title: Psychological distress, fatigue and long-term sickness absence: prospective results from the Maastricht Cohort Study.
abstract: OBJECTIVE
  Little is known about psychological distress as a risk factor for the onset of long-term sickness absence and even less about the influence of fatigue in this relationship.
  
  
  METHODS
  We examined the relationship between psychological distress and the onset of long-term sickness absence during 18 months of follow-up while considering fatigue. Analyses were based on 6403 employees participating in the Maastricht Cohort Study.
  
  
  RESULTS
  Psychological distress was related to the onset of long-term sickness absence (women relative risk 1.45, 95% confidence interval = 1.23-1.72; men 1.33, 1.21-1.46). Adjustment for fatigue weakened the associations, particularly in women. Caseness analyses revealed different effects of psychological distress and fatigue in the onset of long-term sickness absence in men and women.
  
  
  CONCLUSIONS
  The findings underline the need for interventions aiming at psychological distress and, depending on the gender, also at fatigue, to reduce the risk of long-term sickness absence.
authors.affiliation: National Institute of Occupational Health, Copenhagen, Denmark. utb@ami.dk
authors.forename: Ute
authors.initials: U
authors.lastname: Bültmann
authors.forename: Marcus J H
authors.initials: MJ
authors.lastname: Huibers
authors.forename: Ludovic P G M
authors.initials: LP
authors.lastname: van Amelsvoort
authors.forename: Ijmert
authors.initials: I
authors.lastname: Kant
authors.forename: Stanislav V
authors.initials: SV
authors.lastname: Kasl
authors.forename: Gerard M H
authors.initials: GM
authors.lastname: Swaen
mesh_terms: D000041:Absenteeism; D000328:Adult; D015331:Cohort Studies; D016021:Epidemiologic Studies; D005221:Fatigue; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012307:Risk Factors; D018582:Sick Leave; D013315:Stress, Psychological; D017132:Workplace