Study objectives: The objective of this prospective cohort study was to determine whether psychosocial work characteristics and social relations exert independent effects on the incidence of sickness absence in a population of middle aged French employees over six years of follow up. Design: This study included 9631 men and 3595 women participating in the French GAZEL cohort. Social relations (social networks, personal social support, and social relations satisfaction) were measured in 1994 by self report. Psychosocial work characteristics (decision latitude, psychological demands, and social support at work) were ascertained in 1995. Sickness absence data were collected independently. The authors studied the incidence of short (>7 days), intermediate (7-21 days), and long (>21 days) spells of absence from 1995 to 31 December 2001. Rate ratios associated with psychosocial exposures, adjusted on sociodemographic characteristics, and health behaviours, were calculated by means of log-linear Poisson regression. Setting: A cohort of 20000 employees of France's national gas and electricity company (the GAZEL study). Main results: Among men and women, levels of decision latitude and personal social support below the median predicted 17% to 24% increases in absence rates. Low satisfaction with social relations and low social support at work lead to a 10% to 26% excess in sick leaves among men. No interactive effects were found between the variables under study.Conclusions: The quality of the work environment and of social relations affect sickness absence over an extended period of follow up. This study supports the hypothesis of independent, not interactive effects.S ickness absence, a general indicator of health status, 1 2 is a reflection of disease. On an individual level, it is also determined by an individual occupational status, 3 4 family circumstances, 5 and sociocultural characteristics. 6 Collectively sickness absence rates are associated with workplace organisation, [7][8][9] social policy (for example, sick leave benefits), 10 labour market characteristics, 11 and the local sickness absence culture.12 Sickness leave is also a socioeconomic indicator, relevant for employers. 13 While short spells are thought to be most affeced by social and occupational factors, long absences are reliable indicators of health status.
14Psychosocial work conditions predict the occurrence of cardiovascular 15 and musculoskeletal 16 17 disease, and are associated with sick leave independently of occupational status. In particular, controlling for professional grade, a lack of control over the content, and the execution of job related tasks, 11 12 18-20 high job demands, 12 17 and low social support at work 12 15 17 21 are directly related to more frequent sickness absence spells. According to the job strain and the iso-strain models, these factors exert interactive health effects; with regard to sickness absence this hypothesis is partly substantiated.12 The health impact of job stress factors may be mediated by psychological...