The linkage of depressive and anxiety disorders with the expected labor market affiliation (ELMA): a longitudinal multi-state study of Danish employees

Abstract

Objective Depressive and anxiety disorders are prevalent among employees in general. Still, knowledge regarding the contribution of these disorders to the dynamics of the labor market in terms of working time, sickness absence, and unemployment is scarce. We aim to quantify the linkage of depressive and anxiety disorders with labor market participation using the expected labor market affiliation method (ELMA), in a large sample of Danish employees. Methods We combined three survey waves on occupational health with six high-quality national registers in N = 43,148 Danish employees, of which the 2012 survey contributed 29,665 person years, the 2014 survey 33,043 person years, and the 2016 survey 35,375 person years. We used the new ELMA method to estimate the multi-state transition probabilities and 2-year expected time in work, sickness absence, and unemployment. Depressive and anxiety disorders were assessed by the Major Depression Inventory and the SCL-ANX4 scales, respectively. We adjusted for multiple variables by applying inverse probability weighting in groups of gender and age. Results Depressive and anxiety disorders among employees link to reduced labor market affiliation by significantly changed transitions probabilities between the labor markets states, viewed as reduced working time by 4–51 days (in two years), increased time in sickness absence by 6–44 days (in two years), and unemployment by 6–12 days (in two years) when compared to employees without depression or anxiety disorders. The results were most pronounced for women employees and for employees with both depression and anxiety disorders. Conclusions The study reveals detailed insight into what extent depression and anxiety disorders influence the labor market affiliation, in terms of the complex interrelation between working time, sickness absence, and unemployment. The study emphasizes the importance of preventing and handling depressive and anxiety disorders among employees for strengthening work participation.

The labor market costs of work-related stress: A longitudinal study of 52 763 Danish employees using multi-state modeling

“…The analysis included nine covariates previously used in studies about work-related stress in relation to long-term sickness absence and work disability ( 3 , 13 ). The covariates were associated with adverse health outcomes, possibly through selection, eg, selection into part-time work, or through causation, eg, smoking and sickness absence.…”

“…The ELMA uses Cox proportional hazard regression for establishing time-dependent transition probabilities for each covariate while incorporating modern survival terms such as left and right censoring, time truncation, recurrent events, and competing events management while fulfilling a Markov assumption ( 28 ). Using numerical integration, ELMA converts complex patterns of state-conditioned transition probabilities into overall state duration estimates ( 29 , 30 ) before conducting variance analysis on the duration estimates to find the variable-specific contributions ( 8 , 13 , 31 ).…”

“…Nevertheless, almost all economic and epidemiologic studies on work-related stress include only a single labor market outcome ( 12 ), such as the risk of sickness absence. Studies investigating the impact of multiple labor outcomes and their interconnectivity are rare ( 8 ), thereby omitting essential knowledge concerning recurrent sickness absence leading to decreased work participation, unemployment, and early retirement ( 8 , 13 ). Moreover, translating the findings into real-world contexts such as costs can be challenging for companies and employers facing the complex behavior of sick listings among employees.…”

“…However, since we can only estimate the actual production value lost while employees were absent from work, we use the term ‘costs of work absenteeism’ to describe the costs of any negative difference between the number of working days deduced from the analysis and the expected number of working days. The ELMA method has shown to be a well-founded analytical tool for analyzing multiple labor market outcomes while including the interconnectivity between multiple outcomes ( 8 , 13 , 20 ).…”

Work Ability and Work Nonparticipation

“…Still, these differences might have caused a certain degree of inaccuracy in the risk estimates. We did not consider multiple transitions as done, for example, in previous studies using the Expected Labor Market Affiliation method, 31 which estimates transitions between different indicators of work nonparticipation. However, we considered the risk for at least one event of work nonparticipation and the number of months of such events.…”