Ira Madan

King's College London | KCL · School of Medicine

Purpose To systematically identify and evaluate interventions to improve work participation for adults with upper limb musculoskeletal conditions, and explore contextual factors and mechanisms that suggest how the intervention is effective, for whom, and in what setting. Methods The review protocol was pre-registered with PROSPERO (CRD42023433216)...

Objectives The objectives of this study were to examine post COVID-19 syndrome (PCS) among healthcare workers (HCWs) in England and explore risk factors for the condition. Methods Data were collected by National Health Service (NHS) CHECK, a longitudinal study exploring HCWs’ mental and physical well-being during and after the COVID-19 pandemic. N...

Background Personal independence payment (PIP) is a benefit that covers additional daily living costs people may incur from a long-term health condition or disability. Little is known about PIP receipt and associated factors among people who access mental health services, and trends over time. Individual-level data linking healthcare records with a...

Objectives To investigate the effectiveness of adding a brief vocational advice intervention to usual care in reducing the number of days absent from work over a period of 6 months in adults given a fit note by their general practice. Design Multicentre, pragmatic, two parallel-arm, randomised controlled trial with health economic analyses and nes...

Introduction Long COVID (LC) occurs when people experience symptoms for weeks, months or even years after a COVID-19 infection. This review looks at research exploring the LC definitions, prevalence, symptoms, risk factors, and associated impacts in research on healthcare workers (HCWs). Data sources We systematically searched five electronic data...

Objective To determine key workforce variables (demographic, health and occupational) that predicted NHS staff's 1) absence due to illness (both COVID-19 and non-COVID-19 related) and 2) expressed intention to leave their current profession. Methods Staff from 18 NHS Trusts were surveyed between April 2020 and January 2021, and again approximately...

Introduction Previous studies on impact of the COVID-19 pandemic on healthcare workers’ (HCWs) mental health relied on self-reported screening measures to estimate point prevalence. Screening measures, designed to be sensitive, have low positive predictive value and often overestimate prevalence. We present a more accurate prevalence of common ment...

Introduction Chronic pain impacts individuals’ work. Existing questionnaires have focussed on assessing consequences for productivity and we have previously noted a discrepancy with the wide range of impacts described in qualitative literature. Given that there have been major changes in how people work, there is a need to develop an instrument to...

Introduction The proportion of working-age people with one or more long-term conditions (LTCs) is rising. It is important to understand the risk factors underlying the progression of LTCs and how LTCs impact on employment. This study aimed to determine risk factors predicting the initial development and progression of LTCs in working-age people liv...

Introduction Stammering (stuttering) is a speech disorder with high heterogeneity, characterised by involuntary disrupted speech (dysfluency). We assessed the impact of stammering on work, occupational health (OH) usual care, and assessed the demand for a workplace support intervention. Methods Mixed methods. Results 470 healthcare workers who st...

Introduction We explored opportunities, barriers and enablers to growing a multidisciplinary occupational health workforce. Methods Mixed methods Results 30/127 OH departments contributed workforce data. We found wide variation in staff composition and job roles. Nursing and medical staff were the dominant staff groups, with psychologists, physio...

Background In 2013, Universal Credit (UC) was introduced by the UK Government. Understanding of how UC provision is allocated among people with mental disorders, and its intersection with protected characteristics is limited. This study aimed to explore (1) how UC receipt, including UC conditionality regime, varied among users of specialist mental...

IntroductionIn the UK, mental disorders are one of the most common reasons for claiming a benefit relating to unemployment, income, sickness and disability. Limited information exists regarding the demographic characteristics and psychiatric profiles of working age individuals claiming benefits in London. Until recently, detailed data on both menta...

Background The utility of the occupational medicine diploma in the UK is yet to be explored. The NHS ‘Growing Occupational Health (OH) and Wellbeing’ programme provides opportunities for diplomates to increase their OH work. Aims To assess what proportion of diplomates carry out OH work, the type of work being undertaken, to identify obstacles imp...

Background South Asia generally reports low levels of amphetamine-type stimulant (ATS) use, with few studies on the pattern of ATS use. We assessed the pattern of ATS use and associated high-risk behavior in Manipur, a north-eastern state of India. Methods 209 adult male ATS users (mean age 28.8 years) from three districts of Manipur were intervie...

Introduction Musculoskeletal disorders affect over a third of the UK adult population and are a common reason for sick leave from work. The aims of this study were to describe the reported provision of work participation support for adults with hand and upper limb conditions by UK hand therapists, and to identify potential training needs in this ar...

Chronic pain affects individuals' work participation. The impact of chronic pain on work has historically been measured through sickness absence, though it is now appreciated that the impacts on work are far wider. This mixed-methods review aimed to identify the full range of impacts of pain on work in addition to impacts that are currently measure...

This study describes a cohort of working age adults from a novel data linkage. The data linkage is comprised of routine electronic mental healthcare records from The South London and Maudsley (SLaM) NHS Foundation Trust and benefits records from The Department for Work and Pensions (DWP). The data linkage spans 15 years, with SLaM data covering the...

Objectives People with mental disorders are likely to be overrepresented among Universal Credit (UC) recipients. Despite this, individual level data is lacking on mental disorder diagnosis by UC status, and the intersectionality of different socio-demographic characteristics. Associations were explored between UC receipt, socio-demographic and diag...

Objectives To describe the process and outcomes of establishing a unique data linkage between mental healthcare records from the South London and Maudsley (SLaM) NHS Foundation Trust with benefits records from the Department for Work and Pensions. Methods448,404 IDs of patients who accessed secondary mental healthcare services at SLaM were sent to...

Objectives The progression of long-term conditions (LTCs) from zero-to-one (initiation), and from one-to-many (progression)are common trajectories that impact a person’s quality of life including their ability to work. This study aimed to explore the demographic, socioeconomic, psychosocial, and health-related determinants of LTC initiation and pro...

Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a disabling long-term condition of unknown cause. The National Institute for Health and Care Excellence (NICE) published a guideline in 2021 that highlighted the seriousness of the condition, but also recommended that graded exercise therapy (GET) should not be used and cognitive–behavi...

Background During the COVID-19 pandemic, concern has been raised about suicide risk among healthcare workers (HCWs). We investigated the incidence risk and prevalence of suicidal thoughts and behaviour (STB), and their relationship with occupational risk factors, among National Health Service HCWs in England between April 2020 and August 2021. Met...

Work participation is known to benefit people's overall health and wellbeing, but accessing vocational support during periods of sickness absence to facilitate return-to-work can be challenging for many people. In this study, we explored how vocational advice was delivered by trained vocational support workers (VSWs) to people who had been signed-o...

Background: Potentially morally injurious events (PMIEs) can negatively impact mental health. The COVID-19 pandemic may have placed healthcare staff at risk of moral injury. Aim: To examine the impact of PMIE on healthcare staff wellbeing. Methods: Twelve thousand nine hundred and sixty-five healthcare staff (clinical and non-clinical) were re...

Objective Synthesising evidence of the effects of interventions to improve work participation among people with health problems is currently difficult due to heterogeneity in outcome measurements. A core outcome set for work participation is needed. Study design and setting Following the Core Outcome Measures in Effectiveness Trials methodology, w...

Objectives To describe the process and outcomes of a data linkage between electronic secondary mental healthcare records from the South London and Maudsley (SLaM) NHS Foundation Trust with benefits records from the Department for Work and Pensions (DWP). We also describe the mental health and benefit profile of patients who were successfully linked...

Staff in the National Health Service (NHS) are under considerable strain, exacerbated by the COVID-19 pandemic; whilst NHS Trusts provide a variety of health and wellbeing support services, there has been little research investigating staff perceptions of these services. We interviewed 48 healthcare workers from 18 NHS Trusts in England about their...

Background Previous studies on the impact of the COVID-19 pandemic on the mental health of health-care workers have relied on self-reported screening measures to estimate the point prevalence of common mental disorders. Screening measures, which are designed to be sensitive, have low positive predictive value and often overestimate prevalence. We a...

Background Work participation is important for health and can be considered as engagement in a major area of life which is of significance for most people, but it can also be thought of as fulfilling or discharging a role. Currently, academic research lacks a comprehensive classification of work participation outcomes. The International Classificat...

Objectives To study the overall disease prevalence, and associations between demographic, socioeconomic, psychosocial, and health-related factors, and self-reporting one or more long-term health conditions (LTCs) in a working-age inner-city population. Design Cross-sectional household-based survey with a follow-up timepoint. Setting South-East Lo...

Background Healthcare workers (HCWs) have faced considerable pressures during the COVID-19 pandemic. For some, this has resulted in mental health distress and disorder. Although interventions have sought to support HCWs, few have been evaluated. Aims We aimed to determine the effectiveness of the ‘Foundations’ application (app) on general (non-psy...

Introduction There is variability in the information available for patients after carpal tunnel release (CTR). We aimed to establish (i) what advice should be provided regarding return to driving after CTR; (ii) how work activities should be categorised and defined in relation to CTR, and when patients should be recommended to return to these activ...

Background We sought to explore the value and benefits of accredited specialists employed in the National Health Service (NHS), and proposed strategies for expanding their role. Aims To explore the core characteristics of accredited specialists and to examine how their skills could be further utilized to enhance occupational health (OH) services....

Staff in the National Health Service (NHS) have been placed under considerable strain during the COVID-19 pandemic; whilst NHS Trusts provide a variety of health and wellbeing support services, there has been little research investigating staff perceptions of these services. Moreover, the research that does exist typically includes only clinical st...

Background Potentially morally injurious events (PMIEs) can negatively impact mental health. The COVID-19 pandemic may have placed healthcare staff at risk of moral injury. Aim To examine the impact of PMIE on healthcare staff wellbeing. Method 12,965 healthcare staff (clinical and non-clinical) were recruited from 18 NHS-England trusts into a su...

Objective To examine variations in impact of the COVID-19 pandemic on the mental health of all types of healthcare workers (HCWs) in England over the first 17 months of the pandemic. Method We undertook a prospective cohort study of 22,501 HCWs from 18 English acute and mental health NHS Trusts, collecting online survey data on common mental disor...

Background Limited research suggests that non-occupational health doctors rarely discuss occupation with their patients. There is a gap in research regarding the attitudes and practices of doctors towards discussing patient occupation and return to work. The aim of this work was to explore the attitudes of ophthalmology doctors towards work as a cl...

Background We investigated the feasibility of recruiting patients unemployed for more than 3 months with chronic pain using a range of methods in primary care in order to conduct a pilot trial of Individual Placement and Support (IPS) to improve quality of life outcomes for people with chronic pain. Methods This research was informed by people wit...

Background: to assess the feasibility and acceptability of conducting a trial of the clinical and cost-effectiveness of a new case-management intervention to facilitate the return to work of healthcare workers on sick leave with a common mental disorder (CMD). Methods: a mixed methods feasibility study. Results: systematic review examined forty...

Purpose Heterogeneity in work participation (WP) outcomes measurements hampers large scale evidence synthesis in systematic reviews of trials. In this survey we explore authors’ reasons for choosing specific WP outcomes and their measurement methods, including employment status, absence from work, at-work productivity loss, and employability. Metho...

Background: There has been increasing evidence that physicians in gynaecology are not routinely enquiring about work during consultations. Aims: To explore the effect gynaecological conditions can have on work functioning, the importance of work outcomes among patients and whether work considerations are discussed during clinical consultations....

Background: Work participation is important for health and can be considered as engagement in a major area of life which is of significance for most people, but it can also be thought of as fulfilling or discharging a role. Currently, academic research lacks a comprehensive classification of work participation outcomes. The International Classifica...

Background: Rates of mental health problems are increasing among medical students, who have added pressures compared with non-medical students. Medical student populations exhibit low rates of help-seeking and often struggle with disclosing health conditions due to the barriers experienced and concerns over negative repercussions. Aims: This stu...

Background Although medical students have a duty to seek advice for their health conditions, they tend to avoid disclosure and help-seeking behaviours, therefore potentially posing a risk to themselves and their patients. The literature regarding their decisions to seek help or disclose health conditions is limited. The study’s purpose was to explo...

Background Stammering (stuttering) is a speech condition with high heterogeneity, affecting approximately 1% of adults. Research shows it can limit career progression, impact job performance and quality of life. Aims To assess the psychosocial impact of stammering among healthcare workers and to develop a new workplace support intervention. Metho...

Objective To explore the patterns of sickness absence in National Health Service (NHS) staff attributable to mental ill health during the first wave of the COVID-19 epidemic in March–July 2020. Design Case-referent analysis of a secondary dataset. Setting NHS Trusts in England. Participants Pseudonymised data on 959 356 employees who were contin...

Objectives Sickness absence is strongly associated with poor mental health, and mental disorders often go untreated. In this population-based cohort study, we identified people receiving fit notes from their general practitioner (GP) and determined access to mental health treatment stratified by health complaint and demographic variables. Design L...

Objective To investigate how work participation outcomes in randomized controlled trials are measured internationally and across disciplines. Study design and setting We identified trials that reported on work participation in Medline, Embase, PsycINFO and Cochrane Central published between 2014 and 2019. Screening, selection and data extraction w...

Background This study quantifies the risk of Covid-19 among ethnic groups of healthcare staff during the first pandemic wave in England. Methods We analysed data on 959 356 employees employed by 191 National Health Service trusts during 1 January 2019 to 31 July 2020, comparing rates of Covid-19 sickness absence in different ethnic groups. Result...

Background Sickness absence rates vary widely across a large acute NHS Trust, with the highest rates in some of the largest directorates. Aims This study was aimed to identify factors associated with sickness absence in teams and to inform interventions to improve staff health and well-being. Methods Using 2018 data from the electronic staff reco...

Background Patterns of sickness absence shed useful light on disease occurrence and illness-related behaviours in working populations. Methods We analysed prospectively collected, pseudonymized data on 959 356 employees who were continuously employed by National Health Service trusts in England from 1 January 2019 to 31 July 2020, comparing the fr...

Objective To quantify occupational risks of COVID-19 among healthcare staff during the first wave (9 March 2020–31 July 2020) of the pandemic in England. Methods We used pseudonymised data on 902 813 individuals employed by 191 National Health Service trusts to explore demographic and occupational risk factors for sickness absence ascribed to COVI...

Objectives This study reports preliminary findings on the prevalence of, and factors associated with, mental health and well-being outcomes of healthcare workers during the early months (April–June) of the COVID-19 pandemic in the UK. Methods Preliminary cross-sectional data were analysed from a cohort study (n=4378). Clinical and non-clinical sta...

Objective: To explore the patterns of sickness absence in National Health Service (NHS) staff attributable to mental ill health during the first wave of the Covid19 epidemic in March to July 2020 Design: Case-referent analysis of a secondary data set Setting: NHS Trusts in England Participants: Pseudonymised data on 959,356 employees who were conti...

Objective To quantify occupational risks of Covid-19 among healthcare staff during the first wave of the pandemic in England Methods Using pseudonymised data on 902,813 individuals continuously employed by 191 National Health Service trusts during 1.1.19 to 31.7.20, we explored demographic and occupational risk factors for sickness absence ascribe...

Objective To explore impacts of the COVID-19 pandemic on patterns of sickness absence among staff employed by the National Health Service (NHS) in England. Methods We analysed prospectively collected, pseudonymised data on 959,356 employees who were continuously employed by NHS trusts during 1 January 2019 to 31 July 2020, comparing the frequency o...

Objectives The fit note replaced the sick note in the UK in 2010, with the aim of improving support for patients requiring sickness absence, yet there has been very little research into fit note use. This study aims to describe number of fit notes by condition, to improve our understanding of patterns of fit note use in primary care. Previous fit n...

Background: The NHS is the biggest employer in the UK. Depression and anxiety are common reasons for sickness absence among staff. Evidence suggests that an intervention based on a case management model using a biopsychosocial approach could be cost-effective and lead to earlier return to work for staff with common mental health disorders. Object...

Objectives This study reports preliminary findings on the prevalence of, and factors associated with, mental health and wellbeing outcomes of healthcare workers during the early months (April-June) of the COVID-19 pandemic in the UK. Methods Preliminary cross-sectional data were analysed from a cohort study (n=4,378). Clinical and non-clinical staf...

Background Chronic pain is a common cause of health-related incapacity for work among people in the UK. Individualised placement and support is a systematic approach to rehabilitation, with emphasis on early supported work placement. It is effective in helping people with severe mental illness to gain employment, but has not been tested for chronic...

Background Hand dermatitis is highly prevalent among nurses due to their frequent exposure to wet work. Providing cost-effective dermatological health surveillance for this occupational group presents a challenge to health service providers. Aims To ascertain the predictive value of nurses’ self-assessment of whether they had current hand dermatit...

Background: Research on sickness absence has typically focussed on single diagnoses, despite increasing recognition that long-term health conditions are highly multimorbid and clusters comprising coexisting mental and physical conditions are associated with poorer clinical and functional outcomes. The digitisation of sickness certification in the...

Background Research on sickness absence has typically focused on single diagnoses, despite increasing recognition that long-term health conditions are highly multimorbid and clusters comprising coexisting mental and physical conditions are associated with poorer clinical and functional outcomes. The digitisation of sickness certification in the UK...

Background: Few data are available on the pattern of use of fit notes issued in secondary care settings. Aims: To evaluate the pattern and quality of e-fit notes issued in an NHS Trust. Methods: Anonymized data on patients admitted to Guy's and St Thomas' NHS Foundation Trust (London, UK) who had an e-fit note issued from 1 January to 31 Augus...

BACKGROUND: Chronic pain is a common cause of health-related incapacity for work in the UK. Individualised Placement and Support (IPS) is a systematic approach to rehabilitation with emphasis on early funded work placement. It is effective in helping people with severe mental illness to gain employment but has not been tested for chronic pain. OBJ...

The coronavirus disease 2019 (COVID-19) pandemic is having a profound effect on all aspects of society, including mental health and physical health. We explore the psychological, social, and neuroscientific effects of COVID-19 and set out the immediate priorities and longer-term strategies for mental health science research. These priorities were i...

Objectives Introduced in the UK in 2010, the fit note was designed to address the problem of long-term sickness absence. We explored (1) associations between demographic variables and fit note receipt, ‘maybe fit’ use and long-term conditions, (2) whether individuals with long-term conditions receive more fit notes and are more likely to have the ‘...

Background: Occupational hand dermatitis poses a serious risk for nurses. Objectives: To evaluate the clinical and cost-effectiveness of a complex intervention in reducing the prevalence of hand dermatitis in nurses TRIAL DESIGN: Cluster randomised controlled trial at 35 hospital trusts/health boards/universities in the United Kingdom. Methods:...