The number of sick leave days taken by AOK members due to mental health issues has risen by 47% since 2014, making it the second-biggest cause of absence after respiratory diseases.
High responsibility, low reward
Healthcare, education and social services tend to have the highest proportion of mental health-related diagnoses.
“They have jobs with high responsibility, they need to combine task performance and social interaction and they have to deal with emotional problems, but also with physical stressors, including violence,” Siegrist said. “And often these are low-paid people with a rather low socioeconomic status.”
The combination of low pay, social status or security with high demands is what scholars describe as an effort-reward imbalance.
A large body of international occupational health research has linked this imbalance to mental health issues and long-term absence. It also increases the risk of coronary heart disease.
Recent evidence from Germany’s schools illustrates the problem. The 2024 German School Barometer found that nearly half of teachers reported psychological or physical violence among pupils at their school, while more than one-third felt emotionally exhausted several times a week.
Nursing tells a similar story. Despite acute staff shortages, recent German studies have found surprisingly limited wage increases, particularly in hospitals and public institutions.
The health ministry declined to comment when asked about absenteeism rates being highest in sectors with the biggest mental health and emotional pressures.
No sign of widespread abuse