Appreciation and job control predict depressive symptoms: results from the Study on Mental Health at Work

Gender-specific perception of job stressors and resources: a structural equation model-based secondary analysis

Objective

Stress is an extensive issue in modern society, affecting men and women differently. A better understanding of these patterns is required within the work context. Therefore, this study aimed to identify gender differences in the effects of stressors (quantitative demands, qualitative demands, working time) and resources (job control, quality of leadership, co-worker support) on subjective perceived stress across occupational groups.

Methods

This study was conducted as a secondary data analysis based on the 'German Study on Mental Health at Work' data. The national representative cross-sectional sample included 4,118 employees. The data were analyzed using structural equation modeling.

Results

Correlations between quantitative demands, working time, co-worker support, quality of leadership, job control, and subjective perceived stress were first confirmed for a total sample of employees. Gender differences in these interactions were then analyzed using multi-group equation modeling and a gender-stratified sample. Men and women showed an increase in subjective perceived stress for high quantitative demands. This increase was more prominent for men. Women further showed an increase in subjective perceived stress in response to long working time. High co-worker support, quality of leadership, and job control had stress-reducing effects but did not result in significant gender differences. No association was found between qualitative demands and subjective perceived stress.

Conclusion

The results underline that not all working conditions significantly impact stress for both genders and gender differences exist only within the stressors. Hence, gendered strategies may only be required in some constellations. However, specific contexts require integrating gendered approaches in research and operational practice.

Associations of depressive symptoms and psychosocial working conditions with sickness absences in a Finnish cohort of 11,495 employees

Objective

To examine the relevance of questions on psychosocial working conditions and depressive symptoms, as used in a screening questionnaire in preventive occupational health care, to predict repetitive short or long sickness absences.

Methods

The participants were 11,495 employees of various occupations in Finnish companies. The data were prospectively collected by one occupational healthcare service provider (Finla) and included register data of sickness absences and responses to a questionnaire used in pre-employment and periodic health examinations between 2011 and 2019. Long sickness absences of > 30 days and repetitive short sickness absences of one to ten days in a 24-month follow-up were used as outcome variables for multiple logistic regression analysis.

Results

Strong associations were found between repetitive short and long sickness absences, and the questions on depressive symptoms "felt hopeless about the future", "felt melancholic", "felt everything was an effort", and "feelings of worthlessness". Among questions on psychosocial working conditions, strong associations were found between sickness absences and questions on decision authority, self-reformation opportunities, job versatility, and appreciation for their work.

Conclusions

Questionnaires on depressive symptoms and psychosocial work environment can help identify patients with an increased risk of sickness absence. Data accumulating in occupational health care should be used more systematically to reduce the risk of work disability through targeted occupational health interventions.

Longitudinal association of exposure to work-related stress with major depressive disorder and the role of occupational burnout in this association in the general population

PURPOSE

To prospectively assess (1) the associations of Effort-Reward Imbalance (ERI), its individual components, and over-commitment with (a) the onset of a Major Depressive Episode (MDE) during a 3.6-year follow-up in a population-based cohort in participants with no current Major Depressive Disorder (MDD) in the beginning of the follow-up (n = 959), (b) incidence of MDD in the subsample of participants exempt from lifetime MDD (n = 490), and (c) the onset of a new MDE (i.e. recurrence) in the subsample of participants with remitted but no current MDD (n = 485), and (2) potential effect modification of burnout on these associations.

METHODS

DSM-IV Axis-I disorders were elicited using the semi-structured Diagnostic Instrument for Genetic Studies at each investigation. The ERI Questionnaire was used to measure ERI and overcommitment. Burnout was measured with the Maslach Burnout Inventory General Survey. Serially adjusted logistic regression models were used. The effect of burnout dimensions on these associations was assessed by testing interactions between the ERI and burnout dimensions.

RESULTS

(1) ERI was prospectively associated with the onset of MDE, even after adjustment for burnout [OR (95CI) = 1.22 (1.003-1.49)]. (2) The association between ERI and MDD incidence became non-significant after adjusting for burnout. (3) ERI was not associated with recurrence of pre-existing MDD. (4) burnout did not interact with ERI.

CONCLUSIONS

Our results support a longitudinal association between ERI and the risk of onset of MDE in the community. Burnout did not modify this effect, but it may partially account for the association between ERI and MDD incidence.

Taking appreciation to heart: appreciation at work and cardiovascular risk in male employees

Introduction

While perceived appreciation at work has been associated with self-reported health and wellbeing, studies considering biological health markers are lacking. In this study, we investigated whether appreciation at work would relate to coronary heart disease (CHD) risk as well as the specificity of this proposed association.

Methods

Our study comprised a total of 103 male participants, including apparently healthy, medication-free, non-smoking men in the normotensive to hypertensive range (n = 70) as well as medicated hypertensive and CHD patients (n = 33). CHD risk was assessed by blood pressure [mean arterial pressure (MAP)], the diabetes marker glycated hemoglobin A1c (HbA1c), blood lipids [total cholesterol (TC)/high-density lipoprotein-cholesterol (HDL-C) ratio], coagulation activity (D-dimer and fibrinogen), and inflammation [interleukin (IL)-6, tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP)]. Perceived appreciation at work, as well as potentially confounding psychological factors (social support, self-esteem, and work strain due to a lack of appreciation), were measured by self-report questionnaires.

Results

We found higher appreciation at work to relate to lower overall composite CHD risk (p's ≤ 0.011) and, in particular, to lower MAP (p's ≤ 0.007) and lower blood lipids (p's ≤ 0.031) in medication-free participants as well as all participants. This overall association was independent of confounding factors, including related psychological factors (p's ≤ 0.049).

Discussion

Our findings indicate that appreciation at work might be an independent health-promoting resource in terms of CHD risk. Implications include that encouraging appreciation at work may help reduce the development and progression of CHD.

How does lowering psychosocial risks influence sickness absence? A prospective cohort study analyzed as a quasi-experiment

BACKGROUND

We examined how reducing work-related psychosocial stressors affected long-term sickness absence of younger and older employees.

METHODS

We used data from 43 843 public sector employees in Finland who participated in surveys in 2018 and 2020. We assessed psychosocial factors, such as job demands, job control, work effort, job rewards and worktime control. We obtained sickness absence data from registers for spells longer than 10 consecutive working days. We applied age-specific propensity score weighting and generalized linear models to estimate the effects of changes in psychosocial factors between 2018 and 2020 on sickness absence in 2020.

RESULTS

Among employees under 50 years, increasing job rewards by 1 SD reduced the risk of sickness absence by 17% [risk ratio (RR) 0.83, 95% CI 0.72-0.96]. Among employees aged 50 years or older, decreasing job demands by 1 SD reduced the risk of sickness absence by 13% (RR 0.87, 95% CI 0.78-0.98), and increasing job control by 1 SD reduced the risk by 12% (RR 0.88, 95% CI 0.76-1.01). Changes in efforts and worktime control had no significant associations with sickness absence.

CONCLUSIONS

Reducing psychosocial stressors can lower the occurrence of long-term sickness absence, but the associations differ by age group. Younger workers benefit more from enhancing job rewards, while older workers benefit more from lowering job demands and increasing job control. To establish the causal impact of psychosocial risk reduction on sickness absence across age groups, future research should employ randomized controlled trials as the methodological approach.

Perceived precarious life: a SEM model for re-dimensioning of precarious work and its impact on mental health

Introduction

Precarious work is one of the most studied concepts related to work, and its effects have been analyzed in relation to variables such as mental health and wellbeing. However, there is a tendency to atomise the analysis of precarious work, without understanding that people's working life is intertwined with other areas of their life.

Objective

Faced with this situation, this paper presents the concept of perceived precarious life, which is aligned with contemporary models of social inclusion and exclusion. Thus, perceived precarious life comprises variables of labor precariousness, social support and hopelessness in the family economic situation.

Methods

To test this idea, a structural equation model (SEM) is presented, which tests the structure of the construct of perceived precarious life by relating it to mental health and coping strategies.

Results

After testing the fit of the model in both men and women, a SEM path analysis is designed between the variables, observing that perceived precarious life has an effect on mental health (β = 0.635, p < 0.01). This relationship is mediated by unproductive coping strategies (β = 0.142, p < 0.01).

Conclusion

This model exposes a broad and integrated conceptualization of precariousness, combining aspects of work, relationships and hopelessness, which allows for an understanding of the integral experience of precariousness.

Individual placement and support: History, current status, and future directions

Over the past three decades, Individual Placement and Support (IPS) has emerged as a robust evidence-based approach to helping people with severe mental illnesses, such as schizophrenia, bipolar disorder, and major depression, to obtain and succeed in competitive employment. This review addresses the history, principles, research, and future directions of IPS. It covers current evidence on employment outcomes, cost-effectiveness, and nonvocational outcomes. It also describes current attempts to extend IPS to new populations. The authors provide an overview of numerous systematic reviews and meta-analyses of randomized controlled trials involving people with serious mental illness. For studies addressing nonvocational outcomes and new populations, the review uses best available evidence. Published reviews agree that IPS enables patients with serious mental illness in high-income countries to succeed in competitive employment at a higher rate than patients who receive other vocational interventions. Within IPS programs, quality of implementation, measured by standardized fidelity scales, correlates with better outcomes. Employment itself leads to enhanced income, psychosocial outcomes, clinical improvements, and decreased mental health service use. As IPS steadily spreads to new populations and new settings, research is active across high-income countries and spreading slowly to middle-income countries. IPS is an evidence-based practice for people with serious mental illness in high-income countries. It shows promise to help other disability groups also, and emerging research aims to clarify adaptations and outcomes.

Are Work Demand, Support and Control Associated with Work Ability and Disability during Back Pain Treatment? A Prospective Explorative Study

Background: Low back pain is a multifactorial disease with consequences for work ability and social participation. Improved integration of the work domain in health care management is needed. The aim of this study was to explore the relation between working conditions with outcome of low back pain treatment. Methods: Observational study of 41 patients attending physiotherapy for low back pain. Work demands, support and control were registered at baseline and work ability and disability also at baseline, with follow up after three and nine months. We used mixed-effects models to estimate the longitudinal associations between working conditions and outcome. Results: Higher work demands were related to reduced work ability (−1.1 points, 95% CI: −2.1 to −0.1) and slightly increased disability (5.6 points, 95% CI: 0.5 to 10.7). Lack of social support from colleagues was associated with reduced work ability (−2.7 points, 95% CI: −0.2 to 1.5) and disability (14.0 points, 95% CI: 4.9 to 23.1). Conclusions: This explorative study found associations between work demands and support, and work ability and disability outcome. Screening for psychosocial working conditions may influence the work ability and disability treatment outcome. The results need replication in larger samples and may indicate that patients seeking primary care management for low back pain should be screened for work demands, support and control.