Impact of psychosocial work factors on risk of medically certified sick leave due to common mental disorders: a nationwide prospective cohort study of Norwegian home care workers.

BACKGROUND: The Norwegian home care services experience a high level of sick leave, a large proportion of which is due to common mental disorders. A substantial number of such cases can be attributed to psychosocial factors at work, but more knowledge about occupation-specific risk factors is needed to develop targeted preventive measures to reduce sick leave levels. The aim of this study is to identify the most prominent psychosocial work factors influencing the risk of sick leave spells due to common mental disorders. METHODS: Employees from a random sample of 130 Norwegian home care services (N = 1.819) completed a baseline survey on 15 psychosocial work factors. Participants were subsequently followed up for 26 months using registry data on sick leave. The outcome measure was the number of medically certified sick leave spells due to common mental disorders during follow-up in the Norwegian social insurance database. Incidence risk ratios (IRR) and 95% confidence intervals (CIs) were calculated using negative binomial regression with robust standard errors. RESULTS: Emotional dissonance (IRR 1.30, 95% CI 1.05-1.60) and emotional demands (IRR 1.35, 95% CI 1.14-1.58) were associated with an excess risk of sick leave, while control over work pacing (IRR 0.78, 95% CI 0.62-0.98) was associated with a reduced risk. An estimated 30% (95% CI 8.73-48.82) of sick leave cases were attributable to emotional dissonance and 27% (95% CI 4.80-46.33) were attributable to emotional demands. Control over work pacing was estimated to have prevented 20% (95% CI 1.32-37.78) of the sick leave cases. CONCLUSIONS: This study found that emotional dissonance and emotional demands were robust risk factors for sick leave due to common mental disorders, and that control of work pacing constituted a robust protective factor against sick leave.

Effects of the Labor Inspection Authority's regulatory tools on physician-certified sick leave and employee health in Norwegian home-care services - a cluster randomized controlled trial.

OBJECTIVE: This study aimed to determine the effects of the Labor Inspection Authority's regulatory tools on physician-certified sick leave and self-reported health outcomes among employees in municipal home-care services in Norway. METHODS: We conducted a cluster-randomized controlled trial in the home-care service sector, and 96 eligible municipalities were randomly assigned to one of three groups: (i) labor inspection visits, based on the Labor Inspection Authority's standard inspections; (ii) guidance-through-workshops, where participants from home-care services met with labor inspectors to receive information and discuss relevant topics; and (iii) the control group. Data on employee self-reported health (N=1669) were collected at baseline and 6 and 12 months after the interventions. Additionally, registry data (N=1202) on diagnosis specific physician-certified sick leave were collected for 18 months after the interventions. RESULTS: We found no statistically significant effects of either intervention on self-reported health outcomes. There was, for both interventions, a pattern of decrease in days and periods of physician-certified sick leave due to musculoskeletal diagnoses and increase in days and periods of physician-certified sick leave due to psychological diagnoses, but these were not statistically significant. CONCLUSION: Labor inspections and guidance-through-workshops had no statistically significant effect on self-reported health and physician-certified sick leave. The results should be interpreted with caution given the low response rate and subsequent attrition, and in the context of the COVID-19 pandemic. Future studies, in various industries, should further elucidate whether regulatory tools influence employee health and sick leave due to musculoskeletal and mental disorders.

Office design, telework from home, and self-certified sickness absence: A cross-sectional study of main and moderating effects in a nationally representative sample.

OBJECTIVES: This study aimed to investigate (i) the main effects of office design and access to telework from home (TWFH) on self-certified sickness absence and (ii) the moderating effects of access to TWFH on the relationship between office design and self-certified sickness absence. METHODS: The study used cross-sectional survey data from a nationally representative sample from Norway (N=4329). Research objectives were investigated with negative binomial hurdle models, adjusting for age, gender, education level, leadership responsibility, and time spent on office work. Moderating effects of TWFH were evaluated with pairwise comparisons and plots of estimated marginal means. RESULTS: In adjusted models, employees in conventional open-plan offices [odds ratio (OR) 1.32, 95% confidence interval (CI) 1.13-1.54] had significantly higher odds of sickness absence than employees in private offices. Employees with access to TWFH (OR 0.86, 95% CI 0.74-0.99) had significantly lower odds of sickness absence than employees with no access. Among employees with access to TWFH, those in conventional open-plan offices had significantly higher predicted probability of self-certified sickness absence than those in private offices (z=4.41, P<0.0001). There were no significant differences between office designs among employees who did not have access to TWFH. There were no significant main or moderating effects on the number of sickness absence episodes in adjusted models. CONCLUSIONS: The current study identifies conventional open-plan offices as a potential risk factor for sickness absence. While access to TWFH may be a protective factor overall, it amplified - rather than attenuated - differences in sickness absence between employees in private offices and conventional open-plan offices.

Do regulatory tools instigate measures to prevent work-related psychosocial and ergonomic risk factors? A process evaluation of a Labour inspection authority trial in the Norwegian home-care services.

OBJECTIVE: There is a research gap regarding the way managers and employee representatives respond to Labour Authority interventions targeting work-related psychosocial and ergonomic risk factors. The present study aimed to determine if (I) labour inspections and (II) guidance-through-workshops led by inspectors were perceived by the target audience as equally useful and educational; and to determine if utility and enhanced knowledge were associated with the implementation of measures to prevent work-related risk factors. Finally, it aimed to determine if the managers in the intervention groups to a greater extent than the controls reported implementing such measures. RESULTS: Managers and employee representatives in both intervention groups reported a high level of perceived utility as well as a high level of enhanced knowledge. Both utility (p < 0.05) and enhanced knowledge (p < 0.05) were significantly associated with the implementation of, or plans to soon implement, measures to improve working conditions. When compared to controls, implemented measures, or plans to implement measures, were reported significantly more frequently by managers in the inspection group (p < 0.05). Trial Registration ClinicalTrials.gov ID: NCT03855163 Registered on February 26, 2019.

Effects of the Labour Inspectorate Authority's regulatory tools on psychosocial and biomechanical work factors in Norwegian home care services: a cluster randomised controlled trial.

OBJECTIVES: This study aimed to determine the effects of the Labour Inspectorate Authority's (LIA's) regulatory tools on psychosocial and biomechanical work factors in the Norwegian municipal home care services. METHODS: A cluster-randomised controlled trial conducted in the home care services with employee questionnaire data on work factors at baseline, and 6 and 12 months after the interventions. In total, 96 eligible municipalities were randomly assigned to either the control group or one of two interventions: (1) labour inspection visits, based on the LIA's standard inspections; and (2) guidance-through-workshops, where the participating services highlighted issues and trained labour inspectors provided guidance based on existing labour laws and regulations. RESULTS: No favourable intervention effect was observed for the inspection intervention. No effects were observed for most of the variables in the guidance intervention, although an effect was observed for the following psychosocial factors: decision control, control over work intensity and empowering leadership. However, after adjusting for multiple testing, none of the observed effects were statistically significant. CONCLUSION: Labour inspections did not affect psychosocial and biomechanical work factors in the home care services. A favourable effect of the guidance intervention on psychosocial work factors was observed. However, this was not evident after adjusting for multiple testing. Further research is needed to elaborate on how labour inspections and other regulatory tools can impact psychosocial and biomechanical work factors. TRIAL REGISTRATION NUMBER: NCT03855163.

The relationship between telework from home and the psychosocial work environment: a systematic review.

OBJECTIVE: Telework from home (TWFH) has become routine for many, yet research on how this may affect the psychosocial work environment is sparse. To understand the effects that TWFH may have on the psychosocial work environment, this systematic literature review identified, evaluated, and summarized findings on the association of TWFH with factors of the psychosocial work environment. METHODS: Searches were conducted in MEDLINE, Embase, Amed, PsycINFO, and PubMed. The topic of the study reflected TWFH, and subjects should be office workers employed at a company. Outcomes should reflect psychosocial work environment factors. Inclusion criteria stated that studies should be primary, quantitative, and published in a peer-reviewed journal. English language publications dating from January 2010 to February 2021 were included. Risk of bias was assessed using the Newcastle-Ottawa scale (NOS) and quality of overall evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: Searches resulted in 3354 publications, and after screening rounds 43 peer-reviewed original studies satisfying predetermined inclusion and exclusion criteria were included. Fourteen individual psychosocial work environment outcome categories were studied. Limited overall evidence to support effects of TWFH on the included work environment outcomes, with evidence being rated either of low or very low quality. Flexibility and autonomy are discussed as potential mediating variables in the relationship between TWFH and the psychosocial work environment. CONCLUSION: There is a lack of high-quality research investigating effects of TWFH on the psychosocial work environment. To suggest TWFH guidelines or recommendations, there is a need for research with high-quality longitudinal designs, precise measures of time use and location of work, and validated measures of factors known to be of importance. PROSPERO registration number CRD42021233796.

The relationship between telework from home and employee health: a systematic review.

BACKGROUND: Globalization and technological progress have made telework arrangements such as telework from home (TWFH) well-established in modern economies. TWFH was rapidly and widely implemented to reduce virus spread during the Coronavirus disease (COVID-19) pandemic, and will probably be widespread also post-pandemic. How such work arrangements affect employee health is largely unknown. Main objective of this review was to assess the evidence on the relationship between TWFH and employee health. METHODS: We conducted electronic searches in MEDLINE, Embase, Amed, PsycINFO, PubMed, and Scopus for peer-reviewed, original research with quantitative design published from January 2010 to February 2021. Our aim was to assess the evidence for associations between TWFH and health-related outcomes in employed office workers. Risk of bias in each study was evaluated by the Newcastle-Ottawa Scale and the collected body of evidence was evaluated using the the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: We included 14 relevant studies (22,919 participants) reporting on 28 outcomes, which were sorted into six outcome categories (general health, pain, well-being, stress, exhaustion & burnout, and satisfaction with overall life & leisure). Few studies, with many having suboptimal designs and/or other methodological issues, investigating a limited number of outcomes, resulted in the body of evidence for the detected outcome categories being GRADED either as low or very low. CONCLUSIONS: The consisting evidence on the relationship between TWFH and employee health is scarce. The non-existence of studies on many relevant and important health outcomes indicates a vast knowledge gap that is crucial to fill when determining how to implement TWFH in the future working life. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO registration ID # CRD42021233796 .

Effectiveness of the Labour Inspection Authority's regulatory tools for work environment and employee health: study protocol for a cluster-randomised controlled trial among Norwegian home-care workers.

INTRODUCTION: There is a need to evaluate whether, and to what degree, labour inspections or other regulatory tools have the desired effects on psychosocial, organisational and mechanical work environment, and employee health. The Norwegian Labour Inspection Authority (NLIA) uses different tools and strategies to enforce compliance with occupational safety and health (OSH) legislation. The aim of the present study is to evaluate the effects of labour inspections and other regulatory tools employed by the NLIA. The home-care service is one of the fastest growing occupations and a prioritised area for the NLIA, hence the present study will investigate regulatory tools in this sector. METHODS AND ANALYSIS: The research project has been designed as a longitudinal, cluster-randomised, controlled trial and will be conducted among Norwegian home-care workers. The objective of the research project is to evaluate the effects of the NLIA's regulatory tools (inspection and guidance) on: (1) compliance with OSH legislation and regulation; (2) psychosocial, organisational and mechanical work environment; (3) employee health in terms of musculoskeletal and mental health complaints; and (4) sickness absence. Public home-care services have been randomised to three intervention groups and one control group. Home-care services in the intervention groups will receive one of three intervention activities from the NLIA: (1) inspection from the Labour Inspection Authority; (2) guidance through an online interactive risk-assessment tool; and (3) guidance on psychosocial, organisational and mechanical work environment through workshops. The interventions will be performed at the organisational level (home-care service), and the effects of the interventions on the working environment and health complaints will be measured at the individual level (home-care employees). ETHICS AND DISSEMINATION: This project has been approved by the Regional Committees for Medical and Health Research Ethics (REC) in Norway (REC South East) (2018/2003/REK sør-øst C), the Norwegian Center for Research Data (566128), and will be conducted in accordance with the World Medical Association Declaration of Helsinki. The results will be reported in international peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT03855163.

Self-reported skin problems and the healthy worker effect in the general working population of Norway: a three-year prospective study.

Objectives This study aimed to assess whether the occurrence of skin problems in 2006 (baseline) was associated with response frequency, quitting a job due to health problems, and change in occupational skin exposures in 2009. Methods We conducted a three-year prospective study of the general working population of Norway. Associations between baseline indicators (sex, age, education, occupation), and occurrence of skin problems with response frequency at follow-up were assessed with Chi-square test and unconditional logistic regression. Associations between the occurrence of skin problems at baseline with quitting a job due to health problems and skin exposure at follow-up were also assessed with unconditional logistic regression. Results We found no evidence of an association between the occurrence of skin problems at baseline and a lower response frequency at follow-up. Age, sex, education, and occupation were the most important predictors for response at follow-up. Skin problems at baseline consistently predicted quitting a job due to health problems at follow-up. No evidence of change in the patterns of occupational skin exposures at follow up in 2009 was found for workers reporting skin problems in 2006. Conclusion While skin problems at baseline were not related to a lower response frequency at follow-up, our results suggest that workers reporting skin problems may quit their jobs due to health problems. Preventive efforts are still needed to reduce hazardous occupational skin exposures among workers reporting skin problems.

Interaction of smoking with respiratory effects of occupational dust exposure: a prospective population study among Norwegian men.

Dust at work is associated with risk of respiratory symptoms, the population attributable fraction is 19, and smoking is an effect modifier http://ow.ly/w0RF30jUL2Z.

Influence of occupational factors on regional differences in sick leave: A prospective population study.

AIMS: Number of sick leave days vary by county, but little is known about the extent to which this gradient may be explained by differences pertaining to occupational composition and occupational exposure. METHODS: A randomly drawn cohort from the general population in Norway, aged 18-69 years, was interviewed by telephone in the second half of 2009 ( n=12,255; response at baseline=60.9%) and followed up in national registries to the end of 2010. Eligible respondents were registered with an active employee relationship in 2009 and 2010 ( n=8275). Information on counties ( n=19) was based on the administrative register. The outcome of interest was the number of physician-certified sick-leave days divided by scheduled man-days during 2010 (i.e. sick-leave percentage (SLP)). RESULTS: The average SLP during 2010 was 5.2%. The between-county variation in SLP ranged from 4.0% to 7.2%. Compared to the age- and gender-adjusted model, adjustment for occupation, economic sector and self-reported occupational exposure reduced the median difference in SLP between the county with the lowest SLP (reference county) and the SLP in the other counties by 1.08 percentage points (i.e. a 58% reduction). The impact of occupational composition and occupational exposure on the total between-county variance in SLP was a 16% reduction. CONCLUSIONS: Occupational composition and self-reported occupational exposure help to explain a significant part of the difference in SLP between counties, and appear to be more important explanatory factors than demographic variables, self-reported health and smoking.

Psychosocial factors at work and sleep problems: a longitudinal study of the general working population in Norway.

PURPOSE: A growing number of longitudinal studies report associations between adverse psychosocial factors at work and sleep problems. However, the evidence regarding the direction of these associations and the effects of changes in exposure across time is limited. This study examined the plausibility of normal, reverse, and reciprocal associations between ten psychosocial factors at work and sleep problems. In addition, we analyzed if reduced exposure across time had the anticipated result of reducing the risk of sleep problems. METHODS: Randomly drawn from the general working-age population, the cohort comprised respondents with an active employee relationship in 2009 and 2013 (N = 5760). Exposures and outcome were measured on two occasions separated by 4 years. We computed several sex-stratified logistic regression models with adjustments for various plausible confounders. RESULTS: We found support for the commonly hypothesized unidirectional forward associations between psychosocial factors at work and sleep problems among women only. Among men, psychosocial stressors at work and sleep problems were reciprocally and reversely related. Nevertheless, reduced exposure levels across time pertaining to effort-reward imbalance (OR = 0.36; 95% CI = 0.19-0.69) and lack of social support (OR = 0.55; 95% CI = 0.32-0.93) among men, and work-family imbalance (OR = 0.26; 95% CI = 0.15-0.46) among women were associated with a robust significant lower risk of sleep problems compared to those in the stable high exposure groups. CONCLUSIONS: The study results suggest that preventive measures targeting effort-reward imbalance and lack of social support among men, and work-family imbalance among women, might contribute to reduce the risk of troubled sleep among employees.

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

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

Do Work-Related Mechanical and Psychosocial Factors Contribute to the Social Gradient in Low Back Pain?: A 3-Year Follow-Up Study of the General Working Population in Norway.

STUDY DESIGN: A prospective cohort study. OBJECTIVE: The aim of the study was to investigate the extent to which work-related factors contribute to the social gradient in low back pain (LBP). SUMMARY OF BACKGROUND DATA: A social gradient in LBP is well established, but only a few studies have examined the extent to which exposure to mechanical and psychosocial work environment factors is a pathway for this gradient. METHODS: A randomly drawn cohort from the general population in Norway aged 18 to 66 years was followed up for 3 years (n = 12,550, response rate at baseline = 67%). Eligible respondents were in paid work during 2006 and 2009 (n = 6819). Based on administrative register data respondents were coded into five educational levels (university/college ≥4 years was set as the reference group). Outcome of interest was self-reported moderate or severe LBP at follow-up adjusted for baseline LBP. RESULTS: In total, 11.2% (397 individuals) men and 14.5% (461 individual) women reported LBP at follow-up. There was a strong social gradient ranging from 16.4% (elementary) to 6.4% (university/college ≥4 years). The corresponding figures among women were 22.4% and 7.5%. Corrected for age, LBP at baseline and working hours, educational level was a significant predictor of LBP at follow-up (odds ratios 1.8-2.3 in men and 1.7-3.1 in women). Adjusting for mechanical factors reduced the gradient by 39% to 43% in men and 28% to 34% in women. Adjusting for psychosocial factors reduced the gradient by 5% to 12% in men and increased the gradient by 7% to 11% in women. CONCLUSION: Work-related mechanical factors contributed substantially to the social gradient in LBP among both men and women. The impact of psychosocial factors was modest among men and contributed to an increased gradient among women. LEVEL OF EVIDENCE: 3.

Occupational noise exposure and hearing: a systematic review.

PURPOSE: To give a systematic review of the development of noise-induced hearing loss (NIHL) in working life. METHODS: A literature search in MEDLINE, Embase, Web of Science, Scopus, and Health and Safety Abstracts, with appropriate keywords on noise in the workplace and health, revealed 22,413 articles which were screened by six researchers. A total of 698 articles were reviewed in full text and scored with a checklist, and 187 articles were found to be relevant and of sufficient quality for further analysis. RESULTS: Occupational noise exposure causes between 7 and 21 % of the hearing loss among workers, lowest in the industrialized countries, where the incidence is going down, and highest in the developing countries. It is difficult to distinguish between NIHL and age-related hearing loss at an individual level. Most of the hearing loss is age related. Men lose hearing more than women do. Heredity also plays a part. Socioeconomic position, ethnicity and other factors, such as smoking, high blood pressure, diabetes, vibration and chemical substances, may also affect hearing. The use of firearms may be harmful to hearing, whereas most other sources of leisure-time noise seem to be less important. Impulse noise seems to be more deleterious to hearing than continuous noise. Occupational groups at high risk of NIHL are the military, construction workers, agriculture and others with high noise exposure. CONCLUSION: The prevalence of NIHL is declining in most industrialized countries, probably due to preventive measures. Hearing loss is mainly related to increasing age.

Self-reported Occupational Skin Exposure and Risk of Physician-certified Long-term Sick Leave: A Prospective Study of the General Working Population of Norway.

Little is known about the contribution of occupational skin exposure as a risk factor for physician-certified long-term sick leave in the general working population of Norway. This study drew a cohort (n = 12,255; response at baseline 69.9%) randomly from the general population of Norway. Occupational skin exposure (in 2009) was measured based on 5 items. The outcome of interest was physician-certified long-term sick leave ≥ 16 days during 2010. Statistical adjustment for psychosocial and mechanical occupational exposures was performed. Long-term sick leave was predicted by occupational skin exposure to cleaning products (odds ratio (OR) 1.7; 95% confidence interval (95% CI) 1.1-2.5) and waste (OR 2.1; 95% CI 1.1-3.7) among men, and occupational skin exposure to water (OR 1.3; 95% CI 1.0-1.6) among women. The estimated population attributable risk for occupational skin exposure was 14.5%, which emphasizes its contribution as an important risk factor for long-term sick leave.

Self-reported occupational exposure to chemical and physical factors and risk of skin problems: a 3-year follow-up study of the general working population of Norway.

Prospective studies on occupational dermatoses in the general working population are sparse. This study investigated prospectively the impact of self-reported occupational exposure to chemicals and physical factors on the risk of skin problems. The cohort comprised respondents drawn randomly from the general population in Norway, who were registered employed in 2006 and 2009 (n = 6,745). Indoor dry air (odds ratio (OR) 1.3; 95% confidence interval (95% CI) 1.1-1.6) was a significant baseline predictor of skin problems at follow-up, whereas exposure to cleaning products (OR 1.7; 95% CI 1.2-2.5), water (OR 1.4; 95% CI 1.1-1.9) and indoor dry air (OR 1.6; 95% CI 1.1-2.1) at both measurement time-points was significantly associated with skin problems. The population risk attributable to these factors was 16%. This study quantified the contribution of occupational exposure factors to skin problems in the general working population of Norway.

Psychosocial factors at work and occupational injuries: A prospective study of the general working population in Norway.

BACKGROUND: We examined the effects of psychosocial stressors at work on subsequent injuries, taking into account organizational and mechanical working conditions. METHODS: Randomly drawn from the general population, the cohort comprised respondents with an active employee relationship in 2006 and 2009 (n = 6,745). OUTCOME MEASURE: "Have you, over the past 12 months, afflicted injuries that were caused by an accident at work, and resulting in time off work after the day of the accident?". RESULTS: High job strain (Odds ratio [OR] 2.31; 95% confidence interval [CI] 1.16-4.57), high role conflict (OR 3.01; 95% CI 1.70-5.31), and high emotional demands (OR 1.96; 95% CI 1.15-3.35) predicted injury at follow up (P < 0.01). The population risk attributable to each of these factors ranged from 11% to 14%. CONCLUSIONS: Excess risk of occupational injuries was attributable to job strain, role conflict, and emotional demands. These factors are potentially amenable to preventive measures.

Psychosocial and organizational risk factors for doctor-certified sick leave: a prospective study of female health and social workers in Norway.

BACKGROUND: Doctor-certified sick leave differs substantially across sectors, and among health and social workers, in particular, there is an increased risk. Previous studies have shown that work environmental factors contribute to sick leave. Hence, the identification of specific organizational and psychosocial risk factors for long- term sick leave, taking into account potential confounding related to mechanical risk factors such as lifting and awkward body postures, will be of importance in the work of prevention. METHODS: A randomly drawn population sample of Norwegian residents was interviewed about working conditions in 2009 (n = 12,255; response rate 60.9%). Female health and social care workers (n = 925) were followed in a national registry for subsequent sickness absence during 2010. The outcome of interest was doctor-certified sick leave of 21 days or more (long-term sick leave). Eleven work-related psychosocial and organizational factors were evaluated. RESULTS: In total, 186 persons (20.1%) were classified with subsequent long-term sick leave. After thoroughly adjusting for competing explanatory variables, the most consistent predictors for long-term sick leave were violence and threats of violence (OR = 1.67; 95% CI 1.14-2.45). The estimated population attributable risk for violence and threats of violence was 13%. CONCLUSIONS: The present study among female health and social care workers revealed a substantial relationship between self-reported violence and threats of violence and subsequent long- term sick leave.