoughboroughUK
  4. 4.University of GroningenGroningenUSA

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