Publications of 2025
Impact of eating disorders on paid or unpaid work participation and performance: a systematic review
Eating disorders (EDs), including binge eating disorders (BEDs), bulimia nervosa (BN) and anorexia nervosa (AN), can inflict adverse effects on well-being, daily functioning, and workplace performance, presenting significant occupational, social, and economic challenges. This systematic review seeks to explore the relationship between ED symptomatologies and their impacts on work performance. This systematic review adhered to The Preferred Reporting Items for Systematic Reviews and Meta-analyses. Formal methods of critical appraisal for both qualitative and quantitative studies were utilized. Six studies were included.
Participants across all studies (n = 20,367) exhibited heightened levels of presenteeism, absenteeism, work productivity impairment, and higher annual burden costs compared to their non-ED counterparts. Impaired decision-making, cognitive inflexibility, and poor executive functioning significantly impact work participation and performance, underscoring the need for workplace policies that reduce stigma and stress, and calls for further research into how environmental factors and interventions affect ED recovery.
Work is a source of income, a critical determinant of physical and mental well-being, and a social determinant of health, influencing various health outcomes through multiple pathways. Fitness for work is a critical consideration and involves determining whether a worker is fit to perform their job duties without posing a risk to themselves or others. As part of fitness for work evaluations, an individual’s work ability should be considered as encompassing their capacity to perform occupational tasks and considering the worker’s health status, functional status, skills, and work environment. Using a holistic and biopsychosocial approach ensures that the worker’s abilities, environment, and occupation are considered part of the fitness for work evaluation. Other considerations include the evaluation of risks and work accommodations.
Zhiyang Shi, Aaron Howe, Maryam Shahzad, Ali Bani-Fatemi, Beatrice Sharkey, Behdin Nowrouzi-Kia
This study explored Ontario construction skilled trades employer and worker perspectives on workplace diversity, equity, and inclusion (DEI) and the promotion of worker mental health and wellbeing through building DEI organizational culture. A phenomenological qualitative study was conducted. Fifty-two (N = 52) participants were recruited and interviewed. Interview data were analyzed using a six-step thematic approach. Three themes were developed: 1) Challenges in organizational culture: participants reported that sexism and biased beliefs on the professional competency of workers from under-represented groups were prevalent within their organizations. Participants highlighted business leadership’s role in building DEI organizational culture and addressing issues that have affected their organizational reputations and worker retention. 2) Barriers to promoting DEI: a meritocratic hiring approach was identified and restricted the opportunities for under-represented groups. Participants identified a lack of accommodations available in their workplace environment, and some reported lacking awareness of DEI-related issues. 3) Strategies to promote DEI: participants suggested that increasing early career opportunities could help apprentices from under-represented groups build experience and make informed career decisions. These opportunities may also help employers understand an apprentice’s qualifications. Establishing various resources and peer support systems to support the mental health and wellbeing of under-represented workers was also suggested. Multiple challenges existed within the current skilled trades organizational culture, including sexism, biases, hiring barriers, and insufficient accommodations and awareness. Creating career opportunities and social support systems is needed to address these challenges and support worker mental health and wellbeing.
Bao-Zhu Stephanie Long, Kishana Balakrishnar, Luke A. Fiorini, Aaron Howe, Ali Bani-Fatemi, Basem Gohar, Behdin Nowrouzi-Kia
Telework, also referred to as telecommuting, remote work, flexible work, and virtual work, involves working from a location different from the traditional office and often uses online communication technologies. Despite the numerous advantages associated with teleworking, it also raises concerns about work-life balance and health implications due to working after hours (WAH). This proposed study aims to understand the health consequences of teleworkers working beyond their scheduled hours. This review will search seven online databases (APA PsycINFO, Medline, Embase, Scopus, Business Source Premier, CINAHL, and Sociological Abstracts) to gather relevant articles. The inclusion criteria will encompass peer-reviewed studies published from 2010 onwards, focusing on WAH among teleworkers and reporting mental and physical health consequences. The exclusion criteria will include non-peer-reviewed articles, grey literature, and studies involving patients with pre-existing conditions. This review will provide valuable insights into the mental and physical health consequences of WAH among teleworkers, underscoring the urgent need for strategies to mitigate these risks and promote overall well-being. Future efforts, including collaborations between researchers, industry leaders, and policymakers, can guide the development of targeted interventions and evidence-based policies that improve telework environments and support long-term worker health and productivity.
Alexia M Haritos, Bao-Zhu Stephanie Long, Ali Bani-Fatemi, Aaron Howe, Yiyan Li, Behdin Nowrouzi-Kia
Individuals who work in the nursing sector play a crucial role in the healthcare system, yet those working in long-term care (LTC) facilities often face challenges and are at risk of burnout due to occupational factors such as workload. This burnout can affect their ability to provide optimal care to their residents. This scoping review protocol aims to understand the impact of burnout on the capacity to deliver high-quality care among nursing-related occupations in LTC settings. A search will be conducted across Embase, CINAHL, Medline and APA PsycINFO. Studies will be included if they examine nursing professionals employed in the LTC sector, assess their experiences of burnout and explore how this burnout affects the quality of care they provide. No restrictions on publication year will be applied, and all study designs except knowledge syntheses will be considered. Eligible studies will be published in English or available in English translation. The study screening and data extraction will be completed by two independent reviewers. The included studies will undergo quality assessment using the Agency for Healthcare Research and Quality tool and the Newcastle-Ottawa Scale and the Critical Appraisal Skills Programme. A narrative synthesis approach will be used to report the findings. Ethics approval and consent to participate are not applicable. A scoping review will be prepared by a research team at the University of Toronto following the protocol procedure. Subsequently, this manuscript will be prepared and submitted to a peer-reviewed journal to disseminate study findings to the research community and contribute to the growing field of nursing well-being research.
Kishana Balakrishnar, Bao-Zhu Stephanie Long, Luke A. Fiorini, Aaron Howe, Ali Bani-Fatemi, Basem Gohar, Behdin Nowrouzi-Kia
There has been a significant rise in telework since the onset of the COVID-19 pandemic. Telework offers several benefits, such as greater flexibility and increased productivity. It also presents challenges such as increased after-hours work, which can negatively impact workers' physical and mental wellbeing. This scoping review aims to identify the antecedents of after-hours work among teleworkers. Online databases, including Medline via OVID, Embase via OVID, APA PsycINFO via OVID, International Bibliography of Social Sciences (IBSS) via ProQuest, Sociological Abstracts via ProQuest, Business Source Premier via EBSCOhost, and CINAHL via EBSCOhost will be searched to gather literature on factors affecting after-hours work among teleworkers. The inclusion criteria include study participants aged 18 or older, part of the working population, and individuals teleworking for at least six months. Additionally, the studies must be empirical, peer-reviewed, discuss the antecedents of after-hours work, and be published from 2010 to 2024. The findings from this study will guide organisations and healthcare professionals in developing strategies to reduce after-hours work among individuals who telework, thereby improving their overall health and wellbeing. The registration number for this scoping review on Open Science is (DOI 10.17605/OSF.IO/6A7M9).
Behdin Nowrouzi-Kia, Zahi Touma, Antonio Avina-Zubieta, Mary Fox, William Shaw, Maggie Ho, Qixuan Li, Catherine Ivory, Paul Fortin, Stephanie Keeling, Jennifer Reynolds, Derek Haaland, Janet Pope, Lily Lim, Murray Urowitz, Laura Whittall Garcia and Dafna Gladman
Research studies from different countries have shown that variations in the relationship between some occupational factors and mental health and stress exist. Studies that have investigated this relationship within the Canadian population are limited. The objective of this study was to explore the relationships between the number of working hours, occupation, employment type, sex, and age on mental health and stress. Multivariable and univariate ordinal logistics regression models were applied to the 2017–2018 Canadian Community Health Survey (CCHS) dataset to investigate the associations that may exist between perceived mental health and stress, self-rated variables on a Likert scale, and various occupational factors. When compared to respondents who worked 31–40 h per week, those working 1–10 (OR = 1.20, p < 0.001) and 11–20 (OR = 1.19, p < 0.001) hours per week were more likely to have worse mental health. However, the 1–10 and 11–20 h worked per week groups were 26% and 17%, respectively, less likely to have higher stress compared to the group working 31–40 h per week. Mental health and stress were found to be associated with occupation group, employment type, age, and sex. This study provides evidence on how occupational factors impact mental health and stress within the Canadian population, for which there is a dearth of research on.
​Caroline Dignard, Michel Larivière, Behdin Nowrouzi-Kia, Nancy Lightfoot, Zsuzsanna Kerekes & Line Tremblay
Consequences of poor mental health in the workplace are well documented, but mental health research specific to the mining industry remains scarce, especially in Canada. Findings are nonetheless compelling, as they seem to reflect higher rates of mental health-related symptoms among mining workers. The objective of this paper is to determine the symptom prevalence of stress, anxiety, and depression among a sample of Canadian mining workers and to identify demographic, psychosocial, and health-related, and work-related factors associated with stress, anxiety, and depression for these workers. 2224 mining workers across 25 worksites at one company in Ontario, Canada completed a self-reported questionnaire. The prevalence of depression symptoms (12.5%) and anxiety (5.9%) in this sample was found to be higher than in the working-age Canadian population, and multiple regression analyses revealed many shared predictors for stress, anxiety, and depression symptoms. The demographic, psychosocial and health-related predictors can be classified into four main categories: (1) individual characteristics, (2) interpersonal relationships, (3) lifestyle, and (4) the overlap between physical and mental health. Work-related predictors were also grouped into four categories: (1) work schedule and demands, (2) effort-reward imbalance and recognition and reward, (3) job insecurity and job satisfaction, and (4) the physical and psychological work environment. The findings illustrate the importance of recognizing the multidimensionality of health: mental health problems are undoubtedly the result of a number of interrelated factors, which include mental, physical, and social components, in addition to demographic and workplace-specific factors.
​Anson Kwok Choi Li, Jennifer Casole & Behdin Nowrouzi-Kia
Research studies from different countries have shown that variations in the relationship between some occupational factors and mental health and stress exist. Studies that have investigated this relationship within the Canadian population are limited. The objective of this study was to explore the relationships between the number of working hours, occupation, employment type, sex, and age on mental health and stress. Multivariable and univariate ordinal logistics regression models were applied to the 2017–2018 Canadian Community Health Survey (CCHS) dataset to investigate the associations that may exist between perceived mental health and stress, self-rated variables on a Likert scale, and various occupational factors. When compared to respondents who worked 31–40 h per week, those working 1–10 (OR = 1.20, p < 0.001) and 11–20 (OR = 1.19, p < 0.001) hours per week were more likely to have worse mental health. However, the 1–10 and 11–20 h worked per week groups were 26% and 17%, respectively, less likely to have higher stress compared to the group working 31–40 h per week. Mental health and stress were found to be associated with occupation group, employment type, age, and sex. This study provides evidence on how occupational factors impact mental health and stress within the Canadian population, for which there is a dearth of research on.
Background: Systemic lupus erythematosus (SLE) disease symptoms that can significantly restrict work ability and work participation resulting in reduced mental well-being. This study investigates the significant impact of work participation and disability on the mental wellbeing, health-related quality of life, and disease-related outcomes in individuals with SLE.
Methods: With the objective of creating an SLE-related functional profile rooted in work disability (WD) prevention, 46 SLE patients were purposively recruited from Canadian medical centres. Through semi-structured interviews guided by a WD prevention framework, factors associated with WD and lived experiences of SLE-related WD were qualitatively explored. Braun and Clarke’s six-stage inductive thematic analysis was used to organize the data.
Results: Most participants experienced some form of work disability across their employment history related to their clinical manifestations of SLE, including hospitalizations, physical limitations, fatigue, and neurocognitive symptoms (e.g. brain fog). Thematic analysis revealed three key themes: (a) the influence of illness experience on work, (b) the stigmatization of illness disclosure, and (c) the availability of workplace resources/accommodations. Participants emphasized the desirability of work with reduced physical and mental demands, increased personal control, and workplace flexibility to prevent WD.
Conclusion: The study underscores the need for a collaborative, multi-component, and multidisciplinary intervention targeting psychosocial and workplace factors to establish a goal-oriented preventative framework, potentially improving WD outcomes in SLE individuals.
Kishana Balakrishnar, Bao-Zhu Stephanie Long, Alexia M. Haritos, Edris Formuli, Behdin Nowrouzi-Kia
Background: The increased demands and stressors from the COVID-19 pandemic led to widespread burnout and job stress, prompting concerns about retention rates. This study identifies demographic and occupational predictors of Canadian nurses’ intent to leave their jobs due to burnout and job stress during the COVID-19 pandemic.
Methods: Data was utilized from the Survey on Health Care Workers’ Experiences During the Pandemic conducted by Statistics Canada. Multivariate logistic regression models were generated to analyze the associations between demographic and occupational factors and nurses’ intent to leave.
Results: A total of 12,246 eligible participants responded to the survey (54.9% response); however, the analysis was restricted to 1138 nurses after excluding participants of other healthcare occupations. Younger nurses were significantly more likely to consider leaving their jobs [OR = 9.95, 95% CI: (5.92–16.73)], as well as nurses living in Alberta [OR = 3.16, 95% CI: (1.58–6.32)] and British Columbia [OR = 3.16, 95% CI: (1.66–6.03)]. Moreover, nurses with less work experience [OR = 3.91, 95 CI = (2.53–6.05)], work in acute care [(OR = 3.31, 95 CI = (1.69–6.51)], experienced changes in workload [OR = 2.69, 95% CI: (1.58–4.57)], had increased work hours [OR = 1.92, 95% CI: (1.27–2.92)], and lacked emotional support [OR = 3.43, 95 CI = (2.31–5.09)] had greater odds of intending to leave.
Conclusion: The findings underscore the need for strategies to mitigate stress and burnout among nurses, particularly during public health crises. Implementing measures to address these factors could help improve retention rates and ensure a stable nursing workforce during future pandemics.
Many organizations have shifted to hybrid or remote work arrangements in response to the COVID-19 pandemic. Illness, whether physical or psychological, can manifest during telework (remote or home-based work), leading to presenteeism and absenteeism behaviour. However, varying definitions of presenteeism and absenteeism have made measuring presenteeism, absenteeism, and their antecedents increasingly challenging. This scoping study seeks to define presenteeism and absenteeism in the (tele)workplace and systematically identify the factors contributing to their occurrence. A systematic literature search was performed on seven online databases: MEDLINE, CINAHL, PsycINFO, ABI Inform Global, SCOPUS, Web of Science and Business Source Premier. We applied the PRISMA-ScR guidelines and Joanna Briggs Institute framework to systematically collect, identify, and report studies. The inclusion criteria encompassed studies with participants aged 18 to 65 years old who currently work in a telework environment for at least 50% of their work hours. Of 826 initially identified studies, 18 studies were included after screening (11 quantitative, three qualitative and two mixed-methods studies). A total of 26,805 workers were included in this review across 16 empirical studies. Overall, presenteeism is defined as working while ill, and absenteeism is known as being absent from work or taking sick leave. We identified three major categories for the antecedents of presenteeism and absenteeism behaviour: organizational (i.e., job demand and telework), environmental (i.e., work and home environment), and individual (i.e., poor mental health and job perception). Presenteeism and absenteeism among teleworkers manifest from organizational, environmental, and individual forces that lead to working while sick, or being absent from work, respectively. We found that each of these antecedents relates to one another through the social determinants of health framework. Our conceptual findings guide developing top-down organizational policies and strategies that address presenteeism and absenteeism behaviour, particularly in telework settings.
Objective: To identify candidate Systemic Lupus Erythematosus (SLE) domains from the literature for consideration towards the development of the SLE Core Outcome Set.
Methods: This was a comprehensive scoping literature review of SLE clinical trials and systematic reviews published since 2010. Studies were identified from 5 databases and were screened for eligibility. Candidate domains were extracted from the included studies. Candidate domains were winnowed and binned by the Outcome Measures in Rheumatology (OMERACT) SLE Advisory Group.
Results: Of the 4063 studies identified, 507 met inclusion criteria and proceeded to data extraction. Multiple domains and items were extracted, which winnowing and binning reduced to 25 candidate domains.
Conclusion: The 25 candidate domains cover the important aspects of SLE and the 4 core areas of disease impact according to OMERACT framework. The 25 candidate domains constitute a feasible and manageable number of domains to proceed with to the core domain consensus stage that covers the wide range of impact of SLE. The candidate domains will be supplemented by ongoing qualitative research with patients living with SLE to identify additional domains before proceeding to the consensus stage.
Objective: This study aims to explore how occupational therapists working in private practices in Canada use clinical indicators and tools to determine if clients require 24-hour attendant care.
Design: A qualitative research study.
Setting: The setting involved semi-structured, one-on-one interviews with occupational therapists in Canada.
Participants: Occupational therapists were selected through purposive sampling: (1) registered Canadian occupational therapists, (2) with over 10 years of private practice experience, and (3) who have assessed the need for 24-hour attendant care at least once before the study.
Main measures: The interviews were conducted, transcribed, coded, and thematically analyzed by two researchers using Braun and Clarke's protocol. The paper is also reported based on the consolidated criteria for reporting qualitative research guidance.
Results: The study involved nine occupational therapists (eight women and one man), with 14 to 24 years of private practice experience in Ontario. Three main themes in the decision-making process for 24-hour attendant care were identified: (1) Individualized and Holistic Assessments; (2) Clinical Expertise-Based Decision-making; and (3) Risk Assessment in Decision-Making.ConclusionsThis study provides a greater understanding of the decision-making process of occupational therapists working in Canada when recommending 24-hour attendant care. However, further research and development of guidelines are needed to support occupational therapists in this area.
Objective: This scoping review aims to comprehensively explore the facilitators and barriers influencing the return to work (RTW) process following a concussion, with a focus on the person impacted by concussion, medical system, funder, and workplace domains.
Design: A scoping review of electronic databases, including CINAHL, Embase, MEDLINE, PsycINFO and Web of Science, was conducted to identify relevant studies published up to April 6, 2024. Studies were included if they examined factors influencing RTW following a concussion and were available in English. Data extraction, numerical analysis and deductive content analysis were performed to determine key themes from the data. Reporting guidelines provided by the PRISMA-ScR were adhered to, and the protocol has been registered and can be accessed at the Open Science Framework.
Results: Twenty studies met the inclusion criteria and were included in the review. Findings were organized into 4 main themes influencing the RTW process: the person impacted by concussion, medical system, funder, and workplace. These were further categorized into 2 subthemes: supportive elements and challenges. Various supportive elements within each theme were identified, such as individualized rehabilitation services, graduated return to work, and developing personal agency in the individual impacted by concussion. Challenges such as lack of patient education, delayed access to services, and isolating workplace accommodations were highlighted. These findings underscore the complex interplay of factors shaping the RTW trajectory post-concussion.
Conclusion: This scoping review provides a detailed examination of supportive elements and challenges in the RTW process following a concussion. The identified themes offer valuable insights for clinicians and researchers seeking to optimize RTW outcomes and support individuals re-entering the workforce after a concussion. Future research should prioritize an examination of relevant policies and practices, assessing long-term outcomes, and explore strategies to integrate support systems to enhance the RTW experience.
Introduction: Prior research has identified that older rural patients and their families view preparation for detecting and responding to worsening health after a hospital stay as their most pressing unmet need, and perceive an evidence-based warning signs intervention that prepares them to do so as highly likely to meet this need. Yet, little is known about healthcare professionals' perspectives about potential barriers and facilitators to implementing warning signs interventions, especially in rural communities.
Aim: This study aimed to identify potential barriers and facilitators to healthcare professionals' provision of a warning signs intervention in rural communities.
Materials and methods: In this qualitative descriptive study, we examined healthcare professionals' perspectives on potential barriers and facilitators to providing a warning signs intervention. A purposive, criterion-based sample of healthcare professionals, stratified by professional designation (three strata - nurses, physicians, and allied healthcare professionals) who provide health care to rural dwellers in Ontario, Canada participated in semi-structured telephone focus-group discussions or 1:1 interviews on barriers and facilitators to delivering the intervention. Data were analyzed using conventional qualitative content analysis.
Results: Twenty-seven healthcare professionals participated in focus groups and 15 in 1:1 interviews for a total of 42 healthcare professionals. Analysis by healthcare professional stratum revealed nine categories of barriers and facilitators: material resources; human resources; healthcare professional communication; healthcare professional knowledge and skill; healthcare professional buy-in; context of rural practice; patient- and family-specific characteristics; risks and liabilities; and timing of intervention delivery. Seven of these categories converged across healthcare professional strata. However, the reasons why different healthcare professional strata perceived the categories as important, and the ways in which they saw them functioning as barriers and facilitators, varied. Our findings shed light on barriers and facilitators that should be considered to ensure successful implementation of the intervention in rural communities.
Discussion: This study adds to the limited research on rural healthcare professionals' perspectives on barriers and facilitators to delivering a warning signs intervention.
Objective: This study aims to explore how occupational therapists working in private practices in Canada use clinical indicators and tools to determine if clients require 24-hour attendant care.
Design: A qualitative research study.
Setting: The setting involved semi-structured, one-on-one interviews with occupational therapists in Canada.
Participants: Occupational therapists were selected through purposive sampling: (1) registered Canadian occupational therapists, (2) with over 10 years of private practice experience, and (3) who have assessed the need for 24-hour attendant care at least once before the study.
Main measures: The interviews were conducted, transcribed, coded, and thematically analyzed by two researchers using Braun and Clarke's protocol. The paper is also reported based on the consolidated criteria for reporting qualitative research guidance.
Results: The study involved nine occupational therapists (eight women and one man), with 14 to 24 years of private practice experience in Ontario. Three main themes in the decision-making process for 24-hour attendant care were identified: (1) Individualized and Holistic Assessments; (2) Clinical Expertise-Based Decision-making; and (3) Risk Assessment in Decision-Making.ConclusionsThis study provides a greater understanding of the decision-making process of occupational therapists working in Canada when recommending 24-hour attendant care. However, further research and development of guidelines are needed to support occupational therapists in this area.
Jessica DeMars, Quentin Durand-Moreau, Erin Branton, Behdin Nowrouzi-Kia and Douglas P. Gross
The editorial highlights that the condition's heterogeneous, fluctuating, and unpredictable symptoms, particularly post-exertional symptom exacerbation (PESE), pose significant challenges for working adults and traditional return to work (RTW) processes. It argues that conventional occupational rehabilitation approaches with rigid timelines are ineffective and that insurers and employers often hold unrealistic expectations. The editorial advocates for prolonged, flexible, phased, or gradual RTW, including potential permanent accommodations, guided by a 'Do No Harm' principle that carefully tailors interventions to symptoms. Crucially, it stresses that the worker with Long COVID should be central to the process, with a focus on their lived experience and function over potentially misleading objective findings. The article also points to the need for systemic changes, like moving away from 'all or none' disability models, and further research into tailored care pathways and symptom trajectories.
Shane Avila, Yifan Hao, Ali Bani-Fatemi, Aaron Howe, Behdin Nowrouzi-Kia
A recent publication studying individuals with arthritis and the effects it has on both their personal and professional lives.
Behdin Nowrouzi-Kia, Leslie Carlin, Andrea D. Furlan, Shireen Harbin, Colette N. Severin, Emma Irvin, Nancy Carnide, Aaron Thompson, Anil Adisesh
A recent publication investigating the needs, barriers and facilitators that impact primary care providers in supporting patients' stay-at-work and return-to-work efforts following injury or illness.
Gabriela Castañeda Millan, Alexia Haritos, Edris Formuli, Maryna Mazur, Kishana Balakrishnar, Bao-Zhu Stephanie Long, Behdin Nowrouzi-Kia
A recent publication investigating the predictors of and barriers to mental health help-seeking among healthcare workers amidst the COVID-19 Pandemic.