A comparison of self-reported sickness absence with absences recorded in employers' registers: evidence from the Whitehall II study

Using intervention mapping to facilitate and sustain return-to work after breast cancer: protocol for the FASTRACS multicentre randomized controlled trial

BACKGROUND

Women with breast cancer face many barriers to return to work (RTW) after their cancer. The main objective of the FASTRACS-RCT is to evaluate the impact of the FASTRACS (Facilitate and Sustain Return to Work after Breast Cancer) intervention on the sustainable RTW of breast cancer patients, 12 months after the end of active treatment.

METHODS

FASTRACS-RCT is a prospective, national, multicentre, randomized, controlled and open-label study. A total of 420 patients with early breast cancer scheduled for surgery and (neo)adjuvant chemotherapy, will be randomly assigned (1:1 ratio) to: (i) the intervention arm comprising four steps over 6 months : Handing over the intervention tools; transitional medical consultation with the general practitioner (GP); pre-RTW visit with the company's occupational physician (OP); catch-up visit with a hospital-based RTW expert (if sick leave > 10 months) (ii) the control arm to receive usual care. The design of the FASTRACS intervention was informed by intervention mapping for complex interventions in health promotion planning, and involved patients and representatives of relevant stakeholders. Specific tools were developed to bridge the gap between the hospital, the GP, the OP and the workplace: a toolkit for breast cancer patients comprising a theory-based guide; specific checklists for the GP and the OP, respectively; and a theory-based guide for workplace actors (employer, manager, colleagues). The primary endpoint will associate sustainable RTW (full-time or part-time work at 50% or more of working time, for at least 28 consecutive days) and days off work. It will be assessed at 4, 8 and 12 months after the end of active oncological treatment. Secondary endpoints will include quality of life, anxiety, depression, RTW self-efficacy, physical activity, social support, job accommodations, work productivity, job status, and the usefulness and acceptability of the intervention's tools.

DISCUSSION

FASTRACS-RCT will be supplemented by a realist evaluation approach aimed at understanding the influence of context in activating the intervention's mechanisms and effects. If the expected impact of the intervention is confirmed, the intervention will be adapted and scaled-up for other cancers and chronic diseases to better integrate healthcare and work disability prevention.

TRIAL REGISTRATION

NCT04846972 ; April 15, 2021.

Sickness absence and associations with sociodemographic factors, health risk behaviours, occupational stressors and adverse mental health in 40,343 UK police employees

AIMS

Police employees may experience high levels of stress due to the challenging nature of their work which can then lead to sickness absence. To date, there has been limited research on sickness absence in the police. This exploratory analysis investigated sickness absence in UK police employees.

METHODS

Secondary data analyses were conducted using data from the Airwave Health Monitoring Study (2006-2015). Past year sickness absence was self-reported and categorised as none, low (1-5 days), moderate (6-19 days) and long-term sickness absence (LTSA, 20 or more days). Descriptive statistics and multinomial logistic regressions were used to examine sickness absence and exploratory associations with sociodemographic factors, occupational stressors, health risk behaviours, and mental health outcomes, controlling for rank, gender and age.

RESULTS

From a sample of 40,343 police staff and police officers, forty-six per cent had no sickness absence within the previous year, 33% had a low amount, 13% a moderate amount and 8% were on LTSA. The groups that were more likely to take sick leave were women, non-uniformed police staff, divorced or separated, smokers and those with three or more general practitioner consultations in the past year, poorer mental health, low job satisfaction and high job strain.

CONCLUSIONS

The study highlights the groups of police employees who may be more likely to take sick leave and is unique in its use of a large cohort of police employees. The findings emphasise the importance of considering possible modifiable factors that may contribute to sickness absence in UK police forces.

Protocol for a pilot cluster randomised controlled trial of a multicomponent sustainable return to work IGLOo intervention

BACKGROUND

Long-term sickness costs businesses in the United Kingdom (UK) approximately £7 billion per annum. Most long-term sickness absences are attributed to common mental health conditions, which are also highly prevalent in people with acute or musculoskeletal health conditions. This study will pilot the IGLOo (Individual, Group, Leaders, Organisation, overarching context) intervention which aims to support workers in returning to and remaining in work following long-term sickness absence. The potential impact of the intervention is a timely return to work (main trial primary outcome) and prevention of a further episode of long-term sick leave. The intervention will be piloted in a randomised controlled trial (RCT) to examine the feasibility of the intervention (pilot trial primary outcome) and to inform a fully powered definitive trial to evaluate sustainable return to work (RTW) in people with primary or secondary mental ill-health who go on long-term sick leave.

METHODS AND DESIGN

A two-arm feasibility randomised controlled trial (with a 30-month study period including 12-month follow-up) of the IGLOo intervention will be conducted in large organisations (≥ 600 workers) from the Yorkshire and Humberside regions, in the UK. Eight consenting organisations will be recruited and randomised to the intervention or control arms of the study (1:1 ratio), with a minimum recruitment target of 13 workers eligible to participate from each. Organisations assigned to the control group will continue with their usual practice. Feasibility data will include data collected on recruitment, retention and attrition of participants; completion of research outcome measures; and intervention compliance. Measurements of mental health, RTW, work outcomes, quality-of-life, workplace support and communication and other demographic data will be taken at baseline, 3, 6, 9 and 12 months in all participants. Qualitative interviews and survey data with all participants will explore the experiences of participants, acceptability of the intervention components and evaluation measures. Exploratory economic evaluation will be conducted to further inform a definitive trial.

DISCUSSION

The findings from this pilot study will help to inform the development of a definitive cluster RCT designed to examine the efficacy of this intervention on health and work-related outcomes in UK workers on long-term sick leave.

TRIAL REGISTRATION

ISRCTN11788559 (prospectively registered, date registered 6 October 2022).

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.

Intermethod agreement of self-reports compared to register data collection for return to work and sickness absence: a systematic review and meta-analysis

OBJECTIVES

To determine the intermethod agreement of self-reported vs. register data of 'sickness absence' (SA) and 'return to work' (RTW) outcome measurements.

STUDY DESIGN AND SETTING

We conducted a systematic review and a meta-analysis of studies reporting mean differences (MDs) and sensitivity and specificity for self-report vs. register data and an inductive analysis of the self-report question formulations. An information specialist searched Medline, Embase, PsycINFO for studies published from inception to November 2022. Screening and data extraction was done by two authors independently.

RESULTS

Twenty-three studies were included of which eighteen with an overall high risk of bias. Self-reports had a pooled MD of 1.84 SA days (95% confidence interval [CI] 0.26-3.41, I2 98%, 18 studies, 38,716 participants) compared to registries which varied among studies from 204 more to 17 days less. The median average sick leave in studies in the self-report group was 8 days (interquartile range 4-23 days). Being absent from work measured with self-report had a sensitivity of 0.83 (0.76-0.88 95% CI) and a specificity of 0.92 (0.88-0.94 95% CI) compared to registry data. The high heterogeneity amongst the studies could not be explained by recall time, gender, register type, prospective or retrospective self-reports, health problem, SA at baseline or risk of bias. Studies lacked standard outcome reporting, had unclearly formulated questions in self-reports and there was little information on the registers' quality.

CONCLUSION

Current self-reports may differ from register-based absence data but in an inconsistent way. Due to inconsistency and high risk of bias the evidence is judged to be of very low certainty. Further research is needed to develop clear standard questions which can be used for SA and RTW self-reports. Quality of registers needs to be better evaluated. Percentage positive and negative agreement, MDs and 2 × 2 tables should be reported for studies investigating agreement between SA and RTW outcome measures.

Predicting long-term sickness absence with employee questionnaires and administrative records: a prospective cohort study of hospital employees

OBJECTIVE

This study aimed to compare the utility of risk estimation derived from questionnaires and administrative records in predicting long-term sickness absence among shift workers.

METHODS

This prospective cohort study comprised 3197 shift-working hospital employees (mean age 44.5 years, 88.0% women) who responded to a brief 8-item questionnaire on work disability risk factors and were linked to 28 variables on their working hour and workplace characteristics obtained from administrative registries at study baseline. The primary outcome was the first sickness absence lasting ≥90 days during a 4-year follow-up.

RESULTS

The C-index of 0.73 [95% confidence interval (CI) 0.70-0.77] for a questionnaire-only based prediction model, 0.71 (95% CI 0.67-0.75) for an administrative records-only model, and 0.79 (95% CI 0.76-0.82) for a model combining variables from both data sources indicated good discriminatory ability. For a 5%-estimated risk as a threshold for positive test results, the detection rates were 76%, 74%, and 75% and the false positive rates were 40%, 45% and 34% for the three models. For a 20%-risk threshold, the corresponding detection rates were 14%, 8%, and 27% and the false positive rates were 2%, 2%, and 4%. To detect one true positive case with these models, the number of false positive cases accompanied varied between 7 and 10 using the 5%-estimated risk, and between 2 and 3 using the 20%-estimated risk cut-off. The pattern of results was similar using 30-day sickness absence as the outcome.

CONCLUSIONS

The best predictive performance was reached with a model including both questionnaire responses and administrative records. Prediction was almost as accurate with models using only variables from one of these data sources. Further research is needed to examine the generalizability of these findings.

Sick Leave Due to Stress, What are the Costs for Dutch Employers?

Purpose Stress-related illnesses are prevalent in Western society, causing sick leave and putting a heavy economic burden on employers and society. For Dutch employers it is particularly relevant to have insight into the costs of absenteeism due to stress-related illness, as they are legally obligated to continue payment of wages. Therefore, this study assessed the duration and costs of an episode of sick leave due to stress-related illness for Dutch employers. Methods Data on sick leave due to various stress-related illnesses were obtained from a nationwide occupational health service database. Stress-related illnesses included tension complaints, burn-out, overexertion, and other reactions to stress. The duration per sick leave episode was estimated in working days, after which the average cost per sick leave period was estimated using age- and gender-specific price weights. Results During the study period, 16,676 employees took 17,338 episodes of sick leave due to stress-related illness. On average, one episode of sick leave lasted 101 working days, for which the costs for the employer were on average €19,151 per worker. Women were responsible for most episodes of sick leave and were on average 37 days more absent per episode compared to men. Moreover, of all kinds of stress-related illnesses, burn-out had the longest duration of sick leave with 313 calendar days and 163 working days, resulting in an average cost of €30,770. Conclusions Sick leave due to stress-related illness places a heavy burden on employers and thus society. Further research should be conducted on how to reduce this burden.

Do Differences in Drinking Attitudes and Alcohol-Related Problems Explain Differences in Sick Leave? A Multilevel Analysis of 95 Work Units Within 14 Companies From the WIRUS Study

Background

Systematic reviews have shown a strong relationship between alcohol consumption and sick leave. The effect of alcohol consumption on sick leave may, however, vary according to the work environment. While attitudes toward drinking may impact sick leave, there is little research on the contribution of drinking attitudes to sick leave. Moreover, alcohol-related problems and drinking attitudes may be influenced by the broader sociocultural contexts of the organizational units where people work.

Objectives

This study aimed to explore the relationship of alcohol-related problems and drinking attitudes with sick leave while considering the nesting of employees within working units within companies.

Method

Data from the WIRUS (Workplace Interventions preventing Risky alcohol Use and Sick leave) study were linked to company-registered sick leave data for 2,560 employees from 95 different work units in public (n = 9) and private companies (n = 5) in Norway. Three-level (employee, work unit, and company) negative binomial regression models were estimated to explore the 12-month prospective association of alcohol-related problems and drinking attitudes with four measures of sick leave (one-day, short-term, long-term, and overall sick leave days). Models were adjusted for gender, age, cohabitation status, educational attainment, work position, and employment sector.

Results

We observed higher variation of one-day, short-term, and overall sick leave days between companies than between work units within companies (15, 12, and 30% vs. 0, 5, and 8%, respectively). However, neither alcohol-related problems nor drinking attitudes were associated with sick leave and, thus, those variations in sick leave were not explained by alcohol-related problems or drinking attitudes.

Conclusion

Our findings suggest company-level differences are more important than within company differences when explaining differences in sick leave. While alcohol-related problems or drinking attitudes were not associated with sick leave, future studies may need to explore the role of company policies, practices, or social norms in variations in sick leave rates.

Home-Based Telework and Presenteeism: New Lessons Learned From the Covid-19 Pandemic

OBJECTIVE

Previous research found increased sickness presenteeism (working despite sickness) associated with home-based telework. The Covid-19 pandemic offers new insights into mechanisms, as a large proportion of the workforce was forced to work from home, irrespective of organizational and individual predispositions.

METHODS

A path analysis based on survey data from a sample of teleworkers collected during the Covid-crisis was performed.

RESULTS

We found no general relationship between telework and sickness presenteeism. However, employees with telework experience before the pandemic use telework more often for work intensification which is associated with increased sickness presenteeism. As teleworking before the pandemic is associated with indirect work control (goal-directed management), indirect effects of such work organizations on presenteeism were confirmed.

CONCLUSION

As hypothesized in prior research, indirect work control may increase self-endangering behavior which is amplified by telework.

Factors associated with sickness absence in a large NHS Trust

BACKGROUND

Sickness absence rates vary widely across a large acute NHS Trust, with the highest rates in some of the largest directorates.

AIMS

This study was aimed to identify factors associated with sickness absence in teams and to inform interventions to improve staff health and well-being.

METHODS

Using 2018 data from the electronic staff record and NHS Staff Survey, we examined variables associated with cost centre sickness absence rates, perceived abuse and staff engagement scores using multivariable linear regression.

RESULTS

Data were available for 9362/15 423 (61%) of staff. Cost centre sickness absence was significantly positively associated with predominance of nursing and midwifery staff (β = 0.28 [0.012-0.55]) and significantly inversely associated with predominance of medical and dental staff (β = -0.94 [-1.2 to -0.65]) and proportion white (β = -1.11 [-1.9 to -0.37]). Cost centre sickness absence was not significantly associated with staff engagement, reported abuse, age or higher headcount. Cost centre staff engagement was significantly positively associated with proportion white (β = 0.98 [0.42-1.6]). Reported abuse by managers (β = -13 [-22 to -4.2]) and by colleagues (β = -24 [-35 to -12]) was significantly inversely associated with proportion white. Reported abuse by colleagues was significantly associated with predominance of medical and dental (β = 7.6 [2.3-13]) and nursing and midwifery staff (β = 9.1 [4.4-14]).

CONCLUSIONS

These observed associations of sickness absence, staff engagement and perceived abuse with job mix and ethnicity should be further explored. Individual or team-level data, rather than cost centre-level data, might more meaningfully elucidate why sickness absence rates vary between groups of staff.

Absenteeism and associated labour costs according to depressive symptom severity in the German general population: why preventive strategies matter

Purpose

Depression is a highly prevalent mental health condition with substantial individual, societal and economic consequences. This study focussed on the association of depressive symptom severity with absenteeism duration and employer labour costs.

Methods

Using cross-sectional data from the German Health Update 2014/2015, multivariable zero-inflated Poisson regression (ZIP) models explored the association of depressive symptom severity (8-item depression patient health questionnaire—PHQ-8), with absenteeism weeks during 12 months in men and women working full- or part-time. The predicted sick leave weeks were multiplied by mean average labour costs.

Results

The sample consisted of 12,405 persons with an average sick leave of 1.89 weeks (SD 4.26). Fifty-four % were women and 57% were between 40 and 59 years of age. In men and women, mild, moderate, moderately severe and severe depressive symptoms were associated with a significant factor increase in sick leave weeks compared to persons with no or minimal symptoms. Labour costs increased with increasing symptom severity from € 1468.22 for men with no or minimal depressive symptoms to € 7190.25 for men with severe depressive symptoms and from € 1045.82 to € 4306.30 in women, respectively.

Conclusion

The present results indicate that increasing depressive symptom severity is associated with increasing absenteeism and employer costs. They emphasize the need for implementation, realignment or extension of professional work-site health promotion programmes aiming at the improvement and maintenance of employee health and the reduction of labour costs associated with depression-related sick leave.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00420-021-01788-7.

Effect of Psychological Distress on the Association of Workplace Social Capital with Presenteeism and Sickness Absence

Greater workplace social capital (WSC) can be related to workers' health and productivity. We sought to clarify the association between horizontal WSC and presenteeism and sickness absence (SA) and to examine the effects of psychological distress on these associations among Japanese workers. A cross-sectional study was conducted in 2017 at seven large Japanese companies. Logistic regression analysis was performed with presenteeism and SA as the dependent variables, horizontal WSC as an independent variable, and sociodemographic characteristics and psychological distress as covariates. After adjustment for sociodemographic characteristics, the results showed that greater horizontal WSC was associated with lower presenteeism and SA. The odds ratios for the relationship between horizontal WSC and presenteeism and that between horizontal WSC and SA dropped moderately after adjustment for psychological distress but remained significant. Further exploration of the factors underlying the relationship between WSC and productivity is needed to confirm if WSC enhances workers' health and productivity and to inform the development of effective occupational health initiatives.

What is Number of Days in Number of Times? Associations Between, and Responsiveness of, Two Sickness Presenteeism Measures

OBJECTIVE

To examine the associations between sickness presenteeism (SP) reported as number of days with SP reported as number of times and to evaluate their responsiveness.

METHODS

The study population (n = 454) consisted of employed individuals, at risk of long-term sickness absence. Correlation analyses were performed to examine associations between the two SP measures and external constructs such as work performance, general health, and registered sick leave. Both SP constructs were measured several times to examine responsiveness.

RESULTS

The SP measures are moderately correlated. They moderately correlated with work performance and health status measures. SP reported as number of times seems to be more sensitive than number of days in detecting changes after rehabilitation.

CONCLUSIONS

Numerical or categorical constructs are valid sources of data on SP. However, categorized SP seems to be more responsive.

Impact of Workplace Conflicts on Self-Reported Medically Certified Sickness Absence in Latvia

Sickness absence is one of the most important working population health indicators. It is a complex phenomenon that is investigated by health care and occupational health specialists, economists, and work psychologists. Sickness absence is used as a predictor for morbidity and mortality, but besides the health status of an individual, sickness absence is influenced by demographic, socio-economic factors, and work environment factors. Conflicts at work are a common psychosocial risk factor that can affect sickness absence. The aim of the study was to investigate the association between different types of workplace conflict and self-reported medically certified sickness absence using cross-sectional survey data pooled from four periodic national surveys-Work conditions and risks in Latvia (2006-2018). The sample is representative of the working population of Latvia, as respondents were randomly drawn from different regions and industries. In total, the study sample (n = 8557) consisted of employees between 16 and 80 years old (average 42.8 +/- 12.6) of which 46.2% were males and 53.8% were females. Researchers used the computer-assisted personal interviewing (CAPI) method for collecting data. The association between workplace conflicts and sickness absence was analysed by using binomial logistic regression and calculated as odds ratios (OR) with 95% confidence intervals (CI), with adjustment for gender, age, education and survey year. The risk of sickness absence was higher among women (OR = 1.24, CI 1.13-1.35), employees aged 25-44 years old and employees with higher income. Controlling for socio-demographic factors and survey year, the odds of sickness absence increased significantly for all types of workplace conflict analysed. The strongest association with sickness absence was related to conflicts between managers and employees (OR = 1.51, CI 1.37-1.66) and conflicts between groups of employees (OR = 1.45, CI 1.31-1.61). Conflicts between employees and with customers also increased the odds of sickness absence (OR = 1.39, CI 1.27-1.52 and OR = 1.11, CI 1.01-1.23, respectively). Our findings suggest that tailored interventions at a company level for reducing workplace conflicts as risk factors of sickness absence are required. Those should focus on the improvement of managers' leadership and human resource management skills.

Validity of participants' self-reported diagnosis for a work absence due to a mental health problem compared with physician-certified diagnosis for the same work absence among 709 Canadian workers

OBJECTIVES

This study assesses the validity of a self-reported mental health problem (MHP) diagnosis as the reason for a work absence of 5 days or more compared with a physician-certified MHP diagnosis related to the same work absence. The potential modifying effect of absence duration on validity is also examined.

METHODS

A total of 709 participants (1031 sickness absence episodes) were selected and interviewed. Total per cent agreement, Cohen's kappa, sensitivity and specificity values were calculated using the physician-certified MHP diagnosis related to a given work absence as the reference standard. Stratified analyses of total agreement, sensitivity and specificity values were also examined by duration of work absence (5-20 workdays,>20 workdays).

RESULTS

Total agreement value for self-reported MHP was 90%. Cohen's kappa value was substantial (0.74). Sensitivity was 77% and specificity was 95%. Absences of more than 20 workdays had a better sensitivity than absences of shorter duration. A high specificity was observed for both short and longer absence episodes.

CONCLUSION

This study showed high specificity and good sensitivity of self-reported MHP diagnosis compared with physician-certified MHP diagnosis for the same work absence. Absences of longer durations had a better sensitivity.

Estimating the potential reduction in future sickness absence from optimizing group-level psychosocial work characteristics: a prospective, multicenter cohort study in German industrial settings

BACKGROUND

Absence from work due to sickness impairs organizational productivity and performance. Even in organizations with perfect work conditions, some inevitable baseline sickness absence exists amongst working populations. The excess sickness absence observed above this baseline rate has become the focus of traditional health promotion efforts, addressing preventable physical illness, health behavior and mental health at the personal level. However, a health and safety approach following the TOP-rule would consider work-group psychosocial work characteristics as a potential risk factor amenable to organizational measures. To date, there is a scarcity of studies relating psychosocial work characteristics to possible reduction of excess sickness-absence rates.

METHODS

We aimed to estimate the potentially avoidable excess fraction of absence attributable to work-group psychosocial characteristics. We considered work-group averaged perception of psychosocial work characteristics as a proxy to the methodologically elusive objective assessment of organizational characteristics. Participants were recruited from multiple sites of a German automotive manufacturer with individuals nested within work groups. We predicted 12-month follow-up work-group sickness absence rates using data from a baseline comprehensive health examination assessing work characteristics, health behavior, and biomedical risk factors. We considered the quartile of work-groups yielding favorable psychosocial work characteristics as a realistic existing benchmark. Using the population attributable fraction method we estimated the potentially amenable sickness absence from improving work-group psychosocial characteristics.

RESULTS

Data from 3992 eligible participants from 29 work groups were analyzed (39% participation rate, average age 41.4 years (SD = 10.3 years), 89.9% males and 49% manual workers.). Work-group absence rates at follow up varied from 2.1 to 8.9% (mean 5.1%, 11.7 missed days). A prediction model of seven psychosocial work characteristics at the work group level explained 70% of the variance of future absence rates. The estimated reduction from improving psychosocial work characteristics to the benchmark level amounted to 32% of all sickness absence, compared to a 31% reduction from eliminating health behavioral and medical risk factors to the benchmark target.

CONCLUSIONS

Psychosocial characteristics at the work-group level account for a relevant proportion of all sickness absence. Health promotion interventions should therefore address psychosocial characteristics at the work group level.

Associations of sustained smoking and smoking cessation with work-related outcomes: a longitudinal analysis

Purpose

The aim of this study was to assess the association between sustained smoking and quitting with work-related outcomes among older workers.

Methods

We categorized a sample of older employees into non-smokers, sustained smokers and quitters. Multivariable regression models were used to test longitudinal associations of sustained smoking and smoking cessation with sickness absence, productivity loss and work ability.

Results

We included 3612 non-smokers, 673 sustained smokers and 246 quitters. Comparing sustained smokers to non-smokers, we found higher (but not statistically significant) sickness absence for sustained smokers [1.01, 95% confidence interval (CI) − 0.16–2.17]. We did not find differences in productivity loss (OR 0.82, 95% CI 0.60–1.13) and work ability (0.05, 95% CI −0.05–0.15). For employees with a relatively high physical health at baseline, comparing quitters to sustained smokers, we found higher (but not statistically significant) productivity loss for quitters (OR 2.23, 95% CI 0.94–5.31), and no difference in sickness absence (0.10, 95% CI − 2.67–2.87), and work ability (− 0.10, 95% CI −  0.36–0.16). For employees with a relatively low physical health at baseline, comparing quitters to sustained smokers, we found a statistically significant lower work ability (− 0.31, 95% CI − 0.57–0.05), and no difference in sickness absence (2.53, 95% CI − 1.29–6.34) and productivity loss (OR 1.26, 95% CI 0.66–2.39).

Conclusions

We found no evidence that sustained smokers have less favorable work-related outcomes than non-smokers or that quitters have more favorable work-related outcomes than sustained smokers. The benefits of smoking cessation for employers might take a longer time to develop.

Interventions to improve return to work in depressed people

BACKGROUND

Work disability such as sickness absence is common in people with depression.

OBJECTIVES

To evaluate the effectiveness of interventions aimed at reducing work disability in employees with depressive disorders.

SEARCH METHODS

We searched CENTRAL (The Cochrane Library), MEDLINE, Embase, CINAHL, and PsycINFO until April 4th 2020.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) and cluster-RCTs of work-directed and clinical interventions for depressed people that included days of sickness absence or being off work as an outcome. We also analysed the effects on depression and work functioning.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted the data and rated the certainty of the evidence using GRADE. We used standardised mean differences (SMDs) or risk ratios (RR) with 95% confidence intervals (CI) to pool study results in studies we judged to be sufficiently similar.  MAIN RESULTS: In this update, we added 23 new studies. In total, we included 45 studies with 88 study arms, involving 12,109 participants with either a major depressive disorder or a high level of depressive symptoms. Risk of bias The most common types of bias risk were detection bias (27 studies) and attrition bias (22 studies), both for the outcome of sickness absence. Work-directed interventions Work-directed interventions combined with clinical interventions A combination of a work-directed intervention and a clinical intervention probably reduces days of sickness absence within the first year of follow-up (SMD -0.25, 95% CI -0.38 to -0.12; 9 studies; moderate-certainty evidence). This translates back to 0.5 fewer (95% CI -0.7 to -0.2) sick leave days in the past two weeks or 25 fewer days during one year (95% CI -37.5 to -11.8). The intervention does not lead to fewer persons being off work beyond one year follow-up (RR 0.96, 95% CI 0.85 to 1.09; 2 studies, high-certainty evidence). The intervention may reduce depressive symptoms (SMD -0.25, 95% CI -0.49 to -0.01; 8 studies, low-certainty evidence) and probably has a small effect on work functioning (SMD -0.19, 95% CI -0.42 to 0.06; 5 studies, moderate-certainty evidence) within the first year of follow-up.  Stand alone work-directed interventions A specific work-directed intervention alone may increase the number of sickness absence days compared with work-directed care as usual (SMD 0.39, 95% CI 0.04 to 0.74; 2 studies, low-certainty evidence) but probably does not lead to more people being off work within the first year of follow-up (RR 0.93, 95% CI 0.77 to 1.11; 1 study, moderate-certainty evidence) or beyond (RR 1.00, 95% CI 0.82 to 1.22; 2 studies, moderate-certainty evidence). There is probably no effect on depressive symptoms (SMD -0.10, 95% -0.30 CI to 0.10; 4 studies, moderate-certainty evidence) within the first year of follow-up and there may be no effect on depressive symptoms beyond that time (SMD 0.18, 95% CI -0.13 to 0.49; 1 study, low-certainty evidence). The intervention may also not lead to better work functioning (SMD -0.32, 95% CI -0.90 to 0.26; 1 study, low-certainty evidence) within the first year of follow-up.   Psychological interventions A psychological intervention, either face-to-face, or an E-mental health intervention, with or without professional guidance, may reduce the number of sickness absence days, compared with care as usual (SMD -0.15, 95% CI -0.28 to -0.03; 9 studies, low-certainty evidence). It may also reduce depressive symptoms (SMD -0.30, 95% CI -0.45 to -0.15, 8 studies, low-certainty evidence). We are uncertain whether these psychological interventions improve work ability (SMD -0.15 95% CI -0.46 to 0.57; 1 study; very low-certainty evidence). Psychological intervention combined with antidepressant medication Two studies compared the effect of a psychological intervention combined with antidepressants to antidepressants alone. One study combined psychodynamic therapy with tricyclic antidepressant (TCA) medication and another combined telephone-administered cognitive behavioural therapy (CBT) with a selective serotonin reuptake inhibitor (SSRI). We are uncertain if this intervention reduces the number of sickness absence days (SMD -0.38, 95% CI -0.99 to 0.24; 2 studies, very low-certainty evidence) but found that there may be no effect on depressive symptoms (SMD -0.19, 95% CI -0.50 to 0.12; 2 studies, low-certainty evidence). Antidepressant medication only Three studies compared the effectiveness of SSRI to selective norepinephrine reuptake inhibitor (SNRI) medication on reducing sickness absence and yielded highly inconsistent results. Improved care Overall, interventions to improve care did not lead to fewer days of sickness absence, compared to care as usual (SMD -0.05, 95% CI -0.16 to 0.06; 7 studies, moderate-certainty evidence). However, in studies with a low risk of bias, the intervention probably leads to fewer days of sickness absence in the first year of follow-up (SMD -0.20, 95% CI -0.35 to -0.05; 2 studies; moderate-certainty evidence). Improved care probably leads to fewer depressive symptoms (SMD -0.21, 95% CI -0.35 to -0.07; 7 studies, moderate-certainty evidence) but may possibly lead to a decrease in work-functioning (SMD 0.5, 95% CI 0.34 to 0.66; 1 study; moderate-certainty evidence). Exercise Supervised strength exercise may reduce sickness absence, compared to relaxation (SMD -1.11; 95% CI -1.68 to -0.54; one study, low-certainty evidence). However, aerobic exercise probably is not more effective than relaxation or stretching (SMD -0.06; 95% CI -0.36 to 0.24; 2 studies, moderate-certainty evidence). Both studies found no differences between the two conditions in depressive symptoms.

AUTHORS' CONCLUSIONS

A combination of a work-directed intervention and a clinical intervention probably reduces the number of sickness absence days, but at the end of one year or longer follow-up, this does not lead to more people in the intervention group being at work. The intervention may also reduce depressive symptoms and probably increases work functioning more than care as usual. Specific work-directed interventions may not be more effective than usual work-directed care alone. Psychological interventions may reduce the number of sickness absence days, compared with care as usual. Interventions to improve clinical care probably lead to lower sickness absence and lower levels of depression, compared with care as usual. There was no evidence of a difference in effect on sickness absence of one antidepressant medication compared to another. Further research is needed to assess which combination of work-directed and clinical interventions works best.

Night work for hospital nurses and sickness absence: a retrospective study using electronic rostering systems

There is conflicting evidence on the effect of night work on sickness absence. Most previous studies used self-reporting to identify shift patterns and measure levels of sickness absence. In contrast, this study used objective data from electronic rosters to explore the association of nurses' patterns of night work and sickness absence. This was a retrospective longitudinal study of nurse roster data from 32 general medical and surgical wards in a large acute hospital in England. We used data from 3 years and included both registered nurses and unregistered nursing assistants. We used generalized linear-mixed models to explore the association between night work and the subsequent occurrence of sickness absence. Of 601,282 shifts worked by 1944 nursing staff, 38,051 shifts were lost due to sickness absence. After controlling for potential confounders including proportion of long (≥12 h) shifts worked, proportion of overtime shifts, proportion of shifts worked in the past 7 days, and staff grade, we found that staff working more than 75% of their shifts in the past 7 days as night shifts were more likely to experience sickness absence (aOR = 1.12; 95% CI: 1.03-1.21), compared to staff working on day only schedules. Sub-group analysis found that an association between a high proportion of night shifts worked and long-term sickness (aOR = 1.31; 95% CI: 1.15-1.50), but not short-term sickness. Working high proportions of night shifts, likely representing permanent night work schedules, is associated with a higher risk of long-term sickness absence for nurses working in inpatient adult wards in acute hospitals. The higher sickness absence rates associated with permanent night shifts could result in additional costs or loss of productivity for hospitals. This study challenges the assumption that permanent night schedules maximize circadian adjustment and, therefore, reduce health problems.

Association between job strain and sick leave: a systematic review and meta-analysis of prospective cohort studies

OBJECTIVES

Sick leave imposes large costs on society, and job strain is one of the factors leading to sick leave. A systematic review and meta-analysis of longitudinal studies was conducted to address job strain and its association with sick leave.

STUDY DESIGN

This is a systematic review and meta-analysis.

METHODS

PubMed and Scopus databases were reviewed, in addition to searches in Google Scholar and ResearchGate to ensure the inclusion of any grey literature articles. After screening the studies, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses principles, articles with longitudinal design were found desirable for meta-analysis. The risk ratio (RR) and 95% confidence interval (CI) were calculated, and publication bias was examined.

RESULTS

Eighteen longitudinal cohort studies were selected. Job strain and sick leave were found to be associated, and the RR of this association was equal to 1.44. Risk of sick leave based on job strain in men and women was equal to 1.66 (95% CI: 1.15-2.40) and 1.16 (95% CI: 1.08-1.24), respectively. The results showed no publication bias as per Begg's test.

CONCLUSIONS

Job strain was associated with an increased risk of sick leave. Occupational conditions have significant effects on the risk of sick leave-one of which is job strain. Therefore, improving organisational conditions can have a significant impact on reducing sick leave.

Cardiorespiratory Fitness and Device-Measured Sedentary Behaviour are Associated with Sickness Absence in Office Workers

Physical activity reduces the risk of several noncommunicable diseases, and a number of studies have found self-reported physical activity to be associated with sickness absence. The aim of this study was to examine if cardiorespiratory fitness, device-measured physical activity, and sedentary behaviour were associated with sickness absence among office workers. Participants were recruited from two Swedish companies. Data on sickness absence (frequency and duration) and covariates were collected via questionnaires. Physical activity pattern was assessed using ActiGraph and activPAL, and fitness was estimated from submaximal cycle ergometry. The sample consisted of 159 office workers (67% women, aged 43 ± 8 years). Higher cardiorespiratory fitness was significantly associated with a lower odds ratio (OR) for both sickness absence duration (OR = 0.92, 95% confidence interval (CI) 0.87-0.96) and frequency (OR = 0.93, 95% CI 0.90-0.97). Sedentary time was positively associated with higher odds of sickness absence frequency (OR = 1.03, 95% CI 0.99-1.08). No associations were found for physical activity at any intensity level and sickness absence. Higher sickness absence was found among office workers with low cardiorespiratory fitness and more daily time spent sedentary. In contrast to reports using self-reported physical activity, device-measured physical activity was not associated with sickness absence.

Millennials: sickness presenteeism and its correlates: a cross-sectional online survey

OBJECTIVE

Sickness presenteeism (SP) is a well-documented phenomenon in the current workforce. However, little is known about the SP of future employees (Millennials). We investigated rate and propensity of presenteeism and health-related and work-related correlates in university students to obtain information about the relevance of SP in the future workforce. Sickness presenteeism (SP) refers to going towork while ill.¹ DESIGN AND SETTING: We administered a cross-sectional online survey in August 2018 involving self-assessments of health-related and work-related behaviour. As planned, we analysed rates, instances and propensities of presenteeism and absenteeism. The target population was Millennial university students.

RESULTS

749 German university students, average age 24.7±3.6 years, 49.5% women, mean academic progress 4.5±2.7 semesters, <1% without work experience, 15.4±10.3 mean weekly working hours. Presenteeism rates in the complete sample were 64% at school and 60.4% at work. For the subsample of participants who reported sickness, presenteeism rates were 87.9% at school and 87% at work. Presenteeism propensity among them was 0.67±0.34 at school and 0.68±0.35 at work. SP at school and at work was significantly correlated with subjective health (r=0.29, p=0.000 and r=0.25, p=0.000) and locus of control (r=-0.20, p=0.000 and r=-0.26, p=0.000). Age and sex adjusted multiple regression analysis showed that subjective health explained 9.7% of the variance in SP at school (B=0.049, p=0.000) and 8.1% of the variance in SP at work (B=0.037, p=0.000).

CONCLUSIONS

The SP rates of the future workforce were in line with previous research on older employees, whereas the presenteeism propensities we found here were higher. Across all analyses, subjective health proved to be associated with presenteeism. Thus, the relevance of SP will remain constant or might even increase with regard to the future workforce. Programmes offering health education should be implemented to sensitise this generation as early as possible.

Joint effect of paid working hours and multiple job holding on work absence due to health problems among basic education teachers in Brazil: the Educatel Study

The objectives were to assess the joint effect of working hours paid per week and multiple job holding on sickness absence, by sex, among basic education teachers in Brazil. This study is based on a survey carried out over a representative sample of 5,116 active basic education teachers in Brazil between 2015 and 2016 (Educatel Study). We created a dummy variable to assess the joint effect of weekly paid working hours [standard (35-40 hours); part-time (< 35 hours); moderately long (41-50 hours); and very long (> 50 hours)] and multiple job holding (working in several schools - no/yes). Working 35-40 hours in one school was the reference category. We conducted Poisson regression models with robust variance to obtain prevalence ratios (PR) and 95% confidence intervals (95%CI) of the association with self-certified sickness absence and medically certified sickness absence. Models were adjusted for age, type of contract and salary, and stratified by sex. Significant associations with sickness absence were only found among teachers working in more than one school. Associations with self-certified sickness absence were found among women with standard and men with moderately long working hours, and for both women and men working > 50 hours (PR: 1.21, 95%CI: 1.09-1.35; PR: 1.40, 95%CI: 1.18-1.66; respectively). Associations with medically certified sickness absence were found among teachers working > 50 hours, among women (PR: 1.30, 95%CI: 1.03-1.63) and men (PR: 1.41, 95%CI: 1.04-1.92). Teachers working longer hours in several schools could be suffering health problems, deriving in work absence.

Workplace Interventions can Reduce Sickness Absence for Persons With Work-Related Neck and Upper Extremity Disorders: A One-Year Prospective Cohort Study

OBJECTIVE

The objective of this study was to investigate whether workplace interventions are effective in reducing sickness absence in persons with work-related neck and upper extremity disorders and whether disorder improvement after intervention reduces sickness absence.

METHODS

This study was a prospective cohort study of workers with work-related neck pain or upper extremity disorders. Data were obtained from the Swedish "Work-related disorders" and "Work environment" surveys. Register data on sickness-absence 1 year after the surveys were made and obtained from the Swedish health insurance database.

RESULTS

A significant lower number of sickness-absence days were found for workers reporting improvement after intervention.

CONCLUSION

The findings in this study suggest that workplace intervention can reduce sickness absence for workers with neck or upper extremity disorders only if the intervention improves the disorder. The interventions were most effective in reducing medium long sickness absence periods.

Improving office workers' mental health and cognition: a 3-arm cluster randomized controlled trial targeting physical activity and sedentary behavior in multi-component interventions

BACKGROUND

Physically inactive and sedentary lifestyles are negatively related to both mental health and cognition. For office-workers, who spend two-thirds of their workday sitting, it is important to improve these lifestyles. The aim of this study is to assess the effectiveness of multi-component interventions, incorporating individual, environmental and organizational changes, to increase physical activity or reduce sedentary behavior among office-workers in order to improve mental health and cognition.

METHODS

a 3-arm, clustered randomized controlled trial (RCT) with waiting list control group amongst adult office-workers of two large Swedish companies. Cluster teams will be randomized into 6-month interventions or to a passive waiting list control group which will receive the allocated intervention with a 6-month delay. Two multicomponent interventions will be studied of which one focuses on improving physical activity and the other on reducing sedentary behavior. Both interventions include 5 sessions of motivational counselling. In the physical activity intervention persons also get access to a gym and team leaders will organize lunch walks and encourage to exercise. In the sedentary behavior intervention standing- and walking meetings will be implemented and team leaders will encourage to reduce sitting. The recruitment target is 110 office-workers per arm (330 in total). Measurements will be repeated every 6 months for a total intended duration of 24 months. Proximal main outcomes are physical activity measured with accelerometers and sedentary behavior with inclinometers. Distal outcomes are self-reported mental health and a cognition test battery. Additional outcomes will include cardiovascular fitness, body composition, sleep, self-reported physical activity and sedentary behavior, other health habits, physical health, and working mechanisms from blood samples and questionnaires.

DISCUSSION

This cluster RCT will contribute to the currently available evidence by comparing the effectiveness of multi-component interventions targeting physical activity or sedentary behavior with the end goal of improving mental health and cognition. This study is strong in its cluster randomized design, numerous objective outcome measures and long-term follow-up. The exact content of the interventions has been defined by combining theory with results from a larger research project as well as having a continuous dialogue with the involved companies.

TRIAL REGISTRATION

ISRCTN92968402 .

Relationships Between Aerobic Fitness Levels and Cognitive Performance in Swedish Office Workers

Objectives: Aerobic exercise influence cognition in elderly, children, and neuropsychiatric populations. Less is known about the influence of aerobic exercise in healthy samples (particularly working age), and of different fitness levels on cognition. Two hypotheses were posed: (1) low fitness levels, compared to moderate and high, will be related to poorer cognitive performance, and (2) breakpoints for the beneficial relationship between VO₂ and cognition will be observed within the moderate-to-high fitness span.

Design and Methods: The sample consisted of n=362 office workers. A submaximal cycle ergometer test estimated maximal oxygen consumption (VO_2max, mL·kg⁻¹·min⁻¹). Based on estimated VO_2max participants were split into tertiles; low (n = 121), moderate (n = 119), and high (n = 122). A cognitive test battery (9 tests), assessed processing speed, working memory, executive functions and episodic memory.

Results: Both hypotheses were confirmed. Groups of moderate (≈40) and high (≈49) fitness outperformed the group of low (≈31) fitness for inhibition and episodic recognition, whereas no significant differences between moderate and high fitness were observed (ANCOVAs). Breakpoints between benefits fromVO_2max for inhibition and recognition were estimated to ≈44/43 mL·kg⁻¹·min⁻¹ (multivariate broken line regressions).

Conclusions: Results suggest that it is conceivable to expect a beneficial relationship between VO_2max and some cognitive domains up to a certain fitness level. In a sample of healthy office workers, this level was estimated to 44 mL·kg⁻¹·min⁻¹. This has implications on organizational and societal levels; where incentives to improve fitness levels from low to moderate could yield desirable cognitive and health benefits in adults.

Information bias of social gradients in sickness absence: a comparison of self-report data in the Norwegian Mother and Child Cohort Study (MoBa) and data in national registries

Background

Measurement error in self-report questionnaires is a common source of bias in epidemiologic studies. The study aim was to assess information bias of the educational gradient in sickness absence among participants in the Norwegian Mother and Child Cohort Study (MoBa), comparing self-report data with national register data.

Methods

MoBa is a national prospective cohort study. The present study included 49,637 participants, born 1967–1976, who gave birth 2000–2009. The highest completed education level was recorded in categories and as educational years. Sickness absence was defined as one or more spell lasting more than 16 days between pregnancy weeks 13 and 30. We computed sickness absence risk in mid-pregnancy in strata of education level. Associations between completed educational years and sickness absence were estimated as risk differences in binomial regression and compared between self-report and register data. In additional analyses, we aimed to explain discrepancies between estimates from the two data sources.

Results

The overall registry-based sickness absence risk was 0.478 and decreased for increasingly higher education in a consistent fashion, yielding an additive risk difference in association with one additional education year of − 0.032 (95% confidence interval − 0.035 to − 0.030). The self-report risk was lower (0.307) with a corresponding risk difference of only − 0.013 (95% confidence interval − 0.015 to − 0.011). The main explanation of the lower risk difference in the self-report data was a tendency for mothers in low education categories to omit reporting sickness absence in the questionnaire.

Conclusions

A plausible explanation for the biased self-report association is complexity of the sickness absence question and a resulting educational gradient in non-response. As shown for sickness absence in mid-pregnancy in the present study, national registries could be a preferred alternative to self-report questionnaires.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6208-9) contains supplementary material, which is available to authorized users.

Sickness presenteeism as coping behaviour under conditions of high job control

Job control – denoting an employee’s decision authority regarding timing, location or method – plays a key role in occupational research and is typically viewed as a positive resource that helps to buffer negative health effects induced by work demands. Moreover, previous research has suggested that higher job control helps to reduce sickness presenteeism of employees – defined as attending work while ill. Conversely, by considering various theoretical approaches (such as the vitamin model and the ‘entreployee’ concept) it is hypothesized that very high levels of job control may increase sickness presence behaviour of employees as a coping strategy aimed at overcoming a perceived threat of productivity loss due to sickness. As a consequence, a u-shaped curvilinear association between job control and sickness presenteeism is expected – especially for vulnerable individuals. Based on survey data collected from a heterogeneous random sample of 532 employees, a curvilinear association between job control and sickness presenteeism is confirmed, which is amplified for individuals with a higher number of days with sickness. It is concluded that an increase in job control at low or moderate levels is associated with reduced sickness presenteeism, whereas very high levels of job control are related to an increased need for sickness presence.

Are long nursing shifts on hospital wards associated with sickness absence? A longitudinal retrospective observational study

Objective

To investigate whether working 12 hr shifts is associated with increased sickness absence among registered nurses and health care assistants.

Background

Previous studies reported negative impacts on nurses’ 12 hr shifts; however, these studies used cross‐sectional techniques and subjective nurse‐reported data.

Methods

A retrospective longitudinal study using routinely collected data across 32 general inpatient wards at an acute hospital in England. We used generalized linear mixed models to explore the association between shift patterns and the subsequent occurrence of short (<7 days) or long‐term (≥7 days) sickness absence.

Results

We analysed 601,282 shifts and 8,090 distinct episodes of sickness absence. When more than 75% of shifts worked in the past 7 days were 12 hr in length, the odds of both a short‐term (adjusted odds ratio = 1.28; 95% confidence index: 1.18–1.39) and long‐term sickness episode (adjusted odds ratio = 1.22; 95% confidence index: 1.08–1.37) were increased compared with working none.

Conclusion

Working long shifts on hospital wards is associated with a higher risk of sickness absence for registered nurses and health care assistants.

Implications for Nursing Management

The higher sickness absence rates associated with long shifts could result in additional costs or loss of productivity for hospitals. The routine implementation of long shifts should be avoided.

Musculoskeletal Disorders as Common Problems among Iranian Nurses: A Systematic Review and Meta-analysis Study

BACKGROUND

Considering the importance of musculoskeletal disorders (MSDs) as one of the health consequences of job stress among nurses and significant contradictions in prevalence in different parts of the body, this study was carried out to determine the prevalence of MSDs among Iranian nurses.

METHODS

All published studies from June 2000 until June 2015 were considered in reliable databases such as PubMed, Google Scholar, Google search, Scopus, ScienceDirect, and Persian databases such as SID, Iran Medex, and Magiran. These studies, after quality control, were entered into meta-analysis using the random effects model, a total of 41 papers were assessed between 2004 and 2015.

RESULTS

The prevalence rate of these disorders was 60.98%, 47.76%, 46.53%, 44.64%, 42.8%, 36.8%, 24.61%, and 17.5%, respectively, obtained for the back, neck, knees, upper back, ankles, shoulders, hands, hips, thighs, and elbows. Prevalence of MSDs will lead to high costs of medical, absenteeism from work, or even unemployment.

CONCLUSIONS

Due to high prevalence of these disorders among Iranian nurses, providing effective training in the field of ergonomics and undergoing appropriate exercises are necessary to control it.

Age differences in the association between stressful work and sickness absence among full-time employed workers: evidence from the German socio-economic panel

Purpose

We aim to extend current knowledge on associations between stressful work and sickness absence, first, by studying associations between ERI and sickness absence among full-time employees from various occupations, and second, by investigating if associations vary by age.

Methods

We use data from four waves of the German socio-economic panel (GSOEP), collected among men and women between 2006 and 2012, with 9418 observations. Stressful work is measured with a short form of the ERI questionnaire. We investigate an imbalance between effort and reward (ER ratio) as well as the two main components (“high effort” and “low reward”). Sickness absence is measured by self-reported number of sickness days (assessed the following year). After descriptive analyses, we estimate a series of multivariable regressions, including tests for interactions between age and work stress.

Results

Each of the three indicators of stressful work is related to higher number of sickness days, with except of “high effort” in case of men. Findings remain significant after adjusting for social position (income, education and occupational class) and health. In addition, for both men and women, associations were slightly higher among older workers, though interactions did not reach statistical significance.

Conclusion

Our findings support that stressful work is linked to sickness absence across a wide spectrum of jobs with varying incomes and educational levels, and also that associations are slightly more pronounced among older workers.

Electronic supplementary material

The online version of this article (10.1007/s00420-018-1298-3) contains supplementary material, which is available to authorized users.

Associations Between Supportive Leadership Behavior and the Costs of Absenteeism and Presenteeism: An Epidemiological and Economic Approach

OBJECTIVE

This study investigates associations between supportive leadership behavior (SLB) and presenteeism/absenteeism, and estimates related costs.

METHODS

Cross-sectional data from a German industrial sample (n = 17,060) assessing SLB and presenteeism/absenteeism were used. Adjusted interval regressions were performed. The study population was split into tertiles with respect to SLB, and minimum and maximum costs for each tertile were estimated on the basis of national industry averages.

RESULTS

Low SLB was associated with higher presenteeism [-0.31, 95% confidence interval (95% CI) -0.33 to -0.28)] and absenteeism (-0.36, 95% CI -0.40 to -0.32). Compared with high SLB, the costs of low SLB for absenteeism are between 534.54 and 1675.16 Euro higher per person and year. For presenteeism, this difference ranges between 63.76 and 433.7 Euro.

CONCLUSIONS

SLB has the potential to reduce absenteeism, presenteeism, and associated costs. To contribute to workforce health, productivity, and efficiency, SLB merits being fostered by corporate policy.

[Occupational risks during pregnancy: Feedback from occupational medical services]

OBJECTIVES

To describe the follow-up of pregnancies at work and exposures to pregnancy occupational hazards.

METHODS

A cross-sectional study was performed between January and December 2014 in occupational health services of Languedoc-Roussillon region. Eligible workers were interviewed by occupational health physicians (OHPs) after delivery and at the time of returning to work (exposure, anticipation, prevention, communication, sick leave). Occupational skill levels were classified according to the French standard classification of occupations (version 2003) from the French National Institute of Statistics. Socioeconomic deprivation was assessed using the Evaluation of Deprivation and Inequalities in Health Examination (EPICES) individual scale.

RESULTS

A total of 1347 workers were recruited. The mean age was at 30.7±4.5 years. Among pregnant workers, there were 54.2% of employees, 30.7% of intermediate occupations, 10.4% of managers and, 4.7% of manual workers. Twenty-two percent of workers were classed as deprived. Also, 43.2% of workers were exposed to three or more occupational hazards during pregnancy. Only 17.7% of workers had medical visits with OHP during pregnancy and 14.7% benefited from workstation adjustments. In contrast, the level of sick leaves was high (74.2%).

CONCLUSION

Our results argue for the need to follow pregnancies at work. However, the low level of prevention activities and the high level of sick leaves raise the question of the management of pregnant women at work.

[Teacher sick leave: Prevalence, duration, reasons and covariates]

BACKGROUND

Absences from work have considerable social and economic impact. In the education sector, the phenomenon is particularly worrying since teacher sick leave has an impact on the overall performance of the education system. Yet, available data are scarce.

METHODS

In April-June 2013, 2653 teachers responded to a population-based postal survey on their quality of life (enquête Qualité de vie des enseignants, MGEN Foundation/Ministry of education, response rate 53 %). Besides questions on work environment and health, teachers were asked to describe their eventual sick leave(s) since the beginning of the school year: duration, type and medical reasons. Self-reported information was reinforced by administrative data from ministerial databases and weighted to be extrapolated to all French teachers. Tobit models adjusted for individual factors of a private nature were used to investigate different occupational risk factors of teacher sick leave, taking into account both the estimated effect on the probability of sick leave and the length of it.

RESULTS

More than one in three teachers (36 %) reported having had at least one day of sick leave since the beginning of the school year. Respiratory/ENT diseases were the leading reason for sick leave (37 %). However, and because sick leave duration depended on the underlying health problem, such diseases came in third place among justifications of sick leave days (14 %), far behind musculoskeletal problems (27 %) and neurological and psychological disorders (25 %). Tobit models suggested that some occupational factors significantly associated with the risk of sick leave may represent promising preventive targets, including high psychological demand, workplace violence and unfavorable socio-environmental context.

CONCLUSION

Our study provides objective evidence about the issue of sick leave among French teachers, highlighting the usefulness of implementing actions to minimize its weight. To this end, the study findings point-out the importance of considering not only the probability of sick leave, but also its duration.

Interactional justice at work is related to sickness absence: a study using repeated measures in the Swedish working population

Background

Research has shown that perceived unfairness contributes to higher rates of sickness absence. While shorter, but more frequent periods of sickness absence might be a possibility for the individual to get relief from high strain, long-term sickness absence might be a sign of more serious health problems. The Uncertainty Management Model suggests that justice is particularly important in times of uncertainty, e.g. perceived job insecurity. The present study investigated the association between interpersonal and informational justice at work with long and frequent sickness absence respectively, under conditions of job insecurity.

Methods

Data were derived from the 2010, 2012, and 2014 biennial waves of the Swedish Longitudinal Occupational Survey of Health (SLOSH). The final analytic sample consisted of 19,493 individuals. We applied repeated measures regression analyses through generalized estimating equations (GEE), a method for longitudinal data that simultaneously analyses variables at different time points. We calculated risk of long and frequent sickness absence, respectively in relation to interpersonal and informational justice taking perceptions of job insecurity into account.

Results

We found informational and interpersonal justice to be associated with risk of long and frequent sickness absence independently of job insecurity and demographic variables. Results from autoregressive GEE provided some support for a causal relationship between justice perceptions and sickness absence. Contrary to expectations, we found no interaction between justice and job insecurity.

Conclusions

Our results underline the need for fair and just treatment of employees irrespective of perceived job insecurity in order to keep the workforce healthy and to minimize lost work days due to sickness absence.

Electronic supplementary material

The online version of this article (10.1186/s12889-017-4899-y) contains supplementary material, which is available to authorized users.

Quebec Serve and Protect Low Back Pain Study: A Web-based Cross-sectional Investigation of Prevalence and Functional Impact Among Police Officers

STUDY DESIGN

Web-based cross-sectional study.

OBJECTIVE

The aim of this study was to describe the prevalence and the burden of low back pain (LBP) and chronic low back pain (CLBP) among Quebec police officers.

SUMMARY OF BACKGROUND DATA

Police officers have work-related factors associated with LBP, but chronicity and impacts of this condition have been little explored among this population.

METHODS

Between May and October 2014, a web-based cross-sectional study was conducted among police officers working in the province of Quebec (Canada). Nine police organizations accepted to disseminate the email invitation to their members. The survey included the French-Canadian version of the Nordic Musculoskeletal Questionnaire and other items regarding functional impact of LBP and associated treatments.

RESULTS

A total of 3589 police officers completed the questionnaire. Mean age was 38.5 ± 8.7 years, 32.0% were women, and 67.4% reported being car-patrol officers. A majority reported LBP symptoms in the past 12 months (67.7%) and 96.5% of them perceived that presence of LBP was totally/partially linked to their work in the police force. Prevalence of CLBP among all responders was 28.7%. Police officers reporting CLBP, as compared to those reporting acute or subacute LBP symptoms in the past 12 months, were more likely to report LBP-related reduction of work activities (64.4% vs. 45.7%; P < 0.001) and more working days lost in the past 12 months (average of 11.9 ± 43.5 vs. 1.5 ± 9.8; P < 0.001). A greater proportion also reported LBP-related health care visits in the past 12 months (86.2% vs. 64.2%; P < 0.001) and current use of pain medications/complementary alternative medicines (90.1% vs. 69.7%; P < 0.001).

CONCLUSION

CLBP is a frequent and burdensome condition among Quebec police officers. Our results underline the importance for police organizations to promote CLBP prevention and to implement workplace management programs.

LEVEL OF EVIDENCE

3.

Association of Burnout with Workforce-Reducing Factors among EMS Professionals

OBJECTIVES

Emergency medical services (EMS) professionals often work long hours at multiple jobs and endure frequent exposure to traumatic events. The stressors inherent to the prehospital setting may increase the likelihood of experiencing burnout and lead providers to exit the profession, representing a serious workforce and public health concern. Our objectives were to estimate the prevalence of burnout, identify characteristics associated with experiencing burnout, and quantify its relationship with factors that negatively impact EMS workforce stability, namely sickness absence and turnover intentions.

METHODS

A random sample of 10,620 emergency medical technicians (EMTs) and 10,540 paramedics was selected from the National EMS Certification database to receive an electronic questionnaire between October, 2015 and November, 2015. Using the validated Copenhagen Burnout Inventory (CBI), we assessed burnout across three dimensions: personal, work-related, and patient-related. We used multivariable logistic regression modeling to identify burnout predictors and quantify the association between burnout and our workforce-related outcomes: reporting ten or more days of work absence due to personal illness in the past 12 months, and intending to leave an EMS job or the profession within the next 12 months.

RESULTS

Burnout was more prevalent among paramedics than EMTs (personal: 38.3% vs. 24.9%, work-related: 30.1% vs. 19.1%, and patient-related: 14.4% vs. 5.5%). Variables associated with increased burnout in all dimensions included certification at the paramedic level, having between five and 15 years of EMS experience, and increased weekly call volume. After adjustment, burnout was associated with over a two-fold increase in odds of reporting ten or more days of sickness absence in the past year. Burnout was associated with greater odds of intending to leave an EMS job (personal OR:2.45, 95% CI:1.95-3.06, work-related OR:3.37, 95% CI:2.67-4.26, patient-related OR: 2.38, 95% CI:1.74-3.26) or the EMS profession (personal OR:2.70, 95% CI:1.94-3.74, work-related OR:3.43, 95% CI:2.47-4.75, patient-related OR:3.69, 95% CI:2.42-5.63).

CONCLUSIONS

The high estimated prevalence of burnout among EMS professionals represents a significant concern for the physical and mental well-being of this critical healthcare workforce. Further, the strong association between burnout and variables that negatively impact the number of available EMS professionals signals an important workforce concern that warrants further prospective investigation.

Exposure to occupational hazards for pregnancy and sick leave in pregnant workers: a cross-sectional study

Background

This study aimed to investigate the association between exposure to occupational hazards for pregnancy and sick leave (SL) in pregnant workers.

Methods

A cross-sectional study was performed in French occupational health services in 2014. Occupational hazards for pregnancy were assessed by occupational health physicians (OHPs). After delivery and at the time of returning to work, 1,495 eligible workers were interviewed by OHPs. Information on SL was self-reported. Risk ratios (RRs) were calculated from multivariable analyses based on a generalized linear model with a Bernoulli distribution and a log link adjusted for selected confounders for binary outcomes or zero-inflated negative binomial regression for count outcomes.

Results

Among recruited workers, 74.9% presented “at least one SL” during pregnancy. After adjustment, the cumulative index of occupational hazards (0, 1–2, 3–4, ≥ 5 risks) for pregnancy was significantly associated with “at least one SL” during pregnancy in a dose–response relationship. This gradient was also observed with “early SL” (<15 week gestation): from 1 to 2 risks, RR = 1.48 (95% confidence intervals (CIs): 0.92-2.38); from 3 to 4 risks, RR = 2.03 (95% CI: 1.25-3.30); equal to or higher than five risks, RR = 2.90 (95% CI: 1.89-4.44); with “duration of absence” (adjusted mean): from 1 to 2 risks, m = 38.6 days; from 3 to 4 risks, m = 46.8 days; equal to or higher than five risks, m = 53.8 days. We also found that deprivation, pregnancy at risk, assisted reproductive therapy, work-family conflicts, home-work commuting felt as difficult and young age are associated with a higher risk of SL.

Conclusions

Our results support the assertion that pregnant workers exposed to occupational hazards for pregnancy without medical complications are also at risk of taking SL during pregnancy. More prevention in the workplace for pregnant workers exposed to occupational hazards could reduce SL.

Active Commuting: Workplace Health Promotion for Improved Employee Well-Being and Organizational Behavior

Objective: This paper describes a behavior change intervention that encourages active commuting using electrically assisted bikes (e-bikes) for health promotion in the workplace. This paper presents the preliminary findings of the intervention’s impact on improving employee well-being and organizational behavior, as an indicator of potential business success.

Method: Employees of a UK-based organization participated in a workplace travel behavior change intervention and used e-bikes as an active commuting mode; this was a change to their usual passive commuting behavior. The purpose of the intervention was to develop employee well-being and organizational behavior for improved business success. We explored the personal benefits and organizational co-benefits of active commuting and compared these to a travel-as-usual group of employees who did not change their behavior and continued taking non-active commutes.

Results: Employees who changed their behavior to active commuting reported more positive affect, better physical health and more productive organizational behavior outcomes compared with passive commuters. In addition, there was an interactive effect of commuting mode and commuting distance: a more frequent active commute was positively associated with more productive organizational behavior and stronger overall positive employee well-being whereas a longer passive commute was associated with poorer well-being, although there was no impact on organizational behavior.

Conclusion: This research provides emerging evidence of the value of an innovative workplace health promotion initiative focused on active commuting in protecting and improving employee well-being and organizational behavior for stronger business performance. It considers the significant opportunities for organizations pursuing improved workforce well-being, both in terms of employee health, and for improved organizational behavior and business success.

Improving Access to Mental Health Care by Delivering Psychotherapeutic Care in the Workplace: A Cross-Sectional Exploratory Trial

OBJECTIVE

Common mental disorders like mood and anxiety disorders and somatoform disorders have high costs, yet under-treatment is still frequent. Many people with common mental disorders are employed, so the workplace is potentially a suitable context in which to provide early treatment. Our study investigates whether a change of setting (workplace versus standard care) improves access to treatment for common mental disorders.

METHODS

Conditional latent profile analysis was applied to identify user profiles for work ability (WAI), clinical symptoms like depression (patient health questionnaire depression, PHQ-9), health-related quality of life (QoL, SF-12), and work-related stress (Maslach Burnout Inventory, irritation scale). Patients were recruited consecutively, via psychotherapeutic consultation in the workplace (n = 174) or psychotherapeutic consultation in outpatient care (n = 193).

RESULTS

We identified four user profiles in our model: 'severe' (n = 99), 'moderate I-low QoL' (n = 88), 'moderate II-low work ability' (n = 83), and 'at risk' (n = 97). The 'at risk' profile encompassed individuals with reduced work ability (36.0, 34.73 to 37.37), only mild clinical symptoms (PHQ-9 5.7, 4.92 to 6.53), no signs of work-related stress and good quality of life. A higher proportion of the 'at risk' group than of the 'severe' group sought help via the psychotherapeutic consultation in the workplace (OR 0.287, P < 0.01); this effect remained after controlling for gender.

CONCLUSIONS

Offering secondary mental health care in the workplace is feasible and accepted by users. Offering treatment in the workplace as an alternative to standard outpatient settings is a viable strategy for improving access to treatment for common mental disorders.

Workplace Outcomes in Work-Disability Prevention Research: A Review with Recommendations for Future Research

Introduction Outcome assessment is a central issue in work disability prevention research. The goal of this paper was to (1) ascertain the most salient workplace outcomes; (2) evaluate the congruence between business and science perspectives; (3) illustrate new perspectives on assessing longitudinal outcomes; and (4) provide recommendations for advancing outcome evaluation in this area of research. Methods The authors participated in a year-long collaboration that culminated in a sponsored 3-day conference, "Improving Research of Employer Practices to Prevent Disability", held October 14-16, 2015, in Hopkinton, MA, USA. The collaboration included a topical review of the literature, group conference calls to identify key areas and challenges, drafting of initial documents, review of industry publications, and a conference presentation that included feedback from peer researchers and a question/answer session with a special panel of knowledge experts with direct employer experience. Results Numerous workplace work-disability prevention outcome measures were identified. Analysis indicated that their applicability varied depending on the type of work disability the worker was experiencing. For those who were working, but with health-related work limitations (Type 1), predominant outcomes were measures of productivity, presenteeism, and work-related limitations. For those who were off work due to a health condition (Type 2), predominant outcomes were measures of time off work, supervisor/employee interactions, and return-to-work (RTW) preparation. For those who had returned to work (Type 3), predominant outcomes were measures of presenteeism, time until RTW, percentage of work resumption, employment characteristics, stigma, work engagement, co-worker interactions, and sustained or durable RTW. For those who had withdrawn from the labor force (Type 4), predominant outcomes were cost and vocational status. Discussion Currently available measures provide a good basis to use more consistent outcomes in disability prevention in the future. The research area would also benefit from more involvement of employers as stakeholders, and multilevel conceptualizations of disability outcomes.

Safety climate, worker health and organizational health performance

Purpose

The purpose of this paper is to investigate the relationship between organizational safety climate and organizational health performance outcomes (i.e. absenteeism, presenteeism, health care utilization) mediated by individual worker health. The authors used three pathways to examine this relationship: a physical pathway starting with physical safety climate and mediated by musculoskeletal disorders (MSDs), a psychosocial pathway starting with psychosocial safety climate and mediated by emotional exhaustion, and a combined pathway starting with psychosocial safety climate and mediated by both MSDs and emotional exhaustion.

Design/methodology/approach

Three mediational multilevel analyses were conducted using a sample of 8,761 employees working in 177 health care organizations.

Findings

Although the findings did not support the hypothesized physical pathway, they showed that the psychosocial pathway worked satisfactorily for two of the three health performance outcomes (absenteeism and presenteeism). The combined physical and psychosocial pathway explained differences in the third outcome: health care utilization.

Originality/value

This is one of the few studies to include both physical and psychosocial pathways that lead to employee health and organizational performance. The results underscore the importance of paying attention to psychological health and safety in the health care workplace. Not only for the psychological health of employees, but also to improve their physical health and subsequent organizational health performance.

Determinants of presenteeism prevalence and propensity: Two sides of the same coin?

Research on the determinants of sickness presence can be based on employees' number of sickness presence days or employees' propensity to "opt" for presenteeism in case of sickness. This study compares associations between potential determinants and presenteeism in cross-sectional data from a sample of Austrian employees by considering days of sickness absence and presence and an estimator for sickness-presence propensity as outcome variables. The sets of significant determinants for the number of sickness presence days and propensity were found to be overlapping, but not equivalent. Whereas determinants of the number of days can help to identify groups with high presenteeism prevalence, determinants of propensity can help to identify factors that restrict the decision process in case of sickness. With respect to possible interventions aimed at reducing presenteeism, results relating to both perspectives should be considered.

Sickness Absence and Precarious Employment: A Comparative Cross-National Study of Denmark, Finland, Sweden, and Norway

BACKGROUND

Precarious employment is a major social determinant of health and health inequalities with effects beyond the health of workers.

OBJECTIVE

To investigate the association between precarious employment and sickness absence in 4 Nordic countries, Denmark, Finland, Norway, and Sweden.

METHODS

Logistic regression analyses were conducted separately for each country on data from 4186 respondents aged 15-65 years in Denmark, Finland, Norway, and Sweden derived from the 2010 European Working Conditions Survey. Sickness absence was based on self-reports and defined as absence of seven or more day per year. Precarious employment was operationalized as a multidimensional construct of indicators. Analyses were also conducted separately for men and women.

RESULTS

The prevalence of sickness absence was lowest in Sweden (18%), and highest in Finland (28%). 3 precarious employment indicators were positively associated with sickness absence; the pattern being largely similar in the total sample. In the sex-disaggregated sample, 5 precarious employment indicators increased the likelihood of sickness absence; the pattern was heterogeneous, with women generally having significantly higher odds of sickness absence than men. "Low household income" and "sickness presenteeism" were strong predictors of sickness absence among both sexes in most of the 4 studied countries. Sickness absence varied between the Nordic countries in the sex-disaggregated analyses.

CONCLUSION

Precarious employment indicators predicted sickness absence in the Nordic countries. Findings emphasize the need to prioritize informed and monitored collective bargaining for all workers, increase working time flexibility, and improving work conditions.