Young adults and sick leave length of mental illnesses

ORIGINAL RESEARCH published: 13 June 2022 doi: 10.3389/ pubh.2022.882707 F on ie s in Public Heal h | www. on ie sin.o g 1June 2022 | Volume 10 | A icle 882707 Edi ed by: Rosa Magallon, Uni e si y o Za agoza, Spain Re iewed by: Aleksand Klju ˇ cniko , College o In o ma ion Managemen and Business Adminis a ion, Czechia Ma ek Vochozka, Ins i u e o Technology and Business, Czechia Manuela T a ona iciene, Vilnius Gediminas Technical Uni e si y, Li huania *Co espondence: Bea a Ga u o a [email p o ec ed] Special y sec ion: This a icle was submi ed o Public Men al Heal h, a sec ion o he jou nal F on ie s in Public Heal h Recei ed: 24 Feb ua y 2022 Accep ed: 09 May 2022 Published: 13 June 2022 Ci a ion: Ga u o a B and Ta hanico a M (2022) Young Adul s and Sick Lea e Leng h o Men al Illnesses. F on . Public Heal h 10:882707. doi: 10.3389/ pubh.2022.882707 Young Adul s and Sick Lea e Leng h o Men al Illnesses Bea a Ga u o a 1 *and Mi iama Ta hanico a 2 1Facul y o Managemen and Economics, Tomas Ba a Uni e si y in Zlín, Zlín, Czechia, 2Facul y o Mining, Ecology, P ocess Con ol and Geo echnologies, Technical Uni e si y o Košice, Košice, Slo akia Objec i es: The objec i e was o explo e whe he a sick lea e leng h ela ed o men al mo bidi y di e s ac oss di e en occupa ional ca ego ies. Me hods: In he analysis, egis y o sick lea es was analyzed. P o ided analysis is ocused on he leng h o sick lea es ela ed o men al diseases caused by subs ance use o o he ac o s. Dependen a iable is he sick lea e leng h, and he independen a iables a e he ca ego ies o disease and occupa ion. K uskal–Wallis es , Shapi o–Wilk es , and B own–Fo sy he (B–F) a e used. Resul s: The e a e di e ences in men al sick lea e leng hs caused by subs ance use o o he ac o s. In he case o men al illnesses a ibu able o d ugs, di e ences in he sick lea e du a ion among di e en wo king g oups we e no ound. Conside ing men al diso de s caused by o he ac o s, he e a e di e ences in he sick lea e du a ion among di e en wo king g oups. Conclusions: The e is no e idence o longe sick lea e in people diagnosed wi h men al diso de ela ed o subs ance use. Di e ences in occupa ional ca ego ies do no ela e o sick lea e leng h. Keywo ds: men al diseases, subs ance use, heal h li e acy, young adul s, public heal h INTRODUCTION Nowadays, coun ies wi h apidly aging popula ions and low bi h a es ace he challenge o g owing economic bu den o he u u e gene a ions. This challenge a ac s he a en ion o policymake s as well as he esea ch eams ac oss he wo ld o examine he heal h and socioeconomic condi ions and he abili y o young adul s o b ing economic alue o coun y. Mo e a en ion is paid o men al heal h as young people a e daily exposed o s ess ul li e e en s ha nega i ely a ec hei heal h. S ess ul e en s may be he consequence o low social s a us, pa en al and pee ela ionship quali y, social exclusion, e c. (1). People diagnosed wi h ch onic s ess o exposed o any o he li e e en a e endange ed mo e by men al diseases (2). Men al heal h is impo an in young people because o he de elopmen o cogni i e, social, and emo ional being o young people as well. Acco ding o Bi n e al., people exposed o high le el o s ess in ea ly childhood a e a highe isk o a wide ange o beha io al p oblems o men al diso de s (3). Global Bu den Disease S udy 2017 (GBD) shows ha men al diso de s ha e consis en ly o med mo e han 14% o age-s anda dized yea s li ed wi h disabili y (YLDs) o nea ly h ee decades. Men al diseases ha e >10% p e alence in all 21 GBD egions (4). Se e e men al illness is di icul o ea , and hus, eno mous pha macological and psychological esou ces a e needed o in e ene. T ea men and p e en ion o men al diso de s equi e he in e ac ion o a ious social and biological isk and p o ec i e ac o s h oughou he li e cou se (5). As s a ed by Ga u o a and Ta hanico a Men al Illnesses o Young Adul s Ma he e al., men al diso de s a e a majo public heal h p oblem wo ldwide and he leading cause o wo k disabili y (sick lea e and disabili y pension) in Eu ope. Gene ally, sick lea e becomes mo e common wi h age; howe e , sick lea e due o men al diso de s is he mos common in a younge age. Sick lea e due o men al diso de s has been ound o ha e a nega i e e ec on u u e wo k li e, such as a highe isk o unemploymen and a lowe income (6). Salomonsson e al. con i m ha sick lea e due o common men al diso de s (CMDs) inc eases apidly and p esen s a majo socie al challenge (7). Ma he e al. emphasize ha sick lea e due o men al diso de s inc eased he isk o eoccu ing sick lea e wi hin 2 yea s, disabili y pension and unemploymen , independen o gene ics, and sha ed en i onmen (8). Lidwall e al. s ess ou ha he isk o sick lea e wi h men al diso de is highe among women compa ed o men, among pe sons aged 30–39 and among pa en s in amilies wi h unde age child en (9). Subs ance use p esen s high isk o de elopmen o men al diso de s. Child en and adolescen s a ec ed by alcohol use migh ha e ad e se heal h e ec s ela ed o men al diso de s. Lima e al. highligh a bidi ec ional associa ion be ween alcohol use and men al heal h condi ion, whe e he p esence o one issue almos doubles he isk o ha ing he o he issue (10). Acco ding o Ami i and Behnezdad, i can be concluded ha alcohol consump ion inc eases he isk o sick lea e in wo king popula ion (11). In he s udy o Malla e al., he au ho s emphasize he ea ly onse o mos men al diso de s and subs ance abuse as well as hei pe sis ence in o adul hood. Mo eo e , Malla e al. wa n abou he delays in seeking p o essional help, which nega i ely a ec s no only young people bu also socie y as well. The e is a necessi y o di e en concep ual amewo ks o he ea men o you h men al diso de s and ans o ma ion o p o ided se ices. I is necessa y o no only educe he unme needs bu also allow a mo e meaning ul explo a ion o he na u e o such p oblems and he bes way o ea hem (12). Inabili y o ecognize men al heal h p oblems o younge people hinde s ea ly de ec ion and help-seeking beha io s (13). The way people ea hemsel es is highly in luenced by hei heal h li e acy. Acco ding o Liu, heal h li e acy is an impo an de e minan o heal h (14). Heal h li e acy is a unc ion o many ac o s, mos ly social and indi idual. Wi ink and Oos e ha en s a e ha heal h li e acy is linked o li e acy and en ails people’s knowledge, mo i a ion, and compe ences o access, unde s and, app aise, and apply heal h in o ma ion o make judgemen s and ake decisions in e e yday li e conce ning heal h ca e, disease p e en ion, and heal h p omo ion o main ain o imp o e quali y o li e du ing he li e cou se (15). Acco ding o Flea y e al., he e is a meaning ul ela ionship be ween heal h li e acy and adolescen s’ heal h beha io s (16). Duplaga’s esea ch on heal h li e acy, which ook place in Poland, showed ha lowe heal h li e acy is associa ed wi h a lowe sel - assessmen o heal h, he p e alence o obesi y and disabili y, less equen physical ac i i y, lowe consump ion o ui s and ege ables, and wi h mo e equen hospi aliza ions (17). Ca od- A al in o ms on he ac o s associa ed wi h poo men al heal h such as po e y, low educa ional le el, gende disc imina ion, unheal hy li es yle, iolence, physical ill-heal h, unemploymen , social exclusion, and human igh s iola ions (18,19). B ode e al. admi ha he unique pa icula i ies o child en and young people ele an o heal h li e acy include hei disease and heal h- isk p o iles, hei ulne abili y o demog aphic ac o s, hei social ole and s a us, and hei igh o pa icipa ion (20). The e a e also gende di e ences in men al heal h o people. Men al diso de s a ec mo e deeply women compa ed o men a e e y le el o household income (18). Mo e ulne able g oups o people a e young people wi h lowe educa ion. Such people occupy lowe job posi ions a wo k, which a e no demanding on he a ained educa ional le el, such as elemen a y occupa ions, plan and machine ope a o s and assemble s, c a and ela ed ade wo ke s, skilled ag icul u al, o es y, and ishe y wo ke s. Mo eo e , Milne e al. s a e ha imp o ing employmen oppo uni ies could educe nea ly hal o he ad e se e ec s o low educa ion on men al heal h o young people (21). Mo e e ec i e in e en ions would be eached i he e we e close links be ween heal h li e acy and beha io change amewo ks (22). The e o e, i is necessa y o inc ease he heal h li e acy in younge age. Sukys e al. wa n ha heal h li e acy among young uni e si y s uden s is insu icien (23). Indi iduals mus unde s and and use in o ma ion ega ding how o bene i om heal hca e se ices and main ain a heal hy li e. The inc ease in heal h li e acy migh inc ease he pa icipa ion o indi iduals in p omo ing heal hy beha io s. All beha io s ha can a ec heal h mus be unde con ol (24). Men al heal h li e acy can be inc eased wi h speci ic in e en ions, which p o ided in he p ima y ca e o in mains eam o online media (13,25,26). Low le els o heal h li e acy migh be a p oblem in wo k en i onmen , as people wi h lowe heal h li e acy a e a highe isk o sp eading he illness and o longe pe iod needed o ea men (15,17,19,22). Longe ea men exp essed by a longe sick lea e du a ion ep esen s a se ious economic bu den no only o company, bu also, in he o m o los p oduc i i y, o socie y as well. Sick lea e, associa ed wi h men al illness as well as any o he ypes o illness, ep esen s long- e m expendi u es o he s a e, especially in economies whe e he heal hca e sys em is inanced om he s a e money. Young people who ha e a men al illness o diso de a e no only cu en economic bu den, bu also a u u e one. The sick lea e du a ion a ies depending on he ype o disease. Some diseases a e ea able whe eas o he s a e incu able o ha e las ing consequences ha esul s in o inancial dependence on amily membe s o s a e aid. These ac s we e he mo i a ion o ou esea ch aiming o ind ou whe he he occupa ional ypes o young people a ec he leng h o hei incapaci y o wo k due o men al illnesses acqui ed h ough he use o addic i e subs ances o o he isk ac o s. In his s udy, sick lea e leng h is compa ed in ega d o he ypes o men al disease and he wo k/occupa ional ca ego ies in he case o he Czech Republic. Men al diseases a e di ided in o wo g oups: men al diseases ela ed o subs ance use (legal and illegal d ugs) and men al diseases ela ed o o he ac o s (demen ia, beha io al synd omes associa ed wi h physiological dis u bances and physical ac o , beha io al and emo ional diso de s, e c.). The di e ence in he leng h o sick lea e be ween occupa ional ca ego ies is supposed, as hose ca ego ies a e di e en ia ed by he le el o heal h li e acy. Limi ed heal h li e acy in luences how people ca e abou hei heal h and hei F on ie s in Public Heal h | www. on ie sin.o g 2June 2022 | Volume 10 | A icle 882707 Ga u o a and Ta hanico a Men al Illnesses o Young Adul s heal h p e en ion. The di e ences in he leng h o sick lea e a e expec ed in he case o men al illnesses caused by addic ions, as addic ed people a e mo e likely o be in wo king ca ego ies ha does no need any u he le el o educa ion. METHODS This s udy aims o examine he di e ences in he leng h o sick lea es ela ed o alcoholic and non-alcoholic men al diso de s and diseases, which is de ined acco ding o In e na ional S a is ical Classi ica ion o Diseases and Rela ed Heal h P oblems (ICD-10) as diagnoses F00–F99 (27). In he analysis, da abase o sick lea es om 2017, co e ing he sick lea es in he Czech Republic, was used. This da abase includes da a on sick lea e s a ing om i s day o wo king absence o las day o sick lea e. In he Czech Republic, pe sons pa icipa ing in he sickness insu ance a e en i led o sickness cash bene i (dá ka nemoci o nemocenské) when hey a e empo a ily incapable o wo k o in qua an ine s a ing om he 14 h day o hei sick lea e. People who a e eligible o sickness bene i s a e hose who a e employed o sel -employed o a leas , he ones who pay sickness insu ance con ibu ion. I mon hly income is highe o equals o EUR 117.11, i is compulso y by law o pa icipa e in sickness insu ance. Sickness bene i is gi en by employe om i s o 14 h day o sick lea e; i he sick lea e is longe han 14 days, hen sickness bene i is gi en o employee by sickness insu ance. Sel - employed people a e gi en sickness bene i s a ing om 15 h day o hei sickness. The e a e he limi s based on which he sickness bene i is calcula ed. Sickness bene i is calcula ed as 60% o daily income o he i s 30 days o sickness; 66% o daily income o he nex 30 days; and 72% o daily income o he days ha exceeds 61. In ou analysis, we conside all pe iod o sick lea e ( om s a ing day o he las day). The diagnose issued on pa ien ’s ansc ip ion is de e mined based on he examina ion o men al heal h specialis . Analyzed da a we e p o ided by he Czech Social Secu i y Adminis a ion as a pa o esea ch p ojec A- 86-19: “Economic Quan i ica ion o Social Cos s o he Use o Alcohol, Tobacco and Illici D ugs in he Czech Republic,” app o ed by he E hical Commi ee o he Gene al Uni e si y Hospi al in P ague. The main aim o his p ojec was o quan i y he social cos s ela ed o d ug abuse. To u he analyze he subs ance use p oblem in he Czech Republic, in his a icle, we dis inguish be ween sick lea e leng h ela ed o subs ance use and ela ed o o he causes. As men al diseases a e dange ous mos ly in younge people, because young people p esen po en ial u u e economic bu den, we analyzed only sick lea es o people aged up o 29 yea s (6). Eu os a de ines young adul s as people aged 15–29 yea s (28). Da abase o sick lea e p o ides de ailed in o ma ion abou each case o sick lea e such as demog aphic ac o s, diagnosis ela ed o sick lea e, and ca ego y o pa ien s’ wo k. In his da abase, he e a e only sick lea e co e ing employees, sel -employed people, and people paying he social insu ance, and da a on unemployed people a e missing. E e y case o sick lea e is he e o e de ined by pa ien ’s: TABLE 1 | The in e na ional s anda d classi ica ion o occupa ions (31). N◦Wo k ca ego y 0 A med o ces occupa ions 1 Manage s 2 P o essionals 3 Technicians and associa e p o essionals 4 Cle ical suppo wo ke s 5 Se ices and sales wo ke s 6 Skilled ag icul u al, o es y and ishe y wo ke s 7 C a and ela ed ades wo ke s 8 Plan and machine ope a o s and assemble s 9 Elemen a y occupa ions •age—calcula ed as he di e ence be ween yea 2017 and he yea o bi h, •sex—male, emale, •diagnosis—co esponding code o diagnosis (acco ding o ICD−10); i is he diagnosis ha ela e o sick lea e, •leng h o sick lea e—calcula ed as he di e ence be ween he end da e and s a da e o sick lea e, •occupa ions ca ego y— he e a e 10 wo king ca ego ies (acco ding o wo k classi ica ion CZ–ISCO), •ID—nume ical code, •NUTS 3 o employe —NUTS 3 code o place o wo k, •NUTS 3 o doc o —NUTS 3 code o place o doc o , •NUTS 3 o pa ien —NUTS 3 code o place whe e pa ien li es. The e a e 10 wo k ca ego ies de ined by he CZ-ISCO classi ica ion o occupa ions (29). Fi s wo king ca ego y p esen s manage s. Tha posi ion usually equi es highe educa ion. On he con a y, he las ( he nin h) ca ego y p esen s elemen a y occupa ions. All occupa ional ca ego ies a e p esen ed in Table 1. I is supposed ha he wo k ca ego y ha dly ela es o educa ion, whe eas he le el o educa ion a ained o a la ge ex en a ec s employabili y and he ype o wo k pe o med. Nex , compa ed o people wi h lowe educa ion, i is supposed ha people wi h highe educa ion will ake ca e o hei heal h mo e wi h emphasis on be e p e en ion. In gene al, heal h li e acy is highe in people wi h highe educa ion. On he con a y, people wi h lowe educa ion migh ha e mo e social p oblems ela ed o addic ion o any kind o psychical issue, e c. Mo eo e , as lowe educa ed people a e supposed o ha e lowe heal h li e acy, hei sick lea e migh be longe ; he e o e, his s udy aims o de e mine he di e ences in he leng h o sick lea e ac oss di e en wo k ypes as ollows: •di e ences in he leng h o sick lea e wi hin di e en men al diagnose g oup (g oups F10–F19 o g oups F00–F09, F20– F99). •di e ences in he leng h o ime ela ed o sick lea e a ibu able o diagnoses de ined as F10–F19 wi hin di e en wo k ca ego ies. •di e ences in he sick lea e leng h a ibu able o diagnoses de ined as F00–F09, F20–F99 wi hin di e en wo k ca ego ies. F on ie s in Public Heal h | www. on ie sin.o g 3June 2022 | Volume 10 | A icle 882707 Ga u o a and Ta hanico a Men al Illnesses o Young Adul s •pai wise di e ences in case o sick lea e ela ed o F00– F09, F20–F99. In gene al, o examine his kind o ela ionship, he ANOVA, analysis o a iance, is used. Howe e , acco ding o Shapi o–Wilk es , he assump ion o no mali y was iola ed. The e o e, K uskal–Wallis and independen samples Mann–Whi ney U es we e pe o med o examine he exis ence o di e ences in he du a ion o sick lea e as bo h a e a non-pa ame ic al e na i es o ANOVA (30,31). The du a ion o sick lea e, conside ed as dependen a iable, is no om he no mal dis ibu ion, since he majo i y o sick lea es ook sho e pe iod o ime. The e o e, he dis ibu ion is skewed o he igh . B own–Fo sy he (B–F) was used o es an assump ion o equal a iances ha was no iola ed. Acco ding o ou assump ions, he es ed hypo heses a e as ollows: •H1: The e is he di e ence in he leng h o sick lea e compa ing men al diagnoses caused by subs ances (diagnoses F10–F19 acco ding o ICD−10) and men al diagnoses caused by o he issues (F00–F09, F20–F99 acco ding o ICD−10). •H2: Compa ing di e en wo king ca ego ies, he e is he di e ence in median o leng h o sick lea es ela ed o subs ance use (F10–F19). •H3: Compa ing di e en wo king ca ego ies, he e is he di e ence in median o leng h o sick lea es ela ed o o he issues (F00–F09, F20–F99). •H4: Sample 1 and Sample 2 dis ibu ions a e he same. The design and ealiza ion o he s udy we e app o ed by he e hics commi ee o he Gene al Uni e si y Hospi al in P ague as indi idual esea ch ( e . 915/20 S–IV). RESULTS Fi s , we di ided all cases o sick lea e ela ed o men al diso de in o wo g oups, and hen, we examined he di e ences wi hin bo h g oups by using independen samples Mann–Whi ney U es . The Mann–Whi ney U es was selec ed as he dependen a iable (leng h o sick lea e) is no om no mal dis ibu ion, and we compa e only wo g oups. Those g oups a e as ollows: •men al diso de s/diagnoses ela ed o he consump ion o subs ance (alcohol, obacco, illegal d ugs), he e o e he diagnoses—de ined by ICD−10 as F10–F19; •men al diso de s/diagnoses ela ed o o he causes—de ined by ICD−10 as F00–F09 and F20–F99. The i s pa o analy ical p ocesses consis s o de e mining desc ip i e s a is ics o he a iable leng h o sick lea e, p esen ed in Table 1 in ela ion o i s hypo hesis: H1: The e is a di e ence in he leng h o sick lea e compa ing men al diagnoses caused by subs ances (diagnoses F10–F19 acco ding o ICD–10) and men al diagnoses caused by o he issues (F00–F09, F20–F99 acco ding o ICD–10). The p- alue was es ima ed a 0.0001; he e o e, we ejec he null hypo hesis in a o o he al e na i e hypo hesis a TABLE 2 | Independen -samples Mann–Whi ney U es Summa y: he leng h o sick lea e ela ed o men al diso de caused by d ugs (alcohol, obacco, illici d ugs) and o he condi ions, in he s udy sample o young adul s aged 15–29 yea s, he Czech Republic, 2017. Type Value To al N5,981 Mann-Whi ney U 1015174,000 Wilcoxon W 16508135,000 Tes s a is ic 1015174,000 S anda d e o 33925,690 S anda dized es s a is ic −4,120 Asymp o ic Sig. (2-sided es ) <0.001 TABLE 3 | K uskal–Wallis es esul s: he leng h o sick lea e ela ed o men al illnesses caused by d ugs (alcohol, obacco, illici d ugs), in he s udy sample o young adul s aged 15–29 yea s, he Czech Republic, 2017. Wo k ca ego y NRank sum Mean ank F10–F19: he leng h o sick lea e by wo k ca ego ies 0 12 3258.5 271.54 1 5 1173.5 234.70 2 5 1168.5 233.70 3 26 4941.0 190.04 4 20 4067.0 203.35 5 91 19626.0 215.67 6 5 589.5 117.90 7 167 35652.5 213.49 8 35 6884.5 196.70 9 49 8959.0 182.84 K uskal–Wallis es de ails H s a is ic 10.47 X²app oxima ion 10.47 DF 9 p- alue 0.3136 he 5% signi icance le el. Acco ding o p- alue, he e a e he di e ences in dis ibu ion o he leng h be ween men al diagnoses a ibu able o subs ance use (F10–F19) and o he ypes o men al diseases (F00–F09, F20–F99). As s a ed in Table 2, leng h o sick lea e ela ed o men al disease F10–F19 di e s om he leng h o sick lea e ela ed o men al disease F00–F09, F20–F99. Men al diso de s ca ego y: F10–F19 (N=415) has a la ge mean ank 3, 327, 8 han men al diso de ca ego y ela ed o o he causes (N=5 566) wi h mean ank (2 965,89) and hus ends o ake la ge alues. A s a is ically signi ican di e ence was ound (U =1,015,174, p<0.001). Nex , we pe o med K uskal–Wallis H es o es he second hypo hesis: H2: Compa ing di e en wo king ca ego ies, he e is a di e ence in he median o leng h o sick lea es ela ed o subs ance use (F10– F19). F on ie s in Public Heal h | www. on ie sin.o g 4June 2022 | Volume 10 | A icle 882707 Ga u o a and Ta hanico a Men al Illnesses o Young Adul s As p esen ed in Table 3, he p- alue was es ima ed a 0.3136; he e o e, we do no ejec he null hypo hesis in a o o he al e na i e hypo hesis a he 5% signi icance le el. Acco ding o p- alue, he e a e no di e ences in he median o he leng h be ween sepa a e wo king ca ego ies. As opposed o ou assump ion H2, in he case o men al illnesses a ibu able o excessi e use o alcohol, illegal d ugs, o smoking, he e a e no di e ences in he du a ion o sick lea e. Ou assump ion o a longe du a ion o sick lea e in case o people wi h lowe le el o educa ion has no been con i med. TABLE 4 | K uskal–Wallis es esul s: he leng h o sick lea e ela ed o men al illnesses caused by o he condi ions, in he s udy sample o young adul s aged 15–29 yea s, he Czech Republic, 2017. Wo k ca ego y NRank sum Mean ank F00–F09, F20–F99: he leng h o sick lea e (in days) by wo k ca ego ies 0 397 1052902.0 2652.15 1 79 252820.0 3200.25 2 80 216649.0 2708.11 3 562 1582469.5 2815.78 4 555 1588038.0 2861.33 5 1,327 3780646.5 2849.02 6 37 96767.0 2615.32 7 1,556 4350593.0 2796.01 8 455 1168787.0 2568.76 9 518 1403289.0 2709.05 K uskal-Wallis es de ails H s a is ic 21.62 X²app oxima ion 21.62 DF 9 p- alue 0.0101 H3: Compa ing di e en wo king ca ego ies, he e is a di e ence in median o leng h o sick lea es ela ed o o he issues (F00– F09, F20–F99). Acco ding o esul s in Table 4, he p- alue was es ima ed a 0.0101; he e o e, we ejec he null hypo hesis in a o o he al e na i e hypo hesis a he 5% signi icance le el. Acco ding o p- alue, he e a e he di e ences in median o he leng h be ween men al diagnoses a ibu able o o he issues (F00–F09, F20– F99). In he case o men al illnesses F00–F09, F20–F99, we ound he di e ences in he leng h o sick lea e wi hin di e en wo k ca ego ies. As he e a e di e ences wi hin he ype o men al disease ( ela ed o subs ance use o no ela ed o subs ance use) and di e ences among occupa ional g oups, we compa ed he a e age leng h o sick lea e be ween men and women in ega d o ICD−10 g oups, shown in Table 5. The e o e, Table 5 shows he a e age leng h o sick lea e in ega d o men al disease in ega d o ICD−10 classi ica ion and gende . As i may be seen, in he case o men, he g ea e a e age leng h o sick lea e is ela ed o in ellec ual disabili y (g oup F70–F79), amoun ed a 85.63. On he con a y, beha io al synd omes associa ed wi h physiological dis u bances and physical ac o s a e ela ed o sick lea e wi h he sho es a e age du a ion amoun ed a 20.17 days on a e age. In he case o women, he longes a e age sick lea e is ela ed o o ganic, including symp oma ic, men al diso de s (F00–F09) amoun ed a 53.11 days on a e age. Neu o ic, s ess- ela ed, and soma o o m diso de s (F40–F49), amoun ed a 30.89 days on a e age, a e ela ed o sho es du a ion o sick lea e. H4: Sample 1 and Sample 2 dis ibu ions a e he same. Based on he cu en esul s, i is e iden ha he e a e di e ences in leng h o sick lea e be ween di e en occupa ional ca ego y in bo h Sample 1 and Sample 2. The esul s a e p esen ed in Table 6. In ou u he analysis, we es ed he null hypo hesis ha he Sample 1 and Sample 2 dis ibu ions a e he same, whe eas hose samples p esen he wo k ca ego y. K uskal–Wallis es p o ided e y s ong e idence o a di e ence (p<0.001) be ween he mean anks o a leas one pai o g oups. The e was e y s ong TABLE 5 | Desc ip i e s a is ics: he a e age leng h o sick lea e in he s udy sample o young adul s aged 15–29 yea s, acco ding o In e na ional S a is ical Classi ica ion o Diseases and Rela ed Heal h P oblems, e sion 10, he Czech Republic, 2017. ICD−10 ICD−10 desc ip ion A e age leng h o sick lea e Men Women F40–F49 Neu o ic, s ess- ela ed and soma o o m diso de s 26.87 30.89 F30–F39 Mood [a ec i e] diso de s 35.32 37.37 F20–F29 Schizoph enia, schizo ypal and delusional diso de s 68.30 52.59 F60–F69 Diso de s o adul pe sonali y and beha io 44.64 51.38 F10–F19 Men al and beha io al diso de s due o psychoac i e subs ance use 44.86 43.30 F50–F59 Beha io al synd omes associa ed wi h physiological dis u bances and physical ac o s 20.17 44.57 F00–F09 O ganic, including symp oma ic, men al diso de s 36.79 53.11 F70–F79 In ellec ual disabili y 85.63 36.63 F90–F99 Beha io al and emo ional diso de s wi h onse usually occu ing in childhood and adolescence, unspeci ied men al diso de 45.19 38.36 F80–F89 Diso de s o psychological de elopmen 66.20 38.50 The bold alues indica es ha ou o all diagnoses, only men al illnesses a e conside ed in his a icle. F on ie s in Public Heal h | www. on ie sin.o g 5June 2022 | Volume 10 | A icle 882707 Ga u o a and Ta hanico a Men al Illnesses o Young Adul s TABLE 6 | Pai wise compa isons: he a e age leng h o sick lea e in he s udy sample o young adul s aged 15–29 yea s, acco ding o In e na ional S a is ical Classi ica ion o Diseases and Rela ed Heal h P oblems, e sion 10, he Czech Republic, 2017. Sample 1–Sample 2 Sig. Adj. Sig.a Plan and machine ope a o s and assemble s–P o essionals 0.986 1.000 Plan and machine ope a o s and assemble s–Elemen a y occupa ions 0.281 1.000 Plan and machine ope a o s and assemble s–A med o ces occupa ions 0.392 1.000 Plan and machine ope a o s and assemble s–Technicians and associa e p o essionals 0.082 1.000 Plan and machine ope a o s and assemble s–C a and ela ed ades wo ke s 0.066 1.000 Plan and machine ope a o s and assemble s–Se ices and sales wo ke s 0.013 0.580 Plan and machine ope a o s and assemble s–Cle ical suppo wo ke s <0.001 0.000 Plan and machine ope a o s and assemble s–Skilled ag icul u al, o es y, and ishe y wo ke s 0.289 1.000 Plan and machine ope a o s and assemble s–Manage s <0.001 0.000 A med o ces occupa ions–P o essionals 0.853 1.000 A med o ces occupa ions–Elemen a y occupa ions 0.960 1.000 A med o ces occupa ions–Technicians and associa e p o essionals 0.577 1.000 A med o ces occupa ions–C a and ela ed ades wo ke s 0.463 1.000 A med o ces occupa ions–Cle ical suppo wo ke s 0.025 1.000 A med o ces occupa ions–Se ices and sales wo ke s 0.059 1.000 A med o ces occupa ions–Skilled ag icul u al, o es y and ishe y wo ke s 0.546 1.000 P o essionals–Manage s 0.096 1.000 Elemen a y occupa ions–Manage s <0.001 0.000 P o essionals–Elemen a y occupa ions 0.872 1.000 P o essionals–C a and ela ed ades wo ke s 0.884 1.000 P o essionals–Technicians and associa e p o essionals 0.858 1.000 P o essionals–Cle ical suppo wo ke s 0.581 1.000 P o essionals–Se ices and sales wo ke s 0.654 1.000 P o essionals–Skilled ag icul u al, o es y and ishe y wo ke s 0.794 1.000 Elemen a y occupa ions–Technicians and associa e p o essionals 0.358 1.000 Elemen a y occupa ions–Se ices and sales wo ke s 0.028 1.000 Elemen a y occupa ions–Cle ical suppo wo ke s 0.025 1.000 Elemen a y occupa ions–Skilled ag icul u al, o es y and ishe y wo ke s 0.555 1.000 A med o ces occupa ions–Manage s 0.015 0.693 Elemen a y occupa ions–C a and ela ed ades wo ke s 0.233 1.000 C a and ela ed ades wo ke s–Cle ical suppo wo ke s 0.065 0.089 C a and ela ed ades wo ke s–Se ices and sales wo ke s 0.162 1.000 Technicians and associa e p o essionals–C a and ela ed ades wo ke s 0.925 1.000 Technicians and associa e p o essionals–Se ices and sales wo ke s 0.406 1.000 Technicians and associa e p o essionals–Skilled ag icul u al, o es y and ishe y wo ke s 0.776 1.000 Technicians and associa e p o essionals–Manage s 0.040 1.000 C a and ela ed ades wo ke s–Manage s 0.026 0.765 Technicians and associa e p o essionals–Cle ical suppo wo ke s 0.495 1.000 C a and ela ed ades wo ke s–Skilled ag icul u al, o es y and ishe y wo ke s 0.793 1.000 Cle ical suppo wo ke s–Se ices and sales wo ke s 0.776 1.000 Cle ical suppo wo ke s–Skilled ag icul u al, o es y and ishe y wo ke s 0.832 1.000 Se ices and sales wo ke s–Skilled ag icul u al, o es y and ishe y wo ke s 0.762 1.000 Se ices and sales wo ke s–Manage s 0.105 1.000 Cle ical suppo wo ke s–Manage s 0.092 1.000 Skilled ag icul u al, o es y and ishe y wo ke s–Manage s 0.842 1.000 The bold alues indica es he mos signi ican alues. e idence (p<0.001, adjus ed using he Bon e oni co ec ion o mul iple es s) o a di e ence be ween plan and machine ope a o s and assemble s s. cle ical suppo wo ke s, plan and machine ope a o s and assemble s s. manage s, and elemen a y occupa ions s. manage s. The e was no e idence o a di e ence be ween he o he pai s. F on ie s in Public Heal h | www. on ie sin.o g 6June 2022 | Volume 10 | A icle 882707 Ga u o a and Ta hanico a Men al Illnesses o Young Adul s DISCUSSION Men al illnesses p esen se ious heal h issues accompanied by a ious symp oms ha nega i ely a ec a pe son’s beha io , emo ional s a e, hough s, and cogni i e abili ies. Many non- communicable diseases, leading o high social bu dens, a e associa ed wi h obesi y, ela ed pa hologies, diabe es, high choles e ol, ca dio ascula p oblems, men al diseases, e c. (32). Men al illnesses ake many o ms, om mild dep ession, anxie y o se e e dep ession, and psychosis. Robe s & G imes, Hewle e al., and Pa el e al. s a e ha men al illnesses can ha e a sho e m bu also a ch onic o m and a ec he en i e popula ion o coun ies. The di e en ia ion o age and gende o hese mild as well as se ious ch onic men al diseases is p o en (33–35). As s a ed in he p e ious s udies o Song e al. and McDaid e al., he impo ance o sol ing he p oblem o men al illness o he popula ion a ises om heal h and economic aspec s. Conside ing heal h, men al illnesses a e o en associa ed wi h a highe incidence o au oimmune diseases and wo sen he ea men o hese diseases o como bidi ies (36,37). People wi h se e e men al illness li e on a e age 20 yea s sho e , and gene al men al heal h p oblems sho en li e expec ancy by up o 7.5 yea s (32,33). F om an economic poin o iew, imp o ing men al heal h has a posi i e impac on employmen and p oduc i i y o he economy, i educes social expendi u es, because heal hy people ha e a highe abili y and p econdi ions o wo k e icien ly. Psychia ic pa ien s ha e a g ea e isk o p ema u e all-cause mo ali y han he gene al popula ion. Epidemiological s udies show ha he li e expec ancy o pa ien s wi h majo psychia ic diso de s is educed by 7 o 24 yea s. Indeed, he ca dio ascula disease (CVD) isk bu also ha o he ela ed como bidi ies o diabe es, s oke, and obesi y has p o en o be signi ican ly inc eased in a mul i ude o psychia ic condi ions, including dep ession, schizoph enia, bipola diso de (BD), and anxie y diso de (34,36). Young people ace s ess ul si ua ions ha in luence hei men al heal h. Mi chell e al. and Bi n e al. con i med ha young adul s a e a high isk o de eloping men al disease and beha io al diso de s as psychic o young people is no ully o med (2,3). This migh educe hei abili y o wo k and he e o e be wholly economically ac i e and con ibu e o na ional GDP. Men al diso de in younge people migh nega i ely in luence hei abili y o ind wo k, o gain good social s a us, and o become economically independen . I any kind o disease sp ead ou in younge age, he economic bu den o his pe son is highe as he yea s li ing wi h disabili y inc ease. In he case o men al illness, i is necessa y o dis inguish whe he he illness has b oken ou as a esul o subs ance abuse o is a di e en ype o disease; he e o e, men al diso de s migh be di ided in o wo g oups: men al diseases a ibu able o subs ance use (F10–F19) and men al diseases no a ibu able o subs ance use (F00–F09, F20–F99). Gene ally, men al diso de s occu in people who ha e long- e m p oblems caused by social and psychological ac o s, e c. Acco ding o Liu e al., Wi ink and Oos e ha en, and Duplaga, he g ea p oblem is people wi h limi ed heal h li e acy, mos ly people wi h lowe educa ion (14,15,17). I is necessa y o c ea e app op ia e policy ha deals wi h he p oblem o social inequali y, di e en ypes o access o educa ion and disad an aged condi ions in which a young pe son migh g ow up. People wi h highe educa ion (such as manage s, p o essionals, echnicians, and associa e p o essionals) a e supposed o ha e be e access o heal h ca e as hey p esumably ca e abou hei heal h and p e en ion mo e. This was con i med in ou pai wise analysis which shows ha he e a e di e ences be ween manage s (supposed o be highe educa ed, o ca e mo e abou hei heal hca e) and plan and machine ope a o s and assemble s (supposed o be opposi e o manage s). On he con a y, people who ha e only p ima y educa ion o a e no educa ed a all do no usually ca e abou hei heal h as much as educa ed people. The social s a us o lowe educa ed people migh be wo se and hei heal h li e acy is lowe oo. The e o e, as s a ed by Duplaga, Ca od-A al, and Zheng e al., heal hca e o people, who do no ca e abou hei heal h, p e en ion, and heal hie li e, migh be mo e complica ed, longe , and mo e expensi e (17–19). As he heal h sys em o Czech Republic is based on Bisma ck model o heal h ca e, longe heal h p oblems ela ed o longe sick lea e will inc ease he expenses o s a e. Acco ding o many p e ious s udies, i is supposed ha he leng h o sick lea e will be in luenced by he social s a us and ela ed wo k ca ego y (6,8,9). Fi s , we examined he di e ences in he leng h o sick lea e in people wi h addic ion, he e o e people wi h sick lea e ela ed o diagnoses F10–F19. This assump ion was no con i med as he leng h o sick lea e was highe in people wi h men al diso de a ibu able o o he issues such as demen ia in Alzheime ’s disease, schizoph enia, and bipola e ec i e diso de , e c. As i is seen in Table 5, in case o bo h women and men, he a e age leng h o sick lea e ela ed o men al diseases caused by subs ance use is he i h longes . In case o women, i is 43.3 days on a e age and in case o men, i is 44.86 days on a e age. P e ious s udies con i m a ela ionship be ween lowe educa ion and a highe incidence o men al diseases (37– 39). We supposed ha people in occupa ional ca ego ies 9 (elemen a y occupa ions), 8 (plan and machine ope a o s and assemble s), 7 (c a and ela ed ades wo ke s), and 6 (skilled ag icul u al, o es y, and ishe y wo ke s) ha e p esumably lowe educa ion and will be mo e endange ed by men al diseases ela ed o addic ion. Thus, we examined he exis ence o di e ence in median in he leng h o sick lea e. Howe e , his assump ion was no con i med. The e o e, we do no ha e enough e idence o con i m ha leng h o sick lea e, in people who ha e men al disease a ibu able o subs ance use, a ies om one occupa ional ca ego y o ano he . Conside ing men al diso de s o beha io al issues ha a e no ela ed o subs ance use (F00–F09 and F20–F99), ou las assump ion was ha he e is a di e ence in leng h o sick lea e among di e en occupa ional ca ego ies. To make he analysis mo e de ailed, we did he pai wise compa ison o ge o know exac ly wha kind o occupa ional ca ego ies a e s a is ically signi ican om o he g oups. F on ie s in Public Heal h | www. on ie sin.o g 7June 2022 | Volume 10 | A icle 882707 Ga u o a and Ta hanico a Men al Illnesses o Young Adul s The e a e many ac o s ha in luence he ou b eak o men al disease and associa ed sick lea e. Ca od-A al s a es ha he e a e di e ences in mo bidi y ela ed o men al diseases among men and women (18). I is con i med by ou indings, which show ha he a e age numbe o days o sickness lea e ela ed o men al illness is highe o men compa ed o women. This is he impo an in o ma ion o he policymake s. Fu he mo e, based on ou esul s, conside ing only he men al diso de s ela ed o subs ances, he e is no di e ence in wo king ca ego ies among young people wi h di e en le els o educa ion. This may esul om he ac ha people who ha e some kinds o men al diso de a ibu able o addic ion a e p esen ed in all wo king ca ego ies, o leng h o hei sick lea e is simila (40,41). Thus, he addic ion does no seem o be ela ed o di e en occupa ional ca ego ies. As ou s udy shows, i is impo an o examine he di e ences in mo bidi y a ibu able o men al diseases and beha io al diso de s. I is impo an o iden i y and moni o ac o s ha can be a majo cause o an ou b eak o men al illness, especially in people wi h lowe educa ion. These people a e mo e a isk o disease’s ou b eak because hei heal h li e acy is lowe . The employmen o a pa icula pe son can be he esul o se e al ac o s. Thus, he key ac o in employmen is he educa ional le el and ype (42,43). Fu he mo e, nowadays, people a e wo king unde p essu e, a wo k because o highe demands o employe s (19). The sociocul u al en i onmen , poli ical egula ions, and public heal h s a egies a y conside ably among coun ies (44). The e o e, when se ing heal h policies, i is necessa y o pe o m he analyses ha de ine ulne able g oups o he popula ion in mo e de ail aking in o accoun also he di e ences in he occupa ional g oups. In he case o men al illnesses ha a e no associa ed wi h he use o alcohol, obacco, o illici d ugs, he e a e no di e ences in he du a ion o sick lea e be ween people in indi idual occupa ional ca ego ies. On he con a y, he di e ence is e iden in people wi h se e al men al diagnoses ha a e no a ibu able o subs ance use. Limi a ion o his s udy is he impossibili y o compa ison o o he coun ies as ou analysis is based on he da a wi h speci ic s uc u e. Da a access o such a da a in o he coun ies may be limi ed by legisla ion. As he social sys em o coun ies migh be di e en , his kind o da a migh exis in di e en s uc u es o migh no exis a all. Fu he analysis migh be p o ided wi h he main aim o show which occupa ions a e di e en om he o he s. DATA AVAILABILITY STATEMENT The da a analyzed in his s udy is subjec o he ollowing licenses/ es ic ions: This esea ch was suppo ed by he In e nal G an Agency o FaME Tomas Ba a Uni e si y in Zlin: RVO/2022. Reques s o access hese da ase s should be di ec ed o ga[email p o ec ed]. ETHICS STATEMENT E hical e iew and app o al was no equi ed o he s udy on human pa icipan s in acco dance wi h he local legisla ion and ins i u ional equi emen s. W i en in o med consen om he pa icipan s was no equi ed o pa icipa e in his s udy in acco dance wi h he na ional legisla ion and he ins i u ional equi emen s. AUTHOR CONTRIBUTIONS BG: concep ualiza ion, alida ion, in es iga ion, and p ojec adminis a ion. MT: me hodology, o mal analysis, and esou ces and da a cu a ion. BG and MT: w i ing—o iginal d a p epa a ion and w i ing— e iew and edi ing. All au ho s con ibu ed o he a icle and app o ed he submi ed e sion. FUNDING This wo k was suppo ed by In e nal G an Agency o FaME Tomas Ba a Uni e si y in Zlin: RO/2022: Use o co po a e social esponsibili y in he hospi alisa ion sec o in he Czech Republic and he Slo ak Republic o inc ease e iciency and sus ainabili y o he heal h sys ems and he Slo ak Resea ch and De elopmen Agency: Con ac No. APVV-17-0360: Mul idimensional analysis o signi ican de e minan s o public p ocu emen e iciency wi h emphasis on he applica ion o Heal h Technology Assessmen in he p ocu emen p epa a ion phase. REFERENCES 1. McMahon G, C ea en A-M, Gallaghe S. S ess ul li e e en s and adolescen well-being: he ole o pa en and pee ela ionships. S ess Heal h. (2020) 36:299–310. doi: 10.1002/smi.2923 2. Mi chell C, McMillan B, Hagan T. Men al heal h help-seeking beha iou s in young adul s. B J Gen P ac . (2017) 67:8–9. doi: 10.3399/bjgp17X688453 3. Bi n RM, Roebe BJ, Pollak SD. Ea ly childhood s ess exposu e, ewa d pa hways, and adul decision making. PNAS. 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Risk o me abolic synd ome and i s componen s in people wi h schizoph enia and ela ed psycho ic diso de s, bipola diso de and majo dep essi e diso de : a sys ema ic e iew and me a-analysis. Wo ld Psychia y. (2015) 14:339–47. doi: 10.1002/wps.20252 Con lic o In e es : The au ho s decla e ha he esea ch was conduc ed in he absence o any comme cial o inancial ela ionships ha could be cons ued as a po en ial con lic o in e es . Publishe ’s No e: All claims exp essed in his a icle a e solely hose o he au ho s and do no necessa ily ep esen hose o hei a ilia ed o ganiza ions, o hose o he publishe , he edi o s and he e iewe s. Any p oduc ha may be e alua ed in his a icle, o claim ha may be made by i s manu ac u e , is no gua an eed o endo sed by he publishe . Copy igh © 2022 Ga u o a and Ta hanico a. This is an open-access a icle dis ibu ed unde he e ms o he C ea i e Commons A ibu ion License (CC BY). 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