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Abstract: Objective This paper presents an overview of 50 years of research on psychosocial working conditions and health with regards to conceptualization, interventions and policy. We reflect on the promise of past and current research on psychosocial working conditions and, in addition, discuss current progress in translating this research into workplace practice and improvements in people’s working lives.Methods We conducted a narrative review of meta-reviews and key publications on psychosocial working conditions and health. The review covers a historical overview of theories of the past 50 years, measurement of psychosocial working conditions, health effects, intervention research, and policy development on psychosocial working conditions.Results Psychosocial working conditions are conceptualized in different ways, with increasing complexity in the understanding developing over time. Exposures related to psychosocial working conditions are associated with a wide range of health outcomes, in particular cardiovascular disease and mental health conditions. In response to growing evidence on associations between psychosocial working conditions and health outcomes, intervention research has expanded rapidly, but for various reasons the evidence base is stronger and more extensive for individual- than organizational-level interventions. This individual/organizational imbalance is reflected in practice, and may partly explain why policy interventions have yet to show reductions in exposures to psychosocial work factors and associated adverse outcomes.Conclusions Pressing needs for advancing the field include improvements in capturing exposure dynamics, developing objective measures of exposure, methodologic advancements to optimize causal inference in etiologic studies, and alternatives to randomized controlled trials for intervention evaluation. by Boot CRL, LaMontagne AD, Madsen IEH. doi:10.5271/sjweh.4179 PubDate: Wed, 07 Aug 2024 16:50:01 +020 DOI: 10.5271/sjweh.4179
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Abstract: Objectives British Columbia (BC), Canada, experienced an unprecedented summer with record-breaking high temperatures in 2021. Yet the health impact has not been examined in occupational settings. This study aimed to characterize occupational heat-related illness (HRI) among BC workers estimated by incidence rates and associations between heatwaves and HRI, compare risks from 2021 and prior summers of 2001–2020, and assess differential impacts on worker groups by demographics and occupations.Methods We identified HRI from workers’ compensation claims that occurred between June and August from 2001–2021 in BC. Incidence rates were calculated using working population estimates from Statistics Canada’s Labour Force Survey. A time-stratified case-crossover design with conditional Poisson regression was used to examine the impact of heatwaves on occupational HRI. All analyses were stratified by year (2021 versus 2001–2020), age, sex, and occupation.Results Of the 521 claims identified, 107 (21%) occurred in 2021. Incidence rates for 2021 and prior summers were 3.97 [95% confidence interval (CI) 3.26–4.80] and 0.93 (95% CI 0.85–1.03) claims per 100 000 workers, respectively. This difference represents a 327% increase. Rates were higher in health occupations in 2021 versus 2001–2020. During 2001–2021, the risk of HRI during heatwave days was 4.33 (95% CI 2.98–6.27) times that during non-heatwave days, and the risk was higher among middle-aged workers and workers in trades, transport, and equipment operations. The 2021 heatwaves had greater impact on younger and female workers than those from prior summers.Conclusions Heat is a crucial workplace hazard. Prevention strategies should prioritize at-risk workers and not be limited to heatwaves. by Guo X, Weinberger KR, Tamburic L, Peters CE, McLeod CB. doi:10.5271/sjweh.4173 PubDate: Wed, 31 Jul 2024 17:57:26 +020 DOI: 10.5271/sjweh.4173
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Abstract: Objective This study systematically reviewed and meta-analyzed the differential attrition and utilization of occupational mental health interventions, specifically examining delivery methods (internet-based versus in-person).Methods The research, with papers spanning 2010–2024, involved filtering criteria and comprehensive searches across PubMed, Scopus, and Web of Science Core (PROSPERO registration n. CRD42022322394). Of 28 683 titles, 84 records were included in the systematic review, with 75 in meta-analyses. Risk of bias was assessed through the revised Cochrane risk of bias tool for randomized control trials and funnel plots. Differential attrition across studies was meta-analysed through a random-effects model with limited maximum-likelihood estimation for the degree of heterogeneity.Results Findings reveal higher mean differential attrition in the intervention group, indicating a potential challenge in maintaining participant engagement. The attrition rates were not significantly influenced by the mode of intervention delivery (internet versus in-person). Compensation for participation and year of publication could potentially influence differential attrition from baseline to follow-up measurements.Conclusions These results suggest a need for cautious consideration of attrition in occupational mental health intervention study designs and emphasize the importance of adapting statistical analyses to mitigate potential bias arising from differential attrition. by de Miquel C, Haro JM, van der Feltz-Cornelis CM, Ortiz-Tallo A, Chen T, Sinokki M, Naumanen P, Olaya B, Lima RA. doi:10.5271/sjweh.4177 PubDate: Mon, 29 Jul 2024 16:24:02 +020 DOI: 10.5271/sjweh.4177
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Abstract: Objective Occupational health has been influenced by societal and industrial changes. This study aimed to clarify topic trends in occupational health research in 1990–2022.Methods We conducted a text-mining-adjusted bibliometric study using research titles in occupational health. Data on research titles and the years of publication were collected from 26 peer-reviewed journals on PubMed. Using morphological and correspondence analyses in text mining, we structured research topics into multiple categories and visualized the relationship between all categories and publication years. Statistical analyses were conducted using the text mining software – KH Coder 3.0. Results We obtained 48 645 articles containing 714 890 words in their titles. The research topics were classified into 4 categories and 17 subcategories, of which those of occupations; countries; non-intervention; psychosocial factors; lifestyle factors; safety; symptoms; therapy and care; and productivity have recently shown an increasing trend. In contrast, the subcategories of risk, chemical factors, disease, and organ damage showed decreasing trends. Chemical factors, which were the main topics in the 1990s, included risk, organ damage, and disease. Productivity, the main topic in the 2020s, co-occurred with lifestyle factors, symptoms, and intervention. Conclusions Focal areas in occupational-health research shift according to societal trends. Occupational-health research has primarily analyzed issues in developed countries with capitalist values and may not have sufficiently covered issues in developing countries. It is imperative for policymakers and public funding bodies to determine priorities for investigation in the field. by Sakai K, Nagata T, Mori T, Inoue S, Fujiwara H, Odagami K, Adi NP, Tatemichi M, Mori K. doi:10.5271/sjweh.4176 PubDate: Sat, 06 Jul 2024 15:58:06 +020 DOI: 10.5271/sjweh.4176
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Abstract: Objectives This study aimed to evaluate the independent and interactive effects of changes in overtime and night shifts on burnout among nurses during the COVID-19 pandemic.Methods Nurses working in an Italian university hospital (N=317) completed the Maslach Burnout Inventory in September 2019 and again in December 2020. Based on hospital administrative data, changes in overtime and night shifts in the same years were categorized into three groups each. Linear regressions were used to estimate 2020 burnout differences between exposure groups, controlling for 2019 burnout levels, demographic and work-related characteristics, and to test the interaction between the two exposures. Results Nurses in the onset of high overtime group had higher emotional exhaustion [4.33, 95% confidence interval (CI) 1.74−6.92], depersonalization (2.10, 95% CI 0.49−3.71), and poor personal accomplishment (2.64, 95% CI 0.55−4.74) compared to stable low overtime nurses. Nurses in the increase in night shifts group had lower emotional exhaustion (-4.49, 95% CI -7.46− -1.52) compared to no night shift nurses. Interaction analyses revealed that this apparently paradoxical effect was limited to stable low overtime nurses only. Moreover, increases in night shifts were associated with higher depersonalization and poor personal accomplishment in nurses in the stable high overtime group.Conclusions Increase in overtime is an independent risk factor for burnout among nurses, highlighting the need for specific regulations and actions to address it. Long-standing guidelines for the assignment of night shifts might have contributed to attenuate the impact of their increase on nurses’ mental health. by Giusti EM, Veronesi G, Gianfagna F, Magnavita N, Campana F, Borchini R, Iacoviello L, Ferrario MM. doi:10.5271/sjweh.4178 PubDate: Sat, 06 Jul 2024 14:14:44 +020 DOI: 10.5271/sjweh.4178
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Abstract: Emergent health challenges related to workWork is not only central to population health but is also a significant driver of social inequality in health (1). In a recent Lancet series on work and health, the authors outlined six emergent challenges concerning work: the impact of technology, the intersection of work with sociodemographic health determinants, migrant work, precarious employment, long working hours, and climate change (1). The authors of the Lancet series also presented recommendations for future research, advocating for the utilization of mixed-methods, innovative analytical approaches (eg, causal modeling), realist evaluation, and interdisciplinary collaboration. Although each of these approaches are highly relevant, their integrated application was only vaguely outlined. We believe that each of these work and health challenges show features of complex adaptive systems. They are multifaceted, constantly evolving, and emerge from our complex and disordered real world, which is often characterized by interactions, non-linearity, interference, feedback loops, and adaptation. Consequently, future research on work and health may benefit from adopting a complex systems perspective to obtain a comprehensive understanding of the drivers of these challenges (2–4). We have recently developed an interdisciplinary framework for knowledge production aimed at understanding complex health issues within the domain of public health, rooted in complex systems theory (5). This framework can serve to organize our thinking, formulate research questions, and integrate methodologies related to each of these six work and health challenges. Briefly outlined, the Health Complexity framework relates to three core dimensions in which complex health issues may be conceptualized: patterns, mechanisms, and dynamics (5). Patterns: Looking for specific patterns of disease or risk factors allows us to empirically identify health issues that emerge from the mechanisms and dynamics of the underlying systems, eventually allowing us to discover vulnerable subgroups, and thereby set boundaries for targeted interventions.Mechanisms: Understanding the core mechanisms that give rise to these emergent health patterns and how they are connected across scales through interactions and interference can help us identify potential leverage points for intervention.Dynamics: Building evidence on the dynamics that make patterns and mechanisms change over time will allow us to identify vicious circles associated with particularly high morbidity. Between them, these dimensions cover seven key features of complex systems (emergence, interactions, non-linearity, interference, feedback loops, adaptation, and evolution), which we have highlighted as central to public health. The Health Complexity framework builds upon the ideas of methodological pluralism (6–8) and is intended to be an overarching framework for interdisciplinary and collaborative research on complex health issues, also in the field of work and health. As an illustration, we will outline the elements needed to examine one of these challenges – precarious employment – through a complex systems lens, particularly highlighting how this approach influences the way we phrase research questions on health problems that do justice to the complexity of the real world. Precarious employment viewed through a complex systems lensWith globalization and technological advancements, there has been a shift towards a gig economy. This has led to an increase in temporary, part-time, and freelance work, which often lacks stability and benefits. Precarious employment specifically refers to such work characterized by employment insecurity, income inadequacy, and lack of rights and protection (9). The lack of stability and benefits associated with precarious employment combined with poor working conditions have been shown to have negative effects on physical and mental health (10–13). Workers may experience higher levels of stress, depression, and other health problems due to financial insecurity and lack of access to healthcare, which collectively may be an important driver of health inequality and of health decline. In a life course perspective, there may also be important feedback mechanisms exacerbating such inequality, with poor health not only being a consequence of precarious employment, but workers with poor health may be more likely to be excluded from stable work (14). Overall, the increasing prevalence of precarious employment represents a substantial challenge for public health, which can be seen as a sort of byproduct of larger societal trends. We believe that employing a complex systems lens can help us generate relevant scientific knowledge about the fundamental drivers of this problem. This essentially entails three interlinked steps organized around the three core dimensions of the Health Complexity Framework (figure 1).Patterns: As a first step, we need to zoom out and understand the health effects associated with emergent patterns of precarious employment in their context across time and space, asking questions such as:•How does precarious employment change over time, and how does this changing pattern affect population health'•Are there certain population groups, defined, eg, by socioeconomic status, age, occupation, migrant status, or geographical regions who experience more adverse health effects by precarious employment than others'Systematically evaluating health patterns associated with precariousness can help us define boundaries for targeted prevention. Employing classical epidemiological surveillance methods alongside data science techniques for uncovering patterns within multidimensional large-scale datasets serves as key examples of such pattern identification.Mechanisms: PubDate: Tue, 02 Jul 2024 22:28:09 +020 DOI: 10.5271/sjweh.4175
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Abstract: Objectives This study examined the associations between implemented disability-related policies and practices (DPP) and sustained employment among partially disabled employees in The Netherlands.Methods Employer survey data on implemented DPP were linked to register data on employment outcomes of partially disabled employees (N=6103 employees from N=366 employers). DPP included six domains based on 48 elements: sick leave policy, occupational health and safety services (OHS), prevention policy, reintegration policy, reintegration practices within the current employer and reintegration practices towards another employer. DPP domains were standardized on a 0–1 scale. Separate logistic regression models were estimated for DDP domains on one-year sustained employment adjusted for employee characteristics, firm size, and sector.Results Almost all organizations implemented at least one element of DPP on prevention policy, OHS, sick leave policy, and reintegration practices within the current employer, and two-thirds on reintegration policy and reintegration practices towards another employer. Implemented DPP on prevention policy [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.3–4.0], OHS (OR 1.9, 95% CI 1.1–3.2), and sick leave policy (OR 1.8, 95% CI 1.0–3.3) were positively associated with sustained employment. No significant results were found for reintegration policy and both reintegration practices domains. Stratified analysis showed that DDP domains were particularly associated with sustained employment in larger organizations and in the private sector.Conclusions Implemented DPP related to sick leave policy, OHS and prevention policy are associated with sustained employment among partially disabled employees, in particular in larger organizations and in the private sector. by van Ooijen R, Koning PWC, Boot CRL, Brouwer S. doi:10.5271/sjweh.4174 PubDate: Fri, 14 Jun 2024 17:08:37 +020 DOI: 10.5271/sjweh.4174
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Abstract: Objective This study aimed to investigate (i) the risk of work disability (>10-day sickness absence spell or disability pension) due to common mental disorders (CMD) among social workers compared with other health and social care, education, and non-human service professionals and (ii) whether the risk was mediated by job stress.Methods A cohort of 16 306 public sector professionals in Finland was followed using survey data from baseline (2004 or if not available, 2008) on job stress [job strain or effort-reward imbalance (ERI)] and register data on work disability due to CMD from baseline through 2011. A Cox proportional hazards model was used to analyze the risk of work disability due to CMD between three occupation-pairs in a counterfactual setting, controlling for age, sex, job contract, body mass index, alcohol risk use, smoking, and physical inactivity.Results Social workers’ job stress was at higher level only when compared to education professionals. Thus, the mediation hypothesis was analyzed comparing social workers to education professionals. Social workers had a higher risk of work disability due to CMD compared with education professionals [hazard ratio (HR) 2.08, 95% confidence interval (CI) 1.58–2.74]. This HR was partly mediated by job strain (24%) and ERI (12%). Social workers had a higher risk of work disability than non-human service professionals (HR 1.54, 95% CI 1.13–2.09), but not compared with other health and social care professionals.Conclusions Job stress partly mediated the excess risk of work disability among social workers only in comparison with education professionals. by Rantonen O, Ervasti J, Alexanderson K, Oksanen T, Aalto V, Mittendorfer-Rutz E, Salo P. doi:10.5271/sjweh.4170 PubDate: Mon, 03 Jun 2024 15:21:04 +020 DOI: 10.5271/sjweh.4170
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Abstract: Objectives Physicians have been shown to have lower mortality compared to the general population, particularly regarding lifestyle-associated causes of death. Prior literature is divided on whether this is due to higher socioeconomic position (SEP), healthier lifestyle, or other specific occupational characteristics. This study analyzed the mortality of Austrian physicians compared to the general population and other (health) professionals with a similar SEP, and investigated patterns of lifestyle-associated mortality among physicians.Methods Data from professional associations and cause-of-death statistics were collated to determine causes of death for all occupational groups. Gender-specific age-standardized mortality rates (ASMR) and standardized rate ratios (SRR) were calculated to compare main causes of death [cancer, cardiovascular disease (CVD), external causes] among physicians to other (health) professionals and the general population. Standardized mortality ratios (SMR) were calculated for more detailed causes of death in physicians compared to the general population.Results Physicians had lower all-cause mortality than the general population [SRR 0.45, 95% confidence interval (CI) 0.41–0.49 for males and SRR 0.60, 95% CI 0.54–0.66 for females] and health professionals (SRR 0.72, 95% CI 0.60–0.88 for males and SRR 0.77, 95% CI 0.63–0.93 for females), mostly due to low CVD and cancer mortality. SMR for detailed causes of death among physicians exhibited a pattern of particularly low mortality in lifestyle-associated causes of death and an increased SMR for suicide among female physicians (SMR 1.58, 95% CI 1.22–2.02).Conclusions This study confirmed lower mortality among physicians compared to the general population and compared to other (health) professionals. Low physician mortality can be primarily explained by lifestyle-associated causes of death. by Zimmermann C, Waldhoer T, Schernhammer E, Strohmaier S. doi:10.5271/sjweh.4172 PubDate: Wed, 29 May 2024 23:40:55 +020 DOI: 10.5271/sjweh.4172
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Abstract: Objectives This study aimed to quantify the duration of work participation and reasons for working years lost, according to gender and educational attainment, among a Norwegian population.Methods Register data on labor market attachment between 2000–2015 were obtained from Statistics Norway. We included five cohorts: individuals turning 20 (N=323 333), 30 (N=386 006), 40 (N=388 962), 50 (N=358 745), and 60 years (N=284 425) between 1 January 2000 and 31 December 2005. Individuals were followed for ten years. Data completeness allowed calculation of the average time spent in work and years lost to health-related absences and non-employment states per cohort. Changes in state probabilities over time were also depicted. Mean differences between genders and educational levels, and corresponding 95% confidence intervals were based on 1000 bootstrap samples.Results Both genders spent most time in work; however, per cohort, women worked approximately one year less than men. As cohorts aged, main reasons for working years lost changed from education and economic inactivity to sickness absence and disability pensioning; this trend was stronger for women than men. Individuals with a low education spent fewer years in work and more years in sickness absence and disability pensioning than highly educated peers. This difference tended to be larger for women and older cohorts.Conclusions Per cohort, women participated one year less in work than men and, depending on age, spent more time in education, economic inactivity, sickness absence, and disability pensioning. Stronger educational gradients were seen for work and health-related absences for older cohorts and women. by Merkus SL, Hoff R, Hasting RL, Undem K, Robroek SJW, Gran JM, Mehlum IS. doi:10.5271/sjweh.4167 PubDate: Thu, 23 May 2024 22:02:54 +020 DOI: 10.5271/sjweh.4167
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Abstract: Objectives Several studies have found higher sickness absence in shared and open workspaces than in private offices, but little is known about why these differences occur. We propose and test job control as a potential mechanism underlying observed differences in the risk of physician-certified sickness absence between private offices and shared and open workspaces.Methods We conducted a counterfactual mediation analysis using observational survey data from a nationally representative sample of Norwegian employees merged with prospective data from national registries (N=5512). The registry data included information about whether participants had any physician-certified sickness absence the year following the survey. Models were adjusted for age, sex, education level, occupation group, executive/leadership responsibility, and time spent on office work.Results We found significantly higher sickness absence risk in conventional [risk ratio (RR) 1.12, 95% confidence interval (CI) 1.01‒1.25] and non-territorial (RR 1.20, 95% 1.04‒1.37) open-plan and non-territorial shared-room offices (RR 1.29, 95% CI 1.13‒1.48) compared to private offices. Natural indirect effects due to job control were statistically significant in all contrasts and accounted for 19–34% of total effects depending on contrast.Conclusions Findings were in line with hypothesized relationships and suggest that job control may be a mechanism underlying observed differences in sickness absence across office concepts. Future studies should continue to explore potential mechanisms linking shared and open workspaces to higher sickness absence and other unfavorable outcomes in the workplace, particularly with study designs that provide stronger basis for causal inference. by Borge RH, Johannessen HA, Fostervold KI, Nielsen MB. doi:10.5271/sjweh.4163 PubDate: Thu, 23 May 2024 21:18:38 +020 DOI: 10.5271/sjweh.4163
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Abstract: Objective Leisure-time physical activity (PA) has been hypothesized to reduce the likelihood of occupational injuries, but it is unclear whether this association varies between workplace and commuting injuries. The aim of this study was to examine the association between PA and risk of workplace and commuting injuries.Methods Data were derived from the Finnish Public Sector study including 82 716 person-observations (48 116 participants). PA was requested repeatedly in four questionnaire surveys between 2000–2012. The average level of PA from two subsequent questionnaires was used to assess long-term PA. To obtain a 1-year incidence of injuries, participants were linked to occupational injury records from the national register. Logistic regression analysis with generalized estimating equations was used to examine the association between PA and injury risk. The analysis was adjusted for age, sex, education, work schedule, job demand, sleep difficulties, cardiovascular diseases, diabetes, and depression for workplace and commuting injuries, and workplace injuries were additionally adjusted for physical heaviness of an occupation and injury risk by occupation.Results Higher level of PA was associated with a lower risk of workplace injuries compared to inactive participants [odds ratio (OR) 0.85, 95% confidence interval (CI) 0.73–0.98]. This association was most marked in the ≥50-year-old age group (OR 0.78, 95% CI 0.64–0.99). No association between the PA and the risk for commuting injuries was observed.Conclusion Higher PA is associated with lower risk of workplace injuries particularly among older employees. by Alhainen M, Härmä M, Pentti J, Ervasti J, Kivimäki M, Vahtera J, Stenholm S. doi:10.5271/sjweh.4165 PubDate: Thu, 23 May 2024 10:45:11 +020 DOI: 10.5271/sjweh.4165
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