Challenges and opportunities for preventing depression in the workplace: a review of the evidence supporting workplace factors and interventions

Conversational agents for depression screening: A systematic review

OBJECTIVE

This work explores the advances in conversational agents aimed at the detection of mental health disorders, and specifically the screening of depression. The focus is put on those based on voice interaction, but other approaches are also tackled, such as text-based interaction or embodied avatars.

METHODS

PRISMA was selected as the systematic methodology for the analysis of existing literature, which was retrieved from Scopus, PubMed, IEEE Xplore, APA PsycINFO, Cochrane, and Web of Science. Relevant research addresses the detection of depression using conversational agents, and the selection criteria utilized include their effectiveness, usability, personalization, and psychometric properties.

RESULTS

Of the 993 references initially retrieved, 36 were finally included in our work. The analysis of these studies allowed us to identify 30 conversational agents that claim to detect depression, specifically or in combination with other disorders such as anxiety or stress disorders. As a general approach, screening was implemented in the conversational agents taking as a reference standardized or psychometrically validated clinical tests, which were also utilized as a golden standard for their validation. The implementation of questionnaires such as Patient Health Questionnaire or the Beck Depression Inventory, which are used in 65% of the articles analyzed, stand out.

CONCLUSIONS

The usefulness of intelligent conversational agents allows screening to be administered to different types of profiles, such as patients (33% of relevant proposals) and caregivers (11%), although in many cases a target profile is not clearly of (66% of solutions analyzed). This study found 30 standalone conversational agents, but some proposals were explored that combine several approaches for a more enriching data acquisition. The interaction implemented in most relevant conversational agents is text-based, although the evolution is clearly towards voice integration, which in turns enhances their psychometric characteristics, as voice interaction is perceived as more natural and less invasive.

Sustainable return to work after depression - A comparative study among occupational physicians and affected employees

Introduction

The number of sick days taken from work due to depression is steadily rising. A successful return to work (RTW) is essential for sustainable reintegration. This study aims to identify factors to optimize RTW and to investigate approaches for sustainable RTW (sRTW) after depressive episodes.

Methods

Semi-structured expert interviews with senior occupational physicians (OPs, N = 5) served to develop two surveys among OPs (N = 180) and employees after depressive episode (N = 192). Predictors of RTW rating, workplace-based RTW interventions and sRTW interventions were analyzed using multiple hierarchical regression, chi-square difference and t-tests.

Results

For OPs, employee training on mental illness prevention was found to be the strongest predictor of overall RTW rating, whereas understanding and appreciation in conversations and stigmatization were strongest predictors of overall RTW rating by the employees. Compared to the employees, OPs reported significantly more availability of workplace-based interventions. To prevent relapse, the employees prioritized sufficient time and financial security during the RTW process more than OPs.

Conclusions

The study identified facilitating and hindering factors that can inform further research and practice to improve RTW after depressive episodes. To redress the awareness gap about the availability of workplace-based interventions, regular contact between OPs and employees is crucial. Several factors were considered to be of varying importance for relapse prevention by the two groups. Multiple perceptions and needs ought to be taken into account during RTW.

Depression and Diabetes in Workers Across the Life Span: Addressing the Health of America's Workforce-Behavioral Risk Factor Surveillance System, 2014-2018

OBJECTIVE

Diabetes affects nearly 12.2% of U.S. adults. Comorbid depressive symptoms among U.S. workers with diabetes are associated with increased unemployment and reduced work performance. This study examined the age-group-specific prevalence of depression among U.S. workers with self-reported diabetes and identified factors associated with depression.

METHODS

Data from the 2014-2018 Behavioral Risk Factor Surveillance System were used to examine the prevalence of depression among adult workers with diabetes in the United States. Relationships between depression prevalence and diabetes and demographic, physical, and behavioral risk factors were examined through bivariate and multivariable analyses. Age was categorized into four groups: 18-34, 35-54, 55-64, and ≥65 years.

RESULTS

The overall prevalence of self-reported depression among U.S. workers with diabetes was 17.4-30% higher than among those without diabetes. Workers with diabetes aged 18-34 years had the highest depression prevalence (28.7%) compared with other age-groups. Female workers with diabetes were significantly more likely than male workers to report depression in all age-groups. Young adult workers with diabetes who had another chronic disease were nearly three times more likely to report depression than those without another chronic condition. There were no overlapping patterns of prevalence of diabetes and depression by state.

CONCLUSION

Workers with diabetes are at an increased risk of depression, which can affect their overall health and productivity. These findings indicate that, among those with diabetes, young adult workers and women are most likely to have depression. Employee wellness programs may address the specific needs of individuals with diabetes and depression.

Different Influence of Negative and Positive Spillover between Work and Life on Depression in a Longitudinal Study

Background

This study investigated the longitudinal associations between the degrees of positive and negative spillover in work–life balance (WLB) at baseline and reports of depressive mood at a 2-year follow-up in Korean women employees.

Methods

We used a panel study design data of 1386 women employees who participated in the Korean Longitudinal Survey of Women and Families in both 2014 and 2016. Depressive mood was measured using the “10-item Center for Epidemiologic Studies Depression Scale.” Associations between the positive and negative spillover in WLB at baseline and reports of new incidence of depressive mood at 2-year follow-up were explored using a multivariate logistic regression model.

Results

Negative spillover in WLB at baseline showed a significant linear association with reports of depressive mood at 2-yearfollow-up after adjusting for age, education level, marital status, number of children, and positive spillover (P = 0.014). The highest scoring group in negative spillover (fourth quartile) showed a significant higher odds ratio of 1.95 compared with the lowest scoring group (first quartile; P = 0.036).

Conclusion

Positive spillover in WLB showed a U-shaped association with depression. The degrees of positive and negative spillover in WLB among Korean women employees at baseline were associated with new incidence of depressive mood within 2 years. To prevent depression of female workers, more discrete and differentiated policies on how to maintain healthy WLB are required.

Corporate Application of Health Literacy

BACKGROUND

The growing concern of low health literacy in populations combined with the interest of companies to develop cultures of health and the emerging interest in the workplace as an arena for improving health literacy is increasingly acknowledged. This study aimed to explore how companies currently apply the concept of health literacy as part of their health efforts in the work sphere.

METHODS

A systematic literature review was conducted based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines. The search was performed in the databases PubMed, Science Direct, and Directory of Open Access Journals from July 2019 to August 2019 and included the search terms "health literacy," "health literate," and "health competence" combined with the search terms "company/companies," "corporation/corporates," "workplace," "business," and "organization." Studies were eligible for inclusion if they (1) were written in English or German, (2) were concerned with employers/employees, companies, corporations, or organizations, (3) dealt with health literacy in particular, and (4) were formatted as journal articles, systematic literature reviews, or book chapters.

KEY RESULTS

The search identified 20 articles. A thematic analysis resulted in 5 clusters with 2 to 3 sub-themes illustrating the characteristics of how corporations apply health literacy. The clusters entailed the conceptualization of health literacy, its measurement, and the application of health literacy in strategies, interventions, and training.

DISCUSSION

The literature review reveals that the application of health literacy by companies is in its infancy. More research and practical experience are warranted on how companies can mobilize and facilitate a health literate workforce. [HLRP: Health Literacy Research and Practice. 2021;5(3):e218-e225.] Plain Language Summary: This literature study explored the role of advancing health literacy in companies. Five aspects were identified as important, including the understanding of the concept, its measurement, and its integration into strategies, interventions, and training. The involvement of management and the staff was crucial for success.

Disparities in Depression Status Among Different Industries in Transition Economy: A Cross-Sectional Study of Mongolia

Transition economies tend to rely on rapid growth of specific industries and hence often leads to disparities in health status among the working population. This study aims to determine the depression status in different industries and occupational groups in Mongolia, a country that is experiencing an economic transition. We conducted a cross-sectional survey between July and September 2018 in Ulaanbaatar, Mongolia. A total of 1784 employees from 22 private and public companies were enrolled in this study. The Patient Health Questionnaire-9 (PHQ-9) was used to determine the severity of depression. Prevalence of depression is evaluated using weighted analysis. The association between occupational groups (white, blue, and pink collars), industries, and PHQ-9 score was analyzed using linear regression. In multiple regression, the workers in the transportation, public administration, and education industries exhibited the highest depression scores (P < .001). Traditional variables such as age, sex, and marital status remained significant predictors in our model. Industrial types should not be overlooked in identifying depression in the working population. This is especially true for a transition economy like Mongolia. Analysis by industries is essential to promote stress management in the future among vulnerable groups in specific industries.

Evaluating Occupational Stress Levels of the Railway Workers

AIM

This study aimed to determine the levels of stress that are experienced by railway workers.

METHOD

This descriptive, cross-sectional study was conducted at the facilities of Turkish State Railways. The study sample included 322 male workers. The study data were collected between February and April 2015. A personal information form and the Doetinchem Organizational Stress Questionnaire were used to collect data.

RESULTS

It was determined that the employees are influenced by all sub-dimensions of the groups of stressors, social changes, psychological tensions, and complaints about health, and they have a medium level of stress. The study found that the workers were mostly influenced by their responsibilities and occupational uncertainty in future.

CONCLUSION

Descriptive characteristics of the workers and work-related and occupational characteristics showed statistically significant difference in mean scores of the subscales of stressors, social variables, psychological variables, and health complaints. In future, defining stress-related factors by determining the stress levels of employees will guide the initiatives intended to reduce work-related stress.

Innovative Self-Confidence Webinar Intervention for Depression in the Workplace: A Focus Group Study and Systematic Development

Brief face-to-face self-confidence workshops were effective in reducing depression among the public. Technological advances have enabled traditional face-to-face interventions to be adapted using unique technology-mediated platforms. This article details the formative development of a self-confidence web-based seminar (webinar) intervention for workplace depression. The first section discusses a qualitative study that explores the feasibility and acceptability of adapting the self-confidence workshops into a webinar platform on employees in the workplace. The second section describes the systematic development of this new webinar intervention informed by the qualitative study findings, a published systematic review, and previous face-to-face self-confidence workshops. The qualitative study involves three focus groups (n = 10) conducted in a small organization. Three themes were identified relevant to the running of the new self-confidence webinars in the workplace: personal (content, time and duration preference, features of the webinar, individual participation, personalization), interpersonal (stigma from others, engagement with participants/presenter, moderated interaction), and organizational (endorsement from management, work demand). For the intervention development, the format, structure, features, and content of the self-confidence webinar intervention are described. Features such as file sharing, virtual whiteboard, live chat, and poll are explained with the intervention primarily based on cognitive behavior therapy and coping flexibility concepts.

Identifying Strategies for Decreasing Work-Related Stress Among Working Men: An International Delphi Consensus Study

OBJECTIVE

The objective was to identify helpful, feasible strategies that can be implemented by working men to decrease work-related stress.

METHODS

An international Delphi consensus study was conducted with four panels of stakeholders. Three rounds of surveys were sent to panellists who rated the helpfulness and feasibility of strategies. Strategies were considered to have reached consensus if 80+% of at least three panels "agreed" or "strongly agreed" that the strategies were helpful or feasible.

RESULTS

Eighty-one strategies reached consensus out of a total 127 for helpfulness in decreasing work-related stress. Eleven strategies did not reach consensus in any of the vignettes. Only two strategies reached consensus for feasibility.

CONCLUSION

While many strategies are perceived as helpful for decreasing workplace stress, the feasibility of the strategies likely depends on an individual's particular needs and context.

Exploring the Association Between Health Literacy and Psychological Well-Being Among Industry Managers in Germany

OBJECTIVE

Industry managers are typically exposed to high work demands but have received limited attention by research, particularly concerning the issue of health literacy and how this relates to their psychological well-being. The aim of this study was to explore the association between health literacy and psychological well-being among managers in Germany.

METHODS

An online survey of a sample of 126 commercial industry managers was conducted. Effects of health literacy on psychological well-being (WHO-5 index) were investigated using path analysis.

RESULTS

The findings show a quarter of managers were classified as having poor well-being. Health literacy, namely the facets self-regulation (β = 0.40, P < 0.001), self-perception (β = 0.26, P < 0.001), self-control (β = 0.25, P < 0.01), and proactive approach to health (β = 0.09, P < 0.05), were positively associated with psychological well-being.

CONCLUSION

The study indicates that higher health literacy is associated with decreased risk of poor well-being.

An outreach collaborative model for early identification and treatment of mental disorder in Danish workplaces

BACKGROUND

Depression and anxiety are prevalent mental disorders among the working population with potentially high personal and financial cost. The overall aim of this study was to test the applicability of an outreach collaborative model for early identification and treatment of clinical and sub-clinical mental disorders among Danish employees. This applicability was examined by I) investigating the fractions of identified and treated clinical and subclinical cases, II) describing the distribution and characteristics of cases identified and III) investigating the effect of allocated treatment.

METHODS

A longitudinal study design with four assessments (T0-T3) over 16 months was applied. Self-reporting questionnaires probing for psychopathology were distributed to all employees in six consecutively enrolled companies at the four time points. Employees meeting the screening criteria at T1 were assessed diagnostically. Subjects diagnosed with a clinical mental disorder were allocated to outpatient psychiatric treatment, and subjects with subclinical conditions were allocated to preventive cognitive behavioural therapy. Follow-up was conducted 6 and 12 months after initiation of treatment. We used chi-squared test and F-test to compare the different groups on baseline characteristics and mixed effects linear regression to analyse the treatment effects.

RESULTS

Forty (6.8%) of the 586 responders at T1 were diagnosed with a clinical mental disorder and referred to outpatient psychiatric treatment. Thirty-three (5.6%) were affected by a subclinical condition and referred to preventive treatment. Nearly two-thirds (63%) of the employees diagnosed with a clinical condition had never received treatment before. Symptom severity decreased significantly for both treated groups until follow-up. When compared to a composed control group, subclinical cases displayed a more rapid initial significant symptomatic decrease on the global symptom scale (coefs = - 0.914, 95% CI [- 1.754, - 0,075]) and anxiety sub-scale (coefs = - 1.043, 95% CI [- 2.021, - 0.066]). This did not apply to the clinical cases as no significant difference in change were identified.

CONCLUSIONS

The outreach collaborative model demonstrated an applicability to identify both clinical and subclinical cases, among these a high number of employees with an unmet need for treatment. We found evidence of a positive initial effect on symptomatology from the allocated preventive treatment among the subclinical cases, but not for clinical cases.

TRIAL REGISTRATION

Retrospectively registered at December 18, 2018 at clinicaltrials.gov, identifier: NCT03786328 .

Opinion paper: poor response to treatment of depression in people in high occupational levels

The working environment may have a significant effect on response to treatment of depression and this issue has not yet been sufficiently addressed in the scientific literature. There is evidence showing that being engaged in high-level positions can be an obstacle to the success of treatment. This article discusses the few evidence in the literature and some of the possible mechanisms involved. Specific personality attributes and difficulties in adapting to depression may delay access to care and may also reduce treatment compliance. The presence of stress in jobs that require high cognitive function and lack of social support may be elements that hinder the recovery process. Residual symptoms that impact on cognitive functions may undermine adherence to treatment and adversely affect the response. The implications of these issues are potentially relevant for clinical practice in the treatment of depression and for future research.

Indicated Prevention Interventions in the Workplace for Depressive Symptoms: A Systematic Review and Meta-analysis

CONTEXT

Depressive symptoms are highly prevalent and cause substantive morbidities and loss of functioning among employees. Depression may be prevented at its early stages. However, there is a paucity of information regarding indicated preventive interventions for depression among employees. The objective of this review is to examine the effectiveness of indicated interventions for the reduction of depressive symptoms in the workplace.

EVIDENCE ACQUISITION

A systematic review and meta-analysis of articles published between January 2000 and September 2017 was conducted using major electronic databases, including PubMed/MEDLINE, PsycINFO, EMBASE, SOCINDEX, and ABI/ProQuest. Studies were selected based on a set of predefined inclusion criteria. Primary outcome measures were depressive symptomatology, and the interventions were preventive in nature. Studies were pooled based on the intervention type and the effect size was measured using the standardized mean difference.

EVIDENCE SYNTHESIS

A computer and hand search of the literature yielded 4,462 papers, from which 16 trials were identified to be suitable for meta-analysis. Eight of 16 studies reported significant effects for workplace preventive interventions targeting depressive symptoms in which six were cognitive behavioral therapy (CBT)-based interventions and two were non-CBT-based interventions. Small to medium effect sizes were found for both CBT- and non-CBT-based interventions (standardized mean difference= -0.44, 95% CI= -0.61, -0.26, I²=62.1% and standardized mean difference= -0.32, 95% CI= -0.59, -0.06, I²=58%, respectively).

CONCLUSIONS

This review demonstrates that indicated interventions can significantly reduce the level of depressive symptoms among workers. The implementation of evidence-based workplace interventions should consequently be considered to prevent the development of depressive symptoms among employees.

Employee health codes of conduct: what would they look like and who wants to accept them?

Purpose

– Most workplace health promotion efforts have failed to consistently and sustainably encourage employees to take responsibility for their health. The purpose of this paper is to explore a potentially high-impact solution – Health Codes of Conduct – for engaging and motivating employees to assume responsibility for their health.

Design/methodology/approach

– This mixed methods study draws on interview and survey methodology with a sample of 149 working adults to examine the feasibility of Health Codes of Conduct. Descriptive and inferential statistics are calculated to understand reactions, characteristics of the companies likely to support the idea, and components of a Health Code of Conduct.

Findings

– Nearly all employees offered moderate to high support for Health Codes of Conduct; this included overweight but not obese employees. Additionally, all demographic groups either moderately or strongly supported the policy when they included either monetary incentives (such as prescription discounts) or often overlooked non-monetary incentives (such as employee recognition). Some of the more popular features of Health Codes of Conduct included annual physical exams, exercise routines, and simply being encouraged to stay home when ill.

Research limitations/implications

– Health Codes of Conduct offer a surprisingly well-supported potential solution. Favorable reactions were observed across all examined segments of workers, even overweight (but not obese) employees. Using the specific features of Health Codes identified here, visionary companies can tailor their company’s Health Code of Conduct with the appropriate monetary and non-monetary incentives and disincentives.

Social implications

– What if the workplace could be a positive source of health and empowerment for valued employees? The authors show employee Health Codes of Conduct could be this empowering, engaging solution that has been missing.

Originality/value

– This paper is the first to propose the concept Health Codes of Conduct and solicit feedback from employees on this novel idea. Furthermore, the authors identify both the monetary and non-monetary incentives and disincentives that employees believe would be most compelling.

Mental health of Japanese psychiatrists: the relationship among level of occupational stress, satisfaction and depressive symptoms

Background

Psychiatrists in clinical practice face a number of stressors related to patient care, such as overwork. On the other hand, they gain satisfaction from their work. We quantified and assessed the potential relationship between levels of occupational stress, satisfaction, and depressive symptoms among Japanese clinical psychiatrists. We surveyed 206 psychiatrists with up to 15 years of clinical experience who primarily worked in patient care. Levels of occupational stress and occupational satisfaction were measured using the Visual Analogue Scale and the level of depressive symptoms was measured by the Center for Epidemiologic Studies Depression Scale. Workplace stressors and satisfiers were also evaluated.

Results

Out of 206 psychiatrists, 154 (74.8%) responded to the survey. The respondents’ mean (SD) age was 34.3 (5.2) years. The estimated prevalence of significant depressive symptoms was 34.4% (n = 53), and the experienced frequent violence was 14.9% (n = 23). The level of depressive symptoms was inversely correlated with the level of occupational satisfaction. In respondents who reported a moderate level of occupational stress, having fewer depressive symptoms was associated with higher occupational satisfaction, but this association was not significant in those who reported a high level of stress. In addition, high occupational satisfaction was associated with interest towards work content, ability to work at one’s discretion, opportunities for growth and career development, and ease of communication with supervisors and colleagues.

Conclusions

Nearly one-third of the psychiatrists screened positive for significant depressive symptoms. Having fewer depressive symptoms was associated with higher occupational satisfaction in those who reported a moderate level of stress. Implications from the present findings may be to enhance occupational satisfaction by discussing work interests with a supervisor, as well as increased opportunities for career development, which may prevent depression among psychiatrists.

Electronic supplementary material

The online version of this article (doi:10.1186/s13104-015-1054-7) contains supplementary material, which is available to authorized users.

Prevalence rates for depression by industry: a claims database analysis

PURPOSE

To estimate and interpret differences in depression prevalence rates among industries, using a large, group medical claims database.

METHODS

Depression cases were identified by ICD-9 diagnosis code in a population of 214,413 individuals employed during 2002-2005 by employers based in western Pennsylvania. Data were provided by Highmark, Inc. (Pittsburgh and Camp Hill, PA). Rates were adjusted for age, gender, and employee share of health care costs. National industry measures of psychological distress, work stress, and physical activity at work were also compiled from other data sources.

RESULTS

Rates for clinical depression in 55 industries ranged from 6.9 to 16.2 %, (population rate = 10.45 %). Industries with the highest rates tended to be those which, on the national level, require frequent or difficult interactions with the public or clients, and have high levels of stress and low levels of physical activity.

CONCLUSIONS

Additional research is needed to help identify industries with relatively high rates of depression in other regions and on the national level, and to determine whether these differences are due in part to specific work stress exposures and physical inactivity at work.

CLINICAL SIGNIFICANCE

Claims database analyses may provide a cost-effective way to identify priorities for depression treatment and prevention in the workplace.

Transformational leadership and depressive symptoms among employees: mediating factors

Purpose

– The purpose of this paper is to examine whether the link between transformational leadership and depressive symptoms among employees is mediated by such personal resources as occupational self-efficacy, perceived meaningfulness of the work, and work-related rumination.

Design/methodology/approach

– The study was conducted using questionnaires among 557 Finnish municipal employees in various occupations. The statistical analysis was based on structural equation modeling. A multiple mediation model enabled us to investigate the specific indirect effects of each mediator. Model comparison was applied to ascertain whether the mediation should be considered as full or partial.

Findings

– Results based on model comparison showed that the proposed factors fully mediated the negative relationship between transformational leadership and depressive symptoms. Thus high level of transformational leadership was associated with high levels of occupational self-efficacy and perceived meaningfulness of the work, and low level of work-related rumination during off-job time, which, in turn, were associated with low level of depressive symptoms. The fully mediated model explained 36 percent of the variance in depressive symptoms. All of the three mediators made a unique contribution to this relationship.

Research limitations/implications

– The results imply that transformational leadership behaviors may decrease depressiveness among employees through strengthening the personal resources of employees. However, as the study is cross-sectional, causal relationships can only be hypothesized.

Originality/value

– The study sheds new light on the possible processes through which transformational leaders may exert their health-promoting effects on employees even in terms of depressive symptoms.

Preventing the development of depression at work: a systematic review and meta-analysis of universal interventions in the workplace

BACKGROUND

Depression is a major public health problem among working-age adults. The workplace is potentially an important location for interventions aimed at preventing the development of depression, but to date, the mental health impact of universal interventions in the workplace has been unclear.

METHOD

A systematic search was conducted in relevant databases to identify randomized controlled trials of workplace interventions aimed at universal prevention of depression. The quality of studies was assessed using the Downs and Black checklist. A meta-analysis was performed using results from studies of adequate methodological quality, with pooled effect size estimates obtained from a random effects model.

RESULTS

Nine workplace-based randomized controlled trials (RCT) were identified. The majority of the included studies utilized cognitive behavioral therapy (CBT) techniques. The overall standardized mean difference (SMD) between the intervention and control groups was 0.16 (95% confidence interval (CI): 0.07, 0.24, P = 0.0002), indicating a small positive effect. A separate analysis using only CBT-based interventions yielded a SMD of 0.12 (95% CI: -0.01, 0.24, P = 0.07). [corrected].

CONCLUSIONS

There is good quality evidence that universally delivered workplace mental health interventions can reduce the level of depression symptoms among workers. There is more evidence for the effectiveness of CBT-based programs than other interventions. Evidence-based workplace interventions should be a key component of efforts to prevent the development of depression among adults.

Psychometric properties of the Chinese-version Quality of Nursing Work Life Scale

In this study, we developed and tested the psychometric properties of the Chinese-version Quality of Nursing Work Life Scale along seven subscales: supportive milieu with security and professional recognition, work arrangement and workload, work/home life balance, head nurse's/supervisor's management style, teamwork and communication, nursing staffing and patient care, and milieu of respect and autonomy. An instrument-development procedure with three phases was conducted in seven hospitals in 2010-2011. Phase I comprised translation and the cultural-adaptation process, phase II comprised a pilot study, and phase III comprised a field-testing process. Purposive sampling was used in the pilot study (n = 150) and the large field study (n = 1254). Five new items were added, and 85.7% of the original items were retained in the 41 item Chinese version. Principal component analysis revealed that a model accounted for 56.6% of the variance with acceptable internal consistency, concurrent validity, and discriminant validity. This study gave evidence of reliability and validity of the 41 item Chinese-version Quality of Nursing Work Life Scale.

A qualitative study of the interactions among the psychosocial work environment and family, community and services for workers with low mental health

Background

The psychosocial work environment can benefit and harm mental health. Poor psychosocial work environments and high level work-family conflict are both associated with poor mental health, yet little is known about how people with poor mental health manage the interactions among multiple life domains. This study explores the interfaces among paid work, family, community and support services and their combined effects on mental health.

Methods

We conducted 21 in-depth semi-structured interviews with people identified as having poor mental health to examine their experiences of paid employment and mental health and wellbeing in the context of their daily lives.

Results

The employment-related psychosocial work environment, particularly workplace relationships, employment security and degree of control over hours, strongly affected participants’ mental health. The interfaces among the life domains of family, community and access to support services suggest that effects on mental health differ according to: time spent in each domain, the social, psychological and physical spaces where domain activities take place, life stage and the power available to participants in their multiple domains. This paper is based on a framework analysis of all the interviews, and vignettes of four cases. Cases were selected to represent different types of relationships among the domains and how interactions among them either mitigated and/or exacerbated mental health effects of psychosocial work environments.

Conclusions

Examining domain interactions provides greater explanatory capacity for understanding how people with low mental health manage their lives than restricting the research to the separate impacts of the psychosocial work environment or work-family conflict. The extent to which people can change the conditions under which they engage in paid work and participate in family and social life is significantly affected by the extent to which their employment position affords them latitude. Policies that provide psychosocial protections to workers that enable them to make changes or complaints without detrimental repercussions (such as vilification or job loss) and increase access to welfare benefits and support services could improve mental health among people with paid work. These policies would have particularly important effects for those in lower socioeconomic status positions.

Employees' negative and positive work-home interaction and their association with depressive symptoms

BACKGROUND

Depression is the leading cause of disability and high costs worldwide. One possibility for preventing depression in the workplace, which has received little consideration so far, is the promotion of a successful balance between work and personal life. The aim of this study was to investigate employees' negative and positive work-home interaction and their association with depressive symptoms.

METHODS

A cross-sectional study was conducted in the micro- and nanotechnology sector in Germany. A stepwise multivariate logistic regression analysis was performed using data from N = 213 employees.

RESULTS

The results suggest that while negative work-home interaction is associated with an increased risk for depressive symptoms, positive work-home interaction is correlated with a lower risk. Neither positive nor negative interaction in the home-to-work direction demonstrated a significant association with depressive symptoms.

CONCLUSION

When attempting to prevent mental illnesses, such as depression, it is important to develop strategies aimed at reducing conflict between work and personal life and promoting a positive exchange between these two domains.

Depression in employees in privately owned enterprises in China: is it related to work environment and work ability?

This study examines the individual and workplace factors related to depression and stress in a large privately owned enterprise in China. The cross-sectional study design involved 13 privately owned retail enterprises in China. A self-report survey was administered to 4,847 employees aged 18–54 recruited through the management boards of the 13 enterprises. A chi-square test was used to compare differences between the depressed and non-depressed groups on a number of demographic variables and chronic diseases. Logistic regression analysis was performed to assess depression in relation to individual factors (work ability and resilience) and organisational environmental factors (workplace ethos and culture, psychosocial environment and health promotion policies and activities). Significant relationships were found between employee depression all personal factors, and one organisational environmental factor. Personal factors include poor work ability and low resilience, while workplace factors include workplace ethos and culture. The primary organisational environmental factor was a low level of enterprise ethos and culture.

When health care workers experience mental ill health: institutional practices of silence

Based on findings from an institutional ethnography in a large mental health organization, we explore how institutional forces shape the experiences of health care workers with mental health issues. We interviewed 20 employees about their personal experiences with mental health issues and work and 12 workplace stakeholders about their interactions with workers who had mental health issues. We also reviewed organizational texts related to health, illness, and productivity. In analyzing transcripts and texts, silence emerged as a core underlying process characterizing individual and organizational responses to employees with mental health issues. Silence was an active practice that took many forms; it was pervasive, complex, and at times, paradoxical. It served many functions for workers and the organization. We discuss the theoretical and practical implications of the findings for workers with mental health issues.

Differences in well-being between GPs, medical specialists, and private physicians: the role of psychosocial factors

OBJECTIVE

To examine the well-being differences among physicians working in different health care sectors and to test whether psychosocial stressors account for these differences. The well-being indicators used were psychological distress, self-rated health, and work ability.

DATA SOURCES/STUDY SETTING

A total of 2,841 randomly selected Finnish physicians (response rate 57 percent) returned the postal questionnaire, of which 2,047 (1,241 women) fulfilled all the participant criteria.

STUDY DESIGN

This is a cross-sectional questionnaire study.

PRINCIPAL FINDINGS

General practitioners and medical specialists experienced lower well-being than private physicians and this difference was partly explained by differences in psychosocial stressors.

CONCLUSIONS

General practitioners and medical specialists report more problems in well-being than private physicians. It is of particular importance to be aware of the sector-specific difficulties in work environments.

Job demands and resources and their associations with early retirement intentions through recovery need and work enjoyment

Orientation: Job characteristics play a major role in shaping employees’ early retirement decisions.Research purpose: The objective of this study was to examine the mechanisms through which job characteristics associate with early retirement intention, using the Job Demands-Resources (JD-R) model as a theoretical framework.Motivation of the study: Early retirement presents a threat to existing health and pension systems, and to organisational functioning. Therefore, it is important to examine how workrelated factors contribute to early retirement decisions.Research design, approach and method: Two parallel processes were theorised to shape early retirement intention: a health impairment process (i.e. job demands → recovery need → early retirement intention) and a motivational process (i.e. job resources → work enjoyment → early retirement intention). Survey data were collected from a heterogeneous sample of 1812 older workers (age > 45). Structural equation modeling was used to test the hypotheses.Main findings: Job demands and job resources were both associated with work enjoyment, which was associated with early retirement intention. Recovery need did not add to the prediction of early retirement intention.Practical/managerial implications: To retain older workers, companies should promote work conditions and practices that keep older workers motivated. Good health may be a necessary condition for retaining older workers, but it does not appear to be a sufficient one.Contribution/value-add: The results suggest that – for early retirement intention – the motivational process is more prominent than the health impairment process.

Depression in the workforce: the intermediary effect of medical comorbidity

BACKGROUND

It is amply documented that mood disorders adversely affect job satisfaction, workforce productivity, and absenteeism/presenteeism. It is also well documented that mood disorders are an independent risk factor for several chronic medical disorders (e.g., obesity, diabetes mellitus, cardiovascular disease). Emerging evidence indicates that the workforce dysfunction associated with depression is partially mediated by medical comorbidity.

METHODS

We conducted a PubMed search of all English-language articles published between 2005 and July 2009 with the following search terms: major depressive disorder and depression, cross-referenced with work productivity, disability, economic cost, absenteeism, presenteeism, and medical comorbidity. Articles selected for review were based on adequacy of sample size, the use of standardized experimental procedures, validated assessment measures, and overall manuscript quality.

RESULTS

Mood disorders are the most impairing condition amongst working adults. It is estimated that approximately 35-50% of employees with depression will take short-term disability leave at some point during their job tenure. Moreover, 15-20% of the workforce will receive short-term disability benefits during any given year; the annual income of individuals affected by depression is reduced by approximately 10% when compared to unaffected employees. Chronic stress-sensitive conditions independently contribute to workforce maladjustment and associated disability. The mood disorder population is differentially affected by several stress-related medical conditions resulting in greater impairment in the workforce.

CONCLUSION

Disability modelling in the depressed employee has emphasized the complex interrelationship between depressive symptoms, workforce stress, and consequent disability. A more refined model must include the effects of chronic medical conditions as a powerful mediator and/or moderator of workforce impairment. Multidisciplinary interventions have been demonstrated to reduce, but not eliminate workforce disability related to depression, underscoring the need for elucidating other modifiable factors. Screening, treatment, and prevention initiatives need to target chronic medical conditions in depressed employees in order to reduce overall workforce disability.