Written by: Lise A. Haveraaen, Lisebet S. Skarpaas og Randi W. Aas

The psychosocial work environment can affect whether sick-listed employees return to work after sickness absence, or not. Results from a cohort study of sick-listed employees who participated in a return to work-programme found that employees who experienced the combination of low psychological job demands and high levels of decision control, were four times as likely to return to work three months after the return to work-programme. High levels of social support from co-workers and supervisors tripled the probability of returning to work compared to having low social support.

Over the last centuries, increasing attention has been placed on how stress affects our health. High psychological job demands, in combination with low decision control in the work situation can cause serious health challenges among employees. Lack of support from colleagues and the supervisor can be extra challenging. Several studies have found an association between social and psychological aspects of the work environment and long-term sickness absence.


The aim of this study was to examine whether – and to what extent – the psychosocial work environment also can impact return to work after sickness absence.

The study was designed as a cohort study of 251 sick-listed employees who participated in 40 different Rapid-RTW-services in Norway. The demand-control-model, which was developed by Karasek, was used as a basis for the study. The Job Content Questionnaire (JCQ) was used to gather information on the workplace characteristics. The data on workplace characteristics were connected to national register data on sickness absence. Return to work was measured three months after the employees finished treatment in the programme.

Psychological job demands concerns what is expected from you in the job, how many demands you have, and how much time-pressure etc. is linked to these expectations. Decision control concerns the extent of control you have over the decisions that are made in the job. Social support is concerned with the support you get from your supervisor and your colleagues. 

The results from the study show that employees who experienced low psychological job demands, and high supervisor and co-worker support were three times as likely to return to work compared to employees who experienced high demands and low social support. People in jobs which combined low job demands and high levels of control were four times as likely to be working three months after the programme.


This study examined to which extent factors in the workplace, such as psychological job demands, decision control and social support, affect whether employees return to work after sickness absence. The results speak for themselves. Interventions aimed at returning people to work might therefore benefit from putting more emphasise on psychosocial work characteristics in the future. It is for example possible to assess these factors at the start of a return-to-work intervention. This way we can identify employees who experience a gap between the demands they are faced with, and the control they have over the work situation. We can also identify employees who experience a lack of social support in the workplace. These factors could also be discussed during workplace visits. Conversations with the supervisor can reduce the demands, increase the employees’ decision control and ensure good support from both supervisors and colleagues.

A challenge in this type of studies is that we cannot control for all factors that may affect return to work. This concern was addressed by including and controlling for various factors that are known to influence return to work. Nonetheless, the findings in the study are strong, and seen together with other studies with similar findings, we can recommend that return-to-work programmes and interventions should focus on factors outside the sick-listed employee, such as the demands, the decision control and the support they receive from those around them in the workplace.


This is a summary of the article:

Haveraaen LA, Skarpaas LS, Berg, JE, Aas RW. (2015) Do psychological job demands, decision control and social support predictreturn to work three months after a return-to-work (RTW) programme? The rapid-RTW cohort study. Work, 2015. 53(1): p. 61-71.

Click here to read the article.


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