Emotional demands at work measured via a job exposure matrix and sickness absence from common mental disorders: a population-based study of sex differences

Emotional demands in relational work are increasingly recognized as risk factors for common mental disorders (CMDs), yet evidence on the sex-specific population burden for long-term sickness absence (LTSA) with CMD diagnoses remains limited. We conducted a nationwide cohort study of 1.84 million employed individuals in Norway aged 17–74, excluding those with CMD-related LTSA in 2017. Exposure to emotional demands in 2018 was assigned using an occupation-based job exposure matrix (JEM) we developed for this study from nationally representative survey data (n = 40,700). CMD-related LTSA (>16 days) was ascertained from administrative registers with follow-up from January 1 to December 31, 2019. Cox proportional hazards models estimated hazard ratios (HRs), population attributable fractions (PAFs), and population attributable cases (PACs), stratified by sex, and adjusted for age, education level, immigration background, tenure, working hours, job demands and job control. Higher emotional demands were associated with CMD-related LTSA in an exposure–response pattern for both sexes. Among women, adjusted HRs increased from 1.24 (Q2) to 1.77 (Q4), with a PAF of 29.7% corresponding to 10,757 cases. Among men, adjusted HRs increased from 1.20 (Q2) to 2.61 (Q4), yielding a PAF of 23.3% corresponding to 4116 cases. Women accumulated more person-years in higher emotional-demand quartiles than men (64% vs 33%), and differential exposure accounted for 23.4% (95% CI: 15.8–34.2) of women's excess risk. Occupations characterized by high emotional demands are associated with increased risk of CMD-related LTSA, with women bearing a greater population burden due to higher exposure levels and baseline risk.