Employee presenteeism: Why employers should care

Most employers notice when someone calls in sick.

What's often harder to recognise is when an employee comes to work every day, attends meetings, answers emails, and appears productive, while struggling beneath the surface.

They may be recovering from illness, dealing with anxiety, feeling emotionally exhausted, or showing signs of burnout. They're still working, but doing so requires significantly more effort than usual.

This is known as presenteeism. While absenteeism is easy to measure, presenteeism can remain hidden for months. Yet, its impact can be substantial, affecting productivity, decision-making, and workplace relationships.

As organisations place greater focus on workplace mental health and psychosocial safety, understanding presenteeism has become increasingly important.

What is employee presenteeism?

Employee presenteeism refers to attending work while physically or psychologically unwell in a way that affects performance, concentration, or overall wellbeing.

The concept was once associated primarily with physical illness. Today, it encompasses a much broader range of experiences. An employee might be managing chronic stress, anxiety, depression, burnout, sleep deprivation, or personal challenges while continuing to work as though everything is normal.

For some employees, taking time off feels difficult. They may worry about falling behind, creating extra work for colleagues, missing deadlines, or being perceived as less committed than others. And this often leads to forcing themselves to show up and work even when their mind and body aren’t exactly conditioned to work.

Presenteeism versus absenteeism

Absenteeism and presenteeism are often discussed together, but they affect organisations in different ways.

With absenteeism, the issue is visible. An employee takes leave and managers can clearly see the impact on staffing and workloads. Presenteeism is more difficult to identify. The employee is still present, but their ability to work effectively may be reduced.

Research suggests that presenteeism may cost organisations more than absenteeism because it can persist for long periods without being recognised. A systematic review published in the Journal of the American Medical Association (JAMA) found that lost productivity associated with presenteeism often exceeds the costs of absenteeism across a range of chronic health conditions, including depression, allergies, arthritis, and back pain.

Why employees work when they should be recovering

Most people understand the value of rest when they're unwell. However, it’s still very understandable when they choose to work through illness, stress, and exhaustion.

Several factors could be at play.

Financial pressures

For some workers, taking time off isn't simply a health decision. Casual employees, contractors, and gig workers may lose income when they're unable to work, and the financial concerns can leave them feeling like they have no choice but to keep grinding.

Workload pressures and burnout

When employees already feel stretched, taking time off can seem impossible. A day away from work may mean returning to hundreds of emails, looming deadlines, and increased pressure.

This cycle can contribute to burnout over time. Employees keep pushing through because they feel they have no other option, even when their energy, motivation, and concentration are declining.

Job insecurity

Periods of organisational change can increase presenteeism. Employees may worry that taking sick leave could affect how they're perceived, particularly during restructures, economic uncertainty, or when competition for roles is high.

Tech fatigue and digital presenteeism

Remote and hybrid work have transformed how many Australians work. They've also created new opportunities for employees to work when they should be resting.

For example, someone with a cold may decide they're well enough to answer emails from home. A worker experiencing stress may continue checking messages late into the evening. These habits can contribute to digital presenteeism.

Combined with tech fatigue and blurred boundaries between work and personal life, constant connectivity can make recovery more difficult.

Impacts and business costs of mental health presenteeism

When people think about attending work while sick, they often picture physical illness. However, mental health-related presenteeism is increasingly recognised as one of the most significant and costly challenges facing modern workplaces.

An employee experiencing anxiety may spend far longer than usual on routine decisions. Someone living with depression may struggle to concentrate, stay motivated, or engage with colleagues. A person experiencing burnout may continue showing up each day while feeling emotionally exhausted, detached from their work, and unable to perform at their usual level.

Unlike physical illness, these challenges aren't always visible. Employees may still attend meetings, respond to emails, and meet deadlines, but often with reduced energy, focus, and effectiveness. Over time, this can lead to more mistakes, slower decision-making, lower productivity, reduced creativity, and strained workplace relationships.

The impact extends beyond individual employees. Teams may experience increased workloads when colleagues are unable to contribute at their usual capacity, while managers can spend more time addressing performance issues, errors, or interpersonal tensions. In safety-critical industries, fatigue, stress, and impaired concentration may also increase the risk of workplace incidents.

There are significant long-term business costs, too. Employees who experience prolonged stress, poor mental health, or burnout are more likely to become disengaged, take extended periods of leave, or leave the organisation altogether.

This can contribute to higher turnover, increased recruitment and training costs, and the loss of valuable knowledge and experience.

Signs of presenteeism employers should look for

Presenteeism isn't always obvious. Employees may continue performing their duties while struggling significantly behind the scenes. Rather than focusing on isolated incidents, managers should pay attention to ongoing patterns and behavioural changes.

These signs don't automatically indicate presenteeism, but they can signal that an employee may benefit from additional support.

How workplace culture influences presenteeism

Workplace culture can either reduce presenteeism or reinforce it. In some organisations, employees feel comfortable taking leave when they're unwell. In others, there may be an unspoken expectation to keep working regardless of personal circumstances.

Leaders play an important role in shaping these norms. When managers regularly work through illness, send emails late at night, or avoid taking leave themselves, employees may interpret those behaviours as expectations.

Psychological safety also matters. Employees are more likely to seek support when they feel comfortable discussing challenges without fear of judgement, embarrassment, or negative consequences.

Work-life balance is another important factor. When workloads consistently exceed capacity, recovery becomes difficult and chronic stress can begin to accumulate. Over time, this increases the likelihood of burnout and presenteeism.

What employers can do to reduce presenteeism

Reducing presenteeism requires more than encouraging employees to take sick leave. Organisations need to address the underlying factors that cause people to keep working when they need time to recover.

Assess psychosocial risks

Many drivers of presenteeism stem from psychosocial risks, including excessive workloads, low role clarity, poor support, workplace conflict, and unrealistic expectations.

If you’re unsure how to start supporting your team better, our free psychosocial risk assessment tool can help. It will guide you in identifying potential issues before they contribute to burnout, stress, and poor mental health outcomes.

Encourage mental health days

Employees should feel comfortable taking time away from work when they need it.

Normalising mental health days and stress leave sends a clear message that wellbeing matters and that recovery is a legitimate part of maintaining performance.

Importantly, leaders should model these behaviours themselves.

Train managers to recognise early warning signs

Managers are often best positioned to notice changes in behaviour, workload capacity, or engagement. Providing leaders with training in mental health awareness and supportive conversations can help organisations intervene earlier and more effectively.

Focus on sustainable performance

Long hours and constant availability are not reliable indicators of productivity.

Organisations that focus on outcomes, encourage healthy boundaries, and respect time outside work are generally better positioned to prevent burnout and presenteeism.

Improve access to mental health support

Access to professional support can help employees manage challenges before they become more serious.

Many organisations provide an Employee Assistance Program (EAP) as part of their wellbeing strategy. While EAPs can be valuable, some employers are also exploring more flexible approaches that improve accessibility and encourage earlier intervention.

Support options may include counselling or psychology support, wellbeing resources psychosocial safety initiatives, and access to critical incident support.

Final thoughts

Presenteeism often signals that employees are struggling with illness, stress, burnout, or workload pressures while feeling unable to step away and recover. Left unaddressed, it can affect wellbeing, productivity, team morale, and staff retention.

Creating a healthier workplace starts with understanding the factors that drive presenteeism and fostering an environment where people feel supported to prioritise their health. This includes reviewing workloads, identifying psychosocial risks, encouraging mental health days when needed, and ensuring employees can access appropriate support.

Many organisations offer an Employee Assistance Program (EAP), while others are exploring more flexible approaches to workplace mental health. Talked's pay-as-you-go EAP provides employees with access to evidence-based support without the complexity of traditional workplace programs. If you'd like to learn more about supporting your team and creating a mentally healthier workplace, book a demo with Talked.