Importance Mental health problems are associated with considerable occupational, medical, social, and economic burdens. Psychosocial stressors at work have been associated with a higher risk of mental disorders, but the risk of sickness absence due to a diagnosed mental disorder, indicating a more severe condition, has never been investigated in a systematic review and meta-analysis.

Objective To synthesize the evidence of the association of psychosocial stressors at work with sickness absence due to a diagnosed mental disorder among adult workers.

Data Sources Seven electronic databases (MEDLINE, Embase, PsycInfo, Web of Science, CINAHL, Sociological Abstracts, and International Bibliography of the Social Sciences), 3 gray literature databases (Grey Literature Report, WHO-IRIS and Open Grey), and the reference lists of all eligible studies and reviews were searched in January 2017 and updated in February 2019.

Study Selection Only original prospective studies evaluating the association of at least 1 psychosocial stressor at work from the 3 most recognized theoretical models were eligible: the job demand-control-support model, including exposure to job strain (high psychological demands with low job control); effort-reward imbalance model; and organizational justice model. Study selection was performed in duplicate by blinded independent reviewers. Among the 28 467 citations screened, 23 studies were eligible for systematic review.

Data Extraction and Synthesis This meta-analysis followed the PRISMA and MOOSE guidelines. Data extraction and risk of bias evaluation, using the Risk of Bias in Nonrandomized Studies–Interventions tool, were performed in duplicate by blinded independent reviewers. Data were pooled using random-effect models.

Main Outcomes and Measures Sickness absence due to a mental disorder with a diagnosis obtained objectively.

Results A total of 13 studies representing 130 056 participants were included in the 6 meta-analyses. Workers exposed to low reward were associated with a higher risk of sickness absence due to a diagnosed mental disorder compared with nonexposed workers (pooled risk ratio [RR], 1.76 [95% CI, 1.49-2.08]), as were those exposed to effort-reward imbalance (pooled RR, 1.66 [95% CI, 1.37-2.00]), job strain (pooled RR, 1.47 [95% CI, 1.24-1.74]), low job control (pooled RR, 1.25 [95% CI, 1.02-1.53]), and high psychological demands (pooled RR, 1.23 [95% CI, 1.04-1.45]).

Conclusions and Relevance This meta-analysis found that workers exposed to psychosocial stressors at work were associated with a higher risk of sickness absence due to a mental disorder. A better understanding of the importance of these stressors could help physicians when evaluating their patients’ mental health and work capacity.

重要性 心理健康问题与相当大的职业，医疗，社会和经济负担相关。工作中的社会心理压力源与更高的精神疾病风险相关，但是由于没有经过系统的回顾和荟萃分析，因此未发现由于诊断出的精神疾病而导致的疾病缺席风险，这表明病情更加严重。

目的 综合研究成年工人心理社会压力源与因诊断出的精神障碍而导致的疾病缺席之间的联系。

数据源 七个电子数据库（MEDLINE，Embase，PsycInfo，Web of Science，CINAHL，社会学摘要和国际社会科学书目），3个灰色文献数据库（灰色文献报告，WHO-IRIS和开放灰色）和参考文献所有符合条件的研究和评论的列表于2017年1月进行了搜索，并于2019年2月进行了更新。

研究选择 只有从3个最公认的理论模型中评估至少1个工作中的社会心理压力源的关联的原始前瞻性研究才有资格：工作需求-控制-支持模型，包括工作压力的暴露（较高的心理需求和较低的工作控制） ; 努力回报不平衡模型；和组织公正模型。研究选择由双盲独立审阅者重复进行。在筛选的28 467篇文献中，有23篇研究符合系统评价的条件。

数据提取和综合 该荟萃分析遵循PRISMA和MOOSE指南。盲人独立审阅者使用非随机研究-干预工具中的偏倚风险进行数据提取和偏倚风险评估。使用随机效应模型汇总数据。

主要结果和措施 客观上由于精神错乱引起的疾病消失，并得到了客观的诊断。

结果 6项荟萃分析共包括13项研究，代表130 056名参与者。与未暴露的工人相比，暴露于低报酬的工人与被诊断为精神疾病的人相比，由于没有被诊断出的精神障碍而患病的风险更高（合并风险比[RR]，1.76 [95％CI，1.49-2.08]），回报失衡（合并的RR，1.66 [95％CI，1.37-2.00]），工作压力（合并的RR，1.47 [95％CI，1.24-1.74]），低工作控制（合并的RR，1.25 [95％CI， 1.02-1.53​​]）和较高的心理需求（合并RR，1.23 [95％CI，1.04-1.45]）。

结论与相关性 这项荟萃分析发现，工作中暴露于社会心理压力源的工人与因精神错乱而导致疾病缺席的风险更高。更好地了解这些压力源的重要性可以帮助医生评估患者的心理健康和工作能力。