Association between depression screening and sick leave among employees in Serbia

Depression and sick leave in Serbia

  • Snežana Knežević Academy of Applied Studies Polytechnic, Belgrade https://orcid.org/0000-0001-9137-2122
  • Jelena Milasinovic Health center, Kraljevo
  • Roksanda Stojanovic Health center, Kraljevo
  • Snezana Milanovic Medical school, Zvezdara, Belgrade
  • Dragana Savic Health center, Kraljevo
  • Jelena Markulic Health center, Kraljevo
  • Dalibor Stajic Department of Hygiene and Ecology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac https://orcid.org/0000-0002-7887-5347
DOI: https://doi.org/10.5937/pomc22-60088
Keywords: working-age population, mental health, depression, prevention, sick leave

Abstract


Objective. The mental health of employees represents a key factor affecting absenteeism and productivity. This study aimed to examine the association between depressive symptoms and absenteeism among employees in Serbia and to identify demographic and socioeconomic factors influencing this relationship.

Methods. A cross-sectional study was conducted using data from the National Health Survey, including a sample of 4,652 employees aged 18-65 years. Descriptive statistics and binary logistic regression, adjusted for demographic and socioeconomic factors, were used to analyze the association between depressive symptoms and absenteeism.

Results. The prevalence of mild depressive symptoms was 2.3%, and depressive episodes were 0.6%. Women showed significantly higher prevalence of depressive symptoms compared to men (3.9% vs 2.1%, p=0.002). The most common symptoms were fatigue (2.1%) and sleep problems (1.6%). All depressive symptoms showed a statistically significant association with absenteeism (p<0.01). Absenteeism frequency increases with symptom severity: 1.6% in the absence of symptoms, 4.7% for mild symptoms, while long-term absenteeism with mild symptoms was 10.4%. Participants with mild depressive symptoms had twice the odds for absenteeism (OR=2.01), while those with depressive episodes had over three times higher odds (OR=3.20).

 

Conclusion. The study confirms a significant association between the presence of depressive symptoms and absenteeism among employees in Serbia, with a clear risk gradation depending on symptom severity. Higher prevalence of depressive symptoms in women indicates the need for gender-adapted preventive approaches. Findings support the implementation of depression screening as an early strategy for reducing absenteeism in the working population.

Author Biography

Snežana Knežević, Academy of Applied Studies Polytechnic, Belgrade

PhD student at the Faculty of Medical Sciences, and Faculty of Hospitality and Tourism in Vrnjačka Banja, lecturer at Academy of Applied Studies Polytechnic Belgrade, teaching associate at the University of Kragujevac. Master manager of health care, general medicine specialist, accredited educator of health workers in the field of violence in the family (UNFPA Serbia) (2019). Member of the Serbian Medical Society Scientific Board (Section of General Medicine) (2019). Member of the Editorial Board of the Journal of General Medicine (2020). Author of scientific research papers, presentations at international and domestic conferences, published in international and domestic proceedings. European winner of the Montegut Global Scholarship Program award for contribution to primary health care (2019). Member of EGPRN, EPCCS, WONCA SIGFV, and SIG LM. Associate on the IMOCAFV project and coordinator for the Republic of Serbia (2020). Reviewer of papers for the WONCA European and World Conferences (2020 -).

References

1. Guidelines on mental health at work [Internet]. [cited 2025 Mar 25]. Available from: https://www.who.int/publications-detail-redirect/9789240053052
2. Olsson C, Tinnerholm Ljungberg H, Björk Brämberg E, Jensen I, Nybergh L. A Gender Perspective on Sick Leave Among Young Adults – Barriers and Resources for Return to Work as Experienced by Young Employees and Managers: A Protocol for a Qualitative Study. Int J Qual Methods. 2021 Jan 1;20:16094069211032072.
3. Bryan ML, Bryce AM, Roberts J. The effect of mental and physical health problems on sickness absence. Eur J Health Econ. 2021;22(9):1519–33.
4. Jakovljevic M, Malmose-Stapelfeldt C, Milovanovic O, Rancic N, Bokonjic D. Disability, Work Absenteeism, Sickness Benefits, and Cancer in Selected European OECD Countries-Forecasts to 2020. Front Public Health. 2017;5:23.
5. Amiri S, Behnezhad S. Depression symptoms and risk of sick leave: a systematic review and meta-analysis. Int Arch Occup Environ Health. 2021 Oct;94(7):1495–512.
6. Amiri S, Behnezhad S. Sleep disturbances and risk of sick leave: systematic review and meta-analysis. Sleep Biol Rhythms. 2020 Oct 1;18(4):283–95.
7. Clarke L, Chisholm K, Cappuccio FP, Tang NKY, Miller MA, Elahi F, et al. Sleep disturbances and the At Risk Mental State: A systematic review and meta-analysis. Schizophr Res. 2021 Jan;227:81–91.
8. Hwang J, Cho SS, Kim JI. Association between insomnia and absenteeism or presenteeism among Korean employees. Ann Occup Environ Med. 2022;34:e41.
9. Sagherian K, Geiger-Brown J, Rogers VE, Ludeman E. Fatigue and risk of sickness absence in the working population: A systematic review and meta-analysis of longitudinal studies. Scand J Work Environ Health. 2019 Jul 1;45(4):333–45.
10. Kanerva N, Pietiläinen O, Lallukka T, Rahkonen O, Lahti J. Unhealthy lifestyle and sleep problems as risk factors for increased direct employers’ cost of short-term sickness absence. Scand J Work Environ Health. 2018 Mar 1;44(2):192–201.
11. Tingulstad A, Meneses-Echavez J, Evensen LH, Bjerk M, Berg RC. Effectiveness of work-related interventions for return to work in people on sick leave: a systematic review and meta-analysis of randomized controlled trials. Syst Rev. 2022 Sep 5;11(1):192.
12. Antczak E, Miszczyńska KM. Causes of Sickness Absenteeism in Europe-Analysis from an Intercountry and Gender Perspective. Int J Environ Res Public Health. 2021 Nov 11;18(22):11823.
13. Santini ZI, Becher H, Jørgensen MB, Davidsen M, Nielsen L, Hinrichsen C, et al. Economics of mental well-being: a prospective study estimating associated health care costs and sickness benefit transfers in Denmark. Eur J Health Econ. 2021;22(7):1053–65.
14. Björkenstam E, Helgesson M, Gustafsson K, Virtanen M, Hanson LLM, Mittendorfer-Rutz E. Sickness absence due to common mental disorders in young employees in Sweden: are there differences in occupational class and employment sector? Soc Psychiatry Psychiatr Epidemiol. 2022 May;57(5):1097–106.
15. Joosen MCW, Lugtenberg M, Arends I, van Gestel HJAWM, Schaapveld B, Terluin B, et al. Barriers and Facilitators for Return to Work from the Perspective of Workers with Common Mental Disorders with Short, Medium and Long-Term Sickness Absence: A Longitudinal Qualitative Study. J Occup Rehabil. 2022 Jun;32(2):272–83.
16. De Bortoli MM, Oellingrath IM, Fell AKM, Burdorf A, Robroek SJW. Influence of lifestyle risk factors on work ability and sick leave in a general working population in Norway: a 5-year longitudinal study. BMJ Open. 2021 Feb 5;11(2):e045678.
17. Keus van de Poll M, Nybergh L, Lornudd C, Hagberg J, Bodin L, Kwak L, et al. Preventing sickness absence among employees with common mental disorders or stress-related symptoms at work: a cluster randomised controlled trial of a problem-solving-based intervention conducted by the Occupational Health Services. Occup Environ Med. 2020 Jul;77(7):454–61.
18. Iwasaki S, Deguchi Y, Hirota T, Shirahama Y, Nakamichi Y, Okawa Y, et al. Ten-year trends in long-term sickness absence among Japanese public servants: 2009-2018. Ind Health. 2023 Feb 1;61(1):68–77.
19. Virtanen M, Jokela M, Madsen IEH, Magnusson Hanson LL, Lallukka T, Nyberg ST, et al. Long working hours and depressive symptoms: systematic review and meta-analysis of published studies and unpublished individual participant data. Scand J Work Environ Health. 2018;44(3):239–50.
20. Knežević S, Gajić T, Sekulić D, Djoković F, Vukolić D, Zrnić M. Work-life balance: a historical review and insights for the hospitality industry. Tur Posl. 2023 Dec 21;(32):91–9.
21. Axén I, Björk Brämberg E, Vaez M, Lundin A, Bergström G. Interventions for common mental disorders in the occupational health service: a systematic review with a narrative synthesis. Int Arch Occup Environ Health. 2020 Oct;93(7):823–38.
22. Milanović, A., Đerić, A., & Pucar, N. (2024). Uticaj fizičke aktivnosti na kognitivne funkcije kod starije populacije. PONS - medicinski časopis, 21(1), 26-32.
23. Živanović, S., Pavlović, J., Hadživuković, N., Kalajdžić, O., Kucurski, L., & Kulić, V. (2023). Procjena kognitivnog statusa kod starijih osoba u zajednici. PONS - medicinski časopis, 20(1), 3-8.
24. Trifunović, B. M., & Fišeković Kremić, M. B. (2023). Motivacija zdravstvenih radnika u preventivnim aktivnostima. Opšta medicina, 29(1-2), 7-18.
Published
2025/11/24
Issue
Vol. 22 No. 1 (2025): PONS MEDICINSKI CASOPIS
Section
Original Scientific Paper