A systematic review and meta-analysis uncovering the relationship between alcohol consumption and sickness absence. When type of design, data, and sickness absence make a difference

Aim Earlier research has revealed a strong relationship between alcohol use and sickness absence. The aim of this review was to explore and uncover this relationship by looking at differences in type of design (cross-sectional vs. longitudinal), type of data (self-reported vs. registered data), and type of sickness absence (long-term vs. short term). Method Six databases were searched through June 2020. Observational and experimental studies from 1980 to 2020, in English or Scandinavian languages reporting the results of the association between alcohol consumption and sickness absence among working population were included. Quality assessment, and statistical analysis focusing on differences in the likelihood of sickness absence on subgroup levels were performed on each association, not on each study. Differences in the likelihood of sickness absence were analyzed by means of meta-analysis. PROSPERO registration number: CRD42018112078. Results Fifty-nine studies (58% longitudinal) including 439,209 employees (min. 43, max. 77,746) from 15 countries were included. Most associations indicating positive and statistically significant results were based on longitudinal data (70%) and confirmed the strong/causal relationship between alcohol use and sickness absence. The meta-analysis included eight studies (ten samples). The increased risk for sickness absence was likely to be found in cross-sectional studies (OR: 8.28, 95% CI: 6.33–10.81), studies using self-reported absence data (OR: 5.16, 95% CI: 3.16–8.45), and those reporting short-term sickness absence (OR: 4.84, 95% CI: 2.73–8.60). Conclusion This review supports, but also challenges earlier evidence on the association between alcohol use and sickness absence. Certain types of design, data, and types of sickness absence may produce large effects. Hence, to investigate the actual association between alcohol and sickness absence, research should produce and review longitudinal designed studies using registry data and do subgroup analyses that cover and explain variability of this association.

Comparing the new interdisciplinary Health in work intervention to conventional monodisciplinary welfare interventions at Norwegian workplaces: Protocol for a pragmatic cluster-randomized trial (Preprint)

BACKGROUND Musculoskeletal and mental health complaints are the dominant diagnostic categories in long-term sick leave and disability pensions in Norway. Continuing to work despite health complaints is often beneficial, and a good work environment can improve work inclusion for people affected. In 2001, the Norwegian Labour and Welfare Administration (NAV) began to offer inclusive work measures (IWM) to improve the psychosocial work environment, as well as work inclusion of people with health complaints. In 2018, NAV and specialist health services started offering the new collaborative Health in work programme. Its workplace intervention (HIW) presents health- and welfare information that may improve employees´ coping ability regarding common health complaints. It encourages understanding of coworkers´ health complaints and appropriate work adjustments, in order to increase work participation. OBJECTIVE This protocol presents an ongoing, two-arm, pragmatic cluster-randomised trial. Its aim is to compare the effect of monodisciplinary IWM (treatment as usual) and interdisciplinary HIW in terms of changes in overall sickness absence, healthcare utilisation, health-related quality of life, and costs. Secondary objectives are to compare changes in individual sickness absence, psychosocial work environment, job and life satisfaction, health, and health anxiety, both at the individual and the group level. METHODS Data will be collected from national registers, trial-specific registrations and questionnaires. Effects will be explored by difference-in-difference analysis, and regression modelling. Multilevel analysis will visualise any cluster effects by intraclass correlation coefficients. RESULTS Inclusion is completed with 97 workplaces and 1383 individual consents. CONCLUSIONS Data collection will be finished with the last questionnaires to be sent out in July 2023. This trial will contribute to fill knowledge gaps about effectiveness and costs of workplace interventions, thereby benefitting health and welfare services, political decision-makers, and the public and business sectors. CLINICALTRIAL The trial is approved by the Norwegian Regional Committee for Medical and Health Research Ethics and registered in Clinicaltrials.gov (NCT04000035). Findings will be published in reports, peer-reviewed journals and at conferences.

Big five personality traits and physician-certified sickness absence

Although several studies show that personality traits are associated with absenteeism, few large-scale studies have examined these relationships prospectively, integrating survey data and register data on sickness absence. This study examines whether personality is associated with sickness absence, and whether health factors, gender, age, type of occupation and job satisfaction moderate this relationship. We combine survey data assessing the Big Five personality traits from a large sample of Norwegian employees aged 18–62 years ( N = 5017) with register data on physician-certified sickness absence up to four years after. Negative binomial regression analyses showed that extraversion was positively associated with subsequent sickness absence when controlling for several covariates, including health, work factors and previous spells of sickness absence. Neuroticism also showed significant positive associations with sick leave; however, the association diminished when accounting for previous spells of sickness absence. Moderator analyses demonstrated that age and type of occupation affected some of the associations between personality and sickness absence. The findings indicate that – in addition to general health promotion measures – specific interventions targeting individuals high in extraversion may be beneficial in reducing sick leave. How socio-demographic and work-related factors moderate the relationship between personality and sickness absence may be an interesting future research area.

Role of social benefits for future long-term sickness absence, disability pension and unemployment among individuals on sickness absence due to mental diagnoses: a competing risk approach

Purpose To investigate associations between social benefits and disability pension (DP), long-term sickness absence (LTSA, ≥ 90 days), or unemployment among Swedish twins with sickness absence (SA) due to mental diagnoses. Methods This population-based prospective twin study included register data on first incident SA spell (< 90 days) due to mental diagnoses (ICD 10 codes F00-F99) during the follow-up 2005–2016. SA < 90 days due to other diagnoses than mental diagnoses or any other social insurance benefit was identified for the preceding year of the first incident SA spell due to mental diagnoses (coded yes/no). Comparing those with any previous social benefits vs without, cumulative incidence curve to compare time to an event, and Cox proportional hazards models for cause-specific hazard ratios (HR, 95% confidence intervals, CI) treating first incident DP, LTSA and unemployment as competing risks were modeled. Results During follow-up, 21 DP, 1619 LTSA, and 808 unemployment events took place. Compared to those without, those with at least one benefit had a higher risk for DP (HR 5.03; 95%CI 1.80, 14.01), LTSA (1.67; 1.50, 1.84) and unemployment (1.24; 1.03, 1.50). The cumulative incidence for DP was very low, < 1%, for LTSA 80% with any previous social benefits vs. 60% without, and for unemployment ≤ 5%. Conclusion Social benefits received during the preceding year of SA due to mental diagnoses (< 90 days) predict DP, LTSA, and unemployment. Hence, previous social benefits may provide means for early identification of persons at risk for exit from labor market.

Process facilitators shifting between the support and expert roles in a complex work environment intervention in the Swedish healthcare sector

PurposeProcess facilitation as part of a complex intervention for changing or improving practices within workplaces is becoming a common work method. The aim of this study was to investigate what characterizes the process-facilitating role in a complex intervention.Design/methodology/approachThe present study focuses on a complex work environment intervention targeting eight organizational units (workplaces) in the Swedish healthcare sector. The study applies a mixed-method approach and has been carried out in two steps. First, a qualitative process evaluation was performed. Secondly, an evaluation was conducted to see to what extent these identified conditions and mechanisms affected the quantitative intervention effect in term of sickness absence.FindingsThe analysis shows that the facilitating role consisted of three overlapping and partially iterative phases. These phases involved different activities for the facilitating role. Depending on how the facilitating role and the intervention were designed, various supporting conditions were found to significantly affect the outcome of the intervention measured as the total sickness absence.Research limitations/implicationsIt is concluded that the facilitation is not static or fixed during the change process. Instead, the facilitation role develops and emerges through the process of support during the different implementation phases.Practical implicationsThe facilitative role of performing support is based on a combination of support role activities and expert role activities. The support role focuses on support activities, while the expert role includes capacity building through knowledge- and legitimacy-oriented activities.Originality/valueThis study contributes to earlier research by developing a methodological approach for carrying out process facilitation in complex interventions.

Does Exposure to High Job Demands, Low Decision Authority, or Workplace Violence Mediate the Association between Employment in the Health and Social Care Industry and Register-Based Sickness Absence? A Longitudinal Study of a Swedish Cohort

Background: The aim of this paper was to investigate if job demands, decision authority, and workplace violence mediate the association between employment in the health and social care industry and register-based sickness absence. Methods: Participants from the Swedish Longitudinal Occupational Survey of Health who responded to questionnaires in 2006–2016 (n = 3951) were included. Multilevel autoregressive cross-lagged mediation models were fitted to the data. Employment in the health and social care industry at one time point was used as the predictor variable and register-based sickness absence >14 days as the outcome variable. Self-reported levels of job demands, decision authority, and exposure to workplace violence from the first time point were used as mediating variables. Results: The direct path between employment in the health and social care industry and sickness absence >14 days was, while adjusting for the reverse path, 0.032, p = 0.002. The indirect effect mediated by low decision authority was 0.002, p = 0.006 and the one mediated by exposure to workplace violence was 0.008, p = 0.002. High job demands were not found to mediate the association. Conclusion: Workplace violence and low decision authority may, to a small extent, mediate the association between employment in the health and social care industry and sickness absence.

The impact of stress and lifestyle factors on short-term sickness absence in a large Danish industrial company

Objectives: Work-related stress and certain lifestyles have been associated with sickness absence among employees. We analysed relations between stress and lifestyles (as risk factors) and short-term sickness absence among employees of a large Danish industrial company. Moreover, we analysed the impact of risk factors on short-term sickness absence. Methods: A self-administered questionnaire was completed by 7753 employees (67% response rate). Relations between risk factors (dyssomnia, low physical activity, alcohol, smoking, unhealthy food habits, overweight and stress) and short-term sickness absence were analysed by calculating etiologic fractions and binary logistic regression. Relations between the number of risk factors and short-term sickness absence were also analysed. Finally, the cost of short-term sickness absence from risk factors was estimated to illustrate the potential savings in avoided loss of productivity that could be gained from intervention programmes. Results: Stress, overweight, smoking and dyssomnia are significantly related to short-term sickness absence. Etiologic fractions revealed that these factors were associated with between 29.8% and 37.8% of short-term sickness absence. The number of risk factors was also related to the risk and length of sickness absence. Conclusions: This study identified risk factors that could be addressed by intervention programmes to reduce short-term sickness absence. Based on the results, focus on the risk factors that account for most short-term sickness absence and reduction of the number of risk factors could potentially reduce short-term sickness absence. A 30% reduction is equivalent to an avoidance of a loss of productivity of 4.5%, corresponding to €9.4 million per year.