Major depressive episodes and work stress: results from a national population survey

The association between type and number of adverse working conditions and mental health during a time of economic crisis (2010-2012)

PURPOSE

Many studies have been published on the association between adverse psychosocial working conditions and mental health, but only a few related types of adverse job conditions and a count of these adversities to workers' mental health, using standardized diagnostic interviews. This study addresses this issue.

METHODS

Data were used from the second wave of the Netherlands Mental Health Survey and Incidence Study-2, a nationally representative face-to-face survey of the general population, including 3,672 workers, 166 unemployed and 239 disabled persons. Among workers, psychosocial working conditions (decision latitude, psychological job demands, job security and co-worker support) were assessed with the Job Content Questionnaire. Mental health symptoms were assessed with the Mental Health Inventory (MHI)-5 and DSM-IV diagnoses/syndromes with the Composite International Diagnostic Interview 3.0.

RESULTS

Adverse psychosocial job conditions were related to workers' mental health. The strongest association was found for low job security which increased the chance of mental health symptoms and mental disorders by twofold. Workers in the poorest quality jobs, i.e. experiencing at least three adverse working conditions, had a 3 to almost 5 times higher chance of mental disorders than those in the most optimal jobs. Having a poor quality job was not associated with better mental health compared to being unemployed or disabled. In general, similar relations were found for mood, anxiety and substance use disorders.

CONCLUSIONS

In planning future strategies to prevent mental disorders at the workplace, the focus should be on workers who experience job insecurity and on those who report several adversities.

Threats of dismissal and symptoms of major depression: a study using repeat measures in the Swedish working population

BACKGROUND

Job insecurity is considered a profound work stressor. While previous research has indicated that job insecurity represents a substantial mental health burden, few studies have examined its relationship with symptoms of major depression. The aim of this study was to assess whether episodic and repeated self-reported threats of dismissal increase the risk of subsequent symptoms of major depression and whether symptoms of major depression are related to subsequent experience of threats of dismissal.

METHODS

The study is based on the Swedish Longitudinal Occupational Survey of Health (SLOSH) study, a cohort study with multiple repeated measurements. The sample consisted of 6275 participants who were in regular paid employment and who provided data in 2008, 2010 and 2012. Severity of depression was assessed with a brief Symptom Checklist scale and categorised according to symptoms of major depression or not.

RESULTS

Results based on generalised estimating equations logit models showed that prior threats of dismissal predicted symptoms of major depression OR 1.37; 95% CI 1.04 to 1.81) after adjustment for prior depression and major confounders. Especially related threats increased the risk of major depression symptoms (OR 1.74 CI 1.09 to 2.78). Major depression symptoms also increased the odds of subsequent threats of dismissal (OR 1.52, CI 1.17 to 1.98).

CONCLUSIONS

These findings support a prospective association between threats of dismissal and symptoms of major depression, in particular repeated exposure to threats of dismissal. The results also indicate that threats of dismissal are more likely to be reported by workers with symptoms of major depression.

The multilevel determinants of workers' mental health: results from the SALVEO study

PURPOSE

This study examined the contribution of work, non-work and individual factors on workers' symptoms of psychological distress, depression and emotional exhaustion based on the multilevel determinants of workers' mental health model.

METHODS

Data from the SALVEO Study were collected in 2009-2012 from a sample of 1,954 employees nested in 63 workplaces in the province of Quebec (Canada). Multilevel regression models were used to analyse the data.

RESULTS

Altogether, variables explain 32.2 % of psychological distress, 48.4 % of depression and 48.8 % of emotional exhaustion. Mental health outcomes varied slightly between workplaces and skill utilisation, physical and psychological demands, abusive supervision, interpersonal conflicts and job insecurity are related to the outcomes. Living in couple, having young children at home, family-to-work conflict, work-to-family conflict, strained marital and parental relations, and social support outside the workplace associated with the outcomes. Most of the individual characteristics also correlated with the three outcomes. Importantly, non-work and individual factors modulated the number and type of work factors related to the three outcomes.

CONCLUSION

The results of this study suggest expanding perspectives on occupational mental health that fully recognise the complexity of workers' mental health determinants.

Occupational factors and subsequent major depressive and generalized anxiety disorders in the prospective French national SIP study

Background

The literature has been extensive on the associations between psychosocial work factors and mental health. Nevertheless, the studies using prospective design, various concepts and more than one measurement point in time for these factors and diagnostic interview to assess mental disorders remain seldom in the literature. This study is an attempt to fill the gap in this topic.

Methods

The study was based on a national representative sample of 4717 workers of the French working population (SIP survey), interviewed in 2006 and reinterviewed again in 2010 and free of mental disorders at baseline. Psychosocial work factors, measured in both 2006 and 2010, included: psychological demands, decision latitude, social support, reward, emotional demands, role conflict, ethical conflict, tensions with the public, job insecurity and work-life imbalance. Other occupational factors related to working time/hours and physical work environment were also studied. Major depressive (MDD) and generalized anxiety disorders (GAD) were measured using a standardised diagnostic interview (MINI). Covariates were age, occupation, marital status, having a child under 3 y, social support outside work and stressful life events. Multivariate analyses were performed using weighted logistic regression models.

Results

Using models taking all occupational factors into account simultaneously, low reward and job insecurity predicted MDD. Psychological demands, low reward, emotional demands and job insecurity were predictive of GAD. The more frequent the exposure to job insecurity, the higher the risk of MDD and GAD, and the more frequent the exposure to psychological demands and low reward, the higher the risk of GAD. No effect was observed for repeated exposure to occupational factors.

Conclusions

Classical and emergent psychosocial work factors were predictive factors of depression and anxiety with dose–response associations in terms of frequency of exposure. More attention may be needed on emergent psychosocial work factors and frequent exposure to these factors.

The relationships among work stress, resourcefulness, and depression level in psychiatric nurses

Psychiatric nurses are exposed to highly stressful work environments that can lead to depression over time. This study aimed to explore the relationships among work stress, resourcefulness, and depression levels of psychiatric nurses. A cross-sectional design with randomized sampling was used; 154 psychiatric nurses were recruited from six medical centers in Taiwan. Psychiatric nurses' work stress was found positively correlated with their depression level, and negatively related to resourcefulness. Work stress significantly predicted depression level. These results suggest that the hospital administrative units may develop training courses about resourcefulness skills to reduce psychiatric nurses' work stress, and improve their mental health.

Depression and employment status in primary and tertiary care settings

OBJECTIVE

Major depressive disorder (MDD) is a leading cause of disability. Impairment in work function considerably adds to symptom burden and increases the economic impact of this disorder. Our study aimed to investigate the factors associated with work status in MDD within primary and tertiary care.

METHOD

We used data from 2 large databases for our analysis--Study 1: the InSight database, a chart review of MDD patients treated by primary care physicians across Canada (n=986); and Study 2: the International Mood Disorders Collaborative Project, a cross-sectional study of mood disorder patients (Canadian data only: n=274).

RESULTS

Both studies demonstrated high rates of unemployment and disability (30.3% to 42.1%). Quebec showed the highest rate of unemployment (21%) and British Columbia had the greatest percentage of patients on disability (15%). Employed and unemployed groups were similar based on clinical characteristics; however, unemployed people may have higher age, prevalence of medical comorbidity, and greater likelihood of receiving a benzodiazepine. Increased disability rates were associated with history of childhood abuse, duration of current major depressive episode, comorbidity, benzodiazepine use, as well as greater depression and anxiety severity. The unemployed-disability groups had greater somatic symptoms and anhedonia. In keeping with this, anhedonia was the strongest predictor of disability. Absenteeism was also high across both studies.

CONCLUSIONS

Unemployment and disability rates in MDD are high. The presence of anhedonia and medical comorbidity significantly influenced work status, emphasizing the need for treatment strategies to alleviate the additional symptom burden in this subpopulation.

Evaluating Job Demands and Control Measures for Use in Farm Worker Health Surveillance

Workplace stress likely plays a role in health disparities; however, applying standard measures to studies of immigrants requires thoughtful consideration. The goal of this study was to determine the appropriateness of two measures of occupational stressors ('decision latitude' and 'job demands') for use with mostly immigrant Latino farm workers. Cross-sectional data from a pilot module containing a four-item measure of decision latitude and a two-item measure of job demands were obtained from a subsample (N = 409) of farm workers participating in the National Agricultural Workers Survey. Responses to items for both constructs were clustered toward the low end of the structured response-set. Percentages of responses of 'very often' and 'always' for each of the items were examined by educational attainment, birth country, dominant language spoken, task, and crop. Cronbach's α, when stratified by subgroups of workers, for the decision latitude items were (0.65-0.90), but were less robust for the job demands items (0.25-0.72). The four-item decision latitude scale can be applied to occupational stress research with immigrant farm workers, and potentially other immigrant Latino worker groups. The short job demands scale requires further investigation and evaluation before suggesting widespread use.

Physical and psychosocial wellbeing of nurses in a regional Queensland hospital

Occupational stress is common among nurses. Two factors that may influence stress levels are diet and physical activity. The purpose of this study was to investigate the diets and physical activity levels of nurses and to quantify the relationships between these behaviours and anxiety, depressed mood, stress, and burnout. Nurses (N = 52) from one regional hospital completed a survey assessing physical activity, nutrition, and psychological functioning. Almost two-thirds (65%) of participants had met recommended levels of both moderate and vigorous physical activity in the week prior. Participants met recommended levels for fruit, but not vegetable, consumption. Burnout and stress levels were close to norms for physicians and nurses. Scores for depressed mood, anxiety, and stress symptoms were within one standard deviation of norms for the Australian adult population. Several moderately sized correlations were found between the psychological constructs measured and both physical activity and nutrition. Although most of the participants were physically active and seemed to be consuming nutritious diets, some nurses may need encouragement to adopt similarly healthy behaviours.

Prevalence and associated factors of depressive symptoms among Chinese underground coal miners

Although underground coal miners are quite susceptible to depressive symptoms due to a highly risky and stressful working environment, few studies have focused on this issue. The purpose of the study was to evaluate the prevalence of depressive symptoms and to explore its associated factors in this population. A cross-sectional survey was conducted in a coal-mining population in northeast China. A set of self-administered questionnaires was distributed to 2500 underground coal miners (1,936 effective respondents). Depressive symptoms, effort-reward imbalance (ERI), overcommitment (OC), perceived physical environment (PPE), work-family conflict (WFC), and some demographic and working characteristics were measured anonymously. The prevalence of depressive symptoms was 62.8%, and the mean level was 20.00 (9.99). Hierarchical linear regression showed that marital status, education, monthly income, and weekly working time were significantly associated with depressive symptoms. A high level of depressive symptoms was significantly associated with high ERI, PPE, WFC, and OC. Accordingly, most Chinese underground coal miners probably have depressive symptoms that are mainly predicted by some occupational psychosocial factors. Efforts should be made to develop strategies to reduce ERI and OC, improve physical working environment, and care for workers' family well-being, thereby mitigating the risk of depression among Chinese underground coal miners.

Relationships among work stress, job satisfaction, mental health, and healthy lifestyle behaviors in new graduate nurses attending the nurse athlete program: a call to action for nursing leaders

BACKGROUND

Although nurses are educated to take outstanding care of others, they themselves often have poor health outcomes, including high rates of depression and obesity, which are associated with stressful work environments. Furthermore, a high percentage of new graduate nurses leave their positions in the first year of employment, resulting in exorbitant costs to health care systems.

PURPOSE

The aim of this study was to determine the relationships among key variables that influence job satisfaction and healthy lifestyle behaviors of new graduate nurses, including workplace stress, work environment, lifestyle beliefs, and mental health.

DESIGN

A descriptive correlational design was used with baseline data from 61 new graduate nurses attending the 2-day Nurse Athlete program, a workshop that focuses on nutrition, energy management, and physical activity.

RESULTS

Higher levels of workplace stress were associated with higher levels of depression and anxiety as well as lower levels of resiliency, job satisfaction, and healthy lifestyle beliefs.

IMPLICATIONS

Nurse leaders and managers must invest in creating healthy work environments for new and experienced nurses as well as provide mental health screening, resources, and intervention programs that focus on education and skills-building in health promoting behaviors, including emotional regulation of stress, anxiety, and depression.

The Factors Associated with Anxiety and Depression in Slovenian Armed Forces Members on a Peacekeeping Mission in the Western Balkans / Dejavniki, Povezani Z Depresijo In Tesnobnostjo Pri Slovenskih Vojakih Na Mirovni Misiji Na Zahodnem Balkanu

Objective: To identify the factors associated with the onset of depression and anxiety in professional soldiers on a peacekeeping mission in Kosovo in 2009.

Methods: A cross-sectional study of 244 members of the Slovenian Armed Forces on a peace-keeping mission, using the Depression Self Rating Scale, the Self-Rating Anxiety Scale and a background questionnaire, was performed.

Results: A 6.9% prevalence of depression and a 7.9% prevalence of anxiety were identified. The presence of a chronic pain condition and the recent termination of an intimate relationship were independently associated with the onset of either anxiety or depression or with a co-morbidity of anxiety and depression.

Conclusions: In spite of medical and psychological examinations prior to peacekeeping operations, the onset of anxiety and depression calls for special attention and empowerment by teaching peacekeepers how to use their social support and personal mastery resources.

Using Bayesian networks to analyze occupational stress caused by work demands: preventing stress through social support

Occupational stress is a major health hazard and a serious challenge to the effective operation of any company and represents a major problem for both individuals and organizations. Previous researches have shown that high demands (e.g. workload, emotional) combined with low resources (e.g. support, control, rewards) are associated with adverse health (e.g. psychological, physical) and organizational impacts (e.g. reduced job satisfaction, sickness absence). The objective of the present work is to create a model to analyze how social support reduces the occupational stress caused by work demands. This study used existing Spanish national data on working conditions collected by the Spanish Ministry of Labour and Immigration in 2007, where 11,054 workers were interviewed by questionnaire. A probabilistic model was built using Bayesian networks to explain the relationships between work demands and occupational stress. The model also explains how social support contributes positively to reducing stress levels. The variables studied were intellectually demanding work, overwork, workday, stress, and social support. The results show the importance of social support and of receiving help from supervisors and co-workers in preventing occupational stress. The study provides a new methodology that explains and quantifies the effects of intellectually demanding work, overwork, and workday in occupational stress. Also, the study quantifies the importance of social support to reduce occupational stress.

Analysis of job stress in workers employed by three public organizations in Serbia

OBJECTIVES

The present study analyzes job stress in terms of education, age and the presence of cardiovascular and endocrine/metabolic diseases.

MATERIAL AND METHODS

A total of 411 workers employed by three public organizations completed the Job Content Questionnaire to classify their jobs based on the job strain model. Data about health condition, education and habits was obtained by the use of medical examinations and an interview.

RESULTS

The analysis of the completed Job Content Questionnaires indicates that workers with high education have significantly higher decision latitude (DL) than low-educated workers (one-way ANOVA, p < 0.0001). DL was also different between age groups (one-way ANOVA, p < 0.0001) - the highest DL values were observed in the oldest group, while the lowest DL mean was found in the youngest group. Psychological job demands (PJD) and social support (SS) were not significantly different between educational and age groups. The frequency of job stress categories was significantly different between low and highly-educated workers (χ(2) test, df = 3, p < 0.0001) and also between different age groups (χ(2) test, df = 6, p < 0.0001). The majority of highly-educated men were exposed to "active" jobs (high PJD and high DL). Most frequently, men older than 45 years experienced jobs with high DL ("active" and "low strain"), men aged 35 to 45 years were exposed to jobs with high PJD ("high strain" and "active") while the majority of men younger than 35 years were exposed to jobs with low DL ("high strain" and "passive"). No association between cardiovascular and endocrine/metabolic disorders and different job stress categories was observed.

CONCLUSION

"High strain" and "passive" jobs were most frequently identified among low-educated and young men. Despite the absence of association between job stress and cardiovascular and endocrine/metabolic diseases, we recommend prevention of work stress, particularly in the case of low-educated workers and workers younger than 45 years exposed to unfavorable job stress categories.

Cannabinoids ameliorate impairments induced by chronic stress to synaptic plasticity and short-term memory

Repeated stress is one of the environmental factors that precipitates and exacerbates mental illnesses like depression and anxiety as well as cognitive impairments. We have previously shown that cannabinoids can prevent the effects of acute stress on learning and memory. Here we aimed to find whether chronic cannabinoid treatment would alleviate the long-term effects of exposure to chronic restraint stress on memory and plasticity as well as on behavioral and neuroendocrine measures of anxiety and depression. Late adolescent rats were exposed to chronic restraint stress for 2 weeks followed each day by systemic treatment with vehicle or with the CB1/2 receptor agonist WIN55,212-2 (1.2 mg/kg). Thirty days after the last exposure to stress, rats demonstrated impaired long-term potentiation (LTP) in the ventral subiculum-nucleus accumbens (NAc) pathway, impaired performance in the prefrontal cortex (PFC)-dependent object-recognition task and the hippocampal-dependent spatial version of this task, increased anxiety levels, and significantly reduced expression of glucocorticoid receptors (GRs) in the amygdala, hippocampus, PFC, and NAc. Chronic WIN55,212-2 administration prevented the stress-induced impairment in LTP levels and in the spatial task, with no effect on stress-induced alterations in unconditioned anxiety levels or GR levels. The CB1 antagonist AM251 (0.3 mg/kg) prevented the ameliorating effects of WIN55,212-2 on LTP and short-term memory. Hence, the beneficial effects of WIN55,212-2 on memory and plasticity are mediated by CB1 receptors and are not mediated by alterations in GR levels in the brain areas tested. Our findings suggest that cannabinoid receptor activation could represent a novel approach to the treatment of cognitive deficits that accompany a variety of stress-related neuropsychiatric disorders.

Psychosocial work factors, major depressive and generalised anxiety disorders: results from the French national SIP study

BACKGROUND

Anxiety and depression are prevalent mental disorders in working populations. The risk factors of these disorders are not completely well known. Developing knowledge on occupational risk factors for mental disorders appears crucial. This study investigates the association between various classical and emergent psychosocial work factors and major depressive and generalised anxiety disorders in the French working population.

METHODS

The study was based on a national random sample of 3765 men and 3944 women of the French working population (SIP 2006 survey). Major Depressive Disorder (MDD) and Generalised Anxiety Disorder (GAD) were measured using a standardised diagnostic interview (MINI). Occupational factors included psychosocial work factors as well as biomechanical, physical, and chemical exposures. Adjustment variables included age, occupation, marital status, social support, and life events. Multivariate analysis was performed using logistic regression analysis.

RESULTS

Low decision latitude, overcommitment, and emotional demands were found to be risk factors for both MDD-GAD among both genders. Other risk factors were observed: high psychological demands, low reward, ethical conflict, and job insecurity, but differences were found according to gender and outcome. Significant interaction terms were observed suggesting that low decision latitude, high psychological demands, and job insecurity had stronger effects on mental disorders for men than for women.

LIMITATIONS

Given the cross-sectional study design, no causal conclusion could be drawn.

CONCLUSIONS

This study showed significant associations between classical and emergent psychosocial work factors and MDD-GAD. Preventive actions targeting various psychosocial work factors, including emergent factors, may help to reduce mental disorders at the workplace.

Stress modulation of reconsolidation

Memories are consolidated and are inscribed as stable traces in the brain; however, once they are retrieved, they are rendered labile and can be modified in a process termed reconsolidation. Studies illustrate the power of behavioral stress and stress hormones to modulate memory processes while focusing on consolidation. However, sparse evidence indicates a critical role of stress in modulating reconsolidation. In this review, we discuss the effects of stress and stress-related neurotransmitter systems on reconsolidation of emotional and non-emotional types of memories. We show that although some general features underlie consolidation and reconsolidation, there is a possible dissimilarity between the two processes that may be dependent on factors such as the cognitive task employed, specific type of stressor, and the arousal state of the animal. The ability to disrupt or facilitate the reconsolidation of emotional and drug-related memories by stress exposure has important implications for the treatment of anxiety disorders linked to traumatic memories, such as post-traumatic stress disorder and of drug-of-abuse memories.

Perceived stress and self-esteem mediate the effects of work-related stress on depression

The aim of the present study was to investigate the impact of perceived stress and self-esteem on work-related stress and depression. Two hundred and eighty-four Korean nurses participated in the study. The participants completed four questionnaires, including the Korean short version of the occupational stress scale, the perceived stress scale, the Rosenberg self-esteem scale and the Beck depression inventory. Structural equation modelling was used to determine the relationships among work-related stress, perceived stress, self-esteem, and depression. Work-related stress was positively associated with depression. Perceived stress was inversely related to self-esteem and positively associated with work-related stress and depression, respectively. Self-esteem was negatively associated with work-related stress and depression. Structural equation modelling revealed that self-esteem and perceived stress fully mediate the relationship between work-related stress and depression. Future studies should further investigate the effect of psychological characteristics on work-related stress and symptoms of depression.

Repeated job strain and the risk of depression: longitudinal analyses from the Whitehall II study

OBJECTIVES

We addressed whether repeated job strain and low work social support increase the risk of major depressive disorder (MDD).

METHODS

We used work characteristics from Karasek's Job Strain model, measured on 3 occasions over 10 years in a cohort of 7732 British civil servants, to predict subsequent onset of MDD with the Composite International Diagnostic Interview.

RESULTS

Repeated job strain was associated with increased risk of MDD (odds ratio [OR] = 2.19; 95% confidence interval [CI] = 1.48, 3.26; high job strain on 2 of 3 occasions vs none) in a fully adjusted model. Repeated low work social support was associated with MDD (OR = 1.61; 95% CI = 1.10, 2.37; low work social support on 2 of 3 occasions vs none). Repeated job strain remained associated with MDD after adjustment for earlier psychological distress.

CONCLUSIONS

Demonstration of an increased association for repeated job strain adds to the evidence that job strain is a risk factor for depression. Recognition and alleviation of job strain through work reorganization and staff training could reduce depression in employees.

Depression in hospital-employed nurses

Depression impacts 9.4% of the adult population in the United States, and it is known to impact work performance. Nurses with depression are not only likely to suffer themselves, but their illness may have an impact on their coworkers and potentially the quality of care they provide. Thus, the purpose of this study was to determine the prevalence of depression in a random sample of hospital-employed nurses to determine individual and workplace characteristics that are associated with depression. A cross-sectional survey design of 1171 registered nurses was used. Measures included individual characteristics, workplace characteristics, work productivity, and depression (9-item Patient Health Questionnaire). Data analysis demonstrated a depressive symptom rate of 18%. The linear regression model accounted for 60.6% of the variation in the 9-item Patient Health Questionnaire depression scores. Body mass index, job satisfaction, number of health problems, mental well-being, and health-related productivity had significant relationships with depression (P < .05). Hospital-employed nurses have higher rates of depressive symptoms than national norms. Advanced practice nurses can assist with educating nurses on recognizing depression and confidential interventions, including the use of computerized cognitive-based therapy.

Demands, skill discretion, decision authority and social climate at work as determinants of major depression in a 3-year follow-up study

PURPOSE

The psychosocial work environment may be a determinant of the development and course of depressive disorders, but the literature shows inconsistent findings. Thus, the aim of this study is to determine longitudinal effects of the job demands-control-support model (JDCSM) variables on the occurrence of major depression among working men and women from the general population.

METHODS

The sample comprised 4,710 working women and men living in Stockholm, who answered the same questionnaire twice, 3 years apart, who were not depressed during the first wave and had the same job in both waves. The questionnaire included JDCSM variables (demands, skill discretion, decision authority and social climate) and other co-variables (income, education, occupational group, social support, help and small children at home, living with an adult and depressive symptoms at time 1; and negative life events at time 2). Multiple logistic regressions were run to calculate odds ratios of having major depression at time 2, after adjustment for other JDCSM variables and co-variables.

RESULTS

Among women, inadequate work social climate was the only significant risk indicator for major depression. Surprisingly, among men, high job demands and low skill discretion appeared as protective factors against major depression.

CONCLUSIONS

The results showed a strong relationship between inadequate social climate and major depression among women, while there were no certain effects for the remaining exposure variables. Among men, few cases of major depression hampered well-founded conclusions regarding our findings of low job demands and high skill discretion as related to major depression.

A population-based longitudinal study on work environmental factors and the risk of major depressive disorder

To investigate the relation between work environmental factors and the risk of major depressive disorder (MDD) over 1 year, the authors conducted a population-based longitudinal study of randomly selected employees in Alberta, Canada (January 2008 to November 2011). Participants without a current or lifetime diagnosis of MDD at baseline (n = 2,752) were followed for 1 year. MDD was assessed using the World Health Organization’s Composite International Diagnostic Interview-Auto 2.1. The overall 1-year incidence of MDD was 3.6% (95% confidence interval: 2.8, 4.6); it was 2.9% (95% confidence interval: 1.9, 4.2) in men and 4.5% (95% confidence interval: 3.3, 6.2) in women. The relations between work environmental factors and MDD differed by sex. In men, high job strain increased the risk of MDD in those who worked 35–40 hours per week; job insecurity and family-to-work conflict were predictive of MDD. Women who worked 35–40 hours per week and reported job insecurity, a high effort-reward imbalance, and work-to-family conflict were at a higher risk of developing MDD. Job strain, effort-reward imbalance, job insecurity, and work-to-family conflicts are important risk factors for the onset of MDD and should be targets of primary prevention. However, these work environmental factors appear to operate differently in men and in women.

Perceived needs for and use of workplace accommodations by individuals with a depressive and/or anxiety disorder

OBJECTIVE

To estimate the percentages of need for and use of workplace mental health accommodations, and to identify factors related to the use of accommodations.

METHODS

Participants with a mental disorder, identified from the community, were questioned about need for and use of workplace accommodations (n = 784). Mental disorders were assessed using the World Health Organization's Composite International Diagnostic Interview.

RESULTS

Eighty-three percent needed accommodations; only 30.5% had received accommodations. Having received accommodations was not related to demographic or socioeconomic factors. Participants with a 12-month disorder were less likely to have received accommodations than others.

CONCLUSIONS

A significant proportion of workers with a mental disorder and need for accommodations have not received accommodations at their workplaces. The accommodations needed by this population are not expensive and can potentially be provided by modifying management practices.

Predictors of 1-year outcomes of major depressive disorder among individuals with a lifetime diagnosis: a population-based study

BACKGROUND

Examining predictors of the outcomes of major depressive disorder (MDD) is important for clinical practice and population health. There are few population-based longitudinal studies on this topic. The objectives of this study were to (1) estimate the proportions of persistent and recurrent MDD among those with MDD over 1 year, and (2) identify demographic, socio-economic, workplace psychosocial and clinical factors associated with the outcomes.

METHOD

From a population-based longitudinal study of the working population, participants with a lifetime diagnosis of MDD were selected (n=834). They were classified into two groups: those with and those without current MDD. The proportions of 1-year persistence and recurrence of MDD were estimated. MDD was assessed by the World Health Organization (WHO) Composite International Diagnostic Interview, CIDI-Auto 2.1, by telephone.

RESULTS

The proportions of persistent and recurrent MDD in 1 year were 38.5% [95% confidence interval (CI) 31.1-46.5] and 13.3% (95% CI 10.2-17.1) respectively. Long working hours, negative thinking and having co-morbid social phobia were predictive of persistence of MDD. Perceived work-family conflict, the severity of a major depressive episode and symptoms of depressed mood were significantly associated with the recurrence of MDD.

CONCLUSIONS

Clinical and psychosocial factors are important in the prognosis of MDD. The factors associated with persistence and recurrence of MDD may be different. More large longitudinal studies on this topic are needed so that clinicians may predict potential outcomes based on the clinical profile and provide interventions accordingly. They may also take clinical action to change relevant psychosocial factors to minimize the chance of persistence and/or recurrence of MDD.

Three job-related stress models and depression: a population-based study

OBJECTIVES

To estimate the current prevalence of major depression in a sample of working population, and to examine the associations between job strain, effort-reward imbalance and family-work conflicts and major depression.

METHODS

A sample of employees who were between the ages of 25 and 65 years and who were working in Alberta at the time of survey was recruited using the method of random digit dialing (n = 4,302). Data about job stress, effort-reward imbalance and work-family conflicts and depression were collected via telephone. Depression was assessed by the Patient Health Questionnaire (PHQ-9) for depression.

RESULTS

The 2-week prevalence of major depression based on the DSM algorithm was 3.2%. The prevalence of severe depression was 0.8%. Job strain, effort-reward imbalance and work-family conflicts were strongly associated with continuous depression score. Effort-reward imbalance was significantly associated with depression scores in women, but not in men. Effort-reward imbalance was significantly associated with depression scores in participants with job strain ratio >1, but not in those with a lower job strain ratio. The association between work to family conflict and depression score was stronger in participants with a job strain ratio greater than one than in those whose job strain ratio was one or less.

CONCLUSIONS

The three job-related stress models are widely used in occupational health research. They are equally important in predicting depression and interact with each other. Improving work environment based on these models holds potentials to reduce the synergetic effects, therefore, improving employees' mental health.

Association between depressive symptoms and metabolic syndrome in police officers: results from two cross-sectional studies

Policing is one of the most dangerous and stressful occupations and such stress can have deleterious effects on health. The purpose of this study was to examine the association between depressive symptoms and metabolic syndrome (MetSyn) in male and female police officers from two study populations, Buffalo, NY and Spokane, WA. Depressive symptoms were measured using the Center for Epidemiologic Studies-Depression (CES-D) scale. MetSyn was defined using the 2005 AHA/NHBLI guidelines. Analysis of covariance was used to describe differences in number of MetSyn components across depressive symptom categories. The number of MetSyn components increased significantly across categories of CES-D for Spokane men only (p-trend = 0.003). For each 5-unit increase in CES-D score, odds increased by 47.6% for having hypertriglyceridemia, by 51.8% for having hypertension, and by 56.7% for having glucose intolerance. Exploring this association is important since both are predictors of future chronic health problems and the results could be helpful in developing future gender-specific prevention and intervention efforts among police officers.

Occupational pressure-targeting organisational factors to ameliorate occupational dysfunction

INTRODUCTION

Chronic pressure at work has debilitating impact on healthcare employers (e.g. reduced productivity, high costs, poor patient care) and on female healthcare employees (e.g. sickness, dysfunction). This paper highlights relationship at work as the key occupational source of work-stress which is organisational in nature.

METHODS

A cross-sectional study (n = 230) was conducted using the Pressure Management Inventory on several female dominated health professions within a large public hospital. Analysis of variance was used to show relationship between sources and outcome of pressure. Linear regressions were used to predict which sources of pressure (IV) was linked to the outcomes of occupational pressure (DV).

RESULTS

The number one source of occupational pressure is relationships at work (i.e. with supervisors), and not workload. 'Relationship' is also the key predictor of several negative outcomes of pressure at work. Analysis of variance showed significant differences in two sources of pressures, i.e. Workload (P = 0.04) and Home-work balance (P = 0.03).

CONCLUSION

This paper provides insights into the occupational pressure of women health professionals by highlighting the organisational sources of pressure and the implications for preventing occupational dysfunction secondary to stress at work.

Increasing prevalence of depression from 2000 to 2006

AIM

Depression is the leading cause of disability and is projected to become the second highest burden of disease (measured in disability-adjusted life years) by 2020, but only a few studies have examined changes over time in the occurrence of depression. The aim of this study is to provide evidence to the hypothesis that the prevalence of depression is rising in the Danish population. We will do that in a longitudinal design among adult Danes by studying the trends from 2000 to 2006 of major depressive disorder (MDD) as well as the distribution across the whole Major Depression Inventory (MDI) scale. In addition, we will investigate whether the trend in MDD is similar across socioeconomic groups.

METHODS

A random sample of 4759 Danes in their forties and fifties were followed in a longitudinal study based on postal questionnaires answered in 2000 and 2006.

RESULTS

The prevalence of MDD increased from 2.0% to 4.9% during 2000-06. Also the distribution of the MDI score in its entirety moves higher up the scale, with the 90th percentile changing from 12 in year 2000 to 20 in 2006. The increasing prevalence is in absolute terms more pronounced among women in their forties and in lower socioeconomic positions.

CONCLUSIONS

The rising MDI score indicates that MDD as well as mental health generally is of public health concern.

Does job strain interact with psychosocial factors outside of the workplace in relation to the risk of major depression? The Canadian National Population Health Survey

OBJECTIVES

To investigate whether job strain interacts with psychosocial factors outside of the workplace in relation to the risk of major depression and to examine the roles of psychosocial factors outside of the workplace in the relationship between job strain and the risk of major depression.

METHODS

Data from the longitudinal cohort of the Canadian National Population Health Survey (NPHS) were used. Major depressive episode (MDE) in the past 12 months was assessed by the Composite International Diagnostic Interview-Short Form. Participants who were working and who were between the ages of 18 and 64 years old in 2000/2001 (n = 6,008) were followed to 2006/2007. MDE that occurred from 1994/1995 to 2000/2001 were excluded from the analysis.

RESULTS

High job strain, negative life events, chronic stress and childhood traumatic events were associated with the increased risk of MDE. There was no evidence that job strain interacted with psychosocial factors outside of the workplace in relation to the risk of MDE. The incidence proportion in participants who reported having exposed to none of the stressors, one type of stressor, two types of stressors and three or more types of stressors was 2.6, 4.3, 6.6 and 14.2%, respectively. The odds of developing MDE in participants who were exposed to three or four types of stressors was more than four times higher than the reference group.

CONCLUSION

MDE may be facilitated by simultaneous exposure to various stressors. There is a dose-response relationship between the risk of MDE and the number of stressors.

Impact of depression on work productivity and its improvement after outpatient treatment with antidepressants

OBJECTIVE

Depressive disorders influence socioeconomic burden at both the individual and organizational levels. This study estimates the lost productive time (LPT) and its resulting cost among workers with major depressive disorder (MDD) compared with a comparison group. It also estimates the change in productivity after 8 weeks of outpatient psychiatric treatment with antidepressants.

METHODS

Working patients diagnosed with MDD without other major physical or mental disorders were recruited (n = 102), along with age- and sex-matched healthy controls from the Seoul Metropolitan area (n = 91). The World Health Organization's Health and Work Performance Questionnaire and the Hamilton Rating Scale for Depression were utilized to measure productivity and severity of depression, respectively, at baseline and at 8 weeks of treatment.

RESULTS

The LPT from absenteeism and presenteeism (reduced performance while present at work) was significantly higher among the MDD group. Workers with MDD averaged costs due to LPT at 33.4% of their average annual salary, whereas the comparison group averaged costs of 2.5% of annual salary. After 8 weeks of treatment, absenteeism and clinical symptoms of depression were significantly reduced and associated with significant improvement in self-rated job performance (31.8%) or cost savings of $7508 per employee per year.

CONCLUSIONS

We confirmed that significant productivity loss arises from MDD and that this loss can be reduced with psychiatric intervention after a time period as short as 8 weeks. Mental health professionals should work with employers to devise a cost-effective system to provide workers with accessible quality care.

A Study on Social Support and Depression by Gender among Adults

PURPOSE

This study was to compare social support and depression by gender, to investigate related factors, and to inquire effect of social support on depression by gender.

METHODS

This study analyzed raw data from a project funded by Jeju Province. The data were collected through home visit interview from 750 households which were selected by using randomized cluster sampling method. CES-D and MOS SSS were used for measuring depression and social support. Data obtained from 896 adults were analyzed using t-test, chi2 test and hierarchical regression.

RESULTS

There was no significant difference of depression prevalence, presenting 15.2% for men and 14.5% for women. The related factors were marital status, educational level, and socioeconomic status for men and only socioeconomic status for women. The result of hierarchical regression presented that social support was significant on depression, showing increase of R2 from .151 to .328 when adding social support to other variables for men, increase of R2 from .058 to .192 for women.

CONCLUSION

The social support was an influential factor on depression both men and women, the development of strategies considering risk population by gender for enhancing social support to prevent and to manage depression was suggested.

The psychosocial factors at work related to depression among female white-collar workers in Vilnius (Lithuania)

OBJECTIVES

The aim of this study is to establish which psychosocial factors at work are related to depression among female white-collar workers in Vilnius.

MATERIALS AND METHODS

The data was collected in a case-control study in 2002-2004. The cases were selected from patients treated at Vilnius mental health centers. The controls were randomly selected from employed Vilnius residents. A descriptive statistic and logistic regression was applied.

RESULTS

3 psychosocial factors and possible confounders within the evaluated model were statistically reliable (model χ(2): 44.47, p < 0.05 ). The adjusted odds ratio for uneven work distribution was 2.17 (95% CI: 1.38-3.51, p < 0.005), the odds ratio for possibility to control was 10.81 (95% CI: 2.13-54.71, p < 0.005), and the odds ratio for family esteem was 2.13 (95% CI: 1.01-4.59, p < 0.005).

CONCLUSION

This study suggests that work distribution, possibility to control and family esteem, together with stressful life events and mental health disorders in the family, are related to depression among female white-collar workers.

Health disparities in police officers: comparisons to the U.S. general population

Police officers have one of the poorest cardiovascular disease (C'D) health profiles of any occupation. The goal of this study was to determine if police officers in the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Study (between 2004 and 2009) had a more adverse CV profile than the general US. employed population. Nearly one-half (46.9%) of the officers worked a non-day shift compared to 9% of U.S. workers. The percent of officers with depression was nearly double (12.0% vs. 6.8%) and officers were nearly four times more likely to sleep less than six hours in a 24-hour period than the general population (33.0% vs. 8.0%). A higher percentage of officers were obese (40.5% vs. 32.1%), had the metabolic syndrome (26.7% vs. 18.7%), and had higher mean serum total cholesterol levels (200.8 mg/dL vs. 193.2 mg/dL) than the comparison employed populations. In addition to having higher levels of traditional CVD risk factors, police officers had higher levels of non-traditional CVD risk factors. These findings highlight the need for expanding the definition of a health disparity to include occupation. Future studies should expand this comparison to additional traditional and non-traditional CVD risk factors and to other occupational groups.

Objektive Erfassung von Job Demands und Decision Latitude sowie Zusammenhänge der Tätigkeitsmerkmale mit Erholungsunfähigkeit

Ziel der vorliegenden Studie war die Beantwortung der Frage, ob sich Zusammenhänge von Job Demands und Decision Latitude ( Karasek, 1979 ) mit Fehlbeanspruchungsfolgen auch zeigen, wenn die Tätigkeitsmerkmale mit objektiven Arbeitsanalysemethoden erfasst werden. Zur Operationalisierung der Tätigkeitsmerkmale wurden theoriebasiert Items des Tätigkeitsbewertungssystems TBS ( Pohlandt et al., 2003 ; Rudolph et al., 1987 ) ausgewählt. Die neu gebildeten Skalen Job Demands-TBS und Decision Latitude-TBS wurden in einer Stichprobe von 397 Erwerbstätigen aus verschiedenen Branchen zur Vorhersage von Erholungsunfähigkeit eingesetzt. Simultane konfirmatorische Faktorenanalysen mit den TBS-Items und den FIT-Items ( Richter et al., 2000 ) wurden berechnet. Hierarchische Regressionsanalysen konnten zeigen, dass hohe objektiv und subjektiv erfasste Job Demands sowie geringe subjektiv erfasste Decision Latitude mit Erholungsunfähigkeit einhergehen. Die Erfassung von Job Demands und Decision Latitude mit dem TBS ermöglicht eine vom subjektiven Erleben des Arbeitsplatzinhabers unabhängige Erfassung der Tätigkeitsmerkmale und die direkte Ableitung von Maßnahmen zur Gestaltung gesundheitsförderlicher Arbeitsbedingungen.

Depression in the workforce: the intermediary effect of medical comorbidity

BACKGROUND

It is amply documented that mood disorders adversely affect job satisfaction, workforce productivity, and absenteeism/presenteeism. It is also well documented that mood disorders are an independent risk factor for several chronic medical disorders (e.g., obesity, diabetes mellitus, cardiovascular disease). Emerging evidence indicates that the workforce dysfunction associated with depression is partially mediated by medical comorbidity.

METHODS

We conducted a PubMed search of all English-language articles published between 2005 and July 2009 with the following search terms: major depressive disorder and depression, cross-referenced with work productivity, disability, economic cost, absenteeism, presenteeism, and medical comorbidity. Articles selected for review were based on adequacy of sample size, the use of standardized experimental procedures, validated assessment measures, and overall manuscript quality.

RESULTS

Mood disorders are the most impairing condition amongst working adults. It is estimated that approximately 35-50% of employees with depression will take short-term disability leave at some point during their job tenure. Moreover, 15-20% of the workforce will receive short-term disability benefits during any given year; the annual income of individuals affected by depression is reduced by approximately 10% when compared to unaffected employees. Chronic stress-sensitive conditions independently contribute to workforce maladjustment and associated disability. The mood disorder population is differentially affected by several stress-related medical conditions resulting in greater impairment in the workforce.

CONCLUSION

Disability modelling in the depressed employee has emphasized the complex interrelationship between depressive symptoms, workforce stress, and consequent disability. A more refined model must include the effects of chronic medical conditions as a powerful mediator and/or moderator of workforce impairment. Multidisciplinary interventions have been demonstrated to reduce, but not eliminate workforce disability related to depression, underscoring the need for elucidating other modifiable factors. Screening, treatment, and prevention initiatives need to target chronic medical conditions in depressed employees in order to reduce overall workforce disability.

Working conditions and depressive symptoms in the 2003 decennial health survey: the role of the occupational category

INTRODUCTION

The aim of this study is to describe the associations between depressive symptoms and some working conditions according to broad occupational categories in France.

METHODS

These data came from the decennial health survey conducted in 2003 in France by the National Institute for Statistics and Economics Studies (6,082 men, 5,521 women). The data collected included: depressive symptoms (Center for Epidemiological Studies-Depression Scale), psychosocial factors at work and potential confounding factors.

RESULTS

Associations between psychosocial work factors and depressive symptoms varied, according to occupational category and sex. Time pressure was significantly associated with depressive symptoms in the less advantaged occupational categories. The lack of job control was associated with depressive symptoms only in managers and associate professionals and technicians. Only low social support was systematically associated with depressive symptoms, regardless of occupational category.

CONCLUSION

These results should be taken into account to adapt strategies of mental health disorders prevention at work, for a better efficacy.

The prevalence of mental disorders in the working population over the period of global economic crisis

OBJECTIVES

The ongoing global economic crisis may have affected people's mental health. This study aimed to, among a sample of the working population, estimate and compare the prevalence of depressive and anxiety disorders in different time intervals from January 2008 to October 2009 and to examine the demographic and socioeconomic correlates of mental disorders.

METHODS

From January 2008 to October 2009, 3579 employees in Alberta were recruited using the random digit dialing method. Mental disorders were assessed using the World Health Organization's Composite International Diagnostic Interview-Auto 2.1. The lifetime and 12-month prevalence of depressive and anxiety disorders in different time intervals were estimated and compared.

RESULTS

The 12-month prevalence of major depressive disorder (MDD) before September 1, 2008; between September 1, 2008, and March 1, 2009; and between March 1, 2009, and October 30, 2009, was 5.1%, 6.8%, and 7.6% (P = 0.03), respectively. The lifetime prevalence of dysthymia reported during the 3 periods was 0.4%, 0.7%, and 1.5% (P = 0.006), respectively. No changes in the 12-month prevalence of social phobia, panic disorder, and generalized anxiety disorder were found over time.

CONCLUSIONS

The ongoing global economic crisis may have contributed to the increased prevalence of MDD. Future studies are needed to monitor the changes in the prevalence and to describe how the event may affect people's employment status, income, and health.

[The association between psychosocial work demands and mental health problems in Quebec: a gender-based analysis]

OBJECTIVE

The objective of the study was to conduct a gender-based analysis of associations between certain psychosocial work demands and certain mental health problems in Québec.

METHODS

The study comprised 2,877 workers, with a response rate of 78%. Data collection was conducted by means of computer-assisted interviews, mainly in person. The mental health problems retained in the model were: psychological distress, a major episode of depression, and a positive score on the global depression index. The psychosocial work demands measured were: level of decision latitude, of psychological job demands and of social support. A set of job and personal characteristics were also measured.

FINDINGS

In all, 41% of Québec workers have a low level of decision authority and 46% experience low skill discretion at work. Moreover, 45% reported having little social support and 40% high psychological job demands. The findings show that 25% of the population studied had experienced a level of psychological distress during the month preceding the survey, and during the previous 12 months, 4% had had a major episode of depression and 6.4% a score on the global depression index indicating depression. These indicators seemed more marked among women compared to men. The findings of the multivariate analysis showed that among women, low skill discretion surprisingly appeared to be a protective factor against a major episode of depression.

CONCLUSION

The reasons for these differences between the sexes are discussed and seem related to such factors as more unfavourable working conditions for women, as well as double workloads (home and work), and a relationship to work that differs from that of men.

The impact of worker health on long term care: implications for nursing managers

Long-term care (LTC) facilities face many challenges, including retention of qualified and caring staff and maintaining high-quality care. In 2008, the Institute of Medicine (IOM)(1) reported widespread consensus that there are insufficient numbers of competent licensed and direct care staff to manage, supervise, and deliver high-quality care to the elderly population. Although examples of excellence in nursing home care exist, average quality of care has remained persistently low,(2) and little progress has been made to improve safety in LTC.(3) The Nursing Home Reform Act (which was included in the 1987 Omnibus Budget Reconciliation Act) mandates minimum staffing levels in Medicare and Medicaid certified LTC facilities. Although research has documented the importance of adequate staffing for quality of care, little attention has been placed on the productivity of staff and how this may impact care. The purpose of this article is to discuss the issue of worker presenteeism (reduced productivity due to health problems) and how this may be affecting quality of resident care. Strategies for nurse managers to recognize and address presenteeism are also discussed.

A prospective study of predictors of depression symptoms in police

Police work is one of the most stressful occupations. Previous research has indicated that work stress and trauma exposure may place individuals at heightened risk for the development of depression symptomatology. This prospective longitudinal study was designed to examine predictors of depression symptoms in police service. Participants comprised 119 healthy police recruits from an ongoing prospective study. They completed baseline measures of depression symptoms, childhood trauma exposure, neuroticism, and self-worth during academy training. Follow-up measures of depression symptoms, PTSD symptoms, critical incident exposure, negative life events, and routine work environment stress were assessed after 12 months of police service. Hierarchical linear regression analysis was conducted to examine predictors of current levels of depression symptoms, controlling for baseline depression symptoms and current PTSD symptoms. Greater childhood trauma exposure, lower self-worth during training, and greater perceived work stress in the first year of police service predicted greater depression symptoms at 12 months. Depression symptoms at 1 year of police service were partly independent from PTSD symptoms at 12 months. Greater childhood trauma exposure and lower self-worth during training may be important variables to screen as risk factors for duty-related depression. Strategies to reduce routine work environment stress have the potential to decrease duty-related depression in law enforcement.

Job strain in physical therapists

BACKGROUND

Job stress has been associated with poor outcomes. In focus groups and small-sample surveys, physical therapists have reported high levels of job stress. Studies of job stress in physical therapy with larger samples are needed.

OBJECTIVE

The purposes of this study were: (1) to determine the levels of psychological job demands and job control reported by physical therapists in a national sample, (2) to compare those levels with national norms, and (3) to determine whether high demands, low control, or a combination of both (job strain) increases the risk for turnover or work-related pain.

DESIGN

This was a prospective cohort study with a 1-year follow-up period.

METHODS

Participants were randomly selected members of the American Physical Therapy Association (n=882). Exposure assessments included the Job Content Questionnaire (JCQ), a commonly used instrument for evaluation of the psychosocial work environment. Outcomes included job turnover and work-related musculoskeletal disorders.

RESULTS

Compared with national averages, the physical therapists reported moderate job demands and high levels of job control. About 16% of the therapists reported changing jobs during follow-up. Risk factors for turnover included high job demands, low job control, job strain, female sex, and younger age. More than one half of the therapists reported work-related pain. Risk factors for work-related pain included low job control and job strain.

LIMITATIONS

The JCQ measures only limited dimensions of the psychosocial work environment. All data were self-reported and subject to associated bias.

CONCLUSIONS

Physical therapists' views of their work environments were positive, including moderate levels of demands and high levels of control. Those therapists with high levels of demands and low levels of control, however, were at increased risk for both turnover and work-related pain. Physical therapists should consider the psychosocial work environment, along with other factors, when choosing a job.

Psychosocial work environment and depressive symptoms among US workers: comparing working poor and working non-poor

BACKGROUND

The psychosocial work environment has been associated with mental health outcomes; however, little research has examined this relationship for low-wage workers. The purpose of this study was to investigate the relationship between psychosocial job characteristics and depressive symptoms for US workers using an expanded model of job quality.

METHODS

Data were from the 2002 National Study of the Changing Workforce, a nationally representative study of wage and salaried workers in the US. Working poor was defined as households earning <250% of the federal poverty threshold.

RESULTS

Multivariate logistic regression models show for working poor employees, job insecurity was the single significant correlate of depressive symptoms after controlling for other demographic and work environment variables. For working non-poor employees, high psychological demands and low supervisor and coworker support were associated with depressive symptoms.

CONCLUSIONS

Findings suggest all jobs do not equally affect employees' depressive symptoms. Implications for research that may improve the mental health of the working poor in the US are presented.

Changes in perceived job strain and the risk of major depression: results from a population-based longitudinal study

Major depression is a prevalent mental disorder in the working population. Improving the work environment may reduce the risk of major depression. The authors examined data from the longitudinal cohort of the Canadian National Population Health Survey from 1994-1995 to 2004-2005. Survey participants were classified into 4 groups by changes in job strain status from 1994-1995 to 2000-2001 (no change in low job strain, no change in high job strain, changing from high to low job strain, and changing from low to high job strain). The incidence proportion of major depressive episodes in each of the 4 groups was 4.0%, 8.0%, 4.4%, and 6.9%, respectively. Participants who reported a change from high to low job strain had a risk of major depression similar to those exposed to persistently low job strain. Among those exposed to persistent high job strain, only participants who reported good or excellent health at baseline had a higher risk of major depression, but those who reported fair or poor health did not. Reducing job strain may have positive impacts on the risk of depression. Self-rated health is a strong predictor of depression and plays an important role in the relation between job strain and depression.

Predictors of depressive symptoms in female medical-surgical hospital nurses

Predictors of depressive symptoms were identified in a sample of 150 female medical-surgical hospital nurses. Participants completed a demographic questionnaire and instruments to measure occupational stress (Nursing Stress Scale), major life events (Social Readjustment Rating Scale), somatic symptoms (Patient Health Questionnaire-15), and depressive symptoms (Center for Epidemiologic Studies-Depression Scale; CES-D) during a one time survey. Thirty-five percent of the nurses scored > or = 16 on the CES-D, the cutoff for mild to moderate depressive symptoms. Fatigue or low energy (43%), pain in their extremities or joints (30%), trouble sleeping (29%), back pain (28%), and headaches (18%) were the primary somatic complaints. Depressive symptoms were positively correlated with somatic symptoms (r = .55, p < .01), major life events (r = .41, p < .01), and occupational stress (r = .29, p < .01). Years employed in the hospital setting (r = -.22, p < .01) and household income (r = -.18, p < .05) were inversely related to depressive symptoms. Hierarchical multiple regression was used to identify predictors of nurses' depressive symptoms. Somatic symptoms (beta = .39, p < .01), occupational stress (beta = .18, p < .05), major life events (beta = .18, p < .05), and income (beta = -.15, p < .05) accounted for 34% of the variance in nurses' depressive symptom scores. The information from this study can guide the development of interventions to reduce depressive symptoms among hospital nurses. Reductions in depressive symptoms can advance health and quality of life for the hospital nurse. Symptom alleviation or reduction may improve nursing care delivery when distressing symptoms interfere with professional performance among nurses.