Mental Health Overtakes Respiratory Illness as Top Cause of German Sick Leave

For the first time on record, psychological disorders have become the leading reason for work absences in Germany, according to new data from DAK-Gesundheit. The shift comes as the country’s governing coalition pushes forward with controversial plans to tighten sick-note rules.

The health insurer’s half-year report for 2026 shows an overall drop in absenteeism. The sickness rate fell to 5.3 percent from 5.4 percent a year earlier, while average missed days per employee slipped from 9.9 to 9.6. The improvement was driven largely by a 21 percent decline in respiratory infections, which now account for 175 sick days per 100 insured members.

But mental health diagnoses tell a different story. They jumped 9 percent to 184 days per 100 members, making them the single biggest driver of lost work time. The hardest-hit demographic is workers aged 60 and older. DAK CEO Andreas Storm has called for introducing partial sick leave and expanding prevention programs aimed at long-term illness.

The political debate around absenteeism is heating up. In early July, the coalition committee of the CDU, CSU, and SPD agreed to reverse current policy: employees would need to present a doctor’s note starting from the first day of illness, rather than from the fourth day as now. The change would also scrap the telephone-based sick certification introduced during the pandemic.

Implementation, however, is not guaranteed. The SPD has made its approval conditional on establishing a guaranteed appointment system for specialist doctors. The Union has signaled openness to allowing exceptions through company-level agreements.

Medical professionals are pushing back hard. The National Association of Statutory Health Insurance Physicians called the plan “out of touch with reality,” arguing it would flood practices with patients seeking nothing more than paperwork. Each practice could see up to 15 extra patients daily. One general practitioner warned that telephone certification remains valuable for mild infections, as it prevents contagious patients from spreading illness in waiting rooms.

The Left Party in Saxony’s state parliament also opposes the move. Parliamentary group leader Susanne Schaper said sick people would be forced to drag themselves to clinics, worsening their conditions. Notably, telephone sick notes already play a minor role — they account for just 0.8 to 1.2 percent of all certifications.

Public sentiment runs against the proposed change. A Civey survey of 2,000 workers found that 72 percent feel they must justify calling in sick. More than 95 percent admitted to having gone to work while ill, fearing negative consequences. A separate YouGov poll showed 59 percent of the population reject mandatory sick notes from day one.

The broader reform package includes other measures. The maximum fixed-term contract duration without a specific reason would double from two to four years. And starting in 2027, top earners making at least €177,500 in annual gross salary would see their dismissal protection weakened — in exchange for a severance payment.

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