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Meta-Analysis
. 2020 Aug 1;77(8):842-851.
doi: 10.1001/jamapsychiatry.2020.0322.

Psychosocial Stressors at Work and the Risk of Sickness Absence Due to a Diagnosed Mental Disorder: A Systematic Review and Meta-analysis

Caroline S Duchaine  1   2   3 , Karine Aubé  1 , Mahée Gilbert-Ouimet  1 , Michel Vézina  4 , Ruth Ndjaboué  1   3 , Victoria Massamba  1   2 , Denis Talbot  1   2 , Mathilde Lavigne-Robichaud  1   2 , Xavier Trudel  1   2 , Ana-Paula Bruno Pena-Gralle  1   2 , Alain Lesage  5 , Lynne Moore  2 , Alain Milot  1   2 , Danielle Laurin  1   3   6 , Chantal Brisson  1   2   3
Affiliations
Meta-Analysis

Psychosocial Stressors at Work and the Risk of Sickness Absence Due to a Diagnosed Mental Disorder: A Systematic Review and Meta-analysis

Caroline S Duchaine et al. JAMA Psychiatry. .

Abstract

Importance: Mental health problems are associated with considerable occupational, medical, social, and economic burdens. Psychosocial stressors at work have been associated with a higher risk of mental disorders, but the risk of sickness absence due to a diagnosed mental disorder, indicating a more severe condition, has never been investigated in a systematic review and meta-analysis.

Objective: To synthesize the evidence of the association of psychosocial stressors at work with sickness absence due to a diagnosed mental disorder among adult workers.

Data sources: Seven electronic databases (MEDLINE, Embase, PsycInfo, Web of Science, CINAHL, Sociological Abstracts, and International Bibliography of the Social Sciences), 3 gray literature databases (Grey Literature Report, WHO-IRIS and Open Grey), and the reference lists of all eligible studies and reviews were searched in January 2017 and updated in February 2019.

Study selection: Only original prospective studies evaluating the association of at least 1 psychosocial stressor at work from the 3 most recognized theoretical models were eligible: the job demand-control-support model, including exposure to job strain (high psychological demands with low job control); effort-reward imbalance model; and organizational justice model. Study selection was performed in duplicate by blinded independent reviewers. Among the 28 467 citations screened, 23 studies were eligible for systematic review.

Data extraction and synthesis: This meta-analysis followed the PRISMA and MOOSE guidelines. Data extraction and risk of bias evaluation, using the Risk of Bias in Nonrandomized Studies-Interventions tool, were performed in duplicate by blinded independent reviewers. Data were pooled using random-effect models.

Main outcomes and measures: Sickness absence due to a mental disorder with a diagnosis obtained objectively.

Results: A total of 13 studies representing 130 056 participants were included in the 6 meta-analyses. Workers exposed to low reward were associated with a higher risk of sickness absence due to a diagnosed mental disorder compared with nonexposed workers (pooled risk ratio [RR], 1.76 [95% CI, 1.49-2.08]), as were those exposed to effort-reward imbalance (pooled RR, 1.66 [95% CI, 1.37-2.00]), job strain (pooled RR, 1.47 [95% CI, 1.24-1.74]), low job control (pooled RR, 1.25 [95% CI, 1.02-1.53]), and high psychological demands (pooled RR, 1.23 [95% CI, 1.04-1.45]).

Conclusions and relevance: This meta-analysis found that workers exposed to psychosocial stressors at work were associated with a higher risk of sickness absence due to a mental disorder. A better understanding of the importance of these stressors could help physicians when evaluating their patients' mental health and work capacity.

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Conflict of interest statement

Conflict of Interest Disclosures: Ms Duchaine and Drs Gilbert-Ouimet, Vézina, Trudel, Lesage, Moore, Milot, and Brisson reported receiving grants from Canadian Institute of Health Research during the conduct of the study. Dr Brisson reported receiving grants from Canadian Institute of Health Research outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flowchart for the Selection of the Included Studies
aWrong study design: cross-sectional studies, ecological studies, intervention studies, case-control studies with a retrospective design, qualitative or case studies, and not original studies; wrong outcome: all-cause absence, self-reported absence or reason for absence, mental health not evaluated, nonvalidated measure of mental health, or off topic; wrong exposure: psychosocial stressors at work from at least 1 of the 3 considered models were not measured or were measured with a nonvalidated tool; wrong population: population of patients or of workers on sick leave, pregnant women, or in a process of returning to work; and wrong analyses: association between psychosocial stressors at work and mental health not reported (not an objective of the study).
Figure 2.
Figure 2.. Psychosocial Stressors at Work From the Job-Demand-Control-Support Model and the Risk of Sickness Absence Owing to a Diagnosed Mental Disorder
A, Job strain. B, Psychological demands (PDs). C, Job control (JC). D, Social support (SS). The data marker sizes are proportional to the weight of the studies included in the meta-analysis.
Figure 3.
Figure 3.. Association of Psychosocial Stressors at Work From the Effort-Reward Imbalance (ERI) Model With the Risk of Sickness Absence Owing to a Diagnosed Mental Disorder
A, Effort-reward imbalance; B, Reward. The data markers sizes are proportional to the weight of the studies included in the meta-analysis.
See this image and copyright information in PMC

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