Self-reported Health Complaints Research Articles

Variations between world regions in individual health: a multilevel analysis of the role of socio-economic factors

Living in a particular region might affect health. We aimed to assess variations between regions in individual health. The role of socio-economic factors in the associations was also investigated. World Health Survey data were analysed on 220 487 individuals. Main outcomes included self-reported health, health complaints and disability. The main predictor variable was a modified regional classification of countries. Multilevel logistic regression was used to assess associations between individual health and regions, while accounting for individual and country-level socio-economic factors, notably occupation, education, national income and female literacy. Individual health varied significantly between regions. For instance, compared with Western Europeans, Southern Asians and Western Africans reported poorer health, the odds ratios (ORs) being 2.05 [95% confidence interval (CI) 1.31-3.23] and 1.88 (95% CI 1.26-2.81), respectively. Accounting for socio-economic factors attenuated or, in a few cases, reversed the associations. For example, the OR for Southern Asia and Western Africa respectively became 0.94 (95% CI 0.37-2.37) and 0.77 (95% CI 0.26-2.25). Individuals from Central Europe and the Former Soviet Union were the most likely to report poor health, OR 1.92 (95% CI 1.07-3.44) and OR 4.17 (95% CI 1.91-9.10) respectively. Overall, men were less likely than women to report poor health. Substantial regional variations in individual health exist, only partly explained by socio-economic factors. Additional policy and health research are needed to investigate Central Europe and Former Soviet Union rates that consistently lag behind Latin America, Asia and Africa.

Work and health: A comparison between Norwegian onshore and offshore employees

The effect of work-related variables on self reported health complaints were examined among Norwegian onshore and offshore oil workers. Differences in work and health perceptions were also examined as part of the paper. Employees working onshore and offshore in the maintenance and modification division of a large contractor company took part in the study (N=414, response rate 47.1%). The design of the study was a cross-sectional survey. A questionnaire was distributed to onshore personnel while at work - in cooperation with the personnel safety representative - and sent to the home addresses of the offshore personnel. Offshore workers perceived significantly more hazards associated with the work and experienced less control over the work pace compared to onshore workers. Onshore workers experienced significantly more pressure at work and their work tasks as more repetitive. Differences in health perceptions were identified in terms of job type in the onshore and offshore groups respectively. Different work-related factors influenced the self-reported health complaints among onshore and offshore workers. Workers in different work environments and in different job types encounter different type of threats to employee health, indicating that job type must be taken into account when studying the relationship between work-related factors and employee health.

CHILDREN’S HEALTH: AAP Publishes Oil Protection Guidelines for Children

Sparked by requests from anxious parents throughout the U.S. Gulf Coast region after the Deepwater Horizon oil rig exploded on 20 April 2010, the American Academy of Pediatrics (AAP) worked with the Pediatric Environmental Health Specialty Units (PEHSU)1 to develop fact sheets for clinicians and parents that pulled together the best available information on protecting children against oil exposures.2 The recommendations, which have been endorsed by the American College of Medical Toxicology and the American Academy of Clinical Toxicology, cover a wide range of measures addressing air, water, beach, and food issues, and they can be applied in any oil-exposure situation.3 The recommendations are only professional best estimates based on the limited information about health effects of oil spills on adults, acknowledges Katherine Kirkland, executive director of the Association of Occupational and Environmental Clinics, which runs PEHSU. “There really isn’t any research done on children,” she says. The fact sheets will be updated as more information becomes available, says Scott Needle, a Florida pediatrician and member of the AAP Disaster Preparedness Advisory Council. Along with physical health concerns, the fact sheets address psychological problems that may develop in children because of worries about their own health or that of their parents. Needle says it’s essential for parents to try to head off problems by talking with their children and to reassure them that people are working to clean up the oil and keep this from happening again. “We are also concerned about the potential long-term community effects, particularly economic and psychological, and especially affecting areas that have already been battered by severe hurricanes and other stressors in recent years,” Needle says. “The majority of our experience in long-term effects comes from studying the Exxon Valdez spill in Alaska, and affected communities there are still dealing with the mental health effects.” Even if children do not exhibit health symptoms directly, he says, their overall health and sense of well-being may continue to be impacted on a long-term basis. John Lanza, director of the Escambia County Health Department in Pensacola, Florida, had not heard of the PEHSU guidelines,4 but he says his county adopted similar recommendations based on research conducted by a consortium of Florida panhandle counties after the spill began. The county also conducted an extensive community education effort that parents and children seem to have heeded. The number of acute health problems reported so far has been minimal.5 Data on longer-term effects on children may be hard to come by, however—of the four Gulf states tracking self-reported spill-related health complaints, only Louisiana is breaking out exposure and health effect data by age,5 and no definitive plans for researching health effects on children have surfaced. Moreover, as recently as mid-September new sightings of oil were being reported for several Louisiana beaches, marshes, and offshore areas,6 and there are widespread concerns that oil will continue to resurface in still other areas when storms pass through. It’s extremely difficult to predict how soon after any given storm that it will be safe to visit shoreline areas, says Stephen West, a Coast Guard spokesman working with the Unified Area Command.

Seasonal variation in self-reported arousal and subjective health complaints

Many aspects of human physiology and behavior are seasonally related. Although there are many studies using self-ratings of, for example, subjective health and stress, few involve adjusting effects for seasonal differences. To estimate the need of adjusting for season in field studies, 24 healthy men and women were studied in a design that required them to fill in questionnaires on one workday every month, for 12 consecutive months. The results showed that ratings of stress were higher during winter and early spring, but only in the early afternoon and not in the morning or the evening. While some subjective health complaints were rated higher during winter, the ratings of energy and self-rated health did not vary throughout seasons. This concludes that seasonal variations may be a source of bias in questionnaire studies. Yet, further studies are needed to more definitely sort out which phenomena and self-rating measures that co-vary with season.

Self-reported health complaints in a primary care population living under stressful conditions in the Gaza Strip, Palestine

Background: The population in the Gaza Strip has been living under chronically stressful conditions as a result of the ongoing Israeli–Palestinian conflict. Objectives: To identify health complaints reported by attendants consulting primary care physicians in the Gaza Strip. Methods: The study took place in 10 governmental primary health care centres and 5 clinics of the United Nations Relief and Works Agency in the Gaza Strip, during autumn 2005. Self-reported health complaints were recorded through face-to-face interviews with 956 respondents using a validated and reliable questionnaire. Results: Abdominal pain and headache were the most frequent complaints reported among patients aged 18 to 44 years, accounting for 23.3% and 22.7% of total complaints in males and females, respectively. Fatigue and joint pain were the most common complaints among patients aged 45 years and above, accounting for 26% and 33.9% of total complaints in males and females, respectively. Conclusions: The most common complaints, as reported by patients attending PHC facilities were stress-related and could be attributed to the ongoing conflict and high level of violence and uncertainty in the area. These complaints present a challenge to primary care providers in their efforts to improve the everyday quality of life of Palestinian residents with scarce means and resources.

Relationship between alexithymia, mood and internalizing symptoms in children and young adolescents: Evidence from an Iranian sample

It is commonly assumed that there is a direct relationship of alexithymia with internalizing symptoms, such as Somatic Complaints. However, the fact that alexithymia is also strongly related to negative mood states suggests that the frequently found association between alexithymia and internalizing symptoms is actually mediated by mood states. Therefore, the aim of this study was to examine the unique contribution of alexithymia to the prediction of internalizing symptoms (self-reported health complaints and worrying/ruminative thoughts) in a population with children and young adolescents ( n = 579, mean age 12 years and 2 months) by testing two models through structural equation modelling. The first model assumed an indirect relationship of alexithymia with internalizing symptoms, via mood. The second model also assumed a direct relationship between alexithymia and internalizing symptoms. The results showed a clear misfit of the first model, but a good fit of the second model. These outcomes suggest that there is a unique contribution of alexithymia to the explanation of internalizing symptoms in children and young adolescents over and above negative mood.

Application of different statistical methods to estimate relative risk for self-reported health complaints among shoe factory workers exposed to organic solvents and plastic compounds

Objectives : Prevalence odds ratio (POR) is commonly used as a surrogate for relative risk (RR) in crosssectional studies. When prevalences are high, POR may be a poor approximation for RR. Prevalence ratios (PRs) are more easily interpretable when evaluating exposure effects. Our objectives were to compare estimates of PRs and corresponding 95% confidence intervals (CIs) using three different statistical methods on a real data set, furthermore, to report possible practical problems in applying the methods. Methods: Two statistical methods were compared: log-binomial regression and Cox regression. We examined selected high prevalence symptoms: headache, tingling of limbs, and breathing difficulty, and their association with solvent-exposed work tasks in 164 Hebron shoe factory workers. Results: The two methods estimated identical crude point PR estimates and quite similar adjusted estimates. CIs were wider in Cox regression than in log-binominal regression, as exemplified by adjusted estimates for the association between participation in cleaning tasks and tingling of limbs in log-binomial regression (PR=1.78; CI=1.25–2.54), Cox regression (PR=1.76; CI=1.01–3.06). When we used Cox regression with robust variance we obtained narrower CIs (PR=1.76; CI=1.19–2.60). In the log-binomial regression analysis we had to exclude a few subjects with a predicted risk exceeding one. Conclusions: Log-binomial regression is appropriate from a theoretical viewpoint. However, some individuals had a predicted risk larger than one, which caused the computation to abort. Cox regression could produce heavy ties when adjusted for confounders and yielded rather wide CIs, however, by using robust variance we will obtain narrow CIs. In conclusion, the two suggested methods have certain limitations and difficulties. However, Cox regression encountered less serious problems than in the other methods, and is also widely available.

Differential exposure and differential vulnerability as counteracting forces linking the psychosocial work environment to socioeconomic health differences

BackgroundIn this article, the link between (1) psychosocial working conditions (job demands, job autonomy, task variation, social support), (2) self-reported health (persistent fatigue, musculoskeletal complaints, emotional well-being) and (3) socioeconomic...

Discrepant Trends in Mental Health Complaints Among Younger and Older Adolescents in Sweden: An Analysis of WHO Data 1985–2005

To elucidate the time trends in self-reported mental health complaints (internalizing problems) among school children in Sweden during a time characterized by economic downturns and upturns, with a focus on possible differences across grades and genders. The study uses nationwide and repeated cross-sectional data collected five times during 1985-2005 among students in Sweden in grades 5, 7, and 9. The number of participating students each year varied between 2,933 and 4,421. The attrition rates varied between 10% and 15% in the participating schools. Data were subjected to descriptive analysis and multinomial logistic regression using a composite measure of self-reported mental health complaints. The study results show significantly higher rates of mental health complaints in 2005/2006 compared with 1985/1986 among older adolescents, in particular girls, whereas the rates are almost unchanged among younger boys and girls. Only among girls in grade 9 has there been a successively (linear) increase of mental health complaints across years of investigations. The increasing rates of mental health complaints among older adolescents, in particular girls, are a cause for concern and a challenge for public health work. By showing discrepant time trends among younger and older adolescents, the results of the study nuance the predominant and unambiguous notions about continuously deteriorating mental health among children and adolescents in Sweden. To address hypotheses concerning the causes of the discrepant time trends, suggestions are made for comparative cross-country analyses based on data from Sweden and other European countries.

An analysis of gender differences in self-reported health, use of medicines and access to information sources about medicines among adolescents

Adolescence is a key period in the emergence of gender differences in health that persist into adulthood. Knowledge about health-related gender differences among adolescents could be instrumental in informing policy and practice to effect health improvement among this age group. The main objectives of this study were therefore to investigate gender differences in self-reported health complaints and use of medicines during the preceding 3 months and access to information sources about medicines among adolescents in Malta. A self-administered questionnaire was distributed among adolescents attending secondary schools in Malta. A stratified random sample design generated a sample size of 514 students. Common health complaints, use of medicines, and sources of information about medicines were investigated by means of author-designed checklists. The analytical sample was formed from 474 usable questionnaires collected from students aged 14-16 years, of which 53.8% were females. In general, a female excess emerged for health complaints and use of medicines except for sport injuries and use of vitamins. Gender differences were statistically significant for a female excess in the retrieval of information from the package insert (p < .001), parents or adult relatives (p < .01) and friends or schoolmates (p < .05). The findings of this study underscore the need for awareness of gender differences in the health of adolescents among health care providers, policy makers, and educators. An important implication of the findings is that the health needs of adolescents could be more equitably addressed by adopting a holistic patient-oriented approach particular to the health needs of each individual.

Occupational health risks of barbers and coiffeurs in Izmir

The objective of this study was to examine self-reported occupational health risks and health complaints of barbers and hairdressers. A total of 1284 individuals from 300 workplaces in Izmir participated in this study. The workers completed the questionnaires during their training in occupational health. Self-reported symptoms were allergy: 35% and musculoskeletal symptoms: 32%. The frequency of allergy complaints was found to be significantly higher in older individuals and in women. Allergic complaints were more frequent in i) those having history of allergy, ii) in the group where the use of protective clothing and gloves was lower, iii) in smokers and in those who found ventilation in the workplace to be inadequate. Only 41.2% reported that they used gloves and 15.2% reported the use of protective clothing within the last month. It appears that poor occupational factors in barbers' salons and exposure to hairdressing chemicals bring about health problems of the hairdressers.

Empowerment bei Kindern und Jugendlichen – die Bedeutung personaler und sozialer Ressourcen und persönlicher Autonomie für die subjektive Gesundheit

Scientific research on empowerment so far is nearly exclusively focused on the adult population. Nevertheless, it is possible to show a link between empowerment and a) the developmental psychology concepts of resilience, b) autogenetic concepts and c) concepts of risks and resources. This paper aims to study the role of personal, familial and other social resources as well as personal autonomy for subjective health-ratings. A secondary analysis of the health data of 7,000 children and adolescents aged 10-17 years of the German health behaviour in school-aged children (HBSC) study as well as 1,700 children aged 11-17 years of the mental health module (BELLA Study) within the German health interview and examination survey for children and adolescents (KiGGS) was performed. Statistical analyses encompassed analyses of variance and linear regression. Analyses of the HBSC study showed a protective effect for school-class climate as well as parental support, whereby school was associated with fewer self-reported health complaints. Analyses of the BELLA/KiGGS study showed personal, familial and other social resources as well as personal autonomy as unique predictors for a better health-related quality of life (KINDL-R). This was true even if psychological problems were observed. The results confirm the importance of strengthening personal, familial and other social resources as well as the principal importance of personal autonomy for coping with health risks and health impairments. Future research explicitly focussed on empowerment could relate to the role of personal resources within children's and adolescents' contact with the medical and health care system. It can be expected that strengthening personal resources benefits and improves the communication and active participation of children and adolescents within treatment-decision and -evaluation.

Characteristics of visitors to homeopaths in a total adult population study in Norway (HUNT 2)

To study the characteristics of people visiting homeopaths in a total adult population in Norway. Data from a total population cross sectional health survey conducted in 1995-1997 in Central Norway (HUNT 2) with 65,495 participants. Variables included in the analysis were age, marital status, education, being a social welfare recipient, lifestyle (daily smoker), Hospital Anxiety and Depression Scale (HADS-T), global health perception, self-reported health complaints and a variety of diseases. Significance level p<0.01. 40,027 persons over 20 years answered the question on visits to a homeopath. 4.3% had consulted a homeopath during the last 12 months. The likelihood of a person consulting a homeopath was most strongly associated with being female (adjusted odds ratio 2.3, 95% confidence interval 2.1-2.6) and having a lower perceived global health (increasing from 1.5, 1.2-1.8 for good global health to 2.9, 1.9-4.3 for poor global health). There was a weaker but significant association between increased likelihood of visiting a homeopath and being 30-39 years (1.3, 1.1-1.4), having a HADS-T score between 10-14 (1.3, 1.1-1.6) and 15-19 (1.6, 1.3-2.0), having a health complaint the last year (1.5, 1.2-1.7), hay fever (1.7, 1.5-2.0), consulted for a psychiatric complaint (1.5, 1.3-1.8) and another chronic disease than the ones asked about in this study (1.3, 1.1-1.6). Being a smoker was significantly associated with decreased likelihood of consulting a homeopath (0.7, 0.6-0.7). There was also a trend for increased likelihood of visits to homeopaths (p<0.1) for those 60 years and over, social welfare recipients, having a chronic complaint and HADS-T score of 20 or higher, and decreased likelihood for widow(er)s. CONCLUSIONS AND PROPOSALS: Being female and having a lower perceived global health were the variables most strongly associated with visits to a homeopath. More studies on visits to homeopaths from other populations (countries, children and adolescent) are needed.

Health complaints and use of medicines among adolescents in Malta.

To investigate self-reported health complaints and the use of medicines among adolescents in Malta. A self-administered questionnaire was used to survey self-reported health complaints, the use and the sources of medicines that had been accessed, during the preceding 3 months among adolescents attending secondary schools in Malta. A stratified random sample design generated a sample size of 514 students. The health complaints and use of medicines that were investigated included ear problems/hay fever/cold/cough, headache, skin problems, sport injuries, indigestion/diarrhoea/constipation, eye problems and menstrual pain (for girls). The use of vitamins and antibiotics was also investigated. A total of 477 students participated in the final data collection. Correct information was submitted by 474 students, (aged 14-16 years), who formed the analytical sample, of which 53.8% were girls. The students reported a mean number of 2.70 (SD = 1.39) out of a total of 7 health complaints and 90.3% reported using at least 1 medicine during the preceding 3 months. The community pharmacy was cited as the most commonly accessed source for most of the medicines that were investigated. A proportion of 24.3% of the students had taken at least 1 medicine without adult guidance during the preceding 3 months. Almost 10% of those who had taken antibiotics, had accessed them from the home medicine cabinet. A high proportion of adolescents in Malta reported the use of medicines to alleviate the symptoms of common health complaints. This result is concordant with previous research carried out in the United Kingdom, Germany, Slovakia and Kuwait. A considerable proportion of students in this study had obtained medicines without adult guidance and accessed antibiotics from the home medicine cabinet. This highlights the importance of carefully designed education programs for adolescents that will integrate information about the proper use of medicines.

Measurement of Physical Environmental Parameters and Apparent Ventilation Rates Aboard Passenger Aircraft

Abstract As part of the ASHRAE RP-1262 Phase 1 study of the airliner cabin environment, measurements were made of physical environmental parameters aboard four passenger aircraft in revenue service. The objectives of these measurements were to measure physical environmental parameters and ventilation rates on board commercial airliners in revenue service and to correlate those measurements with self-reported health effects and complaints. The measurements included temperature, relative humidity, total pressure, air velocity, sound level, light level, and motion. These measurements were recorded each second throughout the flight. In addition, measurements of carbon dioxide levels in the cabin were made that, along with passenger loadings and assumed metabolic rates, allowed the calculation of an apparent air change rate. Because as another part of the study, passengers filled-out written surveys on their comfort and health experience, this study provides unique simultaneous measurement of both physical environmental parameters in an aircraft cabin and the human response. Results of these measurements are presented as temporal graphs for the duration of the flight and are compared to various benchmarks. Among the results, air change rates ranged from 10 to 16 air changes per hour, noise levels varied from 68 to 80 dBA, according to the location in the cabin. Relative humidity values declined from 30 to 35 % during the boarding process to as low as 7 to 8 % during the cruise portion of the flights. The temperature variation was greatest during the boarding process and was generally near 25°C, during the cruise portion of the flights. Over all four flights, the cabin pressure varied from 562 to 740 torr. There was a wide variation in light levels: from over 8000 lux if sunlight was present, to about 250 lux if the window shades were in use.

An international scoring system for self-reported health complaints in adolescents

Aimed to develop a unitary scoring system for the 'Health Behaviour in school-aged Children' (HBSC) symptom checklist that would facilitate cross-national comparisons and interpretation. Rasch measurement analysis and investigation of differential item functioning (DIF) were conducted. Data were obtained from the 'WHO collaborative study HBSC 2001/2002'. A total of 162,305 students aged 11, 13 and 15 years from 35 European and North American Countries were surveyed. Unidimensionality of the items and local independence were tested using means of confirmatory factor analysis. DIF across countries, age groups and gender was investigated using a logistic regression procedure. Item and person parameters were estimated according to the Rating Scale Model (RSM). All items proved to be unidimensional. One item displayed noticeable DIF across countries and was discarded. The remaining items were functioning equally across subgroups. The RSM analysis resulted in Rasch model conform item parameter estimation. Infit mean square values between 0.84 and 1.35 revealed acceptable item fit. The control of DIF enables comparable and unbiased assessment of subjective health complaints across countries, age groups and gender. A scoring algorithm could be developed which enables a cross-cultural comparable and interval-scaled assessment of subjective health complaints.

PTSD symptom clusters associated with physical health and health care utilization in rural primary care patients exposed to natural disaster

This study investigated the influence of exposure to a tornado disaster and disaster-related posttraumatic stress disorder (PTSD) symptomatology on physical health complaints and primary health care utilization among rural medical patients. One-hundred five patients completed self-report measures assessing disaster exposure, PTSD symptoms, and self-reported physical health complaints. Objective rates of health care utilization were gathered by a review of medical records. Tornado disaster exposure and generalized psychological distress were associated with physical health complaints one year following the disaster. After controlling for age, gender, and levels of predisaster health care utilization, PTSD Cluster C (avoidance) symptoms were associated with increased rates of postdisaster health care utilization. Implications of these findings for interventions within the medical system are discussed.

Perceived job demands relate to self-reported health complaints

Illness and illness behaviour are important problems in the Dutch workforce. Illness has been associated with job demands, with high demands relating to poorer health. It has not been reported whether subjective health complaints relate to job demands. To investigate whether perceived (physical and mental) workload and specific job demands are associated with self-reported health complaints. Cross-sectional study of a random sample of 983 male employees working in manufacturing industry. Job demands and health complaints were investigated using the self-completed Basic Occupational Health Questionnaire. The relationship between demands and health complaints were studied using logistic regression analysis with health complaints as the outcome variable. The questionnaires of 867 workers (88%) were suitable for analysis. The prevalence of health complaints was high. Physical workload was related to musculoskeletal symptoms. Standing work predicted pain in the legs and thoracic as well as low back pain, while sedentary work predicted low back pain. Heavy lifting predicted low back pain and pain in the extremities. Regular bending predicted low back pain and pain in the legs. Repetitive movements predicted pain in the arms and thoracic as well as low back pain. Mental workload was associated with fatigue and chest pain. Working under time pressure and working behind schedule were not related to self-reported health complaints. Perceived physical job demands matched with self-reported musculoskeletal complaints, whereas perceived mental job demands were unrelated to specific complaints.

Self-Reported Occupational Health Issues among Lithuanian Dentists

This article describes the second phase of a large study of Lithuanian dentists' health, and focuses on self-reported physical health complaints, general health state and associations between the two. In 2006, a postal questionnaire survey of all (N=2,449) licensed dentists registered with the Lithuanian Dental Association was conducted, obtaining a response rate of 68.2%. Fatigue (94.7%) and back pain (91.0%) were the most prevalent physical complaints reported, and they were also the most likely to become chronic among all physical disorders. Hypertension, joint diseases and allergy were the most prevalent diagnosed and treated diseases during the previous 12 months. Only half of the surveyed Lithuanian dentists (50.4%) rated their health as satisfactory. Logistic regression revealed that fatigue (Odds Ratio: 0.52; 95%CI: 0.29-0.94), headache (OR: 0.62; 95%CI: 0.42-0.90), hand problems (OR: 0.62; 95%CI: 0.44-0.87), chest pain (OR: 0.51; 95%CI: 0.40-0.64) and musculoskeletal complaints (OR: 0.41; 95%CI: 0.28-0.60) had a significant negative impact on dentists' self-reported general health. Overall, this study suggests that Lithuanian dentists do experience a certain amount of occupationally-related health problems. It is therefore important to increase health knowledge on occupational hazards and also to emphasize the importance of early diagnosis and treatment for these disorders in Lithuania, as elsewhere.

Health complaints and sickness absence in Norway, 1996–2003

From 1996 to 2003, the total number of sickness absence days increased by 65% in Norway. To investigate if this could be explained by a corresponding increase in the prevalence of self-reported health complaints in the same period. Representative samples of the Norwegian working population in 1996 (n = 838) and 2003 (n = 637) answered the subjective health complaints (SHC) questionnaire. The single items of the SHC questionnaire were matched with the corresponding sickness absence statistics from the National Insurance Administration in 1996 and 2003. The main finding was a poor concordance between the change in prevalence of health complaints and the change in the prevalence of sickness absence for diagnoses corresponding to these complaints. The prevalence of health complaints in Norway was high and relatively stable from 1996 to 2003. The only complaints that increased in prevalence during the period were allergy and severe asthma. Sickness absence for health complaints, however, showed a general increase. The diagnoses with the largest percentage increase in sickness absence were sleep problems, tiredness, anxiety and palpitation, although the absolute number of individuals with sickness absence for these complaints was small. The increased sickness absence in Norway from 1996 to 2003 cannot be explained by an increase in health complaints in the general population in the same period. The increase in sickness absence is most likely to be explained by multifactorial causes, such as changes in working life and health expectations.