title: Job strain, health and sickness absence: results from the Hordaland Health Study.
abstract: OBJECTIVE
  While it is generally accepted that high job strain is associated with adverse occupational outcomes, the nature of this relationship and the causal pathways involved are not well elucidated. We aimed to assess the association between job strain and long-term sickness absence (LTSA), and investigate whether any associations could be explained by validated health measures.
  
  
  METHODS
  Data from participants (n = 7346) of the Hordaland Health Study (HUSK), aged 40-47 at baseline, were analyzed using multivariate Cox regression to evaluate the association between job strain and LTSA over one year. Further analyses examined whether mental and physical health mediated any association between job strain and sickness absence.
  
  
  RESULTS
  A positive association was found between job strain and risk of a LTSA episode, even controlling for confounding factors (HR = 1.64 (1.36-1.98); high job strain exposure accounted for a small proportion of LTSA episodes (population attributable risk 0.068). Further adjustments for physical health and mental health individually attenuated, but could not fully explain the association. In the fully adjusted model, the association between high job strain and LTSA remained significant (HR = 1.30 (1.07-1.59)).
  
  
  CONCLUSIONS
  High job strain increases the risk of LTSA. While our results suggest that one in 15 cases of LTSA could be avoided if high job strain were eliminated, we also provide evidence against simplistic causal models. The impact of job strain on future LTSA could not be fully explained by impaired health at baseline, which suggests that factors besides ill health are important in explaining the link between job strain and sickness absence.
authors.affiliation: School of Psychiatry, University of New South Wales, Sydney, Australia.
authors.forename: Min-Jung
authors.initials: MJ
authors.lastname: Wang
authors.affiliation: Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway; Department of Public Mental Health, Division of Mental Health, Norwegian Institute of Public Health, Bergen, Norway.
authors.forename: Arnstein
authors.initials: A
authors.lastname: Mykletun
authors.affiliation: Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway.
authors.forename: Ellen Ihlen
authors.initials: EI
authors.lastname: Møyner
authors.affiliation: Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway.
authors.forename: Simon
authors.initials: S
authors.lastname: Øverland
authors.affiliation: Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, United Kingdom.
authors.forename: Max
authors.initials: M
authors.lastname: Henderson
authors.affiliation: Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom.
authors.forename: Stephen
authors.initials: S
authors.lastname: Stansfeld
authors.affiliation: Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, United Kingdom.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hotopf
authors.affiliation: School of Psychiatry, University of New South Wales, Sydney, Australia; Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, United Kingdom; Black Dog Institute, Sydney, Australia.
authors.forename: Samuel B
authors.initials: SB
authors.lastname: Harvey
mesh_terms: D000041:Absenteeism; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D017533:Marital Status; D015999:Multivariate Analysis; D009664:Norway / Q000453:epidemiology; D009784:Occupational Diseases / Q000453:epidemiology / Q000523:psychology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D018582:Sick Leave / Q000706:statistics & numerical data*; D013315:Stress, Psychological / Q000453:epidemiology* / Q000209:etiology
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