Money talks: performance-based reimbursement systems impact on perceived work, health and patient care for physicians in Sweden.

Introduction: The study aimed to investigate in which way performance-based reimbursement (PBR) systems in Swedish healthcare services (1) subjectively impacted physicians' work and patient care and (2) were associated with the occurrence of stress-induced exhaustion disorders among physicians. Method: The study applied a mixed-method design. Data were collected from a representative sample of Swedish physicians. In the questionnaire, respondents were asked to answer an open-ended question regarding their reflections on PBR. The answers to the open-ended question were analysed using thematic analysis. Respondents were also asked to rate the impact of PBR on their work. The association between PBR and self-rated stress-induced exhaustion disease was analysed with logistic regressions. Stress-induced exhaustion disorder was measured using the Burnout Assessment Scale. Results: Thematic analysis resulted in four themes: (1) Money talks, (2) Patients are affected, (3) Medical morals are challenged, and (4) PBR increase the quantity of illegitimate tasks. Logistic regressions showed that physicians who experienced PBR had an impact on their work and had a two-fold higher risk of stress-induced exhaustion disorder. Discussion: Our findings suggest that current reimbursement systems in Sweden play an essential role in Swedish healthcare and negatively influence physicians' work and health. Also, current PBR impact patients negatively. No previous study has explored the potentially harmful impact of PBR on how physicians perceive work, health and patient care. Results indicate that policymakers should be encouraged to deeply review PBR systems and focus on ways that they can limit the negative impact on physicians' work and health while meeting future challenges.

Healthcare in distress: A survey of mental health problems and the role of gender among nurses and physicians in Sweden.

INTRODUCTION: The present article aimed to investigate 1) if mental health problems (depression and burnout including the dimensions; emotional exhaustion, mental distance and cognitive and emotional impairment) differed between nurses and physicians in Sweden, 2) if any differences were explained by differences in sex compositions, and 3) if any sex differences were larger within either of the two professions. METHOD: Data were derived from a representative sample of nurses (n = 2903) and physicians (n = 2712) in 2022. Two scales were used to assess burnout (KEDS and BAT) and one to assess depression (SCL-6). The BAT scale has four sub-dimensions. Descriptive statistics and logistic regression were used to analyse each scale and dimension separately. RESULTS: Results showed that 16-28 % of nurses and physicians reported moderate to severe symptoms of burnout. The prevalence differed between occupations across the scales and dimensions used. Nurses reported higher scores on KEDS while physicians reported higher scores on BAT including the four dimensions. Also, 7 % of nurses' and 6 % of physicians' scores were above the cut-off for major depression. The inclusion of sex in the models changed the odds ratios of differences between doctors and nurses in all mental health dimensions except mental distance and cognitive impairment. LIMITATIONS: This study was based on cross-sectional survey data which has some limitations. CONCLUSION: Our study suggests that the prevalence of mental health problems is prominent among nurses and physicians in Sweden. Sex plays an important role in the difference in the prevalence of mental health problems between the two professions.

Sickness absence and disability pension three years before and seven years after first childbirth: A Swedish population-based cohort study.

AIMS: There is a widely held belief, in Sweden and internationally, that women with children are more likely to be on sickness absence (SA) than their nulliparous counterparts. However, empirical findings in the field are limited and inconsistent. We aimed to explore initially nulliparous women's patterns of SA and disability pension (DP) three years before and seven years after 2009, by later parity. METHODS: We conducted a longitudinal cohort study of nulliparous women in Sweden on 31 December 2009 (N=426,918). We compared crude and standardized numbers of SA/DP net days in the three years before (Y-3 to Y-1) and the seven years (Y+1 to Y+7) after the date of the first birth in 2010 or 2 July 2010 in the following three groups: (1) women with no childbirth during the seven-year follow-up and an additional nine months (i.e. 7.8 years), (2) women with a first childbirth in 2010 and no additional childbirth during the next 7.8 years, and (3) women with their first childbirth in 2010 and minimum one more during the next 7.8 years. RESULTS: Women remaining nulliparous had consistently more standardized mean SA/DP days than women giving birth. Compared with women with one birth, women with several births had similar mean numbers of standardized SA/DP days during Y-3 and Y-2, more during Y+1 to Y+3 and fewer during Y+4 to Y+7. CONCLUSIONS: In contrast to the widely held societal belief, we found that in all years women who gave birth had fewer SA/DP days than those remaining nulliparous.

Sickness absence in relation to first childbirth in nulliparous women, employed in the education and care branches in the public or private sectors: A Swedish longitudinal cohort study.

BACKGROUND: Pregnancy and childbirth entail increased risks of sickness absence (SA). Many women work in education and care, two branches characterised by high SA levels; it is not known if the link between childbirth and SA in these branches differs between private and public sectors. We examined SA and disability pension (DP) in relation to childbirth among women working in the education and care branches, and if these patterns differed between public and private sectors. METHODS: We performed a Swedish register-based cohort study. Study participants were nulliparous women living in Sweden in December 2004 and employed in education or care (n = 120,013). We compared SA/DP in the three years before and after 2005 among women who had no childbirth during follow-up (B0), had one childbirth in 2005 and no more (B1), and had one childbirth in 2005 and at least one more during follow-up (B1+). Analyses were performed for all and by public or private sector. RESULTS: Of all studied women, 70% worked in the public sector. Women in B1 and B1+ had, except for the year before childbirth, comparable or lower mean combined SA/DP days than women in the B0 group; women in the B1+ group had, except for the year before childbirth, the lowest mean level of SA/DP. We observed no substantial differences in these patterns between public and private sectors. CONCLUSIONS: Patterns of SA/DP among nulliparous women who did or did not give birth did not differ substantially between public and private sectors among women in the educational and care branches.

The Swedish HealthPhys Study: Study Description and Prevalence of Clinical Burnout and Major Depression among Physicians.

Objectives: The study purpose was to describe the Swedish HealthPhys cohort. Using data from the HealthPhys study, we aimed to describe the prevalence of clinical burnout and major depression in a representative sample of Swedish physicians across gender, age, worksite, hierarchical position, and speciality in spring of 2021, during the third wave of the Covid-19 pandemic. Method: The HealthPhys questionnaire was sent to a representative sample of practising physicians (n = 6699) in Sweden in February to May of 2021 with a 41.3% response rate. The questionnaire included validated instruments measuring psychosocial work environment and health including measurements for major depression and clinical burnout. Results: Data from the HealthPhys study showed that among practising physicians in Sweden the prevalence of major depression was 4.8% and clinical burnout was 4.7%. However, the variations across sub-groups of physicians regarding major depression ranged from 0% to 10.1%. For clinical burnout estimates ranged from 1.3% to 14.5%. Emergency physicians had the highest levels of clinical burnout while they had 0% prevalence of major depression. Prevalence of exhaustion was high across all groups of physicians with physicians working in emergency departments, at the highest (28.6%) and anaesthesiologist at the lowest (5.6%). Junior physicians had high levels across all measurements. Conclusions: In conclusion, the first data collection from the HealthPhys study showed that the prevalence of major depression and clinical burnout varies across genders, age, hierarchical position, worksite, and specialty. Moreover, many practising physicians in Sweden experienced exhaustion and were at high risk of burnout.

Is work-life interference a risk factor for sickness absence? A longitudinal study of the Swedish working population.

BACKGROUND: While there is increasing literature on the health effects of work-life interference, few studies have investigated the relationship between a direct measure of work-life interference and objective sickness absence measures. The aim of this study is to investigate whether work-life interference is a risk factor for subsequent long-term sickness absence (LTSA). METHODS: Data were derived from the Swedish Longitudinal Occupational Survey of Health 2010, 2012, 2014 and 2016. Data were linked to register data on LTSA (having at least one continuous period of medically certified sick leave exceeding 14 days) the following 2 years after each data collection wave. We applied generalized estimating equations, odds ratios (ORs) and 95% confidence intervals (CIs). The sample included 15 244 individuals (43.1% men and 56.9% women). Nearly a fifth of the sample (18.7%, n = 1110) started at least one period of LTSA at any point between 2010 and 2018. RESULTS: Work-life interference was found to be a risk factor for subsequent LTSA (OR = 1.55; 95% CI = 1.44-1.67) even when adjusting for relevant factors including general health (OR = 1.39; 95% CI = 1.29-1.51). We found no significant moderating effect of gender. CONCLUSION: The results of this study indicate that work-life interference is a risk factor for subsequent LTSA for working men and women in Sweden.

Gender composition in occupations and branches and medically certified sick leave: a prospective population study.

OBJECTIVE: To investigate whether gender-segregated occupations and branches are associated with future medically certified sick leave for women and men. METHODS: All gainfully employed residents in Sweden in December 31st 2014 aged 16-69 years (n = 4 473 964) were identified in national registers. Subjects working in segregated (61-90%) and extremely segregated (> 90%) occupations and branches were evaluated v/s subjects in gender-integrated occupations and branches (40-60%). Combinations of segregation by occupation and branch were also investigated. Two-year prospective medically certified sick leaves (> 14 days) were evaluated using logistic regression with odds ratios recalculated to relative risks (RR), adjusted for work, demographic and health related factors. RESULTS: The sick leave risk was higher for those working in extremely female-dominated occupations (women RR 1.06 and men RR 1.13), and in extremely female-dominated branches (women RR 1.09 and men RR 1.12), and for men in extremely male-dominated branches (RR 1.04). The sick leave risk was also higher for both women and men in female-dominated occupations regardless of the gender segregation in the branch they were working in. However, the differences in sick leave risks associated with gender segregation were considerably smaller than the differences between occupations and branches in general. CONCLUSIONS: Gender segregation in occupations and branches play a role for sick leave among women and men, especially within extremely female-dominated occupations and branches. However, gender segregation appears to be subordinate to particular occupational hazards faced in diverse occupations and branches.

Sickness absence and disability pension in relation to first childbirth and in nulliparous women according to occupational groups: a cohort study of 492,504 women in Sweden.

BACKGROUND: Childbirth has been suggested to increase sickness absence (SA) and disability pension (DP). This may vary by occupation; however, knowledge in this field remains limited. We explored SA and DP in the years before and after childbirth among women in four occupational groups and those without occupation. METHODS: We studied nulliparous women aged 18-39 years, living in Sweden on December 31, 2004 (n = 492,504). Women were categorized into five skill-level based occupational groups and three childbirth groups; no childbirths within 3 years (B0), first childbirth in 2005 with no childbirth within 3 years (B1), and first childbirth in 2005 with at least one more birth within 3 years (B1+). We compared crude and standardized annual mean SA (in spells> 14 days) and DP net days in the 3 years before and 3 years after first childbirth date. RESULTS: Women in the highest skill level occupations and managers, had less mean SA/DP days during most study years than women in the lowest skill level occupations group. In B1 and B1+, absolute differences in mean SA/DP, particularly in SA, among occupational groups were highest during the year before childbirth. DP was most common in B0, regardless of group and year. CONCLUSIONS: We found that women's mean SA/DP days before and after first childbirth was higher with decreasing skill-level of the occupational group and these differences were most pronounced in the year before childbirth. DP was most common among women not giving birth, regardless of occupational group.

A follow-up of the introduction of a maximum entitlement period for receiving sickness benefits in Sweden: A nationwide register-based study.

In 2008, Sweden introduced a policy change to limit the number of days for sickness benefits (SB). This study aimed to elucidate the characteristics of those who reached the maximum entitlement period for receiving sickness benefits (MEPSB) and their future main source of income. Methods: All 5,309,759 individuals, aged 20-63 and residents of Sweden in 2009 were followed from July 2008 to July 2010 regarding SB-days and date of MEPSB and then categorised into three groups: I) no SB-days, II) ongoing SB-days, and III) MEPSB. Mean numbers of SB-days 2.5 years before and 2 years after the policy change and main source of income in 2011 were assessed. Associations between sociodemographic factors, occupation and paid work as main source of income were estimated by odds ratio (OR). Results: A total of 0.7% reached MEPSB in 2010. The mean numbers of SB-days before and after the policy change were higher in the MEPSB group than in the other two groups. In the MEPSB group, 14% had their main source of income from paid work in 2011; this was more common among women born in Sweden (OR = 1.29), people living with a partner and children (women OR = 1.29; men OR = 1.48), and those with occupations representing high educational levels. Conclusions: One out of seven individuals with MEPSB in 2010 had their main source of income from paid work in 2011, although they had a long-term SB before and after the policy change. Further research is warranted to address the long-term effects of this policy change.

Gender equality and sick leave among first-time parents in Sweden.

Aims: To examine gender equality in the family and sick leave among first-time parents. Methods: Heterosexuals who became first-time parents between 2002 and 2009 (N = 223,332) were identified in national registers. Gender equality in the family was evaluated by parental insurance and income from gainful employment representing the domestic and work spheres respectively and was defined as each parent contributing 40-60% of the family total. The risk of a new medically certified sick-leave spell (>14 days) was evaluated by hazard ratio (HR) using the Cox proportional hazard regression, adjusted for demographic and socioeconomic factors. Results: Gender equality was associated with an increased risk of sick leave compared with traditional roles where women had the main responsibility in the domestic sphere and men in the work sphere (HR 1.30 in women and 1.19 in men). In addition, situations with one partner exposed to double burden or untraditional settings were associated with an increased risk. Conclusions: Equal sharing or taking the lion's share of paid work and domestic responsibilities were associated with an increased risk of sick leave among first-time parents in Sweden. Family-friendly policies are important for facilitating the life of dual earner families, but do not fully counteract the work-life demands of first-time parents.

Sickness absence and disability pension before and after first childbirth and in nulliparous women: longitudinal analyses of three cohorts in Sweden.

OBJECTIVE: Childbirth is suggested to be associated with elevated levels of sickness absence (SA) and disability pension (DP). However, detailed knowledge about SA/DP patterns around childbirth is lacking. We aimed to compare SA/DP across different time periods among women according to their childbirth status. DESIGN: Register-based longitudinal cohort study. SETTING: Sweden. PARTICIPANTS: Three population-based cohorts of nulliparous women aged 18-39 years, living in Sweden 31 December 1994, 1999 or 2004 (nearly 500 000/cohort). PRIMARY AND SECONDARY OUTCOME MEASURES: Sum of SA >14 and DP net days/year. METHODS: We compared crude and standardised mean SA and DP days/year during the 3 years preceding and the 3 years after first childbirth date (Y-3 to Y+3), among women having (1) their first and only birth during the subsequent 3 years (B1), (2) their first birth and at least another delivery (B1+), and (3) no childbirths during follow-up (B0). RESULTS: Despite an increase in SA in the year preceding the first childbirth, women in the B1 group, and especially in B1+, tended to have fewer SA/DP days throughout the years than women in the B0 group. For cohort 2005, the mean SA/DP days/year (95% CIs) in the B0, B1 and B1+ groups were for Y-3: 25.3 (24.9-25.7), 14.5 (13.6-15.5) and 8.5 (7.9-9.2); Y-2: 27.5 (27.1-27.9), 16.6 (15.5-17.6) and 9.6 (8.9-10.4); Y-1: 29.2 (28.8-29.6), 31.4 (30.2-32.6) and 22.0 (21.2-22.9); Y+1: 30.2 (29.8-30.7), 11.2 (10.4-12.1) and 5.5 (5.0-6.1); Y+2: 31.7 (31.3-32.1), 15.3 (14.2-16.3) and 10.9 (10.3-11.6); Y+3: 32.3 (31.9-32.7), 18.1 (17.0-19.3) and 12.4 (11.7-13.0), respectively. These patterns were the same in all three cohorts. CONCLUSIONS: Women with more than one childbirth had fewer SA/DP days/year compared with women with one childbirth or with no births. Women who did not give birth had markedly more DP days than those giving birth, suggesting a health selection into childbirth.

Mental disorder sick leave in Sweden: A population study.

BACKGROUND: The inability to perform productive work due to mental disorders is a growing concern in advanced societies. OBJECTIVE: To investigate medically certified mental disorder and all-cause sick leave in a working population using demographic, socioeconomic and occupational predictors. METHODS: The study population was the entire Swedish work force aged 16-64 years in December 31st 2011. The outcome was sick leave exceeding 14 days in 2012 with adjustment for 13 confounders. RESULTS: The risk of sick leave with a mental disorder is higher among women compared to men, among persons aged 30-39 and among parents in families with underage children. Employees in welfare service occupations within health care, education and social services have an elevated risk of mental disorder sick leave and constitute a large proportion of the workforce. CONCLUSION: The results support the need for improving early detection and prevention of mental disorders in the workforce. Improvements in psychosocial work environments are essential, where the higher risk in female dominated welfare occupations particularly, have repercussions on the quality of the welfare services provided for vulnerable groups in society. Better work-life balance in families with younger children could also mitigate the effects of a high total workload in that particular phase of life.

Effort-reward imbalance, overcommitment and their associations with all-cause and mental disorder long-term sick leave - A case-control study of the Swedish working population.

OBJECTIVES: To investigate if effort-reward imbalance (ERI) and overcommitment (OC) are associated with all-cause and mental disorder long-term sick leave (LS), and to identify differences in associations between genders, private versus public sector employees and socioeconomic status groups. MATERIAL AND METHODS: The study uses a cross-sectional case-control design with a sample of 3477 persons on long-term sick leave of more than 59 days and a control group of 2078 in employment. Data on sick leave originate from social insurance registers, while data on health, working and living conditions were gathered through a survey. The binary logistic regression was used to test the multivariate associations. RESULTS: Effort-reward imbalance was associated with all-cause LS among the women (odds ratio (OR) = 1.58, 95% CI: 1.2-2.08), but not among the men. Associations for mental disorder LS were evident for both ERI and OC among both genders (ERI/OC: women OR = 2.76/2.82; men OR = 2.18/2.92). For the men these associations were driven by high effort, while for the women it was low job esteem in public sector and low job security in private sector. Among the highly educated women, ERI was strongly related to mental disorder LS (OR = 6.94, 95% CI: 3.2-15.04), while the highly educated men seemed to be strongly affected by OC for the same outcome (OR = 5.79, 95% CI: 1.48-22.57). CONCLUSIONS: The study confirmed the independent roles of ERI and OC for LS, with stronger associations among the women and for mental disorders. The ERI model is a promising tool that can contribute to understanding the prevailing gender gap in sick leave and increasing sick leave due to mental disorders. Int J Occup Med Environ Health 2016;29(6):973-989.

Sick leave diagnoses and return to work: a Swedish register study.

PURPOSE: To provide a detailed description of return to work (RTW) for different diagnoses. METHODS: A sample of 617,611 cases of sick leave with minimum duration of 14 days started in 2009 and 2010 was followed for 450 days. Data on sick leave episodes, diagnosis (ICD-10 codes on 3-digit level) and background factors were retrieved from Swedish National Social Insurance registers. RTW was analysed with Cox proportional hazard regression with separate analyses for women and men. RESULTS: The diseases with the lowest RTW rates were present within malign neoplasms, severe mental disorders and severe cardiovascular diseases. High-RTW rates were present for infectious respiratory diseases, viral infections and less severe cardiovascular diseases. There were distinct differences across diagnoses within all diagnosis chapters. This also holds for mental disorders and musculoskeletal diseases, which are the most common causes of sick leave. The results for women and men across different diseases and disorders were strikingly similar. CONCLUSIONS: Systematic use of standard information such as detailed sick listing diagnosis could, at low-additional cost, pinpoint cases at risk for prolonged sick leave. The use of broad diagnosis categories in sick leave research may be questioned since there are distinct differences in RTW within ICD-10 chapters.

Sick leave patterns in common musculoskeletal disorders--a study of doctor prescribed sick leave.

BACKGROUND: Comparative data on sick leave within musculoskeletal disorders (MSDs) is limited. Our objective was to give a descriptive overview of sick leave patterns in different MSDs. METHODS: Using electronic medical records, we collected information on dates and diagnostic codes for all available sick leave certificates, during 2 years (2009-2010), in the North Western part of the Skåne region in Sweden (22 public primary health care centres and two general hospitals). Using the International Classification of Diseases (ICD) 10 codes on the certificates we studied duration, age and sex distribution and recurrent periods of sick leave for six strategically chosen MSDs; low back pain (M54) disc disorders (M51), knee osteoarthritis (M17) hip osteoarthritis (M16) rheumatoid arthritis (M05-M06) and myalgia (M79). RESULTS: All together 20 251 sick leave periods were issued for 16 673 individuals 16-64 years of age (53% women). Out of the selected disorders, low back pain and myalgia had the shortest sick leave periods, with a mean of 26 and 27 days, respectively, while disc disorders and rheumatoid arthritis had the longest periods with a mean of 150 and 147 days. For low back pain and myalgia 27% and 26% of all sick leave was short (8-14 days) and only 11% and 13%, were long (≥90 days). For the other selected MSDs, less than 5% of the periods were short. For disc disorders, hip osteoarthritis and rheumatoid arthritis, more than 60% of the periods were long (p > 0.001). For back disorders and myalgia most periods were issued in the age groups between 40-49, with similar patterns for women and men. Osteoarthritis and rheumatoid arthritis had most periods in the age groups of 50-64, and patterns for women and men differed. Low back pain, rheumatoid arthritis and myalgia had the greatest share of recurrent sick leave (31%, 34% and 32% respectively). CONCLUSION: Duration, age and sex distribution and numbers of recurrent sick leave varies considerably between different MSDs. This underscores the importance of using specified diagnosis, in sick leave research as well as in planning of treatment and rehabilitation and evaluation of prognosis.

Termination of sickness benefits or transition to disability pension after changes in sickness insurance: a Swedish register study.

PURPOSE: To assess whether the changes in Swedish sickness insurance in 2008 were associated with termination of benefits (TOB) or transition to disability pension (DP) for individuals in compensated sick leave of varying duration. Changes were (1) introduction of sick-listing guidelines and (2) stricter criteria for eligibility to disability pension and sickness cash benefit and time limits for the latter. METHODS: The study population consisted of 2 556 211 cases of compensated sick leave with onset during 2006-2010 from the Swedish national social insurance registers. TOB and DP were analysed with Cox-proportional hazard regression. RESULTS: After the introduction of sick-listing guidelines, TOB increased for both women [hazard ratio (HR) 1.10] and men (HR 1.07). The additional introduction of stricter rules 4 months later were modestly associated with TOB (HR: women 1.01, men 0.99) and transition to DP among men decreased with stronger associations for spells exceeding 180 days (HR 0.86). For women transition to DP surprisingly increased with stricter criteria (HR 1.09), although this pattern was reversed in sick leave spells exceeding 1 year (HR 0.90). CONCLUSIONS: Introducing sick-listing guidelines for different illnesses and diseases could have had a considerable impact on TOB. The additional introduction of stricter eligibility rules and time limits seem to have contributed less to TOB but clearly reduced DP in longer sickness spells.

Does unbalanced gender composition in the workplace influence the association between psychosocial working conditions and sickness absence?

INTRODUCTION: Earlier research has shown that bad psychosocial working conditions contribute to sick-leave. Some theorists argue that skewed gender composition can be one of the factors contributing to bad psychosocial working conditions. OBJECTIVES: We examine whether workplace gender composition has an effect on the association between job strain and sick-leave. METHODS AND PARTICIPANTS: Associations were assessed using a case-control study with Swedish data collected in 2008 (n=5595). RESULTS: Results indicated that there was an association between high strain jobs and sickness absence among both women (Adj. OR 2.04, CI95% 1.62-2.57) and men (2.24, 1.67-3.01). Furthermore, both women (2.87, 1.34-6.26) and men (2.53, 1.74-3.69) in male-dominated workplaces had the highest risk for sickness absence due to high strain jobs. Male-dominated workplaces were, in general adverse for both women and men. CONCLUSIONS: The results indicated that a minority position strengthens job strain for women while it weakens the association for men. Using modern gender theories, we could argue that some of these results might be explained by the general use of masculinity as the social norm in the labor market. However, findings from this study need to be validated by further research.

Work-family interference and long-term sickness absence: a longitudinal cohort study.

BACKGROUND: Alongside work environment factors, interference between work and domestic life has been proposed as an important explanation for long-term sickness absence, particularly for women. The aim was to investigate the association between work-to-family interference, family-to-work interference and long-term sickness absence among women and men in different family- and work-related settings. METHODS: The study population was a random sample of 2867 gainfully employed adults in Sweden aged 25-50. In 2004, telephone interview data were collected that included questions about family, work and health. The outcome measure was having at least one spell of long-term sickness absence (>14 days) in 2005 based on social insurance register data. Associations were analysed by logistic regression. RESULTS: Work-to-family interference was more common than family-to-work interference and more often reported by women. The overall associations with long-term sickness absence were weak. However, after adjustment for age and self-reported health, work-to-family interference was associated with long-term sick leave among men with higher socioeconomic status (odds ratio 2.87; 95% CI 1.36-6.07), and there was also a tendency to association among women bearing the main responsibility for housework and family (1.59; 0.99-2.54). CONCLUSIONS: These findings suggest that work-to-family interference is associated with long-term sickness absence in the working population, but in a gender- and situation-specific manner. Hence, extensive work responsibilities for men, and probably extensive family responsibilities for women, could hamper the balance between work and family and increase the risk of long-term sick leave. Further studies are warranted within this area.

Long-term sickness absence: changes in risk factors and the population at risk.

OBJECTIVES: To investigate changes over time in factors associated with long-term sickness absence (LTSA) and in the fraction of LTSA attributable to these risk factors in 1986-1989 and 2002, respectively. MATERIALS AND METHODS: Data from two earlier Swedish studies respectively comprising 1622 and 2009 employees with a history of LTSA (> or = 60 days), and 1019 and 1903 employed members of the general labour force as controls (ages 20-64 years) was used. The studies were conducted before and after extensive changes in the Swedish labour market during the 1990s, and they used sickness absence data from national social insurance records and self-reported information on sociodemographic, lifestyle, and work characteristics. Associations between these factors and LTSA were estimated by logistic regression, and population attributable fractions were calculated. RESULTS: The results indicate that, after the 1990s, LTSA was associated with female sex (odds ratio = 1.84, 95% CI: 1.57-2.15) and was also more strongly associated with various aspects of the psychosocial work environment and job situations. A larger population at risk, primarily an ageing workforce, account for a large proportion of LTSA. CONCLUSIONS: The results confirm consistent associations between LTSA and several established risk factors, and they also reveal a change in the risk panorama. The current findings demonstrate that, to understand the magnitude of LTSA, both risk factors and the population at risk must be monitored over time. Prevention should aim to create healthy workplaces in general and also focus on female-dominated public sector occupations.

What is healthy work for women and men? - A case-control study of gender- and sector-specific effects of psycho-social working conditions on long-term sickness absence.

The aim of the study was to investigate the relevance of the demand-control model and social support in predicting long-term sickness absence (LTSA). Identifying gender- and sector- (private vs. public) specific patterns was in focus. The study uses a cross-sectional design with a case and a control group. The cases are a sample of 2 327 long-term sick listed (>60 days) and the controls are a Swedish population-based sample of 2 063. Data on sickness absence were retrieved from the Swedish national social insurance registers. Data on health, working and living conditions were gathered through a self-administered questionnaire. The results show that employed women have a notably higher risk for LTSA than employed men. High-strain jobs increase the odds for LTSA among both women and men. Active jobs were also associated with LTSA among women. The study confirms the demand-control model (job strain hypothesis) and social support and their associations with LTSA. However, the job strain hypothesis is more evident in the private sector. Active jobs with high psychological demands and high decision latitude seem to be problematic for many women, especially in the private sector. Thus, the active learning hypothesis receives no support for women in the Swedish working population in general.