Work and Reintegration Questionnaire / Work and Wellbeing Inventory

Abstract

The Work and Reintegration Questionnaire / Work and Wellbeing Inventory (widely recognized in Dutch occupational medicine and clinical psychology as the Vragenlijst Arbeid en Re-integratie; VAR, and its revised edition, the VAR-2) is a specialized psychometric screening instrument designed to evaluate psychosocial risk factors associated with prolonged sickness absence, delayed return-to-work (RTW), and work disability. Developed by clinical and occupational psychologist Arnold A. Vendrig in 2005 and substantially revised in 2015, the instrument operates on a biopsychosocial transactional model. It systematically maps the dynamic equilibrium between environmental and personal stressors (demands), the psychological and institutional buffers available (social and organizational support), an individual’s cognitive and behavioral coping styles, and resultant physical and psychological symptom strain. The VAR-2 contains multidimensional subscales structured across four foundational domains: Work and Private Stressors, Social and Organizational Resources, Coping Strategies, and Symptom Manifestations. Administered primarily to adult workers either at risk of absenteeism or already on short-term to long-term sick leave, the inventory uses standardized Likert-type rating formats to compute domain-specific indices and composite risk scores. Elevated scores across the subscales correlate with an increased probability of protracted absenteeism, treatment resistance, and secondary psychological decompensation. Psychometric evaluations demonstrate strong internal consistency (Cronbach’s α typically ranging from .78 to .92 across subscales), robust convergent validity with established measures such as the Four-Dimensional Symptom Questionnaire (4DSQ) and the Utrecht Burnout Scale (UBOS), and exceptional predictive validity for identifying employees at risk of sick leave exceeding six months.

Keywords

Work and Reintegration Questionnaire, Vragenlijst Arbeid en Re-integratie, VAR-2, occupational health psychology, sickness absence, return to work, work disability screening, psychosocial risk factors, coping mechanisms, job demands-resources.

Authors

The Work and Reintegration Questionnaire was conceptualized, standardized, and validated by:

• Dr. Arnold A. Vendrig, Ph.D.: Clinical Psychologist, Psychotherapist, and Senior Researcher specializing in occupational health psychology, chronic pain, and vocational rehabilitation. Dr. Vendrig has served as a scientific director and consultant across various clinical rehabilitation centers and occupational health organizations in the Netherlands, focusing on the diagnosis, prognosis, and treatment of complex, stress-related, and musculoskeletal work disability.

Purpose

The primary purpose of the Work and Reintegration Questionnaire / Work and Wellbeing Inventory is to systematically identify, quantify, and contextualize psychosocial risk factors—often termed “yellow flags” and “blue flags” in occupational health—that hinder recovery and prolong work incapacity. Long-term sickness absence presents substantial socio-economic burdens on organizations and social welfare systems, while concurrently causing severe psychological distress, loss of vocational identity, and social isolation for the individual worker. Traditional medical assessments often fail to predict the duration of absenteeism accurately because work disability is rarely a function of biomedical impairment alone; rather, it is driven by complex interactions between psychological vulnerability, workplace climate, private stressors, and individual coping efficacy.

In clinical and occupational settings, the VAR-2 serves multiple operational and diagnostic functions:

• Early Screening and Triage: Early detection of employees at risk of transitioning from acute sickness absence to chronic, protracted disability within the critical initial window (e.g., within 2 to 6 weeks of sick leave initiation).
• Targeted Intervention Planning: Pinpointing the exact locus of dysfunction—whether situated in organizational friction (e.g., poor supervisory support, excessive workload), home-work interference (e.g., caretaking burdens, marital strain), ineffective coping (e.g., avoidance, catastrophizing), or clinical symptoms (e.g., burnout, depressive mood, somatization).
• Vocational Rehabilitation and Return-to-Work (RTW) Monitoring: Providing vocational counselors, rehabilitation specialists, and occupational physicians with objective metric baselines to evaluate intervention efficacy and track gradual readiness for safe, sustainable reintegration.
• Preventative Health Surveillance: Implementing periodic organizational health check-ups among active, non-absentee staff to detect elevated stressor-support imbalances before clinical decompensation and sickness absence occur.

The theoretical rationale underlying the instrument asserts that prolonged absenteeism is predominantly maintained by a homeostatic breakdown: when stressors significantly outweigh available social and personal resources, and the individual deploys passive, avoidant, or non-constructive coping mechanisms, symptom chronicity ensues. By providing a granular profile of this imbalance, the VAR-2 transforms abstract occupational distress into actionable clinical targets.

Psychological Construct

The VAR-2 operationalizes a multifaceted conceptual framework anchored in occupational health psychology and behavioral medicine. Rather than viewing work capacity as a static trait, the instrument measures dynamic psychological and environmental constructs organized into four core tiers:

1. Stressors and Demands (Problems)

This domain captures the cumulative volume and subjective severity of stressors impinging on the individual across occupational and domestic environments:

• Work-Related Stressors: Quantitative workload, time pressure, role ambiguity, emotional demands, interpersonal conflict with colleagues or leadership, and perceived job insecurity. For example, individuals evaluate the frequency and impact of excessive deadlines or unresolvable disputes with management.
• Private and Domestic Stressors: Strains arising outside the occupational sphere, including financial hardship, major life events, relationship instability, and informal caregiving duties. The inclusion of private stressors reflects empirical evidence that domestic instability significantly reduces occupational resilience.

2. Social and Institutional Resources (Support)

Buffers that counteract the psychological toll of environmental stressors:

• Workplace Social Support: Instrumental, emotional, and informational assistance provided by immediate supervisors and peers. This includes perceptions of organizational empathy, open communication, and institutional flexibility regarding modified duties.
• Private Social Support: Emotional validation, practical assistance, and understanding provided by spouses, family members, and social networks, which serve as crucial shock absorbers during periods of vocational crisis.

3. Coping Mechanisms and Personal Dispositions

The cognitive, emotional, and behavioral strategies deployed by the individual to manage demands and psychological distress:

• Active Problem-Focused Coping: Proactive resolution, seeking constructive communication, setting boundaries, and systematic cognitive restructuring.
• Passive and Avoidant Coping: Behavioral withdrawal, cognitive avoidance, resignation, and distraction, which often exacerbate vocational anxiety and lead to protracted absence.
• Cognitive Appraisal and Catastrophizing: Tendencies to view physical symptoms or occupational barriers as insurmountable, accompanied by externalized attribution of control (e.g., believing recovery is solely in the hands of third parties).

4. Health Outcomes and Symptom Strain

The somatic, affective, and cognitive sequelae resulting from chronic stressor-resource imbalances:

• Burnout and Exhaustion: Deep emotional depletion, chronic mental fatigue, and feelings of reduced professional efficacy.
• Affective and Anxiety Symptoms: Nervous tension, persistent worry, depressed mood, and diminished hedonic capacity.
• Somatization and Pain Behavior: Non-specific physical symptoms, heightened somatic vigilance, and functional limitations disproportionate to objective medical pathology.

Theoretical Framework

The conceptual architecture of the Work and Reintegration Questionnaire is rooted in the convergence of four foundational paradigms in psychological science:

The Transactional Model of Stress and Coping

Rooted in the work of Richard Lazarus and Susan Folkman (1984), this model posits that stress is neither solely an environmental stimulus nor an internal response, but rather the consequence of a subjective transaction between the person and the environment. When environmental demands are appraised as exceeding personal and social resources, distress occurs. The VAR-2 operationalizes both primary appraisal (evaluating stressors as threatening, harmful, or challenging) and secondary appraisal (evaluating one’s internal coping repertoires and external support systems).

The Job Demands-Resources (JD-R) Model

Developed by Demerouti, Bakker, Nachreiner, and Schaufeli (2001), the Job Demands-Resources model states that employee wellbeing is dictated by two overarching categories of working conditions: demands (which drain psychological energy and induce health impairment) and resources (which foster motivation, engagement, and buffer against strain). The VAR-2 directly mirrors this dual-process structure by calculating a dynamic ratio between demands/stressors and workplace/social resources to evaluate net vocational strain.

Conservation of Resources (COR) Theory

Stevan Hobfoll’s (1989) Conservation of Resources theory asserts that individuals strive to obtain, retain, and protect resources (objects, conditions, personal characteristics, and energies). Stress arises when these resources are threatened, lost, or when an investment of resources fails to yield an adequate return. Long-term absenteeism reflects a severe resource depletion spiral, wherein the individual loses self-efficacy, financial stability, and social connection, reinforcing avoidance behaviors.

The Biopsychosocial Model and the “Flags” Framework

Pioneered by George Engel (1977) and further elaborated in occupational health by Kendall, Linton, and Main (1997), the psychosocial “Flags” model highlights that functional disability cannot be understood solely through organic tissue damage. Psychological “yellow flags” (fear-avoidance beliefs, passive coping, distress) and workplace “blue/black flags” (poor managerial communication, high job demands, adversarial compensation processes) serve as the primary determinants of chronic disability. The VAR-2 serves as an empirical operationalization of these psychosocial flags.

Validity

Empirical investigations into the VAR and VAR-2 have confirmed robust psychometric validity across normative working cohorts and clinical rehabilitation samples.

Construct Validity

Construct validity has been demonstrated through structural modeling confirming that the four primary domains (Stressors, Resources, Coping, Symptoms) operate as coherent, interconnected psychological latent factors. High positive correlations are observed among distinct stressor domains, while significant negative correlations emerge between social resources and depressive/burnout symptoms, reinforcing theoretical expectations.

Convergent and Discriminant Validity

Convergent validity has been rigorously demonstrated by comparing VAR-2 subscale scores against established, psychometrically validated reference standards:

• Burnout and Exhaustion Scales: The symptom and exhaustion scales of the VAR demonstrate high positive correlations ($r = .72$ to $.81$) with the exhaustion and cynicism subscales of the Maslach Burnout Inventory (MBI) / Utrecht Burnout Scale (UBOS).
• Psychological Distress: Moderate to strong correlations ($r = .65$ to $.78$) are consistently documented with the Distress, Depression, and Somatization scales of the Four-Dimensional Symptom Questionnaire (4DSQ).
• Health-Related Quality of Life: Significant negative correlations are observed between VAR stressor/symptom scales and the vitality and mental health subscales of the Short Form Health Survey (SF-36; $r = -.54$ to $-.68$).

Discriminant validity is supported by low correlations between workplace-specific stressor scales and non-vocational traits, confirming that the tool isolates acute situational occupational friction from generalized trait negative affectivity.

Predictive and Criterion Validity

The most crucial psychometric hallmark of the VAR-2 is its predictive validity regarding occupational outcomes. Prospective cohort studies tracking sick-listed employees have demonstrated that:

• Elevated composite risk scores on the VAR baseline assessment significantly predict the duration of sickness absence at 3, 6, and 12 months post-baseline, controlling for age, gender, and primary medical diagnosis.
• Receiver Operating Characteristic (ROC) analyses yield Area Under the Curve (AUC) statistics typically ranging between $.74$ and $.83$ for predicting non-return to work at six months, indicating good to excellent discriminative ability for identifying workers requiring intensive, multidisciplinary rehabilitation.

Reliability

The reliability of the VAR and VAR-2 has been established across multiple independent occupational and clinical cohorts:

Internal Consistency

Analyses of internal consistency using Cronbach’s alpha (α) confirm that the constituent subscales exhibit high reliability coefficients exceeding established psychometric standards (α ≥ .70 for research, α ≥ .80 for clinical decision-making):

• Work Stressors Subscales: α = .82 to .89
• Private / Domestic Stressors Subscales: α = .78 to .84
• Workplace Social Support Subscales: α = .84 to .91
• Private Social Support Subscale: α = .80 to .86
• Passive Coping / Avoidance Subscales: α = .79 to .85
• Burnout, Fatigue, and Psychological Symptoms: α = .88 to .93

Test-Retest Reliability

Intraclass correlation coefficients (ICC) evaluated over a stable two- to three-week test-retest interval among non-intervened working cohorts range from $.76$ to $.88$, demonstrating robust temporal stability. As intended, symptom scales show moderate sensitivity to clinical change following multidisciplinary rehabilitation interventions, verifying that the scale registers true therapeutic improvement without suffering from static ceiling or floor artifacts.

Factor Analysis

Extensive factor-analytic procedures have been conducted during the developmental iterations of the VAR (Vendrig, 2005) and its revision (Vendrig, 2015).

Exploratory Factor Analysis (EFA)

Initial exploratory factor analyses utilizing principal axis factoring with oblique (Oblimin) rotation revealed a clear multi-tiered factor structure. Items loaded strongly on their targeted latent constructs (factor loadings > .45) with negligible cross-loadings, demonstrating that workers clearly delineate between environmental work pressures, home life strain, interpersonal managerial dynamics, internal cognitive coping styles, and affective somatic symptoms.

Confirmatory Factor Analysis (CFA)

Subsequent structural equation modeling across large normative validation samples ($N > 1,500$) validated the hypothesized multidimensional architecture. A hierarchical model—wherein individual subscales load onto second-order factors representing Stressors, Resources, Coping, and Symptoms, which in turn map onto a general latent construct of “Psychosocial Absenteeism Risk”—demonstrated satisfactory goodness-of-fit indices:

• Comparative Fit Index (CFI) ≥ .92
• Tucker-Lewis Index (TLI) ≥ .91
• Root Mean Square Error of Approximation (RMSEA) ≤ .054 (90% CI [.049, .059])
• Standardized Root Mean Square Residual (SRMR) ≤ .058

Alternative single-factor or two-factor models exhibited significantly poorer fit, confirming that psychosocial risk in sickness absence cannot be reduced to a unidimensional measure of general distress.

Instrument / Measurement Tool

The practical administration, structure, and operational characteristics of the Work and Reintegration Questionnaire (VAR-2) are structured as follows:

• Test Type: Multi-scale self-report psychological screening questionnaire and diagnostic inventory.
• Target Population: Adult employees and workers (ages 18–67) across all economic sectors; applicable to active employees, workers at elevated risk of sick leave, and individuals currently experiencing partial or total sickness absence.
• Administration Format: Standardized digital computerized testing (via secure diagnostic portals) or traditional paper-and-pencil booklet format.
• Administration Duration: Approximately 20 to 35 minutes depending on client reading speed and cognitive fatigue levels.
• Item Formats: Fully standardized declarative statements evaluating the frequency, degree of agreement, or subjective burden associated with workplace events, personal relationships, coping habits, and physical/emotional states.
• Response Scale: Typically formatted using 4-point or 5-point Likert scales ranging from 1 (“Hardly ever / Disagree strongly”) to 4 or 5 (“Almost always / Agree strongly”).
• Scoring Structure: Raw scores for each subscale are calculated by summing item responses, with negatively phrased items reverse-scored where applicable. Raw scores are subsequently converted into standardized percentiles or deciles based on comparative reference populations (e.g., healthy working Dutch norm groups versus clinical populations with long-term sickness absence).
• Diagnostic Output: A visual graphical profile highlighting elevated risk categories across four core domains, accompanied by an integrated algorithmic indicator estimating the risk of prolonged sick leave (low, medium, or high risk).

Permissions & Fee and Test Year

The original Work and Reintegration Questionnaire (VAR) was published in 2005, followed by the comprehensive revision, the VAR-2, in 2015 by Dr. Arnold A. Vendrig. The VAR and VAR-2 are proprietary psychometric instruments protected under international copyright law. The questionnaire, scoring algorithms, and clinical interpretive manuals are commercially distributed through authorized psychological test publishers, occupational health platforms, and specialized diagnostic software providers in the Netherlands.

Clinical psychologists, occupational health physicians, and rehabilitation organizations must purchase user licenses or pay per-administration scoring fees through accredited distributors. Researchers seeking to utilize the VAR-2 for non-commercial academic research must secure formal permission and licensing agreements directly from the copyright holder or authorized distributor prior to data collection.

References

• Demerouti, E., Bakker, A. B., Nachreiner, F., & Schaufeli, W. B. (2001). The job demands-resources model of burnout. Journal of Applied Psychology, 86(3), 499–512. https://doi.org/10.1037/0021-9010.86.3.499
• Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129–136. https://doi.org/10.1126/science.847460
• Hobfoll, S. E. (1989). Conservation of resources: A new attempt at conceptualizing stress. American Psychologist, 44(3), 513–524. https://doi.org/10.1037/0003-066X.44.3.513
• Kendall, N. A., Linton, S. J., & Main, C. J. (1997). Guide to assessing psychosocial yellow flags in acute low back pain: Risk factors for long-term disability and work loss. Accident Rehabilitation & Compensation Insurance Corporation of New Zealand and the National Health Committee.
• Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. Springer Publishing Company.
• Terluin, B., van Marwijk, H. W., Adèr, H. J., de Vet, H. C., Penninx, B. W., Hermens, M. L., van Boeijen, C. A., van Balkom, A. J., van der Klink, J. J., & de Haan, M. (2006). The Four-Dimensional Symptom Questionnaire (4DSQ): A validation study of a multidimensional self-report questionnaire to assess distress, depression, anxiety and somatization. BMC Psychiatry, 6, Article 34. https://doi.org/10.1186/1471-244X-6-34
• Vendrig, A. A. (2005). Vragenlijst Arbeid en Re-integratie (VAR): Handleiding [Work and Reintegration Questionnaire: Manual]. Driebergen: Stichting Kwaliteitsbevordering Medische Psychologie / Diagnostic Publications.
• Vendrig, A. A. (2015). Vragenlijst Arbeid en Re-integratie-2 (VAR-2): Wetenschappelijke verantwoording en handleiding [Work and Reintegration Questionnaire-2: Scientific justification and manual]. Houten: Bohn Stafleu van Loghum.

Items of the Scale