The longitudinal relationship between control over working hours and depressive symptoms: Results from SLOSH, a population-based cohort study

Prospective effects of work-time control on overtime, work-life interference and exhaustion in female and male knowledge workers

AIMS

Employee-based flexible working hours are increasing, particularly among knowledge workers. Research indicates that women and men use work-time control (WTC; control over time off and daily hours) differently: while men work longer paid hours, women use WTC to counteract work-life interference. In a knowledge-worker sample, we examined associations between WTC and overtime, work-life interference and exhaustion and tested whether gender moderates the mediating role of overtime.

METHODS

The sample contained 2248 Swedish knowledge workers. Employing hierarchical regression modelling, we examined effects of control over time off/daily hours on subsequent overtime hours, work-life interference and exhaustion in general and in gender-stratified samples. Using conditional process analysis, we tested moderated mediation models.

RESULTS

Control over time off was related to less work-life interference (βmen= -0.117; 95% confidence interval (CI): -0.237 to 0.003; βwomen= -0.253; 95% CI: -0.386 to -0.120) and lower exhaustion (βmen= -0.199; 95% CI: -0.347 to -0.051; βwomen= -0.271; 95% CI: -0.443 to -0.100). For control over daily hours, estimates were close to zero. While men worked more overtime (42 min/week), we could not confirm gender moderating the indirect effect of control over time off/daily hours on work-life interference/exhaustion via overtime. Independent of gender, effects of control over time off on work-life interference were partly explained by working fewer overtime hours.

CONCLUSIONS

Control over time off was related to lower exhaustion and better work-life balance (in particular for women). We found no evidence for men's work-life interference increasing with higher WTC owing to working more overtime. Knowledge workers' control over time off may help prevent work-life interference and burnout.

Money talks: performance-based reimbursement systems impact on perceived work, health and patient care for physicians in Sweden

Introduction

The study aimed to investigate in which way performance-based reimbursement (PBR) systems in Swedish healthcare services (1) subjectively impacted physicians' work and patient care and (2) were associated with the occurrence of stress-induced exhaustion disorders among physicians.

Method

The study applied a mixed-method design. Data were collected from a representative sample of Swedish physicians. In the questionnaire, respondents were asked to answer an open-ended question regarding their reflections on PBR. The answers to the open-ended question were analysed using thematic analysis. Respondents were also asked to rate the impact of PBR on their work. The association between PBR and self-rated stress-induced exhaustion disease was analysed with logistic regressions. Stress-induced exhaustion disorder was measured using the Burnout Assessment Scale.

Results

Thematic analysis resulted in four themes: (1) Money talks, (2) Patients are affected, (3) Medical morals are challenged, and (4) PBR increase the quantity of illegitimate tasks. Logistic regressions showed that physicians who experienced PBR had an impact on their work and had a two-fold higher risk of stress-induced exhaustion disorder.

Discussion

Our findings suggest that current reimbursement systems in Sweden play an essential role in Swedish healthcare and negatively influence physicians' work and health. Also, current PBR impact patients negatively. No previous study has explored the potentially harmful impact of PBR on how physicians perceive work, health and patient care. Results indicate that policymakers should be encouraged to deeply review PBR systems and focus on ways that they can limit the negative impact on physicians' work and health while meeting future challenges.

Overtime work, job autonomy, and employees' subjective well-being: Evidence from China

Introduction

Chinese workers suffer more from overtime than in many countries. Excessive working hours can crowd out personal time and cause work-family imbalance, affecting workers' subjective well-being. Meanwhile, self-determination theory suggests that higher job autonomy may improve the subjective well-being of employees.

Methods

Data came from the 2018 China Labor-force Dynamics Survey (CLDS 2018). The analysis sample consisted of 4,007 respondents. Their mean age was 40.71 (SD = 11.68), and 52.8% were males. This study adopted four measures of subjective well-being: happiness, life satisfaction, health status, and depression. Confirmation factor analysis was employed to extract the job autonomy factor. Multiple linear regression methods were applied to examine the relationship between overtime, job autonomy, and subjective well-being.

Results

Overtime hours showed weak association with lower happiness (β = -0.002, p < 0.01), life satisfaction (β = -0.002, p < 0.01), and health status (β = -0.002, p < 0.001). Job autonomy was positively related to happiness (β = 0.093, p < 0.01), life satisfaction (β = 0.083, p < 0.01). There was a significant negative correlation between involuntary overtime and subjective well-being. Involuntary overtime might decrease the level of happiness (β = -0.187, p < 0.001), life satisfaction (β = -0.221, p < 0.001), and health status (β = -0.129, p < 0.05) and increase the depressive symptoms (β = 1.157, p < 0.05).

Conclusion

While overtime had a minimal negative effect on individual subjective well-being, involuntary overtime significantly enlarged it. Improving individual's job autonomy is beneficial for individual subjective well-being.

Associations between inflexible job conditions, health and healthcare utilisation in England: retrospective cross-sectional study

OBJECTIVES

To estimate the strength of association between having an inflexible job and health-related quality of life and healthcare utilisation; and to explore heterogeneity in the effects by gender, age and area-level deprivation.

DESIGN

Retrospective cross-sectional study.

SETTING

Seven waves of the English General Practice Patient Survey between 2012 and 2017.

PARTICIPANTS

1 232 884 people aged 16-64 years and in full-time employment. We measured job inflexibility by inability to take time away from work during usual working hours to seek medical care.

PRIMARY AND SECONDARY OUTCOME MEASURES

Health-related quality of life (EQ-5D-5L); number of months since the respondent last saw a general practitioner (GP) or nurse; use of out-of-hours general practice in the past 6 months. We used regression analyses to estimate the strength of association between outcomes and having an inflexible job, adjusting for person and area-level characteristics.

RESULTS

One-third of respondents reported job inflexibility. The probability of job inflexibility was higher at younger ages and in more deprived areas. Job inflexibility was associated with lower EQ-5D-5L utility scores of 0.017 (95% CI 0.016 to 0.018) for women and 0.016 (95% CI 0.015 to 0.017) for men. Women were more affected than men in the mental health domain. The reduction in health-related quality of life associated with having an inflexible job was greater for employees who were older or lived in more deprived areas. Having an inflexible job was associated with a longer time since the last visit to their GP of 0.234 (95% CI 0.201 to 0.268) months for women and 0.199 (95% CI 0.152 to 0.183) months for men.

CONCLUSIONS

Inequalities in the prevalence of inflexible jobs contribute to inequalities in health. One mechanism may be through reduced access to healthcare. Policymakers and employers should ensure that all employees have sufficient job flexibility to protect their health.

Working from home, work-time control and mental health: Results from the Brazilian longitudinal study of adult health (ELSA-Brasil)

This cross-sectional study investigated the association between work-time control (WTC), independently and in combination with hours worked (HW), and four mental health outcomes among 2,318 participants of the Longitudinal Study of Adult Health (ELSA-Brasil) who worked from home during the COVID-19 pandemic. WTC was assessed by the WTC Scale, and mental health outcomes included depression, anxiety, stress (measured by the Depression, Anxiety and Stress Scale, DASS-21), and self-rated mental health. Logistic regression models were used to determine odds ratios (ORs) and 95% confidence intervals (CIs). Among women, long HW were associated with stress (OR = 1.56; 95% CI = 1.11–2.20) and poor self-rated mental health (OR = 1.64; 95% CI = 1.13–2.38), whereas they were protective against anxiety among men (OR = 0.59; 95% CI = 0.37–0.93). In both sexes, weak WTC was associated with all mental health outcomes. Among women, the long HW/weak WTC combination was associated with all mental health outcomes, and short HW/weak WTC was associated with anxiety and stress. Among men, long HW/strong WTC was protective against depression and stress, while short HW/strong WTC and short HW/weak WTC was associated with all mental health outcomes. In both sexes, weak WTC, independently and in combination with HW, was associated with all mental health outcomes. WTC can improve working conditions, protect against mental distress, and fosterwork-life balance for those who work from home.

The Effect of Employee-Oriented Flexible Work on Mental Health: A Systematic Review

The effect of flexible work on mental health is not well known. The aim of this systematic review was to assess the effects of employee-oriented flexible work on mental health problems and associated disability. Literature searches were conducted in the PubMed, Scopus, Web of Sciences, Cochrane Library, PsycINFO, ProQuest and EconPapers databases from their inception through October-November 2020. Sixteen studies on the associations of worktime control, working from home, or flexible working arrangements with mental health related outcomes were included in the review: one cluster randomized controlled trial, two non-randomized controlled trials, two cross-over studies, and 11 prospective cohort studies. Three reviewers independently assessed the met-hodological quality of the included studies and extracted the data. The included studies differed in design, intervention/exposure, and outcome, so meta-analysis was not carried out and qualitative results were reported. A few prospective cohort studies found that low employees’ control over worktime increases the risk of depressive symptoms, psychological distress, burnout, and accumulated fatigue. One cross-over and a few cohort studies found small beneficial effects of working partly from home on depressive symptoms, stress, and emotional exhaustion. A small number of controlled trials, cross-over or cohort studies found that flexible working arrangements increase employees’ control over working hours, but have only modest beneficial effects on psychological distress, burnout, and emotional exhaustion. This systematic review suggests that employee-oriented flexible work may have small beneficial effects on mental health. However, randomized controlled trials and quasi-experimental studies are needed to identify the health effects of flexible work.

Association of changes in work due to COVID-19 pandemic with psychosocial work environment and employee health: a cohort study of 24 299 Finnish public sector employees

OBJECTIVES

To examine the associations of COVID-19-related changes in work with perceptions of psychosocial work environment and employee health.

METHODS

In a cohort of 24 299 Finnish public sector employees, psychosocial work environment and employee well-being were assessed twice before (2016 and 2018=reference period) and once during (2020) the COVID-19 pandemic. Those who reported a change (='Exposed') in work due to the pandemic (working from home, new tasks or team reorganisation) were compared with those who did not report such change (='Non-exposed').

RESULTS

After adjusting for sex, age, socioeconomic status and lifestyle risk score, working from home (44%) was associated with greater increase in worktime control (standardised mean difference (SMD)Exposed=0.078, 95% CI 0.066 to 0.090; SMDNon-exposed=0.025, 95% CI 0.014 to 0.036), procedural justice (SMDExposed=0.101, 95% CI 0.084 to 0.118; SMDNon-exposed=0.053, 95% CI 0.038 to 0.068), workplace social capital (SMDExposed=0.094, 95% CI 0.077 to 0.110; SMDNon-exposed=0.034, 95% CI 0.019 to 0.048), less decline in self-rated health (SMDExposed=-0.038, 95% CI -0.054 to -0.022; SMDNon-exposed=-0.081, 95% CI -0.095 to -0.067), perceived work ability (SMDExposed=-0.091, 95% CI -0.108 to -0.074; SMDNon-exposed=-0.151, 95% CI -0.167 to -0.136) and less increase in psychological distress (risk ratio (RR)Exposed=1.06, 95% CI 1.02 to 1.09; RRNon-exposed=1.16, 95% CI 1.13 to 1.20). New tasks (6%) were associated with greater increase in psychological distress (RRExposed=1.28, 95% CI 1.19 to 1.39; RRNon-exposed=1.10, 95% CI 1.07 to 1.12) and team reorganisation (5%) with slightly steeper decline in perceived work ability (SMDExposed=-0.151 95% CI -0.203 to -0.098; SMDNon-exposed=-0.124, 95% CI -0.136 to -0.112).

CONCLUSION

Employees who worked from home during the pandemic had more favourable psychosocial work environment and health, whereas those who were exposed to work task changes and team reorganisations experienced more adverse changes.

The Effect of Worktime Control on Overtime Employees' Mental Health and Work-Family Conflict: The Mediating Role of Voluntary Overtime

Overtime has become a widespread phenomenon in the current information age that creates a high speed working pace and fierce competition in the high technology global economy. Based on the time-regulation mechanism and effort-recovery model, we examined the effect of worktime control (WTC) on mental health and work-family conflict (WFC) among overtime employees, and whether voluntary overtime mediated the relationships. We also examined two separate dimensions of WTC (control over time-off and control over daily hours). The results showed that control over time-off was related to decreased depression, anxiety, stress and WFC, while control over daily hours was related to decreased stress and WFC. Generally, control over time-off was beneficial to females and employees with dependents. Furthermore, mediation results showed that voluntary overtime was a complete mediator of relationships between WTC and depression and anxiety as well as a partial mediator of the relationship between WTC and stress. However, this study did not find a mediating effect of voluntary overtime on the WTC-WFC relationship. Limitations and practical implications are discussed.

The Effect of Using Participatory Working Time Scheduling Software on Employee Well-Being and Workability: A Cohort Study Analysed as a Pseudo-Experiment

Shift workers are at increased risk of health problems. Effective preventive measures are needed to reduce the unfavourable effects of shift work. In this study we explored whether use of digital participatory working time scheduling software improves employee well-being and perceived workability by analysing an observational cohort study as a pseudo-experiment. Participants of the Finnish Public Sector cohort study with payroll records available between 2015 and 2019 were included (N = 2427). After estimating the propensity score of using the participatory working time scheduling software on the baseline characteristics using multilevel mixed-effects logistic regression and assigning inverse probability of treatment weights for each participant, we used generalised linear model to estimate the effect of using the participatory working time scheduling software on employees’ control over scheduling of shifts, perceived workability, self-rated health, work-life conflict, psychological distress and short sleep (≤ 6 h). During a 2-year follow-up, using the participatory working time scheduling software reduced the risk of employees’ low control over scheduling of shifts (risk ratio [RR] 0.34; 95% CI 0.25–0.46), short sleep (RR 0.70; 95% CI 0.52–0.95) and poor workability (RR 0.74; 95% CI 0.55–0.99). The use of the software was not associated with changes in psychological distress, self-rated health and work-life conflict. In this observational study, we analysed as a pseudo-experiment, the use of participatory working time scheduling software was associated with increased employees’ perceived control over scheduling of shifts and improved sleep and self-rated workability.

Predicting new major depression symptoms from long working hours, psychosocial safety climate and work engagement: a population-based cohort study

OBJECTIVES

This study sought to assess the association between long working hours, psychosocial safety climate (PSC), work engagement (WE) and new major depression symptoms emerging over the next 12 months. PSC is the work climate supporting workplace psychological health.

SETTING

Australian prospective cohort population data from the states of New South Wales, Western Australia and South Australia.

PARTICIPANTS

At Time 1, there were 3921 respondents in the sample. Self-employed, casual temporary, unclassified, those with working hours <35 (37% of 2850) and participants with major depression symptoms at Time 1 (6.7% of 1782) were removed. The final sample was a population-based cohort of 1084 full-time Australian employees.

PRIMARY AND SECONDARY OUTCOME MEASURES

The planned and measured outcomes were new cases of major depression symptoms.

RESULTS

Long working hours were not significantly related to new cases of major depression symptoms; however, when mild cases were removed, the 41-48 and ≥55 long working hour categories were positively related to major depression symptoms. Low PSC was associated with a threefold increase in risk for new major depression symptoms. PSC was not related to long working hours, and long working hours did not mediate the relationship between PSC and new cases of major depression symptoms. The inverse relationship between PSC and major depression symptoms was stronger for males than females. Additional analyses identified that WE was positively related to long working hours. Long working hours (41-48 and ≥55 hours) mediated a positive relationship between WE and major depression symptoms when mild cases of major depression were removed.

CONCLUSION

The results suggest that low workplace PSC and potentially long working hours (41-48; ≥55 hours/week) increase the risk of new major depression symptoms. Furthermore, high WE may increase long working hours and subsequent major depression symptoms.

Shift work, work time control, and informal caregiving as risk factors for sleep disturbances in an ageing municipal workforce

Objectives:

This study aimed to examine the contribution of shift work, work time control (WTC) and informal caregiving, separately and in combination, to sleep disturbances in ageing employees.

Methods:

Survey data were obtained from two prospective cohort studies with repeated measurements of working conditions, informal caregiving, and sleep disturbances. We used fixed-effect conditional logistic regression analysis to examine whether within-individual changes in shift work, WTC and informal caregiving were associated with changes in sleep. Secondary analyses included between-individuals comparison using standard logistic regression models. Results from the two cohorts were pooled using meta-analysis.

Results:

Low WTC and informal caregiving were associated with sleep disturbances in within-individual analyses [odds ratios (OR) ranging between 1.13 (95% confidence interval 1.01–1.27) and 1.48 (95% CI 1.29–1.68)] and in between-individuals analyses [OR 1.14 (95% CI 1.03–1.26) to 1.33 (1.19–1.49)]. Shift work alone was not associated with sleep disturbances, but accumulated exposure to shift work, low WTC and informal caregiving was associated with higher risk of sleep disturbances (OR range 1.21–1.76). For some of the sleep outcomes, informal caregiving was related to a higher risk of sleep disturbances when WTC was low and a lower risk when WTC was high.

Conclusions:

Informal caregiving and low WTC are associated with risk of sleep disturbances among ageing employees. The findings also suggest that low WTC in combination with informal caregiving may increase the risk of sleep disturbances whereas high WTC may alleviate the adverse impact of informal caregiving on sleep.

Variability in daily or weekly working hours and self-reported mental health problems in Korea, Korean working condition survey, 2017

BACKGROUND

Working hour regulation in Korea is being revised to allow increasing variability in number of working hours. We sought to investigate the association between variability in the number of daily or weekly working hours with or without long working hours (> 52 h/w) and mental health among South Korean workers.

METHODS

We used data from 28,345 full-time, non-shift employed workers working more than 30 h per week participating in the Korean Working Condition Survey in 2017. We defined six groups according to variability in daily or weekly working hours (same number vs different number) and weekly working hours (31-40, 41-52, > 52 h per week). Odds ratios (ORs) and confidence intervals (CIs) for self-reported depressive symptoms and anxiety were calculated using workers with same number of working hours/31-40 h per week as the reference.

RESULTS

Variability in number of work hours every day or week combined with > 52 working hours per week showed the highest risk of depressive symptoms (OR = 5.13, 95% CI 3.25-8.11) and anxiety (OR = 3.75, 95% CI 2.39-5.88) compared to the reference group, controlling for age, sex, education, occupation, industry, salary, workers' choice of working hours and overtime payment. Workers working ≤52 h/w were adversely impacted by variable working hours as well.

CONCLUSIONS

Variable daily or weekly working hours were associated with poorer self-reported depressive and anxiety symptoms in Korea, among full-time and non-shift workers. Reform of the Korean Labor Standards Act warrants consideration.

Effects of nurses' shiftwork characteristics and aspects of private life on work-life conflict

Background

As nurses work highly irregular hours, the characteristics of shiftwork and aspects of their private lives are important factors that may contribute significantly to work-life conflict.

Purpose

This study examined the effects of nurses’ shiftwork characteristics and aspects of their private lives on work-life conflict.

Methods

The participants included 271 registered nurses working three-shift rotations in five types of units at four hospitals in South Korea. We distributed structured questionnaires regarding shiftwork characteristics, private life, and work-life conflict. Data were analyzed using multiple linear regression analysis.

Results

The significant factors relating to work-life conflict included control over shift start and finish times (β = -0.16, p = .019), frequency of swapping shifts with colleagues (β = 0.15, p = .025) among shiftwork characteristics, and leisure constraints (β = 0.39, p = < .001) in aspects of private life.

Conclusion

Plan and policies for improving nursing environments should focus on improving nurses’ control over shiftwork and decreasing leisure constraints.

The mediating effect of work-life interference on the relationship between work-time control and depressive and musculoskeletal symptoms

Objectives Evidence shows that work-time control (WTC) affects health but underlying mechanisms are still unclear. Work-life interference (WLI) might be a step on the causal pathway. The present study examined whether WLI mediates effects on mental and physical health and contrasted these to other causal pathways. Methods Four biennial waves from the Swedish Longitudinal Occupational Survey of Health (SLOSH, N=26 804) were used. Cross-lagged analyses were conducted to estimate if WLI mediated effects from WTC (differentiating between control over daily hours and time off) to subsequent depressive and musculoskeletal symptoms. Other causal directions (reversed mediation, direct and reversed direct effects) and robustness of mediation (by including covariates) were examined. Results WLI partially mediated the relationship of WTC (control over daily hours/time off) with both health outcomes. Indirect effect estimates were small for depressive symptoms (-0.053 for control over time off and -0.018 for control over daily hours) and very small for musculoskeletal symptoms (-0.007 and -0.003, respectively). While other causal directions were generally weaker than causal mediational pathways, they played a larger role for musculoskeletal compared to depressive symptoms. Estimates relating to control over time off were in general larger than for control over daily hours. Conclusions Our results suggest that WLI mediates part of the effect from WTC to mental/musculoskeletal symptoms, but small estimates suggest that (i) WTC plays a small but consistent role in effects on health and (ii) particularly regarding musculoskeletal disorders, other causal directions and mediators need to be further examined.

Association of work-time control with sickness absence due to musculoskeletal and mental disorders: An occupational cohort study

OBJECTIVES

Work-time control is associated with lower sickness absence rates, but it remains unclear whether this association differs by type of diagnosis and sub-dimension of work-time control (control over daily hours and control over time off) and whether certain vulnerable groups benefit more from higher levels of work-time control.

METHODS

Survey data from the Finnish 10-town study in 2004 were used to examine if baseline levels of work-time control were associated with register data on diagnose-specific sickness absence for 7 consecutive years (n = 22 599). Cox proportional hazard models were conducted, adjusted for age, sex, education, occupational status, shift work including nights, and physical/mental workload.

RESULTS

During follow-up, 2,818 individuals were on sick leave (≥10 days) due to musculoskeletal disorders and 1724 due to mental disorders. Employees with high (HR = 0.80, 95% CI 0.74-0.87; HR = 0.76, 95% CI 0.70-0.82, respectively) and moderate (HR = 0.83, 95% CI 0.77-0.90; HR = 0.85, 95% CI 0.79-0.91, respectively) levels of control over daily hours/control over time off had a decreased risk of sickness absence due to musculoskeletal disorders. Sub-group analyses revealed that especially workers who were older benefitted the most from higher levels of work-time control. Neither sub-dimension of work-time control was related to sickness absence due to mental disorders.

CONCLUSIONS

Over a 7-year period of follow-up, high and moderate levels of work-time control were related to lower rates of sickness absence due to musculoskeletal disorders, but not due to mental disorders.

Health and work-life balance across types of work schedules: A latent class analysis

This study explores how different aspects of working time demands (e.g., shift work) and working time control (e.g., beginning/end of workday) can be clustered into distinct types of work schedules and how they relate to health and work-life balance. Data from 13,540 full-time employees interviewed in the 2015 BAuA-Working Time Survey was used. By means of latent class analysis, we extracted six types of work schedules. Subjective health was highest in the flexible extended and flexible standard schedules, both featuring high working time control. Work-life balance was highest in the flexible standard and rigid standard schedules and lowest in schedules with high working time demands, namely the extended shift, rigid all-week, and rigid extended schedules. Employees with high working time demands and low control represent risk groups prone to impairments of well-being. Overall, this study offers an intuitive taxonomy for the design of sustainable work schedules.

Parent's Relative Perceived Work Flexibility Compared to Their Partner Is Associated With Emotional Exhaustion

A number of studies have found that control over work conditions and hours is positively related to mental health. Still, potential positive and negative effects of work flexibility remain to be fully explored. On the one hand, higher work flexibility might provide better opportunities for recovery. On the other hand, especially mothers may use flexibility to meet household and family demands. Here, we investigated the association between parent's work flexibility, rated relative to their partner, and emotional exhaustion in interaction with gender. Additionally, gender differences in time use were investigated. Cross-sectional analyses based on responses of employed parents to the 2012 wave of the Swedish Longitudinal Occupational Survey of Health (SLOSH) were conducted (N = 2,911). Generalized linear models with gamma distribution and a log-link function were used to investigate associations between relative work-flexibility (lower, equal, or higher as compared to partner), gender, and emotional exhaustion. After control for potential confounders, we found that having lower work flexibility than the partner was associated with higher levels of emotional exhaustion as compared to those with higher relative work flexibility. Also, being a mother was associated with higher levels of emotional exhaustion, independent of possible confounders. An interaction effect between low relative work flexibility and gender was found in relation to emotional exhaustion. Regarding time use, clear differences between mothers' and fathers' were found. However, few indications were found that relative work flexibility influenced time use. Mothers spent more time on household chores as compared to fathers, while fathers reported longer working hours. Fathers spent more time on relaxation compared with mothers. To conclude, our results indicate that lower relative work flexibility is detrimental for mental health both for mothers and fathers. However, while gender seems to have a pronounced effect on time use, relative work flexibility seems to have less influence on how time is used. Generally, mothers tend to spend more time on unpaid work while fathers spend longer hours on paid work and report more time for relaxation.