The Price of Absence: Productivity Costs and Sickness-Absence Episodes Attributable to Mental and Behavioral Disorders in the Brazilian Federal Workforce — A Nationwide Time-Series Study (2012–2024)

BACKGROUND: Mental and behavioral disorders (MDs) represent a leading cause of sickness absence among Brazilian public servants, generating substantial social and economic burdens. Despite their impact, comprehensive nationwide assessments of productivity costs attributable to MDs over extended periods remain scarce. OBJECTIVES: The aim of this study was to estimate the productivity costs associated with MDs (ICD-10 Chapter V) among Brazilian federal civil servants from 2012 to 2024 compared with the four other most prevalent non-mental causes of absence. METHODS: We conducted a retrospective longitudinal study using administrative data from SIAPE-SAÚDE (n = 471,507 workers/year average). Outcomes were classified according to ICD-10, focusing on MDs (F00-F99) and comparing them with the four other most prevalent non-mental causes. Productivity costs were estimated using the Human Capital Approach, calculating lost workdays (22 days per 30-day leave) multiplied by daily remuneration. Annual episode rates, average leave duration, and mean costs were stratified by region, education, gender, and age. All monetary values were adjusted to December 2024. RESULTS: MDs accounted for 3.94 billion Brazilian Real (BRL) (38% of total costs among leading causes), representing 13.9 million days lost. Costs were concentrated in mood disorders (F30-F39: BRL 2.04 billion) and neurotic/stress-related disorders (F40-F48: BRL 1.49 billion). Episode rates increased from 42.3 to 83.8 per 1000 employees (2012-2019), declined in 2020 (39.4), then recovered to 85.8 in 2023. Women showed higher episode rates (particularly those aged ≤ 30 years: ≈ 160 per 1000), while men exhibited longer absences (44.7 vs 37.5 days) and higher per-case costs (BRL 11,720 vs BRL 8905). Marked increases occurred in autism spectrum disorders (+ 1673%) and attention-deficit/hyperkinetic disorder (ADHD) (+ 331%). CONCLUSIONS: MDs impose a substantial and persistent burden of productivity costs on the Brazilian federal public service, with rising sickness-leave episode rates over the period and pronounced gender, educational, and regional disparities, requiring targeted, equity-oriented occupational health policies.