Work related violence and threats and the risk of depression and stress disorders

Insula-cortico-subcortical networks predict interoceptive awareness and stress resilience

BACKGROUND

Interoception, the neural sensing of visceral signals, and interoceptive awareness (IA), the conscious perception of interoception, are crucial for life survival functions and mental health. Resilience, the capacity to overcome adversity, has been associated with reduced interoceptive disturbances. Here, we sought evidence for our Insula Modular Active Control (IMAC) model that suggest that the insula, a brain region specialized in the processing of interoceptive information, realizes IA and contributes to resilience and mental health via cortico-subcortical connections.

METHODS

64 healthy participants (32 females; ages 18-34 years) answered questionnaires that assess IA and resilience. Mental health was evaluated with the Beck Depression Inventory II that assesses depressive mood. Participants also underwent a 15 minute resting-state functional resonance imaging session. Pearson correlations and mediation analyses were used to investigate the relationship between IA and resilience and their contributions to depressive mood. We then performed insula seed-based functional connectivity analyzes to identify insula networks involved in IA, resilience and depressive mood.

RESULTS

We first demonstrated that resilience mediates the relationship between IA and depressive mood. Second, shared and distinct intra-insula, insula-cortical and insula-subcortical networks were associated with IA, resilience and also predicted the degree of experienced depressive mood. Third, while resilience was associated with stronger insula-precuneus, insula-cerebellum and insula-prefrontal networks, IA was linked with stronger intra-insula, insula-striatum and insula-motor networks.

CONCLUSIONS

Our findings help understand the roles of insula-cortico-subcortical networks in IA and resilience. These results also highlight the potential use of insula networks as biomarkers for depression prediction.

Exposure to work-related violence and/or threats of violence as a predictor of certified sickness absence due to mental disorders: a prospective cohort study of 16,339 Swedish men and women in paid work

OBJECTIVES

The aim of this prospective cohort study was to investigate if exposure to work-related violence and/or threats of violence predict certified sickness absence due to mental disorders.

METHODS

Information on work-related exposure to violence and/or threats of violence were derived from the biannual Swedish Longitudinal Occupational Survey of Health (SLOSH) study 2012-2016, including individuals in paid work across Sweden and from different occupations/sectors (n = 16,339). Certified sickness absence due to mental disorders were ascertained from register data from the Swedish Social Insurance Agency. Odds ratios of certified sickness absence due to mental disorders according to exposure to work-related violence were estimated using multiple logistic regression. Several potential confounding variables, such as demographic and socio-economic factors, age, sex, cohabitation, children living at home, socio-economic status, educational level, as well as other types of psychosocial work environmental factors, were adjusted for in the analyses.

RESULTS

In the total study sample, 9% reported exposure to violence and/or threats of violence and the prevalence of sickness absence due to mental disorders was 5%. Exposure to work-related violence and/or threats of violence was associated prospectively with certified sickness absence due to mental disorders (odds ratio 1.46, 95% confidence interval 1.17-1.82, p < 0.01). Analysis of possible interaction showed no difference in association when comparing women to men and different age groups.

CONCLUSIONS

Exposure to work-related violence and/or threats of violence appear to increase the odds of certified sickness absence due to mental disorders. Preventive measures aiming to lower the risk of exposure is thus of great importance.

Status and Determinants of Symptoms of Anxiety and Depression among Food Delivery Drivers in Shanghai, China

(1) Background: The psychological status of employees, especially vulnerable populations, has received considerable research attention. However, as a newly emerging and popular occupation in the gig industry, food delivery drivers have received little attention. The majority of these workers are immigrants who are already in a precarious position due to a lack of available jobs, inadequate medical care, poor diets, and communication and acculturation difficulties even before they take these jobs, which involve long working hours and exposure to the elements. (2) Methods: To examine the anxiety and depression symptoms of these workers and possible influencing factors, a cross-sectional study was conducted with a sample of food delivery drivers working for the Meituan Company (one of the largest e-platform companies in China). Anxiety and depression scales were adapted from the GAD-7, and the PHQ-9 was used to assess participants' related symptoms. Differences were compared in terms of sociodemographic, work situation, and lifestyle variables. Binary logistic regressions were conducted to analyze the effects of various factors on the two psychological dimensions. (3) Results: Among the 657 participants, the proportions of participants reporting anxiety and depression symptoms were 46.0% and 18.4%, respectively. Lack of communication with leaders (OR_AN = 2.620, 95% CI: 1.528-4.493, p < 0.001; OR_DE = 1.928, 95% CI: 1.039-3.577, p = 0.037) and poor sleep quality (OR_AN = 2.152, 95% CI: 1.587-2.917, p < 0.001; OR_DE = 2.420, 95% CI: 1.672-3.504, p < 0.001) were significant risk factors for both anxiety and depression symptoms. Women (OR = 2.679, 95% CI: 1.621-4.427, p < 0.001), those who climbed ≥31 floors per day (OR = 2.415, 95% CI: 1.189-4.905, p = 0.015), and those with a high frequency of breakfast consumption (OR = 3.821, 95% CI: 1.284-11.369, p = 0.016) were more likely to have anxiety symptoms. Participants who earned less than 5000 RMB (OR = 0.438, 95% CI: 0.204-0.940, p = 0.034), were unwilling to seek medical help (OR = 3.549, 95% CI: 1.846-6.821, p < 0.001), or had a high frequency of smoking (OR = 5.107, 95% CI: 1.187-21.981, p = 0.029) were more likely to be depressive. (4) Conclusion: The existence of communication channels with leaders and good sleep quality are protective factors for anxiety and depression symptoms. Participants who were female, climbed ≥31floors per day, and had a high frequency of eating breakfast were more likely to have anxiety symptoms, while earning less, unwillingness to seek medical help, and a high frequency of smoking were risk factors for depression symptoms.

Hussenoeder F, Conrad I, Riedel-Heller S, Romero Starke K. Psychosocial Occupational Exposures and Mental Illness

BACKGROUND

The purpose of this study is to investigate the exposure-risk relationship between psychosocial occupational stress and mental illness.

METHODS

We conducted a systematic review with meta-analyses as an update of a systematic review published in 2014. The study protocol was registered in PROSPERO (CRD42020170032). Literature searches were carried out in the MEDLINE, PsycINFO, and Embase databases. All procedural steps were performed independently by two reviewers; discordances were solved by consensus. All of the included full texts were subject to a methodological appraisal. Certainty of evidence was determined with the GRADE procedure.

RESULTS

The pooled risk of depression was found to be approximately doubled in workers exposed to high job strain, which is defined as high work demands combined with low job control (effect estimate [EE] = 1.99, 95% CI [1.68; 2.35], heterogeneity [I2] = 24.7%, n = 8). In particular, high work demands are associated with incident depression (ES = 13.8 [1.19; 1.61], I2 = 69.0%, n = 9) and with incident anxiety disorder (ES = 1.79 [1.44; 2.23], I2 = 48.1%, n = 5). There were only a small number of methodologically adequate studies available on burnout, somatoform disorders, suicidal ideation, and suicide. Thus, no pooled risk estimates were calculated, although some individual studies showed a considerably increased risk.

CONCLUSION

Psychosocial occupational stress is clearly associated with depression and anxiety disorders.

Effects of Indirect Experience of Client Violence on Social Workers' Posttraumatic Stress Disorder

OBJECTIVE

This study aims to empirically determine if indirect exposure to client violence has significant negative effects on social workers' posttraumatic stress disorder (PTSD) the same way direct victimization does.

METHODS

Using a sample of 1,359 social workers drawn from the data collected by the Seoul Association of Social Workers, this study employs descriptive statistics to examine the prevalence of indirect experiences with client violence, and utilizes a series of hierarchical regression analyses to demonstrate the potential impact of indirect exposure to client violence on PTSD. To assess the severity of PTSD symptoms in participants, the Korean version of the Impact of Events Scale-Revised (IES-R-K) was employed.

RESULTS

A descriptive analysis shows that 12.4% of the sample indirectly experienced client violence by witnessing it or hearing about a violent incident, whereas 6.0% were directly victimized. Hierarchical regression analyses indicate that direct experience (B=4.548, p<0.05) and indirect experience (B=7.297, p<0.001) of client violence have a significant association with the scores on IES-R-K. An investigation of the interaction terms between experiences of client violence and violence-prevention training illustrates that such training significantly moderates the influence on the scores on IES-R-K from indirect exposure to client violence (B=-8.639, p<0.01).

CONCLUSION

Social workers who are indirectly exposed to client violence experience PTSD symptoms comparable to their colleagues who were directly victimized. Further, violence-prevention training has greater ameliorative effects with regard to indirect experience of client violence than for direct victimization.

Depressive Symptoms Following Work-Related Violence and Threats and the Modifying Effect of Organizational Justice, Social Support, and Safety Perceptions

Work-related threats and violence is a major occupational hazard and the consequences for victims may be a range of physical and psychological symptoms. The purpose of this study was to examine the associations between exposure to work-related violence and threats and subsequent risk for depression and to examine whether the associations were modified by social support, organizational justice and safety perceptions. Questionnaire data was collected in 2010, 2011 and in 2015. A total of 5,342 employees from special schools, psychiatric wards, eldercare and the Prison and Probation Services (PPS) participated in the first round in 2010. The analysis was performed by multivariate logistic regression. Staff exposed for work-related threats and violence had an increased risk for depression compared to non-exposed staff. The risk was highest for staff working in PPS. Compared to low levels, there were a tendency for high levels of social support, organizational justice and safety perception to attenuate the associations between work-related threats and violence and depression. However, none of the differences were statistically significant. Many employees working in human service sectors are exposed to work-related threats and violence which increases the risk for depression. The risk for depression following work-related threats and violence may be modified by social support, organizational justice and the perception of safety workplace. It is recommended that workplaces adopt an integrated organizational approach including both prevention of work-related threats and violence and intervention to modify the health consequences of work-related threats and violence.

Maternal life and work stressors during pregnancy and asthma in offspring

Background

Maternal stressors during pregnancy are potential risk factors for asthma in offspring. However, previous studies have been limited by the use of self-reported data focusing on stressors either in private life or at work. This study examined the association between maternal stressors both in private life and at work during pregnancy and asthma in offspring.

Methods

In the Danish National Birth Cohort, 75 156 live-born singletons born during 1996–2002 were identified. Maternal information on job title were available around weeks 12–16 of gestation. Data on maternal bereavement, life-threatening illness, suicide attempt and alcohol or drug abuse of a close relative and offspring childhood asthma (3–10 years of age) were obtained from Danish nationwide registers. Maternal psychosocial work stressors (job control, psychological job demands, emotional job demands, work-related violence and threats of work-related violence) were estimated by the use of job-exposure matrices. The association between maternal stress and childhood asthma was analysed in Cox models adjusted for maternal age, comorbidity and parity.

Results

Neither private-life nor work stressors were related to onset of asthma in offspring. Separate analyses by parental atopy or onset of asthma in offspring supported the main findings.

Conclusions

This study does not support an elevated risk of childhood asthma related to exposure to stress during pregnancy.

Work-related violence and depressive disorder among 955,573 employees followed for 6.99 million person-years. The Danish Work Life Course Cohort study: Work-related violence and depression

BACKGROUND

We examined the association between probability of work-related violence and first diagnosis of depressive disorder whilst accounting for the potential selection of individuals vulnerable to depression into occupations with high probability of work-related violence.

METHODS

Based on a pre-published study protocol, we analysed nationwide register data from the Danish Work Life Course Cohort study, encompassing 955,573 individuals followed from their entry into the workforce, and free from depressive disorder before work-force entry. Depressive disorder was measured from psychiatric in- and outpatient admissions. We measured work-related violence throughout the worklife by the annual average occupational risk of violence exposure. Using Cox proportional hazards regression, we examined the longitudinal association between work-related violence (both past year and cumulative life-long exposure) and first depressive disorder diagnosis, whilst adjusting for numerous confounders including parental psychiatric and somatic diagnoses, childhood socioeconomic position, and health services use before workforce entry.

RESULTS

The risk of depressive disorder was higher in individuals with high probability of past year work-related violence (hazard ratio: 1.11, 95% CI: 1.06-1.16) compared to employees with low probability of exposure, after adjustment for confounders. Among women, associations were robust across industries, whereas among men, associations were limited to certain industries.

LIMITATIONS

Violence was measured on the job group and not the individual level, likely resulting in some misclassification of the exposure.

CONCLUSIONS

Work-related violence may increase the risk of depressive disorder, independent of pre-existing risk factors for depressive disorder. These findings underline the importance of preventing work-related violence.

The relationship between onset of workplace violence and onset of sleep disturbances in the Swedish working population

The study investigated the association between onset of workplace violence and onset of sleep disturbances. We used self-reported data from the Swedish Longitudinal Occupational Survey of Health (SLOSH) collected in 2014, 2016, and 2018. A two-wave design was based on participants who had no exposure to workplace violence or sleep disturbances at baseline (n = 6,928). A three-wave design was based on participants who in addition were unexposed to sleep disturbances in the second wave (n = 6,150). Four items of the Karolinska Sleep Questionnaire were used to measure sleep disturbances and one question was used to measure the occurrence of workplace violence or threats of violence. Multivariate logistic regression analyses were performed. In the two-wave approach, onset of workplace violence was associated with onset of sleep disturbances after adjustment for sex, age, occupational position, education, and civil status (adjusted odds ratio 1.41, 95% confidence interval 1.02-1.96). The association was no longer statistically significant after further adjustment for night/evening work, demands, control, and social support at work. In the three-wave approach, results were only suggestive of an association between onset of workplace violence and subsequent onset of sleep disturbances after adjustment for sex, age, occupational position, education, and civil status. Onset of frequent exposure to workplace violence was associated with subsequent onset of sleep disturbances in the adjusted analyses, but these analyses were based on few individuals (13 exposed versus 5,907 unexposed). The results did not conclusively demonstrate that onset of workplace violence predicts development of sleep disturbances. Further research could elucidate the role of other working conditions.

Are depressive disorders caused by psychosocial stressors at work? A systematic review with metaanalysis

In the last decade, many studies have examined associations between poor psychosocial work environment and depression. We aimed to assess the evidence for a causal association between psychosocial factors at work and depressive disorders. We conducted a systematic literature search from 1980 to March 2019. For all exposures other than night and shift work and long working hours, we limited our selection of studies to those with a longitudinal design. We extracted available risk estimates for each of 19 psychosocial exposures, from which we calculated summary risk estimates with 95% confidence intervals (PROSPERO, identifier CRD42019130266). 54 studies were included, addressing 19 exposures and 11 different measures of depression. Only data on depressive episodes were sufficient for evaluation. Heterogeneity of exposure definitions and ascertainment, outcome measures, risk parameterization and effect contrasts limited the validity of meta-analyses. Summary risk estimates were above unity for all but one exposure, and below 1.60 for all but another. Outcome measures were liable to high rates of false positives, control of relevant confounding was mostly inadequate, and common method bias was likely in a large proportion of studies. The combination of resulting biases is likely to have inflated observed effect estimates. When statistical uncertainties and the potential for bias and confounding are taken into account, it is not possible to conclude with confidence that any of the psychosocial exposures at work included in this review is either likely or unlikely to cause depressive episodes or recurrent depressive disorders.

Occupational Risk for Post-Traumatic Stress Disorder and Trauma-Related Depression: A Systematic Review with Meta-Analysis

There is evidence suggesting that occupational trauma leads to post-traumatic stress disorder (PTSD) and depression. However, there is a lack of high-quality reviews studying this association. We, therefore, conducted a systematic review with a meta-analysis to summarize the evidence of occupational trauma on PTSD and depression. After a database search on studies published between 1994 and 2018, we included 31 studies, of which only four had a low risk of bias. For soldiers exposed to wartime deployment, the pooled relative risk (RR) was 2.18 (95% CI 1.83-2.60) for PTSD and 1.15 (95% CI 1.06-1.25) for depression. For employees exposed to occupational trauma, there also was an increased risk for PTSD (RR = 3.18; 95% CI 1.76-5.76) and for depression (RR = 1.73; 95% CI 1.44-2.08). The overall quality of the evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was moderate; the evidence was high only for the association between workers after exposure to trauma and development of PTSD. The study results indicate an increased risk of PTSD and depression in soldiers after participation in war and in employees after occupational trauma.

Not All Emotional Demands Are the Same: Emotional Demands from Clients' or Co-Workers' Relations Have Different Associations with Well-Being in Service Workers

There has been an increased interest in the study of emotional demands (ED) at work and its impact on workers’ well-being. However, ED have been conceptualized as a unitary concept, focused on interactions with clients, and excluding other potential sources of ED at work. Therefore, the aim of the current study is to explore the relation between ED from different relational sources (clients/patients/customers and colleagues, supervisors, and employees) and service workers’ exhaustion and engagement. Cross-sectional data from a sample of 2742 service workers were analysed using structural equation modelling. Results showed that ED from both sources (clients and colleagues) were associated with more emotional exhaustion, particularly if dealing with clients was not an integrated part of the role. Further, ED from clients’ relations were negatively associated with engagement for managers with staff responsibility, but positively for managers without staff responsibility. We also found moderating effects of psychosocial safety climate (PSC), whereby ED had the strongest effect on emotional exhaustion when PSC was low. This study suggests that different relational sources of ED at work have a different impact on employees’ well-being. Strategies that promote a reduction of extra-role ED, and the development of a PSC in the organization, could therefore offer possible solutions to promote employees’ psychological well-being and motivation.

Education and training for preventing and minimizing workplace aggression directed toward healthcare workers

BACKGROUND

Workplace aggression constitutes a serious issue for healthcare workers and organizations. Aggression is tied to physical and mental health issues at an individual level, as well as to absenteeism, decreased productivity or quality of work, and high employee turnover rates at an organizational level. To counteract these negative impacts, organizations have used a variety of interventions, including education and training, to provide workers with the knowledge and skills needed to prevent aggression.  OBJECTIVES: To assess the effectiveness of education and training interventions that aim to prevent and minimize workplace aggression directed toward healthcare workers by patients and patient advocates.

SEARCH METHODS

CENTRAL, MEDLINE, Embase, six other databases and five trial registers were searched from their inception to June 2020 together with reference checking, citation searching and contact with study authors to identify additional studies.

SELECTION CRITERIA

Randomized controlled trials (RCTs), cluster-randomized controlled trials (CRCTs), and controlled before and after studies (CBAs) that investigated the effectiveness of education and training interventions targeting aggression prevention for healthcare workers.

DATA COLLECTION AND ANALYSIS

Four review authors evaluated and selected the studies resulting from the search. We used standard methodological procedures expected by Cochrane. We assessed the certainty of evidence using the GRADE approach.

MAIN RESULTS

We included nine studies-four CRCTs, three RCTs, and two CBAs-with a total of 1688 participants. Five studies reported episodes of aggression, and six studies reported secondary outcomes. Seven studies were conducted among nurses or nurse aides, and two studies among healthcare workers in general. Three studies took place in long-term care, two in the psychiatric ward, and four in hospitals or health centers. Studies were reported from the United States, Switzerland, the United Kingdom, Taiwan, and Sweden. All included studies reported on education combined with training interventions. Four studies evaluated online programs, and five evaluated face-to-face programs. Five studies were of long duration (up to 52 weeks), and four studies were of short duration. Eight studies had short-term follow-up (< 3 months), and one study long-term follow-up (> 1 year). Seven studies were rated as being at "high" risk of bias in multiple domains, and all had "unclear" risk of bias in a single domain or in multiple domains. Effects on aggression Short-term follow-up The evidence is very uncertain about effects of education and training on aggression at short-term follow-up compared to no intervention (standardized mean difference [SMD] -0.33, 95% confidence interval [CI] -1.27 to 0.61, 2 CRCTs; risk ratio [RR] 2.30, 95% CI 0.97 to 5.42, 1 CBA; SMD -1.24, 95% CI -2.16 to -0.33, 1 CBA; very low-certainty evidence). Long-term follow-up Education may not reduce aggression compared to no intervention in the long term (RR 1.14, 95% CI 0.95 to 1.37, 1 CRCT; low-certainty evidence). Effects on knowledge, attitudes, skills, and adverse outcomes Education may increase personal knowledge about workplace aggression at short-term follow-up (SMD 0.86, 95% CI 0.34 to 1.38, 1 RCT; low-certainty evidence). The evidence is very uncertain about effects of education on personal knowledge in the long term (RR 1.26, 95% CI 0.90 to 1.75, 1 RCT; very low-certainty evidence). Education may improve attitudes among healthcare workers at short-term follow-up, but the evidence is very uncertain (SMD 0.59, 95% CI 0.24 to 0.94, 2 CRCTs and 3 RCTs; very low-certainty evidence). The type and duration of interventions resulted in different sizes of effects. Education may not have an effect on skills related to workplace aggression (SMD 0.21, 95% CI -0.07 to 0.49, 1 RCT and 1 CRCT; very low-certainty evidence) nor on adverse personal outcomes, but the evidence is very uncertain (SMD -0.31, 95% CI -1.02 to 0.40, 1 RCT; very low-certainty evidence). Measurements of these concepts showed high heterogeneity.

AUTHORS' CONCLUSIONS

Education combined with training may not have an effect on workplace aggression directed toward healthcare workers, even though education and training may increase personal knowledge and positive attitudes. Better quality studies that focus on specific settings of healthcare work where exposure to patient aggression is high are needed. Moreover, as most studies have assessed episodes of aggression toward nurses, future studies should include other types of healthcare workers who are also victims of aggression in the same settings, such as orderlies (healthcare assistants). Studies should especially use reports of aggression at an institutional level and should rely on multi-source data while relying on validated measures. Studies should also include days lost to sick leave and employee turnover and should measure outcomes at one-year follow-up. Studies should specify the duration and type of delivery of education and should use an active comparison to prevent raising awareness and reporting in the intervention group only.

Distinguishing burnout from depression: An exploratory qualitative study

Whether depression and burnout are synonymous or not has been a longstanding debate. Many studies have examined for similarities and differences, but findings have overall been inconclusive, with most studies being quantitative in design. We therefore undertook a qualitative study in which participants who self-identified as having experienced both burnout and depression were asked how they distinguished between the two conditions. Thematic qualitative analysis was undertaken and while a fifth of the sample stated that their burnout and depression experiences were indistinguishable or were very similar, we also identified 11 key themes of difference. The most prevalent themes captured differences in the perceived cause of each condition, in experiencing hopelessness as against helplessness, and impacts on levels of functioning, sadness, anger, anxiety and emotional lability. We also identified differences in suicidal ideation between the two conditions. While some differences identified could be dimensional and suggest that burnout is simply synonymous with or a developmental phase of depression, the several categorical symptom differences nominated by participants suggest that most sufferers who have experienced both conditions perceive them as distinct. Such 'lived experience' reports are therefore intrinsically informative and should shape further quantitative analyses.

Workplace Violence and Long-term Sickness Absence: Assessment of the Potential Buffering Effect of Social Support in Two Occupational Cohort Studies

OBJECTIVES

We aimed to determine the effect of workplace violence on long-term sickness absence, and whether social support from supervisors and colleagues buffer this effect.

METHODS

Information on workplace violence and social support were derived from the Danish Work Environment Cohort Study in 2000, 2005, and 2010 and the Swedish Longitudinal Occupational Survey of Health in 2006 and 2008. Individual- and joint-effects on register-based long-term sickness absence were determined using logistic regression models for repeated measurements. Cohort-specific estimates were combined in random effect meta-analyses.

RESULTS

Workplace violence and low social support were independently associated with a higher risk of long-term sickness absence, and we did not find evidence of an interaction.

CONCLUSION

Exposure to workplace violence is a risk factor for long-term sickness absence while social support is associated with a lower risk of long-term sickness absence.

Anxiety, Depression and Sleep Disturbance among Customer-Facing Workers

BACKGROUND

Mental health problems are a growing issue among customer-facing workers. This study aimed to investigate the workers' symptoms of anxiety, depression, and sleep disturbance caused by customer complaints and the suppression of one's emotions at work.

METHODS

This study used the data from the fifth Korean Working Conditions Survey 2017 database. The subjects comprised 23,128 workers (men, 11,007; women, 12,121). The odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using multiple logistic regression models, to determine the effect of the exposure level of engaging with angry clients and suppressing one's emotions at work on mental health.

RESULTS

Among the workers engaging with angry customers, compared to the "Rarely" group as a reference point, the "Always" group showed elevated OR values (at [95% CI]) of 1.52 (1.10-2.10), 1.86 (1.05-3.27), 4.43 (3.11-6.33), 3.74 (2.51-5.55), 3.89 (2.65-5.70) for men workers; and 2.86 (1.94-4.22), 2.55 (1.73-3.75), 3.75 (2.82-4.98), 3.81 (2.84-5.09), 3.84 (2.88-5.12) for women workers, for depression, anxiety, difficulty falling asleep, waking up during sleep, and extreme fatigue after waking up, respectively. For suppressing one's emotions at work, the OR values of the "Always" group were 2.32 (1.53-3.51), 2.46 (1.73-3.50), 2.54 (1.88-3.43), 2.64 (1.92-3.64), 2.42 (1.81-3.24) for men workers; and 2.23 (1.53-3.25), 2.31 (1.61-3.33), 2.26 (1.72-2.96), 1.53 (1.19-1.97), 2.15 (1.62-2.85) for women workers, for depression, anxiety, and difficulty falling asleep, waking up during sleep, and extreme fatigue after waking up, respectively.

CONCLUSION

The emotional labor demanded from customer-facing workers, incurred by facing customer complaints and suppressing one's emotions at work, was found to be significantly associated with the development of depression, anxiety, and sleep disturbance symptoms among the Korean working population.

Gender differences in the association of living and working conditions and the mental health of trafficking survivors

OBJECTIVES

To assess the association of living and working conditions experienced during trafficking with mental health of female and male survivors.

METHODS

We analyzed a cross-sectional study of 1015 survivors who received post-trafficking services in Cambodia, Thailand, and Vietnam. Modified Poisson regression models were conducted by gender to estimate prevalence ratios.

RESULTS

For females, the elevated prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) symptoms was associated with adverse living conditions, while for males the prevalence of anxiety (PR = 2.21; 95% CI 1.24-3.96) and depression (PR = 2.63; 95% CI 1.62-4.26) more than doubled and almost tripled for PTSD (PR = 2.93; 95% CI 1.65-5.19) after adjustment. For males in particular, excessive and extreme working hours per day were associated with more than a four- and threefold greater prevalence of PTSD. Being in a detention center or jail was associated with all three mental health outcomes in males.

CONCLUSIONS

Providers and stakeholders need to consider the complex mental health trauma of the differential effects of living and working conditions for female and male survivors during trafficking to support treatment and recovery.

Antidepressant treatment among social workers, human service professionals, and non-human service professionals: A multi-cohort study in Finland, Sweden and Denmark

BACKGROUND

Social workers have an elevated risk for mental disorders, but little is known about their antidepressant treatment.

AIMS

To examine any and long-term antidepressant treatment among social workers in Finland, Sweden and Denmark.

METHODS

We linked records from drug prescription registers to three prospective cohorts: the Finnish Public Sector study, years 2006-2011, and nation-wide cohorts in Sweden and Denmark, years 2006-2014, including a total of 1.5 million employees in (1) social work, (2) other social and health care professions, (3) education and (4) office work. We used Cox proportional hazards models to estimate hazard ratios for any and long-term (>6 months) antidepressant treatment among social workers compared to the three reference occupational groups and carried out meta-analyses.

RESULTS

During follow-up, 25% of social workers had any prescriptions for antidepressants (19-24% reference occupations) and 20% for long-term treatment (14-19% reference occupations). The pooled effects for any and long-term treatment showed that probabilities were 10% higher in social workers compared to other health and social care professionals and 30% higher compared to education and non-human service professionals. Probabilities for any treatment in the three countries were relatively similar, but for long-term treatment social workers in Finland had a greater risk compared with other human service professions.

LIMITATIONS

There were differences between the cohorts in the availability of data. Specific diagnoses for the antidepressant treatment were not known neither adherence to treatment.

CONCLUSION

Social workers have a higher risk for any and long-term antidepressant treatment than other human and non-human service professionals.

Hearing laughter improves the recovery process of the autonomic nervous system after a stress-loading task: a randomized controlled trial

Background

It has become necessary to develop mental health management methods that do not require specialized skills or tools to implement. With this in mind, we performed a subjective and objective investigation of the stress-reducing effect of hearing laughter.

Methods

Ninety healthy students were randomly assigned to a laughter (n = 45) or rest (n = 45) group. Both groups were then administered the Uchida-Kraepelin test for 15 min, which served as a stress-loading method. The laughter group listened to a specially prepared CD for five minutes, while the rest group rested for five minutes. The participants’ subjective stress level was assessed using a visual analogue scale and their physiological status was assessed by measuring blood pressure and monitoring heart rate variability.

Results

The visual analogue scale score for subjective stress was found to decrease significantly in both the laughter and rest groups after the intervention. However, a two-way repeated-measures analysis of variance revealed significant interaction and main effects for the change in heart rate and the natural logarithm of the high-frequency component of heart rate variability (lnHF). A post-hoc analysis using Dunnett’s test showed that hearing laughter caused the lnHF to significantly increase compared to that recorded during the Uchida-Kraepelin test and the rest period.

Conclusions

These results suggest that hearing laughter might produce a relaxing effect by increasing parasympathetic nervous activity. This would make it an easily accessible method for improving the recovery process of the autonomic nervous system after a stress-loading task that does not require specialized skills or tools.

Trial registration

UMIN000016422. Retrospectively registered on 2 February 2015.

Electronic supplementary material

The online version of this article (10.1186/s13030-018-0141-0) contains supplementary material, which is available to authorized users.

Work Stress and Depressive Symptoms in Fishermen With a Smoking Habit: A Mediator Role of Nicotine Dependence and Possible Moderator Role of Expressive Suppression and Cognitive Reappraisal

This study examined pathways of influence between work stress, depressive symptoms, nicotine dependence, expressive suppression, and cognitive reappraisal in fishermen with smoking habits in Qionghai, Hainan province, China (N = 1068). These fishermen responded to multiple assessments a week before leaving on a deep-sea fishing trip, including a Mental Stressor Investigation Questionnaire (MSIQ), the Center for Epidemiological Studies Depression Scale (CES-D), the Russell Reason for Smoking Questionnaire (RRSQ), and an Emotion Regulation Questionnaire (ERQ). Structural equation modeling (SEM) analyses of the collected data in Mplus 7 showed that work stress and nicotine dependence were independent predictors of depressive symptoms. The relationship between work stress and depressive symptoms was found to be partially mediated by nicotine dependence and be moderated by cognitive reappraisal. The evidence suggests it advantageous to examine the need of work stress, nicotine dependence, and cognitive reappraisal when attempting to understand depressive symptoms in fishermen with a smoking habit. These findings suggest that improving nicotine dependence through work stress management and training in cognitive reappraisal could be utilized as effective modalities for improving depressive symptoms.

The impact of work-related physical assaults on mental health among Japanese employees with different socioeconomic status: The Japan Work Stress and Health Cohort Study (JSTRESS)

Background

Work-related physical assaults or violence has severely impacted on the safety of the work environment and employees’ mental health. The aim of the present study was to investigate the prevalence of physical assaults, the effect of socioeconomic status (SES) on it and depression associated with it in employees working at large companies.

Methods

A total of 22,770 Japanese employees responded to a self-administered questionnaire including SES (educational status and occupational status), violence victimization, worksite social support and depression (response rate, 85%). The 12-month prevalence of physical assaults and depression was examined using a single question and the Center for Epidemiologic Studies Depression scale, respectively.

Results

The prevalence of physical assaults was 1.8% both in males and females. Although the risk of exposure to physical assaults was 2–3 times higher in the blue-collar group than in the manager group, the association of exposure to physical assaults with depression was stronger in the manager and white-collar worker group (Prevalence ratio [PR]=2.1 in males; 1.8 in females) than in the blue-collar worker group (PR=1.7 in males; 1.5 in females) after adjusting demographic and occupational covariates. A similar pattern was observed for education in males; the association was stronger than in the lower education group (PR=2.1 and 1.8).

Conclusions

Low SES is a risk factor of exposure to physical assaults, however, the association of physical assaults with depression was significantly greater among company employees of higher SES than those of lower SES.

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1.8% of Japanese employees experience physical assaults during working time.

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Employees with low SES are at high risk for exposure to physical assaults.

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The impact of violence on depression is greater among employees with high SES.

Violence at work and depressive symptoms in primary health care teams: a cross-sectional study in Brazil

PURPOSE

Implementation of primary care has long been a priority in low- and middle-income countries. Violence at work may hamper progress in this field. Hence, we examined the associations between violence at work and depressive symptoms/major depression in primary care teams (physicians, nurses, nursing assistants, and community health workers).

METHODS

A cross-sectional study was undertaken in the city of Sao Paulo, Brazil. We assessed a random sample of Family Health Program teams. We investigated depressive symptoms and major depression using the nine-item Patient Health Questionnaire (PHQ-9), and exposure to violence at work in the previous 12 months using a standardized questionnaire. Associations between exposure to violence and depressive symptoms/major depression were analyzed using multinomial logistic regression.

RESULTS

Of 3141 eligible workers, 2940 (93 %) completed the interview. Of these, 36.3 % (95 % CI 34.6-38.1) presented intermediate depressive symptoms, and 16 % (95 % CI 14.6-17.2), probable major depression. The frequencies of exposure to the different types of violence at work were: insults (44.9 %), threats (24.8 %), physical aggression (2.3 %), and witnessing violence (29.5 %). These exposures were strongly and progressively associated with depressive symptoms (adjusted odds ratio 1.67 for exposure to one type of violence; and 5.10 for all four types), and probable major depression (adjusted odds ratio 1.84 for one type; and 14.34 for all four types).

CONCLUSION

Primary care workers presenting depressive symptoms and those who have experienced violence at work should be assisted. Policy makers should prioritize strategies to prevent these problems, since they can threaten primary care sustainability.

Violence against metropolitan bus drivers and fare collectors in Brazil

OBJECTIVE

To analyze the correlation between sociodemographic factors and working conditions of bus workers in a metropolitan area and violence against them.

METHODS

This cross-sectional study used a nonprobabilistic sample estimated according to the number of workers employed in bus companies located in three cities in the Belo Horizonte metropolitan region in 2012 (N = 17,470). Face-to-face interviews were conducted using a digital questionnaire. The factors associated with violence were analyzed in two stages using Poisson regression, according to each level. The magnitude of the association was evaluated using prevalence ratios with robust variance and a statistical significance of 5%, and 95% confidence intervals were obtained.

RESULTS

The study sample comprised 782 drivers and 691 fare collectors; 45.0% participants reported at least one act of violence in the workplace in the last 12 months, with passengers being predominantly responsible. The age of the bus workers was inversely associated with violence. Chronic diseases, sickness absenteeism, and working conditions were also associated with violence.

CONCLUSIONS

The findings on the correlation between violence and working conditions are essential for implementing prevention strategies by transportation service managers.

The role of sleep disturbances in the longitudinal relationship between psychosocial working conditions, measured by work demands and support, and depression

STUDY OBJECTIVES

Because work demands and lack of social support seem to be prospectively linked to sleep problems, and sleep problems are linked to depression, sleep problems may play a role in the relationship between these work characteristics and depressive symptoms. In order to shed more light on this relationship, the current study investigated whether disturbed sleep is a mediator in the longitudinal relationships between work demands, social support, and depression.

DESIGN

Longitudinal cohort study with repeated survey measures on four occasions.

SETTING

Swedish workforce.

PARTICIPANTS

2,017 working participants from the Swedish Longitudinal Occupational Survey of Health in 2006, 2008, 2010, and 2012.

MEASUREMENTS AND RESULTS

Work demands (four items) and social support (six items) were assessed with the Demand Control Questionnaire, disturbed sleep (four items) with the Karolinska Sleep Questionnaire, and depressive symptoms with a brief subscale (six items) from the Symptom Checklist. Autoregressive longitudinal mediation models using structural equation modeling were tested. The work characteristics, and disturbed sleep, were found to be separately associated with depressive symptoms in subsequent waves. However, only demands were found to be longitudinally related to subsequent disturbed sleep. The longitudinal autoregressive models supported a weak mediating role of disturbed sleep in the relationship between demands and depressive symptoms (standardized beta 0.008, P < 0.001), but not between support and depressive symptoms.

CONCLUSIONS

These results indicate that higher demands at work might cause an increase in depressive symptoms, in part, by increasing disturbed sleep, although the mediated effect was relatively small compared to the total effect.

Clinically assessed consequences of workplace physical violence

Objectives

To assess consequences of physical violence at work and identify their predictors.

Methods

Among the patients in a medicolegal consultation from 2007 to 2010, the subsample of workplace violence victims (n = 185) was identified and contacted again in average 30 months after the assault. Eighty-six victims (47 %) participated. Ordinal logistic regression analyses assessed the effect of 9 potential risk factors on physical, psychological and work consequences summarized in a severity score (0–9).

Results

Severity score distribution was as follows: 4+: 14 %; 1–3: 42 %; and 0: 44 %. Initial psychological distress resulting from the violence was a strong predictor (p < 0.001) of the severity score both on work and long-term psychological consequences. Gender and age did not reach significant levels in multivariable analyses even though female victims had overall more severe consequences. Unexpectedly, only among workers whose jobs implied high awareness of the risk of violence, first-time violence was associated with long-term psychological and physical consequences (p = 0.004). Among the factors assessed at follow-up, perceived lack of employers’ support or absence of employer was associated with higher values on the severity score. The seven other assessed factors (initial physical injuries; previous experience of violence; preexisting health problems; working alone; internal violence; lack of support from colleagues; and lack of support from family or friends) were not significantly associated with the severity score.

Conclusions

Being a victim of workplace violence can result in long-term consequences on health and employment, their severity increases with the seriousness of initial psychological distress. Support from the employer can help prevent negative outcomes.

Impact of hospital type II violent events: use of psychotropic drugs and mental health services

BACKGROUND

While violence can adversely affect mental health of victims, repercussions of violence against workers is not as well characterized.

MATERIALS AND METHODS

We explored relationships between workplace violent events perpetrated by patients or visitors (Type II) against hospital employees and the employee use of psychotropic medications or mental health services using a data system that linked violent events with health claims.

RESULTS

Significant associations were observed between reported Type II workplace violent events and employee prescription claims for anti-depressants and anxiolytics combined (RR = 1.45, 95% CI = 1.01-2.33) and anti-depressants alone (RR = 1.65, 95% CI = 1.10-2.48). No significant association between reported violent events and health claims for treatment of depression or anxiety was observed.

CONCLUSIONS

Type II violence experienced by hospital workers may lead to increased use of psychotropic drugs, particularly anti-depressants but also anxiolytics. Our results suggest an important role of employee assistance programs in mitigating the psychological consequences of workplace violent events.

Voice complaints among public transport workers in the metropolitan region of Belo Horizonte, Brazil

OBJECTIVE

To investigate the prevalence of voice complaints among bus transport workers in a metropolitan area in Brazil and examine whether sociodemographic and occupational factors were associated with this outcome. This study is part of a larger study that investigated the working conditions and health of drivers and conductors of urban transportation.

METHODS

The sample size (1,607 participants) was calculated by means of quotas and was stratified according to occupation (drivers and conductors) in the bus companies of Belo Horizonte, Betim and Contagem. Face-to-face interviews were facilitated by means of a digital questionnaire, applied by the interviewer using a netbook. The outcome variable was constructed from combining the responses to the following two questions: (1) Over the last two weeks, have you felt tired when speaking? (no/sometimes/every day). (2) Over the last two weeks, have you noticed any worsening of your voice quality? (no/sometimes/every day). Sociodemographic, lifestyle, occupational characteristic and health situation data were gathered.

RESULTS

The prevalence found was 29% overall: 24% for drivers and 34% for conductors. Attention was drawn to positive associations with the function of conductor and with reports of exposure to vibration and thermal discomfort. Among the individual factors, only female gender reached statistical significance.

CONCLUSION

Risk factors exist that justify interventions to promote voice health within the urban transport sector under study. It would be appropriate to investigate whether vibration of the whole body would influence the functioning and morphology of the larynx.

Psychosocial working conditions and psychological well-being among employees in 34 European countries

PURPOSE

The aim of this study was to explore the associations between psychosocial working conditions and psychological well-being among employees in 34 European countries. Another objective was to examine whether these associations varied according to occupation and country.

METHODS

The study was based on data from the European Working Conditions Survey 2010 including 33,443 employees, 16,512 men and 16,931 women, from 34 European countries. Well-being was measured by the WHO-5 well-being index. Twenty-five psychosocial work factors were constructed including job demands, role stressors, work hours, job influence and freedom, job promotion, job insecurity, social support, quality of leadership, discrimination and violence at work, and work-life imbalance. The associations between these factors and well-being were examined using multilevel logistic regression analyses. Different models were performed including interaction tests.

RESULTS

When all 25 psychosocial work factors were studied simultaneously in the same model with adjustment variables, 13 showed a significant association with poor well-being among both genders: quantitative demands, demands for hiding emotions, low possibilities for development, low meaning of work, low role conflict, low quality of leadership, low social support, low sense of community, job insecurity, low job promotion, work-life imbalance, discrimination, and bullying. The association with low sense of community on poor well-being was particularly strong.

CONCLUSIONS

A large number of psychosocial work factors were associated with poor well-being. Almost no country and occupational differences were found in these associations. This study gave a first European overview and could be useful to inform cross-national policy debate.

Musculoskeletal pain and reported workplace assault: a prospective study of clinical staff in nursing homes

OBJECTIVE

This study examined prospectively the effect of workplace violence on musculoskeletal symptoms among nursing home workers.

BACKGROUND

Previously we reported a cross-sectional relationship between physical assaults at work and musculoskeletal pain. This follow-up provides stronger evidence of the effect of workplace violence on musculoskeletal outcomes within the same workforce over two years.

METHOD

Nursing home workers who responded to three consecutive annual surveys formed the study cohort (n = 344). The outcomes were any musculoskeletal pain, widespread pain, pain intensity, pain interference with work and sleep, and co-occurring pain with depression. The main predictor was self-reported physical assault at work during the 3 months preceding each survey. Prevalence ratios (PRs) were assessed with log-binomial regression, adjusting for other workplace and individual factors.

RESULTS

Every fourth nursing home worker, and 34% of nursing aides, reported persistent workplace assault over the 2 years. Among respondents assaulted frequently, two thirds experienced moderate to extreme musculoskeletal pain, and more than 50% had pain interfering with work and/or sleep. Baseline exposure to assault predicted pain outcomes 1 year later. Repeated exposure was associated with a linear increase over 2 years in the risks of pain intensity, interference with work, and interference with sleep; co-occurring pain and depression had an adjusted PR of 3.6 (95% CI = 1.7-7.9).

CONCLUSION

Workplace assault, especially when repeated over time, increases the risk of pain that may jeopardize workers' ability to remain employed.

APPLICATION

More effective assault prevention would protect and support the workforce needed to care for our increasing elderly and disabled population.

Co-effect of Demand-control-support model and effort-reward imbalance model on depression risk estimation in humans: findings from Henan Province of China

OBJECTIVE

To investigate the co-effect of Demand-control-support (DCS) model and Effort-reward Imbalance (ERI) model on the risk estimation of depression in humans in comparison with the effects when they are used respectively.

METHODS

A total of 3 632 males and 1 706 females from 13 factories and companies in Henan province were recruited in this cross-sectional study. Perceived job stress was evaluated with the Job Content Questionnaire and Effort-Reward Imbalance Questionnaire (Chinese version). Depressive symptoms were assessed by using the Center for Epidemiological Studies Depression Scale (CES-D).

RESULTS

DC (demands/job control ratio) and ERI were shown to be independently associated with depressive symptoms. The outcome of low social support and overcommitment were similar. High DC and low social support (SS), high ERI and high overcommitment, and high DC and high ERI posed greater risks of depressive symptoms than each of them did alone. ERI model and SS model seem to be effective in estimating the risk of depressive symptoms if they are used respectively.

CONCLUSION

The DC had better performance when it was used in combination with low SS. The effect on physical demands was better than on psychological demands. The combination of DCS and ERI models could improve the risk estimate of depressive symptoms in humans.

Condições de trabalho nos ônibus e os transtornos mentais comuns em motoristas e cobradores: Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil, 2012

A prevalência de transtornos mentais comuns (TMC) contribui para a carga mundial de doenças. O objetivo foi descrever a prevalência de TMC numa amostra de motoristas e cobradores da Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil, e verificar se as condições do trânsito e as condições internas aos ônibus estavam associadas ao desfecho. Os respondentes foram 1.607 trabalhadores. A amostra não probabilística foi estimada de acordo com as quotas do efetivo distribuído nas empresas de ônibus (n = 17.470). As entrevistas face a face utilizaram o questionário digital. Trânsito ruim perdeu significância estatística na análise multivariável; renda mais elevada e condições de trabalho e de segurança inadequadas mantiveram-se associadas ao desfecho. Comportamentos nocivos e situação vulnerável de saúde foram associados com TMC. Abordar a saúde dos trabalhadores dos ônibus urbanos é uma rara contribuição que pode amparar a elaboração de políticas públicas dirigidas às populações metropolitanas.

Immigrant status, antenatal depressive symptoms, and frequency and source of violence: what's the relationship?

This study describes the prevalence of violence during pregnancy and examines the association between the experience of violence since the beginning of pregnancy and the prevalence of antenatal depressive symptoms while taking into account immigrant status. Cross-sectional study including 5,162 pregnant women attending Montreal hospitals for antenatal care was conducted, with 1,400 being born outside of Canada. CES-D scale was used to evaluate depression at 24-26 weeks of pregnancy. The Abuse Assessment Screen scale was used to determine the frequency and severity of violence since the beginning of pregnancy. Relationship with abuser was also considered. All modeling was done using logistic regressions. Threats were the most frequent type of violence, with 63 % happening more than once. Long-term immigrant women reported the highest prevalence of all types of violence (7.7 %). Intimate partner violence (IPV) (15 %) was most frequently reported among the poorest pregnant women. Strong associations exist between more than one episode of abuse and depression (POR = 5.21 [3.73; 7.23], and IPV and depression [POR = 5.81 [4.19; 8.08]. Immigrant status did not change the associations between violence and depression. Violence against pregnant women is not rare in Canada, and it is associated with antenatal depressive symptoms. These findings support future development of perinatal screening for violence, follow-up, and a culturally sensitive referral system.

Work-related violence and incident use of psychotropics

Although the mental health consequences of domestic violence are well documented, empirical evidence is scarce regarding the mental health effects of violence in the workplace. Most studies have used data from small occupation-specific samples, limiting their generalizability. This article examines whether direct exposure to work-related violence is associated with clinically pertinent mental health problems, measured by purchases of psychotropics (antidepressants, anxiolytics, hypnotics), in a cross-occupational sample of 15,246 Danish employees free from using psychotropics at baseline. Self-reported data on work-related violence were merged with other data on purchases of medications through a national registry to estimate cause-specific hazard ratios during 3.6 years (1,325 days) of follow-up in the years 1996-2008. Outcomes were examined as competing risks, and analyses were adjusted for gender, age, cohabitation, education, income, social support from colleagues, social support from supervisor, and influence and quantitative demands at work. Work-related violence was associated with purchasing antidepressants alone (hazard ratio = 1.38, 95% confidence interval: 1.09, 1.75) or in combination with anxiolytics (hazard ratio = 1.74, 95% confidence interval: 1.13, 2.70) but not with purchasing anxiolytics or hypnotics only. The frequency of violent episodes and risk of caseness were unrelated. Work-related violence is associated with increased risk of clinically pertinent mental health problems. Reducing levels of work-related violence may help to prevent mental disorders in the working population.

Development and application of a population-based system for workplace violence surveillance in hospitals

BACKGROUND

A unique and comprehensive reporting and population-based violence surveillance system in a multi-site hospital system is presented.

METHODS

Incidence rates and rate ratios (RR) were calculated by year, hospital, violence type, and job category in six hospitals, 2003-2008.

RESULTS

Incidence rates per hospital for the 6-year period ranged from a low of 1.52 to a high of 10.89 incidents/100 full-time equivalents (FTEs), with the highest risk at a hospital with an outpatient mental health facility (RR = 7.16, 95%CI = 5.17-10.26). Rates for worker-on-worker violence exceeded rates for patient-to-worker violence from 2004 to 2008. Mental health technicians (RR = 13.82, 95%CI =  1.13-17.29) and security personnel (RR = 2.25, CI = 1.68-3.00) were at greatest risk for violence.

CONCLUSIONS

This surveillance system provides ongoing information on professional groups and hospital departments at risk and trends in violence reporting over time. It can be used to determine where appropriate violence prevention efforts are most needed, and to evaluate violence interventions.

Drivers' and conductors' views on the causes and ways of preventing workplace violence in the road passenger transport sector in Maputo City, Mozambique

Background

Workplace violence (WPV) is an occupational health hazard in both low and high income countries. To design WPV prevention programs, prior knowledge and understanding of conditions in the targeted population are essential. This study explores and describes the views of drivers and conductors on the causes of WPV and ways of preventing it in the road passenger transport sector in Maputo City, Mozambique.

Methods

The design was qualitative. Participants were purposefully selected from among transport workers identified as victims of WPV in an earlier quantitative study, and with six or more years of experience in the transport sector. Data were collected in semi-structured interviews. Seven open questions covered individual views on causes of WPV and its prevention, based on the interviewees' experiences of violence while on duty. Thirty-two transport professionals were interviewed. The data were analyzed by means of qualitative content analysis.

Results

The triggers and causes of violence included fare evasion, disputes over revenue owing to owners, alcohol abuse, overcrowded vehicles, and unfair competition for passengers. Failures to meet passenger expectations, e.g. by-passing parts of a bus route or missing stops, were also important. There was disrespect on the part of transport workers, e.g. being rude to passengers and jumping of queues at taxi ranks, and there were also robberies. Proposals for prevention included: training for workers on conflict resolution, and for employers on passenger-transport administration; and, promoting learning among passengers and workers on how to behave when traveling collectively. Regarding control and supervision, there were expressed needs for the recording of mileage, and for the sanctioning of workers who transgress queuing rules at taxi ranks. The police or supervisors should prevent drunken passengers from getting into vehicles, and drivers should refuse to go to dangerous, secluded neighborhoods. Finally, there is a need for an institution to judge alleged cases of employees not handing over demanded revenues to their employer.

Conclusions

The causes of WPV lie in problems regarding money, behavior, environment, organization and crime. Suggestions for prevention include education, control to avoid critical situations, and a judicial system to assess malpractices. Further research in the road passenger transport sector in Maputo City, Mozambique and similar settings is warranted.

[The influence of workplace violence on work-related anxiety and depression experience among Korean employees]

PURPOSE

Work-related anxiety and depression are frequent work-related mental health problems. In this study the relationship between workplace violence and work-related anxiety and/or depression among Korean employees was evaluated.

METHODS

Data were obtained from the Korean Working Condition Survey of 2006. Participants were 9,094 Korean workers aged 15-64 yr. Multiple logistic regression using SAS version 9.1 was used.

RESULTS

The incidence of work-related anxiety, work-related depression and workplace violence were 4.5%, 3.5%, and 1.8% respectively. When personal and occupational risk factors were adjusted, workplace violence was significantly associated with work-related anxiety and depression (OR for anxiety: 4.07, CI: 2.62-6.34; OR for depression: 4.60, CI: 2.92-7.25). Work-related anxiety was significantly related to type of employment, working period at present workplace, work time, shift work, job demand, and social support from superiors. Factors influencing work-related depression were gender, education, alcohol consumption, company size, type of employment, working period at present workplace, work time, shift work, and job demand.

CONCLUSION

To promote psychological health in workers there is a need to develop work-related anxiety and depression prevention programs and to decrease in workplace violence. In developing these programs, consideration should be given to personal factors, working conditions, and psychosocial working environments.

Occupation and mental health in a national UK survey

OBJECTIVES

To measure the prevalence of common mental disorder (CMD) by occupation in a representative sample of Great Britain and to identify occupations with increased and decreased risk of CMD.

METHODS

A cross-sectional interview-based survey was carried out including 5,497 working male and female respondents, 16-64 years from a stratified random survey of private households in Britain. Occupations were classified by the Standard Occupational Classification (SOC) into four groups: major, sub-major, minor and constituent unit groups. Common Mental Disorder was measured by the Revised Clinical Interview Schedule.

RESULTS

Major SOC groups with higher prevalence of common mental disorder included clerical and secretarial, sales, and personal and protective services whereas craft and related, 'other' professional occupations and plant and machine operatives had lower prevalence compared to 13% overall prevalence in all adults. In sub-major SOC groups managers and administrators, teaching professionals, clerical and secretarial, 'other' sales and personal service occupations had higher prevalence whereas many professional and skilled occupations had lower prevalence. Specific SOC unit groups with higher prevalence included primary and secondary teachers, welfare community, youth workers, security staff, waiters, bar staff, nurse auxiliaries and care assistants. General managers in government and large organizations (OR=2.79, 95% CI 1.41-5.54), managers in transport and storing (OR=2.44, 95% CI 1.18-5.03), buyers and mobile sales persons (OR=2.48, 95% CI 1.09-5.60), sales occupations (NES) (OR=2.78, 95% CI 1.25-6.19) and clerks (NES) (OR=2.71, 95% CI 1.59-4.61) had increased risk of common mental disorder relative to specialist managers adjusting for social and financial factors and physical ill-health.

CONCLUSIONS

Occupations with higher risk of common mental disorder may be typified by high levels of job demands, especially emotional demands and lack of job security. The reasons why occupations have low rates of common mental disorder are varied and may include high levels of job discretion, good job training and clearly defined job tasks.

Violence at the workplace increases the risk of musculoskeletal pain among nursing home workers

BACKGROUND

Despite the high prevalences of workplace physical violence and musculoskeletal symptoms among health care workers, very few studies have examined the relationship between these two phenomena.

METHODS

We surveyed 920 clinical nursing home workers by questionnaire regarding musculoskeletal pain in the low back, shoulders, wrists or hands, and knees. Information was also collected on exposure to physical assaults at work during the preceding 3 months, other workplace safety features, physical workload and psychosocial work environment. Log-binomial regression was used to estimate the prevalence ratios (PR) with 95% CIs.

RESULTS

Almost one-half of respondents reported being assaulted at least once during the preceding 3 months by a resident or resident's visitor. The prevalence of low back pain increased from 40% among non-assaulted workers to 70% among those assaulted three or more times. The highest risk was found for widespread pain (three or more areas), with an adjusted PR of 2.7 (95% CI 1.8 to 3.9) for workers assaulted three or more times. Good workplace safety buffered the effects, so that violence increased the risk of most pains considerably less in a work environment perceived to be safe.

CONCLUSIONS

To our knowledge, this is the first study to show a dose-response association between physical assaults and musculoskeletal pain in a health care setting where violence is a frequent occurrence. This emphasises the need to address violence as a workplace hazard through practical measures for prevention as well as in future aetiological research on musculoskeletal disorders.