Risk Of Long-term Sickness Absence Research Articles

The role of job strain in the relationship between depression and long-term sickness absence: a register-based cohort study

PurposeThough individuals with depression and those with poor working conditions are more likely to be on long-term sickness absence (LTSA), less is known about how working conditions may modify the associations between depression status and LTSA. This study aims to examine the association between depression and LTSA among Swedish workers with different levels of job strain and its individual components (job demands and job control).MethodsAll Swedish workers 30 − 60 years old (N = 3,065,258) were studied in 2005. At baseline (2005–2010), workers were categorized as: without depression, being prescribed antidepressants, and being in inpatient/outpatient care. Job strain was measured using a Swedish Job Exposure Matrix, and data on LTSA were obtained from 2011 to 2021. The association between depression and LTSA was assessed using Cox proportional-hazards regression stratified by categories of job strain.ResultsCompared to workers without depression, workers with depression had higher risk of LTSA across all job strain levels. Depression was associated with the highest hazards of LTSA in active jobs, but a similar population attributable fraction (PAF) was found across categories of job strain, indicating similarities between the different categories.ConclusionThere was evidence of a moderating effect of job strain in the relationship between depression and LTSA, but also evidence that this was due to differences in baseline depression prevalence in the different job strain categories. Future research is needed to determine alternative factors which could be relevant for reducing LTSA among those who have already developed depression.

Cardiorespiratory fitness in midlife and subsequent incident depression, long-term sickness absence, and disability pension due to depression in 330,247 men and women

ObjectiveSpecific information for whom and when cardiorespiratory fitness (CRF) is associated with depression risk is lacking. We aimed to study the association between adulthood CRF and incident depression, long-term sickness absence, and disability pension due to depression, as well as examine moderation of sex, age, education, and occupation on associations. MethodsA large prospective cohort study follows participants over time with Swedish occupational health screenings data. The study includes 330,247 individuals (aged 16–79 years, 46% women) without a depression diagnosis at baseline. CRF was estimated from a submaximal cycle test. ResultsCRF was associated beneficially from low to higher levels with incident depression and long-term sickness absence due to depression. Further, CRF at high levels (≥46 ml/min/kg) was associated with a decreased risk of receiving disability pension due to depression. The associations remained after adjustment for age and sex, but not lifestyle-related factors and co-morbidity. Participants with moderate and high CRF had 16% and 21%, respectively, lower risk for incident depression, and participants with high CRF had 11% lower risk for long-term sickness absence due to depression. Associations between higher CRF and the outcomes were mainly evident in men, younger participants, and individuals with low education. ConclusionIn a large sample of adults without a depression diagnosis at baseline, higher CRF was shown to be beneficially related to the risk of incident depression and, to some extent, long-term sickness absence due to depression. If causal, targeted interventions focusing on increasing CRF in these sub-groups should be prioritized.

Long-term sickness absence among adults with ADHD: the role of psychosocial working conditions

Abstract Background Symptoms of Attention-deficit/hyperactivity disorder (ADHD) do not only occur during childhood but often persist into adulthood and affect individuals’ ability to work. Adults with ADHD compared to those without ADHD are at a higher risk of negative labour market outcomes, such as long-term sickness absence (LTSA). Identifying modifiable factors in the workplace such as psychosocial working conditions may be a plausible strategy to lower this risk. This study aimed to investigate the effect modification of job control and job demands on the risk of LTSA among adults with ADHD. Methods The study population consisted of around 3.7 million individuals aged 20-60 years in Sweden in 2009. Of them, 0.3% had a diagnosis of ADHD extracted from the national patient registers. LTSA was defined as having one sick-leave spell of 90 days or more between 2010-2020. Job control and job demands were measured using job exposure matrices. Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of LTSA among adults with ADHD compared to those without. Stratified analysis was conducted to test the effect modification by job demand-control status. Results During the follow-up, 812,971 (22%) adults had LTSA. Both men and women with a diagnosis of ADHD were at a higher risk of LTSA (HR 1.75, 95% CI 1.68-1.82 and HR 1.61, 95% CI 1.55-1.68, respectively) compared to those without ADHD, after adjusting for demographics, previous LTSA, and other mental and somatic disorders. The increased risk of LTSA among adults with ADHD was present regardless of the levels of job control, job demands and job demand-control categories (HRs ranged from 1.55 to 2.10). Conclusions Adults with a diagnosis of ADHD have a higher risk of LTSA and job demand-control status does not seem to substantially modify this risk. Future studies identifying factors in the workplace that may potentially help prevent LTSA among adults with ADHD are highly warranted. Key messages • Adults with ADHD have a higher risk of LTSA regardless of the job demand-control status. • There is an urgent need to identify factors that may help improve the work ability of this population.

Is the association between alcohol use and sickness absence modified by socioeconomic position? findings from the Stockholm public health cohort

BackgroundThe distribution of sickness absence tends to be socially patterned less is however known about the underlying mechanisms and pathways of the social gradient found in sickness absence. The present study aims to investigate (i) if the risk function between average volume of alcohol consumption and sickness absence is modified by socio-economic position (SEP), and (ii) whether such an effect modification can be attributed to differences in drinking patterns and other risk factors including other lifestyle behaviours, health status, and working conditions.MethodsThe study was based on data from the Stockholm public health cohort 2006, with an analytical sample of 13 855 respondents aged 18–64 years. Self-reported information on occupational class (a measure of SEP), alcohol consumption, other lifestyle behaviour, health and working conditions was collected from the survey. The outcome of long-term (> 14 days) sickness absence between 2006 and 2008 was obtained from national registers. Negative binomial regression was used to estimate the Incidence Rate Ratios (IRR) with 95% confidence intervals (CI).ResultsIn the initial analyses, heavy drinking manual workers had a 5-fold increased risk of long-term sickness absence compared to non-manual employees who were moderate drinkers, and approximately 60% of the excess risk among heavy drinking manual workers was attributable to an interaction between alcohol use and SEP. Adjusting for working conditions was associated with the largest attenuation of the risk estimate, compared to other lifestyle behaviors and health. In the fully adjusted model, the IRR was further attenuated for the manual workers and the joint effect of SEP and heavy drinking remained in the final model with an attributable proportion of 49%.ConclusionsIndividuals in Sweden with lower levels of SEP appear to be more vulnerable to alcohol consumption in relation to sickness absence, where differences in working conditions explained a large part but not all of the differential vulnerability.

Musculoskeletal pain intensity and risk of long-term sickness absence in the general working population: A prospective cohort study with register follow-up

Determining predictors of sickness absence could allow for better screening, guidance, and development of preventive efforts aimed at those in increased risk. This study aimed to determine the prospective association between musculoskeletal pain intensity and risk of incident register-based long-term sickness absence in the general working population, as well as to determine the population attributable fraction.Drawing on data from a nation-wide questionnaire survey, this prospective cohort study followed a representative sample of the Danish general working population without recent long-term sickness absence (≥6 consecutive weeks) (n = 69,273) for long-term sickness absence up to two years (mean follow-up: 93 weeks) in a national register. The predictor was musculoskeletal pain intensity in the neck/shoulder and low-back during the preceding three months rated on an 11-point numerical rating scale from 0 to 10.The weighted incidence of long-term sickness-absence was 8.9% during two-year follow-up (n = 6165). We observed a clear dose-response association between musculoskeletal pain intensity of the neck/shoulder or low-back and the risk of incident long-term sickness absence, with a lower threshold of increased risk of 4 and 3 (scale 0–10) for neck/shoulder (HR (95% CI): 1.25 (1.09–1.42)) and low-back pain (HR (95% CI): 1.13 (1.00–1.29)), respectively. Prevention of pain intensities at or above 4 out of 10 could potentially prevent 17% (population attributable fraction, PAF (95% CI): 16.8 (13.6–20.1)) of the total long-term sickness absence in the general working population. Large-scale interventions to prevent and manage musculoskeletal pain need to be documented and implemented.

Does it matter for health if steps are taken during work or leisure? A prospective accelerometer study using register-based long-term sickness absence

BackgroundWalking is known to be good for health. However, it is unknown whether it matters if steps are taken during work or leisure. Therefore, we aimed to examine the prospective association between accelerometer-measured steps taken during work or leisure and register-based long-term sickness absence (LTSA).MethodsWe included 937 blue- and white-collar workers from the PODESA cohort who wore a thigh-based accelerometer over four days to measure number of steps during work and leisure. Steps were divided into domain based on diary data. First event of LTSA was retrieved from a national register with four years’ follow-up. We used Cox proportional hazard models to analyze the association between domain-specific and total daily steps and LTSA, adjusted for age, sex, job type, smoking, and steps in the other domain (e.g., work/leisure).ResultsWe found more steps at work to be associated with a higher LTSA risk [Hazard Ratio (HR):1.04; 95% CI: 1.00–1.08 per 1000 steps]. No significant association was found between steps during leisure and LTSA (HR: 0.97; 95% CI: 0.91–1.02), nor between total daily steps and LTSA (HR: 1.01; CI 95% 0.99–1.04).ConclusionsMore steps at work were associated with higher risk of LTSA, while steps during leisure was not clearly associated with LTSA risk. These findings partly support ‘the physical activity paradox’ stating that the association between physical activity and health depends on the domain.

Safety climate at work and risk of long-term sickness absence: Prospective cohort with register follow-up among 63,500 workers

ObjectiveSafety climate at work is a known predictor of accidents and may therefore have consequences for absenteeism. This study investigates the relevance of safety climate at work as a predictor for the risk of long-term sickness absence (LTSA). MethodsWe followed 63,500 employees of the general working population in Denmark, without prior LTSA, in four biannual national cohort surveys in the period 2012–2018 for two years in a national register of social transfer payments. Weighted Cox-regression was used to control for age, gender, survey year, education, lifestyle, psychosocial work factors, occupational group, and depressive symptoms. We determined the prospective association of the number of safety climate problems (0–5) with the risk of LTSA of six or more week’s absence. ResultsDuring follow-up, 5,743 employees developed LTSA (weighted percentage: 8.6%). Compared with individuals not reporting any safety climate problems, those reporting 1, 2, 3 and 4–5 problems experienced significantly increased risk of LTSA with hazard ratios of 1.13, 1.18, 1.20 and 1.44, respectively. Sensitivity analyses, including only those with physically demanding work and stratifying for gender, showed the same tendencies, although only reaching statistical significance for 4–5 safety climate problems. Interaction analyses showed that gender, age and education, did not modify the association between number of safety climate problems and risk of LTSA. ConclusionThe presence of safety climate problems at work increases the risk of LTSA in the general working population. The presence of safety climate problems can be considered a proactive indicator that actions need to be taken to improve safety, health, and wellbeing in the workplace.

Organizational injustice and sickness absence: The moderating role of locked-in status

Organizational injustice is known to negatively affect employees’ health and to increase the risk for sickness absence. The negative health effects are also known to be more pronounced in uncontrollable, strain increasing, situations at the workplace. This study tests whether locked-in status, i.e., being stuck in a non-preferred workplace, modifies the associations between injustice perceptions and frequent (≥2 times/yr) and long (≥ 8 days/yr) sickness absence. The sample contained 2631 permanent employees from the Swedish Longitudinal Occupational Survey of Health in 2018 and 2020. Multigroup structural equation modelling was used to compare the proposed relationships between employees who are locked-in in their workplace and employees who are not. We found a positive association between higher overall organizational injustice and long sickness absence two years later, with the association being stronger for the locked-in group. Also, higher injustice was associated with more frequent sickness absence, but only for those not being locked-in.Employees being locked-in seem to have higher risk of long-term sickness absence which might indicate more serious health problems. Employees not being locked-in more often take short sickness absence, which could indicate a coping behaviour to handle high strain. This study adds knowledge to the role of locked-in status as a moderator in the much-studied relationship between organizational justice and health as well as to the multiple reasons underlying sickness absence.

Emotional demands and all-cause and diagnosis-specific long-term sickness absence: a prospective cohort study in Sweden.

High emotional demands at work require sustained emotional effort and are associated with adverse health outcomes. We tested whether individuals in occupations with high emotional demands, compared with low demands, had a higher future risk of all-cause long-term sickness absence (LTSA). We further explored whether the risk of LTSA associated with high emotional demands differed by LTSA diagnoses. We conducted a prospective, nationwide cohort study on the association between emotional demands and LTSA (>30 days) in the workforce in Sweden (n = 3905685) during a 7-year follow-up. Using Cox regression, we analyzed sex-stratified risks of all-cause and diagnosis-specific LTSA due to common mental disorders (CMD), musculoskeletal disorders (MSD) and all other diagnoses. Multivariable adjusted models included age, birth country, education, living area, family situation and physical work demands. Working in emotionally demanding occupations was associated with a higher risk of all-cause LTSA in women [hazard ratio (HR) = 1.92, 95% confidence interval (CI): 1.88-1.96] and men (HR = 1.23, 95% CI: 1.21-1.25). In women, the higher risk was similar for LTSA due to CMD, MSD and all other diagnoses (HR of 1.82, 1.92 and 1.93, respectively). In men, risk of LTSA due to CMD was pronounced (HR = 2.01, 95% CI: 1.92-2.11), whereas risk of LTSA due to MSD and all other diagnoses was only slightly elevated (HR of 1.13, both outcomes). Workers in occupations with high emotional demands had a higher risk of all-cause LTSA. In women, risk of all-cause and diagnosis-specific LTSA were similar. In men, the risk was more pronounced for LTSA due to CMD.

Duration and intensity of occupational lifting and risk of long-term sickness absence: Prospective cohort study with register follow-up among 45 000 workers

This study aimed to investigate the prospective association of lifting duration and lifting load with the risk of long-term sickness absence (LTSA). We followed manual workers with occupational lifting (N=45 346) from the Work Environment and Health in Denmark Study (2012-2018) for two years in a high-quality national register on social transfer payments (DREAM). Cox regressions with model-assisted weights were employed to estimate the risk of LTSA from lifting duration and loads. During follow-up, 9.6% of the workers had an episode of LTSA. Compared to workers with seldom lifting (reference), workers lifting ½ and ¾ of the workday had increased risk of LTSA [hazard ratios (HR) of 1.36 [95% confidence interval (CI) 1.20-1.56] and 1.22 (95% CI 1.07-1.39)], respectively. Lifting load showed a positive exposure-response association with LTSA (trend test, P<0.01), with HR for lifting 5-15, 16-29, and ≥30 kg at 1.11 (95% CI 1.02-1.22), 1.17 (95% CI 1.03-1.34), and 1.29 (95% CI 1.11-1.50), respectively. Age-stratified analyses showed increased risk of LTSA among workers ≥50 years with a high proportion of work-related lifting compared to their younger counterparts. Occupational lifting for ½ the workday increased the risk of LTSA, while higher occupational lifting load exacerbated this risk in an exposure-response manner. The study underscores the importance of reducing both lifting duration and loads for prevention of LTSA at the workplace, especially among older workers.

Time period effects in work disability due to common mental disorders among young employees in Sweden-a register-based cohort study across occupational classes and employment sectors.

We aimed to investigate time period effects in the risk of work disability, defined as long-term sickness absence (LTSA) and disability pension (DP) due to common mental disorders (CMDs), among young employees according to employment sector (private/public) and occupational class (non-manual/manual). Three cohorts, including all employed individuals with complete information on employment sector and occupational class, aged 19-29 years and resident in Sweden on 31 December 2004, 2009 and 2014 (n = 573516, 665138 and 600889, respectively) were followed for 4 years. Multivariate-adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) were estimated to examine the risk of LTSA and DP due to CMDs using Cox regression analyses. In all cohorts, public sector employees had higher aHRs for LTSA due to CMDs than private sector employees, irrespective of occupational class, e.g. aHR, 95% CI: 1.24, 1.16-1.33 and 1.15, 1.08-1.23 among non-manual and manual workers in cohort 2004. The rates of DP due to CMDs were much lower in cohorts 2009 and 2014 than 2004 leading to uncertain risk estimates in the later cohorts. Still, public sector manual workers had a higher risk for DP due to CMDs than manual workers in the private sector in cohort 2014 than in 2004 (aHR, 95% CI: 1.54, 1.34-1.76 and 3.64, 2.14-6.18, respectively). Manual workers in the public sector seem to have a higher risk of work disability due to CMDs than their counterparts in the private sector calling for the need for early intervention strategies to prevent long-term work disability.

Do different job demands interact as predictors of long-term sickness absence? A register-based follow-up on 55 467 Danish workers

ObjectivesTo assess interactions between combinations of quantitative demands, emotional demands, unclear and contradictory demands, and violence/threats of violence in the prospective association with risk of long-term sickness absence (LTSA).MethodsWe included...

Time period effects in work disability due to common mental disorders among young employees

Abstract Background Previous research on period effects in risk for work disability due to common mental disorders across employment sectors and occupational classes in young employees is lacking. Temporal changes in the healthcare system or social insurance policies or other structural/organisational changes could contribute to such time period effects. We aimed to investigate time period effects in the risk of work disability, defined as long-term sickness absence (LTSA) and disability pension (DP) due to common mental disorders (CMDs), among young employees according to their employment sector (private/public) and occupational class (non-manual/manual). Methods Three cohorts, including all employed individuals with complete information on employment sector and occupational class, aged 19-29 years and resident in Sweden on the 31-Dec-2004, 2009 and 2014 (n = 573,516, 665,138 and 600,889 individuals in cohort 2004, 2009 and 2014, respectively) were followed for four years. Crude and multivariate-adjusted hazard ratios (HRs and aHRs, respectively) with 95% confidence intervals (CIs) were estimated regarding the risk of LTSA and DP due to CMDs using Cox regression analyses. Results In cohort 2004, public sector employees had a higher relative risk for LTSA due to CMDs than private sector employees (aHR, (95%CI): 1.24, 1.16-1.34 and 1.18, 1.11-1.26 among non-manual and manual workers). These associations were similar in the later cohorts. Compared to cohort 2004, the rate of DP due to CMDs was considerably lower in the later cohorts leading to uncertainties in the risk estimates limiting the comparability for time period effects regarding the risk of DP due to CMDs across employment sectors and occupational classes. Conclusions Stricter regulation changes regarding the receipt of DP in Sweden, rather than other time period events, may have differentially affected the risk of work disability among young non-manual and manual employees working in the private and public sectors. Key messages

Does occupational forward bending of the back increase long-term sickness absence risk? A 4-year prospective register-based study using device-measured compositional data analysis.

Forward bending of the back is common in many jobs and a risk factor for sickness absence. However, this knowledge is based on self-reported forward bending that is generally imprecise. Thus, we aimed to investigate the dose-response relation between device-measured forward bending at work and prospective register-based risk of long-term sickness absence (LTSA). At baseline, 944 workers (93% from blue-collar jobs) wore accelerometers on their upper back and thigh over 1-6 workdays to measure worktime with forward bending (>30˚ and >60˚) and body positions. The first event of LTSA (≥6 consecutive weeks) over a 4-year follow-up were retrieved from a national register. Compositional Cox proportional hazard analyses were used to model the association between worktime with forward bending of the back in an upright body position and LTSA adjusted for age, sex, body mass index (BMI), occupational lifting/carrying, type of work, and, in an additional step, for leisure time physical activity (PA) on workdays. During a mean worktime of 457 minutes/day, the workers on average spent 40 and 10 minutes on forward bending >30˚ and >60˚ in the upright position, respectively. Five more minutes forward bending >30˚ and >60˚ at work were associated with a 4% [95% confidence interval (CI) 1.01-1.07] and 8% (95% CI 1.01-1.16) higher LTSA risk, respectively. Adjustment for leisure-time PA did not influence the results. We found a dose-response association between device-measured forward bending of the back and prospective LTSA risk. This knowledge can be integrated into available feasible methods to measure forward bending of the back for improved workplace risk assessment and prevention.

Chronic disorders, work-unit leadership quality and long-term sickness absence among 33 025 public hospital employees.

This study aimed to examine the association between work-unit level leadership quality and individual-level long-term sickness absence (LTSA) in the hospital sector and effect modification by chronic disorders. This longitudinal analysis included 33 025 Danish public hospital employees who were followed-up for one year after baseline in March 2014. Leadership quality was assessed by questionnaire with mean responses aggregated by work-unit and characterized in tertiles. LTSA during follow-up was determined from employer records. Chronic disorders at baseline was assessed from the Danish hospital and prescription registers. We performed multilevel logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) adjusting for potential confounders. We evaluated interaction between chronic illness and low leadership quality on multiplicative and additive scales. We identified employees as healthy (60.8%) or with somatic (31.6%), mental (3.3%), or both somatic and mental (4.3%) disorders. During follow-up, 6% of employees registered a LTSA. Medium and high leadership quality were associated with lower risk of LTSA with OR of 0.84 (95% CI 0.76-0.94) and 0.73 (95% CI 0.65-0.82) respectively, compared to low leadership quality. Associations were similar for healthy employees and employees with only somatic disorders, whereas no association was observed for employees with mental disorders (in presence or absence of somatic disorders). No statistically significant (α=0.05) interactions between leadership quality and chronic disorders on LTSA were observed. The findings suggest that the quality of leadership in work units is associated with risk of long-term sick leave in the Danish public hospital sector and that strong leadership protects employees against LTSA.

Workplace Bullying and Long-Term Sickness Absence—A Five-Year Follow-Up Study of 2476 Employees Aged 31 to 60 Years in Germany

Objectives: The aim was to investigate workplace bullying as a risk factor for five-year occurrence of long-term sickness absence (LTSA) in a representative cohort of employees in Germany. Methods: In the German Study on Mental Health at Work (S-MGA) (n = 2476), episodes of long-term sickness absence (LTSA) between baseline and follow-up were assessed in the follow-up interview. Workplace bullying was measured in the baseline interview using a hybrid approach, which combines the behavioural experience and self-labelling methods. Through binomial regressions, the association of baseline level of workplace bullying with first-episode LTSA during follow-up was estimated, adjusting for baseline age, gender, occupational level, smoking status and physical demands at work. Results: Severe bullying heightened the risk for LTSA by approximately 50% (Rate ratio—RR: 1.48, 95% Confidence interval—CI: 1.05; 2.19), while occasional bullying heightened the risk by 15% (RR: 1.15, CI: 0.85; 1.55). When excluding LTSA events occurring in the first 2 years, the associations between bullying and LTSA increased by approximately one third. Conclusions: Workplace bullying seems to be a risk factor for LTSA even when controlling for occupational level, smoking and physical demands at work and when taking possible reverse causality into account. We suggest to investigate effects of LTSA in more settings, to distinguish between occasional and severe bullying and employ longer follow-up intervals.

Overtime Work and the Incidence of Long-term Sickness Absence Due to Mental Disorders: A Prospective Cohort Study.

BackgroundAlthough previous research has focused on the association between long working hours and several mental health outcomes, little is known about the association in relation to mental health-related sickness absence, which is a measure of productive loss. We aimed to investigate the association between overtime work and the incidence of long-term sickness absence (LTSA) due to mental disorders.MethodsData came from the Japan Epidemiology Collaboration on Occupational Health Study (J-ECOH). A total of 47,422 subjects were followed-up in the period between April 2012 and March 2017. Information on LTSA was obtained via a study-specific registry. Baseline information was obtained at an annual health checkup in 2011; overtime working hours were categorized into <45; 45–79; 80–99; and ≥100 hours/month.ResultsDuring a total follow-up period of 211,443 person-years, 536 people took LTSA due to mental disorders. A Cox proportional hazards model showed that compared to those with less than 45 hours/month of overtime work, those with 45–79 hours/month were at a lower risk of LTSA due to mental health problems (hazard ratio [HR] 0.63; 95% confidence interval [CI], 0.56–0.71) while those with overtime work of ≥100 hours/month had a 2.11 (95% CI, 1.12–3.98) times higher risk of LTSA due to mental health problems.ConclusionEngaging in excessive overtime work was linked with a higher risk of LTSA due to mental health problems while the lower risk observed among individuals working 45–79 hours/month of overtime work might have been due to a healthy worker effect.

Combined psychosocial work factors and risk of long-term sickness absence in the general working population: Prospective cohort with register follow-up among 69 371 workers.

This study aimed to investigate the importance of combined psychosocial work factors for the risk of long-term sickness absence (LTSA). We followed 69 371 employees in the general working population (Work Environment and Health in Denmark study 2012-2018), without LTSA during the preceding year, for up to two years in the Danish Register for Evaluation of Marginalization. Using k-means cluster analyses and weighted Cox-regression controlling for age, gender, survey year, education, health-behaviors, and physical work demands, we determined the prospective association of 11 identified clusters - based on the combination of nine psychosocial work factors (recognition, quantitative demands, work pace, emotional demands, influence, justice, role clarity, role conflicts, and support from colleagues) - with the risk of LTSA. During 124 045 person-years of follow-up, 6197 employees developed LTSA (weighted 8.5%). Using the cluster with the most favorable psychosocial scores as reference, clusters scoring poorly on several combined psychosocial factors had increased risk of LTSA. The cluster scoring poor on all nine psychosocial factors exhibited the highest risk [hazard ratio (HR) 1.68, 95% confidence interval (CI) 1.45-1.94]. Scoring poorly on one or two psychosocial factors did not increase the risk of LTSA when combined with favorable scores on the other psychosocial factors. Interaction analyses showed that gender, but not age and education, modified the association between cluster and LTSA. Scoring poorly on several combined psychosocial work factors plays an important role in the risk of LTSA. Scoring favorably on several psychosocial factors outweighed the potentially adverse effects of scoring poorly on one or two factors.

Diabetes, prediabetes, and long-term sickness absence due to mental disorders: Japan Epidemiology Collaboration on Occupational Health Study

ObjectivesTo investigate the association of diabetes and prediabetes with long-term sickness absence (LTSA) due to mental disorders or specific mental disorders. MethodsA prospective cohort study was conducted using data from the Japan Epidemiology Collaboration on Occupational Health Study. A total of 62,065 workers who received health check-ups in 2011 (nine companies) or 2014 (two companies) and were followed up to March 31, 2020 were included in this study. Diabetes status was defined based on the American Diabetes Association criteria, and diabetes was differentiated into diabetes with/without anti-diabetic treatment for additional analysis. A Cox proportional hazards regression model was used to investigate these associations. ResultsDuring maximum 8-year follow-up period, 1024 participants underwent LTSA due to mental disorders. The adjusted hazard ratio (aHR) and corresponding 95% confidence interval (CI) of LTSA due to all mental disorders were 1.10 (0.88–1.38) and 1.45 (1.07–1.98) for prediabetes and diabetes, respectively. Diabetic individuals with/without treatment were both at a high risk of LTSA due to mental disorders. For specific mental disorders, diabetes was associated with a higher risk of LTSA due to reaction to severe stress and adjustment disorders (aHR = 3.02, 95% CI = 2.01–4.52) while it was marginally associated with LTSA due to depressive episode (aHR = 1.25, 95% CI = 0.98–1.60). Prediabetes was also associated with LTSA due to reaction to severe stress and adjustment disorders (aHR = 1.41, 95% CI = 1.08–1.84). ConclusionsThe present study suggests the importance of screening diabetes status and providing psychological support for decreasing the risk of LTSA due to mental disorders within working populations.

Potential of micro-exercise to prevent long-term sickness absence in the general working population: prospective cohort study with register follow-up

This study assesses the potential of workplace-based micro-exercise (brief and simple exercise bouts) to prevent long-term sickness absence (LTSA) at the population level. In the Work Environment and Health in Denmark Study (2012–2018), we followed 70,130 workers from the general working population, without prior LTSA, for two years in the Danish Register for Evaluation of Marginalisation. We used Cox regression with model-assisted weights and controlled for various confounders. From 2012 to 2018, the percentage of workers in Denmark using workplace-based micro-exercise during and outside of working hours increased from 7.1 to 10.9% and from 0.8 to 1.4%, respectively. The incidence of long-term sickness absence (at least 30 days) was 8.4% during follow-up. The fully adjusted model showed reduced risk of long-term sickness absence from using micro-exercise during working hours, (HR 0.86, 95% CI 0.77–0.96), but not when used outside of working hours. If used by all workers, micro-exercise during working hours could potentially prevent 12.8% of incident long-term sickness absence cases (population attributable fraction). In conclusion, micro-exercise performed during working hours holds certain potential to prevent incident long-term sickness absence in the general working population. Large-scale implementation of workplace-based micro-exercise may represent an unexploited opportunity for public health promotion.