Original article
Occupational burnout and medically certified sickness absence: A population-based study of Finnish employees

https://doi.org/10.1016/j.jpsychores.2007.06.022Get rights and content

Abstract

Objective

Occupational burnout is a common problem in working populations, but its association with sickness absence is poorly understood. The contribution of occupational burnout to medically certified sickness absence was examined in a population-based sample of employees.

Methods

A representative sample of 3151 Finnish employees aged 30–60 years participated in a comprehensive health study in 2000–2001, including an assessment of physician-diagnosed physical illnesses and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders based on the Composite International Diagnostic Interview. Burnout was measured with the Maslach Burnout Inventory—General Survey. Sickness absences longer than 9 days in 2000–2001 were extracted from a register of the Social Insurance Institution of Finland.

Results

The occurrence of medically certified sickness absence was more prevalent among employees with burnout than among those without burnout. After adjusting for sociodemographic factors and mental and physical disorders, the odds ratio of sickness absence for severe burnout was 6.9 [95% confidence interval (95% CI)=2.7–17.8] for men and 2.1 (95% CI=1.1–4.0) for women. Among employees with mental or physical disorders, severe burnout was associated with a 7.7-fold risk of sickness absence among men and with a 2.6-fold risk among women. The duration of absence was related to burnout among men with absences, for whom severe burnout accounted for 52 excess sickness absence days during the 2-year period after adjusting for sociodemographic factors, mental disorders, and physical illnesses.

Conclusions

Severe burnout is associated with a substantial excess risk of medically certified sickness absence among both men and women. This association is independent of prevalent mental disorders and physical illnesses.

Introduction

Burnout is a psychological outcome of chronic stress [1]. By definition, it refers to a state of exhaustion combined with cynicism towards the value of one's work and with diminished experience of professional efficacy [2]. The estimated prevalence of severe burnout, which has been found to be persistent in nature [3], varies between 2% and 7% in working populations [4], [5], [6].

Burnout is explained by high work demands and low resources at work, in combination with insufficient means of coping [4], [7]; these attributes are also the basic elements in theories of psychosocial stress [8]. Because psychosocial work characteristics are risk factors for sickness absence [9], [10], [11], [12], [13], the contribution of burnout to such absences could be substantial.

Among 4810 representatives of the Swedish working-age population, self-reported stress-related absences lasting at least 1 month were more common among those with burnout [5]. In prospective studies on specific occupational branches, burnout has been shown to be related to an increased number of self-certified sickness absence days and periods [14], company-registered absence duration [15], and medically certified periods of absence [16]. However, no population-based evidence on burnout and medically certified sickness absence is available.

Because burnout is associated with mental disorders [6], [17] and physical illnesses [18], these disorders and illnesses could explain associations between burnout and sickness absence. For example, depression and other mental disorders constitute a major economic burden to employers in terms of lost workdays and reduced productivity [19], [20], [21], [22], [23]. Absence from work due to mental disorders has increased in both the Unites States and European countries [24], [25], [26], [27], [28]. Because previous studies on burnout and sickness absence have not controlled for mental and physical disorders, the independent contribution of burnout to sickness absence remains unknown at the population level.

The aim of this study was to investigate the relationship between burnout and long (>9 days) register-based medically certified sickness absence in a representative population sample. In addition to sociodemographic factors, we controlled for co-occurring mental disorders and physical illnesses in the analyses to determine the independent burden of burnout in sickness absence.

Section snippets

Study population and procedure

A multidisciplinary epidemiological health survey, the Health 2000 Study, was carried out in 2000–2001 in Finland. The two-stage stratified cluster sample was representative of the Finnish population and included 8028 persons aged ≥30 years [29]. Five university hospital districts were used for stratification and sampling, each serving approximately 1 million inhabitants and differing in several features related to geography, economic structure, health services, and the sociodemographic

Results

The final study population of 3151 persons comprised 1579 men and 1572 women. The characteristics of the study population are described in Table 1. Among both men and women, 25% of the participants suffered from mild burnout. Severe burnout was present among 1.8% of men and among 2.9% of women. There was no statistical difference in the level of burnout between the sexes [χ2(2)=3.39, P=.1837]. As shown in Table 1, manual workers, unmarried men, and women aged >50 years reported symptoms of

Discussion

In our study of a population-based sample of Finnish employees, the risk of having a medically certified sickness absence lasting >9 workdays was higher for both men and women with burnout than for their colleagues who were free of burnout. Severe burnout was associated with sickness absence even after adjusting for mental disorders and physical illnesses among both sexes. In addition, among women, also mild burnout was independently associated with absences, while among men with absences,

Acknowledgments

Kirsi Ahola, Mika Kivimäki, and Jussi Vahtera were supported by the Academy of Finland (projects 105195 and 117604).

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