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Journal of Occupational and Environmental Medicine, Publish Ahead of Print

DOI: 10.1097/JOM.0000000000001879

Leadership quality and risk of long-term sickness absence among 53,157 employees of the

Danish workforce

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Jeppe Karl Sørensen, MSc (1), Elisabeth Framke, PhD (1), Thomas Clausen, PhD (1), Anne

Helene Garde, PhD (1,2), Nina Føns Johnsen, PhD (1), Jesper Kristiansen, PhD (1), Ida E.H.

Madsen, PhD (1), Mads Nordentoft, MSc (1), Reiner Rugulies, PhD (1,2,3)

(1) National Research Centre for the Working Environment, Copenhagen, Denmark; (2)

Department of Public Health, University of Copenhagen, Denmark; (3) Department of

Psychology, University of Copenhagen, Denmark

Corresponding Author:

Jeppe Karl Sørensen, MSc

National Research Centre for the Working Environment

Lersø Parkallé 105, DK-2100 Copenhagen, Denmark

Phone: +45 39 16 53 05; Fax: +45 39 16 52 01; e-mail: [email protected]

Funding:

The Danish Working Environment Research Fund (grant number 10-2016-03). The

funding source had no further role in the study design; data collection, analysis and interpretation

of data; in the writing of the paper, or in the decision to submit the paper for publication.

Conflict of interest:

None declared.

This is an open access article distributed under the terms of the Creative Commons Attribution-Non

Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share

the work provided it is properly cited. The work cannot be changed in any way or used commercially

without permission from the journal.

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ABSTRACT

Objective:

To examine whether low leadership quality predicts long-term sickness absence

(LTSA) in Denmark.

Methods:

Using Cox models, we estimated the association between exposure to low leadership

quality and onset of register based LTSA (≥6

weeks) during 12-months

follow-up among 53,157

employees without previous LTSA.

Results:

During 51,155 person-years, we identified 2,270 cases of LTSA. Low leadership

quality predicted LTSA with a dose-response pattern after adjustment for confounders. The

hazard ratio (HR) of LTSA in the lowest compared to the highest quartile of leadership quality

was 1.61 (95% CI: 1.43-1.82). Further, change from high to low leadership quality over time

predicted risk of LTSA (HR=1.42, 95% CI: 1.02-1.97) compared to persistent high leadership

quality.

Conclusions:

Exposure to low leadership quality is a risk factor of LTSA in the Danish

workforce.

Keywords:

Psychosocial work factors; Stress; Managerial quality; Absenteeism; Longitudinal

study; Occupational health

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INTRODUCTION

Leadership quality also denoted managerial quality or supervisory quality, relates to specific

behaviors or actions of a leader toward their subordinates. This includes for example the leader‟s

ability to provide guidance, solve conflicts, or support employees in their professional

development.

High leadership quality may be a job resource with the potential of buffering

health-hazardous exposures at work. According to Schaufeli and Bakker (2004) job resources are

aspects of work that reduce job demands, are functional in achieving work goals, and/or

stimulate personal growth, learning and development.

Low leadership quality may also cause

adverse working conditions, for example negative behaviors at work such as workplace

bullying.

Further, in accordance with the “Stress-as-Offense-to-Self” theory by Semmer et al.,

low leadership quality may be considered as a stressor in itself, as lack of appreciation,

acknowledgement, and the breach of the social contract of what can be reasonably expected from

a leader may directly affect employees‟ well-being.

Long-term sickness absence (LTSA) may be considered an important indicator of both somatic

and mental ill-health as it is strongly associated with risk of both disability pension and

mortality.

5, 6

Although leadership quality is a major topic in work and organizational

psychology,

it is uncertain whether low leadership quality is associated with risk of LTSA. So

far, prospective cohort studies on the association between leadership quality and risk of LTSA

have shown inconsistent results, with studies both demonstrating associations, absence of

associations and associations only in subgroups.

8-13

In general, this literature is characterized by

studies that are either based on relatively small samples or samples limited to specific

occupational groups. Further, to our knowledge, no studies have yet investigated associations

between changes in leadership quality over time and risk of LTSA. Examining such associations

would be important for guiding future interventions.

In this article, we report results from a large prospective study linking survey data of more than

53,000 Danish employees from a wide range of job types and industries with register data on

LTSA, defined as six or more consecutive weeks of sickness absence. In order to examine the

potential effects of intervening on leadership quality among employees in Denmark we

investigated (i) if low leadership quality predicted risk of LTSA and (ii) if low leadership quality

predicted risk of LTSA differently among men and women, age groups, educational groups and

sector of employment (private or public). We further investigated in a subsample of more than

7,000 employees with repeated measurement on leadership quality, (iii) if a change from high to

low leadership quality predicted risk of LTSA compared to persistent high level of leadership

quality.

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METHODS

Study design and population

We used data from the 2012, 2014 and 2016 waves of the Work Environment and Health in

Denmark study (WEHD), a biennial survey data on working conditions and health. The design of

WEHD is described in more detail elsewhere.

Briefly, WEHD consists of a stratified workplace

sample conducted in 2012 and 2016, a nationwide sample conducted in 2012, 2014 and 2016,

and a cohort that consists of all responders from the 2012 wave of the nationwide sample who

also received a questionnaire in 2014 and 2016. We included first-time respondents from the

stratified workplace sample and the nationwide sample (study population 1) and respondents

from the cohort responding in 2012 and 2014 (study population 2). Inclusion criteria for all

participants were being (i) liable to pay taxes in Denmark, (ii) aged 18-64 years, (iii) employed

with at least 35 hours monthly and with a monthly income of at least 3,000 DKK (460 US

Dollar, 400 Euro as of 31 December 2012), and (iv) not having a „research protected‟ address.

Figure 1 presents data source and flowcharts for study population 1 and 2. Study population 1

included all first time respondents from the 2012, 2014 and 2016 waves, a total of 67,402

individuals. The average response rate was 50%. We excluded 5,116 respondents reporting non-

employment at baseline (i.e. the date individuals filled in the questionnaire), 5,242 respondents

with LTSA during the two years before or at baseline, 989 respondents who received either

retirement benefits or disability pension or emigrated during the two years before baseline, 1,633

respondents without a leader, and 1,268 respondents with missing data on key variables

including leadership quality (n=631), yielding a final sample of 53,157 participants in study

population 1.

Study population 2 included 11,471 individuals who responded to both the 2012 and 2014 wave.

We excluded respondents reporting non-employment in 2012 or 2014 (n=1,444), had LTSA

(n=1,376) or received retirement benefits, disability pension or migrated (n=268) in the four-

year time period ranging from two years before filling in the questionnaire in the 2012 wave until

filling in the questionnaire in the 2014 wave, reported that they had no leader (n=444), and had

missing data on key variables (n=316), yielding a final sample of 7,623 respondents in study

population 2.

Measurement of leadership quality

Leadership

quality was measured with eight items developed for WEHD: How often … (Q1)

“does your immediate manager explain the company's objectives so you understand what they

mean for your work tasks?“; (Q2) “do you have sufficient authority in relation to your

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responsibilities

at work?”; (Q3) “does your immediate manager take the time to engage in your

professional development?”; (Q4) “does your immediate manager involve you in the planning of

your work?”; (Q5) “does your immediate manager give you the necessary

feedback (praise and

criticism) for your work?”; (Q6) “is your work recognized and appreciated by the

management?”; (Q7) “do you get the necessary help and support from your immediate

manager?”; (Q8) “can you trust the information that comes from the management?”.

Response categories for all items were “Never” (1), “Seldom” (2), “Sometimes” (3), “Often” (4)

and “Always” (5). Scores were summed for all participants with non-missing

values on four or

more leadership quality items, resulting in a scale with a potential range from 8 to 40 points, with

higher scores indicating better leadership quality. Participants with missing values on three or

less leadership quality items were assigned the mean score of their non-missing items. In total

52,800 (99.3 %) responded to all eight items.

In study population 1, we categorized the leadership quality score into four groups based on the

quartiles within the study population (1st quartile=23.0, 2nd quartile=27.0, and 3rd

quartile=32.0) and labelled the groups: “Low leadership quality” (8.0≤score<23.0, mean=18.6,

SD=3.1); “Medium-low leadership quality” (23.0≤score≤27.0, mean=25.1, SD=1.4); “Medium-

high leadership quality” (27<score≤32.0, mean=30.0, SD=1.4); and “High leadership quality”

(32<score≤ 40.0, mean=35.9, SD=2.3).

In study population 2, we categorized the leadership quality score by median split as high

(≥median) or low (<median) leadership quality in 2012 (median=28.0) and 2014 (median=27.0),

respectively. We then categorized the respondents into four groups based on the level of

leadership quality (high or low) in 2012 and 2014: “Persistent high leadership quality”; “Change

from high to low leadership quality”; “Change from low leadership to high leadership quality“;

and “Persistent low leadership quality”.

In study population 2, we categorized the leadership quality score by median split as high or low

leadership quality in 2012 (median=28.0) and 2014 (median=27.0), respectively. We then

categorized the respondents into four groups based on the level of leadership quality (high or

low) in 2012 and 2014: “Persistent high leadership quality”; “Change from high to low

leadership quality”; “Change from low leadership to high leadership quality“; and “Persistent

low leadership quality”.

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The leadership quality items was developed for the WEHD questionnaire and its psychometric

properties as a scale have not previously been tested. Therefore, we conducted a factor analysis

(rotation method: varimax) in population 1. The eight items loaded on one global factor with an

eigenvalue of 4.57 and all rotated factor loadings ranged from 0.63 to 0.84, confirming the

unidimensionality of the scale. The internal consistency of the scale was high with a Cronbach‟s

alpha of 0.89.

Measurement of LTSA

Using the respondents‟ unique

civil registration number, the WEHD questionnaire data was

linked to the DREAM register (Danish Register-Based Evaluation of Marginalization). DREAM

contains weekly information on all social transfer payments in Denmark since 1991, and

retirement, maternity leave, emigration, death and all compensation granted for sickness absence

since 1996.

The type of social transfer payment is reported per week for each person.

We defined LTSA as any

sickness absence spell lasting 30 days or more (≥ 6 weeks). The reason

for this cut-off point was that of January 2012 only sickness absence spells of 30 days or more

were reimbursed by the municipality and subsequently registered in DREAM. We assessed the

first episode of six or more consecutive weeks of sickness absence for each individual during 12

month (52 weeks) follow-up after baseline. We used the same definition of LTSA for study

population 1 and 2.

Measurement of covariates

As covariates we included sex (men or women), age (continuous), highest completed education

in four categories (high; middle-high; middle-low; or low), according to the International

Standard Classification of Education (ISCED),

cohabitation (yes/no), number of children living

at home (no children; at least one child younger than 8 years old; or at least one child aged 8 to

17 while no children younger than 8 years old in the household), and sector of employment

(private or public). We selected these covariates, as they are associated with risk of LTSA in

Denmark.

10, 11, 17

Information on sex, age, education, cohabitation and children was retrieved

from population based registers.

18-21

Information on sector of employment was retrieved from the

Integrated Database for Labor Market Research.

We further included job type defined by one-

digit DISCO-08 number, the Danish version of the International Standard Classification of

Occupations‟ (ISCO-08)

system,

and industry by using the codes of the Danish version of the

EU‟s nomenclature (NACE, Statistical classification of economic activities in the European

Community) from Statistics Denmark.

We used “the standard industrial grouping for

publishing purposes” that

aggregates the 726 possible industries into 10 groups. We included job

type and industry as previous research suggest that job type is associated with participation in

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WEHD

and we expected that reported leadership quality might differ between employees in

different industries.

Statistical analysis

Using Cox proportional regression models, we estimated hazard ratios (HR) and 95% confidence

intervals (95% CI) for the association between exposure to different levels of leadership quality

reported at baseline and risk of LTSA during a 12 months follow-up period with calendar time as

the underlying time axis. Participants were followed from the date of first time questionnaire

completion (study population 1) and the second time questionnaire completion (study population

2), respectively, until first episode of LTSA or censoring due to statutory retirement, voluntary

early retirement, disability pension, emigration, death or end of follow-up, whichever came first.

We calculated cases per 1,000 person years, crude estimates and estimates adjusted for sex, age,

education, cohabitation and children living at home, sector of employment, job type, industry

and type of sample (stratified workplace sample or nationwide sample). Because we used

calendar time as the underlying time axis in the analyses, estimates were also adjusted for the

year participants filled in the questionnaire accounting for trends in sickness absence over time

and design differences between the three WEHD waves.

Proportional hazard assumptions for leadership quality and covariates were visually inspected

using Log-Log curves. We found no indication of violation of the proportional hazard

assumption.

In study population 1 we tested for a dose-response relationship between lower levels of

leadership quality and risk of LTSA by estimating the fully adjusted HR (95% CI) for one unit

decrease in the categorized leadership quality groups. Further, we tested if low leadership quality

predicted risk of LTSA differently depending on sex, age, educational attainment and sector of

employment by repeating the analyses separately for men and women, age groups (18-29, 30-44,

45-54, 55-64 years), the four educational groups (low, middle-low, middle-high, high) and labor

market sector (employment in private or public sector).

In study population 2, we examined the association between changes in leadership quality from

the 2012 to the 2014 survey and risk of LTSA in the 12 months after the 2014 survey. We

estimated adjusted HRs (95% CI) for subsequent risk of LTSA among respondents experiencing

persistent low leadership quality, a change from low to high leadership quality, and change from

high to low leadership quality between 2012 and 2014 compared to respondents with persistent

high leadership quality between 2012 and 2014. We used the same covariates as in the analysis

on study population 1.

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Sensitivity analysis

We conducted two sensitivity analysis among the respondents from study population 1. First, to

test for reversed causation we excluded cases of LTSA during the first 6 month of follow-up

(n=1,823). We then estimated HR and 95% CI for the association between low leadership quality

at baseline and risk of LTSA from 6 months after baseline until 12 months after baseline.

Second, we examined the association between the eight leadership quality items separately and

risk of LTSA. We standardized the eight items and the leadership quality score with a mean of

zero and a standard deviation of one and estimated HR and 95% CI for LTSA per one standard

deviation decrease in the leadership quality item i.e. from higher to lower leadership quality

score during 12 months of follow-up. Estimates were adjusted for the same covariates as in the

analysis on study population 1. This analysis was limited to respondents from study population 1

without missing values on any of the eight leadership quality items (n: 52,800).

RESULTS

Characteristics of the study populations

Table 1

shows the baseline characteristics of the two study populations. In study population 1

slightly more than half were men (52.5%), mean age was 45.0 years (SD=11.3) and the majority

was employed in the private sector (57.6%). Most participants had middle-low education (upper

and post-secondary education, 43.6%), were cohabiting (77.9%), had no children living at home

(55.2%), where professionals (31.7%), and were working with public administration, education

and health (39.7%). The mean leadership quality score was 27.3 (SD=6.5) and similar across the

study participants‟ characteristics. In comparison

with study population 1, participants in study

population 2 were more often women (53.4%) and had a higher mean age of 47.8 (SD=10.0).

Leadership quality and predicted risk of LTSA in study population 1

During 51,155 person years, we identified 2,270 cases of LTSA (44 cases per 1,000 person-

years). Among LTSA cases, the mean time from baseline to LTSA was 26.7 weeks (0.51 years).

Participants were censored during follow-up due to statutory retirement pension (n: 734),

voluntary early retirement (n: 933), disability pension (n: 80), emigration (n: 216) or death (n:

282).

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Table 2

shows LTSA cases per 1,000 person-years and the crude and adjusted hazard ratios of

the association between exposure to levels of leadership quality at baseline and onset of LTSA

during follow-up. The number of LTSA cases per 1,000 person-years was 36, 38, 43 and 60 for

high, medium-high, medium-low and low leadership quality, respectively. The corresponding

adjusted hazard ratios were 1.09 (95% CI: 0.96-1.24), 1.19 (95% CI: 1.05-1.35) and 1.61 (95%

CI: 1.43-1.82), respectively. There was a dose-response association between lower leadership

quality scores and higher risk of LTSA. For each one unit decrease in the level of leadership

quality (from higher to lower levels), the adjusted HR for LTSA was 1.17 (95% CI: 1.13-1.22).

Leadership quality and LTSA separately for men and women, age groups, educational

level and sector of employment in study population 1

Figure 2

shows the association between leadership quality and risk of LTSA separately for men

and women, age groups, educational level, and sector of employment. Low leadership quality

predicted risk of LTSA in both men and women, in all age groups, at all educational levels and

among employees in the private and public sector. We found no indication of interactions

between leadership quality and sex (p-value: 0.37), age groups (p-value: 0.55), educational level

(p-value: 0.86), or sector of employment (p-value: 0.48).

Change in leadership quality and predicted risk of LTSA in study population 2

Table 3

shows for study population 2 LTSA cases per 1,000 person-years and the crude and

adjusted hazard ratios for the association between changes in leadership quality from the 2012 to

the 2014 survey and onset of LTSA during 12 months follow-up after the 2014 survey. The

number of LTSA cases per 1,000 person-years was 36, 46, 50 and 32 for persistent high

leadership quality, persistent low leadership quality, change from high to low leadership quality,

and change from low to high leadership quality, respectively. Compared to persistent high

leadership quality change from high leadership quality to low leadership quality predicted risk of

LTSA with a HR of 1.42 (95% CI: 1.02-1.97). Persistent low compared to persistent high

leadership quality was associated with risk of LTSA with a HR of 1.28 (95% CI: 0.97-1.69).

The risk of LTSA in employees changing from low to high leadership quality was similar to that

of employees with persistent high leadership quality (HR=0.90, 95% CI: 0.71-1.47).

Sensitivity analysis

When we excluded cases during the first 6 months of follow-up, results were similar to the main

analyses (Online-table

http://links.lww.com/JOM/A751).

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When we analyzed the eight leadership quality items, separately, we found that a one standard

deviation decrease in the score predicted risk of LTSA for all eight items with adjusted HRs

ranging from 1.11 to 1.22 (Online-figure

http://links.lww.com/JOM/A752). We found the

strongest associations for items concerning authority in relation to responsibility (Q2),

recognition and appreciation by the management (Q6), help and support from the immediate

manager (Q7), and trusting information from the management (Q8). A one standard deviation

decrease in the total leadership quality score predicted risk of LTSA with an adjusted HR of 1.23

(95% CI: 1.18-1.28) (Online-figure

http://links.lww.com/JOM/A752).

DISCUSSION

Summary of results

This study of 53,157 employees from a wide range of job types and industries in Denmark

showed that during 12 month of follow-up low leadership quality, compared to high leadership

quality, was associated with higher risk of onset of LTSA, measured as six or more consecutive

weeks of sickness absence. There was a clear dose-response association between lower levels of

leadership quality and higher risk of LTSA. Low leadership quality predicted a higher risk of

LTSA in both men and women, in all age groups, at all educational levels, and among employees

in the private and public sector.

In a subsample of 7,623 employees with repeated measurements of leadership quality, change

from high to low leadership quality was associated with higher risk of onset of LTSA compared

to persistent high leadership quality. The increased risk of LTSA among employees who had

experienced a worsening in leadership quality suggest that the association between low

leadership quality and risk of LTSA is mainly driven by workplace conditions and not by

personality traits of the respondents.

Comparison with previous research

Previous research on leadership quality and risk of LTSA has shown inconsistent results, with

some studies reporting associations and other studies not or only in subgroups.

8-13

For example, a

Danish study by Clausen et al. reported that low compared to high leadership quality predicted

risk of LTSA with a HR of 1.21 (95% CI: 1.12-1.31) among 39,408 employees from four

occupational groups.

The slightly stronger estimate in our study (HR: 1.61, 95% CI: 1.43-1.82)

may be due to (i) differences in the items measuring leadership quality, (ii) higher exposure

contrast in our study (categorization into tertiles by Clausen et al. and into quartiles in our study)

and (iii) different definitions of LTSA (≥3

weeks and ≥6 weeks, respectively).

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Another Danish study by Lund et al reported that a higher degree of leadership quality was

associated with a lower risk of LTSA among women but not among for men.

In our study,

though, we found associations in both women and men. A reason for this difference may be the

different sample sizes of the two studies. Our sample was ten times larger (53,157 vs. 5,357) and

the amount of LTSA cases was nearly six times larger (2,270 vs 359) compared to the study by

Lund et al. Consequently, our study had higher statistical power, increasing the chances to detect

also small associations and to estimate associations with a high level of precision.

Strengths and limitations

The strengths of this study are the large dataset with 53,157 employees representing a wide range

of job types and industries in the Danish workforce. The use of register-based LTSA ensured

almost no loss to follow-up. To our knowledge, this is the largest study on the association

between leadership quality and sickness absence to date. The large number of participants and

cases allowed us to conduct subgroup analyses demonstrating that associations between

leadership quality and LTSA was similar for men and women and across age groups, educational

groups and sector of employment.

The leadership quality score used in this study was a newly developed tool for WEHD and had

not been tested previously. We therefore conducted a factor analysis of the scale before

analyzing the association between leadership quality and LTSA. The items of the scale loaded on

one global factor, the internal consistency of the scale was high and a Cronbach‟s alpha of 0.89

indicated a high degree of correlation between the items. A sensitivity analysis showed that all

eight items predicted LTSA in the same direction and contributed to the ability of the leadership

quality scale to predict LTSA. Thus, although the leadership quality scale was not tested

previously, it turned out as a reliable scale with predictive validity regarding risk of LTSA.

To ensure that our results were not affected by reverse causation we conducted a sensitivity

analysis excluding LTSA events during the first 6 month after baseline. The analysis showed

similar estimates with an increased risk of LTSA among participants reporting low leadership

quality, indicating that the association between leadership quality and risk of LTSA is not due to

reverse causation.

Several limitations of the study should be noted. First, the Danish registers do not include cause

of LTSA and consequently we do not know whether a participant was sick due to a somatic

disease or mental disorder. Consequently, we were not able to analyze whether low leadership

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quality predicted LTSA due to a somatic disease or mental disorder differently, which could be

important to clarify as low leadership quality previously has been associated with an increased

risk of both ischemic heart diseases and depressive disorder.

25, 26

Second, our study was limited

to spells of sickness absence of six weeks or more as sickness absence in DREAM is registered

when the employee‟s salary after 30 days is reimbursed by the municipalities. Long-term

and

short-term sickness absence may have different causes and therefore our results cannot be

generalized to all types of sickness absence. Third, the baseline response rate in the three WEHD

waves of 54 %, 50 % and 50 %, respectively may raise concerns about the representativeness of

the results. A recent analysis conducted on the 2012 WEHD wave showed that sex, age,

cohabitations, education and job type were associated with the likelihood of responding to the

questionnaire in 2012,

and consequently we adjusted for these variables in the analyses.

Finally, it is unclear whether our results are generalizable to employees in other countries with

different sickness absence legislations. As our study, like most previous research on work

environment and LTSA, has been conducted in a Nordic country, future prospective studies on

leadership quality and LTSA in other than Nordic countries is encouraged.

We did not adjust the estimates for other psychosocial work conditions, even though previous

research has shown associations between other psychosocial work environment factors and risk

of LTSA,

8, 10, 13, 27

including a study using the WEHD data that found an association between

high emotional demands and LTSA.

We refrained from these adjustments, because we

reasoned that low leadership quality may cause the occurrence of several potentially adverse

psychosocial work environment factors, for example high quantitative demands, high emotional

demands, low job control, or even workplace bullying.

Thus, these other psychosocial work

environment factors might not be confounders but mediators in the causal pathway linking low

exposure to leadership quality with risk of LTSA, which would make statistical adjustment

inappropriate. We suggest that future studies investigate how psychosocial working conditions

may mediate the association between leadership quality and LTSA.

Conclusion

Low leadership quality predicted an increased risk of LTSA in a large nationwide sample of

employees in Denmark. Associations were similar across men and women, age groups,

educational levels, and sector of employment. Compared to persistent high leadership quality a

change from high to low leadership quality two years apart predicted a higher risk of LTSA

indicating that the increased risk of LTSA is likely related to workplace conditions rather than

individual traits of the employees. As we found that low leadership quality predicted a 1.61 fold

increased risk of LTSA, measured as six or more weeks of sickness absence, leadership quality

may be considered an important social stressor at work whit considerable consequences.

Therefore, future intervention studies should examine if improving leadership quality can reduce

LTSA among employees.

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Figure 1. Data sources and flowcharts for creating study population 1 and study population

LTSA: Long-term sickness absence, RR: Response rate, WEHD: Work Environment and Health

in Denmark

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Figure 2. Association between leadership quality and long-term sickness absence during

12-months follow-up by sex, age groups, educational groups and sector of employment

among 53,157 employees (study population 1)

Estimates are adjusted for sex, age, cohabitation, children, educational level and sector of

employment (private or public, and type of sample (nationwide sample or stratified workplace

sample). As calendar time was the underlying time axis, estimates are also adjusted for year of

survey and design differences between the three waves. PY: Person years, HR: Hazard ratio, CI:

Confidence intervals

BEU, Alm.del - 2019-20 - Bilag 243: Orientering om resultater fra en NFA-artikel om ledelseskvalitet og langtidssygefravær, fra beskæftigelsesministeren

Table 1. Characteristics of the study population at baseline and average leadership quality in study

population 1 (n=53,157) and study population 2 (n=7,623)

Study population 1

% Mean leadership

quality (SD)

Sex

Men

Women

Age (mean 45.0 / 47.8)

18-29

30-44

45-54

≥55

Cohabitation

Yes

Children living at home

No children

At least one child aged 0-7 years

At least one child aged 8-17 years

(no children < 8

years)

Educational level

High (Second state tertiary)

Middle-high (First stage tertiary)

Middle-low (Upper and post-

secondary)

Low (Primary lower secondary)

Sector of employment

Private

Public

Job type

Commissioned armed forces

officers

Managers

Professionals

Technicians and associate

professionals

General office clerks

Personal services workers

Skilled agricultural, forestry and

fishery

workers

Building and related trades

workers

Plant and machine operators and

assemblers

Study population 2

% Mean leadership

quality (SD)

in 2012

3,555

4,068

46.7

53.4

27.1 (6.3)

27.7 (6.3)

27,891

25,266

52.5

47.5

27.5 (6.5)

27.0 (6.5)

6,096

16,971

17,120

12,970

11.5

31.9

32.2

24.4

27.7 (6.5)

27.2 (6.4)

27.2 (6.6)

27.2 (6.7)

423

2,224

2,703

2,273

5.5

29.2

35.5

30.0

28.0 (6.3)

27.3 (6.1)

27.3 (6.2)

27.2 (6.5)

41,428

11,729

77.9

22.1

27.4 (6.5)

26.8 (6.7)

6,131

1,492

80.4

19.6

27.5 (6.3)

27.0 (6.4)

29,341

10,479

13,337

55.2

19.7

25.1

27.2 (6.7)

27.3 (6.3)

27.5 (6.4)

4,374

1,320

1,929

57.4

17.3

25.3

27.4 (6.4)

27.4 (6.1)

6,560

15,531

23,187

7,879

12.3

29.2

43.6

14.8

27.9 (6.1)

27.3 (6.3)

27.1 (6.7)

27.3 (7.0)

1,094

2,513

3,194

822

14.4

33.0

41.9

10.8

28.0 (6.0)

27.4 (6.1)

27.2 (6.4)

27.2 (6.7)

30,621

22,536

57.6

42.4

27.4 (6.7)

27.0 (6.4)

4,231

3,392

55.5

44.5

27.5 (6.3)

27.2 (6.2)

315

2,474

16,839

7,198

4,915

7,930

318

0.6

4.7

31.7

13.5

9.3

14.9

0.6

27.6 (5.8)

28.9 (6.3)

27.5 (6.1)

27.5 (6.2)

27.2 (6.6)

27.3 (6.8)

27.7 (7.0)

339

2,712

1,152

723

1,000

0.8

4.5

35.6

15.1

9.5

13.1

0.3

26.6 (5.4)

29.1 (6.0)

27.3 (6.1)

27.0 (6.2)

27.0 (6.6)

27.3 (6.7)

28.7 (5.9)

4,348

3,047

8.2

5.7

26.0 (6.6)

25.3 (7.1)

501

335

6.6

4.4

25.7 (6.2)

25.3 (7.0)

BEU, Alm.del - 2019-20 - Bilag 243: Orientering om resultater fra en NFA-artikel om ledelseskvalitet og langtidssygefravær, fra beskæftigelsesministeren

Elementary occupations

Unknown job type

Industry

Agriculture, forestry and fishing

Manufacturing, mining and

quarrying

and utility service

Construction

Trade and transport

Information and communication

Financial and insurance

Real estate

Other business services

Public administration, education

and

health

Arts, entertainment and other

services

Unknown industry

Sample type

Nationwide sample

Stratified workplace sample

Leadership quality (Score)

High (4. quartile)

Middle-high (3. quartile)

Middle-low (2. quartile)

Low (1. quartile)

Change in leadership quality

between 2012 and 2014

Persistent high leadership quality

Persistent low leadership quality

Change from high to low

leadership

quality

Change from low to high

leadership

quality

3,784

1,989

7.1

3.7

26.8 (7.1)

28.9 (7.0)

391

390

5.1

26.2 (7.1)

28.6 (6.8)

582

8,766

1.1

16.5

28.9 (6.7)

26.7 (6.6)

1,078

1.0

14.1

29.5 (6.5)

26.8 (6.6)

2,886

8,969

1,894

541

4,672

21,081

5.4

16.9

3.6

1.0

8.8

39.7

26.9 (6.6)

27.2 (6.9)

27.9 (6.1)

29.2 (5.7)

27.3 (6.7)

27.6 (6.5)

27.2 (6.4)

271

1,286

331

333

111

671

3,160

3.6

16.9

4.3

4.4

1.5

8.8

41.5

27.0 (6.5)

27.0 (6.6)

27.6 (6.0)

28.4 (5.7)

27.0 (6.4)

27.8 (6.4)

26.8 (6.3)

1.855

3.5

1.0

27.7 (6.8)

26.6 (7.3)

302

4.0

0.1

27.8 (7.1)

26.6 (10.4)

40,427

12,730

53,157

12,800

13,980

14,470

11,907

76.0

24.0

100.0

24.1

26.3

27.2

22.4

27.4 (6.5)

26.9 (6.6)

27.3 (6.5)

35.9 (2.3)

30.0 (1.4)

25.1 (1.4)

18.6 (3.1)

7,623

100.0

27.4 (6.3)

2,607

2,764

1,213

34.2

36.3

15.9

33.1 (3.4)

21.7 (4.0)

31.2 (2.9)

1,039

13.6

23.6 (3.5)

SD: Standard deviation

BEU, Alm.del - 2019-20 - Bilag 243: Orientering om resultater fra en NFA-artikel om ledelseskvalitet og langtidssygefravær, fra beskæftigelsesministeren

Table 2. Association between exposure to different levels of leadership quality at baseline and onset

of long-term sickness absence during 12-months follow-up among 53,157 employees (study

population 1)

Person-

years

(PY)

Leadership quality

High leadership quality

Medium-high leadership quality

Medium-low leadership quality

Low leadership quality

Dose-response

Decrease in the level of leadership

quality (from higher to lower levels)

Cases

per

1,000

Crude

HR (95% CI)

Adjusted*

HR (95% CI)

11,501

13,979

13,461

12,214

416

535

581

738

1.00

1.06 (0.93-1.20)

1.19 (1.05-1.35)

1.67 (1.48-1.88)

1.00

1.09 (0.96-1.24)

1.19 (1.05-1.35)

1.61 (1.43-1.82)

51,155

2,270

1.19 (1.15-1.24)

1.17 (1.13-1.22)

*Adjusted for sex, age, cohabitation, children, educational level and sector of employment (private or public), job

type, industry, job type, industry, and type of sample (nationwide sample or stratified workplace sample). As

calendar time was the underlying time axis, estimates are also adjusted for year of survey and design differences

between the three waves. PY: Person years, HR: Hazard ratio, CI: Confidence intervals

Table 3. Association between changes in leadership quality from 2012 and 2014 and long-

term sickness absence during 12-months follow-up among 7,623 employees (study

population 2)

Person- Cases

years

(PY)

Change in leadership quality

Persistent high leadership

2,519

quality

Persistent low leadership quality 2,637

Change from high to low

leadership quality

Change from low to high

leadership quality

1,161

1,005

Cases

per

1,000

Crude

HR (95% CI)

Adjusted*

HR (95% CI)

120

1.00

1.31 (1.01-1.70)

1.39 (1.00-1.99)

0.88 (0.59-1.32)

1.00

1.28 (0.97-

1.69)

1.42 (1.02-

1.97)

0.90 (0.60-

1.35)

*Adjusted for sex, age, cohabitation, children, educational level and sector of employment (private or

public), job type, industry, and type of sample (nationwide sample or stratified workplace sample). As

calendar time was the underlying time axis, estimates are also adjusted for year of survey and design

differences between the three waves. PY: Person years, HR: Hazard ratio, CI: Confidence intervals