title: Death or illness of a family member, violence, interpersonal conflict, and financial difficulties as predictors of sickness absence: longitudinal cohort study on psychological and behavioral links.
abstract: OBJECTIVE
  Although an association between stressful life events and health problems has been demonstrated, the underlying mechanisms have remained unclear. We examined whether psychological problems and health-risk behaviors underpin the health effects of different event categories.
  
  
  METHODS
  The initially healthy participants were 2991 (796 men, 2195 women) municipal employees who had taken no sick leave in 1995. In 1997, they completed a questionnaire requesting information on recent life events and psychological and behavioral factors. The outcome was recorded sickness absences in 1998.
  
  
  RESULTS
  In men, the death or serious illness of a family member, violence, and financial difficulties increased the risk of later sickness absence. According to structural equation modeling, violence and financial difficulties also induced psychological problems such as anxiety, mental distress, and lowered sense of coherence. Psychological problems were associated with heightened cigarette and alcohol consumption, which in turn increased sickness absence. A corresponding structural model did not fit the data in relation to death or serious illness of a family member. In women, life events were associated with psychological problems and smoking but not sickness absence.
  
  
  CONCLUSIONS
  Longitudinal evidence suggests that increased psychological problems and behaviors involving risk to health partially mediate the effect of stressful life events on health, as indicated by sickness absence. This model received support among men and for the event categories of violence and financial difficulties. Women were less affected by stressful life events than men.
authors.affiliation: Department of Psychology, Division of Applied Psychology, University of Helsinki and Finnish Institute of Occupational Health, Helsinki, Finland. mika.kivimaki@occuphealth.fi
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
authors.forename: Jussi
authors.initials: J
authors.lastname: Vahtera
authors.forename: Marko
authors.initials: M
authors.lastname: Elovainio
authors.forename: Benita
authors.initials: B
authors.lastname: Lillrank
authors.forename: May V
authors.initials: MV
authors.lastname: Kevin
mesh_terms: D001293:Attitude to Death; D001294:Attitude to Health; D015331:Cohort Studies; D003220:Conflict, Psychological; D003863:Depression / Q000453:epidemiology / Q000209:etiology; D004467:Economics; D005190:Family; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D007398:Interpersonal Relations; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D012309:Risk-Taking; D017678:Sex Distribution; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000209:etiology; D014754:Violence