摘要：Objectives. We tested the hypothesis that sickness absence from work predicts workers' risk of later depression. Methods. Study participants (n = 7391) belonged to the French GAZEL cohort of employees of the national gas and electricity company. Sickness absence data (1996–1999) were obtained from company records. Participants' depression in 1996 and 1999 was assessed with the Center for Epidemiologic Studies–Depression (CES-D) scale. The analyses were controlled for baseline age, gender, marital status, occupational grade, tobacco smoking status, alcohol consumption, subthreshold depressive symptoms, and work stress. Results. Among workers who were free of depression in 1996, 13% had depression in 1999. Compared with workers with no sickness absence during the study period, those with sickness absence were more likely to be depressed at follow-up (for 1 period of sickness absence, fully adjusted odds ratio [OR] = 1.53, 95% confidence interval [CI] = 1.28, 1.82; for 2 or more periods, fully adjusted OR = 1.95, 95% CI = 1.61, 2.36). Future depression was predicted both by psychiatric and nonpsychiatric sickness absence (fully adjusted OR = 3.79 [95% CI = 2.81, 5.10] and 1.41 [95% CI = 1.21, 1.65], respectively). Conclusions. Sickness absence records may help identify workers vulnerable to future depression. In industrialized countries, depression affects up to 20% of individuals at some point during their lifetimes and is a leading cause of disability and decreased quality of life. 1 , 2 Typically, the disorder begins in adulthood, significantly impairing individuals' ability to fulfill their family and work roles. 3 Depression is a strong, independent, and underestimated risk factor for work-related disability. 4 Fortunately, it can be treated, and research suggests that adequate mental health treatment of affected individuals can improve both their clinical outcomes and work performance. 5 , 6 Conversely, individuals' ability to fulfill their usual roles at work, as measured by sickness absence, appears to predict future health. 7 – 10 , 11 In particular, sickness absence may predict the occurrence of mental health problems such as depression, but to date this question has not been thoroughly examined. To test the hypothesis that sickness absence from work predicts future onset of depression, we used data from the GAZEL study, an ongoing occupational cohort study of 20 000 workers, 12 in which exhaustive sickness absence data were collected directly from company records. To account for the possibility that sickness absence reflects prior mental health problems, we restricted the analysis to workers who did not have depression during the 12 months preceding the 1996 assessment and adjusted the analyses for subthreshold depressive symptoms. Additionally, our analyses controlled for participants' demographic characteristics, occupational grade, health behaviors, and work stress, because these factors may be associated with the onset of depression.
