Høgelund Jan, Holm Anders, Eplov Lene Falgaard
The Danish National Centre for Social Research, Copenhagen, Denmark.
J Ment Health Policy Econ. 2012 Dec;15(4):157-70.
Part-time sick leave (PTSL) allows employees on full-time sick leave (FTSL) to resume work at reduced hours. When the partly absent employee's health improves, working hours are increased until the employee is able to work regular hours. Studies have found that PTSL is an effective instrument for reducing sick leave durations for employees with musculoskeletal disorders and for employees on sick leave in general. This is the first published article to document how PTSL affects sick leave durations for employees with mental disorders.
The aim is to estimate the effect of PTSL on the duration until returning to regular working hours for employees with mental disorders. We compare this effect to that of PTSL for employees with non-mental disorders ('other disorders').
We use combined survey and register data about 226 employees on long-term sick leave with mental disorders and 638 employees with other disorders. These data contain information about type of disorder, PTSL and FTSL (full-time sick leave) durations, and various background characteristics. We use a mixed proportional hazard regression model that allows us to control for unobserved differences between employees on PTSL and those on FTSL.
Our analyses show that PTSL has no effect on the duration until returning to regular working hours for employees with mental disorders. Furthermore, looking at specific disorders such as depression and stress-related conditions, we find no significant effects of PTSL. In contrast, in line with previous research, we find that PTSL significantly reduces the duration until returning to regular working hours for employees with other disorders. The analyses also illustrate the importance of controlling for unobserved differences between employees on PTSL and those on FTSL. Without this control, PTSL significantly reduces the duration until returning to regular working hours. When we control for unobserved characteristics, this effect decreases, and for employees with mental disorders the effect vanishes entirely.
The lack of an effect of PTSL for employees with mental disorders needs replication in other studies. If subsequent studies confirm our findings, one should not necessarily conclude that PTSL is an ineffective intervention: PTSL may play a role in combination with other workplace interventions and in combination with person-centred interventions. The study is limited by self-reported data about disorders and a relatively small number of employees with mental disorders.
Our findings suggest that while PTSL reduces sick leave durations for employees with other disorders, it does not affect sick leave durations for employees with mental disorders. These results may indicate that PTSL by itself is insufficient for promoting the return to work of employees with mental disorders.
Future studies could benefit from larger data sets with disorder information based on medical assessments. In addition to quantitative effect studies, future studies could focus on qualitative workplace mechanisms that may counteract the potential positive effects of PTSL for employees on sick leave with mental disorders.
兼职病假（PTSL）允许休全职工伤病假（FTSL）的员工减少工作时长后恢复工作。当部分缺勤员工的健康状况改善时，工作时长会逐渐增加，直至该员工能够正常工作。研究发现，兼职病假是减少肌肉骨骼疾病员工以及一般工伤病假员工病假时长的有效手段。本文是首篇发表的记录兼职病假如何影响精神疾病员工病假时长的文章。
目的是评估兼职病假对精神疾病员工恢复正常工作时长所需时间的影响。我们将此影响与非精神疾病员工（“其他疾病”）的兼职病假影响进行比较。
我们使用了关于226名长期休精神疾病病假的员工和638名患有其他疾病员工的综合调查与登记数据。这些数据包含疾病类型、兼职病假和全职工伤病假时长以及各种背景特征的信息。我们使用混合比例风险回归模型，以便能够控制兼职病假员工和全职工伤病假员工之间未观察到的差异。
我们的分析表明，兼职病假对精神疾病员工恢复正常工作时长所需时间没有影响。此外，针对抑郁症和与压力相关疾病等特定疾病进行观察时，我们发现兼职病假没有显著影响。相比之下，与先前的研究一致，我们发现兼职病假能显著缩短患有其他疾病员工恢复正常工作时长所需的时间。分析还说明了控制兼职病假员工和全职工伤病假员工之间未观察到差异的重要性。如果不进行这种控制，兼职病假会显著缩短恢复正常工作时长所需的时间。当我们控制未观察到的特征时，这种影响会减弱，对于精神疾病员工，这种影响则完全消失。
精神疾病员工的兼职病假缺乏效果这一发现需要在其他研究中得到验证。如果后续研究证实我们的发现，不一定能得出兼职病假是无效干预措施的结论：兼职病假可能与其他工作场所干预措施以及以个人为中心的干预措施相结合发挥作用。本研究受到疾病自我报告数据以及精神疾病员工数量相对较少的限制。
我们的研究结果表明，虽然兼职病假能减少患有其他疾病员工的病假时长，但对精神疾病员工的病假时长没有影响。这些结果可能表明，仅靠兼职病假不足以促进精神疾病员工重返工作岗位。
未来的研究可以受益于基于医学评估的包含疾病信息的更大数据集。除了定量效果研究外，未来的研究可以关注可能抵消兼职病假对精神疾病病假员工潜在积极影响的定性工作场所机制。
