Need for recovery after work predicts sickness absence: A 2-year prospective cohort study in truck drivers

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Abstract

Background: Incomplete recovery from work-related fatigue after work (i.e., sustained activation) is assumed to mediate the relation between the exposure to stressful working conditions and the development of health problems. The need for recovery after work scale reflects the extent to which workers have difficulties to recover adequately from work-related fatigue after a working day. Objectives: The aim of this study was to establish if need for recovery after work in truck drivers (1) predicts future sickness absence (>14 working days) and (2) mediates the prospective relation between stressful working conditions (low control, high job demands) and sickness absence. Methods: Self-administered questionnaires, providing information about need for recovery after work, sickness absence, job control, and job demands (psychological, physical, and supervisor job demands), were sent to a random sample of 2000 drivers in 1998. Of the 1123 responders, 820 returned a completed questionnaire 2 years later (response 72%). This study was restricted to the 526 participants who still worked at follow-up as a truck driver at the same company. Results: High baseline need for recovery after work was associated with an increased risk for subsequent sickness absence (odds ratio [OR] 2.19, 95% confidence interval [CI] 1.13–4.24) after adjustment for age, previous sickness absence, marital status, educational level, and company size. Additional adjustment for baseline stressful working conditions led to a marginally reduction of the excess risk for sickness absence. Conclusions: High need for recovery after work increases the risk of subsequent sickness absence that is not explained by relevant (non-) work-related factors. However, the results did not testify that need for recovery after work mediates between the exposure to stressful working conditions, and the subsequent occurrence of sickness absence. Practically, the results indicate that monitoring recovery complaints in truck drivers may assist practitioners to take efficient preventive measures at the appropriate time.

Introduction

Mental (e.g., burnout and depression) and musculoskeletal health complaints (e.g., low back pain, neck pain) are a major concern in modern society. In the Netherlands, 12% of the workers' absenteeism days is due to mental health complaints, which together with work-related musculoskeletal health complaints (13%), constitute the most frequent diagnoses [1]. Furthermore, mental and musculoskeletal health complaints formed the main reasons for work disablement among two-thirds of the population diagnosed as “not able to work” in the Netherlands [1]. Similar figures for mental [2] and musculoskeletal health complaints [3], [4] are found in the UK and Sweden.

Stressful working conditions seem to play an important role in the development of the aforementioned health complaints. Epidemiological research (for reviews, see [5], [6]) guided by the job demand control model [7] and the job demand control support model [8] has demonstrated that being exposed to a work environment characterized by high psychological demands, low control, and low social support is associated with an elevated risk for musculoskeletal health complaints (e.g., low back pain, neck pain) and mental health complaints (e.g., burnout and depression). Moreover, a range of studies showed that these stressful working conditions are associated with potentially harmful psychophysiological reactions such as elevated catecholamine excretion levels [9] and increased blood pressure [10].

In contrast to the vast amount of studies about the relations between stressful working conditions and health complaints, research regarding the question on how stressful working conditions may lead to health complaints in the long run is limited. Although the knowledge with respect to the underlying mechanisms of work stress-related health problems is scarce, the theoretical development in this research field is considerable. A driving force behind this progress is the theory of sustained activation [11], which states that the psychophysiological activation response enables the individual to react successfully during a stressful situation. On the short term, the activation response is considered adaptive. On the longer term, however, health problems may appear when the elevation of this psychophysiological response is prolonged [11], [12]. This prolonged response is labeled sustained activation.

Sustained activation is an important source of allostatic load [13], defined as the cost of chronic exposure to fluctuating or heightened neural or neuroendocrine response resulting from repeated or chronic environmental challenge that an individual reacts to as being particularly stressful. High allostatic load can lead to pathophysiological consequences that include an increased risk for the incidence of cardiovascular disease [14] suppressed cellular immunity found to increase vulnerability to common cold [15], [16], and an increased likelihood of chronic musculoskeletal tension (a risk factor for musculoskeletal health problems) [17].

Elaborating on sustained activation theory, Meijman et al. [18], [19] and Sluiter et al. [20] introduced the concept of (need for) recovery after work. Need for recovery after work reflects the extent to which workers feel they have problems to recover from work-related fatigue after a working day. The concept of need for recovery after work is seen as an acute and short-term reaction of work and as an intermediate variable between the exposure to stressful working conditions (e.g., high demands and low control) and the development of psychosomatic health problems on the longer term. Specifically, Meijman et al. [18], [19] and Sluiter et al. [20] hypothesized that repeated insufficient recovery after a working period (i.e., sustained activation) can be seen as the take-off of a vicious circle where extra effort has to be exerted at the beginning of every new working period to rebalance the suboptimal psychophysiological state and to prevent performance breakdown. Meijman et al. [18], [19] and Sluiter et al. [20] assumed that the consequential cumulated fatigue from repeated insufficient recovery leads to a cumulative health deterioration. This cumulative health deterioration may, in the long run, result in long-term sickness absence [21].

Research has demonstrated that (especially long-term) sickness absence is indicative of psychosomatic health problems [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32] and is a precursor of serious morbidity [33]. Moreover, the influence of musculoskeletal health complaints (e.g., low back pain, neck pain) and mental health complaints (e.g., burnout and depression) appears to increase when sickness absence is prolonged [22], [34].

In accordance with the above hypothesis, Sluiter et al. [20] found that the need for recovery after work was a strong predictor of psychosomatic health complaints in Dutch coach drivers. However, because this study examined the relation between the need for recovery after work and psychosomatic health complaints in a cross-sectional design, the question remains whether a high need for recovery after work is an antecedent or consequence of health complaints. Accordingly, the present study was conducted to expand this knowledge. The aim of this study was twofold: (1) to establish whether need for recovery after work predicts sickness absence in truck drivers and (2) to establish whether need for recovery after work mediates the relationship between stressful working conditions (in terms of job demands and job control) and sickness absence.

Section snippets

Subjects and times of measurements

In September 1998 (baseline), a random sample of truck drivers was taken from the directory of the Dutch Central Bureau of Occupational Health Care in Road transport (n=2000). Of the 2000 mailed self-administered questionnaires, 1225 were returned. Two years later, in September 2000 (follow-up measurement), 102 of these 1225 drivers were not traceable anymore. Therefore, 1123 (1225−102) truck drivers received a second questionnaire, of whom 820 participants returned a questionnaire (response:

Results

Table 1 displays baseline information of the cohort. As can be seen from Table 1, almost all participants of the follow-up population were males (99%), married (84%), and had had a primary education (30%) or a lower vocational/secondary education (60%). Mean age of the participants was 39 years (S.D.=9.4 years) in 1998. The average number of years of truck driving was 17 (S.D.=9.5 years). On average, the drivers worked 58 h/week at baseline (S.D.=10.9 h). Forty-two percent and 46% of the

Discussion

In accordance with our hypothesis and after adjustment of potential confounders, truck drivers with a high need for recovery after work had an increased chance to drop out because of sickness exceeding 14 working days 2 years later. Contrary to our expectations, need for recovery after work did not mediate the relation between stressful working conditions and sickness absence.

To appreciate the implications of these results, several methodological aspects of this study should be addressed. The

Acknowledgements

Partial funding for this study was provided by the Dutch organization for occupational health care in the road transport industry, BGZ Wegvervoer. We thank Jake P.J. Broersen, PhD (SKB Center of Expertise on Health and Work, Amsterdam) for his valuable advice.

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