Effort-reward imbalance, procedural injustice and relational injustice as psychosocial predictors of health: complementary or redundant models?

Effort-reward and overcommitment at work and psychiatric symptoms in healthcare professionals: The mediation role of allostatic load

Background

Despite decades of advancement to support interventions for managing work-related stress, mental health issues have significantly escalated among healthcare professionals. Effort-reward imbalance (ERI) and overcommitment in the workplace are linked to several psychiatric disorders. However, the underlying biological mechanisms remain unclear. This study investigated whether ERI and overcommitment among healthcare professionals were linked to Allostatic Load (AL) and whether AL mediates the relationship between ERI, overcommitment and mental health issues.

Methods

One hundred forty-two nursing workers (n = 142; 90.1 % female, mean age: 39.5 ± 9.6) were randomly recruited from a university hospital in Sao Paulo, Brazil, and applied the ERI scale that assesses work effort, reward, and overcommitment. The Perceived Stress Scale (PSS), The Beck Depression Inventory (BDI), and the Self-Report Questionnaire for psychiatric symptoms (SRQ-20) evaluated the mental health outcomes. Ten neuroendocrine, metabolic, immunologic and cardiovascular biomarkers were analyzed, and values were transformed into an AL index using clinical reference cutoffs.

Results

Linear regression adjusted for covariates showed that higher scores for overcommitment were associated with higher AL indexes, which in turn were associated with higher SRQ-20, but not with PSS and DBI scores. As expected, higher scores for effort, lower for reward, and higher ERI were associated with higher scores for PSS, SRQ-20, and DBI, but not with AL index. Direct effect estimates showed that overcommitment was directly associated with higher SRQ-20 scores, and indirectly via AL.

Conclusion

Our study reveals that overcommitment, rather than ERI, was linked to increased AL in healthcare workers. Additionally, AL mediates the relationship between overcommitment and higher psychiatric symptoms, highlighting a key mechanism by which work stress can lead to mental health problems. Individual's responses to high work demands need to be considered when designing predictive models and interventions for mental health issues.

Prediction of violence or threat of violence among employees in social work, healthcare and education: the Finnish Public Sector cohort study

OBJECTIVES

To develop a risk prediction algorithm for identifying work units with increased risk of violence in the workplace.

DESIGN

Prospective cohort study.

SETTING

Public sector employees in Finland.

PARTICIPANTS

18 540 nurses, social and youth workers, and teachers from 4276 work units who completed a survey on work characteristics, including prevalence and frequency of workplace violence/threat of violence at baseline in 2018-2019 and at follow-up in 2020-2021. Those who reported daily or weekly exposure to violence or threat of violence daily at baseline were excluded.

EXPOSURES

Mean scores of responses to 87 survey items at baseline were calculated for each work unit, and those scores were then assigned to each employee within that work unit. The scores measured sociodemographic characteristics and work characteristics of the work unit.

PRIMARY OUTCOME MEASURE

Increase in workplace violence between baseline and follow-up (0=no increase, 1=increase).

RESULTS

A total of 7% (323/4487) of the registered nurses, 15% (457/3109) of the practical nurses, 5% of the social and youth workers (162/3442) and 5% of the teachers (360/7502) reported more frequent violence/threat of violence at follow-up than at baseline. The area under the curve values estimating the prediction accuracy of the prediction models were 0.72 for social and youth workers, 0.67 for nurses, and 0.63 for teachers. The risk prediction model for registered nurses included five work unit characteristics associated with more frequent violence at follow-up. The model for practical nurses included six characteristics, the model for social and youth workers seven characteristics and the model for teachers included four characteristics statistically significantly associated with higher likelihood of increased violence.

CONCLUSIONS

The generated risk prediction models identified employees working in work units with high likelihood of future workplace violence with reasonable accuracy. These survey-based algorithms can be used to target interventions to prevent workplace violence.

The Relationship Between Effort-Reward Imbalance and Depressive Symptoms Among Chinese Firefighters: Moderating by Coping Styles

OBJECTIVES

This study aims to examine the association between effort-reward imbalance (ERI) and depressive symptoms among Chinese firefighters and the moderating role of positive and negative coping styles in the above association.

METHODS

A cross-sectional study including 1328 male firefighters was conducted in China. We adopted the Center for Epidemiologic Studies Depression Scale to measure depressive symptoms.

RESULTS

Results showed that ERI was associated with depressive symptoms. Individuals with a higher ERI ratio and greater overcommitment were likely to have higher level of depressive symptoms. Furthermore, negative coping style strengthened the relationship between ERI ratio and overcommitment with depressive symptoms, whereas the positive coping style presented none significant moderation.

CONCLUSIONS

These findings indicate that reforming the effort-reward system might be helpful for mental health promotion among Chinese firefighters.

[Professional gratification crisis, overcommitment, and burnout among Ukrainian anesthesiologists and intensive care physicians during the SARS-CoV-2 pandemic]

Background

Mental stress of anesthesiologists and intensive care physicians is varied and complex. Overcommitment (OC) is characterized by an excessive tendency to professional commitment, which can lead to psychological stress and consequently to psychological disorders, such as burnout. The prevalence of burnout among intensive care physicians is internationally widespread. The aim of this study was to determine OC and gratification among Ukrainian anesthesia and intensive care physicians during the SARS-CoV‑2 pandemic and to analyze the risk of burnout in this professional group, and the associations between OC and burnout.

Methods

A total of 73 Ukrainian male (47.9%) and female (52.1%) intensive care physicians participated in the survey. The mean age was 39.8 ± 10.94 years (range 23-78 years). In addition to sociodemographic and occupational data, occupational gratification was collected using the effort-reward imbalance (ERI) questionnaire with additional questions on OC, and the Maslach burnout inventory (MBI). Participants were classified and compared into groups with different OC (< 16 points and ≥ 16 points).

Results

Of the participants 75% (55) could be classified into a group with OC < 16 points, and 18 presented an elevated OC. A significant difference in effort (13.9 ± 4.1 vs. 17.2 ± 3.6 points; p = 0.003) and ERI ratio (0.58 ± 0.2 vs. 0.77 ± 0.2; p = 0.006) was found between these two groups. In the group with OC ≥ 16 points, 50% of participants reported high emotional exhaustion (vs. 12.7% with OC < 16 points; p = 0.002), but also high performance (61.1% vs. 32.7%; p = 0.005). Overall, a burnout prevalence of 2.7% was found in the total sample, with both subjects represented in the OC < 16 points group. Higher emotional exhaustion was associated with higher OC, higher effort, and lower reward.

Discussion

The study results showed high emotional exhaustion among subjects with high overcommitment and three quarters of the respondents showed symptoms of burnout. For this reason, health promotion measures and prevention should be offered to counteract the high stresses during the pandemic. These should include relationship and behavioral prevention.

Prediction of bullying at work: A data-driven analysis of the Finnish public sector cohort study

AIM

To determine the extent to which change in (i.e., start and end of) workplace bullying can be predicted by employee responses to standard workplace surveys.

METHODS

Responses to an 87-item survey from 48,537 Finnish public sector employees at T1 (2017-2018) and T2 (2019-2020) were analyzed with least-absolute-shrinkage-and-selection-operator (LASSO) regression. The predictors were modelled both at the individual- and the work unit level. Outcomes included both the start and the end of bullying. Predictive performance was evaluated with C-indices and density plots.

RESULTS

The model with best predictive ability predicted the start of bullying with individual-level predictors, had a C-index of 0.68 and included 25 variables, of which 6 remained in a more parsimonious model: discrimination at work unit, unreasonably high workload, threat that some work tasks will be terminated, working in a work unit where everyone did not feel they are understood and accepted, having a supervisor who was not highly trusted, and a shorter time in current position. Other models performed even worse, either from the point of view of predictive performance, or practical useability.

DISCUSSION

While many bivariate associations between socioeconomic characteristics, work characteristics, leadership, team climate, and job satisfaction were observed, reliable individualized detection of individuals at risk of becoming bullied at workplace was not successful. The predictive performance of the developed risk scores was suboptimal, and we do not recommend their use as an individual-level risk prediction tool. However, they might be useful tool to inform decision-making when planning the contents of interventions to prevent bullying at an organizational level.

Perceived overall injustice and organizational deviance-Mediating effect of anger and moderating effect of moral disengagement

Introduction

This study is dedicated to exploring the influence of perceived overall injustice on employee anger and deviant behavior. Based on fairness heuristic theory and cognitive appraisal theory of emotion, a model was developed to investigate the relationship between perceived overall injustice, anger and organizational deviance. Based on social cognitive theory, the moderating role of moral disengagement was proposed.

Methods

The data were collected from three Chinese manufacturing corporations with a total effective sample size of 264. SPSS 26 and Mplus 8.3 were adopted to analyze data. Confirmatory factor analysis, descriptive statistics analysis and correlation results were illustrated. Hierarchical regression was used to test the model.

Results

Statistical results showed that there is a significant positive relationship among perceived overall injustice, anger and organizational deviance. The moderating effect of moral disengagement on the relationship between perceived overall injustice and organizational deviance is significant, while that on the relationship between anger and organizational deviance is insignificant.

Discussion

This study built a model to discuss the emotional and behavioral influences of perceived overall injustice. The findings suggest that individuals feel more anger as the level of perceived overall injustice increases, which thus lead to higher level of organizational deviance. Morally disengaged employees are more likely to engage in organizational deviance after being treated unfairly. However, the moderating effect of moral disengagement on the relationship of anger and organizational deviance was insignificant. The reason might be because anger is an aggressive emotion and individual experiencing anger may lead to impulsive behavior regardless of moral rules. Implications and limitations have been discussed.

Unrewarding work and major depressive episode: Cross-sectional and prospective evidence from the U.S. MIDUS study

Depression is a serious mental health condition and is the leading cause of disability worldwide. Previous research has demonstrated that work stress may contribute to the development of depression through psychophysiological pathways. The present study assessed associations of work stress - in terms of the effort-reward imbalance (ERI) model measuring unrewarding work - with major depressive episode (MDE). Data were from the Mid-life in the United States study, a national, population-based sample of U.S. workers with 9-year follow-up prospective cohort design. The cross-sectional sample at baseline had 2204 workers, and the prospective sample had 1591 workers at follow-up (78.7% follow-up rate). Multivariable Bayesian logistic regression and Poisson regression were applied for examining cross-sectional and prospective associations, respectively. ERI was assessed by a validated 17-item scale at baseline, and MDE in the past 12 months was assessed by the Composite International Diagnostic Interview Short Form at both baseline and follow-up. It was found that ERI at baseline was associated with higher odds of prevalent MDE in the cross-sectional sample (OR = 1.47, HPD interval [1.26-1.69]), and with higher risk of MDE at follow-up in the prospective sample (RR = 1.29, HPD interval [1.01-1.60]). In both cross-sectional and prospective analyses, strongest associations were observed among workers with the highest quartile of ERI, after adjusting for demographic, socioeconomic, lifestyle, and other psychosocial factors. The stable and robust findings strengthen and extend previous findings that unrewarding work is a risk factor of mental health. If confirmed by further evidence, intervention targeting work stress reduction is warranted.

Managers' Action-Guiding Mental Models towards Mental Health-Related Organizational Interventions-A Systematic Review of Qualitative Studies

Research indicates that managers' active support is essential for the successful implementation of mental health-related organizational interventions. However, there is currently little insight into what subjective beliefs and perceptions (=mental models) make leaders support such interventions. To our knowledge, this is the first qualitative systematic review of this specific topic, and it considers 17 qualitative studies of managers' perspective. Based on the theory of planned behavior, this review provides an overview of three action-guiding factors (attitudes, organizational norms and behavioral control) that can serve as starting points for engaging managers in the implementation of mental health-related measures and ensuring their success. Our results provide evidence that supportive organizational norms may particularly help to create a common sense of responsibility among managers and foster their perceived controllability with respect to changing working conditions. Our study thus contributes to a more differentiated understanding of managers' mental models of health-related organizational interventions.

Association between work ability and work stressors: cross-sectional survey of elderly services and health and social care service employees

BACKGROUND

Work in the health and social care services (HSS) is very stressful and sickness absences are high. Nevertheless, little is known about their work stressors and work ability. The first aim of this study is to describe the prevalence of different work stressors and their accumulation among eldercare workers compared to general HSS workers. Second aim is to analyze associations between different work stressors and work ability and thus provide information on factors that are important in enhancing work ability.

METHODS

This cross-sectional survey examined HSS employees in Finland in 2020. The response rate was 67% (N = 22,502). Descriptive analyses were used to describe the control variables and the differences between the work stressors of general HSS and eldercare employees. After this, multinomial logistic regression analysis revealed the association between work stressors and work ability.

RESULTS

Eldercare employees experienced more often moral distress than HSS employees in general, and this further lowers their work ability. Single work stressors--Karasek's strain, Siegrist's ERI, organizational injustice and moral distress--increased the odds of low work ability (OR range 1.4-2.5) in comparison to no work stressors. However, the association with single stressors was roughly one third of that with the accumulation of all four work stressors (OR = 6.8). Thus, the accumulation of several stressors was most harmful for work ability.

CONCLUSIONS

This study provides novel information on the accumulation of work stressors in relation to work ability. The results suggest that in order to enhance work ability, HSS organizations should pay more attention to preventing several stressors from accumulating. Eldercare organizations in particular need to develop effective measures for lowering moral distress.

Injustice Through Cultural Lens: A Pilot Qualitative Exploration of Pain-Related Injustice Appraisals Among Arab-Americans with Chronic Low Back Pain

The current qualitative study sought to obtain an in-depth understanding of how Arab-Americans conceptualize perceived injustice concerning their chronic low back pain (CLBP) by reflecting on the Injustice Experience Questionnaire (IEQ). Twelve Arab-American adults with CLBP were recruited from a metropolitan area in Alabama using a purposive sampling technique. Participants took part in individual, face-to-face, semi-structured interviews reflecting on each statement from the IEQ. Descriptive data analysis was generated for demographic and pain variables. Directed content analysis was conducted to identify themes and sub-themes. 'Blame and unfairness' and 'severity and irreparability of loss,' the 2 established theoretical factors comprising pain-related injustice appraisal were used as predominant themes. Acceptance emerged as an inductive theme with the following sub-themes: positive appraisal and resilience, attempts to reduce pain, religious values and fate, and belief that everything happening for a reason. The influence of religion was noted across all themes. The current pilot findings suggest that Arabic culture, heavily infused with Islamic beliefs, influences how Arab-Americans conceptualize pain-related injustice appraisals. Additional exploration of the cultural appropriateness of the IEQ among individuals of Arab background is needed to further elaborate on the subject of faith and religious belief suggested by the current study. Perspective: Although the study findings largely reflected established injustice literature constructs, several emergent themes regarding pain-related injustice appraisal were influenced by the participants' culture and religious beliefs. These findings may indicate that specific psychotherapeutic approaches that have been proven effective among some groups may not function similarly in other populations.

Organizational Justice and Cognitive Failures in Japanese Employees: A Cross-Sectional Study

OBJECTIVE

We examined the association of organizational justice (ie, procedural justice and interactional justice) with cognitive failures, and the mediation effect of psychological distress on this association in Japanese employees.

METHODS

A total of 189 men and 35 women from two sites of a manufacturing company in Japan were surveyed using a self-administered web-based questionnaire. A multiple mediation analysis was conducted.

RESULTS

A significant negative total effect of procedural justice on cognitive failures was observed (c = -0.180 [95% confidence interval: -0.315 to -0.044]). Furthermore, the mediation effect of psychological distress was significant (c-c' = -0.213 [95% confidence interval: -0.323 to -0.115]). Similar patterns were observed for interactional justice.

CONCLUSIONS

Employees may be more likely to experience cognitive failures in daily activities in work settings where organizational justice is lower, which seems to be explained by psychological distress.

Socioeconomic Status, Mental Health, and Workplace Determinants among Working Adults in Hong Kong: A Latent Class Analysis

This study provides insights on mental health correlates and work stress patterns in a representative sample of working adults in Hong Kong using an intersectional perspective. Using data from a cross-sectional, population-based telephone survey of 1007 working adults in Hong Kong, latent class analysis was conducted to identify socioeconomic classes within the sample. Three latent classes were identified, and they differed significantly in all the SES variables. Results suggested mental health to be the lowest in Class 1, the lowest income group. The three classes did not differ from their perceived level of job demand and control in work-related stress. Predictably, the highest income group perceived the lowest level of effort-reward imbalance. The lowest paid class was also reported perceiving the lowest level of relational justice. Different barriers to mental health services were also identified. Finally, cultural implications associated with work stress patterns, research, and practice implications are discussed. This study provides an empirical foundation for future studies to investigate patterns of job stress and mental health needs in a diverse population of working adults, with a particular focus on addressing the intersectional profiles of working adults and their needs in mental health services.

Psychotropic medication before and after disability retirement by pre-retirement perceived work-related stress

BACKGROUND

Retirement has been associated with improved mental health, but it is unclear how much this is due to the removal of work-related stressors. We examined rates of psychotropic medication use before and after the transition to disability retirement due to mental, musculoskeletal and other causes by pre-retirement levels of perceived work stress (effort-reward imbalance, ERI).

METHODS

Register-based date and diagnosis of disability retirement of 2766 participants of the Finnish Public Sector study cohort were linked to survey data on ERI, social- and health-related covariates, and to national records on prescribed reimbursed psychotropic medication, measured as defined daily doses (DDDs). Follow-up for DDDs was 2-5 years before and after disability retirement. We assessed differences in the levels of DDDs before and after retirement among those with high vs. low level of pre-retirement ERI with repeated measures regression.

RESULTS

Those with high (vs. low) levels of ERI used slightly more psychotropic medication before disability retirement due to mental disorders [rate ratio (RR) 1.14, 95% confidence intervals (CI) 0.94-1.37], but after retirement this difference attenuated (RR 0.94, 95% CI 0.80-1.10, P for interaction 0.02). Such a change was not observed for the other causes of disability retirement.

CONCLUSIONS

The level of psychotropic medication use over the transition to disability retirement due to mental, but not musculoskeletal or other, causes was modified by pre-retirement perceived work-related stress. This suggests that among people retiring due to mental disorders those who had stressful jobs benefit from retirement more than those with low levels of work-related stress.

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.

How psychological contract breach affects long-term mental and physical health: the longitudinal role of effort-reward imbalance

This study contributes to the research of employee health and well‐being by examining the longitudinal effects of psychological contract (PC) breach on employees’ health. We integrate Social Exchange and Conservation of Resources theories to position effort–reward imbalance (ERI) as the mediating mechanism. We also assessed the moderating role of perceived job control as a boundary condition through which employees could prevent PC breach and ERI from adversely affecting their health. Using three‐wave longitudinal survey data from 389 employees, we estimated a path model using each variable’s growth parameters (intercept and slope). We found support for our hypotheses regarding stable effects; we found positive associations between PC breach and physical and mental health complaints and a need for recovery through ERI perceptions. We further tested employees’ perceived control over the work environment as a boundary condition and found support for its role in attenuating the positive relationship between PC breach and ERI perceptions, but not for its moderating role in the ERI–health outcomes relationship. Our findings indicate that exposure to PC breach has a detrimental impact on employee health/well‐being via perceptions of ERI and allow us to unravel one of the cognitive mechanisms leading to potential employee ill‐health. We conclude with theoretical and practical implications.

Do the work unit characteristics directly or indirectly affect psychological distress in female call-handlers?

PURPOSE

This study aimed to test if work unit characteristics (WUCs) reported by call-center managers were directly related to the psychological distress reported by call-handlers or if these associations were mediated by the psychosocial working conditions (PWC).

METHODS

Managers of 105 call-centers were interviewed about their call-center's WUCs by occupational physicians. 2719 female call-handlers from these call-centers completed self-reported questionnaires to evaluate PWC (Karasek, Siegrist, and other specific workplace stressors) and psychological distress (GHQ12 score). A two-level analysis tested the relationships between the 14 WUCs and GHQ12 score, with and without adding PWC as confounders. Unchanged coefficients between WUCs and GHQ12 score were assumed to flag a direct association between WUCs and psychological distress. In the case of changed coefficients, the mediated proportion was estimated using multiple mixed models.

RESULTS

Five out of fourteen WUCs were related to GHQ12 score: outbound-call type, call-center size, number of activity parameters displayed on the screen, the existence of a fixed break, and the assigned role of the supervisor being the monitoring/supervision of call-handler activities. After adding PWC, the association remained statistically significant only for outbound calls. For the other WUCs, the proportion of mediation by stressor ranged from 56 to 66%. Mediation was mostly through job demand, lack of reward and ethical conflict dimensions.

CONCLUSION

The main results were that (1) associations exist between the WUCs reported by managers and the psychological distress reported by call-handlers, and (2) that most of these associations are mediated by psychosocial working conditions.

Psychosocial Risk Management in the Teaching Profession: A Systematic Review

Teachers are facing various job demands with psychosocial aspects being fundamental due to the nature of the occupation. Although teachers' work is associated with different psychosocial health risks, little is known on how to identify and tackle those.

Thus, a systematic literature search as per the PRISMA statement was conducted via MEDLINE (PubMed), PSYNDEX (PubPsych), and ScienceDirect. Two reviewers independently screened 2261 titles and abstracts and 169 full-texts. According to the inclusion criteria established a priori, articles from peer-reviewed journals (English or German) on psychosocial risk management in teachers were incorporated.

Despite a comprehensive and sensitive search, only four publications could be identified, outlining a process to implement risk management and different assessment tools. Taken together, data presented in the articles were scarce.

Recommendations for process steps and the assessment of psychosocial risks can be derived from the findings. To implement effective psychosocial risk management in the teaching profession, further research is needed, though. Effective and practicable approaches, which are accepted by the target group, should be further developed and investigated. Relevant causes of occupational strain in the teaching profession must be identified and assessed reliably. Low-threshold interventions should be implemented, and the outcome must be evaluated afterward.

The association of occupational stress and sleep duration with anxiety symptoms among healthy employees: A cohort study

The aim of this study is to identify occupational stress associated with the development of new-onset anxiety symptoms and the dose-response relationship between sleep duration and the onset of anxiety symptoms. Data from 29,251 healthy employees who had undergone at least two comprehensive health examinations at Kangbuk Samsung Hospital Health Screening Center were analysed. Anxiety symptoms were assessed using the Beck Anxiety Inventory. Occupational stress and sleep duration were measured using a self-reported questionnaire about total sleep time and the Korean Occupational Stress Scale-Short Form (KOSS-SF), respectively. Flexible parametric proportional hazards model used to estimate the hazard ratios. Compared with the groups without case-level anxiety, discomfort in an organizational climate, high job demands, job insecurity, organizational injustice and lack of reward were associated with the onset of case-level anxiety. Compared with less than 6 hr of sleep per day, the beneficial level of sleep duration was 7 ≤ to <9 hr a day. Almost all subscales of job stress were associated with the development of anxiety symptoms. In addition, the efficacious level of sleep duration for reducing the onset of future anxiety symptoms was 7 ≤ to <9 hr a day.

Estimating the potential reduction in future sickness absence from optimizing group-level psychosocial work characteristics: a prospective, multicenter cohort study in German industrial settings

BACKGROUND

Absence from work due to sickness impairs organizational productivity and performance. Even in organizations with perfect work conditions, some inevitable baseline sickness absence exists amongst working populations. The excess sickness absence observed above this baseline rate has become the focus of traditional health promotion efforts, addressing preventable physical illness, health behavior and mental health at the personal level. However, a health and safety approach following the TOP-rule would consider work-group psychosocial work characteristics as a potential risk factor amenable to organizational measures. To date, there is a scarcity of studies relating psychosocial work characteristics to possible reduction of excess sickness-absence rates.

METHODS

We aimed to estimate the potentially avoidable excess fraction of absence attributable to work-group psychosocial characteristics. We considered work-group averaged perception of psychosocial work characteristics as a proxy to the methodologically elusive objective assessment of organizational characteristics. Participants were recruited from multiple sites of a German automotive manufacturer with individuals nested within work groups. We predicted 12-month follow-up work-group sickness absence rates using data from a baseline comprehensive health examination assessing work characteristics, health behavior, and biomedical risk factors. We considered the quartile of work-groups yielding favorable psychosocial work characteristics as a realistic existing benchmark. Using the population attributable fraction method we estimated the potentially amenable sickness absence from improving work-group psychosocial characteristics.

RESULTS

Data from 3992 eligible participants from 29 work groups were analyzed (39% participation rate, average age 41.4 years (SD = 10.3 years), 89.9% males and 49% manual workers.). Work-group absence rates at follow up varied from 2.1 to 8.9% (mean 5.1%, 11.7 missed days). A prediction model of seven psychosocial work characteristics at the work group level explained 70% of the variance of future absence rates. The estimated reduction from improving psychosocial work characteristics to the benchmark level amounted to 32% of all sickness absence, compared to a 31% reduction from eliminating health behavioral and medical risk factors to the benchmark target.

CONCLUSIONS

Psychosocial characteristics at the work-group level account for a relevant proportion of all sickness absence. Health promotion interventions should therefore address psychosocial characteristics at the work group level.

Work-Family Conflict and Depressive Symptoms Among Chinese Employees: Cross-Level Interaction of Organizational Justice Climate and Family Flexibility

This study aims to examine how organizational and family factors protect employees from depressive symptoms induced by work-family conflict. With a cross-sectional design, a total of 2184 Chinese employees from 76 departments completed measures of work-family conflict, organizational justice, family flexibility, and depressive symptoms. The results showed that work-family conflict including work-to-family conflict and family-to-work conflict was positively associated with depressive symptoms. In cross-level analysis, organizational justice climate weakened the adverse effect of work-family conflict on depressive symptoms and the buffering effects of procedural and distributive justice climate in the association between work-family conflict and depressive symptoms depended on family flexibility. Specifically, compared with employees with high family flexibility, procedural and distributive justice climate had a stronger buffering effect for employees with low family flexibility. These results indicate that organization and family could compensate each other to mitigate the effect of work-family conflict on employees’ depressive symptoms. Cultivating justice climate in organization and enhancing family flexibility might be an effective way to reduce employees’ depressive symptoms.

Hospital Medical and Nursing Managers' Perspective on the Mental Stressors of Employees

Working conditions in hospitals are characterized by occupational stressors, which lead to potentially harmful psychosocial stress reactions for medical and nursing staff. Representative surveys showed that almost every second hospital physician or nurse is affected by burnout and that there is a strong association between leadership behavior and employee health. Workplace health promotion programs can only be successful and sustainable if managers support them. However, it is still unclear whether hospital managers are aware of the working conditions and perceive them as an influence on the health of their employees. Therefore, the aim of this qualitative study was to explore the hospital medical and nursing managers' perspective on the mental stress of their employees. Semi-standardized interviews with 37 chief physicians (CP), senior physicians (SP) and senior nurses (SN) in total were carried out in one German hospital. The interviews were content-analyzed based on the guideline for the mental risk assessment of the 'Gemeinsame Deutsche Arbeitsschutzstrategie' (GDA). Most reported work characteristics related to work organization, work task, and social factors. Staff shortage could be identified as an underlying stressor for several other burdens. Social support by managers and among colleagues was mentioned as main resource. The findings indicate that managers strive to reduce the burden on their staff, especially through their personal support. Nevertheless, it seemed that managers need additional resources to counteract stressors.

Work-related psychosocial risk factors for stress-related mental disorders: an updated systematic review and meta-analysis

OBJECTIVE

The objective was to conduct an update of a previously published review and meta-analysis on the association between work-related psychosocial risk factors and stress-related mental disorders (SRD).

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Medline, Embase and PsycINFO were searched for articles published between 2008 and 12 August 2019 and references of a systematic review performed for the period before 2008 were included. Primary prospective studies were included when outcome data were described in terms of SRD assessment or a dichotomous outcome, based on a validated questionnaire, and at least two levels of work-related exposure were reported (exposed vs less or non-exposed). We used GRADE to assess the evidence for the associations between risk factors and the onset of SRD.

RESULTS

Seventeen studies met the inclusion criteria. In total, a population of 73 874 workers from Belgium, Denmark, England, Finland, Japan, the Netherlands and Sweden were included in the meta-analysis of 14 prospective cohort studies. This meta-analysis revealed moderate evidence for associations between SRD and effort reward imbalance (OR=1.9, 95% CI 1.70 to 2.15), high job demands (OR=1.6, 95% CI 1.41 to 1.72), organisational justice (ORs=1.6 to 1.7, CIs 1.44 to 1.86), social support (ORs=1.3 to 1.4, CIs 1.16 to 1.69), high emotional demands (OR=1.6, 95% CI 1.35 to 1.84) and decision authority (OR=1.3, CI 1.20 to 1.49). No significant or inconsistent associations were found for job insecurity, decision latitude, skill discretion and bullying.

CONCLUSION

Moderate evidence was found that work-related psychosocial risk factors are associated with a higher risk of SRD. Effort-reward imbalance, low organisational justice and high job demands exhibited the largest increased risk of SRD, varying from 60% to 90%.

Hospital Medical and Nursing Managers' Perspectives on Health-Related Work Design Interventions. A Qualitative Study

BACKGROUND

Research indicates that the active support of managers is essential for the sustainable implementation of health-related work design interventions in organizations. However, little is known about managers' perceptions of such health promotion measures.

OBJECTIVE

Our study aims to provide information that help to foster managers active support of health-related work design interventions in hospitals. Based on Ajzen's Theory of Planned Behavior (TPB) we explore the attitudes, perceived organizational norms, and perceived behavioral control of managers in the hospital regarding such interventions.

METHODS

Semi-structured interviews with 37 managers (chief physicians, senior physicians, and senior nurses) were carried out in one German hospital. A software aided qualitative content analysis was applied.

RESULTS

We observed that the majority of managers are aware of the importance of health-related work design. We found a high variation in the perception of organizational norms related to mental health promotion of employees. Behavioral control for supporting interventions is perceived more on an individual (e.g., appraisal interviews, professional development or support) and team level (e.g., fair work schedule, regular team meetings), less on an organizational level.

CONCLUSION

To enable and to motivate hospital medical and nursing managers to support health-related work design, hospitals need to establish clear organizational norms that the health promotion of their employees is an important organizational goal. Moreover, managers need to get more work-design competencies and decision latitude to get more control. Important arguments for the top hospital management could be that health-related work design is highly effective for economic success, for treatment quality, and that the middle management already has a positive attitude toward the implementation of measures that help promote the mental health of their staff.

Cluster-randomised trial evaluating a complex intervention to improve mental health and well-being of employees working in hospital - a protocol for the SEEGEN trial

Background

Health care employees in Germany and worldwide are exposed to a variety of stressors. However, most of the hospitals in Germany lack a systematic workplace health management. Thus, this study aims at the evaluation of the effects of a behavioural as well as organisational (´complex´) intervention on the mental health and well-being of hospital staff.

Methods

Mental health in the hospital workplace (SEElische GEsundheit am Arbeitsplatz KrankeNhaus – SEEGEN) is an unblinded, multi-centred cluster-randomised open trial with two groups (intervention group (IG) and waitlist control group (CG)). Study participants in the intervention clusters will receive the complex intervention; study participants in the waitlist control clusters will receive the complex intervention after the last follow-up measurement. The intervention consists of five behavioural and organisational intervention modules that are specifically tailored to hospital employees at different hierarchical and functional levels. Hospital staff may select one specific module according to their position and specific needs or interests. Towards the end of the intervention roundtable discussions with representatives from all professional groups will be held to facilitate organisational change. Primary outcome is the change in emotional and cognitive strain in the working environment, from baseline (T0) to 6 month-follow up (T1), between IG and CG. In addition, employees who do not participate in the modules are included in the trial by answering shorter questionnaires (cluster participants). Furthermore, using mixed methods, a process evaluation will identify uptake of the intervention, and mediators and moderators of the effect.

Discussion

There seems to be growing psychological strain on people working in the health care sector worldwide. This study will examine whether investing directly in the hospital staff and their interpersonal relationship may lead to measurable benefits in subjective well-being at the workplace and improved economic performance indicators of the hospital. In case of a positive outcome, health promotion strategies looking at behavioural as well as organisational components within the hospital may gain additional importance, especially in regard of the growing financial pressure within the health sector.

Trial registration DRKS

The SEEGEN study is registered at the German Clinical Trial Register (DRKS) under the DRKS-ID DRKS00017249. Registered 08 October 2019, URL.

https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017249.

Caring for Oneself or for Others? How Consistent and Inconsistent Profiles of Health-Oriented Leadership Are Related to Follower Strain and Health

Health-oriented leadership consists of three dimensions that contribute to employee health: staff care, i.e., health-specific follower-directed leadership, as well as both leaders' and followers' self care, i.e., health-specific self-leadership. This study explores profiles of follower self care, leader self care and staff care, and investigates the relationships with follower health in two samples. We identified four patterns of health-oriented leadership: A consistently positive profile (high care), a consistently negative profile (low care), and two profiles showing inconsistencies between follower self care, leader self care, and staff care (leader sacrifice and follower sacrifice). The high care profile reported the best health compared to both the low care profile and the inconsistent profiles. The follower sacrifice profile reported more strain than the leader sacrifice profile, while strain and health levels were the least favorable in the low care profile. Findings reveal that (in-)consistency between follower-directed leadership and self-leadership contributes to follower strain and health.

Exposure to organisational injustice and serious psychological distress: longitudinal analysis of details of exposure from a private Japanese company

OBJECTIVES

Studies have shown that organisational injustice (OIJ) is associated with mental disorders. However, there is little research regarding details on OIJ exposure. We examined the effect of OIJ on serious psychological distress (SPD) by considering the exposure frequency, the exposure duration and the OIJ-free period after the disappearance of exposure.

METHODS

We used a prospective cohort design. OIJ exposure was assessed three times with 1-year intervals between assessments, and the subjects were grouped according to the exposure histories. The outcome assessment for SPD by scores of 13 or higher on the K6 questionnaire was carried out 3 years after the baseline scores were obtained. Participants were all full-time regular employees of one office of a manufacturing company in Japan. Participants who were being treated for mental disorders, those with SPD and those with missing data on the K6 questionnaire in the baseline survey were excluded from the prospective cohort. Self-reported questionnaire data from 1087 employees who participated in all surveys and answered all questions were analysed. Logistic regression analysis was used to explore the effect of OIJ on SPD.

RESULTS

SPD developed in 35 participants. Frequent OIJ exposure was associated with a higher risk for SPD (p for trend=0.002). Of the 1087 participants, 319 (29.3%) experienced a change in OIJ exposure at least once, and 8.6% of subjects experienced such a change twice. These changes in OIJ exposure were more strongly related to SPD than was the frequency of OIJ exposure.

CONCLUSIONS

OIJ was associated with SPD onset particularly when the workers were more frequently exposed to it. Moreover, frequent changes in the OIJ exposure were associated with a higher risk for SPD. Because OIJ exposure can change in a relatively short time, considering exposure histories may provide useful information for preventing mental disorders.

Development of an e-learning prototype for assessing occupational stress-related disorders: a qualitative study

BACKGROUND

Occupational stress-related disorders are complex to diagnose and prevent, due to their multifactorial origin. We developed an e-learning programme aimed at supporting occupational physicians when diagnosing and preventing occupational stress-related disorders. In order to explore the extent to which a developed e-learning prototype was perceived as useful and feasible by occupational physicians, we executed a qualitative study.

METHODS

We conducted semi-structured, face-to-face interviews with fifteen occupational physicians, who were recruited using a combination of convenience and purposive sampling. Participants were shown a hard copy prototype of the e-learning programme, on which they were invited to comment in terms of perceived usefulness and feasibility. The interview data was transcribed verbatim and coded by two researchers using a content analysis approach.

RESULTS

Occupational physicians perceived e-learning as useful when it contributed to creating a full clinical picture and supported the diagnosis. Its structure had to support occupational physicians to work systematically. The programme had to be applicable to their daily practice and had to incorporate learning tools in order to increase the competences of occupational physicians. Feasibility was perceived to increase when the e-learning programme took less time to complete, when the quantity of written text was not too high, and when the user was guided and recertification points provided.

CONCLUSIONS

An e-learning programme can be an asset in continuing medical education for occupational physicians when assessing occupational stress-related disorders. Perceived usefulness depended on the clinical picture, structure, practicality and the increasing of competences. Feasibility depended on text, time, structure and reward.

Does Cardiorespiratory Fitness Moderate the Association between Occupational Stress, Cardiovascular Risk, and Mental Health in Police Officers?

Background: Chronic exposure to occupational stress may lead to negative health consequences. Creating less stressful work environments and making employees physically and psychologically more resilient against stress are therefore two major public health concerns. This study examined whether cardiorespiratory fitness moderated the association between occupational stress, cardiovascular risk, and mental health. Methods: Stress was assessed via the Effort-Reward Imbalance and Job Demand-Control models in 201 police officers (36% women, Mage = 38.6 years). Higher levels of blood pressure, blood lipids, blood sugar, and unfavorable body composition were considered as cardiovascular risk factors. Burnout, insomnia and overall psychological distress were used as mental health indicators. Cardiorespiratory fitness was assessed with a submaximal bicycle test. Results: High cardiorespiratory fitness levels were associated with a reduced cardiometabolic risk, whereas high stress levels were associated with better mental health. Among participants who perceived a high Effort-Reward Imbalance, those with high fitness levels showed lower overall cardiovascular risk scores than their colleagues with low fitness levels. Conclusions: Work health programs for police officers should consider the early screening of burnout, sleep disturbances, and overall mental wellbeing. To increase cardiovascular health, including fitness tests in routine health checks and promoting physical activity to further increase cardiorespiratory fitness appears worthwhile.

Examining Injustice Appraisals in a Racially Diverse Sample of Individuals With Chronic Low Back Pain

Injustice perception has emerged as a risk factor for problematic musculoskeletal pain outcomes. Despite the prevalence and impact of chronic low back pain (CLBP), no study has addressed injustice appraisals specifically among individuals with CLBP. In addition, despite racial/ethnic disparities in pain, existing injustice research has relied almost exclusively on white/Caucasian participant samples. The current study examined the associations between perceived injustice and pain, disability, and depression in a diverse community sample of individuals with CLBP (N = 137) -51 (37.2%) white, 43 (31.4%) Hispanic, 43 (31.4%) black or African American). Anger variables were tested as potential mediators of these relationships. Controlling for demographic and pain-related covariates, perceived injustice accounted for unique variance in self-reported depression and disability outcomes, but not pain intensity. State and trait anger, and anger inhibition mediated the association between perceived injustice and depression; no additional mediation by anger was observed. Significant racial differences were also noted. Compared with white and Hispanic participants, black participants reported higher levels of perceived injustice related to CLBP, as well as higher depression and pain-related disability. Black participants also reported higher pain intensity than white participants. Current findings provide initial evidence regarding the role of injustice perception specifically in the context of CLBP and within a racially diverse participant sample. Results highlight the need for greater diversity within injustice and CLBP research as well as research regarding socially informed antecedents of injustice appraisals. Perspective: Perceived injustice predicted worse outcomes in CLBP, with effects partially mediated by anger. Black participants reported worse pain outcomes and higher injustice perception than their white or Hispanic counterparts. Given racial inequities within broader health and pain-specific outcomes, this topic is critical for CLBP and perceived injustice research.

School context and subjective distress: The influence of teacher justice and school-specific well-being on adolescents’ psychological health

Notwithstanding the large consensus on the idea that justice should be favoured in school contexts to promote student well-being, there is still a lack of research that has investigated how the experience of justice at school spreads impact on global adolescent psychological health. The aim of this study is to investigate the degree to which the experience of teacher (in)justice is possibly related to some of the indicators of adolescent global psychological health, namely individual and social functioning, psychological problems, and somatic symptoms. We also test the role of two components of school-specific well-being, i.e., emotional engagement and classroom connectedness, here considered as potential mediators between teacher justice and psychological health. Structural equation modelling indicated that teacher justice is positively associated with emotional engagement, classroom connectedness and individual functioning, and negatively related to psychological problems. The relation from teacher justice to individual functioning was partially mediated by emotional engagement and classroom connectedness. The relation from teacher justice to social functioning and somatic symptoms was fully mediated by classroom connectedness, while a partial mediation was found between teacher justice and psychological problems via classroom connectedness. These results are commented at the light of their implications for teacher practices.

Associations of psychosocial working conditions with health outcomes, quality of care and intentions to leave the profession: results from a cross-sectional study among physician assistants in Germany

BACKGROUND

Numerous epidemiological studies among health care staff have documented associations of adverse psychosocial working conditions with poorer health-related outcomes, a reduced quality of patient care and intentions to leave the profession. The evidence for physician assistants in Germany remains limited though.

METHODS

We surveyed a total of 994 physician assistants between September 2016 and April 2017. Psychosocial working conditions were measured by the established effort-reward imbalance (ERI) questionnaire and by a questionnaire specifically developed to capture psychosocial working conditions among physicians. Health outcomes (i.e., self-rated health, depression, anxiety), self-rated quality of care and the intention to leave the profession were assessed by established measures. We ran multivariable logistic regression analyses.

RESULTS

The prevalence of work stress in terms of ERI equalled 73.77%. Work stress according to the ERI model was associated with significantly poorer self-rated health [odds ratio (OR) 3.62], elevated symptoms of depression (OR 8.83) and anxiety (OR 4.95), poorer quality of care (OR for medical errors 4.04; OR for interference of work with patient care 3.88) and an increased intention to leave one's current profession (OR 3.74). The PA-specific questionnaire showed similar, albeit weaker, associations (all ORs > 1.22).

CONCLUSIONS

Our results are in line with previous findings among health care staff and provide specific and novel evidence for physician assistants. Interventions aiming at the improvement of working conditions seem needed given their potential adverse consequences in terms of employee health, quality of care, and personnel policy.

Effort-reward imbalance in police work: associations with the cortisol awakening response

PURPOSE

We hypothesized that effort-reward imbalance (ERI) is associated with an atypical cortisol response. ERI has been associated with higher job stress. Stress triggers cortisol secretion via the hypothalamic-pituitary-adrenal (HPA) axis, and significant deviation from a typical cortisol pattern can indicate HPA axis dysfunction.

METHODS

176 police officers participated from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Study. ERI was the exposure variable. Outcome variables were saliva-based peak and mean cortisol values, total area under the curve ground (AUCG) and baseline (AUCI); linear regression line fitted to log-transformed cortisol. Regression analyses were used to examine linear trend between ERI and cortisol parameters. Repeated measures analysis examined whether the pattern of cortisol over time differed between low ERI (< median) and high ERI (≥ median).

RESULTS

Mean age was 46 years (SD = 6.6). After adjustment for potential confounders, there was a significant inverse association between ERI and peak cortisol (β = - 0.20, p = 0.009), average cortisol (β = - 0.23, p = 0.003), and total area under the curve (β = - 0.21, p = 0.009). ERI was not significantly associated with AUCI (β = - 0.11, p = 0.214); slope of the regression line fitted to the cortisol profile (β = - 0.009, p = 0.908). Repeated measures analyses showed that the cortisol pattern did not vary significantly between high and low ERI using the median as a cut point (interaction p value = 0.790).

CONCLUSIONS

ERI was inversely associated with the magnitude of awakening cortisol over time, indicating HPA axis dysregulation and potential future health outcomes.

Gender Differences of Occupational Stress Associated with Suicidal Ideation among South Korean Employees: The Kangbuk Samsung Health Study

OBJECTIVE

In this study, the relationship between occupational stress and suicidal ideation was investigated, focusing on gender differences among Korean employees.

METHODS

Cross-sectional data for 53,969 workers were collected at Kangbuk Samsung Hospital health screening centers. Risk of suicidal ideation was assessed using a self-reported questionnaire examining suicidal ideation during the past year. Occupational stress was measured using 24 items of the Korean Occupational Stress Scale-Short Form (KOSS-SF). Logistic regression analysis was employed to estimate the odds ratios and 95% confidence intervals of the relationships between suicidal ideation and components of occupational stress.

RESULTS

In multivariable-adjusted models, all job stress contributed to increased risk of suicidal ideation in males. Most subscales, except insufficient job control and organizational system, were risk factors of suicidal ideation in females. Further adjustments for depression markedly attenuated this relationship. However, the effects of insufficient job control and lack of reward on suicidal ideation remained significant in males, and interpersonal conflict remained significant in females.

CONCLUSION

The results suggest that occupational stress plays a significant role in increasing risk of suicidal ideation through elevation of depressive symptoms. Gender differences in components of occupational stress associated with suicidal ideation were also observed.

The Factorial Structure and Psychometric Properties of the Persian Effort-Reward Imbalance Questionnaire

Background

With global changes in the current state of work and employment, the role of health-adverse psychosocial work environments has received increasing attention in developed as well as in rapidly developing countries. Thus, there is a need to apply valid measurement tools for monitoring and preventive purposes. This study aims to examine the factorial structure and psychometric properties of the Persian version of the effort-reward imbalance (ERI) questionnaire, assessing one of the internationally leading concepts of stressful work.

Methods

This descriptive cross-sectional study of a random sample of 202 white collar employees in an industrial company in Iran analyzes the ERI scales by exploratory and confirmatory factor analysis. Moreover, aspects of construct and criterion validity are tested. To this end, correlations of ERI scales with subscales of organizational injustice, a complementary work stress model, and also the correlations of ERI scales with a questionnaire assessing psychosomatic symptoms are performed.

Results

Internal consistency of the three ERI scales was satisfactory (Cronbach α effort: 0.76, reward: 0.79, overcommitment: 0.75). Fit indices of confirmatory factor analysis pointed to an adequate representation of the theoretical construct (e.g., adjusted goodness of fit index (AGFI): 0.73, goodness of fit index (GFI): 0.78). Negative correlations with subscales of organizational injustice supported the notion of construct validity of the ERI scales, and positive correlations of ERI scales with psychosomatic symptoms indicated preliminary criterion validity.

Conclusion

The Persian version of the ERI questionnaire has acceptable psychometric properties and can be used as a valid instrument in research on this topic.

Chronic exposure to adverse psychosocial work factors and high psychological distress among white-collar workers: A 5-year prospective study

OBJECTIVES

Prospective studies which evaluated whether the effects of chronic exposure to psychosocial work factors on mental health persisted over time are scarce. For the first time, this study evaluated: 1) the effect of chronic exposure to effort-reward imbalance over 5years on the prevalence of high psychological distress among men and women, and 2) the persistence of this effect over time.

METHODS

Overall, 1747 white-collar workers from three public organizations participated in a prospective study. Psychological distress and effort-reward imbalance were measured using validated questionnaires at baseline, and at 3- and 5-year follow-ups. Prevalence ratios (PRs) of high psychological distress were estimated using log-binomial regression according to baseline and repeated exposure.

RESULTS

Compared to unexposed workers, those with repeated exposure to effort-reward imbalance had a higher prevalence of high psychological distress. Workers exposed only at some time-points also had a higher prevalence. The deleterious effect of repeated exposure observed at the 3-year follow-up persisted at the 5-year follow-up among women (PR=2.48 95% confidence interval (CI) 1.97-3.11) and men (PR=1.91 95% CI 1.20-3.04). These effects were greater than those found using a single baseline measurement.

CONCLUSION

The current study supported a deleterious effect of repeated exposure to effort-reward imbalance on psychological distress, and a lack of adaptation to these effects over time among men and women. Since psychological distress may later lead to severe mental problems, current results highlight the need to consider exposure to these adverse work factors in primary and secondary preventions aimed at reducing mental health problems at work.