Abstract Introduction We examined how physically and mentally demanding working conditions contribute to sickness presenteeism, absence, and their combinations among young and early midlife employees. Methods We prospectively linked the Helsinki Health Study survey on physical and mental strenuousness of work and hours per day in physical work with the employer's sickness absence register (n = 4,039; ages 19 to 39 in 2017). We used the Work Ability Score (WAS, work ability 0 to 10) and WAS-related discount factors to estimate annual presenteeism days lost due to reduced work ability. We calculated incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for sickness presenteeism, sickness absence, and their combinations using negative binomial regression, adjusting for age, gender, marital status, and education. Results Participants had on average 9.7 sickness presenteeism and 10.4 absence days during the mean follow-up of 0.93 yr. Overall, 57% had sickness presenteeism and 78% absence days, while 47% had both and 11% neither. Sickness presenteeism and absence days increased with the intensity of physically and mentally demanding working conditions. After age and gender adjustments, the associations were particularly strong between mentally strenuous work and sickness presenteeism (intermediate: IRR: 1.55, CI: 1.43 to 1.69; strenuous: IRR: 2.84, CI: 2.55 to 3.17), both alone or combined with absence. Adjusting for education marginally contributed to the associations concerning physical working conditions. Conclusions The particularly strong association between mentally strenuous work and sickness presenteeism highlights the need to identify and offer targeted support to employees who perceive their work as mentally strenuous, benefiting not only individuals, but also employers and society.
Svärd et al. (2026) studied this question.