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Opinion: The mental ill health and wellbeing effects of presenteeism

Presenteeism can cause productivity loss, poor health, exhaustion and workplace epidemics. Chris Burrow, OSH Content Developer from the Advice and Practice Team at the Institution of Occupational Safety and Health, outlines how and why it is bad for organisations.

Presenteeism is when a worker attends work despite having a sickness or work affecting injury. There is a psychological urge to attend work when they know they are not in a fit state to do so. But why is this bad for organisations?

Presenteeism has financial and resource cost implications for organisations. In some cases, these implications are costlier than the worker going on sickness absence leave in the first instance. Presenteeism can cause workers to be less productive than normal, have a lower morale, and become fatigued more easily as they are experiencing different bodily effects on top of their sickness or injury symptoms. The accumulation of some of these effects can lead to mental ill health and negative wellbeing; but how and why?

Stress is a cause of mental ill health. It can be acute or chronic. If it is acute, reactions are immediate (‘fight or flight’ survival responses); whereas if it is chronic, reactions trigger the creation of the hormone cortisol that can remain present in the body for a prolonged period. The difference is that chronic reactions are more likely to affect brain functionality. If a worker is sick for a long time and continues to attend work, associated workplace pressures can cause an individual to experience additional stress. Some of the mental and physical symptoms related to chronic stress are anxiety, memory loss, high blood pressure, obesity, heightened emotions and confusion. These additional ill health effects could result in further sickness absence than what was originally required to recover from the initial absence.

Microbial pathogens (such as viruses or bacteria) can trigger stress which can be increased by the thought and action of attending work in a ‘sickness’ or ‘weakened’ state. Most occupational safety and health (OSH) professionals are aware that stress processes are a perfectly normal response in the human body and is needed for everyday situations. However, it can be a harmful physical or psychological reaction. Hormones are produced (including adrenaline and cortisol) that are responsible for biological responses when faced with undue pressures or threats; such as sickness or the effects from injury.

Pathogens can also affect the brain by triggering chemical changes and aiding in the development of, or enhancement of, symptoms relating to mental ill health. Chemical imbalances affect the ability of neurotransmitters in the brain to transfer messages from one neuron to another and on to the rest of the body. When neurons become impaired, the function of the nerve receptors and nerve systems change, resulting in poor or no communications. This can produce different mental ill health symptoms. For example, bacteria such as Streptococcus can contribute to the development of obsessive-compulsive disorder (OCD), and a parasite infection known as Toxoplasma gondii is thought to be connected with the development of schizophrenia.

Another effect of stress is bodily inflammation, which is a part of the body’s immune response. On the contrary to popular belief that only physical injuries cause inflammation, one of the main sources is stress created from emotional triggers. This is stress caused during injury or attack by pathogens which then triggers the body to prepare to heal wounds or fight infections. Stress activates the immune system to prepare to heal wounds or fight infections which increases inflammation throughout the body and farther alters someone’s emotional state (mood). For example, when someone is sick with a common cold or influenza, often their emotional state undergoes a negative change (depression). Depression and inflammation become synergised as the immune system reacts to infection. This is what causes the behavioural and emotional changes (people become less sociable, more tired/fatigued, and generally more withdrawn) and not the infection itself. Therefore, presenteeism wrongly encourages workers to enter the workplace in an already emotionally and cognitively weakened state.

Recovery is also vitally important. If workers are unable to fully recover from sickness away from the workplace, pathogens can be passed to other colleagues. This can lead to further sickness absence throughout the workforce which will have more financial and resource implications for the organisation.

Related to presenteeism is another form of unrequired work attendance known as ‘leavism’. This is when workers use annual leave and scheduled time off (e.g. lieu days and regular days off) to complete work or make themselves ‘always available’. This too can lead to mental ill health and negative wellbeing effects. Workers subject themselves to work demands and pressures by not separating themselves from their job which has connotations on their work-life balance. This can not only increase work-related stress for an individual; it can integrate and interfere with their personal life.

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