Job Strain and Psychologic Distress: Influence on Sickness Absence Among Finnish Employees

doi:10.1016/j.amepre.2007.05.003

American Journal of Preventive Medicine

Volume 33, Issue 3, September 2007, Pages 182-187

https://doi.org/10.1016/j.amepre.2007.05.003 Get rights and content

Background

Work stress is a recognized risk factor for mental health disorders, but it is not known whether work stress is associated with the morbidity among individuals with psychologic distress. Another shortcoming in earlier research is related to common method bias—the use of individual perceptions of both work stress and psychologic distress. This prospective study was assessed using the General Health Questionnaire (GHQ-12), which identified psychologic distress as a predictor of sickness absence and the effect of work-unit measures of job strain on sickness absence among cases.

Methods

Survey data were collected on work stress, indicated by high job strain, for a cohort of public sector employees (6663 women, 1323 men), aged 18 to 62 at baseline in 2000–2002, identified as GHQ-12 cases. Coworker assessments of job strain were used to control for bias due to response style. A 2-year follow-up included recorded long-term (>7 days) medically certified sickness absence. Adjustments were made for age, socioeconomic position, baseline chronic physical disease, smoking, and heavy alcohol consumption.

Results

Cases with psychologic distress had 1.3 to 1.4 times higher incidence of long-term sickness absence than noncases. Among cases, high job strain predicted sickness absence (hazard ratio 1.17 in women, 1.41 in men). The significant effect of job strain on sickness absence was found among workers in high socioeconomic positions (hazard ratio 1.54 for women, 1.58 for men) but not among employees in low socioeconomic positions (hazard ratio 1.06 for women, 1.31 for men).

Conclusions

Psychologic distress has an independent effect on medically certified sickness absence. The identification of employees with high job strain and the improvement of their working conditions should be considered as an important target in the prevention of adverse consequences of psychologic distress.

Introduction

Over the past decade, data from surveys and registers have shown increasing psychologic stress at work, and that mental disorders, especially depression, are a growing reason for work disability and premature exclusion from the labor market.1, 2, 3, 4 Although severe mental disorders predict functional incapacity and work disability, there is a lack of evidence on whether the widely used General Health Questionnaire (GHQ)⁵ may also be useful in screening for mental disorders that can increase work disability risk in the form of long-term sickness absence.6, 7

To most effectively prevent work disability and premature exclusion from the labor market, one should take into account not only factors that affect the risk in healthy populations but also those influencing the prognosis of workers with psychologic distress. One of the most widely used work stress theories is the job strain model,8, 9 also known as the demand-control model. According to the model, high job demands, low job control and, in particular, a combination of high job demands and low job control, referred to as job strain, involves a health risk. Extensive literature has shown psychosocial work stress to be among the risk factors for mental ill health and sickness absence in working populations.8, 9, 10, 11, 12, 13, 14, 15, 16, 17 Furthermore, one study has shown that low job control plays a more important role in mental distress among individuals in high socioeconomic positions (SEPs) than among those in low SEPs.¹⁸

Although many studies with depressed patients have shown that adverse life events, life stressors,19, 20 and low social support21, 22, 23, 24 worsen their prognosis, there is no evidence available regarding work stress as a prognostic factor for psychologic distress. To our knowledge, none of the earlier studies have used certified sickness absence as a prognostic outcome among individuals with psychologic distress. Furthermore, it is not known whether individuals with psychologic distress are more vulnerable to psychologic work stress and resulting absence than those without it. Finally, a major methodologic limitation in earlier studies on work stress and mental health is related to bias due to response style and psychologic reactivity, that is, both the exposure and the outcome have been based on individuals’ perceptions.

The objective of this prospective study was to examine the contribution of job strain to the prognosis among employees with psychologic distress. In this study, prognosis was evaluated with the occurrence of medically certified long-term sickness absence. Work-unit measures of job strain were calculated in which the assessment is based on coworkers’ opinions of strain. This study examined whether this measure of job strain predicts sickness absence among workers with psychologic distress and whether this association is dependent on individual SEPs.

Section snippets

Methods

The data were from the Finnish Public Sector Study, a study focusing on local government employees of 10 towns and employees in 21 public hospitals that provide municipal services and public specialized health care in the provinces of southern, western, and northern Finland.25, 26 The ethics committee of the Finnish Institute of Occupational Health approved the study. The eligible population covered a wide range of occupations from city mayor to semi-skilled cleaner, and the most common

Results

Participants had a 1.3 to 1.4 times higher incidence of long-term (>7 days) sickness absence than excluded respondents with no psychologic distress at baseline (adjusted HR 1.37, 95% CI=1.31 to 1.42 among women and HR 1.33, 95% CI=1.20 to 1.46 among men).

Table 1 presents descriptive statistics for the 7986 cases of psychologic distress. Women were younger than men, more often had a chronic physical disease, were less often smokers and heavy drinkers, and worked more often in work units with

Discussion

This study of nearly 8000 cases of psychologic distress showed that coworker-assessed high job demands, low job control, and high job strain were significant prognostic factors for sickness absence. Furthermore, high job strain was more strongly related to a higher risk of sickness absence among those in a high SEP than among those in a low SEP. As far as we are aware, this is the first study of the relationship between job strain and sickness absence among employees identified by the GHQ-12 to

Conclusion

Psychologic distress is associated with long-term medically certified sickness absence in a large contemporary working population. High job strain has an adverse effect on prognosis among employees with psychologic distress. As mental health problems account for a considerable proportion of the disease burden and are a major cause of permanent work disability, the identification of employees with high job strain and the improvement of their working conditions should be considered as an

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For example, a study of Laschinger et al. (2001) found that those nurses who belonged to a high strain group had lower job satisfaction compared to those in an active job group. A Finnish study showed that higher job strain and lower control over one's job predicted sickness absence (Virtanen et al., 2007), whereas another Finnish study from older people care facilities presented the association between use of restraint practices and low control and high demands (Pekkarinen et al., 2006). When considering staff turnover and the Demand-Control model, previous studies have also found an association between the two factors.
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Research articleJob Strain and Psychologic Distress: Influence on Sickness Absence Among Finnish Employees

Background

Methods

Results

Conclusions

Introduction

Section snippets

Methods

Results

Discussion

Conclusion

J Psychosom Res

J Affect Disord

Soc Sci Med

Soc Sci Med

Soc Sci Med

Soc Sci Med

The burnout companion to study and practice—A critical analysis

Mielenterveys ja työkyvyttömyyseläkkeet. (Mental health and disability pension, in Finnish) Eläketurvakeskuksen monisteita 50

The epidemiology of major depressive disorder

JAMA

Cost of lost productive work time among US workers with depression

JAMA

The detection of psychiatric illness by questionnaire. Maudsley monograph no. 21

Does psychological distress predict disability?

Int J Epidemiol

Job demands, job decision latitude and mental strain: implications for job redesign

Admin Science Q

Healthy workStress, productivity, and the reconstruction of working life

Psychosocial work environment and sickness absence among British civil servants: the Whitehall II Study

Am J Public Health

Psychosocial factors at work and sickness absence in the Gazel cohort: a prospective study

Occup Environ Med

Employee worktime control moderates the effects of job strain and effort-reward imbalance on sickness absence: the 10-town study

J Epidemiol Community Health

Job strain and sick leave among Japanese employees: a longitudinal study

Int Arch Occup Environ Health

Work, personality and mental health

Br J Psychiatry

The job demand-control(-support) model and psychological well-being: a review of 20 years of empirical research

Work Stress

Work stress as a risk factor for major depressive episode(s)

Psychol Med

Life circumstances and personal resources as predictors of the ten-year course of depression

Am J Community Psychol

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Am J Psychiatry

Coping, stress, and social resources among adults with unipolar depression

J Pers Soc Psychol

Research article
Job Strain and Psychologic Distress: Influence on Sickness Absence Among Finnish Employees