Recurrent Sickness Absence Research Articles

Incidence Rates and Predictors of Recurrent Long-Term Mental Sickness Absence Due to Common Mental Disorders.

Several predictors have been identified for mental sickness absence, but those for recurrences are not well-understood. This study assesses recurrence rates for long-term mental sickness absence (LTMSA) within subgroups of common mental disorders (CMDs) and identifies predictors of recurrent LTMSA. This historical prospective cohort study used routinely collected data from 16,310 employees obtained from a nationally operating Dutch occupational health service (ArboNed). Total follow-up duration was 23,334 person-years. Overall recurrence rates were assessed using Kaplan-Meier estimators. Recurrence rates within subgroups of CMDs were calculated using person-years. Univariable and multivariable Cox proportional hazards models were used to identify predictors. 15.6% of employees experienced a recurrent LTMSA episode within three years after fully returning to work after a previous LTMSA episode. Highest recurrence rates for LTMSA were observed after a previous LTMSA episode due to mood or anxiety disorders. Mood or anxiety disorders and shorter previous episode duration were predictors of recurrent LTMSA. No associations were found for age, gender, company size, full-time equivalent and job tenure. Employees should be monitored adequately after they fully returned to work after LTMSA. It is recommended to monitor high-risk employees (i.e. employees with mood or anxiety disorders and short LTMSA episode) more intensively, also beyond full return to work. Moreover, diagnosis of anxiety and depressive symptoms should be given a higher priority in occupational healthcare.

Factors Related to the Recurrence of Sickness Absence Due to Common Mental Health Disorders: A Systematic Review.

Employees who experience sickness absence (SA) due to common mental disorders (CMD) are at increased risk of recurrent sickness absence (RSA). This systematic literature review examines the factors at different levels in the work and non-work context that increase or decrease the likelihood of RSA due to CMD. The resulting knowledge enables more accurate identification of employees at risk of RSA. We conducted a search in June 2023 using the following databases: PubMed, PsycInfo, Web of Science, Cumulative Index to Nursing & Allied Health Literature (Cinahl), Embase and Business Source Ultimate (BSU). Inclusion criteria were as follows: (self-)employees, CMD, related factors, RSA. The quality of the studies was assessed using the Mixed Methods Appraisal Tool (MMAT). The Individual, Group, Leader, Organisation and Overarching/social context (IGLOO) model were used to cluster the found factors and these factors were graded by evidence grading. Nineteen quantitative and one qualitative studies of mainly high and some moderate quality were included in this review. A total of 78 factors were found. These factors were grouped according to the IGLOO levels and merged in 17 key factors. After evidence grading, we found that mainly low socioeconomic status (SES) and the type of previous SA (short-term SA and SA due to CMD) are predictors of an increased risk of RSA. Having a low SES and previous experience of SA (short term, or due to CMD) are factors that predict the chance of RSA, implying the need for prolonged support from occupational health professionals after the employee has returned to work.

Commuting and sick leave: a retrospective longitudinal study among a Belgian military population

ObjectivesIn a military context, people often have to deal with long commuting distance. The aim of the current study is to investigate to what extent commuting distances predict sickness absence...

The effects of a national, voluntary agreement for a more inclusive working life on work participation following long-term sickness absence: a Norwegian cohort study.

This study aimed to estimate the average individual effect of the company-level Norwegian Agreement on a More Inclusive Working Life (IA Agreement) on individuals' (i) sustained return to work after a sickness absence (SA) episode, and (ii) recurrent SA. Using register data, 79 253 men and 94 914 women born in Norway 1967-1976 were followed for one year between 2005 and 2010 after returning to work from an SA episode (>16 days). Weighted Cox proportional hazard models analysed time to first exit from work by companies' IA status (IA/non-IA). Weighted cumulative incidence differences between IA and non-IA groups with 95% bootstrapped confidence intervals (CI) were calculated for the competing events of full SA, graded (<100%) SA, unemployment/economic inactivity, education, disability pension, and death/emigration. Stabilised inverse probability of treatment weights balanced IA/non-IA groups according to nine covariates. Analyses were stratified by gender, and separately for two initial SA diagnoses (musculoskeletal and psychological). Both men [adjusted hazard ratio (HR) 0.96, 95% CI 0.93-0.99] and women (adjusted HR 0.97, 95% CI 0.94-0.99) in IA companies were less likely to exit work in the year following SA. Similar findings were seen among individuals with musculoskeletal diagnoses and women with psychological diagnoses. Men with psychological diagnoses were more likely to exit work. Recurrent full and graded SA were more likely, and unemployment/economic inactivity less likely, in IA companies. However, the estimated effects were small and the CI often included the null. Individuals working in IA companies were more likely to remain in work. This was mainly due to reduced unemployment/economic inactivity, suggesting the IA Agreement may have influenced work participation through other means than reduced SA.

Level of education and sustainable return to work among long-term sick-listed workers with depression: a register-based cohort study (The Norwegian GP-DEP Study)

ObjectivesSick-listed workers with depression are at higher risk of long-term, recurrent sickness absence and work disability, suggesting reduced likelihood of sustainable return to work (SRTW). Though likelihood of RTW has...

School ethos and recurring sickness absence: a multilevel study of ninth grade students in Stockholm

Abstract Background A non-negligible proportion of Swedish students is recurrently absent from school due to various health problems. Recurring absence from school has potentially severe consequences for future prospects. Thus, identifying factors that may contribute to counteracting recurring sickness absence among students is important. The aim of this study was to investigate whether higher levels of teacher-reported school ethos were associated with lower levels of recurring sickness absence among their students, when adjusting for relevant confounders at the student- and the school-level. Methods Data from four cross-sectional surveys performed in 2014 and 2016 were combined. The Stockholm School Survey was carried out among 9,298 ninth grade students (ages 15-16 years) in 147 school units, and the Stockholm Teacher Survey was performed among 2,024 teachers in the same units. School ethos was captured by an index of 12 teacher-reported items that was aggregated to the school-level. Recurring student sickness absence was based on self-reports and defined as absence on &amp;gt; 10 occasions during the current school year. Student-level control variables were gender, family structure, parental education, parental unemployment and migration background. School-level control variables were sociodemographic composition and student-teacher ratio. Two-level logistic regressions were performed. Results About 9.5% of the students reported recurrent sickness absence. Students attending schools with higher levels of teacher-rated school ethos had a lower likelihood of reporting recurring sickness absence compared with those attending schools with lower levels of ethos, even when adjusting for potential confounders at the student- and the school-level (OR 0.78, p = 0.015). Conclusions Recurring sickness absence was less common among students attending schools with higher levels of teacher-rated ethos. The findings suggest that schools have the capacity to promote student health. Key messages A strong school ethos was linked with lower levels of recurring sickness absence among the students, even when adjusting for potential confounders at the student- and the school-level. A strong school ethos may contribute to counteracting recurring sickness absence among students.

Employment sustainability after return to work among Japanese stroke survivors

PurposeFew studies have investigated the work continuance rate among stroke survivors who return to work (RTW). The objective of this study was to investigate work sustainability after RTW and the causes of recurrent sickness absence (RSA) among Japanese stroke survivors.MethodsData on stroke survivors were collected from an occupational health register. The inclusion criteria were as follows: employees who were aged 15–60 years old and returned to work after an episode of sick leave due to a clinically certified stroke that was diagnosed during the period from 1 January 2000 through 31 December 2011.Results284 employees returned to work after their first episode of stroke-induced sick leave. The work continuance rate for all subjects was 78.8 and 59.0% at one and 5 years after the subjects’ RTW, respectively. After returning to work, the subjects worked for a mean of 7.0 years. Of 284 employees who returned to work, 86 (30.3%) experienced RSA. The RSA were caused by recurrent strokes in 57.0% (49/86) of cases, mental disorders in 20.9% (18/86) of cases, and fractures (often due to accidents involving steps at train stations or the subject’s home) in 10.5% (9/86) of cases. 21 employees resigned after returning to work. The resignation rates at 1 and 5 years were 4.9 and 7.6%, respectively. According to the multivariate analysis including all variables, the subjects in the ≥ 50 year group were at greater risk of work discontinuation than the ≤ 49 year (reference) age group (HR: 2.26, 95% CI 1.39–3.68).ConclusionsOccupational health professionals need to provide better RTW support to stroke survivors and should pay particularly close attention to preventing recurrent strokes, mental disorders, and fractures.

The clinical effectiveness of a cognitive behavioural therapy intervention in a work setting: a 5-year retrospective analysis of outcomes.

The National Institute for Health and Clinical Excellence (NICE) guidance recommends Cognitive Behavioural Therapy (CBT) as part of multidisciplinary occupational mental health interventions for people with long-term or recurrent short-term sickness absence from work (NICE, 2009). Despite this, there is a paucity of data for both randomised trials for CBT and literature that supports the transferability of CBT into occupational environments. This service evaluation aimed to evaluate the clinical effectiveness of CBT by analysing data from a partnership scheme between a local authority and a local heath board using a routine employee population. A clinical cohort of 81 employees referred through the partnership scheme completed CBT over a 5-year period via a CBT nurse therapist. A sample of 76 employees was included in the evaluation who completed pre-/post-measures to establish outcome. Of these, 30 were followed up at a 3-year point, completing the same measures. Each of the clinical measures yielded significant outcomes at 95% confidence intervals, and large effect sizes using Cohen's d both at post-test and follow-up. No significant difference was shown between post-treatment and follow-up outcomes. CBT was demonstrated to be clinically effective within an occupational mental health setting. In conclusion, partnership schemes with a focus on mental health between public sector agencies can have a positive outcome for the funding agency as well as individual employees.

Sickness absence among public workers in the healthcare sector of the Federal District, Brazil.

To describe the profile and indicators of sickness absence for civil servants allocated to the 18 public health units of a Federal District (Brasilia) Health Region, Brazil. Cross-sectional study of all sick leaves longer than 3 days granted in 2014. Sickness absence indicators were calculated and analyzed per sex, marital status, age, educational level, professional category, length in the job, working hours and workplace. The analyzed population (n=2,501) was granted 2,205 sick leaves in total, corresponding to 40,755 missed work days. The prevalence of sickness absence was 39%, the leave frequency index 88%, the severity index 16 days, the average sickness absence length 42 days, and the average length of leaves 18 days. More than 85% of the missed work days corresponded to workers with recurrence of sickness absence. Mental and behavioral disorders and musculoskeletal diseases were the main causes of sick leave. Planning health actions demands accurate knowledge of the characteristics and morbidity profile of this population of workers. The results of the present study express the magnitude of sickness absence in the public health sector, and point to the need for thorough change in the organization of the work process and innovative interventions in the workplace.

Integrated mental health care and vocational rehabilitation to improve return to work rates for people on sick leave because of depression and anxiety (the Danish IBBIS trial): study protocol for a randomized controlled trial

BackgroundDepression and anxiety are among the largest contributors to the global burden of disease and have negative effects on both the individual and society. Depression and anxiety are very likely to influence the individual’s work ability, and up to 40% of the people on sick leave in Denmark have depression and/or anxiety. There is no clear evidence that treatment alone will provide sufficient support for vocational recovery in this group. Integrated vocational and health care services have shown good effects on return to work in other, similar welfare contexts. The purpose of the IBBIS (Integrated Mental Health Care and Vocational Rehabilitation to Individuals on Sick Leave Due to Anxiety and Depression) interventions is to improve and hasten the process of return to employment for people in Denmark on sick leave because of depression and anxiety.Methods/designThis three-arm, parallel-group, randomized superiority trial has been set up to investigate the effectiveness of the IBBIS mental health care intervention and the integrated IBBIS mental health care and IBBIS vocational rehabilitation intervention for people on sick leave because of depression and/or anxiety in Denmark. The trial has an investigator-initiated multicenter design. A total of 603 patients will be recruited from Danish job centers in 4 municipalities and randomly assigned to one of 3 groups: (1) IBBIS mental health care integrated with IBBIS vocational rehabilitation, (2) IBBIS mental health care and standard vocational rehabilitation, and (3) standard mental health care and standard vocational rehabilitation. The primary outcome is register-based return to work at 12 months. The secondary outcome measures are self-assessed level of depression (Beck Depression Inventory II), anxiety (Beck Anxiety Inventory), stress symptoms (Four-Dimensional Symptom Questionnaire), work and social functioning (Work and Social Adjustment Scale), and register-based recurrent sickness absence.DiscussionThis study will provide new knowledge on vocational recovery, integrated vocational and health care interventions, and prevention of recurrent sickness absence among people with depression and anxiety. If the effect on return to work is different in the intervention groups, this study can contribute to current knowledge on shared care models for health care and vocational rehabilitation services.Trial registrationClinicalTrials.gov, NCT02872051. Retrospectively registered on 15 August 2016.

Recurrent Sickness Absence due to Depression: A Two-year Cohort among Japanese Employees.

Recurrent Sickness Absence due to Depression: A Two-year Cohort among Japanese Employees.

Stability of return to work after a coordinated and tailored intervention for sickness absence compensation beneficiaries with mental health problems: results of a two-year follow-up study

Purpose: Mental health problems (MHPs) are increasingly common as reasons for long-term sickness absence. However, the knowledge of how to promote a stable return to work (RTW) after sickness absence due to MHPs is limited. The purpose of this study was to assess the effects of a multidisciplinary, coordinated and tailored RTW-intervention in terms of stability of RTW, cumulative sickness absence and labour market status after 2 years among sickness absence compensation beneficiaries with MHPs. Methods: In a quasi-randomised, controlled trial, we followed recipients of the intervention (n = 88) and of conventional case management (n = 80) for 2 years to compare their risk of recurrent sickness absence and unemployment after RTW, their cumulative sickness absence and their labour market status after 2 years. Results: We found no statistically significant intervention effect in terms of the risk of recurrent sickness absence or unemployment. Intervention recipients had more cumulated sickness absence in year one (mean difference = 58 days; p < 0.01) and year two (mean difference = 36 days; p = 0.03), and fewer were self-supported at the end of follow-up (52% versus 69%; p = 0.02). Conclusion: The intervention showed no benefits in terms of improved stability of RTW, reduced sickness absence or improved labour market status after 2 years when compared to conventional case management.Implications for RehabilitationEvidence for effective return-to-work (RTW) interventions for people with mental health problems is limited, as most research to date has been done in the context of musculoskeletal disorders.A complex, multidisciplinary intervention, detached from the workplace, does not appear to improve the stability of RTW and may actually lead to more sickness absence days and less self-support when compared to conventional case management of sickness absence beneficiaries in Denmark.A stronger focus on cooperation with social insurance officers and employers may produce better results.

Recovery and recurrence of mental sickness absence among production and office workers in the industrial sector.

Manual workers in the public sector have previously been found to be at risk of mental sickness absence (SA). As the impact of mental illness differs across economic sectors, this study investigated mental SA in the industrial sector, differentiating between office and production workers. Ten-year observational cohort study including 14 369 (8164 production and 6205 office) workers with a total of 101 118 person years. SA data were retrieved from an occupational health register. Mental SA episodes were medically certified as emotional disturbances [10th version of the International Classification of Diseases (ICD-10 R45)] or mental and behavioural disorders (ICD-10 F00-F99). The first mental SA episode since baseline was called index mental SA. Recurrences were defined as any mental SA episode occurring >28 days after recovery from index mental SA. The incidence of mental SA was higher in production workers than in office workers, but office workers needed longer time to recover from mental SA. Mental SA recurred as frequently in production workers as in office workers. The median time to recurrence was 15.9 months and tangibly shorter in office workers (14.9 months) than in production workers (16.7 months). Production and office workers aged >55 years were at increased risk of recurrent mental SA within 12 months of recovery from index mental SA. The incidence of mental SA was higher in production workers than in office workers, whereas recurrence rates did not differ between them. Occupational health providers should pay special attention to older workers as they are at increased risk of recurrent mental SA.

Effect and process evaluation of a coordinated and tailored return-to-work intervention among sickness absence beneficiaries with mental health problems in Denmark

Background We evaluated a coordinated and tailored work rehabilitation intervention (CTWR) aiming to facilitate return-to-work (RTW) of sickness absence beneficiaries with mental health problems. The intervention was a collaboration between a Danish municipality and a private rehabilitation team and was externally evaluated by our research group. We hypothesised that recipients of CTWR would return to work faster and have a lower risk of recurrent sickness absence and unemployment than recipients of conventional case management (CCM). Methods …

Prediction of future labour market outcome in a cohort of long-term sick-listed Danes.

BackgroundTargeted interventions for the long-term sick-listed may prevent permanent exclusion from the labour force. We aimed to develop a prediction method for identifying high risk groups for continued or recurrent long-term sickness absence, unemployment, or disability among persons on long-term sick leave.MethodsWe obtained individual characteristics and follow-up data from the Danish Register of Sickness Absence Compensation Benefits and Social Transfer Payments (RSS) during 2004 to 2010 for 189,279 Danes who experienced a period of long-term sickness absence (4+ weeks). In a learning data set, statistical prediction methods were built using logistic regression and a discrete event simulation approach for a one year prediction horizon. Personalized risk profiles were obtained for five outcomes: employment, unemployment, recurrent sickness absence, continuous long-term sickness absence, and early retirement from the labour market. Predictor variables included gender, age, socio-economic position, job type, chronic disease status, history of sickness absence, and prior history of unemployment. Separate models were built for times of economic growth (2005–2007) and times of recession (2008–2010). The accuracy of the prediction models was assessed with analyses of Receiver Operating Characteristic (ROC) curves and the Brier score in an independent validation data set.ResultsIn comparison with a null model which ignored the predictor variables, logistic regression achieved only moderate prediction accuracy for the five outcome states. Results obtained with discrete event simulation were comparable with logistic regression.ConclusionsOnly moderate prediction accuracy could be achieved using the selected information from the Danish register RSS. Other variables need to be included in order to establish a prediction method which provides more accurate risk profiles for long-term sick-listed persons.

Risk factors of recurrent sickness absence due to depression: a two-year cohort study among Japanese employees

Depression has a high recurrence rate among employees. There have been few studies investigating risk factors for recurrent sickness absence due to depression after return to work (RTW). The objective of this study was to identify potential risk factors. Subjects were 540 full-time employees at the biggest telecommunication company in Japan who returned to work from April 2002 to March 2008 after their first leave of absence due to depression. The Cox proportional hazard model was employed to find risk factors for recurrent sickness absence by analyzing variables including demographic, work-related and work environmental factors. Of 540 study subjects, 200 employees (37.0 %) experienced recurrent sickness absence due to depression after RTW within the follow-up period. Higher organizational job demand evaluated by the Brief Job Stress Questionnaire (BJSQ) was found to be a risk factor (OR 1.46, 95 % CI 1.01-2.10) for recurrent sickness absence due to depression adjusted for confounding factors. High organizational job demand (evaluated by BJSQ) is a risk factor for recurrent sickness absence due to depression after RTW.

Process evaluation of a problem solving intervention to prevent recurrent sickness absence in workers with common mental disorders

Common mental disorders (CMDs) are a major cause of sickness absence. Twenty to 30% of the workers who return to work after sickness absence due to CMDs experience recurrent sickness absence. We developed the Stimulating Healthy participation And Relapse Prevention (SHARP)-at work intervention, a problem solving intervention delivered by occupational physicians (OPs), to prevent recurrent sickness absence in this worker population in The Netherlands. A process evaluation was conducted alongside a cluster-randomised controlled trial to (1) evaluate whether the SHARP-at work intervention was implemented according to the protocol and differed from treatment in the control group, and (2) to investigate the relationship between the key elements of the intervention and the effect outcome (i.e. recurrent sickness absence). We collected process data for both the intervention and control group on recruitment, reach, dose delivered, dose received, fidelity, context and satisfaction. Data on recurrent sickness absence was collected through the registry system of the collaborating occupational health service. The study was performed in the Netherlands, and between 2010 and 2012, 154 OPs and 158 participants participated. Compared to the control group, participants in the intervention group more frequently had two or more consultations with the OP (odds ratio [OR] = 3.2, 95% confidence interval [CI] = 1.2–8.8) and completed more assignments (OR = 33.8, 95% CI = 10.4–109.5) as recommended in the intervention protocol. OPs and participants were satisfied with the intervention and rated it as applicable. Several individual intervention components were linked to the effect outcome. The process evaluation showed that the SHARP-at work intervention was conducted according to the protocol for the majority of the participants and well-received by OPs and participants. Furthermore, the intervention differed from treatment in the control group. Overall, the results provide support for implementing the intervention in practice.

Prevention of recurrent sickness absence in workers with common mental disorders: results of a cluster-randomised controlled trial

ObjectivesWorkers with common mental disorders (CMDs) frequently experience recurrent sickness absence but interventions to prevent this are lacking. The goal of this study was to evaluate the effectiveness of the...

Prefrontal dysfunction in remitted depression at work reinstatement using near-infrared spectroscopy

A long-term and/or recurrent sickness absence from work due to depression has been an important health problem in industrial countries. In addition, previous sick leave is a risk factor of recurrence. However, many characteristics, especially biological aspects, have not been investigated in remitted depressive patients who were ready to return to work from sickness absence. Therefore, the purpose of this study is to clarify the pathophysiological characteristics of patients who were at risk for recurrence of sickness absence. We recruited 21 patients and 16 healthy control subjects. All patients were ready to return to work within one month from long-term sickness absence. All subjects were examined for prefrontal function represented by oxyHb changes during the verbal fluency task (VFT) and the Stroop task using near-infrared spectroscopy. Suppressed prefrontal reaction during the VFT and increased prefrontal reaction during the Stroop task were observed in the patient group compared with the control group. Significantly lengthened reaction time was observed in the incongruent condition in the patient group during the Stroop task. Depressive patients showed impaired executive function measured by the Stroop task and had prefrontal dysfunction despite clinical remission. Residual prefrontal dysfunction may be one biological reason for repetitive sickness absence.

Predictors of recurrent sickness absence among workers having returned to work after sickness absence due to common mental disorders

The aim of this study was to investigate whether sociodemographic, disease-related, personal, and work-related factors - measured at baseline - are predictors of recurrent sickness absence (SA) at 6 and 12 months follow-up among workers who returned to work after SA due to common mental disorders (CMD). Based on a cluster-randomized controlled trial, this prospective study comprised 158 participants, aged 18-63 years, with partial or full return to work (RTW) and an occupational physician-diagnosed CMD. Data on predictors were collected with questionnaires and administrative data. Outcome was the incidence of recurrent SA (ie, decreased work for ≥30% of contract hours due to all-cause SA regardless of partial or full RTW) at 6 and 12 months follow-up. Longitudinal logistic regression analysis with backward elimination was used. We found that company size >100 [odds ratio (OR) 2.59, 95% confidence interval (95% CI) 1.40-4.80] and conflicts with the supervisor (OR 2.21, 95% CI 1.21-4.04) were predictive of recurrent SA. Having ≥1 chronic diseases decreased the risk of recurrent SA (OR 0.54, 95% CI 0.30-0.96). Two work- and one disease-related factor predicted the incidence of recurrent SA among workers with CMD. Healthcare providers can use these findings to detect and help workers who have returned to work and are at higher risk for recurrent SA. Furthermore, future interventions to prevent recurrent SA could focus on supervisor conflicts.