Anxiety and depression increase risk of sick leave
Long-term sick leave is a burden for individuals and society at large, yet very little is known about the underlying reasons for it. Researchers at the Norwegian Institute of Public Health, in collaboration with Australian and British institutes, have identified anxiety as a more important risk factor than previously thought.
Common mental disorders such as anxiety and depression will affect 1 of 3 of us at some point in our lives. The core symptoms of mental disorders affect a person's emotional, cognitive and social functioning, which can impact on working ability. Previous studies have found a link between mental disorders and sick leave, though they have been uncertain as to whether mental disorder increases the risk of sick leave, or the other way around. Prolonged absence from the workplace can contribute to avoidance behaviour, especially in those with anxiety, which can make it even harder for these individuals to get fully back to work. It is therefore important to examine the long-term associations between common mental disorders and sick leave in order to help plan more effective interventions aimed to prevent and reduce sick leave among individuals with common mental disorders.
This study examined anxiety and depression levels among 13 436 participants in the Hordaland Health Study. Common mental disorders were assessed at the start of the study with the Hospital Anxiety and Depression Scale. Participants were then followed for up to 6 years, retrieving information on sick leave of 16 days or more from the official Norwegian registry over state paid sick leave benefits. Information on other possible causal factors such as socioeconomic status and physical health was also obtained from the health study.
Anxiety is most important
The study has several findings that have not been previously shown in similar studies. Firstly, it shows that common mental disorders increase the risk of very prolonged absence (over 90 days) and repeated episodes of sick leave. Secondly, it shows that the risk of these outcomes is highest among those with both anxiety and depression simultaneously. Thirdly, the results indicate that anxiety may be more important than depression.
"Surprisingly, we found that anxiety alone is a stronger risk factor for prolonged and frequent sick leave than depression alone. Further, anxiety seems to be a relatively stable risk factor for sick leave, as we found an increased risk of sickness absence up to six years after the anxiety level was assessed," says Ann Kristin Knudsen, who is lead author of the study and PhD student at the University of Bergen and the Division of Mental Health at the Norwegian Institute of Public Health.
The effects of pain
A number of risk factors can simultaneously influence long-term sick leave. In particular, pain was found to have a considerable impact on the association between common mental disorders and sick leave: adjusting for pain ("removing" its effect in the statistical model) reduced the association.
"Adjusting for pain may have given us artificially low effect sizes, since pain, anxiety and depression are closely related and may reflect the same underlying health condition," explains Knudsen.
In other words, the association between common mental disorders and sick leave may actually be stronger.
Benefits of prospective studies
This is the first study with a long enough follow-up period (6 years) to show that the effect of mental disorder on sick leave remains over time.
"Previous research has largely been based on patient data, organizational data or diagnoses of sick leave certificates, or in studies where the prevalence of mental disorder was measured during sick leave. The latter is problematic because we do not know what comes first, sick leave or mental health problems," explains Knudsen.
Since this was a prospective study, following individuals both with and without common mental disorders over time, it provides evidence that common mental disorders increases risk of sick leave and not the other way around. On the other hand, people with common mental disorders also suffered several episodes of sick leave during the follow-up time, which may indicate that both sick leave and the mental health problems affect each other and thus result in a "vicious circle" with repeated sick leaves.
Implications for clinicians
This study is one of the few to show the importance of anxiety, which has largely been ignored in previous studies in this area. Previous studies not accounting for the impact of anxiety may thus have overestimated the effect of depression on sick leave. Without awareness of anxiety, physicians and clinicians may not detect anxiety sufficiently, which can hamper rehabilitation efforts. Future research should focus on how health professionals dealing with sick leave can best identify anxiety and other mental disorders to help prevent the prolongation of sick leave or further sick leave episodes.
More information: Knudsen, A.K., Harvey, S.B., Mykletun, A. and Øverland, S. (2012) Common mental disorders and long-term sickness absence in a general working population. The Hordaland Health Study. Acta Psychiatrica Scandinavica: 111. DOI: 10.1111/j.1600-0447.2012.01902.x
Provided by Norwegian Institute of Public Health
- Referral to talking therapies may cut use of health services and sick leave Oct 03, 2011 | not rated yet | 0
- Women take almost 50 percent more short-term sick leave than men Feb 05, 2008 | not rated yet | 0
- Can non-medical factors trigger sick leave? Mar 23, 2011 | not rated yet | 0
- Repeatedly working when ill boosts risk of long term sick leave Apr 30, 2009 | not rated yet | 0
- Long-term cancer survivors struggle to keep regular work hours Jun 19, 2012 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Why is zone 1 in liver more prone to ischemic injury?
May 23, 2013 Hi, Is it because around central vein, there is only deoxygenated blood from the vein where as in the periphery there is hepatic artery. Also why...
How can there be villous adenoma in colon, if there are no villi there
May 22, 2013 As title suggest. Thanks :smile:
How can there be a term called "intestinal metaplasia" of stomach
May 21, 2013 Hello everyone, Ok Stomach's normal epithelium is simple columnar, now in intestinal type of adenocarcinoma of stomach it undergoes "intestinal...
Pressure-volume curve: Elastic Recoil Pressure don't make sense
May 18, 2013 From pressure-volume curve of the lung and chest wall (attached photo), I don't understand why would the elastic recoil pressure of the lung is...
If you became brain-dead, would you want them to pull the plug?
May 17, 2013 I'd want the rest of me to stay alive. Sure it's a lousy way to live but it beats being all-the-way dead. Maybe if I make it 20 years they'll...
MRI bill question
May 15, 2013 Dear PFers, The hospital gave us a $12k bill for one MRI (head with contrast). The people I talked to at the hospital tell me that they do not...
- More from Physics Forums - Medical Sciences
More news stories
(HealthDay)—We've all seen them: the surfers who race to the beach when a hurricane hits, the guy who decides to ride out the storm in his overmatched boat, the tornado chasers who fearlessly steer their ...
Psychology & Psychiatry 13 hours ago | not rated yet | 0
Women at a particular stage in their monthly menstrual cycle may be more vulnerable to some of the psychological side-effects associated with stressful experiences, according to a study from UCL.
Psychology & Psychiatry 14 hours ago | 3.7 / 5 (3) | 0 |
Ernie Pyle – an iconic war correspondent in World War II – reportedly said "There are no atheists in foxholes." A new joint study between two brothers at Cornell and Virginia Wesleyan found that only ...
Psychology & Psychiatry 16 hours ago | 2.5 / 5 (4) | 1
(Medical Xpress)—Research by Stanford scholar Emma Seppala at the Center for Compassion and Altruism Research and Education found that post-traumatic stress disorder decreased in veterans who participated ...
Psychology & Psychiatry 17 hours ago | 5 / 5 (1) | 0
(Medical Xpress)—Patients with diabetes who are depressed are much more likely to develop episodes of dangerously low blood sugars, or hypoglycemia, than are those who are not depressed, a new study has ...
Psychology & Psychiatry 18 hours ago | not rated yet | 0 |
(Medical Xpress)—A new study by researchers in the US has shown that an ancient virus can be modified to help in the fight against the simian immunodeficiency virus SIV, which is the equivalent in monkeys ...
17 hours ago | 5 / 5 (3) | 0 |
Two mutations central to the development of infantile myofibromatosis (IM)—a disorder characterized by multiple tumors involving the skin, bone, and soft tissue—may provide new therapeutic targets, according to researchers ...
11 hours ago | 3 / 5 (2) | 0 |
Biological processes are generally based on events at the molecular and cellular level. To understand what happens in the course of infections, diseases or normal bodily functions, scientists would need to ...
14 hours ago | 5 / 5 (4) | 0 |
How can healthy people who hear voices help schizophrenics? Finding the answer for this is at the centre of research conducted at the University of Bergen.
17 hours ago | 4 / 5 (2) | 2
(Medical Xpress)—The way Alzheimer's disease is portrayed by advocacy groups and the media is having undue influence on the euthanasia debate, according to a Deakin University nursing ethics professor.
18 hours ago | not rated yet | 2
Talking on a hands-free device while behind the wheel can lead to a sharp increase in errors that could imperil other drivers on the road, according to new research from the University of Alberta.
11 hours ago | not rated yet | 0