Organisational justice and change in justice as predictors of employee health: the Whitehall II study

Do pre-employment influences explain the association between psychosocial factors at work and coronary heart disease? The Whitehall II study

OBJECTIVES

To examine whether the association between psychosocial factors at work and incident coronary heart disease (CHD) is explained by pre-employment factors, such as family history of CHD, education, paternal education and social class, number of siblings and height.

METHODS

A prospective cohort study of 6435 British men aged 35-55 years at phase 1 (1985-1988) and free from prevalent CHD at phase 2 (1989-1990) was conducted. Psychosocial factors at work were assessed at phases 1 and 2 and mean scores across the two phases were used to determine long-term exposure. Selected pre-employment factors were assessed at phase 1. Follow-up for coronary death, first non-fatal myocardial infarction or definite angina between phase 2 and 1999 was based on clinical records (250 events, follow-up 8.7 years).

RESULTS

The selected pre-employment factors were associated with risk for CHD: HRs (95% CI) were 1.33 (1.03 to 1.73) for family history of CHD, 1.18 (1.05 to 1.32) for each quartile decrease in height and 1.16 (0.99 to 1.35) for each category increase in number of siblings. Psychosocial work factors also predicted CHD: 1.72 (1.08 to 2.74) for low job control and 1.72 (1.10 to 2.67) for low organisational justice. Adjustment for pre-employment factors changed these associations by 4.1% or less.

CONCLUSIONS

In this occupational cohort of British men, the association between psychosocial factors at work and CHD was largely independent of family history of CHD, education, paternal educational attainment and social class, number of siblings and height.

Psychosocial work environment and emotional exhaustion--does a service provision model play a role?

OBJECTIVES

To investigate whether outsourcing of primary health care (PHC) services has affected the psychosocial work environment and emotional exhaustion.

METHODS

Panel mail study 2000-2002 in Finland, 369 PHC employees. Comparison between Southern municipality (SM) after outsourcing PHC services to a not-for-profit organization and three municipalities with municipal service providers.

RESULTS

Despite the positive development of the psychosocial work environment in SM, emotional exhaustion had increased there like in the comparison municipalities. However, in 2002 emotional exhaustion was at a lower level in SM than in one of the comparison municipalities. This difference could not be attributed to the production model itself but rather to baseline levels and changes in work demands and work resources.

CONCLUSIONS

Outsourcing of PHC services may improve employee health and thus effectiveness of health care if a new service provider emphasizes employee health more than a previous one and is more flexible to improve the quality of the psychosocial work environment. However, change itself may be stressful, and frequent changes of service providers should be avoided.

Promoting employee wellbeing: the relevance of work characteristics and organizational justice

Research focusing on the relationship between organizational justice and health suggests that perceptions of fairness can make significant contributions to employee wellbeing. However, studies examining the justice-health relationship are only just emerging and there are several areas where further research is required, in particular, the uniqueness of the contributions made by justice and the extent to which the health effects can be explained by linear, non-linear and/or interaction models. The primary aim of the current study was to determine the main, curvilinear and interaction effects of work characteristics and organizational justice perceptions on employee wellbeing (as measured by psychological health and job satisfaction). Work characteristics were measured using the demand-control-support (DCS) model (Karasek and Theorell, 1990) and Colquitt's (2001) four justice dimensions (distributive, procedural, interpersonal and informational) assessed organizational justice (Colquitt, 2001). Hierarchical regression analyses found that in relation to psychological health, perceptions of justice added little to the explanatory power of the DCS model. In contrast, organizational justice did account for unique variance in job satisfaction, the second measure of employee wellbeing. The results supported linear relationships between the psychosocial working conditions and the outcome measures. A significant two-way interaction effect (control x support at work) was found for the psychological health outcome and the procedural justice by distributive justice interaction was significant for the job satisfaction outcome. Notably, the findings indicate that in addition to traditional job stressors, health promotion strategies should also address organizational justice.

Physical and psychosocial working conditions as explanations for occupational class inequalities in self-rated health

BACKGROUND

Socio-economic health inequalities are well documented, but efforts to explain health inequalities are less. However, previous studies suggest that working conditions provide potential explanations for inequalities in health.

METHODS

Cross-sectional questionnaire survey data, collected from municipal employees of the City of Helsinki, aged 40-60 years (n = 8960, response rate 67%) in 2000-02, were examined using binomial regression analysis. Socio-economic position was measured by six occupational social classes ranging from top managers to manual workers, and the outcome was self-rated health (SRH). Key physical and psychosocial working conditions and work arrangements were included as explanatory factors for inequalities in health.

RESULTS

Occupational class inequalities in SRH were clear among women [prevalence ratio (PR) 1.89, 95% confidence interval (CI) 1.54-2.32] and men (PR 1.78, 95% CI 1.40-2.25). Heavy physical workload explained a half of the health inequalities among women and almost one-third among men. Physical and chemical exposures at work explained one-fifth of the health inequalities among women and a half among men. Job control explained 24% of the men's and 40% of women's inequalities, whereas job demands widened the inequalities by 13-14%. The effects of shift work and working hours were negligible. In the fully adjusted model, 60% of the women's and 32% of the men's inequalities in SRH were explained.

CONCLUSION

Physical working conditions explained a large part and job control, a somewhat smaller part of socio-economic inequalities in SRH. Improving physical working conditions and increasing job control provide potential routes to reduced inequalities in health among employees.

Gender specificity in the prediction of clinically diagnosed depression. Results of a large cohort of Belgian workers

BACKGROUND

The recent increase in the incidence of clinical depression represents a major public health and socio-economical burden. Depression has its roots in both professional and private domains but few epidemiological studies have looked at predictors of long term clinical depression as defined by a sick-leave of 28 days or more and a diagnosis by a general practitioner in both genders.

OBJECTIVES

To study baseline predictors of long term spells of clinical depression within the framework of a large prospective study, the Belstress Study, in 6,659 men and 2,737 women aged 35-59 years at baseline survey.

METHODS

Kaplan-Meyer survival curves and Cox regression models were used in order to relate long term clinical depression defined by a sick-leave of 28 days or more to baseline socio-demographic and work and non-work variables.

RESULTS AND CONCLUSIONS

Density incidence of long term clinical depression is 0.5 years and 1.1/1,000 persons/months for men and women respectively. In univariate analyses specific gender predictors were observed as for men predictors besides level of education, were work related: high job-strain OR 1.67 (CI 95% 1.03; 2.71) and work dissatisfaction OR 1.78 (CI 95% 1.09; 2.91) whereas for women baseline predictors are related to private life dissatisfaction OR 1.84 (CI 95% 1.16; 2.91) and to a lesser degree low social support from co-workers OR 1.50 (CI 95% 0.93; 2.40). In both genders baseline severe depression symptoms defined by a CES-D score of percentile 90 or above is a predictor of long term sick-leave for clinical depression. In multivariate analyses, in a model without baseline CES-D high job-strain and job dissatisfaction remain independent predictors for incident clinical depression in men whereas only private life dissatisfaction remains a significant predictor in women. When added to the model CES-D is the most powerful predictor of clinical depression in both genders. Together with level of education, work dissatisfaction remains borderline significant in men whereas private life dissatisfaction remains an independent predictor for clinical depression in women. In men baseline symptoms of depression alleviate the impact of high job-strain on incident clinical depression whereas in women, private life dissatisfaction remains an independent predictor of clinical depression.

Does a change in psychosocial work factors lead to a change in employee health?

OBJECTIVE

The aim was to identify psychosocial factors at work that promote positive changes in employee health and factors that prevent negative changes in employee health.

METHOD

This study is part of a large longitudinal study and includes 1212 employees. Data for psychosocial work factors and self rated health was collected in 2000 and 2003. A modified Poisson regression was used to find factors of relevance for positive and negative changes in health.

RESULTS

A negative change in leadership, organizational commitment and reporting job strain increased the risk for negative change in health. Improved leadership and social climate increased the chance for positive changes in health.

CONCLUSION

By improving psychosocial factors at work, it is possible to promote employee health as well as prevent employee ill-health.

Organizational justice and sleeping problems: The Whitehall II study

OBJECTIVES

To test the hypothesis that organizational injustice contributes to sleeping problems. Poor sleep quality can be a marker of prolonged emotional stress and has been shown to have serious effects on the immune system and metabolism.

METHODS

Data were from the prospective Whitehall II study of white-collar British civil servants (3143 women and 6895 men, aged 35-55 years at baseline). Age, employment grade, health behaviors, and depressive symptoms were measured at Phase 1 (1985-1988) and baseline sleeping problems were assessed at Phase 2 (1989-1990). Organizational justice was assessed twice, at Phases 1 and 2. The outcome was mean of sleeping problems during Phases 5 (1997-1999) and 7 (2003-2004).

RESULTS

In men, low organizational justice at Phase 1 and Phase 2 were associated with overall sleeping problems, sleep maintenance problems, sleep onset problems, and nonrefreshing sleep at Phases 5 and 7. In women, a significant association was observed between low organizational justice and overall sleeping problems and sleep onset problems. These associations were robust to adjustments for age, employment grade, health behaviors, job strain, depressive symptoms, and sleeping problems at baseline.

CONCLUSIONS

This study shows that perceived unfair treatment at workplace is associated with increased risk of poor sleep quality in men and women, one potential mechanism through which justice at work may affect health.

Applying the lessons of SARS to pandemic influenza: an evidence-based approach to mitigating the stress experienced by healthcare workers

We describe an evidence-based approach to enhancing the resilience of healthcare workers in preparation for an influenza pandemic, based on evidence about the stress associated with working in healthcare during the SARS outbreak. SARS was associated with significant long-term stress in healthcare workers, but not with increased mental illness. Reducing pandemic-related stress may best be accomplished through interventions designed to enhance resilience in psychologically healthy people. Applicable models to improve adaptation in individuals include Folkman and Greer’s framework for stress appraisal and coping along with psychological first aid. Resilience is supported at an organizational level by effective training and support, development of material and relational reserves, effective leadership, the effects of the characteristics of “magnet hospitals,” and a culture of organizational justice. Evidence supports the goal of developing and maintaining an organizational culture of resilience in order to reduce the expected stress of an influenza pandemic on healthcare workers. This recommendation goes well beyond the provision of adequate training and counseling. Although the severity of a pandemic is unpredictable, this effort is not likely to be wasted because it will also support the health of both patients and staff in normal times.

Reliability and validity of the Japanese version of the Organizational Justice Questionnaire

OBJECTIVES

Previous European studies reporting low procedural justice and low interactional justice were associated with increased health problems have used a modified version of the Moorman's Organizational Justice Questionnaire (OJQ, Elovainio et al., 2002) to assess organizational justice. We translated the modified OJQ into the Japanese language and examined the internal consistency reliability, and factor-based and construct validity of this measure. A back-translation procedure confirmed that the translation was appropriate, pending a minor revision.

METHODS

A total of 185 men and 58 women at a manufacturing factory in Japan were surveyed using a mailed questionnaire including the OJQ and other job stressors.

RESULTS

Cronbach alpha coefficients of the two OJQ subscales were high (0.85-0.94) for both sexes. The hypothesized two factors (i.e., procedural justice and interactional justice) were extracted by the factor analysis for men; for women, procedural justice was further split into two separate dimensions supporting a three- rather than two-factor structure. Convergent validity was supported by expected correlations of the OJQ with job control, supervisor support, effort-reward imbalance, and job future ambiguity in particular among the men.

CONCLUSION

The present study shows that the Japanese version of the OJQ has acceptable levels of reliability and validity at least for male employees.

Effects on blood pressure do not explain the association between organizational justice and coronary heart disease in the Whitehall II study

OBJECTIVE

To examine whether lower BP mediates the inverse association between organizational justice and incident coronary heart disease (CHD). Previous studies suggest lower blood pressure (BP) and reduced risk of CHD among employees with high organizational justice (the perception of being treated fairly by supervisors).

METHODS

Prospective occupational cohort study of 4250 men and 1812 women free of CHD and hypertension at study entry (the Whitehall II study). Justice was assessed at phase 1 (1985-1988) and phase 2 (1989-1990); systolic and diastolic BP at phases 1, 3 (1992-1993), and 5 (1997-1999); hypertension at phases 3 and 5; and incident CHD from phase 2 to phase 5 (231 events, mean follow-up 9.6 years).

RESULTS

A higher level of organizational justice was associated with a slightly lower mean level of diastolic BP over time. After adjustment for age, sex, ethnicity, and employment grade, higher organizational justice was associated with lower CHD incidence. This association was not attenuated after further adjustment for measures of BP and hypertension, although these measures were associated with increased CHD risk.

CONCLUSIONS

This study suggests that sustained lower levels of BP do not represent a key mechanism through which organizational justice protects against CHD. The importance of this study is that it eliminates a strong candidate mediator of the association between organizational justice and CHD and thus allows future research to concentrate on other mechanisms.

Justice at work, job stress, and employee health

A small but growing literature has documented an association between justice at work and employee health. However, the pathways and mechanisms underlying this association are not well understood. This article proposes a conceptual framework that bridges the organizational justice, occupational stress, and occupational epidemiology literatures. Justice appraisals are proposed to be both important mediators and moderators in the causal flow from exposure to the organizational environment to employee health. The potential role of justice in enhancing employee health is compared to that of the well-established concepts of social support and job control. Directions for future research are suggested, along with strategies for overcoming challenges inherent in this multidisciplinary area of research. Implications for work-site health interventions are discussed.

Effort-reward imbalance and relational injustice at work predict sickness absence: the Whitehall II study

OBJECTIVES

Sickness absence is a major occupational health problem, but evidence for associations between potentially modifiable psychosocial work factors and sickness absence is still scarce. We studied the impact of relational justice and effort-reward imbalance on subsequent rates of sickness absence.

METHODS

The Whitehall II prospective cohort study of British civil servants, 10,308 men and women, was established between 1985 and 1988. Indicators of effort-reward imbalance and the relational component of organizational justice were constructed from questions included at baseline. Participants were classified into three groups (low, intermediate, and high) for both effort-reward imbalance and relational justice. Short (< or =7 days) and long (>7 days) spells of sickness absence during 1985-1989 and 1991-1995 were used to study immediate and longer term effects of work characteristics.

RESULTS

After adjustment for age, employment grade, and baseline health, men and women with low relational justice had increased risks of long spells of sickness absence of 14% and 28% in comparison to men and women experiencing high levels of justice. Similar effect sizes (25% and 21%) were found for high vs. low effort-reward imbalance. Both work measures also predicted short spells of sickness absence. Effort-reward imbalance (men and women) and relational justice (women only) each predicted long spells of sickness absence independently of the other.

CONCLUSIONS

Both relational justice and effort-reward imbalance are important determinants of sickness absence. Workplace interventions to improve these aspects of working conditions have the potential to reduce levels of sickness absence.

Organisational justice and smoking: the Finnish Public Sector Study

OBJECTIVE

To examine the extent to which the justice of decision-making procedures and interpersonal relationships is associated with smoking.

SETTING

10 municipalities and 21 hospitals in Finland.

DESIGN AND PARTICIPANTS

Cross-sectional data derived from the Finnish Public Sector Study were analysed with logistic regression analysis models with generalised estimating equations. Analyses of smoking status were based on data provided by 34,021 employees. Separate models for heavy smoking (> or = 20 cigarettes/day) were calculated for 6295 current smokers.

RESULTS

After adjustment for age, education, socioeconomic position, marital status, job contract and negative affectivity, smokers who reported low procedural justice were about 1.4 times more likely to smoke > or = 20 cigarettes/day compared with their counterparts who reported high levels of justice. In a similar way, after adjustments, low levels of justice in interpersonal treatment was significantly associated with an increased prevalence of heavy smoking (OR 1.35, 95% CI 1.03 to 1.77 for men and OR 1.41, 95% CI 1.09 to 1.83 for women). Further adjustment for job strain and effort-reward imbalance had little effect on these results. No associations were observed between justice components and smoking status or ex-smoking.

CONCLUSIONS

The extent to which employees are treated with justice in the workplace seems to be associated with smoking intensity independently of established stressors at work.

Effort-reward imbalance, procedural injustice and relational injustice as psychosocial predictors of health: complementary or redundant models?

OBJECTIVE

Effort-reward imbalance at work is an established psychosocial risk factor but there are also newer conceptualisations, such as procedural injustice (decisions at work lack consistency, openness and input from all affected parties) and relational injustice (problems in considerate and fair treatment of employees by supervisors). The authors examined whether procedural injustice and relational injustice are associated with employee health in addition to, and in combination with, effort-reward imbalance.

METHODS

Prospective survey data from two cohorts related to public-sector employees: the 10-Town study (n = 18 066 (78% women, age range 19-62) and the Finnish Hospital Personnel study (n = 4833, 89% women, age range 20-60). Self-rated poor health, minor psychiatric morbidity and doctor-diagnosed depression were assessed at baseline (2000-2) and at follow-up (2004). To determine incident morbidity, baseline cases were excluded.

RESULTS

In multivariate models including age, sex, occupational status and all three psychosocial factors as predictors, high effort-reward imbalance and either high procedural injustice or high relational injustice were associated with increased morbidity at follow-up in both cohorts. After combining procedural and relational injustice into a single measure of organisational injustice, high effort-reward imbalance and high injustice were both independently associated with health. For all outcome measures, a combination of high effort-reward imbalance and high organisational injustice was related to a greater health risk than high effort-reward imbalance or injustice alone.

CONCLUSION

Evidence from two independent occupational cohorts suggests that procedural and relational components of injustice, as a combined index, and effort-reward imbalance are complementary risk factors.

Workplace conflict resolution and the health of employees in the Swedish and Finnish units of an industrial company

New patterns of working, the globalisation of production and the introduction of information technologies are changing the way we work. This new working environment has eliminated some risks whilst introducing others. The importance of the psychosocial working environment for the health of employees is now well documented, but the effects of managerial style have received relatively little attention. Yet management is an increasingly important aspect of companies' policies. In this paper, we examine the relationship between conflict management in the workplace and self-reported measures of stress, poor general health, exhaustion and sickness absence due to overstrain or fatigue. Our sample consists of non-supervisory employees (N = 9309) working in the Swedish and Finnish plants of a multinational forestry company who were surveyed in 2000. Bivariate analyses show that those who report that differences are resolved through discussion are least likely to report stress, poor general health, exhaustion or sickness absence. Those who report that authority is used or that no attempts are made to resolve differences have quite similar rates across all measures. Binary logistic regression analyses were performed for all health outcomes controlling for age, sex, occupational group, job complexity, job autonomy and support from superiors. Results show significantly lower likelihoods of reporting stress, poor general health, exhaustion or sickness absence amongst employees who report that differences of opinion are resolved through discussion compared to those who report that no attempts are made. No significant differences were found between those who reported that differences were resolved through use of authority and subjects in the 'no attempt' category. These results suggest that the workplace conflict resolution is important in the health of employees in addition to traditional psychosocial work environment risk factors.

Injustice at work and incidence of psychiatric morbidity: the Whitehall II study

BACKGROUND

Previous studies of organisational justice and mental health have mostly examined women and have not examined the effect of change in justice.

AIM

To examine effects of change in the treatment of employees by supervisors (the relational component of organisational justice) on minor psychiatric morbidity, using a cohort with a large proportion of men.

METHODS

Data are from the Whitehall II study, a prospective cohort of 10 308 white-collar British civil servants (3143 women and 6895 men, aged 35-55 at baseline) (Phase 1, 1985-88). Employment grade, relational justice, job demands, job control, social support at work, effort-reward imbalance, physical illness, and psychiatric morbidity were measured at baseline. Relational justice was assessed again at Phase 2 (1989-90). The outcome was cases of psychiatric morbidity by Phases 2 and 3 (1991-93) among participants case-free at baseline.

RESULTS

In analyses adjusted for age, grade, and baseline physical illness, women and men exposed to low relational justice at Phase 1 were at higher risk of psychiatric morbidity by Phases 2 and 3. Adjustment for other psychosocial work characteristics, particularly social support and effort-reward imbalance, partially attenuated these associations. A favourable change in justice between Phase 1 and Phase 2 reduced the immediate risk (Phase 2) of psychiatric morbidity, while an adverse change increased the immediate and longer term risk (Phase 3).

CONCLUSION

This study shows that unfair treatment by supervisors increases risk of poor mental health. It appears that the employers' duty to ensure that employees are treated fairly at work also has benefits for health.

Psychosocial work characteristics and incidence of newly diagnosed depression: a prospective cohort study of three different models

This study explored the association between psychosocial work characteristics and incidence of depression as indicated in three complementary models (the Job Strain Model, the Team Climate Model, and the Procedural Justice Model). Participants were 4815 Finnish hospital personnel (4278 women and 537 men) free from diagnosed depression at entry into the study. A baseline survey in 1998 measured psychosocial work characteristics, health-related behaviours, psychological distress, and doctor-diagnosed depression. The factor analysis of pooled questionnaire items on psychosocial work characteristics supported a five-factor solution with the following distinct dimensions: team climate, relational justice, procedural justice, job control, and job demands. Items in these dimensions were used as scales and job strain was modelled as a combination of job demands and job control. A follow-up survey in 2000 identified 225 incident cases of depression. After adjustment for age, sex and income, poor team climate, low procedural justice, and low relational justice were associated with a higher risk of new depression, the odds ratios (ORs) 1.58 (95% confidence interval (CI) 1.11-2.24), 1.45 (95% CI 1.03-2.04), and 1.39 (95% CI 1.00-1.96), respectively. After additional adjustment for lifestyle factors and exclusion of those with psychological distress at baseline, there was still an association between poor team climate and risk of depression (ORs 1.55 and 1.75, respectively). Job control, work demands, and job strain did not predict the 2-year incidence of depression, and the effects of all psychosocial work characteristics were attenuated when entered simultaneously in the model. In conclusion, work unit social factors seem to be predictive of subsequent doctor-diagnosed depression, but other aspects of psychosocial work environment may also be important.

A prospective study of cumulative job stress in relation to mental health

Background

This study tests associations between psychosocial stress at work measured by the effort-reward imbalance model in a dynamic perspective, and multiple indicators of poor mental health, in a prospective design.

Methods

1986 male and female employees from four Belgian enterprises were followed-up over one year within the framework of the Somstress study. Based on two consecutive measurements, an index of cumulative job stress was constructed and its associations with five indicators of mental health were studied, excluding caseness at entry (for depression, anxiety, somatisation, chronic fatigue and psychotropic drug consumption respectively). Taking into account the longitudinal design, four categories of job stress are defined: 1) employees free from stress at both measures, 2) job stress present at first measure but not at the second one, 3) recent onset of job stress as evidenced by second measure 4) workers exposed to stress at both measures. Multivariate logistic regression with appropriate adjustments was applied.

Results

In bivariate analysis, a clear graded association of cumulative job stress with all five mental health indicators is observed, both in men and women. In multivariate logistic regression analysis, recent onset of stress is strongly associated with poor mental health among men (odds ratios ranging from 1.8 to 4.6), while cumulative stress shows strongest effects on mental health in women (odds ratios ranging from 1.4 to 7.1).

Conclusion

Cumulative experience and recent onset of job stress in terms of high effort spent and low reward received is associated with elevated risk of all five indicators of poor mental health at follow-up in a large cohort of employees.

Labor market trajectories and health: a four-year follow-up study of initially fixed-term employees

With the growth of atypical employment, there is increasing concern about the potential health-damaging effects of unstable employment. This prospective study of Finnish public-sector employees in 1998-2002 examined labor market trajectories and changes in health. At entry, all participants had a fixed-term job contract. Trajectories were measured by exposure to unstable employment during follow-up, destination employment status at the end of follow-up, and the way in which these elements were combined. Nonoptimal self-rated health at baseline was associated with high exposure to unstable employment and unemployment as the destination. After adjustment for health and psychological distress at baseline, a trajectory with stable employment as the destination was associated with a decreased risk of psychological distress at follow-up (odds ratio = 0.68, 95% confidence interval: 0.46, 0.98), whereas a trajectory toward the labor market periphery was related to increased risk of nonoptimal health (odds ratio = 2.54, 95% confidence interval: 1.47, 4.39) when compared with remaining in fixed-term employment. A significant dose-response relation was seen between the measure combining exposure to instability with destination employment status and nonoptimal health. This longitudinal study provides evidence of health-related selection into employment trajectories and suggests that the trajectories themselves carry different health risks.