Effects of work-related stress reduction on depressive symptoms among Japanese blue-collar workers

Understanding possible personal correlates of organizational citizenship behavior: Mindfulness and oneness behaviors

The current study aims to understand the mechanisms underlying the predictive relationship between mindfulness and organizational citizenship behaviors especially targeted for other individuals inside the organizations. As part of this relationship model, oneness behaviors were suggested as an actor of mediation. A sample of 281 blue collar employees participated for the study with employing a multi-source data gathering method. In line with the self-regulation and Buddhist based conceptualizations, and previous related research, statistical analyses revealed significant effects of mindfulness on organizational citizenship behavior towards individuals (OCBI) after controlling demographic variables, and showed fully mediated roles of one and other sub dimensions in mindfulness-OCBI interaction. The current study brings a novel approach to mindfulness and organizational citizenship relationship by including oneness behaviors inside the research model while stressing the importance of interconnectedness and how it could be practiced inside the organizations.

Effectiveness of a workplace intervention reducing psychosocial stressors at work on blood pressure and hypertension

Objectives

To assess the effectiveness of a workplace intervention reducing psychosocial stressors at work in lowering blood pressure and hypertension prevalence.

Methods

The study design was a quasi-experimental pre–post study with an intervention group and a control group. Post-intervention measurements were collected 6 and 36 months after the midpoint of the intervention. Participants were all white-collar workers employed in three public organisations. At baseline, the intervention and the control groups were composed of 1088 and 1068 workers, respectively. The intervention was designed to reduce psychosocial stressors at work by implementing organisational changes. Adjusted changes in ambulatory blood pressure and hypertension prevalence were examined.

Results

Blood pressure and hypertension significantly decreased in the intervention group while no change was observed in the control group. The differential decrease in systolic blood pressure between the intervention and the control group was 2.0 mm Hg (95% CI: −3.0 to –1.0). The prevalence of hypertension decreased in the intervention group, when compared with the control group (prevalence ratio: 0.85 (95% CI: 0.74 to 0.98)).

Conclusions

Findings suggest that psychosocial stressors at work are relevant targets for the primary prevention of hypertension. At the population level, systolic blood pressure reductions such as those observed in the present study could prevent a significant number of premature deaths and disabling strokes.

An individualized mental health education programme for Japanese managers

Background

Mental health education for managers has typically been conducted using a group format. Few studies have examined the provision of individualized education.

Aims

This study discussed the evaluations and characteristic needs of participants in an individualized mental health education programme while examining avenues for providing such education.

Methods

Eighty-nine individualized education sessions were conducted for managers (87 males, 2 females) with a mean age of 42.6 years (SD = 5.1) at an assembly factory in Japan. Data from anonymous self-administered questionnaires completed before and after the education programme were analysed.

Results

Overall, 95% of the managers (81/85) approved the individualized education format. The characteristic needs of participants with high motivation (45%, 38/85) were mental health consultations for managers (37%, 14/38, 95% confidence interval [CI] 1.62–14.7, P < 0.01) and subordinate-related concerns (18%, 7/38, 95% CI 1.11–22.8, P < 0.05).

Conclusions

Individualized education may be a suitable method for conducting mental health consultations. It is recommended that the introduction of individualized education formats be implemented through voluntary consultations following group education. Individualized education may contribute to early intervention for work-related mental disorders.

Gender, Depression, and Blue-collar Work: A Retrospective Cohort Study of US Aluminum Manufacturers

BACKGROUND

Industrial blue-collar workers face multiple work-related stressors, but evidence regarding the burden of mental illness among today's blue-collar men and women remains limited.

METHODS

In this retrospective cohort study, we examined health and employment records for 37,183 blue- and white-collar workers employed by a single US aluminum manufacturer from 2003 to 2013. Using Cox proportional hazards regression, we modeled time to first episode of treated depression by gender and occupational class. Among cases, we modeled rates of depression-related service utilization with generalized gamma regression.

RESULTS

Compared with their white-collar counterparts, blue-collar men were more likely to be treated for depression (hazard ratio [HR] = 1.3; 95% confidence interval [CI] = 1.1, 1.4) as were blue-collar women (HR = 1.4; 1.2, 1.6). Blue-collar women were most likely to be treated for depression as compared with white-collar men (HR = 3.2; 95% CI = 2.1, 5.0). However, blue-collar workers used depression-related services less frequently than their white-collar counterparts among both men (rate ratio = 0.91; 95% CI = 0.84, 0.98) and women (rate ratio = 0.82; 95% CI = 0.77, 0.88).

CONCLUSIONS

Blue-collar women were more likely to be treated for depression than white-collar workers, and blue-collar women were most likely to be treated for depression compared with white-collar men. However, blue-collar men and women used depression-related healthcare services less frequently than white-collar workers. These findings underscore that blue-collar women may be uniquely susceptible to depression, and suggest that blue-collar workers may encounter barriers to care-seeking related mental illness other than their insurance status.

Human resource management training of supervisors for improving health and well-being of employees

BACKGROUND

Many workers suffer from work-related stress and are at increased risk of work-related cardiovascular, musculoskeletal, or mental disorders. In the European Union the prevalence of work-related stress was estimated at about 22%. There is consensus that stress, absenteeism, and well-being of employees can be influenced by leadership behaviour. Existing reviews predominantly included cross-sectional and non-experimental studies, which have limited informative value in deducing causal relationships between leadership interventions and health outcomes.

OBJECTIVES

To assess the effect of four types of human resource management (HRM) training for supervisors on employees' psychomental stress, absenteeism, and well-being. We included training aimed at improving supervisor-employee interaction, either off-the-job or on-the-job training, and training aimed at improving supervisors' capability of designing the work environment, either off-the-job or on-the-job training.

SEARCH METHODS

In May 2019 we searched CENTRAL, MEDLINE, four other databases, and most relevant trials registers (ICTRP, TroPHI, ClinicalTrials.gov). We did not impose any language restrictions on the searches.

SELECTION CRITERIA

We included randomised controlled trials (RCT), cluster-randomised controlled trials (cRCT), and controlled before-after studies (CBA) with at least two intervention and control sites, which examined the effects of supervisor training on psychomental stress, absenteeism, and well-being of employees within natural settings of organisations by means of validated measures.

DATA COLLECTION AND ANALYSIS

At least two authors independently screened abstracts and full texts, extracted data and assessed the risk of bias of included studies. We analysed study data from intervention and control groups with respect to different comparisons, outcomes, follow-up time, study designs, and intervention types. We pooled study results by use of standardised mean differences (SMD) with 95% confidence intervals when possible. We assessed the quality of evidence for each outcome using the GRADE approach.

MAIN RESULTS

We included 25 studies of which 4 are awaiting assessment. The 21 studies that could be analysed were 1 RCT, 14 cRCTs and 6 CBAs with a total of at least 3479 employees in intervention and control groups. We judged 12 studies to have an unclear risk of bias and the remaining nine studies to have a high risk of bias. Sixteen studies focused on improving supervisor-employee interaction, whereas five studies aimed at improving the design of working environments by means of supervisor training.Training versus no interventionWe found very low-quality evidence that supervisor training does not reduce employees' stress levels (6 studies) or absenteeism (1 study) when compared to no intervention, regardless of intervention type or follow-up. We found inconsistent, very low-quality evidence that supervisor training aimed at employee interaction may (2 studies) or may not (7 studies) improve employees' well-being when compared to no intervention. Effects from two studies were not estimable due to missing data.Training versus placeboWe found moderate-quality evidence (2 studies) that supervisor training off the job aimed at employee interaction does not reduce employees' stress levels more than a placebo training at mid-term follow-up. We found low-quality evidence in one study that supervisor training on the job aimed at employee interaction does not reduce employees' absenteeism more than placebo training at long-term follow-up. Effects from one study were not estimable due to insufficient data.Training versus other trainingOne study compared the effects of supervisor training off the job aimed at employee interaction on employees' stress levels to training off the job aimed at working conditions at long-term follow-up but due to insufficient data, effects were not estimable.

AUTHORS' CONCLUSIONS

Based on a small and heterogeneous sample of controlled intervention studies and in contrast to prevailing consensus that supervisor behaviour influences employees' health and well-being, we found inconsistent evidence that supervisor training may or may not improve employees' well-being when compared to no intervention. For all other types of interventions and outcomes, there was no evidence of a considerable effect. However, due to the very low- to moderate-quality of the evidence base, clear conclusions are currently unwarranted. Well-designed studies are needed to clarify effects of supervisor training on employees' stress, absenteeism, and well-being.

Validation of the Job Content Questionnaire among hospital nurses in Vietnam

Objectives

The aim of this study was to examine the reliability and validity of the Job Content Questionnaire (JCQ) in Vietnamese among hospital nursing staff.

Methods

The 22‐items version of the JCQ was used. This includes four scales: (a) psychological demands (5 items); (b) job control (9 items); (c) supervisor support (4 items); and (d) coworker support (4 items). All 1258 nurses in a general hospital in Vietnam, excluding 11 who were due to retire, were invited to complete the cross‐sectional survey. The internal consistency reliability was estimated using Cronbach's α. Construct validity was examined using exploratory factor analysis (EFA). Convergent validity was evaluated by calculating correlations between the JCQ scores and DASS 21 and overtime work.

Results

In total, 949 (75%) of the 1258 eligible nurses completed the survey. Cronbach's α values demonstrated acceptable internal consistency in two scales (supervisor support α = .87; coworker support α = .86), while Cronbach's α was below the acceptable threshold of 0.70 for job control (α = .45) and job demand (α = .50). EFA assuming a four‐factor structure showed a factor structure that was almost identical to the original JCQ, with two items loading on other scales. The subscales of depression, anxiety, and stress response of DASS 21 and the subscales of JCQ were significantly correlated, as expected.

Conclusion

The results suggest that the JCQ in Vietnamese can be used with some reliability and validity for examining psychosocial work environment among nurses. Further studies should be done to confirm and expand our findings in a variety of occupational groups and in other Asian low‐ and middle‐income countries.

Employees' and line managers' active involvement in participatory organizational interventions: Examining direct, reversed, and reciprocal effects on well-being

This study examined how employee participation and perceptions of line managers' support during a participatory organizational intervention were related to well-being over time. Although previous studies suggest that employees' and managers' active involvement in participatory organizational interventions may be related to well-being, little is known about the temporal aspects, such as at which time during the intervention these factors matter, or possible reciprocal effects. Building on conservation of resources theory, we tested hypotheses concerning direct, reversed, and reciprocal relationships between employee participation and perceptions of line manager support in relation to well-being. We used a four-wave panel design consisting of 159 hospital workers. Cross-lagged analyses showed that perceived line managers' support in the initiation and active phase was related to participation in the active phase. Participation in the initiation and active phase was related to well-being in the active and sustained phase, respectively. Results also revealed that participation in the initiation phase was related to perceived line managers' support in the active phase, which in turn predicted participation in the active phase, which translated into job satisfaction in the sustained phase supporting reversed and reciprocal effects in the form of resource caravans. Theoretical implications for research and practice are discussed.

Psychosocial Stressors at Work and Ambulatory Blood Pressure

PURPOSE OF REVIEW

Psychosocial stressors at work from the demand-latitude and effort-reward imbalance models are adverse exposures affecting about 20-25% of workers in industrialized countries. This review aims to summarize evidence on the effect of these stressors on blood pressure (BP).

RECENT FINDINGS

Three systematic reviews have recently documented the effect of these psychosocial stressors at work on BP. Among exposed workers, statistically significant BP increases ranging from 1.5 to 11 mmHg have been observed in prospective studies using ambulatory BP (ABP). Recent studies using ABP have shown a deleterious effect of these psychosocial stressors at work on masked hypertension as well as on blood pressure control in pharmacologically treated patients. Evidence on the effect of these psychosocial stressors on BP supports the relevance to tackle these upstream factors for primary prevention and to reduce the burden of poor BP control. There is a need for increased public health and clinical awareness of the occupational etiology of high BP, hypertension, and poor BP control.

Evaluation of health education interventions on Chinese factory workers' knowledge, practices, and behaviors related to infectious disease

BACKGROUND

Workplaces are a common location for infectious disease transmission among adults. To provide recommendations regarding appropriate health promotion programs, we evaluated the impact of three different interventions on factory workers.

METHODS

In a prospective intervention study carried out from October 2012 to June 2013, three factories were selected and each was assigned a different intervention method (i.e. self-study group, manager training group and interactional group discussion group). Participants were scored on their knowledge, behavior, and hygienic practices related to infectious disease prevention both before and after the intervention.

RESULTS

A total of 1154 participants completed the survey before the intervention and 1111 completed the survey after. The sum infectious disease knowledge score in the manager training group was higher after the intervention (9.09/12) than before (8.63/12, t=4.47, p<0.05). There was no significant difference in sum infectious disease knowledge score pre and post intervention for both the self-study group and the interactional group discussion.

CONCLUSIONS

Overall, change in health behaviors and hygiene practices were not as affected compared to changes in knowledge after interventions related to infectious disease health promotion. Training managers who then interact with workers may be an effective and efficient way of educating workers on health issues.

Improvement of the Work Environment and Work-Related Stress: A Cross-Sectional Multilevel Study of a Nationally Representative Sample of Japanese Workers

OBJECTIVE

This cross-sectional multilevel study aimed to investigate the relationship between improvement of the work environment and work-related stress in a nationally representative sample in Japan.

METHODS

The study was based on a national survey that randomly sampled 1745 worksites and 17,500 nested employees. The survey asked the worksites whether improvements of the work environment were conducted; and it asked the employees to report the number of work-related stresses they experienced. Multilevel multinominal logistic and linear regression analyses were conducted.

RESULTS

Improvement of the work environment was not significantly associated with any level of work-related stress. Among men, it was significantly and negatively associated with the severe level of work-related stress. The association was not significant among women.

CONCLUSIONS

Improvements to work environments may be associated with reduced work-related stress among men nationwide in Japan.

Process Evaluation in Occupational Stress Management Programs: A Systematic Review

Objective.

To conduct a systematic review of workplace stress management intervention studies that have incorporated process evaluation.

Data Source.

Electronic databases such as PsycINFO and MEDline were searched.

Study Inclusion Criteria.

The inclusion criteria included interventions published in the English language that were focused on either individual- or organizational-level stress management interventions at the workplace, with an outcome evaluation.

Data Extraction.

Each article was coded on key process-relevant variables, including context, recruitment, reach, dose delivered, dose received, fidelity, implementation, and participant's attitudes toward the intervention. Studies that reported on at least one of these process variables were also coded on the following study characteristics: Participants, setting, evaluation design, intervention content, intervention format, and study outcomes.

Data Synthesis.

Statistical Package for the Social Science was used to analyze the data with descriptive statistics.

Results.

Of the 84 studies identified that met the study inclusion criteria, 52 (61.9%) reported findings on at least one of the key relevant process-relevant variables. Variables most frequently included were recruitment (30%), intervention dose received (22%), participants' attitudes toward intervention (19%), and program reach (13%). Fewer than half of the studies presented any findings linking process evaluation and outcome evaluation.

Conclusions.

The incomplete reporting of information relevant to process evaluation makes it difficult to identify reliable determinants of effective intervention implementation or outcomes.

Effect of Workplace Counseling Interventions Launched by Workplace Health Promotion and Tobacco Control Centers in Taiwan: An Evaluation Based on the Ottawa Charter

Workplace health promotion (WHP) is important to prevent work-related diseases, reduce workplace hazards, and improve personal health of the workers. Health promotion projects were launched through the centers of WHP funded by the Taiwan Bureau of Health Promotion since 2003. Hence, the aim of this study is to evaluate the impact of WHP programs intervention from 2003 to 2007. The intervention group consisted of 838 business entities which had ever undergone counseling of the three centers in northern, central, and southern Taiwan from 2003 to 2007. The control group was composed of 1000 business entities randomly selected from the business directories of the Ministry of Economic Affairs, Taiwan. The questionnaire survey included general company profiles and the assessment of workplace health according to the five action areas of the Ottawa Charter for Health Promotion. We have received 447 (53.3%) questionnaires from the intervention group and 97 questionnaires from the control group. The intervention group was more effective in using the external resources and medical consultation, and they had better follow-up rates of the abnormal results of annual health examinations. Compared to the control group, the intervention group had a significantly decreased smoking rate in 246 companies (61.2%) and a reduced second-hand smoke exposure in 323 companies (78.6%) (p<0.001). By means of the intervention of WHP programs, we can enhance the awareness of the enterprises and the employees to improve worksite health and to create a healthy work environment.

Considering the Differential Impact of Three Facets of Organizational Health Climate on Employees' Well-Being

One potential way that healthy organizations can impact employee health is by promoting a climate for health within the organization. Using a definition of health climate that includes support for health from multiple levels within the organization, this study examines whether all three facets of health climate--the workgroup, supervisor, and organization--work together to contribute to employee well-being. Two samples are used in this study to examine health climate at the individual level and group level in order to provide a clearer picture of the impact of the three health climate facets. k-means cluster analysis was used on each sample to determine groups of individuals based on their levels of the three health climate facets. A discriminant function analysis was then run on each sample to determine if clusters differed on a function of employee well-being variables. Results provide evidence that having strength in all three of the facets is the most beneficial in terms of employee well-being at work. Findings from this study suggest that organizations must consider how health is treated within workgroups, how supervisors support employee health, and what the organization does to support employee health when promoting employee health.

Source-specific social support and circulating inflammatory markers among white-collar employees

BACKGROUND

Despite known beneficial effects of social support on cardiovascular health, the pathway through which sources of support (supervisor, coworkers, family/friends) influence inflammatory markers is not completely understood.

PURPOSE

We investigated the independent and moderating associations between social support and inflammatory markers.

METHODS

A total of 137 male white-collar employees underwent a blood draw for measurement of high-sensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), monocyte and leukocyte counts, and completed a questionnaire on social support.

RESULTS

Multivariable linear regression analyses controlling for covariates revealed that supervisor support was inversely associated with IL-6 (β = -0.24, p < 0.01) while coworker support was marginally associated with TNF-α (β = -0.16, p < 0.10). Support from family/friends was not associated with inflammatory markers.

CONCLUSION

Social support from the immediate supervisor may be a potential mechanism through which social support exerts beneficial effects on inflammatory markers in working men.

[Interpersonal psychotherapy for work-related stress depressive disorders]

In general work involves health promoting functions but can also have hazardous impacts on well-being. Due to a massive change in working conditions it has become increasingly more recognized that depressive disorders are highly prevalent at the workplace and that work stress belongs to the most common triggers of depressive disorders, particularly in men. It is relevant to differentiate between subjectively experienced burnout and clinical depression. The best investigated psychosocial work stressors include increased job demands in connection with low control possibilities and lack of gratification, interpersonal conflicts, role stress and social isolation. For the treatment of work-related clinical depression, an additional focus of interpersonal psychotherapy (IPT) of depression, namely "work-related stress and burnout experience" was conceptualized based on a vulnerability-stress model and the fact that work usually takes place in an interpersonal context. This new problem area focuses on role stress and conflicts at work and the reduction of stressful working conditions. Interpersonal psychotherapy has so far been useful for the treatment of depression due to problems at work; however, further studies are needed to evaluate the efficacy of this newly designed problem area.

Effects of organisational-level interventions at work on employees' health: a systematic review

Background

Organisational-level workplace interventions are thought to produce more sustainable effects on the health of employees than interventions targeting individual behaviours. However, scientific evidence from intervention studies does not fully support this notion. It is therefore important to explore conditions of positive health effects by systematically reviewing available studies. We set out to evaluate the effectiveness of 39 health-related intervention studies targeting a variety of working conditions.

Methods

Systematic review. Organisational-level workplace interventions aiming at improving employees’ health were identified in electronic databases and manual searches. The appraisal of studies was adapted from the Cochrane Back Review Group guidelines. To improve comparability of the widely varying studies we classified the interventions according to the main approaches towards modifying working conditions. Based on this classification we applied a logistic regression model to estimate significant intervention effects.

Results

39 intervention studies published between 1993 and 2012 were included. In terms of methodology the majority of interventions were of medium quality, and four studies only had a high level of evidence. About half of the studies (19) reported significant effects. There was a marginally significant probability of reporting effects among interventions targeting several organisational-level modifications simultaneously (Odds ratio (OR) 2.71; 95% CI 0.94-11.12), compared to those targeting one dimension only.

Conclusions

Despite the heterogeneity of the 39 organisational-level workplace interventions underlying this review, we were able to compare their effects by applying broad classification categories. Success rates were higher among more comprehensive interventions tackling material, organisational and work-time related conditions simultaneously. To increase the number of successful organisational-level interventions in the future, commonly reported obstacles against the implementation process should be addressed in developing these studies.

Effects of a multidisciplinary stress treatment programme on patient return to work rate and symptom reduction: results from a randomised, wait-list controlled trial

BACKGROUND

To evaluate the efficacy of a multidisciplinary stress treatment programme.

METHODS

General practitioners referred 198 employed patients on sick leave with symptoms of persistent work-related stress. Using a waitlisted randomised controlled trial design, the participants were randomly divided into the following three groups: the intervention group (IG, 69 participants); treatment-as-usual control group (TAUCG, 71 participants), which received 12 consultations with a psychologist, and the waitlisted control group (WLCG, 58 participants). The stress treatment intervention consisted of nine 1-hour sessions conducted over 3 months. The goals of the sessions were the following: (1) identifying relevant stressors; (2) changing the participant's coping strategies; (3) adjusting the participant's workload and tasks, and (4) improving workplace dialogue. Each participant also attended a mindfulness-based stress reduction (MBSR) course for 2 h a week over 8 weeks.

RESULTS

The IG and TAUCG showed significantly greater symptom level (Symptom Check List 92) reductions compared to the WLCG. Regarding the return to work (RTW) rate, 67% of participants in the IG returned to full-time work after treatment, which was a significantly higher rate than in the TAUCG (36%) and WLCG (24%). Significantly more participants in the IG (97%) increased their working hours during treatment compared with the participants in the control groups, TAUCG (71%) and WLCG (64%).

CONCLUSIONS

The stress treatment programme--a combination of work place-focused psychotherapy and MBSR--significantly reduced stress symptom levels and increased RTW rates compared with the WLCG and TAUCG.

Increasing equity of access to high-quality mental health services in primary care: a mixed-methods study

Background

Evidence-based interventions exist for common mental health problems. However, many people are unable to access effective care because it is not available to them or because interactions with caregivers do not address their needs. Current policy initiatives focus on supply-side factors, with less consideration of demand.

Aim and objectives

Our aim was to increase equity of access to high-quality primary mental health care for underserved groups. Our objectives were to clarify the mental health needs of people from underserved groups; identify relevant evidence-based services and barriers to, and facilitators of, access to such services; develop and evaluate interventions that are acceptable to underserved groups; establish effective dissemination strategies; and begin to integrate effective and acceptable interventions into primary care.

Methods and results

Examination of evidence from seven sources brought forward a better understanding of dimensions of access, including how people from underserved groups formulate (mental) health problems and the factors limiting access to existing psychosocial interventions. This informed a multifaceted model with three elements to improve access: community engagement, primary care quality and tailored psychosocial interventions. Using a quasi-experimental design with a no-intervention comparator for each element, we tested the model in four disadvantaged localities, focusing on older people and minority ethnic populations. Community engagement involved information gathering, community champions and focus groups, and a community working group. There was strong engagement with third-sector organisations and variable engagement with health practitioners and commissioners. Outputs included innovative ways to improve health literacy. With regard to primary care, we offered an interactive training package to 8 of 16 practices, including knowledge transfer, systems review and active linking, and seven agreed to participate. Ethnographic observation identified complexity in the role of receptionists in negotiating access. Engagement was facilitated by prior knowledge, the presence of a practice champion and a sense of coproduction of the training. We developed a culturally sensitive well-being intervention with individual, group and signposting elements and tested its feasibility and acceptability for ethnic minority and older people in an exploratory randomised trial. We recruited 57 patients (57% of target) with high levels of unmet need, mainly through general practitioners (GPs). Although recruitment was problematic, qualitative data suggested that patients found the content and delivery of the intervention acceptable. Quantitative analysis suggested that patients in groups receiving the well-being intervention improved compared with the group receiving usual care. The combined effects of the model included enhanced awareness of the psychosocial intervention among community organisations and increased referral by GPs. Primary care practitioners valued community information gathering and access to the Improving Access to Mental Health in Primary Care (AMP) psychosocial intervention. We consequently initiated educational, policy and service developments, including a dedicated website.

Conclusions

Further research is needed to test the generalisability of our model. Mental health expertise exists in communities but needs to be nurtured. Primary care is one point of access to high-quality mental health care. Psychosocial interventions can be adapted to meet the needs of underserved groups. A multilevel intervention to increase access to high-quality mental health care in primary care can be greater than the sum of its parts.

Study registration

Current Controlled Trials ISRCTN68572159.

Funding

The National Institute for Health Research Programme Grants for Applied Research programme.

Systematic review of intervention practices for depression in the workplace

DESIGN

Systematic Review.

OBJECTIVE

To determine which intervention approaches to manage depression in the workplace have been successful and yielded value for employers in developed economies.

DATA SOURCES

We searched MEDLINE, EMBASE, CINAHL, Central, PsycINFO, and Business Source Premier up to June 2010 using search terms in four broad areas: work setting, depression, intervention, and work outcomes.

STUDY SELECTION

Two independent reviewers selected potential articles that met the following criteria: working age individuals with mild or moderate depression; interventions or programs that were workplace-based or could be implemented and/or facilitated by the employer; inclusion of a comparator group in the analysis; outcomes of prevention, management, and recurrences of work disability or sickness absence, and work functioning.

METHODS

Two reviewers independently reviewed each article for quality and extracted data using standardised forms. Following guidelines from the GRADE Working Group, the quality of evidence addressing each outcome was graded as high, moderate, low, or very low on the basis of six criteria: study design, risk of bias, consistency, generalisability, data precision, and economic benefit. Using this information and following Cochrane Collaboration guidelines, the findings for each intervention were summarised and key messages were developed.

RESULTS

We identified ten randomised trials and two non-randomised studies from various countries and jurisdictions that evaluated a wide range of intervention practices. The evidence was graded as "very low" for all outcomes identified. Therefore, no intervention could be recommended.

CONCLUSIONS

To date, there is insufficient quality of evidence to determine which interventions are effective and yield value to manage depression in the workplace.

Association of childhood adversities with the first onset of mental disorders in Japan: results from the World Mental Health Japan, 2002-2004

It is well known that childhood adversities (CAs) are a significant risk factor for mental disorders in later life. However, it is uncertain whether a similar association between CAs and mental disorders can be found in Japan. Few studies have employed an appropriate statistical model that takes into account the high comorbidity of CAs. The purpose of this study is to elucidate the association between CAs and the onset of mental disorders in Japan. We used the data from the World Mental Health Japan, 2002-2004 (n=1722). Respondents completed diagnostic interviews (the World Health Organization Composite International Diagnostic Interview) that assessed lifetime prevalence of 15 Diagnostic and Statistical Manual of Mental Disorders--Fourth Edition (DSM-IV) disorders. Associations of 12 retrospectively reported CAs with the lifetime prevalence of mental disorders were estimated using discrete-time survival analysis. Of the study sample, 32% reported as having experienced at least 1 CA during childhood. The studied CAs were highly comorbid. Parental mental illness showed significant sub-additive effects. The presence of 3 CAs showed a significant interactive effect on any mental health disorder. The number of CAs had a strong interactive effect on the onset of anxiety disorders. Predictive effects of CAs were found only among childhood onset mental disorders. It was confirmed that CAs are one of predictors of the onset of DSM-IV mental disorders, especially during childhood, in Japan.

Sick leave and depression - determining factors and clinical effect in outpatient care

Sickness leave is a major source of societal costs in depression treatment. However, very little is known about the rationale behind sick leave and their effects on depressive symptoms. Aim of the paper is to evaluate the effect of sick leave on treatment outcome and the association of sick leave with patient, depression and treatment-related factors. For this we compared patients with sick leave and non-sick leave regarding symptom reduction following 6 weeks of treatment. A total of 118 patients of 41 physicians in a controlled clinical trial with a naturalistic prospective design were analysed. After 8 weeks of treatment no significant differences were found between patients who had or did not have sick leave, in terms of improvement of depressive symptoms. The analyses of physician, patient and illness-related variables regarding their predictive value showed no significant effect. No systematic effect of sick leave and no clear criteria were found that were related to receiving a sick leave certificate. It can be assumed that physicians do not only base the decision of whether to sign a depressive patient off sick on illness-specific factors. For a targeted implementation of sick leave as therapeutic measure predictors for effectiveness should be defined.

The effect on length of sickness absence by recognition of undetected psychiatric disorder in long-term sickness absence. A randomized controlled trial

BACKGROUND

The burden caused by psychiatric disorders on the individual and society has resulted in more studies examining interventions aimed at reducing sickness absence.

AIMS

To examine if detection of undetected psychiatric disorders in long-term sickness absence (LSA) would improve the rate of return to work.

METHODS

Over one year all 2,414 incident persons on LSA in a well-defined population were within one week after eight weeks of continuous sickness absence posted the Common Mental Disorders Screening Questionnaire (CMD-SQ) to screen for mental disorders. In a randomized controlled trial (RCT), of 1,121 responding participants, persons with a minimum level of psychiatric symptoms 420 were allocated to the intervention group and 416 to the control group. The intervention was a psychiatric examination including diagnostics with Present State Examination and feedback regarding treatment and rehabilitation to the participants themselves, general practitioners and the social service taking care of the participants' rehabilitation back to work. Of the 420 in the intervention group 329 (78.3%) participated in the intervention. The outcomes measure was in an intention treat analysis the rate of return to work.

RESULTS

The rate of return to work was non-significantly lower for the intervention group than for the control group, except for persons without a psychiatric sick-leave diagnosis who were sick-listed from full time work, who showed a significantly higher rate of return to work in the intervention group.

CONCLUSIONS

The effect of interventions for return to work depends on socio-demographic characteristics. Further studies are needed regarding interventions to improve return to work.

Job strain exposures vs. stress-related workers' compensation claims in Victoria, Australia: developing a public health response to job stress

We present a comparative analysis of patterns of exposure to job stressors and stress-related workers' compensation (WC) claims to provide an evaluation of the adequacy of claims-driven policy and practice. We assessed job strain prevalence in a 2003 population-based survey of Victorian [Australia] workers and compared these results with stress-related WC statistics for the same year. Job strain prevalence was higher among females than males, and elevated among lower vs. higher occupational skill levels. In comparison, claims were higher among females than males, but primarily among higher skill-level workers. There was some congruence between exposure and WC claims patterns. Highly exposed groups in lower socio-economic positions were underrepresented in claims statistics, suggesting that the WC insurance perspective substantially underestimates the job stress problems for these groups. Thus to provide a sufficient evidence base for equitable policy and practice responses to this growing public health problem, exposure or health outcome data are needed as an essential complement to claims statistics.

Psychometric properties of the Thai version of the 22-item and 45-item Karasek job content questionnaire

OBJECTIVES

To evaluate the validity and reliability of the Thai version of the job content questionnaire (TJCQ) both 22-item and 45-item versions.

MATERIALS AND METHODS

The study encompassed 10,450 employees in Songkhla province, Thailand. A 45-item job content questionnaire (JCQ) was translated and back translated complying with the JCQ usage policy. TJCQ covers seven scales as follows: psychological demand, decision latitude, supervisor support, coworker support, physical demand, job security and hazard at work. Internal consistency was examined using Cronbach's alpha coefficient. Factor validation was tested using both exploratory and confirmatory factor analysis.

RESULTS

Both 22-item and 45-item versions of TJCQ demonstrated acceptable internal consistency in nearly all scales except for psychological demand. The exploratory and confirmatory factor analysis result gave support to 5-factor model in 22-item version and 8-factor model in 45-item version of TJCQ. The psychological demand scale tended to split into two subscales. Other scales were consistent with the expected dimensions though some items extracted differently along the theoretical dimensions.

CONCLUSIONS

Our study provided evidence for the reliability and validity of the TJCQ among Thai employees and supported the ongoing debate on multifaceted psychological demand and its complexity, making it feasible to extend the TJCQ beyond its original structure.

Working for health? Evidence from systematic reviews on the effects on health and health inequalities of organisational changes to the psychosocial work environment

OBJECTIVE

To map the health effects of interventions which aim to alter the psychosocial work environment, with a particular focus on differential impacts by socio-economic status, gender, ethnicity, or age.

METHODS

A systematic approach was used to identify, appraise and summarise existing systematic reviews (umbrella review) that examined the health effects of changes to the psychosocial work environment. Electronic databases, websites, and bibliographies, were searched from 2000-2007. Experts were also contacted. Identified reviews were critically appraised and the results summarised taking into account methodological quality. The review was conducted in the UK between October 2006 and December 2007.

RESULTS

Seven systematic reviews were identified. Changes to the psychosocial work environment were found to have important and generally beneficial effects on health. Importantly, five reviews suggested that organisational level psychosocial workplace interventions may have the potential to reduce health inequalities amongst employees.

CONCLUSION

Policy makers should consider organisational level changes to the psychosocial work environment when seeking to improve the health of the working age population.

Effects of a worker participatory program for improving work environments on job stressors and mental health among workers: a controlled trial

The Mental Health Action Checklist for a Better Workplace Environment (MHACL) is a tool for a worker participatory approach to improve work environments for worker mental health. The present study investigated the effects of an organizational intervention using the MHACL on reducing job stressors and the psychological distress of workers of a manufacturing enterprise in Japan with a controlled study design. Nine of 45 departments participated in a work environment improvement program, including planning workshops, implementation and monitoring, between July and December 2005 (intervention group, n=321). The remaining 36 departments served as the control group (n=750). Outcomes (job stressors, worksite support, psychological distress, etc.), measured using the Brief Job Stress Questionnaire, as well as sick leave days taken from the company record, were recorded before and six months after the program for both groups. Among women, skill underutilization, supervisor and coworker support, psychological distress, and job satisfaction changed more favorably in the intervention group than in the control group (p<0.05). No significant favorable effect of the program was observed among men. Improvements in the outcomes were more prominent among departments with a 50% or higher rate of worker participation in the planning workshops and among departments with a 50% or higher rate of implemented vs. planned actions. A worker participatory organizational intervention using the MHACL seems effective for promoting mental health among Japanese white-collar women.

The psychosocial and health effects of workplace reorganisation. 2. A systematic review of task restructuring interventions

OBJECTIVE

To systematically review the health and psychosocial effects (with reference to the demand-control-support model) of changes to the work environment brought about by task structure work reorganisation, and to determine whether those effects differ for different socioeconomic groups.

DESIGN

Systematic review (QUORUM) of experimental and quasi-experimental studies (any language) reporting health and psychosocial effects of such interventions.

DATA SOURCES

Seventeen electronic databases (medical, social science and economic), bibliographies and expert contacts.

RESULTS

Nineteen studies were reviewed. Some task-restructuring interventions failed to alter the psychosocial work environment significantly, and so could not be expected to have a measurable effect on health. Those that increased demand and decreased control tended to have an adverse effect on health, while those that decreased demand and increased control resulted in improved health, although some effects were minimal. Increases in workplace support did not appear to mediate this relationship.

CONCLUSION

This systematic review suggests that task-restructuring interventions that increase demand or decrease control adversely affect the health of employees, in line with observational research. It lends support to policy initiatives such as the recently enforced EU directive on participation at work, which aims to increase job control and autonomy.

A systematic review of the job-stress intervention evaluation literature, 1990-2005

Ninety reports of systematic evaluations of job-stress interventions were rated in terms of the degree of systems approach used. A high rating was defined as both organizationally and individually focused, versus moderate (organizational only), and low (individual only). Studies using high-rated approaches represent a growing proportion of the job-stress intervention evaluation literature. Individual-focused, low-rated approaches are effective at the individual level, favorably affecting individual-level outcomes, but tend not to have favorable impacts at the organizational level. Organizationally-focused high- and moderate-rated approaches are beneficial at both individual and organizational levels. Further measures are needed to foster the dissemination and implementation of systems approaches to examining interventions for job stress.

The psychosocial and health effects of workplace reorganisation. 1. A systematic review of organisational-level interventions that aim to increase employee control

OBJECTIVE

Systematic review of the health and psychosocial effects of increasing employee participation and control through workplace reorganisation, with reference to the "demand-control-support" model of workplace health.

DESIGN

Systematic review (QUORUM) of experimental and quasi-experimental studies (any language) reporting health and psychosocial effects of such interventions.

DATA SOURCES

Electronic databases (medical, social science and economic), bibliographies and expert contacts.

RESULTS

We identified 18 studies, 12 with control/comparison groups (no randomised controlled trials). Eight controlled and three uncontrolled studies found some evidence of health benefits (especially beneficial effects on mental health, including reduction in anxiety and depression) when employee control improved or (less consistently) demands decreased or support increased. Some effects may have been short term or influenced by concurrent interventions. Two studies of participatory interventions occurring alongside redundancies reported worsening employee health.

CONCLUSIONS

This systematic review identified evidence suggesting that some organisational-level participation interventions may benefit employee health, as predicted by the demand-control-support model, but may not protect employees from generally poor working conditions. More investigation of the relative impacts of different interventions, implementation and the distribution of effects across the socioeconomic spectrum is required.

Effects of an Education Program for Stress Reduction on Supervisor Knowledge, Attitudes, and Behavior in the Workplace: A Randomized Controlled Trial

Supervisors at work play a large role in stress management at the workplace. Providing supervisors with necessary information and useful skills might be one effective approach that will lead to stress reduction. However, very few studies have investigated the effect of supervisor education by using a rigorous study design. In a randomized controlled trial, we tried to clarify how an education program for stress reduction influences supervisor knowledge, attitudes, and behavior concerning stress management. The subjects were 46 supervisors of an old, established sake brewery manufacturer of 301 employees. The supervisors were assigned to either the intervention group (24 supervisors) or the control group (22 supervisors). We conducted a single-session education program that included the guidelines for worker mental health promotion to the intervention group. The education program was composed of a basic education lecture and active listening training. The effects of this program on supervisor knowledge, attitudes, and behavior were measured using an original, self-administered questionnaire. The intervention effect was tested by examining an interaction effect between groups and time (before education, three and six months after education). The education favorably affected supervisor knowledge (F=7.92; p=.001). As for behavior, the intervention effect was marginally statistically significant (F=2.51; p=.088). For the attitude score, however, there were no beneficial effects. In conclusion, the provision of necessary information and useful skills to supervisors seems to improve supervisor knowledge and behavior regarding stress management at the workplace for at least six months.

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

An action checklist for improving the workplace environment by means of enhancing mental health of workers (Mental Health Action Check List: MHACL) was developed. The use of the checklist for primary prevention was examined. MHACL was developed through three steps: (1) Review of related references and collection of improvement examples for designing a draft MHACL; (2) pilot application of the draft at industrial workplaces and trials at workshops of occupational health staff; and (3) proposing a new MHACL for general use in industry. Workplace improvement actions related to mental health were listed in eight technical areas. From 84 workplaces in Japan, 201 such actions were collected. Typical improvement action phrases were extracted based on these examples, and a draft MHACL containing 40 generally applicable actions were prepared. This draft was applied to selected workplaces for its use as a tool for group discussion. Then, the utility of the checklist was discussed by 105 occupational health staff working in public service offices. The workshop suggested modifications of the draft MHACL including improved check items and usage procedures and the need to use easy-to-understand actions. The final version of the MHACL comprised 30 items in six technical areas: A) sharing work planning, B) work time and organization, C) ergonomic work methods, D) workplace environment, E) mutual support in the workplace, and F) preparedness and care. A new action checklist was proposed for use as a means of changing existing workplace environments and proposing practical actions for improving it. The checklist was confirmed to be useful for organizing workplace-level discussion for identifying immediate improvements at the workplace. The checklist is expected to be widely applied for promoting primary prevention measures in terms of better mental health.

Can sickness absence be reduced by stress reduction programs: on the effectiveness of two approaches

OBJECTIVES

The aim of the study was to evaluate the effectiveness of two brief preventive stress reduction programs--a cognitive focused program and a combined intervention of physical exercise and relaxation--on sickness absence in stressed and non-stressed employees working in various jobs in a telecom company.

METHODS

The study was designed as an a priori randomized trial and the follow-up period for sickness absence was 1 year. Sickness absence data of 242 employees were analyzed with respect to spells of sickness (frequency, incidence rate), days (length, duration) and time between intervention and first subsequent absent spell.

RESULTS

For stressed employees this study suggests that the illness burden represented by absenteeism is not affected by the interventions. There is no substantial difference in effectiveness between the cognitive and physical interventions. However, in comparison with the physical intervention the cognitive intervention decreases the period between the intervention and the first recurrence of a sick leave period with 144 days (marginal significant).

CONCLUSION

The illness burden represented by absenteeism is effected in detail but not substantially by the interventions.

Stressbezogene Interventionen in der Arbeitswelt

Zusammenfassung. Stress- und gesundheitsbezogene Interventionen sind in den letzten Jahren in vielen Bereichen der Arbeitswelt zur Selbstverständlichkeit geworden. Konzepte, Analyse- und Interventionsmethoden wurden entwickelt, Erfahrungsberichte und Evaluationsstudien wurden publiziert. Besonders zu Stressmanagementinterventionen wurden viele Untersuchungen veröffentlicht. Metaanalysen zeigen, dass Stressmanagementtrainings generell wirksam sind; variablen- und zeitspezifische Effekte liegen vor. Zu bedingungsbezogenen Interventionen finden sich vergleichsweise wenig qualitativ gute Evaluationsstudien. Die Ergebnisse zur Wirksamkeit dieser Interventionen sind heterogen. Untersuchungsergebnisse lassen erwarten, dass Effekte von bedingungsbezogenen Maßnahmen davon abhängig sind, inwieweit die Beteiligten involviert sind und/oder inwieweit gesundheitsbezogene Interventionen als solche wahrgenommen werden.

Effects of web-based supervisor training on job stressors and psychological distress among workers: a workplace-based randomized controlled trial

Using workplaces as a unit for randomization, a randomized controlled trial was conducted to determine the effects of web-based supervisor training on the subject of worksite mental health on job stressors, supervisor support and psychological distress among subordinate workers. A total of eight workplaces of a sales and service company were randomly assigned to either training workplaces or non-training workplaces. Supervisors (n=23) at the training workplaces participated in web-based self-learning training on worksite mental health; supervisors (n=23) at the non-training workplaces did not. A total of 81 subordinate workers under the trained supervisors (the intervention group) and 108 subordinate workers under the non-trained supervisors (the control group) completed the Brief Job Stress Questionnaire (BJSQ) at baseline and at a three-month follow-up. No significant intervention effect was observed for any scale of the BJSQ measuring job stressors, supervisor or coworker support, or psychological distress among subordinate workers (p<0.05). The item score of work autonomy changed very little in the intervention group, while it decreased in the control group during the follow-up period, yielding a significant intervention effect (p=0.02). The item score for a friendly atmosphere in the workplace increased in the intervention group, while the score remained stable in the control group, yielding a significant intervention effect (p=0.02). While the present study failed to show any clear effect of the web-based training of supervisors on reduction of job stressors, it may be useful for maintaining worker autonomy and improving the friendliness of the worksite atmosphere.

Effectiveness of a participative intervention on psychosocial work factors to prevent mental health problems in a hospital setting

OBJECTIVES

To assess the effectiveness of a workplace intervention aimed at reducing adverse psychosocial work factors (psychological demands, decision latitude, social support, and effort-reward imbalance) and mental health problems among care providers.

METHODS

A quasi-experimental design with a control group was used. Pre-intervention (71% response rate), and one-year post-intervention measures (69% response rate) were collected by telephone interviews.

RESULTS

One year after the intervention, there was a reduction of several adverse psychosocial factors in the experimental group, whereas no such reduction was found in the control group. However, there was a significant deterioration of decision latitude and social support from supervisors in both experimental and control groups. There was also a significant reduction in sleeping problems and work related burnout in the experimental hospital, whereas only sleeping problems decreased in the control group while both client related and personal burnout increased in this hospital. The comparison between the experimental and control groups, after adjusting for pre-intervention measures, showed a significant difference in the means of all psychosocial factors except decision latitude. All other factors were better in the experimental group.

CONCLUSION

Results suggest positive effects of the intervention, even though only 12 months have passed since the beginning of the intervention. Follow up at 36 months is necessary to evaluate whether observed effects are maintained over time. In light of these results, we believe that continuing the participative process in the experimental hospital will foster the achievement of a more important reduction of adverse psychosocial factors at work. It is expected that the intensity of the intervention will be directly related to its beneficial effects. Long term effects will however depend on the willingness of management and of staff to appropriate the process of identifying what contributes to adverse psychosocial factors at work and to adopt means to reduce them.

Job strain and sick leave among Japanese employees: a longitudinal study

OBJECTIVES

The present study is an investigation of the association between job stress, determined on the basis of a demand-control model or worksite social support at the baseline, and absence due to illness among employed Japanese males and females.

METHODS

We analyzed 448 male and 81 female subjects who had taken no sick leave in the year preceding the baseline (1997) and observed them all until 1999. A self-administered questionnaire was the source information collected. It consisted of questions on socio-demographic variables, occupations, health-related behavior, a Japanese version of the Job Content Questionnaire, and the number of absences in the year preceding both the baseline and follow-up. Logistic regression analyses were used to determine how the characteristics of a job at the baseline affected sickness absence of 5 days or longer per year; controls were established for the gender, age, level of education completed, occupation, number of cigarettes smoked daily, and the amount of alcohol consumed weekly.

RESULTS

Compared to the lowest tertile of the ratio of demand to control (job strain), the highest tertile was significantly associated with an increased risk of sickness absence of 5 days or longer per year (odds ratio 3.02; 95%CI 1.00-9.16) at follow-up. The dose-response relationship was supported (p for trend <0.05). However, individual variables of job demand, job control, and worksite social support were not significantly associated with the risk of absence from illness.

CONCLUSIONS

The study provided prospective evidence that job strain leads to an increased risk of sick leave among Japanese employees.

Effects of web-based supervisor training on supervisor support and psychological distress among workers: a randomized controlled trial

BACKGROUND

A randomized controlled trial was conducted to determine the effects of web-based supervisor training on worksite mental health on supervisor support and psychological distress among subordinate workers.

METHODS

Section chiefs in a computer engineering company were randomly assigned to either a training group (n = 9) or a non-training group (n = 7). The section chiefs in the training group participated in web-based self-learning training on worksite mental health. A total of 92 subordinate workers under the trained section chiefs (the intervention group) and 84 subordinate workers under the untrained section chiefs (the control group) completed a questionnaire at baseline and a 3-month follow-up.

RESULTS

The score of supervisor support greatly decreased in the control group during the follow-up period, and the score changed very little in the intervention group, with a significant intervention effect (P = 0.032). This pattern was more pronounced for one particular item dealing with the extent to which a supervisor listens to personal problems of subordinate workers (the intervention effect, P = 0.012). No intervention effect was observed for the score measuring co-worker support, psychological distress, or other job stressors among subordinate workers (P > 0.05).

CONCLUSIONS

It is suggested that the web-based training of supervisors on worksite mental health is useful in improving, or at least maintaining, supervisor support among subordinate workers.

Effects of a Supervisory Education for Positive Mental Health in the Workplace: A Quasi‐Experimental Study

Single-session supervisory education was developed in conjunction with the Japanese national guidelines for the promotion of employee mental health. Totally 267 voluntary supervisors in a prefectural office were presented with comprehensive information on the role they had to fulfill to promote mental health in the workplace. Totally 864 office employees (53%) were evaluated to determine whether education had had an effect on their psychological distress and job performance. The findings from the departments in which more than one-third of the supervisors had attended education were compared to those from the departments in which no more than one-third of the supervisors had attended education. Three months after the education, the levels of psychological distress and, to a lesser extent, self-reported job performance improved among employees in the departments in which at least one-third of the supervisors attended the education compared to those from departments with lower attendance rates of the supervisors. For the psychological outcome, the positive educational effect was supported by statistically significant interaction terms between time and department category with adjustment for the confounders. Favorable changes were noted among supervisors who received the education in knowledge, attitude, and behavior regarding mental health practices. The behavioral changes were related to decreasing workplace problems and referral of employees to the liaison office and associated medical institutions. Despite several limitations, the findings suggest that providing supervisors with appropriate information has a positive effect on employee psychological well-being.

Psychosocial factors at work and depression in three countries of Central and Eastern Europe

Psychosocial factors at work have been found to predict a range of health outcomes but their effect on mental health outcomes has not been extensively studied. This paper explores the relationship between psychosocial factors at work and depression in three countries of Central and Eastern Europe. The data come from a cross-sectional study of working men (n = 645) and women (n = 523) aged 45-64 years, randomly selected from population registers in Novosibirsk (Russia), Krakow (Poland) and Karvina-Havirov (Czech Republic). The questionnaire included questions on the effort and reward at work, job control, the full CES-D scale of depression, and a range of other characteristics. Linear regression was used to estimate the association between depression score and work characteristics: the logarithm of the effort-reward ratio, and continuous job control score. The means of the depression score were 10.5 for men and 14.2 for women. After controlling for age, sex and country, effort-reward ratio (logarithmically transformed) was strongly related to depression score; a 1 SD increase in the log transformed effort-reward ratio was associated with an increase in the depression of 2.0 points (95% CI 1.5; 2.4), and further adjustment did not materially change the effect. Job control was inversely associated with depression score in Poland and the Czech Republic (not in Russia) but the association was largely eliminated by controlling for socioeconomic characteristics. This study suggests that the effort-reward imbalance at work is related to prevalence of depression in these central and eastern European populations.

[Development of the Brief Scales for Coping Profile (BSCP) for workers: basic information about its reliability and validity]

Coping profile of workers greatly affects the process where job stressors develop health problems, but most of the previously proposed questionnaires for the coping profile are too long to be applied to the program of occupational mental health. In the present study, the authors report the process of developing a new self-rating questionnaire for assessing workers' coping profile which includes only 18 questions. Based on the results of a preparatory study, the 18 questions which provide 6 scales about coping strategies were proposed as the Brief Scales for Coping Profile (BSCP). A self-administered questionnaire including BSCP, Brief Scales for Job Stress (BSJS), and a depression scale (CES-D) was applied to 394 workers in a company, and 328 (83%) responded. Their age was 40.1 +/- 10.0 yr (mean +/- SD), 78% were men, 75% were married, and most of them were white collar workers. Six factors extracted through factor analysis of BSCP closely agreed with the expected 6 scales and also with the results of previous studies. They were named "active solution", "seeking help for solution", "changing a point of view", "changing mood", "emotional expression involving others", and "avoidance and suppression". The Cronbach's reliability coefficients for the scales were from 0.66 to 0.75, showing sufficiently high internal consistency. None of them related to gender or age. Multiple regression analysis revealed that 38% of the variance of the depression score was explained by "workload", "problems in personal relationships", and "reward from work" scores in BSJS, and also with "active solution" and "avoidance and suppression" scores in BSCP. Interaction analysis revealed that the coping profile modifies the relationship between job stressors and depressive symptoms; the "active solution" score was inversely associated with the depression score, particularly for the workers with high "problems in personal relationships" scores and low "reward from work" scores, while "avoidance and suppression" scores were positively associated with the depression score particularly for the workers with high "problems in personal relationships" scores. These results support part of the reliability and validity of BSCP, and also support the feasibility of BSCP as a tool for self-management and health education concerning job stress in the field of occupational mental health. The test-retest reliability and concurrent validity of BSCP should be confirmed in a future study. It also should be confirmed in future whether the coping profile relates with gender, age, job type, or other outcome of job stress in other populations.

The Japanese version of the Multiple Affect Adjective Checklist-Revised: development and validation

In order to develop a Japanese version of the Multiple Affect Adjective Checklist-Revised (MAACL-R), the 66 scored adjectives were translated into Japanese and translated back into English as recommended by Werner and Campbell (1971). Confirmatory factor analyses evidenced the existence of five first-order factors (i.e., the anxiety, depression, hostility, positive affect, and sensation-seeking factors) and the two second-order factors (i.e., the dysphoric and pleasant affect factors) underlying the response to the Japanese MAACL-R. Internal consistency ranged from .73 to .91, and four-week retest reliability ranged from .67 to .74 on the seven scales (Anxiety, Depression, Hostility, Positive Affect, Sensation Seeking, Dysphoria, and PASS). Although correlations with the scales of the State-Trait Personality Inventory, State-Trait Anxiety Inventory, Center for Epidemiologic Studies Depression scale, a sensation-seeking scale, and a subjective well-being scale indicated only acceptable discriminant validity, adequate convergent validity was evidenced by the examination of these correlations. The Japanese version of the MAACL-R seems to be ready for use in research.

[Improvement of work environment]

As a result of a literature review on methodology and the effectiveness of work-environment oriented workplace stress reduction, it is suggested that improvement of the work environment is effective in reducing workers' job stressors and psychological and physiological stress reaction, from a limited number of controlled studies including RCT, as well as a number of case studies and before-after comparison studies. An expert-guided, supervisor and worker participated approach also seems effective. The author proposes five practical steps toward an effective improvement of the work environment based on the review. Remaining topics include the need for more well-designed studies, investigation of the relationship between intervention type and outcome, as well as modifying effects according to social situations, and instruments for implementation.

Work-related stress and depressive disorders

The 1980s and 1990s has seen a considerable change in the workforce structure in industrialised economies. Employees are commonly faced with greater demands and less job security, both of which are likely to be stressful, thus psychological disorders especially depression may increasingly be caused by work-related stressors. An issue of this journal in 1997 (Vol. 43, No. 1) was indeed devoted to stress in the workplace and since then, these workplace changes have progressed and a review seems timely. Because interpreting results of cross-sectional studies is limited by a potential reciprocal relation between work stressors and depression (since "effort after meaning" can influence how "distressed" individuals report stressors at work), this review largely focuses on prospective or predictive studies to minimise this bias. Not surprisingly, the findings from occupational stress research is consistent with the more general life event stress literature showing that specific acute work-related stressful experiences contribute to "depression" and, more importantly perhaps, that enduring "structural" occupational factors, which may differ according to occupation, can also contribute to psychological disorders. There are significant implications for employees, their families, employers and indeed the wider community.

Psychosocial challenges facing physicians of today

Fundamental changes in the organization, financing, and delivery of health care have added new stressors or opportunities to the medical profession. These new potential stressors are in addition to previously recognized external and internal ones. The work environment of physicians poses both psychosocial, ergonomic, and physico-chemical threats. The psychosocial work environment has, if anything, worsened. Demands at work increase at the same time as influence over one's work and intellectual stimulation from work decrease. In addition, violence and the threat of violence is another major occupational health problem physicians increasingly face. Financial constraint, managed care and consumerism in health care are other factors that fundamentally change the role of physicians. The rapid deployment of new information technologies will also change the role of the physician towards being more of an advisor and information provider. Many of the minor health problems will increasingly be managed by patients themselves and by non-physician professionals and practitioners of complementary medicine. Finally, the economic and social status of physicians are challenged which is reflected in a slower salary increase compared to many other professional groups. The picture painted above may be seen as uniformly gloomy. In reality, that is not the case. There is growing interest in and awareness of the importance of the psychosocial work environment for the delivery of high quality care. Physicians under stress are more likely to treat patients poorly, both medically and psychologically. They are also more prone to make errors of judgment. Studies where physicians' work environment in entire hospitals has been assessed, results fed-back, and physicians and management have worked with focused improvement processes, have demonstrated measurable improvements in the ratings of the psychosocial work environment. However, it becomes clear from such studies that quality of the leadership and the physician team impact on the overall work atmosphere. Physicians unaware of the goals of the department as well as the hospital, that do not receive management performance feedback, and who do not get annual performance appraisals and career guidance, rate their psychosocial environment as more adverse than their colleagues. There is also a great need to offer personally targeted competence development plans. Heads of department and senior physicians rate their work environment as of higher quality than more junior and mid-career physicians. More specifically, less senior physicians perceive similar work demands as their senior colleagues but rate influence over work, skills utilization, and intellectual stimulation at work as significantly worse. In order to combat negative stressors in the physicians' work environment, enhancement initiatives should be considered both at the individual, group, and structural level. Successful resources used by physicians to manage the stress of everyday medicine should be identified. Physicians are a key group to ensure a well-functioning health care system. In order to be able to change and adapt to the ongoing evolution of the Western health care system, more focus needs to be put on the psychosocial aspects of physicians' work.