Psychological symptoms and subsequent sickness absence
- 249 Downloads
Mental health problems are associated with sickness absence (SA). The present study aimed at establishing which symptoms—distress, depression, anxiety, or somatization—at which symptom levels were associated with SA frequency and duration. Moreover, a number of possible confounders or effect modifiers were taken into account.
A survey was completed by 3,678 employees of a large Dutch telecom company. Symptoms were measured using the Four-Dimensional Symptom Questionnaire (4DSQ). SA data were registered by the company’s occupational health service during the 12 months’ period following the survey. Poisson regression was used to analyze the number of SA spells (SA frequency). Negative binomial regression was used to analyze the total number of SA days (SA duration).
In the bivariate analyses distress, depression, anxiety, and somatization impacted on SA frequency and duration. In the multivariate analyses, anxiety and depression turned out not to be directly associated with SA, suggesting that the effect of anxiety and depression was due to the association between anxiety/depression and distress/somatization. Regarding the SA frequency, the rate ratio for ‘subclinical’ distress was 1.13 (95% CI 1.03–1.25), for ‘clinical’ distress 1.26 (1.08–1.47), for ‘subclinical’ somatization 1.34 (1.23–1.46), and for ‘clinical’ somatization 1.69 (1.46–1.95). Regarding the SA duration, the count ratio for ‘subclinical’ distress was 1.15 (95% CI 0.91–1.44), for ‘clinical’ distress 1.50 (1.04–2.16), for ‘subclinical’ somatization 1.34 (1.10–1.64), and for ‘clinical’ somatization 1.45 (1.04–2.03).
Somatization and distress are key to understand why depression and anxiety are related to SA.
KeywordsDepression Anxiety Somatoform disorders Distress Absenteeism
Conflict of interest
BT is the copyright owner of the 4DSQ and receives copyright fees from companies that use the 4DSQ on a commercial basis (the 4DSQ is freely available for non-commercial use in health care and research). BT received fees from various institutions for workshops on the application of the 4DSQ in primary care settings.
- Andrea H, Beurskens AJHM, Metsemakers JFM et al (2003) Health problems and psychosocial work environment as predictors of long term sickness absence in employees who visited the occupational physician and/or general practitioner in relation to work: a prospective study. Occup Environ Med 60:295–300. doi: 10.1136/oem.60.4.295 CrossRefGoogle Scholar
- Bourbonnais R, Mondor M (2001) Job strain and sickness absence among nurses in the province of Québec. Am J Ind Med 39:194–202. doi: 10.1002/1097-0274(200102)39:2<194:AID-AJIM1006>3.0.CO;2-K CrossRefGoogle Scholar
- Clarke DM, Smith GC (2000) Somatisation: what is it? Aust Fam Physician 29:109–113Google Scholar
- Horwitz AV, Wakefield JC (2007) The loss of sadness. How psychiatry transformed normal sorrow into depressive disorder. Oxford University Press, New YorkGoogle Scholar
- Niedhammer I, Goldberg M, Leclerc A et al (1998) Psychosocial factors at work and subsequent depressive symptoms in the Gazel cohort. Scand J Work Environ Health 24:197–205Google Scholar
- Terluin B (1996) De Vierdimensionale Klachtenlijst (4DKL). Een vragenlijst voor het meten van distress, depressie, angst en somatisatie [The four-dimensional symptom questionnaire (4DSQ). A questionnaire to measure distress, depression, anxiety, and somatization]. Huisarts Wet 39:538–547Google Scholar
- Terluin B, Brouwers EPM, van Marwijk HWJ et al (2009) Detecting depressive and anxiety disorders in distressed patients in primary care; comparative diagnostic accuracy of the four-dimensional symptom questionnaire (4DSQ) and the hospital anxiety and depression scale (HADS). BMC Fam Pract 10:58. doi: 10.1186/1471-2296-10-58 CrossRefGoogle Scholar
- Welch K (2009) Generalized linear models using SPSS. Ann Arbor, MI: University of Michigan. http://www-personal.umich.edu/~kwelch/510/2009/handouts/spss_poisson_regression.doc. Accessed 5 April 2011