Associations between health and combinations of sickness presence and absence

Re-visiting the six-item Stanford presenteeism scale (SPS-6) and its psychometric properties

Presenteeism has often been considered as the correlate of absenteeism and associated to productivity loss. This study sought to re-examine the psychometric properties of the 6-item Stanford Presenteeism Scale (SPS-6), a popular measure which has been translated in a number of languages. The study adopted a cross-sectional design with 268 participants aged 18 - 65 working in a multinational IT company with headquarters based in Poland. The respondents participated willingly in an online questionnaire on a presenteeism health-related productivity measure (SPS-6), job resources (peer support), job demands (work-to-family conflict), engagement and burnout. Their responses were subjected to statistical analyses. Confirmatory Factor Analysis revealed that the SPS-6 is better represented by two singular and independent components, namely completing work and avoiding distractions, rather than an aggregated measure of health-related productivity. In fact, the aggregated measure had convergent and discriminant validity issues. We also assessed, via Structural Equation Modeling (SEM), the explanatory role of the SPS-6 within the wider well-being discourse by subjecting its' factors as outcomes using the JD-R framework. Here, burnout was better at explaining its relationship to avoiding distractions and completing work compared to engagement, while avoiding distractions was more dominant than completing work in explaining indirect pathways. Given the convergent and discriminant validity of its two-dimensional measures, we argue that the SPS-6 is a better assessment of health-related productivity in the light of presenteeism when keeping both components separate rather than adding the scores from both dimensions to provide a global score as has been the practice so far. In addition, the SEM findings suggest that both SPS-6 components may require different theoretical explanations. This study supports a growing chorus of scholars who argue the need to look deeper into the presenteeism phenomenon, not least its measures.

Living longer, working longer: analysing time trends in working life expectancy in Germany from a health perspective between 2002 and 2018

Population ageing poses growing challenges to social security systems, in particular to public pension funds. The study analyses how Working Life Expectancy (WLE) and Healthy Working Life Expectancy (HWLE) in terms of three health indicators developed in Germany. Based on the German Socio-Economic Panel (GSOEP) from 2002 to 2018 (n = 211,141), time trends in labour force rates, mental and physical Health-Related Quality of Life (HRQoL), self-rated health (SRH) and the respective combinations (health indicator*labour force) were analysed for all respondents aged 18-74. WLE and HWLE were calculated using the Sullivan method. WLE and HWLE in men and women at age 18 and 50 clearly increased over time. These increases in HWLE were found in terms of all three health indicators. This development was mainly driven by the clear increase of the labour force rates, since the shares of individuals with good and satisfactory SRH or average and good HRQoL remained largely stable over time. The results show that from a health perspective there have been potentials for increases in WLE during the past two decades and that increasingly more healthy life years are spent economically active. However, life years in the labour force but in poor health have increased, too. The absence of clear improvements in health emphasises the importance of current and future preventive measures to maintain health, especially among the middle-aged and older labour force.

Sickness Presenteeism as a Link between Long Working Hours and Employees' Outcomes: Intrinsic and Extrinsic Motivators as Resources

The aim of this study was to test the flow from long working hours to sickness presenteeism behavior and its outcomes for employees, while integrating intrinsic and extrinsic work value orientations as moderators in the process. We employed a two-wave design with a five-month interval. Data were obtained from 275 employees in Taiwan. The results of latent moderated structural equations (LMS) revealed that long working hours were positively associated with presenteeism, which in turn was negatively related to employees’ well-being and job performance. Furthermore, the negative indirect effect of working long hours on job performance via presenteeism was weaker for those with a higher intrinsic work value orientation. The negative indirect effect of working long hours on well-being via presenteeism was weaker for those with a higher extrinsic work value orientation. We demonstrated that the long-term impact of presenteeism behavior could be understood by viewing work value orientations as resource gains to compensate resource depletion in a demanding work context. This resource dynamism is pivotal to realizing the functional or dysfunctional outcomes of presenteeism behavior. Theoretical and managerial implications of the findings for employees’ well-being and organizational effectiveness are discussed.

Treatment interruption is a risk factor for sickness presenteeism: A large-scale cross-sectional study during the COVID-19 pandemic

OBJECTIVES

This study examined the relationship between interruption to routine medical care during the coronavirus disease 2019 pandemic and sickness presenteeism among workers in Japan.

METHODS

A cross-sectional study using data obtained from an internet monitor questionnaire was conducted. Interruption to medical care was defined based on the response "I have not been able to go to the hospital or receive treatment as scheduled." The fraction of sickness presenteeism days in the past 30 days was employed as the primary outcome. A fractional logit model was used for analysis to treat bounded data.

RESULTS

Of the 27 036 participants, 17 526 (65%) were workers who did not require routine medical care, 8451 (31%) were using medical care as scheduled, and 1059 (4%) experienced interrupted medical care. The adjusted odds ratio (aOR) of sickness presenteeism was significantly higher among workers who experienced interrupted medical care (3.44; 95% confidence interval [CI]: 3.04-3.89) than those who did not require routine medical care. In terms of symptoms, the highest aOR was observed among workers with mental health symptoms (aOR: 5.59, 95% CI: 5.04-6.20).

CONCLUSIONS

This study suggests the importance of continuing necessary treatment during a pandemic to prevent presenteeism.

Unlocking the Contradictory Outcomes of Presenteeism Through a Temporal Model: Effort Exertion as a Mediator

The effects of presenteeism, that is, working while ill or exhausted, are unclear, as previous research has yielded contradictory results. The aim of this study was thus two-fold: clarify the differential effects of short versus long-term presenteeism and corroborate the mediating effect of effort exertion on the relationship between presenteeism and work-related outcomes. We adopt a three-wave panel design and measure all the variables at three different points (initially, after one week and after one year) to understand the effects of presenteeism over time. Our sample consists of 361 Chinese employees working in diverse industries in Taiwan. We analyze the panel data using structural equation modeling and bootstrapping. Our results reveal that presenteeism is positively associated with increased effort, work engagement, and job performance after one week. By contrast, presenteeism is negatively associated with job performance and work engagement though positively associated with emotional exhaustion after one-year. Our research contributes to clarify paradoxical results regarding presenteeism's consequences, as well as corroborating that effort exertion mediates the relationship between presenteeism and work outcomes. We also identify practical implications for organizations managing employees working remotely, a more common reality with the outbreak of the COVID-19 pandemic, the ensuing lockdowns and digitalization which has started to become the norm for a significant proportion of working sectors. Finally, we suggest recommendations for future research on presenteeism.

Presenteeism in small and medium-sized enterprises: Determinants and impacts on health

BACKGROUND

Small and medium sized enterprises are yet uncharted territory in terms of presenteeism. In addition, the Demand-Control-Support (DCS) and Siegrist's Effort-Reward Imbalance (ERI) models are proposed to predict stress-related health problems, but not for sickness behaviors such as presenteeism.

OBJECTIVE

This study aims to examine the relationships between psychosocial risk factors, presenteeism, mental and physical health in the context of small and medium-sized enterprises (SMEs). This study also examines the moderating effect of company size on these associations.

METHODS

To test the association between psychosocial risks, presenteeism, and health, only people working in small and medium-sized enterprises (SMEs) of between 2 and 199 employees were included in the sample, giving a total of 2,525 SME employees surveyed. To test the differences in exposure to psychosocial risk and presenteeism, and the moderating impact of size on the relationship between psychosocial risks, presenteeism, and health, we took the original sample (4608) of the EQCOTESST.

RESULTS

The results confirm the associations between job demands, social support and effort-reward imbalance, and presenteeism. Also, the associations between presenteeism and health problems in SMEs' context. Multi-group analyses show that the business's size does not moderate the strength of the relationships between psychosocial risks, presenteeism and health.

CONCLUSION

The current study highlights that SMEs are somehow protected from certain psychosocial constraints such as high job demands, and low social support, but are more exposed to others such as effort-reward imbalance.

Favorable Working Conditions Related to Health Behavior Among Nurses and Care Assistants in Sweden-A Population-Based Cohort Study

Objective: To analyze the associations between favorable physical and psychosocial work factors and health behavior among healthcare employees (nurses and care assistants) with health complaints.

Methods: The study was based on seven iterations (2001–2013) of a biennial Swedish work environment survey linked with data from public registers. In all, 7,180 healthcare employees, aged 16–64 years, who had reported health complaints, were included. Health behavior was operationalized through four combinations of sickness absence (SA) and sickness presence (SP): ‘good health behavior' (Low SP/Low SA), ‘recovery behavior' (Low SP/High SA), ‘risk behavior' (High SP/Low SA), and ‘poor health behavior' (High SP/High SA). Odds ratios (OR) were calculated by multinomial logistic regression with 95% confidence intervals (CI).

Results: After adjusting for socio-demographic factors, those who rarely worked in strenuous postures had an increased probability of having ‘good health behavior' (OR range: nurses 1.72–2.02; care assistants 1.46–1.75). Those who rarely experienced high job demands had increased odds for having ‘good health behavior' (OR: nurses 1.81; OR range: care assistants 1.67–2.13), while having good job control was found to be related to ‘good health behavior' only among care assistants (OR range 1.30–1.68). In the full model, after also considering differences in health, none of the work environment indicators affected ‘good health behavior' among nursing professionals. Among care assistants, rarely having heavy physical work and having low psychosocial demands remained significantly associated with ‘good health behavior' (OR range: 1.24–1.58) and ‘recovery behavior' (OR range: 1.33–1.70). No associations were found between favorable work environment factors and ‘risk behavior' among the two groups of employees. However, positive assessments of the work situation were associated with ‘good health behavior,' even after controlling for all confounders for both groups (OR range: 1.43–2.69).

Conclusions: ‘Good health behavior' and ‘recovery behavior' among care assistants were associated with favorable physical and psychosocial working conditions even when health was considered. This implies that reduced sickness presence and sickness absence among care assistants can be achieved through improved physical and psychosocial working conditions.

Reasons for presenteeism in different occupational branches in Sweden: a population based cross-sectional study

Objective

To compare the prevalence and reasons for presenteeism in occupations in three branches defined as employees handling people, handling things or handling symbols.

Method

A cross-sectional population-based cohort study was conducted. The study group was drawn from a representative sample (n = 6230) aged 16–64, who had been interviewed in 2015 or in 2017 for the Swedish Work Environment Surveys (SWES). The odds ratios (ORs) stratified by occupational category for reasons of presenteeism, with 95% confidence intervals (CI), were estimated using binomial multiple logistic regression analysis.

Results

The study showed that presenteeism was more common among employees handling people (74%), when compared to employees handling things (65%) or handling symbols (70%). The most common reason for presenteeism among employees handling people was “I do not want to burden my colleagues”, while “Because nobody else can carry out my responsibilities” was most common in the other two categories. After control for socio-demography, work environments and health, the differences in reasons mostly remained significant between the three occupational categories.

Conclusion

The differences between occupational categories are important for prevalence and reasons for presenteeism. As presenteeism affects the future health of employees and the productivity of the work unit, attempts to reduce presenteeism may be important. Because the reasons vary between occupations, customized preventive measures should be applied in different occupational settings. Among employees handling people, covering up for absence in work team is relevant, while among employees handling symbols and handling things the corresponding focus could be on shared responsibilities for specific tasks.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00420-021-01701-2.

Sickness Absence and Sickness Presence Among Health and Care Employees in Sweden-Health Complaints, Health Behavior, and Future Long-Term Sickness Absence

OBJECTIVE

To describe if health complaints relate to health behavior in terms of sickness absence (SA) and sickness presence (SP) and to examine how complaints and health behavior predicts the risk for future long-term sickness absence (LTSA).

METHODS

Data originates from work environment surveys 2001 to 2013 and SA registers 2002 to 2016 of 1838 nurses, 7430 care assistants, and 40,515 individuals in all other occupations. Descriptive and regression analyses were conducted.

RESULTS

Physical complaints and high SA in combination with high SP increased the risk of LTSA among nurses and care assistants. Nurses' high SP and care assistants' high SA elevated the LTSA risk.

CONCLUSIONS

Strategies to reduce the reasons behind physical health complaints among health care workers are warranted. SP among nurses and SA among care assistants should be considered in the organization of their job demands.

Exhaustion and Impaired Work Performance in the Workplace: Associations With Presenteeism and Absenteeism

OBJECTIVE

The aim of this study was to investigate the association between presenteeism and absenteeism during the previous year and the current levels of exhaustion and impaired work performance in a Swedish university setting.

METHODS

In a study of 3525 employees, an ordinal logistic regression and general linear model was used to examine the association between presenteeism and absenteeism during the previous year and the current exhaustion and impaired work performance, respectively.

RESULTS

Presenteeism, but not absenteeism, during the previous year independently increased the risk of having moderate or severe exhaustion. Presenteeism, absenteeism, and exhaustion remained positively associated with impaired work performance when health status and other confounders had been adjusted for.

CONCLUSIONS

Presenteeism, but not absenteeism, was associated with exhaustion. Both presenteeism and absenteeism were the salient correlates of impaired work performance.

Doctor's presenteeism and its relationship with anxiety and depression: a cross-sectional survey study in China

OBJECTIVES

The impact of presenteeism on doctors' health, quality of patient care and overall performance of health institutions has been reported. The study aimed to investigate the prevalence of presenteeism among doctors, the association between presenteeism and anxiety/depression, and aspects that can help alleviate presenteeism.

DESIGN

A cross-sectional anonymous survey study was conducted between 2017 and 2018.

SETTING

30 hospitals in Hangzhou city, Zhejiang Province, China including 10 category 1 hospitals (20-99 beds), 10 category 2 hospitals (100-499 beds) and 10 category 3 hospitals (> 500 beds) which had the highest population coverage.

PARTICIPANTS

At least 3 doctors from each department in the studied hospitals participated. Each participant received a gift worth around US$5 at completion of the survey.

PRIMARY AND SECONDARY OUTCOME MEASURES

The prevalence of presenteeism and its relationship with anxiety or depression were evaluated as the primary outcomes. Secondary outcomes included the prevalence of abnormal cases of anxiety and depression.

RESULTS

The survey was completed by 1153/1309 hospital doctors (response rate 88.1%). Presenteeism was reported by 66.4% of participants. Using the Hospital Anxiety and Depression Scale, 68.8% and 72.3% of participants had abnormal cases of anxiety and depression, respectively. Logistic regression analysis showed that participants with abnormal cases of anxiety, borderline cases of depression or abnormal cases of depression were more likely to practice presenteeism (all p<0.05). Other significant work-related contributing factors included: time working at the current hospital, management duty, monthly salary and ease of replacement (all p<0.05).

CONCLUSION

Presenteeism was prevalent among doctors in China and the association of presenteeism with abnormal cases of anxiety or depression was significant. Considering the modifiable work-related contributing factors, appropriate measures at the healthcare institutions to support doctors' mental health, help them develop and reinforce management skills, and ensure appropriate manpower are important to alleviate presenteeism behaviour.

Sickness presenteeism: Are we sure about what we are studying? A research based on a literature review and an empirical illustration

BACKGROUND

There has been an increasing interest in studying sickness presenteeism (SP). An ever-increasing amount of scientific literature is published using this term, yet there appears to be considerable heterogeneity in how it is assessed, which could result in substantial differences in the definition and interpretation of the phenomenon really being studied. We aim to discuss what really is being studied, depending on how the phenomenon is operationalized, measured, and analyzed.

METHODS

A study based on a literature review and an empirical illustration using data of the third Spanish Psychosocial Risks Survey (2016).

RESULTS

Differences are observed based on the population in which SP is measured, the cut-off points used to define a worker as presenteeist, the reasons for an SP episode and even an analysis of the phenomenon treated as a count or as a dichotomous.

CONCLUSIONS

Without being completely exclusive, it seems that restricting the population of analysis to only those workers who consider that they should not have gone to work due to their health, and/or establishing low cut-off points to define someone as presenteeist, would more clearly delimit the study of SP to the exercise of a right to sick leave. In contrast, working with the entire population or using high cut-off points appears to relate the study of SP more with health status and less with the exercise of rights. On the other hand, taking the reasons for SP into account would probably help to improve interpretation of the phenomenon.

Do Temporary Workers More Often Decide to Work While Sick? Evidence for the Link between Employment Contract and Presenteeism in Europe

European employees are increasingly likely to work in cases of illness (sickness presenteeism, SP). Past studies found inconsistent evidence for the assumption that temporary workers decide to avoid taking sick leave due to job insecurity. A new measure to identify decision-based determinants of SP is presenteeism propensity (PP), which is the number of days worked while ill in relation to the sum of days worked while ill and days taken sickness absence. We investigated the link between employment contract and PP using cross-sectional data from 20,240 employees participating in the 2015 European Working Conditions Survey. Workers were grouped by type and duration of employment contract. The link between contract and PP was estimated using a multilevel Poisson model adjusted for socio-demographical, occupational and health-related covariates. We found that European employees worked 39% of the days they were ill. In contrast to previous studies, temporary workers were significantly more likely to decide for presenteeism than permanent workers were, especially when the contract was limited to less than 1 year. Controlling for perceived job insecurity did just marginally attenuate this association. Presenteeism was also more common among young and middle-aged workers; however, we did not find a significant interaction between contract and age affecting presenteeism. In conclusion, the employment contract is an important determinant of presenteeism. Our results give reason to believe that temporary workers show increased attendance behavior independent of job insecurity, because they are less likely to have access to social protection in case of illness.

The relation between indicators of low employment quality and attendance behavior in countries of the European Union

Background

Previous research demonstrated an association between low employment quality and lower sickness absence, which may be explained by presenteeism. Therefore, this study aimed exploring the relation between three indicators of employment quality (long working hours, precarious employment, job insecurity) and attendance behavior.

Methods

The association between employment quality and attendance behavior was investigated in 28.999 workers (mean age: 40.0 years, 53% males) of the fifth wave of the European Working Conditions Survey, using multilevel multinomial logistic regression analysis. Attendance behavior was operationalized as different combinations of sickness absence and presenteeism.

Results

Those working >48 h/week, had a higher risk to report presenteeism (with or without sickness absence). They had a lower risk to report sickness absence without presenteeism. Workers with a precarious contract had a lower risk to report absenteeism without presenteeism and the combination of both presenteeism and absenteeism. Finally, for workers perceiving job insecurity, the risk for presenteeism without sickness absence was significantly higher.

Conclusions

Several indicators of low employment quality were associated with attendance behavior, suggesting a complex behavioral mechanism in workers facing low job quality employment. Therefore, policy makers are recommended to re-establish the indefinite contractual employment as the standard, avoiding long working hours.

Sickness presence in the Swedish Police in 2007 and in 2010: Associations with demographic factors, job characteristics, and health

BACKGROUND

Sickness presence (SP) is a complex phenomenon that has been shown to predict sickness absence, poor work performance, and suboptimal self-rated health. However, more research is needed to increase the understanding of how SP relates to occupational factors, demographic variables, and self-rated health.

OBJECTIVE

The aims of this study were to investigate (1) the prevalence of SP among the Police employees in Sweden in 2007 and in 2010; (2) the association between demographics, seniority, occupational group (police officer vs civil servant), and self-reported health on the one hand and SP on the other hand for both years separately.

METHODS

Survey data from Swedish Police employees from 2007 (n = 17,512) and 2010 (n = 18,415) were analyzed using logistic regression to assess odds ratios (OR) and 95% confidence intervals (CI).

RESULTS

The prevalence of SP was stable between the years, but the proportion who stated that they had not been ill at all decreased from 2007 to 2010 (28.0% vs. 23.6%), while the proportion stating always having stayed at home when ill did not differ; 45.0% in 2007 to 45.8% in 2010. The ORs of SP were higher among those with suboptimal self-rated health compared to those with optimal self-rated health (4.38 (95% CI 4.02- 4.78) and 4.31 (3.96- 4.70) in 2007 and 2010, respectively) and among police officers compared with civilians (1.26 (1.17-1.36) and 1.19 (1.10-1.28)), whereas no clear patterns were found for age, gender, and seniority.

CONCLUSIONS

The prevalences of SP were about the same in 2007 and 2010 and were slightly lower compared to in previous studies. The strong association between SP and suboptimal self-rated health suggests that high levels of SP may be an early marker of future illness and sickness absence. In future studies of SP it is important to account for having been ill, that is, at risk of SP.

The consequences of sickness presenteeism on health and wellbeing over time: A systematic review

RATIONALE

The association between sickness presenteeism, defined as going to work despite illness, and different health outcomes is increasingly being recognized as a significant and relevant area of research. However, the long term effects on future employee health are less well understood, and to date there has been no review of the empirical evidence. The aim of this systematic review was to present a summary of the sickness presenteeism evidence so far in relation to health and wellbeing over time.

METHODS

Eight databases were searched for longitudinal studies that investigated the consequences of workplace sickness presenteeism, had a baseline and at least one follow-up point, and included at least one specific measure of sickness presenteeism. Of the 453 papers identified, 12 studies met the eligibility criteria and were included in the review.

FINDINGS

We adopted a thematic approach to the analysis because of the heterogeneous nature of the sickness presenteeism research. The majority of studies found that sickness presenteeism at baseline is a risk factor for future sickness absence and decreased self-rated health. However, our findings highlight that a consensus has not yet been reached in terms of physical and mental health. This is because the longitudinal studies included in this review adopt a wide variety of approaches including the definition of sickness presenteeism, recall periods, measures used and different statistical approaches which is problematic if this research area is to advance. Future research directions are discussed.

Capacidade para o trabalho de cirurgiões-dentistas da atenção básica: prevalência e fatores associados

Resumo Objetivo: avaliar os fatores associados à capacidade para o trabalho de cirurgiões-dentistas. Métodos: a amostra foi constituída por 167 cirurgiões-dentistas vinculados à Estratégia Saúde da Família. Foram aplicados questionários sobre a capacidade para o trabalho, dados sociodemográficos, caraterísticas relacionadas ao trabalho, aspectos de saúde autorreferidos, estilo de vida e fadiga. Na análise univariada utilizou-se a estatística descritiva; na bivariada, o teste Qui-quadrado de Pearson, e, na multivariada, a regressão de Poisson. Resultados: 46,7% da amostra mostrou capacidade inadequada para o trabalho, sendo as variáveis independentes associadas: sexo feminino (RP=1,12; IC95%: 1,01-1,23), limpeza não adequada (RP=1,14; IC95%: 1,01-1,29), ambiente úmido (RP=1,35; IC95%: 1,15-1,59), ambiente de trabalho com muito barulho (RP=1,10; IC95%: 1,01-1,30), tarefas repetitivas e monótonas (RP=1,36; IC95%: 1,20-1,55), insatisfação com sono (RP=1,15; IC95%: 1,05-1,25), estado de saúde regular (RP=1,25; IC95%: 1,10-1,41), apresentar de uma a quatro morbidades diagnosticadas (RP=1,14; IC95%: 1,04-1,26), cinco ou mais morbidades (RP=1,52; IC95%: 1,38-1,70) e níveis altos de percepção de fadiga (RP=1,15; IC95%: 1,04-1,26). Conclusão: A amostra estudada apresentou incapacidade para o trabalho, que foi associada a fatores sociodemográficos, características do trabalho, aspectos de saúde e altos níveis de fadiga.

Relationship between sickness presenteeism and awareness and presence or absence of systems for return to work among workers with mental health problems in Japan: an Internet-based cross-sectional study

OBJECTIVES

The objective of this study was to clarify the relationship between sickness presenteeism and the degree of awareness of company regulations regarding financial compensation for absenteeism.

METHODS

An Internet-based survey of 258 full-time workers who had more than 28 days of sickness absence due to mental health problems was conducted. Workers were categorized as having either low or high sickness presenteeism, and awareness and presence or absence of systems for return to work and duration of financial compensation were compared between groups.

RESULTS

The following factors were significantly related to high sickness presenteeism based on logistic regression analyses: working for a private company (odds ratio [OR]=2.57; 95% confidence interval [CI]=1.10-5.99); recognition of a gradual resumption system (OR=3.89, 95% CI=1.02-14.81); and awareness regarding the duration of financial compensation (OR=1.04, 95% CI=1.01-1.07).

CONCLUSIONS

No relationship was found between mental sickness presenteeism and presence or absence of systems for return to work in our multivariate analysis; however, a relationship was apparent between sickness presenteeism and characteristics of the workers' companies. These results are expected to contribute to research involving human resources and occupational health.