Finnish Institute of Occupational Health, Helsinki, Finland; Stress Research Institute, Stockholm University, Stockholm, Sweden; Finnish Institute for Health and Welfare, Mannerheimintie 166, 00270 Helsinki, Finland.
Finnish Institute of Occupational Health, Helsinki, Finland.
J Affect Disord. 2020 Mar 1;264:333-339. doi: 10.1016/j.jad.2020.01.006. Epub 2020 Jan 7.
Uncertainty remains whether associations for psychological distress and sickness absence (SA) observed between and within individuals differ, and whether age, gender and work-related factors moderate these associations.
We analyzed SA records of 41,184 participants of the Finnish Public Sector study with repeated survey data between 2000 and 2016 (119,024 observations). Psychological distress was measured by the General Health Questionnaire (GHQ-12), while data on SA days were from the employers' registers. We used a hybrid regression estimation approach adjusting for time-variant confounders-age, marital status, occupational class, body mass index, job contract type, months worked in the follow-up year, job demand, job control, and workplace social capital-and time-invariant gender (for between-individual analysis).
Higher levels of psychological distress were consistently associated with SA, both within- and between-individuals. The within-individual association (incidence rate ratio (IRR) 1.68, 95% CI 1.61-1.75 for SA at high distress), however, was substantially smaller than the between-individual association (IRR 2.53, 95% CI 2.39-2.69). High levels of psychological distress had slightly stronger within-individual associations with SA among older (>45 years) than younger employees, lower than higher occupational class, and among men than women. None of the assessed work unit related factors (e.g. job demand, job control) were consistent moderators.
These findings may not be generalizable to other working sectors or cultures with different SA policies or study populations that are male dominated.
Focus on within-individual variation over time provides more accurate estimates of the contribution of mental health to subsequent sickness absence.
个体内和个体间心理困扰与病假（SA）的关联是否存在差异，以及年龄、性别和与工作相关的因素是否调节这些关联，目前仍存在不确定性。
我们分析了芬兰公共部门研究中 41184 名参与者的 SA 记录，这些参与者在 2000 年至 2016 年期间接受了重复调查（共 119024 次观察）。心理困扰通过一般健康问卷（GHQ-12）进行测量，而 SA 天数的数据则来自雇主的登记处。我们使用混合回归估计方法进行分析，调整了时变混杂因素（年龄、婚姻状况、职业类别、体重指数、工作合同类型、随访年内工作月数、工作需求、工作控制和工作场所社会资本）和时不变性别（用于个体内分析）。
较高水平的心理困扰与个体内和个体间的 SA 均呈正相关。然而，个体内关联（SA 在高困扰时的发病率比（IRR）1.68，95%CI 1.61-1.75）明显小于个体间关联（IRR 2.53，95%CI 2.39-2.69）。在年龄较大（>45 岁）的员工中，较高水平的心理困扰与 SA 之间的个体内关联略强于年轻员工，而在较低的职业类别和男性中则比女性更强。评估的工作单位相关因素（如工作需求、工作控制）均不是一致的调节因素。
这些发现可能不适用于其他工作领域或文化，这些领域或文化可能具有不同的 SA 政策或研究人群以男性为主。
关注随时间变化的个体内变化可以更准确地估计心理健康对随后 SA 的贡献。
