title: Joint association of sleep problems and psychosocial working conditions with registered long-term sickness absence. A Danish cohort study.
abstract: Sleep problems and adverse psychosocial working conditions are associated with increased risk of long-term sickness absence. Because sleep problems affect role functioning they may also exacerbate any effects of psychosocial working conditions and vice versa. We examined whether sleep problems and psychosocial working conditions interact in their associations with long-term sickness absence.
  
  
  
  We linked questionnaire data from participants to two surveys of random samples of the Danish working population (N=10 752) with registries on long-term sick leave during five years after questionnaire response. We defined sleep problems by self-reported symptoms and/or register data on hypnotics purchases of hypnotics. Psychosocial working conditions included quantitative and emotional demands, influence, supervisor recognition and social support, leadership quality, and social support from colleagues. Using time-to-event models, we calculated hazard ratios (HR) and differences and examined interaction as departure from multiplicativity and additivity.
  
  
  
  During 40 165 person-years of follow-up, we identified 2313 episodes of long-terms sickness absence. Sleep problems predicted risk of long-term sickness absence [HR 1.54, 95% confidence interval (95% CI) 1.38-1.73]. This association was statistically significantly stronger among participants with high quantitative demands and weaker among those with high supervisor recognition (P<0.0001).
  
  
  
  High quantitative demands exacerbated the association of sleep problems with risk of long-term sickness absence whereas high supervisor recognition buffered this association. To prevent long-term sickness absence among employees with sleep problems, workplace modifications focusing on quantitative demands and supervisor recognition may be considered. Workplace interventions for these factors may more effectively prevent sickness absence when targeted at this group. The efficacy and effectiveness of such interventions needs to be established in future studies.
authors.affiliation: National Research Centre for the Working Environment, Lerso Parkalle 105, DK-2100 Copenhagen, Denmark. ihm@nrcwe.dk.
authors.forename: Ida Eh
authors.initials: IE
authors.lastname: Madsen
authors.forename: Ann D
authors.initials: AD
authors.lastname: Larsen
authors.forename: Sannie V
authors.initials: SV
authors.lastname: Thorsen
authors.forename: Jan H
authors.initials: JH
authors.lastname: Pejtersen
authors.forename: Reiner
authors.initials: R
authors.lastname: Rugulies
authors.forename: Børge
authors.initials: B
authors.lastname: Sivertsen
mesh_terms: D000041:Absenteeism; D000328:Adult; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D016272:Occupational Health; D018582:Sick Leave / Q000706:statistics & numerical data*; D012893:Sleep Wake Disorders / Q000453:epidemiology* / Q000523:psychology; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D017132:Workplace / Q000523:psychology*