Unwanted sexual attention at work and long-term sickness absence: a follow-up register-based study

Gender-based violence and harassment at work and health and occupational outcomes. A systematic review of prospective studies

BACKGROUND

Many people experience forms of gender-based violence and harassment (GBVH) in the context of their work. This includes a wide range of experiences, from subtle expressions of hostility to physical assault, that can also be of a sexual nature (e.g., sexual harassment or assault). This systematic review aimed to summarize findings about the prospective associations of work-related GBVH with people's health and occupational situation.

METHODS

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Scopus, Web of Science, MEDLINE and PsycINFO were searched for prospective studies in English from 1990 to May 24, 2023. Studies were included if they concerned a working population, exposure to any form of GBVH in the work context, and a health outcome or manifest occupational outcome. Quality was assessed with a modified version of the Cochrane 'Tool to Assess Risk of Bias in Cohort Studies', and studies assessed as low quality were excluded from the narrative synthesis. For the narrative synthesis, we grouped the results by similar exposures and outcomes and reported the strength and statistical significance of the associations.

RESULTS

Of the 1 937 screened records, 29 studies were included in the narrative synthesis. Studies were mainly conducted in the USA and northern Europe and investigated exposure to sexual violence or harassment (SVH). Only two included studies investigated non-sexual kinds of GBVH. Consistently, studies showed associations of work-related SVH with poor mental health and there were indications of an association with hazardous substance use. There was no consistent evidence for an association of SVH with subsequent sickness absence, and there were too few studies concerning physical health and occupational outcomes to synthesize the results.

CONCLUSIONS

There is consistent evidence of work-related SVH as a risk factor for subsequent poor mental health. There is no indication that the health consequences of SVH differ between women and men, although women are more often affected. There is a need for conceptual consistency, the consideration of non-sexual behaviors and prospective studies that test clear hypotheses about the temporal sequence of events.

Gender-based harassment in Swedish workplaces and alcohol-related morbidity and mortality: A prospective cohort study

OBJECTIVE

The study investigated experiences of different types of work-related gender-based harassment (GBH), specifically sexual and gender harassment, as risk factors for alcohol-related morbidity and mortality (ARMM).

METHODS

Information about experiences of (i) sexual harassment (SH-I) and (ii) gender harassment (GH-I) from inside the organization and (iii) sexual harassment from a person external to the organization (SH-E) were obtained from the Swedish Work Environment Survey 1995-2013, a biannual cross-sectional survey, administered to a representative sample of the Swedish working population. The survey responses from 86 033 individuals were connected to multiple registers containing information about alcohol-related diagnoses, treatment, or cause of death. Cox proportional hazard models were fitted to assess hazard ratios (HR) of incident ARMM during a mean follow-up of eight (SH-I and GH-I) and ten (SH-E) years.

RESULTS

A higher prospective risk estimate of ARMM was found among participants who reported experiences of SH-E [HR 2.01, 95% confidence interval (CI) 1.61-2.52], GH-I (HR 1.33, CI 1.03-1.70), or SH-I (HR 2.37, CI 1.42-3.00). Additional analyses, distinguishing one-time from reoccurring harassment experiences, indicated a dose-response relationship for all three harassment types. Gender did not modify the associations. Under the assumption of causality, 9.3% (95% CI 5.4-13.1) of the risk of ARMM among Swedish women and 2.1% (95% CI 0.6-3.6) among Swedish men would be attributable to any of the three types of GBH included in this study.

CONCLUSIONS

Experiences of GBH in the work context may be a highly relevant factor in the etiology of ARMM.

Association between Experiences of Different Types of Harassment or Derogatory Treatment and Sexual Harassment among Employees at a Large Swedish University

Sexual harassment (SH) and other forms of mistreatment continue to be a significant problem at workplaces, leading to negative health and work-related outcomes. Previous studies have mainly examined SH and other types of workplace harassment separately. In this study we investigated whether harassment related to any of the seven Swedish legal grounds for discrimination (sex, transgender identity or expression, ethnicity, religion or other belief, disability, sexual orientation, or age) and derogatory treatment were associated with SH at a large Swedish university. Using cross-sectional survey data obtained from 33% of all staff, multivariable logistic regression analysis was performed to investigate associations between harassment, derogatory treatment, and SH. We found a sixfold increased risk of SH among women with experience of other forms of harassment and a three-times-higher risk among women with experience of derogatory treatment, indicating that SH co-occurs with other forms of mistreatment. This pattern was similar among men, although men reported lower prevalence of mistreatment. Our findings have implications for preventive strategies at academic workplaces indicating that issues related to the defence of power and various types of abusive behaviours, including SH, both need to be addressed to create more equal opportunities for all employees.

Sexual harassment among employees and students at a large Swedish university: who are exposed, to what, by whom and where - a cross-sectional prevalence study

BACKGROUND

Sexual harassment (SH) in the workplace is prevalent and associated with poor health. Universities are large workplaces with complex formal and informal power relations, which may influence the prevalence of SH. Although employees and students share the university context, few studies on SH have included both groups. The overall aim of the study was to investigate SH among employees and students at a large Swedish public university regarding types of harassment, prevalence in different groups, characteristics of the perpetrators, and the circumstances in which it occurs.

METHODS

A cross-sectional analysis was performed, based on a web-based survey with 120 items that was sent out to all staff, including PhD students (N = 8,238) and students (N = 30,244) in November 2019. The response rate was 33% for staff and 32% for students. Exposure to SH was defined as having experienced at least one of ten defined SH behaviors during their work or studies.

RESULTS

Among women, 24.5% of staff and 26.8% of students reported having been exposed to SH. The corresponding figures were 7.0% and 11.3% for male staff and students and 33.3% and 29.4% for non-binary individuals among staff and students. Unwelcome comments, suggestive looks or gestures, and 'inadvertent' brushing or touching were the three most common forms of reported harassment, both among staff and students. Attempted or completed rape had been experienced by 2.1% of female and 0.6% of male students. Male and female perpetrators were reported by about 80% and 15%, respectively, of exposed participants. Among staff most reported events occurred during the everyday operation of the university, while among students the majority of the events took place during social events linked to student life. When exposed to a perpetrator from the same group (staff or students), women reported more often being in a subordinate power position in relation to the perpetrator.

CONCLUSIONS

The results indicate that sexual harassment is common in the university context, and interventions and case management routines of events should consider power relations between victim and perpetrator, as well as the various contexts within which sexual harassment takes place.

Personal and Bystander Harassment Experiences and Outcomes for Hospital Nurses

OBJECTIVES

To examine experiences, context, and outcomes of personal and bystander harassment among hospital nurses.

BACKGROUND

Harassment of nurses is common, affecting victims and bystanders. Yet, little is known about the nature and context of these experiences.

METHOD

A cross-sectional study of hospital nurses was completed via an anonymous online survey.

RESULTS

A majority of nurses experienced personal or bystander harassment. Nearly half experienced both of these forms of harassment. Personal harassment victims frequently told their managers and coworkers, but actions to prevent further harassment or mitigate harm were rare. Bystanders frequently intervened to help victims of personal harassment but rarely reported it. These experiences negatively impacted work relationships and performance.

CONCLUSION

Personal and bystander harassment may co-occur in cultures that tolerate harassment. The lack of response to personal harassment and lack of reporting of bystander harassment may perpetuate it.

One-year incidence of sexual harassment and the contribution to poor mental health in the adult general population

Background

Sexual harassment (SH) has been highlighted as an important determinant for mental health. The aims of this study were to describe SH in terms of cumulative 1-year incidence, exposed groups, types of perpetrators and settings, and to measure the association between SH and poor mental well-being.

Methods

Data from two waves of the Scania Public Health Cohort Study, comprising 7759 randomly recruited individuals above 18 years. Exposure to SH was measured by an instrument that also recorded place of exposure and type of perpetrator. Poor mental well-being was assessed by General Health Questionnaire (GHQ)-12, 36-Item Short Form Health Survey questionnaire (SF-36) (mental health module) and self-reported use of prescribed psychotropic medication. Logistic regression was used for multivariate analyses.

Results

The cumulative 1-year incidence of SH was six times greater among women, the highest figure (17.5%) was noted for women 18–34 years of age. No difference was noted regarding educational level or country of origin. Public places, including public transportation, and unknown offenders were the most frequently reported setting of SH for both genders. Exposure to SH was associated with a doubled risk for low mental well-being, according to all three outcome definitions, and after adjustment for mental health 6 years earlier. Female gender was related to greater vulnerability to SH exposure concerning GHQ-12 and SF-36. The Population Attributable Fraction for poor mental health was calculated to 13% for women 34 years and younger.

Conclusion

The results of this study make SH an important issue for gender policy as well as for public health policy and intervention.

Associations Between Workplace Violence, Mental Health, and Physical Health among Korean Workers: The Fifth Korean Working Conditions Survey

BACKGROUND

Workplace violence (WPV) is a global public health problem and a threat to the health of Korean workers. This study assessed the prevalence and risk factors of WPV and its association with mental and physical health among Korean workers.

METHODS

Data obtained for 50,205 respondents to the Fifth Korean Working Conditions Survey were utilized for this study. Verbal abuse, threats, physical violence, and sexual harassment were assessed individually and as a composite for "any WPV." Workers were characterized by education, income, shift work status, access to a health and safety education program, work sector and overall health. Descriptive analyses and multiple logistic regression analyses were used to estimate the prevalence of WPV and its association with mental and physical health.

FINDINGS

Overall, 5.6% of workers reported experiencing one of four forms of WPV. The prevalence of verbal abuse, threats, physical violence, and sexual harassment were 4.9%, 0.7%, 0.2%, and 1.1%, respectively. Most perpetrators were customers. Prevalence of WPV was associated with lower education level, poor health status, long working hours, shift work, and no experience of health and safety education; 9.0% of service workers experienced violence. Workers who had experienced WPV were more likely to experience anxiety, sleep-related problems, depressive symptoms, back pain, headache/eye strain, and overall fatigue.

CONCLUSIONS/APPLICATIONS TO PRACTICE

Workplace violence is a serious occupational and public health concern in Korea. These results suggest managing WPV may improve workers' well-being and that violence-prevention strategies, policies, and regulations should be implemented across most industries.

Psychological Workplace Violence and Health Outcomes in South Korean Nurses

BACKGROUND

Workplace violence (WPV) and its health consequences should continue to be investigated to foster a healthy and safe working environment, which may reduce nurse staff turnover and improve nurse staff shortages. This study aimed to address the gap in understanding WPV in non-western nurses by examining the relationship between psychological WPV experience, psychological well-being, subjective job stress, and presenteeism among South Korean nurses.

METHODS

This cross-sectional study used data from the fifth Korean Working Conditions Survey (KWCS), and 477 nurses were analyzed. For the analysis, selected variables were extracted from the KWCS through a review of the existing literature. In the analysis, we included psychological WPV experiences, such as verbal abuse, unwanted sexual attention, threats, and/or humiliating behaviors over the past 1 month. We measured health outcomes including nurses' psychological well-being, subjective job stress, and presenteeism.

FINDINGS

Psychological WPV within the previous month was experienced by 11.1% of the participants. Experience with verbal abuse, threats, or humiliating behaviors was associated with more job stress, higher presenteeism, and poor psychological well-being.

CONCLUSION/APPLICATION TO PRACTICE

Study findings suggest that a comprehensive WPV prevention program accompanied by interventions aiming to reduce job stress and improve the well-being of nurses should be actively implemented. To prevent psychological WPV and improve the health of nurses, evidence-based efforts, such as establishment of WPV prevention procedures and education/training of workers at the national, organizational, and individual levels are needed.

Effects of adverse social behaviour at the workplace on subsequent mental distress: a 3-year prospective study of the general working population in Norway

OBJECTIVE

We aimed to provide an integrated picture of the relationship between different facets of adverse social behaviour (ASB) at work and mental health problem.

METHODS

Data were provided from a longitudinal nationwide study of the general population in Norway. Eligible respondents were in paid work during a reference week in 2013, or temporarily absent from such work, and was interviewed at 3-year follow-up (n = 3654, response at baseline/follow-up = 53.1%/71.8%). We investigated the prospective associations of self-reported exposure to ASBs, including threats/acts of violence, bullying, sexual harassment and workplace conflicts, with mental distress (the Hopkins Symptoms Checklist) at follow-up, by means of multiple logistic regression.

RESULTS

In total, 6.6% (242 individuals) were classified with mental distress at follow-up. Work-related predictors were sexual harassment (OR = 1.64 07, 95% CI 1.03 - 2.61), bullying (OR = 2.07, 95% CI 1.19 - 3.60) and workplace conflicts (OR = 1.51, 95% CI 1.07 - 2.13). An elevated, but non-statistically significant association was observed for threats/acts of violence. No significant interactions were found between ASB and mental distress score at baseline. Overall there were few indications of substantial confounding related to age, sex, education level or occupation. After adjusting for these factors, the overall population attributable risk of mental distress attributable to any exposure to ASB was 11.3% (95%CI 0.6-22.3).

CONCLUSIONS

We observed robust associations between exposure to three out of four types of ASB and risk of mental distress. Taken together, the results underscore that adverse social behaviour at the workplace may have a substantial impact on the level of mental distress in the general working population.

Adverse social behaviour at the workplace and subsequent physician certified sick leave: a three-wave prospective study of the general working population in Norway

OBJECTIVES

We aimed to provide an integrated picture of the relationship between different facets of adverse social behaviour (ASB) at the workplace and sick leave.

METHODS

Data from a randomly drawn prospective cohort of the general working population. Eligible respondents were interviewed in 2009, 2013 or 2016, and were registered with an employee relationship of at least 50 working days in the national register the year following the survey interviews (n=21 674 observations/13 470 respondents). We investigated the prospective associations of self-reported exposure to ASB, including threats/acts of violence, bullying and sexual harassment, with physician-certified sick leave of 1-16 days (ie, low level of sick leave (LLSL)) and >16 days (ie, high level of sick leave (HLSL)) by means of mixed effects logistic regression.

RESULTS

The prevalence of sick leave was 18.4% (n=3986 observations) for LLSL and 16.1% (n=3492 observations) for HLSL. The different facets of ASB were independently associated with higher odds of sick leave, with stronger associations for HLSL than for LLSL. Adjusted for sex, age, education level, occupation, previous sickness absence level, OR (95% CI) for HLSL was 1.97 (1.61 to 2.35) for threats/acts of violence, 1.97 (1.53 to 2.54) for bullying and 1.41 (1.10 to 1.79) for sexual harassment. The population risks of LLSL and HLSL attributable to ASB were 5.27 (95% CI 1.85 to 8.81) and 8.27% (95% CI 4.01 to 12.48), respectively.

CONCLUSIONS

Threats/acts of violence, bullying and sexual harassment were all independent predictors of sick leave, with threats/acts of violence appearing as the single most important factor.

Psychosocial Work Environment Explains the Association of Job Dissatisfaction With Long-term Sickness Absence: A One-Year Prospect Study of Japanese Employees

BACKGROUND

Using a 1-year prospective design, we examined the association of job dissatisfaction with long-term sickness absence lasting 1 month or more, before and after adjusting for psychosocial work environment (ie, quantitative job overload, job control, and workplace social support) in Japanese employees.

METHODS

We surveyed 14,687 employees (7,343 men and 7,344 women) aged 20-66 years, who had not taken long-term sickness absence in the past 3 years, from a financial service company in Japan. The Brief Job Stress Questionnaire, including scales on job satisfaction and psychosocial work environment, was administered, and information on demographic and occupational characteristics (ie, age, gender, length of service, job type, and employment position) was obtained from the personnel records of the surveyed company at baseline (July-August 2015). Subsequently, information on the start dates of long-term sickness absences was obtained during the follow-up period (until July 2016) from the personnel records. Cox's proportional hazard regression analysis was conducted.

RESULTS

After adjusting for demographic and occupational characteristics, those who perceived job dissatisfaction had a significantly higher hazard ratio of long-term sickness absence than those who perceived job satisfaction (hazard ratio 2.91; 95% confidence interval, 1.74-4.87). After additionally adjusting for psychosocial work environment, this association was weakened and no longer significant (hazard ratio 1.55; 95% confidence interval, 0.86-2.80).

CONCLUSIONS

Our findings suggest that the association of job dissatisfaction with long-term sickness absence is spurious and explained mainly via psychosocial work environment.

Work related sexual harassment and risk of suicide and suicide attempts: prospective cohort study

OBJECTIVE

To analyse the relation between exposure to workplace sexual harassment and suicide, as well as suicide attempts.

DESIGN

Prospective cohort study.

SETTING

Sweden.

PARTICIPANTS

86 451 men and women of working age in paid work across different occupations responded to a self-report questionnaire including exposure to work related sexual harassment between 1995 and 2013. The analytical sample included 85 205 people with valid data on sexual harassment, follow-up time, and age.

MAIN OUTCOME MEASURES

Suicide and suicide attempts ascertained from administrative registers (mean follow-up time 13 years).

RESULTS

Among the people included in the respective analyses of suicide and suicide attempts, 125 (0.1%) died from suicide and 816 (1%) had a suicide attempt during follow-up (rate 0.1 and 0.8 cases per 1000 person years). Overall, 11 of 4095 participants exposed to workplace sexual harassment and 114 of 81 110 unexposed participants committed suicide, and 61/4043 exposed and 755/80 513 unexposed participants had a record of suicide attempt. In Cox regression analyses adjusted for a range of sociodemographic characteristics, workplace sexual harassment was associated with an excess risk of both suicide (hazard ratio 2.82, 95% confidence interval 1.49 to 5.34) and suicide attempts (1.59, 1.21 to 2.08), and risk estimates remained significantly increased after adjustment for baseline health and certain work characteristics. No obvious differences between men and women were found.

CONCLUSIONS

The results support the hypothesis that workplace sexual harassment is prospectively associated with suicidal behaviour. This suggests that suicide prevention considering the social work environment may be useful. More research is, however, needed to determine causality, risk factors for workplace sexual harassment, and explanations for an association between work related sexual harassment and suicidal behaviour.

Precarious employment and self-reported experiences of unwanted sexual attention and sexual harassment at work. An analysis of the European Working Conditions Survey

Unwanted sexual attention (UWSA) and sexual harassment (SH) are prevalent experiences for women in working life and often accompanied by poor health. Despite increasing numbers especially of young people working in insecure and irregular employment settings, there is little empirical evidence if such precarious arrangements are associated with UWSA or SH. To investigate this, we used a representative sample of the European working population consisting of 63,966 employees in 33 countries who participated in the European Working Conditions Survey in 2010 or 2015. Precarious employment (PE) was assessed on the basis of seven indicators and a formative index derived from them: temporary employment, contractual duration < 1 year, schedule unpredictability, involuntary part-time, low information on occupational health and safety risks (OSH), low pay (wage < 60%), and multiple job-holding. We measured self-reported experiences of workplace UWSA during the last month and SH during the last 12 months each using a single-item questionnaire. Multi-level Poisson regressions were used to estimate prevalence ratios for UWSA and SH according to PE adjusted for survey year, age, education, type of household, migration background, job tenure, weekly working hours, occupational position, working sector, company size, workplace gender ratio, and visiting customers or clients. 0.8% of men reported UWSA in the last month and 2.6% of the women. SH in the last year was reported by 0.4% of the men and 1.3% of the women. For both men and women, PE was significantly associated with elevated prevalence of UWSA and SH, in particular when reporting schedule unpredictability, multiple job-holding and low information on OSH. Our results suggest that precariously employed individuals may be more prone to experience unwanted sexual behaviour at the workplace compared with workers in non-precarious settings.

An unintended consequence? Examining the relationship between visible tattoos and unwanted sexual attention

In the wake of the increasing popularity of tattoos, the present study explored whether tattoos have an adverse impact on employees. Specifically, this research examined the relationship between visible tattoos and unwanted sexual attention, along with perceived sexual harassment climate and perceived inclusion climate as potential moderators of this relationship. With a sample of 417 restaurant and retail employees, the results from logistic regression analyses demonstrated that possessing a visible tattoo was associated with increased odds of experiencing unwanted sexual attention. Perceived inclusion climate attenuated this relationship, whereby individuals with visible tattoos were less likely to experience unwanted sexual attention in a more favorable climate. Although perceived sexual harassment climate was directly related to unwanted sexual attention, it did not moderate the visible tattoo-unwanted sexual attention relationship.

Workplace sexual harassment and depressive symptoms: a cross-sectional multilevel analysis comparing harassment from clients or customers to harassment from other employees amongst 7603 Danish employees from 1041 organizations

Background

Previous research has reported that sexual harassment can lead to reduced mental health. Few studies have focused on sexual harassment conducted by clients or customers, which might occur in person-related occupations such as eldercare work, social work or customer service work. This study examined the cross-sectional association between sexual harassment by clients or customers and depressive symptoms. We also examined if this association was different compared to sexual harassment conducted by a colleague, supervisor or subordinate. Further, we investigated if psychosocial workplace initiatives modified the association between sexual harassment by clients or customers and level of depressive symptoms.

Methods

We used data from the Work Environment and Health in Denmark cohort study (WEHD) and the Work Environment Activities in Danish Workplaces Study (WEADW) collected in 2012. WEHD is based on a random sample of employed individuals aged 18–64. In WEADW, organizational supervisors or employee representatives provided information on workplace characteristics. By combining WEHD and WEADW we included self-reported information on working conditions and health from 7603 employees and supervisors in 1041 organizations within 5 occupations. Data were analyzed using multilevel regression and analyses adjusted for gender, age, occupation and socioeconomic position.

Results

Exposure to workplace sexual harassment from clients or customers was statistically significantly associated with a higher level of depressive symptoms (2.05; 95% CI: 0.98–3.12) compared to no exposure. Employees harassed by colleagues, supervisors or subordinates had a higher mean level of depressive symptoms (2.45; 95% CI: 0.57–4.34) than employees harassed by clients or customers. We observed no statistically significant interactions between harassment from clients and customers and any of the examined psychosocial workplace initiatives (all p > 0.05).

Conclusions

The association between sexual harassment and depressive symptoms differed for employees harassed by clients or customers and those harassed by colleagues, supervisors or subordinates. The results underline the importance of investigating sexual harassment from clients or customers and sexual harassment by colleagues, supervisors or subordinates as distinct types of harassment. We found no modification of the association between sexual harassment by clients or customers and depressive symptoms by any of the examined psychosocial workplace initiatives.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4669-x) contains supplementary material, which is available to authorized users.