Perceived stress and sickness absence: a prospective study of 17,795 employees in Denmark

Abstract

Objectives: The aims were to examine (1) the prospective association between perceived stress and sickness absence, and if this association (2) differed by sex, and (3) was stronger when only long-term sickness absence (≥ 31 days) instead of all-length sickness absence (≥ 1 day) was included. Moreover, different cut-points for the length of the sickness absence periods were applied.

Methods: We followed respondents (10,634 women and 7161 men) from the 'Work Environment and Health in Denmark' 2014-survey for up to 18 months in the 'Register of Work Absences' from Statistics Denmark. Perceived stress was measured by a single question: "In the last 2 weeks, how often have you felt stressed?" We used Cox-regression with repeated events, adjusted for age, sector, education, and previous sickness absence.

Results: The hazard ratio (HR) for all-length sickness absence (≥ 1 day) for "Often/Always" stress compared to "Seldom/Never" stress was statistically significant among both men (HR = 1.25 [1.13-1.38]) and women (HR = 1.43 [1.34-1.51]). The HR was statistically significant for women (HR = 2.26 [1.89-2.70]), but not for men (HR = 1.22 [0.86-1.73]), when the analyses were restricted to long-term sickness absence (≥ 31 days). The sex-difference was statistically significant. Additional analyses with cut-points at ≥ 2, ≥ 4, ≥ 6, ≥ 8, ≥ 11, ≥ 15, ≥ 20, and ≥ 25 sickness absence days showed that among women, the HR increased gradually with increasing lengths of the sickness absence periods.

Conclusions: The prospective association of perceived stress with risk of sickness absence was stronger among women than men. Among women, perceived stress was more strongly associated with long-term sickness absence than with all-length sickness absence.

Keywords: Long-term sickness absence; Sex difference; Short-term sickness absence; Stress reaction; Stress symptom.

Fig. 1

The hazard ratio of perceived stress for sickness absence (‘Often/Always’-stress, ‘Sometimes’-stress, versus reference level ‘Seldom/Never’-stress). Results shown for sickness absence defined as periods ≥ 1, ≥ 2, ≥ 4, ≥ 6, ≥ 8, ≥ 11, ≥ 15, ≥ 20, ≥ 25, and ≥ 31 days

Fig. 2

The hazard ratio of perceived stress for sickness absence (‘Often/Always’-stress, ‘Sometimes’-stress, versus reference level ‘Seldom/Never’-stress). Results shown for sickness absence defined as periods ≥ 1, ≥ 2, ≥ 4, ≥ 6, ≥ 8, ≥ 11, ≥ 15, ≥ 20, ≥ 25, and ≥ 31 days. The analyses for ‘Sometimes’-stress and sickness absence ≥ 20, ≥ 25, and ≥ 31 days were not conducted because the proportional hazard assumption was not fulfilled