Changes in Psychosocial Work Conditions in Taiwanese Employees by Gender and Age from 2001 to 2010

The effect of multiple types of workplace violence on burnout risk, sleep quality, and leaving intention among nurses

OBJECTIVE

The aim of our study is to explore the associations between multiple types of workplace violence (WPV) and burnout risk, sleep problems, and leaving intention among nurses.

METHODS

This cross-sectional survey recruited 1,742 nurses, and data on WPV experiences were collected through self-administered questionnaires. Work conditions, burnout risk scales, sleep quality, and leaving intentions were also evaluated. Multivariate logistic regression analyses were performed to examine the associations of WPV with burnout risk, sleep quality, and leaving intentions, adjusting for demographic characteristics and work conditions.

RESULTS

The study found that 66.7% of nurses reported experience of WPV, with 26.9% experiencing both physical and nonphysical forms. Those who experienced multiple types of WPV reported worse work conditions, higher burnout risk, poorer sleep quality, and a stronger leaving intention compared to those without such experiences. Adjusting for working conditions, logistic regression analysis showed that nurses who experienced multiple types of WPV had 2.12-fold higher odds of high personal burnout risk, 2.36-fold higher odds of high client-related burnout risk, 1.95-fold higher odds of poor sleep quality, and 1.80-fold higher odds of high leaving intention, compared to those without WPV experiences.

CONCLUSIONS

Strategies by hospital managers and policymakers to monitor and reduce workplace violence are vital for sustaining nurses' mental health, well-being, and preventing early attrition from the profession.

Association Between Retirement Age and Incidence of Depressive Disorders: A 19-Year Population-Based Study

OBJECTIVE

To investigate the occurrence of depressive disorders spanning the transition to retirement, and explore the relationship between retirement age and depressive disorders.

METHODS

We utilized a national population-based health insurance database encompassing 2 million Taiwanese individuals from 2000 to 2019. The study focused on individuals aged 50 years and older who were employed at the baseline, and 84,224 individuals had records of retirement during the follow-up period. Depressive disorders were identified using codes from the International Classification of Diseases. To assess the trend in the incidence of depressive disorders 7-year period before and after retirement, an interrupted time series analysis was performed. Cox-proportional hazard models were employed to investigate the association between retirement age and the occurrence of depressive disorders following retirement.

RESULTS

The incidence of depression peaks at the time of retirement and shows a significant decrease after retirement. Incidence of depressive disorders was 6.4 and 7.6 per 1000 person-years among individuals who retired between the ages of 60-64 and 65-69. Comparing the two groups, those who retired between 65 and 69 exhibits a higher risk of developing depressive disorders (hazard ratio = 1.10, 95% confidence interval = 1.02-1.18). This association is particularly pronounced among women and individuals residing in areas with low urbanization levels.

CONCLUSION

Retirement marks a crucial life milestone accompanied by a peak in depressive disorders. It is important to address the higher risk of depression associated with late retirement among socially disadvantaged groups.

Relationship of long working hours and night shift working hours with incident diabetes: a retrospective cohort study in Taiwan

PURPOSE

The relationship among long working hours, night shift working hours, and diabetes is still unclear. We aimed to evaluate the association of long working hours and night shift working hours with diabetes among health care workers.

METHODS

We conducted a retrospective cohort study among health care workers in a tertiary medical center in Taiwan from 2002 to 2019. We compared the risk of diabetes among tertiles of total working hours (35-41, 42-45, and ≥46 h per week) and evaluated the relationship between long working hours and diabetes risk. We divided participants into three work patterns: day work only, evening shift workers, and night shift workers. In night shift workers, we further evaluated night shift working hours and incident diabetes using tertiles of night shift working hours (<17, 17-45, and ≥46 h per month). We estimated hazard ratios and 95% confidence intervals for incident diabetes using multivariable Cox proportional hazards models.

RESULTS

The study included 7081 participants. There were 301 incident cases of diabetes during 52,454 person-years. The adjusted hazard ratio (95% confidence interval) for participants who worked greater than or equal to 46 working hours per week was 3.45 (1.27, 9.39) compared with those who worked 35-41 hours. Compared with night shift workers who worked less than 17 h, the adjusted hazard ratios (95% confidence interval) for those who worked 17-45 and ≥46 night shift working hours per month were 2.26 (1.08, 4.75) and 2.60 (1.27, 5.33), respectively.

CONCLUSIONS

Long working hours and night shift working hours increased the risk of diabetes.

Association between maternal shift work during pregnancy child overweight and metabolic outcomes in early childhood

Background

Previous studies found that maternal shift work during pregnancy was associated with many reproductive hazards, including small for gestational age, preterm birth, stillbirth, and neurodevelopmental impairment. Some studies also showed that these children are more likely to become overweight in early childhood. However, the association with metabolic factors, such as insulin resistance and dyslipidemia, was less studied. Hence, we aimed to understand better the relationship between maternal shift work during pregnancy and the risk of childhood overweight and metabolic outcomes. Confounding factors were also discussed, including diet, exercise, and demographical factors.

Methods

We enrolled pregnant women before delivery in the Taiwan Birth Panel Study (TBPS) II conducted between 2010 and 2012, and followed the children of these participants in 2018. The objective of this study is to investigate the influence of prenatal and postnatal factors on infant and early childhood health. During the follow-up in 2018, we checked children's demographic data, obtained blood specimens, and checked their blood sugar, blood insulin, and lipid profiles. Structured questionnaires were used to evaluate demographic data. Multiple linear and logistic regressions were used to examine the associations between maternal shift work during pregnancy and child overweight, metabolic disorders, such as HOMA-IR, and lipid profiles.

Results

In this study, we included 407 mother-children pairs with different work shifts (350 day workers and 57 shift workers), and a sub-population without underweight children was also created (290 day workers and 47 shift workers). Shift work during pregnancy was associated with a higher Homeostasis Model Assessment-Insulin Resistance index (HOMA-IR) and a higher odds ratio for overweight in children born from mothers doing shift work during pregnancy after adjustment. The findings were attenuated when we investigated the effect of shift work before pregnancy.

Conclusion

Our study suggested that maternal shift work during pregnancy was associated with child overweight and insulin resistance in early childhood.

Work-to-Family Conflict and its Associations With Workers' Burnout, Poor Self-Rated Health, and Minor Mental Disorder: A Survey of General Employees in Taiwan

OBJECTIVES

To examine the distribution of work-to-family conflict (W-FC) across socio-demographic groups and a wide spectrum of occupations, and its associations with workers' burnout, self-rated health, and mental health status by sex.

METHODS

A cross-sectional household survey of representative employees was conducted in 2013. A standardized questionnaire was administered to collect information.

RESULTS

W-FC was high in employees aged 35 to 44 years old and in certain occupational groups. Long working hours, rotating work shift, high work demands, high job control, low workplace justice, and family care burden were risk factors for W-FC, and high W-FC score was significantly associated with burnout, poor self-rated health, and minor mental disorder.

CONCLUSIONS

To improve workers' health, it is essential to identify high risk groups and adopt measures to reduce conflicts between work and family life.

Effect of Work-Family Conflict, Psychological Job Demand, and Job Control on the Health Status of Nurses

Work-family conflicts (WFCs) are common in the healthcare sector and pose significant health risks to healthcare workers. This study examined the effect of WFCs on the health status and nurses' leaving intentions in Taiwan. A self-administered questionnaire was used to survey 200 female nurses' experiences of WFC from a regional hospital. Data on psychosocial work conditions, including work shifts, job control, psychological job demands, and workplace justice, were collected. Health conditions were measured using the Beck Depression Inventory-II and self-rated health. Leaving intentions were measured using a self-developed questionnaire. The participants' average work experience was 6.79 (Standard Deviation (SD) = 5.26) years, their highest educational level was university, and work shifts were mostly night and rotating shifts. Approximately 75.5% of nurses perceived high levels of WFCs. Leaving intentions were correlated with WFCs (r = 0.350, p < 0.01) and psychological work demands (r = 0.377, p < 0.01). After adjusting for age, educational level, and work characteristics, high levels of WFCs were associated with poor self-rated health, and depression, but not associated with high leaving intentions. Nurses' experiences of high levels of WFCs greatly affected their health status.

Occupational trajectories of working conditions in Sweden: Development trends in the workforce, 1997-2015

Objective:

This study aimed to explore the development of working conditions within and between occupations in the Swedish labor market from 1997 to 2015 and whether any polarization in working conditions concurrently occurred between occupations.

Methods:

Cross-sectional data from ten waves of the Swedish Work Environment Surveys (1997–2015) were used and an aggregated occupational-level dataset was created using the Swedish Standard Classification of Occupations. To capture the patterns of change in working conditions over time (ie, growth), growth curve modeling was used to identify the starting points for 89 occupations (intercepts) as well as both the shape (functional form) and rate of growth (slope) over time.

Results:

The Swedish labor market was stable overall, with some small, mainly positive, changes in job demands and resources. Different occupations developed in divergent directions, but there was no evidence of polarization.

Conclusions:

The findings indicate that macro-level stability can hide highly heterogeneous patterns of change among different occupational groups. This type of analysis, taking context into account, could be valuable for decision makers intending to improve the work environment.

Trends in Work Conditions and Associations with Workers' Health in Recent 15 Years: The Role of Job Automation Probability

Job automation and associated psychosocial hazards are emerging workplace challenges. This study examined the trends in work conditions and associations with workers’ health over time in jobs with different automation probabilities. We utilized data from six waves of national questionnaire surveys of randomly selected 95,762 employees between 2001 and 2016. The Job Content Questionnaire, the Copenhagen Burnout Inventory, and the Self-Rated Health Scale were applied, and working time was self-reported. Automation probability was derived for 38 occupations and then categorized into three groups. Trends in work conditions and the associations between automation probability, work conditions and health were examined. We observed a 7% decrease in high automation probability jobs, an overall increase in job demands for and prevalence of shift work, and a decrease in job control. Workers with high automation probability jobs had low job demands, low job control and high job insecurity. Low automation probability was associated with burnout in logistic regression models. The odds ratio of job insecurity, long working hours, and shift work relating to health was higher in the later years of the surveys. In conclusion, there has been a decrease in high automation probability jobs. Workers employed in jobs with different levels of automation probability encountered different work condition challenges.

Differential effects of employment grade on the association between long working hours and problem drinking

OBJECTIVE

To examine the association between working hours and problem drinking in employees from different employment grades.

METHODS

We used data from a national survey of randomly sampled Taiwanese workers. A total score of 2 or more on the Cut down, Annoyed, Guilty, and Eye-Opener (CAGE) questionnaire was used to identify problem drinkers. Weekly working hours were categorized into five groups: <40, 40, 41-48, 49-59, and ≥60. Employees were classified into three employment grades: managers and professionals, skilled workers, and low-skilled workers. The associations between working hours and problem drinking in employees from different employment grades were examined by logistic regression models.

RESULTS

In skilled workers, problem drinking was associated with <40 and 41-48 working hours, but not with >48 working hours. In low-skilled workers, problem drinking was most strongly associated with 49-59 working hours.

CONCLUSION

The association between working hours and problem drinking was not linear and differed with employment grades.

Self-reported work conditions in Canada: examining changes between 2002 and 2012

OBJECTIVES

To examine changes in self-reported work conditions over a 10-year time period in Canada, as measured using two comparable cross-sectional surveys conducted in 2002 and 2012.

METHODS

Population-based data were obtained from the Canadian Community Health Survey. Work conditions (psychosocial work conditions, work hours, work demands, job satisfaction) were measured using the same modules across survey cycles. Regression models provided estimates for trends in work conditions, adjusting for differences in socio-demographic and survey administration characteristics over time.

RESULTS

We observed changes in self-reported work conditions across cycles, including higher levels of co-worker/supervisor support and job security; lower levels of psychological demands; and increases in shorter/regular work hours over time. These findings were consistent in both the base and adjusted models. Although skill discretion, decision authority, and job satisfaction improved over time in our base models, these findings were attenuated towards the null in adjusted models. Respondents in 2012 had a greater odds of reporting a physically demanding work environment compared to 2002. Differential time trends were observed by geographic region.

CONCLUSIONS

Our study found improvements in some self-reported measures of the psychosocial work environment in Canada over time. These changes were not accounted for by socio-demographic or survey administration differences across survey cycles. Despite these overall trends, absolute levels of some work conditions have not changed. Given the relevance of work conditions as a determinant of health, a continued focus on improving all aspects of the work environment should remain a public health priority to improve the health of working-aged Canadians.

Late chronotype and high social jetlag are associated with burnout in evening-shift workers: Assessment using the Chinese-version MCTQshift

Chronotypes are associated with shift work tolerance and sleep in shift workers, and sleep mediates the impact of shift work on mental health. However, the role of chronotype in the association between shift work and mental health has not been clarified. In this study, we aimed to examine the association between chronotype and burnout in shift workers, using the validated Munich ChronoType Questionnaire for shift workers (MCTQ^shift). A total of 288 shift workers with irregular shift frequencies were recruited and completed the Chinese-version MCTQ^shift and the Morningness-Eveningness Questionnaire (MEQ). Chronotypes were assessed by the calculation of corrected mid-sleep time (MSF_SC) from mid-sleep time on free days (MSF) based on their exact shift schedules. Another 26 evening-shift nurses were monitored with actigraphy for at least two consecutive evening shifts and the following two free days. Burnout was evaluated using the Copenhagen Burnout Inventory. We found that MSF^E_SC, MSF^E and mid-sleep time on workdays (MSW^E) had normal distributions and correlated significantly with MEQ scores (r = - 0.47, -0.45 and -0.47, respectively; all p < 0.001). MSW was more closely correlated with actigraphy-derived mid-sleep time on the free day before workdays than that on workdays (r = 0.61 and 0.48, respectively, p < 0.05). Sleep duration was significantly longer on workdays among evening-shift workers who slept late on workdays than those who slept early (β = 0.59, p < 0.001). After demographic and work characteristics were adjusted for in linear regression models, late chronotype and high social jetlag were associated with burnout scores in evening-shift workers. In conclusion, the Chinese-version MCTQ^shift is a valid tool for chronotype assessment. Interventions to improve sleep in shift workers should be tailored to chronotype due to variations in sleep behavior. Late chronotype may be an inherent feature of mental health problems, because the association with burnout was significant in both day workers in previous studies and shift workers.

The impact of the introduction of new recognition criteria for overwork-related cardiovascular and cerebrovascular diseases: a cross-country comparison

Cardiovascular and cerebrovascular diseases (CVDs) related to overwork are common in Asia, as is death from overwork, known as karoshi. Japan was the first country in the world to introduce criteria for recognizing overwork-related CVDs in 1961. Taiwan followed Japan in putting in place new policies and then updating these in 2010. We aimed to investigate the effect of introducing the new criteria for recognizing overwork-related CVDs in both countries. We defined the baseline period as the 5 years before launch of the new criteria, then collected data to 5 years after the new criteria. We applied a Poisson regression model to analyze the longitudinal change in rates of overwork-related CVDs before and after, adjusting for indicators of working conditions. Implementation of the new criteria was associated with a 2.58-fold increase in the rate of overwork-related CVDs (p-value < 0.05). However, the examined policy framework in Taiwan still appears to miss a substantial number of cases compared to that are captured by a similar policy framework used to capture overwork-related CVD rates in Japan by a factor of 0.42 (p-value < 0.05). Accordingly, we make a case for enhancements of Taiwan’s system for reporting and recognizing overwork-related diseases and deaths.

Night shift and rotating shift in association with sleep problems, burnout and minor mental disorder in male and female employees

OBJECTIVES

Shift work is associated with adverse physical and psychological health outcomes. However, the independent health effects of night work and rotating shift on workers' sleep and mental health risks and the potential gender differences have not been fully evaluated.

METHODS

We used data from a nationwide survey of representative employees of Taiwan in 2013, consisting of 16 440 employees. Participants reported their work shift patterns 1 week prior to the survey, which were classified into the four following shift types: fixed day, rotating day, fixed night and rotating night shifts. Also obtained were self-reported sleep duration, presence of insomnia, burnout and mental disorder assessed by the Brief Symptom Rating Scale.

RESULTS

Among all shift types, workers with fixed night shifts were found to have the shortest duration of sleep, highest level of burnout score, and highest prevalence of insomnia and minor mental disorders. Gender-stratified regression analyses with adjustment of age, education and psychosocial work conditions showed that both in male and female workers, fixed night shifts were associated with greater risks for short sleep duration (<7 hours per day) and insomnia. In female workers, fixed night shifts were also associated with increased risks for burnout and mental disorders, but after adjusting for insomnia, the associations between fixed night shifts and poor mental health were no longer significant.

CONCLUSIONS

The findings of this study suggested that a fixed night shift was associated with greater risks for sleep and mental health problems, and the associations might be mediated by sleep disturbance.

Nurse practitioner job content and stress effects on anxiety and depressive symptoms, and self-perceived health status

AIM

We explored the impact of job content and stress on anxiety, depressive symptoms and self-perceived health status among nurse practitioners (NPs).

BACKGROUND

Taiwan's NP roles vary between hospitals as a result of the diverse demands and complex tasks that cause job-related stress, potentially affecting the health of the NP.

METHODS

This study utilised a cross-sectional descriptive design with 161 NPs from regional hospitals participating. Data collection involved demographics, the Taiwan Nurse Stress Checklist, the Job Content Questionnaire, the Beck Anxiety Inventory, the Beck Depression Inventory, a General Health Status Checklist and salivary cortisol tests.

RESULTS

NPs reported moderate job stress, similar job control to nurses, mild anxiety and depression, and below-average self-perceived health. Being a licensed NP, personal response, competence, and incompleteness of the personal arrangements subscales of job stress, and anxiety predicted self-perceived health after adjusting for other covariates.

CONCLUSIONS

Job stress and anxiety affect NP health.

IMPLICATIONS FOR NURSING MANAGEMENT

NPs are a valuable resource, and the healthcare system demand is growing. Reasonable NP staffing, working hours, proper promotion systems, the causes of job stress, job content clarification and practical work shift scheduling need to be considered. The occupational safety and physical and psychological health of NPs are strongly associated with the quality of patient care.

Is suicidal ideation linked to working hours and shift work in Korea?

OBJECTIVE

This study attempted to use the community health survey (CHS) to identify the effect of long working hours (long WHs) and night/shift work on suicidal ideation among the employed population of Korea.

METHODS

This study used data from 67,471 subjects who were administered the 2008 CHS which obtained information regarding sociodemographic characteristics, health behaviors and working environment, using structured questionnaires and personal interviews. We adopted multiple logistic regression models for gender and employment stratification.

RESULTS

Among male employees, suicidal ideation was significantly associated with only moderately long WHs (51-60 hours), after controlling covariates (adjusted odds ratio [aOR], 1.30; 95% confidence interval [95%CI], 1.07 to 1.57). Self-employed/male employer populations had higher suicidal ideation when they had moderately long WHs (aOR, 1.23; 95%CI, 1.01 to 1.50) and very long WHs (over 60 hours) (aOR, 1.31; 95%CI, 1.08 to 1.59). Among the female population, suicidal ideation was significantly association with moderately long WHs in the employee group (aOR, 1.31; 95%CI, 1.08 to 1.58) and moderately (aOR, 1.35; 95%CI, 1.08 to 1.69) and very (aOR, 1.33; 95%CI, 1.07 to 1.65) long WHs in the self-employed/employer group. Shift work was a significant predictor only in the female population in the employee groups (aOR, 1.45; 95%CI, 1.23 to 1.70).

CONCLUSIONS

Long WHs and shift work were associated with suicidal ideation when taking into account gender and employment differences. The harmful effects of exceptionally long WHs in Korea, among other Organization for Economic Co-operation and Development (OECD) countries, raise concerns about public and occupational health. To address the issue of long WHs, labor policies that reduce maximum working hours and facilitate job stability are needed.

Receipt of physical therapy among osteoarthritis patients and its influencing factors

OBJECTIVE

To explore major patient and provider characteristics influencing the receipt of physical therapy (PT) among patients newly diagnosed with osteoarthritis.

DESIGN

A population-based, cross-sectional study on outpatient PT for patients newly diagnosed with osteoarthritis within the period of 2005 to 2010.

SETTING

Sample of 1 million National Health Insurance enrollees.

PARTICIPANTS

People aged ≥18 years with an incidence of osteoarthritis and receiving initial outpatient treatment. A total of 29,012 patients were included (N=29,012).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The outcome variable of interest was the probability of receiving PT within 1 year of osteoarthritis diagnosis. Both individual and provider characteristics were investigated to determine their influence on PT receipt.

RESULTS

Of the 29,012 included patients with osteoarthritis, only 24.8% of them received PT within the first year of diagnosis. Men and older adults were less likely to receive PT. In addition, low-income patients with osteoarthritis were less likely to receive PT. Furthermore, PT receipt was increased in patients treated by physicians who were women and by physicians who specialized in rehabilitation medicine. In addition, we observed a pattern indicating that the lower the accreditation level of the practice setting, the greater the probability of receiving PT.

CONCLUSIONS

Because of the National Health Insurance program in Taiwan, direct medical costs of PT have been substantially reduced; however, variations are still observed among different patient and provider characteristics. The major role of providers in PT receipt for patients with osteoarthritis should not be ignored.

Changes in psychosocial work factors in the French working population between 2006 and 2010

PURPOSE

The aim of the study was to assess the changes in psychosocial work factors in the French working population between 2006 and 2010 and to examine potential differential changes according to age, occupation, public/private sector, work contract and self-employed/employee status.

METHODS

The study sample included 5,600 workers followed up from 2006 to 2010 from the national representative Santé et Itinéraire Professionnel (SIP) survey. Psychosocial work factors included decision latitude, psychological demands, social support, reward, overcommitment, long working hours, predictability, night- and shift work, emotional demands, role conflict, ethical conflict, tensions with the public, job insecurity and work-life imbalance, and were measured using scores. Linear regressions were used to analyse the change in the scores of these factors adjusted for age and initial score. All analyses were stratified by gender.

RESULTS

Psychosocial work factors worsened between 2006 and 2010: decision latitude, social support, reward, role conflict and work-life imbalance for both genders, and psychological demands, emotional demands, ethical conflict and tensions with the public for women. Differential changes according to age, occupation, public/private sector, work contract and self-employed/employee status were observed suggesting that some groups may be more likely to be exposed to negative changes especially the younger, low- and high-skilled and public sector workers.

CONCLUSION

Monitoring exposure to psychosocial work factors over time may be crucial, and prevention policies should take into account that deterioration of psychosocial work factors may be sharper among subgroups such as younger, low- and high-skilled and public sector workers.