High job demands, stress and job insecurity are among the main reasons that people go to work when they are ill, according to new research published in the Journal of Occupational Health Psychology, a publication of the American Psychological Association. High job satisfaction and a strong sense of commitment to an organization, however, also may motivate people to work more intensively, even when sick, the investigators found.

Mariella Miraglia, Ph.D., a lecturer in organizational behavior at University of East Anglia in the United Kingdom, and Gary Johns, Ph.D., of Concordia University in Montreal, analyzed data from 61 previous studies involving more than 175,960 participants in at least 36 countries. They found that job demands caused by workload, understaffing, overtime and time pressure, along with difficulty of finding cover and personal financial difficulties, were key reasons that people might not take a day off.

“Working while ill can compound the effects of the initial illness and result in negative job attitudes and withdrawal from work,” Miraglia said. “However, the possible negative consequences of being absent can prompt employees to show up ill or to return to work when not totally recovered.”

So what can employers do? Mirgalia offers some suggestions:

  • Review attendance-related policies for features — such as number of paid sick days, number of absences permitted without a doctor’s note and thresholds for disciplinary action or loss of job — that could decrease absence and increase ‘presenteeism.’

  • Implement workplace wellness and health programs to reduce stress and job-related illness.

  • Increase job resources such as job control and colleague, supervisor and organizational support.

  • Design jobs that limit the level of demands to which employees are exposed every day — reduce excessive workload, time pressure and overtime work — and ensure that employees have the resources they need to do their jobs.

It’s possible that instances exist in which going to work when sick could be a positive choice — for example, when gradually recovering from long-term sickness, when trying to improve self-esteem in the face of chronic illness or when trying to set an example of “citizenship behavior,” but Miraglia said that more research on the topic is needed. “It could be a good thing for some people, a way of integrating back into work again,” she added, “but it would depend how much the individual and organization wanted it and were prepared to be flexible, for example by modifying job descriptions or offering [flex] time.”