Common Mental Disorders and Sickness Absence: A Register-Linkage Follow-Up Study Among Finnish Municipal Employees

Work-Related Psychosocial Risk and Protective Factors Influencing Workplace Sickness Absence: A Systematic Literature Review

PURPOSE

Employee sickness absence (SA) is a significant issue facing organizations and individuals worldwide, leading to multiple negative consequences, such as increased costs, early retirement, decreased productivity, and reduced quality of work. Therefore, within the occupational health and safety (OHS) framework, it is crucial to explore the factors that help workforces stay at work sustainably. This study investigates the role of work-related psychosocial factors (WRPFs) as predictors of SA and suggests proactive measures to prevent its occurrence.

METHODS

A systematic literature review was conducted within the Job Demands-Resources Model framework. Following the PRISMA Checklist, 1087 articles from PsycINFO, Medline, and Web of Science databases were screened, and 30 longitudinal studies were included.

RESULTS

The findings describe SA as a multifaceted phenomenon influenced by risk (e.g., poor quality leadership, bullying, and violence) and protective WRPFs (e.g., developmental opportunities and social support). These factors, spanning contextual, content-related, and relational dimensions, collectively influence workers' SA over time.

CONCLUSIONS

These insights provide valuable guidance for researchers and OHS stakeholders, supporting the development of research and interventions aimed at preventing SA. This research contributes important knowledge to the field, paving the way for more targeted strategies that address the organizational causes of SA and promote healthier, more productive work environments.

Sickness absence trajectories among young and early midlife employees with psychological distress: the contributions of social and health-related factors in a longitudinal register linkage study

PURPOSE

Psychological distress has been associated with sickness absence (SA), but less is known about whether there are distinct patterns in the development of SA among people with psychological distress. We examined trajectories of short- and long-term SA among employees with psychological distress and how social and health-related factors are associated with them.

METHODS

We used the employer's register data on all-cause short- (≤ 10 working days) and long-term (> 10 working days) SA with a two-year follow-up. We prospectively linked the Helsinki Health Study survey data on 19-39-year-old employees of the City of Helsinki, Finland, in 2017, to the SA data. We included 1060 participants (81% women) who reported experiencing psychological distress, measured by the emotional wellbeing scale of RAND-36. Survey responses of age; gender; education; marital status; social support, procedural and interactional organisational justice, and bullying at work; physical activity; diet; tobacco and alcohol use; prior SA; and the level of psychological distress were included as exposures. Group-based trajectory modelling and multinomial logistic regression were used for the analyses.

RESULTS

We identified four short-term SA trajectories: 'low' (n = 379, 36% of participants), 'descending' (n = 212, 20%), 'intermediate' (n = 312, 29%), and 'high' (n = 157, 15%); and two long-term SA trajectories: 'low' (n = 973, 92%) and 'high' (n = 87, 8%). A higher education, fewer prior SA, and lower levels of psychological distress were associated with the 'low' short- and long-term SA trajectories.

CONCLUSION

SA trajectories differ among employees with psychological distress. Early intervention and support are needed among employees with mental health symptoms to prevent future SA.

Plant food consumption and emotional well-being: the Helsinki Health Study among 19-39-year-old employees

BACKGROUND AND OBJECTIVES

Associations between fruit and vegetable consumption and mental health have been observed, but studies comparing different types of plant foods are sparse. This study among Finnish municipal employees examined associations of the consumption of a range of different plant foods with emotional well-being (EWB).

DATA AND METHODS

We used survey data from the Helsinki Health Study conducted in 2017 among 19-39-year-old employees of the City of Helsinki, Finland (N = 5898, response rate 51.5%, 80% women). Consumption of plant foods, including fruit, berries, fresh and cooked vegetables and wholegrain bread, was measured by a food frequency questionnaire and dichotomised into daily/non-daily consumption. The EWB scale of the RAND-36 questionnaire was dichotomised, with the lowest quartile indicating 'poor EWB' and the three higher quartiles indicating 'good EWB'. We used logistic regression for analysing the associations between plant food consumption and EWB. Analyses were sex-stratified and age, socioeconomic circumstances and psychosocial working conditions were adjusted for.

RESULTS

Prevalence of daily consumption of plant foods varied from 25% for berries and cooked vegetables to 70% for fresh vegetables. Daily consumption was associated with good EWB among both women and men. The strongest age-adjusted association was found for fresh vegetables, with women (OR 1.48, 95% CI 1.27-1.74) and men (OR 1.86, CI 1.37-2.52) with daily consumption having clearly higher odds of good EWB compared to non-daily consumers. Associations slightly attenuated but mostly remained after adjusting for socioeconomic circumstances and working conditions.

CONCLUSIONS

More frequent plant food consumption was associated with good EWB. Thus, the results support the need for interventions that investigate whether the promotion of plant food consumption could show potential mental health benefits among employees.

The significance of managers' knowledge of common mental disorders on managerial stigma towards employee depression: a cross-sectional study in Sweden

BACKGROUND

Common mental disorders (CMD) such as depression, anxiety and stress-related disorders have increased in the working-age population in many countries but are still often associated with social stigma in workplaces. Managers have a key role in supporting employees with impaired health. Identifying factors that can improve stigmatizing attitudes among managers towards CMD is crucial. The aim of this study was to investigate managers' knowledge of CMD on managerial stigma; more specifically knowledge aquired through training and education and through occupational and personal experience of CMD on low managerial stigma towards employee depression.

METHODS

Data from a web-based survey conducted in 2017 among 3038 managers in Sweden were used. Managers' attitudes towards employee depression were measured using the Swedish version of the Managerial Stigma towards Employee Depression questionnaire. Binary logistic regression analysis, with adjustments for work setting and managerial experience, was conducted for associations between sources of knowledge of CMD and low managerial stigma.

RESULTS

With regard to knowledge acquired through training, medical training on CMD was significantly associated with a higher probability for low managerial stigma towards employee depression after adjustments (odds ratio [OR], 1.95; 95% confidence interval [CI], 1.26-3.01), whereas no significant associations were found between knowledge acquired through managerial training on CMD or level of formal education and low managerial stigma. With regard to knowledge acquired through professional and personal experience, occupational experience of treating people with CMD was significantly associated with a higher probability for low managerial stigma (OR, 2.03; 95% CI, 1.40-2.94) as was occupational experience of employees with CMD (1 employee: OR, 1.31; 95% CI, 1.04-1.66); >1 employee, OR 1.35 (CI 1.05-1.73). Personal experience of CMD was significantly associated with low managerial stigma (OR, 1.98; 95% CI, 1.60-2.46).

CONCLUSIONS

Managers' knowledge and understanding of CMD may increase the probability of a low level of managerial stigma towards employees with depression. Managers' professional and/or personal experiences of CMD were important sources of knowledge in relation to a low level of stigmatizing attitudes. Organizations should encourage the use of managers' experience-based knowledge of CMD in addition to training on CMD to reduce managerial stigma.

The Role of Mental Health on Workplace Productivity: A Critical Review of the Literature

BACKGROUND

Mental health disorders in the workplace have increasingly been recognised as a problem in most countries given their high economic burden. However, few reviews have examined the relationship between mental health and worker productivity.

OBJECTIVE

To review the relationship between mental health and lost productivity and undertake a critical review of the published literature.

METHODS

A critical review was undertaken to identify relevant studies published in MEDLINE and EconLit from 1 January 2008 to 31 May 2020, and to examine the type of data and methods employed, study findings and limitations, and existing gaps in the literature. Studies were critically appraised, namely whether they recognised and/or addressed endogeneity and unobserved heterogeneity, and a narrative synthesis of the existing evidence was undertaken.

RESULTS

Thirty-eight (38) relevant studies were found. There was clear evidence that poor mental health (mostly measured as depression and/or anxiety) was associated with lost productivity (i.e., absenteeism and presenteeism). However, only the most common mental disorders were typically examined. Studies employed questionnaires/surveys and administrative data and regression analysis. Few studies used longitudinal data, controlled for unobserved heterogeneity or addressed endogeneity; therefore, few studies were considered high quality.

CONCLUSION

Despite consistent findings, more high-quality, longitudinal and causal inference studies are needed to provide clear policy recommendations. Moreover, future research should seek to understand how working conditions and work arrangements as well as workplace policies impact presenteeism.

Outcomes of psychiatric interviews and self-rated symptom scales in people on sick leave for common mental disorders: an observational study

OBJECTIVES

To investigate the correspondence between diagnoses on sick leave certificates and diagnoses made in structured psychiatric interviews. Secondary aims were to investigate length of sick leave by diagnoses on sick leave certificates, diagnoses made in structured interviews and symptom severity.

DESIGN

Observational study consisting of a secondary analysis of data from a randomised controlled trial and an observational study.

SETTING

The regions of Stockholm and Västra Götaland, Sweden.

PARTICIPANTS

480 people on sick leave for common mental disorders.

INTERVENTIONS

Participants were examined with structured psychiatric interviews and self-rated symptom severity scales.

OUTCOME MEASURES

(1) Sick leave certificate diagnoses, (2) diagnoses from the Mini International Neuropsychiatric Interview and the Self-rated Stress-Induced Exhaustion Disorder (SED) Instrument (s-ED), (3) symptom severity (Montgomery-Asberg Depression Rating Scale-self-rating version and the Karolinska Exhaustion Disorder Scale) and (4) number of sick leave days.

RESULTS

There was little correspondence between diagnoses on sick leave certificates and diagnoses made in structured psychiatric interviews. Many participants on sick leave for SED, anxiety disorder or depression fulfilled criteria for other mental disorders. Most on sick leave for SED (76%) and anxiety disorder (67%) had depression (p=0.041). Length of sick leave did not differ by certificate diagnoses. Participants with SED (s-ED) had longer sick leave than participants without SED (144 vs 84 days; 1.72 (1.37-2.16); p<0.001). More severe symptoms were associated with longer sick leave.

CONCLUSION

Diagnoses on sick leave certificates did not reflect the complex and overlapping nature of the diagnoses found in the structured psychiatric interviews. This finding is relevant to the interpretation of information from health data registers, including studies and guidelines based on these data. A result of clinical interest was that more severe symptoms predicted long-term sick leave better than actual diagnoses.

Sickness absence due to common mental disorders in young employees in Sweden: are there differences in occupational class and employment sector?

BACKGROUND

A large proportion of sickness absence (SA) in young adults is due to common mental disorders (CMDs). Still studies on CMD-related SA in young workers are lacking, especially studies for those employed in the private sector. The current study investigated the associations between sector of employment, occupational class and SA due to CMDs. In addition, associations between type of employment branch and SA due CMDs within each sector were examined.

METHODS

This population-based longitudinal cohort study included 663,583 employees, 19-29 years, residing in Sweden in 2009. Employment sector (i.e., private/public) and occupational class (non-manual/manual workers) were measured in 2009. Risk estimates of SA due to CMDs, between 2010 and 2016, were calculated as Hazard Ratios (HR) with 95% confidence intervals (CI), using Cox regression analysis.

RESULTS

Sector of employment was associated with SA due to CMDs, such that public sector workers had an elevated risk when compared with private sector employees (adjusted HR: 1.31 (95% CI 1.29-1.33). Moreover, manual workers had a slightly elevated risk for SA due to CMDs compared to non-manual workers. Within the private sector, in both manual and non-manual workers, those employed in education and health and social services evidenced the highest rates and risks of SA due to CMDs.

CONCLUSION

Sector of employment and occupational class play a role in SA due to CMDs in young employees. These findings should be considered when identifying high-risk groups for SA in the young working population.

How Managers Find Out About Common Mental Disorders Among Their Employees

OBJECTIVE

To explore how managers find out about common mental disorders (CMDs) among employees and associations with managers' work- and knowledge-related characteristics and attitude to CMDs.

METHODS

Data from an online survey in 2017 with Swedish managers (n = 1810) were used. Different ways managers find out about CMDs were measured, and multivariate logistic regression analysis was conducted for associations with manager characteristics.

RESULTS

Few managers found out about CMDs themselves; another source was more common, for example, employees' self-disclosure. Managers' overseeing fewer subordinates and those with a negative attitude to depression were more likely to find out about CMDs themselves. The significance of mental health training and education could not be established.

CONCLUSION

Managers' awareness about employees' CMDs mainly came about through employees' self-disclosure. Managers' attitudes and work conditions were related to the way of finding out.

Frequent short sickness absence, occupational health service utilisation and long-term sickness absence due to mental disorders among young employees

Objectives

We examined whether frequent short-term sickness absence (FSTSA) and primary care use in occupational health service (OHS) were associated with medically-certified long-term sickness absence (LTSA) due to mental disorders among young employees.

Methods

We used record-linkage data covering the young employees (< 35 years) of the City of Helsinki, Finland (n = 8,282) from 2010 to 2014. The outcome was LTSA due to mental disorders. Cox regression models were fitted.

Results

FSTSAs were associated with subsequent LTSA. Also OHS use predicted LTSA due to mental disorders; however, this association was not found for those with prior FSTSA.

Conclusions

Both FSTSA and primary care use indicate subsequent LTSA independently, and together these indicators identify a larger proportion of individuals at risk of LTSA due to mental disorders.

Associations of Sleep and Health Functioning with Premature Exit from Work: A Cohort Study with a Methodological Emphasis

Sleep and functioning are associated with a risk of early workforce exit. However, patterns of change in sleep and functioning through time have not been investigated using person-oriented approaches to show what features of sleep and functioning are associated with an early exit. We examined the pattern of interactions between sleep and health functioning characterizing homogenous subgroups of employees and their associations with premature work exit. An additional aim was to provide a tutorial providing detailed description on how to apply these models, compared to traditional variable based risk factors. We analyzed data from 5148 midlife employees of the City of Helsinki, Finland, surveyed over three phases (2000–02, 2007, and 2012). Using repeated measures latent class analyses (RMLCA) we classified people into groups based on their trajectories in sleep and functioning. We identified four longitudinal groups: (1) Stable good sleep and functioning (reference), (2) Persistent sleep problems and good or moderate functioning, (3) Poor functioning with good sleep, and (4) Problematic sleep and health functioning. Compared to group 1, elevated risk was found in all classes with group 4 being the worst. In conclusion, focusing on person-orientated patterns of interactions between sleep and functioning helped produce qualitatively different and quantitatively stronger predictions than using conventional risk factor methodology. Thus, longitudinal person-oriented approaches may be a more powerful method for quantifying the role of sleep and health functioning as risks for premature exit from work.

Timing of Entry into Paid Employment, Adverse Physical Work Exposures and Health: The Young Helsinki Health Study

It is not well known how the timing of entry into paid employment and physical work exposures contribute to different health outcomes in young employees. Thus, we determined the associations of age at entry into paid employment and physical work exposures with general and mental health in young employees and determined whether associations differ by behavior-related risk factors. Data were collected via online and mailed surveys in autumn 2017 from employees of the City of Helsinki aged 18–39 years (n = 5897; 4630 women and 1267 men, response rate 51.5%). Surveys comprised measures of age at entry into paid employment, seven working conditions, behavior-related risk factors and health outcomes (self-rated health [SRH] and common mental disorders [CMD] as generic indicators of physical and mental health). Logistic regression analysis was used. After full adjustment, age at entry was not associated with the health outcomes; however, in additional analyses, younger age at first employment was associated with smoking and obesity (OR 3.00, 95% CI 2.34–3.85 and 1.67, 95% CI 1.32–2.11 for those started working at age of ≤18 years, respectively). Of the working conditions, sitting and standing were positively associated with poor SRH and CMD and uncomfortable working postures with CMD. Working conditions were broadly similarly associated with health outcomes among those with and without behavior-related risk factors. Although we found little support for modification by behavior-related risk factors, overweight, obesity and smoking were associated with poor SRH and binge drinking and smoking with CMD. Additionally, moderate and high levels of leisure-time physical activity were inversely associated with poor SRH. In conclusion, early entry into paid employment appears not to associate to immediate poorer health in young employees, although it was associated with smoking and obesity even after full adjustment. Exposure to physically heavy work and uncomfortable working postures may increase the risk of adverse health outcomes.

Employment and earnings trajectories before and after sickness absence due to major depressive disorder: a nationwide case-control study

OBJECTIVES

To examine employment and earnings trajectories before and after the first sickness absence period due to major depressive disorder (MDD).

METHODS

All individuals (n=158 813) in Finland who had a first sickness absence period (lasting longer than 9 days) due to MDD between 2005 and 2015 were matched with one randomly selected individual of the same age and gender with no history of MDD. Employment status and earnings were measured using register-based data annually from 2005 to 2015. Generalised estimating equations were used to examine the trajectories of employment and earnings before and after MDD diagnosis in men and women separately.

RESULTS

Sickness absence due to MDD was associated with increased probability of non-employment during and after the year of the first sickness absence period. In men, but not in women, the probability of being employed was lower 5 years before the sickness absence period due to MDD. When compared with the individuals in the control group, men had around 34% and women 15% lower earnings 1 year, and 40% and 23%, respectively, 5 years, after the first sickness absence period due to MDD. More severe MDD and longer duration of sickness absence period were associated with lower probability of being employed.

CONCLUSIONS

Sickness absence due to MDD was associated with considerable reduction in employment and earnings losses. For men and individuals with more severe MDD, this reduction was before the first sickness period. This supports a reciprocal association between employment and earnings with MDD.

Work environment risk factors for the duration of all cause and diagnose-specific sickness absence among healthcare workers in Sweden: a prospective study

OBJECTIVES

Increasing sickness absence (SA) has been reported among healthcare workers in Sweden. Our aim was to analyse the impact of work environment factors on short-term and long-term SA based on musculoskeletal and psychiatric diagnoses among healthcare workers.

METHODS

The study sample consisted of healthcare workers (n=12 452) drawn from representative samples of workers aged 16 to 64, who participated in the Swedish Work Environment Surveys (SWES) between 1993 and 2013. The outcomes were either short-term (≤28 days) or long-term (>104 days) SA between 1994 and 2016. HRs and 95% CIs were calculated for the impact of physical and psychosocial working conditions on risk of subsequent short-term or long-term SA for 3 years after participation in SWES.

RESULTS

Heavy physical work and strenuous work postures showed elevated HRs for short-term and long-term SA compared with those without these work exposures. Similarly, high job demands and low job control each increased the risk for both short-term and long-term SA compared with employees with low job demands and high job control. Low job support increased the risk for short-term SA compared with those with high job support. Working conditions were strongly related to short-term SA due to musculoskeletal diagnoses but not to short-term SA due to psychiatric diagnoses. None of the work characteristics, except strenuous postures, elevated the risk for long-term SA due to psychiatric diagnosis compared with employees without these characteristics.

CONCLUSIONS

Ergonomic improvements and stress reduction among healthcare workers are likely to reduce the prevalence of SA foremost due to musculoskeletal diagnoses.

Development and Construct Validity of the Work Instability Scale for People With Common Mental Disorders in a Sample of Depressed and Anxious Workers: A Rasch Analysis

BACKGROUND

Sick leave due to common mental disorders, encompassing depression and anxiety disorders, is high. Capturing early signs of reduced function could aid adjustments of work tasks and environment and, thus, endorse a pro-active approach to occupational and health care interventions to prevent long-term sick-leave spells. However, few measurements exist to identify early signs of imbalance, and none that is illness-specific. The aim of this study was to develop a work instability scale for people with common mental disorders and to test the fundamental psychometric properties of the scale.

METHODS

Participants were working adults 18-65 years old with depression or anxiety. The scale development started with qualitative interviews (n = 27) which informed the drafting of a dichotomous, self-report questionnaire. Cognitive debriefing (n = 12) was used to check face validity and modify the draft. Internal construct validity of the draft was tested using Rasch analysis (n = 128). The work ability index was used as a comparator measure.

RESULTS

The initial 63-item draft showed poor fit to Rasch model expectations. Items displaying poor fit or local response dependency were stepwise removed, resulting in a unidimensional 34-item scale fitting the model expectations, and with no differential item functioning. Person-item threshold distribution showed that the scale is better suited to measure low to moderate work instability, than to measure high instability. Correlations between the newly developed scale and the work ability index showed a significant, moderately strong correlation.

CONCLUSIONS

In the initial target sample, the 34-item scale showed acceptable fundamental properties and internal construct validity. Further validation of the scale in a larger sample, including tests for external validity, is warranted.

Psychological distress and sickness absence: Within- versus between-individual analysis

BACKGROUND

Uncertainty remains whether associations for psychological distress and sickness absence (SA) observed between and within individuals differ, and whether age, gender and work-related factors moderate these associations.

METHODS

We analyzed SA records of 41,184 participants of the Finnish Public Sector study with repeated survey data between 2000 and 2016 (119,024 observations). Psychological distress was measured by the General Health Questionnaire (GHQ-12), while data on SA days were from the employers' registers. We used a hybrid regression estimation approach adjusting for time-variant confounders-age, marital status, occupational class, body mass index, job contract type, months worked in the follow-up year, job demand, job control, and workplace social capital-and time-invariant gender (for between-individual analysis).

RESULTS

Higher levels of psychological distress were consistently associated with SA, both within- and between-individuals. The within-individual association (incidence rate ratio (IRR) 1.68, 95% CI 1.61-1.75 for SA at high distress), however, was substantially smaller than the between-individual association (IRR 2.53, 95% CI 2.39-2.69). High levels of psychological distress had slightly stronger within-individual associations with SA among older (>45 years) than younger employees, lower than higher occupational class, and among men than women. None of the assessed work unit related factors (e.g. job demand, job control) were consistent moderators.

LIMITATIONS

These findings may not be generalizable to other working sectors or cultures with different SA policies or study populations that are male dominated.

CONCLUSIONS

Focus on within-individual variation over time provides more accurate estimates of the contribution of mental health to subsequent sickness absence.

Diagnosis-Specific Sickness Absence and Subsequent Common Mental Disorders: A Register-Linkage Cohort Study among Finnish Public Sector Employees

Sickness absence is associated with poor health outcomes, but little is known about its consequences for general mental health. This study examined the associations between diagnosis-specific sickness absence and subsequent common mental disorders (CMD). Register data on medically certified all-cause sickness absence and sickness absence due to mental disorders and musculoskeletal diseases from 2004-2007 were linked to the Helsinki Health Study 2007 and 2012 survey data on City of Helsinki employees in Finland (N = 3560). Using logistic regression and multinomial logistic regression, we analysed the associations between the total number of reimbursed sickness absence days in 2004-7 and CMD General Health Questionnaire 12) in 2007 and 2012 and CMD changes. Sickness absence due to mental disorders (age- and sex-adjusted odds ratio (OR)range: 2.16 to 2.93), musculoskeletal diseases (OR range: 2.79 to 2.93) and all-cause sickness absence (OR range: 1.48 to 3.20) were associated with CMD in 2007. In 2012, associations with lower ORs were observed. Associations were also found with changing and especially repeated (OR range: 1.49 to 3.40) CMD. The associations remained after adjusting for work-related covariates and health behaviours. Diagnosis-specific sickness absence showed persistent associations with subsequent CMD and their changes. Attention should be paid to both the short- and long-term consequences of sickness absence for employee mental health.

The contribution of physical working conditions to sickness absence of varying length among employees with and without common mental disorders

Aims: The aim was to examine whether the contribution of physical work exposures to the risk of sickness absence (SA) is different between those with and without common mental disorders (CMD). Methods: We used questionnaire data on four work exposures and CMD from 6159 participants of the Helsinki Health Study cohort with 12,458 observations from three surveys (2000–2002, 2007 and 2012). We formed combination exposures for the work exposures (hazardous exposures, physical workload, computer and shift work) with CMD. Associations with SA of different length were examined with negative binomial regression models. Results: We observed stronger associations for CMD with SA than for the individual work exposures. The strength of the associations for hazardous exposures and physical workload increased with length of SA, especially when the participant also had CMD. The strongest associations for the combined exposures were observed for SA ⩾15 days, the rate ratios being 2.63 (95% CI 2.27–3.05) among those with hazardous exposure and CMD, and 3.37 (95% CI 2.93−3.88) among those with heavy physical workload and CMD. Conclusions: Employees with hazardous exposures or physical workload combined with CMD were at the highest risk of SA compared with those without these exposures or with only one exposure.

Common mental disorders and trajectories of work disability among midlife public sector employees - A 10-year follow-up study

OBJECTIVE

We examined trajectories of work disability, indicated by sickness absence and disability retirement, among midlife public sector employees with and without common mental disorders (CMD) at baseline. We also examined adverse childhood events, occupational class, long-standing illness and health behaviour as determinants of the trajectories.

METHODS

A sample from the Helsinki Health Study was extracted comprising 2350 employees. Baseline characteristics were obtained from mail surveys conducted in 2000-2 and 2007. CMD were measured by the General Health Questionnaire. Participants were followed between the ages of 50-59. Work disability trajectories were modelled by the annual number of work disability months in group-based trajectory analysis. Multinomial regression was used to predict trajectory group memberships.

RESULTS

Three trajectories were identified: no work disability (consisting 59% of the all employees), stable/low (31%) and high/increasing disability (10%). Employees with CMD were more likely to belong to the stable/low (odds ratio 1.73 [95% confidence interval 1.37-2.18]), and the high/increasing (2.55 [1.81-3.59]) trajectories. Stratified models showed that the determinants of the trajectories were largely similar for those with CMD compared to those without CMD except that obesity was a somewhat stronger predictor of the high/increasing trajectory among employees with CMD.

LIMITATIONS

The focus on midlife public sector employees limits the generalisability to other employment sectors and younger employees.

CONCLUSIONS

CMD were strongly associated with a trajectory leading to early exit from employment and a stable/low work disability trajectory. These findings have implications for interventions promoting work ability of employees with mental ill-health.

Changes in common mental disorders and diagnosis-specific sickness absence: a register-linkage follow-up study among Finnish municipal employees

OBJECTIVE

This study examined the associations between changes in common mental disorders (CMD) and subsequent diagnosis-specific sickness absence (SA) among midlife and ageing municipal employees.

METHODS

Data from the Helsinki Health Study phase I (2000-2002) and phase II (2007) surveys among employees of the City of Helsinki, Finland, were linked with prospective register data from the Social Insurance Institution of Finland on diagnosis-specific (mental, musculoskeletal, other causes) SA (n=3890). Associations between change in CMD (General Health Questionnaire 12) from phase I to phase II and the first SA event in 2007-2014 were analysed using Cox regression modelling. Sociodemographic, work and health-related covariates from phase I, and SA from the year preceding phase I were controlled for.

RESULTS

Having CMD at one or two time points, that is, favourable and unfavourable change in CMD and repeated CMD, were all associated with a higher risk of SA due to mental, musculoskeletal and other diagnoses compared with women and men with no CMD. Favourable change in CMD reduced the risk of SA when compared with repeated CMD. The strongest associations were observed for repeated CMD (HR range: 1.44 to 5.05), and for SA due to mental diagnoses (HR range: 1.15 to 5.05). The associations remained after adjusting for the covariates.

CONCLUSIONS

Changing and repeated CMD increased the risk of SA due to mental, musculoskeletal and other diagnoses. CMD should be tackled to prevent SA and promote work-ability among ageing employees.