Workplace adjustments and sick leave duration among individuals with stress-related disorders: A longitudinal register follow-up in Sweden

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Jonsdottir This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7684948/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background: Sick leave with stress-related disorders has increased substantially in Sweden and other OECD countries, posing a significant challenge to public health and workforce participation. While employer support has been shown to contribute to return to work (RTW), there is limited evidence regarding which specific workplace adjustments facilitate this process. Objective: This study aims to investigate the types of workplace adjustments individuals with stress-related disorders receive to facilitate RTW and whether such adjustments are associated with a reduced number of sick leave days. Methods: This study combined data from a national survey of 1,412 individuals on long-term sick leave due to stress-related disorders (ICD-10 F43 codes) with register data on sick leave from the Swedish Social Insurance Agency. Workplace adjustments were self-reported via a multiple-choice questionnaire. Sick leave outcomes were measured as gross and net sick leave days at 6 and 18 months. Multivariable quantile regression was used to examine associations between reported adjustments and the distribution of sick leave days, adjusting for age, sex, and education. Results: Eighty per cent of participants reported having received at least one workplace adjustment, with changes in work tasks being most common. Quantile regression analyses revealed that workplace adjustments were associated with fewer net sick leave days, particularly among individuals with longer durations of sick leave. At 18 months, individuals who had received workplace adjustments had significantly fewer net sick leave days across the 40 th to 90 th percentiles , with the largest difference at the 90 th percentile (153 fewer net sick leave days; p<0.001). Conclusions: Workplace adjustments may reduce the duration of sickness absence among individuals sick-listed with stress-related disorders, particularly for those at risk of long-term sick leave. These findings underscore the importance of early, individualised work modifications as part of the rehabilitation process. stress-related disorders sick-leave return to work workplace adjustments Figures Figure 1 Figure 2 Introduction Sickness absence with mental health disorders has steadily increased over the past two decades and now accounts for nearly half of all ongoing sick leave cases in Sweden ( 1 ). Within this group, stress-related diagnoses – including acute stress reaction, adjustment disorder, reaction to severe stress, and exhaustion disorder (ED) – are the most prevalent, representing 23% of all sick leave cases registered by the Swedish Social Insurance Agency ( 2 ). This high prevalence reflects a broader trend, with a significant increase in sickness absence with stress-related disorders, not only in Sweden but in numerous other Western Organisation for Economic Co-operation and Development (OECD) nations​ ( 3 ). Stress-related disorders impose a considerable societal burden due to their association with poor health status in affected individuals, which in turn contributes to reduced productivity, extended rehabilitation periods, and elevated healthcare costs ( 4 ). In 2005, the diagnosis of Exhaustion Disorder (ED) was introduced into clinical practice in Sweden and incorporated into the Swedish version of ICD-10 under the diagnostic code F43.8A, which is used for classification purposes. The symptoms of ED include severe fatigue, cognitive dysfunction, sleep disturbances, and emotional instability, often requiring extensive recovery periods ( 5 ). ED shares several characteristics with the international concept of burnout ( 6 ), particularly clinical burnout, which is defined by severe exhaustion, cognitive dysfunction, and emotional detachment ( 7 ). To the best of our knowledge, no previous studies have evaluated how workplace adjustments at the individual level affect sick leave outcomes for patients with stress-related disorders, making comparisons with previous research difficult. Most interventions involving workplace adjustments include multiple components, such as tailored accommodations combined with clinical or organisational measures, or standardised programmes applied to all employees. As a result, it is difficult to determine the specific impact of adjustments such as modified work tasks or flexible working hours on RTW, which is defined in the present study as duration and extent of sick leave. Some studies have shown promising effects on RTW when the workplace is actively involved. For instance, Karlson et al. (2010, 2014) demonstrated that a structured dialogue between employees and supervisors, supported by occupational health services, was associated with a faster return to part-time work for individuals on sick leave with due to burnout. The intervention was also associated with long term RTW stability among younger participants ( 8 , 9 ). Similarly, Dalgaard et al. (2017) reported that a work-focused cognitive behavioural intervention combined with optional workplace measures led to significantly improved RTW among employees with work-related stress ( 10 ). However, these findings from individual studies align only partially with the broader literature from review studies, which presents a more mixed picture regarding stress-related diagnoses and RTW. Evidence from some reviews suggests that the impact of interventions on RTW among individuals with ED or burnout remains modest or unclear ( 11 , 12 ). Conversely, other reviews have reported more favourable outcomes, suggesting that interventions involving workplace engagement and multicomponent approaches may enhance RTW among individuals with burnout ( 13 , 14 ). Taken together, methodological heterogeneity and lack of standardisation limit the current evidence regarding RTW among individuals with stress-related disorders, and the specific contribution of workplace adjustments remains unexplored. To address this gap, the present study aims to provide further insight into the association between self-reported workplace adjustments and RTW among individuals sick-listed with stress-related disorders, using linked survey and register data. The underlying hypothesis is that workplace adjustments are positively associated with a shorter duration of sickness absence. Aim The primary aim of this study is to investigate the types of workplace adjustments individuals with stress-related disorders receive to facilitate RTW. The secondary aim is to assess whether such adjustments are associated with duration and extent of sick leave. Method Study design and data sources The present study is a register-based follow-up of a cross-sectional survey, which was conducted as a secondary analysis of data originally collected as part of a Swedish government evaluation of work-oriented rehabilitation for individuals on sick leave due to stress-related disorders ( 15 ). The evaluation was commissioned by the Swedish Parliament’s Social Insurance Committee and carried out by the Swedish Parliament’s Evaluation and Research Secretariat in collaboration with Statistics Sweden (SCB) and the Swedish Social Insurance Agency ( 16 ). This study combined self-reported data from a nationwide questionnaire, distributed by SCB in October 2023 to individuals on long-term sick leave with due to stress-related disorders, with objective register data from the Swedish Social Insurance Agency’s (MiDAS) database. Additional demographic and occupational variables were retrieved from national registers ( 16 ). Participants and inclusion criteria Participants included in the present study met the following inclusion criteria: being registered residents of Sweden and receiving either sickness or rehabilitation benefit from the Swedish Social Insurance Agency. Eligible individuals had initiated a sickness absence case in March or April 2023 and remained on sick leave as of September 2023. Furthermore, they had not received any sickness or rehabilitation benefit during the three months preceding the start of the current case. Participants were employed and entitled to sickness benefit at the time of the initial application and throughout the subsequent months. The following groups were excluded: hourly employees, daily wage earners, students, individuals on parental leave, and self-employed individuals (including those who combined self-employment with other employment). All participants were subject to the Swedish rehabilitation chain, which sets out a structured timeline for evaluating work ability in relation to specified reference points ( 17 ). As part of a larger study, a questionnaire was sent to all individuals, regardless of diagnosis, who met these inclusion criteria (N = 10,216). The questionnaire was distributed as a combined web and paper survey, with one initial mailing and three reminders, yielding an overall response rate of 40.7% (n = 4,156; See Fig. 1 ). In the present study, respondents on sick leave with stress-related diagnoses according to the International Classification of Diseases, 10th Revision (ICD-10) were included. These diagnoses were acute stress reaction (F43.0), adjustment disorder (F43.2), reaction to severe stress (F43.9), and exhaustion disorder (F43.8A). This selection yielded a sample of n = 1425 participants. For the main analyses, a final analytical sample of n = 1412 was used, as these individuals had completed the questionnaire item regarding workplace adjustments, which was the main exposure variable in this study. See Table 1 for diagnostic distribution and criteria. Table 1 Summary of F43 diagnoses included in the present study ICD-10 Code Diagnosis Summary of Diagnostic Criteria N (%) F43.0 Acute Stress Reaction Characterised by intense fear, helplessness, or horror, developing within one month of exposure to a traumatic stressor. Common symptoms include intrusive memories, avoidance behaviour, heightened arousal, and changes in mood or thinking. 202 (14%) F43.2 Adjustment Disorder Emotional or behavioural symptoms triggered by a clearly identifiable stressor, appearing within 3 months. Symptoms cause significant distress or impairment and are disproportionate to the expected response. 158 (11%) F43.8A Exhaustion Disorder Persistent fatigue and exhaustion due to identifiable stress exposure lasting at least 6 months. Accompanied by physical, cognitive, and/or psychological symptoms, resulting in significant functional impairment. 762 (54%) F43.9 Reaction to Severe Stress Used for short-term stress or crisis reactions where criteria for F43.0, F43.2, or F43.8A are not fully met. Often applied when a specific diagnosis is unclear. 290 (21%) Measurements Demographics included in the present study were sex, age, level of education, and occupation. The original questionnaire was developed by researchers at the Swedish Parliament’s Evaluation and Research Secretariat, in collaboration with the Swedish Social Insurance Agency, and was reviewed by a survey methodology expert at SCB ( 18 ). Special emphasis was placed on the item wording, the structure of response categories, the clarity of instructions, and the overall design and layout of the instrument ( 15 ). The questionnaire comprises 23 items covering support measures, workplace adjustments, rehabilitation, and access to healthcare and treatment. The questionnaire was distributed as a combined web- and paper-based survey, including one initial mailing and three reminders. For the purpose of this study, one item from the original questionnaire was selected to examine participants’ self-reported experiences of workplace adjustments in relation to their return to work. This was a multiple-choice item where more than one option could be selected. Other adjustments were reported in free-text responses. Answers that matched existing categories were sorted accordingly (see Table 2 ). Table 2 Multiple-choice question about self-reported workplace adjustments made by employers to facilitate return to work among individuals sick-listed with stress-related disorders. What types of workplace adjustments has your employer made to facilitate your return to work? 1. No adjustments were made 2. I was reassigned to a different position or role (temporarily or permanently) 3. I was given modified work tasks (e.g., less stressful or physically demanding tasks) 4. I received support or workload relief from colleagues 5. I was allowed to work during times (or days) that suited me better 6. I was allowed to take more frequent breaks 7. I was given the opportunity to work from home (more than before) 8. I was given the opportunity to work undisturbed or in a secluded space 9. I received guidance or supervision from a manager, mentor, or support person 10. I was provided with assistive devices 11. Other adjustment (with the option to provide a free-text description of any additional adjustments). Outcome measures and statistical analyses Baseline descriptive statistics and adjustments at work are given in terms of count and percentages. Age was dichotomised into younger than 40 years and 40 years or older. Level of education was dichotomised into lower (elementary school/upper secondary school) and higher (university education). Adjustments at work were dichotomised into adjustments and no adjustments. Data on registered sick leave days were retrieved from the Swedish Social Insurance Agency’s Micro Database for Analysing Social Insurance (MiDAS). In Sweden, sick leave benefits are granted for 25%, 50%, 75%, or 100% of a working day, depending on how much the ability to work is reduced due to a medical condition. Both gross days (number of sick days, regardless of extent of sick leave) and net days (number of sick days converted into whole sick days) were used as outcomes in this study. Multivariable quantile regression was applied to estimate the differential impact of workplace adjustments across the distribution of sick leave outcomes (10th to 90th percentiles). This method estimates conditional quantiles of the outcome variable in relation to a set of independent variables and covariates, without requiring assumptions of normality or homoscedasticity. Quantile regression is robust to outliers and particularly suited to modelling outcomes that are non-normally distributed or highly skewed. This method follows the framework outlined by Koenker et al. (2001) ( 19 ). Analyses were performed separately for gross and net sick leave days at 6 and 18 months, adjusting for sex, age, and education. Regression coefficients (B) and 95% confidence intervals were estimated at the 10th through 90th percentiles. All analyses were conducted using the statistical package IBM SPSS Statistics 22. Results Descriptive Statistics The analytic sample comprised 1,412 participants, of whom 78% were women (n = 1101) and 22% were men (n = 311). A majority (73%; n = 1023) belonged to the older age category, and 64% (n = 910) had completed higher education. Regarding workplace adjustments, 80% (n = 1129) reported having received at least one form of adjustment, whereas 20% (n = 283) reported no adjustments. Of those who received adjustments, 25% had received only one adjustment, 19% had received two, 16% had received three, and 20% had received four or more adjustments. Workplace adjustments Chi-square test analyses revealed no significant differences in the proportion of participants who received workplace adjustments by sex ( p = 0.556) or age group ( p = 0.236). However, individuals with higher education were significantly more likely to report having received workplace adjustments compared to those with lower education ( p < 0.001; see Table 3 ). Table 3 Proportion of participants reporting workplace adjustments by sex, age, and level of education. Workplace adjustments % (n) No workplace adjustments % (n) p-value Women 80% (884) 20% (217) 0.556 Men 79% (245) 21% (66) Age < 40 years 82% (319) 18% (70) 0.236 Age ≥ 40 years 79% (810) 21% (213) Lower education 73% (364) 27% (132) < 0.001 Higher education 84% (762) 16% (148) Table 3 . Age: dichotomised as age < 40 years and age ≥ 40 years. Level of education: dichotomised as lower (elementary school/upper secondary school) and higher (university education). p < 0.05 was considered as significant. Among those who received adjustments, the most common was modified work tasks, which was reported by 44% of the sample (n = 622). Assistance from colleagues was reported by 33% (n = 462), flexible working hours by 28% (n = 391), and increased number of breaks by 24% (n = 340). Additional forms of support included the possibility to work from home (16%; n = 229), access to an undisturbed work environment (16%; n = 226), supervision or regular support from a manager or colleague (17%; n = 238), and reassignment to a different role within the organisation (14%; n = 201). Remaining responses indicated that return to work was not yet possible or that support had been received from occupational health services (see Fig. 2 ). Workplace adjustments and sick leave days at 6 months Gross sick leave days With nearly all individuals still on sick leave at six months, gross sick leave days exhibited insufficient variation to yield meaningful quantile regression results Net sick leave days Analyses of net sick leave days over a six-month period indicated a consistent impact of workplace adjustments. From the 20th to the 80th percentile, individuals who had received workplace adjustments reported significantly fewer sick leave days compared with those without adjustments, with the strongest effects observed at the 40th percentile (B = 14.50; 95% CI: 6.02 to 22.98) and the median (B = 15.50; 95% CI: 8.76 to 22.24). Workplace adjustments and sick leave days at 18 months Gross sick leave days The association between workplace adjustments and gross sick leave days became more complex at 18 months. In the lower quantiles (Q10–Q40), individuals who had received adjustments reported significantly more sick leave days compared with those without adjustments (e.g., B = − 32.00; 95% CI: − 52.66 to − 11.34 at Q30). From Q50–Q80, the direction of the association reversed, with workplace adjustments linked to fewer sick leave days. See Table 4 . Net sick leave days The association between workplace adjustments and net sick leave days became more evident at 18 months. In the lower quantiles (Q10–Q30), no significant differences were observed. From Q40 onwards, however, individuals who had received adjustments reported progressively fewer sick leave days compared with those without adjustments, with the effect increasing across the distribution (e.g., B = 35.25; 95% CI: 17.71 to 52.80 at Q50, and B = 153.00; 95% CI: 122.85 to 183.15 at Q90). See Table 5 . Table 4 Quantile differences in gross days between participants with and without workplace adjustments, adjusting for age, sex, and level of education. Percentile Adjustments at work No adjustments at work Percentile difference (95% CI) p 10 183 162 -21.00 (− 35.85; −6.15) 0.006 20 220 198 -22.00 (− 40.39; −3.61) 0.019 30 257 225 -32.00 (− 52.66; −11.34) 0.002 40 291 266 -25.00 (− 47.69; −2.31) 0.031 50 320 328 8.00 (− 15.25; 31.25) 0.500 60 348 380 32.00 (4.03; 59.97) 0.025 70 395 461 66.00 (35.54; 96.46) < 0.001 80 461 520 59.00 (24.84; 93.16) < 0.001 90 535 536 1.00 (− 1.25; 3.25) 0.383 Table 4 . Group-specific percentiles are based on predicted values for a typical individual, averaged across age, sex, and level of education. Β-Coefficient. (95% confidence interval). * p < 0.05 was considered as significant. Table 5 Quantile differences in net days between participants with and without workplace adjustments, adjusting for age, sex, and level of education. Percentile Adjustments at work No adjustments at work Percentile difference (95% CI) p 10 102 104 1.75 (− 9.61; 13.11) 0.763 20 131 129 −2.00 (− 16.29; 12.29) 0.784 30 157 166 9.50 (− 5.27; 24.27) 0.207 40 177 196 18.75 (2.25; 35.26) 0.026 50 200 235 35.25 (17.71; 52.80) < 0.001 60 226 294 68.00 (46.85; 89.15) < 0.001 70 258 365 107.50 (84.32; 130.68) < 0.001 80 297 429 131.50 (102.68; 160.32) < 0.001 90 367 520 153.00 (122.85; 183.15) < 0.001 Table 5 . Group-specific percentiles are based on predicted values for a typical individual, averaged across age, sex, and level of education. Β-Coefficient. (95% confidence interval). * p < 0.05 was considered as significant. Discussion The aim of this study was to explore the types of workplace adjustments reported by employees on sick leave due to stress-related disorders and to examine whether such adjustments were associated with the duration of sickness absence. The main finding was that among employees on sick leave with stress-related disorders, workplace adjustments were most notably associated with faster RTW among those with prolonged sick leave. Thus, findings from the 6-month follow-up showed that individuals with longer durations of sick leave who had received workplace adjustments reported fewer net sick leave days than those who had not received such support. At the 18-month follow-up, an opposite pattern emerged in the lower quantiles of gross sick leave days, where individuals without adjustments reported shorter absences. One possible explanation is that those without adjustments may have had a reduced need for them, for example due to less pronounced impairments in work ability. However, net days provide a more accurate reflection of actual work loss, and in the upper quantiles both gross and net days consistently showed that workplace adjustments were associated with fewer sick leave days. These findings, indicating that workplace adjustments are linked to reduced sickness absence, are in line with previous research suggesting that early dialogue with employers about workplace solutions, including workplace adjustments, can facilitate RTW and reduce sickness absence ( 8 – 10 ). Although some reviews indicate favourable RTW outcomes for work-related interventions ( 13 , 14 ), others present a more inconclusive picture concerning the factors that promote RTW for patients with stress-related diagnoses ( 11 , 20 ). These inconsistencies may reflect the complex nature of the RTW process, particularly for individuals with prolonged sickness absence. The findings of this study suggest that workplace adjustments may be associated with the duration of sickness absence, with approximately 80% of participants reporting having received some form of adjustment. This high proportion may reflect the influence of Swedish regulations, which places a strong responsibility on employers for rehabilitation, including an obligation to offer workplace adjustments as early as possible ( 21 ). According to the social insurance regulations in Sweden, employers must also consider reassignment within three months of the start of a sick leave period ( 17 ). Despite these regulations, 20% of the participants did not receive any workplace adjustments. Persistent symptoms may account for this lack of adjustments, since implementing workplace changes or initiating a partial RTW is often not feasible for individuals with more severe symptoms. Previous research has demonstrated that stress-related symptoms are often long-lasting and are likely to compromise work ability ( 22 , 23 ). Another possible explanation for why some individuals did not receive workplace adjustments is that the feasibility of implementing such measures may vary depending on workplace characteristics. For example, in sectors such as education, healthcare, and social care, which have high levels of sick leave due to stress-related disorders ( 1 ), work tasks may require physical presence, making it more difficult to provide flexible arrangements, such as remote work. Furthermore, redistributing work tasks to accommodate one employee may increase the workload of colleagues, which could limit managers' ability or willingness to implement adjustments. Previous studies have shown that managerial ability ( 24 ) and organisational conditions are essential for the successful implementation of workplace adjustments ( 14 ). In terms of the type of adjustments, changes in work tasks were the most frequently reported, which is in line with previous research indicating work task adjustments as one of the most commonly used adjustments for patients with common mental disorders (CMDs) ( 25 ). Moreover, previous studies have found that work task adjustments are associated with reduced burnout symptoms among health care workers ( 26 ), and that adjustments of work tasks as part of multi-domain interventions are associated with improved RTW rates ( 27 ). Although changes in work tasks may be beneficial, evidence regarding their causal effect on RTW remains limited and requires further research. Strengths and limitations A notable strength of the present study is the integration of self-reported data on workplace adjustments with objective registry data on sickness absence, which enables an assessment of the relationship between adjustments and outcomes. Using both gross and net sick leave days further strengthened the analysis, as net days capture the actual extent of work loss by accounting for partial absences, while gross days may overestimate sickness absence. The large, nationally representative sample and inclusion of two follow-up periods of sick leave data (6 and 18 months) further strengthen the external validity and policy relevance of the findings. Another methodological strength lies in the use of quantile regression, which enabled a more nuanced analysis of how workplace adjustments were associated with sickness absence across different durations. Unlike traditional regression models that focus on mean outcomes, quantile regression allowed us to examine whether the effects of adjustments varied depending on the length of sick leave. This approach revealed that the positive association between workplace adjustments and reduced sick leave days was particularly pronounced among individuals with longer durations of sick leave. By capturing these distributional effects, quantile regression provided important insights into the heterogeneous nature of RTW processes and the potential differential impact of interventions across subgroups. Data about workplace adjustments were collected at a single time point, which could be considered a limitation since work adjustments may have occurred after the measure was performed. In addition, since workplace adjustments were not measured prospectively in relation to each time point, causal inferences remain limited. Moreover, subgroup analyses for specific types of workplace adjustments and sick leave days could not be conducted due to an insufficient number of individuals in each subgroup. Workplace adjustments were evaluated using a single questionnaire item with predefined response options. While this allowed for a broad overview, it limits the understanding of the timing, quality, and extent of the adjustments provided. Moreover, the questionnaire used to assess workplace adjustments was not formally tested for either validity or reliability, which is a methodological limitation. Another important limitation is the inability to conduct non-response analyses for individuals who did not complete the survey due to the lack of background data, thereby preventing the exclusion of potential selection bias. The reliance on self-reported data introduces the possibility of recall or reporting bias, particularly in the interpretation of what constitutes an adjustment. Finally, the findings reflect the Swedish labour market, welfare, and regulatory context, and may not be generalisable to countries with different social insurance or occupational health systems. Clinical Implications The observed association between workplace adjustments and shorter durations of sick leave, particularly among individuals with long-term absence, suggests that such measures may support RTW and could be considered in the rehabilitation process for patients with stress-related diagnosis. Conclusion This study contributes to the growing body of knowledge on how workplace adjustments can support shorter sick leave among individuals with stress-related disorders. The findings indicate that workplace adjustments may facilitate RTW, particularly for those with longer periods of sick leave absence. Abbreviations OECD Organisation for Economic Co-operation and Development RTW Return to work ED Exhaustion disorder ICD-10 International Classification of Diseases, 10th Revision SCB Statistiska centralbyrån (Statistics Sweden) MiDAS Micro Database for Analysing Social Insurance (Försäkringskassan) CMD Common mental disorders SPSS Statistical Package for the Social Sciences Declarations Ethics approval and consent to participate The study was approved on 29 May 2024 by the Swedish Ethical Review Authority, Dnr 2024-03484-01, and conducted in accordance with the Declaration of Helsinki (1964 and its later amendments). Informed consent was obtained from all participants. Generative Artificial Intelligence (AI) Generative AI (ChatGPT, GPT-5 by OpenAI) was used to improve language clarity. All content was critically reviewed and verified by the authors. Author Contribution A.B. had the major responsibility for the planning of the study, analysis of the data and writing the first draft of manuscript. I.J. and G.H. contributed to the planning of the study, interpretation of the data and writing of the manuscript. All authors read and approved the final version of the manuscript. Acknowledgement We would like to thank Emina Hadzibajramovic for valuable advice and support in the development of the study design and Sandra Pettersson for assisting with the data analysis. Data Availability The data that support the findings of this study are available from the corresponding author upon reasonable request. References Försäkringskassan. The Swedish Social Insurance Agency’s Status Report 2023:1 Mental ill-health in today’s working life (Försäkringskassans lägesrapport 2023:1 Psykisk ohälsa i dagens arbetsliv). 2025. Försäkringskassan. Number of current sickness–absence cases due to stress 2025. OECD. 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Line managers’ behaviors to support return to work for workers with common mental disorders. J managerial Psychol. 2022;38(1):34–46. Bertilsson M, Niederberger R, de Rijk A. Work accommodations for employees with common mental disorders and associated manager-related determinants: a cross-sectional study among Swedish managers. Disabil Rehabil. 2024;46(18):4256–75. Aust B, Leduc C, Cresswell-Smith J, O’Brien C, Rugulies R, Leduc M, et al. The effects of different types of organisational workplace mental health interventions on mental health and wellbeing in healthcare workers: a systematic review. Int Arch Occup Environ Health. 2024;97(5):485–522. Nowrouzi-Kia B, Garrido P, Gohar B, Yazdani A, Chattu VK, Bani-Fatemi A et al. Evaluating the Effectiveness of Return-to-Work Interventions for Individuals with Work-Related Mental Health Conditions: A Systematic Review and Meta-Analysis. Healthcare (Basel, Switzerland). 2023;11(10). Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7684948","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":526178382,"identity":"72a5e039-857e-42d8-8772-733d8a145fd2","order_by":0,"name":"Anja Beno","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyElEQVRIiWNgGAWjYHCCBAbGBiDF3kCyFp4DpNgD1iKRQKRq/tkNDz8w7rDJ45d8fk2C4Y8NYS0Sdw4kSzCeSSuWnJ1TJsHYlkaENTcSEoAqDyduuJ2TJsHYcJiwDvkbCck/GNv+J264eSYN6LD/hLUY3EgAGt52IHHDDfZjEgxsBwhrMQRqsUg8k5w4syeH2SKxLZmwFrkbOck3Pu6wS+xnP/7wxoc/doS1AKMwARiZYIYBlEEQsB+AMR4Qp2EUjIJRMApGHAAAqwc9lzsj+68AAAAASUVORK5CYII=","orcid":"","institution":"Region Västra Götaland","correspondingAuthor":true,"prefix":"","firstName":"Anja","middleName":"","lastName":"Beno","suffix":""},{"id":526178383,"identity":"4c41a63e-873b-4b7e-a32f-c738e4766fee","order_by":1,"name":"Gunnel Hensing","email":"","orcid":"","institution":"Gothenburg University","correspondingAuthor":false,"prefix":"","firstName":"Gunnel","middleName":"","lastName":"Hensing","suffix":""},{"id":526178384,"identity":"e3d9dca3-3fb6-4e83-b1f1-7f1f93a61a4d","order_by":2,"name":"Ingibjörg H. Jonsdottir","email":"","orcid":"","institution":"Region Västra Götaland","correspondingAuthor":false,"prefix":"","firstName":"Ingibjörg","middleName":"H.","lastName":"Jonsdottir","suffix":""}],"badges":[],"createdAt":"2025-09-23 00:23:41","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7684948/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7684948/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":93240032,"identity":"ec430042-7576-43a5-b7b9-3719ecfb3a17","added_by":"auto","created_at":"2025-10-10 14:42:03","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":214085,"visible":true,"origin":"","legend":"","description":"","filename":"SubmitversionAB.docx","url":"https://assets-eu.researchsquare.com/files/rs-7684948/v1/0f88a3caa8f392b528a62d9a.docx"},{"id":93238408,"identity":"10011ae4-048d-43fb-9690-f4f271a9c939","added_by":"auto","created_at":"2025-10-10 14:34:03","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":5897,"visible":true,"origin":"","legend":"","description":"","filename":"3c1deb15c22b441782e4892ab0abe23f.json","url":"https://assets-eu.researchsquare.com/files/rs-7684948/v1/dc8e5199a85a58c55a57b899.json"},{"id":93241064,"identity":"f05b68a8-260b-4f50-a2c1-002e359aaa44","added_by":"auto","created_at":"2025-10-10 14:50:03","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":85123,"visible":true,"origin":"","legend":"","description":"","filename":"3c1deb15c22b441782e4892ab0abe23f1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7684948/v1/23444f69524b244baea9ee73.xml"},{"id":93238413,"identity":"0ca3c718-b164-4c1c-a4b1-24605f3e794a","added_by":"auto","created_at":"2025-10-10 14:34:03","extension":"png","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":50184,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7684948/v1/52df15c63f06498e83e675d3.png"},{"id":93240033,"identity":"b1f961b7-cc16-46a0-aa47-b2ebb66eea9d","added_by":"auto","created_at":"2025-10-10 14:42:03","extension":"xml","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":85696,"visible":true,"origin":"","legend":"","description":"","filename":"3c1deb15c22b441782e4892ab0abe23f1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7684948/v1/d4001fc40cd9d64d47fd049c.xml"},{"id":93238411,"identity":"d9c54978-0712-4764-a0eb-c90ff2d5a355","added_by":"auto","created_at":"2025-10-10 14:34:03","extension":"html","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":91862,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7684948/v1/bdab2e0cdf250259b8449087.html"},{"id":93240031,"identity":"77c4cff5-8114-4622-86de-e3f15131b334","added_by":"auto","created_at":"2025-10-10 14:42:03","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":100959,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlow chart of participant recruitment and final analytical sample.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7684948/v1/f9b2d1ffe0ee69679d6b2e6b.png"},{"id":93238407,"identity":"fa77490a-be53-4097-8983-869c3fa1e7db","added_by":"auto","created_at":"2025-10-10 14:34:03","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":48998,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSelf-reported workplace adjustments to facilitate return to work among participants on sick leave with stress-related disorders.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFigure 2. Proportion of participants reporting different types of workplace adjustments during RTW.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7684948/v1/68d25284250cd4b39934ea11.png"},{"id":93243295,"identity":"589f1874-a31d-44f7-82dd-422ef7fbeadd","added_by":"auto","created_at":"2025-10-10 14:58:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1111129,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7684948/v1/8cbc75f8-f4ef-42f1-bf86-daaf1fc237a7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Workplace adjustments and sick leave duration among individuals with stress-related disorders: A longitudinal register follow-up in Sweden","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSickness absence with mental health disorders has steadily increased over the past two decades and now accounts for nearly half of all ongoing sick leave cases in Sweden (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Within this group, stress-related diagnoses \u0026ndash; including acute stress reaction, adjustment disorder, reaction to severe stress, and exhaustion disorder (ED) \u0026ndash; are the most prevalent, representing 23% of all sick leave cases registered by the Swedish Social Insurance Agency (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). This high prevalence reflects a broader trend, with a significant increase in sickness absence with stress-related disorders, not only in Sweden but in numerous other Western Organisation for Economic Co-operation and Development (OECD) nations​ (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eStress-related disorders impose a considerable societal burden due to their association with poor health status in affected individuals, which in turn contributes to reduced productivity, extended rehabilitation periods, and elevated healthcare costs (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn 2005, the diagnosis of Exhaustion Disorder (ED) was introduced into clinical practice in Sweden and incorporated into the Swedish version of ICD-10 under the diagnostic code F43.8A, which is used for classification purposes. The symptoms of ED include severe fatigue, cognitive dysfunction, sleep disturbances, and emotional instability, often requiring extensive recovery periods (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). ED shares several characteristics with the international concept of burnout (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), particularly clinical burnout, which is defined by severe exhaustion, cognitive dysfunction, and emotional detachment (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTo the best of our knowledge, no previous studies have evaluated how workplace adjustments at the individual level affect sick leave outcomes for patients with stress-related disorders, making comparisons with previous research difficult. Most interventions involving workplace adjustments include multiple components, such as tailored accommodations combined with clinical or organisational measures, or standardised programmes applied to all employees. As a result, it is difficult to determine the specific impact of adjustments such as modified work tasks or flexible working hours on RTW, which is defined in the present study as duration and extent of sick leave. Some studies have shown promising effects on RTW when the workplace is actively involved. For instance, Karlson et al. (2010, 2014) demonstrated that a structured dialogue between employees and supervisors, supported by occupational health services, was associated with a faster return to part-time work for individuals on sick leave with due to burnout. The intervention was also associated with long term RTW stability among younger participants (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Similarly, Dalgaard et al. (2017) reported that a work-focused cognitive behavioural intervention combined with optional workplace measures led to significantly improved RTW among employees with work-related stress (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). However, these findings from individual studies align only partially with the broader literature from review studies, which presents a more mixed picture regarding stress-related diagnoses and RTW. Evidence from some reviews suggests that the impact of interventions on RTW among individuals with ED or burnout remains modest or unclear (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Conversely, other reviews have reported more favourable outcomes, suggesting that interventions involving workplace engagement and multicomponent approaches may enhance RTW among individuals with burnout (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTaken together, methodological heterogeneity and lack of standardisation limit the current evidence regarding RTW among individuals with stress-related disorders, and the specific contribution of workplace adjustments remains unexplored. To address this gap, the present study aims to provide further insight into the association between self-reported workplace adjustments and RTW among individuals sick-listed with stress-related disorders, using linked survey and register data. The underlying hypothesis is that workplace adjustments are positively associated with a shorter duration of sickness absence.\u003c/p\u003e\n\u003ch3\u003eAim\u003c/h3\u003e\n\u003cp\u003eThe primary aim of this study is to investigate the types of workplace adjustments individuals with stress-related disorders receive to facilitate RTW.\u003c/p\u003e\u003cp\u003eThe secondary aim is to assess whether such adjustments are associated with duration and extent of sick leave.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003cdiv id=\"Sec4\" class=\"Section3\"\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Method","content":"\u003ch2\u003eStudy design and data sources\u003c/h2\u003e\u003cp\u003eThe present study is a register-based follow-up of a cross-sectional survey, which was conducted as a secondary analysis of data originally collected as part of a Swedish government evaluation of work-oriented rehabilitation for individuals on sick leave due to stress-related disorders (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The evaluation was commissioned by the Swedish Parliament’s Social Insurance Committee and carried out by the Swedish Parliament’s Evaluation and Research Secretariat in collaboration with Statistics Sweden (SCB) and the Swedish Social Insurance Agency (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis study combined self-reported data from a nationwide questionnaire, distributed by SCB in October 2023 to individuals on long-term sick leave with due to stress-related disorders, with objective register data from the Swedish Social Insurance Agency’s (MiDAS) database. Additional demographic and occupational variables were retrieved \u003cem\u003efrom national registers\u003c/em\u003e (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eParticipants and inclusion criteria\u003c/h3\u003e\n\u003cp\u003eParticipants included in the present study met the following inclusion criteria: being registered residents of Sweden and receiving either sickness or rehabilitation benefit from the Swedish Social Insurance Agency. Eligible individuals had initiated a sickness absence case in March or April 2023 and remained on sick leave as of September 2023. Furthermore, they had not received any sickness or rehabilitation benefit during the three months preceding the start of the current case. Participants were employed and entitled to sickness benefit at the time of the initial application and throughout the subsequent months. The following groups were excluded: hourly employees, daily wage earners, students, individuals on parental leave, and self-employed individuals (including those who combined self-employment with other employment). All participants were subject to the Swedish rehabilitation chain, which sets out a structured timeline for evaluating work ability in relation to specified reference points (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAs part of a larger study, a questionnaire was sent to all individuals, regardless of diagnosis, who met these inclusion criteria (N\u0026thinsp;=\u0026thinsp;10,216). The questionnaire was distributed as a combined web and paper survey, with one initial mailing and three reminders, yielding an overall response rate of 40.7% (n\u0026thinsp;=\u0026thinsp;4,156; See Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eIn the present study, respondents on sick leave with stress-related diagnoses according to the International Classification of Diseases, 10th Revision (ICD-10) were included. These diagnoses were acute stress reaction (F43.0), adjustment disorder (F43.2), reaction to severe stress (F43.9), and exhaustion disorder (F43.8A). This selection yielded a sample of n\u0026thinsp;=\u0026thinsp;1425 participants. For the main analyses, a final analytical sample of n\u0026thinsp;=\u0026thinsp;1412 was used, as these individuals had completed the questionnaire item regarding workplace adjustments, which was the main exposure variable in this study. See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for diagnostic distribution and criteria.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSummary of F43 diagnoses included in the present study\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eICD-10 Code\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDiagnosis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSummary of Diagnostic Criteria\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF43.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAcute Stress Reaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCharacterised by intense fear, helplessness, or horror, developing within one month of exposure to a traumatic stressor. Common symptoms include intrusive memories, avoidance behaviour, heightened arousal, and changes in mood or thinking.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e202 (14%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF43.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAdjustment Disorder\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEmotional or behavioural symptoms triggered by a clearly identifiable stressor, appearing within 3 months. Symptoms cause significant distress or impairment and are disproportionate to the expected response.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e158 (11%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF43.8A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExhaustion Disorder\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePersistent fatigue and exhaustion due to identifiable stress exposure lasting at least 6 months. Accompanied by physical, cognitive, and/or psychological symptoms, resulting in significant functional impairment.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e762 (54%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF43.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReaction to Severe Stress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUsed for short-term stress or crisis reactions where criteria for F43.0, F43.2, or F43.8A are not fully met. Often applied when a specific diagnosis is unclear.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e290 (21%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eMeasurements\u003c/h3\u003e\n\u003cp\u003eDemographics included in the present study were sex, age, level of education, and occupation.\u003c/p\u003e\u003cp\u003eThe original questionnaire was developed by researchers at the Swedish Parliament\u0026rsquo;s Evaluation and Research Secretariat, in collaboration with the Swedish Social Insurance Agency, and was reviewed by a survey methodology expert at SCB (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Special emphasis was placed on the item wording, the structure of response categories, the clarity of instructions, and the overall design and layout of the instrument (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The questionnaire comprises 23 items covering support measures, workplace adjustments, rehabilitation, and access to healthcare and treatment. The questionnaire was distributed as a combined web- and paper-based survey, including one initial mailing and three reminders.\u003c/p\u003e\u003cp\u003eFor the purpose of this study, one item from the original questionnaire was selected to examine participants\u0026rsquo; self-reported experiences of workplace adjustments in relation to their return to work. This was a multiple-choice item where more than one option could be selected. Other adjustments were reported in free-text responses. Answers that matched existing categories were sorted accordingly (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultiple-choice question about self-reported workplace adjustments made by employers to facilitate return to work among individuals sick-listed with stress-related disorders.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"1\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhat types of workplace adjustments has your employer made to facilitate your return to work?\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. No adjustments were made\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. I was reassigned to a different position or role (temporarily or permanently)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. I was given modified work tasks (e.g., less stressful or physically demanding tasks)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4. I received support or workload relief from colleagues\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5. I was allowed to work during times (or days) that suited me better\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6. I was allowed to take more frequent breaks\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7. I was given the opportunity to work from home (more than before)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8. I was given the opportunity to work undisturbed or in a secluded space\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9. I received guidance or supervision from a manager, mentor, or support person\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10. I was provided with assistive devices\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11. Other adjustment (with the option to provide a free-text description of any additional adjustments).\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eOutcome measures and statistical analyses\u003c/h3\u003e\n\u003cp\u003eBaseline descriptive statistics and adjustments at work are given in terms of count and percentages. Age was dichotomised into younger than 40 years and 40 years or older. Level of education was dichotomised into lower (elementary school/upper secondary school) and higher (university education). Adjustments at work were dichotomised into adjustments and no adjustments.\u003c/p\u003e\u003cp\u003eData on registered sick leave days were retrieved from the Swedish Social Insurance Agency\u0026rsquo;s Micro Database for Analysing Social Insurance (MiDAS). In Sweden, sick leave benefits are granted for 25%, 50%, 75%, or 100% of a working day, depending on how much the ability to work is reduced due to a medical condition. Both gross days (number of sick days, regardless of extent of sick leave) and net days (number of sick days converted into whole sick days) were used as outcomes in this study.\u003c/p\u003e\u003cp\u003eMultivariable quantile regression was applied to estimate the differential impact of workplace adjustments across the distribution of sick leave outcomes (10th to 90th percentiles). This method estimates conditional quantiles of the outcome variable in relation to a set of independent variables and covariates, without requiring assumptions of normality or homoscedasticity. Quantile regression is robust to outliers and particularly suited to modelling outcomes that are non-normally distributed or highly skewed. This method follows the framework outlined by Koenker et al. (2001) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Analyses were performed separately for gross and net sick leave days at 6 and 18 months, adjusting for sex, age, and education. Regression coefficients (B) and 95% confidence intervals were estimated at the 10th through 90th percentiles. All analyses were conducted using the statistical package IBM SPSS Statistics 22.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eDescriptive Statistics\u003c/h2\u003e\u003cp\u003eThe analytic sample comprised 1,412 participants, of whom 78% were women (n\u0026thinsp;=\u0026thinsp;1101) and 22% were men (n\u0026thinsp;=\u0026thinsp;311). A majority (73%; n\u0026thinsp;=\u0026thinsp;1023) belonged to the older age category, and 64% (n\u0026thinsp;=\u0026thinsp;910) had completed higher education. Regarding workplace adjustments, 80% (n\u0026thinsp;=\u0026thinsp;1129) reported having received at least one form of adjustment, whereas 20% (n\u0026thinsp;=\u0026thinsp;283) reported no adjustments. Of those who received adjustments, 25% had received only one adjustment, 19% had received two, 16% had received three, and 20% had received four or more adjustments.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eWorkplace adjustments\u003c/h3\u003e\n\u003cp\u003eChi-square test analyses revealed no significant differences in the proportion of participants who received workplace adjustments by sex (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.556) or age group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.236). However, individuals with higher education were significantly more likely to report having received workplace adjustments compared to those with lower education (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001; see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eProportion of participants reporting workplace adjustments by sex, age, and level of education.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWorkplace adjustments % (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo workplace adjustments % (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWomen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e80% (884)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20% (217)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.556\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e79% (245)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21% (66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u0026thinsp;\u0026lt;\u0026thinsp;40 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e82% (319)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18% (70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.236\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;40 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e79% (810)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21% (213)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLower education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73% (364)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27% (132)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigher education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e84% (762)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16% (148)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Age: dichotomised as age\u0026thinsp;\u0026lt;\u0026thinsp;40 years and age\u0026thinsp;\u0026ge;\u0026thinsp;40 years. Level of education: dichotomised as lower (elementary school/upper secondary school) and higher (university education). p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered as significant.\u003c/p\u003e\u003cp\u003eAmong those who received adjustments, the most common was modified work tasks, which was reported by 44% of the sample (n\u0026thinsp;=\u0026thinsp;622). Assistance from colleagues was reported by 33% (n\u0026thinsp;=\u0026thinsp;462), flexible working hours by 28% (n\u0026thinsp;=\u0026thinsp;391), and increased number of breaks by 24% (n\u0026thinsp;=\u0026thinsp;340). Additional forms of support included the possibility to work from home (16%; n\u0026thinsp;=\u0026thinsp;229), access to an undisturbed work environment (16%; n\u0026thinsp;=\u0026thinsp;226), supervision or regular support from a manager or colleague (17%; n\u0026thinsp;=\u0026thinsp;238), and reassignment to a different role within the organisation (14%; n\u0026thinsp;=\u0026thinsp;201). Remaining responses indicated that return to work was not yet possible or that support had been received from occupational health services (see Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eWorkplace adjustments and sick leave days at 6 months\u003c/h2\u003e\u003cdiv id=\"Sec12\" class=\"Section3\"\u003e\u003ch2\u003eGross sick leave days\u003c/h2\u003e\u003cp\u003eWith nearly all individuals still on sick leave at six months, gross sick leave days exhibited insufficient variation to yield meaningful quantile regression results\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eNet sick leave days\u003c/h2\u003e\u003cp\u003eAnalyses of net sick leave days over a six-month period indicated a consistent impact of workplace adjustments. From the 20th to the 80th percentile, individuals who had received workplace adjustments reported significantly fewer sick leave days compared with those without adjustments, with the strongest effects observed at the 40th percentile (B\u0026thinsp;=\u0026thinsp;14.50; 95% CI: 6.02 to 22.98) and the median (B\u0026thinsp;=\u0026thinsp;15.50; 95% CI: 8.76 to 22.24).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eWorkplace adjustments and sick leave days at 18 months\u003c/h2\u003e\u003cdiv id=\"Sec15\" class=\"Section3\"\u003e\u003ch2\u003eGross sick leave days\u003c/h2\u003e\u003cp\u003eThe association between workplace adjustments and gross sick leave days became more complex at 18 months. In the lower quantiles (Q10\u0026ndash;Q40), individuals who had received adjustments reported significantly more sick leave days compared with those without adjustments (e.g., B = \u0026minus;\u0026thinsp;32.00; 95% CI: \u0026minus;\u0026thinsp;52.66 to \u0026minus;\u0026thinsp;11.34 at Q30). From Q50\u0026ndash;Q80, the direction of the association reversed, with workplace adjustments linked to fewer sick leave days. See Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eNet sick leave days\u003c/h2\u003e\u003cp\u003eThe association between workplace adjustments and net sick leave days became more evident at 18 months. In the lower quantiles (Q10\u0026ndash;Q30), no significant differences were observed. From Q40 onwards, however, individuals who had received adjustments reported progressively fewer sick leave days compared with those without adjustments, with the effect increasing across the distribution (e.g., B\u0026thinsp;=\u0026thinsp;35.25; 95% CI: 17.71 to 52.80 at Q50, and B\u0026thinsp;=\u0026thinsp;153.00; 95% CI: 122.85 to 183.15 at Q90). See Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eQuantile differences in gross days between participants with and without workplace adjustments, adjusting for age, sex, and level of education.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePercentile\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAdjustments at work\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo adjustments at work\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentile difference (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e183\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e162\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-21.00 (\u0026minus;\u0026thinsp;35.85; \u0026minus;6.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e220\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e198\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-22.00 (\u0026minus;\u0026thinsp;40.39; \u0026minus;3.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.019\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e257\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e225\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-32.00 (\u0026minus;\u0026thinsp;52.66; \u0026minus;11.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e291\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e266\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-25.00 (\u0026minus;\u0026thinsp;47.69; \u0026minus;2.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.031\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e320\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e328\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.00 (\u0026minus;\u0026thinsp;15.25; 31.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.500\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e348\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e380\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32.00 (4.03; 59.97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.025\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e395\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e461\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66.00 (35.54; 96.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e461\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e520\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e59.00 (24.84; 93.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e535\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e536\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.00 (\u0026minus;\u0026thinsp;1.25; 3.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.383\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Group-specific percentiles are based on predicted values for a typical individual, averaged across age, sex, and level of education. Β-Coefficient. (95% confidence interval). * p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered as significant.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eQuantile differences in net days between participants with and without workplace adjustments, adjusting for age, sex, and level of education.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePercentile\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAdjustments at work\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo adjustments at work\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentile difference (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e102\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e104\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.75 (\u0026minus;\u0026thinsp;9.61; 13.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.763\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e131\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e129\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;2.00 (\u0026minus;\u0026thinsp;16.29; 12.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.784\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e157\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e166\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.50 (\u0026minus;\u0026thinsp;5.27; 24.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.207\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e177\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e196\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18.75 (2.25; 35.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.026\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e235\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35.25 (17.71; 52.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e226\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e294\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e68.00 (46.85; 89.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e258\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e365\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e107.50 (84.32; 130.68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e297\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e429\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e131.50 (102.68; 160.32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e367\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e520\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e153.00 (122.85; 183.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. Group-specific percentiles are based on predicted values for a typical individual, averaged across age, sex, and level of education. Β-Coefficient. (95% confidence interval). * p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered as significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe aim of this study was to explore the types of workplace adjustments reported by employees on sick leave due to stress-related disorders and to examine whether such adjustments were associated with the duration of sickness absence. The main finding was that among employees on sick leave with stress-related disorders, workplace adjustments were most notably associated with faster RTW among those with prolonged sick leave. Thus, findings from the 6-month follow-up showed that individuals with longer durations of sick leave who had received workplace adjustments reported fewer net sick leave days than those who had not received such support. At the 18-month follow-up, an opposite pattern emerged in the lower quantiles of gross sick leave days, where individuals without adjustments reported shorter absences. One possible explanation is that those without adjustments may have had a reduced need for them, for example due to less pronounced impairments in work ability. However, net days provide a more accurate reflection of actual work loss, and in the upper quantiles both gross and net days consistently showed that workplace adjustments were associated with fewer sick leave days. These findings, indicating that workplace adjustments are linked to reduced sickness absence, are in line with previous research suggesting that early dialogue with employers about workplace solutions, including workplace adjustments, can facilitate RTW and reduce sickness absence (\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Although some reviews indicate favourable RTW outcomes for work-related interventions (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), others present a more inconclusive picture concerning the factors that promote RTW for patients with stress-related diagnoses (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). These inconsistencies may reflect the complex nature of the RTW process, particularly for individuals with prolonged sickness absence. The findings of this study suggest that workplace adjustments may be associated with the duration of sickness absence, with approximately 80% of participants reporting having received some form of adjustment. This high proportion may reflect the influence of Swedish regulations, which places a strong responsibility on employers for rehabilitation, including an obligation to offer workplace adjustments as early as possible (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). According to the social insurance regulations in Sweden, employers must also consider reassignment within three months of the start of a sick leave period (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Despite these regulations, 20% of the participants did not receive any workplace adjustments. Persistent symptoms may account for this lack of adjustments, since implementing workplace changes or initiating a partial RTW is often not feasible for individuals with more severe symptoms. Previous research has demonstrated that stress-related symptoms are often long-lasting and are likely to compromise work ability (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Another possible explanation for why some individuals did not receive workplace adjustments is that the feasibility of implementing such measures may vary depending on workplace characteristics. For example, in sectors such as education, healthcare, and social care, which have high levels of sick leave due to stress-related disorders (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), work tasks may require physical presence, making it more difficult to provide flexible arrangements, such as remote work. Furthermore, redistributing work tasks to accommodate one employee may increase the workload of colleagues, which could limit managers' ability or willingness to implement adjustments. Previous studies have shown that managerial ability (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) and organisational conditions are essential for the successful implementation of workplace adjustments (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn terms of the type of adjustments, changes in work tasks were the most frequently reported, which is in line with previous research indicating work task adjustments as one of the most commonly used adjustments for patients with common mental disorders (CMDs) (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Moreover, previous studies have found that work task adjustments are associated with reduced burnout symptoms among health care workers (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), and that adjustments of work tasks as part of multi-domain interventions are associated with improved RTW rates (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Although changes in work tasks may be beneficial, evidence regarding their causal effect on RTW remains limited and requires further research.\u003c/p\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and limitations\u003c/h2\u003e\u003cp\u003eA notable strength of the present study is the integration of self-reported data on workplace adjustments with objective registry data on sickness absence, which enables an assessment of the relationship between adjustments and outcomes. Using both gross and net sick leave days further strengthened the analysis, as net days capture the actual extent of work loss by accounting for partial absences, while gross days may overestimate sickness absence. The large, nationally representative sample and inclusion of two follow-up periods of sick leave data (6 and 18 months) further strengthen the external validity and policy relevance of the findings. Another methodological strength lies in the use of quantile regression, which enabled a more nuanced analysis of how workplace adjustments were associated with sickness absence across different durations. Unlike traditional regression models that focus on mean outcomes, quantile regression allowed us to examine whether the effects of adjustments varied depending on the length of sick leave. This approach revealed that the positive association between workplace adjustments and reduced sick leave days was particularly pronounced among individuals with longer durations of sick leave. By capturing these distributional effects, quantile regression provided important insights into the heterogeneous nature of RTW processes and the potential differential impact of interventions across subgroups. Data about workplace adjustments were collected at a single time point, which could be considered a limitation since work adjustments may have occurred after the measure was performed. In addition, since workplace adjustments were not measured prospectively in relation to each time point, causal inferences remain limited. Moreover, subgroup analyses for specific types of workplace adjustments and sick leave days could not be conducted due to an insufficient number of individuals in each subgroup.\u003c/p\u003e\u003cp\u003eWorkplace adjustments were evaluated using a single questionnaire item with predefined response options. While this allowed for a broad overview, it limits the understanding of the timing, quality, and extent of the adjustments provided. Moreover, the questionnaire used to assess workplace adjustments was not formally tested for either validity or reliability, which is a methodological limitation. Another important limitation is the inability to conduct non-response analyses for individuals who did not complete the survey due to the lack of background data, thereby preventing the exclusion of potential selection bias. The reliance on self-reported data introduces the possibility of recall or reporting bias, particularly in the interpretation of what constitutes an adjustment. Finally, the findings reflect the Swedish labour market, welfare, and regulatory context, and may not be generalisable to countries with different social insurance or occupational health systems.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eClinical Implications\u003c/h2\u003e\u003cp\u003eThe observed association between workplace adjustments and shorter durations of sick leave, particularly among individuals with long-term absence, suggests that such measures may support RTW and could be considered in the rehabilitation process for patients with stress-related diagnosis.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study contributes to the growing body of knowledge on how workplace adjustments can support shorter sick leave among individuals with stress-related disorders. The findings indicate that workplace adjustments may facilitate RTW, particularly for those with longer periods of sick leave absence.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOECD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eOrganisation for Economic Co-operation and Development\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eRTW\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eReturn to work\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eED\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eExhaustion disorder\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eICD-10\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInternational Classification of Diseases, 10th Revision\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSCB\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStatistiska centralbyr\u0026aring;n (Statistics Sweden)\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMiDAS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMicro Database for Analysing Social Insurance (F\u0026ouml;rs\u0026auml;kringskassan)\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCMD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCommon mental disorders\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSPSS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStatistical Package for the Social Sciences\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003e The study was approved on 29 May 2024 by the Swedish Ethical Review Authority, Dnr 2024-03484-01, and conducted in accordance with the Declaration of Helsinki (1964 and its later amendments). Informed consent was obtained from all participants.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eGenerative Artificial Intelligence (AI)\u003c/h2\u003e\u003cp\u003eGenerative AI (ChatGPT, GPT-5 by OpenAI) was used to improve language clarity. All content was critically reviewed and verified by the authors.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eA.B. had the major responsibility for the planning of the study, analysis of the data and writing the first draft of manuscript. I.J. and G.H. contributed to the planning of the study, interpretation of the data and writing of the manuscript. All authors read and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to thank Emina Hadzibajramovic for valuable advice and support in the development of the study design and Sandra Pettersson for assisting with the data analysis.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eF\u0026ouml;rs\u0026auml;kringskassan. The Swedish Social Insurance Agency\u0026rsquo;s Status Report 2023:1 Mental ill-health in today\u0026rsquo;s working life (F\u0026ouml;rs\u0026auml;kringskassans l\u0026auml;gesrapport 2023:1 Psykisk oh\u0026auml;lsa i dagens arbetsliv). 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eF\u0026ouml;rs\u0026auml;kringskassan. Number of current sickness\u0026ndash;absence cases due to stress 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOECD. Mental Health and Work,Fitter Minds, Fitter Jobs, From awareness to change in integrated mental health, skills and work policies. 2021.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHassard J, Teoh KRH, Visockaite G, Dewe P, Cox T. The cost of work-related stress to society: A systematic review. J Occup Health Psychol. 2018;23(1):1\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGlise K, Ahlborg G Jr., Jonsdottir IH. Course of mental symptoms in patients with stress-related exhaustion: does sex or age make a difference? BMC Psychiatry. 2012;12:18.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGrossi G, Perski A, Osika W, Savic I. Stress-related exhaustion disorder\u0026ndash;clinical manifestation of burnout? A review of assessment methods, sleep impairments, cognitive disturbances, and neuro-biological and physiological changes in clinical burnout. Scand J Psychol. 2015;56(6):626\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003evan Dam A. A clinical perspective on burnout: diagnosis, classification, and treatment of clinical burnout. Eur J Work Organizational Psychol. 2021;30(5):732\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKarlson B, J\u0026ouml;nsson P, \u0026Ouml;sterberg K. Return to work after a workplace-oriented intervention for patients on sick leave for burnout \u0026ndash; a prospective controlled study. BMC Public Health. 2010;10:301.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKarlson B, J\u0026ouml;nsson P, \u0026Ouml;sterberg K. Long-term stability of return to work after a workplace-oriented intervention for patients on sick leave for burnout. BMC Public Health. 2014;14(1):821.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDalgaard VL, Aschbacher K, Glasscock D, Willert M, Carstensen O, Biering K. Return to work after work-related stress: A randomized controlled trial of a work-focused cognitive behavioral intervention. Scand J Work Environ Health. 2017;43.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLinds\u0026auml;ter E, Sv\u0026auml;rdman F, Wallert J, Ivanova E, S\u0026ouml;derholm A, Fondberg R, et al. Exhaustion disorder: scoping review of research on a recently introduced stress-related diagnosis. BJPsych Open. 2022;8(5):e159.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eK\u0026auml;rkk\u0026auml;inen R, Saaranen T, Hiltunen S, Ryyn\u0026auml;nen OP, R\u0026auml;s\u0026auml;nen K. Systematic review: Factors associated with return to work in burnout. Occup Med (Lond). 2017;67(6):461\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLambreghts C, Vandenbroeck S, Goorts K, Godderis L. Return-to-work interventions for sick-listed employees with burnout: a systematic review. Occup Environ Med. 2023;80(9):538\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePijpker R, Vaandrager L, Veen EJ, Koelen MA. Combined Interventions to Reduce Burnout Complaints and Promote Return to Work: A Systematic Review of Effectiveness and Mediators of Change. Int J Environ Res Public Health. 2019;17(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSCB. Survey on Rehabilitation and Return to Work \u0026ndash; Technical Report: A Description of Implementation and Methods (Enk\u0026auml;tunders\u0026ouml;kning om rehabilitering och \u0026aring;terg\u0026aring;ng i arbete Teknisk rapport - En beskrivning av genomf\u0026ouml;rande och metoder). 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSfU S. Work-Oriented Rehabilitation for Employees on Sick Leave with Stress-Related Disorders \u0026ndash; An Evaluation (Arbetslivsinriktad rehabilitering f\u0026ouml;r sjukskrivna med stressrelaterad oh\u0026auml;lsa \u0026ndash; en utv\u0026auml;rdering). 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eF\u0026ouml;rs\u0026auml;kringskassan. Sickness Benefit, Rehabilitation, and Rehabilitation Compensation (Sjukpenning, rehabilitering och rehabiliteringsers\u0026auml;ttning). 2015.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSCB. Long-Term Sickness Absence \u0026ndash; Methodological Review (L\u0026aring;ngtidssjukskrivna M\u0026auml;tteknisk granskning). 2023.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKoenker R, Hallock KF. Quantile Regression. J economic Perspect. 2001;15(4):143\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAhola K, Toppinen-Tanner S, Sepp\u0026auml;nen J. Interventions to alleviate burnout symptoms and to support return to work among employees with burnout: Systematic review and meta-analysis. Burnout Res. 2017;4:1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAuthority SWE. Work Environment Act. 1977.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGlise K, Wiegner L, Jonsdottir IH. Long-Term follow-up of residual symptoms in patients treated for stress-related exhaustion. BMC Psychol. 2020;8(1):26.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEskilsson T, Olsson D, Ekb\u0026auml;ck AM, J\u0026auml;rvholm LS. Symptoms, work situation and work functioning 10 years after rehabilitation of stress-induced exhaustion disorder. BMC Psychiatry. 2024;24(1):525.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNielsen K, Yarker J. What can I do for you? Line managers\u0026rsquo; behaviors to support return to work for workers with common mental disorders. J managerial Psychol. 2022;38(1):34\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBertilsson M, Niederberger R, de Rijk A. Work accommodations for employees with common mental disorders and associated manager-related determinants: a cross-sectional study among Swedish managers. Disabil Rehabil. 2024;46(18):4256\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAust B, Leduc C, Cresswell-Smith J, O\u0026rsquo;Brien C, Rugulies R, Leduc M, et al. The effects of different types of organisational workplace mental health interventions on mental health and wellbeing in healthcare workers: a systematic review. Int Arch Occup Environ Health. 2024;97(5):485\u0026ndash;522.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNowrouzi-Kia B, Garrido P, Gohar B, Yazdani A, Chattu VK, Bani-Fatemi A et al. Evaluating the Effectiveness of Return-to-Work Interventions for Individuals with Work-Related Mental Health Conditions: A Systematic Review and Meta-Analysis. Healthcare (Basel, Switzerland). 2023;11(10).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-occupational-rehabilitation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"joor","sideBox":"Learn more about [Journal of Occupational Rehabilitation](https://www.springer.com/journal/10926)","snPcode":"10926","submissionUrl":"https://submission.nature.com/new-submission/10926/3","title":"Journal of Occupational Rehabilitation","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"stress-related disorders, sick-leave, return to work, workplace adjustments","lastPublishedDoi":"10.21203/rs.3.rs-7684948/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7684948/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Sick leave with stress-related disorders has increased substantially in Sweden and other OECD countries, posing a significant challenge to public health and workforce participation. While employer support has been shown to contribute to return to work (RTW), there is limited evidence regarding which specific workplace adjustments facilitate this process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e This study aims to investigate the types of workplace adjustments individuals with stress-related disorders receive to facilitate RTW and whether such adjustments are associated with a reduced number of sick leave days.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This study combined data from a national survey of 1,412 individuals on long-term sick leave due to stress-related disorders (ICD-10 F43 codes) with register data on sick leave from the Swedish Social Insurance Agency. Workplace adjustments were self-reported via a multiple-choice questionnaire. Sick leave outcomes were measured as gross and net sick leave days at 6 and 18 months. Multivariable quantile regression was used to examine associations between reported adjustments and the distribution of sick leave days, adjusting for age, sex, and education.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Eighty per cent of participants reported having received at least one workplace adjustment, with changes in work tasks being most common. Quantile regression analyses revealed that workplace adjustments were associated with fewer net sick leave days, particularly among individuals with longer durations of sick leave. At 18 months, individuals who had received workplace adjustments had significantly fewer net sick leave days across the 40\u003csup\u003eth\u003c/sup\u003e to 90\u003csup\u003eth\u003c/sup\u003e percentiles\u003cstrong\u003e, \u003c/strong\u003ewith the largest difference at the 90\u003csup\u003eth \u003c/sup\u003epercentile (153 fewer net sick leave days; p\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Workplace adjustments may reduce the duration of sickness absence among individuals sick-listed with stress-related disorders, particularly for those at risk of long-term sick leave. These findings underscore the importance of early, individualised work modifications as part of the rehabilitation process.\u003c/p\u003e","manuscriptTitle":"Workplace adjustments and sick leave duration among individuals with stress-related disorders: A longitudinal register follow-up in Sweden","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-10 14:33:58","doi":"10.21203/rs.3.rs-7684948/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-19T18:20:09+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-05T08:07:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"242464937741261653822184421455312993757","date":"2025-10-26T14:18:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"71416758556288453794795860657286191217","date":"2025-10-21T11:12:58+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-25T18:56:07+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-25T14:22:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-23T14:31:24+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Occupational Rehabilitation","date":"2025-09-22T12:43:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-occupational-rehabilitation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"joor","sideBox":"Learn more about [Journal of Occupational Rehabilitation](https://www.springer.com/journal/10926)","snPcode":"10926","submissionUrl":"https://submission.nature.com/new-submission/10926/3","title":"Journal of Occupational Rehabilitation","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"c0347838-b7b9-4967-a3c8-90f5844d5208","owner":[],"postedDate":"October 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T17:53:36+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-10 14:33:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7684948","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7684948","identity":"rs-7684948","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}