The Contribution of High Levels of Somatic Symptom Severity to Sickness Absence Duration,Disability and Discharge

Introduction: The primary objectives were to compare the duration of sickness absence in employees with high levels of somatic symptom severity (HLSSS) with employees with lower levels of somatic symptom severity, and to establish the long-term outcomes concerning return to work (RTW), disability and discharge. Secondary objective was to evaluate determinants of the duration of sickness absence in employees with HLSSS. Methods: 489 sick-listed employees registered with five Occupational Health Physician (OHP) group practices were included in this study. We measured their baseline scores for somatic symptoms severity, depressive disorders, anxiety disorders, health anxiety, distress and functional impairment. The OHPs filled in a questionnaire on their diagnosis. A prospective 2-year follow-up was carried out to assess the long-term outcomes concerning sickness absence, and retrospective information was gathered with regard to sickness absence during the 12 months before the employees were sick-listed. Results: The median duration of sickness absence was 78 days longer for employees with HLSSS. They more often remained disabled and were discharged more often, especially due to problems in the relationship between the employer and the employee. HLSSS, health anxiety and older age contributed to a longer duration of sickness absence of employees. Conclusion: High levels of somatic symptom severity are a determinant of prolonged sickness absence, enduring disabilities and health-related job loss. Occupational health physicians should identify employees who are at risk and adhere to guidelines for medically unexplained somatic symptoms.     

Prediction of Long-Term Sickness Absence Among Employees with Depressive Complaints

Introduction To study the properties of a screening instrument in predicting long-term sickness absence among employees with depressive complaints. Methods Employees at high risk of future sickness absence were selected by the screening instrument Balansmeter (BM). Depressive complaints were assessed with the depression scale of the Hospital Anxiety and Depression Scale. The total study population consisted of 7,401 employees. Sickness absence was assessed objectively and analyzed at 12 and 18 months of follow-up using company registers on certified sick leave. Results The relative risk (RR) for long-term sickness absence, for employees at high risk versus not at high risk, was 3.26 (95% CI 2.54–4.22) in men and 2.55 (1.98–3.35) in women, when the BM was applied in the total study population. The RR of long-term sickness absence of employees with depressive complaints compared with employees without depressive complaints was 3.13 (2.41–4.09) in men and 2.45 (2.00–3.00) in women. The RR of long-term sickness absence for the BM applied in employees with depressive complaints was 5.23 in men and 3.87 in women. When the BM with a cut-off point with a higher sensitivity was applied in employees with depressive complaints, the RR for long-term sickness absence was 4.88 in men and 3.80 in women. Conclusions The screening instrument Balansmeter is able to predict long-term sickness absence within employees with depressive complaints. The total prediction of long-term sickness absence proved better in employees with depressive complaints compared with employees of a general working population.     

Gender and age differences in the recurrence of sickness absence due to common mental disorders: a longitudinal study

Background  

Common mental disorders (CMDs) are an important cause of sickness absence and long-term work disability. Although CMDs are known to have high recurrence rates, little is known about the recurrence of sickness absence due to CMDs. The aim of this study was to investigate the recurrence of sickness absence due to CMDs, including distress, adjustment disorders, depressive disorders and anxiety disorders, according to age, in male and female employees in the Netherlands.     

Sickness Absence in Drivers of London Taxis and Buses

Sickness absence data for periods of 1 week or more among 2385London taxi drivers were analysed over a period of 1 year. Thereasons, in order of decreasing prevalence, were accidents,disorders of bone and movement, circulatory disorders, and respiratorydisorders. In order to place the absence rates of taxi driversin perspective, a comparison over the same year was made withsimilar sickness absence data for the total work force (12 639)of bus drivers for London Transport. It was found that the busdrivers incurred about 3 times as many days of sickness absence(22.1 days per person compared with 65 days for taxi drivers)and 4 times as many spells of absence (0.73 spells per personcompared with 0.16 spells for taxi drivers) as compared withtaxi drivers. The main reason for these differences was consideredto be due to the terms of employment including sick pay arrangementsof the two groups. Accepted        1 August 1981 Requests for reprints should be addressed to: Dr A. R. Erlam, Medical Centre, 201 Hamilton Road, Felixstowe, Suffolk, IP2 7DT.     

Employees Sick-Listed with Mental Disorders: Who Returns to Work and When?

Purpose To investigate return to work (RTW) in employees sick-listed with mental disorders classified according to the International Classification of Diseases (ICD). Methods Sickness absences (SA) medically certified as emotional disturbance (ICD-10 R45) or mental and behavioral disorders (ICD-10 F00?CF99) were retrieved from an occupational health service register. RTW was associated with age, gender, and socioeconomic position (SEP) by parametric survival analysis. Results Emotional, neurotic, somatoform, stress-related, and mood disorders encompassed 94?% of all mental SA. Employees with emotional disturbance had the highest RTW rates: after 1?year 95?% had resumed work and after 2?years 98?% compared to 89 and 96?% of employees with neurotic, somatoform and stress-related disorders, and 70 and 86?% of employees with mood disorders. The probability of RTW decreased after 1?month of SA due to emotional disturbance, 2?months of SA with neurotic, somatoform and stress-related disorders, and 3?months of SA with mood disorders. Women resumed their work later than men. Young employees presenting with emotional disturbance, neurotic, somatoform, and stress-related disorders had earlier RTW than older employees and low-SEP employees had earlier RTW than high-SEP employees. Conclusions RTW rates and probabilities differed across categories of mental disorders. Age and SEP were associated with RTW of employees with emotional, neurotic, somatoform, and stress-related disorders, but not with RTW of employees experiencing mood disorders. To maximize the likelihood of RTW, a focus on RTW is important in the first months after reporting sick with mental disorders.     

体力与脑力劳动者伤病缺勤及影响因素的对比研究

[目的]比较体力与脑力劳动者因伤病导致缺勤的情况,探讨危险因素,为预防伤病减少缺勤提供依据。[方法]随机整群抽样法选择3896名体力劳动者与2719名脑力劳动者,调查其伤病缺勤及影响因素。[结果]体力劳动者年均缺勤天数（5.4d）比脑力劳动者（20.8d）低,体力劳动者随年龄增高而增加。体力劳动者的年缺勤率（24.0%）比脑力劳动者（65.6%）低。logistic回归分析结果,性别和教育程度是影响体力劳动者伤病缺勤的背景因素,急性胃肠炎、恶性肿瘤、泌尿系感染等是导致缺勤的主要伤病;而婚姻状况、教育程度和年龄是影响脑力劳动者伤病缺勤的背景因素,肥胖、上呼吸道感染和糖尿病等是引起缺勤的主要疾病。[结论]导致体力与脑力劳动者缺勤的主要伤病存在差异,应根据不同劳动类型制定相应措施,预防疾病,减少缺勤。     

Avoidable Sickness Absence in a Dutch Working Population

Introduction Sickness absence has an important impact on employers (e.g. reduced productivity, high costs) and employees (e.g. replacement, job loss). Therefore, we investigated possible reduction by exploring avoidable sickness absence. Methods A questionnaire was filled out by 2,954 Dutch workers (internet panel of a marketing research company, 2005). We obtained data on self reported sickness absence (6.5 months), including the main reason for each sickness absence spell (4 health and 3 non-health reasons), self-reported work-relatedness of absence and workers’ opinion on whether their absence could have been shorter or prevented, and on 12 listed factors that might have contributed to sickness absence. For each of these factors we calculated the avoidable absence fraction (AAF), analogous to the epidemiological population attributable risk. Results A total of 1,233 workers reported sickness absence. The absence rate was 4.46%. For 11% of the absence rate health was not the main reason. Yet, when non-health was reported as the main reason for absence, health still contributed in half the cases. 35% of the absence rate was mainly work-related. 15% of the workers mentioned that their sickness absence could have been shorter or prevented. The AAFs of contributory factors were 0.129 for home related factors, 0.136 for work-related factors and 0.101 for (occupational) health care and guidance factors. In total, the AAF showed that 21.5% of the absence rate can be considered possibly avoidable. Conclusion According to the studied workers sickness absence rate can be reduced. In reducing the absence, one should not only consider factors from the home and work situation, but also from (occupational) health care.     

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

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

Sickness absence in diabetic employees

OBJECTIVES—To compare sickness absence among diabetic and non-diabetic employees.
METHODS—A cross sectional case-control study was conducted in a random sample of 400 diabetic employees 21-50 years old from Ljubljana that compared their sickness absence in the year 1996 with sickness absence of non-diabetic employees matched by sex, age, and occupation. Sickness absence was compared in total and also in subgroups formed by sex, age, occupation, and disability. Non-parametric statistics were used (χ² test, Wilcoxon matched pairs test).
RESULTS—The randomised sample consisted of 61.2% of men (245) and 38.8% of women (155) with a mean age of 42.5 years. Unskilled workers made up 30.2% of employees, and less than 16.4% were highly educated. Among diabetic employees there were 7.0% disabled and among non-diabetic employees 2.0%. The mean frequency of sickness absences of diabetic employees was 0.89 times in the year 1996 (95% confidence interval (95% CI) 0.70 to 1.08), and of non-diabetic employees 0.56 times (95% CI 0.47 to 0.65), p=0.01. The mean total duration of sickness absence of diabetic employees was 31.71 days (95% CI 24.86 to 38.57), of non-diabetic employees 16.57 days (95% CI 11.72 to 21.42), p<0.01. Differences were also found in subgroups but the size of subgroups was not sufficient to detect significant differences.
CONCLUSIONS—The study confirmed that diabetes affects the ability to work. Appropriate work and good control of the disease are important to prevent long term complications.


Keywords: sickness absence; diabetes mellitus     

Overtime Work and the Incidence of Long-term Sickness Absence Due to Mental Disorders: A Prospective Cohort Study

BackgroundAlthough previous research has focused on the association between long working hours and several mental health outcomes, little is known about the association in relation to mental health-related sickness absence, which is a measure of productive loss. We aimed to investigate the association between overtime work and the incidence of long-term sickness absence (LTSA) due to mental disorders.MethodsData came from the Japan Epidemiology Collaboration on Occupational Health Study (J-ECOH). A total of 47,422 subjects were followed-up in the period between April 2012 and March 2017. Information on LTSA was obtained via a study-specific registry. Baseline information was obtained at an annual health checkup in 2011; overtime working hours were categorized into <45; 45–79; 80–99; and ≥100 hours/month.ResultsDuring a total follow-up period of 211,443 person-years, 536 people took LTSA due to mental disorders. A Cox proportional hazards model showed that compared to those with less than 45 hours/month of overtime work, those with 45–79 hours/month were at a lower risk of LTSA due to mental health problems (hazard ratio [HR] 0.63; 95% confidence interval [CI], 0.56–0.71) while those with overtime work of ≥100 hours/month had a 2.11 (95% CI, 1.12–3.98) times higher risk of LTSA due to mental health problems.ConclusionEngaging in excessive overtime work was linked with a higher risk of LTSA due to mental health problems while the lower risk observed among individuals working 45–79 hours/month of overtime work might have been due to a healthy worker effect.Key words: workplace, occupational health, healthy workers effect, prospective studies, Asia     

Effectiveness of a Coordinated and Tailored Return-to-Work Intervention for Sickness Absence Beneficiaries with Mental Health Problems

Purpose Sickness absence and exclusion from the labour market due to mental health problems (MHPs) is a growing concern in many countries. Knowledge about effective return-to-work (RTW) intervention models is still limited, but a multidisciplinary, coordinated and tailored approach has shown promising results in the context of musculoskeletal disorders. The purpose of this study was to assess the effectiveness of this approach as implemented among sickness absence beneficiaries with MHPs. Methods In a quasi-randomised, controlled trial, we assessed the intervention’s effect in terms of time to RTW and labour market status after 1 year. We used two different analytical strategies to compare time to RTW between participants receiving the intervention (n = 88) and those receiving conventional case management (n = 80): (1) a traditional multivariable regression analysis controlling for measured confounding, and (2) an instrumental variable (IV) analysis controlling for unmeasured confounding. Results The two analytical approaches provided similar results in terms of a longer time to RTW among recipients of the intervention (HR = 0.50; 95 % CI 0.34–0.75), although the estimate provided by the IV-analysis was non-significant (HR = 0.70; 95 % CI 0.23–2.12). After 1 year, more recipients of the intervention than of conventional case management were receiving sickness absence benefits (p = 0.031). Conclusion The intervention delayed RTW compared to conventional case management, after accounting for measured confounding. The delayed RTW may be due to either implementation or program failure, or both. It may also reflect the complexity of retaining employees with mental health problems in the workplace.     

Ten-year trends in long-term sickness absence among Japanese public servants: 2009–2018

Sickness absences are a significant public health and economic problem worldwide. However, sickness absence diagnoses and trends have not been reported in much detail in Japan. This study was a retrospective cohort study. We examined data on certified diagnoses and the durations of sickness absence lasting over 90 days (long-term sickness absence) from 2009–2018 among city public servants in Japan. We found that 1) “Mental and behavioral disorders” (495.0–780.6 per 100,000 employees) was the most prevalent reason for long-term sickness absence, and “Mood disorders” (318.6–584.3 per 100,000 employees) was the most prevalent mental disorders diagnosis in each study year; 2) the prevalence of long-term sickness absence for mental disorders showed decreasing trends (781/100,000 in 2009 to 622/100,000 in 2018; [p=0.005, for the trend test]); 3) the trends differed by gender (p<0.05) and age (p<0.001); and 4) the duration of long-term sickness absence related to mental disorders (13.2 ± 9.0 months) was longer than long-term sickness absence resulting from all physical disorders except for diseases of the circulatory system (15.1 ± 11.6 months). Increased focus on significant depressive and neurotic disorders is needed when promoting mental health in the workplace.     

Job strain and psychologic distress influence on sickness absence among Finnish employees

BACKGROUND: Work stress is a recognized risk factor for mental health disorders, but it is not known whether work stress is associated with the morbidity among individuals with psychologic distress. Another shortcoming in earlier research is related to common method bias-the use of individual perceptions of both work stress and psychologic distress. This prospective study was assessed using the General Health Questionnaire (GHQ-12), which identified psychologic distress as a predictor of sickness absence and the effect of work-unit measures of job strain on sickness absence among cases. METHODS: Survey data were collected on work stress, indicated by high job strain, for a cohort of public sector employees (6,663 women, 1,323 men), aged 18 to 62 at baseline in 2000-2002, identified as GHQ-12 cases. Coworker assessments of job strain were used to control for bias due to response style. A 2-year follow-up included recorded long-term (>7 days) medically certified sickness absence. Adjustments were made for age, socioeconomic position, baseline chronic physical disease, smoking, and heavy alcohol consumption. RESULTS: Cases with psychologic distress had 1.3 to 1.4 times higher incidence of long-term sickness absence than non cases. Among cases, high job strain predicted sickness absence (hazard ratio 1.17 in women, 1.41 in men). The significant effect of job strain on sickness absence was found among workers in high socioeconomic positions (hazard ratio 1.54 for women, 1.58 for men) but not among employees in low socioeconomic positions (hazard ratio 1.06 for women, 1.31 for men). CONCLUSIONS: Psychologic distress has an independent effect on medically certified sickness absence. The identification of employees with high job strain and the improvement of their working conditions should be considered as an important target in the prevention of adverse consequences of psychologic distress.     

Recurrence of sickness absence due to common mental disorders

Purpose  

Common mental disorders (CMDs) are an important cause of work disability. Although CMDs are known to have high recurrence rates, little is known about the recurrence of sickness absence due to CMDs. This study examines the recurrence risk of sickness absence due to CMDs.     

Sickness absence and self-reported health a population-based study of 43,600 individuals in central Sweden

Background  

Sickness absence is very high in Sweden. The reasons for this phenomenon are not well known. The aim of this study was to investigate the association between degree of self-reported sickness absence and health. The hypothesis was that individuals with long-term sickness absence would report more symptoms and lower self-rated health. Another hypothesis was that women are more likely to self-rate psychiatric diagnoses compared to men, who are more likely to self-rate musculoskeletal diagnoses.     

Organisational downsizing and musculoskeletal problems in employees: a prospective study

OBJECTIVES—To study the association between organisational downsizing and subsequent musculoskeletal problems in employees and to determine the association with changes in psychosocial and behavioural risk factors.
METHODS—Participants were 764 municipal employees working in Raisio, Finland before and after an organisational downsizing carried out between 1991 and 1993. The outcome measures were self reports of severity and sites of musculoskeletal pain at the end of 1993 and medically certified musculoskeletal sickness absence for 1993-5. The contribution of changes in psychosocial work characteristics and health related behaviour between the 1990 and 1993 surveys was assessed by adjustment.
RESULTS—After adjustment for age, sex, and income, the odds ratio (OR) for severe musculoskeletal pain between major and minor downsizing and the corresponding rate ratios for musculoskeletal sickness absence were 2.59 (95% confidence interval (95% CI) 1.5 to 4.5) and 5.50 (3.6 to 7.6), respectively. Differences between the mean number of sites of pain after major and minor downsizing was 0.99 (0.4 to 1.6). The largest contribution from changes in work characteristics and health related behaviour to the association between downsizing and musculoskeletal problems was from increases in physical demands, particularly in women and low income employees. Additional contributory factors were reduction of skill discretion (relative to musculoskeletal pain) and job insecurity. The results were little different when analyses were confined to initially healthy participants.
CONCLUSIONS—Downsizing is a risk factor for musculoskeletal problems among those who remain in employment. Much of this risk is attributable to increased physical demands, but adverse changes in other psychosocial factors may also play a part.


Keywords: ocupational health; musculoskeletal disorders; downsizing     

Sickness Absence in an Ambulance Service

Sickness absence in the West Midlands Metropolitan AmbulanceService was studied in comparison with the Post Office and FireService. During the 2 years studied the trend was towards morefrequent but shorter spells of absence, with an overall dropin the number of days per person. During both years, 44 percent of staff took under 6 days absence. In 1979 15 per centtook more than 6 weeks, in 1980 12.5 per cent. Ambulance workerstake more time off than the driving/nursing staff in one healthdistrict and GPO workers, and slightly more than firemen. Amongthese groups, only firemen provide a match for stress, theyare much younger and are almost all men. Ambulance women takeapproximately two-thirds as much again sickness absence as men.(Except for the over fifties, where the relationship is almostexactly reversed, but where the number of women was only 8.)The main cause of sickness absence is musculoskeletal injury,which, although not necessarily incurred at work, is clearlyexacerbated by the nature of the ambulance worker's duties.Some of these spells of absence are very long, and it is clearthat this is the area where the payoff to better training orequipment would be the greatest. Requests for reprints should be addressed to: J. A. Stilwell, Principal Research Fellow, Centre for Research in Industry, Business and Administration, University of Warwick, Coventry CV4 7AL     

Sickness absence due to mental disorders in Japanese workforce.

This study was conducted to elucidate sickness absence due to mental disorders in Japanese companies. Data on sickness absence taken for seven consecutive days or more at eight companies (total number of employees: 44,816) was used for the analysis. Diagnosis of mental disorders was based on medical certificates prepared by physicians. The frequency of absence due to all diseases and mental disorders was 3.0% and 0.3%, respectively. The proportion of frequency absence due to mental disorders compared to that for all diseases was 9.4%. Figures for absence prevalence were almost the same as those for frequency absence. The average length of absence due to mental disorders and non-mental disorders was 119.5 days and 47.3 days, respectively. Rate of absence days due to mental disorders compared to that for all diseases was 21.0%. Percent of sickness absenteeism was 0.4%. In one company, the proportion of frequency absence and rate of absence days due to mental disorders compared to those for all diseases had an increasing tendency over the last six years.     

Emotional dissonance and sickness absence: a prospective study of employees working with clients

Purpose

(1) Determine the relationship between emotional dissonance and medically certified sickness absence among employees working with clients and (2) compare the impact of emotional dissonance on medically certified sickness absence with the impact of other psychological and social work factors.

Methods

A sample of 7758 employees was recruited from 96 Norwegian organizations in the period 2004 to 2014, all working with clients. The study design was prospective with emotional dissonance measured at baseline and then linked to official registry data of medically certified sickness absence for the year following the survey assessment. Quantitative demands, decision demands, role clarity, role conflict, control over work intensity, and decision control were included as additional work exposures. The impact of the study variables on the presence and duration of medically certified sickness absence was investigated with a negative binomial hurdle model.

Results

In the fully adjusted model, emotional dissonance and role conflict significantly predicted the presence of medically certified sickness absence. Control over work intensity and decision control were negatively related to presence of sickness absence. Only role conflict was a risk factor for the duration of sickness absence when all factors were analysed simultaneously.

Conclusion

Emotional dissonance is a risk factor for the presence of medically certified sickness absence in client-driven work environments. Theoretical models of sickness absence, as well as interventions aiming to prevent sickness absence in such environments, should be aware of the effect emotional dissonance may have on employees.

     

Prevention of recurrent sickness absence among employees with common mental disorders: design of a cluster-randomised controlled trial with cost-benefit and effectiveness evaluation

Background  

Common mental disorders, such as depression, anxiety disorder, and adjustment disorder, have emerged as a major public and occupational health problem in many countries. These disorders can have severe consequences such as absenteeism and work disability. Different interventions have been developed to improve the return-to-work of employees with common mental disorders, but still a large proportion of employees experiences health and work problems after their return-to-work. For this reason, the SHARP-at work intervention is developed to prevent a relapse of sickness absence among employees who have returned to work after a period of sickness absence because of common mental disorders. We aim to evaluate the effectiveness, cost-benefit and process of the intervention compared to care as usual.