Gender differences in long term sickness absence.

PURPOSE: Sickness absence is a major public health problem, given its high cost and negative impact on employee well-being. Understanding sickness absence duration and recovery rates among different groups is useful to develop effective strategies for enhancing recovery and reducing costs related to sickness absence. METHODS: Our study analyzed data from a large occupational health service, including over 5 million sick-listed employees from 2010 to 2020, out of which almost 600,000 cases were diagnosed by an occupational health physician. We classified each case according to diagnosis and gender, and performed descriptive statistical analysis for each category. In addition, we used survival analysis to determine recovery rates for each group. RESULTS: Mean sickness duration and recovery rate both differ significantly among groups. Mental and musculoskeletal disorders had the longest absence duration. Recovery rates differed especially during the first months of sickness absence. For men the recovery rate was nearly constant during the first 1.5 year, for women the recovery rate was relatively low in the first three months, and then stayed nearly constant for 1.5 year. CONCLUSION: Across almost all diagnostic classes, it was consistently observed that women had longer average sickness absence durations than to men. Considering mental disorders and diseases of the musculoskeletal system, women had relatively lower recovery rates during the initial months compared to men. As time progressed, the recovery rates of both genders converged and became more similar.

The role of job strain in the relationship between depression and long-term sickness absence: a register-based cohort study.

PURPOSE: Though individuals with depression and those with poor working conditions are more likely to be on long-term sickness absence (LTSA), less is known about how working conditions may modify the associations between depression status and LTSA. This study aims to examine the association between depression and LTSA among Swedish workers with different levels of job strain and its individual components (job demands and job control). METHODS: All Swedish workers 30 - 60 years old (N = 3,065,258) were studied in 2005. At baseline (2005-2010), workers were categorized as: without depression, being prescribed antidepressants, and being in inpatient/outpatient care. Job strain was measured using a Swedish Job Exposure Matrix, and data on LTSA were obtained from 2011 to 2021. The association between depression and LTSA was assessed using Cox proportional-hazards regression stratified by categories of job strain. RESULTS: Compared to workers without depression, workers with depression had higher risk of LTSA across all job strain levels. Depression was associated with the highest hazards of LTSA in active jobs, but a similar population attributable fraction (PAF) was found across categories of job strain, indicating similarities between the different categories. CONCLUSION: There was evidence of a moderating effect of job strain in the relationship between depression and LTSA, but also evidence that this was due to differences in baseline depression prevalence in the different job strain categories. Future research is needed to determine alternative factors which could be relevant for reducing LTSA among those who have already developed depression.

Identifying labour market pathways after a 30-day-long sickness absence -a three-year sequence analysis study in Finland.

BACKGROUND: Return-to-work (RTW) process often includes many phases. Still, multi-state analyses that follow relevant labour market states after a long-term sickness absence (LTSA), and include a comprehensive set of covariates, are scarce. The goal of this study was to follow employment, unemployment, sickness absence, rehabilitation, and disability pension spells using sequence analysis among all-cause LTSA absentees. METHODS: Register data covered full-time and partial sickness allowance, rehabilitation, employment, unemployment benefits, and permanent and temporary disability pension (DP), retrieved for a 30% representative random sample of Finnish 18-59 years old persons with a LTSA in 2016 (N = 25,194). LTSA was defined as a ≥ 30-day-long full-time sickness absence spell. Eight mutually exclusive states were constructed for each person and for 36 months after the LTSA. Sequence analysis and clustering were used to identify groups with different labour market pathways. In addition, demographic, socioeconomic, and disability-related covariates of these clusters were examined using multinomial regressions. RESULTS: We identified five clusters with emphases on the different states: (1) rapid RTW cluster (62% of the sample); (2) rapid unemployment cluster (9%); (3) DP after a prolonged sickness absence cluster (11%); (4) immediate or late rehabilitation cluster (6%); (5) other states cluster (6%). Persons with a rapid RTW (cluster 1) had a more advantaged background than other clusters, such as a higher frequency of employment and less chronic diseases before LTSA. Cluster 2 associated especially with pre-LTSA unemployment and lower pre-LTSA earnings. Cluster 3 was associated especially with having a chronic illness before LTSA. Those in cluster 4 were on average younger and had a higher educational level than others. Especially clusters 3 and 4 were associated with a LTSA based on mental disorders. CONCLUSIONS: Among long-term sickness absentees, clear groups can be identified with both differing labour market pathways after LTSA and differing backgrounds. Lower socioeconomic background, pre-LTSA chronic diseases and LTSA caused by mental disorders increase the likelihood for pathways dominated by long-term unemployment, disability pensioning and rehabilitation rather than rapid RTW. LTSA based on a mental disorder can especially increase the likelihood for entering rehabilitation or disability pension.

Using intervention mapping to develop evidence-based toolkits that support workers on long-term sick leave and their managers.

BACKGROUND: Managing long-term sickness absence is challenging in countries where employers and managers have the main responsibility to provide return to work support, particularly for workers with poor mental health. Whilst long-term sick leave and return to work frameworks and guidance exist for employers, there are currently no structured return to work protocols for employers or for their workers encompassing best practice strategies to support a positive and timely return to work outcome. PURPOSE: To utilise the intervention mapping (IM) protocol as a framework to develop return to work toolkits that are underpinned by relevant behaviour change theory targeting mental health to promote a positive return to work experiensce for workers on long-term sick leave. METHODS: This paper provides a worked example of intervention mapping (IM) to develop an intervention through a six-step process to combine theory and evidence in the development of two toolkits - one designed for managers and one to be used by workers on long-term sick leave. As part of this process, collaborative planning techniques were used to develop the intervention. A planning group was set up, through which researchers would work alongside employer, worker, and mental health professional representatives to develop the toolkits. Additionally, feedback on the toolkits were sought from the target populations of workers and managers and from wider employer stakeholders (e.g., human resource specialists). The implementation and evaluation of the toolkits as a workplace intervention were also planned. RESULTS: Two toolkits were designed following the six steps of intervention mapping. Feedback from the planning group (n = 5; psychologist, psychiatrist, person with previous experience of poor mental health, employer and charity worker) and participants (n = 14; employers = 3, wellbeing director = 1; human resources = 2, managers = 2, employees with previous experience of poor mental health = 5) target populations indicated that the toolkits were acceptable and much needed. CONCLUSIONS: Using IM allowed the development of an evidence-based practical intervention, whilst incorporating the views of all the impacted stakeholder groups. The feasibility and acceptability of the toolkits and their supporting intervention components, implementation process and methods of assessment will be evaluated in a feasibility pilot randomised controlled trial.

Return to work following long term sickness absence: a comparative analysis of stakeholders' views and experiences in six European countries.

Purpose Return to work is a complex and challenging process which takes various forms in different contexts. The aim of this study is to explore and compare cross-country differences in stakeholders' experiences and views on actors, policies and practices relevant for return to work after long-term sickness absence. The comparative exploration is done in six countries with various legislative backgrounds, welfare and social dialogue systems. Methods Using a purposive sample, six multidisciplinary stakeholders group discussions were conducted in six countries: Belgium, Estonia, Ireland, Italy, Romania and Slovakia. A total of 51 individuals comprised of social partners, policymakers or representatives of public bodies and patient associations participated. An interpretative phenomenological analysis was employed to derive the most important themes in the discussions. Results Five major themes emerged from the group discussions. A graphic model is proposed to emphasize the variety of frameworks and processes across countries. Conclusions The core part of the return to work process is the dynamic relation between legislation, stakeholders and practices, which is influenced by broader national and societal factors. The cross-country variation in legislations, stakeholders and practices can be understood as a continuum, from low to high structuring, development and comprehensiveness. Although social dialogue appears to have a role in return to work process with variation across countries, it is not always on top of the agenda of social partners.

Measuring Resilience in Long-term Sick-listed Individuals: Validation of the Resilience Scale for Adults.

Return to work from long-term sick leave is influenced by personal and social factors, which can be measured by resilience, a construct that describe healthy adaptation against adversity. This study aimed to validate the validity and psychometric properties of the resilience scale for adults in a sample of long-term sick-listed individuals, and to investigate measurement invariance when compared with a university student sample. Confirmatory factor analysis was used on a sick-listed sample (n = 687) to identify the scale?s factor structure, and comparison with a university student sample (n = 241) was utilized to determine measurement invariance. Results show that a slightly modified factor structure, in accordance with previous research, achieved acceptable fit in the sick-listed sample, while comparisons with the student sample supported measurement invariance. This means that the study to a large degree support the factor structure of the resilience scale for adults in long-term sick-listed. Furthermore, the results indicate that the scale is similarly understood among long-term sick-listed as in a previously validated student sample. Thus, the resilience scale for adults can be a valid and reliable measure of protective factors in the long-term sickness absence and return to work context, and the subscale and total score can be interpreted similarly in long-term sick-listed as in other populations.

Relationship Between Work Engagement and the Onset of Long-term Sickness Absence Due to Mental Disorders: A 4-year Retrospective Cohort Study.

The aim of the present study was to investigate the association between work engagement and long-term sickness absence due to mental disorders such as mood disorders and anxiety, and whether the relationship differs between men and women, during a 4-year follow-up period. Data were obtained from 21,293 workers at four pharmaceutical companies belonging to the Collabo-Health Study Group in 2014. The baseline data were collected by self-administered questionnaires. We obtained information about long-term sickness absence from the personnel records of the surveyed companies from the baseline survey in 2014 until March 2018. Hazard ratios (HRs) and 95% confidence intervals (CIs) using the low work engagement group as a reference were calculated by Cox proportional hazards analysis as the outcome, defined as the period leading to mental health-related sick leave. A total of 12,025 participants had complete data for analysis, and 123 exhibited long-term sickness absence during a 4-year follow-up period. The high work engagement group for men had a significantly lower HR (0.52, 95% CI: 0.31-0.88, P = 0.015) compared with the low work engagement group. Conversely, among women, the moderate work engagement group had a significantly higher HR (2.44, 95% CI: 1.03-5.84, P = 0.043) compared with the low work engagement group. Work engagement in men may predict the occurrence of long-term sickness absence due to mental disorders in the subsequent four years, but this relationship was different in women. Further research is needed to clarify this issue.

Return to work after first incidence of long-term sickness absence: A 10-year prospective follow-up study identifying labour-market trajectories using sequence analysis.

Aims: The study aim was to identify prototypical labour-market trajectories following a first incidence of long-term sickness absence (LTSA), and to assess whether baseline socio-demographic characteristics are associated with the return-to-work (RTW) process and labour-market attachment (LMA). Methods: This prospective study used Norwegian administrative registers with quarterly information on labour-market participation to follow all individuals born 1952-1978 who underwent a first LTSA during the first quarter of 2004 (n =9607) over a 10-year period (2004-2013). Sequence analysis was used to identify prototypical labour-market trajectories and LMA; trajectory membership was examined with multinomial logistic regression. Results: Sequence analysis identified nine labour-market trajectories illustrating the complex RTW process, with multiple states and transitions. Among this sample, 68.2% had a successful return to full-time work, while the remaining trajectories consisted of part-time work, unemployment, recurrence of LTSA, rehabilitation and disability pension (DP). A higher odds ratio (OR) for membership to trajectories of weaker LMA was found for females and older participants, while being married/cohabitating, having children, working in the public sector, and having a higher education, income and occupational class were associated with a lower OR of recurrence, unemployment, rehabilitation and DP trajectories. These results are consistent with three LMA indicators. Conclusions: Sequence analysis revealed prototypical labour-market trajectories and provided a holistic overview of the heterogeneous RTW processes. While the most frequent outcome was successful RTW, several unfavourable labour-market trajectories were identified, with trajectory membership predicted by socio-demographic measures.

Can work-unit social capital buffer the association between workplace violence and long-term sickness absence? A prospective cohort study of healthcare employees.

PURPOSE: To determine the prospective relation between workplace violence and the risk of long-term sickness absence (LTSA), and study if work-unit social capital could buffer this effect. As an explorative analysis, the association between work-unit social capital and workplace violence is also tested. METHODS: The study is based on the Well-being in HospitAL Employees (WHALE) cohort, including healthcare employees in Denmark. The study sample consisted of 30,044 employees nested within 2304 work-units. Exposure to workplace violence and threats of violence during the past 12 months was measured by self-report. Work-unit social capital was computed by aggregating the mean individual responses within work-units. LTSA was defined as one or more episodes of ≥ 29 consecutive sickness absence days initiated within 2 years following baseline. RESULTS: Employees experiencing workplace violence had a higher risk of LTSA (OR = 1.55; 95% CI 1.39-1.72), but there was no evidence in support of work-unit social capital buffering the effect of workplace violence on LTSA (RERI = 0.24; 95%CI: - 0.36 to 0.84; p = 0.12 for multiplicative interaction). High compared to low work-unit social capital was associated with a lower prevalence of workplace violence (OR = 0.47; 95% CI 0.36-0.61). CONCLUSION: There was a prospective association between workplace violence and LTSA, but work-unit social capital did not buffer this effect. Furthermore, the results revealed an inverse association between work-unit social capital and workplace violence. The findings indicate that  in order to effectively reduce LTSA, preventive interventions need to both prevent workplace violence and strengthen social capital.

Long-term sickness absence in a working population: development and validation of a risk prediction model in a large Dutch prospective cohort.

BACKGROUND: Societal expenditures on work-disability benefits is high in most Western countries. As a precursor of long-term work restrictions, long-term sickness absence (LTSA) is under continuous attention of policy makers. Different healthcare professionals can play a role in identification of persons at risk of LTSA but are not well trained. A risk prediction model can support risk stratification to initiate preventative interventions. Unfortunately, current models lack generalizability or do not include a comprehensive set of potential predictors for LTSA. This study is set out to develop and validate a multivariable risk prediction model for LTSA in the coming year in a working population aged 45-64 years. METHODS: Data from 11,221 working persons included in the prospective Study on Transitions in Employment, Ability and Motivation (STREAM) conducted in the Netherlands were used to develop a multivariable risk prediction model for LTSA lasting ≥28 accumulated working days in the coming year. Missing data were imputed using multiple imputation. A full statistical model including 27 pre-selected predictors was reduced to a practical model using backward stepwise elimination in a logistic regression analysis across all imputed datasets. Predictive performance of the final model was evaluated using the Area Under the Curve (AUC), calibration plots and the Hosmer-Lemeshow (H&L) test. External validation was performed in a second cohort of 5604 newly recruited working persons. RESULTS: Eleven variables in the final model predicted LTSA: older age, female gender, lower level of education, poor self-rated physical health, low weekly physical activity, high self-rated physical job load, knowledge and skills not matching the job, high number of major life events in the previous year, poor self-rated work ability, high number of sickness absence days in the previous year and being self-employed. The model showed good discrimination (AUC 0.76 (interquartile range 0.75-0.76)) and good calibration in the external validation cohort (H&L test: p = 0.41). CONCLUSIONS: This multivariable risk prediction model distinguishes well between older workers with high- and low-risk for LTSA in the coming year. Being easy to administer, it can support healthcare professionals in determining which persons should be targeted for tailored preventative interventions.

Predicting Long-Term Sickness Absence and Identifying Subgroups Among Individuals Without an Employment Contract.

Purpose Today, decreasing numbers of workers in Europe are employed in standard employment relationships. Temporary contracts and job insecurity have become more common. This study among workers without an employment contract aimed to (i) predict risk of long-term sickness absence and (ii) identify distinct subgroups of sick-listed workers. Methods 437 individuals without an employment contract who were granted a sickness absence benefit for at least two weeks were followed for 1 year. We used registration data and self-reported questionnaires on sociodemographics, work-related, health-related and psychosocial factors. Both were retrieved from the databases of the Dutch Social Security Institute and measured at the time of entry into the benefit. We used logistic regression analysis to identify individuals at risk of long-term sickness absence. Latent class analysis was used to identify homogenous subgroups of individuals. Results Almost one-third of the study population (n = 133; 30%) was still at sickness absence at 1-year follow-up. The final prediction model showed fair discrimination between individuals with and without long-term sickness absence (optimism adjusted AUC to correct for overfitting = 0.761). Four subgroups of individuals were identified based on predicted risk of long-term sickness absence, self-reported expectations about recovery and return to work, reason of sickness absence and coping skills. Conclusion The logistic regression model could be used to identify individuals at risk of long-term sickness absence. Identification of risk groups can aid professionals to offer tailored return to work interventions.

Assessment of long-term sickness absence: content and face validity of a new questionnaire based on qualitative data from nominal groups.

BACKGROUND: Increasing rates of long-term sickness absence are a worldwide problem. Belgium is the first country in Europe that aims to screen its entire population of sick leavers (sick leave > 6 weeks) for the risk of long-term sickness absence in order to focus resources on the high-risk group and to provide adequate return-to-work support. Our aim was to investigate content and face validity of a newly designed questionnaire (Quickscan) using item prioritization of patients and professionals in the field of long-term sickness absence. This questionnaire was developed based on a review of the literature and existing instruments (Goorts et al, J Public Health Res 7:1419, 2018). METHODS: Qualitative data were collected using the nominal group technique. The data were gathered exploring factors that influence return-to work restrictions or opportunities. RESULTS: Participants indicated 20 out of 21 of the questionnaire factors as important reasons that might influence the return-to-work process. Additionally, 16 factors were discussed that were not yet included in the Quickscan but that might provide useful information on return-to-work issues, according to the participants. In the prioritization of items, we found considerable diversity among participants. CONCLUSIONS: Our findings demonstrate the validity of the Quickscan items to ask patients about important return-to-work barriers or opportunities. However, additional factors were identified that may improve the assessment of risk for long-term sickness absence.

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.

Long-term sickness absence from work due to physical inactivity: A registry-based study.

AIMS: The aim of this study was to explore the relationship between leisure-time physical inactivity and long-term sickness absence in a representative sample of individuals aged 16-54 years, within the labour market and in good health. It was hypothesised that physically inactive individuals have a higher risk of long-term sickness absence and longer duration of sickness absence. METHODS: The study population was identified from the National Health and Morbidity Survey, 2010. Weekly data on long-term sickness absence were obtained from the National Register on Social Transfer Payments (the DREAM registry). The association of incidence and duration of long-term sickness absence with physical inactivity was explored using logistic and Poisson regression. Data were fitted to models with levels of physical activity, demographic, social and lifestyle characteristics as independent variables. A combined hurdle model was used to estimate the difference in mean number of absence weeks. RESULTS: Logistic regression showed that physically inactive individuals had a 27% higher incidence of long-term sickness absence compared with physically active individuals. The Poisson regression showed that long-term sickness absence was only slightly shorter (1 week less) for moderately active individuals compared with inactive individuals. The hurdle model estimated longer absence periods for inactive individuals (additional 2.5 weeks) in comparison with moderately and highly active individuals. CONCLUSIONS: The study showed that physically inactive individuals have a higher incidence of long-term absence and that physically inactive individuals have longer periods with sickness absence than moderately and highly active individuals. When adjustments for social and health behaviour were included, the estimated associations became statistically insignificant.

The longitudinal association between multiple job holding and long-term sickness absence among Danish employees: an explorative study using register-based data.

PURPOSE: Multiple job holding (MJH) is common in many countries, but little is known about its (health) consequences. Our aim is to explore the longitudinal association between MJH and long-term sickness absence (LTSA) among Danish employees. METHODS: We included employees (N = 8968) who participated in the Danish Work Environment Cohort Study (DWECS), based on a representative sample of the Danish working population. Three dichotomous independent variables were created: MJH in general, combination MJH (i.e. second job as employee) and hybrid MJH (i.e. self-employed in second job). LTSA (≥5 weeks) was measured using the Danish Register for Evaluation of Marginalization during 78 weeks of follow-up. Potential confounders included demographics, health, and work characteristics. Logistic regression analyses were performed to study whether LTSA was associated with MJH in general, combination MJH, and hybrid MJH. Interaction effects for gender, age, total working hours per week (≤37 or >37 h a week), and shift work were tested. RESULTS: In total, 11.7% (N = 1048) of the respondents reported having multiple jobs and 7.6% (N = 678) experienced LTSA during follow-up. After adjustment for confounders, no significant association between LTSA and MJH in general (OR = 0.82), combination MJH (OR = 0.81), or hybrid MJH (OR = 0.83) was found. Among employees working more than 37 h per week, combination MJH was associated with a higher likelihood of LTSA (OR = 1.50). CONCLUSIONS: We did not find evidence for an increased likelihood of LTSA among multiple job holders. Future research should study the likelihood of LTSA among subgroups of multiple job holders, e.g. those working long hours.

Unwanted sexual attention at work and long-term sickness absence: a follow-up register-based study.

BACKGROUND: The current understanding of the relationship between unwanted sexual attention at work and long-term sickness absence (LTSA) is limited for three reasons: 1) the under-researched role of unwanted sexual attention perpetrated by individuals outside the work organization; 2) a widespread use of self-reported measures of sickness absence, with an unclear identification of sickness absence episodes of long duration; 3) the cross-sectional design of most existing studies. The aim of this study was therefore to investigate the relationship between self-reported unwanted sexual attention at work and subsequent LTSA (≥3 weeks), stratifying by gender and source of exposure (i.e., colleagues, managers and/or subordinates vs. clients/customers/patients). METHODS: This prospective study is based on a pooled sample of 14,605 employees from three Danish surveys conducted in 2000, 2004 and 2005, providing a total of 19,366 observations. A single questionnaire-based item was used to assess exposure to unwanted sexual attention. The pooled dataset was merged with Danish register data on LTSA. The risk of first-onset episode of LTSA (up to 18 months after baseline) in connection with unwanted sexual attention was examined using Cox proportional hazards models. We estimated Hazard ratios (HR) and 95 % confidence intervals (95 % CI) adjusted for age, influence at work, work pace, occupational group and mode of data collection. We also adjusted for repeated measures from individual respondents by stratifying the Cox models by wave of survey. RESULTS: Unwanted sexual attention from colleagues, managers and/or subordinates predicted LTSA among men (HR 2.66; 95 % CI 1.42-5.00). Among women, an elevated but non-statistically significant risk of LTSA (HR 1.18; 95 % CI 0.65-2.14) was found. Unwanted sexual attention from clients/customers/patients did not predict LTSA, neither among men nor among women. CONCLUSIONS: The findings indicate a significantly elevated risk of LTSA, among men only, in relation to exposure to unwanted sexual attention from colleagues, managers and/or subordinates. This study therefore suggests both individual and organizational costs associated with unwanted sexual attention at work. Due to the low prevalence of unwanted sexual attention, larger studies with more statistical power are needed to confirm (or disconfirm) the present findings.

Longitudinal Associations Between Biopsychosocial Factors and Sustainable Return to Work of Sick-Listed Workers with a Depressive or Anxiety Disorder.

PURPOSE: Only a limited number of studies have investigated return to work of sick-listed workers with mental health problems, and more knowledge is needed about the influence of non-disorder-related factors. This study aimed to identify longitudinal associations between demographic, personality, disorder-related and work-related characteristics and sustainable return to work of sicklisted workers with a depressive or anxiety disorder. METHODS: We used data of a large Dutch cohort study to prospectively study longitudinal associations between biopsychosocial factors and sustainable return to work in 2 years. Associations were studied by means of univariable and multivariable logistic regression analysis. Participants who were sick-listed at baseline and had a lifetime diagnosis of a depressive and/or anxiety disorder were included in this study (N = 215). RESULTS: In 2 years, 51.6% of the participants returned to work sustainably. Age, household income, extraversion, employment status, skill discretion and job security were significantly (P B 0.05) associated with sustainable RTW in 2 years in the univariable analyses. The multivariable analysis revealed significant associations between sustainable return to work and age (OR per 10 years = 0.67; 95% CI 0.47­0.95), household income (OR per 100 Euro's a month = 1.04; 95% CI 1.00­1.08) and being on sickness benefit versus being (self-)employed (OR 0.39; 95% CI 0.20­0.77). CONCLUSIONS: In the long-run not disorder-related factors, but an older age, the absence of a job and a low household income seem to complicate return to work. Policy and research should focus on facilitators and barriers for return to work of workers with these characteristics.

Ten-year trends in long-term sickness absence among Japanese public servants: 2009-2018.

Sickness absences are a significant public health and economic problem worldwide. However, sickness absence diagnoses and trends have not been reported in much detail in Japan. This study was a retrospective cohort study. We examined data on certified diagnoses and the durations of sickness absence lasting over 90 days (long-term sickness absence) from 2009-2018 among city public servants in Japan. We found that 1) "Mental and behavioral disorders" (495.0-780.6 per 100,000 employees) was the most prevalent reason for long-term sickness absence, and "Mood disorders" (318.6-584.3 per 100,000 employees) was the most prevalent mental disorders diagnosis in each study year; 2) the prevalence of long-term sickness absence for mental disorders showed decreasing trends (781/100,000 in 2009 to 622/100,000 in 2018; [p=0.005, for the trend test]); 3) the trends differed by gender (p<0.05) and age (p<0.001); and 4) the duration of long-term sickness absence related to mental disorders (13.2 ± 9.0 months) was longer than long-term sickness absence resulting from all physical disorders except for diseases of the circulatory system (15.1 ± 11.6 months). Increased focus on significant depressive and neurotic disorders is needed when promoting mental health in the workplace.

Workplace Bullying and Long-Term Sickness Absence-A Five-Year Follow-Up Study of 2476 Employees Aged 31 to 60 Years in Germany.

OBJECTIVES: The aim was to investigate workplace bullying as a risk factor for five-year occurrence of long-term sickness absence (LTSA) in a representative cohort of employees in Germany. METHODS: In the German Study on Mental Health at Work (S-MGA) (n = 2476), episodes of long-term sickness absence (LTSA) between baseline and follow-up were assessed in the follow-up interview. Workplace bullying was measured in the baseline interview using a hybrid approach, which combines the behavioural experience and self-labelling methods. Through binomial regressions, the association of baseline level of workplace bullying with first-episode LTSA during follow-up was estimated, adjusting for baseline age, gender, occupational level, smoking status and physical demands at work. RESULTS: Severe bullying heightened the risk for LTSA by approximately 50% (Rate ratio-RR: 1.48, 95% Confidence interval-CI: 1.05; 2.19), while occasional bullying heightened the risk by 15% (RR: 1.15, CI: 0.85; 1.55). When excluding LTSA events occurring in the first 2 years, the associations between bullying and LTSA increased by approximately one third. CONCLUSIONS: Workplace bullying seems to be a risk factor for LTSA even when controlling for occupational level, smoking and physical demands at work and when taking possible reverse causality into account. We suggest to investigate effects of LTSA in more settings, to distinguish between occasional and severe bullying and employ longer follow-up intervals.

Labor Market Affiliation of Marginal Part-Time Workers in Denmark-A Longitudinal Study.

This longitudinal study examined the labor market affiliations of marginal part-time workers (<15 working hours/week) compared with full-time workers (32−40 working hours/week) within gender and age groups. Analyses were based on 1,492,187 Danish employees with marginal part-time or full-time work at baseline using register data of working hours and labor market affiliation from the Labor Market Account. We used the Expected Labor Market Affiliation method within gender and age groups to estimate the time spent in different labor market states over a 5-year follow-up from 2012−2017. The multistate model included five recurrent labor market states: work, unemployment, long-term sickness absence, studying, and temporarily out, and the results were adjusted for education level, morbidity, and ethnicity. A marginal part-time worker generally had fewer days of work without social benefits and spent more days studying during follow-up compared with a full-time worker. In addition, marginal part-time workers ≥ 25 years old had more days of unemployment and more days of long-term sickness absence. These findings suggest that marginal part-time workers have fewer paid workdays without social benefits compared with full-time workers, depending on age. Further studies should explore whether marginal part-time work is a stepping stone into or out of the labor market.