Präsentismus — Krank zur Arbeit aus Angst vor Arbeitsplatzverlust

Little is known about the long-term consequences of sickness presence (ie, going to work despite ill-health), although one study suggests an association with coronary heart disease. This study examined the effect of sickness presence on future long-term sickness absence. Information from a random sample of 11 838 members of the Danish core workforce was collected from questionnaires, containing questions about work, family and attitudes towards sickness absence. Information on prospective sickness absence spells of at least 2 weeks was derived from an official register during a follow-up period of 1.5 years. Sickness presence is associated with long-term sickness absence of at least 2 weeks' duration as well as with spells lasting at least 2 months. Participants who had gone to work ill more than six times in the year prior to baseline had a 74% higher risk of becoming sick-listed for more than 2 months, even when controlling for a wide range of potential confounders as well as baseline health status and previous long-term sickness absence. The association was consistent for most subgroups of employees reporting various symptoms, but either disappeared or became insignificant when analysing subgroups of employees with specific chronic diseases. Going to work ill repeatedly is associated with long-term sickness absence at a later date. For this reason, researchers and policy-makers should consider this phenomenon more carefully when planning future studies of sickness absence or when laying out new policies.

The term "sickness presence" is used to describe situations where the ability to work is impaired due to disease, but yet the person goes to work. A problem is that the term "sickness presence" implies that being present at work is something exceptional if a person is sick. Most people diagnosed with a disease or disorder do, however, go to work and are not sick listed. Furthermore, the term "sickness presence" is rather diffuse, and it would be beneficial if one or several more specific terms could be used. The current body of scientific literature does not provide sufficient evidence to draw conclusions on the consequences of sickness presence.

Self-rated health (SRH) is known to predict mortality and other health outcomes better than objective ratings, suggesting that patients have important knowledge that physicians do not. The study assessed whether SRH reflects changes in internal states, specifically symptoms and affects. In an event-sampling study, 54 elders completed a SRH measure, positive and negative affect scale, a symptom checklist, and a pain scale every evening for 8 weeks. Using lagged (time series) hierarchical regression, the authors modeled associations of SRH with previous symptoms, moods, and changes in symptoms and mood. The SRH was highest when symptoms had decreased from the previous day and lowest when symptoms had increased, suggesting that SRH reflects a sense of change. Symptoms and affects contributed independently to SRH. Self-rated health was more sensitive to positive than negative affect and also sensitive to changes of positive but not negative affect. Patients may possess a subjective trajectory of health-an awareness of changes in symptoms and affect. This trajectory may constitute an important component of SRH and help to explain its ability to predict health outcomes.