New research from Claire Smith, an assistant professor of psychology at the University of South Florida, finds that employees who feel pressure to work while sick can harm not only their own productivity but also their workplace. This pressure can lead to issues like theft, mistreating coworkers, and even a desire to quit. According to Harvard Business Review, the cost of this behavior, known as “presenteeism,” may reach up to $150 billion a year.

The high costs

Here are some key points from the research, which studied four different groups of workers:

Though staying home sick (absenteeism) lowers productivity, going to work while sick (presenteeism) costs even more. The study introduces “presenteeism pressure”—the expectation that workers should always show up, no matter their condition—and provides a tool, the Presenteeism Pressure Scale, to measure it.

In a survey of 764 workers, many said they worked while sick not just because of personal reasons, but because their workplaces made it seem necessary. This shows how workplace culture can strongly influence whether people come to work when they’re ill.

Employees who feel pressured to work while sick tend to view their employers negatively, feeling that the organization doesn’t care about their well-being. This leads to lower satisfaction and commitment, a conclusion supported by data from more than 800 workers across various industries.

The study also found that this pressure is linked to unproductive and harmful behaviors, and makes employees more likely to want to quit. Data from a group of 350 workers followed over three months confirmed the costly impact of forcing people to work when they’re not well.