Sickness Absence from Work

Sick leaves may vary over the business cycle due to disciplining effects or changes in labour force composition. The latter hypothesis maintains that sickness may be pro-cyclical due to employment of "marginal" workers with poorer health when demand increases. Using individual records of labour force participants in Norway, we investigate the explanatory factors behind differing spells of work absence at different stages of the business cycle. We find no indication that new entrants into the labour force explain increases in absence. On the other hand, insiders increase their absences when the economic conditions improve. Thus, a disciplining effect seems to explain most of the changes in work absence behaviour.

The purpose of our two-year follow-up study was to examine the effect of the social components of the work group, such as group absence norms and cohesion, on sickness absence behavior among individuals with varying attitudes toward work attendance. The social components were measured using a questionnaire survey, and data on sickness absence behavior were collected from the employers' records. The study population consisted of 19,306 Finnish municipal employees working in 1,847 groups (78% women). Multilevel Poisson regression modeling was applied. The direct effects of work group characteristics on sickness absence were mostly insignificant. In contrast, both of the social components of a work group had an indirect impact: The more tolerant the group absence norms (at both individual-and cross-level) and the lower the group cohesion (at the individual level), the more the absence behavior of an individual was influenced by his or her attitude toward work attendance. We conclude that work group moderates the extent to which individuals with a liberal attitude toward work attendance actually engage in sickness absence behavior.

Introduction The aim was to describe the prevalence of sickness presenteeism (SP) and to explore possible associations with work characteristics among Swedish police officers. Methods Questionnaire data from 11,793 police officers were analysed. Relative risks (RR) and 95% confidence intervals (CI) for SP were calculated with modified Poisson regression. SP was defined as having gone to work on two or more occasions during the past 12 months despite judging that one's health would have motivated sickness absence. Results Of the police officers, 47% reported SP. All studied work environment factors were significantly associated with SP. The strongest association was found for stress (RR = 1.46; 95% CI: 1.41-1.52). Low support from colleagues and low control had higher impact on the risk estimates for SP among older subjects. Adjustment for self-rated health lowered the RRs, however, estimates remained statistically significant. The results indicated that SP was most affected by work environment among subjects with good self-rated health. Conclusions SP was high among police officers. Work environment factors seem to be associated with SP, particularly among subjects with good general health.

Objective: Occupational burnout is a common problem in working populations, but its association with sickness absence is poorly understood. The contribution of occupational burnout to medically certified sickness absence was examined in a population-based sample of employees. Methods: A representative sample of 3151 Finnish employees aged 30-60 years participated in a comprehensive health study in 2000-2001, including an assessment of physician-diagnosed physical illnesses and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders based on the Composite International Diagnostic Interview. Burnout was measured with the Maslach Burnout Inventory-General Survey. Sickness absences longer than 9 days in 2000-2001 were extracted from a register of the Social Insurance Institution of Finland. Results: The occurrence of medically certified sickness absence was more prevalent among employees with burnout than among those without burnout. After adjusting for sociodemographic factors and mental and physical disorders, the odds ratio of sickness absence for severe burnout was 6.9 [95% confidence interval (95% CI)=2.7-17.8] for men and 2.1 (95% CI=1.1-4.0) for women. Among employees with mental or physical disorders, severe burnout was associated with a 7.7-fold risk of sickness absence among men and with a 2.6-fold risk among women. The duration of absence was related to burnout among men with absences, for whom severe burnout accounted for 52 excess sickness absence days during the 2-year period after adjusting for sociodemographic factors, mental disorders, and physical illnesses. Conclusions: Severe burnout is associated with a substantial excess risk of medically certified sickness absence among both men and women. This association is independent of prevalent mental disorders and physical illnesses.

The aim of this study is to assess the impact of a broad range of possible factors relating to work, personal circumstances and attitudes towards sickness absence on a person's decision to go to work despite feeling ill, a phenomenon that has been termed sickness presence (SP), or 'presenteeism', in the literature. Using data from a random sample of 12,935 members from the core Danish work force the hypotheses were tested in a cross-sectional design utilising ordered logistic regression models. The results indicate that more than 70% of the core work force goes ill to work at least once during a 12-month period. This means that SP is just as prevalent a phenomenon as sickness absence. Many of the results from earlier studies of SP were replicated and new factors were discovered: for example time pressure (having a supervisory role and/or working more than 45 h per week) and relationship with colleagues (measured by working in a small company, having non-standard hours and degree of cooperation) both increase the likelihood of SP. However, personal circumstances and attitudes, e.g. treating work as home (cf. Hochschild's thesis) and being over-committed to work, were also found to lead to higher levels of SP. Finally, we found that those with a conservative attitude to absence were most likely to turn up ill at work. Overall, work-related factors seem to be slightly more important than personal circumstances or attitudes in determining people's 'decision' to go ill at work. However, the relatively low explanatory power of these combined factors suggests that there are still many unknowns in this field of research.

Prevention of work disability is a primary goal within treatment of spinal disorders. Workrelated outcome measures therefore are essential indices within evidencebased medicine. So far many measures suffer, however, from standardized measurement, standardized terminology, and a lack of theoretical background. This review addresses traditional indicators like work status and sickness absence, and discusses more theory-bound concepts, i.e. work ability, occupational risk factors for recurrence of symptoms and re-injury, work-re-lated attitudes that may become obstacles to recovery, and individual reactions to occupational stressors that increase the risk of maintenance and recurrence of symptoms. The review includes methodological and theoretical considerations and recommendations for the use of workrelated outcome measures in future outcome research.

The aim of this study is to assess the impact of a broad range of possible factors relating to work, personal circumstances and attitudes towards sickness absence on a person's decision to go to work despite feeling ill, a phenomenon that has been termed sickness presence (SP), or 'presenteeism', in the literature. Using data from a random sample of 12,935 members from the core Danish work force the hypotheses were tested in a cross-sectional design utilising ordered logistic regression models. The results indicate that more than 70% of the core work force goes ill to work at least once during a 12-month period. This means that SP is just as prevalent a phenomenon as sickness absence. Many of the results from earlier studies of SP were replicated and new factors were discovered: for example time pressure (having a supervisory role and/or working more than 45 h per week) and relationship with colleagues (measured by working in a small company, having non-standard hours and degree of cooperation) both increase the likelihood of SP. However, personal circumstances and attitudes, e.g. treating work as home (cf. Hochschild's thesis) and being over-committed to work, were also found to lead to higher levels of SP. Finally, we found that those with a conservative attitude to absence were most likely to turn up ill at work. Overall, work-related factors seem to be slightly more important than personal circumstances or attitudes in determining people's 'decision' to go ill at work. However, the relatively low explanatory power of these combined factors suggests that there are still many unknowns in this field of research.

BACKGROUND: Major depressive disorder (MDD) has major consequences for both patients and society, particularly in terms of needlessly long sick leave and reduced functioning. Although evidence-based treatments for MDD are available, they show disappointing results when implemented in daily practice. A focus on work is also lacking in the treatment of depressive disorder as well as communication of general practitioners (GPs) and other health care professionals with occupational physicians (OPs). The OP may play a more important role in the recovery of patients with MDD. Purpose of the present study is to tackle these obstacles by applying a collaborative care model, which has proven to be effective in the USA, with a focus on return to work (RTW). From a societal perspective, the (cost)effectiveness of this collaborative care treatment, as a way of transmural care, will be evaluated in depressed patients on sick leave in the occupational health setting. METHODS/DESIGN: A randomised ...

Background: It is unclear if objective selection of employees, for an intervention to prevent sickness absence, is more effective than subjective 'personal enlistment'. We hypothesize that objectively selected employees are 'at risk' for sickness absence and eligible to participate in the intervention program.

Objective: To analyse cross-cultural differences between Greek and Dutch nursing personnel in association with the risk factors and occurrence and consequences (absenteeism and medical care seeking) of musculoskeletal disorders. Methods: This study was based on questionnaire surveys among 393 nurses and caregivers in nursing homes and homes for the elderly in The Netherlands and among 351 nurses in general hospitals in Athens, Greece. Logistic regression analysis was used to analyse associations between 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 and medical care seeking. Results:

The objective of this study was to conduct a systematic review of the literature on the effectiveness of participatory ergonomic (PE) interventions for improving workers' health. The search strategy targeted six electronic databases and identified 442 potential articles. Each article was examined by pairs of reviewers for relevance (assessed a participative ergonomic workplace intervention, with at least one health outcome, published in English in peer reviewed literature). Twenty-three articles met relevance criteria and were then appraised for methodological strength. Using a best evidence synthesis approach, 12 studies that were rated as 'medium' or higher provided partial to moderate evidence that PE interventions have a positive impact on: musculoskeletal symptoms, reducing injuries and workers' compensation claims, and a reduction in lost days from work or sickness absence. However, the magnitude of the effect requires more precise definition. r

The issue of differential prediction of health outcomes by sociological models of work stress has received little attention so far. This paper argues, both on theoretical and empirical grounds, that active coping with the experience of chronic work stress is more likely to be associated with physical health consequences of sustained autonomic arousal such as hypertension, whereas passive coping may predispose individuals to withdrawal behavior such as sickness absence from work. Based on data from a cross-sectional study on 189 male middle-aged (40-55, 48.3 ___ 4.6 years) middle managers in a car-producing company in Germany, this hypothesis is tested in the framework of the theoretical model of effort-reward imbalance at work. More specifically, the simultaneous manifestation of high effort and low reward at work, indicative of active coping, is expected to statistically predict the risk of being hypertensive. Conversely, suffering from low occupational rewards in the absence of signs of sustained effort, indicative of passive coping, is expected to predict sickness absence (SA) behavior. Multivariate odds ratios (OR) derived from logistic regression analysis and adjusted for important confounders indicate that three measures of low reward are associated with short-term SA (OR ranging from 3.30 to 9.15), that one measure of low reward is associated with long-term SA (OR: 2.67) and that two measures of low reward are associated with number of SA episodes (OR 4.05 and 6.33), whereas no indicator of high effort at work is significantly associated with SA. On the other hand, the OR of being hypertensive is 5.77 in middle managers who suffer from high effort and low reward simultaneously. In conclusion, a sociological model of work stress which allows for differential prediction of health outcomes according to the important notions of active versus passive coping with work demands finds preliminary empirical support. © 1997 Elsevier Science Ltd

Purpose. To investigate the organizational perspectives on the effectiveness of their attendance management policies for chronically ill employees. Methods. A mixed-method approach was employed involving questionnaire survey with employees and in-depth interviews with key stakeholders of the organizational policies.

Objectives: Sickness absence is a major occupational health problem, but evidence for associations between potentially modifiable psychosocial work factors and sickness absence is still scarce. We studied the impact of relational justice and effortreward imbalance on subsequent rates of sickness absence. Methods: The Whitehall II prospective cohort study of British civil servants, 10,308 men and women, was established between 1985 and 1988. Indicators of effort-reward imbalance and the relational component of organizational justice were constructed from questions included at baseline. Participants were classified into three groups (low, intermediate, and high) for both effortreward imbalance and relational justice. Short (≤7 days) and long (N7 days) spells of sickness absence during 1985-1989 and 1991-1995 were used to study immediate and longer term effects of work characteristics. Results: After adjustment for age, employment grade, and baseline health, men and women with low relational justice had increased risks of long spells of sickness absence of 14% and 28% in comparison to men and women experiencing high levels of justice. Similar effect sizes (25% and 21%) were found for high vs. low effort-reward imbalance. Both work measures also predicted short spells of sickness absence. Effort-reward imbalance (men and women) and relational justice (women only) each predicted long spells of sickness absence independently of the other. Conclusions: Both relational justice and effort-reward imbalance are important determinants of sickness absence. Workplace interventions to improve these aspects of working conditions have the potential to reduce levels of sickness absence.

Objectives: To provide evidence of predictors for sickness absence in patients with non-specific chronic low back pain (CLBP), distinguishing predictors aimed at the decision to report sick (absence threshold) and decision to return to work (return to work threshold). Methods: Medical and psychological databases were searched, as well as citations from relevant reviews. Inand exclusion criteria were applied. Two reviewers assessed the methodological quality of the papers independently. Results: Many different predictors were studied, and few factors were studied more than once. Consistent evidence was found for own expectations of recovery only as predictor for the decision to return to work. Patients with higher expectations had less sickness absence at the moment of follow-up measurement. As expected, different predictors were found aiming at the absence threshold or the return to work threshold. Furthermore, predictors varied also with the measurement instruments used, timing of follow-up measurements, and definition of outcomes. Until now, too few studies are available to overcome several potential sources of heterogeneity. Conclusions: No core set of predictors exists for sickness absence in general. The characteristics of the study including the decision to report sick or to return to work determined the influence of several predictors on sickness absence in patients with CLBP. Further research Springer 440 J Occup Rehabil (2006) 16:439-467 and use of a core set of measurements and uniform definitions are needed to predict sickness absence and return to work in patients with CLBP.

Introduction Long-term sickness absence is a major public health and economic problem. Evidence is lacking for factors that are associated with return to work (RTW) in sick-listed workers. The aim of this study is to examine factors associated with the duration until full RTW in workers sick-listed due to any cause for at least 4 weeks. Methods In this cohort study, health-related, personal and job-related factors were measured at entry into the study. Workers were followed until 1 year after the start of sickness absence to determine the duration until full RTW. Cox proportional hazards regression analyses were used to calculate hazard ratios (HR). Results Data were collected from N = 730 workers. During the first year after the start of sickness absence, 71% of the workers had full RTW, 9.1% was censored because they resigned, and 19.9% did not have full RTW. High physical job demands (HR .562, CI .348-.908), contact with medical specialists (HR .691, CI .560-.854), high physical symptoms (HR .744, CI .583-.950), moderate to severe depressive symptoms (HR .748, CI .569-.984) and older age (HR .776, CI .628-.958) were associated with a longer duration until RTW in sick-listed workers. Conclusions Sick-listed workers with older age, moderate to severe depressive symptoms, high physical symptoms, high physical job demands and contact with medical specialists are at increased risk for a longer duration of sickness absence. OPs need to be aware of these factors to identify workers who will most likely benefit from an early intervention.

Background: Major depressive disorder (MDD) has major consequences for both patients and society, particularly in terms of needlessly long sick leave and reduced functioning. Although evidence-based treatments for MDD are available, they show disappointing results when implemented in daily practice. A focus on work is also lacking in the treatment of depressive disorder as well as communication of general practitioners (GPs) and other health care professionals with occupational physicians (OPs). The OP may play a more important role in the recovery of patients with MDD. Purpose of the present study is to tackle these obstacles by applying a collaborative care model, which has proven to be effective in the USA, with a focus on return to work (RTW). From a societal perspective, the (cost)effectiveness of this collaborative care treatment, as a way of transmural care, will be evaluated in depressed patients on sick leave in the occupational health setting.

Background: Employees experiencing depression can take a sickness absence or continue working ('presenteeism'). However, little is known about the factors associated with these behaviors within this population. This study aimed to determine the relative importance of socio-demographic, financial, work and health-related factors associated with presenteeism. Methods: The 2007 Australian National Survey of Mental Health and Wellbeing provided data from employed individuals reporting lifetime major depression with 12-month symptoms (N= 320). Survey adjusted multivariable logistic regression assessed classification of 12-month, depressionrelated presenteeism on the basis of socio-demographic, financial, work and health factors. Results: Acceptable classification of cases was 70% or greater. Classification of cases based on sociodemographic factors, age, sex and marital status, was reasonable (62%). Adding work factors (work hours and occupation type) produced a 1% increase in successfully classified cases (63%). Health factors further increased correctly classified cases (67%). Marital status, housing tenure and co-morbid mental disorders were important indicators of presenteeism behavior. Limitations: Work-related variables were restricted to available measures. Potentially important psychosocial work environment factors were unavailable. Cross-sectional data precluded causal inference. Conclusions: Using available factors, model discrimination did not reach an acceptable level i.e. 70% of presenteeism cases successfully classified. This highlighted the contribution of unmeasured factors to presenteeism behavior. Future research should explore the relative importance of psychosocial work environment and personality factors such as work demands, effort/reward imbalance and conscientiousness. The identified associations between socio-demographic, financial and health factors on work attendance behaviors could inform disease management guidelines for employers via recognition of employees at risk of presenteeism.

The prevalence of musculoskeletal disorders (MSD) in the aluminium industry is high, and there is a considerable work-related fraction. More knowledge about the predictors of sickness absence from MSD in this industry will be valuable in determining strategies for prevention. The aim of this study was to analyse the relative impact of body parts, psychosocial and individual factors as predictors for short- and long-term sickness absence from MSD among industrial workers. A follow-up study was conducted among all the workers at eight aluminium plants in Norway. A questionnaire was completed by 5654 workers at baseline in 1998. A total of 3320 of these participated in the follow-up study in 2000. Cox regression analysis was applied to investigate the relative impact of MSD in various parts of the body and of psychosocial and individual factors reported in 1998 on short-term and long-term sickness absence from MSD reported in 2000. MSD accounted for 45% of all working days lost the yea...

This study estimates the reform effects of a reduction in statutory sick pay levels on sickness absence behavior and labor costs. German federal law reduced the legal obligation of German employers to provide 100% continued wage pay for up to six weeks per sickness episode. In 1996 statutory sick pay was decreased to 80% of foregone gross wages. Within the reform's target groupprivate sector employeesthis measure increased the proportion of employees having zero days of absence between 6 and 8%. Quantile regression estimates indicate that employees with up to 5.5 annual absence days reduced their days of absence by about 12%. Extended analyses suggest that in industries that enforced the cut, behavioral effects were about twice as large. We show that the direct labor cost savings effect stemming from the cut in replacement levels clearly exceeds the indirect effect due to the decrease in absenteeism. Our calculations about the total decrease in labor costs are very much in line with official data which suggest that total employer-provided sick pay decreased by 6.7% or €1.7 billion per year.

Introduction In Denmark, the magnitude and impact of work disability on the individual worker and society has prompted the development of a new ''coordinated and tailored work rehabilitation'' (CTWR) approach. The aim of this study was to compare the effects of CTWR with conventional case management (CCM) on return-towork of workers on sick leave due to musculoskeletal disorders (MSDs). Methods The study was a randomized controlled trial with economic evaluation undertaken with workers on sick leave for 4-12 weeks due to MSDs. CTWR consists of a work disability screening by an interdisciplinary team followed by the collaborative development of a RTW plan. The primary outcome variable was registered cumulative sickness absence hours during 12 months follow-up. Secondary outcomes were work status as well as pain intensity and functional disability, measured at baseline, 3 and 12 months follow-up. The economic evaluation (intervention costs, productivity loss, and health care utilization costs) was based on administrative data derived from national registries. Results For the time intervals 0-6 months, 6-12 months, and the entire follow-up period, the number of sickness absence hours was significantly lower in the CTWR group as compared to the control group. The total costs saved in CTWR participants compared to controls were estimated at US $ 1,366 per person at 6 months follow-up and US $ 10,666 per person at 12 months follow-up. Conclusions Workers on sick leave for 4-12 weeks due to MSD who underwent ''CTWR'' by an interdisciplinary team had fewer sickness absence hours than controls. The economic evaluation showed that-in terms of productivity loss-CTWR seems to be cost saving for the society.

Musculoskeletal disorders account for a higher proportion of sickness absence from work in the European Union than any other health condition. The present study examined the associations between work environment, dispositional optimism/pessimism and medically certified sickness absence caused by musculoskeletal complaints in a sample of employees from the Norwegian Armed Forces (N = 1190, 77.5% men). Dispositional pessimism, but not optimism, predicted the amount of absence also when taking into account the effects of age and the work environment. Overall, our results support previous studies suggesting that pessimism is a more salient predictor of physical health than optimism. Our results also suggest that it may be beneficial for employers to combine medical treatment of musculoskeletal symptoms with psychological treatment targeting pessimistic outcome expectancies in order to reduce the amount of sickness absence.

Sickness absence during pregnancy has increased in Sweden as well as in other countries. Study objective -The study aimed to describe pregnancy related sickness absence and its increase from 1985-87; to consider if the increase were parallel to an increase in sickness absence for all diagnoses or could be explained by a higher birth rate; and to compare different ways of presenting sickness absence data. Design -The data from a prospective incidence study of all new sick leave spells exceeding seven days in 1985-87 were related to the population at risk through relevant data from different registers.

Background At present there exists no overview of the range of evidence currently available regarding the effectiveness of occupational health interventions (OHI). Methods Articles published in 2000 and 2001 in 16 general and specialized biomedical journals were searched for evaluations of OHI studies. Results Out of 8,687 articles searched there were 148 OHI studies. In 21% of the studies the study design was a randomized controlled trial, in 28% it was a controlled trial, an interrupted time-series in 7% and a different design in 44%. The occupational health outcome was exposure in 27% of the studies, worker behavior in 12%, disease symptoms in 30%, disability or sickness absence in 24%, injuries in 4%, and quality of care in 3%.

Sick leaves may vary over the business cycle due to disciplining effects or changes in labour force composition. The latter hypothesis maintains that sickness may be pro-cyclical due to employment of "marginal" workers with poorer health when demand increases. Using individual records of labour force participants in Norway, we investigate the explanatory factors behind differing spells of work absence at different stages of the business cycle. We find no indication that new entrants into the labour force explain increases in absence. On the other hand, insiders increase their absences when the economic conditions improve. Thus, a disciplining effect seems to explain most of the changes in work absence behaviour.

Syftet med detta projekt var att få kunskap om läkares erfarenheter av samverkan med och syn på Försäkringskassan genom kvantitativa och kvalitativa analyser av svar på en enkät som år 2017 skickades till 34 585 yrkesverksamma läkare i Sverige. Svaren jämfördes även med svar från tidigare enkäter. I tabellen nedan framgår studiepopulationers storlek och svarsfrekvens för respektive enkätår.
Resultaten visar att drygt hälften (53 %) av läkarna var nöjda med kontakten med Försäkringskassan. Å andra sidan upplevde majoriteten (77 %) flera svårigheter i kontakten med Försäkringskassan. Dessa inkluderade logistiska svårigheter såsom nåbarhet, medan andra handlade om kommunikation, bemötande, begäran om kompletteringar av intyg, brister i handläggares kompetens samt förutsägbarhet och rättssäkerhet i processerna. Ett flertal av dessa torde ha stor betydelse för samverkan mellan läkare och Försäkringskassan. Således föreligger det en stor förbättringspotential inom flera områden i samverkan mellan läkare och Försäkringskassans handläggare.

Objectives-Shiftwork is now a major feature of working life across a broad range of industries. The features of the shift systems operated can impact on the wellbeing, performance, and sleep of shiftworkers. This paper reviews the current state of knowledge on one major characteristic of shift rotas-namely, shift duration. Evidence comparing the relative eVects of eight hour and 12 hour shifts on fatigue and job performance, safety, sleep, and physical and psychological health are considered. At the organisational level, factors such as the mode of system implementation, attitudes towards shift rotas, sickness absence and turnover, overtime, and moonlighting are discussed. Methods-Manual and electronic searches of the shiftwork research literature were conducted to obtain information on comparisons between eight hour and 12 hour shifts. Results-The research findings are largely equivocal. The bulk of the evidence suggests few diVerences between eight and 12 hour shifts in the way they aVect people. There may even be advantages to 12 hour shifts in terms of lower stress levels, better physical and psychological wellbeing, improved durations and quality of oV duty sleep as well as improvements in family relations. On the negative side, the main concerns are fatigue and safety. It is noted that a 12 hour shift does not equate with being active for only 12 hours. Conclusions-There can be considerable extension of the person's time awake either side of the shift. However, the eVects of longer term exposure to extended work days have been relatively uncharted in any systematic way. Longitudinal comparative research into the chronic impact of the compressed working week is needed. (Occup Environ Med 1998;55:217-229)

The prevalence of musculoskeletal complaints in dentists is high although relatively few studies had focus in this profession. The aim of this study was to investigate the relations between physical, psychosocial, and individual characteristics and different endpoints of musculoskeletal complaints of low back, neck, shoulders and hand/wrist.

Previous studies have shown that elevated, risky levels of alcohol consumption may lead to higher rates of sickness absence. However, no studies have examined the Alcohol Use Disorders Identification Test (AUDIT) or serum carbohydrate-deficient transferrin (CDT) in relation to sickness absence in the workplace. The purpose of this study was to examine the relationship between sick-days, 12 months before screening, and the AUDIT and CDT (CDTect kit). Serum ␥-glutamyltransferase also was used for comparison.