This initial classification assumes that the categories of absenteeism and presenteeism

Exploratory sensitivity analysis revealed workplace accidents costs contributed substantially to total cost and future effort should be directed at understanding the magnitude of this problem. Presenteeism behaviour was defined in the initial scenarios as the absence of depression-related absenteeism in the 12-months prior to the NSMHWB interview. This initial classification assumes that the categories of 12-month absenteeism and presenteeism were mutually exclusive, which is not always correct. Recent research has identified that episodes of absenteeism are often preceded and Theaflavin followed by episodes of presenteeism. This highlights that employed individuals reporting depression can experience both absenteeism and presenteeism within a given period of time. Therefore there may be some error in classification at baseline based on this definition. However, while there was a NSMHWB item which asked respondents to Curdione report the number disability, or presenteeism, days they experienced in the past year, separate to an item which asked individuals to report their number of absence days, it was not depression specific. Therefore, although the method we employed to define presenteeism may be considered a limitation, it was depression-specific and removed the possible influence of co-morbid disorders on work attendance decisions. Further, as we modelled what happened to our hypothetical cohort in 3-month cycles, individuals were assigned probabilities of lost productive time based on both absenteeism and presenteeism as we know they move in and out of these states over time. Absenteeism reporters had lower QALYs, albeit not significantly, compared to presenteeism reporters. This may be due to individuals reporting absenteeism experiencing more severe symptoms which restrict their work ability and by extension their quality-of-life. However, what remains unclear is whether individuals reporting presenteeism have higher quality-adjusted life years due to benefits of continued work attendance such as social support, structured routine and income or whether continuing to work is due to higher quality-of-life.

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