Background: Recently, a three-item screener, derived from the 16-item distress scale of the Four-Dimensional Symptom Checklist (4DSQ), was used to measure psychological distress in sicklisted employees. The aim of the present study was to investigate the ability of the 16-item distress scale and three-item distress screener to identify non-sicklisted employees at risk of sickness absence (SA) due to mental disorders. Methods: Prospective cohort study including 4877 employees working in distribution and transport. The 4DSQ distress scale was distributed at baseline in November 2010. SA diagnosed within the International Classification of Diseases -10 chapter F was defined as mental SA and retrieved from an occupational health register during 2-year follow-up. The area under the receiver operating characteristic curve (AUC) was used to discriminate between workers with ('cases') and without ('non-cases') mental SA during follow-up. Results: A total of 2782 employees (57%) were included in complete cases analysis; 73 employees had mental SA during 2-year follow-up. Discrimination between cases and non-cases was similar for the 16-item distress scale (AUC = 0.721; 95% CI, 0.622-0.823) and the three-item screener (AUC = 0.715; 95% CI, 0.615-0.815). Conclusion: Healthcare providers could use the three-item distress screener to identify non-sicklisted employees at risk of future mental SA.