The psychosocial and health effects of workplace reorganisation. 1. A systematic review of organisational-level interventions that aim to increase employee control

Organizational change: challenges for workplace psychosocial risks and employee mental health

BACKGROUND

Constant organizational change is the norm in many companies today. At present, evidence on the impact of organizational change on psychosocial risks at work and employee mental health is limited. We investigate organizational change and its association with psychosocial risks and mental health in three consecutive surveys covering 12 years.

METHODS

The study was based on data from three cross-sectional waves (2006, 2012, 2018) of the German BIBB/BAuA Employment Survey, comprising 53,295 employees. Four change indicators (i.e., introduction of new software, changes in goods and services produced/provided, downsizing and restructuring), five indicators of psychosocial risks (i.e., time pressure, interruptions, multitasking, working to the limits of capability, and working very quickly) and four mental health indicators (i.e., sleep disturbances, nervousness, tiredness and depressive symptoms) were investigated. We applied Poisson regression analysis to examine associations between organizational change, psychosocial risks, and mental health.

RESULTS

According to the pooled analysis of all three waves, the majority of employees reported having experienced at least one organizational change, such as downsizing or restructuring, between 2006 and 2018. Organizational change was negatively associated with psychosocial risks (e.g., working to the limits of one's capability, PR: 1.66; 95% CI: 1.48-1.86) and with employee mental health (PR: 1.82; 95% CI: 1.61-2.04).

CONCLUSIONS

Organizational change is omnipresent in the modern economy. Our research suggests that transformation processes in organizations can bear risks to employees' health as psychosocial risks increase. Therefore, companies planning organizational change should accompany such processes with occupational health and safety measures.

Reducing sickness absence among public-sector healthcare employees: the difference-making roles of managerial and employee participation

PURPOSE

Evaluations of organizational-level interventions to prevent work-related illness have identified enabling factors, but knowledge of necessary and sufficient conditions for intervention success is needed. The aim was to identify difference-making factors that distinguish intervention groups with and without a positive intervention effect on sickness absence.

METHODS

An organizational-level intervention designed to decrease sickness absence by providing support from process facilitators was implemented at eight healthcare workplaces in Sweden between 2017 and 2018. We applied coincidence analysis (CNA) to analyze 34 factors and determine which factors were necessary and sufficient for a successful implementation of tailored interventional measures on an organizational level (dichotomous) and reduced sickness absence (trichotomous).

RESULTS

Two factors perfectly explained both the presence and absence of a successful implementation: "a high sense of urgency" and "good anchoring and participation from the strategic management". The presence of either of these factors alone was sufficient for successful implementation, whereas the joint absence of both conditions was necessary and sufficient for the absence of successful implementation and an intervention effect. In addition, high employee participation was both necessary and sufficient for a high intervention effect. For organizations without high employee participation, successful implementation led to a medium-effect size.

CONCLUSIONS

This study identified participation as a difference-maker in the implementation process. Participation from different stakeholders turned out to be important in different phases. When implementing organizational-level interventions, high participation from both strategic management and employees appears to be crucial in terms of the intervention's effect on sickness absence.

Multifaceted ORganizational InterventiONs (M-ORION) project for prevention of depression and anxiety among workers: study protocol for a five-arm cluster randomized controlled trial

BACKGROUND

Depression and anxiety are the most common mental health issues experienced by workers. Although organizational intervention has been extensively evaluated as a primary prevention of depression and anxiety, the corresponding scientific evidence remains limited because of the lack of cluster randomized controlled trials (cRCT) and failure to detect organizational-level effects. Therefore, the present study aims to assess the preventive effects of four types of interventions on depression and anxiety among workers in an open, five-arm, parallel-group cRCT.

METHODS

Overall, 140 worksites and 18,200 nested employees will be recruited from September 2023. The eligible worksites will be randomly assigned to each of the five arms, and programs will be offered for 6-12 months. The five arms are 1) psychoeducation for workers, 2) psychoeducation for supervisors, 3) work environment improvement, 4) physical activity promotion, and 5) active control. The primary outcomes of interest are depression and anxiety. We will also assess psychosocial factors at work, work engagement, health-related quality of life, well-being, economic outcomes, physiological outcomes of health checkups, cortisol levels extracted from fingernails, and indices representing the process and implementation outcomes, including program completion rates. Follow-up surveys will be conducted at 6, 12, and 18 months from baseline, and the primary endpoint is set at the 6-month follow-up. Repeated-measures multi-level mixed modeling will be used to evaluate the effect of each intervention compared with the control.

ETHICS AND DISSEMINATION

The study protocol was approved by the Research Ethics Committee of the Kitasato University Medical Ethics Organization (C22-082). The results and findings of this study will be published in a scientific journal and disseminated to companies that participate in the study.

TRIAL REGISTRATION NUMBER

UMIN000050949.

Effects of participatory organizational interventions on mental health and work performance: a protocol for systematic review and meta-analysis

INTRODUCTION

Participatory organizational interventions to improve psychosocial working conditions are important for a safe and healthy work environment. However, there are few systematic reviews or meta-analyses investigating the effects of these interventions on workers' mental health and work-related outcomes. We intend to apply the protocol for systematic review and meta-analysis to examine the effect of participatory organizational intervention on mental health and work performance.

METHODS AND ANALYSIS

The participants, interventions, comparisons, and outcomes (PICO) of the studies in this systematic review and meta-analysis are defined as follows: (P) inclusion of all workers, (I) participatory organizational intervention, (C) treatment as usual or no intervention (including waitlist control), and (O) mental health and work performance. Published studies will be searched using the following electronic databases: PubMed, Embase, PsycINFO, PsycArticles, and Japan Medical Abstracts Society. Studies that (1) include participatory organizational intervention, (2) include participants who were working as of the baseline survey period, (3) assess mental health or work performance outcomes, (4) use a cluster randomized controlled trials design, (5) are published in English or Japanese, and (6) are published in peer-reviewed journals (including advanced online publication) will be included. Study selection and the risk-of-bias assessment will be performed independently by 2 reviewers. A meta-analysis will be performed to statistically synthesize the included studies. Publication bias will be assessed for meta-bias using Egger's test as well as visually on a funnel plot. We will assess heterogeneity by using the Q statistic.

Work-related causes of mental health conditions and interventions for their improvement in workplaces

Mental health problems and disorders are common among working people and are costly for the affected individuals, employers, and whole of society. This discussion paper provides an overview of the current state of knowledge on the relationship between work and mental health to inform research, policy, and practice. We synthesise available evidence, examining both the role of working conditions in the development of mental disorders, and what can be done to protect and promote mental health in the workplace. We show that exposure to some working conditions is associated with an increased risk of the onset of depressive disorders, the most studied mental disorders. The causality of the association, however, is still debated. Causal inference should be supported by more research with stronger linkage to theory, better exposure assessment, better understanding of biopsychosocial mechanisms, use of innovative analytical methods, a life-course perspective, and better understanding of the role of context, including the role of societal structures in the development of mental disorders. There is growing evidence for the effectiveness of interventions to protect and promote mental health and wellbeing in the workplace; however, there is a disproportionate focus on interventions directed towards individual workers and illnesses, compared with interventions for improving working conditions and enhancing mental health. Moreover, research on work and mental health is mainly done in high-income countries, and often does not address workers in lower socioeconomic positions. Flexible and innovative approaches tailored to local conditions are needed in implementation research on workplace mental health to complement experimental studies. Improvements in translating workplace mental health research to policy and practice, such as through workplace-oriented concrete guidance for interventions, and by national policies and programmes focusing on the people most in need, could capitalise on the growing interest in workplace mental health, possibly yielding important mental health gains in working populations.

Shifting from an individual to an organizational perspective in work environment management - a process evaluation of a six-year intervention program within the Swedish public sector

BACKGROUND

Working systematically with the work environment, particularly the organizational and psychosocial work environment entails several challenges for employers. There is a lack of knowledge on how to best undertake this work. Thus, the aim of this study is to evaluate the process of a six-year organizational-level intervention program where workplaces could apply for additional funds to implement preventive intervention measures, with the intention of improving working conditions and reducing sickness absence within the Swedish public sector.

METHODS

The program management process was studied using a mixed-method approach combining qualitative document and content analyses based on process documentation produced between 2017 and 2022 (n = 135), interviews with internal occupational health services professionals in 2021 (n = 9) and quantitative descriptive analyses of submitted applications with decisions from 2017 to 2022 (n = 621).

RESULTS

Qualitative analyses of the process documentation revealed concerns from the project group regarding access to sufficient competence and resources among stakeholders and participating workplaces, and role conflicts and ambiguities between the program and everyday operations. To address these challenges, the application process was developed over time using the knowledge gained from previous years. A change in the mental models in work environment management, from an individual to an organizational perspective, was seen among the project group and the internal occupational health services responsible for implementing most of the granted intervention measures. In addition, the proportion of granted intervention measures on an organizational level increased throughout the years from 39% in 2017 to 89% in 2022. The changes in the application process were believed to be the main contributor to the change among the applying workplaces.

CONCLUSIONS

Results indicate that a long-term organizational-level workplace intervention program may be used, by the employer, as a tool for shifting from an individual- to an organizational perspective in the work environment management. However, additional measures on multiple levels need to be implemented to secure a sustainable shift in perspective within the organization.

Autonomy in the context of cognitive demands-is the resource becoming a stressor?

OBJECTIVE

Autonomy is often associated with positive linear effects on health whereas non-linear correlations have received only sporadic attention. Assuming that the use of autonomy also represents a cognitive demand, this study examines whether health effects of autonomy change depending on further cognitive demands and whether curvilinear relationships can be identified.

METHODS

A survey was carried out in three SMEs with established work analysis questionnaires. 197 Employees were classified into groups with high and with low cognitive demands by means of a two-step cluster analysis. This was modeled as moderator together with curvilinear effects of autonomy in regression analyses.

RESULTS

Curvilinear associations were found for emotional exhaustion, cynicism, and anxiety. They were strongest for anxiety. No moderating effects of cognitive demands and no consistently significant modeled relations were found.

CONCLUSION

The results confirm that autonomy has a positive influence on the health of employees. However, autonomy should not be seen as an isolated resource but embedded in the organizational and societal context.

Creating healthy workplaces in healthcare: Are we delaying progress by focusing on what we can do rather than what we should do?

All the available evidence points to the fact that healthcare is under considerable stress, and while change is urgently needed there is no quick fix; systemic and sustained changes in organizational cultures within healthcare are required. Moreover, the fragility of healthcare systems globally has been starkly exposed by the Coronavirus 2019 pandemic. We have gathered enough evidence to know what is driving poor wellbeing, and how these processes impact on quality of care and patient safety. Indeed, we have a good idea of what we need to do to improve the situation. Therefore, this begs a simpler question; If we know how to create healthy workplaces, why is it so difficult to achieve this in healthcare? In the following perspective paper, we will argue that we can do better if we address the following three issues: (1) we are ignoring the real problems, (2) limited successes that we are achieving are moving us further from tackling the real problems, (3) culture change is accepted as crucial, but we are not accepting what the evidence is telling us about healthcare culture. Tackling burnout is useful and necessary, but we must increase dignity among healthcare employees. Moreover, we need to train line managers to recognize and facilitate the need of employees to feel competent and be appreciated by others, while helping them set wellbeing boundaries.

Association of Psychosocial Stress With Risk of Acute Stroke

IMPORTANCE

Psychosocial stress is considered a modifiable risk factor for stroke. Given the prevalence of chronic and acute exposure to stress, it represents a potentially attractive target for population-health interventions.

OBJECTIVES

To determine the association of psychosocial stress with the risk of acute stroke and explore factors that might modify the association of stress with risk of acute stroke in a large international population.

DESIGN, SETTING, AND PARTICIPANTS

INTERSTROKE is an international retrospective case-control study of risk factors for first acute stroke in 32 countries in Asia, North and South America, Europe, Australia, the Middle East, and Africa. A total of 13 462 patients with stroke and 13 488 matched controls were recruited between January 11, 2007, and August 8, 2015. The present analyses were performed from June 1 to 30, 2021, and included 13 350 cases and 13 462 controls with available data on psychosocial stress.

EXPOSURES

Psychosocial stress and occurrence of stressful life events within the preceding year were measured using a standardized questionnaire of self-reported stress at home and work.

MAIN OUTCOMES AND MEASURES

The association of stress with acute stroke and its subtypes was examined using multivariable conditional logistic regression and factors that might modify the association, particularly self-reported locus of control.

RESULTS

Among 26 812 participants included in the analysis, the mean (SD) age of cases was 62.2 (13.6) years; that of controls, 61.3 (13.3) years; 7960 cases (59.6%) and 8017 controls (59.6%) were men. Several periods of stress and permanent stress were reported for 2745 cases (20.5%) and 1933 controls (14.4%), with marked regional variation in prevalence, with the lowest in China (201 of 3981 [5.0%] among controls and 364 of 3980 [9.1%] among cases) and highest in South East Asia (233 of 855 [26.1%] among controls and 241 of 782 [30.8%] among cases). Increased stress at home (odds ratio [OR], 1.95 [95% CI, 1.77-2.15]) and at work (OR, 2.70 [95% CI, 2.25-3.23]) and recent stressful life events (OR, 1.31 [95% CI, 1.19-1.43]) were associated with an increased risk of acute stroke on multivariable analyses (vs no self-reported stress). Higher locus of control at home was associated with a reduced odds of all stroke (OR, 0.73 [95% CI, 0.68-0.79]), and higher locus of control both at work and at home were associated with a lower odds of acute stroke and significantly diminished the association with stress at work (OR, 2.20 [95% CI, 1.88-2.58]; P = .008 for interaction) and home (OR, 1.69 [95% CI, 1.44-1.98]; P < .001 for interaction) for acute stroke.

CONCLUSIONS AND RELEVANCE

Psychosocial stress is a common risk factor for acute stroke. The findings of this case-control study suggest that higher locus of control is associated with lower risk of stroke and may be an important effect modifier of the risk associated with psychosocial stress.

The Effect of Employee-Oriented Flexible Work on Mental Health: A Systematic Review

The effect of flexible work on mental health is not well known. The aim of this systematic review was to assess the effects of employee-oriented flexible work on mental health problems and associated disability. Literature searches were conducted in the PubMed, Scopus, Web of Sciences, Cochrane Library, PsycINFO, ProQuest and EconPapers databases from their inception through October-November 2020. Sixteen studies on the associations of worktime control, working from home, or flexible working arrangements with mental health related outcomes were included in the review: one cluster randomized controlled trial, two non-randomized controlled trials, two cross-over studies, and 11 prospective cohort studies. Three reviewers independently assessed the met-hodological quality of the included studies and extracted the data. The included studies differed in design, intervention/exposure, and outcome, so meta-analysis was not carried out and qualitative results were reported. A few prospective cohort studies found that low employees' control over worktime increases the risk of depressive symptoms, psychological distress, burnout, and accumulated fatigue. One cross-over and a few cohort studies found small beneficial effects of working partly from home on depressive symptoms, stress, and emotional exhaustion. A small number of controlled trials, cross-over or cohort studies found that flexible working arrangements increase employees' control over working hours, but have only modest beneficial effects on psychological distress, burnout, and emotional exhaustion. This systematic review suggests that employee-oriented flexible work may have small beneficial effects on mental health. However, randomized controlled trials and quasi-experimental studies are needed to identify the health effects of flexible work.

Socioeconomic differences in recruitment and sickness absence in a large NHS health organisation: a cross-sectional study

OBJECTIVE

This study investigates the distribution of the workforce of one large National Health Service (NHS) employer in relation to socioeconomic deprivation and how sickness absence rates varied across these levels of deprivation.

DESIGN

Share of the working age population that was employed at the NHS organisation mapped by area deprivation. The study used negative binomial regression models to investigate the extent to which wage level, occupational group and area deprivation were associated with sickness absence among employees.

SETTING

The study used electronic staff records (2018-2019) of a large NHS organisation in the North West of England.

RESULTS

In the most deprived areas, an additional person per 1000 working age population were employed at this NHS organisation compared with the most affluent areas. Employees from the most deprived quintile had 1.41 (95% CI 1.16 to 1.70) times the higher sickness rates than the employees from the least deprived quintile, when adjusting for age and sex. These differences were largely explained by differences in wage levels and occupation groups, with the lowest wage employees having 2.5 (95% CI 1.87 to 3.42) times the sickness absence rate as the highest wage group and the nursing and midwifery employees having 1.8 (95% CI 1.50 to 2.24) times the sickness absence rate as the administrative and clerical group.

CONCLUSION

This large NHS organisation employed people disproportionately from deprived areas. They were considerably more likely to experience sickness absence compared with people from affluent areas. This appears to be because they were more likely to be in lower wage employment and employed in nursing and nursing assistant. Workplace health policies need to target these workers, adapting to their needs while enabling improvements in their working conditions, pay and career progression.

Multilevel, risk group-oriented strategies to decrease sickness absence in the public sector: evaluation of interventions in two regions in Sweden

Purpose

Sickness absence has been identified as needing to be addressed through multilevel interventions, but knowledge regarding optimal design and implementation of such interventions is scarce. The aim of this study was to evaluate the implementation and effects of a large-scale multilevel intervention in the public sector in Sweden.

Methods

The overall effect of the intervention was assessed using mixed-effect models. Sickness absence data (before, and 6 or 12 months after the intervention) for 90 intervention groups and 378 reference groups was retrieved from administrative personnel systems from the two participating regional councils. The implementation processes were evaluated using qualitative content analysis of qualitative interviews conducted at two timepoints.

Results

The results show that the vast majority of implemented measures were on an individual level and the integration of the intervention differed between the two regions. The reception and perception of the intervention activities seem to have been influenced by the implementation process, and how well the interventions were communicated and integrated, both regarding the integration of the different interventions and their integration into the discrete context and existing routines. No short-term overall effects on sickness absence were found.

Conclusions

The results point to the many challenges in implementing complex interventions, especially where organizational measures are involved—including adequate participation by, and communication between, the involved actors, as well as sufficient resources. The results indicate potential learning effects regarding the awareness of organizational factors in sick leave, after implementing and integrating multilevel strategies.

Prenatal work stress is associated with prenatal and postnatal depression and anxiety: Findings from the Norwegian Mother, Father and Child Cohort Study (MoBa)

BACKGROUND

An emerging body of research suggests that stress experienced in the workplace can have detrimental impacts on maternal mental health, including greater risk of postnatal depression. However, few longitudinal studies have examined these associations during the perinatal period. The objective of this study was to examine the associations between prenatal work stress and subsequent depression and anxiety.

METHODS

This study is based on the Norwegian Mother, Father and Child Cohort Study (MoBa), and included 77,999 employed women recruited between 1999 and 2008. The exposure variable was prenatal work stress measured at 17 weeks' gestation, using an 8-item scale examining factors including autonomy, working relationships, and work enjoyment. Outcomes included depression and anxiety at 30 weeks' gestation and 6 months postpartum, measured using the Symptom Checklist-8. Analyses comprised of unadjusted and adjusted logistic regressions.

RESULTS

After covariate adjustment, prenatal work stress was associated with depression and anxiety at 30 weeks' gestation (OR = 1.33, 95% CI: 1.19-1.49), and 6 months postpartum (OR = 1.44, 95% CI: 1.28-1.61). Most associations remained after adjustment for additional work-related variables and maternity leave.

LIMITATIONS

Work stress was measured once during pregnancy, thus variation of associations by trimester could not be investigated. Findings are reported for a sample with high socioeconomic status, and may not generalize to other populations.

CONCLUSIONS

Women dealing with work stress during pregnancy are more likely to experience subsequent depression and anxiety. Findings can inform the development of workplace strategies to support the mental health of expecting and new mothers.

Do work-family initiatives improve employee mental health? Longitudinal evidence from a nationally representative cohort

BACKGROUND

Work stress and work-family conflict are important correlates of affective disorders. The article explored (1) whether the wide adoption of work-family initiatives improve a national workforce's mental health; (2) whether the potential benefits differ between the initiatives that give employees autonomy over job quality (flexible schedule and telework) or job quantity (work hours); (3) whether the effects depend on employee's perceived availability or actual usage of the initiatives, and if so, what are the respective mechanisms; and (4) whether there are gender differences in the mental health effects.

METHODS

Fixed-effects analyses of five-wave panel surveys from 2010 to 2020 on a probability sample of 34,484 British workers, which measured mental health with the GHQ-12 scale. Job satisfaction and leisure time satisfaction were tested as mediators.

RESULTS

Perceived availability of work-family initiatives improved men and women's mental health by increasing their job satisfaction. Actual usage of work-family initiatives improved women's, but not men's, mental health by increasing their job satisfaction and leisure time satisfaction. The mental health benefits of flexible schedule and telework initiatives are larger than reduced work hours initiatives.

LIMITATIONS

The exploratory study used a broad mental health outcome and did not measure work-family initiatives' effects on specific affective disorders such as anxiety and depression. The study could not eliminate time-varying confounders.

CONCLUSIONS

Actual and perceived job quality are important in workplace mental health promotion. Organizational leaders and policymakers can offer flexible work time and place to reduce work-family conflict and prevent employees' affective disorders.

The differences of the economic losses due to presenteeism and treatment costs between high-stress workers and non-high-stress workers using the stress check survey in Japan

OBJECTIVES

This study sought to examine differences in the economic losses due to presenteeism and costs of medical and dental treatment between high-stress workers and non-high-stress workers using the stress check survey.

METHODS

We conducted a cross-sectional study from April 1, 2018 to March 31, 2019 in a pharmaceutical company. High-stress workers were classified with the Brief Job Stress Questionnaire using two methods: the sum method and the score converted method. The incidence of presenteeism and its costs were determined using a questionnaire. The costs of medical and dental treatment were calculated according to claims. We compared the costs between high-stress and non-high-stress workers using Wilcoxon's rank-sum test.

RESULTS

Of 3910 workers, 6.3% were classified as high-stress using the sum method and 6.6% were classified as high-stress using the score converted method. The costs associated with presenteeism and medical treatment among high-stress workers were higher than the costs among non-high-stress workers, whereas the costs associated with dental treatment were not.

CONCLUSIONS

To motivate employers to improve stressful work environments, it is recommended that presenteeism measurement items be added to the stress check survey, and that the methods used in this study be used to calculate the loss associated with high-stress workers in Japanese companies. However, we must be careful in interpreting absolute presenteeism loss amounts because they are poorly reliable and valid.

Expected Labor Market Affiliation: A New Method Illustrated by Estimating the Impact of Perceived Stress on Time in Work, Sickness Absence and Unemployment of 37,605 Danish Employees

As detailed data on labor market affiliation become more accessible, new approaches are needed to address the complex patterns of labor market affiliation. We introduce the expected labor market affiliation (ELMA) method by estimating the time-restricted impact of perceived stress on labor market affiliation in a large sample of Danish employees. Data from two national surveys were linked with a national register. A multi-state proportional hazards model was used to calculate ELMA estimates, i.e., the number of days in work, sickness absence, and unemployment during a 4-year follow-up period, stratified by gender and age. Among employees reporting frequent work-related stress, the expected number of working days decreased with age, ranging from 103 days lost among older women to 37 days lost among younger and middle-aged men. Young and middle-aged women reporting frequent work- and personal life-related stress lost 62 and 81 working days, respectively, and had more days of sickness absence (34 days and 42 days). In conclusion, we showed that perceived stress affects the labor market affiliation. The ELMA estimates provide a detailed understanding of the impact of perceived stress on labor market affiliation over time, and may inform policy and practice towards a more healthy and sustainable working life.

Effectiveness of a workplace intervention reducing psychosocial stressors at work on blood pressure and hypertension

Objectives

To assess the effectiveness of a workplace intervention reducing psychosocial stressors at work in lowering blood pressure and hypertension prevalence.

Methods

The study design was a quasi-experimental pre–post study with an intervention group and a control group. Post-intervention measurements were collected 6 and 36 months after the midpoint of the intervention. Participants were all white-collar workers employed in three public organisations. At baseline, the intervention and the control groups were composed of 1088 and 1068 workers, respectively. The intervention was designed to reduce psychosocial stressors at work by implementing organisational changes. Adjusted changes in ambulatory blood pressure and hypertension prevalence were examined.

Results

Blood pressure and hypertension significantly decreased in the intervention group while no change was observed in the control group. The differential decrease in systolic blood pressure between the intervention and the control group was 2.0 mm Hg (95% CI: −3.0 to –1.0). The prevalence of hypertension decreased in the intervention group, when compared with the control group (prevalence ratio: 0.85 (95% CI: 0.74 to 0.98)).

Conclusions

Findings suggest that psychosocial stressors at work are relevant targets for the primary prevention of hypertension. At the population level, systolic blood pressure reductions such as those observed in the present study could prevent a significant number of premature deaths and disabling strokes.

Methodological approach for measuring the effects of organisational-level interventions on employee withdrawal behaviour

Background

Theoretical frameworks have recommended organisational-level interventions to decrease employee withdrawal behaviours such as sickness absence and employee turnover. However, evaluation of such interventions has produced inconclusive results. The aim of this study was to investigate if mixed-effects models in combination with time series analysis, process evaluation, and reference group comparisons could be used for evaluating the effects of an organisational-level intervention on employee withdrawal behaviour.

Methods

Monthly data on employee withdrawal behaviours (sickness absence, employee turnover, employment rate, and unpaid leave) were collected for 58 consecutive months (before and after the intervention) for intervention and reference groups. In total, eight intervention groups with a total of 1600 employees participated in the intervention. Process evaluation data were collected by process facilitators from the intervention team. Overall intervention effects were assessed using mixed-effects models with an AR (1) covariance structure for the repeated measurements and time as fixed effect. Intervention effects for each intervention group were assessed using time series analysis. Finally, results were compared descriptively with data from process evaluation and reference groups to disentangle the organisational-level intervention effects from other simultaneous effects.

Results

All measures of employee withdrawal behaviour indicated statistically significant time trends and seasonal variability. Applying these methods to an organisational-level intervention resulted in an overall decrease in employee withdrawal behaviour. Meanwhile, the intervention effects varied greatly between intervention groups, highlighting the need to perform analyses at multiple levels to obtain a full understanding. Results also indicated that possible delayed intervention effects must be considered and that data from process evaluation and reference group comparisons were vital for disentangling the intervention effects from other simultaneous effects.

Conclusions

When analysing the effects of an intervention, time trends, seasonal variability, and other changes in the work environment must be considered. The use of mixed-effects models in combination with time series analysis, process evaluation, and reference groups is a promising way to improve the evaluation of organisational-level interventions that can easily be adopted by others.

Can Working Conditions and Employees' Mental Health Be Improved via Job Stress Interventions Designed and Implemented by Line Managers and Human Resources on an Operational Level?

Organisational-level interventions are recommended for decreasing sickness absence, but knowledge of the optimal design and implementation of such interventions is scarce. We collected data on working conditions, motivation, health, employee turnover, and sickness absence among participants in a large-scale organisational-level intervention comprising measures designed and implemented by line managers and their human resources partners (i.e., operational-level). Information regarding the process, including the implementation of measures, was retrieved from a separate process evaluation, and the intervention effects were investigated using mixed-effects models. Data from reference groups were used to separate the intervention effect from the effects of other concurrent changes at the workplace. Overall, working conditions and motivation improved during the study for both the intervention and reference groups, but an intervention effect was only seen for two of 13 evaluated survey items: clearness of objectives (p = 0.02) and motivation (p = 0.06). No changes were seen in employees' perceived health, and there were no overall intervention effects on employee turnover or sickness absence. When using operational-level workplace interventions to improve working conditions and employees' health, efforts must be made to achieve a high measure-to-challenge correspondence; that is, the implemented measures must be a good match to the problems that they are intended to address.

Changes in risk factors for non-communicable diseases associated with the 'Healthy choices at work' programme, South Africa

BACKGROUND

Globally 71% of deaths are attributed to non-communicable diseases (NCD). The workplace is an opportune setting for health promotion programs and interventions that aim to prevent NCDs. However, much of the current evidence is from high-income countries.

OBJECTIVE

The aim of this study was to evaluate changes in NCD risk factors, associated with the Healthy Choices at Work programme (HCWP), at a commercial power plant in South Africa.

METHODS

This was a before-and-after study in a randomly selected sample of 156 employees at baseline and 137 employees at 2-years. The HCWP focused on food services, physical activity, health and wellness services and managerial support. Participants completed questionnaires on tobacco smoking, harmful alcohol use, fruit and vegetable intake, physical activity, psychosocial stress and history of NCDs. Clinical measures included blood pressure, total cholesterol, random blood glucose, body mass index, waist circumference and waist-to-hip ratio. The 10-year cardiovascular risk was calculated using a validated algorithm. Sample size calculations evaluated the power of the sample to detect meaningful changes in risk factors.

RESULTS

Paired data was obtained for 137 employees, the mean age was 42.7 years (SD 9.7) and 64% were male. The prevalence of sufficient fruit and vegetable intake increased from 27% to 64% (p < 0.001), those meeting physical activity guidelines increased from 44% to 65% (p < 0.001). Harmful alcohol use decreased from 21% to 5% (p = 0.001). There were clinical and statistically significant improvements in systolic and diastolic blood pressure (mean difference -10.2 mmHg (95%CI: -7.3 to -13.2); and -3.9 mmHg (95%CI: -1.8 to -5.8); p < 0.001) and total cholesterol (mean difference -0.45 mmol/l (-0.3 to -0.6)). There were no significant improvements in BMI. Psychosocial stress from relationships with colleagues, personal finances, and personal health improved significantly. The cardiovascular risk score decreased by 4.5% (> 0.05).

CONCLUSION

The HCWP was associated with clinically significant reductions in behavioural, metabolic and psychosocial risk factors for NCDs.

Qualitative process evaluation from a complex systems perspective: A systematic review and framework for public health evaluators

BACKGROUND

Public health evaluation methods have been criticized for being overly reductionist and failing to generate suitable evidence for public health decision-making. A "complex systems approach" has been advocated to account for real world complexity. Qualitative methods may be well suited to understanding change in complex social environments, but guidance on applying a complex systems approach to inform qualitative research remains limited and underdeveloped. This systematic review aims to analyze published examples of process evaluations that utilize qualitative methods that involve a complex systems perspective and proposes a framework for qualitative complex system process evaluations.

METHODS AND FINDINGS

We conducted a systematic search to identify complex system process evaluations that involve qualitative methods by searching electronic databases from January 1, 2014-September 30, 2019 (Scopus, MEDLINE, Web of Science), citation searching, and expert consultations. Process evaluations were included if they self-identified as taking a systems- or complexity-oriented approach, integrated qualitative methods, reported empirical findings, and evaluated public health interventions. Two reviewers independently assessed each study to identify concepts associated with the systems thinking and complexity science traditions. Twenty-one unique studies were identified evaluating a wide range of public health interventions in, for example, urban planning, sexual health, violence prevention, substance use, and community transformation. Evaluations were conducted in settings such as schools, workplaces, and neighborhoods in 13 different countries (9 high-income and 4 middle-income). All reported some utilization of complex systems concepts in the analysis of qualitative data. In 14 evaluations, the consideration of complex systems influenced intervention design, evaluation planning, or fieldwork. The identified studies used systems concepts to depict and describe a system at one point in time. Only 4 evaluations explicitly utilized a range of complexity concepts to assess changes within the system resulting from, or co-occurring with, intervention implementation over time. Limitations to our approach are including only English-language papers, reliance on study authors reporting their utilization of complex systems concepts, and subjective judgment from the reviewers relating to which concepts featured in each study.

CONCLUSION

This study found no consensus on what bringing a complex systems perspective to public health process evaluations with qualitative methods looks like in practice and that many studies of this nature describe static systems at a single time point. We suggest future studies use a 2-phase framework for qualitative process evaluations that seek to assess changes over time from a complex systems perspective. The first phase involves producing a description of the system and identifying hypotheses about how the system may change in response to the intervention. The second phase involves following the pathway of emergent findings in an adaptive evaluation approach.

Process Evaluation of a Participative Organizational Intervention as a Stress Preventive Intervention for Employees in Swedish Primary Health Care

This study is a process evaluation of a trial examining the effects of an organizational intervention (Productivity Measurement and Enhancement System or ProMES) on employee stress. The aims were to explore the implementation process and fidelity to the intervention guidelines, examine the influence of contextual factors (hindrances and facilitators) and explore participants' experience of working with ProMES. We used the UK Medical Research Council (MRC) guidance to guide the process evaluation. The recruitment, reach and dose delivered were satisfactory and participation high. The employees felt ProMES clarified priorities, gave control and increased participation in decision-making. However, difficulty in obtaining statistical productivity data from the central administration office (a central feature of the intervention) hindered full implementation and regular feedback meetings. Staffing shortages interfered with the implementation process, while having seven design teams and one consultant prevented all occupational groups from working simultaneously. A detailed examination of access to necessary organizational data should be undertaken before implementing ProMES. We recommend a better introduction for new employees, more work on design and packaging and giving employees more training in how to use the software program. The study contributes to our understanding of process evaluations in research into organizational stress management interventions.

Evaluation of a Caregiver-Friendly Workplace Program Intervention on the Health of Full-Time Caregiver Employees: A Time Series Analysis of Intervention Effects

OBJECTIVE

To evaluate effectiveness of a workplace educational intervention at improving health-related outcomes in carer-employees.

METHODS

A pre-post test design compared with health of a sample (n = 21) of carer-employees before (T1) and after (T2) a workplace intervention, as well as a final timepoint (T3) 12 months after T1. An aggregate health score was used to measure health and consisted three scales; depression (CES-D), psychosocial (CRA), and self-reported health (SF-12), where higher scores indicated higher frequency of adverse health symptoms. Three random-slope models were created via the linear mixed modeling method (LMM) to illustrate changes in reported health.

RESULTS

All three LMM models reported a reduction in participants' health score, particularly between T1 and T2, indicating a decrease in reported adverse health symptoms.

CONCLUSION

The intervention was successful in improving the health of carer-employees.

Implementation and effectiveness of the Stress Check Program, a national program to monitor and control workplace psychosocial factors in Japan: a systematic review. Translated secondary publication

Purpose

The purpose of this paper is to conduct a comprehensive review on the implementation and the effect of Japan's Stress Check Program, a national program to monitor and control workplace psychosocial factors that was initiated in December 2015.

Design/methodology/approach

We comprehensively reviewed articles published in Japanese and English, assessed the performance of the Stress Check Program and summarized future challenges. We also discussed the implications for practice.

Findings

The available literature presented a scientific basis for the efficiency and validity of predictions using the Brief Job Stress Questionnaire, which is the instrument recommended to screen workers with high stress in the program. No study has verified the effect of the program on workers' mental health by using group analysis of stress check results. There is room for improvement in tools that contribute to identifying workers with high stress and in measures for improving the work environment. The Stress Check Program contrasts with risk management of psychosocial factors at work, widely adopted in European countries as a strategy for improving workers' mental health by focussing on the psychosocial work environment.

Practical implications

Although the effectiveness of the Japanese program needs further evaluation, future developments of the program would provide insight for national policies on psychosocial risks/psychosocial stress at work.

Originality/value

This paper is the first systematic review on the implementation and effects of Japan's Stress Check Program.

Work-related moderators of the relationship between organizational change and sickness absence: a longitudinal multilevel study

Background

A sizeable body of research has demonstrated a relationship between organizational change and increased sickness absence. However, fewer studies have investigated what factors might mitigate this relationship. The aim of this study was to examine if and how the relationship between unit-level downsizing and sickness absence is moderated by three salient work factors: temporary contracts at the individual-level, and control and organizational commitment at the work-unit level.

Methods

We investigated the association between unit-level downsizing, each moderator and both short- and long-term sickness absence in a large Norwegian hospital (n = 21,085) from 2011 to 2016. Data pertaining to unit-level downsizing and employee sickness absence were retrieved from objective hospital registers, and moderator variables were drawn from hospital registers (temporary contracts) and the annual work environment survey (control and organizational commitment). We conducted a longitudinal multilevel random effects regression analysis to estimate the odds of entering short- (< = 8 days) and long-term (> = 9 days) sickness absence for each individual employee.

Results

The results showed a decreased risk of short-term sickness absence in the quarter before and an increased risk of short-term sickness absence in the quarter after unit-level downsizing. Temporary contracts and organizational commitment significantly moderated the relationship between unit-level downsizing in the next quarter and short-term sickness absence, demonstrating a steeper decline in short-term sickness absence for employees on temporary contracts and employees in high-commitment units. Additionally, control and organizational commitment moderated the relationship between unit-level downsizing and long-term sickness absence. Whereas employees in high-control work-units had a greater increase in long-term sickness absence in the change quarter, employees in low-commitment work-units had a higher risk of long-term sickness absence in the quarter after unit-level downsizing.

Conclusions

The results from this study suggest that the relationship between unit-level downsizing and sickness absence varies according to the stage of change, and that work-related factors moderate this relationship, albeit in different directions. The identification of specific work-factors that moderate the adverse effects of change represents a hands-on foundation for managers and policy-makers to pursue healthy organizational change.

Developing Stress Management Programs in a Public Primary Healthcare Institution: Should We Consider Health Workers' Sociodemographic Groups?

Background and Objectives: An essential part of occupational stress management is identifying target groups and developing a wellbeing program that tailors interventions to the specific needs of the target groups. This study aims to explore whether psychosocial risk determinants and organizational intervention objects differ across employees’ groups based on sociodemographic factors in a Lithuanian public primary healthcare institution. Methods: All 690 health workers of the institution were invited to participate (response rate 68%) in a cross-sectional survey between February and March 2017. The questionnaire contained items related to sociodemographic factors (gender, age, job seniority, education, and occupation), 14 psychosocial risk determinants, and 10 organisational intervention objects. Results: The results of the study showed that differences by gender were not statistically significant except for one organisational intervention object (work–life balance). Only a few organisational intervention objects (justice of reward, matching to the job demand, and variety of tasks) had mean rank scores differing statistically across age and job seniority groups. Five organisational intervention objects (work–life balance, variety of tasks, communication, manager feedback, and stress management training) had mean rank scores differing statistically across education groups, and all organisational intervention objects (except stress management training) had mean rank scores differing statistically across occupational groups. Regarding psychosocial risk determinants, excessive work pace had mean rank scores differing statistically across age and job seniority groups. Four (overtime, unclear role, conflicting roles, and being under-skilled) and six psychosocial risk determinants (work overload, overtime, tight deadlines, unclear role, being under-skilled, and responsibility) had mean scores differing statistically across education and occupational groups, respectively. Statistical significance was considered with p-value < 0.05 and 95% confidence interval. Conclusions: The findings showed that different psychosocial risk determinants and organizational interventional objects were emphasized by different sociodemographic groups in the institution, but they did not impact groups in the same measure. Therefore, it is crucial to start by determining the risk group’s specific needs before developing and implementing stress management programs.

Psychosocial working conditions and depressive disorder: disentangling effects of job control from socioeconomic status using a life-course approach

PURPOSE

Job control, the combination of skill discretion and decision authority, is considered a central component of the psychosocial working environment. This longitudinal study examines the relation between job control and risk of incident depressive disorder using a life-course approach.

METHODS

We analyze data from The Danish Work Life Course Cohort study, including all Danish individuals aged 15-30 who entered the Danish labor market during 1995-2009 and were free from depressive disorder at entry (955,573 individuals). We measured job control using a job exposure matrix. Depressive disorders were measured using information from nationwide registers of psychiatric in- and outpatient admissions. Using Cox regression models we estimated the prospective association between job control and risk of incident depressive disorders. Analyses accounted for a range of potential confounders prior to workforce entry including socioeconomic status in adolescence and parental psychiatric and somatic diagnoses prior to labor market entry, together with potential confounders in adulthood including income, education, and demographics.

RESULTS

Lower levels of past year job control were associated with a higher risk of depressive disorder after adjustment for all covariates (HR = 1.27, 95% CI 1.16-1.38). Results stratified by gender showed associations for both men (HR = 1.38, 95% CI 1.19-1.61) and women (HR = 1.19, 95% CI 1.08-1.32).

CONCLUSIONS

Our findings suggest that the level of job control at work affects the risk of clinically diagnosed depressive disorder, and that this association is not due to confounding by socioeconomic status.

The Effect of Organizational Changes on the Psychosocial Work Environment: Changes in Psychological and Social Working Conditions Following Organizational Changes

Purpose: The present study aimed to clarify the prospective effects of various types and frequencies of organizational changes on aspects in the psychosocial work environment. Methods: The study had a prospective, full-panel, repeated measures design. Data were collected by self-administered, online questionnaires, with a 2-year interval between measurement occasions. Five types of organizational change were assessed - company restructuring, downsizing, layoffs, partial closure, and partial outsourcing. The effects of change on eleven, specific work factors were measured utilizing QPS Nordic. At baseline, 12652 employees participated, while 8965 responded at follow-up. Generalized estimating equations were utilized to estimate the effects of change taking place within the last 12 months or more than 24 months prior. Results: Cross-sectional analyses, i.e., changes occurring within the last 12 months, showed all 11 work factors to be statistically significantly associated with the organizational changes restructuring, downsizing, and partial closure (coefficients ranging -0.28 to 0.04). In the prospective analyses, i.e., the effects of change taking place more than 24 months prior, associations were no longer significant for a number of work factors, although all types of organizational change remained significantly associated with at least three work factors (coefficients ranging -0.14 to 0.05). Following repeated organizational changes, statistically significant associations were shown for all 11 work factors (coefficients ranging from 0.39 to -0.04). Conclusion: Following both separate and repeated organizational change, various psychological and social work factors were altered, with the most pronounced effects following repeated change. These results suggest the implementing organizational change, especially repeated change, may have an adverse effect on various parts of the psychosocial work environment. The negative effects of a company's psychosocial working conditions may contribute to the adverse health effects often observed following such changes and help explain why many change initiatives fail to reach its intended results.

Fatigue in ferry shipping employees: the role of work-family conflict and supervisor support

Background

Fatigue is a concern in ferry shipping as it has a negative impact on crew members health and plays a major role in marine incidents and accidents. Research within land-based occupational settings has found that work-family conflict is an important risk factor for fatigue and that support from leaders constitutes a possible resource with the potential to buffer a negative impact from work-family conflict. Though, the working conditions of ferry shipping are likely to interfere with employee’s family life those two factors have received little attention in research on seafarers’ health. Therefore, the aim of this study was to investigate the direct associations between work-family conflict as well as leaders’ support with fatigue in employees of the Danish ferry shipping industry. Further, the study aimed at testing whether support could buffer potential detrimental associations between work-family conflict and fatigue.

Methods

The study design was cross-sectional, and 193 respondents answered to a self-administered questionnaire. Fatigue was measured with the Swedish Occupational Fatigue Inventory. Perceived work-family conflict and perceived supervisor support were assessed with two subscales from the Copenhagen Psychosocial Questionnaire. The association of potential risk factors with fatigue was determined using hierarchical multiple linear regression analyses.

Results

After controlling for confounding, work-family conflict was found to be positively associated with four of the five subdimensions of fatigue; lack of energy, physical discomfort, lack of motivation and sleepiness, while more support from supervisors was related to less lack of energy, physical exhaustion and lack of motivation. Further, supervisor support was found to moderate the effect from work-family conflict on the physical subdimensions of fatigue.

Conclusion

Although restricted by its cross-sectional design and a limited sample, this study provides support for the independent relevance of work family conflict and support from nearest superior for employee fatigue in ferry shipping. Further, there was evidence for a moderating role of such support on the negative impact of work-family conflict on the physical aspects of fatigue. Shipping companies may consider commencing initiatives which reduce conflicts between family life and work obligations, and that leader support may be a relevant component in such initiatives.

Gendered Pathways to Burnout: Results from the SALVEO Study

Aim

Burnout is a pervasive mental health problem in the workforce, with mounting evidence suggesting ties with occupational and safety outcomes such as work injuries, critical events and musculoskeletal disorders. While environmental [work and non-work, work-to-family conflict (WFC)] and individual (personality) pathways to burnout are well documented, little is known about how gender comes to influence such associative patterns. The aim of the study consisted in examining gendered pathways to burnout.

Methods

Data were derived from the SALVEO study, a cross-sectional study of 2026 workers from 63 workplaces from the province of Québec (Canada). Data were analyzed using multilevel path analysis.

Results

Direct effects of gendered pathways were evidenced for work (e.g. decision latitude) and non-work (e.g. child-related strains) environmental pathways, as well as for individual pathways (i.e. internal locus of control). Indirect effects of gendered pathways were also evidenced, with women reporting higher levels of burnout compared to men due to lower levels of decision latitude and of self-esteem, as well as higher levels of WFC. Women also reported lower burnout levels through investing more time into domestic tasks, which could represent a recovery strategy to highly demanding work. WFC further mediated the associations between working hours and burnout, as well as the between irregular work schedules and burnout. These result suggest than men distinctively reported higher levels of burnout due to the specific nature of their work contract negatively impacting on WFC, and incidentally, on their mental health.

Conclusion

Study results supported our hypotheses positing that gender distinctively shapes environmental and individual pathways to burnout. OHS prevention efforts striving for better mental health outcomes in the workforce could relevantly be informed by a gendered approach to burnout.

Dissecting the effect of workplace exposures on workers' rating of psychological health and safety

Objectives

To validate the factor structure of the Copenhagen Psychosocial Questionnaire (COPSOQ) in a North American population and dissect the associations between psychosocial factors and workplace psychological health and safety.

Methods

Confirmatory factor analysis and multivariate linear regression were used to determine the associations between COPSOQ dimensions and a global rating of workplace psychological health and safety. Models were stratified by sex, gender roles, and age.

Results

The COPSOQ factor structure was verified among Canadian workers. Three factors were found to significantly contribute to the global rating of the psychological health and safety for all workers. Few differences were observed across sex, gender roles, and age.

Conclusions

This study identified dimensions of the psychosocial work environment that are strongly associated with the global rating of workplace psychological health and safety. Using a standardized questionnaire like the COPSOQ allows for comparisons over time, between different industries, and worker populations.

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.

Quality circles for quality improvement in primary health care: Their origins, spread, effectiveness and lacunae- A scoping review

Quality circles or peer review groups, and similar structured small groups of 6–12 health care professionals meet regularly across Europe to reflect on and improve their standard practice. There is debate over their effectiveness in primary health care, especially over their potential to change practitioners’ behaviour. Despite their popularity, we could not identify broad surveys of the literature on quality circles in a primary care context. Our scoping review was intended to identify possible definitions of quality circles, their origins, and reported effectiveness in primary health care, and to identify gaps in our knowledge. We searched appropriate databases and included any relevant paper on quality circles published until December 2017. We then compared information we found in the articles to that we found in books and on websites. Our search returned 7824 citations, from which we identified 82 background papers and 58 papers about quality circles. We found that they originated in manufacturing industry and that many countries adopted them for primary health care to continuously improve medical education, professional development, and quality of care. Quality circles are not standardized and their techniques are complex. We identified 19 papers that described individual studies, one paper that summarized 3 studies, and 1 systematic review that suggested that quality circles can effectively change behaviour, though effect sizes varied, depending on topic and context. Studies also suggested participation may affirm self-esteem and increase professional confidence. Because reports of the effect of quality circles on behaviour are variable, we recommend theory-driven research approaches to analyse and improve the effectiveness of this complex intervention.

Nursing Home Employee and Resident Satisfaction and Resident Care Outcomes

BACKGROUND

Nursing home resident care is an ongoing topic of public discussion, and there is great interest in improving the quality of resident care. This study investigated the association between nursing home employees' job satisfaction and residents' satisfaction with care and medical outcomes.

METHODS

Employee and resident satisfaction were measured by questionnaire in 175 skilled nursing facilities in the eastern United States from 2005 to 2009. Facility-level data on residents' pressure ulcers, medically unexplained weight loss, and falls were obtained from the Centers for Medicare and Medicaid Services Long-Term Care Minimum Data Set. The association between employee satisfaction and resident satisfaction was examined with multiple and multilevel linear regression. Associations between employee satisfaction and the rates of pressure ulcers, weight loss, and falls were examined with simple and multilevel Poisson regression.

RESULTS

A 1-point increase in overall employee satisfaction was associated with an increase of 17.4 points (scale 0-100) in the satisfaction of residents and family members (p < 0.0001) and a 19% decrease in the incidence of resident falls, weight loss, and pressure ulcers combined (p < 0.0001), after adjusting for staffing ratio and percentage of resident-days paid by Medicaid.

CONCLUSION

Job satisfaction of nursing home employees is associated with lower rates of resident injuries and higher resident satisfaction with care. A supportive work environment may help increase quality of care in the nation's nursing homes.

Psychosocial Stressors at Work and Ambulatory Blood Pressure

PURPOSE OF REVIEW

Psychosocial stressors at work from the demand-latitude and effort-reward imbalance models are adverse exposures affecting about 20-25% of workers in industrialized countries. This review aims to summarize evidence on the effect of these stressors on blood pressure (BP).

RECENT FINDINGS

Three systematic reviews have recently documented the effect of these psychosocial stressors at work on BP. Among exposed workers, statistically significant BP increases ranging from 1.5 to 11 mmHg have been observed in prospective studies using ambulatory BP (ABP). Recent studies using ABP have shown a deleterious effect of these psychosocial stressors at work on masked hypertension as well as on blood pressure control in pharmacologically treated patients. Evidence on the effect of these psychosocial stressors on BP supports the relevance to tackle these upstream factors for primary prevention and to reduce the burden of poor BP control. There is a need for increased public health and clinical awareness of the occupational etiology of high BP, hypertension, and poor BP control.

The role of job strain in understanding midlife common mental disorder: a national birth cohort study

BACKGROUND

Long-standing concerns exist about reverse causation and residual confounding in the prospective association between job strain and risk of future common mental disorders. We aimed to address these concerns through analysis of data collected in the UK National Child Development Study, a large British cohort study.

METHODS

Data from the National Child Development Study (n=6870) were analysed by use of multivariate logistic regression to investigate the prospective association between job strain variables at age 45 years and risk of future common mental disorders at age 50 years, controlling for lifetime psychiatric history and a range of other possible confounding variables across the lifecourse. Population attributable fractions were calculated to estimate the public health effect of job strain on midlife mental health.

FINDINGS

In the final model, adjusted for all measured confounders, high job demands (odds ratio 1·70, 95% CI 1·25-2·32; p=0·0008), low job control (1·89, 1·29-2·77; p=0·0010), and high job strain (2·22, 1·59-3·09; p<0·0001) remained significant independent predictors of future onset of common mental disorder. If causality is assumed, our findings suggest that 14% of new cases of common mental disorder could have been prevented through elimination of high job strain (population attributable fraction 0·14, 0·06-0·20).

INTERPRETATION

High job strain appears to independently affect the risk of future common mental disorders in midlife. These findings suggest that modifiable work-related risk factors might be an important target in efforts to reduce the prevalence of common mental disorders.

FUNDING

iCare Foundation and Mental Health Branch, NSW Health.

The Place of Social Recovery in Mental Health and Related Services

This article looks at the place of social recovery in mental health and social care services, alongside personal recovery. Despite its conceptual and practice centrality to the new meaning of recovery, social recovery has remained a relatively neglected dimension. This article attempts to provide an updated critical commentary based on findings from fifty nine studies, including a variety of research methodologies and methods. Definitions of social recovery within the new meaning of recovery are looked at. This is followed by outlining the development and significance of this dimension as reflected in the key areas of shared decision making, co-production and active citizenship, re-entering employment after experiencing mental ill health, being in employment, poverty and coping with poverty, the economic and the scientific cases for social recovery. The article highlights the connections between service users’ experiencing mental health and social care systems, and the implications of ideologies and policies reflecting positions on social recovery. The complexity of social recovery is indicated in each of these areas; the related conceptual and methodological frameworks developed to research this dimension, and key achievements and barriers concerning everyday practice application of social recovery. The summary indicates potential future development perspectives of this dimension.

Effect of the National Stress Check Program on mental health among workers in Japan: A 1-year retrospective cohort study

Objectives:

This retrospective cohort study evaluated the impact of the Stress Check Program, a recently introduced national policy and program aimed at reducing psychological distress among Japanese workers.

Methods:

A baseline survey was conducted from November 2015 to February 2016, the period when Japan began enforcing the Stress Check Program. A one-year follow-up survey was conducted in December 2016. In the follow-up survey, two exposure variables were collected: having taken the annual stress survey, and experiencing an improvement in the psychosocial work environment. Psychological distress was assessed using the Brief Job Stress Questionnaire (BJSQ) at baseline and 1-year follow-up. The two exposure variables were used to define four groups: "Neither", "Stress survey (SS) only", "Psychosocial work environment improvement (WI) only", and "Both". BJSQ results were analyzed using repeated measures general linear modeling (GLM).

Results:

The study included 2,492 participants: 1,342 in the "Neither" group, 1,009 in the "SS only" group, 76 in the "WI only" group, and 65 in the "Both" group. Overall time-group interaction effects were not significant. The "Both" group showed significantly greater improvements in psychological distress than the "Neither" group (p = 0.02) at the 1-year follow-up, although the effect size was small (d = -0.14).

Conclusions:

Combination of the annual stress survey and improvement in psychosocial work environment may have been effective in reducing psychological distress in workers, although the effect size was small.

Participatory redesign of work organisation in hospital nursing: A study of the implementation process

AIMS

The main goal of the study was to apply and analyse a moderated participatory small-group procedure with registered nurses, which aims at the development and implementation of measures to improve work organisation in hospital wards and nursing units.

BACKGROUND

Participation in job redesign is an essential prerequisite of the successful implementation of improvement measures in nursing.

METHODS

The study was carried out in a public hospital of maximum care in Germany. We selected 25 wards with the most critical reported exhaustion and general health and applied a series of moderated small-group sessions in which the registered nurses jointly identified deficits in their work organisation, developed improvement measures, and then implemented and assessed them.

RESULTS

Registered nurses of 22 wards actively took part in the small-group procedure. All nursing units jointly identified organisational deficits, developed possible improvement measures, and implemented them. The nursing teams then evaluated the implemented measures which were already assessable at the end of our research period; nearly all (99.0%) showed improvements, while 69.4% actually attained the desired goals.

CONCLUSION

Participatory small-group activities may be successfully applied in hospital nursing in order to improve work organisation.

IMPLICATIONS FOR NURSING MANAGEMENT

Participatory assessment and redesign of nurses' work organisation should be integrated into regular team meetings. The nursing management should actively support the implementation process.