Interaction Effects of Physical and Psychosocial Working Conditions on Risk for Sickness Absence: A Prospective Study of Nurses and Care Assistants in Sweden

A Systematic Review and Evaluation of the Tools Measuring Work-Related Psychosocial Factors in Prospective Research on Sickness Absence of Health Care Workers

PURPOSE

This systematic literature review aims to list the validated tools measuring work-related psychosocial factors (WRPFs) influence health care workers' (HCWs) sickness absence (SA), and to evaluate their psychometric and practical properties.

METHODS

Using the PsycINFO, Medline, and Web of Science databases, the search targeted prospective studies on WRPFs and SA in HCWs published between 2012 and 2023. The validated, self-report tools that measured WRPFs and that yielded at least one significant predictor of SA in HCWs were identified. An evaluation of the psychometric and practical properties was performed.

RESULTS

Based on inclusion criteria, three prospective studies on HCWs were included, and twelve tools were listed. Psychometric and practical properties were "excellent" for six tools, "good" for four, and "questionable" for two.

CONCLUSIONS

Researchers and occupational health practitioners can use tools with "good" to "excellent" overall quality to measure traditional WRPFs that predict SA in HCWs. There is a need to develop and validate tools that measure WRPFs representing the specific characteristics of the health care working environment. Other WRPFs relevant to the work context of HCWs can be measured by extant tools that could be used in research and program development and evaluation.

Mediating effect of working conditions on the association between education and early labour market exit: a cohort study of Swedish men

OBJECTIVES

It is not fully known what explains educational inequalities in early labour market exits. This study aims to examine the mediating effect of exposure to unfavourable working conditions, measured by low job control and high physical workload, on the association between education and early labour market exit among men.

METHODS

This register-based study included all men born 1951-1953, who underwent Swedish military conscription in late adolescence and had a registered educational level in 2005 (n=115 998). These men were followed from ages 53-55 to 64 regarding early labour market exit (disability pension, long-term sickness absence, long-term unemployment, early old-age retirement with and without income). Mediation analysis was used to examine the role of job control and physical workload in explaining the educational differences in early exit. Factors measured in childhood and late adolescence were included as confounders.

RESULTS

The proportion mediated by job control was around 17% and for physical workload around 22% for the least educated men for exit through disability pension, long-term sickness absence and long-term unemployment. For early old-age retirement with and without income, working conditions were not mediating factors, except for job control mediating up to 18% for exit through early old-age retirement with income.

CONCLUSIONS

Job control and physical workload seem to be important factors explaining the educational differences in most early exit routes, also after accounting for early life factors. These results indicate the importance of improving working conditions to decrease inequalities in early labour market exit and prolong working life.

Correlations between well-being of nurses and psychosocial working conditions - a descriptive cross-sectional study

Introduction

Work in health care is classified as a difficult profession and nurses are considered among the professional group that is exposed to the permanent impact of occupational stress. Psychosocial working conditions and related hazards are defined as those aspects that have the potential to cause harm to an employee's mental or physical health. Lack of psycho-physical health well-being reduces job satisfaction and thus job commitment.

Aim

The aim of this study was to assess the overall well-being of nurses and examine the correlation between nurses' well-being and their assessment of psychosocial working conditions in conjunction with occupational and demographic factors.

Materials and methods

A descriptive cross-sectional survey was conducted among 526 nurses employed in a selected public clinical hospital in Poland. All nurses provided labor during the survey. A diagnostic survey method using the standardized Psychosocial Working Conditions questionnaire based on the demands-control-support stress model was used for measurement.

Results

The examined nurses rated highly job demands (mean 3.46) as well as the scale of desired changes (mean 3.44). The ability to control their work (mean 3.19) and the level of social support (mean 3.21) were rated at a slightly lower level. The scale of well-being was rated highest by respondents (mean 3.68). Several statistically significant correlations (p < 0.05) can be observed between the well-being scale and the other scales of psychosocial working conditions across age categories. The least correlated are the well-being and demands scales, although as age increases with higher levels of well-being, the demands scale scores decrease.

Conclusion

The well-being of the examined nurses was closely related to sociodemographic data and the individual scales of the Psychosocial Working Conditions questionnaire. Chronic diseases are associated with greater demands at work and reduced well-being. Respondents who receive higher levels of support at work experience higher levels of well-being.

Comprehensive evaluation of the impact of workplace exposures on physician-certified sick leave in the general working population

BACKGROUND

Our objective was to quantify the prospective associations between work factors across chemical, physical, mechanical, and psychosocial domains and the onset of medically certified sick leave.

METHODS

Eligible respondents were interviewed in 2009, 2013, or 2016 and were registered in the national sick leave register with an employee relationship lasting more than 50 working days during the year of the survey interviews and the following year (n = 15,294 observations). To focus on the onset of high-level sick leave (HLSL; >16 days a year), we excluded individuals with HLSL during the survey year (baseline). We then used mixed-effect logistic regression models to assess prospective associations between self-reported work conditions and the occurrence of doctor-certified HLSL in the following year.

RESULTS

The average occurrence of HLSL was 13.1%. After adjusting for sex, age, level of education, chronic health problems, and smoking, we observed an exposure-response relationship between cumulative exposure to work factors within all domains and the occurrence of HLSL. When evaluating the impact of combined exposures, predicted odds ratios (OR) for employees exposed to 1, 2, and 3 or more work factors within all domains were 1.60 (95%CI 1.32 - 1.94), 2.56 (95%CI 1.73 - 3.74) and 4.09 (95%CI 2.28 - 7.25), compared to those not exposed.

CONCLUSIONS

The results support the notion that exposure to multiple work factors in various domains, including psychosocial, mechanical, chemical, and physical work conditions, is associated with an increased risk of high-level sick leave. Employers and occupational health professionals should consider the joint impact of these domains when designing interventions.

Combined exposure to heavy physical workload and low job control and the risk of disability pension: A cohort study of employed men and women in Sweden

OBJECTIVE

To investigate the separate and combined effects of overall heavy physical workload (PWL) and low decision authority on all-cause disability pension (DP) or musculoskeletal DP.

METHODS

This study uses a sample of 1,804,242 Swedish workers aged 44-63 at the 2009 baseline. Job Exposure Matrices (JEMs) estimated exposure to PWL and decision authority. Mean JEM values were linked to occupational codes, then split into tertiles and combined. DP cases were taken from register data from 2010 to 2019. Cox regression models estimated sex-specific Hazard Ratios (HR) with 95% confidence intervals (95% CI). The Synergy Index (SI) estimated interaction effects.

RESULTS

Heavy physical workload and low decision authority were associated with an increased risk of DP. Workers with combined exposure to heavy PWL and low decision authority often had greater risks of all-cause DP or musculoskeletal DP than when adding the effects of the single exposures. The results for the SI were above 1 for all-cause DP (men: SI 1.35 95%CI 1.18-1.55, women: SI 1.19 95%CI 1.05-1.35) and musculoskeletal disorder DP (men: SI 1.35 95%CI 1.08-1.69, women: 1.13 95%CI 0.85-1.49). After adjustment, the estimates for SI remained above 1 but were not statistically significant.

CONCLUSION

Heavy physical workload and low decision authority were separately associated with DP. The combination of heavy PWL and low decision authority was often associated with higher risks of DP than would be expected from adding the effects of the single exposures. Increasing decision authority among workers with heavy PWL could help reduce the risk of DP.

Working conditions and mental health functioning among young public sector employees

Background: The associations between adverse working conditions and mental disorders are well established. However, associations between adverse working conditions and poor mental health functioning is a less explored area. This study examines these associations among younger public sector employees of the City of Helsinki, Finland. Methods: We use data from the Young Helsinki Health Study with a representative sample of the employees of the City of Helsinki, aged 19-39 years (n=4 217). Mental health functioning was measured with mental composite summary of the Short Form 36. Working conditions included factors related to both the psychosocial (job control and job demands) and the physical work environment (physical workload). To examine the associations, we used logistic regression models with adjustments for socio-demographics, other working conditions and health-related covariates. Results: After adjustment for sociodemographic characteristics, poor health, health behaviours and other occupational exposures, high job demands (OR=1.69; 95% CI=1.45-1.97) and low job control (OR=1.65; 95% CI=1.40-1.94) were associated with poor mental health functioning. High physical workload was not associated with the outcome (OR=0.87; 95% CI=0.72-1.05) after the adjustments. Conclusions: Adverse psychosocial working conditions were associated with mental health functioning, whereas physical working conditions were not. As impaired functioning is likely to cause health-related lost productivity and can lead to work disability, further research and interventions with a balanced approach focusing on both psychosocial working conditions and mental health functioning are recommended.

Interaction between physical demands and job strain on musculoskeletal symptoms and work performance

This study investigated the interaction between physical demands and job strain on musculoskeletal symptoms in upper extremities (MSUE) and work performance. Two years of prospective data were analysed from 713 full-time workers from twelve manufacturing and healthcare facilities in Washington in the United States. Physical exposure was measured by the Strain Index and Threshold Limit Value for hand activity, giving rise to safe, action, and hazardous physical demand groups. Job strain was calculated as the ratio of psychological job demands to job control. Multilevel modelling analysis showed that job strain affected MSUE and limited work performance less in the high physical demand group than the safe group because the protective effect of job control was smaller in these groups. Findings may suggest that high physical demand jobs are structured such that workers have low job control or high physical demand groups experience job strain not adequately captured by psychosocial variables.Practitioner Summary: The effects of job strain and job control on musculoskeletal symptoms in upper extremities and work performance were smaller among workers with higher physical demands. This could imply that high physical demand jobs limit job control or psychosocial variables may not adequately capture job strain among high physical demand groups.

Profiles of women who have suffered occupational accidents in cleaning: perceived health, psychosocial risks, and personality variables

PURPOSE

The main goal was to identify the variables (sociodemographic, work, psychosocial, perceived health, and personality) associated with occupational accidents suffered in the past by women in the cleaning sector.

METHODS

A sample of 455 women was evaluated.

RESULTS

A total of 23.5% of the workers (n = 107) had suffered an occupational accident with medical leave. In general, women who had suffered some accident in their life had a worse situation in all areas evaluated. Two subsamples of women had a greater association with accidents. Specifically, the presence of work accidents was 15.9 times higher among those who presented a worse perception of their physical effort and a greater tendency towards risky behaviours and 13.5 times higher among those who had a moderate perception of physical exertion and a disability.

CONCLUSION

In general, the characteristics of female workers were found to be associated with different accident rates. Preventive actions should be designed individually.

The changing nature of work - Job strain, job support and sickness absence among care workers and in other occupations in Sweden 1991-2013

This study examined exposure changes in three psychosocial dimensions - job demands, job control, and social support - and the associations between these dimensions and sickness absence throughout the period 1991-2013. The analyses covered periods of economic ups and downs in Sweden and periods involving major fluctuations in sickness absence. Data on care workers (n = 16,179) and a comparison group of employees in other occupations (n = 82,070) were derived from the biennial Swedish Work Environment Survey and linked to register data on sickness absence. Eight exposure profiles, based on combinations of demands, control, and support, were formed. The proportion of individuals with work profiles involving high demands doubled among care workers (14%-29%) while increasing modestly in the comparison group (17%-21%) 1991-2013. The work profile that isolated high-strain (iso-strain), i.e., high demands, low control, and low social support, was more prevalent among care workers, from 4% in 1991 to 11% in 2013. Individuals with work profiles involving high-demand jobs had the highest number of days on sickness absence during the study period and those with the iso-strain work profile had the highest increase in sickness absence, from 15 days per year during 1993-1994, to 42 days during 2000-2002. Employees with a passive work profile (low job demands and low job control) had the lowest rate and the lowest increase in sickness absence. Individuals with active work profiles, where high demands are supposed to be balanced by high job control, had a rather high increase in sickness days around 2000. A conclusion is that there is a long-term trend towards jobs with high demands. This trend is stronger among care workers than among other occupations. These levels of job demands seem to be at such a level that it is difficult to compensate for with higher job control and social support.

Diagnosis-Specific Work Disability before and after Lumbar Spine Decompression Surgery-A Register Study from Sweden

Low back pain (LBP) patients undergoing lumbar spine decompression surgery (LSDS) often suffer from multi-comorbidity and experience high work disability. This study aimed to identify diagnosis-specific work disability patterns in all LBP-patients before and after LSDS during 2008-2010, that were aged 19-60 years and living in Sweden (n = 10,800) and compare these patterns to LBP-patients without LSDS (n = 109,179), and to matched individuals without LBP (n = 472,191). Work disability days (long-term sickness absence (LTSA), disability pension (DP)) during the three years before to three years after the cohort's entry date were identified by generalised estimating equations. LBP-patients undergoing LSDS had higher overall work disability during the three years following surgery (LTSA: 23.6%, DP: 6.3%) than LBP-patients without LSDS (LTSA: 19.5%, DP: 5.9%), and those without LBP (LTSA: 7.9%, DP: 1.7%). Among patients undergoing LSDS, the prevalence of work disability due to dorsopathies increased from 20 days three years before surgery to 70 days in the year after and attenuated to 30 days in the third year following surgery. Work disability for other diagnoses remained stable at a low level in this group (<10 days annually). LBP-patients undergoing LSDS have an unfavourable long-term work disability prognosis, primarily due to dorsopathies. Decompression surgery seemed to restrict further inclines in work disability in the long run.

Sickness Absence and Sickness Presence Among Health and Care Employees in Sweden-Health Complaints, Health Behavior, and Future Long-Term Sickness Absence

OBJECTIVE

To describe if health complaints relate to health behavior in terms of sickness absence (SA) and sickness presence (SP) and to examine how complaints and health behavior predicts the risk for future long-term sickness absence (LTSA).

METHODS

Data originates from work environment surveys 2001 to 2013 and SA registers 2002 to 2016 of 1838 nurses, 7430 care assistants, and 40,515 individuals in all other occupations. Descriptive and regression analyses were conducted.

RESULTS

Physical complaints and high SA in combination with high SP increased the risk of LTSA among nurses and care assistants. Nurses' high SP and care assistants' high SA elevated the LTSA risk.

CONCLUSIONS

Strategies to reduce the reasons behind physical health complaints among health care workers are warranted. SP among nurses and SA among care assistants should be considered in the organization of their job demands.