With a positive corona test, the matter is quite clear: the office remains off limits. But what happens when a headache strikes or even a depressive phase begins? Many people drag themselves to work after all. This phenomenon is called presenteeism - and according to experts, neither sick employees nor employers are helped by it. In the meantime, a market is also developing with digital offerings, particularly for mental health.

Every second employee (51%) in Germany sometimes, often or very often goes to work sick, as the Institute for Occupational Health Consulting in Constance found out for Techniker Krankenkasse. According to the study published in the fall, women tend to be more prone to presenteeism than their male colleagues.

No difference from a business perspective

"From a business perspective, the costs incurred by presenteeism are at least as high as the costs of sickness-related absences," according to the Federal Institute for Occupational Safety and Health. According to psychologist Simon Hahnzog, the proportion could be even higher. The costs incurred by companies due to presenteeism are around twice as high as the combined costs of employees who are actually or allegedly ill. However, many companies are more concerned about blue-collar workers and invest more energy and money in the fight against this absenteeism.

However, Hahnzog makes it clear that those who work sick are only able to perform to a limited extent: "I'm there for eight hours, but I only actually work five." Sick people also make mistakes more often, which in turn leads to follow-up costs: "It's an avalanche effect," says Hahnzog, who also advises companies on the subject. "If one person makes a mistake, ten others may have to work an extra hour." There are also significantly more accidents when people go to work sick. And long-term, regular presenteeism increases the risk of cardiovascular diseases and mental disorders.

Working from home reduces recovery time

The number of days absent from work, particularly due to mental illness, has been rising for years, says Simon Senner, Chief Physician at the Reichenau Psychiatric Center near Constance. This trend was halted at the beginning of the pandemic. "It is likely that existential fears led to more people dragging themselves to work." The number of days absent from work has been rising again since fall 2020 at the latest. In the first half of 2022, there were now significantly more sick days at work than a year ago, according to the DAK health insurance company. This was mainly due to many respiratory illnesses, but corona-related absences also increased.

Hahnzog assumes that the developments resulting from the pandemic are exacerbating the trend: "Working from home has made the threshold for working much lower. I'm not really ill, so I can switch to a Zoom call for a short time." Recovery time at home is reduced. Hahnzog says that employees have been left more to their own devices. Managers, in turn, are less able to keep an eye on the health of employees working from home.

Recognizing possible mental disorders - an app helps

According to the Occupational Health and Safety Act, employers are obliged to carry out a mental health risk assessment, as Senner emphasizes. However, he estimates that only half of them have done so. While it is relatively easy to take safety measures for physical hazards, such as distancing measures, it is more difficult when it comes to mental stress. However, managers could learn how to recognize possible mental disorders and how to address employees appropriately and offer support.

In line with this trend, there are now many apps for people with mental health issues, says Senner, who is also a member of the medical advisory board of Wellster, a provider of digital health platforms. "There is money being invested in topics such as mental health in the workplace."

One example is the start-up Heyvie from Karlsruhe, which was founded in 2021 and aims to help people with migraines. Marius Krämer and Hady Daboul want to take the pain away from sufferers with so-called neurocentric training. "The technology identifies areas of the brain that are not functioning optimally due to old patterns and injuries and aims to get rid of restrictions in the shortest possible time," the two explain.

A few exercises are available free of charge in the app. Depending on the desired scope and application, a four-week programme is available for 19.99 euros, for example, or personalized training from 125 euros per hour. The app was tested until March and hundreds have already used it since then, says Krämer. Unlike the widespread disease back pain, he believes migraines are still stigmatized and tend to lead to presenteeism. "Yet almost everyone knows about headaches."

From employers for employees

Senner in turn advises Nilo Health. The service is intended for companies, who can offer it to employees. For patients, the helloeasy.de website offers online therapy for stress, anxiety or sleep problems, for example.

The consumer advice center points out that there are no uniform quality criteria. "Most apps in this fast-moving market have also not been scientifically tested for their benefits." This means that there can be helpful apps - but also those that can cause damage in the worst case, for example due to incorrect measurements. It is advisable to discuss the issue with your GP.

The market is growing rapidly, says head physician Senner. Digital services are an important source of help and enable those affected to seek support without shame or other obstacles. "Digitalization in the healthcare sector makes it possible to make therapies available to everyone more quickly and individually."