Abstract
Background: The influence of psychosocial factors on absence rates is incompletely understood; much research has been cross-sectional, involving a limited range of psychosocial variables. This paper reports a large prospective study of the relationship between psychosocial factors and absence rates due to low back pain across a multi-site UK pharmaceutical company.
Methods/Results: Baseline data were collected from 4,637 workers, and absence data over the ensuing 15 months were obtained from company records. In addition to demographic and historical variables, a wide range of psychosocial variables was included with a focus on occupational psychosocial factors, termed ‘blue flags’. Validated questionnaires were used to quantify job satisfaction, social support, attribution of cause, control over work, and organisation of work, with psychological distress as a ’yellow flag’. 176 workers took absence due to back pain during follow-up.
Previously defined cut-off scores were used to categorise hypothesised risk; scores beyond the cut-off point were considered detrimental, and the ‘flag’ was considered to be ‘flying’. Odds ratios (OR) were calculated to explore the association between the flags and taking sick leave; a statistically significant association was found with ORs between 1.5 and 2.9. The cut-off scores were then used to compare the length of absence between workers who had zero flags flying and those who had one or more flags flying. Absence over the ensuing 15 months was significantly longer for those people who had one or more flags flying (mean 10.6 days compared with 6.1 days, P< 0.05). There was a trend for longer absence with more flags flying.
Conclusion: This prospective study confirms the influence of blue, as well as yellow, psychosocial flags on both the taking of sick leave and the subsequent length of absence. This supports their hypothesised role as obstacles to recovery that might be suitable targets for occupational health interventions.
Correspondence should be addressed to the editorial secretary: Dr Charles Pither, c/o British Orthopaedic Society, Royal College of Surgeons, 35-43 Lincoln’s Inn Fields, London WC2A 3PN.
