Sickness Absence Research Articles

Repurposing Semaglutide and Liraglutide for Alcohol Use Disorder.

Preliminary studies suggest that glucagon-like peptide-1 receptor (GLP-1) agonists, used to treat type 2 diabetes and obesity, may decrease alcohol consumption. To test whether the risk of hospitalization due to alcohol use disorder (AUD) is decreased during the use of GLP-1 agonists compared with periods of nonuse for the same individual. This cohort study was an observational study conducted nationwide in Sweden using data from January 2006 to December 2023. The population-based cohort was identified from registers of inpatient care, specialized outpatient care, sickness absence, and disability pension. Participants were all residents aged 16 to 64 years who had a diagnosis of AUD. The primary exposure was use of individual GLP-1 agonists (compared with nonuse of GLP-1 agonists), and the secondary exposure was medications with indication for AUD. The primary outcome was AUD hospitalization analyzed in a Cox regression within-individual model. Secondary outcomes were any substance use disorder (SUD)-related hospitalization, somatic hospitalization, and suicide attempt. The cohort included 227 866 individuals with AUD; 144 714 (63.5%) were male and 83 154 (36.5%) were female, with a mean (SD) age of 40.0 (15.7) years. Median (IQR) follow-up time was 8.8 (4.0-13.3) years. A total of 133 210 individuals (58.5%) experienced AUD hospitalization. Semaglutide (4321 users) was associated with the lowest risk (AUD: adjusted hazard ratio [aHR], 0.64; 95% CI, 0.50-0.83; any SUD: aHR, 0.68; 95% CI, 0.54-0.85) and use of liraglutide (2509 users) with the second lowest risk (AUD: aHR, 0.72; 95% CI, 0.57-0.92; any SUD: aHR, 0.78; 95% CI, 0.64-0.97) of both AUD and SUD hospitalization. Use of any AUD medication was associated with a modestly decreased risk (aHR, 0.98; 95% CI, 0.96-1.00). Semaglutide (aHR, 0.78; 95% CI, 0.68-0.90) and liraglutide (aHR, 0.79; 95% CI, 0.69-0.91) use were also associated with decreased risk of somatic hospitalizations but not associated with suicide attempts (semaglutide: aHR, 0.55; 95% CI, 0.23-1.30; liraglutide: aHR, 1.08; 95% CI, 0.55-2.15). Among patients with AUD and comorbid obesity/type 2 diabetes, the use of semaglutide and liraglutide were associated with a substantially decreased risk of hospitalization due to AUD. This risk was lower than that of officially approved AUD medications. Semaglutide and liraglutide may be effective in the treatment of AUD, and clinical trials are urgently needed to confirm these findings.

Sleep quality and the need for recovery among nurses working irregular shifts: A cross-sectional study.

Shift work affects the mental and physical health of nurses, yet the effect of working irregular shifts on sleep and its association with the need for recovery is under-explored. The purpose of this study was to investigate the sleep quality of nurses working irregular shifts, including night shifts, and to determine whether sleep quality is associated with the need for recovery. This cross-sectional study included 405 nurses working irregular shifts. Data were collected using an online questionnaire that included sociodemographic characteristics, the Sleep-Wake Experience List, sleep problems, sleep duration, and the Need for Recovery scale. Data analyses included descriptive statistics, chi-square tests, t-tests, logistic and multiple linear regressions. Nurses who worked irregular shifts had poor sleep quality. Those who also worked night shifts, had significantly poorer sleep quality and experienced more difficulties in daily functioning than those who did not work night shifts. Sleep quality was significantly associated with the need for recovery and this remained so after controlling for confounding variables (β= .554, p = .001). The findings indicate that in nurses who work irregular shifts, the sleep quality is low. In this group, the sleep quality in nurses who work night shifts is lower than in nurses who do not work night shifts. Furthermore, better sleep quality was associated with lower need for recovery. These findings suggest that improving sleep quality in nurses working irregular shifts may lower their need for recovery, which may improve health, and reduce burnout and sickness absence.

Antihypertensive Medication Adherence and Medical Costs, Health Care Use, and Labor Productivity Among People With Hypertension.

Hypertension affects nearly half of US adults yet remains inadequately controlled in over three-quarters of these cases. This study aimed to assess the association between adherence to antihypertensive medications and total medical costs, health care use, and productivity-related outcomes. We conducted cross-sectional analyses using MarketScan databases, which included individuals aged 18 to 64 years with noncapitated health insurance plans in 2019. Adherence was defined as ≥80% medication possession ratio for prescribed antihypertensive medications. We used a generalized linear model to estimate total medical costs, a negative binomial model to estimate health care use (emergency department visits and inpatient admissions), an exponential hurdle model to estimate productivity-related outcomes (number of sick absences, short-term disability, long-term disability), and a 2-part model to estimate productivity-related costs in 2019 US dollars. All models were adjusted for age, sex, urbanicity, census region, and comorbidities. We reported average marginal effects for outcomes related to antihypertensive medication adherence. Among 379 503 individuals with hypertension in 2019, 54.4% adhered to antihypertensives. Per person, antihypertensive medication adherence was associated with $1441 lower total medical costs, $11 lower sick absence costs, $291 lower short-term disability costs, and $69 lower long-term disability costs. Per 1000 individuals, medication adherence was associated with lower health care use, including 200 fewer emergency department visits and 90 fewer inpatient admissions, and productivity-related outcomes, including 20 fewer sick absence days and 442 fewer short-term disability days. Adherence to antihypertensives was consistently associated with lower total medical costs, reduced health care use, and improved productivity-related outcomes.

Sequences of sickness absence, disability pension and unemployment four years before and five years after musculoskeletal diagnosis among Swedish twins.

To investigate sustainable working life via identification of time-related sequences of sickness absence (SA), disability pension (DP) and unemployment four years before and five years after the first musculoskeletal diagnosis in a Swedish twin cohort. Other aims were to account for familial confounding and to examine the associations between sequences and sociodemographic characteristics. Among 28,474 Swedish twins, the patterns of interruptions of working life four years before the first M00-M99 diagnosis (MSD) and five years after MSD diagnosis were investigated with a sequence analysis in a seven-element state space consisting of sustainable working life, unemployment >90 days, moderate SA/DP (30-179 days), almost full year of SA/DP (180-365 days), full year of SA/DP (⩾ 365 days), death, and old-age pension. The six-cluster solution had the best fit to the data. Five clusters had varying patterns of interruptions of sustainable working life (Clusters 2-6, n = 537-1949 with SA/DP, unemployment, but also accounting death and old-age pension) compared with the largest cluster with primarily sustainable working life (n = 23,316). Age, sex and familial factors affected the likelihood of belonging to the clusters with SA/DP. Most Swedish twins with or without MSD diagnosis have a sustainable working life, although MSD was both prevalent and a strong risk factor for belonging to the clusters with SA/DP. Thus, early prevention of MSD and prevention of recurrent or long sickness absences due to any cause would be merited while paying special attention to women also.

Sickness absence patterns during the COVID-19 pandemic among Finnish public sector employees

Abstract Background The patterns of sickness absence (SA), that is, the clustering of differing lengths of episodes and total number of days absent, have not been examined. We examined these SA patterns and factors associated with the patterns during the COVID-19 pandemic. Methods We used survey data from employees of four large Finnish cities in 2020 linked with SA data in 2021 retrieved from employer registers (n = 39 791). SA patterns were defined through cluster analysis (K-means) including number of SA days, short (1-9 days), and long (10-365 days) SA episodes within one year. The associations of employee and work characteristics in 2020 with SA clusters in 2021 were analysed with multinomial regression. Results Four SA patterns (=clusters) were identified: 1) Optimal SA pattern (n = 31 320, 79%), 2) Recurring short SA episodes (n = 5149, 13%), 3) Recurring long SA episodes (n = 2964, 7%), and 4) Very high levels of SA with long episodes (n = 358, 1%). Compared to optimal SA pattern, female gender, higher body mass index, former smoking, abstinence from alcohol, not being in high occupational socioeconomic position, on-site work during COVID-19, and COVID-19 infection were associated with all suboptimal SA patterns. Recurring short SA episodes were more likely in younger employees (odds ratio=0.98, 95% confidence interval 0.97-0.98), those with a temporary job (1.10, 1.00-1.20), current smokers (1.34, 1.21-1.48), those using passive commute modes (1.03, 1.01-1.05 [car]; 1.02, 1.00-1.04 [public transport]), and those who had experienced a team reorganization due to COVID-19 (1.27, 1.10-1.46). The two most adverse SA patterns were more likely among older employees, and less likely among those cycling to work (0.91, 0.84-0.98; 0.97, 0.95-0.99). Conclusions We identified three differential suboptimal SA patterns. Compared to the optimal SA pattern, several individual-level risk factors, but also some COVID-19 related factors were found to associate with suboptimal SA patterns. Key messages • We identified three suboptimal sickness absence patterns during COVID-19 pandemic. • Individual characteristics, but also COVID-19 related factors were associated with the observed sickness absence patterns.

Sickness absence due to mental and somatic diagnoses by occupational class in Finland, 2011–2021

Abstract Background Sickness absence (SA) due to mental disorders has strongly increased in Finland during recent years while sickness absence due to somatic diagnoses has continued to decrease. Research is lacking on recent trends in SA by occupational class, especially during years of increasing mental disorders. The aim of the study is to analyze these trends during 2011-2021. Methods National register data from the Social Insurance Institution of Finland (Kela), Statistics Finland and Finnish Centre for Pensions were linked for all employed Finns aged 25-64 for years 2011-2021 (yearly N about 2 million). SA was measured by sickness allowance, compensated by Kela after 10 days of absence. Age-standardized yearly prevalences of SA due to different diagnoses were calculated for women and men in four occupational classes over 2011-2021. Logistic regression was used to assess differences between occupational classes adjusted for age, marital status, education and region of residence. Results SA due to mental disorders has greatly increased in all occupational classes in Finland after year 2016 among both women and men, while SA due to musculoskeletal and other somatic diagnoses has continued to decrease. Increase in SA due to mental disorders has been largest among lower non-manual employees, especially among women, whereby also overall SA prevalence among female lower non-manual employees has reached the level of manual workers. Men show broadly similar trends but manual workers still have the highest overall SA prevalence. Relative adjusted differences between occupational classes decreased slightly between 2011 and 2021. Conclusions Clear occupational class differences persisted in diagnosis-specific SA throughout 2011-2021. However, the magnitude and order of the class differences changed along with increasing SA due to mental disorders. Occupational class differences should be taken into account when aiming to prevent further increases in SA due to mental disorders. Key messages • Sickness absence (SA) due to mental disorders has increased in all occupational classes in Finland after year 2016, while SA due to somatic diagnoses has continued to decrease. • Increase in SA due to mental disorders has changed the overall occupational class differences in SA in Finland largely because the increase has been strongest among lower non-manual employees.

Sick-leave trajectories among people sickness absent with stress-related diagnoses; cohort studies

Abstract Background Stress-related disorders are common sickness absence (SA) diagnoses in many Western countries. Knowledge of SA and disability pension (DP) patterns among people with such SA is needed. Thus, the aim was to identify future SADP trajectories among people with a new SA spell due to stress-related diagnosis and to examine sociodemographic and health-related factors associated with identified trajectories. Methods Using microdata from nationwide registers, we included all people living in Sweden with a new SA spell >14 days due to stress-related diagnoses (ICD-10 code F43) in 2011 (N = 32,417) or 2018 (N = 65,511), respectively. These two cohorts were followed prospectively for 13 months from the SA spell start, to identify trajectory groups of mean SA/DP days/month using group-based trajectory modeling. We used multinomial logistic regression to explore associations between sociodemographic and health-related predictors and trajectory membership. Results We identified the following SA/DP trajectories in both cohorts: steep drop (30.6% and 35.9% of all included in 2018 and 2011, respectively); fluctuating (8.7%, 11.2%); fast decrease (25.5%, 24.4%); medium decrease (18.1%, 13.1%); slow decrease (10.8%, 7.3%), and constant high (6.2%, 8.0%). Compared to the steep drop trajectory, individuals in the other trajectories were more likely women, older, and had prior SA/DP or secondary outpatient healthcare visits. Starting the SA spell full-time was the strongest predictor for the slow decrease and constant high trajectory, and previous SA or diagnosis of other mental disorders were predictors of the constant fluctuating and constant high trajectory. Conclusions The similarity of the identified trajectories in the two cohorts is a strength. The results reveal the diversity of future SA/DP in this patient group, indicating the importance of identifying patients at risk of long-term SA who might need further interventions early in the process. Key messages • In two population-wide cohorts with a new sickness absence (SA) spell with stress-related diagnoses, six trajectories of SA/disability pension days were identified during the 13-month follow-up. • Most of those in the cohorts had trajectories that ended with no SA/DP after 13 months, while two trajectories, including 15-19% of individuals, showed high or varying SA/DP days during the follow-up.

Joint associations of psychological distress and working conditions with sickness absence in Finland

Abstract Background Psychological distress has increased remarkably, especially among younger age groups, during the last years. Both psychological distress and exposure to strenuous working conditions are known risk factors for sickness absence (SA). We examined whether psychological distress and working conditions are jointly associated with SA periods of 1-7 days and 8+ days among young and midlife Finnish employees. Methods We linked survey data from the Helsinki Health Study cohort from 2017 (response rate 51.5%) with the employer’s SA register for the City of Helsinki, Finland (82% consented to the linkage; n = 3949, 80% women, age 19-39 years). Mean follow-up time was 2.1 years. We calculated rate ratios (RR) and 95% confidence intervals (CI) for SA periods of 1-7 days and 8+ days using negative binomial regression models among participants with and without psychological distress, and with and without exposure to strenuous working conditions. Psychological distress was measured with the emotional wellbeing subscale of RAND-36 (cut-off 60 points). Working conditions included physical and mental strenuousness of work and hours per day spent in heavy physical work. Results Participants with psychological distress and exposure to strenuous working conditions had the highest age- and gender-adjusted RRs for SA periods of ≥ 8 days (physically strenuous work: RR: 2.38, CI: 1.97-2.88; mentally strenuous work: RR: 2.08, CI: 1.72-2.53; ≥3 h per day spent in physical work: RR: 2.48, CI: 2.01-3.06), the interactions being additive. The associations were weaker for SA periods of 1-7 days. Adjusting for marital and employment status, education, alcohol use, smoking and body mass index only slightly attenuated these associations. Conclusions Psychological distress and exposure to strenuous working conditions were additively associated with SA. Both individual- and workplace-related risk factors for SA are important to be considered when planning preventive actions. Key messages • Young and early midlife Finnish employees with simultaneous psychological distress and exposure to strenuous working conditions had the highest rates of SA periods, the interactions being additive. • Both psychological distress and exposure to strenuous physical and mental working conditions should be considered when planning preventive actions to reduce employees’ SA.

Impact of motherhood and social support on the wellbeing of UK female police officers and staff

Abstract Background Female officers and staff face gender-specific challenges, particularly, during pregnancy and motherhood. Our study explores whether and how motherhood affects mental health outcomes (e.g., probable depression and anxiety) and return to work following sickness absence (SA), considering mediating role of workplace social support. Methods Logistic regression analysed probable depression and anxiety using Airwave Health Monitoring Study (AHMS) data. Cox proportional hazards models assessed return to work after sickness absence, linking AHMS with sickness absence data from 26 police forces. Exposure variables were created by the interaction of motherhood status and social support, while covariates included sociodemographic, lifestyle, and work-related factors. Results Mothers with low social support from superiors had higher odds of probable depression (OR = 2.14, 95% CI = 1.81-2.54) and anxiety (OR = 1.86, 95% CI = 1.62-2.14) compared to non-mothers. Moderate and high social support reduced odds of depression (Moderate: OR = 0.97, 95% CI = 0.85-1.11; High: OR = 0.65, 95% CI = 0.57-0.73) and anxiety (Moderate: OR = 1.24, 95% CI = 1.12-1.36; High: OR = 0.82, 95% CI = 0.75-0.9) for mothers, but the impact varied when adjusted for covariates. Mothers with lower levels of social support were less likely to return to work after SA compared to non-mothers, as indicated by the survival analysis (Low social support: HR = 0.83, 95% CI = 0.95-1.13; High social support: HR = 1, 95% CI = 0.96-1.04). These trends persisted across social support sources-colleagues and combined support-emphasising the complex interplay between workplace social support, motherhood, mental health, and sickness absence in policing. Conclusions Our study emphasises boosting workplace social support for female police officers and staff, to aid them in navigating motherhood demands. This improvement can lead to better mental health, retention, job satisfaction, and organisational effectiveness, ultimately promoting community safety. Key messages • Highlighting the importance of workplace social support for female police officers and staff, informs policy makers and practitioners to prioritize social support initiatives within policing. • Lower social support was associated with a reduced likelihood of returning to work after sickness absence, particularly among mothers compared to non-mothers.

Predictors of disability retirement - a prediction model for disability pension application risk

Abstract Background Regarding the objective of preventing early exits from labor market, the late life-course years present an important timeframe. It is essential to identify the employees in the greatest risk of permanently losing their work ability. In practical applications, multifactorial models are needed to evaluate the combined effect of risk factors. In this study, the disability pension risk is modeled based on large unique register data, at the same time assessing the effect of sickness absences (SA) of different lengths. Methods We utilize a logistic model for the risk of filing a first-time disability pension application (DPA) based on register data on 222,321 Finnish municipal sector employees. The data include employment and sickness spells, occupations, and wages in 2016-2018 as covariates. During the 3-year follow-up, 2,969 employees filed a DPA. The data include also short SA spells, a novelty in these kinds of studies. DPA is used as a follow-up to include employees who receive a rejecting decision but still carry a physician’s evaluation of diminished work ability. Results The resulting model can accurately predict the risk of DPA in employee groups. Age, occupation, cumulative SAs preceding the application, and the number of SA spells of all lengths, also short ones, have a significant increasing effect on the DPA risk. Proximity of the retirement age and high earnings decrease the risk of DPA. Surprisingly gender had no effect on the risk. Conclusions The results indicate that register-based sociodemographic data is very useful in modeling the employee DPA risk in public sector employee groups. The resulting model provides a basis for tools for predicting the risk status of employee groups for the use of employers responsible for risk management and early intervention, also allowing for the assessment of economic effects of SAs and disability risk. The presented modeling results are already utilized among public sector employers in Finland. Key messages • Disability pension risk can accurately be predicted in public sector employee groups based on readily available sociodemographic register data. • All sickness absences have a significant increasing effect on the risk of disability pension application, but the effect varies greatly depending on age and occupation.

Precarious employment expectancy by history of mental-health-related sickness absence in Finland

Abstract Background Poor mental health may lead to labour market insecurity including precarious employment and vice versa. Less is known of how mental health is associated with cumulative engagement in precarious employment over the working career. We examined how the working career is expected to be distributed into precarious and other types of employment by history of mental-health-related sickness absence. Methods We used a register-based 70% population sample to examine wage-earners living in Finland in 2018. Applying the Sullivan method, we calculated the expectancy of precarious and non-precarious employment between age 25 and 63 (N = 1268666) based on a novel measure (score with items on temporariness, agency employment, multijob holding, underemployment and income level) and limited employment (due to which precariousness could not be assessed) among those with and without compensated (granted after 10 weekdays) sickness absence due to mental disorders in the past five years (mental SA history). Results Precarious employment expectancy was higher among those with than among those without a mental SA history (2.5 vs. 1.5 among men and 3.5 vs. 2.8 years among women). The difference in the limited employment expectancy was in the same direction, but much larger among men (6.5 vs. 3.3 among men and 4.4 vs. 3.4 years among women). Men with a mental SA history were expected to spend almost a fourth of their working career with either precarious or limited employment, whereas for men without such a history the number was 13%. Conclusions Individuals with mental disorders have notable accumulation of precarious employment over the working career. They also spend excessive time with limited employment, which may have similar elements as precarious employment and reflect broader labour market insecurity. Attempts should be made to ensure that insecure employment conditions among people with mental health problems do not further deteriorate their health and work ability. Key messages • People with mental disorders spend a disproportionate part of their working career either precariously employed or facing other insecurities in the labour market. • Interventions aiming to promote health and work ability should take into account the interplay between poor mental health and poor employment conditions.

Health loss after road transport injury – new perspectives

Abstract Background Health loss in the road transport system is a major public health problem. Globally, about a fifth of all fatalities within the road transport system are represented by pedestrians, and bicyclists are the group with the highest number of severe injuries in the EU. Here we strive to add new perspectives of health loss in different road user groups examining sickness absence (SA) and disability pension (DP) and in the case of injuries after car crashes also relating them to permanent medical impairment (PMI). Methods Several register-based studies were conducted, based on microdata linked at individual level from several Swedish nationwide registers. In one study information about PMI from the insurance company Folksam was also used. In the main analyses we included all working individuals aged 20-59 years injured in a road traffic accident (pedestrians, bicyclists, car occupants, and other road users) in 2015 in Sweden and population-based matched references without any traffic-related injury. Diagnosis specific SA and DP were assessed during 1 year before and 4 years following the accident. Results A third of the traffic-related accidents involved bicyclists, 31% car occupants, 16% pedestrian, and 19% were other accidents. The excess SA days/year was elevated for all road user groups the whole study period. Excess SA due to injury diagnoses was 15-35 days/year during the first year following the accident. Among individuals injured in a car crash that reported the injury to Folksam, 2% had a new DP 2 years after the crash, and 8% had injuries resulting in PMI. A distinct trend showed that the proportion granted DP increased with increasing PMI grade. Conclusions Sickness absence is a common outcome among individuals injured in the road transport system. Together, these studies highlight the importance of preventing not only fatalities in the road transport system but also non-fatal injuries.

Burnout as a multidimensional phenomenon: How can workplaces be healthy environments?

Abstract Purpose Burnout was already a significant problem before the pandemics, but in the aftermath became a serious concern and a public health and occupational health priority. This study had two aims. First, it investigated how different healthy workplace dimensions and other health individual-level variables are related to burnout. Second, it examined differences in terms of presentism, absenteeism, quality of life between employees who report burnout symptoms and those who do not. Methods Participants were 1702 Portuguese employees from various organizations. 69.68% were female, age ranged from 18 to 72 years (M = 43.25 years, SD = 10.40). Almost half of the participants (49.9%; 851 participants) reported having at least one burnout symptom. Results Participants reported that they have felt exhausted (43.7%), irritated (34.5%) and sad (30.5%) always or very often in the last 4 weeks. Regression analysis revealed that the global score on burnout symptoms was negatively related to leadership engagement, psychosocial work environment, personal health resources, health behaviours, and satisfaction with salary. In addition, the global score on burnout symptoms was positively related to worker involvement, enterprise community involvement, perceived stress, and screen time at work. Furthermore, females tend to report a higher level of burnout symptoms compared to males. In addition, burnout has an impact on sickness absenteeism, presentism, and quality of life. Conclusions Our findings have an important contribution to understanding and promoting a healthier work environment and reinforce the need for measures and policies to promote mental health, manage stress, and prevent burnout in the workplace. Key messages • What best explains the burnout symptoms is the workers’ perceived stress, followed by psychosocial risk factors at work. • There is a positive relationship between perceived stress and burnout: effective work stress management is one of the protective factors that prevents burnout.

3.Y.2. Road traffic injuries, disability burden and implications for compensation schemes in Europe

Abstract Reducing traffic fatalities and injuries is a complex challenge, but it is one that is of paramount importance for public health and safety worldwide. In recent years, there have been improvements in trauma care and injury prevention efforts, which reduced mortality rates and increased survival after serious injury. However, an increased heterogeneity in recovery times is observed with survivors of road traffic injuries differing in their adjustment compared to other traumas in terms of symptoms’ onset, variability and chronicity. The recovery trajectory seems to vary widely with a large percentage of survivors in need of extensive time periods for full recovery. Attention has now been shifted towards the adverse effects of non-fatal injuries on functional, mental health, economic and societal outcomes. The capacity of a person to continue functioning, inability to work, sickness absence and reliance on welfare benefits to compensate for loss of income are some of the injury-related long-term consequences, causing great concern for health and social security systems across Europe, as they have been shown to account for more than one third of total road traffic incident costs. These figures fail to include individuals who sustain “minor” injuries, which do not require hospitalisation, yet still impair their ability to work. Despite the rapidly growing epidemiological and clinical attention, there are still several issues missing from research, policy and practice. A universal definition of recovery after a road traffic injury is still missing, and this has been seen as critical for improved understanding of risk factors of poor recovery as well as improved identification of those in need of welfare benefits. Furthermore, long-term sickness absence and disability following road traffic injury in Europe is still understudied and evidence on the different return to work pathways and compensation schemes is scarce. Evidence is still limited on the context in which return to work occurs, the injury profiles most dependent on long term compensation schemes and the policy settings of injury compensation schemes that impact return to work outcomes post injury. Data availability and data linkage issues often cause misclassification errors when granting disability pensions and this remains unattended long after an injury. Welfare benefits are often poorly connected with the injury or other medical diagnoses and this makes it difficult to assess the contribution of injuries on disability pensions and other welfare benefits, especially in comorbid and multimorbid conditions. The current workshop aims to improve our understanding of the long-term consequences and the challenges faced by those injured in road traffic injuries and aid the development of interventions that seek to enable sustained recovery, and help inform policy and practice of healthcare and injury compensation systems. Key messages • Timely access to quality healthcare, rehabilitation therapies, and assistive technologies can significantly improve outcomes and reduce the strain on social security and compensation systems. • Ensuring equitable access to social security benefits for injured individuals, requires efficient compensation schemes that recognize the full impact of the disability on individuals’ life.

Health care and social benefits among long-term unemployed

Abstract Background There is limited knowledge on the diverse pathways behind long-term unemployment. It is considered that impaired health may lead to exclusion from working life, and that unemployment together with financial difficulties may impair health. In this study, we identify different pathways behind long-term unemployment, and analyse differences in health care and social benefits use based on the diverse pathways. This study contributes to the early identification and supportive efforts for those in risk of labour market marginalisation. Methods Those who had been mainly unemployed in years 2020 and 2021 were identified among all working age (18 to 64 years) Finnish citizens. Register data from Statistics Finland, the Social Insurance Institution of Finland and THL were combined for the analysis. Sequence analysis was conducted for individuals with main activity information for each observation years from 2013 until 2021 (n = 72,485, age 26 to 64 in year 2021). Results Those unemployed for two years were on average 49 years of age (38% women). Five clusters were identified based on the main activity over the nine observation years: unemployed (54%), students (3%), employed (23%), inactive (10%) and those returned to unemployment (10%). Health care attendance was most frequent among those in cluster inactive. Mental health diagnoses were most common among those in clusters inactive and students. Share of those with musculoskeletal diagnoses doubled from 2013 until 2021 among the previously employed. Yearly percentage of those with sickness absence (>10 days) varied from 5 to 13% based on a cluster and a year. Share of recipients of basic social assistance was relatively stable throughout the years in all clusters being highest among inactive (50 to 60%) and lowest among students (6 to 18%). Conclusions Information on labour market background might be useful for preventive efforts and while developing services and social security for those in long-term unemployment. Key messages • There exists diverse backgrounds behind long-term unemployment. • Labour market background should be considered while developing services for those in long-term unemployment.

Antidepressant medication before and after exiting paid work: a population-based study from Sweden

Abstract Background Exiting paid work can be linked to changes in mental health. However, antidepressant medication as an indicator of mental disorder has not been studied in a population that continues working longer. We aimed to explore trajectories of antidepressant medication before and after exiting paid work, among people in paid work at least until age 66. We then examined how sociodemographic factors and prior sickness absence and disability pension (SADP) were associated with such trajectories. Methods We included all people living in Sweden 2005-2020, aged 65-70 and in paid work 2010 based on income (N = 32,849, 39% women). All participants were in paid work at least 2005-2011, exited work during 2012-2015 and were not in paid work 2016-2020. We used register microdata for five years before and five years after exiting paid work and included a range of sociodemographic factors at the exit year as well as number of SADP days/year due to mental diagnosis (ICD-10) prior to work exit. We used group-based trajectory modelling to examine developmental patterns in antidepressant medication (ATC-code N06A) and average marginal effects to study factors that were associated with each trajectory. Results A majority, 89.5% did not have any antidepressant medication during the study period. Among those with such medication, two latent trajectories were identified: 94% had constant use and 6% increasing use. Having any SADP due to mental diagnoses before work exit was the most consistent determinant of belonging to the trajectories of increasing or of constant use of antidepressant medication, even after full adjustments. Older age at work exit was associated with a lower likelihood of belonging to increasing antidepressant medication trajectory. Conclusions Exit from paid work did not result in any major changes in the developmental patterns in antidepressant medication. Prior SADP was the most consistent determinant of antidepressant medication even after exit from paid work. Key messages • Most people working until aged 66 or older had no antidepressant use and among those who did, the use was stable. Only in a small group such medication increased, already before their work exit. • Sickness absence or disability pension days with mental diagnoses before work exit was associated with both increasing and constant antidepressant medication trajectories after the work exit.

Sickness absence duration of stress complaints, adaptation disorder or burnout in the Netherlands

Abstract In the Netherlands, occupational physicians can diagnose burnout when employees report sick. Their guideline distinguishes between stress complaints lasting < 3 months, adaptation disorder with complaints lasting 3-6 months and burnout with complaints lasting > 6 months at moment of diagnosis. The Four-Dimensional Symptom Questionnaire (4DSQ) is recommended to assess and monitor. The new Burnout Assessment Tool (BAT) might be an alternative. Research questions were: 1) What are the sickness absence duration, 4DSQ and BAT-scores of absentees diagnosed with stress complaints, adaptation disorder and burnout?; 2) Is the BAT a better predictor of sickness absence duration than the 4DSQ? From 2020-2023, data was collected among all 3,462 employees who were absent due to stress complaints, adaptation disorder or burnout at one large occupational health and safety service via registry data and an employee questionnaire. Results show that two-thirds of those with stress complaints, half of them with adaptation disorder and one third with burnout were absent for less than half a year. 4DSQ and BAT scores differed significantly between the three groups (p<.05). The BAT explained 0.8% of variance in absence duration (p< .001) when controlled for covariates, which explained 1.6% of variance (p< .001). The explanation by BAT was 1.9% within the group with stress complaints (p = 0.002), .4% within the group with adaptation disorder (p=.022) and absent within the group with burnout. Comparable results were found for the 4DSQ. The differences in absence duration between the three groups aligned with the Dutch guidelines. The BAT nor the 4DSQ were clinically relevant predictors of duration of absence for stress-related diagnoses among absentees in the Netherlands. To reduce productivity loss, it seems better to report sick when still in the stage of stress complaints than to wait until a full burnout has developed. The BAT and 4DSQ might help risk assessment in the working population. Key messages • The sickness absence duration of Dutch employees diagnosed with burnout is much longer than that of those with adaptation disorder or stress complaints. • Both the instrument recommended in the guideline and the new instrument have no clinical relevance in predicting sickness absence duration of stress-related diagnoses.

30-month work participation trajectories of employees returning to work with common mental disorders

Abstract Background Promoting a sustainable return to work (RTW) and work participation (WP) for employees with common mental disorders (CMDs) is a crucial challenge for mental healthcare, organisations, and society at large. To date, work-related factors have only very rarely been examined within RTW trajectory studies. The present study aims to examine 30-month WP trajectories and associated individual, health- and work-related factors of employees on sickness absence due to CMDs in Germany. Methods In a prospective cohort study with N = 259 participants, five measurements were conducted at baseline (during the last week of inpatient treatment), and 6, 12, 18 and 30 months later. WP was defined as the proportion of weeks being present at work between two measurement points (self-reported). WP trajectories over 30 months were estimated with Latent Class Growth Analysis (LCGA), and were described according to associated individual, health- and work-related factors. Results We extracted four trajectory classes: Class 1 ‘slowly increasing WP’ (19.6%) with a slow but constantly increasing WP over time, and finally reaching nearly 60% of WP; Class 2 ‘high maintaining WP’ (30.3%) with a maintaining high WP of over 80% after RTW until 30 months; Class 3 ‘highest maintaining WP’ (34.7%) with the highest maintaining WP throughout follow-up and reaching nearly 100% WP after RTW; and Class 4 ‘decreasing WP’ (15.4%) with a positive development of WP until 12 months, reaching of about 90% WP, but then decreasing below 60% WP until 30 months. Participants with persistent high WP (Classes 2 and 3, 65.0%) reported better individual-, health- and work-related characteristics at baseline, and more realized work accommodations during RTW. Conclusions For the majority of the employees, returning to work resulted in sustainable WP during the 30 months study period. However, about one third of the employees should be given more attention in their complete RTW process from treatment to workplace support. Key messages • Sustainable work participation after returning to work with common mental disorders is a long and complex journey. • Employees with a better individual, health- and work-related situation at baseline seem to be more likely to achieve a sustainable work participation.

Systematic review of reviews: occupational exposures and work disability

Abstract Background Occupational exposures significantly impact workers’ health and may lead to temporary or permanent work absence. Although the effect of occupational exposures on work participation has been studied extensively, research remains fragmented in covering different exposures and outcomes. This review investigates the evidence on the associations between occupational exposures and work disability. Methods Following PRISMA guidelines, a systematic review of reviews was conducted using PubMed, Scopus, and Web of Science. Reviews and meta-analyses of observational studies examining associations between occupational exposures and self- or physician-assessed sickness absence or disability retirement, published until 2023, were included. The review findings were supplemented with an additional search for original studies published after 2012 focusing on exposures less covered by the reviews. Quality assessment was performed using AMSTAR and the NH quality assessment tools. Results A total of 21 reviews and meta-analyses and 35 complementing original studies were included. While 10 reviews covered psychosocial exposures and 19 reviews focused on temporary work disability, fewer examined other exposures like chemicals (3 reviews, 7 original studies) or permanent work disability (8 reviews, 17 original studies). Next, we’ll further synthesize these studies to evaluate the levels of the evidence. Conclusions Our review found that published studies primarily focused on work-related psychosocial exposures and temporary work disability, revealing gaps in research on other occupational exposures like chemicals and permanent work disability. Key messages • There’s a need to explore a wider range of occupational exposures and their impact on work disability beyond psychosocial exposures. • The focus of prior reviews on occupational exposures and temporary work disability underscores the importance of studying the impact of these exposures on permanent work disability in future research.

Employees’ work ability during returning to work with common mental disorders: a mixed methods study

Abstract Background A main goal during the return to work (RTW) process after a long-term sickness absence due to common mental disorders (CMDs), is to restore and maintain an employees’ work ability to enable sustained work participation. To date, surprisingly little research has examined the concept of work ability during the RTW process with CMDs. To better understand how to restore employees’ work ability during RTW with CMDs, both quantitative and qualitative research is needed. The goal of this mixed methods study is to expand the understanding of restoring work ability during the RTW process with CMDs. Methods In this mixed methods follow-up study of N = 286 participants, work ability was quantitatively assessed with the Work Ability Score (WAS, range 0-10) at five measurement points (0, 6, 12, 18 and 30 months) during 30 months of follow-up. In a sub-sample, the qualitative work ability experiences of N = 32 participants were jointly analysed with their quantitative work ability ratings at 6 and 12 months. Results In the joint analysis, three groups of qualitative work ability experiences together with their respective quantitative work ability ratings emerged: Employees with (1) poor work ability (WAS 0-3), who did not RTW yet and described great difficulties in coping with everyday life; (2) moderate work ability (WAS 4-6), who mainly did RTW, but still showed a certain level of fragility; and (3) good to very good work ability (WAS 7-10), who mainly returned within 12 months and reported many individual and work accommodations to restore and maintain their work ability. Conclusions The joint evaluation of work ability ratings and experiences allowed a deeper understanding of restoring work ability during the RTW process. This knowledge may help occupational health professionals and other key RTW stakeholders to provide more tailored support during the RTW process and to promote a sustainable RTW for employees with CMDs. Key messages • Restoring and maintaining the work ability of employees with common mental disorders during the return to work process is crucial for their sustained work participation. • Achieving a good to very good work ability helps returning employees with common mental disorders to ‘stay and thrive’ at work again.