Open Access Highly Accessed Open Badges Research article

Work-related psychosocial events as triggers of sick leave - results from a Swedish case-crossover study

Hanna Hultin1*, Johan Hallqvist12, Kristina Alexanderson3, Gun Johansson4, Christina Lindholm3, Ingvar Lundberg5 and Jette Möller1

Author Affiliations

1 Karolinska Institutet, Department of Public Health Sciences, Division of Public Health Epidemiology, Norrbacka 7thfloor, SE-171 76 Stockholm, Sweden

2 Uppsala University, Department of Public Health and Caring Sciences, Division of Preventive Medicine, Box 564, SE-751 22 Uppsala, Sweden

3 Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine, SE-171 77 Stockholm, Sweden

4 Linköping University, National Centre for Work and Rehabilitation, Department of Medicine and Health Sciences, IMH/RAR, SE-581 83 Linköping, Sweden

5 Uppsala University, Department of Medical Sciences, Division of Occupational and Environmental Medicine, Uppsala University Hospital, SE-751 85, Uppsala, Sweden

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BMC Public Health 2011, 11:175  doi:10.1186/1471-2458-11-175

Published: 23 March 2011



Although illness is an important cause of sick leave, it has also been suggested that non-medical risk factors may influence this association. If such factors impact on the period of decision making, they should be considered as triggers. Yet, there is no empirical support available.

The aim was to investigate whether recent exposure to work-related psychosocial events can trigger the decision to report sick when ill.


A case-crossover design was applied to 546 sick-leave spells, extracted from a Swedish cohort of 1 430 employees with a 3-12 month follow-up of new sick-leave spells. Exposure in a case period corresponding to an induction period of one or two days was compared with exposure during control periods sampled from workdays during a two-week period prior to sick leave for the same individual. This was done according to the matched-pair interval and the usual frequency approaches. Results are presented as odds ratios (OR) with 95% confidence intervals (CI).


Most sick-leave spells happened in relation to acute, minor illnesses that substantially reduced work ability. The risk of taking sick leave was increased when individuals had recently been exposed to problems in their relationship with a superior (OR 3.63; CI 1.44-9.14) or colleagues (OR 4.68; CI 1.43-15.29). Individuals were also more inclined to report sick on days when they expected a very stressful work situation than on a day when they were not under such stress (OR 2.27; CI 1.40-3.70).


Exposure to problems in workplace relationships or a stressful work situation seems to be able to trigger reporting sick. Psychosocial work-environmental factors appear to have a short-term effect on individuals when deciding to report sick.