213Original article Scand J Work Environ Health. 2011;37(3):213-218. doi:10.5271/sjweh.3131 Different domains of health functioning as predictors of sickness absencea prospective cohort study by Mikko Laaksonen, PhD,1 PhD, MD, PhD, 2 Eero Lahelma, PhD 1 Laaksonen M, Kääriä S-M, Leino-Arjas P, Lahelma E. Different domains of health functioning as predictors of sickness absence -a prospective cohort study. Scand J Work Environ Health. 2011;37(3):213-218. doi:10.5271/sjweh.3131 Objectives The aim of this study was to examine different domains of health functioning as predictors of sickness absence.Methods The Short Form 36 (SF-36) is one of the best known instruments measuring various domains of physical and mental health functioning. A questionnaire including the SF-36 was mailed to 40-60-year-old employees of the City of Helsinki in 2000-2002. For the subsequent three years, sickness absence episodes >2 weeks were derived from the employer's register. The predictive ability of the eight subscales and two component summaries of the SF-36 were compared using regression methods and receiver operating characteristic (ROC) curve analysis.Results All eight SF-36 subscales and the two component summaries predicted the occurrence of sickness absence over the follow-up period. Among women, bodily pain was the strongest predictor, with 1 standard deviation increase in bodily pain increasing the occurrence of sickness absence by 77% [95% confidence interval (95% CI) 68-86%]. Role limitations due to emotional problems were the weakest predictor of sickness absence (29%, 95% CI 23-36%). Among men, the results were similar to those of women. In both genders, the area under the ROC curve was largest for bodily pain, general health, and physical functioning and lowest for mental health and role limitation due to emotional problems.
ConclusionsThe subscales measuring physical domains of functioning were more strongly associated with sickness absence than the mental subscales. In particular, ability to perform daily activities, pain, and general health were important predictors of sickness absence >2 weeks. Sickness absence has been increasingly used as an outcome in research on work and health. However, there is some debate about the nature and validity of sickness absence as a health measure. It has been argued that motivational factors and employee satisfaction play a decisive role in sickness absence behavior (1, 2), which is also affected by contextual factors at work (3, 4) and outside of work (5, 6). Previous studies examining associations between sickness absence and other health measures have shown that medically confirmed sickness absence predicts future disability retirement (7, 8) and mortality (9-11). In a UK study, medically confirmed sickness absence predicted mortality even better than well-established indicators of general health such as poor self-rated health or having a longstanding illness (12). The association with mortality has been observed for various causes of death (11, 13), and diagnostic inf...