Exploring exposure to multiple psychosocial work factors: prospective associations with depression and sickness absence

BACKGROUND

Most studies on the psychosocial working environment have focused on evaluating the isolated effect of individual psychosocial work factors or looked at effects through a lens of theories such as job strain or effort-reward imbalance. However, to fathom the intricate nature of workers' experience of occupational strain, there is a need to investigate the combined and cumulative effects of multiple exposures to psychosocial work factors on workers' health.

METHODS

In this prospective cohort study, we created an additive index (range 0-4) on number of baseline exposures to quantitative demands, emotional demands, role conflicts, and workplace bullying. Via logistic regression and Cox regression, we estimated the association between the additive index of psychosocial work factors and depressive disorder and long-term sickness absence (LTSA). We assessed the onset of depressive disorder using the Major Depression Inventory at 6-month follow-up and the onset of LTSA using a national register during 12-month follow-up.

RESULTS

For onset of depressive disorder, high exposure to any one [odds ratio (OR) 2.98], two (OR 3.14), three (OR 6.44) and all four (OR 9.62) adverse psychosocial work factors predicted a statistically significant increased risk. For onset of LTSA, high exposure to any one [hazard ratio (HR) 1.13], two (HR 1.67), three (HR 2.31) and all four (HR 4.04) psychosocial work factors predicted an increased risk. The two latter associations were statistically significant. Trend tests indicated an exposure-response relationship for both outcomes.

CONCLUSIONS

Workers reporting exposure to multiple adverse psychosocial work factors had a higher risk of developing depressive disorder and LTSA.

Psychosocial working conditions and sickness absence among younger employees in Denmark: a register-based cohort study using job exposure matrices

OBJECTIVE

Previous literature has established associations between psychosocial working conditions and sickness absence (SA), but only few studies have examined associations among younger employees. This study aimed to investigate associations between psychosocial working conditions and SA among employees, aged 15-30 years, who entered the labor market in Denmark between 2010 and 2018.

METHOD

We followed 301 185 younger employees in registers for on average 2.6 years. Using job exposure matrices, we assessed job insecurity, quantitative demands, decision authority, job strain, emotional demands, and work-related physical violence. Adjusted rate ratios of SA spells of any length were estimated for women and men separately with Poisson models.

RESULTS

Among women, employment in occupations with high quantitative demands, low decision authority, high job strain, high emotional demands, or high work-related physical violence was associated with higher rates of SA. Being employed in occupations with high versus low emotional demands showed the strongest association with SA, with a rate ratio of 1.44 [95% confidence interval (CI) 1.41-1.47]. Among men, being employed in occupations with low decision authority showed the strongest association with SA (1.34, 95% CI 1.31-1.37), whereas occupations with high quantitative demands, high job strain, and high emotional demands were associated with lower rates of SA.

CONCLUSION

We found that several psychosocial working conditions were associated with SA spells of any length. Associations with SA spells of any length resemble associations with long-term SA, suggesting that results from previous studies on long-term SA may be generalizable to all lengths of SA among younger employees.

Association of alcohol use with years lived without major chronic diseases: A multicohort study from the IPD-Work consortium and UK Biobank

Background

Heavy alcohol consumption increases the risk of several chronic diseases. In this multicohort study, we estimated the number of life-years without major chronic diseases according to different characteristics of alcohol use.

Methods

In primary analysis, we pooled individual-level data from up to 129,942 adults across 12 cohort studies with baseline data collection on alcohol consumption, drinking patterns, and history between 1986 and 2005 (the IPD-Work Consortium). Self-reported alcohol consumption was categorised according to UK guidelines - non-drinking (never or former drinkers); moderate consumption (1-14 units); heavy consumption (>14 units per week). We further subdivided moderate and heavy drinkers by binge drinking pattern (alcohol-induced loss of consciousness). In addition, we assessed problem drinking using linked data on hospitalisations due to alcohol abuse or poisoning. Follow-up for chronic diseases for all participants included incident type 2 diabetes, coronary heart disease, stroke, cancer, and respiratory disease (asthma and chronic obstructive pulmonary disease) as ascertained via linkage to national morbidity and mortality registries, repeated medical examinations, and/or self-report. We estimated years lived without any of these diseases between 40 and 75 years of age according to sex and characteristics of alcohol use. We repeated the main analyses using data from 427,621 participants in the UK Biobank cohort study.

Findings

During 1·73 million person-years at risk, 22,676 participants in IPD-Work cohorts developed at least one chronic condition. From age 40 to 75 years, never-drinkers [men: 29·3 (95%CI 27·9-30·8) years, women 29·8 (29·2-30·4) years)] and moderate drinkers with no binge drinking habit [men 28·7 (28·4-29·0) years, women 29·6 (29·4-29·7) years] had the longest disease-free life span. A much shorter disease-free life span was apparent in participants who experienced alcohol poisoning [men 23·4 (20·9-26·0) years, women 24·0 (21·4-26·5) years] and those with self-reported heavy overall consumption and binge drinking [men: 26·0 (25·3-26·8), women 27·5 (26·4-28·5) years]. The pattern of results for alcohol poisoning and self-reported alcohol consumption was similar in UK Biobank. In IPD-Work and UK Biobank, differences in disease-free years between self-reported moderate drinkers and heavy drinkers were 1·5 years or less.

Interpretation

Individuals with alcohol poisonings or heavy self-reported overall consumption combined with a binge drinking habit have a marked 3- to 6-year loss in healthy longevity. Differences in disease-free life between categories of self-reported weekly alcohol consumption were smaller.

Funding

Medical Research Council, National Institute on Aging, NordForsk, Academy of Finland, Finnish Work Environment Fund.

Work stress and loss of years lived without chronic disease: an 18-year follow-up of 1.5 million employees in Denmark

We aimed to examine the association between exposure to work stress and chronic disease incidence and loss of chronic disease-free life years in the Danish workforce. The study population included 1,592,491 employees, aged 30-59 in 2000 and without prevalent chronic diseases. We assessed work stress as the combination of job strain and effort-reward imbalance using job exposure matrices. We used Cox regressions to estimate risk of incident hospital-diagnoses or death of chronic diseases (i.e., type 2 diabetes, coronary heart disease, stroke, cancer, asthma, chronic obstructive pulmonary disease, heart failure, and dementia) during 18 years of follow-up and calculated corresponding chronic disease-free life expectancy from age 30 to age 75. Individuals working in occupations with high prevalence of work stress had a higher risk of incident chronic disease compared to those in occupations with low prevalence of work stress (women: HR 1.04 (95% CI 1.02-1.05), men: HR 1.12 (95% CI 1.11-1.14)). The corresponding loss in chronic disease-free life expectancy was 0.25 (95% CI - 0.10 to 0.60) and 0.84 (95% CI 0.56-1.11) years in women and men, respectively. Additional adjustment for health behaviours attenuated these associations among men. We conclude that men working in high-stress occupations have a small loss of years lived without chronic disease compared to men working in low-stress occupations. This finding appeared to be partially attributable to harmful health behaviours. In women, high work stress indicated a very small and statistically non-significant loss of years lived without chronic disease.

Long working hours and risk of 50 health conditions and mortality outcomes: a multicohort study in four European countries

BACKGROUND

Studies on the association between long working hours and health have captured only a narrow range of outcomes (mainly cardiometabolic diseases and depression) and no outcome-wide studies on this topic are available. To achieve wider scope of potential harm, we examined long working hours as a risk factor for a wide range of disease and mortality endpoints.

METHODS

The data of this multicohort study were from two population cohorts from Finland (primary analysis, n=59 599) and nine cohorts (replication analysis, n=44 262) from Sweden, Denmark, and the UK, all part of the Individual-participant Meta-analysis in Working Populations (IPD-Work) consortium. Baseline-assessed long working hours (≥55 hours per week) were compared to standard working hours (35-40 h). Outcome measures with follow-up until age 65 years were 46 diseases that required hospital treatment or continuous pharmacotherapy, all-cause, and three cause-specific mortality endpoints, ascertained via linkage to national health and mortality registers.

FINDINGS

2747 (4·6%) participants in the primary cohorts and 3027 (6·8%) in the replication cohorts worked long hours. After adjustment for age, sex, and socioeconomic status, working long hours was associated with increased risk of cardiovascular death (hazard ratio 1·68; 95% confidence interval 1·08-2·61 in primary analysis and 1·52; 0·90-2·58 in replication analysis), infections (1·37; 1·13-1·67 and 1·45; 1·13-1·87), diabetes (1·18; 1·01-1·38 and 1·41; 0·98-2·02), injuries (1·22; 1·00-1·50 and 1·18; 0·98-1·18) and musculoskeletal disorders (1·15; 1·06-1·26 and 1·13; 1·00-1·27). Working long hours was not associated with all-cause mortality.

INTERPRETATION

Follow-up of 50 health outcomes in four European countries suggests that working long hours is associated with an elevated risk of early cardiovascular death and hospital-treated infections before age 65. Associations, albeit weak, were also observed with diabetes, musculoskeletal disorders and injuries. In these data working long hours was not related to elevated overall mortality.

FUNDING

NordForsk, the Medical Research Council, the National Institute on Aging, the Wellcome Trust, Academy of Finland, and Finnish Work Environment Fund.

1175Work stress and loss of years lived without chronic disease; an 18-year prospective cohort study

Background

Aim: To examine the association of work stress with future chronic disease incidence and loss of chronic disease-free life years in the Danish workforce.

Method

A population-based prospective register-based cohort study of all employees aged 30-59 in 2000 in Denmark, without chronic diseases at baseline (n = 1,592,491). Using job exposure matrices, we assessed exposure to work stress by a combined measure of job strain and effort-reward imbalance. We estimated the risk of incident hospital-diagnosed chronic disease or death (i.e., type 2 diabetes, coronary heart disease, stroke, cancer, asthma, chronic obstructive pulmonary disease, heart failure, and dementia) during 18 years of follow-up and corresponding chronic disease-free life expectancy.

Results

Individuals working in occupations with high risk of both job strain and effort-reward imbalance had a slightly higher risk of future incident chronic disease compared to those in occupations with low risk of both stressors. The hazard ratio was 1.04 (95% CI 1.02 to 1.05) in women and 1.12 (95% CI 1.11 to 1.14) in men. The corresponding loss in chronic disease-free life expectancy was 0.25 years in women and 0.84 years in men.

Conclusion

Working in occupations with a high risk of work stress was associated with a small loss of years lived without chronic disease compared to working in occupations with low risk of work stress.

Key messages

According to our findings, employees in occupations with high risk of work stress live slightly shorter lives free of chronic diseases compared to employees in occupations with low risk of work stress.

Onset of workplace sexual harassment and subsequent depressive symptoms and incident depressive disorder in the Danish workforce

BACKGROUND

We studied onset of workplace sexual harassment and subsequent risk of depressive symptoms and depressive disorder.

METHODS

We examined 9,981 individuals who participated in the Work Environment and Health in Denmark survey in 2012 and 2014 and 6,647 individuals who also participated in 2016, all unexposed to sexual harassment in 2012. Depressive symptoms and disorder were assessed with the Major Depression Inventory. Using linear regression, we estimated the associations between onset of sexual harassment in the 12 months preceding the 2014 survey and depressive symptoms in 2014 and 2016, respectively. Using logistic regression, we estimated risk of incident depressive disorder in 2014.

RESULTS

Onset of sexual harassment was associated with elevated depressive symptoms in 2014, both for harassment by non-workplace personnel (e.g., patients, estimate (B): 1.61, 95% CI: 0.51-2.72, p = 0.004) and workplace personnel (e.g., supervisors, B: 3.85, 95% CI: 2.51-5.20, p < 0.001), after adjustment for depressive symptoms in 2012. Harassment by workplace personnel was further associated with elevated depressive symptoms in 2016 after adjustment for symptoms in 2012, but not after adjustment for symptoms in 2014. Harassment by workplace personnel was associated with incident depressive disorder in 2014 (odds ratio: 5.26, 95% CI: 2.68-10.31, p < 0.001).

LIMITATIONS

Depressive symptoms and disorder were assessed with a validated self-administered rating scale but not a clinical diagnostic interview. Participants reporting harassment in 2014 had elevated depressive symptoms already in 2012 requiring future investigation.

CONCLUSIONS

Exposure to sexual harassments at the workplace may be a contributing factor in the aetiology of depressive symptoms and disorder.

Onset of Workplace Bullying and Risk of Weight Gain: A Multicohort Longitudinal Study

OBJECTIVE

This study aimed to examine the onset of workplace bullying as a risk factor for BMI increase.

METHODS

Repeated biennial survey data from three Nordic cohort studies were used, totaling 46,148 participants (67,337 participant observations) aged between 18 and 65 who did not have obesity and who were not bullied at the baseline. Multinomial logistic regression was applied for the analysis under the framework of generalized estimating equations.

RESULTS

Five percent reported onset of workplace bullying within 2 years from the baseline. In confounder-adjusted models, onset of workplace bullying was associated with a higher risk of weight gain of ≥ 1 BMI unit (odds ratio = 1.09; 95% CI: 1.01-1.19) and of ≥ 2.5 BMI units (odds ratio = 1.24; 95% CI: 1.06-1.45). A dose-response pattern was observed, and those exposed to workplace bullying more frequently showed a higher risk (P_trend  = 0.04). The association was robust to adjustments, restrictions, stratifications, and use of relative/absolute scales for BMI change.

CONCLUSIONS

Participants with exposure to the onset of workplace bullying were more likely to gain weight, a possible pathway linking workplace bullying to increased long-term risk of type 2 diabetes.

Diurnal rhythms of cortisol and melatonin in night eating and non-night eating male police officers

Background

Working during the night has in previous studies been associated with behavioural changes and diseases. Disturbance between behavioural and biological circadian rhythms have been suggested as a possible mechanism linking night work with cardiovascular diseases and pre-diabetic changes. The aim of this study was to investigate if night eating during two, four and seven consecutive night shifts is associated with differences in the diurnal rhythms of cortisol and melatonin in male police officers in Denmark.

Methods

We conducted an experimental study among 37 male police officers in Denmark who all collected data on the last night shift in three different work schedules with two, four and seven consecutive night shifts, respectively. Night eating was self-reported and defined as eating at least one main meal between midnight and early morning. Differences in the diurnal rhythms of concentrations of cortisol and melatonin in saliva were tested by phase changes and amplitude differences.

Results

Sixteen (43.2%) police officers ate a main meal during the last night shift in all three work schedules. The timing of the lowest cortisol concentration was on average delayed with 2:10 hours (95% CI 0:24-3:56 hours) and the level of the lowest cortisol concentration was on average supressed with 66% (95% CI 47-94%) for night eaters compared to non-night eaters. There was no association with number of consecutive night shifts. The phase and amplitude of melatonin were not statistically significantly different between night eaters and non-night eaters.

Conclusions

Night eating behaviour is associated with differences in the diurnal rhythm of cortisol in Danish male police officers working during the night. The difference in cortisol rhythm between night eaters and non-night eaters on night shifts is not affected by the number of consecutive night shifts.

Key messages

Night eating behaviour is associated with differences in the diurnal rhythm of cortisol. Future studies should focus on potential health outcomes of night eating behaviour among night workers.

Emotional demands at work and risk of long-term sickness absence among 1.5 million Danish employees

Background

Emotional demands concern aspects of work requiring an emotional effort of employees and have been associated with risk of depression and long-term sickness absence (LTSA) in previous studies. Associations may, however, partly be affected by reporting bias. Further, previous studies have primarily been conducted using smaller samples in selected job groups or sectors. We, therefore, examined the association between emotional demands and LTSA using a job exposure matrix (JEM) in a nationwide cohort.

Methods

We included all employed individuals in Denmark who were 30 to 59 years old in 2000. We assessed emotional demands at work with a JEM. JEM values were categorized into quartiles based on the distribution within each year and updated annually from 2000 to 2009. LTSA was register-based, defined as ≥ 6 weeks and assessed until 2015. Individuals with LTSA from 1998 to 2000 were excluded, yielding a sample of 1,521,352 individuals. Exposure in year t was related to outcome in year t + 1 until 2009. We estimated hazard ratios (HR) and 95% confidence intervals (95%CI) using Cox regression adjusted for age, sex, income and ergonomic job demands.

Results

During 15,453,980 person-years, we identified 594,858 LTSA cases. In the fully adjusted model, individuals in the highest emotional demands quartile had a HR of 1.30 (95%CI: 1.29-1.31) compared to individuals the lowest quartile Repeating the analysis separately for women and men showed similar results.

Conclusions

Emotional demands at work were prospectively associated with an increased LTSA risk in this JEM based nationwide cohort study.

Key messages

This study found that emotional demands at work predict risk of long-term sickness absence. Future studies should focus on factors that may buffer the association between emotional demands at work and long-term sickness absence.

Emotional demands at work and risk of depressive disorder: A nationwide Danish cohort study

Background

Studies suggest that high emotional demands at work are associated with increased risk of depression. However, most previous studies have measured emotional demands using self-report and estimates may be inflated due to reporting bias. Furthermore, no study has yet accounted for the potential selection of individuals with increased risk of depressive disorder into occupations with high emotional demands.

Methods

We analyzed data from two separate nationwide register-based Danish cohorts, The Danish Work Life Course Cohort (n = 955,712; person-years=6.99 mill.), and the JEMPAD study (n = 1,680,214; person-years=21.73 mill.). We measured emotional demands annually by job exposure matrices, and depressive disorder using registers on psychiatric hospital treatment. Emotional demands were categorized as quartiles. To account for selection into jobs with high emotional demands, we adjusted for numerous confounders, including health services use before workforce entry, parental socioeconomic position, and psychiatric and somatic diagnoses. The present abstract reports preliminary results based on a subset of the study population used as a development sample (n = 16,163, person-years=168,889). Final results will be available for the conference.

Results

Preliminary findings showed a tendency towards an increased risk of depressive disorder for employees in occupations with the highest level of emotional demands (hazard ratio: 1.20 (95% CI: 0.85-1.69). The association was similar with and without adjustment for confounders and was not explained by selection into occupations with high emotional demands.

Conclusions

If confirmed in analyses of the full study population, our results suggest that high emotional demands at work may be associated with increased risk of depressive disorder, and that this association is explained by neither reporting bias nor a selection of individuals vulnerable to depression into occupations with high emotional demands.

Key messages

Emotional demands may be associated with an increased risk of depressive disorder. Further research is needed to explore the potential for workplace prevention of high emotional demands.

Job control and risk of disability pension in the nationwide Danish Work Life Course Cohort

Background

A large number of studies have found job control to be consistently associated with an increased risk of disability pension. However, most previous studies have measured job control by self-report, introducing possible reporting bias inflating the risk estimates. Furthermore, previous studies have not accounted for the potential selection of individuals with pre-existing risk factors for disability pensioning into low control jobs.

Methods

We analyzed data from the nationwide register-based Danish Work Life Course Cohort (DAWCO; n = 960,562 with approx. 6 million person-years). We measured job control annually by a job exposure matrix, based on a scale of five self-reported items from The Danish Work Environment Cohort Study, and disability pension using registers on public transfer payments. To account for potential selection into occupations with lower levels of job control, we included numerous life course confounders, including parental socioeconomic position and psychiatric and somatic diagnoses.

Results

Employees in jobs with lower levels of job control had increased risk of disability pensioning. The association attenuated after adjustment for confounders but was not explained by selection into job groups with lower levels of job control (hazard ratio: 1.16 (95% CI: 1.03-1.31).

Conclusions

Our findings suggest that lower levels of job control are associated with an increased risk of disability pension, and that this association is explained by neither reporting bias nor a selection of individuals with an increased risk of disability pensioning into job groups with lower levels of job control.

Key messages

Lower levels of job control appear associated with an increased risk of disability pension independent of life course confounders. Further research is needed on preventive measures in occupations with low levels of job control.

Work stress, migration background and risk of long-term sickness absence in Denmark

Background

Work stress may increase risk of long-term sickness absence, but little is known if this association differs by migration background. In this study, we examined the prospective association between effort-reward imbalance at work and risk of long-term sickness absence in individuals with and without migration background in the Danish workforce.

Methods

We included 59,468 respondents from a nationwide survey on work and health, 3,226 with a migration background (immigrants or first generation descendants of immigrants) and 56,242 without a migration background. Effort-reward imbalance was assessed by self-report. Migration background and long-term sickness absence (spells ≥6 weeks) were assessed by national register data. Using Cox regression, we estimated the association between effort-reward imbalance and onset of long-term sickness absence during 12 months follow-up separately for participants with and without a migration background, adjusted for age, sex, education and previous long-term sickness absence.

Results

The effort-reward imbalance score at baseline was similar for respondents with and without a migration background. The hazard ratio for long-term sickness absence during follow-up per 1 standard deviation increment in effort-reward imbalance at baseline was 1.26 (95% CI: 1.16-1.37) and 1.16 (95% CI: 1.13-1.20) for respondents with and without a migration background, respectively.

Conclusions

Work stress, measured by effort-reward imbalance, is associated with an increased risk of long-term sickness absence in workers with and without a migration background in Denmark. Although the estimate was higher in workers with a migration background, confidence intervals overlapped indicating that associations were similar in both groups. The results suggest that prevention activities on effort-reward imbalance and long-term sickness absence should not be prioritized by migration background but should be offered to the whole workforce.

Key messages

Work stress, measured by effort-reward imbalance, is associated with an increased risk of long-term sickness absence in workers with and without a migration background in Denmark. The results suggest that prevention activities on effort-reward imbalance and long-term sickness absence activities should be offered to the whole workforce.

Does dexamethasone have a perineural mechanism of action? A paired, blinded, randomized, controlled study in healthy volunteers

BACKGROUND

Dexamethasone prolongs block duration. Whether this is achieved via a peripheral or a central mechanism of action is unknown. We hypothesized that perineural dexamethasone added as an adjuvant to ropivacaine prolongs block duration compared with ropivacaine alone, by a locally mediated effect when controlled for a systemic action.

METHODS

We performed a paired, blinded, randomized trial, including healthy men. All subjects received bilateral blocks of the saphenous nerve with ropivacaine 0.5%, 20 ml mixed with dexamethasone 2 mg in one leg and saline in the other, according to randomization. The primary outcome was the duration of sensory block assessed by temperature discrimination in the saphenous nerve distribution. Secondary outcomes were sensory block assessed by mechanical discrimination, pain response to tonic heat stimulation, and warmth and heat pain detection thresholds.

RESULTS

We included 20 subjects; one had a failed block and was excluded from the paired analysis. Block duration was not statistically significantly longer in the leg receiving dexamethasone when assessed by temperature discrimination (primary outcome, estimated median difference 1.5 h, 95% confidence interval -3.5 to 0, P=0.050). For all other outcomes, the duration was statistically significantly longer in the leg receiving dexamethasone, but the median differences were <2.0 h. Individual subject analysis revealed that only eight subjects had a block prolongation of at least 2 h in the leg receiving dexamethasone perineurally.

CONCLUSION

Perineural administration of dexamethasone 2 mg showed a modest and inconsistent effect of questionable clinical relevance on block duration.

CLINICAL TRIAL REGISTRATION

NCT01981746.

Sequestration of zinc oxide by fimbrial designer chelators

Type 1 fimbriae are surface organelles of Escherichia coli. By engineering a structural component of the fimbriae, FimH, to display a random peptide library, we were able to isolate metal-chelating bacteria. A library consisting of 4 x 10(7) independent clones was screened for binding to ZnO. Sequences responsible for ZnO adherence were identified, and distinct binding motifs were characterized. The sequences selected exhibited various degrees of affinity and specificity towards ZnO. Competitive binding experiments revealed that the sequences recognized only the oxide form of Zn. Interestingly, one of the inserts exhibited significant homology to a specific sequence in a putative zinc-containing helicase, which suggests that searches such as this one may aid in identifying binding motifs in nature. The zinc-binding bacteria might have a use in detoxification of metal-polluted water.