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      Licencia médica psiquiátrica: revisión de los efectos positivos y negativos del reposo Translated title: Psychiatric sick leave

      review-article
      , ,
      Revista médica de Chile
      Sociedad Médica de Santiago
      Mental Health, Psychiatry, Sick Leave

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          Translated abstract

          There is no consensus amongst physicians, social security representatives and researchers about optimum sick leaves. This is an indication that should maximize positive outcomes and minimize potential side effects, both for the patient and society. The use of sick leaves during the last decade rose steadily, particularly in the psychiatric field. The most important causes of this increase are: changes in public policies, overuse of psychiatric diagnosis to cover up unmet social needs, and modifications to labour structure. It is analysed the impact that this situation has implied for physician patient relationship as well as for health budget. Even though sick leave diminishes presentism associated to a psychiatric disorder, published evidence about the effect of prolonged sick leave shows that damage overruns potential benefits: augmented morbidity and mortality, workplace phobia, economic loss, among others.

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          Most cited references39

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          Unemployment, job retention, and productivity loss among employees with depression.

          This study comprehensively assessed the work outcomes of employees with depression. We collected baseline and six-month follow-up survey data from 229 employees with depression and two employee comparison groups: a group of healthy patients for the control group (N=173) and a group with rheumatoid arthritis (N=87), a frequent source of work disability. Outcomes included new unemployment and, within the employed subgroup, job retention (versus job turnover), presenteeism (that is, diminished on-the-job performance and productivity), and absenteeism. At the six-month follow-up, persons with depression had more new unemployment--14 percent for persons in the dysthymia group, 12 percent for persons in the major depression group, and 15 percent for persons in the group with both dysthymia and major depression, compared with 2 percent for persons in the control group and 3 percent for persons in the rheumatoid arthritis group. Among participants who were still employed, those with depression had significantly more job turnover, presenteeism, and absenteeism. In addition to helping employees with depression obtain high-quality depression treatment, new interventions may be needed to help them to overcome the substantial job upheaval that this population experiences.
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            Sickness absence as a predictor of mortality among male and female employees.

            To determine the extent to which sickness absence is predictive of mortality. Prospective cohort study. Data on medically certified long term absences (>3 days), self certified short term absences (1-3 days), and sick days were derived from employers' records and data on mortality from the national mortality register. 10 towns in Finland. 12821 male and 28915 female Finnish municipal employees with a job contract of five consecutive years. The mean follow up was 4.5 years. After adjustment for age, occupational status, and type of employment contract, the overall mortality rate was 4.3 (95% confidence intervals 2.6 to 7.0) and 3.3 (2.1 to 5.3) times greater in men and women with more than one long term absences per year than in those with no absence. The corresponding hazard ratios for more than 15 annual sick days were 4.7 (2.3 to 9.6) and 3.7 (1.5 to 9.1). Both these measures of sickness absence were also predictive of deaths from cardiovascular disease, cancer, alcohol related causes, and suicide. Associations between short term sickness absences and mortality were weaker and changed to non-significant after adjustment for long term sickness absence. These findings suggest that measures of sickness absence, such as long term absence spells and sick days, are strong predictors of all cause mortality and mortality due to cardiovascular disease, cancer, alcohol related causes, and suicide.
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              Job stress, sickness absence and sickness presenteeism in Nordic elderly care.

              Nordic elderly care has been restructured to obtain more efficiency. Among workers caring for the elderly, levels of perceived job stress could vary, due to understaffing and resource scarcity. This study examines how sickness absence and sickness presenteeism are associated with perceived job stress. Data were obtained by posting questionnaires to lower-level care staff in Sweden (n=483), Denmark (n=704), Finland (n=597), and Norway (n=663). Self-reports about job stress (four items), sickness absence and sickness presenteeism were analysed by cross-tabulations and logistic regression. Each item of job stress was associated with sickness absence and sickness presenteeism in the samples from all four countries. With low levels of job stress, levels of reported sickness absence and sickness presenteeism were relatively moderate. With increasing levels of job stress, the level of sickness presenteeism rose more sharply than that of sickness absence. The results can be interpreted in the light of features inherent in care work. Owing to professional norms and moral obligations, care workers could lower their thresholds for taking sick leave when care organizations are understaffed, because absences will be particularly critical for care recipients in such circumstances. Thus, while increasing job stress tends to be accompanied both by more sickness absence and by more sickness presenteeism, sickness presenteeism rises particularly in cases of high levels of job stress. Owing to cross-sectional data and self-reported information, conclusions are tentative.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                rmc
                Revista médica de Chile
                Rev. méd. Chile
                Sociedad Médica de Santiago (Santiago, , Chile )
                0034-9887
                April 2018
                : 146
                : 4
                : 494-501
                Affiliations
                [1] Santiago Santiago de Chile orgnameUniversidad de Chile orgdiv1Facultad de Medicina orgdiv2Departamento de Psiquiatría y Salud Mental Oriente Chile
                [3] Santiago orgnameUnidad de Psiquiatría de Enlace Hospital Santiago Chile
                [2] Santiago orgnameCentro Comunitario de Salud Mental (COSAM) Chile
                Article
                S0034-98872018000400494
                10.4067/s0034-98872018000400494
                fca2e15c-e254-40c6-8425-7d70ad6262f9

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 06 February 2018
                : 11 July 2017
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 59, Pages: 8
                Product

                SciELO Chile


                Psychiatry,Mental Health,Sick Leave
                Psychiatry, Mental Health, Sick Leave

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