Sickness Presenteeism Predicts Suboptimal Self-Rated Health and Sickness Absence: A Nationally Representative Study of the Swedish Working Population

Background: Earlier studies have suggested that sickness presenteeism (SP) may be a risk factor for future health problems. The purpose of the present study was to test this in a nationally representative prospective study of Swedish workers. Methods: Prospective cohort with a representative sample of the Swedish working population surveyed in 2008 and 2010. Odds ratios (OR) with 95% confidence intervals (CI) were calculated using logistic regression. Results: Those who reported more than 7 days of SP had higher risk of suboptimal SRH compared to those who reported no SP (OR = 5.95; 95% CI 4.98-7.12), also after adjustment for confounders (OR = 1.64; 95% CI 1.30-2.06). Those who reported 1-7 days of SP also had an increased risk before and after adjustments. Inclusion of self-rated physical and psychological work capacity did not attenuate the associations, whereas of emotional exhaustion attenuated the ORs to non-significance for both outcomes, indicating that the health consequences associated with SP are largely related to mental health. Conclusion: The results strengthen earlier findings suggesting that SP can be a risk factor for future suboptimal general health and sickness absence, particularly through mental health problems. This indicates that asking about SP could yield important information for employers, occupational health practitioners and GPs, possibly leading to more timely intervention that could decrease the risk of future sickness absence and more serious health problems, especially in the mental domain. Further studies of the possible causal pathways between SP and future health development are also warranted, especially since going to work is often seen as desirable also for those with poor health.