Organisational downsizing and work stress: testing synergistic health effects in employed men and women

Implantação do Programa Seguro-Emprego e saúde dos trabalhadores na indústria automobilística

RESUMO O objetivo do artigo foi analisar a implantação do Programa Seguro-Emprego (PSE) em relação à saúde dos trabalhadores nas montadoras de autoveículos do ABC. A metodologia incluiu pesquisa documental em acordos coletivos de trabalho, legislação, documentos de entidades sindicais e empresariais. Em 2015, o PSE foi lançado pelo governo como resposta à crise econômica, permitindo redução de até 30% da jornada de trabalho e de salário. Apesar dos questionamentos de grupos sindicais e da resistência operária nas montadoras, a maioria do sindicalismo apoiou a implantação do Programa. Os resultados da pesquisa apontaram o PSE como parte de um novo ciclo de expansão e transformações produtivas na indústria automobilística, ampliando e aprofundando a intensificação do trabalho como forma de geração do desgaste operário. O PSE participa da estratégia empresarial para manter o emprego mais produtivo, selecionando os operários que se manterão no emprego e excluindo trabalhadores considerados de ‘baixo desempenho’ e os ‘compatíveis’ (com redução da capacidade laboral). A inclusão do Programa na reforma trabalhista torna-o alternativa permanente para utilização pelas empresas. Portanto, trata-se de tema relevante para as pesquisas e ações em saúde coletiva e saúde do trabalhador.

Risk of psychological ill health and methods of organisational downsizing: a cross-sectional survey in four European countries

BACKGROUND

The manner in which organizational downsizing is implemented can make a substantial difference as to whether the exposed workers will suffer from psychological ill health. Surprisingly, little research has directly investigated this issue. We examined the likelihood of psychological ill health associated with strategic and reactive downsizing.

METHODS

A cross-sectional survey included 1456 respondents from France, Sweden, Hungary and the United Kingdom: 681 employees in stable workplaces (reference group) and 775 workers from downsized companies. Reactive downsizing was exemplified by the exposures to compulsory redundancies of medium to large scale resulting in job loss or surviving a layoff while staying employed in downsized organizations. The workforce exposed to strategic downsizing was represented by surplus employees who were internally redeployed and supported through their career change process within a policy context of "no compulsory redundancy". Symptoms of anxiety, depression and emotional exhaustion were assessed in telephone interviews with brief subscales from Hospital Anxiety Scale (HADS-A), Hopkins Symptom Checklist (SCL-CD₆) and Maslach Burnout Inventory (MBI-GS). Data were analyzed using logistic regression.

RESULTS

We observed no increased risk of psychological ill health in the case of strategic downsizing. The number of significant associations with psychological ill health was the largest for the large-scale reactive downsizing: surviving a layoff was consistently associated with all three outcome measures; returning to work after the job loss experience was related to anxiety and depression, while persons still unemployed at interview had elevated odds of anxiety. After reactive medium-scale downsizing, unemployment at interview was the only exposure associated with anxiety and depression.

CONCLUSIONS

The manner in which organizational downsizing is implemented can be important for the psychological wellbeing of workers. If downsizing is unavoidable, it should be achieved strategically. Greater attention is needed to employment and health policies supporting the workers after reactive downsizing.

The Effects of Job Insecurity on Health Care Utilization: Findings from a Panel of U.S. Workers

OBJECTIVE

To examine the impacts of job insecurity during the recession of 2007-2009 on health care utilization among a panel of U.S. employees.

DATA SOURCES/STUDY SETTING

Linked administrative and claims datasets on a panel of continuously employed, continuously insured individuals at a large multisite manufacturing firm that experienced widespread layoffs (N = 9,486).

STUDY DESIGN

We employed segmented regressions to examine temporal discontinuities in utilization during 2006-2012. To assess the effects of job insecurity, we compared individuals at high- and low-layoff plants. Because the dataset includes multiple observations for each individual, we included individual-level fixed effects.

PRINCIPAL FINDINGS

We found discontinuous increases in outpatient (3.5 visits/month/10,000 individuals, p = .002) and emergency (0.4 visits/month/10,000 individuals, p = .05) utilization in the panel of all employees. Compared with individuals at low-layoff plants, individuals at high-layoff plants decreased outpatient utilization (-4.0 visits/month/10,000 individuals, p = .008), suggesting foregone preventive care, with a marginally significant increase in emergency utilization (0.4 visits/month/10,000 individuals, p = .08).

CONCLUSIONS

These results suggest changes in health care utilization and potentially adverse impacts on employee health in response to job insecurity during the latest recession. This study contributes to our understanding of the impacts of economic crises on the health of the U.S. working population.

Organizational downsizing and depressive symptoms in the European recession: the experience of workers in France, Hungary, Sweden and the United kingdom

Background

Organizational downsizing has become highly common during the global recession of the late 2000s with severe repercussions on employment. We examine whether the severity of the downsizing process is associated with a greater likelihood of depressive symptoms among displaced workers, internally redeployed workers and lay-off survivors.

Methods

A cross-sectional survey involving telephone interviews was carried out in France, Hungary, Sweden and the United Kingdom. The study analyzes data from 758 workers affected by medium- and large-scale downsizing, using multiple logistic regression.

Main Results

Both unemployment and surviving layoffs were significantly associated with depressive symptoms, as compared to reemployment, but the perceived procedural justice of a socially responsible downsizing process considerably mitigated the odds of symptoms. Perception of high versus low justice was assessed along several downsizing dimensions. In the overall sample, chances to have depressive symptoms were significantly reduced if respondents perceived the process as transparent and understandable, fair and unbiased, well planned and democratic; if they trusted the employer’s veracity and agreed with the necessity for downsizing. The burden of symptoms was significantly greater if the process was perceived to be chaotic. We further tested whether perceived justice differently affects the likelihood of depressive symptoms among distinct groups of workers. Findings were that the odds of symptoms largely followed the same patterns of effects across all groups of workers. Redeploying and supporting surplus employees through the career change process–rather than forcing them to become unemployed–makes a substantial difference as to whether they will suffer from depressive symptoms.

Conclusions

While depressive symptoms affect both unemployed and survivors, a just and socially responsible downsizing process is important for the emotional health of workers.

Work organization, job insecurity, and occupational health disparities

BACKGROUND

Changes in employment conditions in the global economy over the past 30 years have led to increased job insecurity and other work organization hazards. These hazards may play a role in creating and sustaining occupational health disparities by socioeconomic position, gender, race, ethnicity, and immigration status.

METHODS

A conceptual model was developed to guide the review of 103 relevant articles or chapters on the role of work organization and occupational health disparities identified through a comprehensive search conducted by NIOSH. A second review was conducted of employment and workplace policies and programs designed to reduce the health and safety risks due to job insecurity and other work organization hazards.

RESULTS

There is consistent evidence that workers in lower socioeconomic or social class positions are exposed to greater job insecurity and other work organization hazards than workers in higher socioeconomic positions. Likewise, racial and ethnic minorities and immigrants are exposed to greater job insecurity. Limited research examining the effects of interventions targeting work organization hazards on disparities has been conducted; nonetheless, intervention strategies are available and evidence suggests they are effective.

CONCLUSIONS

Job insecurity and work organization hazards play a role in creating and sustaining occupational health disparities. Employment and workplace policies and programs have the potential to reduce these hazards, and to reduce disparities.

Job insecurity during recessions: effects on survivors' work stress

Background

Previous studies show a variety of negative health consequences for the remaining workforce after downsizing events. This study examined self-reported work stress from 2009–2012 in the context of a large multi-site aluminum manufacturing company that underwent severe downsizing in 2009.

Methods

This study examined the association between work stress and working at a work site that underwent severe downsizing. We assessed the level of downsizing across thirty plants in 2009 and categorized seven as having undergone severe downsizing. We linked plant-level downsizing information to individual workers’ responses to an annual work engagement survey, which included three work stress questions. From 2009 to 2012 over 14, 000 employees were asked about their experience of work stress. Though the surveys were anonymous, the surveys captured employees’ demographic and employment characteristic as well as plant location. We used hierarchical logistic regressions to compare responses of workers at severely downsized plants to workers at all other plant while controlling for demographic and plant characteristics. Responses to the work stress questions and one control question were examined.

Results

In all yearly surveys salaried workers consistently reported having more work stress than hourly workers. There was no differential in work stress for workers at severely downsized plants in 2009. In 2010 to 2012, salaried workers who remained at severely downsized plants reported significantly higher work stress than salaried workers at all other plants across multiple work stress questions. Examination of the 2006 survey confirmed that there were no pre-existing differences in work stress among salaried employees working at plants that would eventually experience severe downsizing. In addition, there was no difference in responses to the control question at severely downsized plants.

Conclusion

Salaried workers at plants with high layoffs experienced more work stress after 2009 than their counterparts at non-high layoff plants. Increased work stress is important to monitor and may be a mediating pathway through which the external economic environment leads to adverse health outcomes.

Short- and long-term effects of major organisational change on minor psychiatric disorder and self-rated health: results from the Whitehall II study

OBJECTIVE

To investigate short- and long-term effects of major organisational change on minor psychiatric disorder and self-rated health for women and men in different employment grades.

METHODS

Minor psychiatric disorder and self-rated health among 6710 British civil servants (1993 women and 4717 men) in three employment grades from the Whitehall II study were examined from 1985 to 1988 under stable employment conditions. The short-term effects of organisational change were investigated in 1991-1993 after a time of major restructuring aiming at increasing the influence of market forces in the civil service and the long-term effects were investigated in 1997-1999.

RESULTS

Those who had experienced organisational change and those who anticipated organisational change reported more negative short-term health effects (minor psychiatric disorder and poor self-rated health) compared with those who reported no change. No major differences were found depending on employment grade or gender. The negative health effects had diminished during 1997-1999 for those who reported that a major change had happened before 1991-1993. Those who anticipated an organisational change in 1991-1993 still reported more ill-health in 1997-1999 (both minor psychiatric disorder and self-reported health) than those in the comparison group.

CONCLUSIONS

The results indicate that organisational change affects employees' health negatively in the short term but also that it is possible to recover from such negative effects. As it was not possible to discern any definite difference between the gender and grades, the results point at the importance of working proactively to implement organisational change for women and men at all levels.

Health consequences of the 'Great Recession' on the employed: evidence from an industrial cohort in aluminum manufacturing

While the negative effects of unemployment have been well studied, the consequences of layoffs and downsizing for those who remain employed are less well understood. This study uses human resources and health claims data from a large multi-site fully insured aluminum company to explore the health consequences of downsizing on the remaining workforce. We exploit the variation in the timing and intensity of layoff to categorize 30 plants as high or low layoff plants. Next, we select a stably employed cohort of workers with history of health insurance going back to 2006 to 1) describe the selection process into layoff and 2) explore the association between the severity of plant level layoffs and the incidence of four chronic conditions in the remaining workforce. We examine four health outcomes: incident hypertension, diabetes, asthma/COPD and depression for a cohort of approximately 13,000 employees. Results suggest that there was an increased risk of developing hypertension for all workers and an increased risk of developing diabetes for salaried workers that remain at the plants with the highest level of layoffs. The hypertension results were robust to a several specification tests. In addition, the study design selected only healthy workers, therefore our estimates are likely to be a lower bound and suggest that adverse health consequences of the 2007-2009 recession may have affected a broader proportion of the population than previously expected.

The effect of job strain on psychological morbidity and quality of life in military hospital nurses in Taiwan: a follow-up study

This study investigated changes in job strain in female nurses serving in a military hospital system being restructured and the effect of these changes on psychological morbidity and quality of life (QOL). Questionnaire surveys were sent twice to 618 nurses working in three military hospitals in southern Taiwan at the beginning and at follow up a half year later. A Job Content Questionnaire was used to divide subjects into high and low strain groups. The General Health Questionnaire and the WHO QOL Questionnaire were used to assess psychological morbidity and QOL. Four hundred eighteen nurses completed the study. Initially, the high strain group had a greater prevalence of psychological morbidity and lower QOL than the low strain group. At follow up, high strain group did not have a greater prevalence of psychological morbidity, though significant differences in QOL remained. Job control and social support directly affected the QOL (B=0.42, p<0.001; B=0.41, p=0.038, respectively) and the psychological demand affected directly on psychological morbidity (B=0.12, p<0.001). Job control and psychological demand are different aspects in job strain to impact the psychological morbidity and QOL in nurses working in military hospitals in Taiwan.

Effort-reward imbalance and quality of life of healthcare workers in military hospitals: a cross-sectional study

Background

Taiwan’s National Defense Bureau has been merging its hospitals and adjusting hospital accreditation levels since the beginning of 2006. These changes have introduced many stressors to the healthcare workers in these hospitals. This study investigates the association between job stress, psychological morbidity and quality of life in healthcare workers in three military hospitals.

Methods

We posted surveys to 1269 healthcare workers in three military hospitals located in southern Taiwan. The surveys included the General Health Questionnaire (GHQ), the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF), and the Effort-Reward Imbalance (ERI) Questionnaire. High effort-reward (ER) ratio and overcommitment were defined when scores fell into the upper tertile of the total distribution.

Results

The survey was completed by 791 healthcare workers. On average, women reported a higher ERI than men. High ERI was associated with younger age, higher psychological morbidity, and poor physical and psychological QOL domains in this population. High ER ratio and high overcommitment were associated with psychological morbidity and poor QOL in both sexes. However, high ER ratio was not significantly associated with the social QOL domain in either sexes or the physical QOL domain in males.

Conclusions

There was a clear association between ERI and QOL in the healthcare workers in the military hospitals under reorganization and accreditation in this study. We found ER ratio and overcommitment to be suitable indicators of job stress.

Psychosocial job stress and immunity: a systematic review

The purpose of this review was to provide current knowledge about the possible association between psychosocial job stress and immune parameters in blood, saliva, and urine. Using bibliographic databases (PubMed, PsychINFO, Web of Science, Medline) and the snowball method, 56 studies were found. In general, exposure to psychosocial job stress (high job demands, low job control, high job strain, job dissatisfaction, high effort-reward imbalance, overcommitment, burnout, unemployment, organizational downsizing, economic recession) had a measurable impact on immune parameters (reduced NK cell activity, NK and T cell subsets, CD4+/CD8+ ratio, and increased inflammatory markers). The evidence supports that psychosocial job stresses are related to disrupted immune responses but further research is needed to demonstrate cause-effect relationships.

Unemployment and widespread influenza in America, 1999-2010

Please cite this paper as: Cornwell B. (2012) Unemployment and widespread influenza in America, 1999–2010. Influenza and Other Respiratory Viruses 6(1), 63–70.

Background  Research shows that unemployment reduces access to health care and vaccines and increases financial difficulty, family conflict, and other sources of stress that are known to suppress immune function. In addition, seasonal unemployment rates parallel seasonal influenza activity. Following a theory that argues that macroeconomic conditions affect population health, this paper examines whether there is an association between monthly unemployment rates and influenza activity.

Methods  Data from influenza activity surveillance reports from the Centers for Disease Control and Prevention are combined with information from the Bureau of Labor Statistics on state‐level unemployment rates in the U.S. for the flu seasons between 1999 and 2010. Pooled time‐series cross‐section logistic regression analyses are conducted to examine the effect of the unemployment rate on the likelihood of widespread and/or regional influenza activity in the 48 contiguous states throughout this period. A total of 3712 state‐month observations are examined.

Results  Net of other factors included in the multivariate regression analysis, a one‐percentage‐point increment in the unemployment rate is associated with between a 7·1% and 37·0% increment in the odds of widespread influenza (Odds ratio = 1·21). Likewise, a one‐percentage‐point increment in the unemployment rate is associated with between a 17·1% and 44·7% increment in the odds of at least regional influenza (Odds ratio = 1·30). Results hold regardless of whether time‐varying state‐level characteristics are included.

Conclusions  Higher state‐level unemployment increases the likelihood of regional and widespread influenza activity.

The impact of organizational changes on work stress, sleep, recovery and health

The study objective was to investigate the impact of different kinds of organizational changes, as well as anticipation of such changes, on work-related stress, sleep, recovery and health. It was hypothesized that impaired sleep and recovery increase the adverse health consequences of organizational changes. The data consisted of cross sectional questionnaire data from a random sample of 1,523 employees in the Swedish police force. It could be shown that extensive organizational changes including downsizing or a change in job tasks were associated with a small increase in work stress, disturbed sleep, incomplete recovery and health complaints. However, less extensive organizational changes like relocation did not affect these outcome variables. Anticipation of extensive organizational changes had almost the same effect as actual changes. Furthermore a moderating effect of sleep and work stress on gastrointestinal complaints and depressive symptoms was found. Thus, like former studies already suggested, extensive organizational changes resulted in increased stress levels, poorer health and impaired sleep and recovery. Furthermore, organizational instability due to anticipation of changes was as negative as actual changes. There was also some evidence that disturbed sleep increased these adverse health effects, in particular with respect to anticipation of organizational changes.

Occupational musculoskeletal and mental health: Significance of rationalization and opportunities to create sustainable production systems - A systematic review

This literature review aims to identify occupational musculoskeletal and mental health effects of production system rationalization as well as organizational-level measures that may improve health outcome ("modifiers" in this review). A short review of the effect of ergonomic interventions is included as background and rationalization is discussed as a theoretical concept. Indicator variables for occupational musculoskeletal and mental health and related risk factors are presented. Variables with a generalized format were allowed in the literature searches (e.g., job satisfaction and absenteeism were accepted as risk factor and health indicator, respectively), suitable for the research fields of work sociology, organization science, human resource management (HRM) and economics research. One hundred and sixty-two studies of rationalization effects on health and risk factors and 72 organization-level modifier results were accepted into the final database. Entries were sorted by rationalization strategy and work life sector, and trends in outcome (positive, mixed, no effect, or negative effect on health and risk factors) were determined. Rationalizations have a dominant negative effect on health and risk factors (57% negative, 19% positive); the most negative effects were found for downsizing and restructuring rationalizations in general (71 studies negative, 13 positive) and for the health care sector in particular (36 studies negative, 2 positive). The rationalization strategy High Performance Work System (HPWS) was associated with the highest fraction positive outcome studies (6 of 10 studies). Other rationalization strategies (lean practices, parallel vs. serial production and mechanization level) reported intermediate results, in part dependent on work life sector, but also on the year when studies were carried out. Worker participation, resonant management style, information, support, group autonomy and procedural justice were modifiers with favourable influence on outcome. It is concluded that production system rationalization represents a pervasive work life intervention without a primary occupational health focus. It has considerable and mostly negative influence on worker health, but this can be reduced by attention to modifiers. The results create a basis for new priorities in ergonomic intervention research.

Work stress and health in Western European and post-communist countries: an East-West comparison study

BACKGROUND

There is evidence that psychosocial factors at work influence the risk of poor health in Western societies, but little is known about the effect of work stress in the former communist countries. The aim of this paper is to compare the association of work stress with self-rated health in Western European and post-communist countries.

METHODS

Data from four epidemiological studies were used: the HAPIEE study (Poland, Russia and the Czech Republic), the Hungarian Epidemiological Panel (Hungary), the Heinz Nixdorf Recall study (Germany) and the Whitehall II study (UK). The overall sample consisted of 18 494 male and female workers aged 35-65 years.

RESULTS

High effort-reward imbalance at work was associated with poor self-rated health. The adjusted odds ratios for the highest versus lowest quartile of the effort-reward ratio were 3.8 (95% CI 1.9 to 7.7) in Hungary, 3.6 (95% CI 2.3 to 5.7) in the Czech Republic, 2.5 (95% CI 1.5 to 4.1) in the UK, 2.3 (95% CI 1.6 to 3.5) in Germany, 1.5 (95% CI 1.0 to 2.1) in Poland and 1.4 (95% CI 1.1 to 1.8) in Russia. The differences in odds ratios between countries were statistically significant (p<0.05). A similar pattern was observed for the effect of overcommitment on poor health.

CONCLUSION

The association of effort-reward imbalance at work and of a high degree of work-related overcommitment with poor self-rated health was seen in all countries, but the size of the effects differed considerably. It does not appear that the effects in Eastern Europe are systematically stronger than in the West.

Regions, hospitals and health outcomes over time: A multi-level analysis of repeat prevalence among a cohort of health-care workers

BACKGROUND

The relative importance of region, workplace, and individual determinants of health burden is debated.

OBJECTIVE

To model the contribution of hospital characteristics to employee mental and musculoskeletal disorders.

METHODS

We linked employment records of nurses and support services' staff with health records, neighbourhood census, and hospital administrative data. We conducted multi-level logistic regression analyses with three levels: year (I), employee characteristics (II), and hospital characteristics (III).

RESULTS

Northern region hospitals experienced lower disorder prevalences (odds ratios (OR) 0.58, 95% confidence intervals (0.40, 0.82) for mental and 0.56 (0.44, 0.73) for musculoskeletal disorders). Hospitals with yearly workloads of the highest versus lowest quintiles of inpatient days/1000 employee hours (>86.0 vs. <42.6) and surgical cases/1000 employee hours (>10.5 vs. <3.9) had greater odds of mental (1.29 (1.05, 1.57); 1.22 (1.05, 1.42)) and musculoskeletal (1.38 (1.21, 1.58); 1.21 (1.09, 1.34)) disorders.

CONCLUSION

Opportunities exist for reduction in burden with hospital workload reduction. Further exploration of regional effects is needed.

Overstretched and Unreciprocated Commitment: Reviewing Research on the Occupational Health and Safety Effects of Downsizing and Job Insecurity

Over the past two decades, a leading business practice has been often-repeated rounds of downsizing and restructuring (also referred to as reorganization, re-engineering, and a host of other euphemistic terms) by large private and public sector employers. Frequently associated with other practices such as outsourcing, privatization, and the increased use of temporary workers, downsizing/restructuring has increased the level of job insecurity among workers as well as leading to changes in work processes (including work intensification and multi-tasking) and management behavior. How has downsizing/restructuring and increased job insecurity affected the occupational health, safety, and well-being of workers, and what measures have employers, unions, and governments taken to address any adverse effects? The authors reviewed international studies of the occupational health and safety (OHS) effects of downsizing/restructuring and increased job insecurity undertaken over the past 20 years. After imposing quality filters, they obtained 86 studies. Analysis revealed that 73 (85%) of the studies found poorer OHS outcomes (using a range of measures). Studies were examined to see whether they provided clues as to the reasons for negative outcomes.

Work stress and reduced health in young physicians: prospective evidence from Swiss residents

OBJECTIVES

Job stress, investigated by the effort-reward model in various working environments in different countries, has been widely reported, yet studies addressing physicians are lacking. The present study investigated the perceived job stress, its association with the amount of working hours, and its impact on young physicians' self-reported health and their satisfaction with life during residency.

METHODS

In a prospective study design, a cohort of Swiss medical school graduates was followed up, beginning in 2001. In their second and fourth years of residency, 433 physicians assessed their effort-reward imbalance, overcommitment, physical and mental well-being and satisfaction in life. Taking the longitudinal design into account, four categories of stressed residents were defined: (1) subjects not reporting high work stress at either measurement, (2) subjects reporting high work stress in the second but not in the fourth year of residency, (3) subjects with onset of high work stress in fourth year and (4) residents reporting high work stress at both measurements.

RESULTS

All components of the perceived stress at work were significantly correlated with the amount of working hours, effort showing the highest correlation. While two-thirds of the participants do not report high work stress, assessed by the extrinsic part of the effort-reward imbalance model (the ratio between effort and reward) and 12% show a decrease of stress over time, there are 15% with an increase of stress over time, and 10% with persistently high stress experience. In terms of the intrinsic stress component (overcommitment), 71% show low values, 12% show a decrease, 9% an increase and 8% constantly high values. The groups with constant and increasing extrinsic and intrinsic stress experience exhibit significantly worse health and life satisfaction compared to the remaining groups, after controlling for gender and baseline health.

CONCLUSIONS

Stress at work in young physicians, especially when being experienced over a longer period in postgraduate training, has to be a matter of concern because of its negative impact on health and life satisfaction and the risk of developing symptoms of burnout in the long run.

Distress or no distress, that's the question: A cutoff point for distress in a working population

BACKGROUND

The objective of the present study is to establish an optimal cutoff point for distress measured with the corresponding scale of the 4DSQ, using the prediction of sickness absence as a criterion. The cutoff point should result in a measure that can be used as a credible selection instrument for sickness absence in occupational health practice and in future studies on distress and mental disorders.

METHODS

Distress is measured using the Four Dimensional Symptom Questionnaire (4DSQ), a 50-item self-report questionnaire, in a working population with and without sickness absence due to distress. Sensitivity and specificity were compared for various potential cutoff points, and a receiver operating characteristics analysis was conducted.

RESULTS AND CONCLUSION

A distress cutoff point of >/=11 was defined. The choice was based on a challenging specificity and negative predictive value and indicates a distress level at which an employee is presumably at risk for subsequent sick leave on psychological grounds. The defined distress cutoff point is appropriate for use in occupational health practice and in studies of distress in working populations.

Two models of job stress and depressive symptoms. Results from a population-based study

BACKGROUND

Evidence indicates that an adverse psychosocial work environment contributes to the explanation of depressive symptoms. Research was mainly informed by two theoretical models, the demand-control and the effort-reward imbalance model. Yet, a comparative analysis of the two models, using original scales, has not yet been conducted in an unselected working population.

METHODS

A total of 1,811 working men and women from the baseline screening of an epidemiological cohort study were interviewed (job stress, depressive symptoms [CES-D], health behaviours, medical history, socio-demographic characteristics). Logistic regression models were calculated to estimate associations between depressive symptoms, the two job stress models and relevant covariates.

RESULTS

Analyses showed significantly increased multivariate odds ratio (OR) of job strain and effort-reward imbalance. When the two models were mutually adjusted control [OR, 95% CI=1.9, 1.3-2.7], effort-reward imbalance [OR, 95% CI=3.4, 2.1-5.1] and overcommitment OR, 95% CI=3.9, 2.7-5.8] were independently associated with depressive symptoms Additional tests of interaction between the models revealed relatively highest level of depressive symptoms in employees who simultaneously reported low control and high overcommitment.

CONCLUSIONS

Components of an adverse psychosocial work environment are associated with depressive symptoms in an unselected working population. Policy implications of accumulated evidence on this relation should be addressed.

Socioeconomic status, status inconsistency and risk of ischaemic heart disease: a prospective study among members of a statutory health insurance company

BACKGROUND

Inconsistency in social status and its impact on health have been a focus of research 30-40 years ago. Yet, there is little recent information on it's association with ischaemic heart disease (IHD) morbidity and IHD is still defined as one of the major health problems in socioeconomically developed societies.

METHODS

A secondary analysis of prospective historical data from 68 805 male and female members of a statutory German health insurance company aged 25-65 years was conducted. Data included information on sociodemographic variables, social status indicators (education, occupational grade and income) and hospital admissions because of IHD.

RESULTS

Findings from Cox regression analysis showed an increased risk for IHD in the group with the highest educational level, whereas the lowest occupational and income groups had the highest hazard ratio (HR). Further analysis revealed that after adjustment for income status inconsistency (defined by the combination of higher educational level with lower occupational status) accounts for increased risk of IHD (HR for men, 3.14 and for women, 3.63). An association of similar strength was observed regarding high education/low income in women (HR 3.53). The combination of low education with high income reduced the risk among men (HR 0.29). No respective findings were observed concerning occupational group and income.

CONCLUSIONS

Status inconsistency is associated with the risk of IHD as well as single traditional indicators of socioeconomic position. Information on status inconsistency should be measured in addition to single indicators of socioeconomic status to achieve a more appropriate estimation of the risk of IHD.

Organisational restructuring/downsizing, OHS regulation and worker health and wellbeing

A growing body of international evidence indicates that downsizing and related forms of organisational restructuring are having profound adverse effects on worker safety, health and wellbeing. In particular, evidence links downsizing to poorer mental health outcomes, including bullying and other forms of occupational violence. In Australia federal, state and territory occupational health and safety (OHS) legislation imposes obligations on employers who make changes to the workplace or work processes to identify hazards, undertake risk assessment, consult with employee representatives and take appropriate steps to manage any significant hazards that are identified, including psychosocial hazards. This study shows that while Australian regulators are aware of the problems posed by downsizing they have made only modest efforts to pursue compliance with legislative duties, producing some guidance material that refers to restructuring and workloads and launching a small number of prosecutions. At the same time, there is an increased willingness to address staffing levels and other impacts of downsizing (like working in isolation). Employer and union responses were also examined. The article concludes by identifying a number of initiatives that would enable regulators, unions and employers to address the problems posed by downsizing more effectively.

Quality of work, well-being, and intended early retirement of older employees--baseline results from the SHARE Study

BACKGROUND

Given the challenge of a high proportion of older employees who retire early from work we analyse associations of indicators of a poor psychosocial quality of work with intended premature departure from work in a large sample of older male and female employees in 10 European countries.

METHODS

Baseline data from the 'Survey of Health, Ageing and Retirement in Europe' (SHARE) were obtained from 3523 men and 3318 women in 10 European countries. Data on intended early retirement, four measures of well-being (self-rated health, depressive symptoms, general symptom load, and quality of life), and quality of work (effort-reward imbalance; low control at work) were obtained from structured interviews and questionnaires. Country-specific and total samples are analysed, using logistic regression analysis.

RESULTS

Poor quality of work is significantly associated with intended early retirement. After adjustment for well-being odds ratios (OR) of effort-reward imbalance [OR 1.72 (1.43-2.08)] and low control at work [OR 1.51 (1.27-1.80)] on intended early retirement are observed. Poor quality of work and reduced well-being are independently associated with the intention to retire from work.

CONCLUSION

The consistent association of a poor psychosocial quality of work with intended early retirement among older employees across all European countries under study calls for improved investments into better quality of work, in particular increased control and an appropriate balance between efforts spent and rewards received at work.

A prospective study of cumulative job stress in relation to mental health

Background

This study tests associations between psychosocial stress at work measured by the effort-reward imbalance model in a dynamic perspective, and multiple indicators of poor mental health, in a prospective design.

Methods

1986 male and female employees from four Belgian enterprises were followed-up over one year within the framework of the Somstress study. Based on two consecutive measurements, an index of cumulative job stress was constructed and its associations with five indicators of mental health were studied, excluding caseness at entry (for depression, anxiety, somatisation, chronic fatigue and psychotropic drug consumption respectively). Taking into account the longitudinal design, four categories of job stress are defined: 1) employees free from stress at both measures, 2) job stress present at first measure but not at the second one, 3) recent onset of job stress as evidenced by second measure 4) workers exposed to stress at both measures. Multivariate logistic regression with appropriate adjustments was applied.

Results

In bivariate analysis, a clear graded association of cumulative job stress with all five mental health indicators is observed, both in men and women. In multivariate logistic regression analysis, recent onset of stress is strongly associated with poor mental health among men (odds ratios ranging from 1.8 to 4.6), while cumulative stress shows strongest effects on mental health in women (odds ratios ranging from 1.4 to 7.1).

Conclusion

Cumulative experience and recent onset of job stress in terms of high effort spent and low reward received is associated with elevated risk of all five indicators of poor mental health at follow-up in a large cohort of employees.