Unequal access? Use of sickness absence benefits by precariously employed workers with common mental disorders: a register-based cohort study in Sweden

Hernando Rodríguez, Julio César, 1988-; Matilla Santander, Nuria; Murley, Chantelle; Blindow, Katrina; Kvart, Signild; Almroth, Melody; Kreshpaj, Bertina; Thern, Emelie; Badarin, Kathryn; Muntaner, Carles, 1957-; Gunn, Virginia; Padrosa Sayeras, Eva, 1993-; Julià, Mireia; Bodin, Theo

doi:http://dx.doi.org/10.1136/bmjopen-2023-072459

Unequal access? Use of sickness absence benefits by precariously employed workers with common mental disorders: a register-based cohort study in Sweden

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Hernando-Rodriguez JC, Matilla-Santander N, Murley C, Blindow K, Kvart S, Almroth M, et al. Unequal access? Use of sickness absence benefits by precariously employed workers with common mental disorders: a register-based cohort study in Sweden. BMJ Open. 2023 Jul 19;13(7):e072459. DOI: 10.1136/bmjopen-2023-072459

Abstract

Objective: This study compares the use of sickness absence benefits (SABs) due to a common mental disorder (CMD) between precariously employed and non-precariously employed workers with CMDs. Design: Register-based cohort study. Participants: The study included 78 215 Swedish workers aged 27-61 who experienced CMDs in 2017, indicated by a new treatment with selective serotonin reuptake inhibitors (SSRIs). Excluded were those who emigrated or immigrated, were self-employed, had an annual employment-based income <100 Swedish Krona, had >90 days of unemployment per year, had student status, had SABs due to CMDs during the exposure measurement (2016) and the two previous years, had an SSRI prescription 1 year or less before the start of the SSRI prescription in 2017, had packs of >100 pills of SSRI medication, had a disability pension before 2017, were not entitled to SABs due to CMDs in 2016, and had no information about the exposure. Outcome: The first incidence of SABs due to CMDs in 2017. Results: The use of SABs due to a CMD was slightly lower among precariously employed workers compared with those in standard employment (adjusted OR [aOR] 0.92, 95% CI 0.81 to 1.05). Particularly, women with three consecutive years in precarious employment had reduced SABs use (aOR 0.48, 95% CI 0.26 to 0.89), while men in precarious employment showed weaker evidence of association. Those in standard employment with high income also showed a lower use of SABs (aOR 0.74, 95% CI 0.67 to 0.81). Low unionisation and both low and high-income levels were associated with lower use of SABs, particularly among women. Conclusions: The study indicates that workers with CMDs in precarious employment may use SABs to a lower extent. Accordingly, there is a need for (1) guaranteeing access to SABs for people in precarious employment and/or (2) reducing involuntary forms of presenteeism.