Introduction 1995 1997 2000 2001 2000 2001 1979 2004 2004 2001 2001 2000 2002 2000 2001 1987 2001 2000 2003 1980 1996 2003 1992 1994 1978 1964 1984 2005 1996 1998 2002 2002 2004 2002b 2002a 1991 1991 1993 1993 1992 2005 2003 1989 1992 1998 2001 In summary then, the aim of the study is to examine the role of coping styles in sickness absence. Based on the fact that, contrary to reactive–passive strategies, problem-solving strategies are generally associated with positive results in terms of well-being and overall health outcomes, our hypothesis is that such strategies are positively related to a low frequency of sickness absence and with short lengths and durations. Reactive–passive strategies, on the other hand, are not expected to be related to sickness absence. Subjects and methods Study population and participants N 1 Table 1 Demographics and absenteeism of participants  Variable  Male 91%  Age, mean (SD) (min–max) years 44.2 (7.7) (22–63) Marital status  Married or cohabiting 79%  Single 17%  Divorced or separated 4% Educational level  Lower vocational education 27%  Intermediate vocational education 50%  Higher vocational education and university 21%  Missing/something else 2% Working years present job  1 year 30%  >1–5 year 43%  >5–10 year 14%  >10 year 14% Sickness absence first quarter  0 days  64%  1–7 days 22%  8–14 days 6%  >14 days 7% Function  Blue collar (executive) 41%  Office workers (administrative) 30%  Supervisors 6%  Consultants 16%  Managerial staff 7% 2 Table 2 Demographics and absenteeism of participants and non-participants  n n T  2 Gender (%women) 8.6 14.1 0.000  Age, mean (SD) in years 44.2 (7.7) 40.7 (9.3) 0.000  Salary (%)    0.000  Low 40.6 53.2    Medium 42.9 33.3    High 16.5 13.5   Absenteeism  Length mean (SD) days 14.9 (39.9) 22.9 (59.3) 0.000   Frequency  1.20 (1.31) 1.31 (1.46) 0.000  Measures Coping style 1993 1992 1993 Sickness absence  Sickness absence data were taken from the sickness absence records of the employees filed in the database of ArboNed, an occupational health service (OHS) serving the telecom company. All spells of absence for medical reasons were centrally reported and registered by the executive manager of the company. Absence spells longer than 2 weeks were verified by an occupational physician by inviting the employee on sick leave for an interview. Therefore, the validity of the absence data is assumed to be high. length frequency duration Statistical analysis 2003 2 2 1990 1993 2001 1993 In a next step, scale scores for different coping strategies were calculated and transformed into scale scores ranging from 0 to 100. Finally, tertiles of the distribution of the 0–100 scale scores were used to distinguish between low-, medium- and high levels of the coping strategies. To examine the relationship between coping and sickness absence, odds ratios and corresponding 95% confidence intervals were calculated using logistic regression analysis. Stepwise multiple logistic regression analysis was used to study the (confounding) influence of sociodemographic factors and other determinants on the relationship between coping and sickness absence. The magnitude of the (confounding) effects was assessed by calculating the proportion of the excess risk (OR minus 1.0) explained when fitting these terms in the model. 1958 Results UCL factor structure 3 2 df P Table 3 Fit indices of one-factor (M1) and two-factor (M2) models of coping (UCL-19) Model 2 df GFI AGFI RMSEA NFI NNFI CFI M1 1030.29 152 0.69 0.61 0.14 0.43 0.36 0.43 M2 184.07 142 0..95 0.93 0.06 0.90 0.88 0.90 Null model 17976.60 171 0.54 0.49 0.17 – – – GFI AGFI  RMSEA NFI  NNFI CFI 2 P 1994 Sickness absence and demographics  4 Table 4 Associations of demographics and sickness absence  Sickness absence Length >14 days Duration >7 days Frequency >2x OR 95% CI OR 95% CI OR 95% CI Gender  Woman 1.00  1.00  1.00   Man 0.49 0.38–0.62 0.66 0.51–0.85 0.42 0.32–0.55 Married  Married 1.00  1.00  1.00   Single 0.83 0.66–1.03 1.25 1.03–1.52 1.05 0.82–1.36  Divorced 1.73 1.24–2.41 2.18 0.54–8.81 1.54 1.04–2.28 Education  University 1.00  1.00  1.00   Higher vocational education 0.88 0.59–1.33 1.13 0.72–1.78 1.00 0.63–1.59  Interm. vocational education 1.42 1.00–2.00 1.93 1.30–2.86 1.16 0.78–1.72  Lower vocational education 2.07 1.45–2.96 2.84 1.90–4.24 1.30 0.86–1.96 Present (current) job  >10 years 1.00  1.00  1.00   5–10 years 0.98 0.74–1.28 1.02 0.78–1.34 1.04 0.74–1.46  <5 years 0.67 0.54–0.83 0.61 0.49–0.76 0.91 0.69–1.19 Salary  Low 4–6 1.00  1.00  1.00   Intermediate 7–9 0.50 0.43–0.60 0.49 0.41–0.59 1.71 1.28–2.28  High >9 0.38 0.30–0.49 0.33 0.25–0.44 1.07 0.79–1.44 Age  <35 years 1.00  1.00  1.00   35–45 years 1.38 1.07–1.78 1.54 1.17–2.02 1.20 0.90–1.60  >45 years 1.48 1.16–1.88 1.79 1.38–2.32 0.93 0.70–1.22 History sickness absence in days (length) 1 year before  0 1.00  1.00  1.00   1–7 1.57 1.24–2.01 1.19 0.95–1.50 3.07 2.18–4.31  8–14 3.68 2.85–4.74 2.65 2.08–3.39 6.30 4.44–8.95  > 14 9.72 7.75–12.2 4.26 3.43–5.29 12.9 9.40–17.8 History frequency (1 year before)  0x 1.00  1.00  1.00   1–2x 2.77 2.26–3.41 1.91 1.58–2.32 3.96 2.91–5.40  >2x 8.66 6.81–11.02 3.83 3.04–4.84 17.47 12.6–24.2 n Sickness absence and ways of coping 5 5 5 Table 5 Associations of coping and sickness absence   Sickness absence Length >14 days Duration >7 days Frequency >2x OR 95% CI OR 95% CI OR 95% CI Problem-solving Active problem-focusing  Low 1.00  1.00  1.00   Medium 0.84 0.70–0.99 0.83 0.69–0.99 0.84 0.68–1.04  High 0.61 0.49–0.75 0.69 0.56–0.86 0.78 0.53–0.87 Seeking social support  Low 1.00  1.00  1.00   Medium 0.98 0.82–1.17 0.97 0.80–1.16 1.01 −0.80–1.26  High 0.92 0.75–1.12 0.81 0.66–0.99 1.15 0.90–1.45 Palliative reaction  Low 1.00  1.00  1.00   Medium 1.22 1.01–1.49 1.15 0.94–1.41 1.43 1.13–1.81  High 1.33 1.11–1.59 1.19 0.99–1.43 1.40 1.12–1.74 Reactive–passive Avoidance behaviour  Low 1.00  1.00  1.00   Medium 1.11 0.92–1.32 1.14 0.94–1.37 1.22 0.98–1.51  High 1.35 1.10–1.65 1.32 1.07–1.63 1.39 1.09–1.67 Expression of emotions  Low  1.00  1.00  1.00   Medium 1.05 0.87–1.28 1.21 0.99–1.48 0.91 0.72–1.14  High 1.19 0.95–1.50 1.13 0.89–1.44 1.29 0.99–1.69 Summary table 5   Sickness absence    Length Duration Frequency    Problem-solving Active problem-focusing X X X    Seeking social support – X –    Palliative reaction X – X    Reactive–passive Avoidance behaviour X X X    Expression of emotions – – –    Sickness absence, and demographics and ways of coping 6 4 Table 6 n   Adjustments Length >14 days Duration >7 days Frequency >2x OR 95% CI OR 95% CI OR 95% CI Problem-solving Active problem- focusing No adjustments (crude OR) 0.63 (0.51–0.77) 0.71 (0.57–0.80) 0.69 (0.54–0.89) History sickness absence length 0.71 (0.56–0.88) 0.78 (0.63–0.97) 0.71 (0.55–0.93) History sickness absence length + gender (female) 0.72 (0.58–0.90) 0.79 (0.63–0.98) 0.73 (0.55–0.95) History sickness absence length + gender + salary (high) 0.77 (0.61–0.97) 0.86 (0.69–1.07) 0.74 (0.57–0.98) History sickness absence length + gender + salary + education (high) 0.79 (0.63–0.99) 0.88 (0.71–1.10) 0.74 (0.57–0.98) History sickness absence length + gender + salary + education + marital status (married) 0.79 (0.62–0.99) 0.88 0.70–1.10) 0.74 (0.57–0.98) Seeking social support No adjustments (crude OR) 0.90 (0.73–1.09) 0.80 (0.65–0.98) 1.14 (0.90–1.45) History sickness absence length 0.95 (0.78–1.16) 0.81 (0.66–1.00) 1.06 (0.83–1.37) History sickness absence length + gender (female) 0.83 (0.67–1.03) 0.78 (0.63–0.97) 1.01 (0.78–1.30) History sickness absence length + gender + salary (high) 0.87 (0.70–1.08) 0.83 (0.67–1.02) 1.03 (0.80–1.33) History sickness absence length + gender + salary + education (high) 0.88 (0.71–1.10) 0.84 (0.68–1.04) 1.03 (0.80–1.34) History sickness absence length + gender + salary + education + marital status (married) 0.88 (0.71–1.10) 0.84 (0.68–1.04) 1.03 (0.80–1.34) Palliative reaction No adjustments (crude OR) 1.32 (1.10–1.58) 1.19 (0.99–1.43) 1.37 (1.10–1.72) History sickness absence length 1.24 (1.02–1.50) 1.16 (0.96–1.41) 1.18 (0.93–1.50) History sickness absence length + gender (female) 1.20 (0.99–1.45) 1.14 (0.94–1.38) 1.15 (0.91–1.46) History sickness absence length + gender + salary (high) 1.20 (0.99–1.46) 1.14 (0.94–1.38) 1.15 (0.91–1.45) History sickness absence length + gender + salary + education (high) 1.21 (1.00–1.47) 1.15 (0.95–1.40) 1.15 (0.91–1.46) History sickness absence length + gender + salary + education + marital status (married) 1.22 (1.00–1.48) 1.16 (0.96–1.41) 1.15 (0.91–1.46) Reactive–passive Avoidance behaviour No adjustments (crude OR) 1.36 (1.11–1.66) 1.33 (1.07–1.64) 1.37 (1.07–1.75) History sickness absence length 1.24 (0.99–1.54) 1.29 (1.04–1.60) 1.37 (1.05–1.78) History sickness absence length + gender (female) 1.23 (0.99–1.53) 1.28 (1.03–1.59) 1.36 (1.04–1.77) History sickness absence length + gender + salary (high) 1.22 (0.98–1.52) 1.27 (1.02–1.57) 1.35 (1.04–1.75) History sickness absence length + gender + salary + education (high) 1.21 (0.97–1.51) 1.26 (1.02–1.57) 1.35 (1.03–1.75) History sickness absence length + gender + salary + education + marital status (married) 1.22 (0.97–1.52) 1.27 (1.02–1.58) 1.35 (1.03–1.75) Expression of emotions No adjustments (crude OR) 1.17 (0.97–1.40) 1.01 (0.83–1.22) 1.41 (1.13–1.75) History sickness absence length 1.07 (0.88–1.31) 0.98 (0.80–1.19) 1.34 (1.06–1.68) History sickness absence length + gender (female) 1.06 (0.87–1.29) 0.97 (0.79–1.18) 1.32 (1.05–1.67) History sickness absence length + gender + salary (high) 1.07 (0.87–1.30) 0.98 (0.80–1.19) 1.33 (1.05–1.67) History sickness absence length + gender + salary + education (high) 1.08 (0.88–1.31) 0.99 (0.81–1.20) 1.33 (1.05–1.67) History sickness absence length + gender + salary + education + marital status (married) 1.08 (0.88–1.31) 0.99 (0.81–1.20) 1.33 (1.05–1.67) All odds ratios are based each time on the same 3,575 employees without missing values on each variable in the model  Length Adjustment for sickness absence history increases the excess risk to be absent for more than 14 days in one year by 22% for active problem-focusing (thus, sickness absence history reduces the effect of active coping), while reducing it by 25 and 33% for palliative reaction and avoidance coping, respectively. After adjustment for gender and sickness absence history, the excess risk for length in addition to palliative reaction and sickness absence history decreases by 17%. The excess risk for length adjusted for salary in addition to active problem-focusing, sickness absence history and gender increases by 18%. In summary, adjusted for several confounding variables, the length of sickness absence is effectively influenced by active problem-focusing and palliative reaction. Frequency Adjustment for sickness absence history barely minimizes the risk for frequency by coping considering active problem-focusing and avoidance behaviour. For palliative coping, the reduction for the excess risk amounts to 51%. When adjusted for gender, in addition to sickness absence history, the risk of high frequency in association with palliative reaction reduces by another 16%. In sum, adjusted for several confounding variables the frequency of sickness absence is effectively influenced by active problem-focusing, avoidance behaviour and expression of emotions. Duration Adjustment for sickness absence history reduces the excess risk of active problem focusing by 24%, of seeking social support and palliative reaction by 16%, and of avoidance behaviour by 12%. Adjustment for gender in association with seeking social support affects the excess risk of duration by 16%. In summary, adjusted for several confounding variables, the duration of sickness absence is effectively influenced by active problem focusing, avoidance behaviour and seeking social support. Effects on the onset of a new period of absenteeism 7 Table 7 Kaplan–Meier: the relation between different coping styles and the onset of absenteeism in the year after coping assessment   Log rank Median (days) SE 95% CI Stat df Sign Problem-solving Active problem-focusing  Low 152 7 137–167     Medium 170 13 145–195     High 176 14 149–203 9.44 2 0.01 Seeking social support  Low 168 10 148–188     Medium 165 8 148–182     High 155 17 122–188 0.45 2 0.80 Palliative reaction  Low 182 14 155–209     medium 155 12 132–178     High 146 7 131–161 13.65 2 0.00 Reactive–passive Avoidance behaviour  Low 182 11 160–204     Medium 151 11 130–172     High 144 10 125–163 14.6 2 0.00 Expression of emotion  low 165 10 146–184     Medium 167 11 145–189     High 156 12 133–179 0.98 2 0.61 Discussion  In accordance with our hypothesis, and after adjustment for potential confounders, employees with an active problem-solving coping strategy are less likely to drop out because of sickness absence in terms of frequency, length (total number of days absent, longer than 14 days), and duration (mean duration per spell, more than 7 days) of sickness absence. This positive effect is observed in the case of ‘seeking social support’ only for duration of sickness absence, and in the case of ‘palliative reaction’ only for length and frequency of sickness absence. In contrast, an avoidant coping style, representing a reactive–passive strategy, significantly increases the likelihood of frequent absences, as well as the duration of sickness absence. Expression of emotions, representing another reactive–passive strategy, has no effect on sickness absence. The median time before the onset of a new episode of absenteeism, finally, is significantly extended for active problem-solving and reduced for avoidance and for a palliative response. 1996 2004 2000 2004 1993 1991 1993 2002 2001 1988 1997 1978 1998 2002 2002 2002 1997 1992 1998 2001 1998 1995 2001 1996 A strong point of our study is the detailed way in which sickness absence is assessed, using objective archival data. Thus far, relatively little attention has been paid to the implications of different quantitative measures of sickness absence. Moreover, a prospective design was used that allowed for predicting future sickness absenteeism. 2005 1967 1978 1994 2003 In spite of these limitations, the results of the present study support the notion that problem-solving coping and reactive–passive strategies are inextricably connected with frequency, duration, length and onset of sickness absence. Especially ‘active problem-focusing’ decreases the chance of future sickness absence.