Problem drinking and sickness absence: the mediating role of mental ill health in a Swedish cohort

Background

Although problem drinking is associated with sickness absence, the underlying mechanisms remain unclear. This study aimed to investigate whether this relationship is mediated by mental ill health among Swedish workers.

Methods

This study included 3,926 participants from the 2020, 2022, and 2024 waves of the Swedish Longitudinal Occupational Survey of Health (SLOSH). Problem drinking was assessed using the CAGE questionnaire. Sickness absence (≥8 days/year) and indicators of mental ill health were measured using self-reported questionnaires. A three-wave longitudinal structural equation model (SEM) was employed to estimate the temporal pathway from baseline problem drinking (T1), through a latent mental ill health construct (T2), to subsequent sickness absence (T3). Multi-group analysis was conducted to assess potential gender differences.

Results

Longitudinal SEM supported full mediation. Baseline problem drinking (T1) significantly predicted higher levels of mental ill health at T2 (β = 0.21, p < .001), which in turn significantly predicted sickness absence at T3 (β = 0.23, p < .001). The direct effect of problem drinking on sickness absence was not statistically significant (p = .30), whereas the indirect effect via mental ill health was significant (β = 0.05, p < .001). Multi-group analysis indicated structural invariance across genders (p = .18), suggesting that the mediational pathway operates identically for men and women.

Conclusions

Association between problem drinking and subsequent sickness absence among Swedish workers appears to be fully mediated by mental ill health. Interventions targeting early problem drinking may help prevent future sickness absence by improving psychological well-being.

Key messages

• The association between problem drinking and future sickness absence is fully mediated by mental ill-health.

• Early identification of problem drinking may reduce sickness absence by improving mental health and preventing downstream occupational consequences.