Self-Efficacy and Self-Esteem Predict Return to Work and Buffer the Impact of Treatment Duration: A Longitudinal Panel Study.

Abstract

Purpose: Return to work (RTW) is a key outcome of occupational rehabilitation, but physical recovery alone does not determine it. While prolonged treatment duration is a known barrier to RTW, the extent to which modifiable psychological resources mitigate this effect remains unclear. Therefore, this study aimed to examine whether self-efficacy and self-esteem are associated with RTW and whether self-esteem buffers the adverse effect of prolonged treatment duration.

Methods: Five-year panel data (2018-2022) from the Panel Study of Workers' Compensation Insurance, including 14,607 observations, were analyzed. RTW was operationalized as current work participation at each survey wave based on the official PSWCI economic activity status classification. Generalized estimating equations with a logit link were used to examine main and interaction effects. A Random Forest model was used to assess predictive performance and variable importance.

Results: Self-efficacy (OR = 2.020, p < .001) and self-esteem (OR = 1.519, p = .001) significantly predicted RTW, with self-efficacy showing the strongest effect. Longer treatment duration was associated with reduced probability of RTW (OR = 0.615, p < .001). A significant interaction indicated that self-esteem attenuated the adverse effect of prolonged treatment (OR = 1.098, p = .017). The Random Forest model demonstrated strong predictive performance (AUC = 0.818), with self-efficacy and self-esteem as the top-ranked predictors.

Conclusions: Psychological resources are important for RTW following occupational injury. Self-efficacy and self-esteem were positively associated with RTW, and self-esteem additionally buffered the adverse effect of prolonged treatment duration. These findings support rehabilitation strategies that prioritize modifiable psychological factors to enhance sustainable work reintegration.