The contribution from psychological, social, and organizational work factors to risk of disability retirement: a systematic review with meta-analyses

Disability Evaluation and Treatment for Patients With Psychiatric Disorders

Primary care physicians (PCPs) are often asked to perform disability evaluations for patients with psychiatric disorders, which are now a leading cause of disability worldwide. After acknowledging the limitations of disability assessments for all conditions, this review aims to provide PCPs with practical knowledge to inform their assessments and interventions with a focus on patients with depression. After the disability definitions and programs in the United States are reviewed, a pragmatic approach to assessing function and discussing return to work is offered. Individualized assessment is key, and functional recovery rather than symptom relief should be prioritized. Finally, evidence-based interventions for enhancing the likelihood of return to work are considered. We believe the principles of functional assessment and recovery lend themselves to ready adaptation for use in other psychiatric conditions and chronic somatic syndromes, including chronic pain. The key principles of this approach are as follows: 1) a patient is not categorically disabled, but has specific limitations in specific contexts; 2) graded, work-oriented rehabilitation with tailored problem-solving strategies are essential; 3) involving a multidisciplinary team in coordinated care optimizes functional recovery; 4) return to work is an iterative process aimed at restoring meaningful function in a stepwise fashion; and 5) the relationship between symptoms and function is bidirectional. PCPs can use these principles to plan optimal recovery paths for psychiatrically ill patients presenting with a wide array of biopsychosocial realities.

Joint association of physical and psychosocial working conditions with risk of long-term sickness absence: Prospective cohort study with register follow-up

Aims: The interplay between physical and psychosocial working conditions for the risk of developing poor health is not well understood. This study aimed to determine the joint association of physical and psychosocial working conditions with risk of long-term sickness absence (LTSA) in the general working population. Methods: Based on questionnaire responses about physical working conditions and psychosocial working conditions (influence at work, emotional demands, support from colleagues and support from managers) and two-year prospective follow-up in a national register on social transfer payments, we estimated the risk of incident LTSA of >30 days among 9544 employees without previous LTSA from the Danish Work Environment Cohort Study. The analyses were censored for all events of permanent labour market drop-out (retirement, disability pension, immigration or death) and controlled for potential confounders. Results: In the total cohort, more demanding physical working conditions were associated with risk of LTSA in a dose-response fashion (trend test, p<0.0001). The combination of poor overall psychosocial working conditions (index measure of influence at work, emotional demands, support from managers and support from colleagues) and hard physical working conditions showed the highest risk of LTSA. However, poor overall psychosocial working conditions did not interact with physical working conditions in the risk of LTSA (p=0.9677). Conclusions: The results of this study suggest that workplaces should strive to improve both psychosocial and physical work factors in order to ensure the health of workers.

Work above shoulder level and shoulder complaints: a systematic review

OBJECTIVE

To investigate the association and the exposure-response relationship between work above shoulder height and shoulder pain or disorders.

METHODS

A systematic search was performed in Medline, Embase, and Health and Safety Science Abstracts. Included were articles with prospective cohort, case-control, cross-sectional, or intervention study designs. Quality assessment was based on an evaluation scheme adjusted to study design and normalized to 100%. The cut-off for sufficient quality to include articles was above 40% and cut-off for high-quality articles was above 50% of maximal score. The level of strength of evidence for an association between exposure and effect was assessed according to the GRADE guidelines.

RESULTS

Thirty-four articles were included. Articles that document large effects (higher risk estimates; OR ≥ 2) have higher quality score, include analyses of severe arm elevation, more often use clinical outcome, and report an exposure-response relationship compared to studies reporting lower risk estimates. The studies that reported large effects were all significant. An exposure-response relationship was found in many high-quality studies when relating exposure intensity of arm elevation (level of arm elevation, amplitude) as well as duration of arm elevation, especially > 90°.

CONCLUSION

We conclude on a limited evidence for an association between arm elevation at work and shoulder disorders. Severe arm elevation with elbows above shoulder level (i.e., > 90°) shows a moderate evidence for an association with shoulder disorders.

Prevalence, clustering and combined effects of lifestyle behaviours and their association with health after retirement age in a prospective cohort study, the Nord-Trøndelag Health Study, Norway

Background

Lifestyle behaviours are potential risk factors for disease and mortality, but less is known about the association with health in retirement age. The aim of this paper was to study the prevalence, clustering and combined effects of lifestyle behaviours and their association with health outcomes in the first decade after retirement in a Norwegian cohort.

Methods

Participants were 55–64-year-olds at baseline in the Nord-Trøndelag Health Survey 2 (HUNT2, 1995–97) who also participated in HUNT3 (2006–08). Logistic regression analyses were used to investigate the association of daily smoking, physical inactivity, risky alcohol consumption, disturbed sleep duration, excessive sitting time and low social participation before retirement with self-rated health (n = 4022), life satisfaction (n = 5134), anxiety (n = 4461) and depression (n = 5083) after retirement, 11 years later.

Results

Low social participation and physical inactivity were the most prevalent lifestyle behaviours (41.1 and 40.6%). Risky alcohol consumption and disturbed sleep were the lifestyle behaviours most strongly associated with poor self-rated health, poor life satisfaction and anxiety after retirement (OR’s = 1.39–1.92). Physical inactivity was additionally associated with depression (OR = 1.44 (1.12–1.85)). Physical inactivity had the largest population attributable fractions for reducing poor self-rated health and depression (14.9 and 8.8%). An increasing number of lifestyle risk behaviours incrementally increased the risk for the adverse health outcomes.

Conclusions

Risky alcohol consumption and disturbed sleep duration were most strongly associated with poor health outcomes after retirement age. On a population level, increased physical activity before retirement had the largest potential for reducing adverse health outcomes after retirement age.

Individual- and Company-Level Predictors of Receiving Vocational Rehabilitation: A Multilevel Study of Finnish Private Sector Workplaces

Purpose The aim of this study was to examine the magnitude of company-level variation in vocational rehabilitation (VR) and to determine which individual- and company-level characteristics are associated with receiving VR due to mental disorders, musculoskeletal diseases, and other somatic diseases. Methods A 30% random sample of all Finnish private sector companies with more than 10 employees aged 25-62 years at the end of 2010 (5567 companies with 300,601 employees) was followed up for the receipt of VR over the next 6 years. Company size and industry, as well as gender, age, education, social class and sickness absence measured both at the individual- and company-level were used as explanatory variables in multilevel logit models. Results After controlling for the individual-level characteristics, 12% of the variance in VR was attributed to the company level. The proportion was largest in VR due to musculoskeletal diseases. Receiving VR was more common among women, older employees (except the oldest age group), those with low education (particularly due to musculoskeletal diseases), low social class, and previous sickness absence. Receiving VR was more common in larger companies, and in construction and in health and social work, and less common in professional, scientific and technical activities. Furthermore, receiving VR was more common in companies with low proportion of highly educated employees and with higher sickness absence rates. Conclusions Company-level variation in receiving VR was substantial. Adopting the practices of the companies with highest participation in VR could help to avoid work disability problems.

Social inequalities in medical rehabilitation outcomes-a registry-based study on 219 584 insured persons in Germany

BACKGROUND

Given limited knowledge on the extent of social inequalities in longer-term work ability of people with a chronic disease, this study analyzes social inequalities of three consecutive indicators of work ability following medical rehabilitation in a large sample of insured employees.

METHODS

Based on data from the German statutory pension insurance, a representative 20% random sample of all employed persons undergoing medical rehabilitation between 2006 and 2008 was included in a longitudinal analysis (n=219 584 persons). Three measures of consecutive work-related outcomes (physicians' assessment of work ability at discharge; return to work in the year thereafter; disability pension during follow-up) and socioeconomic position (SEP) (education, occupational position and income) were assessed. Adjusted relative risks (RRs) for each outcome were calculated according to SEP, applying Poisson regression analysis.

RESULTS

The measures of SEP were associated with all three outcomes of work ability in the fully adjusted models. Relatively strongest relationships were observed for education as SEP measure, and they were particularly pronounced for 'low work ability' (RR=2.38 for lower secondary education compared to tertiary education; 95% CI: 2.26-2.51). Based on average marginal effects, absolute differences of work ability by SEP indicate a socially graded pattern, with only few exceptions.

CONCLUSIONS

Despite Germany's universal access to medical and vocational rehabilitation social inequalities in longer-term work ability following chronic disease persist, thus calling for targeted programmes of prevention and occupational health promotion.

Combinations of Job Demands and Job Control and Future Trajectories of Sickness Absence and Disability Pension An 11-year Follow-up of Two Million Employees in Sweden

OBJECTIVE

The aim of this study was to examine the association between combinations of job demands/control and future sickness absence (SA) and disability pension (DP) trajectories over 11 years.

METHODS

A population-based prospective cohort study of female (n = 1,079,631) and male (n = 1,107,999) employees in 2001. With group-based trajectory analysis, we modeled the trajectories of annual mean SA/DP days in 2002 to 2012. We predicted trajectory memberships for job demands/control using multinomial regression.

RESULTS

We found three SA/DP trajectories for women (low stable, medium stable, and high increasing) and two for men (low stable and high increasing). Low demands/low control in women [odds ratio (OR) 1.42; 95% confidence interval (95% CI) 1.38 to 1.45], and low demands and medium/high control in men (equal OR of 1.23; 95% CI 1.18 to 1.28) were strongly associated with high increasing trajectory.

CONCLUSION

The associations between job demands/control varied between SA/DP trajectories and between sexes.

Labor market exit around retirement age in Sweden and trajectories of psychotropic drugs in a context of downsizing

Background

A maintained psychological wellbeing is important in order to continue working longer and remain active into older age. However, little is known about impact of different organizational factors, such as downsizing, on the mental health of older workers exiting the labor market. The aim in this study was to investigate trajectories of purchases of psychotropic drugs in relation to labor market exit later in life in a context with and without downsizing.

Method

People living in Sweden, born 1941–1951, exiting paid work via unemployment, sickness absence/disability pension, or old-age pension were followed from 2005 to 2013 regarding purchases of psychotropic drugs. Individuals employed at a workplace closing down or downsizing with ≥18% between two subsequent years were compared to employees exiting from workplaces without downsizing or workplace closure. Generalized estimating equations was applied to derive trajectories of annual prevalence of purchased antidepressants, sedatives and anxiolytics from 4 years before to 4 years after a labour market exit.

Results

During the period around the exit, old-age retirees experiencing a downsizing/workplace closure did not decrease their purchases of sedatives (OR 1.01 95% CI 0.95–1.07) while the unexposed decreased their purchases during this period (OR 0.95 95% CI 0.92–0.98). Similar differences concerning sedatives and antidepressants between exposed and unexposed were seen for those exiting via sickness absence or disability pension. Furthermore, a significant difference in purchases of anxiolytics was observed between those exposed to downsizing (OR 1.10 95% CI 0.97–1.24) and the unexposed (OR 0.98 95% CI 0.91–1.06) exiting via old-age retirement during the time before the exit.

Conclusion

Downsizing or workplace closure, although weakly, was associated with higher prevalence of psychotropic drugs certain years around the labor market exit. The results support the idea that involuntary labor market exit in mature adulthood may negatively affect the development of mental health.

Physical working conditions and subsequent disability retirement due to any cause, mental disorders and musculoskeletal diseases: does the risk vary by common mental disorders?

PURPOSE

Physical work exposures and common mental disorders (CMD) have been linked to increased risk of work disability, but their joint associations with disability retirement due to any cause, mental disorders or musculoskeletal diseases have not been examined.

METHODS

The data for exposures and covariates were from the Finnish Helsinki Health Study occupational cohort surveys in 2000-2002, 2007 and 2012. We used 12,458 observations from 6159 employees, who were 40-60 years old at baseline. CMD were measured by the General Health Questionnaire (GHQ-12, cut-off point 3+). Four self-reported work exposures (hazardous exposures, physical workload, computer and shift work) were combined with CMD and categorized as "neither", "work exposure only", "CMD only", and "both". Associations with register-based disability retirement were assessed with Cox proportional hazards models for sample survey data adjusting for confounders over 5-year follow-up. Additionally, synergy indices were calculated for the combined effects.

RESULTS

Those reporting CMD and high physical workload had a greater risk of disability retirement due to any cause (HR 4.26, 95% CI 3.60-5.03), mental disorders (HR 5.41, 95% CI 3.87-7.56), and musculoskeletal diseases (HR 4.46, 95% CI 3.49-5.71) when compared to those with neither. Synergy indices indicated that these associations were synergistic. Similar associations were observed for CMD and hazardous exposures, but not for combined exposures to CMD and computer or shift work.

CONCLUSIONS

Identification of mental health problems among employees in physically demanding jobs is important to support work ability and reduce the risk of premature exit from work due to disability.

Temporary Disability Pension, RTW-Intentions, and RTW-Behavior: Expectations and Experiences of Disability Pensioners over 17 Months

Purpose: Individuals receiving a temporary disability pension (TDP) should get the opportunity to return to work (RTW). The current study aims to determine the factors contributing to RTW. Methods: 453 individuals on TDP were interviewed at three measurement points (T1, T2 = T1 + approximately 7 months, T3 = T1 + approximately 17 months). Socio-demographics, psychological predictors, and current work status (maintained TDP, permanent disability pension, old-age pension, employed, or receipt of other benefits) were assessed. Results: Throughout the duration of the study, only four of the former temporary disability pensioners returned to work, and an additional seven made themselves available to the labor market. These were individuals who were younger, in TDP for a shorter period of time, and reported a higher RTW-intention. Higher RTW-intention was cross-sectionally associated with younger age, shorter TDP duration, and more positive outcome expectancies. Additionally, study participants who expected that medical rehabilitation would help them RTW were more motivated to RTW. An increase in RTW-intention over 17 months was related to younger age and better health. Conclusion: Personal factors such as self-efficacy and job-related variables appear less important for RTW than age and subjective health status. The observed RTW rates call for early support and tailored medical rehabilitation interventions that help individuals prevent functional limitations, overcome disability, and facilitate RTW.

Interaction effects of physical and psychosocial working conditions on the risk of disability pension among nursing professionals and care assistants in Sweden: A prospective study

BACKGROUND

Nursing professionals and care assistants are often subject to a combination of negative physical and psychosocial work environment factors, but most disability pension studies on such occupations have focused on one or the other of these factors. As they often coexist, there are reasons to assume that simultaneously being exposed to both types of exposures will increase the risk of disability more than being exposed to either.

OBJECTIVES

The study examined combinations of physical and psychosocial work conditions as predictors of future disability pension among nursing professionals and care assistants in Sweden.

PARTICIPANTS

The study was based on a random and representative sample of 79,004 participants in any of the Swedish Work Environment Surveys from 1993 to 2013. A total of 2576 nursing professionals, 10,175 care assistants, and 66,253 workers in other occupations were included.

METHODS

Information on background factors and disability pension was obtained from population registers. Cox proportional hazard regressions with 95% confidence intervals (CI) were performed to study if pairs of combinations of physical and psychosocial factors were related to an increased risk of disability pension. Additionally, measures of synergistic effects were estimated. The analyses were stratified on occupation group, with adjustment for selected confounders.

RESULTS

The results indicated increased hazard ratios (HR) for disability pension for most combinations of physical and psychosocial working conditions. The hazard ratios for joint exposure to high demands and heavy physical work were high among both nursing professionals (HR 1.91; CI 1.06-3.44) and care assistants (HR 2.09; CI 1.63-2.69). Also, the combination of high demands and strenuous postures resulted in significantly elevated risks of disability pension among nursing professionals (HR 1.95; CI 1.20-3.16) and care assistants (HR 2.18; CI 1.71-2.77). The HRs for joint exposure to low control and both heavy physical work and strenuous postures were significant among all other occupations (HR 2.30; CI 2.05-2.58 and HR 2.24; CI 2.01-2.51), and among care assistants (HR 1.52; CI 1.26-1.85 and HR 1.61; CI 1.34-1.93), but not significant among nursing professionals. The synergistic effects on disability pension from combined exposures were generally positive among all three occupational groups.

CONCLUSION

Nursing professionals and care assistants exposed to both negative physical and psychosocial conditions had an increased risk of disability pension. A synergistic effect with respect to disability pension was found among care assistants who reported low control and strenuous postures at work.

Company-level determinants of disability retirement: a multilevel study of Finnish private sector workplaces

BACKGROUND

We examined whether the risk for disability retirement varies between companies over and above the individual-level characteristics of their employees and which company-level characteristics are associated with the risk for any, full or partial disability retirement.

METHODS

A 30% random sample of Finnish private sector companies with at least 10 employees was used (5567 companies and 301 313 employees). The risk for disability retirement over 6 years was analyzed using multilevel logistic regression. Company size and industry, as well as gender, age, education and social class measured both at the individual- and the company-level were used as explanatory variables.

RESULTS

3.8% of the variance in the risk for disability retirement was attributed to the company level after controlling for individual-level characteristics of the employees. Company-level variance was much larger in partial (11.7%) than in full (4.2%) disability retirement. After controlling for all individual- and company-level characteristics, those working in health and social work activities had increased risk for both full and partial disability retirement. The risk for full disability retirement increased by decreasing educational level of the company. The risk for partial disability retirement increased by increasing company size and was elevated in companies with the highest proportion of women.

CONCLUSIONS

After controlling for the individual-level characteristics, variation in the risk for disability retirement between companies was modest. The more substantial variation in partial disability pension suggests that companies have a marked role in advancing working with partial disabilities.

Effectiveness of the Labour Inspection Authority's regulatory tools for work environment and employee health: study protocol for a cluster-randomised controlled trial among Norwegian home-care workers

INTRODUCTION

There is a need to evaluate whether, and to what degree, labour inspections or other regulatory tools have the desired effects on psychosocial, organisational and mechanical work environment, and employee health. The Norwegian Labour Inspection Authority (NLIA) uses different tools and strategies to enforce compliance with occupational safety and health (OSH) legislation. The aim of the present study is to evaluate the effects of labour inspections and other regulatory tools employed by the NLIA. The home-care service is one of the fastest growing occupations and a prioritised area for the NLIA, hence the present study will investigate regulatory tools in this sector.

METHODS AND ANALYSIS

The research project has been designed as a longitudinal, cluster-randomised, controlled trial and will be conducted among Norwegian home-care workers. The objective of the research project is to evaluate the effects of the NLIA's regulatory tools (inspection and guidance) on: (1) compliance with OSH legislation and regulation; (2) psychosocial, organisational and mechanical work environment; (3) employee health in terms of musculoskeletal and mental health complaints; and (4) sickness absence. Public home-care services have been randomised to three intervention groups and one control group. Home-care services in the intervention groups will receive one of three intervention activities from the NLIA: (1) inspection from the Labour Inspection Authority; (2) guidance through an online interactive risk-assessment tool; and (3) guidance on psychosocial, organisational and mechanical work environment through workshops. The interventions will be performed at the organisational level (home-care service), and the effects of the interventions on the working environment and health complaints will be measured at the individual level (home-care employees).

ETHICS AND DISSEMINATION

This project has been approved by the Regional Committees for Medical and Health Research Ethics (REC) in Norway (REC South East) (2018/2003/REK sør-øst C), the Norwegian Center for Research Data (566128), and will be conducted in accordance with the World Medical Association Declaration of Helsinki. The results will be reported in international peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT03855163.

Physical and Psychosocial Work Environmental Risk Factors for Back Injury among Healthcare Workers: Prospective Cohort Study

The incidence of occupational back injury in the healthcare sector remains high despite decades of efforts to reduce such injuries. This prospective cohort study investigated the risk factors for back injury during patient transfer. Healthcare workers (n = 2080) from 314 departments at 17 hospitals in Denmark replied to repeated questionnaires sent every 14 days for one year. Using repeated-measures binomial logistic regression, controlling for education, work, lifestyle, and health, the odds for back injury (i.e., sudden onset episodes) were modeled. On the basis of 482 back injury events, a higher number of patient transfers was an important risk factor, with odds ratio (OR) 3.58 (95% confidence interval (CI) 2.51–5.10) for 1–4 transfers per day, OR 7.60 (5.14–11.22) for 5–8 transfers per day, and OR 8.03 (5.26–12.27) for 9 or more transfers per day (reference: less than 1 per day). The lack of necessary assistive devices was a common phenomenon during back injury events, with the top four lacking devices being sliding sheets (30%), intelligent beds (19%), walking aids (18%), and ceiling lifts (13%). For the psychosocial factors, poor collaboration between and support from colleagues increased the risk for back injury, with OR 3.16 (1.85–5.39). In conclusion, reducing the physical burden in terms of number of daily patient transfers, providing the necessary assistive devices, and cultivating good collaboration between colleagues are important factors in preventing occupational back injuries among healthcare workers.

Work despite poor health? A 14-year follow-up of how individual work accommodations are extending the time to retirement for workers with poor health conditions

Given many OECD countries' efforts to extend their citizens' working years, research underscores the importance of work accommodations to maintain older workers and enable them to work despite poor health or declines in physical functions. Nevertheless, few studies have investigated the associations between poor health conditions and opportunities to accommodate work in accordance with individual needs and preferences. In this study, we differentiate between three types of poor health conditions (disease, illness, or sickness). We examine the separate effects of these health conditions as well as of possibilities for work accommodations (working hours, pace, planning), on time to retirement. Additionally, we examine the potentially joint effect of poor health and low opportunities for work accommodations. The analyses are based on a representative sample of 1143 Swedish workers from Panel Survey of Ageing and the Elderly (PSAE) with a baseline (2002/2003) age of 55–64 years. Using complementary register data on income, we followed the labor market activity of these individuals until the end of 2015. We employed Cox proportional hazard regression to estimate the time to retirement and adjusted for demographical, socio-economic, and work-related covariates. In comparison to those with good health, having disease, illness, and sickness is associated with a higher risk of earlier exit from the labor market, and the joint effect of poor health and low opportunities for work accommodations increases this risk. High influence to accommodate work while having a disease or sickness supports work participation, while these patterns of associations were not equally consistent for individuals with illness. This study highlights the importance of increasing older individuals’ opportunities to make their own work accommodations, particularly in the presence of disease and sickness, and thereby combat the negative effects of poor health on time to retirement.

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Government efforts to extend working life face challenges concerning older workers health conditions and physical function.

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Poor health is known as an important predictor for early retirement.

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Work accommodations are advocated as critical to maintaining older workers ability to work despite poor health conditions.

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Longitudinal studies capturing individual's health and working conditions with retirement are needed.

Self-reported health problems and obesity predict sickness absence during a 12-month follow-up: a prospective cohort study in 21 608 employees from different industries

OBJECTIVES

To study whether self-reported health problems predict sickness absence (SA) from work in employees from different industries.

METHODS

The results of a health risk appraisal (HRA) were combined with archival data of SA of 21 608 employees (59% female, 56% clerical). Exposure variables were self-reported health problems, labelled as 'work disability (WD) risk factors' in the HRA, presence of problems with occupational well-being and obesity. Age, socioeconomic grading and the number of SA days 12 months before the survey were treated as confounders. The outcome measure was accumulated SA days during 12-month follow-up. Data were analysed separately for males and females. A Hurdle model with negative binomial response was used to analyse zero-inflated count data of SA.

RESULTS

The HRA results predicted the number of accumulated SA days during the 12-month follow-up, regardless of occupational group and gender. The ratio of means of SA days varied between 2.7 and 4.0 among those with 'WD risk factors' and the reference category with no findings, depending on gender and occupational group. The lower limit of the 95% CI was at the lowest 2.0. In the Hurdle model, 'WD risk factors', SA days prior to the HRA and obesity were additive predictors for SA and/or the accumulated SA days in all occupational groups.

CONCLUSION

Self-reported health problems and obesity predict a higher total count of SA days in an additive fashion. These findings have implications for both management and the healthcare system in the prevention of WD.

Multidimensional prognostic factors for chronic low back pain-related disability: a longitudinal study in a Saudi population

BACKGROUND CONTEXT

Chronic low back pain (CLBP) is a major health problem. Identifying prognostic factors is essential for identifying people at risk of developing CLBP-related disability.

PURPOSE

To examine associations between CLBP-related disability at 12-month follow-up and individual, psychosocial and physical factors at baseline, as well as treatment-related factors between baseline and 12-month follow-up among a Saudi population. Additionally, associations between pain intensity and general perceived efficacy (GPE) at 12 months were examined with the aforementioned factors.

DESIGN

A prospective cohort study.

PARTICIPANTS

One hundred Saudi participants over 18 years with a history of LBP greater than 3 months' duration.

MAIN OUTCOME MEASUREMENTS

The primary outcome variable was CLBP-related disability measured by the Arabic Oswestry disability index. Secondary outcome measures were pain intensity over the prior week measured by the VAS and the participant's global perceptions of recovery (general perceived efficacy [GPE]) at 12 months.

METHODS

At baseline (n=115), participants completed questionnaires covering demographics, disability, pain intensity, back beliefs, fear avoidance, psychological distress, and physical activity. They performed standardized physical performance tests, including assessment of pain behaviors using a pain behavior scale. After 12 months, participants (n=100) completed questionnaires on disability, pain intensity, GPE and provided treatment-related information during the previous year. Predictors of disability, pain, and GPE were explored using univariate and multivariate regression analyses.

RESULTS

The prognostic model for moderate-severe CLBP-related disability at 12 months explained 53.0% of the variance. Higher pain intensity, higher fear-avoidance work, and older age predicted higher disability. Having no additional somatic symptoms predicted lower disability. Pain intensity at 12-month follow-up was explained by higher disability at baseline, while not being in paid employment appeared protective (25.7% of variance explained). As univariate associations were weak between predictor variables and GPE, multivariate analysis was not conducted.

CONCLUSION

The study results supported the multifactorial nature of CLBP and reported an important prognostic model in the Saudi population.

Childhood adversities, parental education and disability retirement among Finnish municipal employees

Background

There is increasing evidence that childhood socioeconomic position and childhood adversities influence adult health. However, the potential contribution of these factors to disability retirement is poorly understood. This study aimed to examine the associations between childhood adversities, parental education and disability retirement.

Methods

Data on parental education and childhood adversities were derived from the Helsinki Health Study baseline survey, conducted in 2000–02 among 40- to 60-year old employees of the City of Helsinki, Finland. Data on disability retirement and their diagnoses were obtained from the Finnish Centre of Pensions and followed until the end of 2016. The analyses included 5992 employees. The associations of parental education and childhood adversities with disability retirement due to any cause, musculoskeletal diseases and mental disorders were analysed using Cox regression analysis.

Results

Low parental education was associated with an increased risk of disability retirement due to any cause (maternal education: HR 1.74, 95% CI 1.16–2.62; paternal education: 1.86, 1.38–2.51) and due to musculoskeletal diseases (maternal education: 4.44, 1.66–11.92; paternal education: 3.81, 2.02–7.17). However, adjustment for own education mainly abolished the associations. Economic difficulties in the childhood family, parental alcohol problems and having been bullied at school or by peers increased the risk of disability retirement due to all studied diagnostic groups, whereas parental death or divorce had no effect. Childhood illness (1.53, 1.20–1.95) and parental mental illness (1.68, 1.28–2.20) were associated with disability retirement due to any cause and due to mental disorders (1.65, 1.05–2.59; 3.60, 2.46–5.26). The associations between childhood adversities and disability retirement remained after adjustment for own education, whereas working conditions, and weight and health behaviours somewhat attenuated the associations.

Conclusions

Parental education and childhood adversities contributed to disability retirement even in midlife. Policy actions investing in children’s well-being might promote work ability in midlife.

Psychological and physical job demands, decision latitude, and work-related social support among Iranian waste collectors

Waste collection is known as a stressful and physically demanding job in low/middle income countries. This study aimed to assess the psychological and physical job demands, decision latitude, and work-related social support among Iranian waste collectors. In this cross-sectional study, field observation, video capture, and unstructured interviews were performed to understand the process of waste collection. Data were collected from 200 waste collectors of Shiraz city using a demographic/work characteristics questionnaire and a job content questionnaire (JCQ). Logistic regression analysis was used for the prediction of independent variables affecting job content dimensions. A p < 0.05 was considered to be statistically significant. Results show that the rate of municipal solid waste (MSW) generation in Shiraz city was 0.576 kg/capita/day, which translates into about 1076 tons of waste per day per the current population of 1,869,001. The total amount of MSW produced in Shiraz over a four-year period from 2014 to 2017 were 346,093, 363,505, 392,869, and 400,863 tons, respectively. About half of the waste collectors reported high levels of psychological and physical job demands. More than half were concerned with the low level of decision latitude and social support in the workplace. Night-workers (OR = 3.29) and smokers (OR = 2.75) reported higher psychological job demands than day-workers and non-smokers, respectively. Decision latitude and social support were inversely associated with the level of education (OR = 1.90), and daily working time (OR = 2.46), respectively. Based on the Demand-Control-Support Model, waste collectors were exposed to relatively high levels of job stress associated with occupational risk factors.

Does dispositional optimism moderate the relationship between role conflict and risk of disability retirement?

This study determines whether dispositional optimism moderates the relationship between role conflict and the risk of disability retirement. The study was based on a combination of self-report survey questionnaire data on role conflict and dispositional optimism with official register data on disability benefits from the Norwegian Labour and Welfare Administration. The sample comprised 14,501 Norwegian employees from various occupations and industries. Role conflict was significantly related to higher risk (HR 1.35, 95% CI 1.19-1.53), whereas optimism was associated with decreased risk (HR 0.75, 95% CI 0.64-0.88), of disability retirement. Optimism did not modify the effect on role conflict on disability retirement. Having an optimistic life orientation decreases the risk of disability retirement in general, but does not protect against the detrimental effects of role conflict at the workplace. As optimism is a malleable personality characteristic, organizations may benefit from interventions that help employees experience daily events more positively.

Job demands and control and sickness absence, disability pension and unemployment among 2,194,692 individuals in Sweden

Background: Knowledge is needed on associations between job demands and job control and long-term sickness absence (SA) and unemployment. We explored associations of job demands and job control with SA/disability pension (DP) and unemployment among women and men in paid work. Methods: We included all 2,194,694 individuals living in Sweden in 2001, aged 30–54 years, and in paid work. The Swedish Job Exposure Matrix (JEM) was used to ascertain levels of job demands and job control. Individuals were categorized into nine groups based on combinations of high, medium, or low values on both demands and control. Using multinomial logistic regression, we estimated odds ratios (OR) with 95% confidence intervals (CI) for the association of job demands and job control with risk of long-term SA/DP (>183 net days) and long-term unemployment (>183 days). Results: Regarding SA/DP, among women the risk was highest for those in occupations with low demands and low control (OR=1.32; 95% CI: 1.28–1.36), whereas among men the risk was highest among those in occupations with high demands and low control (OR=1.22; 1.11–1.34). Regarding unemployment, among women the risk was highest among those in occupations with low demands and medium control (OR=1.30; 1.24–1.37), whereas among men the risk was highest for those in occupations with low demands and high control (OR=1.54; 1.46–1.62). Conclusions: Using a JEM among all in a population rather than for specific occupations gives a more comprehensive view of the associations between job demands/job control and long-term SA/DP and unemployment, respectively.

Depression and risk of disability pension: A systematic review and meta-analysis

BACKGROUND AND OBJECTIVE

Depression is a common mental disorder that leads to undesirable consequences. The study of the role of depression in disability pension can provide valuable insights. This study was conducted with the goal of systematic review and meta-analysis of the relationship between depression and disability pension.

METHODS

PubMed, Scopus, PsycInfo, and Google Scholar databases were systematically searched until March 2018. Fifteen prospective cohort studies were selected and included in the meta-analysis. The random-effects method was used to combine the studies. Subgroup analysis was performed, and publication bias was also examined.

RESULTS

Depression was a risk factor for disability pension (pooled risk ratio =1.68 and 95% confidence interval = 1.50-1.88). In men, pooled risk ratio was 1.82 for the effect of depression on the risk of disability pension (95% confidence interval = 1.45-2.28). In women, pooled risk ratio was 1.62 (95% confidence interval = 1.31-2.02). The results showed that there is publication bias.

CONCLUSIONS

Depression is a factor for retirement due to disability. Therefore, the prevention and treatment of depression can reduce socioeconomic and psychological consequences imposed on society.

Determinants of disability pension applications and awarded disability pensions in Finland, 2009 and 2014

Aims: Examining the non-medical determinants of applying for and being awarded disability pension is important for assessing the functionality of the disability pension system. We examined how demographic and socioeconomic factors as well as factors related to the disability process associate with the probability of applying for disability pension and the probability of applicants being awarded pension in 2009 and 2014. Methods: 70% random samples of Finnish non-retired residents aged 18-64 in 2009 (n = 2,076,881) and in 2014 (n = 2,097,790) were analysed with logistic regression analysis. The application rates were 0.9% in 2009 and 0.7% in 2014, and the rates of awarded pensions were 80.6% in 2009 and 72.2% in 2014. Results: Being an upper-level non-manual employee and having more employment during the preceding four calendar years decreased the odds of applying for disability pension but increased the odds of being awarded one. Older age increased the odds of both applying for and being awarded pension. Compared to applications based on mental disorders, those applying due to neoplasms and diseases of the circulatory system had increased odds of being awarded pension whereas those applying due to musculoskeletal diseases or injuries had decreased odds. Only minor temporal changes were found in the determinants of applying for or being awarded disability pension. Conclusions: With a greater probability of disability pension applications but also a lower probability of being awarded pension, the occupational disability process involves a comprehensive disadvantage for lower socioeconomic status groups.

What are they returning to? Psychosocial work environment as a predictor of returning to work among employees in treatment for common mental disorders: A prospective observational pre-post study

INTRODUCTION

Long-term sick leave and disabilities due to common mental disorders are challenging for society, employers, and individuals. Hence, we wanted to investigate whether psychosocial work environments experienced by employees undergoing treatment for such disorders was associated with return to work.

METHODS

At the start of treatment, 164 patients responded to questionnaires concerning their psychosocial work environment (the Job Demand-Control-Support model and the Effort-Reward Imbalance model), symptoms (The Clinical Outcomes in Routine Evaluation Outcome Measure) and ability to work (Work Ability Index). In addition, the respondents reported whether they were working or on sick leave at the start and end of their courses of treatment. Their therapists provided information about diagnoses.

RESULTS

Return to work was associated with control of decisions, support from colleagues, esteem, and job promotion opportunities as measured at the start of treatment. In multivariate analyses, control over decisions and job promotion opportunities continued to predict return to work when adjusted for symptoms, current work ability, and expected future work ability.

DISCUSSION

The working conditions that predicted return to work are considered to facilitate work performance and to be sources of motivation, job satisfaction, and job commitment. Consequently, it is important to examine whether this patient group has a favorable working environment and consider changes in the workplace if the environment is not favorable.

Does leadership support buffer the effect of workplace bullying on the risk of disability pensioning? An analysis of register-based outcomes using pooled survey data from 24,538 employees

PURPOSE

To investigate whether self-reported exposure to workplace bullying predicts the risk of disability pensioning among employees in two occupational groups-(1) employees working with clients or customers and (2) office workers and manual workers-and whether leadership support and occupational group moderates that association.

METHODS

Survey data from 24,538 employees (112,889 person years) were fitted to a national register containing information on disability-pension payments. Using multi-adjusted Cox-regression analysis, observations were followed in the register to assess the risk of disability pensioning. The average follow-up time was 4.6 years (standard deviation [SD] = 1.5).

RESULTS

Self-reported exposure to workplace bullying predicted an increased risk of disability pensioning (hazard ratio [HR] = 1.46; 95% confidence interval [CI]: 1.15-1.86). This association was moderated by leadership support: the association between workplace bullying and disability pensioning was significantly different for respondents who reported low leadership support (HR = 1.97; 95% CI: 1.38-2.80) compared to respondents who reported medium (HR = 1.03; 95% CI: 0.60-1.76) or high leadership support (HR = 1.08; 95% CI: 0.60-1.95). Further analyses showed similar associations between workplace bullying and the risk of disability pensioning among the two occupational groups.

CONCLUSIONS

Self-reported workplace bullying increases the risk of disability pensioning, and this association is buffered by leadership support. Workplace bullying should be considered an important workplace stressor. This study indicates that workplaces may enhance worker retention by actively promoting measures to eliminate the occurrence of workplace bullying and to enhance leadership support.

Associations between effort-reward imbalance and health indicators among school teachers in Chuquisaca, Bolivia: a cross-sectional study

OBJECTIVE

To assess the association between effort-reward imbalance (ERI) and health indicators among Bolivian school teachers.

DESIGN

School-based cross-sectional study.

SETTING

Sixty randomly selected schools from rural (33) and urban (27) schools in Chuquisaca, Bolivia.

PARTICIPANTS

A total of 1062 school teachers were invited to participate, of which 597 answered the questionnaire (response 56.2%).

EXPOSURE MEASURE

Psychosocial factors at work were explored through the short version of the Effort-Reward Questionnaire.

PRIMARY AND SECONDARY OUTCOME MEASURES

Health outcomes included self-rated overall health, mental distress (12-item General Health Questionnaire ≥5) and the 7-day prevalence of low back pain (LBP) as well as neck or shoulder pain (Nordic Questionnaire). Crude and adjusted ORs and their 95% CIs for each health outcome were calculated using logistic regression models.

RESULTS

The median value for the effort-reward ratio was 0.91 (range: 0.3-2.3) with higher values for teachers from rural versus urban schools. Overall, about 43% of the teachers reported their overall health as fair or poor; 45% suffered mental distress, 17% reported LBP and 29% neck or shoulder pain. Prevalences were higher for teachers employed at rural schools compared with those at urban schools. After adjusting for potential confounders and school location, ERI was statistically significantly associated with fair/poor self-rated health (adjusted OR 1.7, 95% CI 1.0 to 2.9); mental distress (1.9; 95% CI 1.2 to 3.1) and LBP (2.3; 95% CI 1.3 to 4.1).

CONCLUSION

Our results indicate the urgent need to improve psychosocial working conditions among Bolivian school teachers, in order to promote their health and well-being.

Influence of physical and psychosocial working conditions for the risk of disability pension among healthy female eldercare workers: Prospective cohort

Aim: To investigate the influence of physical and psychosocial working conditions on the risk of disability pension among eldercare workers. Methods: After responding to a questionnaire in 2005, 4699 healthy female eldercare workers – free from chronic musculoskeletal pain, depressive symptoms and long-term sickness absence – were followed for 11 years in the Danish Register for Evaluation of Marginalization. Time-to-event analyses estimated the hazard ratio (HR) for disability pension from physical exertion during work, emotional demands, influence at work, role conflicts, and quality of leadership. Analyses were mutually adjusted for these work environmental factors as well as for age, education, smoking, leisure physical activity and body mass index. Results: During follow-up, 7.6% received disability pension. Physical exertion and emotional demands were associated with risk of disability pension, and both interacted with age. In age-stratified analyses, older eldercare workers (mean age 53 years at baseline) with moderate and high physical exertion (reference: low) were at increased risk with HRs of 1.51, 95% CI [1.06–2.15] and 2.54, 95% CI [1.34–4.83], respectively. Younger eldercare workers (mean age 36 years at baseline) with moderate emotional demands (reference: low) were at decreased risk with an HR of 0.57, 95% CI [0.37–0.85]. Conclusions: While a higher level of physical exertion is a risk factor for disability pension among older female eldercare workers, a moderate level of emotional demands is associated with lower risk among the younger workers. The age of the worker may be an important factor when providing recommendations for promoting a long and healthy working life.

Study protocol for SeniorWorkingLife - push and stay mechanisms for labour market participation among older workers

Background

Due to demographic changes across Europe there are strong political interests in maintaining the labour force by prolonging working life, i.e. increasing retirement age. This may pose both challenges and opportunities for societies, workplaces, and individuals. The SeniorWorkingLife (Danish: SeniorArbejdsLiv) project investigates push and stay mechanisms for labour market participation – now and in the future - among older workers (≥50 years).

Methods

In July 2018, 30,000 Danes age 50 or older (18,000 employed, 7000 unemployed, 3000 voluntary early retirements, 2000 disability pensions) were invited to participate, of which 15,721 (52.4%) replied to the entire questionnaire and 17,885 (59.6%) replied at least in part. Baseline data collection was terminated in October 2018. The questionnaire covers 14 domains in relation to push and stay mechanisms for labour market participation: 1) basic information (demographics, employment status etc.), 2) multiple-choice question covering a wide range of push and stay mechanisms, 3) role of the workplace, 4) age-discrimination, 5) personal economy, 6) possibility for voluntary early retirement among employed and unemployed, 7) gradual retirement, 8) competencies and continued education, 9) return-to-work, 10) new technologies at the workplace, 11) job satisfaction and well-being, 12) working environment, 13) lifestyle, 14) health and functional capacity. The project aspires to repeat the survey as a prospective cohort every 2–3 years and to perform longitudinal follow-up in Danish high-quality registers about work and health.

Discussion

The SeniorWorkingLife project will provide important knowledge about push and stay mechanisms for labour market participation among older workers. Push refers to mechanisms that increase the risk of premature exit from the labour marker, e.g. due to poor health, poor working environment, age discrimination, and stay to mechanisms prolonging working life e.g. due to attractive working conditions and a good working environment. The project will also to some degree investigate stuck, pull and jump mechanisms. Collaboration and use of the data for scientific purposes by other researchers are encouraged. Interested researchers should contact the corresponding author.

Trial Registration

Registered as cohort study in ClinicalTrials.gov Identifier NCT03634410 (August 16, 2018).

Precarious work and the risk of receiving a disability pension

Aims: Precarious employment is an emerging determinant of occupational health, but its association with work-related disability remains little understood. We operationalised precarious work as a multidimensional construct and examined how the accumulation of precarious job features predicts the incidence of receiving a disability pension (DP). Methods: The study comprised 13,228 employees aged 20–54 who had been interviewed for the Finnish Quality of Work Life Surveys in 1984, 1990, 1997, or 2003. We measured precarious work with five variables that reflect both subjective and objective job insecurity: the threat of dismissal/unemployment; poor employability; low earnings; previous unemployment; and temporary contract. An eight-year follow-up was merged with the pooled cross-sectional data, and Cox proportional hazard ratios (HR) for receiving a DP were compared between the insecurity measures, controlling for sociodemographic covariates, job characteristics and health at the baseline with a step-wise procedure. Results: Precarious employees had an elevated risk of receiving a DP (all covariates adjusted for). The risk of receiving a DP was associated with subjective job insecurity, with the strongest indicator being poor employability. The association between the threat of unemployment and receiving a DP was weak before controlling for health. Among objective insecurity measures, low earnings and earlier unemployment were weakly connected to receiving a DP before controlling for sociodemographic covariates, job characteristics and health. Conclusions: We recommend the evaluation of several precarious job features in future studies. The risk of receiving a DP could potentially be offset by improving individuals’ employability.

Workplace Bullying as a Predictor of Disability Retirement: A Prospective Registry Study of Norwegian Employees

OBJECTIVE

The aim of this study was to determine 1) whether bullying is related to all-cause disability retirement, 2) whether bullying contributes to the variance in disability retirement above high job demands and lack of job control, and 3) to establish gender differences in the relationship.

METHODS

Survey data from 14,501 Norwegian employees on exposure factors linked to registry data on all-cause disability retirement.

RESULTS

Bullying significantly predicted risk of disability retirement (hazard ratio = 1.55; 95% confidence interval = 1.13 to 2.12). This relationship remained statistically significant after adjusting for job demands and lack of job control. Women had the highest risk of disability, but both bullied men and women had a higher risk of disability than nonbullied employees of the same gender.

CONCLUSION

Bullying is a risk factor for disability retirement. Measures taken to prevent bullying may be beneficial for reducing both health problems and disability retirement.

Medical Surveillance, Continuous Health Promotion and a Participatory Intervention in a Small Company

The workplace is an ideal setting for health promotion. The regular medical examination of workers enables us to screen for numerous diseases, spread good practices and correct lifestyles, and obtain a favourable risk/benefit ratio. The continuous monitoring of the level of workers' wellbeing using a holistic approach during medical surveillance enables us to promptly identify problems in work organisation and the company climate. Problems of this kind can be adequately managed by using a participatory approach. The aim of this paper is twofold: to signal this way of proceeding with medical surveillance, and to describe an organisational development intervention. Participatory groups were used to improve occupational life in a small company. After intervention we observed a reduction in levels of perceived occupational stress measured with the Effort/Reward Imbalance questionnaire, and an improvement in psychological wellbeing assessed by means of the Goldberg Anxiety/Depression scale. Although the limited size of the sample and the lack of a control group call for a cautious evaluation of this study, the participatory strategy proved to be a useful tool due to its cost-effectiveness.

Exploring Blue- and White-Collar Employees' Well-Being at Work System

The aim of this study was to examine occupational group-related differences in well-being at work (WBW) indicators ranging from real accidents, absences and retirement to experienced pleasure at work. Occupational group included two categories: blue- and white-collar employees. The study is based on analysing national statistics or ones of various industrial sectors (Study 1), or bases on findings of questionnaires in Finnish case companies (N=7) (Studies 2 and 3). WBW questionnaires answered by 3500 employees. Analysis utilised data that employees of two occupational groups, or company and national statistics revealed about WBW. Analysis was based on factors related to employee, task, tool, organisation and work environment (traditional work system (WS)), psychosocial factors, and information and communication within WS. The biggest and statistically significant differences were emphasised in results and discussion. Although two groups' roles and tasks provide reasons for many differences, the ones should be measured, thoroughly discussed and consciously managed.

Allostatic Load and Effort-Reward Imbalance: Associations over the Working-Career

Although associations between work stressors and stress-related biomarkers have been reported in cross-sectional studies, the use of single time measurements of work stressors could be one of the reasons for inconsistent associations. This study examines whether repeated reports of work stress towards the end of the working career predicts allostatic load, a measure of chronic stress related physiological processes. Data from waves 2 to 6 of the English Longitudinal Study of Ageing (ELSA) were analysed, with a main analytical sample of 2663 older adults (aged 50+) who had at least one measurement of effort-reward imbalance between waves 2–6 and a measurement of allostatic load at wave 6. Cumulative work stress over waves 2–6 were measured by the effort-reward imbalance model. ELSA respondents who had reported two or more occasions of imbalance had a higher (0.3) estimate of the allostatic load index than those who did not report any imbalance, controlling for a range of health and socio-demographic factors, as well as allostatic load at baseline. More recent reports of imbalance were significantly associated with a higher allostatic load index, whereas reports of imbalance from earlier waves of ELSA were not. The accumulation of work related stressors could have adverse effects on chronic stress biological processes.

Retrospectively assessed psychosocial working conditions as predictors of prospectively assessed sickness absence and disability pension among older workers

BACKGROUND

The aim was to explore the association between retrospectively assessed psychosocial working conditions during working life and prospectively assessed risk of sickness absence and disability pension among older workers.

METHODS

The prospective risk of register-based long-term sickness absence (LTSA) and disability pension was estimated from exposure to 12 different psychosocial work characteristics during working life among 5076 older workers from the CAMB cohort (Copenhagen Aging and Midlife Biobank). Analyses were censored for competing events and adjusted for age, gender, physical work environment, lifestyle, education, and prior LTSA.

RESULTS

LTSA was predicted by high levels of cognitive demands (HR 1.31 (95% CI 1.10-1.56)), high levels of emotional demands (HR 1.26 (95% CI 1.07-1.48)), low levels of influence at work (HR 1.30 (95% CI 1.03-1.64)), and high levels of role conflicts (HR 1.34 (95% CI 1.09-1.65)). Disability pension was predicted by low levels of influence at work (HR 2.73 (95% CI 1.49-5.00)) and low levels of recognition from management (HR 2.04 (95% CI 1.14-3.67)).

CONCLUSIONS

This exploratory study found that retrospectively assessed high cognitive demands, high and medium emotional demands, low influence at work, low recognition from management, medium role clarity, and high role conflicts predicted LTSA and/or disability pension.

Night work as a risk factor for future cause-specific disability pension: A prospective twin cohort study in Sweden

The objectives of the study were to investigate the associations between night work and disability pension (DP) due to all causes, cardiovascular (CVD), mental, and other diagnoses, adjusting for familial confounding. The material of the study included comprehensive survey data on 27 165 Swedish twins born in 1935-1958 that were linked with DP data for the survey period (1998-2003) to 2013. Night work was assessed as years of working nights at least every now and then, and categorized into not at all, 1-10 years and over 10 years. For statistical analyses, Cox proportional hazards regressions were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). The results of the study indicated that over 10 years duration of night work had an age- and sex-adjusted HR of 1.48 (95% CI 1.11-1.98) for DP due to CVD and 1-10 years of night work an HR of 1.28 (95% CI 1.06-1.55) for DP due to mental diagnoses, but attenuated when covariates were adjusted for. Both 1-10 years (HR 1.27, 95% CI 1.17-1.39) and >10 years of night work (HR 1.20, 95% CI 1.08-1.34) were associated with DP due to all causes and other diagnoses. These risks remained after adjusting for covariates. To conclude, even modest exposure in terms of duration of night work is a risk factor for all-cause DP, but also for DP due to mental and other diagnoses. The risk of DP due to CVD seems to be associated with longer (>10 years) periods of night work. All the associations between night work and DP seem to be influenced by various covariates.

Temporal changes in health within 5 years before and after disability pension-the HUNT Study

Background

Health status has been reported to change before, during and after disability pension receipt. These associations might be subject to temporal changes according to changes in policy, incidence of disability pensions and other contextual factors. We compared the perceived health around time of disability retirement among persons receiving disability pension in the 1990 s and 2000 s in Norway.

Methods

We linked data from two consecutive cross-sectional population based Norwegian health surveys, HUNT2 (1995-97) and HUNT3 (2006-08), to national registries, identifying those who received disability pension within 5 years before or after participation in the survey (HUNT2: n = 5362, HUNT3: n = 4649). We used logistic regression to assess associations of time from receiving a disability pension with self-rated health, insomnia, depression and anxiety symptoms and subsequently estimated adjusted prevalence over time.

Results

Prevalence of poor self-rated health peaked around time of receiving disability pension in both decades. For those aged 50+, prevalence the year before disability pension was slightly lower in 2006-08 (74%, 95% CI 70-79%) than in 1995-97 (83%, 95% CI 79-87%), whereas peak prevalence was similar between surveys for those younger than 50. Depression symptoms peaked more pronouncedly in 1995-97 than in 2006-08, whereas prevalence of anxiety symptoms was similar at time of receiving disability pension between surveys.

Conclusions

We found no strong evidence of differences in health selection to disability pension in the 2000 s compared to the 1990 s. However, we found indication of less depression symptoms around time of disability pension in the 2000 s compared to the 1990 s.

The new workplace II: protocol for a prospective full-panel registry study of work factors, sickness absence, and exit from working life among Norwegian employees

Background

Previous studies on the effects of work factors on absence and disability retirement have only addressed a limited set of factors and little is known about the mechanisms that govern relationships between work exposures and sickness absence/disability retirement. The main aims of the present project are (1) to examine the impact of a comprehensive set of psychological, social, organizational, and mechanical work factors work factors on sickness absence and disability retirement, and (2) to identify moderating and mediating variables that determine how and when exposures at the workplace are related to sickness absence and disability retirement.

Methods

The study design is prospective and based on longitudinal survey data linked to registry data on sickness absence and disability. Altogether 14,501 respondents have given their permission to the linking of their survey questionnaire data to registry data. The project has been approved by the Regional Committees for Medical and Health Research Ethics and has permission from The Norwegian Data Protection Authority. The questionnaire instruments contain psychometrically validated items and inventories on demographic background factors, work exposures, individual dispositions and attitudes, somatic health, mental distress, well-being, lifestyle factors, and work ability.

Discussion

The findings will have relevance for, and benefit working life and the larger society in a number of ways. Firstly, it will lead to a more knowledge about which work factors that contribute to health, sickness absence, and participation in/exit from the labour force. Secondly, a better understanding of which mediators and moderators that modify and govern these relationships. Both are central to the development of laws and regulations and to any political decision on measures to tackle sickness absence and early retirement.