Psychological factors in long-termsickness absence: the role of shame and social support: Epidemiological studies based on the Health Assets Project
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Long-term sickness absence (LTSA) is an important societal and public health challenge in many Western countries. To tackle the challenges, we need knowledge on risk factors for LTSA and what might prolong sickness absence. Transitions between work and sickness absence are influenced by a variety of factors and agents, including the sick-listed individual and his or her interaction in a social context. The individual’s thoughts, emotions, behaviour and social experiences throughout the sickness absence process are therefore always relevant and will often play an important role. Despite this, there are considerable knowledge gaps in the epidemiological literature regarding social psychological aspects of LTSA. In particular, the role of individuals’ emotions in sickness absence is hardly examined. Furthermore, little is known about associations between the individual’s history of sickness absence and social inclusion and support at work. Thus, there is a need for novel research approaches and study designs to address these issues. The overall aim of this thesis was to increase knowledge about how he social psychological aspects shame and social support relate to long-term sickness absence in the general population. Selective research participation presents an important threat for generalizability of epidemiological studies and more knowledge is needed on selective participation by sickness absence. An additional aim was therefore to examine if history of sickness absence is associated with survey participation. This thesis is based upon three papers, all employing data from the baseline survey of the Swedish, general population-based Health Assets Project (HAP). This survey was conducted in 2008, and linked to official registries of sickness absence (LISA) from the period 2001 to 2009. HAP was specifically designed to gain knowledge about sickness absence, work and health. Three samples, aged 19-64 years, were included: a random general population sample (random-PS) and two samples including individuals with a recent episode of registered sickness absence (employer-reported › 14 days and self-reported other insured ›1 day). In paper I the employer-reported sample was used, in paper II the random general population sample and in paper III all three samples were included. As sickness absence can be a process over time, correlates of both recent and more distant sickness absence was examined. In paper I, the specific aim was to study relationships between shame concerning being sickness absent and LTSA among current sick-listed employees. Levels of shame were found to differ between subgroups of absentees. There was a particularly high level of shame reported among the younger, and those absent due to mental illnesses. Those reporting high levels of shame were more likely to have prolonged sickness absence the subsequent year. The aim in paper II was to examine associations between history of LTSA across seven years and current perceived social support at work among employees. The results showed that those with previous LTSA, and in particular those with high levels of absence over several years, were more likely to report low social support at work and low immediate superior support. The aim of paper III was to examine if history of sickness absence was associated with participation in the HAP survey. No substantial selection by sickness absence was found. Yet, overall participants had somewhat less registered sickness absence in the past than nonparticipants. Participants were also more likely than nonparticipants to be women, older, born in the Nordic countries, married and have higher incomes. This thesis shows the complexity, but also also the importance, of expanding the scientific knowledge on social psychological factors in sickness absence. The examination of sickness absence over nearly a decade provided new and more detailed knowledge about patterns of sickness absence, and their associations with social psychological factors and survey participation. The findings show that LTSA can have negative social implications for the sick-listed individual, more specifically in terms of shame and low perceived social support at work, which may further become barriers towards return to work. Thus, the findings underscore that return to work interventions could benefit from taking into account social psychological aspects of LTSA to secure sustainable work retention.
Består avPaper I: Knapstad, M., Øverland, S., Henderson, M., Holmgren, K., & Hensing, G. (2014): “Shame among long-term sickness absentees: Correlates and impact on subsequent sickness absence”, Scandinavian Journal of Public Health”, 42(1):96-103. Full-tect not available in BORA. The published version is available at: http://dx.doi.org/10.1177/1403494813500590
Paper II: Knapstad, M., Holmgren, K., & Hensing, G., & Øverland, S. (2014): “Previous sickness absence and current low perceived social support at work among employees in the general population: a historical cohort study”, BMJ Open, 4(10):e005963. The article is available at: http://hdl.handle.net/1956/9055
Paper III: Knapstad, M., Löve, J., Holmgren, K., Hensing, G. & Øverland, S. “Does sickness absence influence survey participation?”. Resubmitted to Scandinavian Journal of Psychology. Full-text not available.