Some characteristics of repeated sickness absence.

420-431. Several studies have shown that frequency of absence attributed to sickness is not distributed randomly but tends to follow the negative binomial distribution, and this has been taken to support the concept of `proneness' to such absence. Thus, the distribution of sickness absence resembles that of minor injury at work demonstrated over 50 years ago. Because the investigation of proneness to absence does not appear to have been reported by others in Australia, the opportunity was taken, during a wider study of health among telegraphists in a large communications undertaking, to analyse some characteristics of repeated sickness absence. The records of medically certified and uncertified sickness absence of all 769 telegraphists continuously employed in all State capitals over a two-and-a-half-year period were compared with those of 411 clerks and 415 mechanics and, in Sydney, 380 mail sorters and 80 of their supervisors. All telegraphists in Sydney, Melbourne, and Brisbane, and all mail sorters in Sydney, who were available and willing were later medically examined. From their absence pattern repeaters (employees who had had eight or more certified absences in two and a half years) were separated into three types based on a presumptive origin in chance, recurrent disease and symptomatic non-specific disorder. The observed distribution of individual frequency of certified absence over the full two-and-a-half-year period of study followed that expected from the univariate negative binomial, using maximum likelihood estimators, rather than the poisson distribution, in three of the four occupational groups in Sydney. Limited correlational and bivariate analysis supported the interpretation of proneness ascribed to the univariate fit. In the two groups studied, frequency of uncertified absence could not be fitted by the negative binomial, although the numbers of such absences in individuals in successive years were relatively highly correlated. All types of repeater were commoner in Sydney than in the other capital city offices, which differed little from each other. Repeaters were more common among those whose absence was attributed to neurosis, alimentary and upper respiratory tract disorder, and injury. Out of more than 90 health, personal, social, and industrial attributes determined at examination, only two (ethanol habit and adverse attitude to pay) showed any statistically significant association when telegraphist repeaters in Sydney were compared with employees who were rarely absent. Though repeating tended to be associated with chronic or recurrent ill health revealed at examination, one quarter of repeaters had little such ill health and one quarter of rarely absent employees had much. It was concluded that, in the population studied, the fitting of the negative binomial to frequency of certified sickness absence could, in the circumstances of the study, reasonably be given an interpretation of proneness. In that population also repeating varies geographically and occupationally, and is poorly associated with disease and other attributes uncovered at examination, with the exception of the ethanol habit. Repeaters are more often neurotic than employees who are rarely absent but also are more often stable double jobbers. The repeater should be identified for what help may be given him, if needed, otherwise it would seem more profitable to attack those features in work design and organization which influence motivation to come to work. Social factors which predispose to repeated absence are less amenable to modification.