Why do absenteeism and frequent sick notes rise? Read about the psychological causes of staying away from work, employer obligations and healthy solutions.
Shifts left short on Monday mornings, sick notes that rise before and after public holidays, leave requests arriving one after another from the same department... For many factory managers and HR leaders, absenteeism is a problem that upsets production planning and is often met with anger. The first reaction is usually to tighten monitoring, cut bonuses or draw up lists of "people who take sick notes". Yet behind frequent absence there are often invisible psychological and organisational causes, and unless these are addressed, sanctions only push the problem to change form. In this article I look at the psychological side of absenteeism, the employer's obligations and healthy ways forward.
What Is Absenteeism and How Is It Measured?
Absenteeism is an employee not coming to work during their scheduled working time. Pre-planned and approved leave such as annual leave is generally not counted within this. When people talk about absenteeism they usually mean sick leave (a medical report), unexcused absence and short, unplanned leave.
For a meaningful assessment, looking only at the total number of days is not enough. The following distinctions give more information:
- Short and frequent absence: Absences of one or two days that recur often. These are frequently linked to stress, loss of motivation, problems in the work environment or personal difficulties that the person cannot cope with.
- Long-term absence: Absences lasting weeks or months. These generally point to a serious physical or mental health problem, an accident at work or medical processes such as surgery.
- Patterns: Absence concentrated on particular days, particular shifts or in the team of a particular manager carries strong clues about the source of the problem.
- Comparison by unit: A marked difference between two units doing similar work often points not to an individual but to an organisational cause.
What Does Absenteeism Cost a Business?
The direct cost of absenteeism is the overtime, temporary staff and production losses incurred to make up for the absence. The indirect costs are often larger: the additional load placed on the remaining employees, fatigue and the associated risk of error, uncertainty in planning and tension within the team.
On a global scale, the effect of mental health problems on the workforce is large. According to the World Health Organization, an estimated 12 billion working days are lost every year to depression and anxiety, with a productivity cost of around 1 trillion dollars (WHO, 2026). In Turkey, workplace accidents alone accounted for a total of 4,639,930 days of temporary incapacity to work in 2025 (SGK Statistical Yearbook, 2025). This figure does not include absence due to psychological causes, but it is important as an indication of the burden that work-related health problems place on the workforce.
Another important point: absenteeism and presenteeism, that is, coming to work but not being able to work at full capacity, are linked. Practices that penalise taking leave may improve absence records, but they increase invisible losses by forcing employees to come to work ill or exhausted. I have covered this subject in detail in my article on presenteeism.
Psychological Causes of Frequent Sick Leave
Reading frequent absence merely as "laziness" or "skiving" is often wrong and also makes the solution harder. The main psychological causes are as follows:
Burnout and chronic stress
The World Health Organization defines burnout as an occupational phenomenon resulting from chronic workplace stress that has not been successfully managed (WHO, 2019). A systematic review of 36 prospective studies showed that burnout predicts later absenteeism, job dissatisfaction and presenteeism (Salvagioni et al., 2017). Considering that 66% of employees in Turkey say they spent a large part of the previous day under stress (Gallup, 2026, 2025 data), this link is particularly important.
Depression and anxiety
Depression and anxiety disorders can make it hard to get up in the morning, go to work and keep functioning through the day. These problems often also show themselves through physical symptoms: headaches, stomach problems, muscle pain, constant fatigue. For this reason, psychological struggles may lie behind some of the sick notes issued for physical complaints. This does not mean the note is not genuine; on the contrary, it shows that the body is genuinely struggling.
Relationships at work and mobbing
For an employee who has trouble with their manager, is excluded from the team or is subjected to psychological harassment, coming to work is a source of stress that is relived every day. In this case absence is a way of avoiding and protecting oneself. According to the ILO's 2026 report, 23% of workers worldwide have experienced violence or harassment at work at least once; the most common form is psychological violence at 18% (ILO, 2026).
Work-family conflict and caring load
For employees who have young children or who look after an elderly or sick relative, unexpected situations can lead to absence. In environments where no flexibility is offered, these employees may see taking a sick note as the only way out.
Loss of commitment
For an employee who is not bound to their work by a sense of meaning, the "cost" of not coming in is low. According to Gallup's 2026 report, only 8% of employees in Turkey are truly engaged in their work (Gallup, 2026, 2025 data). Low engagement forms an important basis for short, frequent absence.
Traumatic events
After traumatic events such as an accident at work, violence in the workplace or a sudden loss, employees may show avoidance, sleep problems and anxiety. Post-traumatic stress symptoms can develop after serious accidents at work and make returning to work harder. My article on psychological support after a workplace accident may be a guide on this subject.
Frequent absence is often not the problem itself but a symptom of it; instead of suppressing the symptom, you need to understand the cause.
Reading Absence Patterns: An Example
Say two assembly lines in a production plant make the same product with the same equipment. On the first line, short sick notes have risen markedly over the last six months, while on the second line nothing has changed. The first explanation that comes to mind might be that "the employees on the first line are shirking". But looking more closely, it turns out that six months ago a new shift supervisor started on the first line, targets were raised, breaks were shortened and two experienced employees left. In focus group discussions with the employees, expressions such as "we get shouted at" and "nothing we do is enough" come up often.
In this example, absence is not an individual disciplinary problem; it is an organisational signal about management style, workload and team stability. Bonus deductions or tight monitoring may suppress this signal but do not remove the cause. Support and training for the manager, replanning the workload and open communication with the team, on the other hand, address the source of the problem. Reading the data in this way is the first step towards spending resources in the right place.
The Employer's Obligations and the Legal Framework
Absenteeism is not only a disciplinary matter but also an occupational health and safety (OHS) matter. Article 4 of the Occupational Health and Safety Law No. 6331 (İş Sağlığı ve Güvenliği Kanunu) obliges the employer to ensure the work-related health and safety of employees. Article 15 of the law provides that, on return to work after an accident at work, an occupational disease or repeated absences for health reasons, a health examination is carried out if the employee requests it. Article 17 requires that an employee who has had an accident at work be given additional training before starting work.
Article 5 of the law requires the employer to develop a prevention policy covering the effects of factors such as work organisation and social relationships; the Regulation on Occupational Health and Safety Risk Assessment also provides that sources of psychosocial hazard be identified and recorded (Art. 8). Absence concentrated in a particular unit is an important sign that psychosocial risks should be assessed in that unit. The ILO also counts absenteeism among the key indicators that can be used in monitoring psychosocial risks (ILO, 2026).
What Can Employers Do to Reduce Absenteeism?
1. Analyse the data and look for patterns, not people
Examine absence records by unit, shift, manager, day and duration. The aim is not to find the "guilty" but to understand where and why the problem is concentrated.
2. Hold return-to-work conversations
When an employee returns after leave or a sick note, it is important for their supervisor to have a brief and supportive conversation. Questions such as "I hope you're feeling better. How are you? Do you need any support as you return to work?" bring much more information than an interrogating attitude and strengthen trust. There is no need to ask for medical details; the employee shares what they want to share.
3. Train managers
Noticing an employee who is struggling and talking to them without judgement are learnable skills. In the WHO's guidelines on mental health at work, the recommendation with the strongest evidence is training managers in mental health (strong recommendation, moderate-certainty evidence) (WHO, 2022). In a cluster randomised controlled trial in a fire service in Australia, after a 4-hour mental health training for managers, work-related sick leave in their teams was reported to have fallen by 18% compared with baseline (Milligan-Saville et al., 2017). This study was carried out in a single organisation and an effect was seen only in work-related leave; the results need to be replicated. It is nevertheless a notable finding on the relationship between manager training and absenteeism.
4. Set up phased return-to-work programmes
After a long absence, especially after leave taken for psychological reasons, a phased return (reduced hours, a temporary duty arrangement, regular follow-up meetings) makes readjustment to work easier. The WHO guidelines also recommend combining work-directed support with clinical care on return to work after mental health leave (conditional recommendation, low-certainty evidence) (WHO, 2022).
5. Offer flexibility options
For employees with caring responsibilities, flexibility in shift swaps, hourly leave or short-term arrangements can reduce unplanned absence. Flexibility offers a way of solving the problem without having to resort to a sick note.
6. Address psychosocial risks
Include factors such as workload, shift patterns, the relationship with the manager, mobbing and role ambiguity in the psychosocial risk assessment. In units where absence is concentrated, prioritise this assessment.
7. Provide access to confidential psychological support
It is important that employees facing personal or work-related difficulties have a confidential support channel they can turn to before they stop coming to work. In a large observational data set on EAP (employee assistance programme) counselling cases, a reduction in absenteeism reported by employees was observed after counselling (Attridge et al., 2019); however, because these data contain no control group, they do not provide evidence of causation.
8. Avoid punitive approaches
Meeting every employee who takes a sick note with suspicion, using bonus deductions as the only tool or publishing lists of names damages trust and increases presenteeism. If there is a genuine disciplinary problem, it should be dealt with through a separate and fair process.
How Do You Get Started in Your Organisation?
- Needs analysis: Analyse the last year or two of absence data by unit, shift and duration. With an anonymous employee survey and focus group discussions, measure factors such as stress, workload, the relationship with managers and work-life balance. You can find how such an analysis can be structured on the corporate services page.
- Programme: Based on the findings, plan manager training, return-to-work conversations and phased return procedures, flexibility arrangements and confidential psychological support options together. The ILO stresses that individual measures should not replace organisational measures but complement them (ILO, 2026).
- Measurement: Monitor absence rates, presenteeism indicators, resignations and employee survey results together. Look not only at whether absence falls but at whether it does so in a healthy way.
Frequently Asked Questions
How should I talk to an employee who takes frequent sick notes?
Talk in a private setting with a supportive rather than accusatory attitude. Share your observations without judging and ask whether something is making things difficult for them, at work or outside it. Do not ask for medical details; be content with what the employee shares and, if needed, remind them of the support options.
Is it right to use a bonus system to reduce absenteeism?
Attendance bonuses can improve records in the short term, but by forcing ill employees to come to work they can increase presenteeism and the risk of spreading infectious illness. They can also create a perception of unfairness for employees with a chronic illness or caring responsibilities. They should not be used as a solution on their own.
How should we plan the return to work of an employee who has taken long leave for psychological reasons?
A phased return plan can be made together with the employee, taking the opinion of the occupational physician and the health professional treating them where necessary. Reduced hours, a temporary duty arrangement and regular follow-up meetings in the first weeks make adjustment easier. Taking care over confidentiality and preventing stigma within the team are also important parts of the process.
What does it show when absence is concentrated in a particular unit?
It often points not to an individual but to an organisational cause: excessive workload, the relationship with the manager, conflict within the team, mobbing or working conditions. In this case, assessing psychosocial risks in that unit in detail and gathering employees' views is the most reliable way of understanding the source of the problem.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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