How sick is Berlin?

Berliners take more sick leave than the average German, and they suffer from depression and ‘burnout’ more – at least according to the stats. Is the Berliner Luft making us ill? Or are we all just lazy? We asked the experts.

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Photo by Dirk Vorderstraße (CC BY 2.0)

Berliners take more sick leave than the average German, and they suffer from depression and ‘burnout’ more – at least according to the stats. Is the Berliner Luft making us ill? Or are we all just lazy? We asked the experts.


Image for How sick is Berlin?
Photo by Tamsin Ross Van Lessen

Berlin macht krank (Berlin makes you sick)”, or so a frequent newspaper headline goes. And there seems to be some truth behind it. In 2016, 4.1 percent of employees in Berlin were out sick on an average day, versus 3.9 percent for the whole of Germany according to insurance company DAK Gesundheit. Fellow insurer BKK Dachverband concurred: Berliners took an average of 17.1 sick days in 2015, almost two more than the average German (15.4), and four more than employees in the western state of Baden-Württemberg. Meanwhile, record highs were to be found in Saxony-Anhalt (20.4 days). So is it an Eastern thing? Stefan Poetig, spokesperson for DAK Berlin explains: “In the GDR, it was the practice to get a doctor’s note from day one of an illness, so people still tend to go to the doctor earlier when they’re sick. To an extent, this contributes to Berlin’s higher sickness rate compared to the West.”


The top three reasons for sick leave in Berlin, according to recent stats: musculoskeletal issues like back pain, respiratory infections and mental and behavioural disorders. The latter, which accounts for between 13 percent and 18 percent of all sick days, is particularly unique to Berlin, with BKK citing 284 days of sick leave due to mental illness per 100 members in 2015, well above the German average of 232.7 days.

Are Berliners a sad bunch? According to a 2013 BKK study, 11.4 percent of insured people have been diagnosed with depression, compared to the 9.4 percent German average – only Hamburg, Germany’s second-largest city, fares worse with 12 percent. Psychology professor Frank Jacobi, one of the co-authors of the study, relates the higher rates of depression diagnoses to “urban stress factors”, but not only: “People with a certain predisposition to mental illness tend to be drawn to bigger cities.” So, Berlin attracts the crazies and depressives of Germany and the world? Sounds plausible.

Psychologist Dirk Rennert, who co-edited the study, offers an additional explanation: “There are more therapists in urban areas, so people with mental health problems are more likely to seek help.” This could also explain why in Bavaria, where there is a high density of therapists, the rate of depression is as high as in Berlin – although the industrious southerners don’t take as many sick days for it.

In other words, mental illness isn’t on the rise, just its diagnosis. “Gradually, less stigma is being attached to mental illness. More people are willing to seek help, whereas in the past people with depression were diagnosed with back problems, for example.” IS


Meanwhile, Berlin boasts the highest outpatient treatment rate for burnout syndrome in the country, with 1.53 percent of cases versus a nationwide average of 1.16 percent (BKK, 2013). The mysterious condition which basically means “feeling too exhausted to function properly”, was a trendy diagnosis in Germany for a while, despite being dismissed by the World Health Organisation as a “German phenomenon”, not accounting for “a proper mental or behavioural disorder”.

But overall, burnout seems to be on the decline in Germany. According to DAK, it accounted for 4.3 sick days per 100 insured people in 2015, a steep drop from the 2011 peak of 10.2 days! So are fewer Germans burning out, or are they simply being re-diagnosed? The fact that the number of sick days on account of depression has increased by 41 percent (from 81 to 114 days per 100 insured people) might attest to the latter. On publication of those figures in May 2016, DAK health expert Elisabeth Thomas commented, “Depression has more often been called ‘burnout’ in Germany, as this was more socially accepted – it was understood as a disorder of high performers.”


Last year saw the lowest sickness rate in Berlin in eight years (a 7.3 percent decrease from 2015) and a nearly eight percent dip in the number of sick days on account of mental illness. Are Berliners getting healthier?

Andreas Splanemann, the Berlin spokesperson for the Verdi trade union, is sceptical: “Less sick leave does not mean less illness, that’s my suspicion,” he says. “If you look at Berlin’s high share of precarious jobs, it’s likely that workers fear losing their jobs when they are off sick.” Vincent Jörres, spokesperson for the German association of GPs, agrees: “A drop in the number of absence days is not necessarily related to health reasons. Employees who are under pressure in their jobs may tend not to take sick leave, or even see a doctor.”

In other words: Berlin’s a “normal” Western city now, complete with an increasingly work-focused culture where a simple cold (or a hangover from mid-week partying) no longer warrants time away from the office. First-world capitalism might finally have arrived!