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Introduction
What this paper adds
Common mental disorders predict future sickness absence.
Less is known about whether the risk is greater for clinical as opposed to sub-clinical disorder or whether this association applies to both psychiatric absence and non-psychiatric absence.
Clinical but not sub-clinical common mental disorders predict long spells of psychiatric sickness absence in men but not in women.
Recent common mental disorders are associated with the highest risk of long spells of psychiatric sickness absence in men but not in women.
Common mental disorders do not predict long spells of non-psychiatric sickness absence.
Common mental disorders are associated with impairment of psychological, social and occupational functioning. 1-5 This has considerable economic impact, partly because common mental disorders also predict all-cause sickness absence, 6-12 psychiatric sickness absence 13 14 and disability pension costs. 15 Sickness absence is a meaningful health outcome for employers and the economy because of lost productivity. Common mental disorders make a substantial contribution to the burden of disease because of the numbers of people affected, 16.4% in a UK adult population survey. 16 In cross-sectional studies, dose-response relationships have been found between severity of psychiatric disorder and level of disability, 17 but there have been few prospective epidemiological studies. 18 There are also differences by gender and psychiatric diagnosis. Cumulative incidence of sickness absence tends to be higher in women than in men in keeping with higher rates of common mental disorders in women than in men. 19 20 By contrast, in some studies minor psychiatric morbidity, major depressive disorder, drug abuse/dependence, dysthymia and simple phobia are related to a greater risk of sickness absence in men than in women, 8 21 although other studies show equal risks of sickness absence associated with common mental disorders in men and women. 10 11 A meta-analysis showed a non-significantly decreased risk for psychosocial health and sickness absence in favour of women. 22 Chronically ill men are also more likely to take longer duration of sickness absence than women. 19-21
This study examines the association of common mental disorders and long spells of psychiatric and non-psychiatric sickness absence in the longitudinal Whitehall II Study of British Civil Servants. We test whether sub-threshold as well as clinically significant psychiatric morbidity are associated with increased...