German sick leave dips slightly in first half of 2026 as mental illness becomes top cause, DAK data shows
Average sick days per worker fell to 9.6 from 9.9 a year earlier, but the government is pushing stricter rules for sick notes, sparking protests from doctors.
Slight decline in sick leave
In the first half of 2026, German employees were off sick for an average of 9.6 days, down from 9.9 days in the same period last year, according to an analysis by the DAK-Gesundheit health insurer. The sickness rate fell from 5.4% to 5.3%, meaning that on any given day, 53 out of 1,000 workers were on sick leave. The data, compiled by the IGES Institute from 2.2 million insured individuals, was released on 20 July.
The slight decline in the sickness rate is pleasing.
DAK CEO Andreas Storm cautioned that the figures can shift quickly with real-world illness waves, and that the main challenge remains long-term sickness with many days lost. He welcomed the government's prevention offensive and the planned introduction of partial sick leave as suitable instruments to sustainably lower the sickness rate.
Mental illness overtakes respiratory as top cause
For the first time, mental health conditions such as depression became the leading cause of sick leave, with 184 days lost per 100 insured persons, a 9% increase. Respiratory illnesses, which had topped the list in early 2025 due to a severe flu wave in January and February, dropped by 21% to 175 days per 100 insured. Musculoskeletal problems like back pain ranked third at 174 days.
- Mental illness
- 184 days per 100 insured
- Respiratory
- 175 days per 100 insured
- Musculoskeletal
- 174 days per 100 insured
Age divide: younger workers less sick, over-60s more
The decline in sick leave was concentrated among workers under 55, with the sharpest drops among the youngest: the sickness rate for 15- to 19-year-olds and 20- to 24-year-olds each fell by 0.3 percentage points. In contrast, employees over 60 saw a 0.3 percentage point increase, driven not by more frequent absences but by longer durations when they did fall ill.
Government pushes stricter sick note rules
The data arrives as the black-red coalition government, led by Chancellor Friedrich Merz (CDU), prepares to tighten sick leave regulations. The planned reforms would make a doctor's certificate mandatory from the first day of illness, rather than the current rule requiring it only from the fourth day (though employers can already demand earlier proof). Telephone sick notes, introduced during the pandemic, would be abolished. Health Minister Nina Warken (CDU) has also launched a prevention offensive targeting workplace health.
It's not about having to go to the practice on the first day, but a certificate from the first day should become the rule.
Companies would be allowed to agree on different rules internally, but the core requirement of a day-one certificate remains central to the reform.
Doctors' associations protest
The proposals have drawn sharp criticism from the medical profession. The National Association of Statutory Health Insurance Physicians (KBV) called it bordering on insanity to send thousands of people to already overcrowded practices just to fill out forms.
Anyone who is coughing or has a gastrointestinal infection belongs in bed, not in an overcrowded practice.
The government has not yet set a timeline for the legislation, but the debate is expected to intensify as the Bundestag returns from its summer break.
