Finnish Institute of Occupational Health,Helsinki,Finland.
Department of Clinical Neuroscience,Division of Insurance Medicine,Karolinska Institutet,SE-171 77 Stockholm,Sweden.
Epidemiol Psychiatr Sci. 2017 Dec;26(6):644-654. doi: 10.1017/S2045796016000597. Epub 2016 Sep 9.
Aims Social workers report high levels of stress and have an increased risk for hospitalisation with mental diagnoses. However, it is not known whether the risk of work disability with mental diagnoses is higher among social workers compared with other human service professionals. We analysed trends in work disability (sickness absence and disability pension) with mental diagnoses and return to work (RTW) in 2005-2012 among social workers in Finland and Sweden, comparing with such trends in preschool teachers, special education teachers and psychologists.
Records of work disability (>14 days) with mental diagnoses (ICD-10 codes F00-F99) from nationwide health registers were linked to two prospective cohort projects: the Finnish Public Sector study, years 2005-2011 and the Insurance Medicine All Sweden database, years 2005-2012. The Finnish sample comprised 4849 employees and the Swedish 119 219 employees covering four occupations: social workers (Finland 1155/Sweden 23 704), preschool teachers (2419/74 785), special education teachers (832/14 004) and psychologists (443/6726). The reference occupations were comparable regarding educational level. Risk of work disability was analysed with negative binomial regression and RTW with Cox proportional hazards.
Social workers in Finland and Sweden had a higher risk of work disability with mental diagnoses compared with preschool teachers and special education teachers (rate ratios (RR) 1.43-1.91), after adjustment for age and sex. In Sweden, but not in Finland, social workers also had higher work disability risk than psychologists (RR 1.52; 95% confidence interval 1.28-1.81). In Sweden, in the final model special education teachers had a 9% higher probability RTW than social workers. In Sweden, in the final model the risks for work disability with depression diagnoses and stress-related disorder diagnoses were similar to the risk with all mental diagnoses (RR 1.40-1.77), and the probability of RTW was 6% higher in preschool teachers after work disability with depression diagnoses and 9% higher in special education teachers after work disability with stress-related disorder diagnoses compared with social workers.
Social workers appear to be at a greater risk of work disability with mental diagnoses compared with other human service professionals in Finland and Sweden. It remains to be studied whether the higher risk is due to selection of vulnerable employees to social work or the effect of work-related stress in social work. Further studies should focus on these mechanisms and the risk of work disability with mental diagnoses among human service professionals.
目的 社会工作者报告称压力水平较高，并且因精神诊断住院的风险增加。然而，目前尚不清楚与其他社会服务专业人员相比，社会工作者患精神诊断的工作残疾风险是否更高。我们分析了 2005-2012 年芬兰和瑞典社会工作者的精神诊断（ICD-10 代码 F00-F99）工作残疾（病假和残疾抚恤金）和重返工作（RTW）的趋势，并与学前教师、特殊教育教师和心理学家的此类趋势进行了比较。
方法 从全国健康登记处获得的精神诊断（ICD-10 代码 F00-F99）超过 14 天的工作残疾记录，与两项前瞻性队列研究相关联：芬兰公共部门研究，2005-2011 年和瑞典保险医学所有数据库，2005-2012 年。芬兰样本包括 4849 名员工，瑞典样本包括 119219 名员工，涵盖四个职业：社会工作者（芬兰 1155/瑞典 23704）、学前教师（2419/74785）、特殊教育教师（832/14004）和心理学家（443/6726）。参考职业在教育水平方面具有可比性。使用负二项式回归分析工作残疾风险，使用 Cox 比例风险分析重返工作。
结果 在调整年龄和性别后，芬兰和瑞典的社会工作者患精神诊断的工作残疾风险高于学前教师和特殊教育教师（比率比 1.43-1.91）。在瑞典，但不在芬兰，社会工作者的工作残疾风险也高于心理学家（RR1.52；95%置信区间 1.28-1.81）。在瑞典，在最终模型中，特殊教育教师的 RTW 概率比社会工作者高 9%。在瑞典，在最终模型中，抑郁诊断和与压力相关的障碍诊断的工作残疾风险与所有精神诊断的风险相似（RR1.40-1.77），与社会工作者相比，学前教师在抑郁诊断后的 RTW 概率增加 6%，特殊教育教师在与压力相关的障碍诊断后的 RTW 概率增加 9%。
结论 与芬兰和瑞典的其他社会服务专业人员相比，社会工作者似乎更容易因精神诊断而导致工作残疾。仍有待研究这种更高的风险是由于脆弱的员工选择社会工作，还是由于社会工作中的工作相关压力所致。进一步的研究应侧重于这些机制以及社会服务专业人员中精神诊断的工作残疾风险。
