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Long-term sickness absence due to mental disorders is associated with individual features and psychosocial work conditions.

ABSTRACT: Sickness absence is a socioeconomic global burden. In Brazil, mental disorders are the third leading cause of social security benefits payments. The aim of the present study was to compare factors associated with long-term sickness absence between workers who claimed social benefits due to mental disorders or by other causes. We investigated individual features and occupational characteristics. In addition, we evaluated psychosocial factors at work assessed by the Demand-Control-Support (DCS) and Effort-Reward Imbalance (ERI) models, and whether they were associated with long-term sickness absence due to mental disorders (LTSA-MD).The present case-control study was conducted in São Paulo, Brazil. The sample (n = 385) included workers on sick leave for more than 15 days. Cases were the participants with disabling psychiatric illnesses, and controls were the ones with other disabling diseases. Interviews were conducted to assess individual features (sociodemographic data, health habits/lifestyle, health conditions) and occupational characteristics. The participants' perception of exposure to dimensions of the DCS and ERI models was also recorded. Multiple logistic regressions were performed to evaluate the association between independent variables and LTSA-MD.All the regression analyses showed that LTSA-MD was associated with female sex, self-reported white skin color, higher education level, high tobacco consumption, high alcohol intake, two or more comorbidities, exposure to violence at work, high job strain and low social support at work, effort-reward imbalance and high overcommitment to work. LTSA-MD was associated with separate and combined DCS and ERI stress models.Individual features and work conditions were associated with LTSA-MD. Combined analysis of stress models showed that psychosocial factors at work were significantly associated with LTSA-MD. Resourceful use of this information may contribute to the implementation of preventive actions and strategies to facilitate return to work targeting the populations most susceptible to mental disorders.

SUBMITTER: Silva-Junior JS

PROVIDER: S-EPMC4274157 | biostudies-other | 2014

REPOSITORIES: biostudies-other

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Project description:BACKGROUND: Attempts to identify particular aspects of psychosocial work conditions as predictors of sickness absence remain inconclusive. A global measure has previously been suggested to be an efficient way to measure psychosocial work conditions in questionnaires. This paper investigates whether satisfaction with specific aspects of psychosocial work conditions explains sickness absence beyond its association with a global measure of psychosocial work conditions. METHODS: The participants were 13,437 employees from 698 public service workplaces in Aarhus County, Denmark. 33 items from a questionnaire fell in groupings around six aspects of psychosocial work conditions: skill discretion, professionalism, management, decision authority, workload and cooperation. A global measure rating satisfaction with psychosocial work conditions on a scale from 0 to 10 was also included in the questionnaire. Individual ratings were aggregated to workplace scores. Analysis of variance and multiple linear regression was used to compare the average number of days of yearly sickness absence with different levels of satisfaction with six aspects of psychosocial work conditions. The covariates included were gender, age, occupation, size of workplace, contact to hospital, civil status and children below 13 living at home. RESULTS: Dissatisfaction with each of the six aspects of psychosocial work conditions was associated with an increase in sickness absence. When all aspects were simultaneously included in the model, only skill discretion and professionalism were negatively associated with sickness absence. When a global measure of satisfaction with psychosocial work conditions was also included in the model none of the specific aspects showed a statistically significant association with sickness absence. CONCLUSION: Low global satisfaction with psychosocial work conditions is associated with increased levels of sickness absence. Including specific aspects of psychosocial work conditions in the model does not provide further information regarding the nature of this association.

Project description:ImportanceMental health problems are associated with considerable occupational, medical, social, and economic burdens. Psychosocial stressors at work have been associated with a higher risk of mental disorders, but the risk of sickness absence due to a diagnosed mental disorder, indicating a more severe condition, has never been investigated in a systematic review and meta-analysis.ObjectiveTo synthesize the evidence of the association of psychosocial stressors at work with sickness absence due to a diagnosed mental disorder among adult workers.Data sourcesSeven electronic databases (MEDLINE, Embase, PsycInfo, Web of Science, CINAHL, Sociological Abstracts, and International Bibliography of the Social Sciences), 3 gray literature databases (Grey Literature Report, WHO-IRIS and Open Grey), and the reference lists of all eligible studies and reviews were searched in January 2017 and updated in February 2019.Study selectionOnly original prospective studies evaluating the association of at least 1 psychosocial stressor at work from the 3 most recognized theoretical models were eligible: the job demand-control-support model, including exposure to job strain (high psychological demands with low job control); effort-reward imbalance model; and organizational justice model. Study selection was performed in duplicate by blinded independent reviewers. Among the 28 467 citations screened, 23 studies were eligible for systematic review.Data extraction and synthesisThis meta-analysis followed the PRISMA and MOOSE guidelines. Data extraction and risk of bias evaluation, using the Risk of Bias in Nonrandomized Studies-Interventions tool, were performed in duplicate by blinded independent reviewers. Data were pooled using random-effect models.Main outcomes and measuresSickness absence due to a mental disorder with a diagnosis obtained objectively.ResultsA total of 13 studies representing 130 056 participants were included in the 6 meta-analyses. Workers exposed to low reward were associated with a higher risk of sickness absence due to a diagnosed mental disorder compared with nonexposed workers (pooled risk ratio [RR], 1.76 [95% CI, 1.49-2.08]), as were those exposed to effort-reward imbalance (pooled RR, 1.66 [95% CI, 1.37-2.00]), job strain (pooled RR, 1.47 [95% CI, 1.24-1.74]), low job control (pooled RR, 1.25 [95% CI, 1.02-1.53]), and high psychological demands (pooled RR, 1.23 [95% CI, 1.04-1.45]).Conclusions and relevanceThis meta-analysis found that workers exposed to psychosocial stressors at work were associated with a higher risk of sickness absence due to a mental disorder. A better understanding of the importance of these stressors could help physicians when evaluating their patients' mental health and work capacity.

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Long-term sickness absence due to mental disorders is associated with individual features and psychosocial work conditions.

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