van der Jac Klink

Sickness absence and psychosocial work conditions: a multilevel study

BACKGROUND Psychosocial work conditions, particularly psychological job demands, are inconsistently associated with sickness absence rates. This might be the result of investigating the psychosocial work environment at the individual level, reflecting personal perceptions rather than actual demands. AIM To investigate associations between sickness absence and psychosocial work conditions at both the individual and the workplace level. METHODS A cross-sectional study of insurance company employees (n = 395) in four departments. Psychological job demands, job control and job support were investigated at the individual level using the self-completed Questionnaire on Experience and Assessment of Work. An external occupational psychologist interviewed the supervisor and a group of employees of each department, assessing job demands, job control, job support and psychological distress at the workplace level. These data were related to the number of short (1-7 days), medium (8-21 days) and long (>21 days) episodes of sickness absence in the period January 2001 to December 2002. RESULTS A total of 244 questionnaires (62%) were suitable for analysis. Quantitative job control scores at the individual level differed from qualitative data at the workplace level. Self-assessed job demands and control were unrelated to sickness absence. The rates of short and long episodes of absence were higher in the department with combined high demands and low control, assessed at the workplace level. CONCLUSIONS The associations between psychosocial work conditions and sickness absence depended on the level at which the former were assessed. More multilevel research is needed to disentangle the relations between psychosocial work conditions and sickness absence.

Low job satisfaction does not identify nurses at risk of future sickness absence: Results from a Norwegian cohort study

BACKGROUND Sickness absence is high in healthcare and contributes to nursing staff shortages reducing the efficiency and quality of patient care. Assessing the risk of sickness absence in working nurses opens opportunities for preventive strategies. Job satisfaction has attracted much attention in healthcare research and has been associated with sickness absence among nurses. OBJECTIVES To investigate if job satisfaction scores are useful to identify working nurses at risk of future sickness absence. DESIGN Prospective cohort study with a baseline period from November 2008 to March 2009 and 1-year follow-up. SETTINGS Hospitals, nursing homes, and ambulant care settings in Norway. PARTICIPANTS 2059 Norwegian nurses, of whom 1582 (77%) could be followed-up. METHODS Nurses received a questionnaire at baseline and after 1-year follow-up. The questionnaire contained the Job Satisfaction Index (JSI), a 5-item scale measuring overall job satisfaction, and asked for sickness absence in the last 12 months. Baseline JSI scores were included in a logistic regression model with self-rated sickness absence at 1-year follow-up as outcome variable. Predictions of sickness absence were calibrated by the Hosmer-Lemeshow goodness-of-fit test. The ability of JSI scores to discriminate between nurses with and without sickness absence was examined by receiver operating characteristic analysis and expressed as area under the curve (AUC). RESULTS Low job satisfaction was associated with higher odds of sickness absence (odds ratio [OR]=1.05; 95% confidence interval [CI] 1.01-1.09) and high (≥ 31 days) sickness absence (OR=1.10; 95% CI 1.06-1.14). Calibration was acceptable, but job satisfaction neither discriminated between nurses with and without sickness absence (AUC=0.54; 95% CI 0.51-0.58) nor between nurses with and without high (≥ 31 days) sickness absence (AUC=0.58; 95% CI 0.54-0.63). CONCLUSIONS The results of this study indicated that job satisfaction was associated with sickness absence, though job satisfaction scores as measured with the JSI did not identify working nurses at risk of sickness absence.

Self-rated coping styles and registered sickness absence among nurses working in hospital care: A prospective 1-year cohort study

BACKGROUND Sickness absence is an important problem in healthcare that affects the quality of care. Sickness absence has been related to coping strategies. Problem-focused coping was shown to be associated with low sickness absence and emotion-focused coping with high sickness absence among postal workers. OBJECTIVES This study investigated the relationship between coping styles and sickness absence in healthcare. DESIGN Prospective study linking self-rated coping styles at baseline with the number of episodes of sickness absence during one year of follow-up. SETTING Somatic hospital employing 1,153 persons. PARTICIPANTS Convenience sample of 566 female nurses working in the hospitals clinical wards and outpatient clinic. Of these, 386 (68%) nurses had complete data for analysis. METHODS The nurses completed a questionnaire at baseline with items on health, work, and coping styles. Three styles of coping were defined: problem-solving coping (i.e., looking for opportunities to solve a problem), social coping (i.e., seeking social support in solving a problem), and palliative avoidant coping (i.e., seeking distraction and avoiding problems). Sickness absence data were retrieved from the hospitals register in the following year. The association between the coping styles and the number of both short (1-7 days) and long (>7 days) episodes of sickness absence was assessed by Poisson regression analyses with age, work hours per week, general health, mental health, and effort-reward [ER] ratio as covariates. RESULTS Problem-solving coping was negatively associated with the number of long episodes of sickness absence (rate ratio [RR] = 0.78, 95% confidence interval [CI] = 0.64-0.95). Social coping was negatively associated with the number of both short episodes (RR = 0.88, 95% CI = 0.79-0.97) and long episodes (RR = 0.79, 95% CI = 0.64-0.97) of sickness absence. After adjustment for the ER-ratio, the associations of coping with short episodes of sickness absence strengthened and associations with long episodes weakened, however, significance was lost for both types of sickness absence. Palliative avoidant coping was not associated with sickness absence among female hospital nurses. CONCLUSION Problem-solving coping and social coping styles were associated with less sickness absence among female nurses working in hospital care. Nurse managers may use this knowledge and reduce sickness absence and understaffing by stimulating problem-solving strategies and social support within nursing teams.

Psychosocial work conditions and registered sickness absence: a 3-year prospective cohort study among office employees

PurposeTo investigate associations between a wide variety of psychosocial work conditions and sickness absence in a medium-sized company.MethodsProspective cohort study of 395 employees working in an insurance office. Self-reported psychosocial work conditions were measured by questionnaire in January 2002 and linked to registered sickness absence in the period January 2002 to December 2004 adjusting for earlier sick leave and psychological distress.ResultsThe questionnaires of 244 employees were eligible for analysis. Decision authority and co-worker support were associated with sickness absence days, but their associations with sickness absence episodes were not significant. Role clarity was associated with the number of sickness absence days, but only with the number of short sickness absence episodes in women.ConclusionsThe wide variety of investigated psychosocial work conditions contributed little to the explanation of sickness absence in the medium-sized insurance office.

Sickness absence due to mental health disorders--a societal perspective.

BACKGROUND Sickness absence (SA) is affected by societal factors. Increasing socioeconomic stress may cause or worsen mental health disorders, which are among the most frequent causes of SA. Employees may also be more cautious about being absent, for example in times of poor economy. AIMS To monitor the incidence of SA due to mental health disorders in the Netherlands from 2001 to 2010. METHODS Descriptive observational study of long-term (> 3 weeks) SA available from an occupational health service register. The incidence of both total and mental health long-term SA in each year was calculated and evaluated alongside the changes in SA compensation policies, gross national product and national unemployment statistics. The incidence of mental health SA was stratified based on the economic (agricultural, industrial, private, public) sector. RESULTS The incidence of both total and mental health SA decreased gradually since 2004, and fell during the economic recession in 2009 in all economic sectors, particularly the agricultural and industrial sectors. The incidence of mental health SA increased with preliminary economic recovery in 2010 in the private and public sectors, but not in the agricultural and industrial sectors. CONCLUSIONS Long-term SA due to mental health disorders has decreased since 2004, but further studies across countries are required to confirm and explain this trend.

312 Predictors of work participation of young adults with mild intellectual disabilities

Objectives Unemployment rates among individuals with Intellectual Disabilities (ID) are three to four times higher compared to their non-disabled peers. Evidence for factors associated with work participation of individuals with ID stems from a limited number of cross-sectional studies. Furthermore, studies on predictors for sustainable work participation among young adolescents with ID are lacking altogether. Therefore, the aim of this study was to investigate which factors predict work participation, finding work as well as sustainable employment, of young adults with mild intellectual disabilities. Methods We obtained data on 735 individuals with mild ID, aged 15–27 years, applying for a disability benefit at the Dutch Social Security Institute. Participants completed a questionnaire on personal and social factors at baseline, which were linked to registry-data regarding work outcome. The follow-up period ranged from one year and three months to two years and nine months. Cox regression (survival) analyses were conducted in order to examine which factors predicted work participation. Results Living situation, expectation regarding future work level and self-esteem all predicted finding work as well as sustainable employment for at least 6 months for individuals with mild intellectual disabilities. Motivation was only related to finding work. Conclusion Personal and social factors are valuable in predicting finding work as well as sustainable employment. As this study is the first prognostic study to our knowledge to assess the predictive value of personal and social factors related to work outcome in this group, further research is needed to establish the predictive value of the factors found.

325 5-year trajectories of employment in people with spinal cord injury

Objectives To identify the employment rate over time, to examine employment trajectories and to determine the predictors of distinct employment trajectories in a cohort of people with spinal cord injury (SCI) in The Netherlands. Methods The study population consisted of 179 participants from eight rehabilitation centres who had acute SCI, were 18–65 years old, wheelchair dependent, and able to understand Dutch. At the start of rehabilitation, socio-demographics (age, gender, education), pre-injury occupation (level and physical intensity), injury-related factors (age at onset, neurological level and motor completeness), and functional status were measured. Employment status was defined as “≥1 hour of paid work/week”. Follow-up measurements were conducted 1, 2 and 5 years after discharge. Employment trajectories were modelled with longitudinal latent class analysis. Determinants of distinct trajectories were identified using multivariable logistic regressions. Results The employment rate was 79.5% before injury, 28.2% 1 year, 35.1% 2 year and 44.8% 5 year after discharge. Three distinct employment trajectories were identified: 1) never-worked (N = 35; 20%), those who did not work pre- and post-injury, 2) slow return to work (RTW) (N = 56; 30.9%), those who worked pre-injury and had a slow RTW, and 3) fast RTW (N = 88: 49.1%), those who worked pre-injury and had a fast and sustained RTW. Compared to participants with slow RTW, those with fast RTW had a higher functional status (OR = 1.07, 95% CI = 1.02–1.12) and a pre-injury occupation with low physical intensity (OR = 9.83, 95% CI = 2.27–42.57). The model explained 43% of the variance in RTW trajectory. Conclusion The employment rate increased over time after discharge. Three distinct employment trajectories were identified. Predictors of fast RTW were higher functional status and pre-injury occupation with low physical intensity. Future research should focus on identifying environmental factors that may contribute to a favourable RTW trajectory.

32 Predictors of successful work functioning

Objectives To help workers to stay at work in a healthy, productive and sustainable way and to develop interventions to improve work functioning, it is important to have insight in predictors of successful work functioning. The aim of this study is to identify predictors of successful work functioning in the general working population. Methods A longitudinal study was conducted among the working population. Work functioning was assessed with the Work Role Functioning Questionnaire 2.0 (WRFQ). The total score was categorised as: 0–90; > 90 ≤ 95; and > 95–100 (the latter defined as ‘successful work functioning’). A stepwise multiple ordinal logistic regression analysis was performed to examine relationships between potential predictors and the dependent variable (successful work functioning). Potential predictors included were mental health, fatigue, decision latitude, work engagement, work ability and baseline work functioning. Results Mental health (OR = 1.09, 95% Confidence Interval (CI) = 1.02–1.17) and fatigue (OR = 0.93, 95% CI = 0.88–0.98) were both significant predictors of successful work functioning. After the addition of decision latitude and work engagement, only fatigue was predictive of successful work functioning. The effect was attenuated when work ability was added. In the final model, work ability (OR = 2.07, 95% CI = 1.22–3.49) and baseline work functioning (OR = 1.16, 95% CI = 1.07–1.25) independently predicted successful work functioning. Conclusions Work ability and baseline work functioning are predictive for future successful work functioning. However, research has shown that it is difficult to change work ability. The concept of work functioning, reflecting the interplay between work demands and health, might provide better information for the design of interventions.