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Original Investigation
April 1, 2020

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

Author Affiliations
  • 1CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada
  • 2Faculty of Medicine, Laval University, Quebec City, Québec, Canada
  • 3Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Quebec City, Québec, Canada
  • 4Institut national de santé publique du Québec, Quebec City, Québec, Canada
  • 5Department of Psychiatry, University of Montreal, Montreal, Québec, Canada
  • 6Faculty of Pharmacy, Laval University, Quebec City, Québec, Canada
JAMA Psychiatry. 2020;77(8):842-851. doi:10.1001/jamapsychiatry.2020.0322
Key Points

Question  Do psychosocial stressors at work increase the risk of sickness absence due to a diagnosed mental disorder?

Findings  In this systematic review and meta-analysis, psychosocial stressors at work were associated with an elevated risk of sickness absence due to a diagnosed mental disorder. The risk was up to 76% higher among workers exposed to these work stressors compared with nonexposed workers.

Meaning  Given that psychosocial stressors at work are frequent and modifiable, physicians should be aware of their importance when evaluating their patients’ mental health and work capacity.

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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