Higher Sickness Absence Rates Research Articles

The Relationship between a Health-Promoting Lifestyle and Sickness Absence in a Healthcare Company

Introduction The health and wellbeing of healthcare workers is important. This study aims to determine if associations exist between the health promoting behaviour and sickness absence of people employed in a Middle-Eastern healthcare company over a 12 month period. Method A cross-sectional survey was sent to all employees (n=233); it measured sickness absence in spells and days and, ‘health promoting behaviour’ by use of the Health Promoting Lifestyle Profile II (HPLP II) which measured six subscales: Spiritual Growth, Interpersonal Relations, Nutrition, Physical Activity, Health Responsibility and Stress Management. Results The odds of high spells of sickness absence were 5 times greater in people with poor rather than good health promoting scores, after a post-hoc analysis (OR 5.3, p=0.0039, CI 1.7 to 16.6). Men had better physical activity scores than women (p<0.05). Job role was associated with sickness absence (p=0.003 for spells, 0.005 for days), with administrative staff having higher rates of sickness absence than clinical staff. Conclusion The results suggest that no specific health promoting behaviour was associated with sickness absence in this setting. However, the overall effect shows that higher HPLP II scores are correlated with lower sickness absence. Sickness absence may also be associated with job role.

Psychosocial work factors and sickness absence among young Danish workers with a disease history

Abstract Background Young workers with a disease history may be more sensitive to adverse work environment, which could lead to increased rates of sickness absence (SA). This study investigates the association between psychosocial work factors and SA among young Danish workers with a history of somatic or mental disorders (N = 39,772). Methods We included young workers (aged 15-30) with a history of hospital-diagnosed somatic or mental disorders before labor market entry (between 2010 and 2018). SA spells of any length (≥1 day) were measured in registers and psychosocial work factors were estimated on the occupational level using job exposure matrices. We separately estimated adjusted rate ratios (RR) and 95% confidence intervals (95% CI) for women and men using Poisson regressions. Results Among women, employment in occupations with high quantitative demands, low decision authority, high job strain, high emotional demands, or high work-related physical violence was associated with higher rates of SA. Employment in occupations with high vs. low emotional demands showed the strongest association with a RR of 1.56 (95% CI: 1.48-1.65). Among men, employment in occupations with low decision authority showed the strongest association (1.40 [1.32-1.48]). In contrast, employment in occupations with high quantitative demands or high job strain was associated with lower rates of SA. Conclusions In a large nationwide sample of young workers with a history of somatic or mental disorders, we found several psychosocial work factors associated with SA at the job group level. Associations were overall similar to previously published results on all young workers. The results indicate that young workers with a history of somatic or mental disorders may not be more sensitive to adverse working conditions concerning the risk of SA and that preventive interventions, toward reducing SA, may have a similar impact regardless of disease history. Key messages • Several psychosocial working conditions were associated at the job group level with sickness absence in a nationwide sample of young workers with a disease history. • Associations were similar to previous results indicating that young workers with a disease history may not be more sensitive to adverse working conditions compared to the overall workforce.

Coordinators in the return-to-work process: Mapping their work models.

In recent decades, many countries have implemented return-to-work coordinators to combat high rates of sickness absence and insufficient collaboration in the return-to-work process. The coordinators should improve communication and collaboration between stakeholders in the return-to-work process for people on sickness absence. How they perform their daily work remains unexplored, and we know little about to what extent they collaborate and perform other work tasks to support people on sickness absence. This study examines which work models return-to-work coordinators use in primary healthcare, psychiatry and orthopaedics in Sweden. A questionnaire was sent to all 82 coordinators in one region (89% response rate) with questions about the selection of patients, individual patient support, healthcare collaboration, and external collaboration. Random forest classification analysis was used to identify the models. Three work models were identified. In model A, coordinators were more likely to select certain groups of patients, spend more time in telephone than in face-to-face meetings, and collaborate fairly much. In Model B there was less patient selection and much collaboration and face-to-face meetings. Model C involved little patient selection, much telephone contact and very little collaboration. Model A was more common in primary healthcare, model C in orthopaedics, while model B was distributed equally between primary healthcare and psychiatry. The work models correspond differently to the coordinator's assignments of supporting patients and collaborating with healthcare and other stakeholders. The differences lie in how much they actively select patients, how much they collaborate, and with whom. Their different distribution across clinical contexts indicates that organisational demands influence how work models evolve in practice.

Burnout, mood disorders and socioeconomic consequences among civil servants: a protocol for a systematic review

Introduction: Literature shows the existence of a relationship between working conditions and alterations in mood. Civil servants have certain peculiarities in terms of job stability, which suggests that they should be less susceptible to mood disorders and burnout. It is common to find news in various media about higher rates of sickness absence and presenteeism. They have clinical and socio-economic aftermaths. The aim of this review is to know what intervention strategies have been applied for mood disorders and burnout syndrome among civil servants and what are the socioeconomic consequences Method: Searches will be performed on: MEDLINE, CINAHL, Scopus, PsycINFO, PsycArticles, EconLit, Web of Science and The Cochrane Library of Systematic Reviews. Only peer reviewed papers and reviews written in English or Spanish will be included. Blind paper selections and data extraction will be performed by two independent researchers. In case of discrepancy, a third researcher will act as a tiebreaker. The review will follow the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Discussion: This systematic review will provide evidence to support decision makers from various stakeholder groups, including policymakers, business organisations, labor unions, clinical managers, and the academic community interested in analysing the clinical and socioeconomic consequences of mood disorders among public sector workers regarding issues related to these types of mental health issues. PROSPERO registration number: CRD42023410761

Psychosocial working conditions and sickness absence among younger employees in Denmark: a register-based cohort study using job exposure matrices.

Previous literature has established associations between psychosocial working conditions and sickness absence (SA), but only few studies have examined associations among younger employees. This study aimed to investigate associations between psychosocial working conditions and SA among employees, aged 15-30 years, who entered the labor market in Denmark between 2010 and 2018. We followed 301 185 younger employees in registers for on average 2.6 years. Using job exposure matrices, we assessed job insecurity, quantitative demands, decision authority, job strain, emotional demands, and work-related physical violence. Adjusted rate ratios of SA spells of any length were estimated for women and men separately with Poisson models. Among women, employment in occupations with high quantitative demands, low decision authority, high job strain, high emotional demands, or high work-related physical violence was associated with higher rates of SA. Being employed in occupations with high versus low emotional demands showed the strongest association with SA, with a rate ratio of 1.44 [95% confidence interval (CI) 1.41-1.47]. Among men, being employed in occupations with low decision authority showed the strongest association with SA (1.34, 95% CI 1.31-1.37), whereas occupations with high quantitative demands, high job strain, and high emotional demands were associated with lower rates of SA. We found that several psychosocial working conditions were associated with SA spells of any length. Associations with SA spells of any length resemble associations with long-term SA, suggesting that results from previous studies on long-term SA may be generalizable to all lengths of SA among younger employees.

Pilot Trial of Workable: A Therapist-Supported Digital Program for Injured Workers.

Workplace sickness absence is a major public health and economic problem, and common mental disorders (CMDs) such as anxiety and depression are associated with particularly high rates of long-term sickness absence. Effective return-to-work (RTW) interventions are required. This pilot study investigates the feasibility, acceptability, and potential effectiveness of a new therapist-assisted Web-based RTW intervention (Workable) for injured workers on sick leave for a psychological or physical injury. A single-group open pilot trial design was used, with assessments at pre-treatment and post-treatment. The intervention consisted of 6 weeks of online modules and 6 coaching calls from a psychologist. A total of 13 participants were recruited and 9 completed all questionnaires. Program adherence was high, with 92% of participants completing the 6-week intervention. Participants reported high levels of intervention satisfaction and ease of use. There were large and significant reductions between pre- and post-treatment on measures of depression, anxiety, stress, and workdays missed over the past four weeks, along with a significant increase in self-reported work ability. These results suggest that Workable is a feasible and acceptable intervention for injured workers, with the potential to improve mental health and RTW outcomes. A randomized controlled trial is required to determine the efficacy of the intervention.

Stakeholder perspectives on primary school pupils and sickness absence - exploring opportunities and challenges

ABSTRACT School absenteeism and its underlying causes can have negative effects on the cognitive, psychosocial and health development of a child. Research in primary education shows high rates of sickness absence. Many stakeholders are involved in addressing school absenteeism, including primary school professionals, child and youth healthcare physicians, school attendance officers and parents. This study explores these stakeholders’ perspectives, their approaches and what they envisage to be necessary in order to improve. It also aims to unveil opportunities and challenges in addressing sickness absence among primary school pupils. Qualitative research was performed with six semi-structured focus group interviews and involving 27 participants from the West-Brabant and Amsterdam regions of the Netherlands. Thematic analysis was used. The overarching theme was aiming for the child’s wellbeing. Each focus group interview started with low awareness of sickness absence as a threat to this wellbeing, but awareness grew during the interviews. The participating stakeholders regarded problematic sickness absence as complex due to a wide variety of causes, and felt that each other’s expertise was necessary to reduce sickness absence. Schools registered absence, but only occasionally used planned steps; they based the identification of problematic sickness on gut feeling rather than any agreed-upon criteria. To be able to systematically address sickness absence and thus improve the wellbeing of children, stakeholders felt the need for a clearly structured approach, including monitoring of sickness absence of all pupils, identifying problematic absence and promoting collaboration with other stakeholders. An approach should allow for tailoring solutions to the individual child.

Evaluating the Impact of Intensive Case Management for Severe Vocational Injuries on Work Incapacity and Costs

Purpose This study investigates the impact of an intensive case management program on sick leave days, permanent work incapacity levels and treatment costs for severe vocational injuries set up by the French National Insurance Fund in five health insurance districts. Methods The method employed relies on a four-step matching procedure combining Coarsened Exact Matching and Propensity Score Matching, based on an original administrative dataset. Average Treatment effects on the Treated were estimated using a parametric model with a large set of covariates. Results After one-year follow-up, workers in the treatment group had higher sickness absence rates, with 22 extra days, and the program led to 2.7 (95% CI 2.3–3.1) times more diagnoses of permanent work incapacity in the treatment group. With an estimated yearly operational cost of 2,722 € per treated worker, the average total extra treatment cost was 4,569 € for treated workers, which corresponds to a cost increase of 29.2% for the insurance fund. Conclusions The higher costs found for the treatment group are mainly due to longer sick leave duration for the moderate severity group, implying higher cash transfers in the form of one-off indemnities. Even though workers in the treated group have more diagnoses of permanent work incapacity, the difference of severity between groups is small. Our results on longer sick leave duration are partly to be explained by interactions between the case managers and the occupational physicians that encouraged patients to stay longer off-work for better recovery, despite the higher costs that this represented for the insurance fund and the well-documented adverse side effects of longer periods off-work.

Distribution of sickness absence risk across different levels and patterns of drinking: findings from the Stockholm Public Health Cohort.

Aim:This study estimated (i) the risk function between different indicators of alcohol use and long-term sickness absence, adjusting for possible confounding factors, (ii) whether the risk function between average volume of consumption and sickness absence is modified by heavy episodic drinking (HED), and (iii) to what extent the risk for sickness absence among abstainers is due to health selection bias.Data and methods:The study was based on data from the Stockholm Public Health Cohort 2006, with an analytical sample of 16,477 respondents aged 18–64 years. The outcome included register-based long-term (> 14 days) sickness absence. Negative binominal regression was used to estimate the association between sickness absence and average weekly volume of consumption, frequency of HED, and both in interaction.Results:Abstainers, chronic heavy drinkers and respondents with the highest frequency of HED had approximately two-fold higher rates of sickness absence relative to the reference groups, i.e., moderate drinkers and those with HED one to 6 times per year. Adjustment for confounding factors did not materially affect the shape of the risk function. After exclusion of abstainers with alcohol-related problems, or poor health, the estimates for abstainers became non-significant. Moderate drinkers with HED did not have significantly higher rates of sickness absence than moderate drinkers without HED.Conclusions:Our results suggest a significant association between alcohol use and sickness absence. There were indications that the U-shaped risk function may largely be due to health selection bias among abstainers. We found no indication of effect modification of HED on moderate drinking.

Are our nurses healthy? Cardiorespiratory fitness in a very exhausting profession

Low cardiorespiratory fitness (CRF) is related to higher risk of cardiovascular diseases, increase in all-cause mortality and higher risk of different tumors. The reverse is also true; improvement in CRF is related to decrease in mortality. Cardiopulmonary exercise testing (CPET) is a standard and also the most precise test for determination of CRF - the best possibility is the maximal test measuring different parameters including maximal oxygen consumption. Healthcare professionals throughout the developed world have markedly high rates of sickness absence, burnout, and distress compared to other sectors and this leads to higher risk factors. The study aimed to assess CRF in a group of nurses in a big hospital and compare it with population norms and available published results. Nurses over 50 years of age working in one faculty hospital were gradually included in the study from the beginning of 2018. These nurses work in physically demanding positions. A CPET was carried out following the Bruce protocol. 90 nurses (84 females and 6 males), mean age 55.7 years, were evaluated by CPET. The resting blood pressure was within the norm in 58 persons (64.44%), maximal oxygen consumption in 61 persons (67.8%), W/kg in 25 persons (46.2%). We detected a hypertension reaction in 28 persons (31.1%), some types of arrhythmia in 17 persons (18.9%) and signs of ischaemia in 8 persons (8.9%). The result of CPET led to further examination in 42 persons (46.6%). Detailed examination resulted in change of medication in 21 nurses (23.3%). New diseases were diagnosed in 15 nurses (hypertension, atrial fibrillation, mitral valve prolapse indicated for cardiac surgery, coronary artery stenosis, and lipid disorders). It was concluded that the usage of CPET during the regular medical check-ups significantly increases detection of hidden diseases and thus improves the care for nurses.

Understanding sickness absence in nurses and personal support workers: Insights from frontline staff and key informants in Northeastern Ontario.

Nurses and personal support workers (PSWs) have high sickness absence rates in Canada. Whilst the evidence-based literature helped to identify the variables related to sickness absenteeism, understanding "why" remains unknown. This information could benefit the healthcare sector in northeastern Ontario and in locations where healthcare is one of the largest employment sectors and where nursing staff have high absence and turnover rates. To identify and understand the factors associated with sickness absence among nurses and PSWs through several experiences while investigating if there are northern-related reasons to explain the high rates of sickness absence. In this descriptive qualitative study, focus group sessions took place with registered nurses (n = 6), registered practical nurses (n = 4), PSWs (n = 8), and key informants who specialize in occupational health and nursing unions (n = 5). Focus group sessions were transcribed verbatim followed by inductive thematic analysis. Four main themes emerged, which were occupational/organizational challenges, physical health, emotional toll on mental well-being, and northern-related challenges. Descriptions of why such factors lead to sickness absence were addressed with staff shortage serving as an underlying factor. Despite the complexity of the manifestations of sickness absence, work support and timely debriefing could reduce sickness absence and by extension, staff shortage.

Meta-analysis of nursing-related organizational and psychosocial predictors of sickness absence.

Nursing is a stressful occupation with high rates of sickness absence. To date, there are no meta-analyses that statistically determined the correlates of sickness absence in this population. This meta-analysis examined organizational and psychosocial predictors of sickness absence among nursing staff. As a registered systematic review (PROSPERO: CRD42017071040), which followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, five databases (CINAHL, PROQuest Allied, PROQuest database theses, PsycINFO, PubMed) were reviewed to examine predictors of sickness absence in nurses and nursing assistants between 1990 and 2019. The Population/Intervention/Comparison/Outcome tool was used to support our searches. Effect sizes were analysed using random-effects model. Following critical appraisals using (i) National Institutes of Health's Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and (ii) Strengthening the Reporting of Observational Studies in Epidemiology, 21 studies were included. Nursing assistants had greater odds of sickness absence than nurses. Working night shifts, in paediatrics or psychiatric units, experiencing poor mental health, and fatigue, also increased the odds of sickness absence. There was no evidence that job satisfaction or job strain influenced sickness absence; however, job demand increased the likelihood. Finally, work support reduced the odds of lost-time. We synthesized three decades of research where several factors influenced sickness absence. Due to limited recent research, the results should be interpreted with caution as some practices may have changed overtime or between countries. Nevertheless, these findings could help in applying preventative strategies to mitigate lost-time in a vulnerable working population.

Sickness absence and sickness presence in relation to office type: An observational study of employer-recorded and self-reported data from Sweden.

ObjectivesPrevious research suggesting that open-plan office environments are associated with higher rates of sickness absence rely on self-reports which can be affected by recall bias. This paper investigates the associations of sickness absence, obtained from employer records as well as self-reports, with office type (cell offices and different sizes of open-plan offices). It additionally studies whether office type is associated with sickness presence.MethodsEmployees from two private and one public sector organization were recruited to the study. Office type was ascertained by direct observation or from employee responses to an online survey. Control variables were gender, age, public/private sector and education level. Number of days and episodes of sickness absence were calculated from employer absence records and regressed on office type using negative binomial regression (n = 988). Self-reports of sickness absence and presence were regressed on office type using ordered logistic regression (n = 1237).ResultsOffice type was generally not associated with employer records of number of episodes or days of sickness absence, except that the total number of days of leave was higher in flex offices compared to cell offices (IRR = 2.46, p = 0.007). In general, office type was not associated with self-reported days of sickness absence, apart from participants working in medium-sized open-plan offices who had 0.42 higher log-odds of absence than those working in cell offices (p = 0.004). Office type was not associated with self-reported sickness presence.ConclusionsOffice type was not associated with sickness presence nor, in general, with sickness absence, whether obtained from self-reports or company records. It is not possible to conclude from this study that open-plan offices are associated with greater sickness absence or sickness presence compared to cell offices.

Effects of exposure to workplace terrorism on subsequent doctor certified sickness absence, and the modifying role of psychological and social work factors: a combined survey and register study

BackgroundStudies have shown that terrorist attacks affect the mental and physical health of persons exposed to terrorism. When terror strikes at the workplace where people spend much time, and should feel safe, the health consequences for those affected might be severe. The aim of the study was to determine whether psychological and social work factors moderates effects of exposure to a workplace terrorist attack on subsequent doctor-certified sickness absence.MethodsThe study design combined survey data with register data on sickness absence. Data on exposure to the attack, and psychosocial working conditions were collected by a web-based questionnaire 10 months after the attack. Survey data was linked to registry data on doctor-certified sickness absence over the one-year time period following baseline. The survey response rate was 56% (n = 1974), where 80.6% (1591) gave consent to link survey data to data on sickness absence. Exposure to the attack was assessed as “Directly-”, or “Indirectly exposed”. Psychological and social work factors were measured by the General Questionnaire for Psychological and Social factors at Work (QPSNordic). Data were analyzed with negative binominal hurdle regressions.ResultsDirect exposure to the attack increased the odds of becoming sick-listed if role clarity was average (OR = 1.50) or high (OR = 2.13), but not if low (OR = 1.17). Direct exposure was associated with higher sickness absence rates if control over work pace was low (RR = 1.61). Role conflict, support from co-workers, and -superior showed weaker evidence of moderating effects of exposure on sickness absence.ConclusionsExposure to the bomb explosion, as well as psychosocial working conditions affect the risk of employee sickness absence. Psychosocial working conditions seems to moderate effects of exposure to workplace terrorism on subsequent sickness absence. Organizations would benefit from striving for good psychological and social working conditions both as preventions against illness and sickness absence, and as measures in the aftermath of a workplace terrorist attack.

Equal health at work? Protocol for an observational study of work organisation, workload and musculoskeletal complaints among women and men in grocery retail

IntroductionWomen generally report more work-related musculoskeletal complaints than men and have higher rates of sickness absence, even within occupations. One likely reason is that work tasks within the occupation are...

Individual- and Company-Level Predictors of Receiving Vocational Rehabilitation: A Multilevel Study of Finnish Private Sector Workplaces.

Purpose The aim of this study was to examine the magnitude of company-level variation in vocational rehabilitation (VR) and to determine which individual- and company-level characteristics are associated with receiving VR due to mental disorders, musculoskeletal diseases, and other somatic diseases. Methods A 30% random sample of all Finnish private sector companies with more than 10 employees aged 25-62years at the end of 2010 (5567 companies with 300,601 employees) was followed up for the receipt of VR over the next 6 years. Company size and industry, as well as gender, age, education, social class and sickness absence measured both at the individual- and company-level were used as explanatory variables in multilevel logit models. Results After controlling for the individual-level characteristics, 12% of the variance in VR was attributed to the company level. The proportion was largest in VR due to musculoskeletal diseases. Receiving VR was more common among women, older employees (except the oldest age group), those with low education (particularly due to musculoskeletal diseases), low social class, and previous sickness absence. Receiving VR was more common in larger companies, and in construction and in health and social work, and less common in professional, scientific and technical activities. Furthermore, receiving VR was more common in companies with low proportion of highly educated employees and with higher sickness absence rates. Conclusions Company-level variation in receiving VR was substantial. Adopting the practices of the companies with highest participation in VR could help to avoid work disability problems.

Gender difference in sickness absence: Do managers evaluate men and women differently with regard to the appropriateness of sickness absence?

Aims: Women have much higher rates of sickness absence than men, but the causes of the difference are not well understood. This study examines whether managers have more lenient attitudes towards women's than towards men's absence, as this might contribute to higher rates of sickness absence among women. Differences between managers and other employees are also assessed. Methods: Vignettes were used to measure attitudes towards the legitimacy of sickness absence. The vignettes consisted of brief case descriptions of individuals considering asking their physicians for sick leave, with information about the medical condition (mainly taken from the descriptions in ICPC-2), occupation and gender. Respondents judged how appropriate sickness absence was in each case. Quota sampling was used, and the effective sample size was 899 managers and 1396 other employees, with each respondent evaluating either four or six vignettes. Generalised ordinal logistic regression was used. Results: The gender of the vignette person had no effect on the managers' evaluations of the appropriateness of sickness absence. Irrespective of the gender of the vignette person, however, managers were generally more restrictive than non-managers. Conclusions: Different attitudes on the part of managers towards sickness absence in men and women do not seem to contribute to gender differences in sickness absence, but managers are generally more restrictive compared to non-managerial employees.

Individual- and company level determinants of vocational rehabilitation: a multilevel study

Abstract Backround Vocational rehabilitation (VR) is considered an important means to combat work ability problems and enable people to continue working despite health problems. We examined the magnitude of company level variation in VR and determined which individual- and company level characteristics are associated with access to VR due to mental disorders, musculoskeletal diseases, and other somatic diseases. Methods A 30% random sample of all Finnish private sector companies with more than 10 employees aged 25-62 years at the end of 2010 (5.567 companies with 300.601 employees) was followed up for incident VR for six years. Company size and industry, as well as gender, age, education, social class and sickness absence measured both at the individual- and company level, were used as explanatory variables in multilevel logit models. Results After controlling for the individual level covariates, companies accounted for 12% of the variance in VR. The proportion was largest in VR due to musculoskeletal diseases. VR was more common among women, older employees (except the very oldest age group), those with low education (particularly due to musculoskeletal diseases), low social class, and previous sickness absence. VR was more common in larger companies, and in construction and in health and social work, and less common in professional activities. VR was more common in companies with low proportion of highly educated employees and with higher sickness absence rates. Conclusions Company level variation in VR was substantial after controlling for individual level characteristics of the employees. The employer may have an important role in the prevention of work disability through vocational rehabilitation. Key messages Company level variation in vocational rehabilitation was substantial after controlling for individual level characteristics of the employees. The employer may have an important in the prevention of work disability through vocational rehabilitation.

Cluster headache: Prevalence, sickness absence, and disability pension in working ages in Sweden.

To estimate the prevalence of cluster headache in working-aged people, compare sickness absence rates and disability pension in cluster headache patients to rates in a matched comparison group, and explore associations of sociodemographic factors with such rates. Through population-based registers, we identified 3,240 people aged 16-64, living in Sweden in 2010, who at least once during 2001-2010 received inpatient or specialized outpatient health care with cluster headache (ICD-10 code G44.0) as main diagnosis. A comparison group (n = 16,200), matched for age, sex, type of living area, and educational level, from the total population aged 16-64 (n = 5,945,895) was used. Outcomes were sickness absence (>14 days) and disability pension during 2010. Crude and adjusted prevalence rates and odds ratios with 95% confidence intervals were computed. The prevalence of cluster headache in working-aged people was 0.054%. In 2010, 17.30% of the cluster headache group and 9.16% of the comparison group had been on sickness absence. In the cluster headache group, female patients had higher sickness absence rates (25.31%) and full-time disability pension (13.17%) than male patients (13.38% and 8.79%). Cluster headache patients older than 35 had higher rates than those of the same age in the comparison group. Further, cluster headache patients born outside Sweden were more likely to have full-time disability pension than patients born in Sweden. Much higher rates of the patients had sickness absence or disability pension than in the comparison group. Further shown differences related to sex, age, and other sociodemographic factors need to be addressed.

Randomized controlled trial of acceptance and commitment therapy and a workplace intervention for sickness absence due to mental disorders.

Mental disorders contribute to high rates of sickness absence (SA) and impaired work functioning. The aim of the present study was to evaluate the efficacy of 3 interventions targeting SA of workers. Participants (n = 352; 78.4% females) of working age with current employment, and SA due to depression, anxiety disorders, or exhaustion disorder, were recruited to the study and randomized to (a) acceptance and commitment therapy (ACT), (b) a workplace dialogue intervention (WDI), (c) a combination of ACT and WDI, or (d) treatment as usual (TAU). For SA days, there was a significant interaction effect for the follow-up period, in which ACT + WDI generated more SA compared with TAU. When diagnostic group was included as a moderator, participants with exhaustion disorder had less SA days in the WDI group compared with TAU. For symptoms of depression, anxiety, and stress-related ill health, there were significant interaction effects for ACT and ACT + WDI, when compared with TAU, from pre- to postmeasurement (small to moderate between-groups effect sizes). Within-group effect sizes pre- to postmeasurement (Cohen's d) ranged from .55 to 1.17 (ACT), .40 to .94 (WDI), .26 to 1.13 (ACT + WI), and -.06 to .70 (TAU). There were no differences between groups during follow-up for symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).