Sickness Absence Rates Research Articles

Outcome of multidisciplinary investigations of long-term sickness absentees

Objective. The aim was to investigate the results of multidisciplinary investigations of long-term sickness absentees regarding diagnoses, degree and prognoses of work incapacity, and need of rehabilitation measures and whether this was associated with socio-demographic factors.Method. A cross-sectional study of 545 long-term (>1 year) sickness absentees referred to multidisciplinary investigations by the Social Insurance Office. Data was obtained from questionnaires and medical records. The patients were examined by specialists in psychiatry, orthopaedic surgery, and rehabilitation medicine who afterwards agreed on diagnoses, work incapacity, time to return to work (RTW), and rehabilitation measures. Descriptive statistics and logistic regression were used for description and analyses of data. Data on age, country of birth, education, employment and marital status were included.Results. The prevalence of psychiatric diagnoses was 72%, and 58% of the patients had that in combination with somatic diagnoses. Most patients were assessed to be capable of RTW within 6 – 24 months after further rehabilitation measures. Higher age was associated with a negative prognosis of RTW and those patients were less often recommended additional rehabilitation.Conclusion. Despite long-term sickness absence and high rates of psychiatric and somatic diagnoses in combination, RTW was considered possible for most patients after further rehabilitation measures.

The effect of pain on sickness absence among middle-aged municipal employees

Objectives: To study the effects of pain on sickness absence, taking into account physical and psychosocial work load and socio-economic position. Methods: Data consisted of City of Helsinki personnel register...

Managerial leadership is associated with self-reported sickness absence and sickness presenteeism among Swedish men and women

The objective of this study was to investigate the relationship between managerial leadership and self-reported sickness absence/presenteeism among Swedish men and women. Five thousand one hundred and forty-one Swedish employees, 56% of the participants in a nationally representative sample of the Swedish working population, were included in this cross-sectional questionnaire study. The leadership dimensions measured were five subscales of a standardized leadership questionnaire (Global Leadership and Organizational Behaviour Effectiveness Programme): Integrity, Team integration, Inspirational leadership, Autocratic leadership, and Self-centred leadership. Multiple logistic regression analyses were conducted, adjusting for factors in private life, employment category, labour-market sector, working conditions, self-reported general health, and satisfaction with life in general. Inspirational leadership was associated with a lower rate of short spells of sickness absence (<1 week) for both men and women. Autocratic leadership was related to a greater amount of total sick days taken by men. Sometimes showing integrity was associated with higher rate of sickness absence >1 week among men, and seldom showing integrity was associated with more sickness presenteeism among women. Managers performing Team integration were sometimes associated with women taking fewer short (<1 week) and long (>1 week) spells of sickness absence. Adjustment for self-reported general health did not alter these associations for men, but did so to some extent for women. Managerial leadership was found to be relevant for the understanding of sickness absence in the Swedish working population. There were distinctive gender differences.

Sickness absence from work in the UK

This article presents sickness absence rates by various personal and labour market characteristics from the Labour Force Survey for working-age (men aged 16 to 64 and women aged 16 to 59) employees. It also presents logistic regression analysis, which is a method to combine a range of factors affecting sickness absence to see their effect, and finally looks at other sources of information on sickness absence from work. In the period July 2007 to June 2008, around 5.8 million scheduled working days were lost to sickness or injury, this accounted for 1.5 per cent of scheduled working days. Women and those working in the public sector are most likely to be absent from work because of sickness or injury.

“Inclusive Working Life” in Norway – Experience from “Models of Good Practice” Enterprises

To determine whether enterprises belonging to the Bank of Models of Good Practice were more successful than average Norwegian enterprises in the reduction of sickness absence, promotion of early return to work, and prevention of early retirement. In 2004 we selected 86 enterprises with a total of approximately 90000 employees from the Inclusive Working Life (IWL) Bank of Models of Good Practice. One representative of workers and one of management from each enterprise received a questionnaire on the aims, organization, and the results of the IWL program by mail. Data on sickness absence, use of early retirement, and disability retirement in the 2000-2004 period were collected from the National Insurance Registry. Data on comparable enterprises were obtained from the National Bureau of Statistics. The response rate was 65%. Although the IWL campaign was directed at reducing sickness absence, preventing early retirement, and promoting employment of the functionally impaired, most attention was paid to reducing sickness absence. Sickness absence rate in Models of Good Practice enterprises (8.2%) was higher than in comparable enterprises that were not part of the Models of Good Practice (6.9%). Implementation of many IWL activities, empowerment and involvement of employees, and good cooperation with the occupational health service were associated with a lower rate of sickness absence. On average, 0.7% new employees per year received disability pension, which is a significantly lower percentage than expected on the basis of the rate of 1.3% per year in comparable enterprises. Frequent use of disability pensioning was associated with high rate of sickness absence and having many employees older than 50 years. On average, 0.4% employees per year received early retirement compensation, which was expected on the basis of national estimates. Frequent use of early retirement was associated with having many employees older than 50 years. Models of Good Practice enterprises had a higher than expected sickness absence rate. This indicates that it is difficult to identify Models of Good Practice enterprises and that they cannot be treated as role model enterprises. Good cooperation with the occupational health service and the empowerment and involvement of the employees is associated with a low sickness absence rate.

Sickness absence and psychosocial work conditions: a multilevel study

Psychosocial work conditions, particularly psychological job demands, are inconsistently associated with sickness absence rates. This might be the result of investigating the psychosocial work environment at the individual level, reflecting personal perceptions rather than actual demands. To investigate associations between sickness absence and psychosocial work conditions at both the individual and the workplace level. A cross-sectional study of insurance company employees (n = 395) in four departments. Psychological job demands, job control and job support were investigated at the individual level using the self-completed Questionnaire on Experience and Assessment of Work. An external occupational psychologist interviewed the supervisor and a group of employees of each department, assessing job demands, job control, job support and psychological distress at the workplace level. These data were related to the number of short (1-7 days), medium (8-21 days) and long (>21 days) episodes of sickness absence in the period January 2001 to December 2002. A total of 244 questionnaires (62%) were suitable for analysis. Quantitative job control scores at the individual level differed from qualitative data at the workplace level. Self-assessed job demands and control were unrelated to sickness absence. The rates of short and long episodes of absence were higher in the department with combined high demands and low control, assessed at the workplace level. The associations between psychosocial work conditions and sickness absence depended on the level at which the former were assessed. More multilevel research is needed to disentangle the relations between psychosocial work conditions and sickness absence.

The effect of social deprivation on local authority sickness absence rates

There is an extensive body of research relating to the association between ergonomic and psychosocial factors on sickness absence rates. The impact of deprivation on health indices has also been extensively investigated. However, published research has not investigated the extent of any association between standard measures of deprivation and sickness absence and ill-health retirement rates. To establish if a relationship exists between standard measures of deprivation, used by the UK central government to determine regional health and social welfare funding, and sickness absence and ill-health early retirement rates in English local government employers. Local authority sickness absence rates for 2001-02 were regressed against the 2004 Indices of Multiple Deprivation in a multiple regression model that also included size and type of organization as independent variables. A second model using ill-health retirement as the dependent variable was also estimated. In the full regression models, organization size was not significant and reduced models with deprivation and organization type (depending on whether teachers were employed by the organization or not) were estimated. For the sickness absence model, the adjusted R(2) was 0.20, with 17% of the variation in sickness absence rates being explained by deprivation rank. Ill-health retirement showed a similar relationship with deprivation. In both models, the deprivation coefficients were highly significant: for sickness absence [t = -7.85 (P = 0.00)] and for ill-health retirement [t = -4.79 (P = 0.00)]. A significant proportion of variation in sickness absence and ill-health retirement rates in local government in England are associated with local measures of deprivation. Recognition of the impact of deprivation on sickness absence has implications for a number of different areas of work. These include target setting for Local Government Best Value Performance Indicators, history taking in sickness absence consultations and the role of deprivation as a confounding factor in sickness absence intervention studies.

Explaining the social gradient in long-term sickness absence: a prospective study of Danish employees

Objectives:To identify differences in risk of sickness absence between socioeconomic groups, and to examine to what extent these differences can be explained by health behaviour and work environment factors.Design, setting...

Gender differences in experiencing negative encounters with healthcare: A study of long-term sickness absentees

In most countries there are gender differences in sickness absence and in absentees' return to work (RTW). According to different theories sick-listed persons' experiences of encounters with healthcare professionals can influence self-esteem and RTW. The aim was to analyse gender differences in sickness absentees' experiences of negative encounters with healthcare professionals. A questionnaire, comprising numerous questions on experiences of positive and negative encounters with professionals, was constructed and sent to 10,100 individuals who had been on sick leave for the last 6-8 months. The response rate was 58% (n = 5,802). Almost one-third (32%) of the female respondents and one-quarter of the male (24%), respectively, had experienced negative encounters. The most common of such experiences among both women and men were: that they were treated with indifference, with disrespect, that the professional did not take his/her time, did not listen, did not believe in, or doubted complaints. In regression analyses the women had higher significant crude odds ratios, ranging from 1.29 to 1.71, for agreeing to the separate statements on negative encounters. When adjusting for age, ethnicity, and level of education the gender differences were still significant for 14 of the 23 the statements. Women's high rate of sickness absence is considered a problem in most countries. The subjective experiences of women are an important factor to consider in efforts aiming at reducing the sick-leave rates. One important endeavour among professionals in healthcare could be to shift the focus towards a more empowering professional role.

Effort–reward imbalance and relational injustice at work predict sickness absence: The Whitehall II study

Objectives Sickness absence is a major occupational health problem, but evidence for associations between potentially modifiable psychosocial work factors and sickness absence is still scarce. We studied the impact of relational justice and effort–reward imbalance on subsequent rates of sickness absence. Methods The Whitehall II prospective cohort study of British civil servants, 10,308 men and women, was established between 1985 and 1988. Indicators of effort–reward imbalance and the relational component of organizational justice were constructed from questions included at baseline. Participants were classified into three groups (low, intermediate, and high) for both effort–reward imbalance and relational justice. Short (≤7 days) and long (>7 days) spells of sickness absence during 1985–1989 and 1991–1995 were used to study immediate and longer term effects of work characteristics. Results After adjustment for age, employment grade, and baseline health, men and women with low relational justice had increased risks of long spells of sickness absence of 14% and 28% in comparison to men and women experiencing high levels of justice. Similar effect sizes (25% and 21%) were found for high vs. low effort–reward imbalance. Both work measures also predicted short spells of sickness absence. Effort–reward imbalance (men and women) and relational justice (women only) each predicted long spells of sickness absence independently of the other. Conclusions Both relational justice and effort–reward imbalance are important determinants of sickness absence. Workplace interventions to improve these aspects of working conditions have the potential to reduce levels of sickness absence.

Job Strain, Life Events, and Sickness Absence: A Longitudinal Cohort Study in a Random Population Sample

To examine job strain, adverse life events, and their co-occurrence as predictors of sickness absence. Random sample-based mail survey data on 1806 Finns in gainful employment were linked to sickness absence records (1987-1998) from national health registers. Generalized linear models with negative binomial distribution assumption were applied. After adjustment for demographic characteristics and health behavior, job strain (rate ratio [RR] 1.73; 95% confidence interval [CI] = 1.21-2.48), but not life events, independently predicted increased rate of sickness absence among men. The opposite was true for women, (RR for life events 1.39; 95% CI = 1.10-1.75). No statistically significant interaction between job strain and life events was detected. In addition to job strain, strain originating in private life should be kept in mind when the need for sickness absence of women employees is evaluated within health care.

Working Backs Scotland

Public and professional health education campaign. To change public beliefs about the management of back pain. Within the past decade, there has been a reversal in the strategy of management of back pain, from rest to staying active. There is only one previous public health education campaign on back pain, in a workers compensation setting in Australia. A multimedia campaign was based around 1777 radio advertisements, which were heard by 60% of adults. Information leaflets were prepared for people with back pain, for all health professionals who treat back pain, and for employers. A Web site was set up: www.workingbacksscotland.com. Structured monthly samples of 1000 adults were surveyed on their beliefs about rest or staying active, professional help sought and advice received for 2 months before the campaign and over the following 3 years. Royal Mail sickness absence rates and new awards of social security benefits for back pain were compared in Scotland versus the rest of the United Kingdom, before and after the campaign. There was a significant (P < 0.001) change in the balance of beliefs, from about 55% rest versus 40% staying active to about 30% rest versus 60% staying active. This occurred within 1 month of the launch and was maintained over 3 years. There was a comparable change in professional advice. There was no change in advice about work or the number who said they stayed off work. There was no effect on sickness absence or new awards of social security benefits for back pain. There was a major shift in public beliefs and professional advice but no change in work-related outcomes.

Trends in socioeconomic differences in sickness absence among Finnish municipal employees 1990—99

This study examined the associations of key dimensions of socioeconomic status and long sickness absence spells as well as their changes over time from 1990 to 1999. Municipal employees of the City of Helsinki, Finland, aged 25-59 were studied. The number of participants varied yearly from 24,029 women and 6,523 men to 27,861 women and 7,521 men. Socioeconomic status was assessed by education, occupational class, and individual income. The outcome was the number of over three days' sickness absence spells/100 person years, for which the employer requires medical certification. Low education, occupational class, and individual income were consistently associated with a 2-3 times higher sickness absence rates among both men and women. The age-adjusted sickness absence rates were relatively stable from 1990 to 1994 but increased from 1994 to 1999 among men and women. Socioeconomic differences in sickness absence rates tended to increase. The increase in the level of socioeconomic differences in sickness absence took place during a period of declining unemployment and staff increases at the City of Helsinki, which indicates that labour market conditions play a role in sickness absence.

Reincentivizing – a new theory of work and work absence

BackgroundWork capacity correlates weakly to disease concepts, which in turn are insufficient to explain sick leave behavior. With data mainly from Sweden, a welfare state with high sickness absence rates, our aim was to develop an explanatory theory of how to understand and deal with work absence and sick leave.MethodsWe used classic grounded theory for analyzing data from >130 interviews with people working or on sick leave, physicians, social security officers, and literature. Several hundreds of typed and handwritten memos were the basis for writing up the theory.ResultsIn this paper we present a theory of work incentives and how to deal with work absence. We suggest that work disability can be seen as hurt work drivers or people caught in mode traps. Work drivers are specified as work capacities + work incentives, monetary and non-monetary. Also, people can get trapped in certain modes of behavior through changed capacities or incentives, or by inertia. Different modes have different drivers and these can trap the individual from reincentivizing, ie from going back to work or go on working. Hurt drivers and mode traps are recognized by driver assessments done on several different levels. Mode driver calculations are done by the worker. Then follows employer, physician, and social insurance officer assessments. Also, driver assessments are done on the macro level by legislators and other stakeholders. Reincentivizing is done by different repair strategies for hurt work drivers such as body repair, self repair, work-place repair, rehumanizing, controlling sick leave insurance, and strengthening monetary work incentives. Combinations of these driver repair strategies also do release people from mode traps.ConclusionReincentivizing is about recognizing hurt work drivers and mode traps followed by repairing and releasing the same drivers and traps. Reincentivizing aims at explaining what is going on when work absence is dealt with and the theory may add to social psychological research on work and work absence, and possibly inform sick leave policies.

Place of residence as a correlate of sickness absence in Sweden

A postal questionnaire was sent to 1500 randomly selected men and women aged 20-64 years living in three sparsely populated municipalities in northern Sweden with high rates of sickness absence, and to 1000 corresponding inhabitants in the Swedish capital Stockholm with a low rate of sickness absence. The proportion of participants aged >or=45 years was higher and incomes were lower in municipalities with high rates of sickness absence. In multiple logistic regression analyses with age, education, income, somatic health, mental health, pain and place of residence as independent variables, significant correlates of sick listing in men were: age >or=45 years (odds ratio 5.0; 95% confidence interval 2.4-10.3), poor somatic health (5.4; 2.6-11.0) and severe musculoskeletal pain (4.7; 2.4-9.1); and in women: age >or=45 years (2.6; 1.5-4.8), poor somatic health (12.2; 6.1-24.4), poor mental health (4.5; 2.0-10.1) and severe musculoskeletal pain (5.4; 2.7-10.5). Mental health was deleted by the logistic model for men, and income, education and place of residence for both sexes. We conclude that no support was found for the assumption that factors attributable to place of residence could explain the regional differences in sickness absence.

The mental health effects of multiple work and family demands

Individuals who experience work stress or heavy family demands are at elevated risk of poor mental health. Yet, the cumulative effects of multiple work and family demands are not well known, particularly in men. We studied the association between multiple work and family demands and sickness absence due to non-psychotic psychiatric disorders in a longitudinal study conducted among members of the French GAZEL cohort study (8,869 men, 2,671 women) over a period of 9 years (1995-2003). Work stress and family demands were measured by questionnaire. Medically certified psychiatric sickness absence data were obtained directly from the employer. Rate ratios (RRs) of sickness absence were calculated using Poisson regression models, adjusting for age, marital status, social support, stressful life events, alcohol consumption, body mass and depressive symptoms at baseline. Participants simultaneously exposed to high levels of work and family demands (> or =2 work stress factors and > or =4 dependents) had significantly higher rates of sickness absence due to non-psychotic psychiatric disorders than participants with lower levels of demands (compared to participants exposed to 0-1 work stress factors and with 1-3 dependents, age-adjusted rate ratios were 2.37 (95% CI 1.02-5.52) in men and 6.36 (95% CI 3.38-11.94) in women. After adjusting for baseline socio-demographic, behavioral and health characteristics, these RRs were respectively reduced to 1.82 (95% CI 0.86-3.87) in men, 5.04 (95% CI 2.84-8.90) in women. The effect of multiple work and family demands was strongest for sickness absence due to depression: age-adjusted RRs among participants with the highest level of work and family demands were 4.70 (1.96-11.24) in men, 8.57 (4.26-17.22) in women; fully adjusted RRs: 3.55 (95% CI 1.62-7.77) in men, 6.58 (95%CI 3.46-12.50) in women. Men and women simultaneously exposed to high levels of work stress and family demands are at high risk of experiencing mental health problems, particularly depression.

Does survey non-response bias the association between occupational social class and health?

A non-response rate of 20-40%is typical in questionnaire studies. The authors evaluate non-response bias and its impact on analyses of social class inequalities in health. Set in the context of a health survey carried out among the employees of the City of Helsinki (non-response 33%) in 2000-02. Survey response and non-response records were linked with a personnel register to provide information on occupational social class and long sickness absence spells as an indicator of health status. Women and employees in higher occupational social classes were more likely to respond. Non-respondents had about 20-30% higher sickness absence rates. Relative social class differences in sickness absence in the total population were similar to those among either respondents or non-respondents. In working populations survey non-response does not seriously bias analyses of social class inequalities in sickness absence and possibly health inequalities more generally.

What degree of work overload is likely to cause increased sickness absenteeism among nurses? Evidence from the RAFAELA patient classification system

This paper reports a study examining whether nurses' work overload is associated with increased sick leave and quantifying the loss of working days from work overload. The RAFAELA patient classification system indicates nursing care intensity in relation to an optimum and is one of the few validated monitoring instruments of patient-associated workload among nurses. However, it is not clear whether work overload is a risk factor for increased sickness absenteeism, an important occupational problem in health care. An observational cohort study was carried out with 877 nurses, 31 wards and five Finnish hospitals. Patient-associated workload scores from the RAFAELA system were based on a 6-month monitoring period in 2004. Records of 12-month self certified (1-3 days) and medically certified (>3 days) periods of sick leave in the same year were obtained from employers' registers. The mean workload was 9% (sd = 8%) above the optimum. There was a linear trend between increasing workload and increasing sick leave (P < or = 0.006). Among nurses with workload > or =30% above the optimum the rate of self certified periods of sick leave was 1.44 (95% CI 1.13-1.83) times higher than among those with an optimum workload. The corresponding rate ratio for medically certified sick leave was 1.49 (1.10-2.03). These excess rates of sickness absence resulted in 12 extra sick leave days per person-year. Measuring nurses' workload may be an important part of strategic human resource management of nurses to reduce sick leave among nurses.

Allocation of rehabilitation measures provided by the Social Insurance Institution in Finland: a register linkage study

To study the allocation of rehabilitation measures provided by the Finnish Social Insurance Institution in relation to the characteristics and health status of rehabilitants. A register linkage study. A total of 67,106 full-time local government employees with a minimum of 10-month job contracts in 10 Finnish towns during the period 1994-2002. Data on the rehabilitation granted between 1994 and 2002, special medication reimbursements for chronic diseases, and disability retirement, were derived from the registers of the Social Insurance Institution as an indicator of chronic morbidity and linked to the employers' records on demographic characteristics and rates of sickness absence. In comparison with non-rehabilitants, the rate of sickness absence (> 21 days) was 2.2-2.9-fold (95% confidence interval (CI) 2.0-3.0) higher, the odds ratios of special medication reimbursement 1.5-6.1-fold (95% CI 1.3-6.9) higher and disability retirement 3.1-7.5-fold (95% CI 2.7-9.3) higher among rehabilitants. Older women and employees in manual or lower-grade non-manual jobs predominated in the rehabilitation groups. The proportion of temporary employees receiving rehabilitation was low. Permanently employed older women with an excess burden of health problems predominate in the receipt of rehabilitation provided by the Social Insurance Institution.

Impact of recurrent changes in the work environment on nurses’ psychological well‐being and sickness absence

This paper is a report of a study of how the occurrence and appraisal of recurrent changes in the work environment of hospital nurses affect psychological well-being (i.e. job satisfaction, eustress and distress) and absence through illness. Many researchers have demonstrated the impact of major organizational changes on employees' psychological well-being, but only a few have focused on the permanent consequences in work conditions. In a contemporary healthcare setting, an increased number of recurrent operational changes has become a normal characteristic of nurses' work environment. Specific work situations have frequently been associated with occupational stress, whereas employees' appraisal of recurrent changes as stressors and their relation to psychological well-being and health outcomes (i.e. sickness absence) have been dismissed. A cross-sectional questionnaire survey was conducted in 2003 with 2094 Registered Nurses in 10 general hospitals. Logistic regressions were used to investigate the impact on psychological well-being and prospectively measured rates of sickness absence (frequency and duration). The occurrence of changes in the work environment (in the past 6 months) had had a negative impact on staff psychological well-being. Nurses who had been confronted with changes scored statistically significantly higher for distress. Changes appraised as threatening were negatively related to job satisfaction and eustress, and positively related to distress and sickness absence (frequency and duration). Changes appraised as challenging were positively related to job satisfaction and eustress but had no impact on distress and sickness absence. Future research should take into consideration the impact of the occurrence and appraisal of recurrent changes in the work environment of healthcare employees (i.e. Registered Nurses) on psychological well-being and sickness absence. This should also be considered by managers when dealing with these nursing workforce issues.