Lack of Paid Sick Leave Can Worsen Mental Health, Distress

Sick worker sleeping on deskWorkers who do not receive paid sick leave report higher levels of psychological distress, according to a study published in the American Journal of Orthopsychiatry.

Only seven states require companies to offer paid sick leave. Fifteen specifically prohibit local governments from enacting mandatory paid sick leave legislation. According to the March 2017 National Compensation Survey—Benefits, 32% of private sector workers receive no paid sick leave.

The Link Between Paid Sick Leave and Mental Health

The study gathered data on 17,897 American workers who participated in the 2015 National Health Interview Survey. Participants answered questions about paid sick leave. About 40% had no paid sick leave.

The study used the 6-item Kessler Psychological Distress Scale to assess mental health. Previous research supports this scale’s use as a valid, reliable measure of psychological distress. The Scale assigns a K6 score ranging from 0-24, with higher numbers indicating higher levels of psychological distress. Scores above 13 are correlated with having a mental health diagnosis.

People without paid sick leave were more likely to have a K6 score suggesting a mental health diagnosis. Just 1.4% of participants with paid sick leave had a score higher than 12, compared to 3.1% with no paid sick leave.

Other factors—including being female, being younger, being in worse health, smoking, inadequate sleep, or having a chronic health condition—also increased the risk of high psychological distress. Even after controlling for these factors, the study found people without paid sick leave experienced more psychological distress than their peers. They were also 1.45 times more likely to say their distress interfered with their activities or life.

Can Paid Sick Leave Increase Productivity?

Other studies have found worse mental health can lower employee productivity. A 2014 analysis found a 12% productivity increase among happier workers. A 2008 study linked worse mental health to lower productivity and more missed work days.

If paid sick leave reduces psychological distress, it could also improve on-the-job productivity.


  1. 93 percent of managers and 46 percent of service workers had paid sick leave benefits in March 2017 : The Economics Daily. (n.d.). Retrieved from
  2. Burton, W. N., Schultz, A. B., Chen, C., & Edington, D. W. (2008). The association of worker productivity and mental health: A review of the literature. International Journal of Workplace Health Management, 1(2), 78-94. doi:10.1108/17538350810893883
  3. Insult to injury: US workers without paid sick leave suffer from mental distress. (2017, September 15). Retrieved from
  4. Oswald, A. J., Proto, E., & Sgroi, D. (2014, February). Happiness and productivity [PDF].
  5. Stoddard-Dare, P., Derigne, L., Collins, C. C., Quinn, L. M., & Fuller, K. (2017). Paid sick leave and psychological distress: An analysis of U.S. workers. American Journal of Orthopsychiatry. doi:10.1037/ort0000293

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  • Penelope

    September 20th, 2017 at 3:12 PM

    Of course this is true! There are many of us who have jobs which are already very unstable so there is always this underlying fear about needing to take time off, wondering if we will still have a job to go back to if we have to take any sick leave, paid or unpaid.

  • Laurence

    September 22nd, 2017 at 2:18 PM

    I think that it is already a proven fact that when employees know that their employers care about them then they will go above and beyond what is generally expected of them. That includes being given time to recuperate and recharge their batteries. Everyone needs to know that the people in charge do care about them and giving them personal time can only emphasize that.

  • Kirk

    September 23rd, 2017 at 8:59 AM

    Whether or not it would actually make employees more productive seems a little iffy to me; however I think that it goes without saying that if an employee feels like they are valued or respected then they will then go the extra mile. Maybe giving them generous time off plays into the scenario in that way.

  • cassie r

    September 27th, 2017 at 2:36 PM

    I have had jobs in the past where yes, I have been afraid to take time off even when I was sick because I didn’t know if i would still have a job when I cam back.
    I think that it goes without saying that if you know that your job is protected then you will not feel so hesitant to take some much needed time off from time to time.
    I think that most employers know who their good employees are and if you do not abuse these rights then they will allow you to freely take them.

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