SICKNESS ABSENCE IN THE WHITEHALL-II STUDY, LONDON - THE ROLE OF SOCIAL SUPPORT AND MATERIAL PROBLEMS
SICKNESS ABSENCE IN THE WHITEHALL-II STUDY, LONDON - THE ROLE OF SOCIAL SUPPORT AND MATERIAL PROBLEMS
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DOI：
10.1136/jech.49.5.474
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发表时间：
1995-10-01
影响因子：
6.3
通讯作者：
MARMOT, M
中科院分区：
文献类型：
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作者：
RAEL, EGS;STANSFELD, SA;MARMOT, M
研究目的-调查社会支持、社会网络和慢性压力源的作用：(1)作为病假缺勤的预测因素；（ii）作为病假中社会经济梯度的潜在解释。设计：一项前瞻性队列研究（Whitehall II研究），在基线上测量社会人口因素、健康和社会支持，并前瞻性地测量疾病缺勤时间。背景- 20个以伦敦为基地的英国公务员非工业部门。参与者-参与者为公务员（n = 10308），基线年龄为35-55岁，其中67%（6895）为男性，33%（3413）为女性。白厅II的总体回应率为73%（男性74%，女性71%）。该分析基于41%的样本，他们有病假原因的数据，并回答了所有社会支持问题。只有4-3%的参与者没有完成所有必要的问题并被排除在外。测量和主要结果——来自“最亲密的人”的高水平的信任/情感支持预示着高水平的短期和长期病假。在调整了生理和心理健康的基线后，影响有所增加，这表明高水平的信任/情感支持可能会鼓励疾病行为，而不是产生疾病。社会网络测量显示出一致但不那么引人注目的模式。社会支持的消极方面水平的增加导致更高的病假率。物质问题强烈预测缺勤，但一旦对协变量进行调整，效果就会减弱，这表明健康状况可能是慢性压力源和缺勤之间的一个干预变量。此外，社会支持可以缓冲慢性压力源的影响。除了基线协变量的解释外，社会支持并不能解释由就业等级引起的病假缺勤梯度。结论-因病缺勤是一种复杂的现象，与疾病和应对行为相结合。高水平的信任/情感支持虽然在样本中并不完全一致，但可能会鼓励人们在生病时呆在家里，或者可能伴随着更多的社会义务，延长病假时间。亲密关系的消极方面可能危及健康，从而增加疾病缺勤。
Study objective - To investigate the role of social supports, social networks, and chronic stressors: (i) as predictors of sickness absence; and (ii) as potential explanations for the socioeconomic gradient in sickness absence.Design - A prospective cohort study (Whitehall II study) with sociodemographic factors, health and social support measured at baseline, and spells of sickness absence measured prospectively.Setting - Twenty London based non-industrial departments of the British civil service.Participants - Participants were civil servants (n = 10 308), aged 35-55 years at baseline, of whom 67% (6895) were men and 33% (3413) were women. The overall response rate for Whitehall II was 73% (74% for men and 71% for women). The analysis is based on 41% of the sample who had data on reasons for sickness absence and were administered all social support questions. Only 4-3% of participants did not complete all necessary questions and were excluded.Measurements and main results - High levels of confiding/emotional support from the ''closest person'' predicted higher levels of both short and long spells of sickness absence. After adjusting for baseline physical and psychological health the effects were increased, suggesting that high levels of confiding/emotional support may encourage illness behaviour rather than generate illness, Social network measures showed a consistent but less striking pattern. Increased levels of negative aspects of social support resulted in higher rates of sickness absence. Material problems strongly predicted sickness absence, but the effect was diminished once adjustment for the covariables was made, suggesting that health status may be functioning as an intervening variable between chronic stressors and sickness absence. In addition, social support may buffer the effects of chronic stressors. Social support did not contribute to explaining the gradient in sickness absence by employment grade beyond that explained by the baseline covariables.Conclusions - Sickness absence from work is a complex phenomenon, combining illness and coping behaviours. High levels of confiding/emotional support, although not entirely consistent across samples, may either encourage people to stay at home when they are ill or may be accompanied by more social obligations at home prolonging sickness absence. Negative aspects of close relationships may jeopardise health and hence increase sickness absence.