Occupational stress and incidence of sick leave in the Belgian workforce: the Belstress study

Determinants of sickness absence in police: Case study of Abu Dhabi police department, UAE

Sickness absence among employees is reported to reduce organization profits and performance and thus threaten the organization's existence in the market. The monitoring and reporting of data on sickness absence is considered a crucial element of reactive health and safety control systems in organizations. It is one of the major indicators of organizational continuous commitment to improving the quality of working conditions. However, sickness absence in Police in the United Arab Emirates (UAE) is less investigated. The Occupational Health and Safety Survey developed for this study was distributed to 1317 employees of the Capital Police Directorate of Abu Dhabi Police. The survey was answered by 760 employees (58 %). While 230 (17 %) refused to participate, 259 (20 %) did not return the surveys, and 68 (5 %) were not surveyed as they were on authorized long-term leave for various reasons (and did not receive the survey). This study analyzes if the psychosocial work factors, physical work exposure factors, and employee's perception of the health and safety management system predict sickness absence in the Abu Dhabi Police after taking into account the other covariates. This study found no association between job control and the risk of sickness absence, in contrast to findings from other studies. There was also no association between psychological job demand and the perception of health and safety management with the risk of sickness absence in this study. Officers who fit the 'job strain' category did not have a significant increase in the risk of sickness absence in this study. However, high levels of combined physical exposures reported a significant relation with sickness absence. In conclusion, this, being one of the first studies in the region, provides insights on work factors and perception of HSE on sickness absence and provides recommendations within the context of the region for future studies and address sickness absence among police in the UAE.

Flourishing and the Prioritization of Workplace Elements in General Surgery Residents

INTRODUCTION

To explore and begin to operationalize workplace elements that influence general surgery (GS) resident wellbeing. Tailoring workplace wellbeing interventions is critical to their success. Occupational science has revealed that a person-centered approach to identifying positive and negative workplace influences can inform tailoring while accounting for individual differences. To our knowledge, this approach has not been applied to the surgical training environment.

METHODS

A national sample of GS residents from 16 Accreditation Council for Graduate Medical Education training programs ranked the importance of workplace elements via an anonymous survey. Latent profile analysis was performed to identify shared patterns of workplace element prioritization and their relation to levels of flourishing, a measure of global wellbeing.

RESULTS

GS trainee respondents (n = 300, 34% response rate - average for studies with this sample population) expressed a hierarchy of workplace element importance which differed by gender and race. "Skills to manage stress" and "a team you feel a part of" were prioritized higher by non-males than males. Residents of color and residents underrepresented in medicine, respectively, prioritized "recognition of work/effort" and "skills to manage stress" more than White and overrepresented in medicine residents. Flourishing prevalence varied by 40% with small differences in the specific profile of workplace element prioritization.

CONCLUSIONS

Differences in prioritization of workplace elements reveal subtle but important differences that may guide the design of wellbeing interventions for different populations within surgery.

Absenteeism at Two Occupational Health Services in Belgium from 2014 to 2021

Medical certification is often needed for absences of longer than one workday. The literature remains unclear as to whether this changes absenteeism. Earlier research found that the merging of two firms can augment or diminish short-term absenteeism. This study was conducted to examine whether prolonging self-certification or merging increases short-term absenteeism. Data from January 2014 to December 2021 were retrospectively collected from HR absenteeism files at two occupational health services in Belgium. Sickness periods of longer than 4 weeks were excluded. Company 1 started a merger in 2014, and company 2 prolonged of the self-certification period in 2018. The total full-time equivalents (FTEs) of company 1 increased by 6%, while company 2 had an increase of 28%. At company 1, there was a decline in absenteeism, while company 2 had an increase. The ARIMA (1, 0, 1) model provided a statistically significant local moving average (company 1: 0.123; company 2: 0.086) but no statistically significant parameters for the intervention (company 1: 0.007, p = 0.672; company 2: 0.000, p = 0.970). Prolonging the self-certification period by up to 5 days without medical certification or merging was not found to increase short-term absenteeism.

A Technology-Assisted Telephone Intervention for Work-Related Stress Management: Pilot Randomized Controlled Trial

Background

Stress management interventions combining technology with human involvement have the potential to improve the cost-effectiveness of solely human-delivered interventions, but few randomized controlled trials exist for assessing the cost-effectiveness of technology-assisted human interventions.

Objective

The aim of this study was to investigate whether a technology-assisted telephone intervention for stress management is feasible for increasing mental well-being or decreasing the time use of coaches (as an approximation of intervention cost) while maintaining participants’ adherence and satisfaction compared with traditional telephone coaching.

Methods

A 2-arm, pilot randomized controlled trial of 9 months for stress management (4-month intensive and 5-month maintenance phases) was conducted. Participants were recruited on the web through a regional occupational health care provider and randomized equally to a research (technology-assisted telephone intervention) and a control (traditional telephone intervention) group. The coaching methodology was based on habit formation, motivational interviewing, and the transtheoretical model. For the research group, technology supported both coaches and participants in identifying behavior change targets, setting the initial coaching plan, monitoring progress, and communication. The pilot outcome was intervention feasibility, measured primarily by self-assessed mental well-being (WorkOptimum index) and self-reported time use of coaches and secondarily by participants’ adherence and satisfaction.

Results

A total of 49 eligible participants were randomized to the research (n=24) and control (n=25) groups. Most participants were middle-aged (mean 46.26, SD 9.74 years) and female (47/49, 96%). Mental well-being improved significantly in both groups (WorkOptimum from “at risk” to “good” Â>0.85; P<.001), and no between-group differences were observed in the end (Â=0.56, 95% CI 0.37-0.74; P=.56). The total time use of coaches did not differ significantly between the groups (366.0 vs 343.0 minutes, Â=0.60, 95% CI 0.33-0.85; P=.48). Regarding adherence, the dropout rate was 13% (3/24) and 24% (6/25), and the mean adherence rate to coaching calls was 92% and 86% for the research and control groups, respectively; the frequency of performing coaching tasks was similar for both groups after both phases; and the diligence in performing the tasks during the intensive phase was better for the research group (5.0 vs 4.0, Â=0.58, 95% CI 0.51-0.65; P=.03), but no difference was observed during the maintenance phase. Satisfaction was higher in the research group during the intensive phase (5.0 vs 4.0, Â=0.66, 95% CI 0.58-0.73; P<.001) but not during the maintenance phase.

Conclusions

The technology-assisted telephone intervention is feasible with some modifications, as it had similar preliminary effectiveness as the traditional telephone intervention, and the participants had better satisfaction with and similar or better adherence to the intervention, but it did not reduce the time use of coaches. The technology should be improved to provide more digested information for action planning and templates for messaging.

Trial Registration

ClinicalTrials.gov NCT02445950; https://www.clinicaltrials.gov/ct2/show/study/NCT02445950

Psychosocial work factors and sick leave risk after a terrorist bomb attack: a survey and registry-based longitudinal study of governmental employees in Norway

OBJECTIVES

Studies show that social support may reduce the negative psychological effects of terror. The aim was to explore the effects of the psychosocial work environment on sick leave risk among governmental employees after a workplace bomb attack.

DESIGN

We linked longitudinal survey data collected at 10 and 22 months after the bombing with registry data on doctor-certified sick leave collected from 42 months before the attack to 33 months after the attack. ORs and rate ratios were estimated with mixed effects hurdle models.

SETTING

The bombing of the government ministries in Oslo, Norway, 22 July 2011.

PARTICIPANTS

We identified 1625 participants from a cohort of 3520 employees working in the ministries during the bombing in 2011.

RESULTS

After adjustment for confounders, social support from coworkers reduced the odds of sick leave (OR 0.80, 95% CI 0.68 to 0.93), and there was marginal evidence for reduced odds with support from superior (OR 0.87, 95% CI 0.87 to 1.03). A social work climate, an innovative climate and a human resource primacy climate (HRP) reduced the sick leave risk (eg, HRP OR 0.77, 95% CI 0.66 to 0.90). The hurdle model found no associations between psychosocial support at work and the duration of sick leave.

CONCLUSIONS

Psychosocial support at work can enhance employees' work ability after terror and reduce the sick leave risk by more than 20%. However, a supportive psychosocial work environment did not reduce the duration of sickness absence. The protective role of psychosocial work factors on sick leave may be most significant when employees are at work and interact with their work environment.

Association of fatal myocardial infarction with past level of physical activity: a pooled analysis of cohort studies

AIMS

To assess the association between past level of physical activity (PA) and risk for death during the acute phase of myocardial infarction (MI) in a pooled analysis of cohort studies.

METHODS AND RESULTS

European cohorts including participants with a baseline assessment of PA, conventional cardiovascular (CV) risk factors, and available follow-up on MI and death were eligible. Patients with an incident MI were included. Leisure-time PA was grouped as sedentary (<7 MET-hours), low (7-16 MET-hours), moderate (16.1-32 MET-hours), or high (>32 MET-hours) based on calculated net weekly energy expenditure. The main outcome measures were instant and 28-day case fatality of MI. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using multivariate random-effects models. Adjustments for age, sex, CV risk factors, alcohol consumption, and socioeconomic status were made. From 10 cohorts including a total of 1 495 254 participants, 28 140 patients with an incident MI comprised the study population. A total of 4976 (17.7%) died within 28 days-of these 3101 (62.3%) were classified as instant fatal MI. Compared with sedentary individuals, those with a higher level of PA had lower adjusted odds of instant fatal MI: low PA [OR, 0.79 (95% CI, 0.60-1.04)], moderate PA [0.67 (0.51-0.89)], and high PA [0.55 (0.40-0.76)]. Similar results were found for 28-day fatal MI: low PA [0.85 (0.71-1.03)], moderate PA [0.64 (0.51-0.80)], and high PA [0.72 (0.51-1.00)]. A low-to-moderate degree of heterogeneity was detected in the analysis of instant fatal MI (I2 = 47.3%), but not in that of 28-day fatal MI (I2 = 0.0%).

CONCLUSION

A moderate-to-high level of PA was associated with a lower risk of instant and 28-day death in relation to a MI.

The effect of exposure to long working hours on alcohol consumption, risky drinking and alcohol use disorder: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury

BACKGROUND

The World Health Organization (WHO) and the International Labour Organization (ILO) are developing Joint Estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large network of experts. Evidence from mechanistic data suggests that exposure to long working hours may increase alcohol consumption and cause alcohol use disorder. In this paper, we present a systematic review and meta-analysis of parameters for estimating the number of deaths and disability-adjusted life years from alcohol consumption and alcohol use disorder that are attributable to exposure to long working hours, for the development of the WHO/ILO Joint Estimates.

OBJECTIVES

We aimed to systematically review and meta-analyse estimates of the effect of exposure to long working hours (three categories: 41-48, 49-54 and ≥55 h/week), compared with exposure to standard working hours (35-40 h/week), on alcohol consumption, risky drinking (three outcomes: prevalence, incidence and mortality) and alcohol use disorder (three outcomes: prevalence, incidence and mortality).

DATA SOURCES

We developed and published a protocol, applying the Navigation Guide as an organizing systematic review framework where feasible. We searched electronic bibliographic databases for potentially relevant records from published and unpublished studies, including the WHO International Clinical Trials Register, Ovid MEDLINE, PubMed, Embase, and CISDOC on 30 June 2018. Searches on PubMed were updated on 18 April 2020. We also searched electronic grey literature databases, Internet search engines and organizational websites; hand-searched reference list of previous systematic reviews and included study records; and consulted additional experts.

STUDY ELIGIBILITY AND CRITERIA

We included working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State but excluded children (<15 years) and unpaid domestic workers. We considered for inclusion randomized controlled trials, cohort studies, case-control studies and other non-randomized intervention studies with an estimate of the effect of exposure to long working hours (41-48, 49-54 and ≥55 h/week), compared with exposure to standard working hours (35-40 h/week), on alcohol consumption (in g/week), risky drinking, and alcohol use disorder (prevalence, incidence or mortality).

STUDY APPRAISAL AND SYNTHESIS METHODS

At least two review authors independently screened titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from publications related to qualifying studies. Two or more review authors assessed the risk of bias, quality of evidence and strength of evidence, using Navigation Guide and GRADE tools and approaches adapted to this project.

RESULTS

Fourteen cohort studies met the inclusion criteria, comprising a total of 104,599 participants (52,107 females) in six countries of three WHO regions (Americas, South-East Asia, and Europe). The exposure and outcome were assessed with self-reported measures in most studies. Across included studies, risk of bias was generally probably high, with risk judged high or probably high for detection bias and missing data for alcohol consumption and risky drinking. Compared to working 35-40 h/week, exposure to working 41-48 h/week increased alcohol consumption by 10.4 g/week (95% confidence interval (CI) 5.59-15.20; seven studies; 25,904 participants, I2 71%, low quality evidence). Exposure to working 49-54 h/week increased alcohol consumption by 17.69 g/week (95% confidence interval (CI) 9.16-26.22; seven studies, 19,158 participants, I2 82%, low quality evidence). Exposure to working ≥55 h/week increased alcohol consumption by 16.29 g/week (95% confidence interval (CI) 7.93-24.65; seven studies; 19,692 participants; I2 82%, low quality evidence). We are uncertain about the effect of exposure to working 41-48 h/week, compared with working 35-40 h/week on developing risky drinking (relative risk 1.08; 95% CI 0.86-1.36; 12 studies; I2 52%, low certainty evidence). Working 49-54 h/week did not increase the risk of developing risky drinking (relative risk 1.12; 95% CI 0.90-1.39; 12 studies; 3832 participants; I2 24%, moderate certainty evidence), nor working ≥55 h/week (relative risk 1.11; 95% CI 0.95-1.30; 12 studies; 4525 participants; I2 0%, moderate certainty evidence). Subgroup analyses indicated that age may influence the association between long working hours and both alcohol consumption and risky drinking. We did not identify studies for which we had access to results on alcohol use disorder.

CONCLUSIONS

Overall, for alcohol consumption in g/week and for risky drinking, we judged this body of evidence to be of low certainty. Exposure to long working hours may have increased alcohol consumption, but we are uncertain about the effect on risky drinking. We found no eligible studies on the effect on alcohol use disorder. Producing estimates for the burden of alcohol use disorder attributable to exposure to long working hours appears to not be evidence-based at this time. PROTOCOL IDENTIFIER: https://doi.org/10.1016/j.envint.2018.07.025.

PROSPERO REGISTRATION NUMBER

CRD42018084077.

Work-Related Stress and Associated Factors Among Textile Factory Employees in Northwest Ethiopia: A Cross-Sectional Study

Background

Work-related stress is becoming an alarmingly growing public health concern worldwide. Textile factories are among the most common manufacturing industries that have a higher rate of work-related stress. Investigating the prevalence and factors associated with work-related stress will help planners and decision-makers at every level in planning, managing, and evaluating the health status of the employees. Research evidence is limited for work-related stress in Northwest Ethiopia. Therefore, this study was aimed to assess work-related stress and associated factors among textile factory employees in Northwest Ethiopia.

Methods

A cross-sectional study design was employed among 403 employees in Bahir Dar Textile Factory. Data were collected using an interviewer administered questionnaire, then entered into EpiData version 3.1, and analyzed using SPSS version 22 software. Descriptive statistics, bivariate and multivariate logistic regressions were carried out. In logistic regression analysis, adjusted odds ratio (AOR), along with 95% confidence interval (CI), was used to identify the associated factors of work-related stress. A P-value<0.05 was considered as statistically significant.

Results

The prevalence of work-related stress was 45.2%, with 95% CI=40.0–50.1%. Working in rotational shifts (AOR=2.33, 95% CI=1.34–4.03), current substance use (AOR=5.67, 95% CI=3.38–9.52), poor and medium social support (AOR=3.75, 95% CI=1.71–8.21 and AOR=3.26, 95% CI=1.39–7.64) were significantly associated factors with work-related stress, respectively.

Conclusion and Recommendation

Near to half of the study participants had work-related stress. Work shift, substance use, and social support were among the factors which affect work-related stress. Thus, interventions that could reduce work-related stress such as stress management programs should be considered.

General practitioners' management of patients with psychological stress: audit results from Denmark

Background

In western countries, psychological stress is among the most common causes of long-lasting sick leave and a frequent reason to consult the general practitioner (GP). This study aimed to investigate how GPs manage patients with psychological stress and how the management is associated with the patient’s sex, the GP’s assessment of causality, and coexisting mental disorders.

Methods

We conducted an audit of consecutive cases in Danish general practice. The GPs used electronic medical records to fill in a registration form for each 18–65-year-old patient with whom they had had at least one consultation regarding stress during the past 6 months. Only patients initially in the workforce were included. Age- and sex-adjusted binary regression was applied.

Results

Fifty-six GPs (61% women) identified 785 cases. The patients’ mean age was 44 years and 70% were women. The cause of stress was considered at least partially work-related in 69% of the cases and multifactorial in a third of cases. The management included sick leave (54%), counselling (47%), pharmaceutical treatment (37%), and referral to psychologist (38%). Compared to women, stress in men was less often considered work-related (RR: 0.84, CI95%: 0.77–0.92) and men were less often sick-listed (RR: 0.83 CI95%: 0.73–0.96) but were more often prescribed tranquilizers (RR: 1.72 CI95%: 1.08–2.74).

Conclusions

GPs’ management of patients with stress usually involve elements of counselling, sick leave, referral to psychologist, and medication. Women and men with stress are perceived of and managed differently.

Prevalence of persons contacting general practice for psychological stress in Denmark

OBJECTIVE

The prevalence of psychological stress has previously been estimated based on self-reported questionnaires. This study aimed to investigate the prevalence of persons who contact the general practitioner (GP) for psychological stress and to explore associations between psychological stress and characteristics relating to the patient, the GP, and area-specific socioeconomic factors.

DESIGN

Cross-sectional computer assisted journal audit.

SETTING

General practice in the Region of Southern Denmark.

SUBJECTS

Patients aged 18-65 years with a consultation during a six-month period that was classified with a stress-related diagnosis code.

MAIN OUTCOME MEASURES

Six months prevalence of GP-assessed psychological stress and characteristics relating to the patient, the GP, and area-specific socioeconomic factors.

RESULTS

Fifty-six GPs (7% of the invited) identified 1066 patients considered to have psychological stress among 51,422 listed patients. Accordingly, a 2.1% six months prevalence of psychological stress was estimated; 69% of cases were women. High prevalence of psychological stress was associated with female sex, age 35-54 years, high education level and low population density in the municipality, but not with unemployment in the municipality or household income in the postal district. GP female sex and age <50 years, few GPs in the practice and few patients per GP were also associated with a higher prevalence of psychological stress.

CONCLUSIONS

A total of 2% of the working-age population contacted the GP during a six-month period for psychological stress. The prevalence of psychological stress varies with age, sex and characteristics of both the regional area and the GP. Key points   Psychological stress is a leading cause of days on sick leave, but its prevalence has been based on population surveys rather than on assessment by health care professionals.   • This study found that during six months 2.1% of all working-age persons have at least one contact with the GP regarding psychological stress.   • The six months prevalence of psychological stress was associated with patient age and sex, GP age and sex, practices' number of GPs and patients per GP, and area education and urbanization level.

Computer-based versus in-person interventions for preventing and reducing stress in workers

BACKGROUND

Chronic exposure to stress has been linked to several negative physiological and psychological health outcomes. Among employees, stress and its associated effects can also result in productivity losses and higher healthcare costs. In-person (face-to-face) and computer-based (web- and mobile-based) stress management interventions have been shown to be effective in reducing stress in employees compared to no intervention. However, it is unclear if one form of intervention delivery is more effective than the other. It is conceivable that computer-based interventions are more accessible, convenient, and cost-effective.

OBJECTIVES

To compare the effects of computer-based interventions versus in-person interventions for preventing and reducing stress in workers.

SEARCH METHODS

We searched CENTRAL, MEDLINE, PubMed, Embase, PsycINFO, NIOSHTIC, NIOSHTIC-2, HSELINE, CISDOC, and two trials registers up to February 2017.

SELECTION CRITERIA

We included randomised controlled studies that compared the effectiveness of a computer-based stress management intervention (using any technique) with a face-to-face intervention that had the same content. We included studies that measured stress or burnout as an outcome, and used workers from any occupation as participants.

DATA COLLECTION AND ANALYSIS

Three authors independently screened and selected 75 unique studies for full-text review from 3431 unique reports identified from the search. We excluded 73 studies based on full-text assessment. We included two studies. Two review authors independently extracted stress outcome data from the two included studies. We contacted study authors to gather additional data. We used standardised mean differences (SMDs) with 95% confidence intervals (CIs) to report study results. We did not perform meta-analyses due to variability in the primary outcome and considerable statistical heterogeneity. We used the GRADE approach to rate the quality of the evidence.

MAIN RESULTS

Two studies met the inclusion criteria, including a total of 159 participants in the included arms of the studies (67 participants completed computer-based interventions; 92 participants completed in-person interventions). Workers were primarily white, Caucasian, middle-aged, and college-educated. Both studies delivered education about stress, its causes, and strategies to reduce stress (e.g. relaxation or mindfulness) via a computer in the computer-based arm, and via small group sessions in the in-person arm. Both studies measured stress using different scales at short-term follow-up only (less than one month). Due to considerable heterogeneity in the results, we could not pool the data, and we analysed the results of the studies separately. The SMD of stress levels in the computer-based intervention group was 0.81 standard deviations higher (95% CI 0.21 to 1.41) than the in-person group in one study, and 0.35 standard deviations lower (95% CI -0.76 to 0.05) than the in-person group in another study. We judged both studies as having a high risk of bias.

AUTHORS' CONCLUSIONS

We found very low-quality evidence with conflicting results, when comparing the effectiveness of computer-based stress management interventions with in-person stress management interventions in employees. We could include only two studies with small sample sizes. We have very little confidence in the effect estimates. It is very likely that future studies will change these conclusions.

Social support and its interrelationships with demand-control model factors on presenteeism and absenteeism in Japanese civil servants

OBJECTIVES

To elucidate the impact of social support and its interrelations with other demand-control-support (DCS) model factors on presenteeism and absenteeism, and to determine which DCS factors were most influential.

METHODS

Questionnaires from 2535 local government employees were analyzed. The Brief Job Stress Questionnaire (BJSQ) was used to assess DCS factors including job demand, job control, and social support from supervisors and coworkers. The Stanford Presenteeism Scale 13-item version (SPS-13) was used to evaluate both absenteeism (absent days) and presenteeism. For the latter, the Work Impairment Score (WIS) and the Work Output Score (WOS) were also used. Possible confounder-adjusted logistic and negative binomial regression analyses were performed to obtain odds ratios (ORs) for WIS and WOS and relative risks (RRs) for absenteeism according to DCS factors.

RESULTS

Higher job control had a significantly protective effect on higher WIS in both males and females and a lower WOS in males. Based on a point estimate of an OR per 1 standard deviation change of each DCS factor, job control had the strongest effect on higher WIS in both males and females and a lower WOS in males. Higher job demand resulted in significantly higher ORs for both male and female WIS, and a lower WOS in females. Support from supervisors had a significantly protective effect on higher WIS in females and a lower WOS in males. Support from coworkers had a significantly protective effect on higher WIS in males. Higher support from coworkers had a significantly protective effect on absenteeism among both males and females, and higher job control had a significantly protective effect in females. The combination of high job strain and low support from supervisors had a significantly worsening effect, except for absenteeism in females. High job strain and low support from coworkers had a significantly worsening effect except for WOS in males.

CONCLUSIONS

The results suggest job control was the DCS factor most related to presenteeism. Higher support from supervisors and coworkers had a protective effect on presenteeism, and higher job demand had a worsening effect. Higher support from coworkers had a protective effect on absenteeism among both males and females. Interventions should focus on improving job control as a possible countermeasure to presenteeism, and encouraging support from coworkers as a possible countermeasure to absenteeism.

Health Behaviours As a Mechanism in the Prospective Relation between Workplace Reciprocity and Absenteeism: A Bridge too Far ?

BACKGROUND

The persistent lack of evidence on causal mechanisms between social capital and health threatens the credibility of the social capital-health association. The present study aims to address this ongoing problem by investigating whether health behaviours (i.e. smoking, alcohol consumption, and physical activity) mediate the prospective relation between workplace reciprocity and future sickness absence.

METHODS

A cohort of 24,402 Belgian employees was followed up during 12 months for sickness absence. Workplace reciprocity was measured with four indicators-colleague help, colleague interest, supervisor help, and supervisor concern. Three types of multilevel mediation models were applied.

RESULTS

Overall, workplace reciprocity negatively related to high sickness absence (≥ 10 days) mainly independently from health behaviours. Uniquely, colleague interest positively related to smoking (OR = 1.058, 95% CI = 1.019, 1.098) and smoking in turn, positively related to sickness absence (OR = 1.074, 95% CI = 1.047, 1.101). No behavioural pathways could be identified between company-level reciprocity and sickness absence, and company-level health-related behaviours did not mediate the relation between company-level reciprocity and individual sickness absence.

CONCLUSIONS

These results suggest that both social capital and health behaviours are relevant for employee health, but health behaviours seem not to be the underlying explanatory mechanism between workplace reciprocity and health.

Occupational Stress among Textile Workers in the Democratic Republic of Congo

Context: In the Democratic Republic of Congo (DRC), scientific studies on occupational health are scarce. The present study aims at estimating the level of occupational stress, as well as associated factors, in a textile company.

Methods: We performed a cross-sectional survey among textile workers in DRC. Data (N = 192 subjects) were collected through a self-questionnaire validated for the assessment of stress (Karasek and Siegrist’s scale); supplemented by a medical examination. Frequencies and odds ratios (ORs) were estimated for descriptive analyses. Adjusted ORs were calculated through a logistic regression model to investigate associations between socio-demographic and organisational variables and stress.

Results: Our study highlighted a high level of stress among individuals: 28% of them were suffering from stress, according to Karasek, and 22%, when applying Siegrist’s model. A 14%-isostrain was calculated when considering all workers. A statistically significant association was observed between stress and age, seniority and perceived non-adaptation to work, considering both approaches. Furthermore, when job strain was determined according to Karasek, it was related to the worker status, the poor perception of organisation and alcohol consumption, while stress estimated by applying Siegrist’s model showed an association with education level and the occurrence of cardiac symptoms.

Conclusion: The present study provides of stress among individuals through both models. Several socio-professional factors are associated with stress, which determines populations at risk. The results revealed that both stress models offer complementary information, thus increasing the probability to model workers’ health more exactly and to make recommendations on prevention and management.

Previous sickness absence and current low perceived social support at work among employees in the general population: a historical cohort study

OBJECTIVE

Although sickness absence often is a process over time, most studies have treated the phenomenon as a discrete event and focused more on its causes than its consequences. We aimed to examine whether various patterns of previous long-term sickness absence were associated with current low perceived social support at work.

METHOD

This is a historical cohort study based on data from a population-based survey among Swedish employees (n=2581). The survey data were linked to official registries yielding data on sickness absence 1-7 years prior to the survey.

RESULTS

The main finding was that previous sickness absence was associated with current low perceived social support at work. The highest odds for low social support were found among those who had a stable high level of sickness absence. The two indicators of perceived social support employed were somewhat differently associated with previous sickness absence: Recency of absence showed to be of importance for general support at the workplace and the relationship with colleagues and superiors. Experiencing that one's immediate superior rarely or never regards one's view was, on the other hand, mainly related to having had a high level of sickness absence, irrespective of recency.

CONCLUSIONS

Our results indicate that recency and extent of previous sickness absence are related to perceived social support at work. Future research on the relationship between social support and sickness absence should use repeated measurements and acknowledge the possible bidirectional relationship.

Psychosocial factors at work and sickness absence: results from the French national SUMER survey

OBJECTIVE

This study aims at exploring the associations between psychosocial work factors and sickness absence.

METHODS

The sample from the French National Survey SUMER 2010 included 46,962 employees. Sickness absence spells and days within the last year were studied as two outcomes. Psychosocial work factors included psychological demands, decision latitude, social support, reward, working time, and workplace violence variables. Covariates were age, occupation, economic activity, and other occupational exposures.

RESULTS

For both genders, low latitude, low reward, shift work, bullying, and verbal abuse were risk factors of absence spells while long working hours were a protective factor. High demands, low support, and physical violence were risk factors for women. Low support and bullying for both genders, high demands for women, and low reward, long working hours, and physical violence for men increased absence duration.

CONCLUSIONS

This study highlights the importance of psychosocial work factors as risk factors of sickness absence.

Psychosocial work factors and long sickness absence in Europe

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Efficacy and cost-effectiveness of a web-based and mobile stress-management intervention for employees: design of a randomized controlled trial

Background

Work-related stress is associated with a variety of mental and emotional problems and can lead to substantial economic costs due to lost productivity, absenteeism or the inability to work. There is a considerable amount of evidence on the effectiveness of traditional face-to-face stress-management interventions for employees; however, they are often costly, time-consuming, and characterized by a high access threshold. Web-based interventions may overcome some of these problems yet the evidence in this field is scarce. This paper describes the protocol for a study that will examine the efficacy and cost-effectiveness of a web-based guided stress-management training which is based on problem solving and emotion regulation and aimed at reducing stress in adult employees.

Methods

The study will target stressed employees aged 18 and older. A randomized controlled trial (RCT) design will be applied. Based on a power calculation of d=.35 (1-β of 80%, α = .05), 264 participants will be recruited and randomly assigned to either the intervention group or a six-month waitlist control group. Inclusion criteria include an elevated stress level (Cohen’s Perceived Stress Scale-10 ≥ 22) and current employment. Exclusion criteria include risk of suicide or previously diagnosed psychosis or dissociative symptoms. The primary outcome will be perceived stress, and secondary outcomes include depression and anxiety. Data will be collected at baseline and seven weeks and six months after randomization. An extended follow up at 12 months is planned for the intervention group. Moreover, a cost-effectiveness analysis will be conducted from a societal perspective and will include both direct and indirect health care costs. Data will be analyzed on an intention-to-treat basis and per protocol.

Discussion

The substantial negative consequences of work-related stress emphasize the necessity for effective stress-management trainings. If the proposed internet intervention proves to be (cost-) effective, a preventative, economical stress-management tool will be conceivable. The strengths and limitations of the present study are discussed.

Trial registration

German Register of Clinical Studies (DRKS): DRKS00004749

Sickness benefit claims due to mental disorders in Brazil: associations in a population-based study

This study aims to determine the prevalence and duration of sickness benefit claims due to mental disorders and their association with economic activity, sex, age, work-relatedness and income replacement using a population-based study of sickness benefit claims (> 15 days) due to mental disorders in Brazil carried out in 2008. The prevalence of mental disorders was 45.1 claims per 10,000 workers. Prevalence and duration of sickness benefit claims due to mental disorder were higher and longer in workers aged over 40 years. Prevalence of claims was 73% higher in women but duration of sickness benefit claims was longer in men. Prevalence rates for claims differed widely according to economic activity, with sewage, residential care and programming and broadcasting activities showing the highest rates. Claims were deemed to be work-related in 8.5% of cases with mental disorder showing low work-relatedness in Brazil. A wide variation of prevalence and duration between age, economic activity and work-relatedness was observed, suggesting that working conditions are a more important factor in mental disorder work disability than previously assumed.

Healthcare performance turned into decision support

PURPOSE

The purpose of this study is to first create an overview of relevant factors directly influencing employee absence in the healthcare sector. The overview is used to further investigate the factors identified using employee satisfaction survey scores exclusively. The result of the overall objective is a management framework that allows managers to gain insight into the current status of risk factors with high influence on employee absence levels.

DESIGN/METHODOLOGY/APPROACH

The research consists of a quantitative literature study supported by formal and semi-formal interviews conducted at the case organisations. Employee satisfaction surveys were applied to analyse the development over time of selected factors correlated with concurrent employee absence rates. Checking for causal results, comparisons with the included published literature findings were also carried out.

FINDINGS

Four major clustered factors, three of which constitute the term "social capital", showed a high degree of connection with employee absence rates. The factors are general satisfaction, fairness, reliance and co-operation. Integrating the four elements in a management framework will provide valuable and holistic information about the determinants with regard to current levels of employee absence. The framework will be a valuable support for leaders with the authority to alter the determinants of employee absence.

RESEARCH LIMITATIONS/IMPLICATIONS

Since a great part of the empirical material is supplied from the healthcare sector, the results obtained could be restricted to this sector. Inclusion of data from Arbejdsmarkedets Tillaegspension (ATP) showed no deviation from the results in the healthcare sector.

PRACTICAL IMPLICATIONS

The product of the study is a decision support tool for leaders to cope with levels of employee absence. The framework is holistic and can prove to be a valuable tool to take a bearing of where to focus future initiatives.

ORIGINALITY/VALUE

Gathering former observational studies in a complete overview embracing many relevant factors that influence sickness absence has not yet been attempted. Hospital management is provided with valuable information when given insight into the factors that control employee absence behaviour. Having this insight will enable the managers to promote a healthy working environment, thus lowering employee absence rates to a minimum.

A prospective study of psychosocial work characteristics and long sick leave of Japanese male employees in multiple workplaces

The aim of this study was to identify psychosocial work characteristics associated with long sick leave in a large population of male Japanese employees in multiple workplaces. We examined various psychosocial work characteristics (job overload, job control, supervisor support, coworker support, support by family and friends, role ambiguity, role conflict, intragroup conflict and intergroup conflict) of employees in six factories at the base line. We then conducted a follow-up survey on the recorded long sick leaves of ≥ 30 continuous days taken by the employees due to any medical condition. We found 574 cases of long sick leave out of 15,531 subjects during an average 5.07-yr follow-up. The results showed that high supervisor support was significantly associated with a decrease in the hazard ratio (HR) of long sick leave after adjustment for several confounding factors (95%CI; 0.69-0.97). High role ambiguity also tended to increase HR, but without reaching significance (95%CI; 0.99-1.41). The results suggest that supervisor support in the workplace may be important to reduce long sick leave in Japanese male employees.

Impact of diabetes mellitus onset on sickness absence from work--a 15-year follow-up of the GAZEL Occupational Cohort Study

AIMS

Previous studies do not provide an accurate estimate of the burden of diabetes on sickness absence. The aim of this study was to measure the impact of diabetes onset on absenteeism starting from the earliest occurrence of the disease.

METHODS

The authors used data from a subsample of the French GAZEL cohort of 506 employees with incident diabetes and 2530 matched diabetes-free participants. Medically certified sickness absence data were obtained from company records (1989-2007). Number of sickness absence days and incidence rates of overall and cause-specific absence spells were compared according to diabetes status across three 5-year periods ranging from 10 years before to 5 years after onset of cases' diabetes.

RESULTS

The mean number of sickness absence days was persistently higher in participants with diabetes compared with those without diabetes. This difference increased from 16.4 days (95% confidence interval 7.2-25.5) during the 5-year period preceding diabetes onset to 28.5 days (95% CI 16.1-40.9) during the following 5-year period (P = 0.04). This was due to a steeper relative increase in the incidence of long (but not short) absence spells in participants with diabetes versus those without diabetes [incidence rate ratios 1.33 (95% CI 1.08-1.64) and 1.75 (95% CI 1.43-2.14), respectively; P = 0.02]. Diabetes onset was associated with increased rates of circulatory and metabolic absence spells.

CONCLUSIONS

Onset of diabetes is associated with a substantial increase in sickness absence. This suggests that in addition to its burden on work cessation, diabetes weighs heavily on working ability among people who manage to remain employed.

The role of lifestyle, health, and work in educational inequalities in sick leave and productivity loss at work

Purpose

To investigate the influence of lifestyle, health, and work conditions in the association between education and productivity loss at work and sick leave.

Methods

Employees of six companies filled out a questionnaire on demographics, lifestyle-related, health, and work-related factors, and productivity loss at work and sick leave at baseline (n = 915) and after 1-year (n = 647).

Results

Employees with a low education were more likely to report productivity loss at work (OR = 1.49, 95 % CI 0.98–2.26) and sick leave (OR = 1.81, 95 % CI 1.15–2.85). After adjustment for lifestyle, health, and work conditions, the association between education and productivity loss at work did not attenuate. Work conditions attenuated the association between low education and sick leave (OR = 1.62, 95 % CI 1.01–2.61), and additional adjustment for health and lifestyle-related factors further reduced the strength of the association (OR = 1.42, 95 % CI 0.86–2.34).

Conclusion

Work conditions and lifestyle-related factors partly explained the association between education and sick leave, but did not influence the association between education and productivity loss at work. The educational differences in sick leave prompt for interventions that address behavioral aspects as well as work-related and lifestyle-related factors.

Sick leave in the emergency department: staff attitudes and the impact of job designation and psychosocial work conditions

AIM

To examine patterns of, and attitudes to, sick leave taken by ED and other hospital staff and to compare ED doctor and nurse psychosocial work conditions.

METHODS

This was an observational study in a tertiary referral ED. An audit of sick leave taken over a 2-year period (2007-2008) by all ED, general medicine (GM) and pharmacy pay groups was undertaken. This was followed by a cross-sectional survey of ED staff. It evaluated attitudes towards sick leave and used the Karasek's Job Content Questionnaire to assess psychosocial work conditions.

RESULTS

Overall, sick leave taken by the various staff groups differed significantly (P < 0.01). The ED and GM nurse rates (6.0% and 5.9%, respectively) were approximately twice that of pharmacists (3.3%) and ED allied health staff (3.1%) and more than three times that of all doctor groups (range 1.3-1.9%). ED registrars and nurses tended to take more leave on Monday/Tuesday and Thursday/Friday, respectively. These groups also tended to take more leave in winter/early summer and autumn/spring, respectively. In total, 147 (93.0%, 95% CI 87.6-96.0) ED staff rarely/never took sick leave without being sick. However, 15 (9.5%, 95% CI 5.6-15.5) often/very often took sick leave because of work stress. Compared with ED nurses, ED doctors had significantly more job insecurity and supervisor support but less psychological job demand (P < 0.05).

CONCLUSIONS

Emergency department staff generally report healthy psychosocial work conditions. However, the high rate of ED nurse sick leave might be related to their considerable psychological job demand and perceived lack of supervisor support.

Absenteísmo-doença, modelo demanda-controle e suporte social: um estudo caso-controle aninhado em uma coorte de trabalhadores de hospitais, Santa Catarina, Brasil

O objetivo do estudo foi identificar a contribuição do Modelo Demanda-Controle (MDC) e do suporte social para duração do absenteísmo-doença segundo Licenças para Tratamento de Saúde (LTS) nos trabalhadores de hospitais (servidores públicos) da Secretaria de Estado da Saúde de Santa Catarina (SES/SC), Brasil. Entre as secretarias deste estado, a SES/SC tem a segunda maior frequência de LTS, com destaque nos hospitais. Este é um estudo caso-controle aninhado em uma coorte de trabalhadores de hospitais da SES/SC, com acompanhamento entre 01/07/2008 e 30/06/2009. Os casos foram aqueles que apresentaram LTS nesse período, os critérios de pareamento foram sexo, faixa etária e setor de trabalho. O desfecho foi o total de dias de LTS, as variáveis de exposição foram MDC e o suporte social do supervisor e do colega. Utilizou-se dados primários e secundários, nas análises a regressão Zero-inflado Binomial Negativa, e as variáveis socioeconômicas e ocupacionais nos ajustes. O banco de dados para as análises teve 425 (144 casos; 281 controles) participantes. O baixo suporte do colega aumentou a expectativa de dias de LTS em 2,04 (IC95%: 1,05-3,93), unido ao trabalho de baixa exigência aumentou 2,68 (IC95%: 1,37-5,27) e ao de alta exigência (iso-strain) 78% (IC95%: 1,02-3,12) mais do que o MDC com alto suporte do colega. Este estudo mostrou a importância do suporte do colega sobre a duração absenteísmo-doença, e auxiliou conjeturar que a variável tempo nos trabalhadores de hospital leva a adaptação às exigências das tarefas e a monotonia. Intervenções no relacionamento entre os trabalhadores provavelmente diminuirão a duração de LTS.

Occupational factors and sick leave in Australian employees

OBJECTIVES

To investigate occupational factors associated with sick leave over a 4-year period in Australian employees.

METHODS

Longitudinal data (self-report) from 2861 Australian full-time employees (69.4% male) were used. Occupational factors and relevant covariates were assessed at baseline with sick leave assessed yearly over a 4-year period. The data were analyzed using multinomial logistic regression models.

RESULTS

Job strain and longer commuting time were associated with long sick leave, whereas long work hours were inversely associated with long sick leave.

CONCLUSIONS

These results provide further evidence that certain aspects of work are associated with sick leave, whereas other work aspects such as long work hours are inversely associated with sick leave. Organizations need to understand and address these factors to improve the well-being of employees and increase workplace productivity.

The effect of recalled previous work environment on return to work after a rehabilitation program including vocational aspects for trauma patients

INTRODUCTION

The aim of the present study was to assess the association between remembered previous work place environment and return to work (RTW) after hospitalisation in a rehabilitation hospital.

METHODS

A cohort of 291 orthopedic trauma patients discharged from hospital between 15 December 2004 and 31 December 2005 was included in a study addressing quality of life and work-related questions. Remembered previous work environment was measured by Karasek's 31-item Job Content Questionnaire (JCQ), given to the patients during hospitalisation. Post-hospitalisation work status was assessed 3 months, 1, and 2 years after discharge, using a questionnaire sent to the ex-patients. Logistic regression models were used to test the role of four JCQ variables on RTW at each time point while controlling for relevant confounders.

RESULTS

Subjects perceiving a higher physical demand were less likely to return to work 1 year after hospital discharge. Social support at work was positively associated with RTW at all time points. A high job strain appeared to be positively associated with RTW 1 year after rehabilitation, with limitations due to large confidence intervals.

CONCLUSIONS

Perceptions of previous work environment may influence the probability of RTW. In a rehabilitation setting, efforts should be made to assess those perceptions and, if needed, interventions to modify them should be applied.

Socioeconomic status and duration and pattern of sickness absence. A 1-year follow-up study of 2331 hospital employees

BACKGROUND

Sickness absence increases with lower socioeconomic status. However, it is not well known how this relation depends on specific aspects of sickness absence or the degree to which socioeconomic differences in sickness absence may be explained by other factors.The purpose of the study was to examine differences in sickness absence among occupational groups in a large general hospital; how they depend on combinations of frequency and duration of sickness absence spells; and if they could be explained by self-reported general health, personal factors and work factors.

METHODS

The design is a 1-year prospective cohort study of 2331 hospital employees. Baseline information include job title, work unit, perceived general health, work factors and personal factors recorded from hospital administrative files or by questionnaire (response rate 84%). Sickness absence during follow-up was divided into short (1-3 days), medium (4-14 days) and long (>14 days) spells, and into no absence, "normal" absence (1-3 absences of certain durations) and "abnormal" absence (any other absence than "normal"). Socioeconomic status was assessed by job titles grouped in six occupational groups by level of education (from doctors to cleaners/porters). Effects of occupational group on sickness absence were adjusted for significant effects of age, gender, general health, personal factors and work factors. We used Poisson or logistic regression analysis to estimate the effects of model covariates (rate ratios (RR) or odds ratios (OR)) and their 95% confidence intervals (CI).

RESULTS

With a few exceptions sickness absence increased with decreasing socioeconomic status. However, the social gradient was quite different for different types of sickness absence. The gradient was strong for medium spells and "abnormal" absence, and weak for all spells, short spells, long spells and "normal" absence. For cleaners compared to doctors the adjusted risk estimates increased 4.2 (95% CI 2.8-6.2) and 7.4 (95% CI 3.3-16) times for medium spells and "abnormal" absence, respectively, while the similar changes varied from 0.79 to 2.8 for the other absence outcomes. General health explained some of the social gradient. Work factors and personal factors did not.

CONCLUSIONS

The social gradient in sickness absence was different for absences of different duration and patterns. It was strongest for absences of medium length and "abnormal" absence. The social gradient was not explained by other factors.

The association of patient's family, leisure time, and work situation with sickness certification in primary care in Sweden

OBJECTIVE

To investigate associations between patients' family, leisure time, and work-related factors and physicians' measure as to whether or not to sickness certify the patient in connection with the consultation.

DESIGN

Questionnaire survey to physicians in general practice and their patients. Setting. General practitioners (GPs) and their patients in Orebro county, Sweden.

SUBJECTS

A total of 474 patient-physician consultations from 65 physicians with up to 10 patients each. Main outcome measure. Whether or not a sickness certificate was issued.

RESULTS

Among work-related factors, high "authority over decisions" and high "social support" correlated with 30% or more reduced sickness certification probability. Worrying about becoming ill or being injured from work correlates with almost doubled sickness certification risk. Among family and leisure-time variables, only living with a common law partner and having no children correlated with increased sickness certification risk. In addition to analyses of the whole group (all diagnoses), the two largest diagnostic subgroups, infectious diseases and musculoskeletal diseases, were examined. For the infectious diseases subgroup, high demands in work correlated with increased sickness certification risk, while in the musculoskeletal diseases subgroup, worry about work-related injury or illness was the main factor correlating with increased risk for sickness certification.

CONCLUSIONS

Work-related factors were the most important factors related to sickness certification in this study. Determinants for sickness certification risk differed between diagnostic subgroups.

Flexible working conditions and their effects on employee health and wellbeing

BACKGROUND

Flexible working conditions are increasingly popular in developed countries but the effects on employee health and wellbeing are largely unknown.

OBJECTIVES

To evaluate the effects (benefits and harms) of flexible working interventions on the physical, mental and general health and wellbeing of employees and their families.

SEARCH STRATEGY

Our searches (July 2009) covered 12 databases including the Cochrane Public Health Group Specialised Register, CENTRAL; MEDLINE; EMBASE; CINAHL; PsycINFO; Social Science Citation Index; ASSIA; IBSS; Sociological Abstracts; and ABI/Inform. We also searched relevant websites, handsearched key journals, searched bibliographies and contacted study authors and key experts.

SELECTION CRITERIA

Randomised controlled trials (RCT), interrupted time series and controlled before and after studies (CBA), which examined the effects of flexible working interventions on employee health and wellbeing. We excluded studies assessing outcomes for less than six months and extracted outcomes relating to physical, mental and general health/ill health measured using a validated instrument. We also extracted secondary outcomes (including sickness absence, health service usage, behavioural changes, accidents, work-life balance, quality of life, health and wellbeing of children, family members and co-workers) if reported alongside at least one primary outcome.

DATA COLLECTION AND ANALYSIS

Two experienced review authors conducted data extraction and quality appraisal. We undertook a narrative synthesis as there was substantial heterogeneity between studies.

MAIN RESULTS

Ten studies fulfilled the inclusion criteria. Six CBA studies reported on interventions relating to temporal flexibility: self-scheduling of shift work (n = 4), flexitime (n = 1) and overtime (n = 1). The remaining four CBA studies evaluated a form of contractual flexibility: partial/gradual retirement (n = 2), involuntary part-time work (n = 1) and fixed-term contract (n = 1). The studies retrieved had a number of methodological limitations including short follow-up periods, risk of selection bias and reliance on largely self-reported outcome data. Four CBA studies on self-scheduling of shifts and one CBA study on gradual/partial retirement reported statistically significant improvements in either primary outcomes (including systolic blood pressure and heart rate; tiredness; mental health, sleep duration, sleep quality and alertness; self-rated health status) or secondary health outcomes (co-workers social support and sense of community) and no ill health effects were reported. Flexitime was shown not to have significant effects on self-reported physiological and psychological health outcomes. Similarly, when comparing individuals working overtime with those who did not the odds of ill health effects were not significantly higher in the intervention group at follow up. The effects of contractual flexibility on self-reported health (with the exception of gradual/partial retirement, which when controlled by employees improved health outcomes) were either equivocal or negative. No studies differentiated results by socio-economic status, although one study did compare findings by gender but found no differential effect on self-reported health outcomes.

AUTHORS' CONCLUSIONS

The findings of this review tentatively suggest that flexible working interventions that increase worker control and choice (such as self-scheduling or gradual/partial retirement) are likely to have a positive effect on health outcomes. In contrast, interventions that were motivated or dictated by organisational interests, such as fixed-term contract and involuntary part-time employment, found equivocal or negative health effects. Given the partial and methodologically limited evidence base these findings should be interpreted with caution. Moreover, there is a clear need for well-designed intervention studies to delineate the impact of flexible working conditions on health, wellbeing and health inequalities.

A literature review on sick leave determinants (1984-2004)

OBJECTIVES

A literature review for the years 1984-2004 was performed to identify the determinants of the sick leave frequency and duration over that period and to establish the continuity in the character of those determinants.

MATERIALS AND METHODS

The review referred to national and international studies on the determinants of the frequency and duration of sick leave.

RESULTS

The review presented a highly consistent picture of the factors determining sick leave frequency and duration.

CONCLUSION

Over the study period, the frequency and duration of sick leave were determined by a broad range of factors, a substantial number of which had a similar influence on both the study parameters.

Gender specificity in the prediction of clinically diagnosed depression. Results of a large cohort of Belgian workers

BACKGROUND

The recent increase in the incidence of clinical depression represents a major public health and socio-economical burden. Depression has its roots in both professional and private domains but few epidemiological studies have looked at predictors of long term clinical depression as defined by a sick-leave of 28 days or more and a diagnosis by a general practitioner in both genders.

OBJECTIVES

To study baseline predictors of long term spells of clinical depression within the framework of a large prospective study, the Belstress Study, in 6,659 men and 2,737 women aged 35-59 years at baseline survey.

METHODS

Kaplan-Meyer survival curves and Cox regression models were used in order to relate long term clinical depression defined by a sick-leave of 28 days or more to baseline socio-demographic and work and non-work variables.

RESULTS AND CONCLUSIONS

Density incidence of long term clinical depression is 0.5 years and 1.1/1,000 persons/months for men and women respectively. In univariate analyses specific gender predictors were observed as for men predictors besides level of education, were work related: high job-strain OR 1.67 (CI 95% 1.03; 2.71) and work dissatisfaction OR 1.78 (CI 95% 1.09; 2.91) whereas for women baseline predictors are related to private life dissatisfaction OR 1.84 (CI 95% 1.16; 2.91) and to a lesser degree low social support from co-workers OR 1.50 (CI 95% 0.93; 2.40). In both genders baseline severe depression symptoms defined by a CES-D score of percentile 90 or above is a predictor of long term sick-leave for clinical depression. In multivariate analyses, in a model without baseline CES-D high job-strain and job dissatisfaction remain independent predictors for incident clinical depression in men whereas only private life dissatisfaction remains a significant predictor in women. When added to the model CES-D is the most powerful predictor of clinical depression in both genders. Together with level of education, work dissatisfaction remains borderline significant in men whereas private life dissatisfaction remains an independent predictor for clinical depression in women. In men baseline symptoms of depression alleviate the impact of high job-strain on incident clinical depression whereas in women, private life dissatisfaction remains an independent predictor of clinical depression.

Psychosocial work conditions and registered sickness absence: a 3-year prospective cohort study among office employees

Purpose

To investigate associations between a wide variety of psychosocial work conditions and sickness absence in a medium-sized company.

Methods

Prospective cohort study of 395 employees working in an insurance office. Self-reported psychosocial work conditions were measured by questionnaire in January 2002 and linked to registered sickness absence in the period January 2002 to December 2004 adjusting for earlier sick leave and psychological distress.

Results

The questionnaires of 244 employees were eligible for analysis. Decision authority and co-worker support were associated with sickness absence days, but their associations with sickness absence episodes were not significant. Role clarity was associated with the number of sickness absence days, but only with the number of short sickness absence episodes in women.

Conclusions

The wide variety of investigated psychosocial work conditions contributed little to the explanation of sickness absence in the medium-sized insurance office.

The influence of sick leave frequency determinants on homogeneous groups in two socio-economically comparable, but socio-culturally different regions in The Netherlands

OBJECTIVES

The aim of this study was to explore the influence of sick leave frequency determinants on in terms of age and profession homogeneous groups in two socio-economically comparable, but socio-culturally different regions in The Netherlands, i.e., Utrecht (mean frequency 1.10 spells) and South Limburg (mean frequency 1.92 spells). In addition, to get an idea of the study's topical interest, a literature review on sick leave frequency determinants covering the past few decades was performed.

MATERIAL AND METHODS

184 participants in the Utrecht and South Limburg regions were interviewed on work, individual and health characteristics. Sick leave frequency data were obtained from a social fund. For the literature review (inter)national scientific journals, academic theses and Medline were consulted.

RESULTS

A comparison of sick leave frequency in the two regions showed that, in South Limburg, the determinants called 'opinion on social-medical support during sick leave', 'type of appointment' and 'annual number of visits (family doctor)' were associated with sick leave frequency whereas this was not the case in Utrecht. The literature review presented a highly consistent picture of determinants of sick leave frequency over the last few decades.

CONCLUSIONS

In the two regions studied, different determinants appeared to be associated with sick leave frequency. This phenomenon is attributed to the different socio-cultural characters of the regions. As per region different determinants appeared to be associated with sick leave frequency, nationwide interventions to reduce sick leave frequency should take into account the potential influence of regional differences in determinants that predict sick leave frequency. Sick leave frequency determinants have not changed in the past few decades. Although the study was performed in the nineties, its results are still relevant.

The contribution of nursing to public health practice in the prevention of depression

Depression is perceived worldwide as an important public health issue. Its prevalence has increased over the past 50 years. The reasons for the increase might be related, in part, to improved recognition and a greater willingness to label unhappiness or dysphoria as depression. Severe depression might be less amenable to prevention, although the identification of the stressors likely to trigger an episode in vulnerable individuals might prevent some recurrences. There is the potential, however, for the prevention of mild-to-moderate depression through action at the individual, community, and structural levels. This paper argues that nursing can make an important contribution to this prevention. At the individual level, this might be best accomplished through the development of the role of non-mental health nurses in primary care and workplace settings. At the community and structural levels, nursing as a profession can play an important role in influencing the commissioning of health care and the development of healthy public policy.

Sickness absence and psychosocial work conditions: a multilevel study

BACKGROUND

Psychosocial work conditions, particularly psychological job demands, are inconsistently associated with sickness absence rates. This might be the result of investigating the psychosocial work environment at the individual level, reflecting personal perceptions rather than actual demands.

AIM

To investigate associations between sickness absence and psychosocial work conditions at both the individual and the workplace level.

METHODS

A cross-sectional study of insurance company employees (n = 395) in four departments. Psychological job demands, job control and job support were investigated at the individual level using the self-completed Questionnaire on Experience and Assessment of Work. An external occupational psychologist interviewed the supervisor and a group of employees of each department, assessing job demands, job control, job support and psychological distress at the workplace level. These data were related to the number of short (1-7 days), medium (8-21 days) and long (>21 days) episodes of sickness absence in the period January 2001 to December 2002.

RESULTS

A total of 244 questionnaires (62%) were suitable for analysis. Quantitative job control scores at the individual level differed from qualitative data at the workplace level. Self-assessed job demands and control were unrelated to sickness absence. The rates of short and long episodes of absence were higher in the department with combined high demands and low control, assessed at the workplace level.

CONCLUSIONS

The associations between psychosocial work conditions and sickness absence depended on the level at which the former were assessed. More multilevel research is needed to disentangle the relations between psychosocial work conditions and sickness absence.

Psychosocial work environment and well-being: a cross-sectional study at a thermal power plant in China

To investigate the effects of the job demand-control (DC) model and the effort-reward imbalance (ERI) model on worker's well-being, self-reports for psychosocial work conditions and well-being were made by a sample of 878 workers at a thermal power plant in China using the main dimensions of DC and ERI questionnaires. Logistic regression analyses were employed controlling for age, gender, and educational level, and negative and positive affection among others. Workers reporting high job demands and low job control or high efforts and low rewards had elevated risks of job dissatisfaction, psychosomatic complaints and depressive symptoms. Odds ratios were generally higher in workers reporting both high efforts and low rewards. Furthermore, low reward proved to be a stronger predictor of poor well-being when both job stress models were simultaneously adjusted. To some extent, interaction effects were found for social support, but no interaction effects were found for overcommitment. The findings indicate independent effects of both the DC model and the ERI model on well-being. Future work should explore the combined effects of these two models of psychosocial stress at work on health more thoroughly.