title: Long-term sickness absence due to mental disorders is associated with individual features and psychosocial work conditions.
abstract: OBJECTIVE
  Sickness absence is a socioeconomic global burden. In Brazil, mental disorders are the third leading cause of social security benefits payments. The aim of the present study was to compare factors associated with long-term sickness absence between workers who claimed social benefits due to mental disorders or by other causes. We investigated individual features and occupational characteristics. In addition, we evaluated psychosocial factors at work assessed by the Demand-Control-Support (DCS) and Effort-Reward Imbalance (ERI) models, and whether they were associated with long-term sickness absence due to mental disorders (LTSA-MD).
  
  
  METHODS
  The present case-control study was conducted in São Paulo, Brazil. The sample (n = 385) included workers on sick leave for more than 15 days. Cases were the participants with disabling psychiatric illnesses, and controls were the ones with other disabling diseases. Interviews were conducted to assess individual features (sociodemographic data, health habits/lifestyle, health conditions) and occupational characteristics. The participants' perception of exposure to dimensions of the DCS and ERI models was also recorded. Multiple logistic regressions were performed to evaluate the association between independent variables and LTSA-MD.
  
  
  RESULTS
  All the regression analyses showed that LTSA-MD was associated with female sex, self-reported white skin color, higher education level, high tobacco consumption, high alcohol intake, two or more comorbidities, exposure to violence at work, high job strain and low social support at work, effort-reward imbalance and high overcommitment to work. LTSA-MD was associated with separate and combined DCS and ERI stress models.
  
  
  CONCLUSIONS
  Individual features and work conditions were associated with LTSA-MD. Combined analysis of stress models showed that psychosocial factors at work were significantly associated with LTSA-MD. Resourceful use of this information may contribute to the implementation of preventive actions and strategies to facilitate return to work targeting the populations most susceptible to mental disorders.
authors.affiliation: National Social Security Institute, Ministry of Social Security, São Paulo, SP, Brazil; Department of Environmental Health, School of Public Health, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: João Silvestre da
authors.initials: JS
authors.lastname: Silva-Junior
authors.affiliation: Department of Environmental Health, School of Public Health, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Frida Marina
authors.initials: FM
authors.lastname: Fischer
mesh_terms: D000041:Absenteeism; D000328:Adult; D001938:Brazil; D016022:Case-Control Studies; D004651:Employment / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D001523:Mental Disorders / Q000209:etiology* / Q000523:psychology; D009784:Occupational Diseases / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D012201:Reward; D018582:Sick Leave / Q000706:statistics & numerical data / Q000639:trends*; D012931:Social Environment; D012944:Social Support; D013315:Stress, Psychological / Q000150:complications* / Q000523:psychology; D016526:Workload / Q000523:psychology*