Cohort Profile: The Well-being in HospitAL Employees (WHALE) study

Associations between psychosocial work environment factors and first-time and recurrent treatment for depression: a prospective cohort study of 24,226 employees

AIMS

Adverse factors in the psychosocial work environment are associated with the onset of depression among those without a personal history of depression. However, the evidence is sparse regarding whether adverse work factors can also play a role in depression recurrence. This study aimed to prospectively examine whether factors in the psychosocial work environment are associated with first-time and recurrent treatment for depression.

METHODS

The study included 24,226 participants from the Danish Well-being in Hospital Employees study. We measured ten individual psychosocial work factors and three theoretical constructs (effort-reward imbalance, job strain and workplace social capital). We ascertained treatment for depression through registrations of hospital contacts for depression (International Statistical Classification of Diseases and Related Health Problems version 10 [ICD-10]: F32 and F33) and redeemed prescriptions of antidepressant medication (Anatomical Therapeutic Chemical [ATC]: N06A) in Danish national registries. We estimated the associations between work factors and treatment for depression for up to 2 years after baseline among those without (first-time treatment) and with (recurrent treatment) a personal history of treatment for depression before baseline. We excluded participants registered with treatment within 6 months before baseline. In supplementary analyses, we extended this washout period to up to 2 years. We applied logistic regression analyses with adjustment for confounding.

RESULTS

Among 21,156 (87%) participants without a history of treatment for depression, 350 (1.7%) had first-time treatment during follow-up. Among the 3070 (13%) participants with treatment history, 353 (11%) had recurrent treatment during follow-up. Those with a history of depression generally reported a more adverse work environment than those without such a history. Baseline exposure to bullying (odds ratio [OR] = 1.72, 95% confidence interval [95% CI]: 1.30-2.32), and to some extent also low influence on work schedule (OR = 1.27, 95% CI: 0.97-1.66) and job strain (OR = 1.24, 95% CI: 0.97-1.57), was associated with first-time treatment for depression during follow-up. Baseline exposure to bullying (OR = 1.40, 95% CI: 1.04-1.88), lack of collaboration (OR = 1.31, 95% CI: 1.03-1.67) and low job control (OR = 1.27, 95% CI: 1.00-1.62) were associated with recurrent treatment for depression during follow-up. However, most work factors were not associated with treatment for depression. Using a 2-year washout period resulted in similar or stronger associations.

CONCLUSIONS

Depression constitutes a substantial morbidity burden in the working-age population. Specific adverse working conditions were associated with first-time and recurrent treatment for depression and improving these may contribute to reducing the onset and recurrence of depression.

The Semmelweis Study: a longitudinal occupational cohort study within the framework of the Semmelweis Caring University Model Program for supporting healthy aging

The Semmelweis Study is a prospective occupational cohort study that seeks to enroll all employees of Semmelweis University (Budapest, Hungary) aged 25 years and older, with a population of 8866 people, 70.5% of whom are women. The study builds on the successful experiences of the Whitehall II study and aims to investigate the complex relationships between lifestyle, environmental, and occupational risk factors, and the development and progression of chronic age-associated diseases. An important goal of the Semmelweis Study is to identify groups of people who are aging unsuccessfully and therefore have an increased risk of developing age-associated diseases. To achieve this, the study takes a multidisciplinary approach, collecting economic, social, psychological, cognitive, health, and biological data. The Semmelweis Study comprises a baseline data collection with open healthcare data linkage, followed by repeated data collection waves every 5 years. Data are collected through computer-assisted self-completed questionnaires, followed by a physical health examination, physiological measurements, and the assessment of biomarkers. This article provides a comprehensive overview of the Semmelweis Study, including its origin, context, objectives, design, relevance, and expected contributions.

Impact of a manager-oriented intervention on occupational exposures and well-being among pregnant hospital and day-care employees: A cluster randomised trial

BACKGROUND

Pregnancy can make it difficult to cope with demands at work and may affect women's well-being. We investigated if a manager-targeted educational intervention reduced demanding occupational exposures and improved the psychosocial work environment and well-being among pregnant employees.

METHODS

Data came from a cluster randomised trial in Danish hospitals and day-care institutions. Work units were assigned randomly and were non-blinded to the intervention, where managers were either invited to participate in a three-hour seminar addressing job adjustment in pregnancy or assigned to a control group undertaking their usual practice. Self-reported outcomes by pregnant employees at the work units were the proportion of pregnant employees with demanding occupational exposures, good psychosocial work environment and good well-being. Mixed logistic regression was applied in the population of responders and in intention-to-treat analyses using multiple imputations.

RESULTS

We included 915 pregnant employees: 451 in the intervention group and 464 in the control group. Of 216 invited managers, 103 (48%) participated in the seminar. A total of 339 (37%) pregnant employees answered the questionnaire. The proportion of pregnant employees who had demanding occupational exposures, good psychosocial work environment and good well-being in the intervention versus the control group were 36% versus 39% (odds ratio (OR)=0.90, 95% confidence interval (CI) 0.57-1.44), 56% versus 59% (OR=1.01, 95% CI 0.60-1.71) and 77% versus 73% (OR=1.13, 95% CI 0.68-1.87), respectively.

CONCLUSIONS

This manager-targeted educational intervention did not reduce demanding occupational exposures and did not improve the psychosocial work environment or the well-being among pregnant employees in hospital and day-care settings. Comprehensive and participatory interventions may be considered in future studies.

Impact of hypothetical improvements in the psychosocial work environment on sickness absence rates: a simulation study

Background

The association between psychosocial working environments and sickness absence is well-known. However, the potential for reducing sickness absences of different lengths through improvements in psychosocial work factors is not fully understood. We aim to quantify the potential for reducing short-, intermediate- and long-term sickness absence rates, respectively, through hypothetical improvements in several psychosocial work factors.

Methods

This longitudinal study includes 24 990 public hospital employees from the 2014 wave of the Well-being in Hospital Employees study. The 1-year sickness absence rate was divided into short- (1–3 days), intermediate- (4–28 days) and long-term (29 days or more) periods. We simulated hypothetical scenarios with improvements in 17 psychosocial work factors using the parametric g-formula and estimated resulting changes in sickness absence rate ratios (RRs) with 95% confidence intervals (95% CIs).

Results

Setting all 17 psychosocial work factors to their most desirable levels (vs. least desirable levels) was associated with an overall 54% lower rate of sickness absence (95% CI: 48–60%). Reducing bullying (no vs. yes RR: 0.86, 95% CI: 0.83–0.90) and perceived stress (low vs. high RR: 0.90, 95% CI: 0.87–0.92), and increasing skill discretion (high vs. low RR: 0.91, 95% CI: 0.89–0.94) held the largest potential for reducing the total sickness absence rate. Overall, associations were similar for short-, intermediate- and long-term sickness absence.

Conclusions

The psychosocial working environment was strongly associated with sickness absence. Improving the working environment may have a great impact on short-, intermediate- and long-term sickness absence rates.

Effect of Psychological Distress on the Association of Workplace Social Capital with Presenteeism and Sickness Absence

Greater workplace social capital (WSC) can be related to workers' health and productivity. We sought to clarify the association between horizontal WSC and presenteeism and sickness absence (SA) and to examine the effects of psychological distress on these associations among Japanese workers. A cross-sectional study was conducted in 2017 at seven large Japanese companies. Logistic regression analysis was performed with presenteeism and SA as the dependent variables, horizontal WSC as an independent variable, and sociodemographic characteristics and psychological distress as covariates. After adjustment for sociodemographic characteristics, the results showed that greater horizontal WSC was associated with lower presenteeism and SA. The odds ratios for the relationship between horizontal WSC and presenteeism and that between horizontal WSC and SA dropped moderately after adjustment for psychological distress but remained significant. Further exploration of the factors underlying the relationship between WSC and productivity is needed to confirm if WSC enhances workers' health and productivity and to inform the development of effective occupational health initiatives.

The impact of work-place social capital in hospitals on patient-reported quality of care: a cohort study of 5205 employees and 23,872 patients in Denmark

BACKGROUND

Decision-makers increasingly consider patient-reported outcomes as important measures of care quality. Studies on the importance of work-place social capital-a collective work-place resource-for the experience of care quality are lacking. We determined the association between the level of work-place social capital and patient-reported quality of care in 148 hospital sections in the Capital Region of Denmark.

METHODS

This cross-sectional study combined section-level social capital from 5205 health care professionals and 23,872 patient responses about care quality. Work-place social capital encompassed three dimensions: trust, justice and collaboration. Patient-reported quality of care was measured as: overall satisfaction, patient involvement, and medical errors. Linear regression analysis and generalized linear models assessed the mean differences in patient reported experience outcomes and the risk of belonging to the lowest tertile of care quality.

RESULTS

A higher level of work-place social capital (corresponding to the interquartile range) was associated with higher patient-reported satisfaction and inpatient and acute care patient involvement. The risk of a section belonging to the lowest tertile of patient involvement was lower in sections with higher social capital providing inpatient (RR = 0.39, 0.19-0.81 per IQR increase) and acute care (RR = 0.53, 0.31-0.89). Patient-reported errors were fewer in acute care sections with higher social capital (RR = 0.65, 0.43 to 0.99). The risk of being in the lowest tertile of patient-reported satisfaction was supported for acute care sections (RR = 0.47, 0.28-0.79).

CONCLUSIONS

Although we found small absolute differences in the association between patient-reported experience measures and social capital, even a small upward shift in the distribution of social capital in the hospital sector would, at the population level, have a large positive impact on patients' care experience.

Work-unit social capital and incident purchase of psychotropic medications: A longitudinal cohort-study of healthcare workers

BACKGROUND

Whether workplace social capital affects employees' mental health is debated. We examined the association between work-unit aggregated social capital and incident purchase of psychotropic medications among employees.

METHODS

We used data from the WHALE (Well-being in Hospital Employees) cohort study. The study population comprised 21,711 employees without recent psychotropic purchase-history nested within 2283 work units in the Capital Region of Denmark. Employees were invited to participate in a survey in March 2014 (86% response). We assessed workplace social capital by eight items (covering trust/justice and collaboration) and aggregated the mean of responses up to each work unit and categorized the scores into quartiles. Data on psychotropic purchases (antidepressants and anxiolytics/hypnotics/sedatives) were extracted via linkage to national registers. Using two-level mixed-effects survival models, we analyzed the association between work-unit social capital and psychotropic purchases during a one-year follow-up period adjusting for individual-level workplace social capital.

RESULTS

Low work-unit social capital was associated with higher purchases of overall psychotropic medications in a dose-response manner (low-versus-high: HR=1.32, 95% CI=1.05-1.65), but this effect attenuated after adjusting for individual-level workplace social capital (HR=1.14, 95% CI=0.88-1.46). Low work-unit social capital was associated with higher purchases of antidepressants (HR=1.78, 95% CI=1.16-2.73) even after adjusting for individual-level workplace social capital (HR=1.69, 95% CI=1.05-2.73).

LIMITATIONS

Medical doctors/dentists were underrepresented in the data on workplace social capital.

CONCLUSIONS

Low work-unit social capital may be associated with higher use of antidepressants among healthcare employees. Interventions to improve social capital could potentially promote mental health at work in the healthcare setting.

Public managers' role in creating workplace social capital (WSC) and its effect on employees' well-being and health: a protocol of a longitudinal cohort study (PUMA-WSC)

INTRODUCTION

Workplace social capital (WSC) has been shown to affect employees' well-being and health, yet it is not clear how public managers can create WSC and which forms of WSC are most important. This study is the first prospective cohort study to examine the relationship between management behaviour, WSC, well-being and sickness absence. It uses a validated and detailed scale on WSC, which can distinguish between bonding, bridging, linking and organisational WSC over time. The study thereby provides rich data giving a much-needed detailed image of how WSC impacts on public employees' well-being and health. Additionally, the study pays special attention to the fact that these relationships can be different for different types of employees and therefore tests a set of relevant employee and context-related variables.

METHODS AND ANALYSIS

Project preparations in terms of agreements and data preparation of existing data started in 2019. This prospective cohort study considers and collects organisational data from 2016 to 2025. Annual employee surveys of more than 8000 employees (in a large Danish municipality) will be combined with register data in all years. This generates a unique cohort of public employees in different professions that are traceable over several years. The annual surveys include information on the management behaviour, WSC and employee outcomes. Fine-grained information on sickness absences will be matched for all employees and years under study. Moreover, confounders and the nested nature of the data will be considered.

ETHICS AND DISSEMINATION

Approval has been obtained from The Regional Committee on Health Research Ethics from Southern Denmark and from the University of Southern Denmark. The results will be presented at conferences and published in international peer-reviewed journals and in a practice-oriented monography targeted at public managers. The result will furthermore be disseminated to the involved employees through seminars and workshops in the participating organisations.

Work-unit organizational changes and risk of cardiovascular disease: a prospective study of public healthcare employees in Denmark

PURPOSE

The impact of organizational change at work on cardiovascular disease (CVD) among employees is poorly understood. We examined the longitudinal associations between different types of work-unit organizational changes and risk of CVD among employees.

METHODS

We used multilevel mixed-effects parametric survival models to assess the risk of incident ischemic heart disease and stroke (72 events) during 2014 according to organizational changes in 2013 among 14,788 employees working in the same work unit from January through December 2013. We excluded employees with pre-existing CVD events between 2009 and 2013. Data on organizational changes defined as mergers, split-ups, relocations, change in management, employee layoffs, and budget cuts were obtained from work-unit managers (59% response).

RESULTS

There was an excess risk of CVD in the year following change in management (HR 2.04, 95% CI 1.10-3.78) and employee layoff (HR 2.44, 95% CI 1.29-4.59) in the work unit relative to no change. Exposure to any organizational change also suggested increased risk of CVD (HR 1.48, 95% CI 0.91-2.43). Including perceived stress as mediator in the regression models attenuated the point risk estimates only slightly, indicating no important mediation through this psychosocial factor.

CONCLUSIONS

Work-unit organizational change may be associated with excess risk of incident CVD among the employees relative to stable workplaces.

Work-unit organisational changes and subsequent prescriptions for psychotropic medication: a longitudinal study among public healthcare employees

OBJECTIVES

We examined exposure to different types of organisational changes at work as risk factors for subsequent prescription for psychotropic medication among employees.

METHODS

The study population included 15 038 public healthcare employees nested within 1284 work units in the Capital Region of Denmark. Multilevel mixed-effects parametric survival models were developed to examine time to prescription for psychotropic medications (anxiolytics/hypnotics/sedatives/antidepressants) during the 12-month interval following exposure to organisational changes relative to no change from January to December 2013. Data on work-unit level organisational changes (including mergers, split-ups, relocation, change in management, employee lay-offs and budget cuts) were collected from work-unit managers (59% response).

RESULTS

Any organisational change versus no change was associated with a higher risk of psychotropic prescription (HR: 1.14, 95% CI: 1.02 to 1.26), especially change in management (HR: 1.23, 95% CI: 1.07 to 1.41). Splitting the 12-month follow-up period into two halves yielded particularly high rates of psychotropic prescription in the latter half of the follow-up, for example, any change (HR: 1.25, 95% CI: 1.11 to 1.41), change in management (HR: 1.42, 95% CI: 1.22 to 1.65), mergers (HR: 1.26, 95% CI: 1.06 to 1.50), employee lay-off (HR: 1.23, 95% CI: 1.03 to 1.46) and budget cuts (HR: 1.13, 95% CI: 1.00 to 1.41). The associations did not vary by sex.

CONCLUSIONS

Organisational changes in the workplace, especially change in management, may be associated with increased risk of psychotropic prescription among employees regardless of sex.

Work-unit social capital and long-term sickness absence: a prospective cohort study of 32 053 hospital employees

OBJECTIVE

There is a lack of studies investigating social capital at the workplace level in small and relatively homogeneous work-units. The aim of the study was to investigate whether work-unit social capital predicts a lower risk of individual long-term sickness absence among Danish hospital employees followed prospectively for 1 year.

METHODS

This study is based on the Well-being in HospitAL Employees cohort. The study sample consisted of 32 053 individuals nested within 2182 work-units in the Capital Region of Denmark. Work-unit social capital was measured with an eight-item scale covering elements of trust, justice and collaboration between employees and leaders. Social capital at the work-unit level was computed as the aggregated mean of individual-level social capital within each work-unit. Data on long-term sickness absence were retrieved from the employers' payroll system and were operationalised as ≥29 consecutive days of sickness absence. We used a 12-point difference in social capital as the metric in our analyses and conducted two-level hierarchical logistic regression analysis. Adjustments were made for sex, age, seniority, occupational group and part-time work at the individual level, and work-unit size, the proportion of female employees and the proportion of part-time work at the work-unit level.

RESULTS

The OR for long-term sickness absence associated with a 12-point higher work-unit social capital was 0.73 (95% CI 0.68 to 0.78). Further, we found an association between higher work-unit social capital and lower long-term sickness absence across quartiles of social capital: compared with the lowest quartile, the OR for long-term sickness absence in the highest quartile was 0.51 (95% CI 0.44 to 0.60).

CONCLUSION

Our study provides support for work-unit social capital being a protective factor for individual long-term sickness absence among hospital employees in the Capital Region of Denmark.

Dual impact of organisational change on subsequent exit from work unit and sickness absence: a longitudinal study among public healthcare employees

Objectives

We investigated work-unit exit, total and long-term sickness absence following organisational change among public healthcare employees.

Methods

The study population comprised employees from the Capital Region of Denmark (n=14 388). Data on reorganisation at the work-unit level (merger, demerger, relocation, change of management, employee layoff or budget cut) between July and December 2013 were obtained via surveys distributed to the managers of each work unit. Individual-level data on work-unit exit, total and long-term sickness absence (≥29 days) in 2014 were obtained from company registries. For exposure to any, each type or number of reorganisations (1, 2 or ≥3), the HRs and 95% CIs for subsequent work-unit exit were estimated by Cox regression, and the risk for total and long-term sickness absence were estimated by zero-inflated Poisson regression.

Results

Reorganisation was associated with subsequent work-unit exit (HR 1.10, 95% CI 1.01 to 1.19) in the year after reorganisation. This association was specifically important for exposure to ≥3 types of changes (HR 1.52, 95% CI 1.30 to 1.79), merger (HR 1.29, 95% CI 1.12 to 1.49), demerger (HR 1.41, 95% CI 1.16 to 1.71) or change of management (HR 1.24, 95% CI 1.11 to 1.38). Among the employees remaining in the work unit, reorganisation was also associated with more events of long-term sickness absence (OR 1.15, 95% CI 1.00 to 1.33), which was particularly important for merger (OR 1.31, 95% CI 1.00 to 1.72) and employee layoff (OR 1.31, 95% CI 1.08 to 1.59).

Conclusions

Specific types of reorganisation seem to have a dual impact on subsequent work-unit exit and sickness absence in the year after change.