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The Silent Epidemic: Presenteeism

Presenteeism is an underrepresented concept in the American workplace with an oversized impact on employee wellness and workplace productivity. Presenteeism occurs when an employee comes to work with an unresolved physical or mental health condition, and continues to work, causing a reduction in typical job performance. While absenteeism is most often associated with having the largest negative affect on workplace productivity loss, presenteeism inflicts a loss that is ten times greater. The average employee is absent from the job 4 days a year yet persists in coming to work despite feeling the adverse affects of a physical or mental health condition that decreases productivity an average of 57.5 days per year[i].

Examples of presenteeism are pervasive. They can be found in isolated cases of an employee not taking personal or sick leave when available to recover from an illness, or as part of an underlying cultural trend that silently condones working through an illness.

Understanding not only the prevalence of presenteeism, but also the factors that influence its presence, is integral to how organizations choose to confront this phenomenon.

Here are the most prominent physical health, mental health, and organizational contributors to presenteeism:

·   Policies that organizations implement to curb absenteeism can have an adverse affect on presenteeism. A study shows that steps like reducing sick leave compensation or enforcing disciplinary action for unexpected absences exacerbates employee productivity loss [ii]. These measures compel employees to be present at work while ill, making them less effective at work due to being ill.

·  There are more likely to be cases of presenteeism in professions where an unexpected absence correlates to an increased workload for co-workers, like nursing and teaching[iii].

·  Supervisors and managers are often seen as role models for their department, so it may be no surprise that higher presenteeism rates in management correlate with higher presenteeism rates in their employees[iv].

·  An increase in presenteeism is linked to periods of increased workload and high-pressure situations within organizations. One study shows that asking employees to work more hours to address an increased workload results in a decrease in absenteeism and an increase in presenteeism[v].

·  Depression alone costs U.S. employers $35.7 billion each year in lost productivity related to presenteeism versus $8.3 billion in lost productive time due to absenteeism[vi].  

·  75% of employees with unaddressed mental health conditions report interference with their jobs versus 13% of employees without a mental health condition[vii].

·  Many individuals are unaware that they are experiencing the symptoms of a mental health disorder, thinking instead that it is a physical ailment behind their symptoms. In fact, 50% of visits to primary care doctors result from symptoms unexplained by a physical illness but associated with depression or an anxiety disorder – such as fatigue, sleep disorders, chronic pain, chest pain, dizziness, abdominal discomfort, etc - often leading to unnecessary and expensive testing[viii].

·  It was estimated that an individual with uncontrolled asthma would save $127 in productivity loss per employee each week by controlling their asthmatic symptoms[ix].

·  In a recent study of 300 employed adults with asthma 45.7% reported presenteeism.

· Over a four-week period, employees experiencing chronic pain at work have 3.11 days of lost productivity due to presenteeism compared to their healthy co-workers who had .29 days lost of productivity[x].

·  A study on adult employees with Migraines found that presenteeism occurred in 62% of workday Migraines resulting in an average work productivity loss of 25%[xi]

As you can see, the causes of presenteeism can be diverse within an organization. Taking a proactive approach to identifying and addressing physical and emotional health issues through comprehensive and targeted wellness services has a significant impact on employee health, engagement, and productivity. Allotting sick leave and encouraging employees to take this time when feeling ill translates to a healthier, more productive workforce.

For more information on ways to combat presenteeism within your organization contact David Weiner at


[i] GCC Insights. Based on the responses of 1,872 participants who took GCC’s scientifically validated survey, benchmarked against the World Health Organization ‘Health and Workplace Performance’ Questionnaire (WHO-HPQ). 2015.

[ii] Chatterji M, Tilley C J (2002), ‘Sickness, absenteeism and sick pay’, Oxford Economic Papers, Vol. 54, pp. 669–687

[iii] Aronsson G, Gustafsson K (2005), ‘Sickness presenteeism: prevalence, attendancepressure factors, and an outline of a model for research’, Journal of Occupational and Environmental Medicine, Vol. 47, No. 9

[iv] Bierla I, Huver B, Richard S (2011), ‘Presenteeism at work: the influence of managers’, International Journal of Business and Management Studies, Vol. 3, No. 2

[v] Baker-McClearn D, Greasley K, Dale J, Griffith F (2010), ‘Absence management and presenteeism: the pressures on employees to attend work and the impact of attendance on performance’, Human Resource Management Journal, Vol. 20, No. 3

[vi] Stewart WF et al: Cost of Lost Productive Work Time Among U.S. Workers with Depression. JAMA, June 18, 2003, pp. 3135-3144.

[vii] E. Esposito, J.L. Wang, J.V. Williams, S.B. Patten “Mood and anxiety disorders, the association with presenteeism in employed members of a general population sample.” Epidemiologia e Psychiatria Sociale, July – September; 16(3): 231-7.

[viii] Horn SD: Outcomes and Expenditures: Lessons From a New Research Paradigm, Drug Benefit Trends Supplement titled “Limiting Access to Medications: Impact on Managing Mental Illness,” December 2002.

[ix] M. Sadatsfavi, R. Rousseau, W. Chen, W. Zhang, JM Fitzgerald, “The preventable burden of productivity loss due to suboptimal asthma control: A population-based study.” April 2014

[x] “The burden of pain on employee health and productivity at a major provider of business services,” Allen, H., Hubbard, D., & Sullivan, S. Journal of Occupational and Environmental Medicine, 2005, 47, 658-670.

[xi] Landy, SH;  Runken, MC, Bell, CF, Haskins, LS, and Higbie, RL.  "Impact of Migraine occurrences on work productivity." 14th International Headache Congress. Philadelphia. September, 2009.


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