Long-Term Sickness Absence Due to Mental Disorders Is Associated with Individual Features and Psychosocial Work Conditions

December Long-Term Sickness Absence Due to Mental Disorders Is Associated with Individual Features and Psychosocial Work Conditions Joa o Silvestre da Silva-Junior 0 1 Frida Marina Fischer 1 0 National Social Security Institute, Ministry of Social Security , Sa o Paulo, SP , Brazil, 1 Department of Environmental Health, School of Public Health, University of Sa o Paulo , Sa o Paulo, SP , Brazil Aims: 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 OPEN ACCESS by other causes. We investigated individual features and occupational FCMita(t2io0n1:4)SiLlvoan-gJ-uTneiromrJSSicdk,nFeisscshAerbsence Due to characteristics. In addition, we evaluated psychosocial factors at work assessed by Mental Disorders Is Associated with Individual the Demand-Control-Support (DCS) and Effort-Reward Imbalance (ERI) models, FOeNaEtur9e(s12a)n:de1P1s5y8c8h5o.sodcoiia:1l0W.1o3r7k1C/joonudrnitaiol.npso.nPeL.oS and whether they were associated with long-term sickness absence due to mental 0115885 disorders (LTSA-MD). Editor: James Coyne, University of Pennsylvania, Methods: The present case-control study was conducted in Sao Paulo, Brazil. The United States of America sample (n5385) included workers on sick leave for more than 15 days. Cases were Received: June 1, 2014 the participants with disabling psychiatric illnesses, and controls were the ones with Accepted: November 30, 2014 other disabling diseases. Interviews were conducted to assess individual features Published: December 22, 2014 (sociodemographic data, health habits/lifestyle, health conditions) and occupational aCnopoypreing-hatc:cess20a1rt4iclSeildvais-tJriubnuitoerd, Fuinsdcheerrt.hTehtiesrmiss characteristics. The participants' perception of exposure to dimensions of the DCS of the Creative Commons Attribution License, and ERI models was also recorded. Multiple logistic regressions were performed to rwehpircohdupcetrimonitsinuannreystmricetdeidumu,sep,rodvisidtreibdutthioen,oraignidnal evaluate the association between independent variables and LTSA-MD. author and source are credited. Results: All the regression analyses showed that LTSA-MD was associated with Data Availability: The authors confirm that all data female sex, self-reported white skin color, higher education level, high tobacco ruensdtreircltyioinng. DthaetafianrdeinagvsaialarbelefuflrloymavFaigilsahbalerew:hithttopu:/t/ consumption, high alcohol intake, two or more comorbidities, exposure to violence dx.doi.org/10.6084/m9.figshare.1232203. at work, high job strain and low social support at work, effort-reward imbalance and Funding: The authors have no support or funding high overcommitment to work. LTSA-MD was associated with separate and to report. combined DCS and ERI stress models. Competing Interests: The authors have declared that no competing interests exist. - Conclusions: Individual features and work conditions were associated with LTSAMD. 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. Work is a part of a process of social integration that directly affects the physical and mental health of individuals. Sickness absence is an indicator of the state of health of workers [1]. Sociodemographic characteristics [24], health habits and lifestyles [25], environmental work conditions [2, 56], psychosocial factors at work [5] and the individuals state of health [7] are some of the factors associated with sickness absence. Sick leave due to mental disorders is a global cause of concern that deserves attention as a function of its associated costs [8]. In Brazil, sick leaves lasting up to 15 days are paid by the workers employer, while workers on longer leaves must claim sickness benefits from the public social security system (National Social Security Institute - INSS). Applicants are evaluated by medical experts to establish whether the sick leave benefits should be granted. In recent years, mental and behavioral disorders became the third leading cause of temporary sickness benefits. About 203,000 new sick leave benefits due to mental problems were granted from 2008 to 2011, costing more than US$ 90 million to the Brazilian public pension system [9]. An earlier joint publication by the International Labour Office and the World Health Organization (ILO/WHO) called the attention to the relevance of the psychosocial factors at work for the employees state of health. Long-term exposure to such stressors is associated with psychosomatic complaints, psychiatric symptoms and changes in wellbeing [10]. Theoretical models were developed to define and explain the effects of occupational stress on the workers health, two among which were given special attention, to wit, the DemandControl-Support (DCS) [11] model, which is assessed by means of the Swedish Demand-Control-Support Questionnaire [12], and the Effort-Reward Imbalance (ERI) model [13], which is also assessed by means of a specific questionnaire [14]. According to the literature, there is overlap between those questionnaires dimensions [15]. Analyses combining both models provide better estimates of the effects of stressful experiences at the workplace [16]. Recent studies on sick leave applied the DCS and ERI models to the investigation of psychosocial factors at work, either alone or in combination [17 20]. However, those models have not yet been used in combination to the investigation of such factors and LTSA-MD. A first spell of sickness absence due to mental disorders is associated with risk for recurrence of further sick leaves [21]. For that reason, an accurate understanding of the factors that are related with sickness absence might increase the efficacy of preventive actions and point to strategies to facilitate return to work [22]. 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 DCS and ERI models, and whether they were associated with the outcome variable. Material and Methods The present case-control study was performed at the largest public social security branch in the city of Sao Paulo, Brazil, in 2011. The group of patients assigned to each medical expert was considered to represent a cluster. Every day along the study period, and at each work shift, clusters were randomly selected to compose (...truncated)