Perceived work stress, overcommitment, and self-reported musculoskeletal pain: a cross-sectional investigation

Nursing students' academic conditions, psychological distress, and intention to leave school: A cross-sectional study

BACKGROUND

Psychological distress and intention to leave school are highly prevalent among nursing students. Academic conditions, including psychosocial stressors and school-work-life conflicts, could contribute to psychological distress and intention to leave school.

OBJECTIVE

To explore the associations between academic conditions and 1) psychological distress and 2) intention to leave school.

DESIGN

Cross-sectional correlational design.

SETTINGS

Data collection was performed in February and October 2021 in two nursing schools in Canada: Cegep (publicly funded college, technical degree) and university (bachelor's degree).

PARTICIPANTS

230 nursing students (Cegep 131, university 99).

METHODS

A self-administered online questionnaire assessed academic conditions (psychosocial stressors (Demand-Control-Support, Effort-Reward Imbalance and Overcommitment scales) and school-work-life conflicts (single item)), psychological distress (Kessler-6 scale), intention to leave school, and several covariates. Poisson robust multivariate regression models were built to explore the associations between academic conditions and 1) psychological distress and 2) intention to leave school.

RESULTS

A large proportion of participants experienced high efforts, school-work-life conflicts, overcommitment, and psychological distress (49.5-84.7 %). One out of five participants had had intention to leave school "many times" (Cegep 20.61 %; university 22.22 %). In adjusted analysis, overcommitment and school-work-life conflicts were associated with a higher prevalence of psychological distress (Prevalence ratio = 2.10; 95 % Confidence Intervals = 1.15-3.84 and Prevalence ratio = 2.32; 95 % Confidence Intervals = 1.24-4.32, respectively). Adverse associations were observed between effort-reward imbalance (Prevalence ratio = 2.32; 95 % Confidence Intervals = 1.09-4.94) as well as school-work-life conflicts (Prevalence ratio = 2.40; 95 % Confidence Intervals = 1.05-5.45) and intention to leave school.

CONCLUSIONS

Academic conditions might be risk factors for psychological distress and intention to leave school among nursing students. Interventions targeting modifiable academic conditions might improve nursing students' mental health and retention.

Work-related stress, reason for consultation and diagnosis-specific sick leave: How do they add up?

Work-related stress is common in Western society and disorders associated with stress are often managed in primary health care. This study was set to increase the understanding of the relationship between reason for consultation, work-related stress and diagnosis-specific sick leave for primary health care patients. The longitudinal observational study included 232 employed non-sick listed patients at seven primary health care centres in Sweden. Of these patients, 102 reported high work-related stress, as measured with the Work Stress Questionnaire, and 84 were on registered sick leave within one year after inclusion. The study showed that, compared to those who did not report high work-related stress, highly stressed patients more often sought care for mental symptoms (60/102 versus 24/130), sleep disturbance (37/102 versus 22/130) and fatigue (41/102 versus 34/130). The risk for sick leave with a mental diagnosis within a year after base-line was higher among patients reporting high work-related stress than among those who did not (RR 2.97, 95% CI 1.59;5.55). No such association was however found for the risk of sick leave with a musculoskeletal diagnosis (RR 0.55, 95% CI 0.22;1.37). Seeking care for mental symptoms, sleep disturbance and fatigue were associated with having a future mental sick leave diagnosis (p-values < 0.001), while seeking care for musculoskeletal symptoms was associated with having a future musculoskeletal sick leave diagnosis (p-value 0.009). In summary, compared to those who did not report high work-related stress, patients with high work-related stress more often sought care for mental symptoms, sleep disturbance and fatigue which lead to a mental sick leave diagnosis. Reporting high work-related stress was, however, not linked to having sought care for musculoskeletal symptoms nor future sick leave due to a musculoskeletal diagnosis. Hence, both patients and general practitioners seem to characterize work-related stress as a mental complaint.

Development of an ergonomics risk assessment tool for repetitive task assessment (RTRA)

BACKGROUND

Most ergonomics assessment tools for repetitive task have been used in industries which are mainly focused on assessing the biomechanical risk factors that affect musculoskeletal disorders (MSDs)rather than the psychosocial and work environment risk factors.

OBJECTIVE

To develop a tool for Repetitive Task Risk Assessment (RTRA) and Rapid Upper Limb Assessment (RULA) that can identify biomechanical, physical stress and psychosocial risk factors, prioritize risk reduction action and systematic record keeping.

METHODS

The study consisted of 2 phases; tool development and evaluation of the contents of risk factors by 7 ergonomic experts and intra-rater and inter-rater reliability and validity tests of the tool by 1 researcher and 9 Thai practitioners to assess 30 repetitive tasks.

RESULTS

RULA was modified by adding more biomechanical risk, combining psychosocial and work environment risk factors lead to MSD become the first prototype of RTRA. The Item-Objective Congruence Index (IOC) validated 20 items on usability of each step of the RTRA ranged between 0.64 and 0.93. The examination of the overall intra-rater reliability was 0.932 (95% CI: 0.862-0.967) and the overall inter-rater was 0.956 (95% CI: 0.909-0.978).

CONCLUSION

The tool has high test-retest reliability. There is a suggestion for researchers to understand more on the identification of multiple risk factors in one assessment tool and consider a risk-level rating and scoring for prioritizing risk reduction.

Understanding Reciprocity Among University Students in Low-Resource Settings: Validation and Measurement Using a Mixed-Methods Approach

Objectives

This study aimed to investigate reciprocity among university students in low-resource settings using a convergent mixed-methods approach in Jordan. The study operationalized the effort-reward imbalance (ERI) model which is a sociological framework used to predict occupational-related health outcomes. The basic theory of ERI model assumes that an imbalance of effort and reward predicts adverse health outcomes.

Methods

The research involved two studies, Study I (n = 833) to quantitatively measure ERI and Study II to collect qualitative data (n = 44) on the drivers of ERI among university students. In Study I, a modified Arabic version of the ERI questionnaire was used. The study measured ERI and investigated the reliability and validity of the Arabic version of the ERI model questionnaire. In Study II, data were collected from focus groups and personal interviews and thematic analysis was used.

Results

The results suggested that ERI was associated with poor academic performance (OR=2.31, 95% CI 1.60–3.32), absenteeism (OR=1.66, 95% CI 1.21–2.27), low exercise level (OR=2.02, 95% CI 1.49–2.74) and poor self-reported health (OR=1.12, 95% CI 1.08–1.30). Three major themes emerged, namely high academic load, financial pressures and negative influence on the students' performance, wellbeing and health to explain effort-reward imbalance.

Conclusions

Results suggest that ERI among university students is multi-faceted and is not bound only to academic-related demands and that the extrinsic factors such as the economic context of Jordan is among drivers of ERI.

Objective assessment of mental stress in individuals with different levels of effort reward imbalance or overcommitment using heart rate variability: a systematic review

BACKGROUND

Workloads are increasing and could cause mental stress, e.g., in the form of subjective effort reward imbalance (ERI) and overcommitment (OC). The heart rate variability (HRV) is a valid method for objective monitoring of workload. The aim of this project is to systematically evaluate the literature on HRV as an objective indicator for mental stress in individuals with different levels of ERI or OC.

METHODS

A systematic literature review examining HRV of employees in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement for reporting systematic reviews was performed. Electronic databases used were PubMed, Ovid, Cochrane Libary, Scopus and Web of Science, PsyInfo, Psyndex, and Livio. Only articles from 2005 to 2021 were included. Inclusion criteria were case-control studies, intervention studies, cross-sectional studies, or longitudinal studies with different levels of ERI and/or OC, >10 participants in each group, measurement of 24h HRV by using Holter ECG or chest belt, and full-text in English or German language. The methodological quality was evaluated by using a modified STARD for HRV.

RESULTS

Five studies matched the inclusion criteria by using HRV (24-h ECG) with a different HRV analysis at day and night. It showed an adaptation of HRV with higher ERI or OC with reduced parasympathetic HRV parameters, but the studies were not comparable.

CONCLUSIONS

There is a need for occupational health studies that examine strains and stress of different employees with predominantly mental stress. The well-established parasympathetic mediated HRV parameters seem to be suitable parameters to objectify the stress.

[Assessment of Psychological Stress in Kindergarten Teachers with Varying Degrees of Overcommitment]

OBJECTIVE

Nursery school teachers are exposed to psycho-emotional stress in their profession, which can lead to health problems. The aim of the study was to examine whether and to what extent increased work commitment (overcommitment, OC) affects the health of educators.

METHODS

163 nursery school teachers (age 44.5 ± 12.4 years) were recruited for the study. OC, mental health and the risk of burnout were assessed using standardized questionnaires. ECG recordings over 24 h served as a basis for the calculation of heart rate variability (HRV).

RESULTS

121 teachers showed normal OC and 42 teachers increased OC. In nursery school teachers with elevated OC, self-reported mental health is impaired and vagal mediated HRV (RMSSD and HF) is reduced.

CONCLUSION

Since the subjectively assessed mental health of nursery school teachers with elevated OC deteriorates and HRV is reduced, preventive measures must be taken to maintain the health of nursery school teachers.

Occupational Stress in Spanish Police Officers: Validating the Effort-Reward Imbalance Questionnaire

The Effort-Reward Imbalance Questionnaire (hereinafter, ERIQ) has been largely used worldwide to assess job stress, but it has not yet been applied in Spanish police. The objective of this study was to examine the construct validity and the internal consistency of the ERIQ in police officers. A cross-sectional study was carried out, using a nonprobability sampling (quota). A total of 217 Spanish police officers participated, 192 men (88.47%) and 25 women (11.53%). The mean age was 41 years (SD = 7.51). These police officers completed the ERIQ together with some other questionnaires (DECORE-21, MBI, GHQ and STAI) in order to provide evidence for validity based on the relationships to other constructs. A confirmatory factor analysis was performed and a matrix of correlations with the rest of constructs was created. The results showed an appropriate fit to the original model consisting of three scales. In addition, the scales of the ERIQ presented the expected relationship with the other constructs. The ERIQ is a valid instrument for assessing occupational stress in Spanish police officers and can improve the interventions in this professional group.

Pain complaints after consecutive nights and quick returns in Norwegian nurses working three-shift rotation: an observational study

OBJECTIVES

To determine whether nurses working consecutive night shifts, or short transitions between shifts (quick returns (QRs)), yielded higher risk for pain complaints when compared with regular morning shifts. Sleep duration was tested as a potential mediator.

DESIGN

Observational diary study.

SETTING

Random hospitals.

PARTICIPANTS

Nurses with three-shift rotation (morning, evening and night), n=679, 22-63 years old.

OUTCOMES MEASURES

Daily ratings of working hours, sleep and subjective pain complaints in six anatomical regions (head, neck/shoulder/upper back, upper extremity, low back, lower extremity and abdomen) for 28 days. In addition, we assessed demographics, habitual sleep and pain complaints, work and lifestyle factors. It was tested (1) whether the risk for pain complaints was higher after workday 3 versus after workday 2, and whether the difference was larger for consecutive night shifts versus consecutive morning shifts, and (2) whether the risk for pain complaints was higher after QRs versus after two morning shifts. Risk for pain complaints refers to combined increased risk for any pain and risk for increased intensity.

RESULTS

Adjusted analyses showed no shift type by workday interaction for pain complaints in the neck/shoulder/upper back, upper extremities, low back, lower extremities or abdomen. For headache, a strong trend indicated that the risk was higher on workday 3 compared with workday 2 for night shifts (OR 1.13, 95% CI 0.99 to 1.28). The risk was lowered if sleep duration was taken into account (OR 0.37, 95% CI 0.17 to 0.81). No conclusive support was found for the risk for pain complaints being higher after QRs, compared with after morning shifts.

CONCLUSIONS

For five of six pain complaints, the hypotheses were not supported by the current data. For headache, we found potential support for a sleep-relieving effect on headache after working several nights in a row. Pain complaints were not instigated or exacerbated by an evening-to-morning transition between shifts.

The RAMP package for MSD risk management in manual handling - A freely accessible tool, with website and training courses

In this paper the RAMP Package is presented with the objective to facilitate the application of the RAMP tool to systematically manage MSD risks. The package consists of the RAMP tool (Risk Assessment and Management tool for manual handling Proactively), the RAMP website, and free, globally available online, training courses (MOOCs). An Action module used for managing identified MSD risks is introduced. The tool, encompassing a wide range of risks, is applicable to the whole risk management process. Furthermore, RAMP is openly available for download, and free to use. The RAMP tool and training materials were developed using a participative iterative methodology including researchers and practitioners. RAMP was downloaded in 86 countries in the first 26 months since its' launch and over 2400 learners from high-, middle- and low-income countries have joined the MOOCs. The RAMP Package meets organisations' needs for an accessible, comprehensive risk assessment and management tool.

Moderated Mediation Effect of Mindfulness on the Relationship Between Muscular Skeletal Disease, Job Stress, and Turnover Among Korean Firefighters

Background

This study investigated the effect of increased job stress, caused by musculoskeletal disease (MSD) among firefighters, on a firefighter's intention to leave the profession, henceforth referred to as “turnover intention,” and verified the moderating effect of mindfulness on such a relationship.

Methods

A survey involving a total of 549 Korean male firefighters as participants was conducted herein, and the following results were obtained: the mediation effect of the MSD to turnover intention through job stress was confirmed, and the indirect effect of job stress was verified.

Results

We verified the moderated mediation effect of mindfulness on the relation:MSD, job stress, and turnover intention. The conditional indirect effect for middle and high levels of mindfulness is significant.

Conclusion

The result of this study is supported by proofs of the relationship between a firefighter's MSD, job stress, and turnover intention, and these case studies reveal the moderated mediation effect of dispositional mindfulness.

Unfairness in stressful job environments: the contingent effects of perceived organizational injustice on the relationships between job stress and employee behaviors

Adopting the transactional model of stress and affective events theory, we examine the boundary effects of injustice types (i.e., procedural and distributive) on the relationships between job stress and employee behaviors (i.e., creativity, organizational retaliatory behavior and organizational citizenship behavior). Using two sources of field data (N = 691) with independent measures for predictors (self-reports) and outcomes (peer reports), in the service sector of Pakistan, we tested our hypothesized model using Preacher and Hayes' bootstrapping method for testing moderator effects. The results of the moderation analyses reveal that job stress worsened employees' creativity, citizenship and retaliatory behaviors when injustice levels (procedural and distributive) were high. No support was found for the moderating effect of procedural injustice on the relationship between job stress and retaliatory behavior. In conclusion, this study addresses an important theme that has not previously been explored in a developing country context.

Pain complaints are associated with quick returns and insomnia among Norwegian nurses, but do not differ between shift workers and day only workers

PURPOSE

To determine whether common work schedule characteristics among Norwegian nurses were associated with subjective pain complaints.

METHODS

A cross-sectional study in a sample of 1585 nurses, part of the longitudinal questionnaire-based cohort project 'Survey of Shift work, Sleep and Health' (SUSSH). Pain from six regions were assessed: 'headache', 'neck/shoulder/upper back', 'upper extremities', 'lower back', 'lower extremities', and 'abdomen'. Logistic and negative binomial regression (adjusted for age, sex, percentage of full-time equivalent, marital status and children living at home) were conducted where work schedule, number of night shifts last year, number of quick returns (QR) last year (< 11 h between shifts) and insomnia were predictors of localized pain, widespread pain and number of pain sites.

RESULTS

Localized pain, widespread pain and number of pain sites were associated with insomnia (OR 2.06, 95% CI 1.66-2.55, OR 2.14, 95% CI 1.47-3.09, IRR 1.70, 95% CI 1.51-1.91, respectively). Work schedule and number of night shifts worked last year were not associated with any of the three pain measures. Number of QRs worked last year tended to be associated with number of pain sites.

CONCLUSION

The study did not support the hypothesis that non-daytime work schedules are associated with pain complaints. Neither was there support for the hypothesis linking number of night shifts, or the number of QRs, to pain complaints. Future studies should aim to determine the association between QRs and pain in more detail. Pain complaints were associated with insomnia.

Sleep duration mediates abdominal and lower-extremity pain after night work in nurses

OBJECTIVES

The aim of this study was to investigate the association between different working shifts (i.e. morning, evening, night shifts) and headache, musculoskeletal and abdominal pain, and the extent to which reduced sleep duration could account for these associations.

METHODS

Nurses (N = 679, 649 female, aged 22-53 years) were followed up for a period of 28 consecutive days, responding to a diary about sleep, shift type and pain complaints (measured on a Likert-type scale ranging from 0 to 3). Generalised structural equation modelling mediation analysis (GSEM) was performed to test whether shift type was associated with higher incidence or higher intensity of pain (headache, pain in neck/shoulders/upper back, upper extremity, low back, lower extremity and abdominal pain), and if this effect was mediated by sleep duration (continuous variable), after controlling for age, work and lifestyle factors.

RESULTS

Pain scores in lower extremities were decreased following night shifts in general. However, when night shifts were followed by short sleep duration, the risk of pain in the lower extremities and abdominal pain were increased. Headache and pain in the upper extremity were increased after night shifts, but were not associated with sleep duration. Pain in the neck/shoulder/upper back and lower back was not related to shift work.

CONCLUSIONS

Among nurses in a three-shift rotating schedule, night shifts increased the risk of pain in several regions, but only pain in the lower extremities and abdomen was related to reduced sleep duration.

Associations between hyperacusis and psychosocial work factors in the general population

Purpose

We investigated the association between hyperacusis and aspects of psychosocial work environment in a general population. The objectives were to investigate (1) prevalence and characteristics (among age, sex, access to social support at home, education, smoking, physical exercise, and perceived general health) of hyperacusis in a general working population and (2) associations between hyperacusis and psychosocial factors in the work environment. The psychosocial work aspects included effort, reward, overcommitment, worry, and social and emotional support.

Methods

Using data from a sample stratified for age and sex from the Österbotten Environmental Health Study in Finland, currently employed participants with self-reported hyperacusis and referents were compared on questionnaire instruments quantifying six aspects of their psychosocial work environment.

Results

Among 856 currently employed participants, 47 constituted a hyperacusis group and 809 a reference group. The hyperacusis group scored significantly higher than the referents on worry at work, social support at work, and reward at work, but not on emotional support at work, work overcommitment, or effort at work. About 40% of the hyperacusis group scored on the upper quartile of the three former work environment factors, with odds ratios ranging from 1.91 to 2.56.

Conclusions

The results suggest that worrying about aspects at work, perceiving low social support, and not perceiving being rewarded at work are associated with hyperacusis.

Psychosocial work factors and low back pain in taxi drivers

INTRODUCTION

Taxi drivers are at high risk for low back pain (LBP).

AIM

Identify the association between psychosocial-work factors (Job strain, Iso-strain, effort-reward imbalance [ERI], unfairness, and mental exertion) and LBP in taxi drivers.

METHODS

A cross-sectional study was done with 129 taxi drivers.

RESULTS

Approximately 63% reported LBP in the prior 12 months. Chi square or t-test analyses identified the associations between demographic, work, health, and psychosocial work factors, and self-report of LBP in the prior 12 months. Depression, perceived physical exertion, dispatcher and manager support, unfair treatment at work, and unfair treatment due to nationality were significantly associated with LBP in bivariate analyses. Multivariate logistic regression was done to identify the predictors of LBP. High dispatcher support remained the sole significant predictor for lower prevalence of LBP (OR = 0.66, P = 0.017).

CONCLUSION

Greater understanding of psychosocial work factors may aid in developing interventions to prevent LBP in taxi drivers.

How are socio-demographic and psycho-social factors associated with the prevalence and chronicity of severe pain in 14 different body sites? A cross-sectional population-based survey

BACKGROUND

Severe pain and chronic pain have a high impact on individuals and society. Body location of pain is important with regard to perception, articulation, and underlying biological, mental or social causes of pain.

METHODS

A cross-sectional survey was performed in the general Austrian population with 15,474 personally interviewed subjects aged 15 years and older.

RESULTS

The 1‑year period prevalence of severe pain in any body site was 38.6% and of chronic pain 24.9%. In all, 8.1% had pain in at least three body sites. Subjects aged 65 years and older (52.2%), those with low education (43.4%), unemployed subjects (50.4%), retired subjects (52.4%), those with anxiety/depression (67.7%), and subjects with lack of social support (49.6%) were sub-populations with high pain prevalence. In multivariate analyses, depression/anxiety was associated with prevalence and chronicity of severe pain in all body sites (range of ORs 1.89-5.01), while such associations were found for lack of social support (range of ORs 1.33-1.65), female sex (range of ORs 1.38-2.34), higher age (range of ORs 1.09-1.18 for 5 year intervals), as well as low educational (range of ORs 1.47-2.06 primary vs. tertiary education) and unemployment status (range of ORs 1.50-2.62) in most body sites. Being born in non-EU or EFTA states was associated with pain in many body sites (range of ORs 1.38-2.10).

CONCLUSIONS

Psychosocial factors are associated with pain presence in similar ways irrespective of location. Regarding socio-demographic factors, differences towards the magnitude and the direction in the association with pain frequency and chronicity in different body sites emerged.

Toward a mediation model for nurses' well-being and psychological distress effects of quality of leadership and social support at work

Given the lack of active nurses in industrialized countries throughout the world, in combination with demographic changes, it is of utmost importance to protect nurses' well-being and to prevent psychological distress, because of their strong association with premature occupational leave. The aim of this study was to investigate the effects of quality of leadership and social support at work on well-being and psychological distress of nurses and to determine whether nurses' overcommitment mediates the relationship between the abovementioned determinants and the outcomes. A cross-sectional survey design was used to gather our data. This study utilized part of the database of the Nurses' Early Exit Study. A total of 34,771 nurses (covering all nurse qualifications) working in hospitals, nursing homes, and home-care institutions in 8 European countries filled out a questionnaire (response rate = 51.4%). For all model variables (job satisfaction, satisfaction with salary, positive affectivity, personal burnout, negative affectivity, quality of leadership, social support from immediate supervisor, social support from near colleagues, and overcommitment), psychometrically sound, that is, valid and reliable measures were used. Outcomes from testing a structural equation mediation model indicated that, respectively, positive and negative influences of leadership quality and social support from supervisor and colleagues on nurses' well-being and psychological distress are partially mediated, that is, reduced, by nurses' overcommitment. Social work environment is highly important in relation to nurses' well-being and psychological distress.

Effort-Reward Imbalance and Mental Health Problems in 1074 German Teachers, Compared with Those in the General Population

High degrees of premature retirement among teachers warrant investigating the occupational burden and the mental health status of this profession. A sample of 1074 German teachers participated in this study. Two samples of the general population (N = 824 and N = 792) were used as comparison groups. Work distress was assessed with the Effort-Reward-Imbalance questionnaire, and mental health problems were measured with the General Health Questionnaire (GHQ-12). Teachers reported more effort-reward imbalance (M = 0.64) compared with the general population (M = 0.57), and they perceived more mental health problems (GHQ: M = 12.1) than the comparison group (M = 9.5). School type was not associated with work stress and mental health. Teachers with leading functions perceived high degrees of effort and reward, resulting in a moderate effort-reward ratio and no heightened mental health problems. Teachers working full time reported more effort than teachers working part time, but the reward mean values of both groups were similar. This results in a somewhat unfavourable effort-reward ratio of teachers working full time. Moreover, teachers working full time reported more mental health problems. The results support the appropriateness of the effort-reward conception, applied to the profession of teachers. The higher degree of effort-reward imbalance and the level of mental health problems warrant preventive measures. Copyright © 2014 John Wiley & Sons, Ltd.

The relationship between transformational leadership and effort-reward imbalance

Purpose

– The purpose of this paper is to investigate the relationship between transformational leadership and effort-reward imbalance as well as the moderating role of overcommitment and subjective well-being. In particular, the study focuses on the transformational leadership component individualized consideration and its relationship with effort-reward imbalance.

Design/methodology/approach

– Using linear hierarchical regression analyses, the authors tested four hypotheses on a broad sample of 229 German employees.

Findings

– The results confirm the expected relationship between transformational leadership and effort-reward imbalance and that the strongest relationship exists with individualized consideration. However, there is no support for the hypothesized moderating effects.

Research limitations/implications

– First, the recruitment of the sample via fora and periodicals may bias the results. Second, the dependent and the independent variables were assessed with the same method, thus facilitating a common method bias. Third, the study underlies a cross-sectional design which does not allow drawing conclusions on causality.

Practical implications

– The findings provide implications for leaders by showing that the most effective leadership behaviours are those encompassed by the transformational leadership component individualized consideration when it comes to reducing negative health effects of adverse working conditions. Furthermore, the results suggest that overcommitment plays a major role for employees’ effort-reward imbalance and should thus be addressed by specific training measures.

Originality/value

– Researchers have devoted little attention to revealing how effort-reward imbalance can be avoided or reduced by leaders. The study attempts to fill this gap by exploring the relationship between effort-reward imbalance and transformational leadership.

Three job stress models and their relationship with musculoskeletal pain in blue- and white-collar workers

OBJECTIVES

Musculoskeletal pain has been found to co-occur with psychosocial job stress. However, different conceptualizations of job stress exist, each emphasizing different aspects of the work environment, and it is unknown which of these aspects show the strongest associations with musculoskeletal pain. Further, these associations may differ for white-collar vs. blue-collar job types, but this has not been tested. The present study examined the independent and combined contributions of Effort-RewardImbalance (ERI), Job-Demand-Control (JDC) and Organizational Justice (OJ) to musculoskeletal pain symptoms among white- and blue-collar workers.

METHODS

Participants of a cross-sectional study (n=1634) completed validated questionnaires measuring ERI, JDC, and OJ, and reported the frequency of pain during the previous year at four anatomical locations (lower back, neck or shoulder, arms and hands, and knees/feet). Pain reports were summarized into a single musculoskeletal symptom score (MSS). Analyses were stratified for white- and blue-collar workers.

RESULTS

Among white-collar workers, ERI and OJ were independently associated with MSS. In addition to these additive effects, significant 2-way and 3-way interactions indicated a synergistic effect of job stressors in relation to reported pain. In blue-collar workers, ERI and JDC independently associated with MSS, and a significant 3-way interaction was observed showing that the combination of job stressors exceeded an additive effect.

CONCLUSION

ERI influences pain symptoms in both occupational groups. OJ was independent significant predictor only among white-collar workers, whereas JDC had additive predictive utility exclusively among blue-collar workers. Simultaneous exposure to multiple job stress factors appeared to synergize pain symptom reporting.

Musculoskeletal Symptoms and Risk of Burnout in Child Care Workers - A Cross-Sectional Study

Objectives

German child care workers' job satisfaction is influenced by the consequences of unfavourable underlying conditions. Child care workers tend to suffer from psychosocial stress, as they feel that their work is undervalued. The objective of the present study is to investigate how the psychosocial factors of the effort-reward imbalance (ERI) model influence musculoskeletal symptoms (MS) and the risk of burnout. To our knowledge this is the first study investigating the association between the factors of the ERI model and MS in child care workers.

Methods and Findings

Data from 199 child care workers were examined in a cross-sectional study. Psychosocial factors were recorded with the ERI questionnaire. MS was recorded with the Nordic Questionnaire and risk of burnout with the Personal Burnout scale of the Copenhagen Burnout Inventory. Multivariate analysis was performed using linear and logistic regression models. The response rate was 57%. In most of the sample (65%), an effort-reward imbalance was observed. 56% of the child care workers were at risk of burnout and 58% reported MS. Factors associated with risk of burnout were subjective noise exposure (OR: 4.4, 95%CI: 1.55–12.29) and overcommitment (OR: 3.4; 95%CI: 1.46–7.75). There were statistically significant associations between MS and overcommitment (low back pain—OR: 2.2, 95%CI: 1.04–4.51), low control (overall MS OR: 3.8; 95%CI: 1.68–3.37) and risk of burnout (overall MS OR: 2.3, 95%CI: 1.01–5.28). For ERI no statistically significant associations were found with reference to risk of burnout or MS.

Conclusion

Overcommitment in child care workers is related to MS and risk of burnout. There is also evidence that low control is associated with MS and subjective noise exposure with risk of burnout. Effort-reward imbalance is not related to either outcome. This occupational health risk assessment identifies changeable working factors in different types of facilities.

Psychosocial work factors in new or recurrent injuries among hospital workers: a prospective study

PURPOSE

Accumulating evidence suggests an important role for psychosocial work factors in injury, but little is known about the interaction between psychosocial factors and previous injury experience on subsequent injury risk. We examined the relationships between psychosocial work factors and new or recurrent injury among hospital workers.

METHODS

We studied 492 hospital workers including 116 cases with baseline injury and 376 injury-free referents at baseline over follow-up. Job strain, total support, effort-reward imbalance, overcommitment, and musculoskeletal injury at baseline were examined in logistic regression models as predictors of new or recurrent injury experienced during a 2-year follow-up period.

RESULTS

The overall cumulative incidence of injury over follow-up was 35.6 % (51.7 % for re-injury among baseline injury cases; 30.6 % for new injury among referents). Significantly increased risks with baseline job strain (OR 1.26; 95 % CI 1.02-1.55) and effort-reward imbalance (OR 1.42; 95 % CI 1.12-1.81) were observed for injury only among the referents. Overcommitment was associated with increased risk of injury only among the cases (OR 1.58; 95 % CI 1.05-2.39).

CONCLUSIONS

The effects of psychosocial work factors on new or recurrent injury risk appear to differ by previous injury experience, suggesting the need for differing preventive strategies in hospital workers.

A prospective cohort study of neck and shoulder pain in professional drivers

In a three-year follow-up study, the occurrence of neck and shoulder pain (NSP) in terms of frequency, duration and intensity was investigated in a population of 537 male professional drivers. Over the follow-up period, the cumulative incidences for neck and shoulder pain were 31.9% and 21.4%, respectively. After adjustment for potential confounders, a measure of cumulative whole-body vibration exposure was significantly associated with all NSP outcomes. Lifting loads and work with hands above shoulder level were significantly related to shoulder outcomes, while driving with trunk bent or twisted was associated with neck pain. Limited job decision, low social support and job dissatisfaction were significant predictors of neck outcomes. Psychological distress was associated with all NSP outcomes. The findings of this cohort study suggest that NSP outcomes are of multifactorial origin in driving occupations.

PRACTITIONER SUMMARY

This prospective cohort study highlighted the multifactorial nature of neck and shoulder pain (NSP) outcomes in a population of professional drivers. Cumulative whole-body vibration exposure, physical load factors and adverse psychosocial environment at the workplace, as well as individual-related psychological distress, were significant predictors of the occurrence of NSP in the professional drivers.

Occupational risk factors for upper-limb and neck musculoskeletal disorder among health-care staff in nursing homes for the elderly in France

This study investigated the relation between working conditions, in terms of physical and psychological demand, and upper-limb and neck musculoskeletal disorders (ULNMD) in female staff working in direct contact with the elderly in nursing homes. A cross-sectional survey was conducted in 105 nursing homes in France. Data on nursing-home working conditions were collected by questionnaire from occupational physicians and by self-administered questionnaire from staff. Psychosocial demand at work was assessed on Siegrist's questionnaire and ULNMD on the Nordic questionnaire. 2,328 employees were included: 628 housekeepers, 1,372 nursing assistants and 328 nurses. During the previous 12 months, 50% of the subjects (1,160) had presented with a musculoskeletal complaint concerning the neck, 38% (881) the shoulders, 10% (246) the elbows and 22% (520) the wrists. 9% (219) reported effort/reward imbalance on the 2004 Siegrist questionnaire and 42% were in a situation of over-commitment. ULNMD complaints were associated not only with physical occupational factors but also with psychosocial factors (effort/reward imbalance and over-commitment), both before and after adjustment on individual and occupational factors. Prospective studies are needed to clarify the causal role of occupational, including, organizational, psychosocial factors in ULNMD outcomes. Preventive approaches should take account of both physical and psychosocial occupational factors.

Comparison of concepts in easy-to-use methods for MSD risk assessment

This article presents a comparative analysis of easy-to-use methods for assessing musculoskeletal load and the risk for developing musculoskeletal disorders. In all such methods, assessment of load consists in defining input data, the procedure and the system of assessment. This article shows what assessment steps the methods have in common; it also shows how those methods differ in each step. In addition, the methods are grouped according to their characteristic features. The conclusion is that the concepts of assessing risk in different methods can be used to develop solutions leading to a comprehensive method appropriate for all work tasks and all parts of the body. However, studies are necessary to verify the accepted premises and to introduce some standardization that would make consolidation possible.

Remain in work--what work-related factors are associated with sustainable work attendance: a general population-based study of women and men

OBJECTIVE

To analyze if organizational climate and work commitment, demand and control, job strain, social support, and physical demands at work are associated with remain in work (RIW), that is, work attendance without sick leave over 15 days per year.

METHODS

This Swedish cross-sectional study was based on 4013 workers (aged 19 to 64 years), randomly selected from a general population. Data were collected (2008) through postal questionnaire and registers.

RESULTS

Fair organizational climate, the combination of fair organizational climate and fair work commitment, high control, and low physical demands were associated with RIW for women and men.

CONCLUSIONS

This study adds to the rather scarce research findings on factors that promote RIW by identifying work organizational factors and physical prerequisites as being important. Preventive work to create a healthy work environment could be directed at improving organizational climate and reducing physical demands.

Job stress and work-related musculoskeletal symptoms among intensive care unit nurses: a comparison between job demand-control and effort-reward imbalance models

BACKGROUND

The aims of this study were to compare job demand-control (JDC) and effort-reward imbalance (ERI) models in examining the association of job stress with work-related musculoskeletal symptoms and to evaluate the utility of a combined model.

METHODS

This study analyzed cross-sectional survey data obtained from a nationwide random sample of 304 intensive-care unit (ICU) nurses. Demographic and job factors were controlled in the analyses using logistic regression.

RESULTS

Both JDC and ERI variables had strong and statistically significant associations with work-related musculoskeletal symptoms. Effort-reward imbalance had stronger associations than job strain or iso-strain with musculoskeletal symptoms. Effort-reward imbalance alone showed similar or stronger associations with musculoskeletal symptoms compared to combined variables of the JDC and ERI models.

CONCLUSIONS

The ERI model appears to capture the magnitude of the musculoskeletal health risk among nurses associated with job stress at least as well and possibly better than the JDC model. Our findings suggest that combining the two models provides little gain compared to using effort-reward imbalance only.

Musculoskeletal pain and effort-reward imbalance--a systematic review

Background

Musculoskeletal pain may be triggered by physical strains and psychosocial risk factors. The effort-reward imbalance model (ERI model) is a stress model which measures psychosocial factors in the working world. The question is whether workers with an effort-reward imbalance report musculoskeletal pain more frequently than those with no effort-reward imbalance. A systematic review using a best evidence synthesis approach was conducted to answer this question.

Methods

A literature search was conducted for the period from 1996 to 2012, using three databases (Pubmed, Embase and PsycINFO). The research criteria related to psychosocial, work-related stress as per the ERI model and to musculoskeletal pain. A quality score was developed using various quality criteria to assess the standard of the studies. The level of evidence was graded as in (Am J Ind Med 39:180–193, 2001).

Results

After applying the inclusion criteria, a total of 19 studies were included in the review: 15 cross-sectional studies, three prospective studies and one case–control study. 74% of all studies exhibited good methodological quality, 53% collected data using the original ERI questionnaire, and in 42% of the studies, there was adequate control for physical working conditions. Furthermore, different cut-off points were used to classify exposed and non-exposed individuals. On the basis of 13 studies with a positive, statistically significant association, a moderate level of evidence was inferred for the association between effort-reward imbalance and musculoskeletal pain. The evidence for a role of over-commitment and for its interaction with effort-reward imbalance was rated as inconclusive - on the basis of eight and five studies, respectively.

Conclusions

On the basis of the available evidence, no reliable conclusion may be drawn about any association between the psychosocial factors ascertained using the ERI model and musculoskeletal pain. Before a reliable statement can be made on the association between ERI and musculoskeletal pain, additional longitudinal studies must be performed - with a standardised method for recording and classifying exposure, as well as control of physical confounders. Appropriate preventive measures can then be specified.

Fear-avoidance beliefs associated with perceived psychological and social factors at work among patients with neck and back pain: a cross-sectional multicentre study

Background

Neck and back pain are common and often account for absenteeism at work. Factors at work as well as fear–avoidance beliefs may influence sick-leave in these patients. The aims of this study were to assess: (1) how sick-listed patients in specialised care perceive demand, control, support, effort, reward, and overcommitment at work compared to a general reference group of workers; (2) if women and men report demand, control, support, effort, reward, and overcommitment differently; and (3) the association between psychological and social factors at work and fear–avoidance beliefs about work.

Methods

A cross-sectional multicentre study was carried out in 373 patients on sick leave due to neck and back pain. Psychosocial work factors were measured by demand, control, and support, (Nordic Questionnaire for Psychological and Social Factors at Work), and effort, reward and overcommitment (Effort Reward Imbalance Questionnaire). Fear avoidance beliefs about work were measured by the Fear–Avoidance Belief Questionnaire Work subscale (FABQ-W).

Results

Although the patients differed significantly from a reference working group regarding several subscales of demand, control, support, effort, reward, and overcommitment, the magnitude of these differences were small. The study population also reported significantly higher scores for ‘demand for physical endurance’ than the reference population, and Cohen’s d = 0.55 here indicated a medium degree of difference. Female patients reported significantly higher on support, whereas male patients reported significantly higher demand for physical endurance, quantitative demand, effort, and overcommitment. Demand for physical endurance, job control, job support, high reward, and overcommitment were significantly associated with FABQ-W.

Conclusions

Perceived psychological and social factors at work were strongly associated with fear–avoidance beliefs about work in sick-listed neck and back patients. The demand for physical endurance, control, support, high reward, as well as overcommittment at work outweighed pain and added to the burden of emotional distress and disability regarding fear–avoidance beliefs.

[Etiopathogenetic aspects of somatoform disorders]

The etiopathology of somatoform disorders can only be understood against the background of an integrated biopsychosocial model. Cultural and historical influences must be taken into account as well as contemporary settings of scientific or medical priorities. In this context the emphasis on neurobiological findings can be interpreted as the non-accidental struggle for legitimacy of both patients and physicians. Altogether the available data on factors influencing the formation and maintenance of somatoform symptoms has to be described as both diverse and unspecific and thus points to a challenging research program in the coming years.

Early identification of work-related stress predicted sickness absence in employed women with musculoskeletal or mental disorders: a prospective, longitudinal study in a primary health care setting

PURPOSE

The objectives were to identify work-related stress, and to analyse whether or not work-related stress served to predict sick-leave in a population of employed women who saw a doctor due to musculoskeletal or mental disorder at primary health care centres.

METHODS

This prospective study was based on data collected with the Work Stress Questionnaire (WSQ) at baseline 2008 and at follow-up 2009 in the primary health care centres in western Sweden. A total of 198 women participated.

RESULTS

High perceived stress owing to indistinct organization and conflicts at baseline increased the risk for sick-leave 8 days or longer at follow-up. The adjusted relative risk (RR) was 2.50 (1.14-5.49). The combination of high stress perception owing to indistinct organization and high stress perception owing to individual demands and commitment increased the risk for sickness absence of 8 days or longer with an adjusted RR of 4.34 (1.72-10.99).

CONCLUSIONS

Work-related stress predicted sick-leave during the follow-up at 12 months. The WSQ seemed to be useful in identifying women at risk of future sick-leave. Thus, it can be recommended to introduce questions and questionnaires on work-related stress in primary health care settings to early identify women with the need for preventive measures in order to decrease risk for sick-leave due to work-related stress.

Musculoskeletal symptoms and associated risk factors in a large sample of Chinese workers in Henan province of China

OBJECTIVE

To investigate the one-year prevalence of musculoskeletal symptoms and associated risk factors in a large sample of Chinese workers in various industrial settings.

METHODS

A total of 5,338 (3,632 males and 1,706 females) workers from 13 companies participated in this study. Musculoskeletal symptoms in different body regions in the previous year and their risk factors were assessed by a self-reported questionnaire. Logistic regression analyses were performed to estimate the individual, work-related physical and psychosocial risk factors for the musculoskeletal symptoms.

RESULTS

The most commonly affected body regions among the workers were lower back (59.7%), neck (48.6%), shoulders (38.8%), and wrists (33.5%). Female workers had greater prevalence of musculoskeletal symptoms in the neck, shoulders, and wrists than male workers. Results of multivariate analyses indicated that individual, work-related physical and psychosocial factors were associated with the musculoskeletal symptoms.

CONCLUSION

The results suggest that interventions aimed at reducing musculoskeletal symptoms in the Chinese working population should take into account multiple risk areas including individual, physical job characteristics and work-related psychosocial factors.

Cognitive and psychological reactions of the general population three months after the 2011 Tohoku earthquake and tsunami

Background

The largest earthquake on record in Japan (magnitude 9.0) occurred on March 11, 2011, and the subsequent tsunami devastated the Pacific coast of Northern Japan. These further triggered the Fukushima I nuclear power plant accidents. Such a hugely complex disaster inevitably has negative psychological effects on general populations as well as on the direct victims. While previous disaster studies enrolled descriptive approaches focusing on direct victims, the structure of the psychological adjustment process of people from the general population has remained uncertain. The current study attempted to establish a path model that sufficiently reflects the early psychological adaptation process of the general population to large-scale natural disasters.

Methods and Findings

Participants from the primary disaster area (n = 1083) and other areas (n = 2372) voluntarily participated in an online questionnaire study. By constructing path models using a structural equation model procedure (SEM), we examined the structural relationship among psychological constructs known related to disasters. As post-traumatic stress symptoms (PTS) were significantly more present in people in the primarily affected area than in those in secondary- or non-affected areas, the path models were constructed for the primary victims. The parsimoniously depicted model with the best fit was achieved for the psychological-adjustment centered model with quality of life (QoL) as a final outcome.

Conclusion

The paths to QoL via negative routes (from negative cognitive appraisal, PTS, and general stress) were dominant, suggesting the importance of clinical intervention for reducing negative cognitive appraisal, and for caring for general stress and PTS to maintain QoL at an early stage of psychological adaptation to a disaster. The model also depicted the presence of a positive route where positive cognitive appraisal facilitates post-traumatic growth (PTG) to achieve a higher QoL, suggesting the potential importance of positive psychological preventive care for unexpected natural disasters.

Pain and daily activities in rheumatoid arthritis

AIM

The aim of this study was to describe experiences of pain and its relationship to daily activities in people with rheumatoid arthritis (RA).

METHOD

Seven semi-structured focus group discussions were conducted with 33 men and women of different ages with RA. Data were analysed with content analysis.

RESULTS

Pain affected everyday life and may be a barrier to perform valued activities. Regarding the impact of pain on participation and independence, personal factors and the social environment were found to be important. It could be a struggle to find the right activity balance, since it was easy to be overactive, triggering subsequent elevation of pain levels. However, the participants also described activities as a mediator of pain and a distraction from it.

CONCLUSION

The relationship between pain and daily activities in RA was complex. Pain as an impairment was expressed to be related to activity limitations and participation restrictions, as well as to contextual factors. These findings highlight the clinical importance of paying attention to the complexity of pain and its relation to daily activities and participation.

Healthy working school teachers with high effort-reward-imbalance and overcommitment show increased pro-inflammatory immune activity and a dampened innate immune defence

To test whether chronic work stress is accompanied by altered immune functioning, changes in lymphocyte subsets and in lymphocyte production of cytokines were examined in reaction to acute psychosocial stress. Work stress was measured according to Siegrist's effort-reward-imbalance (ERI) model. ERI reflects stress due to a lack of reciprocity between costs and gains at work. Overcommitment (OC) is conceptualized as a dysfunctional coping pattern mainly characterized by the inability to withdraw from work obligations. Fifty-five healthy teachers (34 women, 21 men, mean age 50.0 ± 8.47 years) were exposed to a standardized laboratory stressor (Trier Social Stress Test). Lymphocyte subset counts and lymphocyte production of tumor-necrosis-factor (TNF)-α, interferon (IFN)-γ, interleukin (IL)-2, -4, -6 and -10 were measured before and after challenge. High levels of ERI and OC were associated with lower natural killer (NK) cell (CD16+/56+) numbers whereas high levels of OC were related to a lower increase in T-helper cells (CD4+) after stress. Furthermore, subjects with higher ERI showed an overall increased pro-inflammatory activity, with higher TNF-α production at both time points and elevated pre-stress IL-6 production. IL-10 production decreased with higher ERI after stress. The ratios of TNF-α/IL-10 and IL-6/IL-10 were significantly increased in subjects high on ERI. Finally, OC was associated with higher IL-2 production post-stress. The present findings suggest a dampened innate immune defence, reflected in lower NK cell numbers together with an increased pro-inflammatory activity in teachers high on ERI and OC. Such pathways could partly be responsible for the increased vulnerability for stress-related diseases in individuals suffering from chronic work stress.

Emotional support predicts more sickness absence and poorer self assessed work ability: a two-year prospective cohort study

BACKGROUND

While back pain and stressful work environment are shown to be important causes of sickness absence the effect of psychosocial resources on sickness absence, and on self assessed work ability, is less commonly investigated. The aim of this study was to assess these associations in a two-year follow-up study.

METHODS

341 working people aged 45 to 64, randomly drawn from the population, responded to a questionnaire at baseline and at a two-year follow-up. Poisson regression was used to analyse the association of psychosocial factors (psychosocial instruments on work environment, emotional support and psychological resources) and previous back pain (low back and/or neck) at baseline with sickness absence (spells and days) at follow-up, controlling for effects of age, sex, BMI, smoking, alcohol, occupation, disease and previous sickness absence. Logistic regression was used to study the associations of psychosocial factors and previous back pain at baseline with self assessed prognosis of poor work ability six months from follow-up. Finally, a multivariate analysis tested the independent effects of previous back pain and 3 psychosocial factors derived in a factor analysis: 1. work environment; 2. emotional support; 3. psychological resources, on work ability and absence days and spells.

RESULTS

80% of the sickness absence spells within the last 12 months before follow-up were short-term (≤ 14 days). In the final model, high emotional support predicted more sickness absence spells (RR 1.36; 1.11-1.67) and days (RR 1.68, 1.22-2.31). Previous back pain (OR 2.56; 1.13-5.81), high emotional support (OR 1.58; 1.02-2.46), and low psychological resources (OR 0.62; 0.44-0.89) were related to poorer self assessed prognosis of work ability at follow up.

CONCLUSIONS

In a general middle aged working population high emotional support was related to more sickness absence and also poorer self assessed prognosis of work ability. Our findings suggest that both sickness absence and self assessed work ability are dependent of life outside work and can be affected by a person's close community.