Pathways of reorganization, leadership and long-term sickness absence due to mental diagnosis among local government public sector employees in Sweden 1998-2012

Abstract

The aim is to study local variation in long-term sickness absence due to mental diagnosis among local government public sector employees during a fifteen year period (1998-2012) and its relation to reported larger reorganizations of local government public services in the periods of 2000-2004, 2006-2008 and 2010-2012. Longitudinal cluster analysis of ecological data is performed on the incidence of 90 days or longer sickness absence including new disability pensions each year between 1998 and 2012, generating clusters of municipalities with lower and higher incidence of sickness absence across the period studied. Aggregate data from surveys performed in 2004, 2008 and 2012 with the leading political, administrative and union representatives in all of the 290 municipal level local governments in Sweden on organizational change are used in logistic regression analysis to elucidate whether there are significant effects of different types of organizational change and leadership during the reorganization on mental sickness rates across time. The analysis is performed with control for organizational complexity of larger cities (residential cities and those with over 50.000 inhabitants), population size generally, and municipality unemployment levels. The results indicate statistically significant effects of both organizational changes reported 2004, 2008 and 2012, as well as leadership reported in 2012, on top of the impact of large scale organizational complexity. Large scale organizational complexity, as well as general organizational change pressure and mandatory management of work place meetings all tend to increase the probability for long-term sickness absence due to mental diagnosis. In contrast, organizational change guided by specific characteristics with regard to implementation within an organizational field (social care in 2008), as well as specific leadership by targeted manager-employee communication, tends to significantly reduce long-term sickness absence. These findings suggest two alternative pathways of reducing mental stress leading to long-term sickness absence for local governments during large scale reorganization: implementation within an organizational field, and managerial work-place policies based on personalized leadership communication.