The Return-to-Work Self-efficacy Questionnaire (RTW-SE): A Validation Study of Predictive Abilities and Cut-off Values for Patients on Sick Leave Due to Anxiety or Depression

Abstract

Purpose This study aimed to evaluate the validity of the Return-to-Work Self-efficacy Questionnaire (RTW-SE) in a Norwegian sample of patients with common mental disorders. The secondary aim was to provide validated cut-off scores for the RTW-SE. Methods Among patients receiving work-focused therapy (N = 626), the RTW-SE was measured pre-and post-treatment, and work status was assessed up to one-year post-treatment. The factor structure, internal consistency and construct validity were assessed. Furthermore, post-treatment cut-off scores were calculated using receiver operating characteristic (ROC) analysis for patients on sick leave at baseline (n = 314) and at the end of treatment (n = 145). The predictive ability of the suggested RTW-SE cut-off scores were investigated longitudinally. Results Exploratory principal component analysis identified a one-factor solution with high internal consistency (0.91). RTW-SE exhibited small to moderate negative correlations with measures of depression and anxiety, and was significantly different between subgroups of patients with different work status, supporting construct validity. Pre- and post-treatment RTW-SE scores significantly predicted full return to work at 3, 6 and 12 months post-treatment. ROC analysis suggested an upper cut-off score of 4.6, associated with full RTW, and lower cut-off score of 3.7, associated with partial RTW. These cut-offs showed acceptable discriminative ability and significant longitudinal predictive ability. Conclusion The RTW-SE possesses good psychometric properties and the suggested cut-off scores have significant predictive ability in a clinical setting.

Sick leave and return to work for patients with anxiety and depression: a longitudinal study of trajectories before, during and after work-focused treatment

“…Total score is recorded as the mean of all responses, and higher score indicates higher self-efficacy. 30 There was no missing sick leave data in the study due to the source being national registries. The same was true for the background characteristics and diagnoses, as they were recorded from patient journals.…”

Exposure to bullying behaviours, resilience, and return to work self-efficacy in patients on or at risk of sick leave

“…Hence, a negative relationship existed between exposure to bullying behaviours and RTW-SE. The patients in the present study had a mean RTW-SE score that is under the suggested cut-off of 3.7 for a low score 52 ) . Based on the negative correlation between exposure to bullying and RTW-SE it could be suggested that patients exposed to severe bullying have a particularly low confidence in their ability to return to work, indicating a high risk of not actually returning.…”

“…For instance, Ortega and colleagues 59 ) found that the risk of long-term sick leave was significantly higher for victims of workplace bullying than for non-victims, even after adjusting for exposure to other psychosocial work characteristics (e.g., role-conflicts). High scores on RTW-SE are however associated with higher probability of returning to work 22 , 52 ) . The negative association between the two was therefore expected.…”

“…The RTW-SE scale 28 , 52 ) is a self-report measure of expectations concerning one’s own ability to function well at work, such as being able to set boundaries, perform one’s work tasks, and being able to focus while at work. This scale has been specifically developed to measure work related self-efficacy in the return to work process for individuals suffering from a CMD 28 ) .…”

“…A higher score indicated a higher level of self-efficacy in relation to one’s work situation. RTW-SE scores between 4.6–6.0 can be categorized as high, scores between 3.7–4.6, as moderate and scores of 1–3.7 as low 52 ) . Since patients were working or on sick leave when they answered the scale, we did not refer to the scale as RTW-SE when in contact with the patients.…”