Silva-Junior João Silvestre da, Fischer Frida Marina
National Social Security Institute, Ministry of Social Security, São Paulo, SP, Brazil; Department of Environmental Health, School of Public Health, University of São Paulo, São Paulo, SP, Brazil.
Department of Environmental Health, School of Public Health, University of São Paulo, São Paulo, SP, Brazil.
PLoS One. 2014 Dec 22;9(12):e115885. doi: 10.1371/journal.pone.0115885. eCollection 2014.
Sickness absence is a socioeconomic global burden. In Brazil, mental disorders are the third leading cause of social security benefits payments. The aim of the present study was to compare factors associated with long-term sickness absence between workers who claimed social benefits due to mental disorders or by other causes. We investigated individual features and occupational characteristics. In addition, we evaluated psychosocial factors at work assessed by the Demand-Control-Support (DCS) and Effort-Reward Imbalance (ERI) models, and whether they were associated with long-term sickness absence due to mental disorders (LTSA-MD).
The present case-control study was conducted in São Paulo, Brazil. The sample (n = 385) included workers on sick leave for more than 15 days. Cases were the participants with disabling psychiatric illnesses, and controls were the ones with other disabling diseases. Interviews were conducted to assess individual features (sociodemographic data, health habits/lifestyle, health conditions) and occupational characteristics. The participants' perception of exposure to dimensions of the DCS and ERI models was also recorded. Multiple logistic regressions were performed to evaluate the association between independent variables and LTSA-MD.
All the regression analyses showed that LTSA-MD was associated with female sex, self-reported white skin color, higher education level, high tobacco consumption, high alcohol intake, two or more comorbidities, exposure to violence at work, high job strain and low social support at work, effort-reward imbalance and high overcommitment to work. LTSA-MD was associated with separate and combined DCS and ERI stress models.
Individual features and work conditions were associated with LTSA-MD. Combined analysis of stress models showed that psychosocial factors at work were significantly associated with LTSA-MD. Resourceful use of this information may contribute to the implementation of preventive actions and strategies to facilitate return to work targeting the populations most susceptible to mental disorders.
病假是一项全球性的社会经济负担。在巴西，精神障碍是社会保障福利支付的第三大主要原因。本研究的目的是比较因精神障碍或其他原因申领社会福利的工人之间与长期病假相关的因素。我们调查了个体特征和职业特征。此外，我们评估了通过需求-控制-支持（DCS）和努力-回报失衡（ERI）模型评估的工作中的心理社会因素，以及它们是否与因精神障碍导致的长期病假（LTSA-MD）相关。
本病例对照研究在巴西圣保罗进行。样本（n = 385）包括病假超过15天的工人。病例为患有致残性精神疾病的参与者，对照为患有其他致残性疾病的参与者。进行访谈以评估个体特征（社会人口统计学数据、健康习惯/生活方式、健康状况）和职业特征。还记录了参与者对DCS和ERI模型维度暴露的感知。进行多元逻辑回归以评估自变量与LTSA-MD之间的关联。
所有回归分析表明，LTSA-MD与女性、自我报告的白种人肤色、高等教育水平、高烟草消费量、高酒精摄入量、两种或更多合并症、工作中遭受暴力、高工作压力和工作中低社会支持、努力-回报失衡以及对工作的过度投入有关。LTSA-MD与DCS和ERI压力模型单独及综合相关。
个体特征和工作条件与LTSA-MD相关。压力模型的综合分析表明，工作中的心理社会因素与LTSA-MD显著相关。明智地利用这些信息可能有助于实施预防行动和策略，以促进最易患精神障碍人群重返工作岗位。
