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Trends in work disability with mental diagnoses among social workers in Finland and Sweden in 2005–2012

  • O. Rantonen (a1), K. Alexanderson (a2), J. Pentti (a1), L. Kjeldgård (a2), J. Hämäläinen (a3), E. Mittendorfer-Rutz (a2), M. Kivimäki (a1) (a4) (a5), J. Vahtera (a6) and P. Salo (a1) (a7)...

Social workers report high levels of stress and have an increased risk for hospitalisation with mental diagnoses. However, it is not known whether the risk of work disability with mental diagnoses is higher among social workers compared with other human service professionals. We analysed trends in work disability (sickness absence and disability pension) with mental diagnoses and return to work (RTW) in 2005–2012 among social workers in Finland and Sweden, comparing with such trends in preschool teachers, special education teachers and psychologists.


Records of work disability (>14 days) with mental diagnoses (ICD-10 codes F00–F99) from nationwide health registers were linked to two prospective cohort projects: the Finnish Public Sector study, years 2005–2011 and the Insurance Medicine All Sweden database, years 2005–2012. The Finnish sample comprised 4849 employees and the Swedish 119 219 employees covering four occupations: social workers (Finland 1155/Sweden 23 704), preschool teachers (2419/74 785), special education teachers (832/14 004) and psychologists (443/6726). The reference occupations were comparable regarding educational level. Risk of work disability was analysed with negative binomial regression and RTW with Cox proportional hazards.


Social workers in Finland and Sweden had a higher risk of work disability with mental diagnoses compared with preschool teachers and special education teachers (rate ratios (RR) 1.43–1.91), after adjustment for age and sex. In Sweden, but not in Finland, social workers also had higher work disability risk than psychologists (RR 1.52; 95% confidence interval 1.28–1.81). In Sweden, in the final model special education teachers had a 9% higher probability RTW than social workers. In Sweden, in the final model the risks for work disability with depression diagnoses and stress-related disorder diagnoses were similar to the risk with all mental diagnoses (RR 1.40–1.77), and the probability of RTW was 6% higher in preschool teachers after work disability with depression diagnoses and 9% higher in special education teachers after work disability with stress-related disorder diagnoses compared with social workers.


Social workers appear to be at a greater risk of work disability with mental diagnoses compared with other human service professionals in Finland and Sweden. It remains to be studied whether the higher risk is due to selection of vulnerable employees to social work or the effect of work-related stress in social work. Further studies should focus on these mechanisms and the risk of work disability with mental diagnoses among human service professionals.

Corresponding author
*Address for correspondence: O. Rantonen, Finnish Institute of Occupational Health, Finnish Institute of Occupational Health, Lemminkäisenkatu 14-18B (DataCity, 6th floor), FI-20520 Turku, Finland. (Email:
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Ahola, K, Virtanen, M, Honkonen, T, Isometsä, E, Aromaa, A, Lönnqvist, J (2011). Common mental disorders and subsequent work disability: a population-based Health 2000 Study. Journal of Affective Disorders 134, 365372.
Alexanderson, K, Norlund, A (2004). Swedish council on technology assessment in health care (SBU). Chapter 1. Aim, background, key concepts, regulations, and current statistics. Scandinavian Journal of Public Health 32 (Suppl. 63), 1230.
Allison, PD (2000). Survival Analysis using the SAS® System: A Practical Guide. SAS Institute Inc: Cary, NC.
Aronsson, G, Astvik, W, Gustafsson, K (2014). Work conditions, recovery and health: a study among workers within pre-school, home care and social work. British Journal of Social Work 44, 16541672.
Blank, L, Peters, J, Pickvance, S, Wilford, J, MacDonald, E (2008). A systematic review of the factors which predict return to work for people suffering episodes of poor mental health. Journal of Occupational Rehabilitation 18, 2734.
Bonde, JPE (2008). Psychosocial factors at work and risk of depression: a systematic review of the epidemiological evidence. Occupational and Environmental Medicine 65, 438445.
Burnett, G, Jones, RA, Bliwise, NG, Ross, LT (2006). Family unpredictability, parental alcoholism, and the development of parentification. American Journal of Family Therapy 34, 181189.
Clausen, T, Nielsen, K, Carneiro, IG, Borg, V (2012). Job demands, job resources and long-term sickness absence in the Danish eldercare services: a prospective analysis of register-based outcomes. Journal of Advanced Nursing 68, 127136.
Cornelius, LR, van der Klink, JJ, Groothoff, JW, Brouwer, S (2011). Prognostic factors of long term disability due to mental disorders: a systematic review. Journal of Occupational Rehabilitation 21, 259274.
DePanfilis, D, Zlotnik, JL (2008). Retention of front-line staff in child welfare: a systematic review of research. Children and Youth Services Review 30, 9951008.
Dewa, CS, Loong, D, Bonato, S, Hees, H (2014). Incidence rates of sickness absence related to mental disorders: a systematic literature review. BMC Public Health 14, 205.
Jönsson, S (2005). Client work, job satisfaction and work environment aspects in human service organizations. Doctoral dissertation, Department of Psychology: Lund University, Sweden.
Kessler, RC, Aguilar-Gaxiola, S, Alonso, J, Chatterji, S, Lee, S, Ormel, J, Ustun, TB, Wang, PS (2009). The global burden of mental disorders: an update from the WHO world mental health (WMH) surveys. Epidemiology and Psychiatric Sciences 18, 2333.
Kivimäki, M, Forma, P, Wikström, J, Halmeenmäki, T, Pentti, J, Elovainio, M, Vahtera, J (2004). Sickness absence as a risk marker of future disability pension: the 10-town study. Journal of Epidemiology, Community and Health 58, 710.
Kokkinen, L, Kouvonen, A, Koskinen, A, Varje, P, Väänänen, A (2014). Differences in hospitalizations between employment industries, Finland 1976 to 2010. Annals of Epidemiology 24, 598605.
Ludvigsson, JF, Andersson, E, Ekbom, A, Feychting, M, Kim, J, Reuterwall, C, Heurgren, M, Olausson, PO (2011). External review and validation of the Swedish national inpatient register. BMC Public Health 11, 116.
Lund, T, Labriola, M, Villadsen, E (2007). Who is at risk for long-term sickness absence? A prospective cohort study of Danish employees. Work 28, 225230.
Madsen, IEH, Aust, B, Burr, H, Carneiro, IG, Diedrichsen, F, Rugulies, R (2012). Paid care work and depression: a longitudinal study of antidepressant treatment in female eldercare workers before and after entering their profession. Depression and Anxiety 29, 605.
Magnusson Hanson, LL, Madsen, IE, Westerlund, H, Theorell, T, Burr, H, Rugulies, R (2013). Antidepressant use and associations with psychosocial work characteristics. A comparative study of Swedish and Danish gainfully employed. Journal of Affective Disorders 149, 38.
Melchior, M, Ferrie, JE, Alexanderson, K, Goldberg, M, Kivimaki, K, Singh-Manoux, A, Vahtera, J, Westerlund, H, Zins, M, Head, J (2009). Using sickness absence records to predict future depression in a working population: prospective findings from the gazel cohort. American Journal of Public Health 99, 14171422.
Mor Barak, ME, Nissly, JA, Levin, A (2001). Antecedents to retention and turnover among child welfare, social work, and other human service employees: what can we learn from past research? A review and meta-analysis. Social Service Review 75, 625661.
Nieuwenhuijsen, K, Bruinvels, D, Frings-Dresen, M (2010). Psychosocial work environment and stress-related disorders – a systematic review. Occupational Medicine (London) 60, 277286.
Nikcevic, AV, Kramolisova-Advani, J, Spada, MM (2007). Early childhood experiences and current emotional distress: what do they tell us about aspiring psychologists? Journal of Psychology 141, 2534.
OECD (2010). Sickness, Disability and Work: Breaking the Barriers – Sweden: Will the Recent Reforms make it?
Rugulies, R, Aust, B, Siegrist, J, von dem Knesebeck, O, Bultmann, U, Bjorner, JB, Burr, H (2009). Distribution of effort-reward imbalance in Denmark and its prospective association with a decline in self-rated health. Journal of Occupational and Environmental Medicine 51, 870878.
Saarinen, A, Blomberg, H, Kroll, C (2012). Liikaa Vaadittu? Sosiaalityöntekijöiden Kokemukset Työnsä Kuormittavuudesta Ja Ristiriitaisuudesta Pohjoismaissa (nordic social workers’ experiences of occupational stress and contradictions in their work). Yhteiskuntapolitiikka 77, 403418.
Samuelsson, Å, Ropponen, A, Alexanderson, K, Svedberg, P (2013). Psychosocial working conditions, occupational groups, and risk of disability pension due to mental diagnoses: a cohort study of 43 000 Swedish Twins. Scandinavian Journal of Work, Environment and Health 39, 351360.
Siebert, DC, Siebert, CF (2005). The caregiver role identity scale: a validation study. Research on Social Work Practice 15, 204212.
Stansfeld, S, Candy, B (2006). Psychosocial work environment and mental health – a meta-analytic review. Scandinavian Journal of Work, Environment and Health 32, 443462.
Stansfeld, SA, Shipley, MJ, Head, J, Fuhrer, R (2012). Repeated job strain and the risk of depression: longitudinal analyses from the Whitehall II study. American Journal of Public Health 102, 23602366.
Stansfeld, SA, Pike, C, McManus, S, Harris, J, Bebbington, P, Brugha, T, Hassiotis, A, Jenkins, R, Meltzer, H, Moran, P, Clark, C (2013). Occupations, work characteristics and common mental disorder. Psychological Medicine 43, 961973.
Statistics Finland (2001). Classification of Occupations 2001. Statistics Finland: Helsinki.
Statistics Sweden MIS (2001). SSYK 96 Swedish Standard Classification of Occupations 1996. Statistiska centralbyrån (Vol. 1).
Svedberg, P, Ropponen, A, Lichtenstein, P, Alexanderson, K (2010). Are self-report of disability pension and long-term sickness absence accurate? Comparisons of self-reported interview data with national register data in a Swedish twin cohort. BMC Public Health 10, 763.
Tham, P, Meagher, G (2009). Working in human services: how do experiences and working conditions in child welfare social work compare? British Journal of Social Work 39, 807827.
Virtanen, M, Honkonen, T, Kivimäki, M, Ahola, K, Vahtera, J, Aromaa, A, Lönnqvist, J (2007). Work stress, mental health and antidepressant medication findings from the health 2000 study. Journal of Affective Disorders 98, 189197.
Wang, M, Alexanderson, K, Runeson, B, Head, J, Melchior, M, Perski, A, Mittendorfer-Rutz, E (2014). Are all-cause and diagnosis-specific sickness absence, and sick-leave duration risk indicators for suicidal behaviour? a nationwide register-based cohort study of 4.9 million inhabitants of Sweden. Occupational and Environmental Medicine 71, 1220.
Wieclaw, J, Agerbo, E, Mortensen, PB, Bonde, JP (2005). Occupational risk of affective and stress-related disorders in the Danish workforce. Scandinavian Journal of Work, Environment and Health 31, 343351.
Wieclaw, J, Agerbo, E, Mortensen, PB, Bonde, JP (2006). Risk of affective and stress related disorders among employees in human service professions. Occupational and Environmental Medicine 63, 314319.
Wittchen, HU, Jacobi, F (2005). Size and burden of mental disorders in Europe–a critical review and appraisal of 27 studies. European Neuropsychopharmacology 15, 357376.
World Health Organization (2010). International Statistical Classification of Diseases and Related Health Problems (ICD-10).
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