Workplace Characteristics, Depression, and Health-Related Presenteeism in a General Population Sample

Translation and Psychometric Testing of the Hägerbäumer Presenteeism Scale in English

PURPOSE

Interest in presenteeism has increased in research. Presenteeism is a behaviour of going to work despite illness. It has been predominantly measured using single items, which introduce limitations to validity. To overcome these limitations, Hägerbäumer developed a German multi-item presenteeism scale.

METHODS

The aim of the study was to provide an English translation and psychometric testing of the scale. This was conducted in two phases with native English-speaking employed adults. Phase 1 includes translation and cognitive debriefing, phase 2 testing construct validity and internal consistency reliability.

RESULTS

Cognitive debriefing with 10 employees revealed no problems with understanding or answering the translated items. In total, 487 employed adults participated in the study, of which data from 287 were included in the analysis. For structural validity, the goodness-of-fit indicators all reached their thresholds (TLI = 0.98, CFI = 0.99, RMSEA = 0.07, SRMR = 0.02). The scale does not show differences between sexes and age groups but between sectors (F6,70.95 = 5.53, p < 0.001). The internal consistency reliability was satisfactory with α = 0.89 (CI 95%, 0.87-0.91).

CONCLUSION

The translated multidimensional scale for measuring presenteeism at the behavioural level demonstrated good psychometric properties in an initial validation. Further psychometric testing is required before using this scale in cross-national comparison in research and international companies.

Prevalence of sickness presenteeism and associated factors among primary school teachers in Gondar city, northwest Ethiopia

Background

Sickness presenteeism, the phenomenon of people going to work despite being ill, is an occupational and psychosocial condition that hurts both the health of workers and organizational productivity. It negatively affects health, increases health-related costs, and the risk of contagious diseases. Primary school teachers are particularly vulnerable to this problem, although little is known about its scope and associated factors. This study aimed to determine the prevalence and factors associated with sickness presenteeism among school teachers in Northwest Ethiopia.

Methods

An institution-based cross-sectional study was employed and the study period was from April 18 to May 18, 2023. A sample of 633 primary school teachers was recruited using two-stage stratified random sampling. Data were collected using structured self-administered questionnaires. Epi-data version 4.6 and STATA version 14 were used for data entry and analysis, respectively. Binary logistic regression analysis was used. A multivariable logistic regression model with an adjusted odds ratio was fitted for statistical significance.

Results

A total of 603 school teachers participated in this study, with a response rate of 95.26%. The overall prevalence of sickness presenteeism in the last 12 months was 54.7% (N = 330) [95% CI (50.9, 58.7)]. Private school teachers [AOR: 2.21, 95% CI (1.14, 4.28)], low supervisor support [AOR: 1.53, 95% CI (1.06, 2.20)], lack of staff replacement availability [AOR: 2.74, 95% CI (1.85, 4.06)], low colleague support [AOR: 2.17, 95% CI (1.40, 3.37)], unsuitable household conditions [AOR: 1.49, 95% CI (1.08, 2.34)], and strict attendance control [AOR: 2.54, 95% CI (1.67, 3.85)] were factors significantly associated with sickness presenteeism.

Conclusion

The prevalence of sickness presenteeism was relatively high among primary school teachers because of factors such as low support from supervisors and colleagues, strict attendance control, lack of staff replacement, unsuitable household conditions, and private school type. Strategies to promote teachers' health include fostering a culture of support and collaboration among colleagues, recruiting adequate staff, and implementing liberal attendance policies.

Workplace mental health screening: a systematic review and meta-analysis

Workplaces are an important location for population mental health interventions. Screening to detect employees at risk of or experiencing mental ill health is increasingly common. This systematic review and meta-analysis examined the efficacy of workplace mental health screening programmes on employee mental health, work outcomes, user satisfaction, positive mental health, quality of life, help-seeking and adverse effects. PubMed, PsycINFO, EMBASE, CENTRAL, Global Index Medicus, Global Health and SciELO were searched (database inception-10 November 2022) and results screened by two independent reviewers. Controlled trials evaluating screening of workers' mental health as related to their employment were included. Random effects meta-analysis was performed to calculate pooled effect sizes for each outcome of interest. Grading of Recommendations Assessment, Development and Evaluation was conducted to evaluate the certainty of findings. Of the 12 328 records screened, 11 were included. These reported 8 independent trials collectively assessing 2940 employees. Results indicated screening followed by advice or referral was ineffective in improving employee mental health symptoms (n=3; d=-0.07 (95% CI -0.29 to 0.15)). Screening followed by facilitated access to treatment interventions demonstrated a small improvement in mental health (n=4; d=-0.22 (95% CI -0.42 to -0.02)). Limited effects were observed for other outcomes. Certainty ranged from low to very low. The evidence supporting workplace mental health screening programmes is limited and available data suggest mental health screening alone does not improve worker mental health. Substantial variation in the implementation of screening was observed. Further research disentangling the independent effect of screening alongside the efficacy of other interventions to prevent mental ill health at work is required.

The Effects of Job Demand-control-support Profiles on Presenteeism: Evidence from the Sixth Korean Working Condition Survey

Background

Presenteeism is closely related to work performance, work quality and quantity, and productivity at work. According to the job demand-control-support model, job demand, job control, and support play important roles in presenteeism. The present study investigated job characteristics profiles based on the job demand-control-support model and identify the association between job characteristics profiles and presenteeism.

Methods

This secondary data analysis used the Sixth Korean Working Condition Survey, a nationwide cross-sectional dataset. The study included 25,361 Korean wage workers employed in the workplace with two or more workers. Participants were classified into four job characteristics profiles based on the job demand-control-support model, using latent profile analysis, and logistic regression was performed to examine the association between study variables.

Results

Overall, 11.0 % of study participants reported experience of presenteeism in the past 12 months. Age, sex, location, monthly income, shift work, work hours, health problems, and sleep disturbances were significantly associated with presenteeism. The rate of presenteeism was the highest in the passive isolate group. The passive collective, active collective, and low-stain collective groups had a 23.0%, 21.0%, and 29.0% lower likelihood of experiencing presenteeism, respectively, than the passive isolate group.

Conclusions

The job demand-control-support profiles and the risk of presenteeism were significantly associated. The most significant group that lowered the experience of presenteeism was the low-strain collective group, which had a low level of demand and high levels of control and support. Therefore, we need a policy to reduce job demand and increase job control and support at the organizational and national levels.

Cultural Adaptation and Validation of the Health and Work Performance Questionnaire in German

BACKGROUND

Research interest in presenteeism as a productivity loss has grown given its estimated costs for organizations. To enable researchers in German-speaking countries to compare their findings internationally, a validated German Health and Work Performance Questionnaire (HPQ) version is needed.

METHODS

First, the HPQ was translated from English into German, culturally adapted, and tested using cognitive debriefing in interviews. Second, the structural validity of the item measuring presenteeism as productivity loss was tested.

RESULTS

Overall, 14 problems with items were identified in the cognitive debriefing. Of these, 57% were comprehension problems. Two of three alternative hypotheses for discriminative validity were accepted. No discrimination was possible for individuals with or without chronic disease.

CONCLUSIONS

The German HPQ has satisfactory cross-cultural validity and can be used to measure overall performance, as well as presenteeism in a specified sample with health problems.

Personality and occupational correlates of anxiety and depression in nurses: the contribution of role conflict, core self-evaluations, negative affect and bullying

Background

The work environment and the fatiguing nature of nursing are risk factors that cause psychological disorders. This study was conducted with the aim of investigating the relationship between role conflict, core self-evaluations, negative affect, and bullying with anxiety and depression in nurses.

Methods

This cross-sectional study was conducted on the nurses working in hospitals of Bandar Abbas, Iran over 4 months (August 2019–November 2019). Data were collected using the Positive and Negative Affect Schedule scale, Role Conflict Questionnaire, Core Self-Evaluations Scale, Negative Acts Questionnaire-Revised, Beck Depression Inventory-Second Edition (BDI-II) and Beck Anxiety Inventory. Data were analyzed using t-test, one-way analysis of variance, Pearson correlation coefficient and multiple regression analysis using SPSS version 22 software and the significance level was considered 0.05.

Results

The findings revealed that there was a significant positive relationship between role conflict (r = 0.422, p < 0.01), negative affect (r = 0.715, p < 0.01), and bullying (r = 0.443, p < 0.01) with anxiety. Moreover, there was a significant negative relationship between core self-evaluations with anxiety (r = − 0.482, p < 0.01). Also, the findings indicated that there was a significant positive relationship between role conflict (r = 0.382, p < 0.01), negative affect (r = 0.672, p < 0.01), and bullying (r = 0.433, p < 0.01) with depression. There was a significant negative relationship between core self-evaluations and depression (r = − 0.603, p < 0.01). Moreover, regression analysis results revealed that negative affect, role conflict, and core self-evaluations predicted 54.3% of anxiety variance significantly. And lastly, negative affect and core self-evaluations predicted 53.3% of depression variance significantly.

Conclusions

Findings indicated that having high negative affect, low core self-evaluations, high role conflict, and exposure to bullying at work enhances the rate of depression and anxiety in nurses. Hence, it is essential to improve the mental health of nurses and thus the quality of care provided by them through recognizing suitable supportive strategies and interventions.

Development and Initial Validation of the Korean Effort and Reward Scale (ERS-K) for Use in Sport Contexts

Background: Applying Siegrist’s (1996) effort-reward imbalance model to athletes, the current study aimed to develop a measure that can evaluate athletes’ effort and reward, and verify its reliability and validity. Methods: The survey was conducted on 530 athletes from universities in Seoul, South Korea. Among the collected data, 276 datasets were used for exploratory factor analysis, 200 for confirmatory factor analysis, and 30 for test-retest reliability analysis; data from surveys that were incomplete or incorrectly answered were excluded. The initial questionnaire was completed based on prior research, expert meetings, and evaluation by the evaluation group. The collected data were subjected to question analysis, exploratory factor analysis, confirmatory factor analysis, reliability analysis, and criterion-related validity analysis. Result: Four factors of the construct of effort were extracted: training strengthening efforts, interpersonal efforts, nutrition management efforts, and cognitive psychology strengthening efforts. Additionally, three factors of the construct of reward were extracted: future stability, social support, and positive growth. Thus. the effort measurement tool was finalized with 14 questions from four factors, and the reward measurement tool was finalized with 14 questions from three factors, with all items rated on a 5-point Likert scale. Conclusions: Siegrist’s efforts to measure job stress and athletes perceived efforts differed somewhat, but were found to be consistent with those reported for Australian occupational jockeys. In addition, athletes’ perceived rewards had similar results to those for Siegrist and Kathleen et al. studies. Based on this study, subsequent studies can more effectively determine whether the effort-reward imbalance model is applicable to athletes.

Association between work style and presenteeism in the Japanese service sector

OBJECTIVES

To address ongoing problems concerning population aging and labor shortages in Japan, employers have sought to improve work efficiency and labor productivity. However, it is unclear how presenteeism is affected by working styles in line with current corporate initiatives, such as reduced working hours, varied employment status, and flexible work arrangements. The purpose of this article was to investigate the association between work style and presenteeism.

METHODS

This cross-sectional study extracted data from employee profiles, employee attendance records, and a questionnaire in a large service sector company. Multiple linear regression was conducted to estimate the contributions of work style variables to the Work Limitations Questionnaire (WLQ) index score.

RESULTS

In total, 21 500 participants were eligible for analysis. The WLQ index was lower for those working < 35 h/week (adjusted regression coefficient [ARC]:-0.35%; 95% CI: -0.48 to - 0.21) and higher for those working 40-44 h/week or ≥ 45 h/week, compared with those working 35-39 h/week. The position of team manager was positively associated with the WLQ index, whereas senior manager (ARC: -1.44%; 95% CI: -1.71 to - 1.17) and part-time staff (ARC: -1.75%; 95% CI: -1.98 to - 1.52) positions were negatively associated with the WLQ index, compared with non-managers. Those who worked remotely had significantly lower WLQ index scores (ARC: -0.61%; 95% CI: -0.95 to - 0.27).

CONCLUSIONS

Reduced working hours and flexible work arrangements were associated with lower work limitations, which imply presenteeism, although additional research is necessary to verify these results.

How to Know if You're Really There: An Evaluation of Measures for Presenteeism in Nursing

OBJECTIVES

To report presenteeism prevalence across presenteeism measures from the work-stress and sickness domains. To evaluate the psychometric fit of those measures in a nursing population.

METHODS

Cross-sectional descriptive survey of 447 US RNs using five reliable and validated measures of presenteeism: Stanford Presenteeism Scale (SPS), Job-Stress-Related Presenteesim Scale (JSRPS), Healthcare Productivity Scale (HPS), Nurses Work Functioning Questionnaire (NWFQ), and Health and Work Questionnaire (HWQ). The survey was evaluated using descriptive, exploratory, and confirmatory factor analysis.

RESULTS

Mean rates among nurses (SPS = 19.50, JSRPS = 2.1, HPS = -15.1, NWFQ = 17.0, and HWQ = 6.7) were higher than previously published and spanned both job-stress and sickness domains of presenteeism. We identified different factor structures than previously published for three of the five instruments.

CONCLUSION

An inclusive conceptualization of presenteeism that includes work-stress and sickness domains is crucial to developing future measures and interventions for presenteeism.

The Association Between PHQ-9 and Fitness for Work Among Depressive Patients

OBJECTIVE

One of the tools to assess depression severity is the Patient Health Questionnaire (PHQ-9). Our aim was to investigate the correlation between PHQ-9 scores and fitness for work (FFW) in major depressive disorder (MDD).

METHODS

A cross-sectional study in patients who were evaluated for their FFW and later compared with PHQ-9.

RESULTS

Questionnaires were collected for 125 patients. A negative correlation between depression severity and absolute working ability (WA) was found for both women (β = -0.4, P < 0.001) and men (β = -0.4, P = 0.05). Multivariate linear regression revealed a negative correlation between WA and depression severity based on PHQ-9 scores (β = -0.4, P < 0.05).

CONCLUSIONS

A negative correlation exists between absolute and relative WA and depression severity, meaning, with the higher severity of depression the lower the WA.

Sickness Presence among Health Care Professionals: A Cross Sectional Study of Health Care Professionals in Slovenia

Background and objectives: Presenteeism is a relatively new phenomenon that people, despite complaints and ill health that should prompt them to rest and take sick leave, go to work in any case. The highest sickness presence is largely to be found in the care and welfare and educational sectors. The aim of the study is to investigate the relations between different factors and sickness presence among health care professionals. Materials and Methods: A cross-sectional study was conducted at the largest hospital in Slovenia involving 5865 health care professionals employed at the University Medical Centre Ljubljana in the period between 1 January 2010 and 31 December 2010. Logistic regression methods were used to assess the associations between risk factors and their interactions and sickness presence. Results: Besides high odds for sickness presence in multivariate modelling for acute (OR = 359.7; 95%CI = 89.1–1452.8) and chronic disease (OR = 722.5; 95%CI = 178.5–2924.5) the highest odds were calculated for poor self-related health (OR = 3.0; 95%CI = 1.9–4.8), no possibility of replacement (OR = 1.9; 95%CI = 1.5–2.3), sickness absence > two times a year (OR = 1.6; 95%CI = 1.2–2.1), disabled workers (OR = 1.6; 95%CI = 1.0–2.5), and lower salary when on sick leave (OR = 1.5; 95%CI = 120–1.9). Risk factors interactions were not found to be associated with sickness presence among health care workers. Conclusions: The pre-requisite for higher sickness presence is workers’ bad health. The results indicate that sickness presence was associated with psycho social risk factors at work and their economic consequences. Continued sickness presence might have negative rather than positive consequences on work and health care professionals’ health in the future. Sickness presence needs to be taken into account for health care organizers.

A Preliminary Investigation of Health and Work-Environment Factors on Presenteeism in the Workplace

OBJECTIVE

This study investigates the health and work-environment factors that are associated with presenteeism.

METHOD

A self-report survey that measured presenteeism, 13 health conditions (eg, stress and allergies), and nine work-environment factors (eg, job strain and leadership) was completed by 229 workers.

RESULTS

The most common health condition was stress, while the most common work-environment factor was job strain. Allergies, asthma, and high blood pressure along with work-life imbalance, poor leadership, and a lack of development opportunities were associated with presenteeism. Finally, several inter-relationships between the health and work-environment factors were also reported.

CONCLUSION

Interventions targeted at the points of intersection among the health conditions and work-environment factors could be a cost-effective way to improve employees' overall well-being at work, and thus reduce presenteeism.

Systematic review of universal and targeted workplace interventions for depression

Depression is increasingly being recognised as a significant mental health problem in the workplace contributing to productivity loss and economic burden to organisations. This paper reviews recently published randomised controlled trials (RCTs) of universal and targeted interventions to reduce depression in the workplace. Studies were identified through searches of EMBASE, MEDLINE/PubMed, PsycINFO, PsycARTICLES Full Text, and Global Health and Social Policy and Practice databases. Studies were included if they included an RCT of a workplace intervention for employees targeting depression as the primary outcome. Twenty-two published RCTs investigating interventions utilising various therapeutic approaches were identified. The cognitive behavioural therapy (CBT) approach is the most frequently used in the workplace, while interventions that combine different therapeutic approaches showed the most promising results. A universal intervention in the workplace that combines CBT and coping flexibility recorded the highest effect size (d=1.45 at 4 months’ follow-up). Most interventions were delivered in group format and showed low attrition rates compared with other delivery formats. Although all studies reviewed were RCTs, the quality of reporting is low. Interventions using different therapeutic approaches with different modes of delivery have been used. Most of these interventions were shown to reduce depression levels among employees in the workplace, particularly those that combine more than one therapeutic approaches.

The reciprocal relationship between sickness presenteeism and psychological distress in response to job stressors: evidence from a three-wave cohort study

OBJECTIVES

Sickness presenteeism (SP) is postulated as workers' response to their general state of health; hence, SP is expected to affect workers' future health. In the present study, we examined the reciprocal relationship between SP and health in response to job stressors, with specific reference to psychological distress (PD) as workers' state of health.

METHODS

We conducted mediation analysis, using data from a three-wave cohort occupational survey conducted at 1-year intervals in Japan; it involved 1,853 employees (1,661 men and 192 women) of a manufacturing firm. We measured SP and PD, using the World Health Organization Health and Work Performance Questionnaire and Kessler 6 score, respectively. For job stressors, we considered job demands and control, effort and reward, and procedural and interactional justice.

RESULTS

PD mediated 11.5%-36.2% of the impact of job control, reward, and procedural and interactional justice on SP, whereas SP mediated their impact on PD, albeit to a much lesser extent in the range of 3.4%-11.3%. Unlike in the cases of these job stressors related to job resources, neither SP nor PD mediated the impact of job demands or effort.

CONCLUSIONS

Our results confirmed the reciprocal relationship between SP and PD in response to selected types of job stressors, emphasizing the need for more in-depth analysis of the dynamics of these associations.

The combined effects of job demand and control, effort-reward imbalance and work-family conflicts on the risk of major depressive episode: a 4-year longitudinal study

Purpose

Work-related psychosocial factors may precipitate the onset of depression. In occupational mental health research, there are three widely used theoretical models, namely, job demand and control (JD-C), effort-reward imbalance (ERI) and work-family conflicts (WFC). However, the interaction between these models and their combined effect on the risk of major depression in the workplace is largely unknown. The aim of this study is to examine the longitudinal combined effects of JD-C, ERI and WFC on the risk of major depression in the working population.

Methods

Longitudinal data (2008-2013) were collected on randomly selected participants (n=4200) from the working population of the province of Alberta, Canada, at baseline and 1-, 2-, 3- and 4-year follow-up. Data about JD-C, ERI, WFC and major depression were collected by trained interviewers using a computer-assisted telephone interviewing method. Generalised estimating equations for longitudinal modelling were used.

Results

There was an independent association between high ERI and high WFC at tx and major depression at tx+1 (OR 1.56, 95% CI 1.25 to 1.96; OR 1.33, 95% CI 1.16 to 1.52), respectively. The combined effects of JD-C and ERI, ERI and WFC, and WFC and JD-C on the risk of major depression were as follows: OR 1.71, 95% CI 1.22 to 2.42, OR 2.47, 95% CI 1.99 to 3.49 and OR 2.21, 95% CI 1.48 to 3.30, respectively. The relative excess risks attributable to the interactions were statistically non-significant.

Conclusions

Work-related psychosocial factors are associated with increased risk of major depression over time, but their combined effect is not synergistic. The effects of the factors depicted in the three occupational health models on the risk of major depression appear to be additive.

Social support and its interrelationships with demand-control model factors on presenteeism and absenteeism in Japanese civil servants

OBJECTIVES

To elucidate the impact of social support and its interrelations with other demand-control-support (DCS) model factors on presenteeism and absenteeism, and to determine which DCS factors were most influential.

METHODS

Questionnaires from 2535 local government employees were analyzed. The Brief Job Stress Questionnaire (BJSQ) was used to assess DCS factors including job demand, job control, and social support from supervisors and coworkers. The Stanford Presenteeism Scale 13-item version (SPS-13) was used to evaluate both absenteeism (absent days) and presenteeism. For the latter, the Work Impairment Score (WIS) and the Work Output Score (WOS) were also used. Possible confounder-adjusted logistic and negative binomial regression analyses were performed to obtain odds ratios (ORs) for WIS and WOS and relative risks (RRs) for absenteeism according to DCS factors.

RESULTS

Higher job control had a significantly protective effect on higher WIS in both males and females and a lower WOS in males. Based on a point estimate of an OR per 1 standard deviation change of each DCS factor, job control had the strongest effect on higher WIS in both males and females and a lower WOS in males. Higher job demand resulted in significantly higher ORs for both male and female WIS, and a lower WOS in females. Support from supervisors had a significantly protective effect on higher WIS in females and a lower WOS in males. Support from coworkers had a significantly protective effect on higher WIS in males. Higher support from coworkers had a significantly protective effect on absenteeism among both males and females, and higher job control had a significantly protective effect in females. The combination of high job strain and low support from supervisors had a significantly worsening effect, except for absenteeism in females. High job strain and low support from coworkers had a significantly worsening effect except for WOS in males.

CONCLUSIONS

The results suggest job control was the DCS factor most related to presenteeism. Higher support from supervisors and coworkers had a protective effect on presenteeism, and higher job demand had a worsening effect. Higher support from coworkers had a protective effect on absenteeism among both males and females. Interventions should focus on improving job control as a possible countermeasure to presenteeism, and encouraging support from coworkers as a possible countermeasure to absenteeism.

Depression in Registered Nurses: A State of the Science

Registered nurses suffer from depression at almost twice the rate of individuals in other professions. Major depression affects both employees and organizations. Depression is linked to increases in work absenteeism, short-term disability, and decreased productivity and presenteeism. Depression experienced by registered nurses may not be fully preventable, but realizing its presence and prevalence in the workplace is of vital importance. It is essential that we have a healthy, vibrant, and present registered nurse workforce to ensure that quality patient outcomes are achieved. This review of 36 articles assesses the current state of the science related to depression in registered nurses so that occupational health nurses can create pathways and work environments for better mental health for registered nurses.

A job demands-resources approach to presenteeism

Purpose

Utilising the job demands-resources (JD-R) model, the purpose of this paper is to examine how aspects of the psychosocial work environment (namely, job demands and resources) are associated with presenteeism, and in particular, whether they are indirectly related via burnout and work engagement.

Design/methodology/approach

A cross-sectional survey of 980 working Australians measured the relationships between job demands (i.e. workplace bullying, time pressure and work-family conflict), resources (i.e. leadership and social support), burnout, work engagement and presenteeism. Path analysis was used to test the proposed hypotheses whilst controlling for participant demographics (i.e. sex, age, work level, duration and education).

Findings

Higher job demands (workplace bullying, time pressure, and work-family conflict) and lower job resources (leadership only) were found to be indirectly related to presenteeism via increased burnout. While increased job resources (leadership and social support) were indirectly related to presenteeism via improved work engagement.

Practical implications

The findings are consistent with the JD-R model, and suggest that presenteeism may arise from the strain and burnout associated with overcoming excessive job demands as well as the reduced work engagement and higher burnout provoked by a lack of resources in the workplace. Intervention programmes could therefore focus on teaching employees how to better manage job demands as well as promoting the resources available at work as an innovative way to address the issue of rising presenteeism.

Originality/value

This study is important as it is one of the first to examine the theoretical underpinnings of the relationship between presenteeism and its antecedents.

Predictors of impaired work functioning in employees with major depression in remission

OBJECTIVES

This study aims to (i) assess work functioning in employees returning to work with a major depression in remission, (ii) study the predictors of impaired work functioning.

METHODS

Participants diagnosed with major depressive disorder (MDD), on long term sick leave (mean 27 weeks) and treated in a specialized mental healthcare setting, were selected from an intervention study sample. They were eligible for this study if they were remitted from their depression and had returned to work for at least 50% of their contract hours at 18 month follow-up. Work functioning was assessed with the Work Limitations Questionnaire (WLQ) and the Need For Recovery scale (NFR). Potential predictors of impaired work functioning were demographic characteristics (assessed at baseline), health characteristics (assessed at baseline, six and twelve month follow-up), and personality- and work characteristics (assessed at 18 month follow-up).

RESULTS

After their return to work with MDD in remission, employees were on average still impaired in their work functioning. Personality characteristics were the strongest predictor of this impaired work functioning, followed by health and work characteristics. In the final prediction model, only a passive reaction coping style remained as predictor.

LIMITATIONS

We used self-report data with respect to work functioning and work characteristics and not an assessment by a supervisor.

CONCLUSIONS

Personality trait, coping style, and ability to manage the work environment should be addressed in mental health and return-to-work interventions. Subsequent improved work functioning may be beneficial for mental health and may reduce societal costs.

Prevalence of Mental Disorders in the South-East of Spain, One of the European Regions Most Affected by the Economic Crisis: The Cross-Sectional PEGASUS-Murcia Project

Background

To describe the lifetime and 12-month prevalence, severity and age of onset distribution of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) disorders and to explore the association between socio-demographic variables and economic stressors with mental disorders during the economic crisis in the general population of Murcia (Spain).

Methods and Findings

The PEGASUS-Murcia Project is a cross-sectional face-to-face interview survey of a representative sample of non-institutionalized adults in Murcia administered between June 2010 and May 2012. DSM-IV disorders were assessed by the Composite International Diagnostic Interview (CIDI 3.0). Main outcome measures were lifetime and 12-month prevalence of Anxiety, Mood, Impulse and Substance Disorders, Severity and Age of Onset. Sociodemographic variables and stressful economic life events during the preceding 12 months were entered as independent variables in a logistic regression analysis. A total of 2,621 participants (67.4% response rate) were interviewed, 54.5% female, mean age 48.6 years. Twelve-month prevalence (95%CI) of disorders: anxiety 9.7% (7.6–12.2), mood 6.6% (5.5–8.1), impulse 0.3% (0.1–1.2) and substance use 1.0% (0.4–2.4) disorders. Lifetime prevalence: anxiety 15.0% (12.3–18.1), mood 15.6% (13.5–18.1), impulse 2.4% (1.4–4.0) and substance use 8.3% (6.2–11.0) disorders. Severity among 12-month cases: serious 29.2% (20.8–39.4), moderate 35.6% (24.0–49.1) and mild severity 35.2% (29.5–41.5). Women were 3.7 and 2.5 times more likely than men to suffer 12-month anxiety and mood disorders, respectively. Substance use was more frequent among men. Younger age and lower income were associated with higher prevalence. Respondents exposed to multiple and recent economic stressors had the highest risk of anxiety disorders.

Conclusions

Mental disorders in the adult population of Murcia during the economic crisis were more prevalent and serious than those in previous estimates for Spain. Prevalence was strongly associated with exposure to stressors related to the economic crisis.

Relationship between sickness presenteeism (WHO-HPQ) with depression and sickness absence due to mental disease in a cohort of Japanese workers

BACKGROUND

Absence due to mental disease in the workplace has become a global public health problem. We aimed to evaluate the influence of presenteeism on depression and absence due to mental disease.

METHODS

A prospective study of 1831 Japanese employees from all areas of Japan was conducted. Presenteeism and depression were measured by the validated Japanese version of the World Health Organization Health and Work Performance Questionnaire (WHO-HPQ) and the K6 scale, respectively. Absence due to mental disease across a 2-year follow up was surveyed through medical certificates obtained for work absence.

RESULTS

After adjusting for age and gender, participants with higher rates of sickness absolute and relative presenteeism (the lowest tertile of the scores) were significantly more likely to be absent due to mental disease (OR=4.40, 95% CI: 1.65-11.73, and OR=3.31, 95% CI: 1.50-7.27). Subsequently, higher rates of sickness absolute or relative presenteeism were significantly associated with higher rates of depression (K6≥13) one year later (OR=3.79, 95% CI: 2.48-5.81, and OR=2.89, 95% CI: 1.98-4.22).

LIMITATIONS

The number of females in the sample was relatively small. However, the rates of absence for females with and without mental illness did not significantly differ from those of men.

CONCLUSIONS

More sickness presenteeism scores were found to be related to higher rates of depression and absence due to mental disease in this large-scale cohort of Japanese workers. Measurement of presenteeism could be used to evaluate the risk for depression and absenteeism. Furthermore, our findings suggest that intervention to improve presenteeism would be effective in preventing depression and absence due to mental illness.

How job demands affect absenteeism? The mediating role of work-family conflict and exhaustion

PURPOSE

To investigate how psychosocial factors (such as job demands and work-family conflict) produce absenteeism in the workplace, using the health impairment process of the job demands-resources model. According to this model, job demands lead to burnout (often measured with the emotional exhaustion component), which in turn could lead to outcomes (such as absenteeism). Work-family conflict (WFC) was also studied, because of contradictory results collected in the existing literature on absenteeism in the workplace, regarding the role of WFC in causing absenteeism.

METHODS

Data were collected on 245 workers using both subjective (questionnaire on psychological risk factors and work-related health) and objective data (sickness leave frequency records). To test the hypothesis that job demands and WFC contribute to absenteeism in the workplace, a subsequent mediation analysis was used, which analysed both (a) the subsequent mediation of WFC and emotional exhaustion and (b) the separate roles played by the mediators proposed (WFC and emotional exhaustion).

RESULTS

Job demands affect absenteeism through the subsequent mediation of WFC and emotional exhaustion. In addition, emotional exhaustion mediates the relationship between job demands and absenteeism, while WFC does not.

CONCLUSION

In conclusion, subsequent mediation highlights the role of emotional exhaustion in causing absenteeism; in fact, when emotional exhaustion is included in the analysis, job demands are associated with higher levels of absenteeism. The results of this study suggest that without the concurrent contribution of emotional exhaustion, WFC does not influence absenteeism in the workplace. Our findings are useful for organizations that aim to reduce absenteeism.

Is sickness presenteeism a risk factor for depression? A Danish 2-year follow-up study

OBJECTIVE

To examine the prospective association between sickness presenteeism (SP), that is, working while ill, and the onset of depression.

METHODS

We carried out a two-wave (2006 to 2008) questionnaire-based study among 1271 employees from 60 Danish workplaces. Sickness presenteeism was assessed by asking participants to report the number of days that they went to work despite illness in the preceding year.

RESULTS

Multivariate logistic regression revealed that, after controlling for several health-related variables and other relevant confounders, reporting 8 or more days of SP was associated with an increased risk of depression among initially nondepressed participants (odds ratio, 2.45; 95% confidence interval, 1.06 to 5.64). No significant sex-related differences were observed in this relationship.

CONCLUSION

Adding to previous evidence on the health effects of SP, this study suggests that working while ill may also be a significant risk factor for the development of depression.

Sickness Presence among Disabled Workers at the University Medical Centre Ljubljana

Objectives

The aim of the article is to investigate the differences in sickness present and non-sickness present in the group of disabled health care professionals.

Methods

Data were gathered from all disabled health care professionals suffering from invalidity of category II or III who were identified in the research among all health care professionals at the University Medical Centre Ljubljana and who were employed there in the period between 1 January 2010 and 31 December 2010. Each employee obtained a questionnaire composed of three standardized international questionnaires.

Results

There were 248 disabled workers of the II. and III. category of invalidity among the participants. Disabled sickness present reported to have more chronic diseases than disabled non-sickness present (OR = 57.0; 95% CI = 24.4–133.2), lower salary when on sick leave (OR = 13.1; 95% CI = 5.7–30.2) and poor self-rated health (OR = 5.8; 95% CI = 2.7–12.3).

Conclusions

The prerequisite for sickness presence among disabled workers is their chronic bad health. It is also formally recognized with the degree of disability. Economic factors are among the most important to direct disabled workers towards sickness presence. The results indicate that workplaces are not adapted to disabled workers in regard to their limitations.

Receiving workplace mental health accommodations and the outcome of mental disorders in employees with a depressive and/or anxiety disorder

OBJECTIVES

To investigate the association between receiving workplace accommodations and the 1-year risk of mood/anxiety disorders.

METHODS

A general population sample of employees in Alberta, Canada, with a prior or current mental disorder (N = 715) was observed for 1 year. Mental disorders were determined on the basis of the Diagnostic and Statistical Manual, 4th revision, criteria.

RESULTS

In participants who needed but did not receive any accommodations, 30.8% had a mood/anxiety disorder 1 year later. Receiving needed accommodations was associated with a lowered risk of 24.5%. Logistic regression showed that the percentage of having accommodation needs met was significantly associated with the risk of a mental disorder 1 year later (odds ratio = 0.27; 95% confidence interval = 0.11 to 0.65).

CONCLUSIONS

Receiving needed accommodations was associated with better outcomes for mental disorders. Studies are needed to confirm the effectiveness of specific accommodations for enhancing the prognosis of mood/anxiety disorders.

Job demands, job resources, and job performance in japanese workers: a cross-sectional study

This study investigated the cross-sectional association of job demands (i.e., psychological demands) and job resources (i.e., decision latitude, supervisor support, co-worker support, and extrinsic reward) with job performance. A total of 1,198 workers (458 males and 740 females) from a manufacturing company in Japan completed a self-administered questionnaire that included the Job Content Questionnaire, Effort-Reward Imbalance Questionnaire, World Health Organization Health and Work Performance Questionnaire, and demographic survey. Hierarchical multiple regression analyses were conducted. After adjusting for demographic characteristics, decision latitude (β=0.107, p=0.001) and extrinsic reward (β=0.158, p<0.001) were positively and significantly associated with job performance while supervisor support (β=-0.102, p=0.002) was negatively and significantly associated with job performance. On the other hand, psychological demands or co-worker support was not significantly associated with job performance. These findings suggest that higher decision latitude and extrinsic reward enhance job performance among Japanese employees.

Work factors are associated with workplace activity limitations in systemic lupus erythematosus

OBJECTIVE

The objective of this study was to examine the extent of workplace activity limitations among persons with lupus and to identify factors associated with activity limitations among those employed.

METHODS

We conducted a cross-sectional study using a mailed survey and clinical data of persons with lupus who attended a large lupus outpatient clinic. Data were collected on demographics, health, work factors and psychosocial measures. The workplace activity limitations scale (WALS) was used to measure difficulty related to different activities at work. Multivariable analysis examined the association of health, work context, psychosocial and demographic variables with workplace activity limitations.

RESULTS

We received 362 responses from 604 (60%) mailed surveys. Among those not employed, 52% reported not working because of lupus. A range of physical and mental tasks were reported as difficult. Each of the physical, cognitive and energy work activities was cited as difficult by more than one-third of participants. Among employed participants, 40% had medium to high WALS difficulty scores. In the multivariable analysis, factors significantly associated with workplace activity limitations were older age, greater disease activity, fatigue, poorer health status measured by the 36-item Short Form Health Survey, lower job control, greater job strain and working more than 40 h/week.

CONCLUSION

People with lupus experience limitations and difficulty at work. Determinants of workplace activity limitations are mainly those related to workplace and health factors.

The preventable burden of productivity loss due to suboptimal asthma control: a population-based study

BACKGROUND

Productivity loss is an overlooked aspect of the burden of chronic health conditions. While modern guidelines emphasize achieving clinical control in asthma management, few studies have reported on the relationship between asthma control and productivity loss. We calculated the productivity loss that can be avoided by achieving and maintaining clinical control in employed adults with asthma.

METHODS

We prospectively recruited a population-based random sample of adults with asthma in British Columbia, Canada. We measured productivity loss due to absenteeism and presenteeism using validated instruments, and ascertained asthma control according to the GINA (Global Initiative for Asthma) classification. We estimated the average gain in productivity for each individual if the individual’s asthma was controlled in the past week, by fitting two-part regression models associating asthma control and productivity loss, controlling for potential confounding variables.

RESULTS

The final sample included 300 employed adults (mean age, 47.9 years [SD 12.0]; 67.3% women). Of these, 49 (16.3%) reported absenteeism, and 137 (45.7%) reported presenteeism. Productivity loss due to presenteeism, but not absenteeism, was associated with asthma control. A person with uncontrolled asthma would avoid $184.80 (Canadian dollars [CAD]) in productivity loss by achieving clinical control during a week, CAD$167.50 (90.6%) of which would be due to presenteeism. The corresponding value was CAD$34.20 for partially controlled asthma and was not statistically significant.

CONCLUSIONS

Our results indicate that substantial gain in productivity can be obtained by achieving asthma control. Presenteeism is more responsive than absenteeism to asthma control, and, thus, is a more important source of preventable burden.

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.

Depression in hospital-employed nurses

Depression impacts 9.4% of the adult population in the United States, and it is known to impact work performance. Nurses with depression are not only likely to suffer themselves, but their illness may have an impact on their coworkers and potentially the quality of care they provide. Thus, the purpose of this study was to determine the prevalence of depression in a random sample of hospital-employed nurses to determine individual and workplace characteristics that are associated with depression. A cross-sectional survey design of 1171 registered nurses was used. Measures included individual characteristics, workplace characteristics, work productivity, and depression (9-item Patient Health Questionnaire). Data analysis demonstrated a depressive symptom rate of 18%. The linear regression model accounted for 60.6% of the variation in the 9-item Patient Health Questionnaire depression scores. Body mass index, job satisfaction, number of health problems, mental well-being, and health-related productivity had significant relationships with depression (P < .05). Hospital-employed nurses have higher rates of depressive symptoms than national norms. Advanced practice nurses can assist with educating nurses on recognizing depression and confidential interventions, including the use of computerized cognitive-based therapy.

A population-based longitudinal study on work environmental factors and the risk of major depressive disorder

To investigate the relation between work environmental factors and the risk of major depressive disorder (MDD) over 1 year, the authors conducted a population-based longitudinal study of randomly selected employees in Alberta, Canada (January 2008 to November 2011). Participants without a current or lifetime diagnosis of MDD at baseline (n = 2,752) were followed for 1 year. MDD was assessed using the World Health Organization’s Composite International Diagnostic Interview-Auto 2.1. The overall 1-year incidence of MDD was 3.6% (95% confidence interval: 2.8, 4.6); it was 2.9% (95% confidence interval: 1.9, 4.2) in men and 4.5% (95% confidence interval: 3.3, 6.2) in women. The relations between work environmental factors and MDD differed by sex. In men, high job strain increased the risk of MDD in those who worked 35–40 hours per week; job insecurity and family-to-work conflict were predictive of MDD. Women who worked 35–40 hours per week and reported job insecurity, a high effort-reward imbalance, and work-to-family conflict were at a higher risk of developing MDD. Job strain, effort-reward imbalance, job insecurity, and work-to-family conflicts are important risk factors for the onset of MDD and should be targets of primary prevention. However, these work environmental factors appear to operate differently in men and in women.

Perceived needs for and use of workplace accommodations by individuals with a depressive and/or anxiety disorder

OBJECTIVE

To estimate the percentages of need for and use of workplace mental health accommodations, and to identify factors related to the use of accommodations.

METHODS

Participants with a mental disorder, identified from the community, were questioned about need for and use of workplace accommodations (n = 784). Mental disorders were assessed using the World Health Organization's Composite International Diagnostic Interview.

RESULTS

Eighty-three percent needed accommodations; only 30.5% had received accommodations. Having received accommodations was not related to demographic or socioeconomic factors. Participants with a 12-month disorder were less likely to have received accommodations than others.

CONCLUSIONS

A significant proportion of workers with a mental disorder and need for accommodations have not received accommodations at their workplaces. The accommodations needed by this population are not expensive and can potentially be provided by modifying management practices.

Predictors of 1-year outcomes of major depressive disorder among individuals with a lifetime diagnosis: a population-based study

BACKGROUND

Examining predictors of the outcomes of major depressive disorder (MDD) is important for clinical practice and population health. There are few population-based longitudinal studies on this topic. The objectives of this study were to (1) estimate the proportions of persistent and recurrent MDD among those with MDD over 1 year, and (2) identify demographic, socio-economic, workplace psychosocial and clinical factors associated with the outcomes.

METHOD

From a population-based longitudinal study of the working population, participants with a lifetime diagnosis of MDD were selected (n=834). They were classified into two groups: those with and those without current MDD. The proportions of 1-year persistence and recurrence of MDD were estimated. MDD was assessed by the World Health Organization (WHO) Composite International Diagnostic Interview, CIDI-Auto 2.1, by telephone.

RESULTS

The proportions of persistent and recurrent MDD in 1 year were 38.5% [95% confidence interval (CI) 31.1-46.5] and 13.3% (95% CI 10.2-17.1) respectively. Long working hours, negative thinking and having co-morbid social phobia were predictive of persistence of MDD. Perceived work-family conflict, the severity of a major depressive episode and symptoms of depressed mood were significantly associated with the recurrence of MDD.

CONCLUSIONS

Clinical and psychosocial factors are important in the prognosis of MDD. The factors associated with persistence and recurrence of MDD may be different. More large longitudinal studies on this topic are needed so that clinicians may predict potential outcomes based on the clinical profile and provide interventions accordingly. They may also take clinical action to change relevant psychosocial factors to minimize the chance of persistence and/or recurrence of MDD.

Factors associated with presenteeism among employed Australian adults reporting lifetime major depression with 12-month symptoms

BACKGROUND

Employees experiencing depression can take a sickness absence or continue working ('presenteeism'). However, little is known about the factors associated with these behaviors within this population. This study aimed to determine the relative importance of socio-demographic, financial, work and health-related factors associated with presenteeism.

METHODS

The 2007 Australian National Survey of Mental Health and Wellbeing provided data from employed individuals reporting lifetime major depression with 12-month symptoms (N=320). Survey adjusted multivariable logistic regression assessed classification of 12-month, depression-related presenteeism on the basis of socio-demographic, financial, work and health factors.

RESULTS

Acceptable classification of cases was 70% or greater. Classification of cases based on socio-demographic factors, age, sex and marital status, was reasonable (62%). Adding work factors (work hours and occupation type) produced a 1% increase in successfully classified cases (63%). Health factors further increased correctly classified cases (67%). Marital status, housing tenure and co-morbid mental disorders were important indicators of presenteeism behavior.

LIMITATIONS

Work-related variables were restricted to available measures. Potentially important psychosocial work environment factors were unavailable. Cross-sectional data precluded causal inference.

CONCLUSIONS

Using available factors, model discrimination did not reach an acceptable level i.e. 70% of presenteeism cases successfully classified. This highlighted the contribution of unmeasured factors to presenteeism behavior. Future research should explore the relative importance of psychosocial work environment and personality factors such as work demands, effort/reward imbalance and conscientiousness. The identified associations between socio-demographic, financial and health factors on work attendance behaviors could inform disease management guidelines for employers via recognition of employees at risk of presenteeism.

Job strain, depressive symptoms, and drinking behavior among older adults: results from the health and retirement study

OBJECTIVE

To examine the relationship between job strain and two indicators of mental health, depression and alcohol misuse, among currently employed older adults.

METHOD

Data come from the 2004 and 2006 waves of the Health and Retirement Study (N = 2,902). Multivariable logistic regression modeling was used to determine the association between job strain, indicated by the imbalance of job stress and job satisfaction, with depression and alcohol misuse.

RESULTS

High job strain (indicated by high job stress combined with low job satisfaction) was associated with elevated depressive symptoms (odds ratio [OR] = 2.98, 95% confidence interval [CI]: 1.99-4.45) relative to low job strain after adjusting for sociodemographic characteristics, labor force status, and occupation. High job stress combined with high job satisfaction (OR = 1.93) and low job stress combined with low job satisfaction (OR = 1.94) were also associated with depressive symptoms to a lesser degree. Job strain was unrelated to either moderate or heavy drinking. These associations did not vary by gender or age.

DISCUSSION

Job strain is associated with elevated depressive symptoms among older workers. In contrast to results from investigations of younger workers, job strain was unrelated to alcohol misuse. These findings can inform the development and implementation of workplace health promotion programs that reflect the mental health needs of the aging workforce.