Objective To examine whether downsizing, the reduction of personnel in organisations, is a predictor of increased sickness absence and mortality among employees. Design Prospective cohort study over 7.5 years of employees grouped into categories on the basis of reductions of personnel in their occupation and workplace: no downsizing ( < 8% reduction), minor downsizing (8-18%), and major downsizing ( > 18%). Setting Four towns in Finland. Participants 5909 male and 16 521 female municipal employees, aged 19-62 years, who kept their jobs. Main outcome measures Annual sickness absence rate based on employers' records before and after downsizing by employment contract; all cause and cause specific mortality obtained from the national mortality register. Results Major downsizing was associated with an increase in sickness absence (P for trend < 0.001) in permanent employees but not in temporary employees. The extent of downsizing was also associated with cardiovascular deaths (P for trend < 0.01) but not with deaths from other causes. Cardiovascular mortality was 2.0 (95% confidence interval 1.0 to 3.9) times higher after major downsizing than after no downsizing. Splitting the follow up period into two halves showed a 5.1 (1.4 to 19.3) times increase in cardiovascular mortality for major downsizing during the first four years after downsizing. The corresponding hazard ratio was 1.4 (0.6 to 3.1) during the second half of follow up. Conclusion Organisational downsizing may increase sickness absence and the risk of death from cardiovascular disease in employees who keep their jobs.

Study objective: To examine whether the effects of work stress on sickness absence vary by the level of control the employees have over their working times. Design: Prospective cohort study. A survey of job strain, effort-reward imbalance, and control over daily working hours and days off was carried out in 2000-01. The survey responses were linked with registered data on the number of medically certified (.3 days) sickness absences from one year before the survey until the end of 2003. The mean follow up period was 28.2 (SD 8.1) months. Adjustments were made for demographics and behavioural health risks. Aggregated measures of worktime control according to workplaces were used to control for differences in reactivity and response style. Setting: Ten towns in Finland. Participants: 16 139 public sector employees who had no medically certified sickness absences in the year preceding the survey. Main results: Among the women, individually measured control over daily working hours and days off moderated the association between work stress and sickness absence. The combination of high stress and good worktime control was associated with lower absence rates than a combination of high stress and poor worktime control. This finding was replicated in the analyses using workplace aggregates of worktime control. Among the men, the findings were less consistent and not replicable using aggregated measures of worktime control. Conclusions: Good control over working times reduces the adverse effect of work stress on sickness absence especially among female employees. W ork stress has been shown to affect several public health domains such as perceived health, 1 2 psychological health, 3 cardiovascular morbidity, 4 5 sickness absence, 6-8 and mortality. 10 11 In specifying the backgrounds of these health effects, the two most prevalent work stress models have identified health risks in ''job strain'' resulting from a combination of high job demands with low control over job content 12 and in ''effort-reward imbalance'' originating from a lack of reciprocity between high efforts spent at work with low rewards received. 13There is an urgent need for evidence on tools that could alleviate the health impairments related to work stress.14 A potential protecting factor could be employee control over working times, recently shown to predict health especially among female employees.15 16 The health benefits of worktime control may stem from advantages in combining work and non-work demands. Worktime control could also be used to flee from particularly stressful work situations and to choose working at times of best possible resources and support.Previously, European Union survey analyses have suggested that working time autonomy helps to reduce the health risk relating to unfavourable working times, but that the positive effect is weak compared with the negative effect of unsociable hours.17 A nationwide US survey has implied that scheduling control could benefit all workers, not just those with conflicting demands, and regardless of...

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We examined whether the combination of uncertainty (lack of work-time control, and negative changes at work) and organizational justice (i.e., justice of decision-making procedures and interpersonal treatment at work) contributes to sickness absence. A total of 7083 male and 24,317 female Finnish public sector employees completed questionnaires designed to assess organizational justice, workload and other factors. Hierarchical regression showed that after adjustment for age, income, and health behaviors low procedural and interactional justice were related to long sickness absence spells. In accordance with the uncertainty management model, these associations were dependent on experienced work-time control and perceived changes at work. r