Workplace social capital and adherence to antihypertensive medication: a cohort study

Social Capital and Depressive Episodes: Gender Differences in the ELSA-Brasil Cohort

Introduction: The association between social capital and depression is a frequent research topic in developed countries, often with inconclusive results. Furthermore, for both social capital and depression, there are gender differences established in the literature. This study investigates gender differences in the association of social capital with the incidence and maintenance of depressive episodes.

Methods: Baseline and second wave data (4 years of follow-up) from the Longitudinal Study of Adult Health (ELSA-Brasil), a multicenter cohort of civil servants with 15,105 workers aged 35–74 years, were used. Social capital was assessed using the Resource Generator, a scale composed of two different dimensions: “social support” and “prestige and education.” Depressive episodes were assessed using the Clinical Interview Schedule - Revised (CIS-R). The statistical analysis was performed using multinomial regression with adjustments for possible confounding factors.

Results: Among men, low social capital in the “social support” dimension was associated with the incidence of depressive episodes (RR = 1.66; 95% CI: 1.01–2.72). Among women, social support was associated with the maintenance of depressive episodes (RR = 2.66; 95% CI: 1.61–4.41). Social capital was not associated with the incidence or maintenance of depressive episodes in the “prestige and education” dimension in both genders.

Conclusion: The results highlight the importance of the dimension “social support” in both genders in its association with mental health. The resource-based social capital approach proved to be adequate for investigating mental health and confirms the idea that social networks can be useful in the treatment and prevention of depressive episodes.

Social capital and cost-related medication nonadherence (CRN): A retrospective longitudinal cohort study using the Health and Retirement Study data, 2006-2016

Prescription drug spending and other financial factors (e.g., out-of-pocket costs) partially explain variation in cost-related medication nonadherence (CRN). Indicators of social capital such as neighborhood factors and social support may influence the health and well-being of older adults as they may rely on community resources and support from family and peers to manage conditions. Previous research on the relationship of social capital and CRN has limited evidence and contradictory findings. Hence, our objective is to assess the relationship of social capital indicators (neighborhood social cohesion, neighborhood physical disorder, positive social support, and negative social support) and CRN using a longitudinal design, 2006 to 2016, in a nationally representative sample of older adults in the United States (US). The Health and Retirement Study is a prospective panel study of US adults aged ≥ 50 years evaluated every two years. Data was pooled to create three waves and fitted using Generalized Estimating Equation modelling adjusting for both baseline and timevarying covariates (age, sex, education, race, total household income, and perceived health status). The three waves consisted of 11,791, 12,336, and 9,491 participants. Higher levels of neighborhood social cohesion and positive social support were related with lower CRN (OR 0.92, 95% CI 0.88-0.95 and OR 0.77, 95% CI 0.70-0.84, p<0.01). In contrast, higher levels of neighborhood physical disorder and negative social support were related to higher CRN (OR 1.07, 95% CI 1.03-1.11 and OR 1.46, 95% CI 1.32-1.62, p<0.01). Interventions targeting social capital are needed, reinforcing positive social support and neighborhood social cohesion and diminishing neighborhood physical disorder and negative social support for older adults.

Associations between psychosocial work environments and social capital: a multilevel analysis study in a Chinese context

BACKGROUND

Understanding the determinants of social capital is the prerequisite to building social capital. However there was few studies to explore factors related to workplace social capital. We aim to examine associations between psychosocial work environments and social capital in a Chinese context through a cross-sectional study.

METHODS

A cross-sectional study was conducted in Shanghai, China from December 2016 through March 2017. In total, 2380 workers from 32 workplaces were randomly sampled by a two-stage sampling procedure. Workplace social capital (WSC), psychosocial work environments (PWEs), and workplace Chinese Confucian values (CCVs), were assessed using validated and psychometrically tested measures. Multilevel ordinal regression models were used to examine the associations of WSC with individual- and workplace-level PWEs and workplace CCVs after controlling for individual socioeconomic characteristics.

RESULTS

After controlling for individual socioeconomic characteristics, all individual-level PWEs (unstandardized coefficients [B] ranging from 0.280 to 2.467) were positively associated with WSC. Individual-level workplace CCVs had mixed associations with WSC-high individual levels of respect for authorities (B: 0.325; 95%CI: 0.134, 0.516) and altruism (B: 0.347; 95%CI: 0.155, 0.539) were associated with high WSC, while high individual levels of acceptance of authorities (B: - 0.214; 95%CI: - 0.381, - 0.046) and the mianzi rule (B: - 0.258; 95%CI: - 0.435, - 0.080) were associatecd with low WSC. No workplace-level variable was associated with WSC.

CONCLUSION

These findings suggest that workplace social capital associates with multiple factors. Psychosocial work environments and cultural context are important in understanding variations in workplace social capital between individuals.

Psychometric assessment of a scale to measure bonding workplace social capital

OBJECTIVES

Workplace social capital (WSC) has attracted increasing attention as an organizational and psychosocial factor related to worker health. This study aimed to assess the psychometric properties of a newly developed WSC scale for use in work environments, where bonding social capital is important.

METHODS

We assessed the psychometric properties of a newly developed 6-item scale to measure bonding WSC using two data sources. Participants were 1,650 randomly selected workers who completed an online survey. Exploratory factor analyses were conducted. We examined the item-item and item-total correlations, internal consistency, and associations between scale scores and a previous 8-item measure of WSC. We evaluated test-retest reliability by repeating the survey with 900 of the respondents 2 weeks later. The overall scale reliability was quantified by an intraclass coefficient and the standard error of measurement. We evaluated convergent validity by examining the association with several relevant workplace psychosocial factors using a dataset from workers employed by an electrical components company (n = 2,975).

RESULTS

The scale was unidimensional. The item-item and item-total correlations ranged from 0.52 to 0.78 (p < 0.01) and from 0.79 to 0.89 (p < 0.01), respectively. Internal consistency was good (Cronbach's α coefficient: 0.93). The correlation with the 8-item scale indicated high criterion validity (r = 0.81) and the scale showed high test-retest reliability (r = 0.74, p < 0.01). The intraclass coefficient and standard error of measurement were 0.74 (95% confidence intervals: 0.71-0.77) and 4.04 (95% confidence intervals: 1.86-6.20), respectively. Correlations with relevant workplace psychosocial factors showed convergent validity.

CONCLUSIONS

The results confirmed that the newly developed WSC scale has adequate psychometric properties.

Workplace social capital, mental health and health behaviors among Brazilian female workers

OBJECTIVE

Previous studies have investigated the relationship between workplace social capital and mental health, yet few have sought to examine the mediating mechanisms. We sought to explore the role of workplace social capital on health related behaviors and on mental health among female employees in Brazil.

METHODS

A cross-sectional study was undertaken with 553 women aged 28-50 years working in the production line of a poultry processing plant. We assessed workplace social capital, common mental disorders, stress (Perceived Stress Scale) and health related behaviors (physical activity, healthy eating habits and co-occurrence of risk behaviors). We used structural equation modeling to clarify relationships between exposures, outcomes, and mediating variables.

RESULTS

Our model demonstrated a direct effect of social capital on the outcomes studied. Higher workplace social capital was associated with lower stress and common mental disorders as well as more favorable health-related behaviors. Our model also showed an indirect effect of social capital on mental health and on behaviors that was mediated by lower levels of perceived stress.

CONCLUSION

Workplace social cohesion may play an important role in the promotion of mental health and healthy behaviors among women employees.

Does worksite social capital enhance retention into a worksite weight-loss programme?

Objective

To determine if worksite social capital predicted retention in a worksite‐based weight‐loss programme using structural equation modelling. A secondary aim was to determine if worksite social capital was related to changes in weight at 6 months.

Methods

Overweight or obese employees from 28 worksites enrolled in a larger 12‐month worksite weight‐loss trial. Workplace social capital was assessed using an eight‐item scale specific to the workplace. Weight was measured using a HealthSpot^tm, and change in weight was computed from weigh‐ins at baseline and 6 months and reported as pounds (lbs) lost. Retention was defined as those employees who completed a weigh‐in at 6 months.

Results

Across the trial, N = 1,790; age = 46.6 ± 11; 73% women; 73% White overweight or obese employees participated. The odds of participant attrition were 1.12 times greater with each unit decrease in social capital score at baseline (p < 0.05), and while the model testing the direct effect of social capital at baseline on weight loss at 6 months demonstrated acceptable fit, social capital was not a significant predictor of weight loss (p > 0.05).

Conclusions

Increased worksite social capital was predictive of retention in a worksite weight‐loss programme. To maximize return on investments for employee wellness and weight‐loss programmes, employers may benefit from understanding the facets of the ‘social’ environment such as social capital that may increase the likelihood of sustained participation.

Underuse of medication for circulatory disorders among unmarried women and men in Norway?

Background

It is well established that unmarried people have higher mortality from circulatory diseases and higher all-cause mortality than the married, and these marital status differences seem to be increasing. However, much remains to be known about the underlying mechanisms. Our objective was to examine marital status differences in the purchase of medication for circulatory diseases, and risk factors for them, which may indicate underuse of such medication by some marital status groups.

Methods

Using data from registers covering the entire Norwegian population, we analysed marital status differences in the purchase of medicine for eight circulatory disorders by people aged 50-79 in 2004-2008. These differences were compared with those in circulatory disease mortality during 2004-2007, considered as indicating probable differences in disease burden.

Results

The unmarried had 1.4-2.8 times higher mortality from the four types of circulatory diseases considered. However, the never-married in particular purchased less medicine for these diseases, or precursor risk factors of these diseases, primarily because of a low chance of making a first purchase. The picture was more mixed for the divorced and widowed. Both groups purchased less of some of these medicines than the married, but, especially in the case of the widowed, relatively more of other types of medicine. In contrast to the never-married, divorced and widowed people were as least as likely as the married to make a first purchase, but adherence rates thereafter, indicated by continuing purchases, were lower.

Conclusion

The most plausible interpretation of the findings is that compared with married people, especially the never-married more often have circulatory disorders that are undiagnosed or for which they for other reasons underuse medication. Inadequate use of these potentially very efficient medicines in such a large population group is a serious public health challenge which needs further investigation. It is possible that marital status differences in use of medicines for circulatory disorders combined with an increasing importance of these medicines have contributed to the widening marital status gap in mortality observed in several countries. This also requires further investigation.

Blood pressure control in hypertensive patients in the "Hiperdia Program": a territory-based study

BACKGROUND

Systemic hypertension is highly prevalent and an important risk factor for cardiovascular events. Blood pressure control in hypertensive patients enrolled in the Hiperdia Program, a program of the Single Health System for the follow-up and monitoring of hypertensive patients, is still far below the desired level.

OBJECTIVE

To describe the epidemiological profile and to assess blood pressure control of patients enrolled in Hiperdia, in the city of Novo Hamburgo (State of Rio Grande do Sul, Brazil).

METHODS

Cross-sectional study with a stratified cluster random sample, including 383 adults enrolled in the Hiperdia Program of the 15 Basic Health Units of the city of Porto Alegre, conducted between 2010 and 2011. Controlled blood pressure was defined as ≤ 140 mmHg × 90 mmHg. The hypertensive patients were interviewed and their blood pressure was measured using a calibrated aneroid device. Prevalence ratios (PR) with 95% confidence interval, Wald's χ(2) test, and simple and multiple Poisson regression were used in the statistical analysis.

RESULTS

The mean age was 63 ± 10 years, and most of the patients were females belonging to social class C, with a low level of education, a sedentary lifestyle, and family history positive for systemic hypertension. Diabetes mellitus (DM) was observed in 31%; adherence to the antihypertensive treatment in 54.3%; and 33.7% had their blood pressure controlled. DM was strongly associated with inadequate BP control, with only 15.7% of the diabetics showing BP considered as controlled.

CONCLUSION

Even for hypertensive patients enrolled in the Hiperdia Program, BP control is not satisfactorily reached or sustained. Diabetic hypertensive patients show the most inappropriate BP control.

The mediating and moderating effects of workplace social capital on the associations between adverse work characteristics and psychological distress among Japanese workers

Our current study investigated how workplace social capital (WSC) mediates and moderates the associations between adverse work characteristics and psychological distress among Japanese workers. We collected cross-sectional data (N=9,350) from a baseline survey of an occupational Japanese cohort study. We focused on individual WSC and considered job demands/control, effort/reward, and two types (i.e., procedural and interactional) of organizational justice as work-characteristic variables. We defined psychological distress as a score of ≥5 on the Kessler Psychological Distress Scale (K6 scale). Multivariate logistic regression analyses predicted a binary variable of psychological distress by individual WSC and adverse work characteristics, adjusting for individual-level covariates. Individual WSC mediated the associations between adverse work characteristics and psychological distress in almost all model specifications. Additionally, individual WSC moderated the associations of psychological distress with high job demands, high effort, and low interactional justice when we used a high WSC cutoff point. In contrast, individual WSC did not moderate such interactions with low job control, reward, or procedural justice. We concluded that individual WSC mediated the associations between adverse work characteristics and psychological distress among Japanese workers while selectively moderating their associations at high levels of WSC.

Effect of depression onset on adherence to medication among hypertensive patients: a longitudinal modelling study

OBJECTIVES

Although a link between depression and poor adherence to antihypertensive medication (AHM) has been found, it is not known whether depression actually leads to poorer adherence or whether poor adherence only is a marker of depression. In this study we aimed to determine the time order between hypertension, depression and changes in adherence to AHM.

METHODS

The analyses were based on data gathered from a longitudinal cohort of Finnish employees (The Finnish Public Sector Study). A total of 852 chronically hypertensive men and women at baseline with a recorded onset of depression during the 9-year observation window and 2359 hypertensive control participants matched for age, sex, socio-economic status, time of study entry, employer and geographic area were included in the study. Individuals with any sign of depression during 4 years before the beginning of the study were excluded. To describe long-term trajectories (4 years before and 4 years after the recorded depression) of AHM adherence in relation to the onset of depression, annual data on reimbursed AHM prescriptions were gathered from the national Drug Prescription Register. Annual nonadherence rates (i.e. number of 'days-not-treated') were based on filled prescriptions.

RESULTS

Among male cases, the rate of 'days-not-treated' was 1.52 times higher (95% confidence interval 1.08-2.14) in the years after the onset of depression compared to preonset levels. In women and in male controls, no change in adherence to AHM was observed between these time periods.

CONCLUSION

In hypertensive men, the onset of recorded depression increases the risk of nonadherence to AHM.

The bright side and dark side of workplace social capital: opposing effects of gender on overweight among Japanese employees

Background

A growing number of studies have sought to examine the health associations of workplace social capital; however, evidence of associations with overweight is sparse. We examined the association between individual perceptions of workplace social capital and overweight among Japanese male and female employees.

Methodology/Principal Findings

We conducted a cross-sectional survey among full-time employees at a company in Osaka prefecture in February 2012. We used an 8-item measure to assess overall and sub-dimensions of workplace social capital, divided into tertiles. Of 1050 employees, 849 responded, and 750 (624 men and 126 women) could be linked to annual health check-up data in the analysis. Binomial logistic regression models were used to calculate odds ratios and 95% confidence intervals for overweight (body mass index: ≥25 kg/m², calculated from measured weight and height) separately for men and women. The prevalence of overweight was 24.5% among men and 14.3% among women. Among men, low levels of bonding and linking social capital in the workplace were associated with a nearly 2-fold risk of overweight compared to high corresponding dimensions of social capital when adjusted for age, sleep hours, physiological distress, and lifestyle. In contrast, among women we found lower overall and linking social capital to be associated with lower odds for overweight even after covariate adjustment. Subsequently, we used multinomial logistic regression analyses to assess the relationships between a 1 standard deviation (SD) decrease in mean social capital and odds of underweight/overweight relative to normal weight. Among men, a 1-SD decrease in overall, bonding, and linking social capital was significantly associated with higher odds of overweight, but not with underweight. Among women, no significant associations were found for either overweight or underweight.

Conclusions/Significance

We found opposite gender relationships between perceived low linking workplace social capital and overweight among Japanese employees.

A cross-sectional study of workplace social capital and blood pressure: a multilevel analysis at Japanese manufacturing companies

OBJECTIVES

We examined the contextual effect of workplace social capital on systolic blood pressure (SBP).

DESIGN

Cross-sectional.

SETTING

A conglomerate from 58 workplaces in Japan.

PARTICIPANTS

Of the 5844 workers at a Japanese conglomerate from 58 workplaces, 5368 were recruited. Individuals who received drugs for hypertension (n=531) and who lacked information on any variable (n=167) were excluded from the analyses, leaving 4735 individuals (3281 men and 1454 women) for inclusion.

PRIMARY AND SECONDARY OUTCOME MEASURES

Systolic blood pressure.

RESULTS

The contextual effect of workplace social capital on SBP was examined using a multilevel regression analysis with a random intercept. Coworker support had a contextual effect at the workplace level (coefficient=-1.97, p=0.043), while a lack of trust for coworkers (coefficient=0.27, p=0.039) and lack of helpfulness from coworkers were associated with SBP (coefficient=0.28, p=0.002).

CONCLUSIONS

The present study suggested that social capital at the workplace level has beneficial effects on SBP.