Presenteeism and mental health of workers during the COVID-19 pandemic: a systematic review

Frontiers in Public Health 01 frontiersin.org Presenteeism and mental health of workers during the COVID-19 pandemic: a systematic review JuanJesúsGarcía-Iglesias 1,2, JuanGómez-Salgado 1,3*, JoaoApostolo 2, RogérioRodrigues 2, EmíliaIsabelCosta 2,4, CarlosRuiz-Frutos 1,3, SantiagoMartínez-Isasi 5,6, DanielFernández-García 7 and ÁngelVilches-Arenas 8,9 1 Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain, 2 Health Sciences Research Unit: Nursing (UICISA: E), Coimbra Nursing School, Coimbra, Portugal, 3 Escuela de Posgrado, Universidad de Especialidades Espíritu Santo, Guayaquil, Guayas, Ecuador, 4 Nursing Department, Health School, University of Algarve, Faro, Portugal, 5 Simulation and Intensive Care Unit of Santiago (SICRUS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Galicia, Spain, 6 CLINURSID Research Group, Faculty of Nursing, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain, 7 Health Research Nursing Group (GREIS), Department of Nursing and Physiotherapy, University of Leon, Leon, Spain, 8 Preventive Medicine and Public Health, University of Seville, Seville, Spain, 9 Preventive Medicine, Virgen Macarena University Hospital, Seville, Spain Background: A large number of workers attend work despite being ill. Attending work during sickness can have a number of consequences for the worker (e.g., worsening of physical and mental condition), for co-workers, and for the company, and for service users. Objectives: The aim of this study was to assess the factors influencing presenteeism and mental health of workers during the COVID-19 pandemic. Methods: A systematic review following the PRISMA format was conducted in the PubMed, Scopus, Web of Science (WoS), Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, and ScienceDirect electronic databases in January 2023, using the following key words: Presenteeism, Mental Health, and COVID-19. The eligibility criteria applied were original articles published in English, Spanish, French, German, and Portuguese, workers during the COVID-19 pandemic (data collection date: January 01, 2020 – January 01, 2023), and articles assessing at least one measure of presenteeism and mental health status. Methodological quality was assessed using the critical appraisal tools of the Joanna Briggs Institute. The followed protocol is listed in the International Prospective Register of Systematic Reviews (PROSPERO) with code CRD42023391409. Results: A total of 25 studies were included in this review recruiting a total of 164,274 participants. A number of factors influencing mental health and sickness presenteeism were identified: (1) mental health-related factors (burnout [in 4 studies], stress [in 9 studies], depression [in 1 study], fear of COVID-19 [in 1 study], no well-being [in 2 studies], etc.); (2) individual factors (health status [in 1 study], being young [in 1 study], workers who experienced interrupted medical care [in 2 studies], having a chronic disease [in 1 study], etc.); (3) factors related to the situation caused by COVID-19 (confinement, symptoms, loss of contract, risk of bankruptcy, etc. [in 1 study each one]); and (4) factors derived from working conditions (organisational support [in 1 study], patient care [in 1 study], work functioning or task performance impairment [in 4 studies], work fatigue [in 2 studies], safety climate [in 1 study], workload [in 1 study], etc.). Conclusion: Identifying the key determinants of presenteeism and understanding the phenomena and origins of sickness presenteeism will help to create a safe OPEN ACCESS EDITED BY Yoshihisa Fujino, University of Occupational and Environmental Health Japan, Japan REVIEWED BY Vasiliki Eirini Chatzea, Hellenic Mediterranean University, Greece Manuel Vaquero-Abellan, University of Cordoba, Spain *CORRESPONDENCE Juan Gómez-Salgado [email protected] RECEIVED 17 May 2023 ACCEPTED 28 August 2023 PUBLISHED 14 September 2023 CITATION García-Iglesias JJ, Gómez-Salgado J, Apostolo J, Rodrigues R, Costa EI, Ruiz-Frutos C, Martínez-Isasi S, Fernández-García D and Vilches-Arenas Á (2023) Presenteeism and mental health of workers during the COVID-19 pandemic: a systematic review. Front. Public Health 11:1224332. doi: 10.3389/fpubh.2023.1224332 COPYRIGHT © 2023 García-Iglesias, Gómez-Salgado, Apostolo, Rodrigues, Costa, Ruiz-Frutos, Martínez-Isasi, Fernández-García and Vilches- Arenas. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. TYPE Systematic Review PUBLISHED 14 September 2023 DOI 10.3389/fpubh.2023.1224332 García-Iglesias et al. 10.3389/fpubh.2023.1224332 Frontiers in Public Health 02 frontiersin.org working environment and optimal organisational systems to protect vulnerable workers in a pandemic context. Systematic review registration: The unique identifier is CRD42023391409. KEYWORDS COVID-19, mental health, occupational health, presenteeism, workers 1. Introduction Work attendance during illness can bean occupational health and public health problem, as it is directly related to productivity and the worker’s perception of ineffectiveness (1). Sickness presenteeism is a type of behaviour displayed by some workers who, despite being ill and having physical and/or psychological conditions, decide to go to work or continue with their workday (2). On the other hand, presenteeism means that workers attend work physically and comply with their working hours, but do not really work or contribute anything beyond their presence (3). It is estimated that around 1in 3 European workers engage in sickness presenteeism (3) and the cost that presenteeism incurs in the workplace is higher than the cost of treatment for these physical and mental illnesses, or even absenteeism (failing to work due to sickness) and sick leaves (4). This decision is usually made autonomously by the worker and may depend on personal characteristics, the economic situation and type of work, the individual’s values and concerns about leaving their job unattended, among other things (5). In fact, both job demands and resources may beelements that influence a worker’s decision to work despite being sick, according to the Job Demands-Resources Model (6, 7). In this line, authors such as Pohling etal. (8) focused on occupational environmental factors and work climate as the theoretical basis for explaining presenteeism according to the Person- Environment (mis)fit theory. When a misfit between work and the person occurs as a result of these factors, workers experience stress and subsequent psychological burnout as a result. This misfit, together with the need to save resources, leads to workers continuing to work despite this situation (9). Attending work during sickness can have a number of consequences for the worker (e.g., worsening physical and mental condition), for co-workers, and for the company and service users (10), hence the importance of its study and evaluation. Nevertheless, before the pandemic, some authors had already found possible links between certain mental health-related problems (such as depression) and a change in productivity caused by sickness presenteeism (11–13). According to the Cambridge dictionary (14), a worker is someone who works in a particular job or in a particular way or someone who works for a company or organisation but does not have a powerful position. Self-employed workers or workers in small businesses may have replacement difficulties in the event of absence from work and are often compelled to work despite being ill (15). A study in Portugal determined that self-employed workers were 85% less likely to take sick leave than employees (14). This can bejustified by the need to continue working despite being sick because of the economic difficulties in general, and the pandemic in particular, in order to find solutions to keep their businesses going (16). Another occupational group with high levels of sickness presenteeism is healthcare workers (5). In this case, work attendance during illness can undermine the quality of care provided, increase the likelihood of incidents that may compromise patient safety and clinical practise (17), and even lead to infecting patients and/or co-workers (18). Specific factors justifying these high levels of presenteeism or sickness presenteeism among health workers may include feelings of professionalism and loyalty (19), personal circumstances, and working conditions (stressful work, high complexity, long working hours, low staffing levels, etc.) (18, 20), situations that worsened considerably during the COVID-19 pandemic. The COVID-19 pandemic has led many organisations to change the way they work and, consequently, the working conditions of their workers. In addition to the pandemic’s impact on people’s mental health (21), the economic situation and job insecurity also worsened (some people worked despite being ill in order not to lose their jobs), some workers switched to teleworking (teleworking from home despite being ill and performing work duties outside of their working hours), chronic programmes were temporarily suspended, and people’s health and consumption habits began to change, with the subsequent consequences at the physical, mental, and social levels (22). Despite recommendations for social distancing and isolation in the case of COVID-19-like symptomatology, many workers were forced to work in order not to lose their jobs or see their income reduced, especially workers with a lower level of education and lower socio-economic status (23), with the consequent impact this may have on their mental health. This study is necessary so as to know the factors that influence presenteeism and to assess which professions suffer the most from sickness-related presenteeism so that organisations and/or companies can take measures based on scientific evidence. Therefore, the aim of this study was to assess the factors associated with mental health and working conditions that affect presenteeism of workers during the COVID-19 pandemic. 2. Methods 2.1. Study design A systematic review of association (aetiology and risk) (24) was conducted following the PRISMA statement guidelines (Preferred Reporting Items for Systematic reviews and Meta-Analyses) (25, 26). The followed protocol is listed in the International Prospective Register of Systematic Reviews (PROSPERO) with code CRD42023391409. This topic was not covered recently by a Review in IJPH or in another journal. 2.2. Databases and search strategy The search was carried out in the Pubmed, Scopus, Web of Science (WoS), Cumulative Index to Nursing and Allied Health Literature García-Iglesias et al. 10.3389/fpubh.2023.1224332 Frontiers in Public Health 03 frontiersin.org (CINAHL), PsycInfo, and ScienceDirect electronic databases based on the keywords that the research question yielded following the PEO strategy (27). The research question was What are the factors related to mental health and working conditions that affect presenteeism of workers during the COVID-19 pandemic? (Table1). Following these keywords, the Medical Subject Headings (MeSH) thesaurus was consulted, yielding the descriptors Presenteeism, Mental Health, and COVID-19. In order to improve the collection of published studies in line with the subject of the study, synonymous terms were used to complete the search strategy based on the MeSH descriptors (Table2), which were joined using the Boolean operators and and or. In this case, the terms Presenteeism, sickness presence, Mental Health, Burnout, Stress, Anxiety, Depression, COVID-19, and SARS- CoV-2 were used. Table3 shows the search strategy used, carried out on January 17, 2023, for each of the aforementioned databases during the search process. 2.3. Selection criteria The following criteria were used for the selection of articles: 2.3.1. Inclusion criteria • Original articles published in English, Spanish, French, German, and Portuguese. • Type: original articles, short communications, and case reports. • Population: workers during the COVID-19 pandemic (someone who works in a particular job or in a particular way or someone who works for a company or organisation). • Data collection date: January 01, 2020 – January 01, 2023. • Articles assessing any of the following values and/or effects and those that include at least one measure of presenteeism and mental health status (presenteeism, mental health, and factors associated): prevalence of presenteeism or sickness presenteeism, consequences and main manifestations, short/medium/longterm effects; influence of mental health on sickness presenteeism, and possible causes of sickness presenteeism; and other factors that reduce or increase presenteeism or sickness presenteeism; differences between countries and professions; differences between telework and face-to-face work. 2.3.2. Exclusion criteria • Studies of low scientific-technical quality after applying the quality assessment tool. • Population: students. • Date of data collection: if out of the inclusion period or if the date of data collection was missing. • Articles that did not answer the research question and were not related to the objective of the review. Studies that did not assess presenteeism or sickness presenteeism as well as mental health were excluded. • Type: opinion articles, editorials, and letters to the editor. 2.4. Data collection and extraction Based on the aforementioned consensual search strategy, two investigators independently performed the searches, eliminated duplicate studies, and selected articles for inclusion after reading the abstract and title according to the previously established criteria. Subsequently, the same two authors reviewed the full text of potentially eligible studies and the decision to include or exclude them in the review was made by consensus. Discrepancies were resolved by a third author. For the data collection after reading the full text of the articles, specific information on the studies was extracted, such as authors’ TABLE1 PEO format: keywords. Population Workers during the COVID-19 pandemic Exposure Factors related with mental health and working conditions Outcomes Presenteeism: prevalence of presenteeism; consequences and main manifestations; short/medium/long-term effects; influence of mental health on presenteeism; differences between countries and professions; other factors associated with presenteeism; differences between telework and face-to-face work; and possible causes of presenteeism. Research question What are the factors related to mental health and working conditions that affect presenteeism of workers during the COVID-19 pandemic? TABLE2 Terms and definitions used in the search. MeSH terms Meaning Terms Presenteeism Reporting for work despite feeling ill Presenteeism OR sickness presence Mental Health Emotional, psychological, and social well-being of an individual or group Mental Health OR Burnout OR Stress OR Anxiety OR Depression COVID-19 A viral disorder generally characterised by high fever; cough; dyspnoea; chills; persistent tremor; muscle pain; headache; sore throat; a new loss of taste and/or smell (see ageusia and anosmia); and other symptoms of a viral pneumonia COVID-19 OR SARS-CoV-2 MeSH, Medical Subject Headings. García-Iglesias et al. 10.3389/fpubh.2023.1224332 Frontiers in Public Health 04 frontiersin.org names and year of publication; context in which the study was conducted; objective of the study; type of study; sample, methodology, and instruments used for data collection; main findings; and quality of the study after applying the critical appraisal tools. 2.5. Methodological quality assessment Two reviewers independently determined the methodological quality of the selected studies using the critical appraisal tools of the Joanna Briggs Institute (JBI) at the University of Adelaide. These tools allowed assessing the methodological quality of a study and determining the extent to which a study has excluded or minimised the risk of bias in its design, conduct, and/or analysis. The versions for analytical cross-sectional studies (8-items) (28), for qualitative research (10 items) (29), for cohort studies (11 items), and for Randomised Controlled Trials (13 items) (30) were used, setting the cut-off point at 6 to beaccepted for inclusion in this review for the first two, 8 for the third, and 10 for the fourth (Supplementary material). The basic parameters of the included articles conform to the applied inclusion criteria (especially study design, year of publication, and country origin). 3. Results The initial search strategies identified a total of 88 references, which were then screened according to the topic of this review. A total of 25 studies were finally selected (Figure1), recruiting a total of 164,274 participants. 22 of which were analytical cross-sectional studies, 1 qualitative research, 1 cohort study, and 1 randomised controlled trial. Four studies had been conducted in Japan (31–34) and 4 in UnitedKingdom (35–38), 3in UnitedStates (39–41), 2in China (42, 43), Germany (44, 45), and the Republic of Korea (46, 47), and 1in Sweden (16), Wales (48), Canada (22), Turkey (49), Lithuania (50), Portugal (51), Australia and NewZealand (52), and Belgium and the Netherlands (53). In 14 of the 25 selected articles, collection took place in 2020; 6 of the 25 were collected in 2021; and the remaining 5 were collected over months in both 2020 and 2021. No studies were found with data collected in 2022 or later. Regarding participants, in 10 studies the sample consisted of health professionals, in 2 studies the sample was collected in the educational environment, and another 2 samples included self-employed workers. The remaining studies (11 out of 25) included workers from other occupational fields or general workers. Working from home or remote working was assessed in 3 of the 25 studies. It was found that between 70.6% (43) and 26% (38) of the subjects in the included studies showed sickness presenteeism. In addition, a number of factors may have also favoured presenteeism or sickness presenteeism, such as mental health-related factors [burnout (34, 45, 49, 51), stress (33–35, 38, 42, 44, 45, 47, 49), depression (46), fear of COVID-19 (49), no well-being (16, 40), cyberbullying (51), sleep disturbance (34), concern about having enough food (41), social isolation (38), and no resilience (38)]; individual factors [poor marital relationship (31), health status (42), being young (38), attention-deficit/hyperactivity disorder symptoms (32), workers who experienced interrupted medical care (33, 40), low physical activity (38, 50), sedentary behaviours (52), having children (41), having health insurance (41), and having a chronic illness (38)]; factors related to the situation caused by COVID-19 [confinement (45), having symptoms of respiratory infectious disease (48), not volunteering to work on the frontline (47), impact on business operations, loss of contract, and risk of bankruptcy (16)]; and factors arising from working conditions [perceived organisational support (49), direct patient care (39), work functioning or task performance impairment (31, 42, 43, 53), work fatigue (34, 43), safety climate (22), workload (22), having no one to replace them (48), geographical distribution (48), transition from in-person to online modes of working (34, 35), salary of less than $35,000 (41), increase in working hours, work–family conflict (16)]. TABLE3 Search strategy used in each database. Databases Search strategy PubMed (“presenteeism”[Title/Abstract] OR “sickness presence”[Title/Abstract]) AND (“COVID-19”[Title/Abstract] OR “SARS-CoV-2”[Title/Abstract]) AND (“mental health”[Title/Abstract] OR “burnout”[Title/Abstract] OR “stress”[Title/Abstract] OR “anxiety”[Title/Abstract] OR “depression”[Title/ Abstract]) Scopus (TITLE-ABS-KEY (mental AND health OR burnout OR stress OR anxiety OR depression) AND TITLE-ABS-KEY (presenteeism OR sickness AND presence) AND TITLE-ABS-KEY (covid-19 OR sars-cov-2)) Web of Science “mental health” OR burnout OR stress OR anxiety OR depression (Topic) AND presenteeism OR sickness presence (Topic) AND COVID-19 OR SARS-CoV-2 (Topic) CINAHL AB (“mental health” OR burnout OR stress OR anxiety OR depression) AND AB (presenteeism OR sickness presence) AND AB (COVID-19 OR SARS-CoV-2) PsycInfo tiab(mental health OR burnout OR stress OR anxiety OR depression) AND tiab(presenteeism OR sickness presence) AND tiab(COVID-19 OR SARS- CoV-2) ScienceDirect Title, abstract, keywords: (mental health OR burnout OR stress OR anxiety OR depression) AND (presenteeism OR sickness presence) AND (COVID-19 OR SARS-CoV-2) Other sources Items identified through other resources Search date: January 17, 2023 García-Iglesias et al. 10.3389/fpubh.2023.1224332 Frontiers in Public Health 05 frontiersin.org The included studies were assessed with the JBI critical appraisal tool, where analytical cross-sectional studies, qualitative research, and randomised controlled trials obtained mediumhigh scores. Table4 shows the characteristics of each of the 25 studies included in this review. 4. Discussion The aim of this study was to assess the factors influencing presenteeism or sickness presenteeism and mental health of workers during the COVID-19 pandemic. In this sense, a series of factors related to mental health that may affect presenteeism have been found, as well as a number of factors specific to the individual, factors inherent to the situation caused by the COVID-19 pandemic, and factors derived from working conditions, among others. 4.1. Presenteeism and mental health Stress is one of the main contributing factors to working despite being ill which, in turn, may beone of the reasons why workers continue to work despite being ill (33–35, 38, 42, 44, 45, 47, 49), and in many cases workload, pressure from colleagues, and organisational culture play a part in this relationship (54). Stress was already related to sickness presenteeism prior to the COVID-19 pandemic, so it appears that COVID-19 is not the only factor that may influence sickness presenteeism as expected (55). There are some high-pressure work environments, such as that of the study by Jia etal. (42), carried out on a sample of 4,261 medical staff, in which it was observed that in high-pressure environments, health problems are more likely to appear and medical staff are more likely to ignore their own health problems, thus increasing sickness presenteeism. In addition to the field of healthcare, it has been observed that the shift from face-to-face work to teleworking has led to workers being forced to beconstantly online and on email, thereby generating constant stress, as they worry about losing their jobs (35). For many workers, they had to stay online at all times to prove their worth at work or to convince their employers that they were not avoiding their duties while working from home (56). Continuous stressful situations can lead to sickness presenteeism due to burnout, as observed in the studies by Basar etal. (49), Ferreira et al. (51), Haehnle et al. (45), and Shimura et al. (34), and to symptoms of depression as seen in the study by Lee etal. (46), in which an association between SP and depression was found to behigher among blue-collar and less educated workers. In the case of the latter, the depressive symptoms of workers who were not able to obtain paid sick leave were 2.18 times higher than those who had the option to do so, hence symptoms of stress, depression, or anxiety were likely to appear. These excessive work demands may lead to presenteeism, while burnout may bea consequence resulting from this situation (9). In this regard, there are a number of factors that could buffer these demands, such as well-being (16, 40) or work engagement (55). On the other hand, there was only one study that determined a relationship between nurses’ fear of contracting COVID-19 and stressrelated presenteeism (49), which can lead to reduced performance, productivity, and efficiency in organisations (57). Other factors such Identified references: 88 Pubmed: 22; CINAHL: 2; Scopus: 2; PsycINFO: 4; WoS: 49; ScienceDirect: 9 References identified through other resources: 0 Type: 2 Population: 4 Low quality: 1 Missing date/No COVID-19 period: 2 Identified references: 88 Pubmed: 22; CINAHL: 2; Scopus: 2; PsycINFO: 4; WoS: 49; ScienceDirect: 9 Articles included in the synthesis: 25 References identified through other resources: 0 Articles forscreening: 59 Excluded by title and abstract Reason for exclusion: reading: 21 Full-text articles:38 Not related to the objective: 4 Type: 2 Population: 4 Low quality: 1 Missing date/No COVID-19 period: 2 Identification Screening EligibilityInclusion Screened records after duplicates removal (n=59) FIGURE1 Search results (PRISMA – Flowchart). García-Iglesias et al. 10.3389/fpubh.2023.1224332 Frontiers in Public Health 06 frontiersin.org TABLE4 Characteristics of the studies included in the systematic review. Studies Context Study objective Type of study Participants Methods Main findings JBI Basar etal. (51) Turkey May–June 2021 To uncover whether nurses’ fear of contracting COVID-19 has resulted in stressrelated presenteeism and burnout, and whether perceived organisational support is effective in dealing with both nurses’ fear of contracting COVID-19 and its undesired consequences. Crosssectional study 513 Nurses - Stress-related Presenteeism Scale - Perceived Organisational Support Scale - Fear of COVID-19 Scale - Burnout Scale They reported notable levels of burnout (M = 4.51, SD = 1.47) and stress-related presenteeism (M = 3.29, SD = 1.01), as well as slightly inadequate levels of perceived organisational support (M = 2.30, SD = 1.07). Fear of COVID-19 infection resulted in burnout (β= 0.35, p< 0.001) and stress-related presenteeism (β= 0.39, p< 0.001). Stress-related presenteeism also resulted in burnout (β= 0.50, p< 0.001), mediating the relationship between fear of contracting COVID-19 and burnout. 8/8 Cheslack- Postava etal. (41) United States April–June 2020 To assess occupational circumstances associated with adverse mental health among health care workers during the COVID-19 pandemic. Crosssectional study 2,076 HCWs - PHQ-9 - GAD-7 2nd outcomes: COVID-related occupational experiences, stress, and anger 50% of the population experienced symptoms, but did not work while sick, 15% worked while sick but not in direct patient care, and 35% worked in direct patient care while sick. Presenteeism experiences were associated with OR of negative mental health of the following: 1.28 (0.98– 1.67), p= 0.07 for those with symptoms who did not work; 1.48 (0.99–2.22), p= 0.05 for those who worked while sick but not in direct patient care; and 2.29 (1.71–3.08), p< 0.001 for those who worked in direct patient care while sick, respectively. 6/8 Fujino etal. (33) Japan December 2020 and December 2021 To examine the association between presenteeism and the risk of divorce among Japanese workers during the COVID-19 pandemic Cohort study 27,036 Participants, with 18,560in the follow-up - WFun Poor marital relationship may have affected presenteeism at baseline. Compared with the group with the lowest WFun score, the OR for the group with moderate WFun was 1.16 (95% CI, 0.74–1.82; p= 0.525), and the OR for the group with the highest WFun was 1.76 (95% CI, 1.18 to 2.62; p= 0.006). 9/11 Gnanapragasam etal. (39) United Kingdom March–June 2021 To determine the effectiveness of the ‘Foundations’ application (app) on general (nonpsychotic) psychiatric morbidity. Randomised controlled trial 1,002 HCWs at 16 NHS trusts (multicentre) Measures were assessed at baseline, after 4 and 8 weeks - GHQ-12 2nd outcomes: BRS-6, SWEMWBS-7; SPS-6; GAD-7; PHQ-9, WSAS- 5, MISS-3, and stressors There was no association between the app group and BRS (aMD = 0.03, 95% CI −0.03–0.09); presenteeism (SPS-6, aMD = 0.38, 95% CI −0.12–0.87); moderate anxiety (GAD-7, aOR = 0.69, 95% CI 0.39 to 01.23); moderate depression (PHQ-9, aOR = 0.61, 95% CI–1.04); moderately severe or severe functioning impairment (WSAS, aOR = 0.61, 95% CI–1.11). 12/13 (Continued) García-Iglesias et al. 10.3389/fpubh.2023.1224332 Frontiers in Public Health 07 frontiersin.org TABLE4 (Continued) Studies Context Study objective Type of study Participants Methods Main findings JBI Hähnle etal. (47) Germany November 2020 to May 2021 (Psychiatric hospitals) To examine the consequences of burnout symptoms at the institutional level, such as staff turnover Crosssectional study 172 Professionals in Psychiatric hospitals of Children and Adolescents - BOSS 2nd outcomes: Intention to make shifts, sickness absence in the last 12 months and quality of job performance. The results show that signs of burnout symptoms impact the turnover tendency, presenteeism, and job performance of professionals. In addition, evidence emerged that professionals were more stressed during the winter lockdown (2020/2021) of the COVID-19 pandemic, and that this influenced turnover tendency, presenteeism, and absenteeism as well as the quality of job performance. 6/8 Jia etal. (44) China Jane 2020 (Hospital) To evaluate the direct effects of work stress, health status and presenteeism on task performance, and further explore the mediating effects of health status and presenteeism, hoping to provide theoretical basis for improving the performance of medical staff. Crosssectional study 4,261 Medical staff - CHSS - SF-36 - SPS-6 - Task Performance Scale The mean scores for work stress, health status, presenteeism and task performance were 2.05 ± 0.84, 4.18 ± 0.68, 2.15 ± 0.79 and 4.49 ± 0.64, respectively. There were significant differences in the task performance scores between different genders, ages, marital statuses, professional titles, departments and work years (p< 0.05). Work stress (β= −0.136, p< 0.001) and presenteeism (β= −0.171, p< 0.001) were negative predictors of task performance. Health status (β= −0.070; p< −0.001) and presenteeism (β= −0.064; p< 0.001) mediated the relationship between work stress and task performance (p< 0.001). Presenteeism mediated the relationship between health status and task performance (β= 0.07; p< 0.001). 8/8 Lee etal. (48)Republic of Korea 2020 To examine the association between sickness presenteeism and depression among Korean workers during the COVID-19 pandemic in relation with the socioeconomic and lifestyle factors. Crosssectional study Employee group (n = 64,666) and employers or selfemployed workers group (n = 19,848). Korean Community Health Survey - PHQ-9 2nd outcome: sickness presenteeism Employees in sickness presenteeism showed a higher association with depressive symptoms than employers or self-employed individuals (OR = 2.18, 95% CI: 1.85, 2.56 among employees vs. OR = 1.76, 95% CI: 1.29, 2.40 among employers or selfemployed individuals). 8/8 Li etal. (45) China December 2020 to May 2021 (Hospital) To investigate the serialmultiple mediating effect of job burnout and fatigue in the relationship between sickness presenteeism and productivity loss among nurses. Crosssectional study 2,968 Nurses (multicentre, 14 hospitals) - Sickness Presenteeism Questionnaire - SPS-6 - Chalder Fatigue Scale - MBI Sickness presenteeism exhibited a prevalence of 70.6% during the COVID-19 pandemic. The mean score of health-related productivity loss was 15.05 ± 4.52, fatigue was 8.48 ± 3.40, and job burnout was 39.14 ± 19.64. Sickness presenteeism was positively associated with fatigue and job burnout while job burnout was positively associated with nurse fatigue. Sickness presenteeism, fatigue, and job burnout were also positively correlated with health-related productivity loss. 8/8 (Continued) García-Iglesias et al. 10.3389/fpubh.2023.1224332 Frontiers in Public Health 08 frontiersin.org TABLE4 (Continued) Studies Context Study objective Type of study Participants Methods Main findings JBI Mansour etal. (24) Canada Time 1 October– November 2020, and Time 2 June–July 2021 To examine the role psychosocial safety climate plays as driver or moderator to reduce presenteeism by lessening work intensification over time and the impact of work intensification over time on presenteeism during the COVID-19 pandemic Crosssectional study 800 Nurses at Time 1 and 344 at Time 2 - JDS - SPS-6 2nd outcomes: Psychosocial safety climate Psychosocial safety climate reduces presenteeism over time by reducing work intensification at time 1. Psychosocial safety climate moderates the relationship between work intensification at time 1 and work intensification at time 2. Psychosocial safety climate as moderator also lessens the detrimental effect of work intensification at time 2 on presenteeism at time 2. Presenteeism among nurses affects their health and psychological well-being. 8/8 Nakai etal. (34) Japan March 2021 To evaluate the impact of the COVID-19 pandemic on employment status, work productivity, QOL, and depressive symptoms in undiagnosed adults with and without attention-deficit/ hyperactivity disorder symptoms in Japan Crosssectional study Participants with (N= 949) and without (N= 942) attention-deficit/ hyperactivity disorder symptoms Japanese Medilead Healthcare Panel - EuroQol 5D-5L - WPAI - PHQ-9 2nd outcomes: Unemployment rate and depressive symptoms The percentage of impairment with respect to presenteeism was higher in those subjects with ADHD symptoms before the pandemic and without ADHD symptoms before the pandemic than in those with ADHD symptoms during the pandemic and without ADHD symptoms during the pandemic. 6/8 Okawara etal. (35) Japan December 2020 To examine the relationship between interruption to routine medical care during the COVID-19 pandemic and sickness presenteeism among workers in Japan. Crosssectional study 27,036 Workers CORoNaWork Treatment status, sickness presenteeism and other covariates The aOR of sickness presenteeism was significantly higher among workers who experienced interrupted medical care (3.44; 95% CI: 3.04–3.89) than among those who did not require routine medical care. The highest OR of sickness presenteeism days was observed for mental health symptoms (aOR: 5.35, 95% CI: 4.85–5.91, p< 0.001). When the analysis was performed based on the 36 treatmentsymptom groups (3 treatment statuses and 12 symptoms), the largest predictive margin of sickness presenteeism days was observed for mental health symptoms and interrupted medical care (predictive margin: 9.9 days, SE = 0.38) 6/8 Pasfield etal. (50) New South Wales March–June 2021 To evaluate factors associated with sickness presenteeism in New South Wales registered veterinarians suffering from influenza-like illness, both before and since the beginning of the COVID-19 pandemic Crosssectional study 122 Veterinarians A mixedmethods questionnaire with eight subsections ‘Having no one to cover’ and geographical distribution were significantly associated with sickness presenteeism. Although sickness presenteeism remained common, participants reported that they were less likely to attend work with symptoms of influenza-like illness since the beginning of the COVID-19 pandemic. 8/8 (Continued) García-Iglesias et al. 10.3389/fpubh.2023.1224332 Frontiers in Public Health 09 frontiersin.org TABLE4 (Continued) Studies Context Study objective Type of study Participants Methods Main findings JBI Sagui-Henson etal. (42) United States March 2020 and March 2021 To examine the effectiveness of evidencebased telecoaching delivered via videoconferencing to people requesting mental health services during the COVID-19 pandemic. Crosssectional study 1,228 Workers who utilised telecoaching - WHO-5 wellbeing questionnaire 2nd outcomes: Burnout, Absenteeism and presenteeism Visit utilisation, and Satisfaction with care Well-being (p= 0.02) significantly increased, while both presenteeism (p< 0.001) and absenteeism (p< 0.001) significantly decreased at follow-up in the full sample, but represented negligible effect sizes. For every 1 unit increase in the moderator, there was a 0.08-point decrease in presenteeism. When participants completed 1 visit, their presenteeism did not change; when participants completed 2–3 visits, their presenteeism significantly decreased by 0.11 points; and when participants completed 4+ visits, their presenteeism significantly decreased by 0.20 points. 8/8 Schulze etal. (46) Germany August– October 2020 (nursing homes) To investigate which psychosocial burdens and potential positive aspects nurses working in long-term care facilities experience during the COVID-19 pandemic Crosssectional study 177 Nurses and nursing assistants (nursing homes) A mixedmethods study - COPSOQ III The sample scored significantly worse regarding the scales ‘quantitative demands’, ‘hiding emotions’, ‘workprivacy conflicts’, ‘role conflicts’, ‘quality of leadership’, ‘support at work’, ‘recognition’, ‘physical demands’, ‘intention to leave profession’, ‘burnout’, ‘presenteeism’ and ‘inability to relax’. The interviews (n = 15) revealed six main themes related to nurses’ psychosocial stress: ‘overall working conditions’, ‘concern for residents’, ‘management of relatives’, ‘inability to provide terminal care’, ‘tensions between being infected and infecting others’ and ‘technicisation of care’. 6/8 Žilinskas etal. (52) Lithuania February– April 2021 To conduct an anonymous online survey among whitecollar workers from various finance, IT and technology companies in Lithuania to define factors associated with worse sleep quality and diminished productivity during a COVID-19 lockdown. Crosssectional study 114 Administrative staff - PSQI - SLOC - GAD-7 - WHO-HPQ 2nd outcomes: sleep hygiene, physical activity and alcohol use There was no association between measures of either presenteeism, absenteeism, or sleep locus of control, and general sleep quality (p> 0.05). However, there was no strong relationship between sleep-related variables (i.e., sleep hygiene, sleep locus of control, quality of sleep) or levels of anxiety and measures of work productivity. 6/8 Adisa etal. (37) United Kingdom July– September 2020 (Remote) To explore how remote working inhibits employee engagement Qualitative research 32 Workers working from home Conservation of resources theory Semi-structured interviews The transition from in-person to online modes of working during the pandemic brought about work intensification, online presenteeism, employment insecurity and poor adaptation to new ways of working from home. These stress factors are capable of depleting vital social and personal resources, thereby impacting negatively on workers engagement levels. 10/11 (Continued)