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"Man är ju inte mer än människa": Långtidssjukskrivning ur ett emotionellt, relationellt och strukturellt perspektiv
Karlstad University, Faculty of Social and Life Sciences, Department of Health and Environmental Sciences. (Folkhälsovetenskap)ORCID iD: 0000-0002-5474-3948
2009 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The background to this thesis is the dramatic increase of the long-term sickness absence that took place in Sweden from the late 1990s. There was also a shift in the diagnostic pattern with rising mental diagnoses.

The overall purpose was to describe and try to understand the process leading to long-term sickness absence from the perspective of the sickness absentees, in order to get a better knowledge base for preventive and rehabilitative actions.

The thesis comprises four studies (I-IV). Research methods have been both qualitative and quantitative. In study I data from individual interviews with 32 persons on long-term sick leave due to burnout was analyzed using a grounded theory approach. In study II the study population comprised of 2064 employed sick-listed persons, a sub sample derived from the 2002 national Swedish survey on health, working conditions, life situation and sick-listing. It was analyzed if persons with burnout had higher probability of having experienced the steps in the burnout staircase compared to other diagnostic groups in accordance with the previously suggested hypothesis of "the burnout staircase". Study III comprised of 2521 employed persons, a sub sample derived from the same national survey as in study II. It was analyzed if psychosocial work environment and conflicts and losses in private life independently or in combination were more strongly associated to sickness absence with mental diagnoses as compared to a healthy population. In study IV individual interviews with 25 professional rehabilitation actors and 14 unemployed sick-listed persons were conducted. Data were analyzed according to grounded theory method.

The process that led to sicknes absence can be described as an emotional deprivation process, illustrated as a flight of stairs (the burnout staircase) describing a sequence of steps toward sickness absence (I). In accordance with the tested hypothesis persons with burnout to a noticeable higher extent reported expereince of being in the different steps in the burnout staircase compared to sickness absentees with other diagnoses. The model seemed to be valid also for persons with other mental diagnoses (II). Reorganization and conflicts at work as well as adding adverse private life events were associated with increased risk for sickness absence with mental diagnosis (III). Three significant factors behind the weak co-operation between local social insurance and employment agencies were identified: indistinct regulation of co-operation, shifting political goals over time and conflicting goals between agencies (IV).

In this thesis it has been suggested that the course of events preceding sickness absence might be understood as a process of emotional deprivation, where the individual is gradually emptied of the life-giving emotional energy revealed in joy, commitment, and empathy. This life-giving force finds its nourishment in safe and secure social relations with others and in a social structure that promotes this type of social relations. The profound changes in the Swedish labour market during the 1990s influenced not just the psychosocial work climate but also the rehabilitation efforts for unemployed sick-listed persons. When the political goal of reducing the unemployment level came to the forefront the indistinct regulation and the conflicting goals in addition were factors that impaired co-ordinated rehabilitation. In this process also the physicians were involved. A labour market problem was turned into a medical problem.

Place, publisher, year, edition, pages
Karlstad: Karlstads universitet , 2009. , p. 105
Series
Karlstad University Studies, ISSN 1403-8099 ; 2009:2
Keywords [en]
long-term sickness absence; burnout process; mental diagnoses; psychosocial work factors; social relations; shame emotion; emotional deprivation; vocational rehabilitation; unemployment; co-operation; adverse life events; reorganization; conflicts; grounded theory
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public Health Science
Identifiers
URN: urn:nbn:se:kau:diva-3224ISBN: 978-91-7063-224-2 (print)OAI: oai:DiVA.org:kau-3224DiVA, id: diva2:132839
Public defence
2009-02-20, Fryxellsalen, 1B 306, Karlstads universitet, Universitetsgatan 2, Karlstad, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2009-02-04 Created: 2009-01-05 Last updated: 2019-07-12Bibliographically approved
List of papers
1. Long-Term Sickness Absence Due to Burnout: Absentees' Experiences
Open this publication in new window or tab >>Long-Term Sickness Absence Due to Burnout: Absentees' Experiences
2008 (English)In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 18, no 5, p. 620-632Article in journal (Refereed) Published
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public Health Science
Identifiers
urn:nbn:se:kau:diva-3505 (URN)10.1177/1049732308316024 (DOI)
Available from: 2009-02-05 Created: 2009-02-05 Last updated: 2019-07-12Bibliographically approved
2. Insecure social bonds at work, mental ill-health and sickness absence
Open this publication in new window or tab >>Insecure social bonds at work, mental ill-health and sickness absence
(English)Manuscript (Other academic)
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public Health Science
Identifiers
urn:nbn:se:kau:diva-3507 (URN)
Available from: 2009-02-05 Created: 2009-02-05 Last updated: 2019-07-12Bibliographically approved
3. Influence of insecure social bonds at work and adverse life events: A comparison between long-term sickness absentees with mental diagnoses and a healthy population
Open this publication in new window or tab >>Influence of insecure social bonds at work and adverse life events: A comparison between long-term sickness absentees with mental diagnoses and a healthy population
(English)Manuscript (Other academic)
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public Health Science
Identifiers
urn:nbn:se:kau:diva-3509 (URN)
Available from: 2009-02-05 Created: 2009-02-05 Last updated: 2019-07-12Bibliographically approved
4. Falling between two stools: how a weak co-operation between the social security and the unemployment agencies obstructs rehabilitation of unemployed sick-listed persons
Open this publication in new window or tab >>Falling between two stools: how a weak co-operation between the social security and the unemployment agencies obstructs rehabilitation of unemployed sick-listed persons
2008 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 30, no 8, p. 569-576Article in journal (Refereed) Published
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public Health Science
Identifiers
urn:nbn:se:kau:diva-3510 (URN)10.1080/09638280701355827 (DOI)
Available from: 2009-02-05 Created: 2009-02-05 Last updated: 2019-07-12Bibliographically approved

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