A Lifecourse Approach to Long-Term Sickness Absence—A Cohort Study

BACKGROUND: Most research on long-term sickness absence has focussed on exposure to occupational psychosocial risk factors such as low decision latitude. These provide an incomplete explanation as they do not account for other relevant factors. Such occupational risk factors may be confounded by social or temperamental risk factors earlier in life. METHODS: We analysed data from the 1958 British Birth Cohort. Long-term sickness absence was defined as receipt of Incapacity Benefit/Severe Disablement Allowance at age 42. In those in employment aged 33 we examined the effects of psychological distress, musculoskeletal symptoms, and low decision latitude. These were then adjusted for IQ, educational attainment, and the presence of early life somatic and neurotic symptoms. RESULTS: Low decision latitude predicted subsequent long-term absence, and this association remained, albeit reduced, following adjustment for psychological distress and musculoskeletal symptoms at age 33. Low decision latitude was no longer associated with long-term absence when IQ and educational attainment were included. Adjusting for early life somatic and neurotic symptoms had little impact. DISCUSSION: A greater understanding of the ways in which occupational risk factors interact with individual vulnerabilities across the life-course is required. Self reported low decision latitude might reflect the impact of education and cognitive ability on how threat, and the ability to manage threat, is perceived, rather than being an independent risk factor for long-term sick leave. This has implications for policy aimed at reducing long-term sick leave.