Risk Of Long-term Sickness Absence Research Articles

Sickness absence among Finnish special and general education teachers

Although teaching is considered a high-stress profession, research on stress-related outcomes among teachers, such as absence from work due to illness (i.e. sickness absence), remains scarce. It is possible that teachers are not a homogeneous group but include subgroups with particularly high risk of sickness absence, such as special education teachers. To examine differences in sickness absence rates between special and general education teachers in a large cohort of 2291 Finnish lower secondary school teachers. Register data on teachers' job titles, sociodemographic characteristics and sickness absence were obtained from 10 municipal employers' registers. Indices of sickness absence included rates of short-term (1-3 days) and long-term (>3 days) absence spells during 2003-05. With multi-level models adjusted for individual- and school-level covariates, we found that although the absolute level of sickness absence was higher among women than among men, male special education teachers were at a 1.36-fold (95% CI: 1.15-1.61) increased risk of short-term and a 1.33-fold (95% CI: 1.01-1.76) increased risk of long-term sickness absence compared with male teachers in general education. Among women, there were no differences in sickness absence between special and general education teachers. Compared to male teachers in general education, male teachers in special education appear to have an excess risk of absence from work due to illness. Future studies should examine the causes for this excess risk and determine the need for preventive interventions.

Acts of offensive behaviour and risk of long-term sickness absence in the Danish elder-care services: a prospective analysis of register-based outcomes

To investigate associations between acts of offensive behaviour (threats, violence, bullying, and unwanted sexual attention) and risk of long-term sickness absence for eight or more consecutive weeks among female staff in the Danish elder-care services. These associations were investigated using Cox regression analysis. Data consisted of a merger between Danish survey data collected among 9,520 female employees in the Danish elder-care services and register data on sickness absence compensation. Compared to unexposed employees, employees frequently exposed to threats (HR = 1.52, 95% CI:1.11-2.07), violence (HR = 1.54, 95% CI:1.06-2.25), and bullying (HR = 2.33, 95% CI:1.55-3.51) had significantly increased risk of long-term sickness absence when adjusting for age, job function, tenure, BMI, smoking status, and psychosocial work conditions. When mutually adjusting for the four types of offensive behaviours, only bullying remained significantly associated with risk of long-term sickness absence (HR = 2.26, 95% CI: 1.50-3.42). No significant associations were found between unwanted sexual attention and risk for long-term sickness absence. Results indicate that prevention of threats, violence, and bullying may contribute to reduced sickness absence among elder-care staff. The results furthermore suggest that work organizations must be attentive on how to handle and prevent acts of offensive behaviour and support targets of offensive behaviours.

The relationship between gender segregation in the workplace and long-term sickness absence in Sweden

The aim of the study is to investigate whether the gender composition in workplaces is related to long-term sickness absence (LSA). We start off with Kanter's theory on ''tokenism,'' suggesting an increased risk of stress among minority groups (tokens), which, in turn, might increase the risk of ill health and LSA. The dataset consists of information obtained from the Swedish level of Living Survey (LNU) and the Swedish Establishment Survey (APU), linked to register-based data from the Swedish Social Insurance Agency. The longitudinal data is representative for the Swedish population and consists of 496 women and 566 men, aged 20-55 at baseline. Our study group consisted of employed persons in 1991 and we analyze, by means of piecewise constant intensity regressions, the first entry into LSA with a follow-up period of nine years. Compared with women in gender-integrated workplaces, women's risk of LSA is most elevated at both extremely male-dominated (0-20% females) and extremely female-dominated workplaces (80-100% females), although the result among women in the most male-dominated group did not reach statistical significance at the 5% level. Men's risk seems less varied by gender composition. The present study suggests that the gender composition in the workplace has an impact on the risk of LSA, especially among women. Our findings lend no support for Kanter's theory on the effects of being a token. Most likely, women's and men's different status positions have an impact on the different associations found.

Burnout Levels and Self-Rated Health Prospectively Predict Future Long-Term Sickness Absence

This study investigates the predictive validity of the Oldenburg Burnout Inventory (OLBI), and of three health indicators (depression, anxiety, and self-rated health), for long-term sickness absence (LTSA). Questionnaires were sent to all employees in a Swedish County Council (N = 6118), and the overall response rate was 65% (N = 3976). As 82% were women, only women were included in the study. Certified LTSA data were collected. Logistic regression analyses showed that high scores on exhaustion, depression, and poor self-rated health increased the risk of future LTSA (≥90 days). Support for the proposed two-factorial structure of the OLBI was found, including the dimensions of exhaustion and disengagement from work. Using burnout measures might be useful to identify those at risk for LTSA, and to enable preventive solutions in organizations.

Work environment as predictor of long-term sickness absence: Linkage of self-reported DWECS data with the DREAM register

The present overview discusses ten papers dealing with four research topics using self-reported work environment in the Danish Work Environment Cohort Study (DWECS) linked with register data on long-term sickness absence (LTSA) in the Danish Register for Evaluation of Marginalisation (DREAM). Research relied on self-reported data among 3000-5000 employees linked with registered LTSA data. Analyses were performed with Cox regression models. Risk groups: Kindergarten teachers and daycare workers were at high risk for LTSA. Mainly physical exposures but also psychosocial factors were risk factors for LTSA. Attributable fractions: A quarter of LTSA spells could be attributed to the physical work environment. Most of the association between social class and LTSA was explained by physical work environment and smoking. Mechanisms: Depressive symptoms, severe pain in hands, and low back and pain intensity were risk factors for LTSA. Only in work sites with traditional leadership did health problems predict LTSA. The linking of DWECS with DREAM has made it possible to estimate the importance of work environment factors for LTSA. Future research should deal with possible risk factors such as health problems and organisational factors.

Job demands, job resources and long‐term sickness absence in the Danish eldercare services: a prospective analysis of register‐based outcomes

To investigate associations between psychosocial job demands, job resources and cases of registered long-term sickness absence among nursing staff in the eldercare services. Research has shown that psychosocial work environment exposures predict sickness absence in healthcare settings. However, only few studies have longitudinally investigated associations between specific job demands and job resources and risk of long-term sickness absence. Questionnaire data were collected in 2004 and 2005 among all employees in the eldercare services in 35 Danish municipalities and were followed in a National register on payment of sickness absence compensation for a 1-year follow-up period (N = 7921). Three psychosocial job demands - emotional demands, quantitative demands and role conflicts - and three job resources - influence, quality of leadership and team climate - were investigated to predict risk of sickness absence for eight or more consecutive weeks in the follow-up period. Data were analysed using Cox proportional hazards model. A percentage of 6·5 of the respondents were absent for eight or more consecutive weeks during follow-up. The analyses showed that emotional demands, role conflicts, influence, quality of leadership and team climate were significantly associated with risk of long-term sickness absence. In an analysis with mutual adjustment for all job demands and job resources, influence constituted the strongest predictor of long-term sickness absence (negative association). Job demands and job resources are significantly associated with risk of long-term sickness absence. Interventions aimed at improving the psychosocial work environment may, therefore, contribute towards preventing long-term sickness absence in the eldercare services.

One-year prospective study on the effect of workplace bullying on long-term sickness absence

To examine the effect of workplace bullying on long-term sickness absence using a prospective design. Although bullying has been identified as a serious problem in the health care sector, little attention has been given to the possible effect of workplace bullying on long-term sickness absence and its implications. The sample consisted of 9949 employees (78.1% response rate) working in the elderly-care sector in 36 Danish municipalities. Long-term sickness absence was measured by linking a survey on work and health to the national register on social transfer payments. Among the 1171 employees that were bullied at work in the past 12 months, 1.8% were frequently bullied and 7.3% were occasionally bullied. The risk of long-term sickness absence was higher for those frequently bullied even after adjusting for psychosocial work characteristics [rate ratio (RR) = 1.92, confidence interval (CI): 1.29-2.84; P < 0.05]. This is the first prospective study that explored the effect of both frequent and occasional bullying on long-term sickness absence among health care employees. The effect of frequent bullying on long-term sickness absence was independent of the psychosocial work characteristics. Workplace bullying might impact negatively the quality of care and patients safety.

The health paradox of occupational and leisure-time physical activity

BackgroundOccupational and leisure-time physical activity are considered to provide similar health benefits. The authors tested this hypothesis.MethodsA representative sample of Danish employees (n=7144, 52% females) reported levels of occupational and...

Clinical and non-clinical depressive symptoms and risk of long-term sickness absence among female employees in the Danish eldercare sector

Background Depression has a high point and life time prevalence and is a major cause of reduced work ability and long-term sickness absence (LTSA). Less is known of the extent to which non-clinical depressive symptoms are related to the risk of LTSA. The aim of this study was to investigate how non-clinical and clinical depressive symptoms are prospectively associated to subsequent LTSA. Methods In a cohort study of 6985 female employees from the Danish eldercare sector depressive symptoms were measured by the Major Depression Inventory (MDI) and scores (0–50) were divided into groups of 0–4, 5–9, 10–14, 15–19, ≥ 20 points and clinical depression. Data was linked to a national register with information on LTSA (≥ 3 weeks). Hazard ratios (HR) for LTSA during a 1-year follow-up were calculated by Cox's proportional hazards model. Results Compared to the reference group (0–4) the HR was stronger for each subsequent group: MDI scores of 5–9: HR = 1.07 (95% CI: 0.93–1.24); 10–14: 1.38 (1.15–1.66); 15–19: 1.54 (1.20–1.98); ≥ 20: 1.96 (1.45–2.64); clinical depression: 2.32 (1.59–3.38); after adjustment for previous LTSA, age, family status, smoking, leisure time physical activity, BMI, and occupational group. Limitations Missing information on the cause of sickness absence and prevalent somatic illness. Conclusion A clear dose–response relationship exists between increasing depressive symptoms and risk of LTSA. The adverse effect of non-clinical depressive symptoms on LTSA already manifests itself at relatively low scores. Clinical relevance: this study illustrates the valuable information of considering the whole continuum of depressive symptoms.

Obesity and sickness absence: results from the CHAP study

Obesity is an increasing public health problem. A small number of studies have examined the relationship between obesity and sickness absence, with mixed results, particularly regarding short-term sickness absence. To determine if obesity is associated with short- and long-term sickness absence and to investigate the mechanisms that may underlie any association. Cross-sectional (n = 1489) and prospective (n = 625) analyses were conducted on staff from London Underground Ltd. All participants underwent regular clinical examinations that involved their height and weight being measured, obesity-related medical problems being diagnosed and psychiatric disorders being identified. The number of days taken for short- (<10 days in an episode) and long-term sickness absence were recorded by managers on an electronic database. There was a positive linear association between employees' body mass index (BMI) and the number of days' work missed due to sickness absence on both cross-sectional and prospective analyses (P < 0.001). Obesity was a risk factor for both short- and long-term sickness absence. Obese individuals typically took an extra 4 days sick leave every year. The majority of the increased risk for long-term sickness absence appeared to be mediated via co-morbid chronic medical conditions. The excess short-term sickness absence was not explained by obesity-related medical problems, psychiatric disorders or workplace factors. Obese employees take significantly more short- and long-term sickness absence than workers of a healthy weight. There is growing evidence to support employers becoming more involved in tackling obesity.

Positive work-related states and long-term sickness absence: A study of register-based outcomes

To investigate the association between positive work-related states and long-term sickness absence (LTSA). The positive states that were investigated were commitment to the work-place (CW) and experience of meaning of work (MW). This association was investigated using Poisson regression analysis. Data consisted of a merge between Danish register data on sickness absence compensation and survey data collected among 9,560 employees in the Danish eldercare sector. CW and MW were significantly associated with LTSA. Employees experiencing low MW had a significantly increased risk of LTSA for more than two and eight weeks, when adjusted for psychosocial work characteristics, work-time arrangements and physical workload. Compared to employees with low and high CW, employees with medium CW had a significantly decreased risk of LTSA for more than eight weeks, when adjusted for psychosocial work characteristics, work-time arrangements and physical workload. Furthermore, employees with low CW had an increased risk of LTSA for more than two weeks, but this association became borderline insignificant when adjusted for psychosocial work characteristics, work-time arrangements and physical workload. The analyses also revealed an interaction effect between CW and MW in predicting LTSA for more than eight weeks. CW and MW are associated with LTSA. Against our expectations, however, we found that high levels of CW and MW were not protective against LTSA. Instead, low levels of MW proved decisive in predicting LTSA, and medium levels of CW had a protective effect on LTSA for more than eight weeks.

Predicting long-term sickness absence and early retirement pension from self-reported work ability

The aim of this paper is to examine the relationship between self-reported work ability and long-term term of sickness absence or early retirement from the labour market. Data on work ability were retrieved from a representative cohort study of Danish wage earners and linked with a register of social payment transfers. In all, 4.743 individuals were followed from 2001 to 2005. Cox regression was used for the analyses. A one point decrease in perceived work ability, on a 10 point scale, was associated with an increased risk of long-term sickness absence (LTSA) of 15.1% (95% CI 12-19%, P<0.0001) and an increased risk of early retirement from the labour market of 33% (95% CI 20-48%, P<0.0001). Reports of reduced work ability were significantly associated with both an increased risk of onset of LTSA and early retirement from the labour market, after adjustment for socio-demographic characteristics and lifestyle variables.

The influence of household work and of having children on sickness absence among publicly employed women in Sweden

To investigate whether family obligations influence the risk of sickness absence among female municipal employees in Sweden. A 1-year prospective cohort study of 1464 female municipal employees <50 years of age in Sweden in 2000 was conducted using questionnaire responses and absence data from the employers' personnel records. The relative risk of having children <16 years of age in the home, marital status, household work, financial situation, working hours and work-family conflicts for repeated sick-leave spells (>or=4 spells) and long-term sickness absence (>or=28 days) were calculated by applying Poisson regression models. Women reporting financial strain or work-family conflicts were at elevated risk for long-term sickness absence. Having children was not a risk factor for repeated sick-leave spells or long-term sickness absence among married/cohabiting women. Single women with children had a two-fold greater risk of repeated sick-leave spells than single women without children. The findings suggest that the combination of gainful employment and children does not influence the risk of repeated sick-leave spells or long-term sickness absence among married/cohabiting publicly employed women. However, this was not true for single women with children, which indicates that their circumstances are particularly strained.

Structured Early Consultation with the Occupational Physician Reduces Sickness Absence Among Office Workers at High Risk for Long-Term Sickness Absence: a Randomized Controlled Trial

Objective To examine the efficacy of structured early consultation among employees at high risk for future long-term sickness absence, in the prevention and/or reduction of sickness absence. The focus of the experiment was the timing of the intervention, that is, treatment before sickness absence actually occurs. Methods In the current prospective randomized controlled trial (RCT), employees at high risk for long-term sickness absence were selected based on responses to a 34-item screening questionnaire including demographic, workplace, health and psychosocial factors associated with long-term sickness absence (>28 days). A total of 299 subjects at risk for future long-term sickness absence were randomized in an experimental group (n = 147) or in a control group (n = 152). Subjects in the experimental group received a structured early consult with their occupational physician (OP), in some cases followed by targeted intervention. The control group received care as usual. Sickness absence was assessed objectively through record linkage with the company registers on sickness absence over a 1 year follow-up period. Results Modified intention-to-treat analysis revealed substantial and statistically significant differences (p = 0.007) in total sickness absence duration over 1 year follow-up between the experimental (mean 18.98; SD 29.50) and control group (mean 31.13; SD 55.47). Per-protocol analysis additionally showed that the proportion of long-term sickness absence spells (>28 days) over 1 year follow-up was significantly (p = 0.048) lower in the experimental (9.1%) versus control group (18.3%). Conclusions Structured early consultation with the OP among employees at high risk for future long-term sickness absence is successful in reducing total sickness absence.

The Impact of Health Behaviour on Long Term Sickness Absence: Results from DWECS/DREAM

Long term sickness absence (LTSA) is a major public health problem. We examined the impact of four, potentially modifiable, health behaviours, such as smoking, alcohol consumption, leisure time physical activity, and the associated variable of body mass index on the risk of subsequent LTSA. This was done by following a representative population sample of 5,020 Danish employees aged 18-69 for 18 months in a national register on social transfer payments. Risk estimates for onset of LTSA and etiologic fractions were computed. In women, ex-smokers and heavy smokers had an increased risk of LTSA of 1.61 and 2.05 respectively after adjustment for age, family status, socio economic status, school education, physical and psychosocial work environment exposures and diagnosed disease. In men, effect estimates were smaller and only borderline significant in the fully-adjusted model. The etiologic fraction of smoking was 17.4% in men and 25.5% in women.

Depressive symptoms and the risk of long-term sickness absence

The aim of this paper is to examine the impact of depressive symptoms on long-term sickness absence in a representative sample of the Danish workforce. This prospective study is based on 4,747 male and female employees, participating in the Danish Work Environment Cohort Study. Depressive symptoms were measured at baseline. Data on sickness absence were obtained from a national register on social transfer payments. Onset of long-term sickness absence was followed up for 78 weeks. The cumulative 78 weeks incidence for the onset of long-term sickness absence was 6.5% in men and 8.9% in women. Both men and women with severe depressive symptoms (<or=52 points) were at increased risk of long-term sickness absence during follow-up (men: HR=2.69; 95% CI: 1.18, 6.12; women: HR=2.27; 95% CI: 1.25, 4.11), after adjustment for demographic, health related, and lifestyle factors. When we divided the depressive symptom scores into quartiles, we found no significant effects with regard to long-term sickness absence. Severe depressive symptoms, as measured with the MHI-5, increased the risk of future long-term sickness absence in the general Danish working population. However, effects were not linear, but occurred mostly only in those employees with high levels of depressive symptoms.

Psychological Distress, Fatigue and Long-Term Sickness Absence: Prospective Results From the Maastricht Cohort Study

Little is known about psychological distress as a risk factor for the onset of long-term sickness absence and even less about the influence of fatigue in this relationship. We examined the relationship between psychological distress and the onset of long-term sickness absence during 18 months of follow-up while considering fatigue. Analyses were based on 6403 employees participating in the Maastricht Cohort Study. Psychological distress was related to the onset of long-term sickness absence (women relative risk 1.45, 95% confidence interval = 1.23-1.72; men 1.33, 1.21-1.46). Adjustment for fatigue weakened the associations, particularly in women. Caseness analyses revealed different effects of psychological distress and fatigue in the onset of long-term sickness absence in men and women. The findings underline the need for interventions aiming at psychological distress and, depending on the gender, also at fatigue, to reduce the risk of long-term sickness absence.

Workplace expansion, long-term sickness absence, and hospital admission

Downsizing has in previous studies, as well as in public debate, been associated with increased sickness absence. No studies have, however, looked at the long-term relation between workplace expansion and morbidity. We investigated exposure to personnel change during 1991-96 in relation to long-term (90 days or longer) medically certified sickness absence and hospital admission for specified diagnoses during 1997-99 in 24?036 participants with a complete employment record in the biennial national Swedish Work Environment Surveys from 1989 to the end of 1999. Accumulated exposure to large expansion (> or =18% per year) was related to an increased risk of long-term sickness absence (odds ratio 1.07 [95% CI 1.01-1.13], p=0.013) and hospital admission (1.09 [1.02-1.16], p=0.017). In this context, odds ratio signifies the change in odds for each additional year of exposure, varying from 0 to 6. Moderate expansion (> or =8% and <18% per year), was associated with a decreased risk of admission (0.91 [0.84-0.98], p=0.012). Moderate downsizing (> or =8% and <18% per year) was associated with an increased risk of sickness absence (1.07 [1.02-1.12], p=0.003). The strongest association between large expansion and sickness absence was in women in the public sector (1.18 [1.08-1.30], p=0.0002), corresponding to an odds ratio of 2.77 [1.62-4.74] between full exposure (all 6 years) and no exposure. This study confirms earlier findings that downsizing is associated with health risks. It also shows that repeated exposure to rapid personnel expansion, possibly connected with centralisation of functions, statistically predicts long-term sickness absence and hospital admission. Although no conclusions about causal pathways can be drawn from our results, this exposure should be considered in future studies, policy making, and occupational health care practice.

Physical leisure-time activities and long-term sick leave: a 15-month prospective study of nurses' aides.

The objective of the study was to determine the relationship between physical leisure-time activities and the occurrence of long-term sick leaves in nurses' aides. Of 5563 Norwegian nurses' aides who were not on sick leave when they completed a questionnaire in 1999, 4744 (85.3%) completed a second questionnaire 15 months later. Brisk walks (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.63 to 0.98), aerobics or gymnastics (OR, 0.71; 95% CI, 0.49 to 1.02), and other physical leisure activities (OR, 0.81; 95% CI, 0.66 to 1.00) for 20 minutes or more at least once a week predicted fewer long-term sick leaves (> 14 days), after adjustments for baseline health complaints, demographic and familial characteristics, former and current smoking, and work factors. In conclusion, regular physical leisure-time activity may be associated with a reduced risk of long-term sickness absence in nurses' aides.