High Levels Of Sickness Absence Research Articles

Exploring line managers’ perspectives on using data in managing sickness absence: a qualitative study

PurposeThe purpose of this study is to explore line managers’ perspectives on data as tool in the management of sickness absence in public sector workplaces in Denmark.MethodsThe study is a qualitative study based on 19 semi-structured interviews with line managers from four public sector workplaces characterized by high levels of sickness absence or poor work environment. The interviews were analysed inductively using thematic analysis.ResultsThe findings show that line managers primarily use data to identify employees at risk of sickness absence. The experiences highlighted related to how and when data are perceived as a valuable tool by the line managers, and that nuances in the data, accessibility of the data and how data are presented are important factors to ensure appropriate follow-up on sickness absence.ConclusionsThe findings suggest that for line managers to use data to manage sickness absence appropriately, the data must be easily accessible, simple for line managers to understand and provide line managers with a sufficient overview of sickness absence in their work units. It is also important to consider other factors affecting sickness absence, such as the work environment, when aiming to reduce sickness absence.

Treatment-resistant depression and labor market affiliation in the Danish welfare society: a register-based study.

We explored if patients with treatment-resistant depression (TRD) go through different states of labor market affiliation during their course of illness before they return to work or obtain early retirement as compared to patients without TRD. All adults between 18 and 58years with a first-time hospital contact due to depression in Danish patients' registers from 2000 to 2014 were followed in a nationwide labor market database. At time of TRD (index week), TRD patients were matched with patients without TRD in a 1:2 ratio. Sequence analysis and logistic regression were applied to explore the association of TRD and labor market affiliation and measures of transitions between labor market states 52weeks before and after the index week. At the index week, 14.1% of patients with TRD were in employment, whereas the proportion was 26.4% among non-TRD patients. Over time, the proportion of patients in employment increased slightly to 25.5% for TRD and 33.7% for non-TRD patients. The proportion of TRD patients with sickness absence at index was 47.0%, while the proportion was 26.2% for non-TRD patients. The adjusted odds of a below mean volatility of labor market transitions, characterized by more episodes in passive social transfer payments and disability pension, were higher among patients with TRD compared with non-TRD patients (OR 1.63, 95% CI [1.56-1.69]). Similarly, the adjusted odds of a below mean integration into employment were 1.63 higher among TRD patients compared with non-TRD patients (95% CI [1.56-1.70]). Patients with TRD have higher levels of sickness absence and lower levels of reintegration into the labor market after meeting the criteria for TRD compared with patients without TRD.

Sickness absence and disability pension within different employment status in multiple sclerosis

Abstract Introduction Limitations associated with Multiple Sclerosis (MS) can restrain work capacity and productivity, reducing the possibility to remain in work. Whilst access to sickness compensation might be an option, transitions to other types of employment, such as self-employment, might be considered. We aim to investigate the association of Sickness Absence (SA) and Disability Pension (DP) with employment status among people with multiple sclerosis (PwMS) before and after MS diagnosis compared with people without MS. Methods A prospective longitudinal study was conducted using Swedish register data of 2,779 MS patients diagnosed with MS in 2008-2012 in working ages (20-59 years) and 13,863 population-based matched references. Levels of SA and DP one year before and four years after MS diagnosis were analyzed. Risk of annual SA and DP levels of more than 180 days were compared among the MS patients and references and, their different types of employment, by means of Cox proportional hazard models and adjusted for socio-demographic variables and SA and DP before MS diagnosis. Results In general, people with MS had higher levels of SA and DP before and shortly after MS diagnosis compared to references. PwMS showed a significantly higher probability of reaching over 180 days of SA (Hazard Ratio [HR]=4.89, 95% Confidence interval [CI]=4.43-5.40) and over 180 days of DP (HR = 6.31, 95% CI = 5.46-7.30)) than the references, regardless of type of employment. Moreover, when compared to employed references, self-employed PwMS had similar likelihood to reach over 180 days of SA than employed PwMS, (HR = 4.27, 95% CI = 3.81-4.77) and (HR = 3.83, 95% CI = 2.73-5.38), respectively. In contrast, self-employed references showed less probability (HR = 0.49, 95% CI = 0.31-0.78) to reach over 180 days of SA compared to the employed references. Conclusions In contrast to references, employed and self-employed PwMS had similar probabilities of reaching over 180 days of SA. Key messages This study emphasizes that in Sweden also self-employed have access to sickness compensation, independently of employment status condition. Access to sickness compensation is utilized by PwMS.

Trajectories of sickness absence and disability pension by type of occupation in multiple sclerosis

Abstract Background Multiple sclerosis (MS) can impact working life, sickness absence (SA), and disability pension (DP). Different types of occupations involve different demands, which may be associated with trajectories of SA and DP among people with MS (PwMS). We aim to explore if annual levels of SA and DP differ according to type of occupation among PwMS and references. Further, we aim to gain knowledge of how trajectories of SA and DP are associated with type of occupation among PwMS. Methods A nationwide Swedish register-based prospective cohort study with six-year follow-up was conducted, including 6,100 individuals with prevalent MS and 38,641 matched population references. Mean annual SA and DP net days during follow-up years were calculated and stratified by type of occupation. Trajectories of SA and DP were identified with group-based trajectory modelling. Multinomial logistic regressions were estimated for associations between identified trajectories and different types of occupations. Results An increase of SA and DP over time in all types of occupations was observed in both PwMS and references, with higher levels of SA and DP among PwMS. Managers had the lowest levels of SA and DP in both groups. Three SA and DP trajectory groups were identified: Persistently Low (55.2%), Moderate Increasing (31.9%), and High Increasing (12.8%). Managers (Odds Ratio [OR] 0.37, 95%CI 0.26-0.52) and those working in Science & Technology (OR 0.64, 95% CI 0.50-0.82) had less probability of belonging to the Moderate Increasing group. Similarly, Managers (OR 0.52, 95%CI 0.30-0.89) and Science & Technology (OR 0.58, 95%CI 0.39-0.88) had also less probability of belonging to the High Increasing group. Conclusions Our findings suggest that the type of occupation plays a role in the level and course of SA and DP among PwMS. Key messages Over time SA and DP levels increased among PwMS regardless of type of occupation. PwMS in Managers or Science and Technology had less probability of belonging to the increasing trajectories.

Working conditions and wellbeing in UK social workers

Summary UK social workers are exposed to chronically poor working conditions and experience extremely high levels of sickness absence. The aim of this study was to gain an in-depth understanding of working conditions and wellbeing of social workers. Seven UK social work employers sent a survey of working conditions, wellbeing, and turnover intentions to all child and family social workers, followed by a series of individual semi-structured interviews with respondents. Data were collected between January and May 2019. Six hundred and seventy-six (41% response rate) completed surveys were returned and 19 interviews undertaken. Findings Quantitative findings demonstrated that working conditions scored better than previous studies, with positive scores on autonomy, peer, and managerial support. However, the four remaining conditions (demands, relationships, role, and change) each scored worse than 75–90% of respondents in UK-wide benchmarks of individuals from various occupations. Regression outcomes demonstrated that demands, control, change, relationships, and peer support each significantly impacted employee wellbeing. Furthermore, over 20% of respondents suggested that they were frequently exposed to poor service user behaviour. Thematic analysis of interviews suggested that workload (demands), relationships with peers, management, and services users, and the way in which change was communicated were the main difficulties cited. Applications It is clear that work is needed to support social worker stress and wellbeing at work. Management should support individuals in terms of developing peer and managerial support, and adopting best practice in reflective supervision. Furthermore, a more robust system of caseload allocation would support and improve significant workload pressures.

Sickness absence and disability pension in relation to first childbirth: three cohorts in Sweden

Abstract Background Childbirth is suggested to be associated with elevated levels of sickness absence (SA) and disability pension (DP). However, knowledge about patterns of SA/DP before and after childbirth as compared to patterns among women who remain nulliparous is limited. We aimed to compare SA/DP across several periods among women with different childbirth status. Methods We analysed three population-based cohorts of all women aged 18-39 years who had not previously given birth and who lived in Sweden on 31 December 1994, 1999, or 2004, respectively. We compared crude and standardized annual mean SA and DP net days during three years preceding to three years after the date of first childbirth, among women having (1) their first and only birth during the subsequent three years, (2) their first birth and at least another delivery, and (3) no childbirths before, nor during the study period. Results Despite an increase in SA in the year preceding the first childbirth, women who gave birth, and especially women with multiple births, tended to have lower levels of SA/DP days throughout the years than women without childbirths. SA/DP days varied across age groups; young women (aged 18-24 years) without childbirths had fewer SA days, but more DP days than their same-aged counterparts who gave birth, regardless of year. These results did not differ across the three cohorts, suggesting that the results were not affected by period effects. Conclusions Women with more than one childbirth had fewer days of SA and DP, as compared to women with one childbirth and to women having no births. Thus, childbirth does not seem to be associated with higher levels of SA and DP. Some of these results can be due to a health selection into giving birth, especially having more births. Key messages Except for the year before delivery, i.e., when pregnant, women giving birth had fewer SA and DP days than women with no births. Thus, childbirth does not seem to be associated with higher SA and DP. Women who had more than one childbirth had less SA/DP days than those with one childbirth.

Changes in the gender segregation of occupations in Sweden between 2003 and 2011.

The aim of this study was to analyze possible changes in the gender composition of occupations in Sweden, using register data covering the whole working population. Cross tabulations on gender by occupation were computed and comparisons made of numbers and proportions of women and men aged 20-64 years to illustrate occupational gender-segregation categories in 2003 and 2011, respectively. All of those in working ages, employed in 2003 and 2011 (4.2 resp 4.7 millions individuals), were included. Differences in the distribution of women and men in all occupations were summarized using two gender-segregation indexes from 2003 and 2011, separately. The proportion of women increased in the gender-integrated (⩾40-<60% women) occupations. Also, the proportion of women in high-skilled professional occupations in the male-dominated category increased, as well as the proportion of men in mostly low-skilled female-dominated occupations, mainly in the service sector. The gender-segregation of occupations measured by the Index of Dissimilarly and the Karmel and MacLachlan Index was lower in 2011 than in 2003. The process of de-segregation has continued during our study period, from 2003 to 2011. The proportion of women increased in occupations that demand higher education, both in gender-integrated and in male-dominated occupations, which can contribute to a decrease in the level of sickness absence for women. Men increased their proportion in low-skilled, female-dominated occupations - a group with high levels of sickness absence or disability pension.

Appropriation or Alienation? The Need of Sense and the Provocative Question on a "Successful Psychosis"

Are mental disorders on the rise, or rather the willingness to disclose them and ask for help? Is humanity becoming increasingly ill or is illness becoming more and more human? Which perspective on mental disorders, especially psychosis, helps the patient to integrate their own experience, and others to avoid social distance? Can psychiatry learn and eventually teach to view these distinct human characteristics not only as pathologic foreignness and abnormality, but also from an anthropological perspective, as a profoundly human expression that exists on a continuum? What value can categories such as purpose and happiness have in this context? The paper introduces the example of Hamburg as city of contradictions with high levels of sickness absence, but simultaneously top scores in the happiness index. Then follows an attempt to outline which perspective on mental illness and which therapeutic stance might be helpful, so that illness and happiness are no longer seen as mutually exclusive. The final case history asks the provocative question if there can be a "successful psychosis".

Whole-system approaches to improving the health and wellbeing of healthcare workers: A systematic review.

BackgroundHealthcare professionals throughout the developed world report higher levels of sickness absence, dissatisfaction, distress, and “burnout” at work than staff in other sectors. There is a growing call for the ‘triple aim’ of healthcare delivery (improving patient experience and outcomes and reducing costs; to include a fourth aim: improving healthcare staff experience of healthcare delivery. A systematic review commissioned by the United Kingdom’s (UK) Department of Health reviewed a large number of international healthy workplace interventions and recommended five whole-system changes to improve healthcare staff health and wellbeing: identification and response to local need, engagement of staff at all levels, and the involvement, visible leadership from, and up-skilling of, management and board-level staff.ObjectivesThis systematic review aims to identify whole-system healthy workplace interventions in healthcare settings that incorporate (combinations of) these recommendations and determine whether they improve staff health and wellbeing.MethodsA comprehensive and systematic search of medical, education, exercise science, and social science databases was undertaken. Studies were included if they reported the results of interventions that included all healthcare staff within a healthcare setting (e.g. whole hospital; whole unit, e.g. ward) in collective activities to improve physical or mental health or promote healthy behaviours.ResultsEleven studies were identified which incorporated at least one of the whole-system recommendations. Interventions that incorporated recommendations to address local need and engage the whole workforce fell in to four broad types: 1) pre-determined (one-size-fits-all) and no choice of activities (two studies); or 2) pre-determined and some choice of activities (one study); 3) A wide choice of a range of activities and some adaptation to local needs (five studies); or, 3) a participatory approach to creating programmes responsive and adaptive to local staff needs that have extensive choice of activities to participate in (three studies). Only five of the interventions included substantial involvement and engagement of leadership and efforts aimed at up-skilling the leadership of staff to support staff health and wellbeing. Incorporation of more of the recommendations did not appear to be related to effectiveness. The heterogeneity of study designs, populations and outcomes excluded a meta-analysis. All studies were deemed by their authors to be at least partly effective. Two studies reported statistically significant improvement in objectively measured physical health (BMI) and eight in subjective mental health. Six studies reported statistically significant positive changes in subjectively assessed health behaviours.ConclusionsThis systematic review identified 11 studies which incorporate at least one of the Boorman recommendations and provides evidence that whole-system healthy workplace interventions can improve health and wellbeing and promote healthier behaviours in healthcare staff.

Registry-based analysis of participator representativeness: a source of concern for sickness absence research?

ObjectivesSelective participation can bias results in epidemiological surveys. The importance of health status is often suggested as a possible explanation for non-participation but few empirical studies exist. In a population-based...

Sickness absence in workplaces: Does it reflect a healthy hire effect?

Sickness absence in workplaces may reflect working conditions. It may also reflect a "healthy hire effect," i.e., that workplaces recruit individuals with experience of sickness absence differently. The purpose of the study was to determine if a history of sickness absence among recruits is associated with the average level of sickness absence in workplaces. In a register-based follow-up study, Swedish workplaces with at least 5 employees in 2006 were selected (approximately 127 000 workplaces with 3.9 million employees). The workplaces were categorized according to the average workplace sickness absence in 2006 and the recruits were categorized according to the individual sickness absence in 2005. The workplaces with a high average level of sickness absence were more likely than those with a low level to hire employees with high sickness absence in the year preceding employment: men - odds ratio (OR) = 7.2, 95% confidence interval (CI): 6.6-7.8, women - OR = 7.5, 95% CI: 6.9-8.1. The results show that there is a greater likelihood of employing individuals with high levels of sickness absence in the workplaces with many days of the average sickness absence than in the workplaces with few days of the average sickness absence. The results suggest that sickness absence in workplaces may reflect a healthy hire effect.

Occurrence of sickness absence and disability pension in relation to childbirth: A 16-year follow-up study of 6323 Swedish twins

Pregnancy, delivery, and the postpartum period may imply morbidity leading to work incapacity; however, this is seldom studied. This study aimed to compare twin sisters giving or not giving birth regarding occurrence of sickness absence (SA) and disability pension (DP). This population-based cohort study included all 6323 female twins born in Sweden 1959-1990, using register data for 1994-2010 about SA and DP. Average number of SA/DP days/year was calculated in relation to the year of the first delivery, or, if not giving birth, the year when the twin sister gave birth. Twin pairs discordant for delivery were used to investigate the importance of genetic and environmental factors for occurrence of SA and DP. In all, 52% had a first delivery during 1994-2010. Except for the year of delivery, the average number of SA days/year was similar when comparing women who gave birth to those who did not, while number of DP days was significantly higher in women who did not give birth. Differences between the groups seem attributable to genetic factors. Women who delivered once had higher levels of SA and DP than those who had several deliveries. DP with mental diagnoses was more common among women who had not delivered whereas DP with musculoskeletal diagnoses occurred more often among women who delivered. Levels of SA were similar among women who gave birth and who did not. Women not giving birth had significantly higher levels of DP, indicating health selections into childbirth.

The gender gap in sickness absence from work and the influence of parental absence on offspring absence 15years later: register-based cohort of Norwegians born in 1974-1976.

BackgroundWomen have shown consistently higher levels of sickness absence from work in comparison to men, but explanations for this gender gap have not been completely understood. Life-course studies suggest that health and health-related social benefits in adult age are influenced by early life experiences. We aimed to estimate intergenerational associations with a 15-year time gap between parents’ and offspring sickness absences, pursuing the hypothesis that this parental influence would have a stronger impact for women than for men.MethodsAll persons born alive between 1974 and 1976 in Norway were followed up in several national registries. Employed persons considered to be at risk of sickness absence and also with parents at risk of sickness absence (n = 78 878) were followed in the calendar year of their 33rd birthday with respect to spells lasting >16 days. The probability of one or more spells during this year constituted the one-year risk under study. Additive risk differences in association with an exposure (parental sickness absence 15 years earlier) were estimated in a binomial regression analysis. The estimates were adjusted for parental socioeconomic factors.ResultsThe 1-year sickness absence risk was higher for women (30.4 %) than for men (12.3 %). The crude risk differences between those exposed and those unexposed to parental sickness absence were similar in percentage points (PP) for women (3.8; 95 % confidence interval (CI) 2.6 to 4.9) and men (3.8; 95 % CI 2.9 to 4.6). The risk differences were moderately attenuated after adjustment for parental education and father’s income to 3.4 PP (2.2 to 4.5) for women and 2.8 PP (2.0 to 3.7) for men. Male absence was more strongly associated with the father’s than with the mother’s sickness absence, while associations for women were stronger for the same diagnostic groups as their parents.ConclusionsParental sickness absence was moderately associated with sickness absence in the next generation. Bias from unmeasured confounders cannot be entirely dismissed. Contrary to our hypothesis, associations were not stronger for women than for men. If parental sickness absence has a long-term causal effect, preventive measures could have an impact over generations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2037-2) contains supplementary material, which is available to authorized users.

Previous sickness absence and current low perceived social support at work among employees in the general population: a historical cohort study

ObjectiveAlthough sickness absence often is a process over time, most studies have treated the phenomenon as a discrete event and focused more on its causes than its consequences. We aimed...

Does the association between musculoskeletal pain and sickness absence due to musculoskeletal diagnoses depend on biomechanical working conditions?

To investigate single-site and multi-site musculoskeletal pain as predictors of future sickness absence due to musculoskeletal disorders (MSD) among blue-collar employees in food industry, and to study to what extent this relationship depends on physical loading at work. Survey responses of 901 employees on working conditions and musculoskeletal pain during the past week were linked to their future sickness absence records obtained from the personnel register of a food industry company. Negative binomial regression models were computed to determine associations of pain in one and in multi-site with the number of sickness absence days due to MSD during a four-year follow-up. Analyses were made in the whole cohort and stratified by the occurrence of repetitive movements and awkward postures (low/high). Multi-site pain occurred among 59 % in the total cohort and predicted sickness absence with a rate ratio of 1.48 [95 % confidence interval (CI) 1.21-1.80], adjusted for age, gender, biomechanical and psychosocial working conditions, body mass index and physical exercise. Similar associations were seen in the sub-cohorts with a low occurrence of repetitive movements (RR 2.18, CI 1.69-2.80) and awkward postures (RR 1.78, CI 1.39-2.28), but not in the sub-cohorts with a high occurrence of these exposure. Single-site pain was not predictive of sickness absence. A very high level of sickness absence in biomechanically strenuous work was found. Multi-site pain predicted sickness absence due to MSD among the employees with low exposure, but not among those with high exposure.

0028 Multi-site musculoskeletal pain and physical working conditions as predictors of sickness absence due to musculoskeletal diagnoses

ObjectivesTo investigate the importance of multi-site musculoskeletal pain as a predictor of sickness absence days due to musculoskeletal disorders (MSD) among blue-collar employees, and to study what extent such a...

Unhealthy lifestyles adversely affect nurses’ ability to deliver quality care

Ward manager Paul Rafferty, pictured, has helped to change the culture at Bradford Teaching Hospitals NHS Foundation Trust by analysing patient complaints. Mr Rafferty regularly meets with patients to hear their views, and ensures complainants meet the staff linked to the complaints. ‘They were challenging conversations and often emotional,’ he said. ‘Staff did not like it at first, but eventually understood that a patient would ring a relative because they did not feel they could ring the call buzzer.’ Mr Rafferty was addressing a 6Cs in Nursing event in London last week, organised by Healthcare Conferences UK. The conference also heard from Barts Health NHS Trust chief nurse Kay Riley. She spoke about the ‘phenomenal’ improvements made to the organisation’s culture and nursing practices since nursing students raised concerns about poor care on an older people’s ward at Whipps Cross University Hospital in east London. Next month, the trust is launching an assessment and development accreditation programme for all band 7 ward nurses, which has four levels and covers nursing metrics, observations, and hearing patient and staff views. ‘It is about building confidence in our knowledge of care on our wards,’ Ms Riley said. promote better health among patients. Students entering their second year were asked to assess their own health for the first phase of the research, which revealed a large number were overweight. London South Bank University professor of health promotion Jane Wills presented the early findings last week at the Commonwealth Nurses Conference in London. As part of the research, a wellness portal – described by Professor Wills as a virtual learning classroom – has been developed. The portal allows participants to examine how healthy they are and track their progress in making improvements, such as losing weight or taking more exercise. Professor Wills said: ‘Healthier nurses matter not only for the sake of the individuals, but because of the effect on health systems. This is a particular concern in the UK because we have high levels of sickness absence in the NHS, which can have an effect on patient safety.’

Female leaders’ experiences of psychosocial working conditions and its health consequences in Swedish public human service organizations

Municipal workplaces have high levels of sickness absence, and deterioration of the psychosocial work environment has been most pronounced for women and employees in this sector of Swedish working life. This study explores how female leaders in one rural municipality in Sweden experience their psychosocial working conditions and its health consequences. Interviews were carried out with 20 female leaders. Data were analyzed with a content analysis method using major dimensions of work stress models. These were job demands, job control, job resources, social support, and its health consequences. The analysis shows that the leaders experience high and conflicting job demands, limited possibilities to influence their work situation, insufficient job resources and social support, and limited time for their own health promotion. However, the leaders experience possibilities to develop skills in their jobs and opportunities to participate in educational programs. The analyses confirm the need for improvements in the prerequisites for female leaders in public human service organizations. It is important to improve female leaders’ psychosocial working conditions by implementing a more narrow control range, increased personal and economical recourses, leadership support, and leader development programs. Keywords: Female leaders; psychosocial working conditions; job demands; job control; job resources; social support; health consequences; human service organizations (Published: 1 March 2013) Citation: Vulnerable Groups & Inclusion. http://dx.doi.org/10.3402/vgi.v4i0.19075

Work health determinants in employees without sickness absence

Working ability is known to be related to good physical condition, clear work tasks, positive feedback and other occupational, organizational and psychosocial factors. In Sweden, high levels of sickness absence are due to stress-related disorders and musculoskeletal pain. To identify work health characteristics in a working population with a large variety of professional skills and occupational tasks. Employers' data on occupation, sickness absence, age and gender in a working population of 11 occupational groups and questionnaire responses regarding work-organization, environment, work stress, pain, health, and socio-demographic factors were collected. Employees with no history of sick-leave were compared with those with a history of sick-leave (1-182 days, mean 25 days). Of 2641 employees, 1961 participated. Those with no history of sick-leave reported less work-related pain, work-related stress, sleep disturbances, worry about their health, 'sick-presenteeism', monotonous work, bent and twisted working positions and exposure to disturbing noise than those with a history of sick-leave (P < 0.001). They also reported better health, support from superiors, having influence on their working hours and evening and week-end working, longer working hours per week (P < 0.001) and more regular physical training (P < 0.01). Socio-demographic factors were less important than gender, and differences in responses between occupational groups were also found. Workers without a history of sick-leave experienced less stress, sleep disturbances, worry about their own health and less neck, shoulder and back pain and more support from their superiors and influence on their working hours.

Unemployment and suicide in the Stockholm population: A register-based study on 771,068 men and women

Several studies have reported a higher risk of suicide among the unemployed. Some individuals may be more prone to both unemployment and suicide due to an underlying health-related factor. In that case, suicide among the unemployed might be a consequence of health-related selection. This study aimed to investigate the relationship between unemployment and suicide, and the importance of previous sickness absence to this relationship. The study was based on 771,068 adults aged 25-58 years in Stockholm County in 1990-1991. Data on sickness absence in 1990-1991 and unemployment in 1991-1993 were collected from registers for each individual. Time and cause of death in 1994-1995 were obtained from Sweden's Cause of Death Register. The association between sickness absence in 1990-1991 and unemployment in 1992-1993, and the association between unemployment in 1992-1993 and suicide in 1994-1995 was investigated using logistic regression. Unemployment lasting for >90 days in 1992-1993 was associated with suicide in men in 1994-1995 [odds ratio (OR) 2.16, 95% confidence interval (CI) 1.38-3.38], while unemployment lasting for ≤ 90 days in 1992-1993 was associated with suicide in women in 1994-1995 (OR 2.68, 95% CI 1.23-5.85). Higher levels of sickness absence were related to an increased risk of subsequent unemployment in both sexes. The higher prevalence of sickness absence among the unemployed attenuated the association between unemployment and suicide in both men and women. Unemployment is related to suicide. Individuals in poor health are at increased risk of unemployment and also suicide. The higher relative risk of suicide among the unemployed seems to be, in part, a consequence of exclusion of less healthy individuals from the labour market.