Research reportRelationship between sickness presenteeism (WHO–HPQ) with depression and sickness absence due to mental disease in a cohort of Japanese workers
Introduction
Long-term sickness absence due to mental disease in the workplace has become a global public health problem (Henderson et al., 2005). Sickness absence due to mental disease, particularly stress-related mental disease, has increased in a number of European countries over the last 20 years (J Rvisalo et al., 2005). In Japan, a survey of government officials found that mental and behavioral disorders were the most frequent causes of long-term absence, constituting 64.6% of all long-term absences due to illness. Furthermore, over the past decade, mental and behavioral disorders have been ranked first among causes of long-term absence due to illness (Japan, 2013a).
Mental disease is also one of the main contributors to global years lived with disability (YLDs), with major depressive disorder and anxiety disorders as the leading causes (Vos et al., 2012). Indeed, depression is one of the main contributors to disability worldwide (Murray and Lopez, 1997). It reduces productivity and quality of life and increases the risk of suicide (Doris et al., 1999). Recent cohort studies have reported an increased risk of suicide for individuals on sick leave due to general (Melchior et al., 2010) and stress-related mental disease (Mittendorfer-Rutz et al., 2012). Japan has one of the highest suicide rates in the world, with the annual number of suicides remaining above 30,000 over the last decade (Japan, 2011). Worldwide, depression ranks third on the list of leading causes of disease burden, causing over 4% of all disability-adjusted life years (DALYs), and is projected to rank first on this list by 2030 (WHO, 2008). Several studies have reported that stress at work can lead to mental disease, especially depression (Wang, 2005, Virtanen et al., 2007).
Illness in the workplace can result in lost productivity (absenteeism and presenteeism). “Absenteeism” refers to an employee׳s time away from work due to illness or disability. “Presenteeism” refers to the decrease in productivity in employees who are present but not functioning at full capacity due to illness or other medical conditions (Kessler et al., 2003a, Kessler et al., 2004). There are various definitions of “presenteeism.” All of the definitions pertain to being physically present at work. Of these, there are two major definitions: going to work despite feeling unhealthy, and productivity loss at work due to health problems (Johns, 2010). We used the latter definition. Presenteeism is measured using the WHO–HPQ, developed by Kessler et al. (Kessler et al., 2003a, Kessler et al., 2004, Kessler et al., 2007b), and is conceptualized as a measure of actual performance in relation to possible performance (Kessler et al., 2007b). There are two forms of WHO–HPQ presenteeism scores: absolute presenteeism is actual performance; relative presenteeism is a ratio of actual performance to the performance of most workers at the same job (Kessler et al., 2007b).
In the USA, major depression and bipolar disorder are associated with 27.2 and 65.5 annual work loss days due to absenteeism or presenteeism, which corresponds to a salary-equivalent of 37 and 14 billion dollars of lost productivity, respectively (Kessler et al., 2006). Furthermore, most studies confirm that presenteeism is far more costly than illness related absenteeism or disability (Hemp, 2004). A small number of studies have investigated the kinds of risk factors related to presenteeism or absence (Holden et al., 2011, Jain et al., 2013), and have found a relationship between sickness presenteeism and sickness absence (Hansen and Andersen, 2009, Bergstrom et al., 2009, Taloyan et al., 2012).
However, few studies have focused on the relationship between absence, presenteeism, and depression, despite the magnitude of the public health problem of sickness absence due to mental disease. Recently, the Japanese study of Health, Occupation and Psychosocial factors related Equity (J-HOPE study (Miyaki et al., 2012; Suzuki et al., 2013)) was performed to develop and expand research aimed at elucidating the mechanisms underlying social disparities in health and to establish control measures. The goal of the current study, a part of J-HOPE, was to evaluate the influence of presenteeism on depression and sickness absence due to mental disease. The reason we evaluated sickness absence due to mental disease rather than general sickness absence was that the health consequences associated with sickness presenteeism are largely related to mental health (Taloyan et al., 2012) and because sickness absence due to mental disease has become a public health problem (Henderson et al., 2005).
In line with the above research, we developed two hypotheses. Musich et al. (2006) reported that increased sickness presenteeism (lost productivity) was significantly associated with high stress and life dissatisfaction. Gustafsson and Marklund (2011) suggested that sickness presenteeism is a strong predictor of future poor health, physical complaints, low mental well-being, and low work ability. A decrease in employees׳ productivity would mean that their work is not going as smoothly as expected, leading them to feel stressed and unhappy. Consequently, they get depressed. Therefore, it is reasonable to assume that depression severity increases when sickness presenteeism worsens. According to the findings above, we formulated the following hypothesis. Hypothesis #1: sickness presenteeism is related to increases in depression in the future.
Many of the medical problems that result in presenteeism (productivity loss) are relatively benign. Employees who repeatedly go to work despite being ill may not obtain the necessary rest and accompanying recuperation, and this may lead to accumulated stress and allostatic load. Moreover, allostatic overload is related to several negative health effects (Mcewen, 1998). Furthermore, more serious illnesses frequently force people to stay home from work (Hemp, 2004), and illness affects both the quantity and quality of work (Hemp, 2004). Moreover, de Graaf et al. (2012) reported that any mental disorder is related to increased absence and less productivity. According to the above reports, we formulated the following hypothesis. Hypothesis #2: sickness presenteeism is related to increased future absence due to mental disease.
Sickness presenteeism caused by various health problems is considered to lead to depression and absence due to mental disease (Hypothesis #1 and #2). Therefore, presenteeism was assessed using the WHO–HPQ, although presenteeism in this questionnaire does not focus on specific health problems.
Section snippets
Participants
The present longitudinal study was based on data obtained from a survey conducted for our occupational cohort study on social class and health, supported by a grant from the Ministry of Education, Culture, Sports, Science and Technology, Japan. Employees of a major Japanese manufacturing company (with headquarters in Kyoto and 11 other major offices throughout Japan) were recruited. All workers were invited to participate and 2266 agreed to participation (response rate: 90.1%; age range: 21–65
Results
The characteristics of study participants at baseline according to the existence or non-existence of sickness absence across a 2-year follow up due to mental disease are presented in Table 1. Those who had experienced absence had significantly lower absolute and relative presenteeism scores. Those who were absent due to mental disease were more likely to exhibit depression (K6≥13) and high ΔK6 scores, although no significant differences were found with respect to K6 scores. There were no
Discussion
This is the first study to evaluate the influence of presenteeism on sickness absence due to mental disease. Previous studies have focused on sickness presenteeism that is related to sickness absence (Hansen and Andersen, 2009, Bergstrom et al., 2009, Taloyan et al., 2012), but not sickness absence due to mental disease. Additionally, the definition of “presenteeism” in previous studies on the association between sickness presenteeism and sickness absence did not refer to lost productivity, but
Conclusions
More sickness presenteeism scores (WHO–HPQ Japanese version) were related to a greater risk of depression, the exacerbation of depressive symptoms, and sickness absence due to mental disease in this large-scale cohort of Japanese workers. Measurement of presenteeism could be used to evaluate the risk for depression and absence. Furthermore, our findings suggest that interventions to improve presenteeism would be effective in preventing depression and absence. Further studies are needed.
Role of funding source
This research is funded by a Grant-in-Aid for Scientific Research (B) (No. 24390160, Chief: Dr. Koichi Miyaki) and a Grant-in-Aid for Scientific Research on Innovative Areas (Research in a Proposed Research Area) (No. 21119001 Chief: Dr. Norito Kawakami) by the Ministry of Education, Culture, Sports, Science and Technology, Japan, and by JSPS KAKENHI Grant number 26253042.
Conflict of interest
No conflict declared.
Acknowledgments
This research is funded by a Grant-in-Aid for Scientific Research (B) (No. 24390160, Chief: Dr. Koichi Miyaki) and a Grant-in-Aid for Scientific Research on Innovative Areas (Research in a Proposed Research Area) (No. 21119001 Chief: Dr. Norito Kawakami) by the Ministry of Education, Culture, Sports, Science and Technology, Japan, and by JSPS KAKENHI Grant number 26253042.
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