Prevalence of sickness absence and ‘presenteeism’

Many research and intervention efforts have focused on preventing and reducing absence from work due to sickness. Although reduced absence from work appears to be profitable for the companies and organisations involved, this will not be the case if employees continue to work or return to work while still feeling sick – a concept known as ‘presenteeism’. An analytical follow-up of a national sample of workers in the Netherlands indicates that a vicious cycle is at work: burnout or exhaustion due to work increases sickness absence, which in turn increases the risk of subsequent presenteeism. The latter may eventually result in even higher levels of sickness levels.

Recent research from TNO Work and Employment has investigated whether ‘presenteeism’ is caused by job demands and whether it increases stress and burnout, resulting eventually in increased sickness absence. Presenteeism refers to the situation where a worker goes to work but actually feels sick and should stay at home (Aronsson et al, 2000). It may also be interpreted as the ‘pressure to attend’ work.

The hypothesis suggested that the relations between the concepts of presenteeism, job demands and burnout may be different for blue-collar, white-collar and people-related jobs; the latter category includes doctors, nurses and teachers, for example, all of which occupations require a lot of interaction with people. The expectation was that the correlation may be felt particularly in people-related jobs. These assumptions were included in the statistical analyses on the basis of previous work (LISREL, Jöreskog and Sörbom, 1996).

Study methodology

The issue of presenteeism was studied in a Dutch longitudinal research panel, selected from the participants of the TNO Work Situation Survey (TNO Arbeidssituatie Survey, TAS) in 2002 and 2004. In this survey, a large sample of employees and self-employed workers responded to a partly written and partly digital questionnaire; a total of 4,000 responses were collected in 2002, increasing to 4,800 responses in 2004. Of this sample, 653 persons participated in both years and their behaviour in respect of sickness absence can be followed longitudinally.

Prevalence of presenteeism

As reported after the 2002 survey (NL0312NU02), presenteeism in the entire sample was approximately 63% in that year: in other words, 63% of workers attended work even when they felt sick. In the longitudinal subsample, pressure to attend work when sick was reported by 60% of workers. No significant difference in presenteeism arose from 2002 to 2004. Due to the longitudinal nature of this study, it can be seen that many respondents who reported presenteeism in 2002 also reported it in 2004 (74% of that group), while among the respondents who did not report presenteeism in 2002, only 35% reported pressure to attend work when sick in 2004. Respondents with primarily people-related jobs more often continued to work despite feeling sick (67%) than respondents with other occupations, for example in construction, manufacturing or administration – these latter groups reported a presenteeism rate of 52%.

Increase in subsequent sickness absence

Analyses revealed that presenteeism in 2004 was caused by burnout and sickness absence measured in 2002. Furthermore, sickness absence in 2004 was caused by burnout and presenteeism measured in 2002: working while sick in 2002 resulted in 2.3 additional days of sick leave per person in 2004. A concurrent relation (r) also exists between job demands and presenteeism (r = 0.16 in 2002, and r = 0.18 in 2004). This implies that there is a tendency to stay at work when sick in cases where the workload is high.

Figure 1: Relation between work burnout, presenteeism and sickness absence


Source: TAS, 2002–2004

Occupation was associated with the different relations between these concepts. Among white-collar workers, higher job demands in 2002 resulted in higher sickness absence in 2004 but, among blue-collar workers, higher job demands in 2002 resulted in lower sickness absence in 2004 (Figure 2).

Figure 2: Relation between job demands in 2002 and sickness absence in 2004, by job category


Source: TAS, 2002–2004

Relevance to prevention

These results imply that a vicious cycle is in operation. Burnout will increase presenteeism as well as subsequent sickness absence. This increase in sickness absence will in turn increase the risk of later presenteeism. Eventually, this increase in presenteeism may result in even higher levels of subsequent sickness absence.

The different effect of job demands on job absence among white-collar workers (higher absence) and blue-collar workers (lower absence) is possibly due to a higher ‘pressure to attend’ from colleagues when work is busy among blue-collar workers than among white-collar workers. Blue-collar workers may also find it relatively more precarious to stay at home when sick in cases of high workload, possibly because it may be more likely that someone else might take over their position. However, in general, presenteeism appeared to be highest in jobs which involve dealing with people.

Working while sick may thus temporarily appear to reduce levels of sickness absence in organisations but the chances are high that presenteeism will result in even higher levels of sickness absence later on. Interventions to reduce sickness levels will eventually be counterproductive if presenteeism is the result.


Aronsson, G., Gustafsson, K. and Dallner, M., ‘Sick but yet at work: An empirical study of sickness presenteeism’, in Journal of Epidemiology & Community Health, 54, 2000, pp. 502–509.

Jöreskog, K.G. and Sörbom, D., LISREL 8: User’s Reference Guide, Chicago: Scientific Software International, 1996.

Karasek, R., Brisson, C., Kawakami, N. et al, ‘The Job Content Questionnaire (JCQ): An instrument for internationally comparative assessments of psychosocial job characteristics’, in Journal of Occupational Health Psychology, 3, 1998, pp. 322–354.

Schaufeli, W.B. and van Dierendonck, D., The construct validity of two burnout measures’, in Journal of Organisational Behavior, 14, 1993, pp. 631–647.

Ernest de Vroome, TNO Work and Employment

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