Abstract
ObjectivesWhile it is generally accepted that high job strain is associated with adverse occupational outcomes, the nature of this relationship and the causal pathways involved are not well elucidated. We aimed to assess the association between job strain and long-term sickness absence (LTSA), and investigate whether any associations could be explained by validated health measures.MethodsData from participants (n = 7346) of the Hordaland Health Study (HUSK), aged 40–47 at baseline, were analyzed using multivariate Cox regression to evaluate the association between job strain and LTSA over one year. Further analyses examined whether mental and physical health mediated any association between job strain and sickness absence.ResultsA positive association was found between job strain and risk of a LTSA episode, even controlling for confounding factors (HR = 1.64 (1.36–1.98); high job strain exposure accounted for a small proportion of LTSA episodes (population attributable risk 0.068). Further adjustments for physical health and mental health individually attenuated, but could not fully explain the association. In the fully adjusted model, the association between high job strain and LTSA remained significant (HR = 1.30 (1.07–1.59)).ConclusionHigh job strain increases the risk of LTSA. While our results suggest that one in 15 cases of LTSA could be avoided if high job strain were eliminated, we also provide evidence against simplistic causal models. The impact of job strain on future LTSA could not be fully explained by impaired health at baseline, which suggests that factors besides ill health are important in explaining the link between job strain and sickness absence.
Highlights
Long-term sickness absence (LTSA) has become a major public health problem in most developed countries [1]
Higher job strain was associated with more somatic symptoms, higher Hospital Anxiety and Depression Scale (HADS) scores and lower Short Form-12 (SF-12) scores
Population attributable fraction (PAF) estimates revealed that incidences of long-term sickness absence (LTSA) would be reduced by 6.76% had there been no exposure to high job strain in the working population
Summary
Long-term sickness absence (LTSA) has become a major public health problem in most developed countries [1]. Self-report surveys, such as the UK’s Labor Force Survey, suggest that stress is the leading ‘cause’ of work-related illnesses, accounting for around 40% of all new incidences of SA episodes [2], leading some to describe work-related stress as a ‘‘modern epidemic’’ [3]. The most dominant model of job stress is Karasek’s demand-control model [4], which is comprised of two main components: self-perceived job control and psychological demands. Job control is characterized by decision authority and skill discretion, while psychological demand is a function of workload, conflicting demands and work pressure. The job strain hypothesis is derived from this model and suggests that psychological demands will have the most negative impact on well-being in the setting of low job control. High strain jobs are those that combine high demands with low control
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