Exposure to psychosocial stress at work may be linked with increased risk of sickness absence (SA) due to a diagnosed mental health disorder, according to a systematic review and meta-analysis published in JAMA Psychiatry.

Mental health disorders are associated with reduced work capacity and productivity, whereas psychosocial stress is associated with an increased risk of mental health disorders. The importance of workplace psychosocial stress should be considered when evaluating patient’s mental health and work capacity.

The study focused on 3 recognized theoretical models for workplace psychosocial stress. First, the job-demand-control-support (JDCS) model identifies high psychological demands, low job control, and scant workplace support as causes for job strain, thus creating psychosocial stress. In the effort-reward imbalance (ERI) model, high effort and low reward lead to psychosocial stress. Lastly, the organizational justice model attributes perceived injustice and fairness in rules and social norms to stress.

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The researchers conducted a meta-analysis of 13 original prospective studies (N=130,056 working adults) that evaluated at least 1 stressor identified by the 3 models and SA due to a diagnosed mental health disorder. Participants exposed to these stressors were compared to nonexposed controls from the same study population. The samples were followed for 6 months to 12 years, and SA generally ranged from 1 to 90 days, including disability pension. The majority of the studies were conducted in either Europe or Canada, with 2 from Japan.

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Of the psychosocial stressors identified by the 3 models, low reward was associated with the highest risk for SA due to a mental disorder (pooled risk ratio [RR], 1.76; 95% CI, 1.49-2.08). Increased risk for SA due to a mental disorder was also correlated with effort-reward imbalance (pooled RR, 1.66; 95% CI, 1.37-2.00), job strain (pooled RR, 1.47; 95% CI, 1.24-1.74), low job control (pooled RR; 1.25; 95% CI, 1.02-1.53), and high psychological demands (pooled RR, 1.23; 95% CI, 1.04-1.45).

Limitations of the meta-analysis included high heterogeneity between studies. However, no major differences were identified in the sensitivity analyses. Selection bias might be a limiting factor, although this bias would likely create an underestimation of the true associations, according to the investigators.

The researchers concluded that “efforts should be made by employers and public health decision makers, with the support of physicians, to develop organizational policies supporting workplaces in reducing these psychosocial stressors at work and, therefore, reducing the risk of mental disorders among workers.”


Duchaine CS, Aubé K, Gilbert-Ouimet M, et al. Psychosocial stressors at work and the risk of sickness absence due to a diagnosed mental disorder: a systematic review and meta-analysis [published online ahead of print, 2020 Apr 1]. JAMA Psychiatry. 2020;e200322.