The causal effect of mental health on labor market outcomes: The case of stress-related mental disorders following a human-made disaster.

As disasters increase due to climate change, population density, epidemics, and technology, information is needed about postdisaster consequences for people's mental health and how stress-related mental disorders affect multiple spheres of life, including labor-market attachment. We tested the causal hypothesis that individuals who developed stress-related mental disorders as a consequence of their disaster exposure experienced subsequent weak labor-market attachment and poor work-related outcomes. We leveraged a natural experiment in an instrumental variables model, studying a 2004 fireworks factory explosion disaster that precipitated the onset of stress-related disorders (posttraumatic stress disorder, anxiety, and depression) among individuals in the local community (N = 86,726). We measured labor-market outcomes using longitudinal population-level administrative data: sick leave, unemployment benefits, early retirement pension, and income from wages from 2007 to 2010. We found that individuals who developed a stress-related disorder after the disaster were likely to go on sickness benefit, both in the short- and long-term, were likely to use unemployment benefits and to lose wage income in the long term. Stress-related disorders did not increase the likelihood of early retirement. The natural experiment design minimized the possibility that omitted confounders biased these effects of mental health on work outcomes. Addressing the mental health and employment needs of survivors after a traumatic experience may improve their labor-market outcomes and their nations' economic outputs.

Cancer Screening after the Adoption of Paid-Sick-Leave Mandates.

BACKGROUND: By the end of 2022, nearly 20 million workers in the United States have gained paid-sick-leave coverage from mandates that require employers to provide benefits to qualified workers, including paid time off for the use of preventive services. Although the lack of paid-sick-leave coverage may hinder access to preventive care, current evidence is insufficient to draw meaningful conclusions about its relationship to cancer screening. METHODS: We examined the association between paid-sick-leave mandates and screening for breast and colorectal cancers by comparing changes in 12- and 24-month rates of colorectal-cancer screening and mammography between workers residing in metropolitan statistical areas (MSAs) that have been affected by paid-sick-leave mandates (exposed MSAs) and workers residing in unexposed MSAs. The comparisons were conducted with the use of administrative medical-claims data for approximately 2 million private-sector employees from 2012 through 2019. RESULTS: Paid-sick-leave mandates were present in 61 MSAs in our sample. Screening rates were similar in the exposed and unexposed MSAs before mandate adoption. In the adjusted analysis, cancer-screening rates were higher among workers residing in exposed MSAs than among those in unexposed MSAs by 1.31 percentage points (95% confidence interval [CI], 0.28 to 2.34) for 12-month colorectal cancer screening, 1.56 percentage points (95% CI, 0.33 to 2.79) for 24-month colorectal cancer screening, 1.22 percentage points (95% CI, -0.20 to 2.64) for 12-month mammography, and 2.07 percentage points (95% CI, 0.15 to 3.99) for 24-month mammography. CONCLUSIONS: In a sample of private-sector workers in the United States, cancer-screening rates were higher among those residing in MSAs exposed to paid-sick-leave mandates than among those residing in unexposed MSAs. Our results suggest that a lack of paid-sick-leave coverage presents a barrier to cancer screening. (Funded by the National Cancer Institute.).

The prevalence, determinants, and consequences of post-COVID in healthcare workers: A cross-sectional survey.

Data on post-coronavirus disease (COVID) in healthcare workers (HCWs) are scarce. We aimed to assess prevalence, determinants, and consequences of post-COVID in HCWs. In fall 2022, we performed a cross-sectional survey in a tertiary care hospital with a web-based questionnaire sent to HCWs. Post-COVID was defined as persistent/new symptoms 3 months after acute COVID. Propensity score weighting was performed to assess the impact of post-COVID on return-to-work. 1062 HCWs completed the questionnaire, 713 (68%) reported at least one COVID, and 109 (10%) met the definition for post-COVID, with workplace contamination reported in 51 (47%). On multivariable analysis, risk factors for post-COVID were female gender (p = 0.047), ≥50 years (p = 0.007), immunosuppression (p = 0.004), ≥2 COVID episodes (p = 0.003), and ≥5 symptoms during acute COVID (p = 0.005). Initial sick leave was prescribed for 94 HCWs (86% post-COVID), for a median duration of 7 [7-9] days, and extended for 23. On return-to-work, 91 (84%) had residual symptoms, primarily asthenia/fatigue (72%) and cognitive impairment (25%). Cognitive impairment at return-to-work was associated with post-COVID. Ten HCWs (9%) received a medical diagnosis of post-COVID, 8 consulted the occupational physician, and four required work adaptation. Post-COVID affected 10% of HCWs. Long-term consequences included repeated sick leaves and residual symptoms on return-to-work.

The burden of working time lost to compensable occupational injury and disease in Australia, 2012-17: a retrospective population-based study.

OBJECTIVES: To determine the national burden of working time lost to occupational injury and disease in Australia compensable by workers' compensation schemes; to characterise the distribution of time lost by age, sex, and injury and disease type. STUDY DESIGN: Retrospective population-based study; analysis of National Dataset for Compensation-based Statistics (NDS) data. SETTING, PARTICIPANTS: Granted workers' compensation claims by people aged 15-100 years including payment of wage replacement benefits for time off work lodged in Australia, 1 July 2012 - 30 June 2017. MAIN OUTCOME MEASURES: Working years lost (WYL) per annum (total number of years of wage replacement benefits paid to injured and ill workers), overall and by sex, age, and injury and disease type; WYL per 10 000 fulltime equivalent (FTE) years worked. RESULTS: A total of 755 330 eligible claims with complete data for analysis variables by people aged 15-100 years were identified, for compensable injuries and disease that led to 41 194 (95% confidence interval [CI], 41 020-41 368) WYL/year. The annual WYL number and rate were each higher for men (25 367 [95% CI, 25 230-25 503] WYL/year; 42.6 [95% CI, 42.1-43.1] WYL/10 000 FTE years) than for women (15 827 [95% CI, 15 720-15 935] WYL/year; 38.8 [95% CI, 38.2-39.4] WYL/10 000 FTE years). Workers aged 45-100 years made 66 742 claims per year (44.1% of all claims) but incurred 21 763 WYL/year (52.8% of all WYL). Traumatic joint and muscle injuries led to 16 494 WYL/year (40.0% of all WYL), musculoskeletal disorders to 8547 WYL/year (20.7%), mental health conditions to 5361 WYL/year (13.0%), fractures to 4276 WYL/year (10.4%), and wounds and lacerations to 3449 WYL/year (8.4%). CONCLUSIONS: Occupational injury and disease covered by workers' compensation result in lost working time in Australia equivalent to more than 41 000 fulltime jobs. Distribution of the burden reflects the greater labour force participation of men, slower recovery of older workers, and the impact of common occupational injuries and diseases. Population-based monitoring of lost working time could support effective occupational health surveillance and allocation of resources for protecting the health of Australian workers.

Associations between work-related factors and sickness presenteeism: a prospective study using the national French working conditions survey.

OBJECTIVES: The objectives were to assess the prospective associations between work-related factors, including psychosocial and physical work factors and working time/hours factors, and sickness presenteeism alone or combined with sickness absence. METHODS: The study relied on prospective data of a national representative sample of 16 129 employees followed up from 2013 to 2016 in France. Work-related factors were assessed in 2013 and included 20 psychosocial work factors, 4 working time/hours factors and 4 physical work factors. Sickness presenteeism was studied using two items in 2016: the presence and duration of sickness presenteeism within the last 12 months. Weighted Hurdle and multinomial logistic regression models were performed to study the prospective associations between work-related factors at baseline and sickness presenteeism (both presence and duration) and sickness absence at follow-up. Models were adjusted for covariates. RESULTS: Almost all psychosocial and physical work factors were predictive of sickness presenteeism (ORs ranging from 1.30 to 2.07 for men, and from 1.16 to 2.30 for women) but only some of them predicted its duration. Dose-response associations were observed between multiple exposures to these factors and sickness presenteeism. These factors predicted more sickness presenteeism alone or combined with sickness absence than sickness absence alone. Gender differences were observed in these associations, as some associations were found to be stronger among women than among men. CONCLUSIONS: There is a need to study sickness presenteeism and sickness absence combined. Prevention oriented towards the psychosocial and physical work environment may contribute to reduce sickness presenteeism and sickness absence.

Emotional demands at work and risk of disability pension: a nationwide cohort study in Denmark.

INTRODUCTION: Working in emotionally demanding jobs is associated with an increased risk of temporarily leaving the labour market due to long-term sickness absence. We tested whether employees working in emotionally demanding jobs are also at higher risk of permanently leaving the labour market due to disability pension compared with employees working in jobs that are not emotionally demanding. METHODS: We conducted a 10-year cohort study in the workforce in Denmark (n=1 670 825), aged 30-59 years at baseline, by linking job exposure matrices with nationwide registries on social transfer payments and covariates. Using Cox regression, we analysed the risk of disability pension in relation to emotional demands in the full population and sex stratified. Multivariable adjusted models included sex, age, cohabitation, migration background, household disposable income and other work environmental factors (physical workload, influence, possibilities for development and role conflicts). RESULTS: We identified 67 923 new cases of disability pension during 15 649 743 person-years of follow-up (mean follow-up: 9.4 years). We found an increasing risk of disability pension with higher levels of emotional demands, with HRs of 1.20, 1.23 and 1.73 for medium-low, medium-high and high emotional demands, respectively, compared with low emotional demands in the most adjusted model. There was an exposure-response association in women and a tendency towards an exposure-response association in men. DISCUSSION: In this nationwide cohort study, we found an increased risk of permanent exit from the labour market due to disability pension in women and men working in emotionally demanding jobs.

Trajectories of work disability among individuals with anxiety-, mood/affective-, or stress-related disorders in a primary healthcare setting.

BACKGROUND: Anxiety-, mood/affective-, or stress-related disorders affect up to one-third of individuals during their lives and often impact their ability to work. This study aimed to delineate trajectories of work disability (WD) among individuals diagnosed with anxiety-, mood/affective-, or stress-related disorder in primary healthcare and to examine associations between trajectory group membership and sociodemographic, clinical, and clinical-related factors. METHODS: The study population included working-age individuals, aged 22-62 years, living in Stockholm County, Sweden, who experienced a new episode of any anxiety-, mood/affective, or stress-related disorder in primary healthcare in 2017 (N = 11,304). Data were obtained from Swedish national and regional registers and were linked using pseudonymised unique personal identification numbers. The primary outcome was days with WD (sum of sickness absence and disability pension days) during the three years before and three years after a diagnosis of anxiety-, mood/affective-, or stress-related disorders in primary healthcare. A zero-inflated Poisson group-based trajectory model was used to identify groups of individuals with similar patterns of WD over the study period, with a multinomial logistic regression used to examine associations of sociodemographic, clinical, and clinical-related factors with trajectory group membership. RESULTS: Four distinct trajectory groups were found, high increasing (5.1%), with high levels, from 16 to 80 days of WD in six-monthly intervals during follow-up, peak (11.1%), with a peak in WD, up to 32 days of WD, around the time of the diagnosis, low increasing (12.8%), with an increase in days of WD from 4 to 22 during the study period, and constant low (71.1%), with almost no WD over the study period. In multinomial regression models, diagnostic category, psychotropic medication use, a diagnosis of a psychiatric disorder within secondary healthcare, age at diagnosis, and occupation were associated with WD trajectory groups. CONCLUSIONS: Around two-thirds of individuals treated for a new episode of any anxiety-, mood/affective-, or stress-related disorder in primary healthcare have an excellent prognosis regarding WD. Several sociodemographic and clinical characteristics were associated with group membership; these factors could identify individuals at risk of long-term welfare dependency and who might benefit from interventions to promote a return to work.

Symptoms, work situation and work functioning 10 years after rehabilitation of stress-induced exhaustion disorder.

BACKGROUND: Stress-induced exhaustion disorder (SED) is the most common reason for long-term sick leave in Sweden and the recovery process may be long and troublesome. This study explores the symptoms of burnout, depression and anxiety among patients with SED 10 years after termination of a multimodal rehabilitation program. Another aim of the study was to investigate work situation, work functioning, and any remaining exhaustion and sleeping disorders among those who were gainfully employed at the 10-year follow-up. METHODS: This longitudinal study included 107 patients (91 women and 16 men), who had been diagnosed with SED 10 years prior to the study. After establishing the diagnosis they all underwent and completed an multimodal rehabilitation program. Data on symptoms of burnout, anxiety and depression were collected before and after the multimodal rehabilitation program, and at follow-ups after additional 1 year and an additional 10 years. At the 10-year follow-up, work situation, work functioning, and symptoms of exhaustion and sleep disorders were assessed in those who were gainfully employed (89 patients). RESULTS: Symptoms of burnout, anxiety, and depression remained stable from the 1- to the 10-year follow-up after completed rehabilitation. Among participants who were gainfully employed, 73% had changed workplaces, and 31.5% had reduced their working hours. Common reasons for these changes were lack of energy or because they had chosen to prioritise their lives differently. Work functioning was rated as moderate, one third self-reported SED to some extent, and one fifth reported moderate-to-severe insomnia. CONCLUSION: A relatively large proportion of former patients with SED have residual health problems 10 years after rehabilitation and some have not been able to return to full-time work. Preventive and early rehabilitative interventions with adjustments and measures at the organisational level are probably needed to achieve a more sustainable working life.

Hospitalization- and death-related financial and employment effects in parents of children with life-limiting conditions: a fixed-effects analysis.

The purpose of this study is to investigate out-of-pocket non-medical expenses and employment-related outcomes in families of children with life-limiting conditions, specifically, to quantify the financial and employment implications of two events: a child's hospitalization and death. This cohort study used panel data collected prospectively for a larger study investigating the effectiveness of specialized pediatric palliative care. Participants were recruited by medical professionals between November 2019 and May 2022 at four Swiss children's hospitals. The care follow-up and bereavement follow-up assessments were 330 and 300 days, respectively. We measured out-of-pocket non-medical expenses, individual full-time equivalent units, and personal income, as well as sick leave and vacation days taken. Analyses included descriptive statistics and two-way linear fixed-effects regressions. The analysis included 110 parents (mothers n = 59, fathers n = 51) of 61 children. Children were hospitalized for a median of 7 days (interquartile range 0-21, range 0-227). The fixed-effects models found a positive association between hospitalization, i.e., length of stay, and travel and accommodation expenses (coefficient 4.18, 95% confidence interval 2.20-6.16). On average, for each week of hospitalization, parents spent an additional 29 Swiss francs on travel and accommodation. During the 300-day bereavement follow-up, six (26%) of 23 parents increased their work commitments, while one reported a decrease. CONCLUSIONS: Families incur higher travel and accommodation expenses during hospitalization than during non-hospitalized periods. Instrumental support, e.g., parking vouchers, can help families minimize these costs. Future studies should investigate whether early return to work during bereavement is driven by economic considerations or a desire for distraction. CLINICAL TRIAL REGISTRATION: Data analyzed in this study were collected as part of a clinical trial, registered on ClinicalTrials.gov, No. NCT04236180, 15 March 2019 What Is Known: • Families of children with life-limiting conditions are at risk of substantial financial burden from high out-of-pocket medical expenses. • It is also known that parents often have to incur out-of-pocket non-medical expenses and reduce their work commitments. Little is known about the economic consequences of losing a child to a life-limiting condition. WHAT IS NEW: • We provide new longitudinal evidence on the hospitalization- and death-related financial and employment implications for families of children with life-limiting conditions. • Child hospitalizations add to families' financial burden through increased travel and accommodation expenses. Work commitments rose during early bereavement.

Appendectomy versus antibiotic treatment for acute appendicitis.

BACKGROUND: Acute appendicitis is one of the most common emergency general surgical conditions worldwide. Uncomplicated/simple appendicitis can be treated with appendectomy or antibiotics. Some studies have suggested possible benefits with antibiotics with reduced complications, length of hospital stay, and the number of days off work. However, surgery may improve success of treatment as antibiotic treatment is associated with recurrence and future need for surgery. OBJECTIVES: To assess the effects of antibiotic treatment for uncomplicated/simple acute appendicitis compared with appendectomy for resolution of symptoms and complications. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, and two trial registers (World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov) on 19 July 2022. We also searched for unpublished studies in conference proceedings together with reference checking and citation search. There were no restrictions on date, publication status, or language of publication. SELECTION CRITERIA: We included parallel-group randomised controlled trials (RCTs) only. We included studies where most participants were adults with uncomplicated/simple appendicitis. Interventions included antibiotics (by any route) compared with appendectomy (open or laparoscopic). DATA COLLECTION AND ANALYSIS: We used standard methodology expected by Cochrane. We used GRADE to assess the certainty of evidence for each outcome. Primary outcomes included mortality and success of treatment, and secondary outcomes included number of participants requiring appendectomy in the antibiotic group, complications, pain, length of hospital stay, sick leave, malignancy in the antibiotic group, negative appendectomy rate, and quality of life. Success of treatment definitions were heterogeneous although mainly based on resolution of symptoms rather than incorporation of long-term recurrence or need for surgery in the antibiotic group. MAIN RESULTS: We included 13 studies in the review covering 1675 participants randomised to antibiotics and 1683 participants randomised to appendectomy. One study was unpublished. All were conducted in secondary care and two studies received pharmaceutical funding. All studies used broad-spectrum antibiotic regimens expected to cover gastrointestinal bacteria. Most studies used predominantly laparoscopic surgery, but some included mainly open procedures. Six studies included adults and children. Almost all studies aimed to exclude participants with complicated appendicitis prior to randomisation, although one study included 12% with perforation. The diagnostic technique was clinical assessment and imaging in most studies. Only one study limited inclusion by sex (male only). Follow-up ranged from hospital admission only to seven years. Certainty of evidence was mainly affected by risk of bias (due to lack of blinding and loss to follow-up) and imprecision. Primary outcomes It is uncertain whether there was any difference in mortality due to the very low-certainty evidence (Peto odds ratio (OR) 0.51, 95% confidence interval (CI) 0.05 to 4.95; 1 study, 492 participants). There may be 76 more people per 1000 having unsuccessful treatment in the antibiotic group compared with surgery, which did not reach our predefined level for clinical significance (risk ratio (RR) 0.91, 95% CI 0.87 to 0.96; I2 = 69%; 7 studies, 2471 participants; low-certainty evidence). Secondary outcomes At one year, 30.7% (95% CI 24.0 to 37.8; I2 = 80%; 9 studies, 1396 participants) of participants in the antibiotic group required appendectomy or, alternatively, more than two-thirds of antibiotic-treated participants avoided surgery in the first year, but the evidence is very uncertain. Regarding complications, it is uncertain whether there is any difference in episodes of Clostridium difficile diarrhoea due to very low-certainty evidence (Peto OR 0.97, 95% CI 0.24 to 3.89; 1 study, 1332 participants). There may be a clinically significant reduction in wound infections with antibiotics (RR 0.25, 95% CI 0.09 to 0.68; I2 = 16%; 9 studies, 2606 participants; low-certainty evidence). It is uncertain whether antibiotics affect the incidence of intra-abdominal abscess or collection (RR 1.58, 95% CI 0.61 to 4.07; I2 = 19%; 6 studies, 1831 participants), or reoperation (Peto OR 0.13, 95% CI 0.01 to 2.16; 1 study, 492 participants) due to very low-certainty evidence, mainly due to rare events causing imprecision and risk of bias. It is uncertain if antibiotics prolonged length of hospital stay by half a day due to the very low-certainty evidence (MD 0.54, 95% CI 0.06 to 1.01; I2 = 97%; 11 studies, 3192 participants). The incidence of malignancy was 0.3% (95% CI 0 to 1.5; 5 studies, 403 participants) in the antibiotic group although follow-up was variable. Antibiotics probably increased the number of negative appendectomies at surgery (RR 3.16, 95% CI 1.54 to 6.49; I2 = 17%; 5 studies, 707 participants; moderate-certainty evidence). AUTHORS' CONCLUSIONS: Antibiotics may be associated with higher rates of unsuccessful treatment for 76 per 1000 people, although differences may not be clinically significant. It is uncertain if antibiotics increase length of hospital stay by half a day. Antibiotics may reduce wound infections. A third of the participants initially treated with antibiotics required subsequent appendectomy or two-thirds avoided surgery within one year, but the evidence is very uncertain. There were too few data from the included studies to comment on major complications.

Effects of work-directed interventions on return-to-work in people on sick-leave for to common mental disorders-a systematic review.

PURPOSE: To evaluate the body of evidence of the effects of work-directed interventions on return-to-work for people on sick leave due to common mental disorders (i.e., mild to moderate depression, anxiety, adjustment disorders and reactions to severe stress). METHODS: The systematic review was conducted in accordance with an a priori developed and registered protocol (Prospero CRD42021235586). The certainty of evidence was assessed by two independent reviewers using the Grading of Recommendations, Assessment, Development and Evaluations. RESULTS: We reviewed 14,794 records published between 2015 and 2021. Of these, eight RCTs published in eleven articles were included in the analysis. POPULATION: Working age adults (18 to 64 years), on sick leave due to mild to moderate depression, anxiety, adjustment disorders or reactions to severe stress. INTERVENTION: Work-directed interventions. COMPARATOR: No comparator, Standard care, or other measures. OUTCOME: return to work, number of days on sick leave, income. Overall, the effects of work-focused CBT and work-focused team-based support on RTW resulted in increased or faster return-to-work compared with standard care or no intervention (low certainty of evidence). The effects of Individual Placement and Support showed no difference in RTW compared with standard care (very low certainty of evidence). CONCLUSION: Interventions involving the workplace could increase the probability of RTW. Areas in need of improvement in the included studies, for example methodological issues, are discussed. Further, suggestions are made for improving methodological rigor when conducting large scale trials.

Gender differences in mental health-related sickness absence in the education sector.

BACKGROUND: The education sector experiences high rates of sickness absence, primarily due to mental health disorders. This issue poses significant challenges, not only for the affected employees but also for their colleagues, pupils, the organization, and the society as a whole. Several factors are likely to contribute to this issue, including work-related factors and gender dynamics, as the education sector has a high proportion of female employees. METHODS: In this study, we use statistical methods to compare the average duration of sickness absence due to mental disorders in the education sector with other sectors. Additionally, we explore the influence of gender, age, and working hours on the duration of sickness absence. For our study we use a large dataset consisting of approximately 200,000 cases of sickness absence due to mental disorders, with more than 32,000 cases from the education sector. RESULTS: Our analysis shows that average sickness absence duration is consistently longer in the education sector than in other sectors, even after accounting for gender and age. Specifically, the average duration of sickness due to mental disorders in the education sector is 235 days, compared to 188 days in other sectors. We also observe gender differences in absence duration in all sectors, with an interaction effect indicating that working in education affects recovery rates more for men than for women. Consequently, the gender difference in absence duration is smaller in the education sector than in other sectors. CONCLUSION: Using a large dataset, we find significant differences in absence duration between employees in the education sector and those in other sectors. Other factors, such as gender, also influence sickness absence duration, but to a lesser extent. Notably, the gender effect on absence duration is smaller in the education sector compared to other sectors.

The role of familial factors and neuroticism in the association between exposure to offensive behaviors at work and long-term sickness absence due to common mental disorders - a prospective twin study.

OBJECTIVES: The aim of this study was to investigate associations between exposure to work-related violence/threats and harassment, and future sickness absence (SA) due to common mental disorders (CMDs), taking familial factors (shared genetics and early-life environment) and neuroticism into account. METHODS: The study sample included 8795 twin individuals from the Swedish Twin Project of Disability Pension and Sickness Absence (STODS), including survey data from the Study of Twin Adults: Genes and Environment (STAGE). Self-reported work-related violence and/or threats as well as work-related harassment (including bullying) and national register data on SA due to CMDs were analyzed using standard logistic regression, and conditional logistic regression among complete twin pairs discordant on exposures. Individuals were followed for a maximum of 13 years. Interactions between neuroticism and exposures were assessed using both multiplicative and additive interaction analyses. RESULTS: Exposure to work-related violence/threats was associated with higher odds of SA due to CMDs when adjusting for age, sex, marital status, children, education, type of living area, work characteristics, and symptoms of depression and burnout (OR 2.11, 95% CI 1.52-2.95). Higher odds of SA due to CMDs were also found for exposure to harassment (OR 1.52, 95% CI 1.10-2.11) and a combined indicator of exposure to violence/threats and/or harassment (OR 1.98, 95% CI 1.52-2.59), compared with the unexposed. Analyses of twins discordant on exposure, using the unexposed co-twin as reference, showed reduced ORs. These ORs were still elevated but no longer statistically significant, potentially due to a lack of statistical power. No multiplicative interaction was found between neuroticism and exposure to work-related violence/threats, or harassment. However, a statistically significant additive interaction was found between neuroticism and exposure to violence/threats, indicating higher odds of SA due to CMDs in the group scoring lower on neuroticism. CONCLUSIONS: Exposure to work-related offensive behaviors was associated with SA due to CMDs. However, the results indicated that these associations may be partly confounded by familial factors. In addition, an interaction between exposure and neuroticism was suggested. Thus, when possible, future studies investigating associations and causality between offensive behaviors at work and mental health-related outcomes, should consider familial factors and neuroticism.

Women's health and psychological well-being in the return-to-work process after long-term sick leave for common mental disorders: women's and first-line managers' perspectives.

BACKGROUND AND AIM: Common mental disorders are common reasons for long-term sick leave, especially among women. Return to work is often complex and unsuccessful, why more knowledge is needed regarding women's health and psychological well-being in the return-to-work process. Therefore, the aim was to describe women's health and psychological well-being in the return-to-work process, from women's and first-line managers' perspectives. METHODS: Individual interviews were conducted with 17 women and 16 first-line managers. Qualitative content analysis was performed based on the content areas "Women's health (i.e. overall well-being, both physical and psychological) throughout the whole RTW process" and "Women's psychological well-being (happiness, meaning and a sense of being significant) at work after work resumption" Themes and categories were created. RESULTS: Women and managers had similar descriptions, i.e. that women's health and psychological well-being depend on the individual characteristics of women themselves, their private life, work and other stakeholders. However, women described relational work tasks (e.g. meeting patients) as beneficial for health, and highlighted small stressors in the work environment, which the managers did not. Having work that was compatible with private life, being in good health, having stimulating work tasks and strengthening relationships at work were important for the women's psychological well-being. CONCLUSIONS: Based on women's and first-line managers experiences, promotion of women's health and psychological well-being during the return-to-work process requires individually adapted assessments and actions involving women's entire life situation. First-line managers should know that relational work tasks (e.g., meeting patients) can be beneficial for women's health as well as that minor stressor in the work environment can put their health at risk.

Association between sickness presenteeism and depressive symptoms: a cross-sectional study using the 6th Korean working conditions survey.

PURPOSE: This study aimed to reveal the relationship of the days of experiencing sickness presentism and depressive symptoms among Korean workers. Sickness presenteeism which defined as the act of going to work despite being feeling unhealthy triggers various adverse effects on mental health, including increased risks of depression. Furthermore, Sickness presenteeism is a major social issue causing substantial socioeconomic costs. METHODS: The data of 25120 participants from sixth Korean Working Condition Survey was utilized in this cross-sectional study. Sickness presenteeism was defined using a self-reported questionnaire and depressive symptoms were assessed by WHO well-being index. Multivariate logistic regression analysis was conducted to calculate the odd ratios for depressive symptoms regarding the number of days experiencing sickness presenteeism. We calculated odds ratios (ORs) and 95% confidence interval (95% CI) for depressive symptoms after categorizing participants into three groups based on the duration of experiencing sickness presenteeism, using cut-off values of 3 and 5 days. RESULTS: Workers who have experienced sickness presenteeism for more than 5 days were at highest risk for depressive symptoms than referent group (OR 2.87; 95% CI 2.17-3.76 in male, OR 3.86; 95% CI 3.02-4.91 in female). Furthermore, there was a trend of increasing risk for depressive symptom as the duration of experiencing sickness presenteeism extended. CONCLUSION: This study presents the association between experiencing sickness presenteeism in the previous 12 months and depressive symptoms. Based on the results, we provide individual and organizational strategies of reducing sickness presenteeism. Also, screening for workers who have experienced sickness presenteeism are needed to ensure good mental health.

Sickness absence after work accidents and post-traumatic stress among white-collar workers in the retail and wholesale industry; a longitudinal Swedish cohort study.

BACKGROUND: Most studies about accidents and about PTSD, respectively, have been conducted either on blue-collar workers, or on the entire working population. There are very few such studies on white-collar workers. AIM: To examine diagnosis-specific sickness absence (SA) and disability pension (DP) after a work accident or PTSD, respectively, among white-collar workers in the private retail and wholesale industry. METHODS: A prospective population-based cohort study of all 192,077 such workers aged 18-67 (44% women) in Sweden in 2012, using linked microdata from nationwide registers. We identified individuals who had secondary healthcare due to work-related accidents (n = 1114; 31% women) or to PTSD (n = 216; 79% women) in 2012-2016. Their average number of net days of diagnosis-specific SA (in SA spells > 14 days) and DP were calculated for 365 days before and 365 days after the healthcare visit. RESULTS: 35% of the women and 24% of the men had at least one new SA spell during the 365 days after healthcare due to work accidents. Among women, the average number of SA/DP days increased from 14 in the year before the visit to 31 days the year after; among men from 9 to 21 days. SA days due to fractures and other injuries increased most, while SA days due to mental diagnoses increased somewhat. 73% of women and 64% of men who had healthcare due to PTSD had at least one new SA spell in the next year. Women increased from 121 to 157 SA/DP days and men from 112 to 174. SA due to stress-related disorders and other mental diagnoses increased the most, while DP due to stress-related diagnoses and SA due to musculoskeletal diagnoses increased slightly. CONCLUSIONS: About a quarter of those who had secondary healthcare due to work accidents, and the majority of those with such healthcare due PTSD, had new SA in the following year. SA due to injury and mental diagnoses, respectively, increased most, however, SA/DP due to other diagnoses also increased slightly. More knowledge is needed on factors associated with having or not having SA/DP in different diagnoses after work accidents and among people with PTSD.

Dizziness and vertigo sick leave before and after insurance restrictions - a descriptive Swedish nationwide register linkage study.

BACKGROUND: Vertigo and dizziness can be disabling symptoms that result in sick leave. Research regarding sickness absence due to dizziness has focused on specific vestibular diagnoses rather than the nonspecific vertigo/dizziness diagnoses. Strict sick leave regulations were introduced in Sweden in 2008. The aim of this study was to describe the vertigo/dizziness sick leave prevalence and duration considering both specific and nonspecific diagnoses according to International Classification of diseases 10th revision (ICD-10) on the 3-digit level, including the less specific "R" diagnoses. METHODS: Through Swedish nationwide registers we identified individuals aged 16-64 years who during the years 2005-2018 were sickness absent > 14 consecutive days - minimum register threshold - due to vertigo/dizziness diagnoses according to ICD10 codes: specific diagnoses (H81.0, H81.1, H81.2, H81.3, H81.4, G11x) and nonspecific (R42, R26, R27, H81.9). We described the demographic characteristics, prevalence and duration of such sick-leave spells. Data were stratified according to diagnostic groups: ataxias, vestibular and nonspecific. RESULTS: We identified 52,179 dizziness/vertigo sick leave episodes > 14 days in 45,353 unique individuals between 2005-2018, which constitutes 0.83% from all sick leave episodes in the given period.The nonspecific diagnoses represented 72% (n = 37741) of sick leave episodes and specific vestibular H-diagnoses 27% (n = 14083). The most common specific vestibular codes was Benign paroxysmal positional vertigo (BPPV) 9.4% (n = 4929). The median duration of sick leave was 31 days (IQR 21-61). Women on sick leave were younger than men (47 vs 51 years, p < 0.05) and had a higher proportion of nonspecific diagnoses compared with men (74% vs 70%, p < 0.05). CONCLUSIONS: The vast majority of vertigo/dizziness sick leave episodes were coded as nonspecific diagnoses and occurred in women. BPPV, a curable vestibular condition, was the most common specific diagnosis. This suggests a potential for improved diagnostics. Women on sick leave due to dizziness/vertigo were younger and more often received nonspecific diagnostic codes. Future studies should determine the frequency of use of evidence based therapies and investigate further the gender differences.

Collaboration in the return-to-work process after sick leave due to common mental disorders: a qualitative study of stakeholders' views on goals and roles.

BACKGROUND: This study explores how the goals of collaboration in the return-to-work (RTW) process for people with common mental disorders are described by the stakeholders involved, and how they experience stakeholders' roles and responsibilities in relation to these goals. METHODS: Interviews were conducted with 41 participants from three Swedish regions. Nine of the participants were workers, six employer representatives, four occupational health professionals, four social insurance officers, 18 RTW coordinators and five physicians. Thematic analysis was conducted. RESULTS: Three main themes and overarching goals when collaborating on RTW were identified. In the first theme, 'creating an informative environment', all stakeholders emphasised clear roles and responsibilities. The second theme, 'striving for consensus in an environment of negotiations', addressed negotiations about when and how to collaborate, on what and with whom, and reveal different views on stakeholders' goals, roles and responsibilities in collaboration. The third theme identified goals for 'creating a supportive environment' for both workers and other stakeholders. Coordinators are found to have an important role in achieving a supportive environment, and in neutralising power imbalances between workers and their employers and social insurance officers. CONCLUSIONS: Competing goals and priorities were identified as hindering successful collaboration, contributing to a spectrum of complex versus easy RTW collaboration. This study suggests some basic conditions for achieving a collaborative arena that is neutral in terms of power balance, where all stakeholders can share their views.

The effect of parental pain, disability benefits and education on risk of long-term sick leave due to musculoskeletal disorders and the modifying effect of sleep and physical activity: the HUNT study.

BACKGROUND: Family factors, sleep, and physical activity have previously been associated with risk of sick leave and disability benefits due to musculoskeletal disorders. However, how these factors act during adolescence and young adulthood is unclear. The aim of this study was to (i) examine if chronic pain, disability benefits and education in parents influence the risk of long-term sick leave due to musculoskeletal disorders in young adulthood, and (ii) to explore if offspring sleep problems and physical activity modify these effects. METHODS: A population-based prospective study of 18,552 adolescents and young adults (≤ 30 years) in the Norwegian HUNT Study. Survey data was linked to national registry data on sick leave, disability benefits, family relations and educational attainment. We used Cox regression to estimate hazard ratio (HR) with 95% confidence interval (CI) for long-term (≥ 31 days) sick leave due to a musculoskeletal disorder in offspring associated with parental factors and the joint effect of parental factors and offspring lifestyle factors. RESULTS: Parental chronic pain (HR 1.36, 95% CI 1.27-1.45), disability benefits (HR 1.41, 95% CI 1.33-1.48) and low educational attainment (HR 1.78, 95% CI 1.67-1.90) increased the risk of long-term sick leave due to musculoskeletal disorders among offspring. There was no strong evidence that sleep and physical activity modified these effects. CONCLUSION: Chronic pain, disability benefit and low education in parents increased the risk of long-term sick leave due to musculoskeletal disorders among offspring, but these effects were not modified by offspring sleep problems or physical activity level. The findings suggest that efforts beyond individual lifestyle factors might be important as preventive measures.

Estimating vaccine effectiveness against COVID-19 using cause-specific sick leave as an indicator: a nationwide population-based cohort study, Norway, July 2021 - December 2022.

BACKGROUND: Due to changes in testing policy and increased use of rapid tests, other indicators for SARS-CoV-2 infections are needed to monitor vaccine effectiveness (VE). We aimed to estimate VE against COVID-19 sick leave (> 3 days, certified by a medical professional) among employed individuals (25-64-years-old) in Norway. METHODS: We performed a nationwide cohort study by collating data from the Emergency preparedness register for COVID-19. We used adjusted Cox proportional hazard models with vaccine status as a time-varying covariate and presented results as adjusted hazard ratios (aHRs) with corresponding 95% confidence intervals. Separate models were run against sick leave and against SARS-CoV-2 infections during the Delta period (June-December 2021), and against sick leave during the Omicron period (January-December 2022) when SARS-CoV-2 PCR-testing was replaced by rapid self-tests and infections were underreported. RESULTS: We included 2,236,419 individuals during the Delta period, of whom 73,776 (3.3%) had a reported infection and 54,334 (2.4%) were registered with sick leave. Of the 2,206,952 included individuals in the Omicron period, 300,140 (13.6%) were registered with sick leave. During the Delta period, 55% (26,611) of individuals who had registered sick leave also had a positive test, compared to 32% (96,445) during the Omicron period. The VE against sick leave during the Delta period followed a similar waning pattern to that against SARS-CoV-2 infections. After the second and third dose, the lowest aHRs were estimated for 2-7 days after vaccination for both sick leave (0.25; 95%CI 0.24-0.26 and 0.26; 95% CI 0.24-0.29) and infection ( 0.16; 95% CI 0.15-0.17 and 0.18; 95% CI 0.16-0.19) respectively. During the Omicron period, aHRs for sick leave were higher than during the Delta period, but the lowest aHRs were still found in 2-7 weeks after receiving the second (0.61; 95% CI 0.59-0.64) or third dose (0.63; 95% CI 0.62-0.64). CONCLUSION: Our results showed that sick leave could be a relevant indicator for VE in the surveillance of COVID-19 and a finding that may be important in the surveillance of other respiratory infection.