The aim of this study was to evaluate the cost-effectiveness of a problem-solving intervention with workplace involvement (PSI-WPI) compared with care as usual (CAU) among employees on sick leave due to common mental disorders in Swedish primary healthcare centers. Employees aged 18 to 59 years on sick leave for common mental disorders (n = 197) were included in a controlled cluster-randomized trial by coordinators (n = 19) recruited at primary care centers in Region Västra Götaland, Sweden. The study was conducted between February 2018 and August 2021, with 18 months of follow-up per participant. The economic evaluation included a cost-effectiveness analysis comparing changes in sick leave with direct costs from a healthcare perspective, calculated from register data, and intervention costs; a cost-utility analysis based on EQ-5D questionnaires and a societal perspective included indirect costs calculated from registered sick leave. Sensitivity analyses explored robustness to alternative missingness assumptions. The PSI-WPI resulted in more sickness absence (average 40 extra days; 95% confidence interval, 3-77 days) compared with CAU and higher healthcare costs (SEK 21 650, SEK 4962-48 262) over 18 months. At 12 months, the cost of care was SEK 23 734 (SEK 537-46 931) higher in the PSI-WPI group. The difference in quality-adjusted life-years between the groups was negligible. The sensitivity analysis indicated robust results, and diagnoses not targeted by the study were important cost drivers. The PSI-WPI was not cost-effective for employees on sick leave due to common mental disorders compared with CAU only.

We examined the association of physical fitness (PF) and accelerometer-based moderate-to-vigorous intensity physical activity (MVPA) with long-term sickness absence (LTSA) incidence over an 8-year of follow-up in Finnish working-age population. Study data was based on Finnish population-based cross-sectional Health 2011 health examination survey's Physical Activity and Fitness sub-sample. Sample included 4821 over 18years old adults, of whom 48% participated. Baseline MVPA was assessed using a hip-worn accelerometer over at least four consecutive days, while PF included assessments of cardiorespiratory and muscular fitness, and balance. MVPA and PF were categorized according to tertile cut points. Information of LTSA, covering all-cause, musculoskeletal, and mental health-related absences lasting more than 10 workdays, were derived from the Finnish Social Insurance Institution's register data. After excluding participants not at risk for LTSA due to old age or retirement, the analytical sample included 1464 participants. Associations were examined with negative binomial regression. After adjusting for key covariates and preceding LTSA, lower LTSA rates were observed among those with highest PF compared to lowest PF (IRR=0.39; 95% CI 0.18-0.85) and with highest MVPA compared to lowest MVPA (IRR=0.35; 95% CI 0.19-0.66). The associations were mainly similar regardless of chronic diseases or whether the cause of LTSA was a musculoskeletal or mental health condition. The associations became inconsistent over time, especially regarding physical activity. These results emphasize the important role of MVPA and PF as factors supporting work ability and preventing LTSA in general working-age population.

To quantify contributions of health- and employment-related risk factors to high annual sickness absence (HASA) among a population-based cohort of older workers in England. Prospective cohort study. 24 general practices geographically dispersed across England. Men and women initially aged 50-64 years recruited as part of the Health and Employment After Fifty study. HASA, defined as a total of more than 20 days sickness absence over a 12-month interval. 4726 men and women were analysed, providing data on 15 333 12-month follow-up intervals. HASA was reported in 1003 (6.5%) follow-up intervals. In adjusted models, the aspects of health with the largest population-attributable fractions (PAFs) % were disabling musculoskeletal pain (25.4, 95% CI 21.2 to 29.3) and depression (11.3, 95% CI 6.1 to 16.2). Among long-term determinants of health, high body mass index had the greatest impact (PAF% 18.2, 95% CI 8.9 to 26.5). After allowance for health, high physical demands of work (PAF% 22.8) and eligibility for more generous sick pay (PAF% 25.8) made substantial contributions. Strategies to minimise avoidable sickness absence at older ages should prioritise: reversal of recent increases in disabling mental illness; encouragement of continued activity in workers with non-specific musculoskeletal pain, supported by modification of occupational tasks if needed; timely surgery for disabling osteoarthritis; reducing obesity; and increasing opportunities for placement in work that is less demanding physically. Further research is needed to clarify the impacts of generous sick pay on patterns of sickness absence.

Musculoskeletal pain (MSP) is a major occupational health challenge and a leading cause of disability and economic burden worldwide. However, prospective evidence on how pain intensity across multiple body regions affects long-term labour market participation and production losses remains limited. This study quantifies working-life expectancy (WLE) and working years lost (WYL) associated with multisite MSP among senior workers and introduces a novel method to estimate its related economic burden. The study includes 23 071 Danish employees aged 50-66 years from the SeniorWorkingLife study (2018 and 2022), linked to national labour-market registers through 2024. Self-reported pain intensity (low, moderate, high) in four body regions was examined. WLE and WYL were estimated using the expected labour market affiliation method, and economic costs were calculated from individual wage data. Moderate-to-high pain in two body regions was associated with reduced WLE and higher production losses. Employees with high back and leg pain had mean annual losses of €8167 per person (€58.8 million total), with 38% attributable to sickness absence. Total losses linked to back and leg pain were estimated at €2.0 billion (0.5% of Denmark's GDP). MSP in senior workers, particularly when affecting multiple body regions, imposes a substantial economic burden through reduced WLE and increased sickness absence. Targeted interventions are needed to manage MSP and sustain employment among older workers.

One key question for current psychotherapy research is how limited resources should be used efficiently to optimise treatment pathways. We examined how primary care level (PCL) psychotherapy, a history of mental disorder, and sociodemographic factors are associated with the later probability of receiving long-term rehabilitative psychotherapy. This longitudinal observational cohort study based on a register data from the Gaps in Mental Health-Related Work Disability and Treatment Outcomes (GapMind) project, which combines data from national registers (Statistics Finland and the Social Insurance Institution of Finland) and the largest occupational health service (OHS) provider in Finland. The study population comprised Finnish occupationally active individuals aged 15-65 (N = 1,261,320). Data on the use of PCL psychotherapy in the OHS between 2019 and 2020 were combined with data on age, gender, socioeconomic status, education, history of mental disorders (including psychotropic medication purchases, sickness absences, pensions, and use of OHS due to mental disorders), and somatic disabling comorbidities and four-model logistic regression analyses were conducted. The primary outcome was the use of long-term psychotherapy during 2020-2022. Participation in PCL psychotherapy (OR 7.05-15.51) and a history of mental disorders (OR 1.67-4.25) were associated with a higher probability of receiving subsequently long-term rehabilitative psychotherapy. Higher age, female gender, and higher socioeconomic status were also associated with an elevated likelihood of engaging in long-term rehabilitative psychotherapy. Participation in PCL psychotherapy, and various clinical and sociodemographic factors were associated with an increased probability of receiving later long-term psychotherapy. These findings may support healthcare systems in leveraging this information to better anticipate the need for long-term psychotherapy.

Burnout remains a major issue in nursing, with negative effects on staff well-being, patient outcomes and organisational performance. Burnout is estimated to affect approximately one in ten nurses globally and is associated with higher sickness absence and turnover rates, reduced empathy towards patients, increased risk of errors, and poorer patient outcomes. This article reviews contemporary evidence on the prevalence, causes and effects of burnout among nurses and discusses the potential benefits of integrating the Maslach Burnout Inventory in nurse supervision as part of the solution for addressing burnout. The author outlines the elements of a structured strategy that healthcare organisations would need to put in place to identify staff at risk of (or experiencing) burnout and support them appropriately.

As the dependency ratio declines, ensuring good work ability (WA) among the working-age population becomes increasingly important. Occupational health care (OHC) provides services to support WA, but more information is needed on their effectiveness and timeliness. This study examined the relationship between the timing of WA support services and work disability among OHC patients with mental health and/or musculoskeletal disorders. This study used patient data on individuals first diagnosed during the follow-up period (2019-22) with mental health and/or musculoskeletal disorders from a nationwide OHC provider in Finland (n = 54 933), linked with national registers on disability benefits, sickness absences and sociodemographic information. The association between the timing of the first WA support action (including WA contacts and negotiations) and work disability was analysed using logistic regression adjusted for sex, age and the number of OHC contacts. Work disability was defined as being granted a permanent or temporary disability pension or accumulating >300 days of sickness absence. Delayed initial WA support contact after the first diagnosis of a mental health or musculoskeletal disorder increased the risk of work disability. A similar finding was observed regarding the timing of WA negotiations among patients with mental health disorders. OHC practice should emphasise the early initiation of WA support services for patients diagnosed with a mental health or musculoskeletal disorder, as delayed support was shown to be associated with work disability.

To explore perceived work ability after sickness absences of varying durations. Questionnaire data from the Healthy Finland survey in 2022-2023, which included self-rated work ability (SRWA), were linked with registry data of the Social Insurance Institution of Finland on sickness allowance for the period 2021-2022. The association between the number of disability days on sickness allowance over a period of 2 years and SRWA were analysed among sickness allowance recipients (N = 2398) by cross-tabulation and multinomial logistic regression taking potential confounding factors into account. The number of days on sickness allowance (p < .001) was associated with subsequent perceived work inability: the probability of perceived work inability increased with more sickness allowance days. Among individuals who received sickness allowance for more than 300 days over 2 years, the relative risk ratio was 174.5 for perceived work inability and 13.6 for perceived partial work inability, compared with those who received sickness allowance for 1-30 days. Nonetheless, only 44% of those with over 300 sickness allowance days perceived themselves to be completely unable to work. Individuals who did not believe they could work until normal retirement age were more likely to perceive themselves as completely or partially unable to work. Perceived partial work inability is common after receiving sickness allowance, but only a minority of recipients perceive themselves to be completely unable to work even after a high number of sickness allowance days. Utilising the remaining work capacity is key to enabling a successful return to the labour market and supporting longer working careers.

Exploring risk factors for long-term sickness absence during emerging adulthood: Continuous and discrete time models using Young-HUNT data on psychological distress and chronic pain.

Burnout is a work-related mental health problem often leading to long-term sickness absence. Research on which return-to-work (RTW) interventions for sick-listed employees with burnout are the most effective in preventing long-term work disability shows no conclusive results. This study aims to investigate the experiences and needs of (occupational) healthcare professionals in supporting the RTW process of employees with burnout. It is part of a larger mixed-methods study focused on developing and implementing an RTW intervention, in the form of a care pathway, for employees suffering from burnout. We conducted nine focus groups with (occupational) healthcare professionals using a semi-structured interview guide with open-ended questions. Thematic content analysis was employed to explore the perspectives of these professionals. A total of thirty-nine professionals participated in the study. Participants described several obstacles in supporting the RTW process of sick-listed employees with burnout: (i) challenges for healthcare professionals in diagnosing burnout and challenges for employees in accepting burnout (ii) diverging opinions on burnout follow-up during sick leave (iii) the need for workplace support (iv) communication needs between (occupational) healthcare professionals. We propose a care pathway that addresses these needs. This study provides insights into the practical challenges and unmet needs faced by (occupational) healthcare professionals, which are addressed by the return-to-work care pathway for employees with burnout proposed in this article.

Disability pension represents a major public health challenge in France, with 843 000 beneficiaries and €8.5 billion expenditure in 2022. The transition from sickness absence to disability pension remains insufficiently documented in the French context. This study identifies risk factors for disability pension among French private-sector employees to inform targeted prevention strategies. We conducted a retrospective cohort study of 228 514 employees from a complementary health insurer (2018-23), encompassing 364 762 sickness absence episodes. Risk factors for transition to disability pension were analyzed using Kaplan-Meier survival and Cox proportional hazards models stratified by absence duration, adjusting for sociodemographic, employment, organizational, and health-related factors. Of all episodes, 6404 (1.8%) progressed to disability pension. Risk was particularly high among individuals aged ≥50 years and among those in higher-risk socio-professional groups, notably executives and individuals belonging to the "Other" category (including farmers, merchants, and business owners), compared with employees. Increased risk was also observed among workers in the lowest income quartile and among employees in large companies. Long-term sickness absence (>180 days) was associated with a higher risk of disability pension. Therapeutic part-time work reduced risk only for short absences. Most risk factors lost predictive power beyond 12 months, with declining effect sizes over time. This study identifies a critical 12-month intervention window. Early interventions should prioritize therapeutic part-time work and strengthen targeted support for older workers, executives, and large company employees to reduce disability pension transitions and curb rising costs.

Overweight/obesity and psychological distress often co-exist and are associated with sickness absence (SA). The objective of this study was to examine joint contribution of overweight/obesity and psychological distress on short and long SA periods, and to explore potential synergistic interactions between these factors. The Helsinki Health Study survey collected in 2017 among 19–39-year-old Finnish municipal employees was linked to employer’s SA registers (1–7 days for short and 8+ days for long SA periods), including participants consenting to linkage (n = 3966, 80% women). The mean follow-up time was 2.1 years. We calculated body mass index (BMI) from weight and height and evaluated psychological distress using the emotional wellbeing subscale of RAND-36 health-related quality of life survey. Rate ratios (RRs) and their 95% confidence intervals (CIs) were calculated for SA periods using negative binomial regression models. Interaction between overweight/obesity and psychological distress was examined using the Synergy Index (S). Most participants (85%) had at least one short and over one-fourth (29%) one long SA period. Overweight/obesity (42%) and psychological distress (23%) jointly contributed to short (RR, 1.62; 95% CI, 1.44–1.82) and long (RR, 2.48; 95% CI, 2.09–2.95) SA periods, compared to those with healthy weight and no psychological distress. The interaction between overweight/obesity and psychological distress was additive for short (S = 1.11), and synergistic for long SA periods (S = 1.40). Sociodemographic factors, working conditions, and health behaviors only slightly attenuated these associations. It is important to consider co-occurrence of overweight/obesity and psychological distress in prevention of SA.

BackgroundDepression is associated with a substantial health and economic burden and shows pronounced regional variation in Germany. While socioeconomic and urban–rural differences in depression prevalence and service use are well documented, less is known about how regional socioeconomic deprivation and urbanization relate to healthcare utilization after accounting for multimorbidity.MethodsWe analyzed nationwide claims data from a large German sickness fund including adults with diagnosed depression (N = 1,083,319). Healthcare utilization in 2023 was measured as healthcare costs, days of sickness absence, any outpatient mental health specialist contact, and outpatient psychotherapy use. Multilevel regression models with individuals nested within 96 spatial planning regions were estimated, adjusting for age, sex, and multimorbidity using the PopGrouper. Regional socioeconomic deprivation was measured using the German Index of Socioeconomic Deprivation, and urbanization was classified as urban, semi-urban, or rural. Proportional variance component analyses quantified explained regional heterogeneity.ResultsHigher regional socioeconomic deprivation was significantly associated with more days of sickness absence (adjusted mean: 34.1 days in the least vs. 40.1 days in the most deprived regions) and a lower likelihood of receiving outpatient psychotherapy (17.9% vs. 16.3%). No significant associations were observed between deprivation and healthcare costs or mental health specialist contacts. Urban regions were associated with higher healthcare costs (2,284€ vs. 2,188€) and more frequent mental health specialist contacts (15.6% vs. 13.5%). Overall regional clustering was modest but most pronounced for mental health specialist contacts.ConclusionRegional socioeconomic deprivation is linked to higher sickness absence due to depression. Regional inequalities in access to mental health services are small but largely unexplained by deprivation, urbanization, and multimorbidity.Supplementary InformationThe online version contains supplementary material available at 10.1007/s43999-026-00092-6.

Staff sickness absence incurs high costs to the NHS and is associated with adverse patient outcomes. Mental and musculoskeletal ill-health are the main causes, with cardiovascular risk factors also common. We tested the feasibility of undertaking a definitive randomised controlled trial to assess the effectiveness and cost-effectiveness of a staff health screening clinic (SHSC) in reducing sickness absenteeism and presenteeism. Individually randomised controlled pilot trial of a SHSC compared with usual care recruiting employees from four English NHS hospitals. Those in the intervention arm were assessed by a nurse using electronic database-driven screening for musculoskeletal, mental and cardiovascular health. Screen positives were given advice and/or referral to services according to UK guidelines. Three co-primary outcomes formed the stop-go criteria: recruitment, referrals, and attendance at referred services. Secondary outcomes included: generalisability, screening results, individual referrals required/attended, health behaviours, acceptability/feasibility of processes, indication of contamination, costs, health-related quality of life, self-reported and employee records of absenteeism. Process evaluation included interviews with participants, intervention delivery staff and service providers. Quantitative analyses used descriptive statistics with framework analysis for qualitative data. Due to the COVID-19 pandemic, follow-up was restricted to 6months and acceptance of referral during the screening assessment used as proxy for attendance. Despite recruitment rates during the truncated timeframe indicating potential to reach target, the final proportion recruited of 314 consented/3788 invited (8.3%) was lower than anticipated, and those recruited were not fully representative of the hospital staff population. 236/314 were randomised. Of 118 allocated to the intervention arm, screening identified 57 (48.3%) eligible for referral, with 18 (31.6%) accepting the referral. Process evaluation demonstrated that the electronic database-driven screening intervention and data collection system was efficient, promoting good fidelity. The intervention could benefit from more personalisation, better understanding of local context, longer training, and better integration with referral services. We have identified a clinical need and perceived benefit for a SHSC. Delivery was feasible and electronic data capture successful. The three stop-go criteria were red (recruitment), green (referral), and amber (attendance); therefore, the Trial Oversight Committee recommended that a full-scale trial should proceed, but with modifications to adapt to local context and adopt processes to engage better with underserved communities. ISRCTN, ISRCTN10237475, registered 09/12/2019, https://www.isrctn.com/ISRCTN10237475.

The economic burden that obesity places on society, both directly and indirectly, is considerable. It is acknowledged that obesity is associated with decreased economic productivity; however, the evidence examining the exact relationship between obesity and key metrics of employment in the European context remains to be consolidated. A systematic literature review was performed to determine the association between body mass index (BMI) and employment outcomes. Searches were conducted across three electronic databases (MEDLINE, Embase, and Epistemonikos). Studies were eligible if they were published in or after 2014 and conducted in a European setting. In total, 34 studies were identified; of these, 20 studies provided evidence to show fewer people with obesity were employed as compared to people with overweight or who had a healthy BMI. Obesity was associated with increased sickness absence (n = 7) and impaired work performance (n = 7). Broad evidence collected from across Europe demonstrates that obesity is associated with unemployment, sickness leave, absenteeism, and presenteeism. Preventing and treating obesity would be expected to have a relatively rapid benefit in terms of improved employment outcomes, including productivity, as well as long-term benefits to population health.

PurposeIdentifying employees at the greatest risk of work disability is critical to preventing early exit from the labor market. Understanding how different factors influence work disability risk in the years leading to a pension is important in preventing early exits. Our aim in this study is to model the risk factors for an employee applying for a disability pension by using a novel and extensive register dataset and to evaluate the predicted risk for different occupations in the workforce.MethodsWe use a logistic model to assess the risk of filing a first-time disability pension application using rich register data. We evaluate the performance of the model and finally present the evaluated risk distribution among current employees. Data are also included for short-term sickness absences, usually not available for register studies. A pension application is used as a follow-up to include employees whose application is rejected but who nonetheless carry a physician’s note of diminished work ability, also a new approach to modeling work disability risk. The data cover all public sector occupations in Finland and their diverse disability risk profiles.ResultsThe constructed risk model accurately and transparently predicts the disability pension application risk in different employee groups. Age, occupation, cumulative sickness days, and number of sickness spells of all lengths, including short ones, were positively associated with the risk; proximity of retirement age and high earnings were negatively associated. Validation measures allow for using the model in providing employers with risk profiles of their employees.ConclusionThe developed model can be used as a tool for predicting the risk status of employee groups and for assessing the economic effects of sickness absences and disability pension risk. The modeling results reported here are already in practical use by public sector employers in Finland, eg, for early intervention.

Background/Objectives: Sickness absence due to breast cancer generates significant indirect costs. This nationwide registry-based study aimed to evaluate temporal patterns and the population-level burden of sickness absence, rehabilitation benefit utilization, and social insurance expenditures related to breast cancer among women in Poland between 2020 and 2024. Methods: This nationwide analysis is based on the Social Insurance Institution registry. Data on females unable to work due to breast cancer were analyzed (ICD-10: C50). Short-term sickness absence was analyzed. Results: The number of sick leave days due to breast cancer varied from 1,241,223 in 2021 to 1,444,863 in 2024. The number of sick leave certificates increased every year: from 55,732 in 2020 to 79,979 in 2024. The most dynamic growth between 2020 and 2024 occurred in the 45-49 group, where sick leave days increased +33.4% and certificates increased +70.6%. There were significant regional differences. The sickness absence days per certificate due to breast cancer decreased over time, from 23.5 days in 2020 to 18.1 days in 2024. The total number of medical certificates on rehabilitation benefit due to breast cancer varied from 4811 in 2021 to 5281 in 2024. Social insurance expenditures on sickness absence varied from 112,064.9 thousand PLN (approximately 25.24 million EUR) in 2020 to 207,687.9 thousand PLN (approximately 48.3 million EUR) in 2024 and expenditures on rehabilitation benefits varied from 56,812.8 thousand PLN (12.8 million EUR) in 2020 to 89,692.6 thousand PLN (20.83 million EUR) in 2024. Conclusions: This population-based registry study revealed a high economic burden of sickness absence due to breast cancer in Poland.

Associations of work- and personal-life-related techno-stressors with emotional exhaustion, sickness absenteeism, and turnover intentions in public administration.

IntroductionTo analyse the long-term dynamics of the burden of sickness absenteeism (SA) at the societal and patient levels in employed patients with selected inflammatory rheumatic diseases (IRDs).MethodsThe burden of SA was analysed over 2 decades prior to the COVID-19 pandemic, with a focus on the subperiod following the introduction of the rheumatology clinical registry biorx.si. Population data for full-time employees on sick leave due to rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS) were obtained from the national administrative database. The societal burden of SA was defined as the total annual number of calendar days on sick leave. The patient-level burden of SA was defined as the average annual number of days on sick leave per patient which was further disaggregated into the average annual number of sick leave episodes per patient and the average annual number of days per sick leave episode. The costs of SA were estimated using the human capital approach. An exponential trend method was used for analysis, and time series were tested for structural breaks.ResultsThe societal burden of SA during the subperiod following the registry introduction decreased, on average, by 3.3% annually among RA patients. The average annual increase in the societal burden of SA was marginal for PsA patients (0.4%) and substantial for AS patients (8.7%). The societal and patient-level burdens of SA varied by sex and job sector. The patient-level burden of SA, however, decreased on average by 2.5% annually for RA patients and increased marginally for both PsA and AS patients. The key pattern suggesting potential improvements in the patient-level burden of SA for the analysed IRDs was an increase in the number of sick leave episodes per patient, offset by shorter episode duration.ConclusionsA study of the societal burden of SA, including its components, and the patient-level burden of SA can support the development of more effective strategies for managing SA and facilitating a faster return to work.

Bipolar disorder (BD) is a chronic psychiatric condition that requires careful pharmacological management. Ensuring treatment effectiveness, safety, adherence, and proper monitoring is essential, especially in pediatric, pregnant, and cognitively impaired patients. To review the available evidence on treatment outcomes, safety, adherence, and monitoring in bipolar disorder. A literature search was conducted using PubMed, Scopus, Web of Science, and Google Scholar. A comprehensive review of systematic reviews, meta-analyses, cohort studies, clinical trials, and case reports was performed. This review was guided by the Scale for the Assessment of Narrative Review Articles (SANRA) criteria. The findings were synthesized qualitatively. This review highlights important challenges and therapeutic considerations in bipolar disorder management. Medication adherence and laboratory monitoring compliance were generally poor. Sleep disturbances were associated with poorer functional outcomes. Combination therapy reduced the risk of manic and depressive recurrence but may lower overall functioning in some patients. Lithium showed favorable long-term outcomes, including reduced sickness absence and lower mortality, whereas pregabalin was linked to poorer occupational outcomes. Untreated bipolar disorder during pregnancy was associated with prematurity and low birth weight. Mechanistically, lithium, valproate, and emerging agents may modulate neuroplasticity and intracellular signaling pathways; however, evidence for cognitive improvement remains limited and inconsistent. Lithium and combination therapies improve relapse prevention, cognitive outcomes, and mortality. However, adverse effects and poor adherence remain challenges. Individualized strategies, regular monitoring, and tailored interventions are essential to optimize care.