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Original research
Adverse social behaviour at the workplace and subsequent physician certified sick leave: a three-wave prospective study of the general working population in Norway
  1. Tom Sterud,
  2. Eirik Degerud,
  3. Øivind Skare,
  4. Therese N Hanvold,
  5. Jan Olav Christensen
  1. National Institute of Occupational Health (STAMI), Oslo, Norway
  1. Correspondence to Dr Tom Sterud, National Institute of Occupational Health (STAMI), PO box 5330 Majorstuen, 0304 Oslo, Norway; tom.sterud{at}


Objectives We aimed to provide an integrated picture of the relationship between different facets of adverse social behaviour (ASB) at the workplace and sick leave.

Methods Data from a randomly drawn prospective cohort of the general working population. Eligible respondents were interviewed in 2009, 2013 or 2016, and were registered with an employee relationship of at least 50 working days in the national register the year following the survey interviews (n=21 674 observations/13 470 respondents). We investigated the prospective associations of self-reported exposure to ASB, including threats/acts of violence, bullying and sexual harassment, with physician-certified sick leave of 1–16 days (ie, low level of sick leave (LLSL)) and >16 days (ie, high level of sick leave (HLSL)) by means of mixed effects logistic regression.

Results The prevalence of sick leave was 18.4% (n=3986 observations) for LLSL and 16.1% (n=3492 observations) for HLSL. The different facets of ASB were independently associated with higher odds of sick leave, with stronger associations for HLSL than for LLSL. Adjusted for sex, age, education level, occupation, previous sickness absence level, OR (95% CI) for HLSL was 1.97 (1.61 to 2.35) for threats/acts of violence, 1.97 (1.53 to 2.54) for bullying and 1.41 (1.10 to 1.79) for sexual harassment. The population risks of LLSL and HLSL attributable to ASB were 5.27 (95% CI 1.85 to 8.81) and 8.27% (95% CI 4.01 to 12.48), respectively.

Conclusions Threats/acts of violence, bullying and sexual harassment were all independent predictors of sick leave, with threats/acts of violence appearing as the single most important factor.

  • sickness absence
  • organisation of work
  • workload
  • psychology

Statistics from


  • Contributors The article was conceived by TS, who also conducted analysis. ED, ØS, TNH and JOC contributed to analytic design, and to the interpretation of results. TS drafted the manuscript with feedback from all authors. All authors contributed to the final draft of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The survey was carried out by Statistics Norway according to statutory rules. Statistics Norway has appointed its own privacy ombudsman, approved by the Norwegian Data Inspectorate.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. Statistics Norway has an established policy for data sharing. Requests for data (ie, The Norwegian Survey on Living conditions survey-working conditions) can be addressed to the Norwegian Centre for Research Data ( or Statistics Norway (mikrodata{at}

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