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von Oelreich E, Eriksson J, Eriksson M, Larsson E, Oldner A. Antidepressant drug use after intensive care: a nationwide cohort study. Sci Rep 2024; 14:15863. [PMID: 38982148 PMCID: PMC11233594 DOI: 10.1038/s41598-024-66028-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 06/26/2024] [Indexed: 07/11/2024] Open
Abstract
Modern intensive care has improved survival rates, but emerging evidence suggests a high prevalence of post-intensive care unit (ICU) health problems, including post-traumatic stress disorder, depression and anxiety. These symptoms may have a detrimental effect on quality of life and increase mortality. The primary objective of this study is to examine the extent of initiation of antidepressant medication among ICU survivors and identify the factors associated with its usage. The secondary objective is to investigate whether the use of these medications is linked to an increased mortality. The nationwide study cohort included 125,130 ICU survivors admitted between 2010 and 2017. Within the first 3 months after ICU discharge, 7% of patients initiated antidepressant medication, by 1 year 15.5% had started medication. We found no tendency to a decrease during the 2-year follow-up period. Factors associated with antidepressant use included middle age, female sex, psychiatric and somatic comorbid conditions, substance dependence, higher illness severity, and longer ICU stay. Antidepressant users had a higher mortality rate, and deaths due to external causes and suicide were more frequent in this group. This study emphasizes the importance of detecting and addressing depression in ICU survivors to improve their quality of life and reduce mortality rates.
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Affiliation(s)
- Erik von Oelreich
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, 171 76, Stockholm, Sweden.
- Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
| | - Jesper Eriksson
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, 171 76, Stockholm, Sweden
- Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Eriksson
- Department of Anaesthesia and Intensive Care, Uppsala University Hospital, Uppsala, Sweden
- Department of Surgical Sciences, Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Emma Larsson
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, 171 76, Stockholm, Sweden
- Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Anders Oldner
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, 171 76, Stockholm, Sweden
- Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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Frank J, Mustard C, Smith P, Siddiqi A, Cheng Y, Burdorf A, Rugulies R. Work as a social determinant of health in high-income countries: past, present, and future. Lancet 2023; 402:1357-1367. [PMID: 37838441 DOI: 10.1016/s0140-6736(23)00871-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 01/17/2023] [Accepted: 04/27/2023] [Indexed: 10/16/2023]
Abstract
This paper, the first in a three-part Series on work and health, provides a narrative review of research into work as a social determinant of health over the past 25 years, the key emerging challenges in this field, and the implications of these challenges for future research. By use of a conceptual framework for work as a social determinant of health, we identified six emerging challenges: (1) the influence of technology on the nature of work in high-income countries, culminating in the sudden shift to telework during the COVID-19 pandemic; (2) the intersectionality of work with gender, sexual orientation, age, race, ethnicity, migrant status, and socioeconomic status as codeterminants of health disparities; (3) the arrival in many Organisation for Economic Co-operation and Development countries of large migrant labour workforces, who are often subject to adverse working conditions and social exclusion; (4) the development of precarious employment as a feature of many national labour markets; (5) the phenomenon of working long and irregular hours with potential health consequences; and (6) the looming threat of climate change's effects on work. We conclude that profound changes in the nature and availability of work over the past few decades have led to widespread new psychosocial and physical exposures that are associated with adverse health outcomes and contribute to increasing disparities in health. These new exposures at work will require novel and creative methods of data collection for monitoring of their potential health impacts to protect the workforce, and for new research into better means of occupational health promotion and protection. There is also an urgent need for a better integration of occupational health within public health, medicine, the life sciences, and the social sciences, with the work environment explicitly conceptualised as a major social determinant of health.
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Affiliation(s)
- John Frank
- Usher Institute, University of Edinburgh, Edinburgh, UK; Institute for Work & Health, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Cameron Mustard
- Institute for Work & Health, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Peter Smith
- Institute for Work & Health, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Yawen Cheng
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Alex Burdorf
- Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands
| | - Reiner Rugulies
- National Research Centre for the Working Environment, Copenhagen, Denmark; Section of Epidemiology, Department of Public Health, University of Copenhagen, Denmark
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Clausen T, Sørensen JK, Dalsager L, Karlsen IL, Kristiansen J. Do different job demands interact as predictors of long-term sickness absence? A register-based follow-up on 55 467 Danish workers. Occup Environ Med 2023; 80:7-13. [PMID: 36270798 PMCID: PMC9763189 DOI: 10.1136/oemed-2022-108444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 10/05/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To assess interactions between combinations of quantitative demands, emotional demands, unclear and contradictory demands, and violence/threats of violence in the prospective association with risk of long-term sickness absence (LTSA). METHODS We included 55 467 employees from the 2012, 2014 and 2016 waves of the Work Environment and Health in Denmark (WEHD) survey. We measured the four independent variables in the WEHD survey and assessed risk of LTSA in a national register during 12 months of follow-up. Using Cox proportional hazards models, adjusted for age, sex, educational attainment and job group, we estimated risk of LTSA and assessed deviation from additivity using relative excess risk due to interaction (RERI). RESULTS For combinations of high emotional demands and high quantitative demands (HR 1.50; 95% CI 1.33 to 1.70; RERI 0.06; 95% CI -0.15 o 0.26) and high emotional demands and violence/threats of violence (HR 1.76; 95% CI 1.53 to 2.02; RERI 0.12; 95% CI -0.43 to 0.66) we found no indications of deviations from additive effects in predicting LTSA. For combinations of violence/threats of violence and high quantitative demands (HR 1.90; 95% CI 1.64 to 2.20; RERI 0.36; 95% CI 0.01 to 0.71) and unclear and contradictory demands and high quantitative demands (HR 1.46; 95% CI 1.31 to 1.62; RERI 0.23; 95% CI 0.04 to 0.42) the results indicated an excess risk of LTSA above additivity (ie, superadditivity). CONCLUSIONS Participants reporting high quantitative demands combined with either violence/threats of violence or unclear and contradictory demands showed a higher risk of LTSA than expected, indicating superadditivity. Results have implications for preventing negative health effects related to adverse psychosocial working conditions.
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Affiliation(s)
- Thomas Clausen
- National Research Centre for the Working Environment, Kobenhavn, Denmark
| | | | - Louise Dalsager
- National Research Centre for the Working Environment, Kobenhavn, Denmark
| | | | - Jesper Kristiansen
- National Research Centre for the Working Environment, Kobenhavn, Denmark
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Hunger B, Seibt R. Psychosocial Work Stress and Health Risks – A Cross-Sectional Study of Shift Workers From the Hotel and Catering Industry and the Food Industry. Front Public Health 2022; 10:849310. [PMID: 35462838 PMCID: PMC9024122 DOI: 10.3389/fpubh.2022.849310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/23/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Psychosocial work stress, and shift and night work are considered risk indicators for impaired health. Using the effort-reward (ER) model, it was possible to examine which relationships exist for shift workers between clusters (CL) of different levels of psychosocial work stress and overcommitment (OC) and cardiovascular or psychological health indicators, and which predictive value is evident in individual health indicators to explain the clusters. Methods The data were collected as part of an occupational health prevention program. The analysis sample consisted of 199 shift workers from alternating shift systems with and without night work (43%) (average age: 40 ± 12 years, men: 47%). Psychosocial work stress was recorded using the ER imbalance (ERI) questionnaire. To determine the clusters, ERI and OC were entered into a cluster analysis. Blood pressure, body mass index, waist-hip ratio, PROCAM score (risk of a heart attack within the next 10 years), sporting activity, and smoking were included as cardiovascular indicators, psychological wellbeing (GHQ-12) and inability to recovery (IR) (FABA) as psychological health indicators. Shift system, sex, and age were entered into the statistical analyses as control variables. Multinomial logistic regression models were used to identify health-related predictors to explain the ER-OC clusters. Results Three different ER-OC clusters emerged: low-stress: 36%, normal: 44%, risk: 20%. While normal psychosocial work stress is present in the low-stress and the normal CL, in the risk CL 28% of the shift workers show a health-endangering ERI and 48% show an excessive OC. No significant cluster-specific differences were determined for the cardiovascular health indicators. Rather, the known sex and age effects were confirmed and the shift system had no significant effect. Significantly more shift workers in the risk CL had impaired psychological health (18 vs. 1/6%) and an IR (52 vs. 0/12%) than in the low-stress and normal CL. IR turned out to be the strongest predictor of the explanation for the ER-OC clusters (49%). Conclusion IR could be assigned an independent diagnostic value for the assessment of psychosocial work stresses and discussed as a new component of occupational health screening concepts for shift workers. Independently of this, the health indicators signal an urgent need for occupational health prevention and care.
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Affiliation(s)
- Bettina Hunger
- German Social Accident Insurance Institution for the Foodstuffs and Catering Industry (BGN), Government Safety Organization Foods and Restaurants, Office of Coordination Potsdam, Potsdam, Germany
| | - Reingard Seibt
- Institute for Preventive Medicine of the Rostock University Medical Centre, Rostock, Germany
- *Correspondence: Reingard Seibt
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Andersen LPS, Hogh A, Andersen JH, Biering K. Depressive Symptoms Following Work-Related Violence and Threats and the Modifying Effect of Organizational Justice, Social Support, and Safety Perceptions. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:7110-7135. [PMID: 30827135 DOI: 10.1177/0886260519831386] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Work-related threats and violence is a major occupational hazard and the consequences for victims may be a range of physical and psychological symptoms. The purpose of this study was to examine the associations between exposure to work-related violence and threats and subsequent risk for depression and to examine whether the associations were modified by social support, organizational justice and safety perceptions. Questionnaire data was collected in 2010, 2011 and in 2015. A total of 5,342 employees from special schools, psychiatric wards, eldercare and the Prison and Probation Services (PPS) participated in the first round in 2010. The analysis was performed by multivariate logistic regression. Staff exposed for work-related threats and violence had an increased risk for depression compared to non-exposed staff. The risk was highest for staff working in PPS. Compared to low levels, there were a tendency for high levels of social support, organizational justice and safety perception to attenuate the associations between work-related threats and violence and depression. However, none of the differences were statistically significant. Many employees working in human service sectors are exposed to work-related threats and violence which increases the risk for depression. The risk for depression following work-related threats and violence may be modified by social support, organizational justice and the perception of safety workplace. It is recommended that workplaces adopt an integrated organizational approach including both prevention of work-related threats and violence and intervention to modify the health consequences of work-related threats and violence.
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Madsen IEH, Svane-Petersen AC, Holm A, Burr H, Framke E, Melchior M, Rod NH, Sivertsen B, Stansfeld S, Sørensen JK, Virtanen M, Rugulies R. Work-related violence and depressive disorder among 955,573 employees followed for 6.99 million person-years. The Danish Work Life Course Cohort study: Work-related violence and depression. J Affect Disord 2021; 288:136-144. [PMID: 33887623 DOI: 10.1016/j.jad.2021.03.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/29/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND We examined the association between probability of work-related violence and first diagnosis of depressive disorder whilst accounting for the potential selection of individuals vulnerable to depression into occupations with high probability of work-related violence. METHODS Based on a pre-published study protocol, we analysed nationwide register data from the Danish Work Life Course Cohort study, encompassing 955,573 individuals followed from their entry into the workforce, and free from depressive disorder before work-force entry. Depressive disorder was measured from psychiatric in- and outpatient admissions. We measured work-related violence throughout the worklife by the annual average occupational risk of violence exposure. Using Cox proportional hazards regression, we examined the longitudinal association between work-related violence (both past year and cumulative life-long exposure) and first depressive disorder diagnosis, whilst adjusting for numerous confounders including parental psychiatric and somatic diagnoses, childhood socioeconomic position, and health services use before workforce entry. RESULTS The risk of depressive disorder was higher in individuals with high probability of past year work-related violence (hazard ratio: 1.11, 95% CI: 1.06-1.16) compared to employees with low probability of exposure, after adjustment for confounders. Among women, associations were robust across industries, whereas among men, associations were limited to certain industries. LIMITATIONS Violence was measured on the job group and not the individual level, likely resulting in some misclassification of the exposure. CONCLUSIONS Work-related violence may increase the risk of depressive disorder, independent of pre-existing risk factors for depressive disorder. These findings underline the importance of preventing work-related violence.
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Affiliation(s)
- Ida E H Madsen
- National Research Centre for the Working Environment, Copenhagen, Denmark.
| | | | - Anders Holm
- The Rockwool Foundation, Copenhagen, Denmark; Western University, London, Canada
| | - Hermann Burr
- Unit Psychosocial Factors and Mental Health, Federal Institute for Occupational Safety and Health, Berlin, Germany
| | - Elisabeth Framke
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Maria Melchior
- Social Epidemiology Research Group, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), INSERM UMR_S 1136, Paris, France
| | - Naja Hulvej Rod
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Denmark
| | - Børge Sivertsen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway; Department of Research and Innovation, Helse Fonna HF, Haugesund, Norway; Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Stephen Stansfeld
- Centre for Psychiatry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Marianna Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland; Division of Insurance Medicine, Karolinska Institute, Sweden
| | - Reiner Rugulies
- National Research Centre for the Working Environment, Copenhagen, Denmark; Section of Epidemiology, Department of Public Health, University of Copenhagen, Denmark; Department of Psychology, University of Copenhagen, Denmark
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Sterud T, Hanvold TN. Effects of adverse social behaviour at the workplace on subsequent mental distress: a 3-year prospective study of the general working population in Norway. Int Arch Occup Environ Health 2021; 94:325-334. [PMID: 33130968 PMCID: PMC7873096 DOI: 10.1007/s00420-020-01581-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 09/05/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We aimed to provide an integrated picture of the relationship between different facets of adverse social behaviour (ASB) at work and mental health problem. METHODS Data were provided from a longitudinal nationwide study of the general population in Norway. Eligible respondents were in paid work during a reference week in 2013, or temporarily absent from such work, and was interviewed at 3-year follow-up (n = 3654, response at baseline/follow-up = 53.1%/71.8%). We investigated the prospective associations of self-reported exposure to ASBs, including threats/acts of violence, bullying, sexual harassment and workplace conflicts, with mental distress (the Hopkins Symptoms Checklist) at follow-up, by means of multiple logistic regression. RESULTS In total, 6.6% (242 individuals) were classified with mental distress at follow-up. Work-related predictors were sexual harassment (OR = 1.64 07, 95% CI 1.03 - 2.61), bullying (OR = 2.07, 95% CI 1.19 - 3.60) and workplace conflicts (OR = 1.51, 95% CI 1.07 - 2.13). An elevated, but non-statistically significant association was observed for threats/acts of violence. No significant interactions were found between ASB and mental distress score at baseline. Overall there were few indications of substantial confounding related to age, sex, education level or occupation. After adjusting for these factors, the overall population attributable risk of mental distress attributable to any exposure to ASB was 11.3% (95%CI 0.6-22.3). CONCLUSIONS We observed robust associations between exposure to three out of four types of ASB and risk of mental distress. Taken together, the results underscore that adverse social behaviour at the workplace may have a substantial impact on the level of mental distress in the general working population.
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Affiliation(s)
- Tom Sterud
- National Institute of Occupational Health (STAMI), PO Box 5330 Majorstuen, N-0033, Oslo, Norway.
| | - Therese N Hanvold
- National Institute of Occupational Health (STAMI), PO Box 5330 Majorstuen, N-0033, Oslo, Norway
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Workplace Violence and Long-term Sickness Absence: Assessment of the Potential Buffering Effect of Social Support in Two Occupational Cohort Studies. J Occup Environ Med 2020; 62:830-838. [PMID: 32769792 DOI: 10.1097/jom.0000000000001975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES We aimed to determine the effect of workplace violence on long-term sickness absence, and whether social support from supervisors and colleagues buffer this effect. METHODS Information on workplace violence and social support were derived from the Danish Work Environment Cohort Study in 2000, 2005, and 2010 and the Swedish Longitudinal Occupational Survey of Health in 2006 and 2008. Individual- and joint-effects on register-based long-term sickness absence were determined using logistic regression models for repeated measurements. Cohort-specific estimates were combined in random effect meta-analyses. RESULTS Workplace violence and low social support were independently associated with a higher risk of long-term sickness absence, and we did not find evidence of an interaction. CONCLUSION Exposure to workplace violence is a risk factor for long-term sickness absence while social support is associated with a lower risk of long-term sickness absence.
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Xu T, Magnusson Hanson LL, Lange T, Starkopf L, Westerlund H, Madsen IEH, Rugulies R, Pentti J, Stenholm S, Vahtera J, Hansen ÅM, Virtanen M, Kivimäki M, Rod NH. Workplace bullying and workplace violence as risk factors for cardiovascular disease: a multi-cohort study. Eur Heart J 2020; 40:1124-1134. [PMID: 30452614 DOI: 10.1093/eurheartj/ehy683] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 07/15/2018] [Accepted: 10/08/2018] [Indexed: 11/14/2022] Open
Abstract
AIMS To assess the associations between bullying and violence at work and cardiovascular disease (CVD). METHODS AND RESULTS Participants were 79 201 working men and women, aged 18-65 years and free of CVD and were sourced from three cohort studies from Sweden and Denmark. Exposure to workplace bullying and violence was measured at baseline using self-reports. Participants were linked to nationwide health and death registers to ascertain incident CVD, including coronary heart disease and cerebrovascular disease. Study-specific results were estimated by marginal structural Cox regression and were combined using fixed-effect meta-analysis. Nine percent reported being bullied at work and 13% recorded exposure to workplace violence during the past year. We recorded 3229 incident CVD cases with a mean follow-up of 12.4 years (765 in the first 4 years). After adjustment for age, sex, country of birth, marital status, and educational level, being bullied at work vs. not was associated with a hazard ratio (HR) of 1.59 [95% confidence interval (CI) 1.28-1.98] for CVD. Experiencing workplace violence vs. not was associated with a HR of 1.25 (95% CI 1.12-1.40) for CVD. The population attributable risk was 5.0% for workplace bullying and 3.1% for workplace violence. The excess risk remained similar in analyses with different follow-up lengths, cardiovascular risk stratifications, and after additional adjustments. Dose-response relations were observed for both workplace bullying and violence (Ptrend < 0.001). There was only negligible heterogeneity in study-specific estimates. CONCLUSION Bullying and violence are common at workplaces and those exposed to these stressors are at higher risk of CVD.
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Affiliation(s)
- Tianwei Xu
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Gothersgade 160, DK-1123 Copenhagen, Denmark.,Division for Epidemiology, Stress Research Institute, Stockholm University, SE-10691, Stockholm, Sweden.,National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100 Copenhagen, Denmark
| | - Linda L Magnusson Hanson
- Division for Epidemiology, Stress Research Institute, Stockholm University, SE-10691, Stockholm, Sweden
| | - Theis Lange
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 2A, DK-1353 Copenhagen, Denmark.,Centre for Statistical Science, Peking University, No. 5 Yiheyuan Road, Beijing CN-100871, China
| | - Liis Starkopf
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 2A, DK-1353 Copenhagen, Denmark
| | - Hugo Westerlund
- Division for Epidemiology, Stress Research Institute, Stockholm University, SE-10691, Stockholm, Sweden
| | - Ida E H Madsen
- National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100 Copenhagen, Denmark
| | - Reiner Rugulies
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Gothersgade 160, DK-1123 Copenhagen, Denmark.,National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100 Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, DK-1353 Copenhagen, Denmark
| | - Jaana Pentti
- Department of Public Health, University of Turku and Turku University Hospital, FI-20014 Turku, Finland
| | - Sari Stenholm
- Department of Public Health, University of Turku and Turku University Hospital, FI-20014 Turku, Finland
| | - Jussi Vahtera
- Department of Public Health, University of Turku and Turku University Hospital, FI-20014 Turku, Finland
| | - Åse M Hansen
- National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100 Copenhagen, Denmark.,Section of Social Medicine, Department of Public Health, University of Copenhagen, Gothersgade 160, DK-1123 Copenhagen, Denmark
| | - Marianna Virtanen
- Division for Epidemiology, Stress Research Institute, Stockholm University, SE-10691, Stockholm, Sweden.,Finnish Institute of Occupational Health, Topeliuksenkatu 41 b, FI-00250 Helsinki, Finland.,Department of Public Health and Caring Sciences, University of Uppsala, Husargatan 3, Uppsala, Sweden
| | - Mika Kivimäki
- Finnish Institute of Occupational Health, Topeliuksenkatu 41 b, FI-00250 Helsinki, Finland.,Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, UK.,Clinicum, Faculty of Medicine, PO Box 63, FI-00014 University of Helsinki, Helsinki, Finland
| | - Naja H Rod
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Gothersgade 160, DK-1123 Copenhagen, Denmark.,Division for Epidemiology, Stress Research Institute, Stockholm University, SE-10691, Stockholm, Sweden
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The Effects of Biofeedback Training and Smartphone-Delivered Biofeedback Training on Resilience, Occupational Stress, and Depressive Symptoms among Abused Psychiatric Nurses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082905. [PMID: 32331460 PMCID: PMC7215829 DOI: 10.3390/ijerph17082905] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/13/2020] [Accepted: 04/20/2020] [Indexed: 12/12/2022]
Abstract
Psychiatric ward (PW) nurses are at a higher risk to encounter workplace violence than are other healthcare providers, and many interventions have been developed to improve their mental health. We compared the effectiveness of biofeedback training (BT) and smartphone-delivered BT (SDBT) interventions on occupational stress, depressive symptoms, resilience, heart rate variability, and respiration rate in a sample of abused PW nurses. This was a quasi-experimental study. Structured questionnaires were administered before and six weeks after the intervention. Data were collected from April 2017 to October 2017. A total of 159 abused PW nurses were randomly assigned to BT, SDBT, and control groups, and 135 of them completed all processes of our protocol, with the study consisting of 119 females (88.1%) and 16 males (11.9%) and their age range being from 22 to 59 with the mean age of 35.61 and a standard deviation of 8.16. Compared to the controls, both the BT and the SDBT intervention groups experienced significant improvements in depressive symptoms, resilience, and respiration rate; and the SDBT group experienced significant reductions in occupational stress. Considering the cost, accessibility, restrictions time and space, SDBT be used as an effective intervention in people with resilience or occupational stress.
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Jaspers SØ, Jakobsen LM, Gadegaard CA, Dyreborg J, Andersen LPSØ, Aust B. Design of a tailored and integrated violence prevention program in psychiatric wards and prisons. Work 2019; 62:525-541. [PMID: 31104039 DOI: 10.3233/wor-192888] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Violence and threats of violence against personnel at psychiatric wards as well as in the prison service is a major work environment problem. To date results from interventions to prevent violence and threats in these sectors have been inconclusive or of small effect. One of the reasons may be that violence and threats of violence occur as a consequence of a complex interaction between employee-level and management-level factors. OBJECTIVE To design a tailored and theory-based intervention program directed at violence prevention in psychiatric wards and prisons that integrates the employee-level and management-level, and development of an evaluation design building on the Context, Process, and Outcome Evaluation Model. METHODS The study follows a stepped-wedged design with 16 work units entering the intervention in four groups with differing start dates from September 2017 to January 2019. The context and process evaluation includes: calculating the implementation degree; mapping of contextual factors; interviews with unit-leaders and employees before and after the intervention. The outcome evaluation includes performing multi-level statistical analysis on data from a three-monthly questionnaire to employees at the participating workplaces. RESULTS The first results will be available in 2020. CONCLUSIONS The comprehensive evaluation of the intervention will give insight into the processes and effects of the intervention.
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Affiliation(s)
- Sofie Østergaard Jaspers
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark.,National Research Center for the Working Environment, Copenhagen, Denmark
| | - Louise Meinertz Jakobsen
- Center for Clinical Research and Disease Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | | | - Johnny Dyreborg
- National Research Center for the Working Environment, Copenhagen, Denmark
| | - Lars Peter SØnderbo Andersen
- Department of Occupational Medicine - University Research Clinic, Danish Ramazzini Centre, Regional Hospital West Jutland, Herning, Denmark
| | - Birgit Aust
- National Research Center for the Working Environment, Copenhagen, Denmark
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Milner A, Scovelle AJ, King TL, Madsen I. Exposure to work stress and use of psychotropic medications: a systematic review and meta-analysis. J Epidemiol Community Health 2019; 73:569-576. [PMID: 30914444 DOI: 10.1136/jech-2018-211752] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND There is good evidence that job stressors are prospectively related to mental health problems, particularly depressive symptoms. This review aimed to examine whether job stressors were also related to use of psychotropic medications. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach, we examined seven electronic databases that indexed literature from a wide range of disciplines. Inclusion criteria were (1) the study included a job stressor or psychosocial working condition as an exposure, and (2) psychotropic medication was an outcome. All effect-size estimates were considered but needed to present either a SE or 95% CIs to be included in meta-analyses. Data were pooled between studies using the relative risk (RR) or odds ratio (OR) and 95% CIs. RESULTS There were 18 unique studies with non-overlapping exposures eligible for inclusion in the quantitative meta-analysis. High job demands were associated with a statistically significant increased risk of psychotropic medication use (RR 1.16, 95% CI 1.02 to 1.31). There was also an elevated RR in relation to work-family conflict (RR 1.26, 95% CI 1.03 to 1.48). In studies reporting OR, high job demands were associated with an OR of 1.39 (95% CI 1.06 to 1.71). CONCLUSIONS The findings of this review highlight the need for policy and programme attention to reduce harmful exposure to psychosocial job stressors. Health-service use measures should be considered as outcomes and may represent more severe mental health conditions.
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Affiliation(s)
- Allison Milner
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Anna J Scovelle
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Tania L King
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Ida Madsen
- National Research Centre for the Working Environment, Copenhagen, Denmark
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Frone MR. Employee Psychoactive Substance Involvement: Historical Context, Key Findings, and Future Directions. ANNUAL REVIEW OF ORGANIZATIONAL PSYCHOLOGY AND ORGANIZATIONAL BEHAVIOR 2019. [DOI: 10.1146/annurev-orgpsych-012218-015231] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Humans have consumed psychoactive substances for millennia, and these substances have played an important role in human culture and human labor. This article investigates our current understanding of the general association between the workplace and employee involvement with psychoactive substances. I begin by briefly exploring the broad evolutionary and historical intersection of psychoactive substances, human culture, and human labor. I then outline the multidimensional nature of employee psychoactive substance involvement and look at its prevalence. Next, I summarize recent research on workplace antecedents, such as work stressors, substance availability, norms, and social control. I then summarize research on the adverse workplace outcomes experienced by employees who use psychoactive substances as well as the collateral effects of such use on coworkers. Throughout the article, I identify directions for future research.
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Affiliation(s)
- Michael R. Frone
- Department of Psychology, University at Buffalo, The State University of New York, Buffalo, New York 14203, USA
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14
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Friis K, Pihl-Thingvad J, Larsen FB, Christiansen J, Lasgaard M. Long-term adverse health outcomes of physical workplace violence: a 7-year population-based follow-up study. EUROPEAN JOURNAL OF WORK AND ORGANIZATIONAL PSYCHOLOGY 2018. [DOI: 10.1080/1359432x.2018.1548437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Karina Friis
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Jesper Pihl-Thingvad
- Department of Occupational & Environmental Medicine, Odense University Hospital and National Center of Psychotraumatology, Odense, Denmark
| | | | | | - Mathias Lasgaard
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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15
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Montesó-Curto P, Aguilar C, Lejeune M, Casadó-Marin L, Casanova Garrigós G, Ferré-Grau C. Violence and depression in a community sample. J Clin Nurs 2017; 26:2392-2398. [DOI: 10.1111/jocn.13493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Pilar Montesó-Curto
- Faculty of Nursing; Rovira i Virgili University; Campus Terres de l'Ebre; Tortosa Tarragona Spain
| | - Carina Aguilar
- Department of Evaluation; Terres de l'Ebre; Catalan Institute of Health; IDIAP Jordi Gol; Tortosa Tarragona Spain
| | - Marylène Lejeune
- Hospital de Tortosa Verge de la Cinta; IISPV; URV; Tortosa Spain
| | - Lina Casadó-Marin
- Faculty of Nursing; Campus Catalunya; Rovira i Virgili University; Tarragona Spain
| | | | - Carme Ferré-Grau
- Faculty of Nursing; Rovira i Virgili University; Tarragona Spain
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16
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Hemminki E, Merikukka M, Gissler M, Wahlbeck K, Savolainen J, Ristikari T, Aaltonen M. Antidepressant use and violent crimes among young people: a longitudinal examination of the Finnish 1987 birth cohort. J Epidemiol Community Health 2016; 71:12-18. [PMID: 27354489 DOI: 10.1136/jech-2016-207265] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/04/2016] [Accepted: 06/05/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND The use of antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), has been questioned due to poor efficacy and safety. We examined whether young violent offenders were more likely antidepressant users prior to their first violent offence than other young persons. METHODS The study is a follow-up of children born in Finland in 1987 (n=59 120), linking national registers to each other using personal identity codes. Data on psychotropic drug use came from a register of reimbursed drugs and data on crimes from a register on court convictions (after the age of 14 years). Participants were followed until the age of 18 years, and for some analyses until the end of the follow-up (mean 21 years). To adjust for differences in background characteristics, regression analyses for antidepressant use were made, using the no-conviction group as the reference. RESULTS Proportions of young people convicted by the age of 18 years were: 5% of boys (1.7% for violent crimes) and 1% (0.5%) of girls. Antidepressant use (both overall and for SSRIs) prior to violent crime was more common among those convicted than among those without convictions. Among boys with repeated violent crimes, it was also more common than among boys with non-violent crimes. Adjustment for differences in background characteristics decreased the associations between antidepressant use and violent crime, but did not eliminate them. CONCLUSIONS The results add further evidence for caution in prescribing antidepressants among young persons. It also calls for a reanalysis of violence measures in the original trial data.
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Affiliation(s)
| | | | | | | | - Jukka Savolainen
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Mikko Aaltonen
- Institute of Criminology and Legal Policy, University of Helsinki, Helsinki Finland
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17
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Molero Y, Lichtenstein P, Zetterqvist J, Gumpert CH, Fazel S. Selective Serotonin Reuptake Inhibitors and Violent Crime: A Cohort Study. PLoS Med 2015; 12:e1001875. [PMID: 26372359 PMCID: PMC4570770 DOI: 10.1371/journal.pmed.1001875] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 08/05/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Although selective serotonin reuptake inhibitors (SSRIs) are widely prescribed, associations with violence are uncertain. METHODS AND FINDINGS From Swedish national registers we extracted information on 856,493 individuals who were prescribed SSRIs, and subsequent violent crimes during 2006 through 2009. We used stratified Cox regression analyses to compare the rate of violent crime while individuals were prescribed these medications with the rate in the same individuals while not receiving medication. Adjustments were made for other psychotropic medications. Information on all medications was extracted from the Swedish Prescribed Drug Register, with complete national data on all dispensed medications. Information on violent crime convictions was extracted from the Swedish national crime register. Using within-individual models, there was an overall association between SSRIs and violent crime convictions (hazard ratio [HR] = 1.19, 95% CI 1.08-1.32, p < 0.001, absolute risk = 1.0%). With age stratification, there was a significant association between SSRIs and violent crime convictions for individuals aged 15 to 24 y (HR = 1.43, 95% CI 1.19-1.73, p < 0.001, absolute risk = 3.0%). However, there were no significant associations in those aged 25-34 y (HR = 1.20, 95% CI 0.95-1.52, p = 0.125, absolute risk = 1.6%), in those aged 35-44 y (HR = 1.06, 95% CI 0.83-1.35, p = 0.666, absolute risk = 1.2%), or in those aged 45 y or older (HR = 1.07, 95% CI 0.84-1.35, p = 0.594, absolute risk = 0.3%). Associations in those aged 15 to 24 y were also found for violent crime arrests with preliminary investigations (HR = 1.28, 95% CI 1.16-1.41, p < 0.001), non-violent crime convictions (HR = 1.22, 95% CI 1.10-1.34, p < 0.001), non-violent crime arrests (HR = 1.13, 95% CI 1.07-1.20, p < 0.001), non-fatal injuries from accidents (HR = 1.29, 95% CI 1.22-1.36, p < 0.001), and emergency inpatient or outpatient treatment for alcohol intoxication or misuse (HR = 1.98, 95% CI 1.76-2.21, p < 0.001). With age and sex stratification, there was a significant association between SSRIs and violent crime convictions for males aged 15 to 24 y (HR = 1.40, 95% CI 1.13-1.73, p = 0.002) and females aged 15 to 24 y (HR = 1.75, 95% CI 1.08-2.84, p = 0.023). However, there were no significant associations in those aged 25 y or older. One important limitation is that we were unable to fully account for time-varying factors. CONCLUSIONS The association between SSRIs and violent crime convictions and violent crime arrests varied by age group. The increased risk we found in young people needs validation in other studies.
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Affiliation(s)
- Yasmina Molero
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Johan Zetterqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Clara Hellner Gumpert
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Seena Fazel
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
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Lassalle M, Chastang JF, Niedhammer I. Working conditions and psychotropic drug use: cross-sectional and prospective results from the French national SIP study. J Psychiatr Res 2015; 63:50-7. [PMID: 25777473 DOI: 10.1016/j.jpsychires.2015.02.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 01/27/2015] [Accepted: 02/23/2015] [Indexed: 11/19/2022]
Abstract
Prospective studies exploring the associations between a large range of occupational factors and psychotropic drug use among national samples of workers are seldom. This study investigates the cross-sectional and prospective associations between occupational factors, including a large set of psychosocial work factors, and psychotropic drug use in the national French working population. The study sample comprised 7542 workers for the cross-sectional analysis and 4213 workers followed up for a 4-year period for the prospective analysis. Psychotropic drug use was measured within the last 12 months and defined by the use of antidepressants, anxiolytics or hypnotics. Three groups of occupational factors were explored: classical and emergent psychosocial work factors, working time/hours and physical work exposures. Weighted Poisson regression analyses were performed to adjust for covariates. In the cross-sectional analysis, psychological demands, low social support and hiding emotions were associated with psychotropic drug use. Job insecurity for men and night work for women were associated with psychotropic drug use. In the prospective analysis, hiding emotions and physical exposure were predictive of psychotropic drug use. Dose-response associations were observed for the frequency/intensity of exposure and repeated exposure to occupational factors. This study underlines the role of psychosocial work factors, including emergent factors, in psychotropic drug use. Prevention policies oriented toward psychosocial work factors comprehensively may be useful to reduce this use.
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Affiliation(s)
- Marion Lassalle
- INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, F-75013 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, F-75013 Paris, France
| | - Jean-François Chastang
- INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, F-75013 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, F-75013 Paris, France
| | - Isabelle Niedhammer
- INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, F-75013 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, F-75013 Paris, France.
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Clausen T, Burr H, Borg V. Does affective organizational commitment and experience of meaning at work predict risk of disability pensioning? An analysis of register-based outcomes using pooled data on 40,554 observations in four occupational groups. Am J Ind Med 2014; 57:709-17. [PMID: 24619706 DOI: 10.1002/ajim.22313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of this study is to investigate whether experience of meaning at work (MAW) and affective organizational commitment (AOC) predict risk of disability pensioning in four occupational groups. METHODS Survey data from 40,554 individuals were fitted to a national register (DREAM) containing information on payments of disability pension. Using multi-adjusted Cox-regression, observations were followed in the DREAM-register to assess risk of disability pensioning. RESULTS Low levels of MAW significantly increased risk of disability pensioning during follow-up referencing high levels of MAW. Respondents with medium levels of AOC had a significantly reduced risk of disability pensioning, when compared to respondents with high levels of AOC. Furthermore, results indicate an interaction effect between AOC and MAW in predicting risk of disability pension. CONCLUSIONS AOC and MAW are significantly associated with risk of disability pensioning. Promoting MAW and managing AOC in contemporary workplaces may contribute towards reducing risk of disability pensioning.
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Affiliation(s)
- Thomas Clausen
- National Research Centre for the Working Environment; Copenhagen Denmark
| | - Hermann Burr
- Federal Institute for Occupational Safety and Health (BAuA); Berlin Germany
| | - Vilhelm Borg
- National Research Centre for the Working Environment; Copenhagen Denmark
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20
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Dement JM, Lipscomb HJ, Schoenfisch AL, Pompeii LA. Impact of hospital type II violent events: use of psychotropic drugs and mental health services. Am J Ind Med 2014; 57:627-39. [PMID: 24526348 DOI: 10.1002/ajim.22306] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND While violence can adversely affect mental health of victims, repercussions of violence against workers is not as well characterized. MATERIALS AND METHODS We explored relationships between workplace violent events perpetrated by patients or visitors (Type II) against hospital employees and the employee use of psychotropic medications or mental health services using a data system that linked violent events with health claims. RESULTS Significant associations were observed between reported Type II workplace violent events and employee prescription claims for anti-depressants and anxiolytics combined (RR = 1.45, 95% CI = 1.01-2.33) and anti-depressants alone (RR = 1.65, 95% CI = 1.10-2.48). No significant association between reported violent events and health claims for treatment of depression or anxiety was observed. CONCLUSIONS Type II violence experienced by hospital workers may lead to increased use of psychotropic drugs, particularly anti-depressants but also anxiolytics. Our results suggest an important role of employee assistance programs in mitigating the psychological consequences of workplace violent events.
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Affiliation(s)
- John M. Dement
- Division of Occupational and Environmental Medicine; Duke University Medical Center; Durham North Carolina
| | - Hester J. Lipscomb
- Division of Occupational and Environmental Medicine; Duke University Medical Center; Durham North Carolina
| | - Ashley L. Schoenfisch
- Division of Occupational and Environmental Medicine; Duke University Medical Center; Durham North Carolina
| | - Lisa A. Pompeii
- The University of Texas; School of Public Health; Houston Texas
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Do psychosocial job demands and job resources predict long-term sickness absence? An analysis of register-based outcomes using pooled data on 39,408 individuals in four occupational groups. Int Arch Occup Environ Health 2014; 87:909-17. [PMID: 24562968 DOI: 10.1007/s00420-014-0936-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 02/12/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate whether psychosocial job demands (work pace and quantitative demands) and job resources (influence at work and quality of leadership) predict long-term sickness absence (LTSA) for more than three consecutive weeks in four occupational groups. METHODS Survey data pooling 39,408 respondents were fitted to a national register containing information on payments of sickness absence compensation. Using multi-adjusted Cox regression, respondents were followed for an 18-month follow-up period to assess risk of LTSA. RESULTS In the entire study population, low and medium levels of influence at work and low quality of leadership predicted a significantly increased risk of LTSA, whereas medium levels of quantitative demands predicted a significantly reduced risk of LTSA. For employees working with clients and for office workers, low and medium influence at work associated with a significantly increased risk of LTSA. For employees working with clients, low quality of leadership predicted a significantly increased risk of LTSA. For manual workers, low influence at work predicted a significantly increased risk of LTSA and medium quantitative demands were associated with a significantly reduced risk of LTSA. For employees working with customers, medium quantitative demands predicted a significantly reduced risk of LTSA. Finally, in predicting LTSA, we found significant interaction effects between job demands and job resources. CONCLUSIONS The study indicates that a lack of job resources--particularly influence at work--are more important predictors of LTSA than high job demands.
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22
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Westreich D, Greenland S. The table 2 fallacy: presenting and interpreting confounder and modifier coefficients. Am J Epidemiol 2013; 177:292-8. [PMID: 23371353 DOI: 10.1093/aje/kws412] [Citation(s) in RCA: 558] [Impact Index Per Article: 50.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
It is common to present multiple adjusted effect estimates from a single model in a single table. For example, a table might show odds ratios for one or more exposures and also for several confounders from a single logistic regression. This can lead to mistaken interpretations of these estimates. We use causal diagrams to display the sources of the problems. Presentation of exposure and confounder effect estimates from a single model may lead to several interpretative difficulties, inviting confusion of direct-effect estimates with total-effect estimates for covariates in the model. These effect estimates may also be confounded even though the effect estimate for the main exposure is not confounded. Interpretation of these effect estimates is further complicated by heterogeneity (variation, modification) of the exposure effect measure across covariate levels. We offer suggestions to limit potential misunderstandings when multiple effect estimates are presented, including precise distinction between total and direct effect measures from a single model, and use of multiple models tailored to yield total-effect estimates for covariates.
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Affiliation(s)
- Daniel Westreich
- Department of Obstetrics and Gynecology, Duke Global Health Institute, Duke University, DUMC3967, Durham, NC 27710, USA.
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Rugulies R, Aust B, Madsen IEH, Burr H, Siegrist J, Bültmann U. Adverse psychosocial working conditions and risk of severe depressive symptoms. Do effects differ by occupational grade? Eur J Public Health 2012; 23:415-20. [PMID: 22683769 DOI: 10.1093/eurpub/cks071] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Depression is a major concern for public health. Both adverse working conditions and low socio-economic position are suspected to increase risk of depression. In a representative sample of the Danish workforce we investigated (i) whether adverse psychosocial working conditions, defined by the effort-reward imbalance (ERI) model, predicted onset of severe depressive symptoms after 5-year follow-up and (ii) whether the effect of ERI was differential across occupational grades. METHODS A cohort of 2701 Danish employees filled in a questionnaire on work and health in 2000 and 2005. ERI was measured with four effort and seven reward items. Depressive symptoms were assessed with the five-item Mental Health Inventory. Participants scoring ≤ 52 points were defined as cases. We used logistic regression to investigate the association of ERI and occupational grade in 2000 with onset of severe depressive symptoms in 2005. Analyses were adjusted for socio-demographics, health behaviours, survey method, self-rated health, sleep disturbances and non-severe depressive symptoms at baseline. RESULTS High ERI predicted onset of severe depressive symptoms at follow-up, after adjustment for co-variates and occupational grade (OR = 2.19, 95% CI = 1.12-4.25). Participants with high ERI and low occupational grade showed a considerably higher OR (2.43, 95% CI = 1.07-5.53) compared to participants with low/medium ERI and low grade (OR = 1.45, 95% CI = 0.72-2.92), high ERI and high grade (OR = 1.26, 95% CI = 0.59-2.70) and low/medium ERI and high grade (reference group). CONCLUSION Adverse psychosocial working conditions predicted onset of severe depressive symptoms. The effect was stronger among employees of lower occupational grades compared to those of higher grades.
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Affiliation(s)
- Reiner Rugulies
- National Research Centre for the Working Environment, Copenhagen, Denmark
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Magnavita N, Heponiemi T. Violence towards health care workers in a Public Health Care Facility in Italy: a repeated cross-sectional study. BMC Health Serv Res 2012. [PMID: 22551645 DOI: 10.1186/1472-6963-12-108 10.1186/1472-6963-12-108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Violence at work is one of the major concerns in health care activities. The aim of this study was to identify the prevalence of physical and non-physical violence in a general health care facility in Italy and to assess the relationship between violence and psychosocial factors, thereby providing a basis for appropriate intervention. METHODS All health care workers from a public health care facility were invited to complete a questionnaire containing questions on workplace violence. Three questionnaire-based cross-sectional surveys were conducted. The response rate was 75% in 2005, 71% in 2007, and 94% in 2009. The 2009 questionnaire contained the VIF (Violent Incident Form) for reporting violent incidents, the DCS (demand/control/support) model for job strain, the Colquitt 20 item questionnaire for perceived organizational justice, and the GHQ-12 General Health Questionnaire for the assessment of mental health. RESULTS One out of ten workers reported physical assault, and one out of three exposure to non-physical violence in the workplace in the previous year. Nurses and physicians were the most exposed occupational categories, whereas the psychiatric and emergency departments were the services at greatest risk of violence. Workers exposed to non-physical violence were subject to high job strain, low support, low perceived organizational justice, and high psychological distress. CONCLUSION Our study shows that health care workers in an Italian local health care facility are exposed to violence. Workplace violence was associated with high demand and psychological disorders, while job control, social support and organizational justice were protective factors.
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Affiliation(s)
- Nicola Magnavita
- Institute of Occupational Medicine, Università Cattolica del Sacro Cuore, Largo Gemelli 8, 00168 Roma, Italy.
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Magnavita N, Heponiemi T. Violence towards health care workers in a Public Health Care Facility in Italy: a repeated cross-sectional study. BMC Health Serv Res 2012; 12:108. [PMID: 22551645 PMCID: PMC3464150 DOI: 10.1186/1472-6963-12-108] [Citation(s) in RCA: 150] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 05/02/2012] [Indexed: 11/17/2022] Open
Abstract
Background Violence at work is one of the major concerns in health care activities. The aim of this study was to identify the prevalence of physical and non-physical violence in a general health care facility in Italy and to assess the relationship between violence and psychosocial factors, thereby providing a basis for appropriate intervention. Methods All health care workers from a public health care facility were invited to complete a questionnaire containing questions on workplace violence. Three questionnaire-based cross-sectional surveys were conducted. The response rate was 75 % in 2005, 71 % in 2007, and 94 % in 2009. The 2009 questionnaire contained the VIF (Violent Incident Form) for reporting violent incidents, the DCS (demand/control/support) model for job strain, the Colquitt 20 item questionnaire for perceived organizational justice, and the GHQ-12 General Health Questionnaire for the assessment of mental health. Results One out of ten workers reported physical assault, and one out of three exposure to non-physical violence in the workplace in the previous year. Nurses and physicians were the most exposed occupational categories, whereas the psychiatric and emergency departments were the services at greatest risk of violence. Workers exposed to non-physical violence were subject to high job strain, low support, low perceived organizational justice, and high psychological distress. Conclusion Our study shows that health care workers in an Italian local health care facility are exposed to violence. Workplace violence was associated with high demand and psychological disorders, while job control, social support and organizational justice were protective factors.
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Affiliation(s)
- Nicola Magnavita
- Institute of Occupational Medicine, Università Cattolica del Sacro Cuore, Largo Gemelli 8, 00168 Roma, Italy.
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