Work-related stress and future sick leave in a working population seeking care at primary health care centres: a prospective longitudinal study using the WSQ

Anna-Maria Hultén, Pernilla Bjerkeli, Kristina Holmgren, Anna-Maria Hultén, Pernilla Bjerkeli, Kristina Holmgren

Abstract

Background: Studying the relationship between work-related stress and sick leave is valuable in identifying and assessing employees at risk of sick leave, but also in developing interventions and taking actions for workers' health. The overall aim of this study was to analyse the association between work-related stress, measured with the work stress questionnaire (WSQ), and registered sick leave in a working population seeking care at primary health care centres in Sweden.

Methods: A prospective longitudinal study was performed with 232 employed patients aged 18-64 years seeking care for mental and/or physical health complaints at seven primary health care centres. Bivariate logistic regression analysis adjusted for educational level, occupational class and marital status was performed using questionnaire data on work-related stress and sociodemographic factors collected between May 2015 until January 2016 together with registered sick leave data from a national database.

Results: High stress due to indistinct organization and conflicts was reported by 21% (n = 49), while 45% (n = 105) reported high stress due to individual demands and commitment. Thirty-six percent were on sick leave for 15 days or more during 12 months after baseline. The odds of being on registered sick leave during this period was approximately twice as high for patients perceiving high stress due to indistinct organization and conflicts (OR 2.25, 95% CI 1.18;4.26), high stress due to individual demands and commitment (OR 2.21, 95% CI 1.28;3.82), low influence at work (OR 2.07, 95% CI 1.20;3.57), or high interference between work and leisure time (OR 2.19, 95% CI 1.27;3.80). Perceiving high stress due to both indistinct organization and conflicts as well as individual demands and commitment quadrupled the odds of sick leave, OR 4.15 (95% CI 1.84; 9.38).

Conclusions: Work-related stress and sick leave were prevalent among the patients. Perceiving one or more of the work-related stressors and stress increased the odds of registered sick leave between two to four times. Hence, to capture the dynamic interaction between the individual and the work environment, a wide spectrum of factors must be considered. In addition, primary health care could be a suitable arena for preventing sick leave due to work-related stress.

Trial registration: ClinicalTrials.gov. Identifier: NCT02480855 . Registered 20 May 2015.

Keywords: Organisational climate; Primary health care; Psychosocial risk factors; Sickness absence; Work Stress Questionnaire (WSQ); Work commitment; Workers’ health.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Distribution of sick leave during 12 months after baseline

References

    1. Fujishiro K, Ahonen EQ, Gimeno Ruiz de Porras D, Chen IC, Benavides FG. Sociopolitical values and social institutions: Studying work and health equity through the lens of political economy. SSM Popul Health. 2021;14:100787.
    1. Eurofound . Working conditions and workers’ health. Luxembourg: Publications Office of the European Union; 2019.
    1. Eurofound . Labour market change: Trends and policy approaches towards flexibilisation. Luxembourg: Publications Office of the European Union; 2020.
    1. Demerouti E, Bakker AB, Gevers JMP. Job crafting and extra-role behavior: The role of work engagement and flourishing. J Vocat Behav. 2015;91:87–96.
    1. Kivimäki M, Vahtera J, Thomson L, Griffiths A, Cox T, Pentti J. Psychosocial factors predicting employee sickness absence during economic decline. J Appl Psychol. 1997;82(6):858–872.
    1. Eurofound . Sixth European Working Conditions Survey – Overview report (2017 update) Luxembourg: Publications Office of the European Union; 2017.
    1. Hassard J, Teoh KRH, Visockaite G, Dewe P, Cox T. The cost of work-related stress to society: A systematic review. J Occup Health Psychol. 2018;23(1):1–17.
    1. Matilla-Santander N, González-Marrón A, Martín-Sánchez JC, Lidón-Moyano C, Cartanyà-Hueso À, Martínez-Sánchez JM. Precarious employment and health-related outcomes in the European Union: a cross-sectional study. Crit Pub Health. 2020;30(4):429–440.
    1. Nixona AE, Mazzolab JJ, Bauera J, Kruegerc JR, Spectora PE. Can work make you sick? A meta-analysis of the relationships between job stressors and physical symptoms. Work Stress. 2011;25(1):1–22.
    1. Virtanen M, Jokela M, Nyberg ST, Madsen IEH, Lallukka T, Ahola K, et al. Long working hours and alcohol use: Systematic review and meta-analysis of published studies and unpublished individual participant data. BMJ (Online) 2015;350:g7772.
    1. Van Der Molen HF, Nieuwenhuijsen K, Frings-Dresen MHW, De Groene G. Work-related psychosocial risk factors for stress-related mental disorders: An updated systematic review and meta-analysis. BMJ Open. 2020;10(7):e034849.
    1. Allebeck P, Mastekaasa A. Chapter 5. Risk factors for sick leave - General studies. Scand J Public Health Suppl. 2004;32(63):49–108.
    1. Mutambudzi M, Theorell T, Li J. Job Strain and Long-Term Sickness Absence from Work: A Ten-Year Prospective Study in German Working Population. J Occup Environ Med. 2019;61(4):278–284.
    1. Schaufeli WB, Bakker AB, van Rhenen W. How changes in job demands and resources predict burnout, work engagement, and sickness absenteeism. J Organ Behav. 2009;30(7):893–917.
    1. Väänänen A, Kalimo R, Toppinen-Tanner S, Mutanen P, Peiró JM, Kivimäki M, et al. Role clarity, fairness, and organizational climate as predictors of sickness absence: A prospective study in the private sector. Scand J Public Health. 2004;32(6):426–434.
    1. Siegrist J, Starke D, Chandola T, Godin I, Marmot M, Niedhammer I, et al. The measurement of effort-reward imbalance at work: European comparisons. Soc Sci Med. 2004;58(8):1483–1499.
    1. Nilsen W, Skipstein A, Østby KA, Mykletun A. Examination of the double burden hypothesis-a systematic review of work-family conflict and sickness absence. Eur J Public Health. 2017;27(3):465–471.
    1. Lazarus RS, Folkman S. Transactional theory and research on emotions and coping. Eur J Pers. 1987;1(3):141–169.
    1. Edwards JR, Cooper CL. The person-environment fit approach to stress: Recurring problems and some suggested solutions. J Organ Behav. 1990;11(4):293–307.
    1. Johnson JV, Hall EM. Job strain, work place social support, and cardiovascular disease: A cross-sectional study of random sample of the Swedish Working Population. Am J Public Health. 1988;78(10):1336–1342.
    1. Fritz H, Cutchin MP. The transactional perspective on occupation: A way to transcend the individual in health promotion interventions and research. J Occup Sci. 2017;24(4):446–457.
    1. Clausen T, Burr H, Borg V. Do psychosocial job demands and job resources predict long-term sickness absence? An analysis of register-based outcomes using pooled data on 39,408 individuals in four occupational groups. Int Arch Occup Environ Health. 2014;87(8):909–917.
    1. Holmgren K, Dahlin-Ivanoff S, Björkelund C, Hensing G. The prevalence of work-related stress, and its association with self-perceived health and sick-leave, in a population of employed Swedish women. BMC Public Health. 2009;9:73.
    1. Holmgren K, Fjällström-Lundgren M, Hensing G. Early identification of work-related stress predicted sickness absence in employed women with musculoskeletal or mental disorders: a prospective, longitudinal study in a primary health care setting. Disabil Rehabil. 2013;35(5):418–426.
    1. Holmgren K, Hensing G, Dellve L. The association between poor organizational climate and high work commitments, and sickness absence in a general population of women and men. J Occup Environ Med. 2010;52(12):1179–1185.
    1. Holmgren K, Ivanoff SD. Women on sickness absence - Views of possibilities and obstacles for returning to work. A focus group study Disabil Rehabil. 2004;26(4):213–222.
    1. Geisler M, Berthelsen H, Muhonen T. Retaining Social Workers: The Role of Quality of Work and Psychosocial Safety Climate for Work Engagement, Job Satisfaction, and Organizational Commitment. Hum Serv Organ Manag Leadersh Gov. 2019;43(1):1–15.
    1. Wickramasinghe V. The mediating effect of job stress in the relationship between work-related dimensions and career commitment. J Health Organ Manag. 2016;30(3):408–420.
    1. Marinaccio A, Ferrante P, Corfiati M, Di Tecco C, Rondinone BM, Bonafede M, et al. The relevance of socio-demographic and occupational variables for the assessment of work-related stress risk. BMC Public Health. 2013;13:1157.
    1. Gilbert-Ouimet M, Trudel X, Aubé K, Ndjaboue R, Duchaine C, Blanchette C, et al. Differences between women and men in the relationship between psychosocial stressors at work and work absence due to mental health problem. Occup Environ Med. 2020;77(9):603–610.
    1. Götz S, Hoven H, Müller A, Dragano N, Wahrendorf M. Age differences in the association between stressful work and sickness absence among full-time employed workers: evidence from the German socio-economic panel. Int Arch Occup Environ Health. 2018;91(4):479–496.
    1. Brooker AS, Eakin JM. Gender, class, work-related stress and health: Toward a power-centred approach. J Community Appl Soc Psychol. 2001;11(2):97–109.
    1. Wynne-Jones G, Mallen CD, Welsh V, Dunn KM. Rates of sickness certification in European primary care: a systematic review. Eur J Gen Pract. 2008;14(3–4):99–108.
    1. Weevers HJA, van der Beek AJ, Anema JR, van der Wal G, van Mechelen W. Work-related disease in general practice: A systematic review. Fam Pract. 2005;22(2):197–204.
    1. Wiegner L, Hange D, Björkelund C, Ahlborg G., Jr Prevalence of perceived stress and associations to symptoms of exhaustion, depression and anxiety in a working age population seeking primary care - An observational study. BMC Fam Pract. 2015;16(1):38.
    1. Adamsson A, Bernhardsson S. Symptoms that may be stress-related and lead to exhaustion disorder: A retrospective medical chart review in Swedish primary care. BMC Fam Pract. 2018;19(1):172.
    1. Holmgren K, Sandheimer C, Mårdby AC, Larsson MEH, Bültmann U, Hange D, et al. Early identification in primary health care of people at risk for sick leave due to work-related stress - Study protocol of a randomized controlled trial (RCT) BMC Public Health. 2016;16(1):1193.
    1. Holmgren K, Hensing G, Dahlin-Ivanoff S. Development of a questionnaire assessing work-related stress in women - Identifying individuals who risk being put on sick leave. Disabil Rehabil. 2009;31(4):284–292.
    1. Frantz A, Holmgren K. The Work Stress Questionnaire (WSQ) - Reliability and face validity among male workers. BMC Public Health. 2019;19:1580.
    1. Statistics Sweden . Socioeconomic classification (SEI) (in Swedish) Stockholm: Statistics Sweden; 1984.
    1. Holmgren K, Hensing G, Bültmann U, Hadzibajramovic E, Larsson MEH. Does early identification of work-related stress, combined with feedback at GP-consultation, prevent sick leave in the following 12 months?: a randomized controlled trial in primary health care. BMC Public Health. 2019;19(1):1110.
    1. Hultén A-M, Bjerkeli P, Holmgren K. Self-reported sick leave following a brief preventive intervention on work-related stress: a randomised controlled trial in primary health care. BMJ Open. 2021;11:e041157.
    1. Hosmer DW, Lemeshow S, Sturdivant RX. Applied logistic regression. 3. Hoboken, N.J.: Wiley; 2013.
    1. Rothman KJ. Epidemiology: an introduction. 2. New York, NY: Oxford University Press; 2012.
    1. Midi H, Sarkar SK, Rana S. Collinearity diagnostics of binary logistic regression model. J Interdiscip Math. 2010;13(3):253–267.
    1. Blom V, Kallings LV, Ekblom B, Wallin P, Andersson G, Hemmingsson E, et al. Self-reported general health, overall and work-related stress, loneliness, and sleeping problems in 335,625 swedish adults from 2000 to 2016. Int J Environ Res Public Health. 2020;17(2):511.
    1. Swedish Social Insurance Agency . Social insurance in figures 2017. Stockholm: Swedish Social Insurance Agency; 2017.
    1. Lidwall U, Marklund S. What is healthy work for women and men? - A case-control study of gender- and sector-specific effects of psycho-social working conditions on long-term sickness absence. Work. 2006;27(2):153–163.
    1. Bouville G, Dello Russo S, Truxillo D. The moderating role of age in the job characteristics–absenteeism relationship: A matter of occupational context? J Occup Organ Psychol. 2018;91(1):57–83.
    1. Meyer JP, Herscovitch L. Commitment in the workplace: Toward a general model. Hum Resour Manage Rev. 2001;11(3):299–326.
    1. Porter LW, Steers RM, Mowday RT, Boulian PV. Organizational commitment, job satisfaction, and turnover among psychiatric technicians. J Appl Psychol. 1974;59(5):603–609.
    1. Hinsch DM, Spanier K, Radoschewski FM, Bethge M. Associations between overcommitment, effort–reward imbalance and mental health: findings from a longitudinal study. Int Arch Occup Environ Health. 2019;92(4):559–567.
    1. du Prel JB, Runeson-Broberg R, Westerholm P, Alfredsson L, Fahlén G, Knutsson A, et al. Work overcommitment: Is it a trait or a state? Int Arch Occup Environ Health. 2018;91(1):1–11.
    1. Katz D, Kahn RL. The social psychology of organizations. New York: Wiley; 1978.
    1. Loh MY, Idris MA, Dormann C, Muhamad H. Organisational climate and employee health outcomes: A systematic review. Saf Sci. 2019;118:442–452.
    1. Kusnanto H, Agustian D, Hilmanto D. Biopsychosocial model of illnesses in primary care: A hermeneutic literature review. J Family Med Prim Care. 2018;7(3):497–500.
    1. Semmer NK, Grebner S, Elfering A. Beyond self-report: Using observational, physiological, and situation-based measures in research on occupational stress. In: Perrewé PL, Ganster DC, editors. Emotional and physiological processes and positive intervention strategies. Amsterdam: JAI; 2003. pp. 205–263.
    1. Marmot M, Feeney A, Shipley M, North F, Syme SL. Sickness absence as a measure of health status and functioning: From the UK Whitehall II study. J Epidemiol Community Health. 1995;49(2):124–130.
    1. Roelen CAM, Koopmans PC, Anema JR, van der Beek AJ. Recurrence of Medically Certified Sickness Absence According to Diagnosis: A Sickness Absence Register Study. J Occup Rehabil. 2010;20(1):113–121.

Source: PubMed

3
Abonnieren