Development of a Mental Health Action Checklist for Improving Workplace Environment as means of Job Stress Prevention

Protocol for a web-based study on the work environment and daily lifestyle of Japanese employees

Mental health problems are prevalent among the working population and must be resolved. We conducted a web-based large-scale study of workers, including a baseline survey and two follow-up surveys, to investigate the associations between self-care behaviors in daily life (e.g., stress coping, sleep, diet, and exercise), work environment improvements, and mental health among Japanese employees from various industries. In this protocol, we demonstrate the study design and demographic data of the participants in the baseline survey. Invitations to participate in this study were sent to 421,825 internet monitor registrants in February 2022. Overall, 20,000 registrants who met the inclusion criteria participated in the survey. There were large variations in occupations and working styles (e.g., physical work, night work, and teleworking) among the participants, and we also found significant differences between male and female participants in the demographic data. An overview of the survey data suggests that the demographic characteristics of the participants in this study are comparable to those reported in previous studies on Japanese employees. We plan to use these survey data in the future to examine the associations of daily lifestyles and work environments with the mental health of Japanese employees.

Multifaceted ORganizational InterventiONs (M-ORION) project for prevention of depression and anxiety among workers: study protocol for a five-arm cluster randomized controlled trial

BACKGROUND

Depression and anxiety are the most common mental health issues experienced by workers. Although organizational intervention has been extensively evaluated as a primary prevention of depression and anxiety, the corresponding scientific evidence remains limited because of the lack of cluster randomized controlled trials (cRCT) and failure to detect organizational-level effects. Therefore, the present study aims to assess the preventive effects of four types of interventions on depression and anxiety among workers in an open, five-arm, parallel-group cRCT.

METHODS

Overall, 140 worksites and 18,200 nested employees will be recruited from September 2023. The eligible worksites will be randomly assigned to each of the five arms, and programs will be offered for 6-12 months. The five arms are 1) psychoeducation for workers, 2) psychoeducation for supervisors, 3) work environment improvement, 4) physical activity promotion, and 5) active control. The primary outcomes of interest are depression and anxiety. We will also assess psychosocial factors at work, work engagement, health-related quality of life, well-being, economic outcomes, physiological outcomes of health checkups, cortisol levels extracted from fingernails, and indices representing the process and implementation outcomes, including program completion rates. Follow-up surveys will be conducted at 6, 12, and 18 months from baseline, and the primary endpoint is set at the 6-month follow-up. Repeated-measures multi-level mixed modeling will be used to evaluate the effect of each intervention compared with the control.

ETHICS AND DISSEMINATION

The study protocol was approved by the Research Ethics Committee of the Kitasato University Medical Ethics Organization (C22-082). The results and findings of this study will be published in a scientific journal and disseminated to companies that participate in the study.

TRIAL REGISTRATION NUMBER

UMIN000050949.

[Job stress and mental health at work]

In Japan, a study on mental health in workplace has expanded from tertiary to secondary and primary preventions of mental health disorders among employees. Recent movements suggest a trend of bringing numerous topics outside the industrial health, including those with perspectives from categories generally known as primordial prevention, such as enhancement of working life quality or improvement of work environment.First, according to the aforementioned trends, the present paper made an effort to organize the terms and concepts related to mental health disorders, which included the foundation for research and practice in this area as well as the outcomes of discussions on the tertiary and secondary preventions.Second, the primary models of work-related stress, along its impact on mental health, and the scales for assessing workers' mental health issues were discussed, which have been used in numerous studies since the 1990s. The introduction of those models and scales contributed immensely to the expansion of this field's research areas. However, a number of significant factors, most of which have social or cultural implications, can influence the connection between stress at workplace and health problems. Therefore, conducting large-scale study or systematic reviews targeting domestic cases exclusively is necessary to obtain evidence for establishing highly versatile measures against mental health problems in Japan.Third, in this regard, several noteworthy large-scale research projects in Japan are highlighted as a hope for encouraging such studies in this field. However, the occupational health practitioners' effort to understand the actual workplace situations where they attend to and to put the understanding into practice has been and will remain an indispensable attribute for them in the future.

Developing Action Plans Based on Machine Learning Analysis to Prevent Sick Leave in a Manufacturing Plant

OBJECTIVE

We aimed to develop action plans for employees' health promotion based on a machine learning model to predict sick leave at a Japanese manufacturing plant.

METHODS

A random forest model was developed to predict sick leave. We developed plans for workers' health promotion based on variable importance and partial dependence plots.

RESULTS

The model showed an area under the receiving operating characteristic curve of 0.882. The higher scores on the Brief Job Stress Questionnaire stress response, younger age, and certain departments were important predictors for sick leave due to mental disorders. We proposed plans to effectively use the Brief Job Stress Questionnaire and provide more support for younger workers and managers of high-risk departments.

CONCLUSIONS

We described a process of action plan development using a machine learning model, which may be beneficial for occupational health practitioners.

Interrelationships Between Job Resources, Vigor, Exercise Habit, and Serum Lipids in Japanese Employees: a Multiple Group Path Analysis Using Medical Checkup Data

BACKGROUND

Physical inactivity is one of the major risk factors for dyslipidemia and coronary heart disease. Job resources have been identified as determinants of employees' vigor and physical activity habits.

PURPOSE

Our first purpose was to comprehensively analyze the series of relationships of job resources, through vigor and exercise habit (i.e., one aspect of physical activity), to serum lipid levels in a sample of Japanese employees in a manufacturing company. Our second purpose was to investigate sex differences in these relationships using a multiple-group path analysis.

METHODS

Data were collected from 4543 employees (men = 4018, women = 525) during a medical checkup conducted in February and March 2012. Job resources (job control, skill utilization, suitable jobs, and meaningfulness of work), vigor, exercise habit, triglyceride, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were measured cross-sectionally.

RESULTS

Job resources and vigor were positively associated with exercise habit in both sexes. Exercise habit was inversely associated with triglyceride (-0.03 in men and -0.01 in women, ps < 0.05) and LDL-C (-0.07 in both sexes, ps < 0.05). HDL-C was positively associated with exercise habit (0.03 in both sexes, ps < 0.05). There was no significant difference by sex in path coefficients, except for the covariance between suitable jobs and meaningfulness of work.

CONCLUSION

Higher levels of job resources were associated with greater vigor, leading to exercise habit, which in turn, improved serum lipid levels. Longitudinal studies are required to demonstrate causality.

Examples of Holistic Good Practices in Promoting and Protecting Mental Health in the Workplace: Current and Future Challenges

Background

While attention has been paid to physical risks in the work environment and the promotion of individual employee health, mental health protection and promotion have received much less focus. Psychosocial risk management has not yet been fully incorporated in such efforts. This paper presents good practices in promoting mental health in the workplace in line with World Health Organization (WHO) guidance by identifying barriers, opportunities, and the way forward in this area.

Methods

Semistructured interviews were conducted with 17 experts who were selected on the basis of their knowledge and expertise in relation to good practice identified tools. Interviewees were asked to evaluate the approaches on the basis of the WHO model for healthy workplaces.

Results

The examples of good practice for Workplace Mental Health Promotion (WMHP) are in line with the principles and the five keys of the WHO model. They support the third objective of the WHO comprehensive mental health action plan 2013–2020 for multisectoral implementation of WMHP strategies. Examples of good practice include the engagement of all stakeholders and representatives, science-driven practice, dissemination of good practice, continual improvement, and evaluation. Actions to inform policies/legislation, promote education on psychosocial risks, and provide better evidence were suggested for higher WMHP success.

Conclusion

The study identified commonalities in good practice approaches in different countries and stressed the importance of a strong policy and enforcement framework as well as organizational responsibility for WMHP. For progress to be achieved in this area, a holistic and multidisciplinary approach was unanimously suggested as a way to successful implementation.

Effectiveness of a comprehensive stress management program to reduce work-related stress in a medium-sized enterprise

Objectives

To assess the effectiveness of a comprehensive workplace stress management program consisting of participatory action-oriented training (PAOT) and individual management.

Methods

A comprehensive workplace stress management program was conducted in a medium-sized enterprise. The baseline survey was conducted in September 2011, using the Korean Occupational Stress Scale (KOSS) and Worker’s Stress Response Inventory (WSRI). After implementing both organizational and individual level interventions, the follow up evaluation was conducted in November 2011.

Results

Most of the workers participated in the organizational level PAOT and made Team-based improvement plans. Based on the stress survey, 24 workers were interviewed by a researcher. After the organizational and individual level interventions, there was a reduction of several adverse psychosocial factors and stress responses. In the case of blue-collar workers, psychosocial factors such as the physical environment, job demands, organizational system, lack of rewards, and occupational climate were significantly improved; in the case of white-collar workers, the occupational climate was improved.

Conclusions

In light of these results, we concluded that the comprehensive stress management program was effective in reducing work-related stress in a short-term period. A persistent long-term follow up is necessary to determine whether the observed effects are maintained over time. Both team-based improvement activities and individual interviews have to be sustainable and complementary to each other under the long-term plan.

Effect on mental health of a participatory intervention to improve psychosocial work environment: a cluster randomized controlled trial among nurses

OBJECTIVES

Improvement of psychosocial work environment has proved to be valuable for workers' mental health. However, limited evidence is available for the effectiveness of participatory interventions. The purpose of this study was to investigate the effect on mental health among nurses of a participatory intervention to improve the psychosocial work environment.

METHODS

A cluster randomized controlled trial was conducted in hospital settings. A total of 434 nurses in 24 units were randomly allocated to 11 intervention units (n=183) and 13 control units (n=218). A participatory program was provided to the intervention units for 6 months. Depressive symptoms as mental health status and psychosocial work environment, assessed by the Job Content Questionnaire, the Effort-Reward Imbalance Questionnaire, and the Quality Work Competence questionnaire, were measured before and immediately after the 6-month intervention by a self-administered questionnaire.

RESULTS

No significant intervention effect was observed for mental health status. However, significant intervention effects were observed in psychosocial work environment aspects, such as Coworker Support (p<0.01) and Goals (p<0.01), and borderline significance was observed for Job Control (p<0.10).

CONCLUSIONS

It is suggested that a 6-month participatory intervention is effective in improving psychosocial work environment, but not mental health, among Japanese nurses.

[Concept analysis of a participatory approach to occupational safety and health]

PURPOSE

The purpose of this study was to analyze a participatory approach to occupational safety and health, and to examine the possibility of applying the concept to the practice and research of occupational safety and health.

METHODS

According to Rodger's method, descriptive data concerning antecedents, attributes and consequences were qualitatively analyzed. A total of 39 articles were selected for analysis.

RESULTS

Attributes with a participatory approach were: "active involvement of both workers and employers", "focusing on action-oriented low-cost and multiple area improvements based on good practices", "the process of emphasis on consensus building", and "utilization of a local network". Antecedents of the participatory approach were classified as: "existing risks at the workplace", "difficulty of occupational safety and health activities", "characteristics of the workplace and workers", and "needs for the workplace". The derived consequences were: "promoting occupational safety and health activities", "emphasis of self-management", "creation of safety and healthy workplace", and "contributing to promotion of quality of life and productivity".

CONCLUSIONS

A participatory approach in occupational safety and health is defined as, the process of emphasis on consensus building to promote occupational safety and health activities with emphasis on self-management, which focuses on action-oriented low-cost and multiple area improvements based on good practices with active involvement of both workers and employers through utilization of local networks. We recommend that the role of the occupational health professional be clarified and an evaluation framework be established for the participatory approach to promote occupational safety and health activities by involving both workers and employers.

Roles of Participatory Action-oriented Programs in Promoting Safety and Health at Work

Reflecting the current international trends toward proactive risk assessment and control at work with practical procedures, participatory action-oriented approaches are gaining importance in various sectors. The roles of these approaches in promoting the safety and health at work are discussed based on their recent experiences in preventing work-related risks and improving the quality of work life, particularly in small-scale workplaces. The emphasis placed on the primary prevention at the initiative of workers and managers is commonly notable. Participatory steps, built on local good practices, can lead to many workplace improvements when the focus is on locally feasible low-cost options in multiple aspects. The design and use of locally adjusted action toolkits play a key role in facilitating these improvements in each local situation. The effectiveness of participatory approaches relying on these toolkits is demonstrated by their spread to many sectors and by various intervention studies. In the local context, networks of trainers are essential in sustaining the improvement activities. With the adequate support of networks of trainers trained in the use of these toolkits, participatory approaches will continue to be the key factor for proactive risk management in various work settings.

[An analysis of the relation between stress coping profile and job stress using structural equation modeling (SEM)]

OBJECTIVES

This study aimed to clarify what type of coping profile can reduce the stress reaction caused by job stress.

METHODS

Using the Brief Job Stress Questionnaire and the Brief Scales for Coping Profile Questionnaire, 1,319 male workers in Japanese manufacturing companies were surveyed. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and Structural Equation Modeling (SEM) were used for the statistical analysis.

RESULTS

Six factors for coping profile and job stress were extracted by EFA. Three factors of job stress were thought to correspond to job overload, good human relations and stress reaction, and three factors of coping profile were thought to correspond to problem-focused coping, emotion-focused active coping and escape-avoidance coping. These factors showed good agreement (GFI=0.947, AGFI=0.915, RMSEA=0.070) in CFA. A path diagram showing that coping profile influenced human relations and job overload, and that these conscious stress factors caused the stress reaction was constructed. The validity of this path model was shown (GFI=0.937, AGFI=0.904, RMSEA=0.074) using SEM. In the path analysis, the emotion-focused active coping profile created good human relations and reduced job overload, and either or both of these stress factors worked in the direction in which the stress reaction was reduced. The emotion-focused active coping profile acted finally to reduced the stress reaction (standardized total effect: -0.205). On the other hand, the escape-avoidance coping profile influences human relations harmfully and increased job overload. The escape-avoidance coping profile remarkably deteriorated the stress reaction (standardized total effect: +0.160). The problem-focused coping profile created good human relations though it increased job overload. Through both stress factors the problem-focused coping profile only increased slightly the stress reaction (standardized total effect: +0.019). However, a correlation existed among the three coping profiles. The problem-focused coping profile positively correlated with the emotion-focused active coping profile, that decreases the stress reaction, but negatively correlated with the escape-avoidance coping profile, that increases the stress reaction. Because it was thought that a worker who tends to use a problem-focused coping profile also often adopted other coping profiles that simultaneously reduced the stress reaction, the many workers who tend to use a problem-focused coping profile finally have reduced stress reactions.

CONCLUSIONS

The emotion-focused active coping profile reduced the stress reaction caused by job stress, but the escape-avoidance coping profile intensified the stress reaction. The problem-focused coping profile, that has often been reported to reduce the stress reaction, finally increased the stress reaction slightly because job overload increased as a cost.