Academic journal article Scandinavian Journal of Work, Environment & Health

Adult Social Position and Sick Leave: The Mediating Effect of Physical Workload

Academic journal article Scandinavian Journal of Work, Environment & Health

Adult Social Position and Sick Leave: The Mediating Effect of Physical Workload

Article excerpt

Sick leave is considered a measure of overall health (1) and is a predictor of mortality (2) among the working population. A persistent finding is that people with lower adult social position have higher levels of sick leave (3), and several longitudinal studies have suggested that working conditions could in part explain this link (4-10). Aspects of the working environment that have been identified as potentially harmful include psychosocial factors (4, 5, 7, 9, 10) and physical workload (5-10), with the latter appearing to be the most important factor explaining the social gradient (7, 9, 10). Despite the consistent pattern of these findings, the pathway linking adult social position to sick leave through physical working conditions has not been clearly elucidated from a causal standpoint (11, 12).

Figure 1 presents the underlying causal diagram representing the relation between adult social position, physical workload, and sick leave. A causal pathway from adult social position to sick leave, via work, is compatible with the aforementioned findings. However, according to the indirect selection hypothesis (13), selection into adult social position is not random; the same early-life-course factors that are driving people into lower adult social positions could also be driving them into jobs with higher physical workload, placing them at increased risk for sick leave. The link between adult social position and sick leave, and the mediating pathway of physical working conditions, could therefore in part be confounded by the contribution of early-life-course factors, and studies that do not control for these will be biased (11, 14). With the exception of the study by North et al (4), who considered the father's social class when examining the mediating effects of psychosocial work characteristics, none of the previous studies considered the role of early-life-course factors in the analyses.

We consider two early-life-course factors: childhood and adolescent social position and the personality trait "neuroticism". The rationale for considering these factors is drawn from two bodies of literature. The first is evidence from epidemiology showing that childhood and adolescent social position directly influences educational attainment (15) while also directly and independently influencing health outcomes, including morbidity (16) and work disability (17, 18). Childhood and adolescent social position could therefore be driving individuals into both lower adult social position and poor health, thereby confounding the relation between adult social position and sick leave. In addition, childhood and adolescent social position has an effect on occupational choice (19), and consequently the level of physical workload associated with a given occupation. Childhood and adolescent social position could thus also confound the indirect pathway from adult social position to sick leave, both by confounding the pathway between adult social position and physical workload, and between physical workload and sick leave.

The second body of evidence is based on findings rooted in personality psychology. Neuroticism-a personality trait characterized by negative emotions in response to threat, frustration, or loss (20)-has been an area of wide interest in the work environment literature (21). Individuals high on neuroticism tend to report more adverse working conditions (21), including higher physical workload (22), and there has been a concern that this reporting pattern is the result of a bias, as opposed to an objective categorization of the work environment (21). At the same time, neuroticism has a well-established link with overall health (23) and sick leave (24), as such, the pathway from physical workload to sick leave could be confounded by neuroticism, as shown in figure 1. Personality has also received some attention as a possible factor driving selection both into lower educational attainment and poor health outcomes (25) and mortality (26). …

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