Psychosocial work factors at work and sick leave, occupational accident and disability pension – a cohort study of civil servants

Introduction
Sickness absence and early retirement due to work disability are significant social and economic problems. Employees with psychosocial type of sickness absence encounter more difficulties in returning to work than other absencies. This study investigated to which extent psychosocial factors at work are associated with health outcomes in a cohort study of Finnish civil servants.

Methods
A total of 967 civil servants participated in a survey on psychosocial factors and health at work. Psychosocial work characteristics were measured with a self-reported questionnaire. Sickness ab-sences, disability pensions and occupational accidents were collected from nationwide registers. The median follow-up time was 7 years. The effect sizes were measured by risk ratios (RR) and their 95% confidence intervals from multiple proportional hazards regression models. The models were adjusted for sex, age, education, change in well-being during prior year, sick leaves during prior year, prior participation in work health promotion, and prior participation in rehabilitation. We considered the predictor to be associated with the outcome if the RR was less than 0.83 or greater than 1.20.

Results
Decreased sickness absence was associated with good team climate, high appreciation at work, and opportunities for mental growth at work while monotonous movements, crowdedness of work place, and shift or period work increased sickness absence. Occupational accidents were associated with violent clients and high work pressure. Good communication at work associated with low ac-cident rates. Decreased disability pensioning was associated with good team climate at work and high work control. Increased pensioning associated with violent clients and shift or period work.

Discussion
Psychosocial work characteristics largely predicted sickness absence, occupational accidents and disability pension among governmental employees. Identification of these risk factors opens up a possibility to improve psychosocial work environment and target psychosocial workplace interven-tions, which ultimately result in decreased work disability.