Working Conditions and Long-Term Sickness Absence Due to Mental Disorders: A Prospective Record Linkage Cohort Study Among 19- to 39-Year-Old Female Municipal Employees

Quantifying the impact of occupational stress on long-term sickness absence due to mental disorders

BackgroundWork-related stressors are a significant predictor of long-term sickness absence due to mental disorders (LTSA-MD) issues.ObjectiveTo examine the relationship between work-related stressors and LTSA-MD among Japanese public servants.MethodsA retrospective cohort study design was utilized, analyzing data from public servants in City A, Japan, who underwent mandatory annual stress checks from 2011 to 2020. The study focused on LTSA-MD instances lasting over three months due to mental disorders. The Brief Job Stress Questionnaire (BJSQ) was employed to measure occupational stress factors. Cox Hazard Models adjusted for demographic and occupational variables were used to examine the relationship between BJSQ sub-items and the onset of LTSA-MD.ResultsAmong the 1026 LTSA-MD instances identified, an association was found between the scores of job stressors, stress responses, and job satisfaction of BJSQ with increased LTSA-MD risk, whereas social occupational support was not related.ConclusionsThe findings highlight the critical role of occupational stress, stress response, and job satisfaction in predicting LTSA-MD among Japanese public servants. Mitigating these factors could significantly reduce the risk of LTSA-MD, underscoring the importance of implementing targeted workplace interventions.

Work-family conflicts and sickness absence due to mental disorders among female municipal employees - a register-linked study comparing health and social care employees to employees in other sectors

OBJECTIVES

This study aimed to examine (i) if work-to-family conflicts (WtFC) and family-to-work conflicts (FtWC) are associated with sickness absence due to mental disorders and (ii) whether these associations are different among health and social care (HSC) employees compared to other municipal employee sectors.

METHODS

The Helsinki Health Study survey data collected in 2017 among 19-39-year-old female municipal employees (N=2557) were prospectively linked to administrative Social Insurance Institution of Finland register data on long-term sickness absence due to mental disorders (SA-MD) covering a follow-up of up to five years. The associations of WtFC and FtWC and SA-MD were analyzed using Cox regression models stratified by employment sector (HSC, education, other), adjusting for sociodemographic and health-related covariates.

RESULTS

Of HSC employees, 16% had SA-MD during the follow-up, which surpassed the figures for employees in education (12%) and other (11%) sectors. In the HSC sector, the youngest employees had the highest prevalence of SA-MD and, among HSC employees, prior SA-MD was the most common. In Kaplan-Meier curves, the steepest increase in SA-MD was observed for HSC employees. WtFC [hazard ratio (HR) 1.84, 95% confidence interval (CI) 1.39-2.45] and FtWC (HR 1.78, 95% CI 1.32-2.40) were associated with SA-MD among HSC employees. The associations were rather similar for employees in education and other sectors. Adjusting for work-related factors and health history somewhat attenuated the associations.

CONCLUSIONS

Better possibilities to combine work and family life might aid in preventing SA-MD in all employment sectors.

The role of job strain in the relationship between depression and long-term sickness absence: a register-based cohort study

PURPOSE

Though individuals with depression and those with poor working conditions are more likely to be on long-term sickness absence (LTSA), less is known about how working conditions may modify the associations between depression status and LTSA. This study aims to examine the association between depression and LTSA among Swedish workers with different levels of job strain and its individual components (job demands and job control).

METHODS

All Swedish workers 30 - 60 years old (N = 3,065,258) were studied in 2005. At baseline (2005-2010), workers were categorized as: without depression, being prescribed antidepressants, and being in inpatient/outpatient care. Job strain was measured using a Swedish Job Exposure Matrix, and data on LTSA were obtained from 2011 to 2021. The association between depression and LTSA was assessed using Cox proportional-hazards regression stratified by categories of job strain.

RESULTS

Compared to workers without depression, workers with depression had higher risk of LTSA across all job strain levels. Depression was associated with the highest hazards of LTSA in active jobs, but a similar population attributable fraction (PAF) was found across categories of job strain, indicating similarities between the different categories.

CONCLUSION

There was evidence of a moderating effect of job strain in the relationship between depression and LTSA, but also evidence that this was due to differences in baseline depression prevalence in the different job strain categories. Future research is needed to determine alternative factors which could be relevant for reducing LTSA among those who have already developed depression.

Mental health literacy for public employees

PURPOSE

Although mental disorders are common in the workplace, they often go unnoticed. There is frequently a gap in the recognition and effective management of these disorders, leading to delayed recovery and worsening conditions. This study evaluates the level of Mental Health Literacy (MHL) among employees of the Finance and Planning Departments in the Federal District, Brazil, and proposes preventive measures and de-stigmatization strategies for mental health in the workplace.

METHODS

MHL among active employees was assessed using the Mental Health Literacy Scale (MHLS), developed by O'Connor and Casey (2015) and validated for Brazilian Portuguese by Buta et al. (2024). The data analysis included descriptive and inferential statistics, with nonparametric tests used to compare MHL across different groups.

RESULTS

The results showed that 27.6% of participants had adequate literacy, 67.9% had problematic levels, and 4.5% had inadequate levels. Women were observed to have higher literacy levels than men. Additionally, significant variations in literacy levels were noted among individuals with different health conditions; those diagnosed with cancer, depression, or other illnesses had higher literacy than those without diagnosed conditions.

CONCLUSION

To address MHL challenges, educational actions such as awareness campaigns, training, and consultancy programs are essential.

Does job stress mediate the risk of work disability due to common mental disorders among social workers compared with other health and social care, education, and non-human service professionals? A prospective cohort study of public sector employees in Finland

OBJECTIVE

This study aimed to investigate (i) the risk of work disability (>10-day sickness absence spell or disability pension) due to common mental disorders (CMD) among social workers compared with other health and social care, education, and non-human service professionals and (ii) whether the risk was mediated by job stress.

METHODS

A cohort of 16 306 public sector professionals in Finland was followed using survey data from baseline (2004 or if not available, 2008) on job stress [job strain or effort-reward imbalance (ERI)] and register data on work disability due to CMD from baseline through 2011. A Cox proportional hazards model was used to analyze the risk of work disability due to CMD between three occupation-pairs in a counterfactual setting, controlling for age, sex, job contract, body mass index, alcohol risk use, smoking, and physical inactivity.

RESULTS

Social workers' job stress was at higher level only when compared to education professionals. Thus, the mediation hypothesis was analyzed comparing social workers to education professionals. Social workers had a higher risk of work disability due to CMD compared with education professionals [hazard ratio (HR) 2.08, 95% confidence interval (CI) 1.58-2.74]. This HR was partly mediated by job strain (24%) and ERI (12%). Social workers had a higher risk of work disability than non-human service professionals (HR 1.54, 95% CI 1.13-2.09), but not compared with other health and social care professionals.

CONCLUSIONS

Job stress partly mediated the excess risk of work disability among social workers only in comparison with education professionals.

Explanations for sickness absence due to common mental disorders: A narrative study of young health and social care workers

Over recent decades, sickness absence due to common mental disorders has increased among young workers. The phenomenon is mostly understood on the basis of epidemiological research, and knowledge regarding the viewpoints of young workers themselves is lacking. Our study explored the explanations for mental health-related sickness absence in the narrative accounts of young workers in high-risk health and social care occupations. Semi-structured narrative interviews were conducted with 23 Finnish young workers (aged 21-34), with self-reported sickness absence related to common mental disorders over the previous year. Our analysis identified three narrative explanations for the onset of mental health problems leading to sick leave: work as the sole cause, work as an additional cause and work as a trigger. These findings indicate that mental health-related sickness absences form a complex phenomenon related to various life and work-related circumstances. More comprehensive preventive measures are needed in the health and social care sector to help tackle mental health problems among young workers.

How does lowering psychosocial risks influence sickness absence? A prospective cohort study analyzed as a quasi-experiment

BACKGROUND

We examined how reducing work-related psychosocial stressors affected long-term sickness absence of younger and older employees.

METHODS

We used data from 43 843 public sector employees in Finland who participated in surveys in 2018 and 2020. We assessed psychosocial factors, such as job demands, job control, work effort, job rewards and worktime control. We obtained sickness absence data from registers for spells longer than 10 consecutive working days. We applied age-specific propensity score weighting and generalized linear models to estimate the effects of changes in psychosocial factors between 2018 and 2020 on sickness absence in 2020.

RESULTS

Among employees under 50 years, increasing job rewards by 1 SD reduced the risk of sickness absence by 17% [risk ratio (RR) 0.83, 95% CI 0.72-0.96]. Among employees aged 50 years or older, decreasing job demands by 1 SD reduced the risk of sickness absence by 13% (RR 0.87, 95% CI 0.78-0.98), and increasing job control by 1 SD reduced the risk by 12% (RR 0.88, 95% CI 0.76-1.01). Changes in efforts and worktime control had no significant associations with sickness absence.

CONCLUSIONS

Reducing psychosocial stressors can lower the occurrence of long-term sickness absence, but the associations differ by age group. Younger workers benefit more from enhancing job rewards, while older workers benefit more from lowering job demands and increasing job control. To establish the causal impact of psychosocial risk reduction on sickness absence across age groups, future research should employ randomized controlled trials as the methodological approach.

Occupational Class Differences in Emotional Exhaustion Among Municipal Employees - The Role of Employment Sector and Psychosocial Working Conditions

Studies examining occupational class differences in burnout symptoms across employment sectors are scarce. The aim of this study was to examine whether occupational class is associated with emotional exhaustion, and whether there are differences in the examined associations between employment sectors. A further aim was to examine to which extent psychosocial working conditions may explain these associations. Survey data were collected in 2017 among 19-39-year-old employees of the City of Helsinki (4630 women and 1267 men, response rate 51.5%). Occupational class included four classes: 1. manuals, 2. routine non-manuals, 3. semi-professionals, 4. managers and professionals. Employment sector was classified into three groups: 1. health and social care, 2. education and 3. 'other'. Linear regression analysis and IBM SPSS 25 statistical program were used. The analytical sample included 4883 participants. The highest occupational class, i.e. managers and professionals, reported the highest emotional exhaustion. In terms of the sector, those working in education had the highest scores of emotional exhaustion. The associations between occupational class and emotional exhaustion differed somewhat between the sectors. Adjustment for job demands attenuated the differences in emotional exhaustion between occupational classes, whereas adjustment for job control and job strain widened the differences. Attention should be paid to occupations with excess mental demands, and to employees in the education sector, who showed the highest risk of emotional exhaustion.

Sickness absence around contact with outpatient mental health care services - differences between migrants and non-migrants: a Norwegian register study

BACKGROUND

Mental disorders are a leading cause of sickness absence. Some groups of migrants are at higher risk of both mental disorder and sickness absence. Yet, research on sickness absence in relation to mental disorders among migrants is limited. This study investigates differences in sickness absence in the twelve-month period around contact with outpatient mental health services between non-migrants and various migrant groups with different length of stays. It also considers whether these differences are similar for men and women.

METHODS

Using linked Norwegian register data, we followed 146,785 individuals, aged 18-66 years, who had attended outpatient mental health services and who had, or had recently had, a stable workforce attachment. The number of days of sickness absence was calculated for the 12-month period surrounding contact with outpatient mental health services. We applied logistic regression and zero-truncated negative binomial regression to assess differences in any sickness absence and number of days of absence between non-migrants and migrants, including refugees and non-refugees. We included interaction terms between migrant category and sex.

RESULTS

Refugee men and other migrant men from countries outside the European Economic Area (EEA) had a higher probability of any sickness absence in the period surrounding contact with outpatient mental health services than their non-migrant counterparts. Women from EEA countries with stays of less than 15 years had a lower probability than non-migrant women. Additionally, refugees, both men and women, with 6-14 years in Norway had more days of absence while EEA migrants had fewer days than their non-migrant counterparts.

CONCLUSIONS

Refugee men and other non-EEA migrant men appear to have higher sickness absence than non-migrant men around the time of contact with services. This finding does not apply to women. Several probable reasons for this are discussed, though further research is required to understand why. Targeted strategies to reduce sickness absence and support the return to work for refugees and other non-EEA migrant men are needed. Barriers to timely help-seeking should also be addressed.