Frequent short sickness absence, occupational health service utilisation and long-term sickness absence due to mental disorders among young employees.

OBJECTIVES: We examined whether frequent short-term sickness absence (FSTSA) and primary care use in occupational health service (OHS) were associated with medically-certified long-term sickness absence (LTSA) due to mental disorders among young employees. METHODS: We used record-linkage data covering the young employees (< 35 years) of the City of Helsinki, Finland (n = 8,282) from 2010 to 2014. The outcome was LTSA due to mental disorders. Cox regression models were fitted. RESULTS: FSTSAs were associated with subsequent LTSA. Also OHS use predicted LTSA due to mental disorders; however, this association was not found for those with prior FSTSA. CONCLUSIONS: Both FSTSA and primary care use indicate subsequent LTSA independently, and together these indicators identify a larger proportion of individuals at risk of LTSA due to mental disorders.

Seeing an occupational health psychologist reduces sickness absence due to mental disorders: A quasi-experimental study.

Mental health problems are a major public health and work-life issue. We examined in a quasi-experimental design whether occupational health psychologist (OHP) appointment reduces subsequent sickness absence (SA) due to mental disorders among younger Finnish employees. The present study was conducted among 18-39-year-old employees of the City of Helsinki using register data from the City of Helsinki and the Social lnsurance Institution of Finland. We examined differences in SA days due to mental disorders (ICD-10, F-diagnosed sickness allowances) between those treated (at least one OHP appointment for work ability support) and the comparison group (no OHP appointment) during a one-year follow-up. The full sample (n = 2286, 84% women) consisted of employees with SA due to a diagnosed mental disorder during 2008-2017. To account for the systematic differences between the treatment and comparison groups, the included participants were matched according to age, sex, occupational class, education, previous SA, occupational health primary care visits and psychotropic medication. The weighted matched sample included 1351 participants. In the weighted matched sample, the mean of SA days due to mental disorders was 11.4 (95% CI, 6.4-16.5) for those treated (n = 238) and 20.2 (95% CI, 17.0-23.4) for the comparison group (p < 0.01) during the follow-up year. The corresponding figures in the full sample were (11.1, 6.7-15.4) days for those treated (n = 288) and (18.9, 16.7-21.1) days for the comparison group (p < 0.01). This quasi-experimental study suggests that seeing an OHP to support work ability reduces SA due to mental disorders.

Socioeconomic Differences in Occupational Health Service Utilization and Sickness Absence Due to Mental Disorders: A Register-Based Retrospective Cohort Study.

Occupational health service (OHS) is the main provider of primary care services for the working population in Finland. We investigated whether socioeconomic differences in the utilization of OHS predict sickness absence (SA) due to mental disorders. We used register linkage data covering the employees of the City of Helsinki aged 18-34 years (N = 6545) and 35-54 years (N = 15,296) from 2009 to 2014. The outcome was medically certified long-term (over 11 days) SA due to mental disorders. Cox regression analyses were performed to obtain hazard ratios (HR) and their 95% confidence intervals (CIs). Employees with low socioeconomic position (SEP) used OHS more frequently. The number of OHS visits independently predicted SA due to mental disorders. HRs were 1.59 (95% CI 1.35, 1.86) for those with frequent visits and 1.73 (95% CI 1.30, 2.29) for those with a clustered visit pattern among 18-34 year old employees; and 1.46 (95% CI 1.18, 1.81) and 1.41 (95% CI 1.14, 1.74) among 35-54 year old employees, respectively. In both age groups, lower education and routine non-manual worker position indicated the highest probability of SA. Low SEP predicts both high OHS utilization and subsequent SA due to mental disorders. Medical records may be used to accurately predict future SA, and the results indicate that preventive measures should be targeted particularly to younger employees with lower SEP.

Association between socioeconomic position and occupational health service utilisation trajectories among young municipal employees in Finland.

OBJECTIVES: To identify groups of municipal employees between the ages of 20 and 34 years with distinct utilisation trajectories of primary care services provided by occupational health service (OHS), measured as the annual number of OHS visits, and to identify demographic and socioeconomic risk factors that distinguish employees in the high utilisation trajectory group(s). METHODS: The present study is a retrospective register-based cohort study. All municipal employees of the City of Helsinki, Finland, aged 20-34 in the Helsinki Health Study, recruited from 2004 to 2013, with follow-up data for 4 years were included in the study (n=9762). The outcome measure was group-based trajectories of OHS utilisation, identified with a group-based trajectory analysis. The demographic and socioeconomic variables used to predict the outcome were age, first language, educational level and occupational class. The analyses were stratified by gender. RESULTS: A large proportion of the young employees do not use OHS. Trajectory groups of 'No visits' (50%), 'Low/increasing' (18%), 'Low/decreasing' (22%) and 'High/recurrent' (10%) use were identified. We found occupational class differences in OHS utilisation patterns showing that lower occupational classes had a higher propensity for 'High/recurrent' OHS utilisation for both genders. CONCLUSIONS: Preventive measures should be targeted particularly to the trajectory groups of 'Low/increasing' and 'High/recurrent' in order to intervene early. In addition, OHS utilisation should be closely monitored among the two lowest occupational classes. More research with longitudinal OHS data is needed.

Socioeconomic differences in health check-ups and medically certified sickness absence: a 10-year follow-up among middle-aged municipal employees in Finland.

BACKGROUND: There is contradictory evidence on the association between health check-ups and future morbidity. Among the general population, those with high socioeconomic position participate more often in health check-ups. The main aims of this study were to analyse if attendance to health check-ups are socioeconomically patterned and affect sickness absence over a 10-year follow-up. METHODS: This register-based follow-up study included municipal employees of the City of Helsinki. 13 037 employees were invited to age-based health check-up during 2000-2002, with a 62% attendance rate. Education, occupational class and individual income were used to measure socioeconomic position. Medically certified sickness absence of 4 days or more was measured and controlled for at the baseline and used as an outcome over follow-up. The mean follow-up time was 7.5 years. Poisson regression was used. RESULTS: Men and employees with lower socioeconomic position participated more actively in health check-ups. Among women, non-attendance to health check-up predicted higher sickness absence during follow-up (relative risk =1.26, 95% CI 1.17 to 1.37) in the fully adjusted model. Health check-ups were not effective in reducing socioeconomic differences in sickness absence. CONCLUSIONS: Age-based health check-ups reduced subsequent sickness absence and should be promoted. Attendance to health check-ups should be as high as possible. Contextual factors need to be taken into account when applying the results in interventions in other settings.

Cohort profile: the Helsinki Health Study.

The Helsinki Health Study cohort was set up to enable longitudinal studies on the social and work related determinants of health and well-being, making use of self-reported as well as objective register data. The target population is the staff of the City of Helsinki, Finland. Baseline data for the cohort were derived from questionnaire surveys conducted in 2000, 2001 and 2002 among employees reaching 40, 45, 50, 55 or 60 years of age in each year. The number of responders at baseline was 8960 (80% women, response rate 67%). Additional age-based health examination data were available. A follow up survey was conducted in 2007 yielding 7332 responders (response rate 83%). Measures of health include health behaviours, self-rated health, common mental disorders, functioning, pain, sleep problems, angina symptoms and major diseases. Social determinants include socio-demographics, socio-economic circumstances, working conditions, social support, and work-family interface. Further register linkages include sickness absence, hospital discharge, prescribed drugs, and retirement updated at the end of 2010. The cohort allows comparisons with the Whitehall II study, London, UK, and the Japanese Civil Servants Study from western Japan. The cohort data are available for collaborative research at Hjelt Institute, Department of Public Health, University of Helsinki, Finland.

Socio-economic and occupational determinants of work injury absence.

BACKGROUND: Measures of socio-economic position, such as education, occupational class and income, are well-known determinants of ill-health, injury and sickness absence. The aim was to analyse socio-economic and occupational determinants of work injury absence and their contribution to overall socio-economic inequalities in all-cause sickness absence. METHODS: A register-based follow-up study included municipal employees of the City of Helsinki aged 25-59 years in 2004. The number of participants was 16,471 women and 5033 men. The mean follow-up time was 3.0 years. Education, occupational class and individual income were used as measures of socio-economic position. The main outcome was medically confirmed work injury and all-cause sickness absence of ≥4 days. Inequality indices were calculated using Poisson regression analysis. RESULTS: High education, occupational class and individual income were consistently associated with lower work injury absence among both women and men. The inequalities in work injury absence were larger than in all-cause sickness absence, especially among men, but the contribution to overall socio-economic inequalities was limited. Among women, bus drivers, cooks and hospital attendants had the highest rates of work injuries. Among men, youth mentors, firemen and janitors had the highest rates. CONCLUSIONS: Our results indicate that relative socio-economic inequalities in work injury absence are larger than in all-cause sickness absence. Prevention of work injuries provides a source of reducing socio-economic inequalities in health, but their effect is not very large. Prevention of work injuries should be targeted to lower white-collar and manual workers and vulnerable occupations.

Gender differences in sickness absence--the contribution of occupation and workplace.

OBJECTIVES: The aim of this study was to examine whether differences in male and female occupations and workplaces explain gender differences in self-certified (1-3 days) and medically confirmed sickness absence episodes of various lengths (> or = 4 days, >2 weeks, >60 days). Analyses in the main ICD-10 diagnostic groups were conducted for absence episodes of >2 weeks. Furthermore, we examined whether the contribution of occupation is related to different distributions of female and male jobs across the social class hierarchy. METHODS: All municipal employees of the City of Helsinki at the beginning of 2004 (N=36 395) were followed-up until the end of 2007. Conditional fixed-effects Poisson regression was used to control for differences between occupations and workplaces. RESULTS: Controlling for occupation accounted for half of the female excess in self-certified and medically confirmed episodes lasting >60 days. In the intermediate categories, this explained about one third of the female excess. The effect of workplace was similar but weaker. Occupational and workplace differences explained the female excess in sickness absence due to mental and behavioral disorders, musculoskeletal diseases, and respiratory diseases. The effect of occupation was clearly stronger than that of social class in self-certified absence episodes, whereas in medically confirmed sickness absence episodes gender differences were to a large extent related to social class differences between occupations. CONCLUSIONS: Differences between occupations held by women and men explain a substantial part of the female excess in sickness absence. Mental and behavioral disorders and musculoskeletal diseases substantially contribute to this explanation.

Interrelationships between education, occupational class, income and sickness absence.

BACKGROUND: Socio-economic position measures, such as education, occupational class and income, are well-known determinants of health. However, previous studies have not paid attention to mutual interrelationships between these socio-economic position measures and medically confirmed sickness absence. METHODS: The study is a register-based study. The participants were municipal employees of the City of Helsinki aged 25-59 years in 2003. There were 21,599 women and 5841 men participants. Three socio-economic position measures were used, namely three-level education, four-level occupational class and gross individual income quartiles. Main outcome measure was medically confirmed sickness absence spells of 4 days or longer. Inequality indices were calculated using Poisson regression analysis. RESULTS: High education, occupational class and individual income were all consistently associated with lower sickness absence rates among both women and men. After mutual adjustment, education and occupational class remained independent determinants of sickness absence. The association of individual income with sickness absence was practically explained by temporally preceding education and occupational class. CONCLUSIONS: Our results indicate that education and occupational class-rather than income-are strong determinants of sickness absence. Education, occupational class and income are complementary socio-economic position measures. To better inform sickness absence policy, future studies should aim to establish whether the observed socio-economic differences reflect broader differences in ill-health, lifestyle and working conditions.

Trends in socioeconomic differences in sickness absence among Finnish municipal employees 1990-99.

AIMS: This study examined the associations of key dimensions of socioeconomic status and long sickness absence spells as well as their changes over time from 1990 to 1999. METHODS: Municipal employees of the City of Helsinki, Finland, aged 25-59 were studied. The number of participants varied yearly from 24,029 women and 6,523 men to 27,861 women and 7,521 men. Socioeconomic status was assessed by education, occupational class, and individual income. The outcome was the number of over three days' sickness absence spells/100 person years, for which the employer requires medical certification. RESULTS: Low education, occupational class, and individual income were consistently associated with a 2-3 times higher sickness absence rates among both men and women. The age-adjusted sickness absence rates were relatively stable from 1990 to 1994 but increased from 1994 to 1999 among men and women. Socioeconomic differences in sickness absence rates tended to increase. CONCLUSIONS: The increase in the level of socioeconomic differences in sickness absence took place during a period of declining unemployment and staff increases at the City of Helsinki, which indicates that labour market conditions play a role in sickness absence.

Does survey non-response bias the association between occupational social class and health?

AIMS: A non-response rate of 20-40%is typical in questionnaire studies. The authors evaluate non-response bias and its impact on analyses of social class inequalities in health. METHODS: Set in the context of a health survey carried out among the employees of the City of Helsinki (non-response 33%) in 2000-02. Survey response and non-response records were linked with a personnel register to provide information on occupational social class and long sickness absence spells as an indicator of health status. RESULTS: Women and employees in higher occupational social classes were more likely to respond. Non-respondents had about 20-30% higher sickness absence rates. Relative social class differences in sickness absence in the total population were similar to those among either respondents or non-respondents. CONCLUSIONS: In working populations survey non-response does not seriously bias analyses of social class inequalities in sickness absence and possibly health inequalities more generally.

Relative weight and sickness absence.

OBJECTIVES: To examine whether high relative weight increases the risk of future sickness absence and to what extent any differences in short and long absence periods can be explained by specific obesity-related disorders, general health, and working conditions. RESEARCH METHODS AND PROCEDURES: The study included 5386 female and 1452 male employees of the city of Helsinki surveyed in 2000 to 2002. Survey data were linked to sickness absence records until the end of 2004 (mean follow-up time 2.9 years). RESULTS: Women and men with higher relative weight had clearly more short (1 to 3 days) and long (>3 days) periods of sickness absence during follow-up. The associations were rather monotonic and stronger for long periods. In women, adjusting for arthrosis and gout decreased the excess risk of long periods among those who were obese. In men, arthrosis, gout, and metabolic disease explained some of the excess risk for both short and long periods among the obese. Adjusting for physical functioning and self-rated health decreased the excess risk for short and long periods of sickness absence among obese women and men. Working conditions had almost no effect on the association between BMI and short or long periods of sickness absence. DISCUSSION: Obesity increases the risk of having short and long periods of sickness absence. This finding can be partly explained by measures of general health and specific obesity-related disorders. Healthy weight maintenance is a crucial issue in promoting occupational functioning and minimizing the costs associated with sickness absence.