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Employee worktime control moderates the effects of job strain and effort-reward imbalance on sickness absence: the 10-town study
  1. Leena Ala-Mursula1,
  2. Jussi Vahtera2,
  3. Anne Linna2,
  4. Jaana Pentti2,
  5. Mika Kivimäki3
  1. 1Centre of Occupational Health, City of Oulu, and Department of Public Health Science and General Practice, University of Oulu, Finland
  2. 2Finnish Institute of Occupational Health, Turku, Finland
  3. 3Department of Psychology, University of Helsinki, Helsinki, Finland
  1. Correspondence to:
 Dr L Ala-Mursula
 Centre of Occupational Health, POBox 36, FIN-90015, Oulu, Finland;


Study objective: To examine whether the effects of work stress on sickness absence vary by the level of control the employees have over their working times.

Design: Prospective cohort study. A survey of job strain, effort-reward imbalance, and control over daily working hours and days off was carried out in 2000–01. The survey responses were linked with registered data on the number of medically certified (>3 days) sickness absences from one year before the survey until the end of 2003. The mean follow up period was 28.2 (SD 8.1) months. Adjustments were made for demographics and behavioural health risks. Aggregated measures of worktime control according to workplaces were used to control for differences in reactivity and response style.

Setting: Ten towns in Finland.

Participants: 16 139 public sector employees who had no medically certified sickness absences in the year preceding the survey.

Main results: Among the women, individually measured control over daily working hours and days off moderated the association between work stress and sickness absence. The combination of high stress and good worktime control was associated with lower absence rates than a combination of high stress and poor worktime control. This finding was replicated in the analyses using workplace aggregates of worktime control. Among the men, the findings were less consistent and not replicable using aggregated measures of worktime control.

Conclusions: Good control over working times reduces the adverse effect of work stress on sickness absence especially among female employees.

  • work stress
  • working times
  • autonomy
  • flexitime
  • longitudinal cohort study

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  • Funding: this study was supported by the Academy of Finland (project 105195, grant 106645), the Finnish Work Environment Fund (projects 101190 and 103432) and the participating towns. The sponsors of the study had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

  • Competing interests: none.

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