The Predictive Validity of the Danish Psychosocial Work Environment Questionnaire With Regard to Onset of Depressive Disorders and Long-Term Sickness Absence.

OBJECTIVES: To investigate the predictive validity of 32 measures of the Danish Psychosocial Work Environment Questionnaire (DPQ) against two criteria variables: onset of depressive disorders and long-term sickness absence (LTSA). METHODS: The DPQ was sent to 8958 employed individuals in 14 job groups of which 4340 responded (response rate: 48.4%). Depressive disorders were measured by self-report with a 6-month follow-up. LTSA was measured with a 1-year follow-up in a national register. We analyzed onset of depressive disorders at follow-up using logistic regression models, adjusted for age, sex, and job group, while excluding respondents with depressive disorders at baseline. We analyzed onset of LTSA with Cox regression models, adjusted for age, sex, and job group, while excluding respondents with previous LTSA. RESULTS: The general pattern of the results followed our hypotheses as high job demands, poorly organized working conditions, poor relations to colleagues and superiors, and negative reactions to the work situation predicted onset of depressive disorders at follow-up and onset of LTSA during follow-up. Analyzing onset of depressive disorders and onset of LTSA, we found risk estimates that deviated from unity in most of the investigated associations. Overall, we found higher risk estimates when analyzing onset of depressive disorders compared with onset of LTSA. CONCLUSIONS: The analyses provide support for the predictive validity of most DPQ-measures. Results suggest that the DPQ constitutes a useful tool for identifying risk factors for depression and LTSA in the psychosocial work environment.

Exploring the Use of Selection, Optimization, and Compensation Strategies Beyond the Individual Level in a Workplace Context - A Qualitative Case Study.

Due to aging populations and the prolonging of working lives, the number of senior workers will increase. Therefore, this study investigates the use of SOC strategies (Selection, Optimization, and Compensation) across organizational levels as a means for senior workers to maintain workability and age successfully at work. The need to expand the perspective of the SOC model beyond the individual level, when applied to a work context, has been emphasized theoretically in the literature, nevertheless, SOC strategies have so far only been examined at the individual level. This study is the first to explore SOC strategies at the organizational, leadership, and group level. We focus on senior employees and the SOC strategies they use to balance out demands and limited resources. Based on 23 semi-structured interviews with senior employees and immediate managers at two hospitals (nurses), and two dairies (skilled/unskilled workers), we explore which specific SOC strategies are used at each level and reflect on the applicability of broadening the perspective of the SOC model when applying it to a work context. Based on the empirical findings and the discussion of the empirical exploration of SOC strategies beyond the individual level, we argue that it is advantageous to further pursue this line of inquiry and include the group, leadership, and organizational level when applying the SOC model in a work setting.

Development of a Questionnaire for Measuring Employees' Perception of Selection, Optimisation and Compensation at the Leadership, Group and Individual Levels.

This study is the first to develop a questionnaire to measure employees' perceptions of the use of the action strategies selection, optimisation, and compensation (SOC) beyond the individual level, which has so far been lacking in research and practice. The study thus contributes an important tool for research into the role of SOC strategies at the leadership, group, and individual levels for long and healthy working lives. It may also be used by practitioners as a tool to provide input when developing targeted interventions to support long and healthy working lives. The development of the questionnaire was based on SOC theory, qualitative and cognitive interviews, and existing SOC questionnaires. The validity and reliability of the questionnaire were tested on data from a cross-sectional survey with responses from 785 nurses and 244 dairy workers. Results from confirmatory factor analyses supported the theoretically expected nine-factor structure of the questionnaire in both study populations (nurses and dairy workers). Furthermore, the results largely supported the criterion validity and internal reliability of the scales in the questionnaire. Nevertheless, further validation across additional occupational groups is needed.

Enhancing the social capital in industrial work teams: results from a participatory intervention.

We investigated the effects of an intervention aiming at enhancing four types of team-level social capital (bonding, bridging and two types of linking social capital) in six dairy plants with a total of 60 teams. Social capital and work engagement was assessed in baseline and follow-up surveys. The follow-up period was approximately 20 months, comprising an intervention period of 12 months. Intervention effects were assessed by comparing changes in team-level mean-scores for teams that had developed action plans with teams that had not. Results show that teams that had developed action plans generally showed a larger increase in social capital and work engagement than other teams. Differences were statistically significant for linking social capital towards the workplace as a whole and work engagement. However, effect sizes indicate an effect of the action plans despite the lack of statistical significance. Moreover, the self-reported level of implementation of the action plans was associated with the size and direction of the observed change.

Effect of a participatory organizational workplace intervention on workplace social capital: post-hoc results from a cluster randomized controlled trial.

BACKGROUND: A high level of workplace social capital (WSC) may contribute to the protection of employees' health. We hypothesized that a participatory workplace intervention would increase the level of WSC defined as vertical WSC (i.e. WSC linking together employees and their leaders) and horizontal WSC (i.e. WSC bonding employees together). METHODS: We conducted a secondary data analysis of a cluster randomized controlled trial that was implemented among all employees in 78 municipal Danish pre-schools (44 intervention and 34 control group schools). The study sample consisted of 606 employees, 386 in the intervention and 220 in the control group. The intervention aimed to improve the psychosocial working environment by using a participatory approach and focusing on core job tasks. Vertical and horizontal WSC was measured by five and four items, respectively, at baseline and at 24-months follow-up. We estimated intervention effect by calculating the interaction of change over time by group assignment (intervention versus control group) and included workplace identification number in a repeated statement to take into account that employees were nested within workplaces. We conducted post-hoc analyses to examine whether intervention effect differed by implementation degree. RESULTS: WSC decreased in both groups. In the main analyses, there was no statistically significant difference between intervention and control group, neither for vertical nor horizontal WSC. However, when we excluded intervention workplaces with a low degree of implementation, we found a statistically significant difference between the intervention and the control group (estimate: 0.25, 95% CI: 0.00 to 0.50, p = 0.049), indicating that vertical WSC decreased in the control group and remained stable in the intervention group. CONCLUSIONS: There was not a statistically significant difference between intervention and control group in the main analysis. Post-hoc analyses, however, suggest that the intervention may have prevented a decrease in vertical WSC among employees in workplaces with a high or a medium degree of implementation. A conference abstract with the key results of this study has been previously presented and published, European Journal of Public Health, Volume 28, Issue suppl_4, November 2018, cky260, https://academic.oup.com/eurpub/article/28/suppl_4/cky260/5187184 . TRIAL REGISTRATION: ISRCTN16271504 , retrospectively registered on November 15, 2016.

The association of vertical and horizontal workplace social capital with employees' job satisfaction, exhaustion and sleep disturbances: a prospective study.

PURPOSE: Workplace social capital (WSC) may be beneficial for employees' health and well-being; however, most studies have analyzed WSC on the individual and not the workplace level. We test whether higher compared to lower levels of vertical WSC (WSC between employees and superiors) and horizontal WSC (WSC between employees), measured at the workplace level, is prospectively associated with higher levels of employees' well-being. METHODS: Using data from an intervention study, we analyzed associations between workplace aggregated vertical and horizontal WSC at baseline with job satisfaction, exhaustion and sleep disturbances at 24-months follow-up. The sample included 606 municipal pre-school employees (71 workplaces). We adjusted for individual and workplace characteristics, baseline scores of outcomes, intervention status, and the interaction of exposure with intervention status. We used the Genmod procedure in SAS with a repeated statement to account for correlation of individuals within workplaces. We repeated analyses using individual-level WSC measurements. RESULTS: Higher levels of vertical and horizontal WSC at baseline predicted a higher level of job satisfaction (0.20, p = 0.01 and 0.24, p = 0.01, respectively) and a lower level of exhaustion (- 0.33, p = 0.04 and - 0.43, p = 0.04) at follow-up in the most adjusted model. Analyses with individual-level measures yielded similar results and further showed an association of a higher level of horizontal WSC with a lower level of sleep disturbances. CONCLUSIONS: Higher levels of vertical and horizontal WSC were prospectively associated with better well-being of employees in municipal pre-schools. Workplaces may thus consider focusing on improving WSC as a means for ensuring or improving employees' well-being.

Enhancing the social capital in industrial workplaces: Developing workplace interventions using intervention mapping.

Social capital in the workplace has been found to be associated with employee wellbeing and work engagement. Yet, evidence of effects of interventions to enhance the social capital are lacking. The intervention mapping method has been described as a useful tool for developing workplace interventions but it is very resource consuming. We aimed to develop an adapted version of the intervention mapping method which is more practically feasible to apply. To get insight into strengths and weaknesses of the adapted method, we applied it and conducted interviews with staff at six companies. The interviews revealed that the action plans developed using the adapted intervention mapping method were generally perceived as relevant and that the action plans had a positive effect on the social capital. However, the implementation of the action plans had been a challenge. In conclusion, the adapted intervention mapping method appears to be suitable for developing interventions to enhance the social capital in the workplace. However, more attention to the implementation of the action plans needs to be incorporated into the method. Suggestions to enhance the implementation included the involvement of the management in the implementation and monitoring of the implementation of the action plans as well as integrating the action plans into existing procedures in the workplace.

The Danish Psychosocial Work Environment Questionnaire (DPQ): Development, content, reliability and validity.

Objectives The aim of this study was to describe the development and the content of the Danish Psychosocial Work Environment Questionnaire (DPQ) and to test its reliability and validity. Methods We describe the identification of dimensions, the development of items, and the qualitative and quantitative tests of the reliability and validity of the DPQ. Reliability and validity of a 150 item version of the DPQ was evaluated in a stratified sample of 8958 employees in 14 job groups of which 4340 responded. Reliability was investigated using internal consistency and test-retest reliability. The factorial validity was investigated using confirmatory factor analysis (CFA). For each multi-item scale, we undertook CFA within each job group and multi-group CFA to investigate factorial invariance across job groups. Finally, using multi-group multi-factor CFA, we investigated whether scales were empirically distinct. Results Internal consistency reliabilities and test-retest reliabilities were satisfactory. Factorial validity of the multi-item scales was satisfactory within each of the 14 job groups. Factorial invariance was demonstrated for 10 of the 28 multi-item scales. The hypothesis that the scales of the DPQ were empirically distinct was supported. The final DPQ version consisted of 119 items covering 38 different psychosocial work environment dimensions. Conclusions Overall, the DPQ is a reliable and valid instrument for assessing psychosocial working conditions in a variety of job groups. The results indicate, however, that questions about psychosocial working conditions may be understood differently across job groups, which may have implications for the comparability of questionnaire-based measures of psychosocial working conditions across job groups.

The association between team-level social capital and individual-level work engagement: Differences between subtypes of social capital and the impact of intra-team agreement.

The study explored the association between team-level social capital and individual-level work engagement. Questionnaire data were collected from six companies in the dairy industry. Seven hundred seventy-two participants divided into 65 teams were included. In confirmatory factor analyses, we found a superior model fit to a four dimensional model of social capital: bonding social capital, bridging social capital and two types of linking social capital. The results showed a positive association between all subtypes of social capital at the team level and work engagement at the individual level. However, this association only remained significant for linking social capital in relation the workplace as a whole when we adjusted for psychosocial working conditions. The level of intra-team agreement in social capital score did not moderate the association between social capital and work engagement. In conclusion, the results provide further support for previous findings suggesting a positive association between social capital and work engagement. They add to the existing knowledge by suggesting that linking social capital in relation to the workplace is the most important explanatory variable for work engagement, thus emphasizing the need to distinguish between subtypes of social capital in research and practice.

Managerial Quality and Risk of Depressive Disorders Among Danish Eldercare Workers: A Multilevel Cohort Study.

OBJECTIVE: To examine whether low managerial quality predicts risk of depressive disorders. METHODS: Using multilevel mixed-effects logistic regression analyses we examined the prospective association of individual-level and workplace-mean managerial quality with onset of depressive disorders among 5244 eldercare workers from 274 workplaces during 20 months follow-up. RESULTS: Low managerial quality predicted onset of depressive disorders in both the individual-level (odds ratio [OR] = 1.85, 95% confidence interval [CI] = 1.25 to 2.76) and the workplace-mean analysis (OR = 1.48, 95% CI = 1.06 to 2.07). Low individual-level managerial quality predicted onset of depressive disorders when workplace-mean managerial quality was high (OR = 3.10, 95% CI = 1.71 to 5.62) but not when it was low (OR = 1.07, 95% CI = 0.61 to 1.87). This interaction was statistically significant (P = 0.03). CONCLUSIONS: Both low individual-level and low workplace-mean managerial quality predicted risk of depressive disorders. The association was strongest among individuals reporting low managerial quality at workplaces with high workplace-mean managerial quality.

The impact of retirement on age related cognitive decline - a systematic review.

BACKGROUND: Knowledge on factors affecting the rate of cognitive decline and how to maintain cognitive functioning in old age becomes increasingly relevant. The purpose of the current study was to systematically review the evidence for the impact of retirement on cognitive functioning and on age related cognitive decline. METHOD: We conducted a systematic literature review, following the principles of the PRISMA statement, of longitudinal studies on the association between retirement and cognition. RESULTS: Only seven studies fulfilled the inclusion criteria. We found weak evidence that retirement accelerates the rate of cognitive decline in crystallised abilities, but only for individuals retiring from jobs high in complexity with people. The evidence of the impact of retirement on the rate of decline in fluid cognitive abilities is conflicting. CONCLUSION: The review revealed a major knowledge gap in regards to the impact of retirement on cognitive decline. More knowledge on the association between retirement and age related cognitive decline as well as knowledge on the mechanisms behind these associations is needed.

The contribution from psychological, social, and organizational work factors to risk of disability retirement: a systematic review with meta-analyses.

BACKGROUND: Previous studies indicate that psychological, social, and organizational factors at work contribute to health, motivation, absence from work, and functional ability. The objective of the study was to assess the current state of knowledge of the contribution of psychological, social, and organizational factors to disability retirement by a systematic review and meta-analyses. METHODS: Data sources: A systematic literature search for studies of retirement due to disability in Medline, Embase, and PsychINFO was performed. Reference lists of relevant articles were hand-searched for additional studies. DATA EXTRACTION: Internal validity was assessed independently by two referees with a detailed checklist for sources of bias. Conclusions were drawn based on studies with acceptable quality. DATA SYNTHESIS: We calculated combined effect estimates by means of averaged associations (Risk ratios) across samples, weighting observed associations by the study's sample size. Thirty-nine studies of accepted quality were found, 37 of which from the Nordic countries. RESULTS: There was moderate evidence for the role of low control (supported by weighted average RR = 1.40; 95% CI = 1.21-1.61) and moderate evidence for the combination of high demands and low control (although weighted average was RR = 1.45; 95% CI = 0.96-2.19) as predictors of disability retirement. There were no major systematic differences in findings between the highest rated and the lowest rated studies that passed the criterion for adequate quality. There was limited evidence for downsizing, organizational change, lack of employee development and supplementary training, repetitive work tasks, effort-reward imbalance to increase risk of disability pension. Very limited evidence was found for job demands, evening or night work, and low social support from ones superior. CONCLUSIONS: Psychological and organizational factors at work contribute to disability retirement with the most robust evidence for the role of work control. We recommend the measurement of specific exposure factors in future studies.

Can psychosocial work conditions protect against age-related cognitive decline? Results from a systematic review.

According to the use it or lose it hypothesis, intellectually stimulating activities postpone age-related cognitive decline. A previous systematic review concluded that a high level of mental work demands and job control protected against cognitive decline. However, it did not distinguish between outcomes that were measured as cognitive function at one point in time or as cognitive decline. Our study aimed to systematically review which psychosocial working conditions were prospectively associated with high levels of cognitive function and/or changes in cognitive function over time. Articles were identified by a systematic literature search (MEDLINE, Web of Science (WOS), PsycNET, Occupational Safety and Health (OSH)). We included only studies with longitudinal designs examining the impact of psychosocial work conditions on outcomes defined as cognitive function or changes in cognitive function. Two independent reviewers compared title-abstract screenings, full-text screenings and quality assessment ratings. Eleven studies were included in the final synthesis and showed that high levels of mental work demands, occupational complexity or job control at one point in time were prospectively associated with higher levels of cognitive function in midlife or late life. However, the evidence to clarify whether these psychosocial factors also affected cognitive decline was insufficient, conflicting or weak. It remains speculative whether job control, job demands or occupational complexity can protect against cognitive decline. Future studies using methodological advancements can reveal whether workers gain more cognitive reserve in midlife and late life than the available evidence currently suggests. The public health implications of a previous review should thereby be redefined accordingly.

Effect of physical exercise on workplace social capital: Cluster randomized controlled trial.

AIMS: While workplace health promotion with group-based physical exercise can improve workers' physical health, less is known about potential carry-over effects to psychosocial factors. This study investigates the effect of physical exercise on social capital at work. METHODS: Altogether, 200 female healthcare workers (nurses and nurse's aides) from 18 departments at three hospitals were randomly allocated at the department level to 10 weeks of (1) group-based physical exercise at work during working hours or (2) physical exercise at home during leisure time. At baseline and follow-up, participants replied to a questionnaire concerning workplace social capital: (1) within teams (bonding); (2) between teams (bridging); (3) between teams and nearest leaders (linking A); (4) between teams and distant leaders (linking B). RESULTS: At baseline, bonding, bridging, linking A and linking B social capital were 74 (SD 17), 61 (SD 19), 72 (SD 22) and 70 (SD 18), respectively, on a scale of 0-100 (where 100 is best). A group by time interaction was found for bonding social capital (P=0.02), where physical exercise at work compared with physical exercise during leisure time increased 5.3 (95% confidence interval 2.3- 8.2)(effect size, Cohen's d = 0.31) from baseline to follow-up. For physical exercise at home during leisure time and exercise at work combined, a time effect (P=0.001) was found for linking A social capital, with a decrease of 4.8 (95% confidence interval 1.9-7.6). CONCLUSIONS: Group-based physical exercise at work contributed to building social capital within teams at the workplace. However, the general decrease of social capital between teams and nearest leaders during the intervention period warrants further research.

Depressive symptoms and early retirement intentions among Danish eldercare workers: Cross-sectional and longitudinal analyses.

BACKGROUND: Depression increases the risk of disability pension and represents a health related strain that pushes people out of the labour market. Although early voluntary retirement is an important alternative to disability pension, few studies have examined whether depressive symptoms incur early voluntary retirement. This study examined whether depressive symptoms and changes in depressive symptoms over time were associated with early retirement intentions. METHODS: We used a cross-sectional (n = 4041) and a prospective (n = 2444) population from a longitudinal study on employees of the Danish eldercare sector. Depressive symptoms were measured by the Major Depression Inventory and the impact of different levels of depressive symptoms (severe, moderately severe, moderate, mild and none) and changes in depressive symptoms (worsened, improved, unaffected) on early retirement intentions were analysed with multinomial logistic regression. RESULTS: In the cross-sectional analysis all levels of depressive symptoms were significantly associated with retirement intentions before the age of 62 years. Similar associations were found prospectively. Depressive symptoms and worsened depressive symptoms in the two year period from baseline to follow-up were also significantly associated with early retirement intentions before age 62. The prospective associations lost statistical significance when controlling for early retirement intentions at baseline. CONCLUSIONS: The whole spectrum of depressive symptoms represents a health related strain that can incur intentions to retire early by early voluntary retirement. In order to change the intentions to retire early, the work related consequences of depressive symptoms should be addressed as early in the treatment process as possible.

Why are they leaving? Causes of actual turnover in the Danish eldercare services.

AIM: To investigate reasons for actual turnover among eldercare staff and to investigate changes in job design that could prevent turnover. BACKGROUND: Many Western countries have difficulties in recruiting healthcare staff to provide care for an ageing population. Knowledge on the causes of turnover among healthcare staff is therefore important. METHOD: In a prospective cohort study (n = 7025) baseline characteristics were compared for employees who respectively quit, retired and worked in eldercare at follow-up. Additionally, a survey was conducted among those employees who left their jobs during follow-up. RESULTS: Employees who quit their jobs (n = 461) primarily stated that psychosocial work conditions caused them to quit, whereas retirees (n = 265) primarily stated reasons related to health and physical job demands. Improvements in the time available for the contact with the elderly, increased skill discretion and improved social relations could prompt employees to reconsider quitting or retiring. CONCLUSION: Work in eldercare has some 'core' aspects that appear desirable to employees who quit or retired. Building on those aspects offers a strategy for enhanced recruitment potential. IMPACT FOR NURSING MANAGEMENT: To reduce turnover managers should improve psychosocial work conditions in eldercare and ensure that physical demands do not exceed the capacities of employees.

Does affective organizational commitment and experience of meaning at work predict risk of disability pensioning? An analysis of register-based outcomes using pooled data on 40,554 observations in four occupational groups.

BACKGROUND: The aim of this study is to investigate whether experience of meaning at work (MAW) and affective organizational commitment (AOC) predict risk of disability pensioning in four occupational groups. METHODS: Survey data from 40,554 individuals were fitted to a national register (DREAM) containing information on payments of disability pension. Using multi-adjusted Cox-regression, observations were followed in the DREAM-register to assess risk of disability pensioning. RESULTS: Low levels of MAW significantly increased risk of disability pensioning during follow-up referencing high levels of MAW. Respondents with medium levels of AOC had a significantly reduced risk of disability pensioning, when compared to respondents with high levels of AOC. Furthermore, results indicate an interaction effect between AOC and MAW in predicting risk of disability pension. CONCLUSIONS: AOC and MAW are significantly associated with risk of disability pensioning. Promoting MAW and managing AOC in contemporary workplaces may contribute towards reducing risk of disability pensioning.

Do psychosocial work conditions predict risk of disability pensioning? An analysis of register-based outcomes using pooled data on 40,554 observations.

AIMS: To investigate whether high psychosocial job demands (quantitative demands and work pace) and low psychosocial job resources (influence at work and quality of leadership) predicted risk of disability pensioning among employees in four occupational groups--employees working with customers, employees working with clients, office workers and manual workers--in line with the propositions of the Job Demands-Resources (JD-R) model. METHODS: Survey data from 40,554 individuals were fitted to the DREAM register containing information on payments of disability pension. Using multi-adjusted Cox regression, observations were followed in the DREAM-register to assess risk of disability pensioning. Average follow-up time was 5.9 years (SD=3.0). RESULTS: Low levels of influence at work predicted an increased risk of disability pensioning and medium levels of quantitative demands predicted a decreased risk of disability pensioning in the study population. We found significant interaction effects between job demands and job resources as combinations low quality of leadership and high job demands predicted the highest rate of disability pensioning. Further analyses showed some, but no statistically significant, differences between the four occupational groups in the associations between job demands, job resources and risk of disability pensioning. CONCLUSIONS: The study showed that psychosocial job demands and job resources predicted risk of disability pensioning. The direction of some of the observed associations countered the expectations of the JD-R model and the findings of the present study therefore imply that associations between job demands, job resources and adverse labour market outcomes are more complex than conceptualised in the JD-R model.

Do psychosocial job demands and job resources predict long-term sickness absence? An analysis of register-based outcomes using pooled data on 39,408 individuals in four occupational groups.

PURPOSE: To investigate whether psychosocial job demands (work pace and quantitative demands) and job resources (influence at work and quality of leadership) predict long-term sickness absence (LTSA) for more than three consecutive weeks in four occupational groups. METHODS: Survey data pooling 39,408 respondents were fitted to a national register containing information on payments of sickness absence compensation. Using multi-adjusted Cox regression, respondents were followed for an 18-month follow-up period to assess risk of LTSA. RESULTS: In the entire study population, low and medium levels of influence at work and low quality of leadership predicted a significantly increased risk of LTSA, whereas medium levels of quantitative demands predicted a significantly reduced risk of LTSA. For employees working with clients and for office workers, low and medium influence at work associated with a significantly increased risk of LTSA. For employees working with clients, low quality of leadership predicted a significantly increased risk of LTSA. For manual workers, low influence at work predicted a significantly increased risk of LTSA and medium quantitative demands were associated with a significantly reduced risk of LTSA. For employees working with customers, medium quantitative demands predicted a significantly reduced risk of LTSA. Finally, in predicting LTSA, we found significant interaction effects between job demands and job resources. CONCLUSIONS: The study indicates that a lack of job resources--particularly influence at work--are more important predictors of LTSA than high job demands.

Sick leave patterns as predictors of disability pension or long-term sick leave: a 6.75-year follow-up study in municipal eldercare workers.

OBJECTIVES: The aim was to study whether a workplace-registered frequent short-term sick leave spell pattern was an early indicator of future disability pension or future long-term sick leave among municipal eldercare workers. SETTING: The municipal healthcare sector in the city of Aarhus, which is the second largest city in Denmark. PARTICIPANTS: All elder care employees who worked the entire year of 2004 in the municipality of Aarhus, Denmark (N=2774). The employees' sick leave days during 2004 were categorised into: 0-2 and 3-17 short (1-7 days) spells, 2-13 mixed short and long (8+ days) spells and long spells only. Student workers (n=180), employees who were absent due to maternal/paternal leave (n=536) and employees who did not work the entire year of 2004 (n=1218) were not included. PRIMARY OUTCOME: Disability pension and long-term sick leave (≥8 weeks) were subsequently identified in a National register. The cumulative incidence proportion as a function of follow-up weeks was estimated using the Kaplan-Meier curve. The relative cumulative incidence (RR) of experiencing events within 352 weeks was analysed in a generalised linear regression model using the pseudo values method adjusted for age, occupation, unfavourable work factors and sick leave length. RESULTS: A frequent short-term and a mixed sick leave pattern showed RRs of being granted a disability pension of 2.08 (95% CI 1.00 to 4.35) and 2.61 (95% CI 1.33 to 5.12) compared with 0-2 short spells. The risk of long-term sick leave was significantly increased for all sick leave patterns compared with 0-2 short spells. Adding sick leave length to the models attenuated all RRs and they became non-significant. CONCLUSIONS: Sick leave length was a better indicator of future workability than spell frequency. Preventive actions should target employees engaged in homecare. The more sick leave days the greater the preventive potential seems, irrespective of spell frequency.