Scand J Work Environ Health 2008, vol 34, no 2 107 Original article Scand J Work Environ Health 2008;34(2):107–112 What makes men and women with musculoskeletal complaints decide they are too sick to work? by Wendela E Hooftman, PhD, 1, 2 Marjan J Westerman, PhD, 1 Allard J van der Beek, PhD, 1, 2 Paulien M Bongers, PhD, 2, 3 Willem van Mechelen, PhD 1, 2 Hooftman WE, Westerman MJ, van der Beek AJ, Bongers PM, van Mechelen W. What makes men and women with musculoskeletal complaints decide they are too sick to work? Scand J Work Environ Health. 2008;34(2):107–112. Objective The objective of this study was to determine what makes men and women with musculoskeletal complaints decide to call in sick for work. Methods Qualitative, face-to-face interviews were used with employees (16 men and 14 women) who had called in sick due to a musculoskeletal complaint and who expected to be absent from work for at least 2 weeks on sick leave. Results The participants fell into the following two main groups: those who were off sick because of a diag- nosed medical condition, such as a fracture, and those who were off sick because of an unidentifiable complaint, such as low-back pain. Employees in the former group called in sick because they were in the hospital or because they reckoned that their condition was too serious to warrant a continuation of work. Employees in the latter group felt hesitant and insecure and found it hard to judge whether absenteeism was justified. They decided either to “play it safe” and stay off work to prevent the complaints from worsening or to seek advice from medi- cal professionals. Their advice did not include explicit instructions to stay at home, but were usually interpreted as such. Finally, women, but not men, were likely to call in sick if they felt that their home situation was being negatively affected by attempts to keep working while suffering physical complaints. Conclusions The decision to call in sick is not taken lightly. Employees with nonspecific disorders base their decision on several factors, including advice from medical professionals. A factor found only among women was work–home interference. Key terms absenteeism; back; gender; neck; qualitative research; upper extremity. 1 Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, Nether- lands. 2 Body@Work, Research Centre Physical Activity, Work and Health, TNO VUmc, Amsterdam, Netherlands. 3 TNO Quality of Life, Work and Employment, Hoofddorp, Netherlands. Correspondence to: Dr Allard van der Beek, EMGO Institute, Van der Boechorststraat 7–9, NL-1081 BT Amsterdam, Neth- erlands. [E-mail: a.vanderbeek@vumc.nl] The high prevalence of sick leave is generally recog- nized as a major problem in modern society. However, different groups of employees may display distinct differences in the patterns of sick leave; for example, younger employees tend to be off sick more often than older employees, and women more often than men (1–3). However, results are not always consistent, and a higher degree of sickness absenteeism has also been found for men (4) and older workers (3). van den Bossche et al (5) showed that 56% of Dutch female employees and 49% of male employees had been on sick leave during the previous year. Women had been absent an average of 1.4 times and 8 days, while men had been absent an average of 1.1 times and 8.2 days. However, 8.1% of the women and 5.9% of the men had been absent for over 8 weeks. The higher frequency of absence for women, on the average (about) equal with respect to the duration of absenteeism for men and women but with more-frequent long absenteeism among women, corresponds with the results of earlier studies, both in the Netherlands (6) and in other countries (2, 7). However, data on gender differences in the average dura- tion of absenteeism are ambiguous (2, 7). Recent Scandi- navian studies have shown that the frequency of sickness “presenteeism” (ie, working when sick leave should be taken) was also greater among women (8, 9). This find- ing suggests that the pattern of absenteeism (eg, frequent short-term leave versus infrequent long-term leave) differs between the genders. This phenomenon may be caused by differences in the reasons for calling in sick.