Health  Vol.8 No.9 , June 2016
A Health Impairment Process of Sickness Presenteeism in Norwegian Physicians: The Mediating Role of Exhaustion
Abstract: Although work factors have been associated with both presenteeism and exhaustion among hospital physicians, we lack knowledge on the dynamic relationship between demands in the work context and presenteeism and how this can be mediated by symptoms of exhaustion when controlling for job resources. The objective of this study is to examine a health impairment process of presenteeism among university hospital physicians. A cross-sectional survey of 545 university hospital physicians in Norway was conducted. Variables included in the model were presenteeism, exhaustion, work-family conflict, role conflict, social support and control over work pace. Findings from structural equation modeling indicated that exhaustion mediates the relationship between job demands and presenteeism. Job resources had no direct effect on presenteeism in the hypothesized model. The variables in the study explained 17% of the variance in presenteeism. The study is one of the first to demonstrate that the relationship between job demands and presenteeism is mediated by exhaustion when controlling for job resources. The results highlight the importance of considering the link between health symptoms and job demands to reduce the negative effects of presenteeism.
Cite this paper: Thun, S. and Løvseth, L. (2016) A Health Impairment Process of Sickness Presenteeism in Norwegian Physicians: The Mediating Role of Exhaustion. Health, 8, 846-856. doi: 10.4236/health.2016.89089.

[1]   Arigoni, F., Bovier, P.A. and Sappino, A.P. (2010) Trend of Burnout among Swiss Doctors. Swiss Medical Weekly, 140, w13070.

[2]   Houkes, I., Winants, Y., Twellaar, M. and Verdonk, P. (2011) Development of Burnout Over Time and the Causal Order of the Three Dimensions of Burnout among Male and Female GPs. A Three-Wave Panel Study. BMC Public Health, 11, 13.

[3]   Peterson, U., et al. (2008) Burnout and Physical and Mental Health among Swedish Healthcare Workers. Journal of Advanced Nursing, 62, 84-95.

[4]   Prins, J.T., et al. (2010) Burnout and Engagement among Resident Doctors in the Netherlands: A National Study. Medical Education, 44, 236-247.

[5]   McKevitt, C., Morgan, M., Dundas, R. and Holland, W.W. (1997) Sickness Absence and ‘Working through’ Illness: A Comparison of Two Professional Groups. Journal of Public Health Medicine, 19, 295-300.

[6]   Rosvold, E.O. and Bjert-ness, E. (2001) Physicians Who Do Not Take Sick Leave: Hazardous Heroes? Scandinavian Journal of Public Health, 29, 71-75.

[7]   Sendèn, M.G., Lovseth, L.T., Schenck-Gustafsson, K. and Fridner, A. (2013) What Makes Physicians Go to Work While Sick: A Comparative Study of Sickness Presenteeism in Four European Countries (HOUPE). Swiss Medical Weekly, 143, 1-6.

[8]   Thun, S., Fridner, A., Minucci, D. and Lovseth, L.T. (2014) Sickness Present with Signs of Burnout: The Relationship between Burnout and Sickness Presenteeism among University Hospital Physicians in Four European Countries. Scandinavian Psychologist, 1, e5.

[9]   Demerouti, E., Le Blanc, P.M., Bakker, A.B., Schaufeli, W.B. and Hox, J. (2009) Present But Sick: A Three-Wave Study on Job Demands, Presenteeism and Burnout. Career Development International, 14, 50-68.

[10]   Lu, L., Cooper, C.L. and Lin, H.Y. (2013) A Cross-Cultural Examination of Presenteeism and Supervisory Support. Career Development International, 18, 440-456.

[11]   Miraglia, M. and Johns, G. (2015) Going to Work Ill: A Meta-Analysis of the Correlates of Presenteeism and a DualPath Model. Journal of Occupational Health Psychology, No Pagi-nation Specified.

[12]   Gustafsson, K. and Marklund, S. (2014) Associations between Health and Combinations of Sickness Presence and Absence. Occupational Medicine, 64, 49-55.

[13]   Grinyer, A. and Singleton, V. (2000) Sickness Absence as Risk-Taking Behaviour: A Study of Organisational and Cultural Factors in the Public Sector. Health, Risk & Society, 2, 7-21.

[14]   Fridner, A. (2004) Career Paths and Career Patterns among Physicians with a Ph.D. Ph.D. Thesis, Uppsala University, Uppsala.

[15]   Bakker, A.B. and Demerouti, E. (2014) Job Demands-Resources Theory. In: Chen, P.Y. and Cooper, C.L., Eds., Work and Wellbeing: A complete Reference Guide, John Wiley & Sons, New York, 1-28.

[16]   Bakker, A.B., Demerouti, E. and Sanz-Vergel, A.I. (2014) Burnout and Work Engagement: The JD-R Approach. Annual Review of Organizational Psychology and Organizational Be-havior, 1, 389-411.

[17]   Demerouti, E., Bakker, A.B., Nachreiner, F. and Schaufeli, W.B. (2001) The Job Demands-Resources Model of Burnout. Journal of Applied Psychology, 86, 499-512.

[18]   Demerouti, E., Bakker, A.B., de Jonge, J., Janssen, P.P.M. and Schaufeli, W.B. (2001) Burnout and Engagement at Work as a Function of Demands and Control. Scandinavian Journal of Work Environment & Health, 27, 279-286.

[19]   Bakker, A.B. and Demerouti, E. (2007) The Job Demands-Resources Model: State of the Art. Journal of Managerial Psychology, 22, 309-328.

[20]   Demerouti, E., Bakker, A.B., Vardakou, I. and Kantas, A. (2003) The Convergent Validity of Two Burnout Instruments. European Journal of Psychological Assessment, 19, 12-23.

[21]   De Vroome, E.M.M., Smulders, P.G.W. and Houtman, I.L.D. (2010) Longitudinal Study on the Determinants and Consequences of Presenteeism. Gedrag & Organisatie, 23, 194-212.

[22]   Kalliath, T. and Morris, R. (2002) Job Satisfaction among Nurses: A Predictor of Burnout Levels. Journal of Nursing Administration, 32, 648-654.

[23]   Piko, B.F. (2006) Burnout, Role Conflict, Job Satisfaction and Psychosocial Health among Hungarian Health Care Staff: A Questionnaire Survey. International Journal of Nursing Studies, 43, 311-318.

[24]   Allen, T.D., Herst, D.E.L., Bruck, C.S. and Sutton, M. (2000) Consequences Associated with Work-to-Family Conflict: A Review and Agenda for Future Research. Journal of Occupational Health Psychology, 5, 278-308.

[25]   Kahn, R.L., Wolfe, D.M., Quinn, R.P., Snoek, J.D. and Rosenthal, R.A. (1964) Organizational Stress: Studies in Role Conflict and Ambiguity. John Wiley, Oxford.

[26]   Van Steenbergen, E.F., Kluwer, E.S. and Karney, B.R. (2014) Work-Family Enrichment, Work-Family Conflict, and Marital Satisfaction: A Dyadic Analysis. Journal of Occupational Health Psychology, 19, 182-194.

[27]   Carlson, D.S., Kacmar, K.M. and Williams, L.J. (2000) Construction and Initial Validation of a Multidimensional Measure of Work-Family Conflict. Journal of Vocational Behavior, 56, 249-276.

[28]   Greenhaus, J.H. and Beutell, N.J. (1985) Sources of Conflict between Work and Family Roles. Academy of Management Review, 10, 76-88.

[29]   Innstrand, S.T., Langballe, E.M., Espnes, G.A., Falkum, E. and Aasland, O.G. (2008) Positive and Negative Work-Family Interaction and Burnout: A Longitudinal Study of Reciprocal Relations. Work & Stress, 22, 1-15.

[30]   Johns, G. (2011) Attendance Dynamics at Work: The Antecedents and Correlates of Presenteeism, Absenteeism, and Productivity Loss. Journal of Occupational Health Psychology, 16, 483-500.

[31]   Dallner, M., et al. (2000) Validation of the General Nordic Questionnaire (QPSNordic) for Psychological and Social Factors at Work. NORD, Copenhagen

[32]   Dellve, L., Hadzibajramovic, E. and Ahlborg Jr., G. (2011) Work Attendance among Healthcare Workers: Preva-lence, Incentives, and Long-Term Consequences for Health and Performance. Journal of Advanced Nursing, 67, 1918-1929.

[33]   Levseth, L.T., Fridner, A., Jónsdóttir, L.S., Marini, M. and Linaker, O.M. (2013) Associations between Confidentiality Requirements, Support Seeking and Burnout among University Hospital Physicians in Norway, Sweden, Iceland and Italy (the HOUPE Study). Stress and Health, 29, 432-437.

[34]   Meijman, T.F. and Mulder, G. (1998) Psychological Aspects of Workload. In: Drenth, P.J.D. and Thierry., H., Eds., Handbook of Work and Organizational Psychology, Hove, Psychology Press. 5-33.

[35]   Lu, L., Peng, S.-Q., Lin, H.Y. and Cooper, C.L. (2014) Presenteeism and Health over Time among Chinese Employees: The moderating Role of Self-Efficacy. Work & Stress, 28, 165-178.

[36]   Johns, G. (2010) Presenteeism in the Workplace: A Review and Research Agenda. Journal of Organizational Behavior, 31, 519-542.

[37]   Viswesvaran, C., Sanchez, J.I. and Fisher, J. (1999) The Role of Social Support in the Process of Work Stress: A Meta-Analysis. Journal of Vocational Behavior, 54, 314-334.

[38]   Caverley, N., Cunningham, B.J. and MacGregor, J.N. (2007) Sickness Presenteeism, Sickness Absenteeism, and Health Following Restructuring in a Public Service Organization. Journal of Management Studies, 44, 304-319.

[39]   Wallace, J.E. and Lemaire, J. (2007) On Physician Well Being—You’ll Get by with a Little Help from Your Friends. Social Science & Medicine, 64, 2565-2577.

[40]   Deery, S., Walsh, J. and Zatzick, C.D. (2014) A Moderated Mediation Analysis of Job Demands, Presenteeism, and Absenteeism. Journal of Occupational and Organizational Psychology, 87, 352-369.

[41]   Hansen, C.D. and Andersen, J.H. (2008) Going Ill to Work—What Personal Circumstances, Attitudes and Work-Related Factors Are Associated with Sickness Presenteeism? Social Science & Medicine, 67, 956-964.

[42]   Johansson, G. and Lundberg, I. (2004) Adjustment Latitude and Attendance Requirements as Determinants of Sickness Absence or Attendance. Empirical Tests of the Illness Flexibility Model. Social Science & Medicine, 58, 1857-1868.

[43]   Jourdain, G. and Vezina, M. (2014) How Psychological Stress in the Workplace Influences Presenteeism Propensity: A test of the Demand-Control-Support Model. European Journal of Work and Organizational Psychology, 23, 483-496.

[44]   Kivimaki, M., et al. (2005) Working While Ill as a Risk Factor for Serious Coronary Events: The Whitehall II study. American Journal of Public Health, 95, 98-102.

[45]   Lindstrom, K. (2000) User’s Guide for the QPS Nordic: General Nordic Questionnaire for Psychological and Social Factors at Work. Copenhagen

[46]   Wannstrom, I., Peterson, U., Asberg, M., Nygren, A. and Gustavsson, P. (2009) Psychometric Properties of Scales in the General Nordic Questionnaire for Psychological and Social Factors at Work (QPS): Confirmatory Factor Analysis and Prediction of Certified Long-term Sickness Absence. Scandinavian Journal of Psychology, 50, 231-244.

[47]   Hellesoy, O.H. (1985) Work Environment Statfjord Field. Work Environment, Health and Safety on a North Sea Oil Platform. Universitetsforlaget, Bergen.

[48]   Levseth, L.T. (2011) The Subjective Burden of Confidentiality. Ph.D. Thesis, Faculty of Medicine, Department of Neuroscience, Norwegian University of Science and Technology, Trondheim.

[49]   Hu, L. and Bentler, P.M. (1999) Cutoff Criteria for Fit Indexes in Covar-iance Structure Analysis: Conventional Criteria versus New Alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6, 1-55.

[50]   Tabachnick, B.G. and Fidell, L.S. (2013) Using Multivariate Statistics. Pearson, Boston.

[51]   Cortina, J.M. (1993) What Is Coefficient Alpha? An Examination of Theory and Applications. Journal of Applied Psychology, 78, 98-104.

[52]   Johansen, V., Aronsson, G. and Marklund, S. (2014) Positive and Negative Reasons for Sickness Presenteeism in Norway and Sweden: A Cross-Sectional Survey. BMJ Open, 4, e004123.

[53]   Baker-McClearn, D., Greasley, K., Dale, J. and Griffith, F. (2010) Absence Management and Presenteeism: The Pressures on Employees to Attend Work and the Impact of Attendance on Performance. Human Resource Management Journal, 20, 311-328.

[54]   Johns, G. (2012) Presenteeism: A Short History and a Cautionary Tale. In: Houdmont, J., Stavroula, L. and Sinclair, R.R., Eds., Contemporary Occupational Health Psychology: Global Perspectives on Research and Practice, John Wiley & Sons, Chichester, 204-220.

[55]   DeSalvo, K.B., Bloser, N., Reynolds, K., He, J. and Muntner, P. (2006) Mortality Prediction with a Single General Self-Rated Health Question. Journal of General Internal Medicine, 21, 267-275.

[56]   Johns, G. and Miraglia, M. (2015) The Reliability, Validity, and Accuracy of Self-Reported Absenteeism from Work: A Meta-Analysis. Journal of Occupational Health Psychology, 20, 1-14.

[57]   Thun, S., Saksvik, P.O., Mehmetoglu, M., Ose, S.O. and Christensen, M. (2013) The Impact of Supervisors’ Attitudes on Organizational Adjustment Norms and Attendance Pressure Norms. Scandinavian Journal of Organizational Psychology, 5, 15-31.