The linkage of depressive and anxiety disorders with the expected labor market affiliation (ELMA): a longitudinal multi-state study of Danish employees.

OBJECTIVE: Depressive and anxiety disorders are prevalent among employees in general. Still, knowledge regarding the contribution of these disorders to the dynamics of the labor market in terms of working time, sickness absence, and unemployment is scarce. We aim to quantify the linkage of depressive and anxiety disorders with labor market participation using the expected labor market affiliation method (ELMA), in a large sample of Danish employees. METHODS: We combined three survey waves on occupational health with six high-quality national registers in N = 43,148 Danish employees, of which the 2012 survey contributed 29,665 person years, the 2014 survey 33,043 person years, and the 2016 survey 35,375 person years. We used the new ELMA method to estimate the multi-state transition probabilities and 2-year expected time in work, sickness absence, and unemployment. Depressive and anxiety disorders were assessed by the Major Depression Inventory and the SCL-ANX4 scales, respectively. We adjusted for multiple variables by applying inverse probability weighting in groups of gender and age. RESULTS: Depressive and anxiety disorders among employees link to reduced labor market affiliation by significantly changed transitions probabilities between the labor markets states, viewed as reduced working time by 4-51 days (in two years), increased time in sickness absence by 6-44 days (in two years), and unemployment by 6-12 days (in two years) when compared to employees without depression or anxiety disorders. The results were most pronounced for women employees and for employees with both depression and anxiety disorders. CONCLUSIONS: The study reveals detailed insight into what extent depression and anxiety disorders influence the labor market affiliation, in terms of the complex interrelation between working time, sickness absence, and unemployment. The study emphasizes the importance of preventing and handling depressive and anxiety disorders among employees for strengthening work participation.

High physical work demands have worse consequences for older workers: prospective study of long-term sickness absence among 69 117 employees.

OBJECTIVE: This study investigates the role of age for the prospective association between physical work demands and long-term sickness absence (LTSA). METHODS: We followed 69 117 employees of the general working population (Work Environment and Health in Denmark study 2012-2018), without LTSA during the past 52 weeks preceding initial interview, for up to 2 years in the Danish Register for Evaluation of Marginalisation. Self-reported physical work demands were based on a combined ergonomic index including seven different types of exposure during the working day. Using weighted Cox regression analyses controlling for years of age, gender, survey year, education, lifestyle, depressive symptoms and psychosocial work factors, we determined the interaction of age with physical work demands for the risk of LTSA. RESULTS: During follow-up, 8.4% of the participants developed LTSA. Age and physical work demands interacted (p<0.01). In the fully adjusted model, very high physical work demands were associated with LTSA with HRs of 1.18 (95% CI 0.93 to 1.50), 1.57 (95% CI 1.41 to 1.75) and 2.09 (95% CI 1.81 to 2.41) for 20, 40 and 60 years old (point estimates), respectively. Results remained robust in subgroup analyses including only skilled and unskilled workers and stratified for gender. CONCLUSION: The health consequences of high physical work demands increase with age. Workplaces should consider adapting physical work demands to the capacity of workers in different age groups.

Associations between physical and psychosocial work environment factors and sickness absence incidence depend on the lengths of the sickness absence episodes: a prospective study of 27 678 Danish employees.

OBJECTIVES: This study examined if the association between work environment factors and sickness absence (SA) depended on the inclusion or exclusion of short-term SA episodes. METHODS: We linked the 'Work Environment and Health in Denmark' survey with the 'Danish Register of Work Absences' (n=27 678). Using covariate adjusted Cox regression, we examined the associations between work environment factors and SA by changing the cut-off points for the length of the SA episodes, for example, episodes ≥1 day, ≥6 days and ≥21 days. We examined three physical work environment factors: 'Back bend or twisted', 'Lifting or carrying', 'Wet hands' and three psychosocial work environment factors: 'Poor influence', 'Role conflicts' and 'Bullying'. RESULTS: 'Back bend or twisted' and 'Lifting or carrying' had small significant HRs for SA episodes ≥1 day and large and highly significant HRs for SA episodes ≥6 days and ≥21 days. 'Wet hands' had small significant HRs for SA episodes ≥1 day for both sexes and large and highly significant HR for ≥6 days for women. HRs of all three psychosocial factors were highly significant for SA episodes ≥1 day and ≥6 days for both sexes, and 'Poor influence' and 'Role conflicts' were significant for SA episodes ≥21 days for women. CONCLUSIONS: The physical work factors had higher associations with SA when SA episodes of 1-5 days were excluded and focus was on SA episodes ≥6 days. The psychosocial work factors were strongly associated with SA both with and without SA episodes of 1-5 days included in the analyses.

The physical activity paradox revisited: a prospective study on compositional accelerometer data and long-term sickness absence.

BACKGROUND: The 'physical activity paradox' advocates that leisure physical activity (PA) promotes health while high occupational PA impairs health. However, this paradox can be explained by methodological limitations of the previous studies-self-reported PA measures, insufficient adjustment for socioeconomic confounding or not addressing the compositional nature of PA. Therefore, this study investigated if we still observe the PA paradox in relation to long-term sick absence (LTSA) after adjusting for the abovementioned limitations. METHODS: Time spent on moderate-to-vigorous physical activity (MVPA) and remaining physical behaviors (sedentary behavior, standing, light PA and time in bed) at work and in leisure was measured for 929 workers using thigh accelerometry and expressed as isometric log-ratios (ilrs). LTSA was register-based first event of ≥6 consecutive weeks of sickness absence during 4-year follow-up. The association between ilrs and LTSA was analyzed using a Cox proportional hazards model adjusted for remaining physical behaviors and potential confounders, then separately adjusting for and stratifying by education and type of work. RESULTS: During the follow-up, 21% of the workers experienced LTSA. In leisure, more relative MVPA time was negatively associated with LTSA (20% lower risk with 20 min more MVPA, p = 0.02). At work, more relative MVPA time was positively associated with LTSA (15% higher risk with 20 min more MVPA, p = 0.02). Results remained unchanged when further adjusted for or stratified by education and type of work. CONCLUSION: These findings provide further support to the 'PA paradox'.

Determinants of voluntary early retirement for older workers with and without chronic diseases: A Danish prospective study.

Aims: This study explored differences in determinants (i.e. health-related, work-related and social factors) of voluntary early retirement between older workers with and without chronic diseases in Denmark. Methods: Workers aged 56-64 years who were members of a voluntary early retirement scheme were selected from the Danish National Working Environment Survey (2008-2009) and were followed in a public register for four years. Cox regression analyses were performed separately for older workers with and without chronic disease to identify the associations between determinants and voluntary early retirement. To explore the differences between groups, an interaction term between the determinant and having a chronic disease was included in the analyses for the total population. Results: Among 1861 eligible older workers, determinants associated with a higher risk of voluntary early retirement included poorer self-rated health, more depressive symptoms, a higher physical workload, lower job satisfaction and lower influence at work. For older workers with a chronic disease (n=1185), the presence of work-family conflict was also associated with a higher risk of voluntary early retirement, whereas for those with no chronic disease (n=676), a poorer relationship with colleagues was an additional determinant. Higher emotional demands, a higher work pace and higher quantitative demands were not significantly associated with voluntary early retirement for either group. None of the interaction terms was found to be statistically significant (p>0.05). Conclusions: Determinants associated with voluntary early retirement did not significantly differ between older workers with or without a chronic disease in Denmark. We conclude that several health-related, work-related and social factors are important for prolonged labour force participation of older workers (with and without a chronic disease).

Impact of depressive symptoms on worklife expectancy: a longitudinal study on Danish employees.

OBJECTIVE: Depressive symptoms are associated with sickness absence, work disability and unemployment, but little is known about worklife expectancy (WLE). This study investigates the impact of depressive symptoms on the WLE of a large sample of Danish employees. METHODS: We used occupational health survey data of 11 967 Danish employees from 2010 and linked them with register data on salary and transfer payments from 2010 to 2015. Depressive symptoms were self-reported using the Major Depression Inventory. We used multistate data and a life table approach with Cox proportional hazard modelling to estimate the WLE of employees, expressed by time in work, unemployment and sickness absence. Separate analyses were conducted for sex and employees with a voluntary early retirement pension scheme. Using age as time axis, we used inverse probability weights to account for differences in educational level, sector, body mass index, smoking habits and loss of employment during sickness absence. RESULTS: The WLE of employees reporting depressive symptoms was shorter compared with those not reporting depressive symptoms; that is, the expected time in unemployment and sickness absence was longer, while the expected time in work was shorter. The shorter WLE was most pronounced in women; for example, a 40-year-old woman with depressive symptoms can expect 3.3 years less in work, 0.8 years more in unemployment and 0.7 years more in sickness absence. Employees with a voluntary early retirement pension scheme showed an even lower WLE. CONCLUSIONS: Our study showed a meaningful impact of depressive symptoms on the WLE of Danish employees using a multistate framework.

Comparison of exhaustion symptoms in patients with stress-related and other psychiatric and somatic diagnoses.

BACKGROUND: Several rating scales assessing stress-related symptoms of exhaustion have emerged in recent years. However, more knowledge is needed about the performance of these rating scales in patients with stress-related disorders as well as in other patient groups. With the recently developed Karolinska Exhaustion Disorder Scale (KEDS), we compared symptoms of exhaustion in different patient groups that were sorted according to diagnosis. METHODS: Patients were sampled consecutively from departments of occupational medicine (DOM) at three Danish hospitals. The total study group comprised 698 care-seeking patients (487 women). Patients with stress-related diagnoses (n = 217; the International Classification of Diseases [ICD]-10 code F43: reaction to severe stress and adjustment disorder) were compared to a diverse group of patients with a range of somatic diagnoses (n = 338) and to patients with other psychiatric diagnoses (n = 143), including subgroups with major depression disorder (n = 34; F32 and F33) and problems related to employment and unemployment (n = 99; Z56). The data were analysed using linear mixed models with the SPSS statistical program. RESULTS: The mean KEDS sum score in patients with stress-related diagnoses (29.3; SD = 8.0) was significantly higher than in patients with other psychiatric diagnoses (25.9; SD = 9.5) and in patients with somatic diagnoses (17.6; SD = 10.8). The subgroup with a major depression disorder had high mean KEDS sum scores (31.4, SD = 8.1), similar to patients with stress-related diagnoses, while the mean KEDS sum score in patients with problems related to employment and unemployment (Z56) was 23.5 (SD = 9.0). Young and old patients scored similarly on KEDS, but in patients with somatic diagnoses, female patients scored significantly higher than male patients. CONCLUSION: The symptoms of exhaustion measured with KEDS were higher in patients with stress-related diagnoses and major depression disorder than in patients with somatic diagnoses. The intermediate level of the symptoms of exhaustion that were associated with problems related to employment and unemployment, (Z56) compared to the lower level of the symptoms with somatic diagnoses, suggests that KEDS might be useful in detecting mild, prodromal states of exhaustion. This needs further investigation.

Perceived stress and sickness absence: a prospective study of 17,795 employees in Denmark.

OBJECTIVES: The aims were to examine (1) the prospective association between perceived stress and sickness absence, and if this association (2) differed by sex, and (3) was stronger when only long-term sickness absence (≥ 31 days) instead of all-length sickness absence (≥ 1 day) was included. Moreover, different cut-points for the length of the sickness absence periods were applied. METHODS: We followed respondents (10,634 women and 7161 men) from the 'Work Environment and Health in Denmark' 2014-survey for up to 18 months in the 'Register of Work Absences' from Statistics Denmark. Perceived stress was measured by a single question: "In the last 2 weeks, how often have you felt stressed?" We used Cox-regression with repeated events, adjusted for age, sector, education, and previous sickness absence. RESULTS: The hazard ratio (HR) for all-length sickness absence (≥ 1 day) for "Often/Always" stress compared to "Seldom/Never" stress was statistically significant among both men (HR = 1.25 [1.13-1.38]) and women (HR = 1.43 [1.34-1.51]). The HR was statistically significant for women (HR = 2.26 [1.89-2.70]), but not for men (HR = 1.22 [0.86-1.73]), when the analyses were restricted to long-term sickness absence (≥ 31 days). The sex-difference was statistically significant. Additional analyses with cut-points at ≥ 2, ≥ 4, ≥ 6, ≥ 8, ≥ 11, ≥ 15, ≥ 20, and ≥ 25 sickness absence days showed that among women, the HR increased gradually with increasing lengths of the sickness absence periods. CONCLUSIONS: The prospective association of perceived stress with risk of sickness absence was stronger among women than men. Among women, perceived stress was more strongly associated with long-term sickness absence than with all-length sickness absence.

Technically measured compositional physical work demands and prospective register-based sickness absence (PODESA): a study protocol.

BACKGROUND: Various physical work demands are shown to be associated with sickness absence. However, these studies have: (a) predominantly used self-reported data on physical work demands that have been shown to be inaccurate compared with technical measurements, (b) principally focused on various physical work demands in 'isolation', i.e. ignoring their co-dependency - compositional nature -, and (c) mainly used register data on long-term sickness absence. The present article describes the protocol of a study with the objective of investigating the association between technically measured compositional data on physical work demands and prospective long- and short-term register-based data on sickness absence. METHODS: 'The technically measured compositional Physical wOrk DEmands and prospective association with register-based Sickness Absence study (PODESA)' comprises data from two Danish cohorts (NOMAD and DPhacto) primarily on blue-collar workers. In the PODESA cohort, data on 1108 workers were collected at baseline (between 2011 and 2014). The cohort data comprise, e.g., self-reported information on descriptives, lifestyle, workday, and health, as well as accelerometer-based measurements of physical work demands (physical activity, movements, and postures). These baseline measurements are linked with prospective register-based data on sickness absence for up to four years after baseline. The prospective association between physical work demands and sickness absence will be analysed using a Compositional Data Analysis approach. DISCUSSION: PODESA provides a unique possibility of unravelling which combinations of physical work demands are associated with prospective sickness absence. PODESA employs technically measured information on physical work demands (taking into account the compositionality of physical work demand data) and prospective sickness absence data. The findings from PODESA can be used to develop strengthened preventive interventions for sickness absence. Results are expected in 2019-2021.

Does workplace social capital protect against long-term sickness absence? Linking workplace aggregated social capital to sickness absence registry data.

AIMS: Most previous prospective studies have examined workplace social capital as a resource of the individual. However, literature suggests that social capital is a collective good. In the present study we examined whether a high level of workplace aggregated social capital (WASC) predicts a decreased risk of individual-level long-term sickness absence (LTSA) in Danish private sector employees. METHODS: A sample of 2043 employees (aged 18-64 years, 38.5% women) from 260 Danish private-sector companies filled in a questionnaire on workplace social capital and covariates. WASC was calculated by assigning the company-averaged social capital score to all employees of each company. We derived LTSA, defined as sickness absence of more than three weeks, from a national register. We examined if WASC predicted employee LTSA using multilevel survival analyses, while excluding participants with LTSA in the three months preceding baseline. RESULTS: We found no statistically significant association in any of the analyses. The hazard ratio for LTSA in the fully adjusted model was 0.93 (95% CI 0.77-1.13) per one standard deviation increase in WASC. When using WASC as a categorical exposure we found a statistically non-significant tendency towards a decreased risk of LTSA in employees with medium WASC (fully adjusted model: HR 0.78 (95% CI 0.48-1.27)). Post hoc analyses with workplace social capital as a resource of the individual showed similar results. CONCLUSIONS: WASC did not predict LTSA in this sample of Danish private-sector employees.

Associations between the workplace-effort in psychosocial risk management and the employee-rating of the psychosocial work environment - a multilevel study of 7565 employees in 1013 workplaces.

AIMS: This study examined the association between the workplace-effort in psychosocial risk management and later employee-rating of the psychosocial work environment. METHOD: The study is based on data from two questionnaire surveys - one including 1013 workplaces and one including 7565 employees from these workplaces. The association was analyzed using multi-level linear regression. The association for five different trade-groups and for five different psychosocial work environment domains was examined. RESULTS: Limited but statistically significant better employee-ratings of the psychosocial work environment in the respective domains were observed among Danish workplaces that prioritized "development possibilities for employees," "recognition of employees," "employees influence on own work tasks," good "communication at the workplace," and "help to prevent work overload." CONCLUSION: Danish workplaces with a high effort in psychosocial risk management in the preceding year had a small but significantly more positive rating of the psychosocial work environment by the employees. However, future studies are needed to establish the causality of the associations.

Physical working conditions as covered in European monitoring questionnaires.

BACKGROUND: The prevalence of workers with demanding physical working conditions in the European work force remains high, and occupational physical exposures are considered important risk factors for musculoskeletal disorders (MSD), a major burden for both workers and society. Exposures to physical workloads are therefore part of the European nationwide surveys to monitor working conditions and health. An interesting question is to what extent the same domains, dimensions and items referring to the physical workloads are covered in the surveys. The purpose of this paper is to determine 1) which domains and dimensions of the physical workloads are monitored in surveys at the national level and the EU level and 2) the degree of European consensus among these surveys regarding coverage of individual domains and dimensions. METHOD: Items on physical workloads used in one European wide/Spanish and five other European nationwide work environment surveys were classified into the domains and dimensions they cover, using a taxonomy agreed upon among all participating partners. RESULTS: The taxonomy reveals that there is a modest overlap between the domains covered in the surveys, but when considering dimensions, the results indicate a lower agreement. The phrasing of items and answering categories differs between the surveys. Among the domains, the three domains covered by all surveys are "lifting, holding & carrying of loads/pushing & pulling of loads", "awkward body postures" and "vibrations". The three domains covered less well, that is only by three surveys or less, are "physical work effort", "working sitting", and "mixed exposure". CONCLUSIONS: This is the first thorough overview to evaluate the coverage of domains and dimensions of self-reported physical workloads in a selection of European nationwide surveys. We hope the overview will provide input to the revisions and updates of the individual countries' surveys in order to enhance coverage of relevant domains and dimensions in all surveys and to increase the informational value of the surveys.

Physical workload and risk of long-term sickness absence in the general working population and among blue-collar workers: prospective cohort study with register follow-up.

OBJECTIVE: To determine the prospective association between physical workload--in terms of specific physical exposures and the number of exposures--and long-term sickness absence (LTSA). METHODS: Using cox-regression analyses, we estimated the risk of register-based incident LTSA (at least 3 consecutive weeks) from self-reported exposure to different physical workloads among 11,908 wage earners from the general working population (Danish Work Environment Cohort Study year 2000 and 2005). RESULTS: The incidence of LTSA was 8.9% during two-year follow-up. Spending 25% or more of the total work time with a bent or twisted back (HR 1.59 (95% CI 1.39 to 1.83)), arms above shoulder height (HR 1.35 (95% CI 1.14 to 1.59)), squatting or kneeling (HR 1.30 (95% CI 1.09 to 1.54)), pushing/pulling or lifting/carrying (HR 1.40 (95% CI 1.22 to 1.62)) and standing in the same place for 50% or more of total work time (HR 1.19 (95% CI 1.00 to 1.42), were risk factors for LTSA when adjusted for baseline age, gender, psychosocial work environment, lifestyle, musculoskeletal and mental disorders, and socioeconomic status. HR increased from 1.25 (95% CI 1.04 to 1.51) for one to 1.94 (95% CI 1.56 to 2.41) for four combined physical workloads. Results largely remained stable in subgroup analyses including only blue-collar workers (n=5055). Population attributable risks for LTSA from one or more physical workloads were 26% and 40% in the general working population and among blue-collar workers, respectively. CONCLUSIONS: Several of the investigated types of physical workload were risk factors for LTSA when exceeding 25% of the work time. A higher number of combined physical workloads was associated with progressively increased risk. Our study underscores the importance of physical workload as risk factors for LTSA in the general working population as well as among blue-collar workers.

Psychosocial work environment and retirement age: a prospective study of 1876 senior employees.

PURPOSE: Retention of senior employees is a challenge for most developed countries. We aimed to identify psychosocial work environment factors of importance for the retention of older employees by evaluating the association between the psychosocial work environment and voluntary early retirement in a longitudinal study. METHODS: Data about work environment, health, and background factors came from the DANES 2008 questionnaire survey. We followed members of the Danish early retirement scheme for up to 4 years in national registers-focusing on the age range, 60-64 years, where early retirement was possible. We used Cox proportional hazard regression to analyze the rate of early retirement. RESULTS: The study included 16 psychosocial work environment factors. The following 10 psychosocial factors were significant predictors of early retirement in covariate adjusted analyses: Low job satisfaction, low influence in job, low possibilities for development, low role clarity, perceived age discrimination, low recognition from management, low workplace justice, poor trust in management, poor leadership quality, and poor predictability. No significant association with early retirement was found for work pace, quantitative demands, emotional demands, role conflicts, social community between colleagues, and trust between colleagues. CONCLUSION: Older employees with high job satisfaction, influence, possibilities for development, positive management relations, and jobs with no age discrimination remained longer at the labor market. However, we found no evidence that low demands or good relations between colleagues could influence older employees' decision on early retirement.

Dimensional comparability of psychosocial working conditions as covered in European monitoring questionnaires.

BACKGROUND: In most countries in the EU, national surveys are used to monitor working conditions and health. Since the development processes behind the various surveys are not necessarily theoretical, but certainly practical and political, the extent of similarity among the dimensions covered in these surveys has been unclear. Another interesting question is whether prominent models from scientific research on work and health are present in the surveys--bearing in mind that the primary focus of these surveys is on monitoring status and trends, not on mapping scientific models. Moreover, it is relevant to know which other scales and concepts not stemming from these models have been included in the surveys. The purpose of this paper is to determine (1) the similarity of dimensions covered in the surveys included and (2) the congruence of dimensions of scientific research and of dimensions present in the monitoring systems. METHOD: Items from surveys representing six European countries and one European wide survey were classified into the dimensions they cover, using a taxonomy agreed upon among all involved partners from the six countries. RESULTS: The classification reveals that there is a large overlap of dimensions, albeit not in the formulation of items, covered in the seven surveys. Among the available items, the two prominent work-stress-models--job-demand-control-support-model (DCS) and effort-reward-imbalance-model (ERI)--are covered in most surveys even though this has not been the primary aim in the compilation of these surveys. In addition, a large variety of items included in the surveillance systems are not part of these models and are--at least partly--used in nearly all surveys. These additional items reflect concepts such as "restructuring", "meaning of work", "emotional demands" and "offensive behaviour/violence & harassment". CONCLUSIONS: The overlap of the dimensions being covered in the various questionnaires indicates that the interests of the parties deciding on the questionnaires in the different countries overlap. The large number of dimensions measured in the questionnaires and not being part of the DCS and ERI models is striking. These "new" dimensions could inspire the research community to further investigate their possible health and labour market effects.

Self-reported workplace bullying and subsequent risk of diagnosed mental disorders and psychotropic drug prescriptions: A register-based prospective cohort study of 75,252 participants.

BACKGROUND: Evidence concerning workplace bullying as a risk factor for mental disorders is currently limited to depressive disorders and mainly based on non-clinical assessments. This study aims to examine the prospective association of self-reported workplace bullying with different types of register-based hospital-diagnosed mental disorders and redeemed psychotropic drug prescriptions. METHODS: Using a cohort study design, we examined a pooled dataset of 75,252 participants from 14 questionnaire-based surveys conducted between 2004 and 2014. In the questionnaires, workplace bullying was measured by a single item. The questionnaires were linked to Danish registers on hospital-diagnosed mental disorders and redeemed psychotropic drug prescriptions up to 2016. Data were analysed by multivariate Cox proportional hazard models, including only participants without a history of mental disorders or prescriptions since 1995. RESULTS: After adjustment for sex, age, marital and socio-economic status, workplace bullying was associated with an excess risk of any mental disorder (HR 1.37; 95 % CI: 1.17-1.59) as well as mood disorders and neurotic, stress-related, and somatoform disorders. In stratified analyses, this association were statistically significant only among women. Workplace bullying was also associated with any psychotropic drug prescription (fully-adjusted HR 1.43; 95 % CI: 1.35-1.53). This association was observed in both sexes and for all prescriptions, including anxiolytics, hypnotics and sedatives, antidepressants, and nootropics. LIMITATIONS: Firm conclusions about sex-related differences cannot be drawn. Residual confounding by unmeasured factors such as personality cannot be ruled out. CONCLUSIONS: Workplace bullying was associated with higher risks of diagnosed mental disorders among women and psychotropic drug prescriptions in both sexes.

The predictive value of mental health for long-term sickness absence: the Major Depression Inventory (MDI) and the Mental Health Inventory (MHI-5) compared.

BACKGROUND: Questionnaires are valuable for population surveys of mental health. Different survey instruments may however give different results. The present study compares two mental health instruments, the Major Depression Inventory (MDI) and the Mental Health Inventory (MHI-5), in regard to their prediction of long-term sickness absence. METHOD: Questionnaire data was collected from N = 4153 Danish employees. The questionnaire included the MDI and the MHI-5. The information of long-term sickness absence was obtained from a register. We used Cox regression to calculate covariance adjusted hazard ratios for long-term sickness absence for both measures. RESULTS: Both the MDI and the MHI-5 had a highly significant prediction of long-term sickness absence. A one standard deviation change in score was associated with an increased risk of long-term sickness absence of 27% for the MDI and 37% for the MHI-5. When both measures were included in the same analysis, the MHI-5 performed best. CONCLUSION: In general population surveys, the MHI-5 is a better predictor of long-term sickness absence than the MDI.

A one-item workability measure mediates work demands, individual resources and health in the prediction of sickness absence.

OBJECTIVES: The study tested the hypothesis that a one-item workability measure represented an assessment of the fit between resources (the individuals' physical and mental health and functioning) and workplace demands and that this resource/demand fit was a mediator in the prediction of sickness absence. We also estimated the relative importance of health and work environment for workability and sickness absence. METHODS: Baseline data were collected within a Danish work and health survey (3,214 men and 3,529 women) and followed up in a register of sickness absence. Probit regression analysis with workability as mediator was performed for a binary outcome of sickness absence. The predictors in the analysis were as follows: age, social class, physical health, mental health, number of diagnoses, ergonomic exposures, occupational noise, exposure to risks, social support from supervisor, job control and quantitative demands. RESULTS: High age, poor health and ergonomic exposures were associated with low workability and mediated by workability to sickness absence for both genders. Low social class and low quantitative demands were associated with low workability and mediated to sickness absence among men. The mediated part was from 11 to 63 % of the total effect for the significant predictors. CONCLUSION: Workability mediated health, age, social class and ergonomic exposures in the prediction of sickness absence. The health predictors had the highest association with both workability and sickness absence; physical work environment was higher associated with the outcomes than psychosocial work environment. However, the explanatory value of the predictors for the variance in the model was low.

Combined psychosocial work factors and risk of long-term sickness absence in the general working population: Prospective cohort with register follow-up among 69 371 workers.

OBJECTIVE: This study aimed to investigate the importance of combined psychosocial work factors for the risk of long-term sickness absence (LTSA). METHODS: We followed 69 371 employees in the general working population (Work Environment and Health in Denmark study 2012-2018), without LTSA during the preceding year, for up to two years in the Danish Register for Evaluation of Marginalization. Using k-means cluster analyses and weighted Cox-regression controlling for age, gender, survey year, education, health-behaviors, and physical work demands, we determined the prospective association of 11 identified clusters - based on the combination of nine psychosocial work factors (recognition, quantitative demands, work pace, emotional demands, influence, justice, role clarity, role conflicts, and support from colleagues) - with the risk of LTSA. RESULTS: During 124 045 person-years of follow-up, 6197 employees developed LTSA (weighted 8.5%). Using the cluster with the most favorable psychosocial scores as reference, clusters scoring poorly on several combined psychosocial factors had increased risk of LTSA. The cluster scoring poor on all nine psychosocial factors exhibited the highest risk [hazard ratio (HR) 1.68, 95% confidence interval (CI) 1.45-1.94]. Scoring poorly on one or two psychosocial factors did not increase the risk of LTSA when combined with favorable scores on the other psychosocial factors. Interaction analyses showed that gender, but not age and education, modified the association between cluster and LTSA. CONCLUSION: Scoring poorly on several combined psychosocial work factors plays an important role in the risk of LTSA. Scoring favorably on several psychosocial factors outweighed the potentially adverse effects of scoring poorly on one or two factors.

Workplace bullying and risk of suicide and suicide attempts: A register-based prospective cohort study of 98 330 participants in Denmark.

OBJECTIVES: The aim of this study was to analyze whether individuals reporting exposure to workplace bullying had a higher risk of suicidal behavior, including both suicide attempt and death by suicide, than those not reporting such exposure. METHODS: Using a prospective cohort study design, we linked data from nine Danish questionnaire-based surveys (2004-2014) to national registers up to 31 December 2016. Exposure to workplace bullying was measured by a single item. Suicide attempts were identified in hospital registers and death by suicide in the Cause of Death Register. Among participants with no previous suicide attempts, we estimated hazard ratios (HR) and 95% confidence intervals (CI), adjusting for sex, age, marital status, socioeconomic status, and history of psychiatric morbidity. RESULTS: The sample consisted of 98 330 participants (713 798 person-years), 63.6% were women, and the mean age was 44.5 years. Of these participants, 10 259 (10.4%) reported workplace bullying. During a mean follow-up of 7.3 years, we observed 184 cases of suicidal behavior, including 145 suicide attempts, 35 deaths by suicide and 4 cases that died by suicide after surviving a suicide attempt. The fully-adjusted HR for the association between workplace bullying and suicidal behavior was 1.65 (95% CI 1.06-2.58). The HR for suicide attempts and death by suicide were 1.65 (1.09-2.50) and 2.08 (0.82-5.27), respectively. Analyses stratified by sex showed a statistically significant association between workplace bullying and suicidal behavior among men but not women. CONCLUSIONS: The results suggest that exposure to workplace bullying is associated with an elevated risk of suicidal behavior among men.