Psychosocial work factors and long sickness absence in Europe

Abstract

Background: Studies exploring a wide range of psychosocial work factors separately and together in association with long sickness absence are still lacking.

Objectives: The objective of this study was to explore the associations between psychosocial work factors measured following a comprehensive instrument (Copenhagen psychosocial questionnaire, COPSOQ) and long sickness absence (>7 days/year) in European employees of 34 countries. An additional objective was to study the differences in these associations according to gender and countries.

Methods: The study population consisted of 16?120 male and 16?588 female employees from the 2010 European working conditions survey. Twenty-five psychosocial work factors were explored. Statistical analysis was performed using multilevel logistic regression models and interaction testing.

Results: When studied together in the same model, factors related to job demands (quantitative demands and demands for hiding emotions), possibilities for development, social relationships (role conflicts, quality of leadership, social support, and sense of community), workplace violence (physical violence, bullying, and discrimination), shift work, and job promotion were associated with long sickness absence. Almost no difference was observed according to gender and country.

Conclusions: Comprehensive prevention policies oriented to psychosocial work factors may be useful to prevent long sickness absence at European level.     

Psychosocial work characteristics and sickness absence in Japanese employees

Objectives: This study was undertaken to examine the association between sickness absence in Japanese employees and job demand/control and occupational class as psychosocial work characteristics. Methods: The study was cross-sectional in design with data collected from 20,464 male and 3,617 female employees, whose mean age was 40.9 years (SD ± 9.1 years) and 36.9 years (SD ± 10.8 years), respectively. The participants were asked to write the total number of sick leaves they had taken during the past year, and a comparison was made between the group with more than 6 days of sickness absence and the group with 0–6 days as a reference group. Job demands, job control, and worksite support from supervisors and colleagues were analyzed by the Job Content Questionnaire, and likewise by the Generic Job Stress Questionnaire of the National Institute for Occupational Safety and Health. Results: Both low job control and low support at the worksite were associated with a high frequency of sickness absence. But there was no clear relationship between job demands and sickness absence. The lowest sickness absence rate was found in male managers and the highest in male and female laborers. Conclusion: This is the first report of a large-scale survey of Japanese employees to show a high frequency of sickness absence associated with increased work stress and a socioeconomically low occupational class.     

Work and family characteristics as socioeconomic determinants in long sickness absence: the Japanese civil servants study

Long sickness absence is more common among low socioeconomic status (SES) groups than high SES groups. This study aimed to evaluate whether work and family characteristics contribute to SES and sex differences in long sickness absence (7 days or more). The participants were 3080 civil servants working for a local Japanese government. In both sexes, low-grade employees were likely to take long sickness absence, with a statistically significant association for men (age-adjusted OR of lowest-grade employees for long sickness absence: 2.30 (95% Confidence Interval (CI): 1.32–4.02)). After adjusting for all variables, SES differences in long sickness absence in men decreased to OR 1.98 (CI 1.10–3.55) but remained significant; in men, being without a spouse was significantly associated with long sickness absence. Employees working long hours had lower OR for long sickness absence after adjusting for all variables in both sexes. Conversely, poor sleep quality and longstanding illness significantly increased OR for long sickness absence. In conclusion, SES differences in sickness absence were explained partly by work and family characteristics, longstanding illness, and poor sleep quality; however, other factors that were not evaluated in this study may also be associated with SES differences.     

The relationship between three stages of job change and long-term sickness absence

Although several researchers originally assumed that change always causes strain, a growing number of studies suggest that job change can have positive effects. However, the focus of these studies has generally been on subjective measures of satisfaction and well-being and rarely on health. Therefore, the purpose of the present study was to investigate how job change relates to long-term sickness absence during three stages: exit, entry, and normalization. Norwegian hospital employees, a low-unemployment group, were followed over a 6-year period as they moved in and out of different jobs. The study used fixed-effect methods to analyze changes in absence for each employee. The results show increased odds of long-term sickness absence during the 2 years prior to exiting an organization, a significant drop after the employee entered a new organization, and then a gradual increase in long-term sickness absence thereafter. After 2 years, the employee's odds of entering into long-term sickness absence were no longer significantly different from normal (i.e., the odds in months not related to job change). These findings on employee health are congruent with conclusions drawn from research on job satisfaction and well-being.     

Coping and sickness absence

Objectives The aim of this study is to examine the role of coping styles in sickness absence. In line with findings that contrast the reactive–passive focused strategies, problem-solving strategies are generally associated with positive results in terms of well-being and overall health outcomes; our hypothesis is that such strategies are positively related to a low frequency of sickness absence and with short lengths (total number of days absent) and durations (mean duration per spell). Methods Using a prospective design, employees’ (N = 3,628) responses on a self-report coping inventory are used to predict future registered sickness absence (i.e. frequency, length, duration, and median time before the onset of a new sick leave period). Results and conclusions In accordance with our hypothesis, and after adjustment for potential confounders, employees with an active problem-solving coping strategy are less likely to drop out because of sickness absence in terms of frequency, length (longer than 14 days), and duration (more than 7 days) of sickness absence. This positive effect is observed in the case of seeking social support only for the duration of sickness absence and in the case of palliative reaction only for the length and frequency of absence. In contrast, an avoidant coping style, representing a reactive–passive strategy, increases the likelihood of frequent absences significantly, as well as the length and duration of sickness absence. Expression of emotions, representing another reactive–passive strategy, has no effect on future sickness absenteeism. The median time before the onset of a new episode of absenteeism is significantly extended for active problem-solving and reduced for avoidance and for a palliative response. The results of the present study support the notion that problem-solving coping and reactive–passive strategies are inextricably connected to frequency, duration, length and onset of sickness absence. Especially, active problem-solving decreases the chance of future sickness absence.     

Parenthood, gender and sickness absence

It is well documented that women have generally higher morbidity rates than men. In line with this women are also more absent from work due to sickness. This paper considers one popular explanation of the morbidity difference in general and of the difference in sickness absence in particular, viz. that women to a greater extent than men are exposed to the 'double burden' of combining paid work with family obligations. We discuss theories of role overload and role conflict, which both assume that the combination of multiple roles may have negative health effects, as well theories of role enhancement, which assume positive health effects of multiple roles. Using two large Norwegian data sets, the relationship between the number of and the age of children on the one hand and sickness absence on the other is examined separately for men and women and for a number of theoretically interesting subpopulations of women defined in terms of marital status (also taking account of unmarried cohabitation), level of education, and working hours. Generally speaking the association between children and sickness absence is weak, particularly for married people of both genders. To the extent that married persons with children are more absent than married persons without children, this is largely due to respiratory conditions. The relationship between children and sickness absence is somewhat stronger for single, never married mothers, but not for single mothers who have been previously married or for women living in unmarried cohabitation. The findings thus provide little support for either role overload/conflict or role enhancement theories. The possibility that these effects are both present and counterbalancing each other or that they are confounded with uncontrolled selection effects can not, however, be ruled out.     

Looking upstream to understand low back pain and return to work: Psychosocial factors as the product of system issues

Low back pain (LBP) is the most common and expensive musculoskeletal (MSK) disorder in industrialized countries. There is evidence that personal and occupational psychosocial variables play a more important role than spinal pathology or the physical demands of the job. However, it is unclear which psychosocial variables are most important. The objective of this study is to understand which psychosocial variables are deemed most important to various workplace stakeholders involved in the process of returning a worker with LBP to work. Nine focus groups were convened with injured workers, small and large employers, unions, health and safety associations, physicians and non-physician clinicians, return to work coordinators and compensation board representatives in Ontario, Canada. A qualitative grounded theory approach was applied to explore, from their perspectives, important psychosocial factors that prevent the promotion of early and safe return to work (RTW) for individuals with LBP. While the study began by asking questions related to the various psychosocial factors and their association to LBP and RTW, it took an interesting turn. The majority of study participants described how psychosocial factors were the product of larger systemic/organizational issues. Rather than focusing solely on individual psychosocial factors, respondents described how the context of a much larger system, and the complex interplay between the many different components of that system, contributes directly or indirectly to the treatment of LBP and RTW. It is the interrelationships between these systems that determine the process of returning an injured worker with LBP back to work. Although it is important to understand how psychosocial factors affect RTW, organizational structures within our social context seem to play a role in shaping how all stakeholders see and emotionally respond to LBP and RTW, as well as the degree to which they can envision taking action on them. We need to consider moving beyond a psychosocial conceptualization of LBP and RTW into a sociopolitical and economic conceptualization. This reconceptualization provides insight into the “upstream factors” associated with LBP and RTW.     

Prognostic factors for respiratory sickness absence and return to work among blue collar workers and office personnel

OBJECTIVES—To analyze factors that determine the occurrence of sickness absence due to respiratory disorders and the time it takes to return to work.
METHODS—A longitudinal study with 2 year follow up was conducted among 326 male blue collar and white collar workers. The survey started with an interview on respiratory complaints and spirometry. Sixty six (21%) workers were lost to follow up. Complete data on sickness absence among 251 workers during the follow up were collected from absence records and self reports. Regression analysis based on a proportional hazards model was applied to identify risk factors for the occurrence and duration of sickness absence due to respiratory disorders.
RESULTS—During the follow up 35% workers attributed at least one period of sickness absence to respiratory complaints, which accounted for 14.2% of all days lost. A history of chronic obstructive pulmonary disease (COPD) did not predict sickness absence for COPD; the same was true for chronic non-specific lung disease (CNSLD). Complaints about asthma contributed significantly to absence due to asthma (relative risk (RR) 3.96; 95% confidence interval (95% CI) 1.99 to 7.90). Job title was a significant predictor of sickness absence due to respiratory complaints. Decrease in forced vital capacity (FVC, <80% of the reference value) was also a significant predictor of absence due to asthma (RR 4.03; 95% CI 1.41 to 11.54) and of respiratory absence (RR 2.49; 95% CI 1.07 to 5.79). Absence with respiratory complaints was not associated with age, height, body mass index, or smoking. Duration of employment was a weak almost significant predictor against respiratory absenteeism (RR 0.94; 95% CI 0.91 to 0.97). Return to work after respiratory absence was worse for blue collar workers than office personnel (RR 5.74; 95% CI 1.90 to 17.4 for welders, and RR 6.43; 95% CI 2.08 to 19.85 for metal workers).
CONCLUSIONS—Asthmatic complaints in the 12 months before the study were associated with sickness absence for these complaints during the follow up. An abnormal level of FVC also influenced respiratory absenteeism. Blue collar workers had more often and more prolonged absences due to respiratory disorders than white collar workers. Workers with absence due to respiratory complaints were at higher risk of subsequent sickness absence in the next year.


Keywords: respiratory complaints; sickness absence; return to work     

Smoking and sickness absence among public health workers

BACKGROUND: As well as causing sickness and death, smoking has high socio-economic costs. The aim of this paper was to examine how closely smoking is associated with sickness absence among healthcare workers. SUBJECTS AND METHODS: Cases and controls were paired by age, gender and occupation among primary healthcare workers in Tenerife, Canary Islands, Spain. Cases were selected from workers that had been absent from work due to sickness for 1 or more days in an entire year, regardless of the cause. Controls were those workers who were not absent due to sickness over the same period. Tobacco consumption was verified by telephone poll. Matched pairs analysis was performed. RESULTS: Among the 292 cases, 40% were smokers, compared with 31% of controls [odds ratio (OR)=1.51, 95% confidence intervals (CI)=1.06-2.14]. The association between smoking and sickness absence was stronger in those aged 30-45 years (OR=1.60, 95%CI=1.04-2.44) and among nurses (OR=2.08, 95%CI=1.05-4.14). When the cause of sickness absence was a respiratory disease, no association was found with smoking. However, an association was found with back pain (OR=5, 95%CI=1.45-17.27). Duration of tobacco consumption was higher in cases (a) when only current smokers were considered (P=0.002), and (b) when including the smoking duration of former smokers (P=0.0004). CONCLUSIONS: Smoking is associated with a higher risk of sickness absence among healthcare workers, particularly due to back pain. This could be used as an incentive to persuade healthcare workers to stop smoking and re-inforce the non-smoking message given to their patients.     

Recurrence of sickness absence episodes certified by general practitioners in the UK

Background: Compared to other areas of sickness certification, recurrence of certified sickness absence has been relatively under-researched.

Objectives: This study aims to report the extent and patterns of recurrence and to identify factors associated with higher rates of recurrence.

Methods: Sickness certification (‘fit note’) data were collected from 68 general practices in eight regions of the UK for 12 months.

Results: Twenty percent of 31,453 patients in the study had a recurrent certified sickness episode, with over half of these having the second episode in the same diagnostic category as their first. Mental health problems accounted for over a half of all days certified in same-diagnosis recurrent episodes. Male gender, residing in an area of social deprivation, a longer episode of initial certified sickness absence, not having return to work (‘may be fit’) advice in the first episode, having a mental disorder or musculoskeletal (particularly back) problem were all independently associated with a higher incidence of recurrence.

Conclusion: Differential risk of recurrence needs to be considered when designing return-to-work interventions. Evaluation of effectiveness of interventions (particularly for sickness absentees with mental health problems) has to consider the sustainability of employment after a return to work.     

Study of the validity of a job-exposure matrix for psychosocial work factors: results from the national French SUMER survey

Objective  To construct and evaluate the validity of a job-exposure matrix (JEM) for psychosocial work factors defined by Karasek’s model using national representative data of the French working population. Methods  National sample of 24,486 men and women who filled in the Job Content Questionnaire (JCQ) by Karasek measuring the scores of psychological demands, decision latitude, and social support (individual scores) in 2003 (response rate 96.5%). Median values of the three scores in the total sample of men and women were used to define high demands, low latitude, and low support (individual binary exposures). Job title was defined by both occupation and economic activity that were coded using detailed national classifications (PCS and NAF/NACE). Two JEM measures were calculated from the individual scores of demands, latitude and support for each job title: JEM scores (mean of the individual score) and JEM binary exposures (JEM score dichotomized at the median). Results  The analysis of the variance of the individual scores of demands, latitude, and support explained by occupations and economic activities, of the correlation and agreement between individual measures and JEM measures, and of the sensitivity and specificity of JEM exposures, as well as the study of the associations with self-reported health showed a low validity of JEM measures for psychological demands and social support, and a relatively higher validity for decision latitude compared with individual measures. Conclusion  Job-exposure matrix measure for decision latitude might be used as a complementary exposure assessment. Further research is needed to evaluate the validity of JEM for psychosocial work factors.     

Predicting the long term course of low back pain and its consequences for sickness absence and associated work disability

Background

Low back pain is characterised by a dynamic pattern of episodes and recovery but little is known about the long term course of back pain due to lack of cohort studies with sufficiently long follow up periods.

Methods

A cohort of 523 workers in nursing homes and homes for the elderly was followed for two years. Physical load was measured by observations at the workplace. Psychosocial factors at work, individual characteristics, and low back pain were determined by questionnaire once a year. The effect of work load on low back pain and the transition of low back pain into sickness absence was calculated with logistic regression analysis. A Markov model was used to construct a hypothetical cohort of workers with follow up of 40 years (40 cycles of 1 year) with transitional probabilities between no complaints, low back pain, and sickness due to low back pain. Permanent disability was used as end state of health.

Results

The transitional probability from no complaints to low back pain varied between p = 0.25 and p = 0.29, from low back pain to sickness absence between p = 0.09 and p = 0.25, and recurrence of sickness absence varied between p = 0.27 and p = 0.50, depending on the level of physical load. During a 40 year career, total sickness absence due to low back pain was approximately 140 weeks (6.6%) among workers with high physical load and about 30 weeks (1.4%) among those with low physical load.

Conclusion

The Markov approach illustrated the potential impact of physical load on (permanent) disability due to low back pain among workers with exposure to physical load. These consequences may go unnoticed in cohort studies with follow up periods of a few years.     

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   

Psychosocial factors at work and perceived health among agricultural meat industry workers in France

Objective  The objective of this study was to describe the perceived health status of the meat industry employees—i.e., working in the slaughtering, cutting, and boning of large animals and poultry—and its relation to their organisational and psychosocial constraints at work. Methods  This postal survey included all 3,000 employees of the meat industry (beef, pork and poultry) in four districts in Brittany, France, whose companies were affiliated with the agricultural branch of the national health insurance fund. The questionnaire asked for social and demographic data and information describing their job and the organisation of their work. The psychosocial factors at work were described according to Karasek’s questionnaire (demand, latitude and social support at work). Perceived health was measured with the Nottingham Health Profile perceived health indicator. Results  This study shows the high prevalence of poor health reported by the workers in this industry. This poor perceived health was worse in women and increased regularly with age. Among the psychosocial factors studied, high quantitative and qualitative demand at work, inadequate resources for good work and to a lesser extent, inadequate prospects for promotion appear especially associated with poor perceived health. Other factors often associated with poor perceived health included young age at the first job and work hours that disrupt sleep rhythms (especially for women). Conclusion  Our results show that this population of workers is especially vulnerable from the point of view of perceived physical and psychological health and is exposed to strong physical, organisational and psychosocial constraints at work. They also demonstrate that poor perceived health is associated with some psychosocial (such as high psychological demand and insufficient resources) and organisational factors at work. These results, in conjunction with those from other disciplines involved in studying this industry, may help the companies to develop preventive activities.     

Interaction of working conditions, job satisfaction, and sickness absences: evidence from a representative sample of employees

We study the predictors of sickness absences among 2800 Finnish workers responding to the cross-sectional Quality of Work Life Survey in 1997. The data contain detailed information on the prevalence of adverse working conditions at the workplace from a representative sample of wage and salary earners. We show by using recursive multivariate models that the prevalence of harms at the workplace is associated with job dissatisfaction and dissatisfaction with sickness absences. The policy lesson is that the improvement of working conditions should be an integral part of any scheme aimed at decreasing sickness absence.     

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.     

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.     

Influence of obesity on the use of sickness absence and social benefits among pregnant working women

OBJECTIVE: To evaluate if obesity in early pregnancy has any possible impact on the capacity of pregnant women to engage in gainful employment. METHODS: Register data from a database on sickness absence and pregnancy benefit and parental benefit claims were combined with type of occupation and body mass index (BMI) for 693 women consecutively delivered during the course of one year at a county hospital in Sweden. RESULTS: The results showed the lowest BMI among women who had administrative jobs and the highest BMI in women who undertook more burdensome and heavy types of manual work. A significant increase in BMI was also seen among those pregnant women who were registered as unemployed. The finding that in the manual types of occupation, obese pregnant women took almost twice as many days of leave provided by the parental benefit programme as did women with a BMI of <25, indicates that obese pregnant women perhaps do not have the same physical endurance required to manage the combined demands of work and pregnancy. No differences were found with regard to sickness absence between obese women and pregnant women with normal BMI; however, differences were found between different occupational groups. CONCLUSIONS: Our study indicates that a woman's BMI at the beginning of pregnancy is associated with her occupational status. Obesity among pregnant women may well be used as a psychosocial indicator as obesity correlates with social and economic problems. Any planned weight reduction programme in antenatal care must therefore consider this important psychosocial aspect.