title: Effect of change in the psychosocial work environment on sickness absence: a seven year follow up of initially healthy employees.
abstract: OBJECTIVE
  To investigate the impact of changes in psychosocial work environment on subsequent sickness absence.
  
  
  METHODS
  Analysis of questionnaire and sickness absence data collected in three time periods: 1990-1991, before the recession; 1993, worst slump during the recession; and 1993-1997, a period after changes.
  
  
  METHODS
  Raisio, a town in south western Finland, during and after a period of economic decline.
  
  
  METHODS
  530 municipal employees (138 men, 392 women) working during 1990-1997 who had no medically certified sick leaves in 1991. Mean length of follow up was 6.7 years.
  
  
  RESULTS
  After adjustment for the pre-recession levels, the changes in the job characteristics of the workers during the recession predicted their subsequent sick leaves. Lowered job control caused a 1.30 (95% CI = 1.19, 1.41) times higher risk of sick leave than an increase in job control. The corresponding figures in relation to decreased social support and increased job demands were 1.30 (95% CI = 1.20, 1.41) and 1.10 (95% CI = 1.03, 1.17), respectively. In some cases there was an interaction with socioeconomic status, changes in the job characteristics being stronger predictors of sick leaves for employees with a high income than for the others. The highest risks of sick leave (ranging from 1.40 to 1.90) were associated with combined effects related to poor levels of and negative changes in job control, job demands and social support.
  
  
  CONCLUSIONS
  Negative changes in psychosocial work environment have adverse effects on the health of employees. Those working in an unfavourable psychosocial environment before changes are at greatest risk.
authors.affiliation: Finnish Institute of Occupational Health, Hämeenkatu 10, FIN 20500 Turku, Finland. jussi.vahtera@occuphealth.fi
authors.forename: J
authors.initials: J
authors.lastname: Vahtera
authors.forename: M
authors.initials: M
authors.lastname: Kivimäki
authors.forename: J
authors.initials: J
authors.lastname: Pentti
authors.forename: T
authors.initials: T
authors.lastname: Theorell
mesh_terms: D000293:Adolescent; D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020415:Personnel Downsizing / Q000523:psychology / Q000639:trends; D018582:Sick Leave / Q000639:trends*; D017132:Workplace / Q000458:organization & administration / Q000523:psychology*