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

Hussenoeder F, Conrad I, Riedel-Heller S, Romero Starke K. Psychosocial Occupational Exposures and Mental Illness

BACKGROUND

The purpose of this study is to investigate the exposure-risk relationship between psychosocial occupational stress and mental illness.

METHODS

We conducted a systematic review with meta-analyses as an update of a systematic review published in 2014. The study protocol was registered in PROSPERO (CRD42020170032). Literature searches were carried out in the MEDLINE, PsycINFO, and Embase databases. All procedural steps were performed independently by two reviewers; discordances were solved by consensus. All of the included full texts were subject to a methodological appraisal. Certainty of evidence was determined with the GRADE procedure.

RESULTS

The pooled risk of depression was found to be approximately doubled in workers exposed to high job strain, which is defined as high work demands combined with low job control (effect estimate [EE] = 1.99, 95% CI [1.68; 2.35], heterogeneity [I2] = 24.7%, n = 8). In particular, high work demands are associated with incident depression (ES = 13.8 [1.19; 1.61], I2 = 69.0%, n = 9) and with incident anxiety disorder (ES = 1.79 [1.44; 2.23], I2 = 48.1%, n = 5). There were only a small number of methodologically adequate studies available on burnout, somatoform disorders, suicidal ideation, and suicide. Thus, no pooled risk estimates were calculated, although some individual studies showed a considerably increased risk.

CONCLUSION

Psychosocial occupational stress is clearly associated with depression and anxiety disorders.

The Demand-Control Model as a Predictor of Depressive Symptoms-Interaction and Differential Subscale Effects: Prospective Analyses of 2212 German Employees

Testing assumptions of the widely used demand–control (DC) model in occupational psychosocial epidemiology, we investigated (a) interaction, i.e., whether the combined effect of low job control and high psychological demands on depressive symptoms was stronger than the sum of their single effects (i.e., superadditivity) and (b) whether subscales of psychological demands and job control had similar associations with depressive symptoms. Logistic longitudinal regression analyses of the 5-year cohort of the German Study of Mental Health at Work (S-MGA) 2011/12–2017 of 2212 employees were conducted. The observed combined effect of low job control and high psychological demands on depressive symptoms did not indicate interaction (RERI = −0.26, 95% CI = −0.91; 0.40). When dichotomizing subscales at the median, differential effects of subscales were not found. When dividing subscales into categories based on value ranges, differential effects for job control subscales (namely, decision authority and skill discretion) were found (p = 0.04). This study does not support all assumptions of the DC model: (1) it corroborates previous studies not finding an interaction of psychological demands and job control; and (2) signs of differential subscale effects were found regarding job control. Too few prospective studies have been carried out regarding differential subscale effects.

Are depressive disorders caused by psychosocial stressors at work? A systematic review with metaanalysis

In the last decade, many studies have examined associations between poor psychosocial work environment and depression. We aimed to assess the evidence for a causal association between psychosocial factors at work and depressive disorders. We conducted a systematic literature search from 1980 to March 2019. For all exposures other than night and shift work and long working hours, we limited our selection of studies to those with a longitudinal design. We extracted available risk estimates for each of 19 psychosocial exposures, from which we calculated summary risk estimates with 95% confidence intervals (PROSPERO, identifier CRD42019130266). 54 studies were included, addressing 19 exposures and 11 different measures of depression. Only data on depressive episodes were sufficient for evaluation. Heterogeneity of exposure definitions and ascertainment, outcome measures, risk parameterization and effect contrasts limited the validity of meta-analyses. Summary risk estimates were above unity for all but one exposure, and below 1.60 for all but another. Outcome measures were liable to high rates of false positives, control of relevant confounding was mostly inadequate, and common method bias was likely in a large proportion of studies. The combination of resulting biases is likely to have inflated observed effect estimates. When statistical uncertainties and the potential for bias and confounding are taken into account, it is not possible to conclude with confidence that any of the psychosocial exposures at work included in this review is either likely or unlikely to cause depressive episodes or recurrent depressive disorders.

Metabolic status is not associated with job stress in individuals with obesity: the ELSA-Brasil baseline

PURPOSE

Job stress has proven to be a relevant cause of stress for adults, but its effect on the development of metabolic alterations in individuals with obesity is still poorly explored. We aimed to investigate the association between job stress and metabolically unhealthy obesity (MUO) phenotype in participants with obesity at the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline assessment.

METHODS

This study analyzed data collected at the baseline examination between 2008 and 2010. A total of 2371 individuals with obesity were included. Two metabolic phenotypes were characterized based on the US National Health and Nutrition Examination Survey criteria. The job stress scale was based on the Brazilian version of the Swedish Demand-Control-Support Questionnaire. The association between job stress domains and MUO phenotype was assessed by binary logistic models.

RESULTS

In our sample, 1297 (54.7%) participants were women, mean age was 49.6 ± 7.1 years and 1696 (71.5%) had MUO. Low skill discretion was associated with MUO after adjustment for age, sex and race. However, in fully-adjusted models, the MUO phenotype was not associated with high job demand (odds ratio [OR] = 1.05; 95% confidence interval [95%CI] 0.82-1.35), low skill discretion (OR = 1.26; 95%CI 0.95-1.68), low decision authority (OR = 0.94; 95%CI 0.70-1.25) nor low social support (OR = 0.93; 95%CI 0.71-1.20).

CONCLUSION

We found a significant association between low skill discretion and an adverse metabolic profile in models adjusted for age, sex and race. No associations were significant between job stress domains and the metabolic profile of individuals with obesity in full models.

Gendered working environments as a determinant of mental health inequalities: a systematic review of 27 studies

BACKGROUND

'Gendered working environments' describes the ways in which (1) differential selection into work, (2) variations in employment arrangements and working hours, (3) differences in psychosocial exposures and (4) differential selection out of work may produce varied mental health outcomes for men and women. The aim of this study was to conduct a systematic review to understand gender differences in mental health outcomes in relation to the components of gendered working environments.

METHODS

The review followed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) search approach and focused on studies published in 2008-2018. The protocol for the review was prospectively registered with PROSPERO (CRD42019124066).

FINDINGS

Across the 27 cohort studies included in the review, we found that (1) there was inconclusive evidence on the effect of occupational gender composition on the mental health of men and women, (2) women's mental health was more likely to be affected by long working hours than men's; however, precarious employment was more likely to be negatively associated with men's mental health, (3) exposure to traditional constructs of psychosocial job stressors negatively affected the mental health of both women and men, and (4) unemployment and retirement are associated with poorer mental health in both genders.

INTERPRETATION

The findings from this review indicate that gendered working environments may affect the mental health of both men and women, but the association is dependent on the specific exposure examined. There is still much to be understood about gendered working environments, and future research into work and health should be considered with a gender lens.

Leave of absence due to depression

Objective:

to analyze the occurrence of leave of absence due to depression among workers.

Method:

census, descriptive-analytical study, with retrospective collection. Population composed of 2,267 workers on leave due to depression with data from the Unified Benefits Information System. The independent variables were: sex, age group, income; county, origin, number of leaves of absence and type of benefit. For data analysis, descriptive statistics were used and the chi-square and Fisher’s exact tests were applied. The variables that presented a value of p≤0.20 were submitted to logistic regression.

Results:

there was a predominance of females, age ≥50 years, from the capital, with income of one to two minimum wages, urban origin and single removal. Single leaves of absence occurred mainly due to a mild depressive episode and the benefit granted to the significant majority was social security sickness benefit. Among those who were on leave of absence more than once, the main cause was recurrent depressive disorder, a current mild episode and, in terms of benefit, social security sickness benefit. There was a statistical association between total time and absence from work. In logistic regression, it was found that the time ≥60 days, was 3.1 times longer in recurrent depressive disorder.

Conclusion:

there were an expressive quantitative number of absences due to depression, in which it was observed, especially, that the absence time remained long.

Gender and age differences in the association between work stress and incident depressive symptoms among Korean employees: a cohort study

PURPOSE

The aim of this study was to identify gender- and age-specific occupational stress associated with depressive symptoms among Korean employees.

METHODS

Data of 73,014 employees aged 18 and above who had undergone comprehensive health examinations at Kangbuk Samsung Hospital Health Screening Center, South Korea, in January 2012 and who were followed up until December 2017 were collected, and 63,959 (participation rate: 87.59%, men: 50,413, women: 13,546) were finally analyzed. A Cox proportional hazards model was used to estimate the hazard ratios and 95% confidence intervals of the relationship between occupational stress and depressive symptoms. In light of gender and age differences in the association between occupational stress and depressive symptoms, interaction and stratification by gender and age groups were tested.

RESULTS

During 238,630 person-years of follow-up, case-level depressive symptoms developed in 4227 participants (an incident rate of 1.8%). There were gender differences in the relationship between job stress and incident depressive symptoms. For men, high job demand, job insecurity, lack of reward, and discomfort in their organizational climate were associated with incident depressive symptoms in all age groups. Insufficient job control was associated with the development of depressive symptoms only in midlife and organizational injustice only in early adulthood. For women, the results for high job demand, organizational injustice, and discomfort in an organizational climate were associated with the onset of depressive symptoms from early adulthood to the midlife decade.

CONCLUSION

The results suggest gender and age differences in the relationship between occupational stress and incident depressive symptoms.

A randomized controlled trial of a transdiagnostic cognitive-behavioral intervention for Afro-descendants' survivors of systemic violence in Colombia

BACKGROUND

Exposure to violence has negative consequences on mental health. Armed-conflict in Colombia has widely affected Afro-descendants in the Pacific region. Evidence regarding effectiveness of mental health interventions is lacking in low-income settings, especially in areas with active conflict. The objective of this study is to evaluate an individualized Common Elements Treatment Approach (CETA), a transdiagnostic psychotherapy model based on Cognitive-Behavioral Therapy, for adult trauma survivors.

METHODS AND FINDINGS

A referred sample of 521 adult Afro-descendants from Buenaventura and Quibdó, Colombia, experiencing significant sadness, suffering or fear (score>0.77 in Total Mental Health Symptoms), with history of traumatic experiences, and with associated functional impairment were randomly allocated to CETA intervention, standby group without intervention, but under monthly monitoring, or a Narrative Community-Based Group Therapy. CETA was provided by trained Lay Psychosocial Community Workers without previous mental health experience, supervised by psychologists, during 12-14 weekly, 1.5-hour sessions. Symptoms were assessed with a locally validated survey built based on the Hopkins Symptom Checklist, the Harvard Trauma Questionnaire, the PTSD CheckList-Civilian Version, a qualitative study for additional general symptoms and a gender-specific functional impairment scale. CETA was compared with the control group and the intervention effects were calculated with mixed models using intention to treat analysis. Participant completion of follow-up was 75.1% and 13.2% voluntarily withdrew. Reduction in post-traumatic stress symptoms was significant in both municipalities when comparing intervention and control groups (mean difference), with a with a moderate effect size in Buenaventura (Cohen's d  =  0.70) and a small effect size in Quibdó (d = 0.31). In Buenaventura, the intervention also had significant effects on depression (large effect size d = 1.03), anxiety (large effect size d = 0.80) and functional impairment (moderate effect size d = 0.70). In Quibdó, it had no significant effect on these outcomes. Changes in Total Mental Health Symptoms were not significant in neither city.

CONCLUSIONS

This trial suggests that CETA, can be effective in improving depression, anxiety, post-traumatic stress and function among victims of systematized violence in low-income and active conflict settings. Nonetheless, the difference of effectiveness between the two cities of intervention may indicate that we cannot assume that a mental health intervention known to be effective in one setting will be effective in another, even in similar circumstances and population. This may have special importance when implementing and reproducing these types of intervention in non-controlled circumstances. Further research should address these concerns. Results can be of use by governmental decision-makers when defining mental health programs for survivors.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01856673 (https://clinicaltrials.gov/ct2/show/NCT01856673).

Predictors of mental complaints among Norwegian male farmers

BACKGROUND

In the Job Demand-Control (JDC) model and the Job Demand-Resource (JDR) model, the individual worker's potential to influence their work, through job control, is associated with better health. Among self-employed farmers, this job control dimension could be analogous to a sense of independence as this occupational group often highlights this as the best thing about the profession.

AIMS

To analyse how work demands, sense of independence and number of close friends, and the interaction between independence and work demands predicted mental health among male farmers in Norway.

METHODS

The sample consisted of male farmers working 1700h or more on the farm annually in 2012. We used the Lisrel structural equation modelling to estimate the direct effects and the interactive effect of independence and work demands.

RESULTS

There were 926 participants. Decrease in work demands, a strong sense of independence and a high number of close friends predicted lower levels of mental complaints. A strong sense of independence buffered the adverse consequences of work demands on mental health.

CONCLUSIONS

In this sample of self-employed full-time male farmers in Norway, we found that sense of independence was important for their mental health; farmers with a high sense of independence seemed to be able to manage high work demands more effectively, thus reducing the level of mental health problems. In addition, we also found that work demands and social relationships were associated with mental health outcomes.

Mood disorders and complementary and alternative medicine: a literature review

Mood disorders are a major public health problem and are associated with considerable burden of disease, suicides, physical comorbidities, high economic costs, and poor quality of life. Approximately 30%-40% of patients with major depression have only a partial response to available pharmacological and psychotherapeutic interventions. Complementary and alternative medicine (CAM) has been used either alone or in combination with conventional therapies in patients with mood disorders. This review of the literature examines evidence-based data on the use of CAM in mood disorders. A search of the PubMed, Medline, Google Scholar, and Quertile databases using keywords was conducted, and relevant articles published in the English language in the peer-reviewed journals over the past two decades were retrieved. Evidence-based data suggest that light therapy, St John's wort, Rhodiola rosea, omega-3 fatty acids, yoga, acupuncture, mindfulness therapies, exercise, sleep deprivation, and S-adenosylmethionine are effective in the treatment of mood disorders. Clinical trials of vitamin B complex, vitamin D, and methylfolate found that, while these were useful in physical illness, results were equivocal in patients with mood disorders. Studies support the adjunctive role of omega-3 fatty acids, eicosapentaenoic acid, and docosahexaenoic acid in unipolar and bipolar depression, although manic symptoms are not affected and higher doses are required in patients with resistant bipolar depression and rapid cycling. Omega-3 fatty acids are useful in pregnant women with major depression, and have no adverse effects on the fetus. Choline, inositol, 5-hydroxy-L-tryptophan, and N-acetylcysteine are effective adjuncts in bipolar patients. Dehydroepiandrosterone is effective both in bipolar depression and depression in the setting of comorbid physical disease, although doses should be titrated to avoid adverse effects. Ayurvedic and homeopathic therapies have the potential to improve symptoms of depression, although larger controlled trials are needed. Mind-body-spirit and integrative medicine approaches can be used effectively in mild to moderate depression and in treatment-resistant depression. Currently, although CAM therapies are not the primary treatment of mood disorders, level 1 evidence could emerge in the future showing that such treatments are effective.