Pain and mental health - separate and joint associations with sickness absence among young employees

Abstract Background Both pain and mental illness associate with work disability. However, few studies have examined the association of concurrent pain and mental distress with sickness absence (SA). We examined separate and joint associations of chronic pain, multisite pain, and mental distress with total and long-term all-cause SA among young and midlife municipal employees. Methods As part of the Young Helsinki Health study, baseline data were collected in 2017 from 19-39-year-old employees of the City of Helsinki, Finland. Chronic (≥3 months) pain, multisite (≥2 body sites) pain and mental distress (RAND-36 emotional wellbeing subscale below median) were reported by 3911 respondents. Register data on total (>1 day) and long-term ((>11 workdays) SA for the following year were obtained from the employer and the Social Insurance Institute of Finland with respondents’ informed consent. Negative binomial regression analyses were performed with sociodemographic, socioeconomic, and health-related factors as confounders. The interaction of gender was examined. Results Chronic pain, multisite pain, and mental distress were associated with total SA. Chronic multisite pain was associated with long-term SA (rate ratio [RR] 2.51, 95% CI 1.17-5.42), and chronic pain (RR 5.04, 95% CI 2.14-11.87) and multisite pain (RR 4.88, 95% CI 2.30-10.33) with long-term SA among those with mental distress. For women, there was a synergistic interaction of multisite pain to the association with total SA (synergy index 1.80, 95% CI 1.27-2.54). Conclusions Chronic and multisite pain associate with SA among young and midlife employees. The associations are generally stronger among women and particularly among those with concurrent mental distress. Interventional studies are needed to confirm if early symptom recognition and support could reduce sickness absence. Key messages • Chronic pain and pain at multiple body sites associate with sickness absence among young and midlife employees, particularly among women and those with concurrent mental distress. • Interventional studies are needed to confirm if sickness absence could be reduced by early recognizing pain and mental distress among employees and providing preventive and therapeutic services.

The starting point for this round table is the observation that the research areas of health systems, health services and population health are usually seen as separate academic specialisations.This hampers the potential for getting insights into the role of health care systems and service provision in the development of population health and health inequalities, and of policies to reduce inequalities.As a result of the different mix of disciplines, with different approaches, different research and publication cultures, and different funding sources health systems research, health services research and population health research have tended to grow apart and to ignore the results from the other areas.In this round table session we will discuss the ways health care systems and health service provision influence inequalities in health.This implies looking at different levels of analysis.Health care systems and inequalities in population health refer to the macro level, and both are influenced by the same political and societal context.Health inequalities are also (and more strongly) influenced by structures and processes at macro level outside the health care system and service provision.Health service professionals form the intermediate level; their actual service delivery takes place at the micro level where health care professionals and users meet.Health care professionals and users of services bring their own attitudes, beliefs and resources that influence their interaction and consequent outcomes.Both meso and micro level are influenced by structures and institutions, in society in general as well as in the design of the health care system.The results of the interactions between health care professionals and users are (e.g.) decisions whether or not to use certain types of care, with consequences for the health and functional abilities of users.These decisions and their consequences are patterned by socio-economic characteristics of care users.These aggregate into patterns of inequality at the macro level.Over time, the influence of health care on population health has increased.The responsibility of health care for upstream causes of health inequalities can be strengthened through deliberate policies.With the (long-term) change of morbidity from infectious disease to chronic disease, prevention is often moving to programmes to support people in changing their lifestyle.This in itself exposes the relationships between health care and health inequalities, as those interventions that require a contribution from individuals tend to increase inequalities since those lacking resources will find it harder to participate.In this round table we present a proposal to integrate the three fields of research.We invite specialists from each of these fields and the audience of the round table to react to our proposal.The aim of this round table is to promote cross-disciplinary collaboration.The two organizing EUPHA sections cover the three areas of research in focus.

Key messages:
The same political and societal context influences the health system, service provision and many of the social determinants of population health.
The potential to address health inequalities through health care may have increased, and requires specific attention to integration of social care and different parts of health care.

Background:
Unhealthy behaviours are associated with increased sickness absence (SA), but few studies have explored these associations using person-oriented approach.We aimed to identify latent classes of unhealthy behaviours among female and male employees and examined their associations with subsequent SA.

Methods:
Health behaviours (leisure-time physical activity, sedentary behaviour, fruit and vegetable [F&V] consumption, sleep, binge drinking, and use of tobacco products) were derived from the Helsinki Health Study questionnaire survey, collected in 2017 among 19-39-year-old employees of the City of Helsinki, Finland.The questionnaire data were linked to employer's SA register.Latent class analysis was used to identify underlying profiles of unhealthy behaviours and negative binomial regression was used to examine their associations with subsequent SA (7 days, >7 days, and all lengths) among 3228 women and 771 men.The mean followup time was 2.1 years.

Conclusions:
Preventive actions should consider simultaneously several unhealthy behaviours while aiming to reduce employees' SA.These actions might benefit from regarding potential gender differences in the clustering of unhealthy behaviours and their associations with SA.

Key messages:
Preventive actions to reduce sickness absence should consider clustering of unhealthy behaviours among employees.Potential gender differences need to be regarded in these actions.
Abstract citation ID: ckac129.312Work after cancer-sickness absence.Barriers and facilitators from survivors' perspective

Amaya Ayala
A Ayala 1,2,3 , L Serra 4 , D Rodriguez-Arjona 5 , FG Benavides People who have suffered from cancer find it difficult to return to work after a sickness absence (SA).Previous evidence indicates that people who survive a cancer have a higher risk than general population of leaving the labor market prematurely or being unemployed due to sequelae of both treatment and disease.Our objective is to identify barriers and facilitators associated with the return and permanence in the workplace of salaried workers after a SA due to cancer in Catalonia.The research used a descriptive qualitative approach with socioconstructivist perspective.A theoretical sampling was carried out until saturation.Three discussion groups (7 people/group) were conducted with people who had suffered a SA due to cancer in Catalonia.The sessions were held virtually and were recorded, transcribed verbatim, and analyzed using thematic analysis and mixed coding with Atlas.ti.Most of the people had returned to work after SA or were looking for a job that was suitable for their health status.Among the barriers to reincorporation to their job detected: (1) coping with the same workload they had before the SA, (2) sequelae associated with cancer treatment that affected their ability to work (stress, low ability to concentrate, chronic fatigue, mobility limitations), (3) having jobs with a high physical load, (4) expectations of colleagues and bosses.Among the facilitating factors: (1) sessions with psycho-oncologists, (2) availability of holidays to adapt their return after SA, (3) teleworking, and (4) job adaptation.Regarding proposals to improve this process, the most outstanding were the implementation of policies that allow a gradual return to work adjusted to the people who want to adhere to it and generalize the possibility of doing psycho-oncological therapy.End of SA after cancer is a key moment for people who go through it, they suffer many difficulties during the process that could be prevented with measures such as a gradual return to work.

Key messages:
Workers who suffer a SA due to cancer face difficulties on their return to work.Initiatives of adaptation and gradual reincorporation to the workplace could improve return to work process after a SA due to cancer.
15th European Public Health Conference 2022