Managers’ sick-leave recommendations - a video vignette study on common mental disorders

Abstract Background Sick leave due to common mental disorders (CMD) in Sweden is higher among women than men. Since the Swedish labor market is highly sex segregated a contributing factor might be managers’ attitudes towards CMD and sick leave. This video vignette study tests three hypotheses on managerś sex and recommendation for sick leave. The hypotheses are: (1) there is an association between negative attitudes towards CMDs and recommending sick leave, and (2) there is an association between educational level and recommending sick leave, and (3) there is an association between workplace factors and managerś recommendation of sick leave. Methods The study sample consisted of 2703 Swedish managers, female (34%) and male (66%). The online survey included a randomized female and male video vignette played by actors and specifically designed for the study. Associations were investigated by means of logistic regression. The covariates were attitudes towards depression, educational level, labor sector, size of company, proportion of women/men at the workplace, and sex of the person in the video vignette. Results The bi-variate crude analysis showed an OR of 1.28 (95% C.I. 1.08-1.51) for female vs. male managers’ recommendation of employee sick leave to the video vignette. Negative attitudes towards CMD did not add to the model, whereas educational level did, OR 1.34 (95% C.I. 1.13-1.59). The final, fully adjusted model showed an OR of 1.39 (95% C.I. 1.16-1.66) for female vs. male managers’ recommendation of employee sick leave. Conclusions The likelihood of a manager recommending sick leave after watching a CMD-labelled video vignette was slightly higher for female managers compared to male, and it remained in the final adjusted model. The results resonate with the registered sick leave and the sex segregation among managers and industries in the Swedish labor market. Key messages Female managers were slightly more likely to recommend sick leave to a video vignette case compared to male managers. Negative attitudes towards CMD were not associated with recommending sick leave.


Background:
Precarious and non-standard employment (NSE) has negative implications for workers' health. As part of a six-country comparative mixed methods case study, this research explores US-based workers' experiences in NSE and its influences on their health and well-being in a context of weak labor regulations and social welfare programs.

Methods:
To understand US policy context, we analyzed country-level labor regulatory and social protection frameworks using 2019 Organization for Economic Cooperation and Development data. To understand workers' experiences, we conducted indepth interviews with NSE workers in various occupations in New York City (N = 40) between January and May 2021. We recruited and screened eligibility via Facebook advertisements and an online questionnaire, respectively. We used deductive and inductive thematic analysis for interview data.

Results:
With heavy reliance on market competition in the US, minimal state regulation and flexible labor markets create less secure employment along with limited government-funded social supports. Workers' experiences center on the Hustle, i.e., figuring out how to make NSE work for them and their families. They lack healthcare coverage and have low expectations of other supportive employment and social protections (e.g., paid leave). While NSE payoffs (e.g., perceived flexibility) were common for most, almost all experience NSE tradeoffs (e.g., job insecurity and instability) that create stress and overwork, negatively implicating overall health and well-being. These impacts differ by access to resources associated with social location (e.g., immigration status). COVID-19 exacerbated these experiences. Discussion: Low expectations of supportive policies of US workers in NSE are linked to the individualized hustle, as they attempt to counter NSE tradeoffs often relying on family to fill those gaps. Over-reliance on privatization for social supports such as healthcare coverage can be detrimental to workers' health. Key messages: US workers in NSE experience stress and overwork with low expectations of support from the state. We caution against increasingly market-based policies in Europe, which may jeopardize public health.
managers' attitudes towards CMD and sick leave. This video vignette study tests three hypotheses on managerś sex and recommendation for sick leave. The hypotheses are: (1) there is an association between negative attitudes towards CMDs and recommending sick leave, and (2) there is an association between educational level and recommending sick leave, and (3) there is an association between workplace factors and managerś recommendation of sick leave.

Methods:
The study sample consisted of 2703 Swedish managers, female (34%) and male (66%). The online survey included a randomized female and male video vignette played by actors and specifically designed for the study. Associations were investigated by means of logistic regression. The covariates were attitudes towards depression, educational level, labor sector, size of company, proportion of women/men at the workplace, and sex of the person in the video vignette.

Results:
The bi-variate crude analysis showed an OR of 1.28 (95% C.I.

Methods:
In-depth interviews with 250 workers in NSE were analysed using a multiple-case study approach and using the welfare state typology as a macro-level framework.

Results:
Despite differences in welfare states, workers in all six countries experienced multiple forms of insecurity as well as relational tension with employers or clients, with clear negative effects on their well-being, in ways that were shaped by broader social inequalities (e.g., related to gender, age, and access to family support). Simultaneously, differences in welfare states were reflected in the level of workers' exclusion from social protections, the temporality of difficulties they faced in planning their lives (e.g., threats to daily survival or to longer-term life planning), and their ability to derive control from NSE despite the insecurity it created. Workers in less generous welfare states experienced heightened insecurity and greater stress from the COVID-19, but the severity of the health and economic crisis was felt by workers in all study countries.

Conclusions:
This study sheds light on the ways that welfare regimes can support -or fail to support -workers in NSE, and suggests the need in all six countries for stronger state responses to NSE, a pressing social determinant of health. Key messages: Employment insecurity is a central dimension of the experience of non-standard employment across the six countries. Differences in state approaches to labour market regulation and social welfare influence how non-standard workers experience insecurities.
Abstract citation ID: ckac130.127 Sickness absence due to common mental disorders among precarious and non-precarious workers

Background:
Mental health disorders have become one of the leading diagnoses causing sickness absence. Previous studies have examined the impact of single employment characteristics or working conditions on sickness absence. However, few studies have investigated the effect of a multidimensional construct of precarious employment on sickness absence. Therefore, this study aims to describe sickness absence due to common mental disorders (CMD) as a proxy for access to social security benefits among precarious and non-precarious workers with mental health problems.

Methods:
Cohort register-based study of the total Swedish population aged 27 to 61 years residing in Sweden in 2016 and having mental health problems defined as being prescribed Selective Serotonin Reuptake Inhibitors (SSRI) in 2017 (N = 19,691). Individuals were classified as precariously employed or not based on a precarious employment score measured multidimensionally in 2016 (i.e., employment insecurity, income inadequacy, and lack of social protection). The outcome was