Imagine a young worker living with a rheumatic disease like arthritis or lupus. Although these conditions are more prevalent among older adults, studies have shown that about 250,000 young adults in Canada live with arthritis—one of the most common rheumatic conditions. These individuals may have days when painful flare-ups make it difficult to show up at work or do their job tasks, or they may have symptoms that need to be managed on a daily basis.
Now imagine that young worker is also experiencing symptoms of depression, which often manifests in young adulthood. Depression is seen in 23 per cent of adults with a rheumatic disease—more common than the 11 per cent seen in the general population. Navigating the challenges of more than one health condition when just starting a career can have lasting impacts on a young person’s working life.
But as an Institute for Work & Health (IWH) research team found in a recent study, having workplace supports can be vital to buffering challenges on productivity these workers may face.
The longitudinal study, published in August 2024 and freely available in the Journal of Occupational Rehabilitation (doi:10.1007/s10926-024-10217-8), found that young adult workers who had both a rheumatic disease and depression had higher levels of absenteeism and presenteeism than those with just one or neither condition. Absenteeism referred to missing workdays, and presenteeism referred to working while unwell, or not at one’s full capacity.
The study found about 70 per cent of young workers with a rheumatic disease, depression or both, did not have adequate workplace supports (that is, job accommodations and benefits) to address their health needs. (In comparison, only 35 per cent of young workers with no health conditions reported their workplace supports did not meet their needs.)
It found participants who reported that their workplace supports were met or exceeded (regardless of their health) had lower odds of absenteeism when compared to those with unmet workplace support needs. Similarly, when examining the specific role of supports including prescription drug coverage, health-care benefits and paid sick leave, the research team found that they each lowered the odds of absenteeism.
The study interviewed 76 young workers three times over a 27-month period, which allowed the research team to examine the effects of workplace supports on absenteeism and presenteeism over time.
Our study is based on a small sample and we would want to see results confirmed in larger sample, but we found that among young adults, having comorbid severe rheumatic disease symptoms and depressive symptoms can have an impact on presenteeism and absenteeism,
say Dr. Kathleen Dobson, IWH associate scientist and lead on the study.
Our findings also suggest that having a supportive working environment, however, can help tackle those lost productivity issues and to sustain workers’ employment, especially among those reporting both sets of symptoms.
About the study
For this study, researchers looked at survey responses from a group of working Canadian young adults, aged 18 to 35 years, with a rheumatic disease such as arthritis, ankylosing spondylitis (arthritis affecting the spine), lupus, and others. This study was one of the first longitudinal studies of the work environment of young adults with rheumatic disease. (Most previous studies about this population group were cross-sectional or focused on mainly clinical outcomes.)
The first of three surveys was conducted in the winter of 2019, with subsequent surveys administered at nine-month intervals. The surveys asked about the severity of participants’ rheumatic disease symptoms and the presence of depressive symptoms. Participants were also asked about productivity levels, namely presenteeism and absenteeism. To gauge presenteeism, participants were asked how their health has impacted their productivity at work on a scale from zero to ten, with ten indicating the highest impact. To gauge absenteeism, participants were asked the number of workdays they missed in the past three months. Participants were also asked whether they needed and had access to 13 different workplace supports.
Impacts on productivity
Seventy-six participants completed all three survey waves and were included in this study. Out of this sample, 17 (22 per cent) had neither severe rheumatic disease or depressive symptoms, another 17 had both, and 42 participants (55 per cent) had one or the other.
Those with one or both conditions had higher levels of presenteeism—on average rating the impact of their health on productivity a six and five out of ten, respectively. In comparison, those with neither condition said their health had little impact on productivity, rating it a two out of ten on average.
Participants with health conditions were also more likely to report absenteeism; 57 per cent of those with one condition and 77 per cent of those with both reported missing work compared with 30 per cent of those with neither condition.
A third of all participants reported that their workplace support needs were met or exceeded. Those with neither condition were twice as likely (65 per cent) as those with either severe rheumatic disease or depression, or both (29 per cent in all cases) to have adequate supports. Regardless of their health, participants who reported that their workplace supports were met or exceeded had lower odds of absenteeism.
Drawing on the three waves of surveys, the research team also examined the effects of workplace supports on productivity over time. Here, they found the results varied.
While absenteeism dropped across all groups in the study over time, a different trend was seen for presenteeism. Of those who reported their support needs were met or exceeded:
- Young workers with no symptoms or symptoms from only one condition reported lower presenteeism over time by one to two points on average.
- Young workers experiencing symptoms from both conditions reported higher presenteeism over time by two points on average.
For participants in all groups who reported that their workplace support needs were not met, presenteeism scores decreased by one to two points.
It may seem counterintuitive that workers with both conditions reported higher presenteeism over time with more workplace supports,
say Dobson. But we may be seeing this trend because those workplace supports—like paid sick days, flexible work arrangements, or access prescription drug coverage—are actually helping them stay at work, rather than having to leave their job.
The high level of presenteeism among those with both conditions, even when they seem to have their support needs met, suggests that these workers can likely benefit from further strategies that address both physical and mental health challenges they may face dealing with both sets of these symptoms at work,
she adds.
What workplace supports are needed?
When it comes to the types of supports that might help these workers, those with both depression and severe rheumatic disease symptoms reported higher needs than those without for paid sick leave, employee assistance programs, work schedule flexibility, workstation modifications, work from home arrangements, and informal modifications to work. The researchers also looked directly at the role of three supports, prescription drug coverage, health-care benefits, and paid sick leave. Similar to the overall findings, with access to these supports, participants were less likely to miss work.
Sometimes when we think about implementing workplace supports, we think about the need for big, sweeping policy changes,
says Dobson. While those are important and not to be understated, there are simple, effective ways for employers to support these workers right now.
For example, having flexible working arrangements, such as the ability to shift a 7:00 a.m. start time to a 9:00 a.m. start time, or being able to work from home instead of having to commute during a symptom flare-up, can help a worker be as productive as they can be, Dobson adds
Rheumatic disease and depression are relatively common health conditions among working-aged adults,
says Dobson. So, it is likely that many workers may be experience one or both sets of symptoms. Our study shows that having access to workplace supports is one way that workplaces can help to retain these workers while supporting their productivity. This not only benefits the worker, but may also help employers avoid the costs of re-hiring and training new employees.