Predictors of work presence--sickness absence in a salutogenic perspective.

The objective of the study was to identify determinants of work presence, i.e. factors that counteract short and/or long term sickness absence. The analyses were based on logistic regression analyses on Swedish regional survey data. Individuals who had not reported sickness absence during the preceding year were compared to on one hand individuals with short term sickness absence (< 28 days) and on the other hand with long term sickness absence (> 28 days). We found predictors of work presence in personal background as well as in work related variables. A high level of sense of coherence was found to counteract short as well as long term sickness absence. Gender specific differences were observed. Although a set of predictors common for the short and long term perspective were found the predictors in general were found to differentiate substantially with respect to short or long term sickness absence. Implications for sickness absence prevention and health promotion could be drawn from the results. Primarily different aspects of control over working situation, work satisfaction and for women a high level of sense of coherence were believed to have these implications.

Falling between two stools; how a weak co-operation between the social security and the unemployment agencies obstructs rehabilitation of unemployed sick-listed persons.

PURPOSE: To explore significant factors behind the weak co-operation between local social insurance and unemployment agencies impairing the rehabilitation of unemployed sick-listed persons. METHOD: Individual, semi-structured face-to-face interviews with main actors directly involved in the sick-listing and rehabilitation process were conducted in the year 2000. In all 39 persons were interviewed: 25 professionals (physicians, public employment and social insurance officers) and 14 clients. Data were analysed according to Grounded theory method. RESULTS: The majority of unemployed sick-listed persons were declared too sick to work and were erased from the unemployment registers. This measure weakened the incentives for co-operation between the two main rehabilitation actors. The implication was that the unemployed sick-listed persons lost the opportunity of the co-ordinated rehabilitation they were entitled to. Three significant factors behind this process were identified by the main actors: indistinct regulation of co-operation, shifting political goals over time and conflicting goals between agencies; the last factor mainly a consequence of the other two. CONCLUSIONS: The findings suggest that labour market changes and manifest political goals influence the rehabilitation efforts giving low priority to difficult-to-place individuals such as unemployed sick-listed persons. In fact, a labour market problem turns into a medical problem. The hypothesis needs further testing in quantitative studies.

Stress-related sickness absence and return to labour market in Sweden.

PURPOSE: To analyse factors influencing chances of returning to work after long-term sickness absence with a stress-related psychiatric diagnosis. Primary focus is on employer- and occupational categories as explanatory variables. METHOD: Data was collected from the regional social insurance office in the county of Värmland for 911 individuals, all with stress-related sickness absences during November in the year 2000. Logistic regressions were carried out on outcome states from long-term sickness absence on two follow-up occasions after two and three years. RESULTS: The results indicate that the employer- and occupational categories only had a minor effect on return to work after the long-term sickness absence. Age and health-related factors together with time factors seem to be more relevant in explaining return to work. CONCLUSIONS: The findings suggest that individual labour market position, as occupation, employer, branch etc, seems to be less important than expected in explaining return to work from sickness absence due to stress-related psychiatric disorders.

Insecure social relations at work and long-term sickness absence due to burnout and other mental diagnoses.

OBJECTIVE: The association between diagnosis and psychosocial work factors in a sickness absent population was examined in order to test the existence of a previously suggested hypothesis of "the burnout staircase", a seven step process prior to the long-term sickness absence due to burnout starting with reorganisations followed by insecure social bonds affecting the work situation as well as trust in oneself and others. PARTICIPANTS: The study population comprised of 2055 employed sick-listed persons (1414 women, 641 men), a sub sample derived from the 2002 national Swedish survey on health, working conditions, life situation and sick-listing. METHODS: Through multinomial logistic regression it was analysed if experiences of the different steps in the burnout staircase increased the probability of burnout compared to other medical diagnoses. RESULTS: The hypothesis was supported. The study revealed strong and significant associations between having experienced reorganisations, insecure social relations fraught with conflicts, incompatible demands, lack of trust and diminished self-esteem and burnout. This was true for both women and men. Strong and significant associations were found also between each step studied and other mental diagnoses for men. CONCLUSION: More studies are needed to further test the hypothesis.