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.     

Different risk factors for musculoskeletal complaints and musculoskeletal sickness absence

OBJECTIVES: The aim of this study was to investigate whether individual, work-related physical and psychosocial risk factors involved in the occurrence of musculoskeletal complaints also determine musculoskeletal sickness absence. METHODS: This cross-sectional study used a self-administered questionnaire to collect data on individual and work-related risk factors and the occurrence of musculoskeletal complaints and musculoskeletal sickness absence among 373 employees of laundry-works and dry-cleaning establishments (response rate 87%). Logistic regression models were used to determine associations between risk factors and the occurrence of musculoskeletal complaints and sickness absence due to these complaints. RESULTS: Both work-related physical and psychosocial factors showed strong associations with low-back pain and upper-extremity complaints. Work-related physical factors did not influence sickness absence, whereas psychosocial factors showed some associations with sickness absence. Sickness absence was associated with The Netherlands as the country of birth [odds ratio (OR) 0.3, 95% confidence interval (95% CI) 0.2-0.6], and female workers had an episode of sickness absence due to low-back pain less often (OR 0.5, 95% CI 0.3-0.9), but more often due to upper-extremity complaints (OR 2.2, 95% CI 1.14.5). CONCLUSIONS: Work-related physical and psychosocial factors largely determine the occurrence of low-back pain and upper-extremity complaints, whereas individual factors predominantly determine whether persons with these musculoskeletal complaints take sick leave.     

Risk factors for musculoskeletal disorders among nursing personnel in Greek hospitals

OBJECTIVES: To investigate the relationships between physical, psychosocial, and individual characteristics and different endpoints of musculoskeletal complaints of the lower back, neck and shoulders. METHODS: In this cross-sectional study a questionnaire survey was carried out among 351 nursing personnel (response 84%) in six general hospitals in Athens, Greece. A questionnaire was used on physical and psychosocial workload, need for recovery, perceived general health and (1) the occurrence of musculoskeletal complaints in the past 12 months, (2) chronic complaints during at least 3 months, and (3) complaints which led to sickness absence. In logistic regression analysis odds ratios (ORs) were estimated for all relevant risk factors. RESULTS: Self-reported factors of physical load were associated with the occurrence of back pain (OR=1.85), neck pain (OR=1.88), and shoulder pain (OR=1.87) but these factors were not associated with chronic complaints and musculoskeletal sickness absence. Physical load showed a trend with the number of musculoskeletal complaints with ORs of 2.47 and 4.13 for two and three musculoskeletal complaints, respectively. No consistent influence of psychosocial factors on complaints, chronicity, or sickness absence was observed. A perceived moderate general health was also a risk factor, and strongest associations were observed for sickness absence due to back pain (OR=2.03), neck pain (OR=8.31), and shoulder pain (OR=6.84). CONCLUSIONS: The handling of physical loads among nurses seems to put them at risk for the occurrence of musculoskeletal disorders. The development of these complaints into chronic complaints and associated sickness absence is strongly determined by perceived general health and almost not associated with work-related physical and psychosocial risk factors. When the influence of work-related risk factors on musculoskeletal health is being investigated, the general health status of individual workers should be taken into account.     

Experience of Health Complaints and Help Seeking Behavior in Employees Screened for Depressive Complaints and Risk of Future Sickness Absence

Introduction The aim of this study was to examine the associations between on the one hand depressive complaints and risk of future sickness absence and on the other hand experience of health complaints and help seeking behavior in the working population. Methods Cross-sectional data were used from employees working in the banking sector (n = 8,498). The screening instrument included measures to examine the risk of future sickness absence, depressive complaints and help seeking behavior. Results Of employees reporting health complaints, approximately 80% had already sought help for these complaints. Experience of health complaints and subsequent help seeking behavior differed between employees with mild to severe depressive complaints and employees at risk of future sickness absence. Experience of health complaints was highest in employees identified with both concepts (69%) compared with employees identified at risk of future sickness absence only (48%) and with mild to severe depressive complaints only (57%). In those employees identified with one or both concepts and who had not sought help already, intention to seek help was about 50%. Conclusions From a screening perspective, employees who do not experience health complaints or who do not have the intention to seek help may refuse participation in early intervention. This might be a bottleneck in the implementation of preventive interventions in the occupational health setting.     

Prediction of sickness absence: development of a screening instrument

Objectives

To develop a concise screening instrument for early identification of employees at risk for sickness absence due to psychosocial health complaints.

Methods

Data from the Maastricht Cohort Study on “Fatigue at Work” were used to identify items to be associated with an increased risk of sickness absence. The analytical procedures univariate logistic regression, backward stepwise linear regression, and multiple logistic regression were successively applied. For both men and women, sum scores were calculated, and sensitivity and specificity rates of different cut‐off points on the screening instrument were defined.

Results

In women, results suggested that feeling depressed, having a burnout, being tired, being less interested in work, experiencing obligatory change in working days, and living alone, were strong predictors of sickness absence due to psychosocial health complaints. In men, statistically significant predictors were having a history of sickness absence, compulsive thinking, being mentally fatigued, finding it hard to relax, lack of supervisor support, and having no hobbies. A potential cut‐off point of 10 on the screening instrument resulted in a sensitivity score of 41.7% for women and 38.9% for men, and a specificity score of 91.3% for women and 90.6% for men.

Conclusions

This study shows that it is possible to identify predictive factors for sickness absence and to develop an instrument for early identification of employees at risk for sickness absence. The results of this study increase the possibility for both employers and policymakers to implement interventions directed at the prevention of sickness absence.     

Productivity Loss at Work; Health-Related and Work-Related Factors

Introduction Productivity loss is an increasing problem in an aging working population that is decreasing in numbers. The aim of this study is to identify work-related and health-related characteristics associated with productivity loss, due to either sickness absence or reduced performance at work. Methods In this cross-sectional study, data of the Netherlands Working Conditions Survey of 2007 were used, which includes a national representative sample of 22,759 employees aged 15 to 64 years. Demographic characteristics, health-related and work-related factors were assessed with a questionnaire. Logistic regression analyses were carried out to study the relationship of work-related and health-related factors with low performance at work and sickness absence in the past 12 months. Results Poor general health, the number of longstanding health conditions, and most types of longstanding health conditions were associated with productivity loss. Health-related factors were in general stronger associated with sickness absence than with low performance at work. Performance: poor health OR 1.54 CI 1.38–1.71, >1 health conditions OR 1.21 CI 1.09–1.35; sickness absence: poor health OR 2.62 CI 2.33–2.93, >1 health conditions OR 2.47 CI 2.21–2.75. Of the different types of longstanding health conditions, only psychological complaints and to a small extent musculoskeletal symptoms, were associated with low performance (respectively OR 1.54 CI 1.27–1.87; OR 1.09 CI 1.00–1.18). Low performance at work was less likely among employees with high physically demanding work (shift work OR 0.70 CI 0.63–0.76, using force OR 0.78 CI 0.72–0.84, and repetitive movements OR 0.74 CI 0.70–0.79). Psychosocial factors were stronger associated with low performance at work than with sickness absence (performance: job autonomy OR 1.28 CI 1.21–1.37, job demands OR 1.23 CI 1.16–1.31, emotionally demanding work OR 1.73 CI 1.62–1.85; sickness absence: job autonomy ns, job demands OR 1.09 CI 1.03–1.17, emotionally demanding work OR 1.09 CI 1.02–1.16). Conclusion Except for psychological complaints, workers with a longstanding health condition generally perform well while being at work. Nevertheless, the likelihood of taking sick leave is increased. Among work-related factors, psychosocial work characteristics have the strongest relation with productivity loss, mostly with performance while at work.     

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.     

Identifying workers at risk of sickness absence by questionnaire

BACKGROUND: Sickness absence is an important economic problem, because of high costs and lost productivity. Determining factors associated with increased risk of sickness absence may lead to the development of preventive measures. AIMS: To determine whether self-report questionnaires can identify those employees at risk of sickness absence METHODS: Prospective study of 238 healthy administrative workers. Participants completed a questionnaire proven to be valid and consistent. The questionnaire consisted of 116 items about health, work and working conditions. Sickness absence was followed-up for a period of 1 year. RESULTS: The questionnaires of 191 workers (80%) were suitable for analysis. The number of reported health complaints was significantly (P < 0.01) associated with sickness absence (OR 2.18; 95% CI 1.32-3.61). Concentration problems were correlated with more frequent absences, and both nervous complaints and coping problems with longer duration. Age (OR 0.96; 95% CI 0.93-0.99; P = 0.02) and job insecurity (OR 0.68; 95% CI 0.47-0.98; P = 0.04) were negatively associated with sickness absence. Psychosocial and physical work factors were not associated with sickness absence. CONCLUSIONS: Questionnaires on health and work can identify employees at future risk of sickness absence. Workers who report multiple health complaints, especially concentration problems, nervous complaints or coping problems, may be at increased risk of sickness absence.     

Psychosocial factors and work related sickness absence among permanent and non-permanent employees

STUDY OBJECTIVE: To examine the association between psychosocial work factors and work related sickness absence among permanent and non-permanent employees by sex. DESIGN: A cross sectional survey conducted in 2000 of a representative sample of the European Union total active population, aged 15 years and older. The independent variables were psychological job demands and job control as measures of psychosocial work environment, and work related sickness absence as the main outcome. Poisson regression models were used to compute sickness absence days' rate ratios. SETTING: 15 countries of the European Union. PARTICIPANTS: A sample of permanent (n = 12 875) and non-permanent (n = 1203) workers from the Third European Survey on Working Conditions. RESULTS: High psychological job demands, low job control, and high strain and passive work were associated with higher work related sickness absence. The risks were more pronounced in non-permanent compared with permanent employees and men compared with women. CONCLUSIONS: This work extends previous research on employment contracts and sickness absence, suggesting different effects depending on psychosocial working conditions and sex.     

The effect of a cognitive and a physical stress-reducing programme on psychological complaints

Objectives: To investigate the short-term and long-term effectiveness of two, brief, preventive, work stress management programmes. One programme was a cognition-focused programme, the other was a newly developed intervention in which physical exercise and relaxation were combined. It was hypothesised that the newly developed intervention would be more effective in reducing psychological complaints than the cognitive intervention. Both programmes consisted of four sessions in a period of 10 weeks. Methods: From a working population engaged in a periodic health check-up, employees above a minimum stress level (n=396) were invited to participate in a randomised comparative outcome study with pre-trial, post-trial and 6-month follow-up measures. After giving informed consent 130 participants entered the study (response rate 33%). Outcome measures consisted of three self-reported questionnaires on psychological complaints. Results: It was found that both interventions revealed a positive impact on psychological complaints, burnout and fatigue, both at short-term and at 6-month follow-up. No statistical interaction effects between the two interventions were found. Calculation of the clinical significance of the effects indicated that 50% of the employees with psychological complaints who participated in the physical intervention and 60% of the employees who participated in the cognitive intervention improved and returned to functioning within normal range both in the short term and in the long term at 6 months. Conclusion: The data indicate that interventions were equally effective on psychological complaints, burnout and fatigue.     

Psychological distress, fatigue and long-term sickness absence: prospective results from the Maastricht Cohort Study

OBJECTIVE: Little is known about psychological distress as a risk factor for the onset of long-term sickness absence and even less about the influence of fatigue in this relationship. METHODS: We examined the relationship between psychological distress and the onset of long-term sickness absence during 18 months of follow-up while considering fatigue. Analyses were based on 6403 employees participating in the Maastricht Cohort Study. RESULTS: Psychological distress was related to the onset of long-term sickness absence (women relative risk 1.45, 95% confidence interval = 1.23-1.72; men 1.33, 1.21-1.46). Adjustment for fatigue weakened the associations, particularly in women. Caseness analyses revealed different effects of psychological distress and fatigue in the onset of long-term sickness absence in men and women. CONCLUSION: The findings underline the need for interventions aiming at psychological distress and, depending on the gender, also at fatigue, to reduce the risk of long-term sickness absence.     

Health-related quality of life and sickness absence in community nursing home employees: randomized controlled trial of physical exercise

BACKGROUND: It is a common belief that physical exercise at the workplace decreases subjective health complaints and reduces sickness absence, but this is not supported by previous randomized studies. AIMS: To evaluate the effectiveness of physical exercise at the workplace. METHODS: One hundred and twenty-nine employees in a community-based nursing home for the elderly were randomized into physical exercise or control groups. A weekly exercise class consisting of light aerobic exercise, muscle strengthening and stretching was held for a 6-month period. The control group was told to continue their ordinary activity. The main outcome measures were aerobic fitness (UKK, walking test), health-related quality of life (COOP/WONCA) and sickness absence. Blinded assessments were carried out at baseline and following the 6-month intervention. Complete sickness absence data were collected from a community register for two comparable 7-month periods. RESULTS: The average number of exercise sessions was 12 (0-26). Self-reported physical activity increased in the intervention group compared with the control group (P < 0.01). Aerobic fitness improved in both groups (P < 0.01). Mean sickness absence increased from 6.8 to 15.6 days in the exercise group and from 10.4 to 14.5 in the control group. No differences between groups were found for aerobic fitness, health-related quality of life or sickness absence. CONCLUSION: The intervention neither improved health-related quality of life nor reduced sickness absence.     

Job demands, health perception and sickness absence

BACKGROUND: Investigation of the relations between job demands, health and sickness absence is required to design a strategy for the prevention of absence and disability. AIM: To study the relationships between (physical and psychological) job demands, health perception and sickness absence. METHODS: Prospective study of 414 male employees working in two organizations with low company absence levels. Job demands and health were examined using the Basic Occupational Health Questionnaire. Sickness absence was followed for 1 year thereafter. The number of days and episodes of absence were counted. RESULTS: The questionnaires of 247 workers (60%) were suitable for statistical analysis. Physical job demands (r = 0.41; P <0.01) and, to a lesser extent, psychological job demands (r = 0.16; P = 0.01) were related to the number of health complaints. Short (1-7 days) duration absence was neither related to job demands nor to the number of health complaints. Longer (>7 days) duration absence was positively related to psychological job demands and to the number of health complaints. CONCLUSIONS: Job demands, particularly physical demands, correlated with perceived health. Poor health predicted long-term sickness absence. Early recognition of poor health should be the basis of a strategy that prevents long-term sickness absence.     

Workplace conflict resolution and the health of employees in the Swedish and Finnish units of an industrial company

New patterns of working, the globalisation of production and the introduction of information technologies are changing the way we work. This new working environment has eliminated some risks whilst introducing others. The importance of the psychosocial working environment for the health of employees is now well documented, but the effects of managerial style have received relatively little attention. Yet management is an increasingly important aspect of companies' policies. In this paper, we examine the relationship between conflict management in the workplace and self-reported measures of stress, poor general health, exhaustion and sickness absence due to overstrain or fatigue. Our sample consists of non-supervisory employees (N = 9309) working in the Swedish and Finnish plants of a multinational forestry company who were surveyed in 2000. Bivariate analyses show that those who report that differences are resolved through discussion are least likely to report stress, poor general health, exhaustion or sickness absence. Those who report that authority is used or that no attempts are made to resolve differences have quite similar rates across all measures. Binary logistic regression analyses were performed for all health outcomes controlling for age, sex, occupational group, job complexity, job autonomy and support from superiors. Results show significantly lower likelihoods of reporting stress, poor general health, exhaustion or sickness absence amongst employees who report that differences of opinion are resolved through discussion compared to those who report that no attempts are made. No significant differences were found between those who reported that differences were resolved through use of authority and subjects in the 'no attempt' category. These results suggest that the workplace conflict resolution is important in the health of employees in addition to traditional psychosocial work environment risk factors.     

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.     

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.

     

Occupation-specific screening for future sickness absence: criterion validity of the trucker strain monitor (TSM)

Background: Monitoring psychological job strain may help occupational physicians to take preventive action at the appropriate time. For this purpose, the 10-item trucker strain monitor (TSM) assessing work-related fatigue and sleeping problems in truck drivers was developed. Objectives: This study examined (1) test–retest reliability, (2) criterion validity of the TSM with respect to future sickness absence due to psychological health complaints and (3) usefulness of the TSM two-scales structure. Methods: The TSM and self-administered questionnaires, providing information about stressful working conditions (job control and job demands) and sickness absence, were sent to a random sample of 2000 drivers in 1998. Of the 1123 responders, 820 returned a completed questionnaire 2 years later (response: 72%). Results: The TSM work-related fatigue scale, the TSM sleeping problems scale and the TSM composite scale showed satisfactory 2-year test–retest reliability (coefficient r=0.62, 0.66 and 0.67, respectively). The work-related fatigue, sleeping problems scale and composite scale had sensitivities of 61, 65 and 61%, respectively in identifying drivers with future sickness absence due to psychological health complaints. The specificity and positive predictive value of the TSM composite scale were 77 and 11%, respectively. The work-related fatigue scale and the sleeping problems scale were moderately strong correlated (r=0.62). However, stressful working conditions were differentially associated with the two scales. Conclusions: The results support the test–retest reliability, criterion validity and two-factor structure of the TSM. In general, the results suggest that the use of occupation-specific psychological job strain questionnaires is fruitful.     

The effect on attendance rates for sickness absence assessment of a revised employee information sheet

BACKGROUND: An increasingly high standard of ethical practice is expected of all doctors and in particular those not providing treatment services. AIMS: This case-control study investigated the effect on non-attendance rates for first sickness absence appointments of a new employee information sheet sent to staff from the two largest departments, education and social services, of a large UK local authority. METHOD: An information sheet detailing the ethical standards applying to a local authority occupational health service was developed and sent to all employees referred by their managers as part of the sickness absence management procedures, along with details of their appointment. RESULTS: A reduction of approximately 1/3 in the rate of non-attendance was noted in the intervention group, which was statistically significant for social services referrals. CONCLUSION: This approach may improve the efficiency and effectiveness of occupational health services, as well as helping to achieve the informed consent of employees undergoing occupational health assessment.     

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.     

Psychosocial work environment exposures as risk factors for long-term sickness absence among Danish employees: results from DWECS/DREAM

OBJECTIVE: This study examines effects of psychosocial risk factors on long-term sickness absence, and investigates possible interactions between psychosocial and physical work environment risk factors. METHODS: A total of 5,357 employees were interviewed in 2000 regarding work environment and followed up during the proceeding 1.5 years regarding onset of long-term sickness absence. RESULTS: Long-term sickness absence among female employees was associated with role conflict, low reward, and poor management quality. Demands for hiding emotions and high emotional demands predicted long-term sickness absence among men. No significant interactions between psychosocial and physical exposures were found for female or male employees. CONCLUSIONS: The study suggests a potential for reducing long-term sickness absence through interventions targeted toward reducing role conflict, and improving reward and management quality among female employees, and through reducing emotional demands and demands for hiding emotions among male employees.