In the Western world mental health problems are increasing and in Sweden these problems are the most common reason for sick leave. Diagnoses of adjustment disorders and reactions to severe stress are increasing the fastest out of all mental health problems. The aim of this study is to contribute new insights into employees’ experiences and management of being on sick leave with a stress-related psychiatric diagnosis. The empirical material consisted of individual interviews with 26 employees who were on sick leave from at least part-time employment because of a stress-related diagnosis. The grounded theory method was used to analyse the results. In the generated model, we propose that sick-listed employees engage in enhancing credibility in relation to themselves and others, here attempting to come across as credible and, thus, avoiding disbelief and the negative attributions of being on sick leave with a psychiatric diagnosis. The interviewees shared the general concern that being perceived as either healthier or sicker than the case may be, as well as greater sensitivity to what others might think, which was manifested as being on guard and controlling their behaviour and emotional display. To return to work, the sick-listed employees tended to re-evaluate their previous performance at work and saw the illness as self-inflicted and as the result of not having been capable of drawing the line between work and leisure.

This exploratory compilation thesis of four sub studies in Social Work aims to qualitatively examine how employees are affected by organisational changes and other work-related processes, and also to increase understanding of the causes of sick leave and being on sick leave through analysing the experiences of people from different professional backgrounds. Against the background of the labour market and social policy changes introduced at the beginning of the 1990s, these are urgent issues to address, particularly since there is a lack of qualitative studies linking work environment to mental health and sick leave, from the perspective of the employee. The focus of this doctoral thesis is on the relational and emotional processes involved.

The empirical material consists of qualitative interviews with assistant nurses and care assistants in municipal home care services for the elderly, and with individuals of different professional backgrounds who were on long-term sick leave with stress-related diagnosis.  

To understand the central contribution of the thesis – working in an uphill struggle – as something beyond the individual experience, the structures framing the individual must be included in the analysis. The feeling of working in an uphill struggle arises in the process of having to work against personal conviction and harbouring conflicting emotions when institutional and structural conditions for gainful employment and health insurance have changed for the worse, thus obstructing the opportunity to fulfil personal performance standards of quality and credibility. Conflicting feelings can lead to emotional dissonance, which unresolved may lead to illness and sick leave. The uphill struggle is manifested in various ways, as presented in the four sub studies.

Denna avhandling i socialt arbete studerar hur arbetstagare påverkas av organisationsförändringar och andra arbetsrelaterade processer som kan föranleda psykisk ohälsa och sjukskrivning, samt hur det är att vara sjukskriven med en psykiatrisk diagnos av stressrelaterad karaktär. Det är angelägna frågor att studera mot bakgrund av den samhällsomvandling som inleddes i början på 1990-talet med omfattande förändringar inom arbetslivet och socialpolitiken, speciellt då det råder brist på fördjupad kunskap utifrån arbetstagares och sjukskrivnas perspektiv.

För att förstå avhandlingens övergripande bidrag, arbete i motvind, som något mera än en individuell upplevelse, måste den kontext som individen lever inom inkluderas i analysen. Känslan av att arbeta i motvind uppkommer genom att tvingas arbeta mot sin övertygelse och härbärgera motstridiga känslor när institutionella och strukturella villkor för lönearbetet och sjukförsäkringen förändrats och försämrats och blir till hinder för att förverkliga egna krav på kvalitet och trovärdighet. Dessa motstridiga känslor kan leda till emotionell dissonans som om den inte löses upp riskerar att leda till ohälsa och sjukskrivning. Arbete i motvind tar sig uttryck på olika sätt som redovisas i avhandlingens fyra delstudier.

Rätten till heltid stöds av politiker och arbetsmarknadens parter för att undanröja det omfattande och ofrivilliga deltidsarbetet för äldreomsorgens personal. Arbetstidsmodeller med inslag av flexibel arbetstid möjliggör detta utan ökade kostnader för arbetsgivaren. För personalen innebär det att delar av såväl arbetstid som arbetsplats blir oförutsägbara. I studien analyseras följderna av denna omvandling ur arbetstagarperspektiv. Resultatet visar att priset för heltid är en organiserad osäkerhet med försämrade och oönskade arbetsvillkor.

Part-time work is more than twice as common among women than men in Sweden. New ways of organizing working hours to allow for more full-time jobs have been introduced for care workers in elderly care, which means unscheduled working hours based on the needs of the workplace. The aim of the study is to analyze how the organization of the unscheduled working hours affect employees' daily lives and their possibility to provide care. The Classic Grounded Theory method was used in a secondary analysis of interviews with employees and managers in Swedish municipal elderly care. The implementation of unscheduled working hours plunged employees into a situation of managing organized insecurity. This main concern for the care workers involved a cyclic process of first having to be available for work because of economic and social obligations to the employer and the co-workers, despite sacrifices in the private sphere. Then, they had to be adaptable in relation to unknown clients and co-workers and to the employer, which means reduced possibilities to provide good care. Full-time jobs were thus created through requiring permanent staff to be flexible, which in effect meant eroded working conditions with high demands on employee adaptability. Solving the part-time problem in elderly care by introducing unscheduled working hours may in effect be counter-productive.

Mental illness is the most common diagnosis resulting in long-term sick leave in Sweden today, especially stress-related syndromes and mood disorders. The aim of this article is to analyse the relational and emotional processes in the workplace that may contribute to the understanding of long-term sick leave for mental-health reasons. We conducted interviews with twenty-six people who were on sick-leave because of diagnoses of mental ill-health. The empirical material was analysed using Classic Grounded Theory. We suggest that the risk of being afflicted with mental illness, and forced into long-term sick leave, increases when there are conflicts at work that remain unresolved and which lead to malignant shaming processes that jeopardize personal dignity. In their struggle to maintain self-esteem, the afflicted escalate their work efforts by increasing work intensity, putting in overtime, and working when ill. Eventually, this behaviour affects their health and results in sick-listing. The strengths and weaknesses of the study are discussed along with the need for further research.