2012. Vol.3, No.4, 315-321
Published Online April 2012 in SciRes (
Copyright © 2012 SciRes. 315
Social Causes to Sickness Absence among Men and
Women with Mental Illnesses
Kari Batt-Rawden1, Gunnar Tellnes2
1Eastern Norway Research Institute, (Østlandsforskning), Lillehammer, Norway
2Institute of Health and Society, University of Oslo, Oslo, Norway
Email: kbr@ ostf
Received January 10th, 2012; revised February 14th, 2012; accepted March 15th, 2012
Introduction: The mental ill-health diagnoses seem to be increasing in Europe and there are global trends
towards increasing stress and ill-health at work. In order to understand the social situation for the sickness
absentees it is important to consider how identities and relationships are formed in interaction with other
people. Aims: 1) To reveal the absentees own perceptions and experiences of being on sick leave; 2) To
understand and uncover the absentees’ own views of the causes of their illnesses. Methods: This study
takes an exploratory approach, examining an area where there has been little data and building upon work
that has focused on sickness absence as a phenomenon. It attempted to do so through a pragmatic synthe-
sis of elements of ethnography and grounded theory. The main study concentrates on two main groups of
diagnoses: musculoskeletal and mental problems. A sample of 30 persons on sickness absence was se-
lected from the county of Oppland, Norway. 14 were diagnosed with musculoskeletal problems and 16
with mental illnesses. This paper deals with one main group; mental illnesses. Seven men and nine
women from the county of Oppland, Norway were diagnosed with mental illnesses in accordance with the
ICD-10 medical classification system (n = 16). Results: Women experience family burdens and caring
responsibilities as social factors to their sickness absence, often due to a lack of support and constant bur-
den from both work and home. Men experience stress and conflicts at work, mostly from the leadership
and its organizational structure. Conclusion: A holistic approach that considers the whole life situation
must also be considered in order to understand gender differences in sickness absence. Furthermore, to
investigate what can be done to reduce long-term sickness absence that is not caused by traditional so-
matic or severe psychological disorders.
Keywords: Mental Illness; Health; Social Causes; Sickness Absence; Coping; Burden; Stress
Background and Current Research on Sickness
Absence Due to Mental Diagnoses
The mental ill-health diagnoses seem to be increasing in
Europe (Järvisalo et al. 2005), and there are global trends to-
wards increasing stress and ill-health at work (Dollard et al.,
2007). Grey cases often arise from a long-lasting negative sub-
jective experience, like pain, in which the medical profession
has been unable to identify an underlying physical and/or
pathological cause (Nordby, Rønning, & Tellnes, 2011). There
is considerable research on the relationship between the psy-
cho-social conditions in working life in general and sickness
absence in particular. In their survey of research on the effect of
working conditions on mental ill health and sickness absence,
Michi and Williams (2003) have found that demands such as
long hours, excessive work under pressure, lack of opportuni-
ties to influence one’s work situation, and poor support from
managers were critical. Their results support the extensive re-
search showing that demanding psycho-social working condi-
tions in combination with few chances to determine how and
when to work exacerbate stress, resulting in negative cones-
quences for employees’ health (Karasek & Theorell, 1990).
Michie and William’s survey also confirms previous research
that has emphasized the importance of social support, which
has shown that rewarding great efforts poorly is deleterious
(Siegrist, 1996). It is also a well-known fact that extensive or-
ganisational changes can, in certain circumstances, induce
stress-related illnesses. One study from Finland, for example,
has found that individuals who have recently been exposed to
cutbacks and reorganization show symptoms of burnout (Ka-
limo, 2000). A Swedish study has also found that the risk of
burnout was twice as great among those who had been exposed
to organizational changes in the previous year than among those
who had not (Hallsten, 2005). The organization of work is not
the only important factor for employees’ health; the quality of
social relations is also significant for the occurrence of mental
ill-health. Problems or worries at home or in the family have
been reported as contributory factors resulting in sickness certi-
fication by 12% of the patients, and problems/worries during
leisure time by 7% (Tellnes, 1990). Almberg et al., (2000) have
found that the feeling of not being involved in major decisions
has a negative effect on the mental health of care-giving rela-
tives. Other expressions of exclusion, such as being frozen out,
belittled or having low social status, relate also to mental
ill-health (Billeter-Koponen & Fredén, 2005; Lindberg et al.,
2006). A recent study by Eriksson et al. (2009) has suggested
that the course of events leading to sickness absence due to
burnout might be understood as a process of emotional depriva-
tion, where the individual is gradually emptied of the life-giv-
ing emotional energy that is expressed as joy, commitment, and
empathy. The process began in connection with unresolved
conflicts, which arose as a result of radical organizational
changes that have continued to escalate (Eriksson, Starrin, &
Janson, 2008). There are, then, various models at the communal,
organizational, and individual levels that help to explain the
contributory factors of mental ill-health.
In order to understand the social situation for the sickness
absentees it is important to consider how identities are formed
in interaction with other people. We know from the literature
that the label of mental illness is linked to an array of negative
stereotypical traits and that people with a mental diagnosis run
the risk of being stigmatized (Corrigan & Lundin, 2001; Scheff,
1966). One distinguishing feature, considered to be stigmatiz-
ing, is that these groups are particularly subjected to shaming in
the form of humiliation, belittling, and condescending and pa-
tronising treatment. Many people would regard them as being
of lesser value. Having been condescended seems to be strongly
associated with long-term sickness absence with a mental di-
agnosis (Engstrøm & Eriksson, 2011). People with mental ill-
ness suffer the most from stigma. Stigma robs people of their
rightful life opportunities, such as employment and housing. In
a study of the relations between social loss, humiliation, and
depression, show that humiliation seems to be as significant a
factor in explaining depression as social loss. Further, these
factors taken together constitute a tangible risk for severe de-
pression. Still other studies show that the experience of sham-
ing in the form of humiliation is a significant cause of depress-
sion (Brown, Tillis, & Hepworth, 1995) and that shaming co-
varies with mental ill-health among those on social assistance
(Starrin, Kalander, Blomqvist, & Janson, 2003) and the unem-
ployed (Starrin & Jönsson, 2006; Rantakeisu, Starrin, & Hag-
quist, 1999). Moreover, in order to understand the nature of
sickness absence, we need research with different perspectives
and a focus on the different sides of the phenomenon. Recent
research also shows how nature-culture experiences, including
a salutogenic perspective, may help people with long term
illnesses to construct experienced life meaning, identify coping
mechanisms and strengthen the self (Batt-Rawden & Tellnes,
2010, 2011).
Aims of the Study
The purpose of our project is to focus on and to discuss how
social factors influence sickness absence. Our study concen-
trates on two main groups of diagnoses: musculoskeletal and
mental health problems. Our approach is concentrating on in-
dividual attitudes and understandings and how they are created
in social interaction. We are also concerned with how men and
women understand and interpret their situation differently. Of
special interest to this study are the attitudes to different kinds
of mental diagnoses. Moreover, to reveal the absentees own
perceptions and experiences of being on sickness absence with
mental diagnoses.
Methodological Approach
This study takes an exploratory approach, examining an area
where there has been little data and building upon work that has
focused on sickness absence as a phenomenon. To realize the
objectives described in the previous section, this exploratory
study sought to elicit informants’ life stories and to instigate
narratives about the role of being long term ill. It attempted to
do so through a pragmatic synthesis of elements of ethnography
and grounded theory. The ethnographic interview is one strat-
egy for getting people to talk about what they know and this
study was ethnographic insofar as it sought to document the
informants’ own meanings derived from and applied to illness
and sickness absence. Moreover, to set these meanings in the
contexts of the informants’ lived experience (Hammersly &
Atkinson, 2000; Ritchie & Lewis, 2003).
Inspired by grounded theory, the research questions at-
tempted to explore and describe social processes of illness and
health as they emerged from the ethnographic data (Glaser
1978; Starrin, Dahlgren, Larsson, & Styrborn 1997). The in-
ductive nature of grounded theory methods assumes an open,
flexible approach, shaping methodological strategies while en-
gaged in the research, rather than having them planned before
beginning the data collection. Grounded theory seems to be the
approach most suited to the study of informants’ own meanings
and practices by using an open-ended interview guide. This
notion of flexibility is important to let themes emerge from the
informants’ own accounts (Charmaz, 2003). Recurrent themes
can be described as themes that both occur several times within
one participant and/or among the sample as a whole. The first
major analytic phase of the research consisted of coding the
data through open coding in order to identify descriptions of
thoughts and ideas related to the interview questions. To gener-
ate categories and subcategories, “focused” coding was used to
compare between incidents, contexts and situations, and con-
nections between incidents, situation and categories were ex-
Recruiting and Selecting a Convenient Sample
The interviewees were selected from the Norwegian Labour
and Welfare Administration [NAV] in Norway, following the
inclusion criteria: an employed woman or man between 20 and
50 + (from two generations) who has an ongoing sickness ab-
sence period exceeding 31 days or a currently expired period,
with a mental or a musculoskeletal diagnosis in accordance
with the ICD-10 medical classification system. The sample was
selected from the county of Oppland, and 30 Norwegians (20
women and 10 men) made contact with the researchers through
phone or e-mail before the interviews were conducted. By
sending information letters to pote ntial informants, describing the
study and the researcher’s names, emails and phone numbers, it
was up to the informants themselves to initiate the first contact
with the researchers, thus the willingness and motivation from
the informants to dedicate time and effort to the study can be
described as a conve nience sample (Charmaz, 2003).
The informants were distributed as follows: Two men were
in their thirties, five men in their forties and three men were in
their fifties. Among the women seven were in their fifties, and
eight in their forties. Three women were in their thirties and
two were in their twenties. Out of the total sample (n = 30)
seven men and nine women were diagnosed with mental ill-
nesses; hence depression and anxiety or burn out (n = 16) and
presented in this paper. Before the interviews, all participants
were informed about full confidentiality and about their right to
break off participa tion at any time. The parti cipants were asked
to sign an informed consent document. The interviews lasted
for about one to two hours per informant, audio-taped and tran-
Copyright © 2012 SciRes.
scribed verbatim.
Recurrent patterns and tendencies showed how men and
women’s mental illnesses were substantiated in complex, prob-
lematic and complicated relationships over time. However there
seems to be a clear pattern: Women experience family burdens
and caring responsibilities as social factors to their sickness
absence, often due to a lack of support and constant burden
from both work and home. Men experience stress and conflicts
at work, mostly from the leadership and its organizational
structure. Opposed to women, men describe seldom problems
with caring responsibilities or family burdens.
Social Factors among Women Leading to Illness—
Family Burdens and Strains
All women in this study describe their stories of being ill as
slightly more complex and long-lasting then men, sometimes
grounded in a complicated and conflict ridden upbringing. This
might be due to drug abuse, violence, high level of relational
conflicts, lack of recognition and neglicance during childhood.
A female informant (age 39) describes how she felt a sudden
burn-out and how her illness progressed highly unexpectedely.
She elaborates her problems as caused by an authoritative
grandfather during her upbringing: It came very sudden, I felt I
hit the wall, and I couldnt manage to go to work, and this
came as a schock, and then the feeling of shame. The reasons
behind my depression, I think, is due to my grandfather who
was very authoritative, and he is the cause of my lack of self-
confidence and self efficacy. It was so scary being so ill, like a
big gap.
It looks as if women who has been exposed to relational pro-
blems and conflicts, quite often has experinced mental health
problems and illnesses over time. These life events seem to
have effected ways to master the challenges and burdens in
daily life. One female (age 60) believes her mental illness is
substatiated in her relationship with her mother, one that was
full of criticism and negative comments, and few postive and
constructive feedbacks on herself. Her self-confidence and self
efficacy was destroyed by being constant criticised. I have
always been a kind of clever girl, and I have always had this
internal pressure in me to cope with challenges and strains in
everyday life, and as a young girl I did not have any postitve
feedback or reassurance from my family from what I did or
achieved, and that ruined my self-confidence...
Additionally, some of these women have had various per-
sonal crisis due to their childrens severe illnesses, drug pro-
blems and sexual harassment. A female informant (age 54)
describes her mental illness as related to a traumatic divorce,
thus her story of being ill relates back to a long lasting internal
pressure of a dysfunctional and pathological marriage. Two of
three children were also affected by the instability and dishar-
mony in the familiy whom had developed mental and somatic
problems. She also had an ongoing and unresolved conflict at
work at the time of the interview. It was a very difficult
marriage, and he punished my daughter when I left him,
causing her to be totally exhausted, and then she became ill,
and I have a son who has had mental health problems since he
was young, and he blames his father for being the cause of it.
Another woman (age 53) had a daughter who was a heroin
addict, and a cohabit who also had a son who had drug prob-
lems and died of an overdose. She describes how she exper-
inced her role in the family and her effort to knit a problematic
famliy life together as unsuccessful, neglecting her own needs.
She managed to keep her job whilst the family had the toughest
time. However, today she is diagnosed with a depression due to
familiy burdens and strains over a long period in her life:
Someone had to knit or hold the family togehter, so I did not
take any heed to my self nor did I listen to my body telling me I
ought to take a long break, I only headed on in full spate. Sara
(age 40) claims that her depression is clearly related to the fact
that her daughter was sexually abused for several years by a
close friend. She realized she could neither cope with her caring
responsibilities nor manage to take care of herself. Being di-
vorced from her husband with whom the children had sparsley
contact with, she had a severe break down followed by being
diagnosed with depression: I feel a lack of energy, I am slee-
pless and I feel I am on call all the time.
Social Processes among Men Leading to Illness—
Work and Stress
In recent years some employees have met new challenges at
work, substantiated in organizational and structural changes,
pressuring people to produce and be more effective in shorter
time. For many men in this study a high tempo job with less
control and flexibility combined with an effort to meet the rapid
changing working climate, several of the male informants feel
an increase in stress levels. Through the demands of work in-
corporating new technologies, new tasks and insecure jobs,
some work places seem to instigate procesess that may lead to
burn out and sickness abcence. One male informant (age 57)
describes his job as one that he gradually became alienated
from. With new owners he felt his work effort was surplused,
and not appreciated and worthy. In 2008 we had to reduce our
staff, and the owners seemed further and further away from us.
Its only the money that counts... since the new leadership took
over we have heard that they really dont want us. We are too
many, they say... You really feel that you are not worthty
anything, we are only a huge cost...
Several male informants tell stories of how strong and inhu-
man pressure at work can lead to conflicts between the leader-
ship and the employees. A male informant (age 42) who has
worked at the same company for many years, observed how the
staff were reduced and how employees felt difficulties in cop-
ing with the ongoing changing realities at work: Quite often we
read in the newspaper about changes at our work before we are
informed about cutbacks in staff. We always get negative cri-
ticism and feedback from the leadership, and they always pin-
point on how we all should achieve better, be more productive
and earn more money for the company like machines we are...
Strong pressure at work may lead to lack of motivation for
work, and along with a neagtive spiral of deteriorating pro-
cesses, the employees run the risk of being long-term ill. These
negative, social processes at work seem to be followed by in-
difference, bad perfomance, lack of motivation, satisfaction, fa-
tigue and apathy by the employees. These elements are illus-
trated through this voice (age 59):
I remember so well the day before I went on sickness ab-
sence... I had some relatives visiting and we were going to have
a nice week-end, and I felt so tired and deflated, and during the
night I said to myself, that this cant go on... I realised my lim-
Copyright © 2012 SciRes. 317
If a leader does not follow up an employee who has devel-
oped health problems due to psycho-sosical factors at work, this
may lead to an extended period of sickness absence and possi-
bly a signing up; After I had been on sickness absence for a
long time, I felt that the cup was full and I had to resign...
Methodological Considerations and Limitations
The research data needs to be set in context. It was collected
from the population of a mid-eastern region of Norway com-
prising the county of Oppland. In line with a qualitative ap-
proach, any conclusions drawn from the sample cannot be gen-
eralised to the population as a whole, though through a series of
similar studies more general conclusions may well emerge. In
this sense, this sample is a convenience sample which is not
statistically representative; nevertheless, some tentative general
conclusions may be proposed. It may be difficult to assess why
it seemed so difficult to recruit a convenient sample. One rea-
son may be because potential informants were too ill to partici-
pate in the study. The invitation letter also included a request to
sign a written consent which was voluntarily. Moreover, people
who are ill may refuse to join the study due to lack of energy,
motivation or personal reasons.
Validity and Reliability
Qualitative researchers vary considerably in their attitudes to
the issue of the “representativeness” of their material and are
sometimes accused of failing to satisfactorily demonstrate the
reliability and objective validity of their data and findings
(Charmaz, 2003; Hallberg, 2002). In qualitative research reli-
ability and validity are discussed in terms of “adequacy of evi-
dence” and “trustworthiness”. Reliability or “adequacy of evi-
dence” is reached when similar relationships between phenom-
ena or themes frequently emerge from the data. Validation or
trustworthiness of the developing theory is based on constant
comparison. From this viewpoint, the rationale of this approach
is to fully exploit one of the principal merits of qualitative
meaning in depth and in and through different life phases,
events and situations, here illustrated through the informants
own voices. It seemed as if all of them had an agenda, a life
story to tell. The fact that each participant was only interviewed
once might have contributed to minor trust and confidence be-
tween participants and researcher. Another aspect of one-off
interview is the inability to check certain accounts or repeat
questions, helping to clarify and identify emerging and recur-
rent themes, issues and topics. However, the impression was
that the informant’s beliefs and opinions were genuine and real,
though their verbalism did vary (Hammersley & Atkinson,
2000; Thagaard, 200; Ritchie & Lewis, 2003; Smith, 2003).
In qualitative studies it is important to reflect upon and con-
sider the role of the researcher: i.e. the researcher’s gender, age
and personal characteristics have been taken into account
(Smith, Dennis, & Johnson, 1997; Schensul, Schensul, & Le-
Compte, 1999). The informants were also able to choose time
and place of the interviews, and this flexibility seemed to be
very well received. The interviews were held in private homes,
cafes’, libraries and at a research office. It was however in-
teresting to detect that there seemed to be no particular connec-
tion between verbal flow of communication and place of inter-
Deteriorati n g Mental Heal t h Pr o ces se s among
The women in this study claim to have insight and personal
opinions considering the development of their own illnesses. It
seems to be a general pattern as to how these women have a
lack of positive criticism, affirmation and acknowledgement in
their upbringing. Combined with authoritative and dominant
persons in their social network who may have had a negative
impact on their self-esteem, self-confidence and self-efficacy,
these factors may have been vital for developing their mental
health illnesses. Moreover, problematic life events and caring
responsibilities along with low support from relatives, seem to
have left some of the women alone with family tasks and bur-
dens. Previous research also show much higher odds ratios for
women working in high strain jobs, as compared to men with
similar working conditions and requires further discussion A
possible explanation; the combined impact of domestic respon-
sibilities and job strain, the so-called double exposure (Eng-
strøm & Eriksson, 2011). For example, Swedish women carry
out about two thirds of all unpaid work related to the home
(Krantz & Östergren, 2001). In the case of a woman working in
a high strain job, this double exposure could have an added
impact on a declining health and, by extension, sickness ab-
sence. Another recent study on sickness absence among em-
ployees in a nursing home in Norway also illustrates how work
overload seems to be the dominant reason for sickness absence,
though, for some, a problem in the private sphere was the de-
termining factor. The role of being certified as sick influenced
the participants’ identity and made them vulnerable to being
stigmatized (Batt-Rawden & Solheim, 2011). Negative stress
occurs when there is incongruence between the external de-
mands and the individuals’ needs and abilities. Our study sup-
ports previous findings (Batt-Rawden & Solheim, 2011; Batt-
Rawden & Tellnes, 2005), highlighting how a complicated
work and life situation decreases individuals’ health. In this
sense, illness is a disruption not only of structures of explana-
tion and meaning for these participants, but also of the mainte-
nance of normal relationships and the mobilization of resources.
This notion of a total life burden perception includes a tradi-
tional division of labor in the family, leaving women with little
or no social or practical support. Despite equality in sex roles in
recent years, it still seems that men and women execute tradi-
tional tasks in the family. In other words, for women it seems to
be the total work burden that results in sickness absence. If
women are left with an overall responsibility for family mem-
ber’s health and well-being, they neglect their own health and
well-being to such an extent that they become ill. From this
perspective, family relational conflicts may affect women’s
health more than men, since men did not proclaim these issues
in this study. Accordingly, sometimes conflicts at work along
with family conflicts can be too much to handle for some
women. Recent studies also show how the family situation
proved important, hence indicating that family conditions like
cohabitation and the presence of children might add to the
workload and stress experienced by employees (Lidwall, 2010;
Johansen & Rønning, 2011). Problematic life events including
family members’ serious illnesses also seem to put womens’
health at risk, making women less capable of handling and
Copyright © 2012 SciRes.
coping with the challenges in everyday life. Illness among fam-
ily members have been reported by 41% of patients to worsen
mental health problems in general practice (Tellnes, Fugelli, &
Bjørndal, 1987). It also seems that many of the women has
been socialized into a typical “clever-girl”-syndrome; that is a
lack of putting down limits and always be available for other
peoples wants and needs. Neglecting their own needs seem to
prevent them from the possibility to refuel their energy levels.
By using their resources to fulfill social expectations and de-
mands from significant others, inherent in a traditional view of
a woman’s role, they ask for help too late.
Deteriorati n g Mental Heal t h Pr o ces se s among Men
Most men in this sample have become ill due to work related
factors, although a couple of men refer to additional problems
due to sudden death in the family. However, it seems to be a
strenuous work, high stress levels, low control and little support
from the leadership or colleagues that lead to an ill health.
Feelings of disempowerment and alienation from important
decisions and discussions related to organizational and struc-
tural changes at work, seem to be the most important issue
raised here. It looks as if the leadership does not have strategies
to handle difficult organizational and structural changes at work,
it may leave the employees frustrated and incapable to act and
control their own job situation. It is well know that organiza-
tional changes at the workplace along with hierarchical leader-
ship and disempowerment of employees may lead to sickness
absence. A positive self-evaluation, and a positive evaluation
by others are strong motives for most people, and many people
go to great pains to protect, or enhance their self-worth (Sem-
mer et al., 2007). Moreover, threats to self-esteem, can play a
major role for experiencing stress (Lazarus, 1999) in line with
the men in this sample. Social support does play a prominent
role in occupational stress research (Semmer et al., 2007), and
as Kornhauser (1965) described a declining mental health of the
industrial worker, as one that are deprived of purpose and zest.
This notion may leave him with negative feelings about himself;
with anxieties, tensions a sense of looseness, emptiness and
futility. In this material these men seem to have lost a social
meaning in their job experiences, resulting in a lack of onto-
logical security (Giddens, 1991). In line with the Effort-Re-
ward-Imbalance model by Siegrist (2002) which show the im-
portance of rewards one receives for investing effort, this no-
tion seems to be unfolded in a gap between leadership and sen-
ior employees rooted in a lack of participation. Since job satis-
faction is strongly influenced by feeling appreciated (Semmer
et al., 2002), condescending comments from the leadership for
not being effective or productive enough, seems here to result
in sickness absence .
These factors are also in line with another study (Eriksson et
al., 2011) which revealed a number of critical phases and events
relating to the work environment faced by all the participants.
The authors describe events that contributed to an understand-
ing of the process leading to sickness absence. This process can
be described as a flight of stairs or the burnout staircase. Exten-
sive changes in the workplace form the first step in the burnout
staircase. The second step in the model is formed by insecure
social bonds fraught with conflict. Increased demands form step
three were noticeable both at work itself and in the relationships
in the workplace. This contradictory demand forms the fourth
step. The increased demands also made it more difficult to
maintain a high level of quality in social contacts. The new
expectations fraught with conflict produced emotional stress
and affected the participants’ trust in others and confidence in
themselves, which is the fifth step in the burnout staircase. In
step six, strong emotions and health problems became increas-
ingly obvious. The seventh step: This collapse, however, ex-
pressed itself in different forms. Several individuals described
dramatic collapses; some were able to identify triggering fac-
tors such as a confrontation at the workplace, while others
could not indicate any special event. Suddenly one day, things
just stopped. The body or brain ceased to function normally.
The collapse was the beginning of a long period of sickness
absence (step eight) (Ericsson et al., 2008). In this material
there are many similarities to the “flight of stairs”, for example
the men described how they gradually moved towards the edge
of an incident pit, sensing their situation as intolerable and un-
bearable. Being incapable of coping with the deteriorating
processes at work, sickness absence was the only option. In line
with previous research (Eriksson et al., 2011), they looked upon
the sickness absence—being ill—as a failure, as something
shameful. Some accused themselves for getting sick and had a
bad conscience of having left their job (Suominen & Lindstrøm,
2008). A burnout might be understood as a process of emo-
tional deprivation, whereby the individual is gradually emptied
of the life-giving emotional energy that is expressed as joy,
commitment, and empathy (Eriksson, 2009; Batt-Rawden, 2010).
Other studies also show a strong relationship between long-
term sickness absence and the psycho-social work environment
(Engstrøm & Eriksson, 2011). Associations between sickness
absence and the psycho-social work environment are also theo-
retically illustrated by the demand-control model (Karasek &
Theorell, 1990), and fair organizational and managerial proce-
dures may buffer the negative effects of psychosocial health
risks outside work (Elovainio et al., 2010). Previous studies
also suggest that long-term sickness absence increases the risk
of adverse economic and social conditions among individuals
(Bryngelson, 2009).
Combined with discussion of sickness absence as a pheno-
menon, we believe our findings can contribute to a wider un-
derstanding of sickness absence, the complexity behind the out-
break of long-term illnesses and ways of coping in everyday
life. From our perspective in this study and previous research,
factors explaining the gender divide and patterns ought to be
explored more fully. Health problems are connected to the
whole person, and it may be difficult to determine the contribu-
tion of different parts in this study. A holistic approach that
considers the whole life situation must also be considered in
order to understand gender differences in sickness absence.
Furthermore, to investigate what can be done to reduce long-
term sickness absence that is not caused by traditional somatic
or severe psychological disorders.
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