The Role of Mental Health on Workplace Productivity: A Critical Review of the Literature

Unpaid overtime and mental health in the Canadian working population

BACKGROUND

Unpaid overtime-describing a situation where extra hours are worked but not paid for-is a common feature of the labor market that, together with other forms of wage theft, costs workers billions of dollars annually. In this study, we examine the association between unpaid overtime and mental health in the Canadian working population. We also assess the relative strength of that association by comparing it against those of other broadly recognized work stressors.

METHODS

Data were drawn from a survey administered to a heterogeneous sample of workers in Canada (n = 3691). Generalized linear models quantified associations between unpaid overtime, stress, and burnout, distinguishing between moderate (1-5) and excessive (6 or more) hours of unpaid overtime.

RESULTS

Unpaid overtime was associated with higher levels of stress and burnout. Relative to those working no unpaid overtime, men working excessive unpaid overtime were 85% more likely to report stress (prevalence ratios [PR]: 1.85, 95% confidence interval [CI]: 1.26-2.72) and 84% more likely to report burnout (PR: 1.84, 95% CI: 1.34-2.54), while women working excessive unpaid overtime were 90% more likely to report stress (PR: 1.90, 95% CI: 1.32-2.75) and 52% more likely to report burnout (PR: 1.52; 95% CI: 1.12-2.06). The association of excessive unpaid overtime with mental health was comparable in magnitude to that of shift work and low job control.

CONCLUSIONS

Unpaid overtime may present a significant challenge to the mental health of working people, highlighting the potential role of wage theft as a neglected occupational health hazard.

Psychiatric diagnoses are common after liver transplantation and are associated with increased health care utilization and patient financial burden

Psychiatric disorders after liver transplantation (LT) are associated with worse patient and graft outcomes, which may be amplified by inadequate treatment. We aimed to characterize the burden of psychiatric disorders, treatment patterns, and associated financial burden among liver transplantation recipients (LTRs). IQVIA PharMetrics (R) Plus for Academics-a large health plan claims database representative of the commercially insured US population-was used to identify psychiatric diagnoses among adult LTRs and assess treatment. Multivariable logistic regression analysis identified factors associated with post-LT psychiatric diagnoses and receipt of pharmacotherapy. Patient financial liability was estimated using adjudicated medical/pharmacy claims for LTRs with and without psychiatric diagnoses. Post-LT psychiatric diagnoses were identified in 395 (29.5%) of 1338 LTRs, of which 106 (26.8%) were incident cases. Treatment varied, with 67.3% receiving pharmacotherapy, 32.1% psychotherapy, 21.0% combination therapy, and 21.5% no treatment. Among 340 LTRs on psychotropic medications before transplant, 24% did not continue them post-LT. Post-LT psychiatric diagnoses were independently associated with female sex, alcohol-associated liver disease (ALD), prolonged LT hospitalization (>2 wk), and pre-LT psychiatric diagnosis. Incident psychiatric diagnoses were associated with female sex, ALD, and prolonged LT hospitalization. Patients with a post-LT psychiatric diagnosis had higher rates of hospitalization (89.6% vs. 81.5%, p <0.001) and financial liability (median $5.5K vs. $4.6K USD, p =0.006). Having a psychiatric diagnosis post-LT was independently associated with experiencing high financial liability >$5K. Over 1 in 4 LTRs had a psychiatric diagnosis in a large national cohort, yet nearly a quarter received no treatment. LTRs with psychiatric diagnoses experienced increased health care utilization and higher financial liability. Sociodemographic and clinical risk factors could inform high-risk subgroups who may benefit from screening and mitigation strategies.

Effectiveness of Vortioxetine in Working Patients with Major Depressive Disorder in China: A Subgroup Analysis of the RELIEVE China Study

Background

Major depressive disorder (MDD) causes significant functional impairments that impact on all aspects of patients' daily lives, including their ability to work, work productivity, and social life.

Purpose

To assess the real-world effectiveness of the multimodal antidepressant vortioxetine in working patients with MDD in China.

Patients and methods

RELIEVE China was an observational, prospective cohort study. Patients (aged ≥18 years) with MDD initiating treatment with vortioxetine in routine clinical practice settings were followed for 24 weeks. In this subgroup analysis, functioning was assessed using the Sheehan Disability Scale (SDS) in patients in full- or part-time work or education at baseline who remained on treatment at all follow-up visits (n=424). Depressive, cognitive, and anxiety symptoms were also assessed. For all endpoints, mean change from baseline at weeks 8 and 24 was analyzed using mixed models for repeated measures.

Results

Clinically relevant and sustained improvements in patient functioning and measures of work productivity were observed over the 24 weeks of vortioxetine treatment. The adjusted mean (standard error) reduction in SDS total score from baseline was 5.4 (0.3) points at week 8 and 8.7 (0.3) points at week 24 (both P<0.001 vs baseline). Significant improvements were observed across all SDS domains and in levels of absenteeism and presenteeism (P<0.001 vs baseline for all endpoints at both time points). Significant improvements in depressive, cognitive, and anxiety symptoms were also observed over the study period (all P<0.001 vs baseline). The proportion of patients in remission (ie, 17-item Hamilton Depression Rating Scale score ≤7) after 24 weeks of vortioxetine treatment was 65.4%. Vortioxetine was well tolerated; nausea was the most common adverse event, reported by 18.6% of patients.

Conclusion

These findings support the effectiveness and tolerability of vortioxetine in working patients with MDD receiving treatment in routine clinical practice settings in China.

World Psychiatric Association-Asian Journal of Psychiatry Commission on Public Mental Health

Although there is considerable evidence showing that the prevention of mental illnesses and adverse outcomes and mental health promotion can help people lead better and more functional lives, public mental health remains overlooked in the broader contexts of psychiatry and public health. Likewise, in undergraduate and postgraduate medical curricula, prevention and mental health promotion have often been ignored. However, there has been a recent increase in interest in public mental health, including an emphasis on the prevention of psychiatric disorders and improving individual and community wellbeing to support life trajectories, from childhood through to adulthood and into older age. These lifespan approaches have significant potential to reduce the onset of mental illnesses and the related burdens for the individual and communities, as well as mitigating social, economic, and political costs. Informed by principles of social justice and respect for human rights, this may be especially important for addressing salient problems in communities with distinct vulnerabilities, where prominent disadvantages and barriers for care delivery exist. Therefore, this Commission aims to address these topics, providing a narrative overview of relevant literature and suggesting ways forward. Additionally, proposals for improving mental health and preventing mental illnesses and adverse outcomes are presented, particularly amongst at-risk populations.

Social Risk Factors and Racial and Ethnic Disparities in Health Care Resource Utilization Among Medicare Advantage Beneficiaries With Psychiatric Disorders

The intersection of social risk and race and ethnicity on mental health care utilization is understudied. This study examined disparities in health care treatment, adjusting for clinical need, among 25,780 Medicare Advantage beneficiaries with a diagnosis of a psychiatric disorder. We assessed contributions to disparities from racial and ethnic differences in the composition and returns of social risk variables. Black and Hispanic beneficiaries had lower rates of mental health outpatient visits than Whites. Assessing composition, Black and Hispanic beneficiaries experienced greater financial, food, and housing insecurity than White beneficiaries, factors associated with greater mental health treatment. Assessing returns, food insecurity was associated with an exacerbation of Hispanic-White disparities. Health care systems need to address the financial, food and housing insecurity of racial and ethnic minority groups with psychiatric disorder. Accounting for racial and ethnic differences in social risk adjustment-based payment reforms has significant implications for provider reimbursement and outcomes.

Association of precarious employment with depressive symptoms and suicidal ideation among female workers: Findings from a nationwide longitudinal study in Korea

BACKGROUND

In this study, we examined the relationship of precarious employment (PE) with depressive symptoms and suicidal ideation among Korean women.

METHODS

We included a nationwide sample of 4162 women drawn from the Korean Longitudinal Study of Women and Families, comprising 7566 observations. PE was assessed using three dimensions: employment insecurity, income inadequacy, and lack of rights and protection. Depressive symptoms were assessed using the 10-item version of the Center for Epidemiological Studies Depression Scale. Generalized estimating equations were used to estimate the association between each element of PE and the depressive symptoms and suicidal ideation over a two-year follow-up period, represented as odds ratios (ORs) and confidence intervals (CIs).

RESULTS

The overall prevalence rates of depressive symptoms and suicidal ideation were 11.8 % and 1.9 %, respectively. Compared with permanent employment, fixed-term employment (OR [95 % CI]:1.29 [1.00-1.67]) or daily employment (OR [95 % CI]:1.53 [1.26-1.99]) was associated with the depressive symptoms at the follow-up. Additionally, lack of social benefits (OR [95 % CI]:1.40 [1.09-1.79]) and high perceived vulnerability (OR [95 % CI]:1.27 [1.08-1.49]) were associated with the depressive symptoms at the follow-up. Additionally, daily employment was associated with the suicidal ideation at the follow-up (OR [95 % CI]:1.94 [1.02-3.68]) and high perceived vulnerability was marginally associated with an increased suicidal ideation risk (OR [95 % CI]:1.49 [0.98-2.29]).

LIMITATION

Causal effect of PE could not be asserted due to the observational nature of this study.

CONCLUSIONS

PE is a social determinant of women's mental health and policy interventions are required to improve their employment conditions.

Work-rest regimens for work in hot environments: A scoping review

BACKGROUND

To limit exposures to occupational heat stress, leading occupational health and safety organizations recommend work-rest regimens to prevent core temperature from exceeding 38°C or increasing by ≥1°C. This scoping review aims to map existing knowledge of the effects of work-rest regimens in hot environments and to propose recommendations for future research based on identified gaps.

METHODS

We performed a search of 10 databases to retrieve studies focused on work-rest regimens under hot conditions.

RESULTS

Forty-nine articles were included, of which 35 were experimental studies. Most studies were conducted in laboratory settings, in North America (71%), on healthy young adults, with 94% of the 642 participants being males. Most studies (66%) employed a protocol duration ≤240 min (222 ± 162 min, range: 37-660) and the time-weighted average wet-bulb globe temperature was 27 ± 4°C (range: 18-34). The work-rest regimens implemented were those proposed by the American Conference of Governmental and Industrial Hygiene (20%), National Institute of Occupational Safety and Health (11%), or the Australian Army (3%). The remaining studies (66%) did not mention how the work-rest regimens were derived. Most studies (89%) focused on physical tasks only. Most studies (94%) reported core temperature, whereas only 22% reported physical and/or mental performance outcomes, respectively. Of the 35 experimental studies included, 77% indicated that core temperature exceeded 38°C.

CONCLUSIONS

Although work-rest regimens are widely used, few studies have investigated their physiological effectiveness. These studies were mainly short in duration, involved mostly healthy young males, and rarely considered the effect of work-rest regimens beyond heat strain during physical exertion.

Evaluation of physical and mental health conditions related to employees' absenteeism

Background

Employees' health conditions are issues for not only employees themselves but also companies and society to keep medical costs low and productivity high.

Data and methods

In this analysis, 15,574 observations from 2,319 employees at four operational sites of a large corporation were used. The dataset contained physical and mental health conditions obtained from annual mandatory medical checkups, the Brief Job Stress Questionnaire (BJSQ), and work record information. Health and other factors related to long-term absenteeism (over three days in a quarter) were analyzed. Data were collected between February 2021 and January 2022, and we converted into quarterly observations. A logit (logistic regression) model was used in the analysis.

Results

Age and gender were identified as important basic characteristics. The estimates for these variables were positive and negative and significant at the 1% level. Among the variables obtained from the medical checkups, the estimates for diastolic blood pressure, HbA1c, anamnesis, heart disease history, smoking, increased weight, and frequency of alcohol consumption were positive and significant at the 1% level, further those for taking antihypertensive medications and kidney disease history were positive and significant at the 5% level. In contrast, the estimates for systolic blood pressure and amount of alcohol consumption were negative and significant at the 1% level. The estimate for taking antihyperglycemic medications and health guidelines were negative and significant at the 5% level. Among the variables obtained from the BJSQ, the estimates for amount of work felt, fatigue and support from family and friends were positive and significant at the 1%, and the estimate for irritation was positive and significant at the 5% level. The estimates for controlling job and physical complaints were negative and significant at the 1% level, and those for usage of employee's ability to work and suitability of the work were negative and significant at the 5% level. As all four operational sites were located in the northeastern region of Japan (cold and snowy in winter), the seasonal effects were significant at the 1% level. The effect of year was also significant and significant differences were observed among the sites at the 1% level.

Conclusion

Some physical and mental health conditions were strongly associated with long-term absenteeism. By improving these conditions, corporations could reduce the number of employee absence days. As absenteeism was costly for corporations due to replacement employees and their training costs to maintain operations, employers must be concerned about rising healthcare (direct and indirect) costs and implement investments to improve employees' health conditions.

Limitations

This study's results were based on only one corporation and the dataset was observatory. The employees were primarily operators working inside the building and most of them are healthy. Therefore, the sample selection biases might exist, and the results cannot be generalized to other types of jobs, working conditions, or companies. As medical checkups and the BJSQ are mandatory for most companies in Japan, the framework of this study can be applied to other companies. Although we used the BJSQ results, better mental measures might exist. Similar analyses for different corporations are necessary.

The association of positive emotions with absenteeism and presenteeism in Japanese workers

BACKGROUND

Negative emotions such as depression have been associated with increased absenteeism and presenteeism, contributing to substantial economic loss. However, no study has investigated if positive emotions such as happiness influence absenteeism and presenteeism.

METHODS

Using data from the Japan COVID-19 and Society Internet Survey (JACSIS), a nationwide survey conducted in September-October 2022 (n = 19,214), we investigated if two major, representative positive emotions (happiness and gratitude) are associated with absenteeism and presenteeism. Absenteeism was defined as reporting more than one day of sick leave in the past one month. Presenteeism was measured with the Work Functioning Impairment Scale. Logistic regression was used to estimate odds ratios.

RESULTS

12.4 % and 21.8 % of subjects reported absenteeism and presenteeism, respectively. Logistic regression estimated that after adjusting covariates, happiness was associated with lower odds of absenteeism (OR = 0.792, 95 % CI [0.706, 0.888]) and presenteeism (OR = 0.531, 95 % CI [0.479, 0.588]) while gratitude was associated with lower odds of presenteeism only (OR = 0.705, 95 % CI [0.643, 0.774]). Furthermore, simultaneous presence of both happiness and gratitude was associated with further lower odds of presenteeism (OR = 0.385, 95%CI [0.338, 0.439]), indicating a synergetic relation.

DISCUSSION

This study is the first to investigate the association between positive emotions and absenteeism and presenteeism. Given the substantial economic loss due to absenteeism and presenteeism, strategies to enhance positive emotions are necessary.

Presenteeism and social interaction in the "new normal" in Japan: a longitudinal questionnaire study

BACKGROUND

Although social interaction and social support during the "new normal" due to coronavirus disease 2019 (COVID-19) may be related to presenteeism, the effect between these factors has not been clear for Japanese workers. The aim of this study was to describe the presenteeism of Japanese workers with reference to social interaction and social support following the lifestyle changes due to COVID-19 and to assess whether social interaction and social support affected their presenteeism.

METHODS

The data were obtained from internet panel surveys from October 2020. Descriptive statistics were calculated, and multiple linear regression was conducted using the data from the first, fourth and fifth surveys, which were conducted during October to November 2020, July to August 2021, and September to October 2021, respectively. To measure presenteeism, questions from "absenteeism and presenteeism questions of the World Health Organization's Heath and Work Performance Questionnaire", short version in Japanese was utilized. Multiple linear regressions were conducted to investigate the effects of social interaction and social support-related factors on presenteeism.

RESULTS

A total of 3,407 participants were included in the analysis. The mean score of absolute presenteeism from the fifth survey was 58.07 (SD = 19.71). More time spent talking with family, a larger number of social supporters and a higher satisfaction level for social support were associated with a higher absolute presenteeism score.

CONCLUSIONS

Our results suggested that social support reduced the presenteeism of the Japanese workers during the "new normal" due to the COVID-19 pandemic. Social interaction with family also relieved presenteeism.

Leveraging behavioral science and artificial intelligence to support mental health in the workplace: a pilot study

Introduction

Many American employers seek to alleviate employee mental health symptoms through resources like employee assistance programs (EAPs), yet these programs are often underutilized. This pilot study explores the design of a behavioral science-based email campaign targeting engagement with stress management and mental health resources via an EAP, among employees of a large home builder in the Southeastern US.

Methods

Behavioral designers created a behavioral science intervention using a multi-step design approach and evidence based behavioral strategies. For this pilot intervention, employees received either a treatment message [i.e., behavioral science message assembled and delivered via the behavioral reinforcement learning (BRL) agent] or a control message (i.e., a single generic, supportive message with a stock photo) with a call to action to utilize their EAP.

Results

A total of 773 employees received emails over the course of 1 year. Engagement was high, with an 80% email open rate. Over 170 employees (22%, 159 treatment and 14 control) clicked the CTA and logged into the EAP site at least once.

Discussion

This pilot study suggests that using behavioral science and artificial intelligence can improve employee usage of EAP, specifically with the intention of exploring mental health and stress management resources, compared to benchmark rates of 5% per year.

Reciprocal longitudinal associations of supportive workplace relationships with depressive symptoms and self-rated health: A study of Korean women

BACKGROUND

Supportive relationships in the workplace are important determinants of an individual's psychological health, buffering work stress. This study aimed to estimate the bidirectional association of workplace relationships with depressive symptoms and self-rated health in female workers.

METHODS

Based on the nationally representative biannual survey data from 2014 (T1) to 2020 (T4) (N = 2556), we used a random intercept cross-lagged panel model (RI-CLPM) to estimate autoregressive and cross-lagged bidirectional associations between workplace relationships and health variables.

RESULTS

Regarding satisfactory workplace relationships and depressive symptoms, a negative correlation was observed at the between-person level. At the within-person level, the cross-lagged path showed that an increase in satisfaction with workplace relationships was related to a subsequent decrease in depressive (T1 to T2: β = -0.039; B = -0.253, P = 0.017). Further, an increase in depressive symptoms was related to subsequent relationship deterioration in the workplace (T1 to T2: β = -0.049, B = -0.007, P = 0.003). Regarding workplace relationships and self-rated health, a positive correlation was observed at the between-person level. At the within-person level, there as was no significant within-person level association between WPR and self-rated health. and the effect sizes were small.

CONCLUSIONS

This study suggests a bidirectional association between workplace relationships and depressive symptoms. Therefore, it is important to implement intervention programs that promote workplace interpersonal relationships and workers' mental health.

Changes in Anxiety and Depression Over the First Year of COVID-19 Pandemic in Philadelphia, PA: Work Characteristics and Mental Health Supports

OBJECTIVE

We investigated the change in anxiety and depression in a general population cohort over the first year of COVID-19 pandemic in relation to work characteristics and mental health support.

METHODS

We administered questionnaires to a convenience sample in Greater Philadelphia, in summer of 2020 and a year later. With more than 60% response rate, 461 people had repeated measurements.

RESULTS

Anxiety declined but depression increased in the cohort after a year of COVID-19 pandemic. Perceived increase in support from family and trade unions, stable employment, and professional mental health support were protective. Depression scores worsened mostly in healthcare, higher education, and manufacturing industries.

CONCLUSIONS

We observed that while anxiety dissipated over the first year of COVID-19 pandemic, depression worsened, perhaps more so in some industries and where mental health support faltered over time.

The Impact of Migration Experience on Rural Residents' Mental Health: Evidence from Rural China

Migration experience is considered to be an important factor affecting mental health. With the increasing number of rural-to-urban migrant workers returning to their hometowns, the impact of migration experience on rural residents is worthy of noting. Using the data from the 2018 China Labor Dynamics Survey, this paper took migration experience as the identification criteria for returning migrant workers and empirically examined the impact of migration experience on rural residents' mental health. Our results indicated that migration experience had a significant negative impact on the mental health of rural residents. That is, returning migrant workers had a worse mental health status than that of rural residents who never left their hometowns. Mechanism analysis showed that social support and social comparison played an intermediary role in the impact of migration experience on the mental health of rural residents. We also detected considerable heterogeneity in the effects of migration experience: the short-term returning migrant workers and the passive returning migrant workers are more likely to be negatively affected by the migration experience. Our results emphasized the mental health problem faced by returning migrant workers. The policy makers should strengthen psychological education and mental health consultation according to the intergenerational differences and individual characteristics of returning migrant workers.