BACKGROUND: The objective of this study was to examine the impact of psychosocial work conditions on sickness absence while addressing methodological weaknesses in earlier studies. METHODS: The participants were 13,437 employees from 698 public service workplace units in Aarhus County, Denmark. Satisfaction with psychosocial work conditions was rated on a scale from 0 (low) to 10 (high). Individual ratings were aggregated to workplace scores. Analysis of variance was used to compare the average number of days of yearly sickness absence in three groups with different levels of satisfaction with psychosocial work conditions. RESULTS: Sickness absence was 30.8% lower in the most satisfied group (11.7 days/year (CI 95%: 10.2; 13.1)) than in the least satisfied group (16.9 days/year (CI 95%: 15.3; 18.6)) adjusted for the covariates included. CONCLUSIONS: Satisfaction with psychosocial work conditions has a strong and independent impact on sickness absence. Am. J. Ind. Med. 52:153-161, 2009. (c) 2008 Wiley-Liss, Inc.