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Mental health-related sick leave has surged by 88% since 2018, now ranking as the second leading cause of absence in Spain, after pain

Mental health and pain account for 51.1% of sick leave days due to temporary disability among salaried employees covered by the General Social Security System and 49% among self-employed workers

Between 2018 and 2023, mental health issues and pain-related conditions (e.g., lower or upper back, neck pains, etc.) were responsible for over two-thirds of the increase in work absenteeism due to temporary disability in Spain. During this period, the number of days lost per year increased from 4.1% to 5.6% among salaried employees.

Even though all pathologies have increased over these five years, mental health has experienced the sharpest rise: 88% among salaried employees and 75% among self-employed workers. Pain-related conditions (e.g., lower or upper back, neck pains, etc.) followed as the second fastest growing diagnosis, with increases of 39% among salaried employees and 36% among self-employed workers. Pain remains the leading cause of lost working days, while mental health conditions have overtaken orthopedics as the second most common.

The sixth brief note from Ivie-Umivale Activa study highlights the main drivers of absenteeism due to temporary disability, focusing on the analysis and evolution of diagnoses in Spain. According to the study, these two pathologies, often harder to objectively diagnose, already account for 51.1% of sick leave days among salaried employees and 49% in the case of self-employed workers. They also account for more than two-thirds of the increase in the indicator of absenteeism due to temporary disability in Spain between 2018 and 2023.

Contribution of diagnoses to the indicator of absenteeism due to temporary disability. 2018 and 2023 (percentage points)

The serious issue of mental health is also evident in the incidence data—number of sick days per 1,000 workers—which increased by 64% over the period, reaching 34.9 sick days per 1,000 employees in 2023. Pain is the second fastest-growing pathology, with a 22% increase, compared to more moderate growth in other conditions such as cancer (+17.8%), cardiovascular disease (+19.2%) and trauma, which rose by only 1%.

Following the sharp increase in temporary disability leave due to mental health diagnoses, this condition has become the leading cause of such leave among workers under 30 and the second most common—after pain—among those over 30. Notably, among young women aged 20 to 29, mental health accounts for 30% of lost working days due to temporary disability.

According to the study by Umivale Activa and Ivie, long-term processes (lasting more than 365 days) and repeat cases (individuals with more than one sick leave in a 12-month period) are key determinants of the recent increase in temporary disability in Spain. Specifically, long-term sick leave related to pain and mental health shows a strong growth in the period. The increase is particularly marked in the case of mental health, whose prevalence (cases lasting more than 365 days at year-end per 10,000 protected workers) has risen by 147%. Pain also saw a notable rise, almost doubling with a 93% increase.

Prevalence in temporary disability cases lasting more than 12 months. General Social Security System Regime. 2018 and 2023 (cases in force at the end of the period per 10,000 protected workers)

Regarding repeat cases, mental health and pain are also the diagnoses with the highest percentage of people experiencing more than one sick leave in a year. In 2023, 64.5% of repeat cases involved mental health and 58% involved pain.

According to the authors, these findings suggest that these types of pathologies—more difficult to assess objectify—present greater challenges for accurate diagnosis, treatment, management, and control by the healthcare system. Additionally, there has been an increase in cases lasting over a year and a half due to pain or mental health issues that ultimately result in denial of permanent disability: 64% for pain and 79% for mental health.

Pathologies by sector and region

The increase in sick leave due to pain and mental health issues is evident across all sectors. In fact, in every sector, the contribution of these two pathologies to lost work days exceeds 35%. In general, there is a correlation between the sectors with the highest overall temporary disability rates and those where pain and mental health issues are most prevalent. The most notable figures are found in: Administrative and support services, with 8.71% of absenteeism due to total sick leave and 4.8% due to these two diagnoses; Water and sanitation (8.07% and 4.13%); and Healthcare (7.45% and 3.96%). At the other end of the spectrum, the lowest figures, with absenteeism rates below 4% and contributions from both pathologies below 2% include Information and communications, Professional activities, Energy, Real estate activities, Financial activities, Education, and Agriculture.

Regionally, the highest temporary disability rates for these two conditions are found in the Canary Islands, Cantabrian provinces, and the northwest of the peninsula. Pain is also notably prevalent in Teruel, Murcia, and parts of the southwest, while mental health is more relevant in Barcelona, Tarragona, and Valencia.

The number of cases due to these two diagnoses has grown significantly across all regions, though with notable differences. For pain, diagnoses increased by 15% in Castilla-La Mancha and 25% in Madrid, compared to 73% in Galicia and 84% in Melilla. Regarding mental health, aside from Castilla-La Mancha, where cases rose by just 3%, in the rest of the regions the differences range from a 54% increase in diagnoses in Navarra to over 100% in Andalusia, the Canary Islands, and Galicia.