The impact of poor psychosocial work environment on non-work-related sickness absence
Introduction
Sickness-related absences are a major concern in occupational health and has increasing become a focus of interest among researchers. Nevertheless, sick leave is an essential resource for the working population. The development of sick pay, which allows workers to receive compensation when they are temporarily unable to work due to illness, has signified important progress for social security systems. That being said, sickness-related benefits are a major source of costs for both insurance companies (i.e., productivity losses and replacement costs) and employees (i.e., potential for variable income reduction) depending on the type of insurance and country-specific social security characteristics (Coggon et al., 2013, Markussen et al., 2011, Torá-Rocamora et al., 2013).
In Spain, sickness absence is covered for both work-related and non-work-related injuries and diseases, but with different regulations (Gimeno et al., 2014). Classification as an occupational disease is constrained by a specific list of conditions, for defined occupations, and developed under the influence of definite exposures (Spanish General Law on Social Security, 1994). Occupational injuries, on the other hand, refer to those caused in the context of an accident at work or while commuting (European Commission, 2013). The remainder of injuries and diseases are considered non-work-related. In the case of non-work-related sickness absence (NWRSA), sick pay extends from the fourth day of sickness absence to 12 months, with the possibility of an additional six month period following an evaluation by the Social Security Institute. Sick leave must be certified by the patient's general practitioner on a weekly basis from the initial onset of the episode until completion (Gimeno et al., 2014). Occupational diseases and injuries generally involve additional benefits (e.g., sick pay from the first day).
In order to minimise the detrimental effects of work absences, it is essential to enhance our knowledge regarding the complex multifactorial processes that result in workers requesting sick leave. Previous research has analysed the impact of the psychosocial work environment on sickness absence (Coggon et al., 2013, Houdmont et al., 2012, Markussen et al., 2011), with significant but variable associations between specific work-related psychosocial factors and sickness absence, including: job strain or its components (Alavinia et al., 2009, Casini et al., 2010, Casini et al., 2013; Laaksonen et al., 2010, Niedhammer et al., 2013), effort–reward imbalance (Head et al., 2007, Ndjaboué et al., 2014), job insecurity (Blekesaune, 2012), or work–family conflict (Casini et al., 2010, Casini et al., 2013; Clays et al., 2009, Hämmig and Bauer, 2014). However, there is a fundamental need to reproduce these analyses in different countries, where social security systems can vary greatly.
Indeed, specific regulations that effect sick pay entitlement within each country, as well as macroeconomic variables (e.g., unemployment rate) can modulate associations between work-related psychosocial factors and sickness absence. To date, several studies have been conducted using cross-sectional designs (Casini et al., 2010, Coggon et al., 2013, Hämmig and Bauer, 2014, Niedhammer et al., 2013, Roelen et al., 2008) or self-reported sickness absence as a surrogate measure of sick leave (Blekesaune, 2012, Coggon et al., 2013, Hämmig and Bauer, 2014, Houdmont et al., 2012, Niedhammer et al., 2013). Therefore, from an occupational viewpoint, many findings in the literature have been biased through the analysis of selected populations (Alavinia et al., 2009, Head et al., 2007, Houdmont et al., 2012, Laaksonen et al., 2010, Rugulies et al., 2010, Virtanen et al., 2008) or low response rates (Casini et al., 2010, Casini et al., 2013; Clays et al., 2009). Moreover, investigations have seldom incorporated tools specifically developed for the assessment of the psychosocial work environment. As such, the generalisability of these results to real professional practice is limited, and evidence regarding the predictive validity of available questionnaires and scales is lacking (Rugulies et al., 2010). Furthermore, no study conducted to date has explicitly focused on the role of psychosocial factors at work on NWRSA.
Here, we aimed to analyse the impact of the psychosocial work environment on sickness absence due to non-work-related diseases and injuries.
Section snippets
Methods
In this prospective cohort study, a sample of 16,693 healthy workers was selected during routine medical check-ups between 2007 and 2010. A stratified random sampling method was used, where strata were defined by gender, age group, and occupational level of the participants. All economic activity sectors and geographical areas (autonomous communities of Spain) were included in the data collection. The quarterly Economically Active Population Survey (third quarter of 2006), which was carried out
Characteristics of participants
The characteristics of the study participants are presented in Table 1. Approximately 70% of the subjects were men, and more than 70% were 25–44 years old. Approximately 80% of the workers had completed secondary education or higher. Only a small percentage of participants were not Spanish. The most frequent employment situations involved non-manual occupations (58.40%), working in the services sector (61.34%), permanent contracts (76.63%), companies with ≥50 workers (51.13%), and length of
Discussion
We observed a consistent association between high exposure to work-related psychosocial factors and increased NWRSA during a one year follow-up period. Furthermore, we identified several psychosocial variables, measured using the brief version of the Spanish adaptation of CoPsoQ, to significantly associate with NWRSA even after adjusting for demographics, occupation, contractual relationship, company-related covariates, and previous health status. Thus, our findings demonstrated that for men
Acknowledgements
The authors thank Joan Minguet at the Institute for Research and Medicine Advancement (IRMEDICA) for the editorial assistance provided in the preparation of this manuscript.
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