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Employee perceptions of mental and physical health in the workplace

This report reveals the results of a survey of 1,000 employees to understand the perceptions of mental and physical health in the workplace.

Introduction

In 2020, Aetna International conducted a survey of 1,000 office-based workers across the UK, U.S., Singapore and UAE to explore their perceptions of mental and physical health in the workplace. The report follows on from two previous studies into workplace health and well-being:

These surveys revealed a disconnect between employee concerns and the actions taken by them and their employers. They showed that while employees are concerned about their well-being, they don’t fully understand their own health, and that action taken to improve it is limited. These reports also showed that the expectations from employees aren’t fully met by their workplace benefits.

This report delves deeper into these topics by exploring workers’ attitudes, actions and opinions in more detail. For example, from our previous surveys, we know that 72% of HR leaders don’t think their employees take enough sick days. In this report, we reveal what people see as a legitimate reason for taking a sick day and if they have ever lied when taking a sick day.

We also know that 87% of workers are worried that stress could affect their ability to work in the future and that only 25% of employees believe their company provides good support for mental health conditions. This survey explores how comfortable employees feel when discussing health issues with their managers, as well as the impact a mental health diagnosis can have on an employee’s behaviour and attitudes.

By diving deeper into these issues, we hope to understand what motivates employee behaviours. This is part of our ongoing mission to understand the needs of businesses and individuals so we can better support our customers around the world, and help them build healthier, happier and more productive workforces.

Key findings

35.8% of employees have lied to their employer about their reasons for taking a sick day

  • 51.7% of the employees diagnosed with mental health issues admitted to lying to their employer about their reasons for taking a sick day
  • Employees with an undiagnosed mental health issue are more likely to lie about a sick day due to stress (44.7%) and feeling down (42.4%) than those with a diagnosis (25.6% and 28% respectively)

29.9% of employees had no sick days in 2019

  • The UK had the highest number of employees who didn’t take a sick day (41%)

47.1% of employees across the globe are unlikely to take a sick day if they are suffering from stress

  • 44.8% would take a sick day for depression but only 28% would take one for anxiety

49.7% of employees have, in their lifetime, suffered from a mental health issue or are not sure whether they have

  • Only 24.2% of these employees have been diagnosed with a mental health issue
  • Employees in the U.S. have the highest rate of mental health diagnoses at 39.3%, compared to just 6% of employees in Singapore

The results

Why people take sick days

Sick days are usually paid for by the employer, up to a predefined limit, and benefit both employee and employer: The worker has time to recover more quickly than if they continued to work, the spread of infectious illnesses is limited, staff morale is maintained and, in some cases, sick leave can stop an individual’s symptoms from worsening.

Almost a third of employees (29.9%) took no sick days in 2019 — the highest response to any single option. In contrast, only 15.6% of people had 10 or more sick days in 2019. Do this many people never get sick enough to take a day off or are people not taking time off when they should?

This question becomes more compelling when the results are broken down by region. In the UK, 41% of respondents took no sick days, more than the average of 29.9%, and the highest of any region. People in the UK are also the least likely to take 10 or more sick days, with just 11.7% of our respondents giving this answer — a third less than the global average.

Aetna Employee Perceptions 2020 Graphic - % of sick days taken in UK, USA, Singapore & UAE Aetna Employee Perceptions 2020 Graphic - % of sick days taken in UK, USA, Singapore & UAE


The U.S. saw the most respondents from any region say that they have had 10 or more sick days at 18.3% — one and a half times more than the UK.

In Singapore, the responses varied, with the employees answering more than any other region that they had taken three, five, six, seven and eight days off in 2019. Of these, the most common response was five days with 15%. Only 20.5% took no sick days in 2019, the lowest for any country.

After the UK respondents, UAE employees answered most often that they had no sick days in 2019 (33%). Excluding zero sick days, the most common number of days for a UAE employee to take off due to illness were two, five and 11 or more. UAE employees were most likely to take 10 days off sick compared to the other countries.

Mental health vs physical health

We wanted to understand whether people take sick days more often for physical ailments or poor mental health. The results show that people are twice as likely to take time off for a physical health issue than a mental health problem (66% versus 34%, respectively).

31% of workers reported that they had taken zero sick days due to mental health. In sharp contrast, only 4% of respondents said they had taken no days in 2019 for physical health reasons. This suggests that either it is ‘easier’ for employees to take time off for a physical issue or that they are simply less affected by mental health issues.

We also asked our respondents if they had a mental health issue and whether it is diagnosed or undiagnosed. Looking at the number of sick days taken by workers with a diagnosis, we can see that they had the highest recording (17%) of 11 or more days off sick. In contrast, those that preferred not to answer whether they have mental health issues were the most likely to not take any sick days — 44.4% compared to the average of 29.9%.

Aetna Employee Perceptions 2020 Graphic - How many sick days did you take in 2019? Aetna Employee Perceptions 2020 Graphic - How many sick days did you take in 2019?


The results also show that the U.S. — which had the highest number of employees taking 10 or more days (18.3%) — had the highest percentage of people diagnosed with a mental health condition (39.3%). This is much higher than the survey’s average diagnosis rate of 24.2%.

Summary

There is a correlation between mental health issues and taking time off sick. This suggests that the issue is not that people are affected less by mental health issues than physical health issues, rather, that we must consider the role that stigma plays in taking time off.

When it’s ok to take a sick day

The data shows a disconnect between the number of employees admitting to taking time off for mental health issues and those taking time off for physical ailments. So, when is it ok to take time off work?

In general, the employees that we asked, were more likely to take a sick day due to physical health issues than mental health issues. Taking an average of the percentages for each ailment, 53.4% of respondents said they are quite likely or very likely to take a sick day for a cough, a cold, flu or sickness and vomiting. However only 30.9% said the same for anxiety, stress and depression.

Mental health

Anxiety

Overall, nearly half of workers (51%) said that they are quite unlikely or very unlikely to take a sick day due to anxiety. Only 11.5% of workers are very likely to take an anxiety sick day.

Workers in Singapore and the UAE are quite likely to take a sick day from anxiety (35% and 38% respectively). This is despite the reported low levels of mental health diagnosis in these regions. Workers in the UK are unlikely to take a sick day due to anxiety (34%), despite 25.3% of UK respondents admitting to currently or previously having anxiety.

Depression

Even though 20.7% of our respondents admitted to suffering from (or having suffered from) depression, only 13% of employees would be very likely to take a sick day if they were feeling depressed. Even of those respondents diagnosed with mental health issues, only 19% would be very likely to take a sick day for depression.

From our U.S. group — of whom, more than half (53.3%) have a diagnosed or undiagnosed mental health condition — 28.3% said they were very unlikely to take a day off. This is more than any other region.

Aetna Employee Perceptions 2020 Graphic - How unlikely is respondent to take sick day for depression? Aetna Employee Perceptions 2020 Graphic - How unlikely is respondent to take sick day for depression?

Stress

In response to a previous question in the survey, 42.4% of people said they have suffered from or are currently suffering from stress (27.1% work-related; 15.3% personal). While 33.2% of employees said that they would take a sick day if they were stressed, almost half (47.1%) said that they wouldn’t.

Those people with a diagnosed mental health problem are almost twice as likely to take a sick day due to stress (44.2% versus 23.5%). Similarly, workers in the U.S. answered that they are very likely to take a sick day due to stress two and a half times more than in Singapore (21% versus 8%).

Physical health

Cold

21.4% of workers are very unlikely to take a day off work if they contracted a common cold.

Although workers in Singapore chose not to take sick days for mental health reasons, they are the most likely to take a sick day for a common cold (55.5% compared to the global average of 40.1%). Only 6.5% of respondents in Singapore said that they would be very unlikely to take time off due a cold — five times less than in the UK (32%). 

Aetna Employee Perceptions 2020 Graphic - How likely would be to take a sick day if you had a common cold? Aetna Employee Perceptions 2020 Graphic - How likely would be to take a sick day if you had a common cold?

Cough

More than double the amount of workers say they are very unlikely to take a day off for a cough, compared to those who answered very likely (30.7% and 12.7% respectively). In fact, half of all respondents said they would be very or quite unlikely to take a day off (50.3%).

There are some clear regional differences for this question. 44% of UK workers are very unlikely to stay at home if they contract a common cough, while only 11% of those in Singapore said the same.

Flu

35.6% of workers are very likely to take time off work if they had the flu. This is the second highest percentage for any of the ailments in question (after sickness and vomiting) and over double that for anxiety, depression and stress individually.

Workers in the U.S. are the most likely to stay home if they have the flu — 47% answered very likely, compared to 26% and 26.5% in Singapore and the UAE respectively. Only 16% of UAE workers would be very unlikely to take time off for the flu.

Sickness and vomiting

Almost three-quarters of the employees we surveyed said they would be quite likely or very likely to take a day off for sickness and vomiting. However, there are still 15.9% who would be likely to continue working.

Aetna Employee Perceptions 2020 Graphic - How likely would be to take a sick day? Aetna Employee Perceptions 2020 Graphic - How likely would be to take a sick day?

Surprisingly, 16% of UAE workers would be very unlikely to take a sick day if they had sickness and vomiting. This is almost double the average of 8.9% and three times more than in the UK (5%).

Why people do or don’t take sick days

We don’t know all the reasons behind the discrepancies seen in these results, but we believe that stigma plays a role. In many cultures, mental health issues have been poorly understood and/or been taboo. While this is changing, there is still work to do, particularly in the two regions we surveyed from the Middle East and Asia Pacific. It remains a sad fact that even those with a mental health diagnosis don’t always take a day off if their health is impaired.

Singapore’s attitude to physical health is markedly different from the other regions. While workers from other regions continue to work with common ailments such as a cough or cold, people from Singapore are more likely to take time off sick.

Why we lie about sick days

The data suggests that mental health stigma persists and people are reluctant or unable to take time off when unwell. To find out more, we asked whether respondents had ever lied to their manager about why they took a sick day.

Aetna Employee Perceptions 2020 Graphic - Have you lied to employer about reasons for taking a sick day? Aetna Employee Perceptions 2020 Graphic - Have you lied to employer about reasons for taking a sick day?

More than one-third of office workers (35.8%) admitted that they have lied about their reasons for taking a sick day. While some of the reasons were ‘conspiratorial’ — for example, due to a job interview (14%) or not having enough holiday days (13.4%) — responses also indicated that mental health and/or stigma could be a factor.

In fact, the most common reasons people lie to managers regarding time off work relate to mental health. 29% of workers have lied about taking a day off sick because they ‘felt down’ and 24% ‘weren’t feeling themselves’. One person stated they “just needed a mental health day”.

While 33.2% of employees said they would take a sick day if they were stressed, a similar percentage (32.1%) have lied about their reasons for taking a sick day for the same reason — stress. This suggests that stress is seen as a legitimate reason for taking a sick day, but there is still a level of shame involved. Stress was the most cited reason for lying.

Mental health stigma

22.6% of people said that they didn’t feel that they could tell their boss why they were off sick because ‘they wouldn’t understand’. This jumps to 26.4% of people with a mental health diagnosis and 35.3% of those with an undiagnosed condition.

In contrast, only 11.3% of people who are confident that they have no mental health issues admit to lying because their boss wouldn’t understand the reasons. This suggests that there is perceived stigma among those people with a mental health condition.

Similarly, 20% of people without a mental health condition said that they lied about taking a sick day because they felt down. This is less than half the amount of people with an undiagnosed condition who answered the same (42.4%).

Regional differences

Aetna Employee Perceptions 2020 Graphic - Why did you lie to your employer about taking a sick day? Aetna Employee Perceptions 2020 Graphic - Why did you lie to your employer about taking a sick day?

Respondents who said that they lied about taking time off for mental health reasons are mainly from the UAE and Singapore — the regions with the lowest rates of diagnosed mental health issues. 39.2% of people in Singapore said that they lied due to feeling down, compared to the global average of 29.6%. And 47.1% of those who have lied about taking a sick day in the UAE said it was due to feeling stressed — in the UK only 19.8% said the same.

Overall, Singapore had the highest number of ‘honest’ employees at 74.5% while the U.S. had the lowest (54.7%). Of those from Singapore that did lie, the most common reason (60.8%) was that they ‘just wanted a day off’. This is almost double the number from UAE (32.9%) and more than twice as high as the UK and U.S. (25.7% and 25% respectively).

Breaking down difficult discussions

The survey asked people how comfortable they feel discussing health issues with their manager. Unsurprisingly, and considering the indications of stigma throughout this report, fewer people would be happy to speak to their boss about mental health (44.3%) than physical health (56.2%). However, for both physical and mental health, more people said they would be comfortable than uncomfortable.

Comparing regions

Workers in the U.S. are the most comfortable of all the regions at discussing both mental and physical health with their employer. Almost one quarter (24.7%) of U.S. respondents said they would feel very comfortable talking about their mental health problems, about three times more than in Singapore (8.5%).

While this correlates to differing levels of mental health in these regions, there is a similar difference regarding physical health. 30.7% of respondents in the U.S. said they would be very comfortable discussing physical ailments, versus just 9% in Singapore. This could suggest a cultural difference — for example, more of a boundary between personal and private life in Singapore than in the U.S.

Aetna Employee Perceptions 2020 Graphic - Comfort Discussing Mental/Physical Health Issues With Manager Aetna Employee Perceptions 2020 Graphic - Comfort Discussing Mental/Physical Health Issues With Manager

The amount of employees in the UAE who are very comfortable speaking to their boss about mental health issues are the same as the UK (18.5% versus 18.3% respectively). This is despite the differences in levels of diagnosed mental health problems — 13% in the UAE and 28.7% in the UK.

The role that diagnosis plays

At 24%, the UAE has the highest rate of undiagnosed mental health conditions when compared to other regions from our survey. This suggests that — in the UAE at least — diagnosis is not a barrier to discussing ill mental health. This is in contrast with Singapore, which our data shows as having the second highest rate of undiagnosed mental health problems (20.5%), but just 29% feel comfortable talking to their employer.

The data suggests that, across all regions, diagnosis makes employees more comfortable discussing their health issues with their employer. 45.4% of those with an undiagnosed mental illness are comfortable discussing mental health with their boss. This increases to 51.7% when considering only those with a diagnosis.

It is notable that mental health diagnosis also correlates with workers’ comfort in discussing physical health. 54.1% of people with an undiagnosed mental health condition say they are comfortable discussing physical ailments with their boss — similar to those without a mental illness (56.3%). Conversely, 62% of those with a diagnosis feel comfortable.

Conclusion

As a health care provider, we want to understand why people take or — importantly — don’t take sick days. By understanding this, we can better support organisations and their employees, to build a healthier, happier and more productive workforce — whether through advice for individuals or helping businesses keep their employees healthy.

This report sheds light on a little-understood area: why people do and don’t take sick days. It has revealed the differing attitudes to physical and mental health, and how this can vary across region.

The report found that stigma still surrounds mental health in the workplace. While mental health affects many employees in the UK and U.S., mental health is generally not seen as a ‘legitimate’ reason for taking a sick day. This is even more apparent in Singapore and the UAE.

Across all regions, people are twice as likely to take time off for a physical health issue than a mental health problem. The U.S., however had the highest percentage of workers taking 10 or more sick days and had higher levels of diagnosed mental health conditions than any other region. While mental health could have an impact on the amount of sick days taken, physical health is still seen as a more ‘legitimate’ reason for a day off.

Despite many employees being affected by workplace or personal stress, respondents’ answers suggest that they didn’t feel it was a ‘legitimate’ reason for taking a sick day. This could be due to a perceived lack of understanding: people with mental health issues are more likely than those without them to say that their employer won’t understand their reasons for taking a day off.

People in Singapore are less comfortable discussing their health with their manager than those in other regions. They are also more likely to take a day off for common physical ailments than any other region. These results suggest that people in Singapore are more private about health in general — they are more likely to stay at home when sick with a cold or cough. There are clear regional differences when it comes to health in the workplace.

How to build a healthier, happier more, productive workforce

Employers can use the insights in this report to help improve the health and well-being of their workforce. Our survey highlights four key challenges and the points below detail our recommendations for businesses.

Challenge 1: Presenteeism

It’s well evidenced that poor mental well-being can affect a person’s productivity or cause long-term stress. In addition, attending work with a physical ailment such as sickness and vomiting can cause the illness to spread across a workforce. Both issues, if not contained, can lead to spiraling absence rates (and costs).

Solutions

  • Implement a sick leave policy that reinforces the importance of taking time off when sick
  • Build a workplace culture that promotes positive social and emotional wellness and actively tackles the ‘always on’ mindset.

Challenge 2: Mental and physical health inequalities

People are more likely to see physical health issues as legitimate reason for taking a day off than mental health issues. The stigma around mental health can make it hard for employees to seek help when they most need it.

Solutions

  • Adopt a holistic approach to health and wellness provision — help staff to perceive mental well-being as one part of a wider strategy to promote healthy living
  • Invest in a comprehensive Employee Assistance Program to support employees’ social and emotional needs.

Challenge 3: Lies about sick days

More than a third of people lie about their reason for taking a sick day and that mental health is often a factor. Without knowing the truth, businesses are unable to identify the real reasons for workplace sickness, stress or lack of productivity.

Solutions

  • Promote a culture of acceptance by ensuring managers champion open communication at all levels
  • Choose a health benefits provider that champions technology that provides easy access to confidential support to help staff seek advice on their terms.

Challenge 4: Diagnosing mental health problems

Many people that identify as having a mental health issue have not had a formal diagnosis, particularly in Singapore and the UAE. People with a diagnosis are more open to discussing their health with their employer, which is essential if workplaces are to prevent issues from escalating by offering the right support at the right time.

Solutions

  • Ensure your health and wellness benefits provider can refer staff to specialist medical professionals, such as psychiatrists and counsellors
  • Train managers in mental health first aid to help them signpost their staff to support at the earliest opportunity.

Appendix

Respondent demographics

Region

  • 300 from the UK
  • 300 from the U.S.
  • 200 from Singapore
  • 200 from the UAE

Gender

  • 55.7% male
  • 44.3% female

Age

  • 18-24 – 10.0%
  • 25-34 – 27.1%
  • 35-44 – 29.8%
  • 45-54 – 20.9%
  • 55-64 – 10.6%
  • 65+   – 1.6%

Employment

  • In full-time paid employment (30 hours or more per week) – 89.6%
  • In part-time paid employment (less than 30 hours per week) – 10.4%

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