Health problems and psychosocial work environment as predictors of long term sickness absence in employees who visited the occupational physician and/or general practitioner in relation to work: a prospective study

Aims: To determine whether psychosocial work environment and indicators of health problems are prospectively related to incident long term sickness absence in employees who visited the occupational physician (OP) and/or general practitioner (GP) in relation to work.

Methods: The baseline measurement (May 1998) of the Maastricht Cohort Study, a prospective cohort study among 45 companies and organisations, was used to select employees at work who indicated having visited the OP and/or GP in relation to work. Self report questionnaires were used to measure indicators of health problems (presence of at least one long term disease, likeliness of having a mental illness, fatigue) and psychosocial work environment (job demands, decision latitude, social support, job satisfaction) as predictors of subsequent sickness absence. Sickness absence data regarding total numbers of sickness absence days were obtained from the companies and occupational health services during an 18 month period (between 1 July 1998 and 31 December 1999). Complete data were available from 1271 employees.

Results: After adjustment for demographics and the other predictors, presence of at least one long term disease (OR 2.36; 95% CI 1.29 to 4.29) and lower level of decision latitude (OR 1.69; 95% CI 1.22 to 2.38) were the strongest predictors for sickness absence of at least one month. A higher likelihood of having a mental illness, a higher level of fatigue, a lower level of social support at work, and low job satisfaction were also significant predictors for long term sickness absence, but their effect was less strong.

Conclusion: In detecting employees at work but at risk for long term sickness absence, OPs and GPs should take into account not only influence of the psychosocial work environment in general and level of decision latitude in particular, but also influence of indicators of health problems, especially in the form of long term diseases.

     

Influence of change in psychosocial work characteristics on sickness absence: The Whitehall II Study

OBJECTIVES: To study the influence of change in self perceived psychosocial work characteristics on subsequent rates of sickness absence. METHODS: Prospective cohort study of British civil service employees. Job control, job demands, and work social supports were measured in 1985/88 and in 1991/93. Analyses included 3817 British civil servants with sickness absence records at baseline (1985-89) and for two follow up periods, early (1994-95) and later follow up (1996-98). RESULTS: Change in work characteristics predicted subsequent incidence of long spells of sickness absence (>7 days) in the early follow up period after adjustment for covariates including baseline work characteristics, health status, and sickness absence. Adjusted rate ratios were 1.23 (95% CI 1.03 to 1.46) for decreased compared with stable decision latitude; 1.17 (95% CI 1.01 to 1.36) for increased compared with stable job demands and 0.79 (95% CI 0.67 to 0.93) for increased compared with stable work social support. These associations were also seen in a sub-sample who did not change employment grade. In the later follow up period, associations between work change and long spells of sickness absence were similar for decision latitude, less pronounced for job demands, and no longer apparent for social supports. Changes in work characteristics were not associated with subsequent short spells of sickness absence (相似文献   

Job satisfaction and short-term sickness absence among Dutch workers

BACKGROUND: Sickness absence is a considerable economic and social problem. Short-term sickness absence is known to be associated with behavioural attitudes. The correlation between sickness absence and job satisfaction has been studied infrequently and with contradictory results. AIMS: This study investigated the correlation between short-term sickness absence and both global and specific job satisfaction. We defined short-term sickness absence as spells of up to 42 days. METHODS: A random sample of 898 Dutch workers from a variety of economic sectors and companies received a self-report questionnaire on their first day of sick leave. The questionnaire measured global and specific job satisfaction. In our regression analysis, we controlled for the confounding factors of age, gender, educational level, perceived workload, job autonomy and decision latitude. The duration of an absence spell was defined as the amount of calendar days between sick leave and return to work. RESULTS: Global job satisfaction did not correlate significantly with the duration of short-term sickness absence. While increasing physical job demands predicted longer absence, increasing job autonomy and educational level predicted shorter absence. Satisfaction with colleagues predicted longer duration absence. CONCLUSION: Global job satisfaction did not correlate with the duration of short-term absence spells, but specific satisfaction with colleagues was associated with longer sickness spells.     

Sickness absence and work strain among Danish slaughterhouse workers: an analysis of absence from work regarded as coping behaviour

This paper comprises two parts: a theoretical part in which a number of theoretical and methodological recommendations about research on absence are made on the basis of a review of selected literature, and an empirical part that contains analyses of absence from work in the Danish slaughterhouse industry. In the theoretical part it is asserted that sickness absence cannot be understood if it is viewed as a simple function of ill health or other individual factors, such as job dissatisfaction. Absence should rather be regarded as a coping behaviour that reflects an individual's perception of his/her health (illness) and is a function of a number of factors at different levels, primarily the combination of job demands and coping possibilities at the job (job strain). Several ideal methodological requirements regarding absence research are formulated on this basis. The empirical part presents an analysis of absence from work in the Danish slaughterhouse industry based on a study of 4407 slaughterhouse workers. It is shown that a number of factors at the company level, the job level and the individual level are associated with an individual's absence from work over a 12-month period. It is further shown that people with high job strain have a significantly higher absence rate, that there is a clear association between sickness absence and perceived health and that absence is part of a pattern along with other coping strategies which are directed against stressing working conditions and perceived ill health. Lastly, it is discussed whether absence from work is a functional coping strategy.     

Effects of organizational justice on depressive symptoms and sickness absence: A longitudinal perspective

A longitudinal three-wave study among a large representative sample of 1519 employees of various companies in The Netherlands examined how organizational justice (as measured by distributive and procedural justice) was related to depressive symptoms and sickness absence. It was predicted that perceived justice would contribute to lower depressive symptoms and sickness absence, whereas depressive symptoms and absenteeism in turn would contribute to lower perceptions of organizational justice. In line with the predictions, we found that both distributive and procedural justice contributed to lower depressive symptoms, and distributive justice contributed to lower sickness absence in the following year. With regard to reversed effects, sickness absence contributed to lower perceptions of distributive justice to some extent. Moreover, sickness absence was related to higher depressive symptoms a year later. This research shows the importance of justice in organizations as a means to enhance the wellbeing of people at work and to prevent absenteeism.     

Combined effects of uncertainty and organizational justice on employee health: testing the uncertainty management model of fairness judgments among Finnish public sector employees

We examined whether the combination of uncertainty (lack of work-time control, and negative changes at work) and organizational justice (i.e., justice of decision-making procedures and interpersonal treatment at work) contributes to sickness absence. A total of 7083 male and 24,317 female Finnish public sector employees completed questionnaires designed to assess organizational justice, workload and other factors. Hierarchical regression showed that after adjustment for age, income, and health behaviors low procedural and interactional justice were related to long sickness absence spells. In accordance with the uncertainty management model, these associations were dependent on experienced work-time control and perceived changes at work.     

Psychosocial work environment and mental health: Job-strain and effort-reward imbalance models in a context of major organizational changes

This study explored the association between the two job-stress models, job-strain and effort-reward imbalance, and mental health outcomes in a working population exposed to major organizational changes. The cross-sectional study was based on 680 subjects, 504 men and 176 women. Psychosocial factors at work included: psychological demands, decision latitude, social support, effort, reward, and overcommitment. Mental health outcomes were depressive symptoms (CES-D) and psychiatric disorders (GHQ-12). Job strain, low decision latitude, effort-reward imbalance, and low reward (especially job instability) were found to be associated with depressive symptoms and/or psychiatric disorders among men. Overcommitment at work was a risk factor for both men and women. Social support at work played a role to reduce depressive symptoms for women. These findings emphasize the deleterious effects of psychosocial work environment on mental health during major organizational changes.     

Can individual health differences be explained by workplace characteristics?-A multilevel analysis

Research on work-related health has mainly focused on individual factors. The present study expands the focus by exploring the role of organizational characteristics of workplaces for different individual health outcomes. The aim of the study was to look at differences in relative effect of workplace variations on five health outcomes, and to explain those differences in health outcomes by organizational characteristics. The sample encompassed 90 workplaces in Sweden and about 4300 individuals employed within these workplaces. Measurement of the workplace characteristics was carried out independently of the measurement of the individual's working conditions and health. Organizational data were collected by interviews with local managers at participating workplaces, and individual data were obtained by means of a survey of the employees. The results showed that a significant proportion of the variance in sickness absence, work ability, general health, and musculoskeletal disorders was attributed to the workplace. Of eight tested organizational characteristics, customer adaptation, lean production, and performance control could explain some of this workplace variance. The results also showed that only one organizational effect remained significant when controlled for the individual confounder of age and gender. High customer adaptation is associated with higher sickness absence. This association is not mediated via differences in mental and physical job strain.     

Organizational Justice: Evidence of a New Psychosocial Predictor of Health

OBJECTIVES: This study examined the justice of decision-making procedures and interpersonal relations as a psychosocial predictor of health. METHODS: Regression analyses were used to examine the relationship between levels of perceived justice and self-rated health, minor psychiatric disorders, and recorded absences due to sickness in a cohort of 506 male and 3570 female hospital employees aged 19 to 63 years. RESULTS: The odds ratios of poor self-rated health and minor psychiatric disorders associated with low vs high levels of perceived justice ranged from 1.7 to 2.4. The rates of absence due to sickness among those perceiving low justice were 1.2 to 1.9 times higher than among those perceiving high justice. These associations remained significant after adjustment for behavioral risks, workload, job control, and social support. CONCLUSIONS: Low organizational justice is a risk to the health of employees.     

Sickness presence,sick leave and adjustment latitude

Objectives

Previous research on the association between adjustment latitude (defined as the opportunity to adjust work efforts in case of illness) and sickness absence and sickness presence has produced inconsistent results. In particular, low adjustment latitude has been identified as both a risk factor and a deterrent of sick leave. The present study uses an alternative analytical strategy with the aim of joining these results together.

Material and Methods

Using a cross-sectional design, a random sample of employees covered by the Upper Austrian Sickness Fund (N = 930) was analyzed. Logistic and ordinary least square (OLS) regression models were used to examine the association between adjustment latitude and days of sickness absence, sickness presence, and an estimator for the individual sickness absence and sickness presence propensity.

Results

A high level of adjustment latitude was found to be associated with a reduced number of days of sickness absence and sickness presence, but an elevated propensity for sickness absence.

Conclusions

Employees with high adjustment latitude experience fewer days of health complaints associated with lower rates of sick leave and sickness presence compared to those with low adjustment latitude. In case of illness, however, high adjustment latitude is associated with a higher probability of taking sick leave rather than sickness presence.     

High physical and psychosocial load at work and sickness absence due to neck pain

OBJECTIVES: This study investigates the relationship between physical and psychosocial load at work and sickness absence due to neck pain. METHODS: A prospective cohort study with a follow-up period of 3 years (1994-1998) was performed among a working population. At the beginning of the study, physical load at work was quantified by means of video recordings. Work-related psychosocial variables were measured by means of the Job Content Questionnaire. The frequency of sickness absence due to neck pain with a minimal duration of 3 days was assessed on the basis of company registrations during the follow-up period. Altogether 758 workers were included in the analyses. Possible confounding by individual characteristics, physical load, and psychosocial load was studied. RESULTS: Work-related neck flexion and neck rotation, low decision authority, and medium skill discretion showed statistically significant increased risks for sickness absence due to neck pain (adjusted rate ratios ranging from 1.6 to 4.2). High quantitative job demands, low skill discretion, and low job security showed nonsignificant increased risks for sickness absence due to neck pain (adjusted rate ratios of 2.0, 1.6 and 1.7, respectively). Work-related sitting, conflicting job demands, supervisor support, and co-worker support did not increase sickness absence due to neck pain. CONCLUSION: Work-related neck flexion, neck rotation, low decision authority, and medium skill discretion are risk factors for sickness absence due to neck pain. There are indications that high job demands, low skill discretion, and low job security are also risk factors for sickness absence due to neck pain.     

A meta-analysis of observational studies identifies predictors of sickness absence

OBJECTIVE: About one in every three employees seen by their occupational physician is absent from work because of psychosocial health complaints. To implement preventive measures, it is necessary to identify predictors for this type of sickness absence. STUDY DESIGN AND SETTING: A meta-analysis was carried out to quantify the association between predictive factors and psychosocial sickness absence and to assess clinical outcomes and heterogeneity. Eligible for inclusion were prospective studies that examined this association and provided sufficient information to estimate summary odds ratios (SORs). RESULTS: Twenty prospective studies were included. Significant SORs for sick leave >3 days were found for being unmarried, 1.37 (95% confidence interval [CI]=1.15-1.64), experiencing psychosomatic complaints, 1.79 (95% CI=1.54-2.07), using medication, 3.13 (95% CI=1.71-5.72), having a burnout, 2.34 (95% CI=1.59-3.45), suffering from psychological problems, 1.97 (95% CI=1.37-2.85), having low job control, 1.28 (95% CI=1.23-1.33), having low decision latitude, 1.33 (95% CI=1.16-1.56), and experiencing no fairness at work, 1.30 (95% CI=1.18-1.45). CONCLUSION: This study shows that predictors of sickness absence can be identified in a homogeneous manner. The results provide leads to public health interventions to successfully improve psychosocial health and to reduce sickness absence.     

Importance of psychosocial work factors on general health outcomes in the national French SUMER survey

AIM: To examine the associations between psychosocial work factors and general health outcomes, taking into account other occupational risk factors, within the national French working population. METHODS: The study was based on a large national sample of 24 486 women and men of the French working population who filled in a self-administered questionnaire in 2003 (response rate: 96.5%). Psychosocial work exposures included psychological demands, decision latitude, social support, workplace bullying and violence from the public. The three health indicators studied were self-reported health, long sickness absence (>8 days of absence) and work injury. Adjustment was made for covariates: age, occupation, work status, working hours, time schedules, physical, ergonomic, biological and chemical exposures. Men and women were studied separately. RESULTS: Low levels of decision latitude, and of social support, and high psychological demands were found to be risk factors for poor self-reported health and long sickness absence. High demands were also found to be associated with work injury. Workplace bullying and/or violence from the public also increased the risk of poor health, long sickness absence and work injury. CONCLUSION: Psychosocial work factors were found to be strong risk factors for health outcomes; the results were unchanged after adjustment for other occupational risk factors. Preventive efforts should be intensified towards reducing these psychosocial work exposures.     

Psychosocial factors at work and sickness absence in the Gazel cohort: a prospective study

OBJECTIVE: To test whether psychosocial factors at work are predictors of rates of sickness absence. METHODS: The study population consisted of middle aged men and women employed by the French national electricity and gas company (EDF-GDF) in various occupations and followed up since 1989 by annual self administered questionnaires and independent data obtained from the medical and personnel departments of EDF-GDF. The 1995 questionnaire provided information about three psychosocial work factors: psychological demands, decision latitude, and social support at work. Sick-ness absence data were provided by the company's social security department. The occurrence of spells and days of absence in the 12 months after completion of the 1995 questionnaire was studied. Potential confounding variables were age, smoking, alcohol, and marital status, assessed in the 1995 questionnaire, and educational level and occupation, assessed from data provided by the personnel department. This study was restricted to the 12,555 subjects of the initial cohort who were still working and answered the self administered questionnaire in 1995. RESULTS: Low levels of decision latitude were associated with more frequent and longer sickness absences among men and women. Low levels of social support at work increased the numbers of spells and days of absence among men only. These associations weakened after adjustment for potential confounding factors, but remained significant. CONCLUSION: The study indicates that psychosocial factors at work, especially decision latitude, are predictive of sickness absence.

 

     

Organizational Characteristics as Predictors of Work Disability: A Prospective Study Among Sick Employees of For-Profit and Not-For-Profit Organizations

INTRODUCTION: This article reports a prospective study that focused on the influence of organizational structure and organizational culture on the outcome of sickness absence, return to work or work disability. Former studies of determinants of work disability hardly have given attention to organizational characteristics and, if so, not following a appropriate prospective design. METHODS: The study population consisted of 455 employees of 45 for-profit and not-for-profit companies participating in the Maastricht Cohort Study on fatigue at work who were on sick leave for at least 6 weeks. Both independent variables which were type of company, size, centralization of decision making and organizational culture, and covariates, which were sex, age, educational level, fatigue, and chronic illness, were all measured before employees reported sick. The dependent variable outcome of the sickness absence, mainly return to work or work disability, was measured 15 months after reporting sick. RESULTS: Multilevel logistic regression analysis, with organizational characteristics as level 2 independent variables and demographic and health characteristics as covariates, suggested that the type of company (for-profit/private or not-for-profit/public) is predictive of the outcome of sickness absence (crude OR = 2.21; CI: 1.16-4.20), but this may be partially due to a higher proportion of fatigued and chronically ill employees in not-for-profit companies (adjusted OR = 2.09; CI: 0.93-4.37). Findings about the role of some other organizational characteristics, like organizational culture, were inconclusive. CONCLUSIONS: Organizational characteristics should next to health characteristics be included in the models of studies which aim at predicting which sick employees are at risk for work disability. To prevent work disability not-for-profit companies might be stimulated to more active return-to-work policy by charging them with the costs of it.     

Work demands,job insecurity and sickness absence from work. How productive is the new,flexible labour force?

BACKGROUND: We investigate one aspect of productivity--sickness absence--and ask whether job insecurity and high work demands are associated with increased sickness absence and, if so, whether mental or physical health mediates this association. We further investigate if having control at work modifies these associations. METHODS: We used cross-sectional survey data from 2,248 employees aged 40-44 years living in two cities of south-eastern Australia. Logistic regressions were used to compare the associations between job insecurity and demands among those with short (1-3 days) or long-term (> 3 days) sickness absence with those who had no sickness absence in the last four weeks. The mediating effects of mental and physical health were assessed by evaluating changes in the magnitude of the association between these work conditions and sickness absence. RESULTS: High job insecurity (OR = 3.28; 95% CI 1.54-6.95) and high work demands (OR = 1.62; 95% CI 1.13-2.30) were significantly associated with long-term, but not with short-term, sickness absence. These associations were unaffected by job control. Depression and anxiety explained 61% of the association between high work demands and long-term sickness absence and 30% of the association between job insecurity and long-term sickness absence. CONCLUSION: Difficult working conditions may reduce productivity by contributing to longer absences from work. IMPLICATIONS: Reforms intended to improve economic performance should address any potential health costs of insecurity or intensification, which could inadvertently decrease productivity, possibly through their impact on mental health.     

Adjustment latitude and attendance requirements as determinants of sickness absence or attendance. Empirical tests of the illness flexibility model

This study investigates whether the two dimensions of illness flexibility at work, adjustment latitude and attendance requirements are associated to sickness absence and sickness attendance. Adjustment latitude describes the opportunities people have to reduce or in other ways change their work-effort when ill. Such opportunities can be to choose among work tasks or work at a slower pace. Attendance requirements describe negative consequences of being away from work that can affect either the subject, work mates or a third party. In a cross-sectional design data based on self-reports from a questionnaire from 4924 inhabitants in the county of Stockholm were analysed. The results showed that low adjustment latitude, as predicted, increased women's sickness absence. However, it did not show any relation to men's sickness absence and men's and women's sickness attendance. Attendance requirements were strongly associated to both men's and women's sickness absence and sickness attendance in the predicted way. Those more often required to attend were less likely to be absent and more likely to attend work at illness. As this is the first study of how illness flexibility at work affects behaviour at illness, it was concluded that more studies are needed.     

The contribution of occupational factors to social inequalities in health: findings from the national French SUMER survey

Social inequalities in health have long been demonstrated, but the understanding of these inequalities remains unclear. Work and its related occupational factors may contribute to these inequalities. The objective of this study was to study the contribution of work factors using an integrated approach (including all types of exposures) to social inequalities in three health outcomes: poor self-reported health, long sickness absence, and work injury. Respondents were 14,241 men and 10,245 women drawn from a survey of the national French working population (response rate: 96.5%). Work factors included job characteristics, and occupational exposures of the physical, ergonomic, biological, chemical, and psychosocial work environment. All work factors were measured through expert evaluation by occupational physicians, except psychosocial work factors, which were self-reported. Strong social gradients were found for all work factors, except for psychological demands, workplace bullying, and aggression from the public. Marked social gradients were also observed for the health outcomes studied, blue collar workers being more likely to report poor self-reported health, long sickness absence, and work injury. The social differences in health were reduced strongly after adjustment for work factors (psychological demands excluded) by 24-58% according to sex and health outcomes. The strongest impacts were found for decision latitude, ergonomic, physical, and chemical exposures, as well as for work schedules. A detailed analysis allowed us to identify more precisely the contributing occupational factors. It suggests that concerted prevention of occupational risk factors would be useful not only to improve health at work, but also to reduce social inequalities in health.     

Work and depression among women in the Federal Republic of Germany

A study was carried out to test the association between workplace stress and depression among working women and men in the Federal Republic of Germany (FRG). The data are from the 1984 German national health survey. The sample (N = 795) was composed of 319 working women and 476 working men. The hypothesis tested was that depression is related to high job demands and low job decision latitude. Correlation and multiple regression analyses supported the hypothesis for both women and men. However, the mean level of decision latitude was lower for women than men, as was the level of job demands. The mean depression score was higher for women, and correlations between depression and high job demands/low decision latitude were stronger for women than men. It was concluded that low decision latitude combined with high job demands, a condition experienced frequently by working women, contributes to depression among working women in the FRG. Study findings shed light on the health of employed women in the FRG and may also have implications for working women in other Western industrialized countries.     

Organisational justice and health of employees: prospective cohort study

Aims: To examine the association between components of organisational justice (that is, justice of decision making procedures and interpersonal treatment) and health of employees.

Methods: The Poisson regression analyses of recorded all-cause sickness absences with medical certificate and the logistic regression analyses of minor psychiatric morbidity, as assessed by the General Health Questionnaire, and poor self rated health status were based on a cohort of 416 male and 3357 female employees working during 1998–2000 in 10 hospitals in Finland.

Results: Low versus high justice of decision making procedures was associated with a 41% higher risk of sickness absence in men (rate ratio (RR) 1.4, 95% confidence interval (CI) 1.1 to 1.8), and a 12% higher risk in women (RR 1.1, 95% CI 1.0 to 1.2) after adjustment for baseline characteristics. The corresponding odds ratios (OR) for minor psychiatric morbidity were 1.6 (95% CI 1.0 to 2.6) in men and 1.4 (95% CI 1.2 to 1.7) in women, and for self rated health 1.4 in both sexes. In interpersonal treatment, low justice increased the risk of sickness absence (RR 1.3 (95% CI 1.0 to 1.6) and RR 1.2 (95% CI 1.2 to 1.3) in men and women respectively), and minor psychiatric morbidity (OR 1.2 in both sexes). These figures largely persisted after control for other risk factors (for example, job control, workload, social support, and hostility) and they were replicated in initially healthy subcohorts. No evidence was found to support the hypothesis that organisational justice would represent a consequence of health (reversed causality).

Conclusions: This is the first longitudinal study to show that the extent to which people are treated with justice in workplaces independently predicts their health.