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Andersen TO, Sejling C, Jensen AK, Drews HJ, Ritz B, Varga TV, Rod NH. Nighttime smartphone use, sleep quality, and mental health: investigating a complex relationship. Sleep 2023; 46:zsad256. [PMID: 37758231 DOI: 10.1093/sleep/zsad256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/23/2023] [Indexed: 10/03/2023] Open
Abstract
STUDY OBJECTIVES This study investigated the complex relationship between nighttime smartphone use, sleep, and mental health among adult populations in Denmark. METHODS Data from three interconnected samples (aged 16-89 years) from the SmartSleep Study included 5798 individuals with survey and register data; 4239 individuals also provided high-resolution smartphone tracking data. Logistic regression models and causal discovery algorithms, which suggest possible causal pathways consistent with the underlying data structure, were used to infer the relationship between self-reported and tracked nighttime smartphone use, self-reported sleep quality, mental health indicators, and register-based psychotropic medication use. RESULTS Frequent self-reported nighttime smartphone use was associated with high perceived stress (OR: 2.24, 95% CI = 1.42 to 3.55) and severe depressive symptoms (OR: 2.96, 95% CI = 2.04 to 4.28). We found no clear associations between tracked nighttime smartphone use and mental health outcomes, except for the cluster that used their smartphones repeatedly during the sleep period, which was associated with severe depressive symptoms (OR = 1.69, 95% CI = 1.24 to 2.31). Poor sleep quality (vs. good sleep quality) was associated with high perceived stress (OR = 5.07, 95% CI = 3.72 to 6.90), severe depressive symptoms (OR = 9.67, 95% CI = 7.09 to 13.19), and psychotropic medication use (OR = 2.13, 95% CI = 1.36 to 3.35). The causal discovery models suggest that nighttime smartphone use affects mental health through both problematic smartphone use and poor sleep quality. CONCLUSION The complex relationship between nighttime smartphone use, sleep, and poor mental health may create a vicious circle over time, and nighttime smartphone use may constitute a potential leverage point for public health interventions aimed at improving sleep and mental health.
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Affiliation(s)
- Thea Otte Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christoffer Sejling
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Kryger Jensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Henning Johannes Drews
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Beate Ritz
- Department of Epidemiology, Fielding School of Public Health, University of California, LA, USA
| | - Tibor V Varga
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Naja Hulvej Rod
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Rugulies R, Aust B, Greiner BA, Arensman E, Kawakami N, LaMontagne AD, Madsen IEH. Work-related causes of mental health conditions and interventions for their improvement in workplaces. Lancet 2023; 402:1368-1381. [PMID: 37838442 DOI: 10.1016/s0140-6736(23)00869-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 02/11/2023] [Accepted: 04/27/2023] [Indexed: 10/16/2023]
Abstract
Mental health problems and disorders are common among working people and are costly for the affected individuals, employers, and whole of society. This discussion paper provides an overview of the current state of knowledge on the relationship between work and mental health to inform research, policy, and practice. We synthesise available evidence, examining both the role of working conditions in the development of mental disorders, and what can be done to protect and promote mental health in the workplace. We show that exposure to some working conditions is associated with an increased risk of the onset of depressive disorders, the most studied mental disorders. The causality of the association, however, is still debated. Causal inference should be supported by more research with stronger linkage to theory, better exposure assessment, better understanding of biopsychosocial mechanisms, use of innovative analytical methods, a life-course perspective, and better understanding of the role of context, including the role of societal structures in the development of mental disorders. There is growing evidence for the effectiveness of interventions to protect and promote mental health and wellbeing in the workplace; however, there is a disproportionate focus on interventions directed towards individual workers and illnesses, compared with interventions for improving working conditions and enhancing mental health. Moreover, research on work and mental health is mainly done in high-income countries, and often does not address workers in lower socioeconomic positions. Flexible and innovative approaches tailored to local conditions are needed in implementation research on workplace mental health to complement experimental studies. Improvements in translating workplace mental health research to policy and practice, such as through workplace-oriented concrete guidance for interventions, and by national policies and programmes focusing on the people most in need, could capitalise on the growing interest in workplace mental health, possibly yielding important mental health gains in working populations.
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Affiliation(s)
- Reiner Rugulies
- National Research Centre for the Working Environment, Copenhagen, Denmark; Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Birgit Aust
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | | | - Ella Arensman
- School of Public Health, University College Cork, Cork, Ireland; National Suicide Research Foundation, University College Cork, Cork, Ireland; Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Norito Kawakami
- Department of Digital Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Junpukai Foundation, Okayama, Japan
| | - Anthony D LaMontagne
- School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Ida E H Madsen
- National Research Centre for the Working Environment, Copenhagen, Denmark
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Arensman E, Leduc M, O'Brien C, Corcoran P, Griffin E, Leduc C, Coppens E, Tsantila F, Ross V, Abdulla K, Hauck P, Amann BL, Aust B, Pashoja AC, Cresswell-Smith J, D'Alessandro L, Fanaj N, Greiner BA, Luyten J, Mathieu S, Maxwell M, Qirjako G, Reich H, Sanches S, Tóth MD, Kilroy J, Michell K, Reavley N, McDaid D, Van Audenhove C. Implementation and evaluation of a multi-level mental health promotion intervention for the workplace (MENTUPP): study protocol for a cluster randomised controlled trial. Trials 2023; 24:621. [PMID: 37777787 PMCID: PMC10543326 DOI: 10.1186/s13063-023-07537-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/25/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Well-organised and managed workplaces can be a source of wellbeing. The construction, healthcare and information and communication technology sectors are characterised by work-related stressors (e.g. high workloads, tight deadlines) which are associated with poorer mental health and wellbeing. The MENTUPP intervention is a flexibly delivered, multi-level approach to supporting small- and medium-sized enterprises (SMEs) in creating mentally healthy workplaces. The online intervention is tailored to each sector and designed to support employees and leaders dealing with mental health difficulties (e.g. stress), clinical level anxiety and depression, and combatting mental health-related stigma. This paper presents the protocol for the cluster randomised controlled trial (cRCT) of the MENTUPP intervention in eight European countries and Australia. METHODS Each intervention country will aim to recruit at least two SMEs in each of the three sectors. The design of the cRCT is based on the experiences of a pilot study and guided by a Theory of Change process that describes how the intervention is assumed to work. SMEs will be randomly assigned to the intervention or control conditions. The aim of the cRCT is to assess whether the MENTUPP intervention is effective in improving mental health and wellbeing (primary outcome) and reducing stigma, depression and suicidal behaviour (secondary outcome) in employees. The study will also involve a process and economic evaluation. CONCLUSIONS At present, there is no known multi-level, tailored, flexible and accessible workplace-based intervention for the prevention of non-clinical and clinical symptoms of depression, anxiety and burnout, and the promotion of mental wellbeing. The results of this study will provide a comprehensive overview of the implementation and effectiveness of such an intervention in a variety of contexts, languages and cultures leading to the overall goal of delivering an evidence-based intervention for mental health in the workplace. TRIAL REGISTRATION Please refer to Item 2a and registration ISRCTN14104664. Registered on 12th July 2022.
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Affiliation(s)
- Ella Arensman
- School of Public Health, University College Cork, Cork, Ireland.
- National Suicide Research Foundation, Cork, Ireland.
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Mount Gravatt, QLD, Australia.
| | | | | | - Paul Corcoran
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
| | - Eve Griffin
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
| | - Caleb Leduc
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
| | - Evelien Coppens
- Centre for Care Research and Consultancy, LUCAS, KU Leuven, Louvain, Belgium
| | - Fotini Tsantila
- Centre for Care Research and Consultancy, LUCAS, KU Leuven, Louvain, Belgium
| | - Victoria Ross
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Mount Gravatt, QLD, Australia
| | - Kahar Abdulla
- European Alliance Against Depression E.V, Leipzig, Germany
| | - Pia Hauck
- European Alliance Against Depression E.V, Leipzig, Germany
| | - Benedikt L Amann
- Centre Fòrum Research Unit, Institut de Neuropsiquiatria I Addiccions, Barcelona, 08019, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain
- Univ. Pompeu Fabra, Barcelona, Spain
| | - Birgit Aust
- The National Research Centre for the Working Environment, Copenhagen, Denmark
| | | | | | - Luigia D'Alessandro
- International Association for Suicide Prevention (IASP), Washington, DC, USA
| | - Naim Fanaj
- College of Medical Sciences Rezonanca, Mental Health Center Prizren, Prishtina, Kosovo
| | | | - Jeroen Luyten
- Department of Public Health and Primary Care, Faculty of Medicine, Leuven Institute for Healthcare Policy, KU Leuven, Belgium
| | - Sharna Mathieu
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Mount Gravatt, QLD, Australia
| | - Margaret Maxwell
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP-RU), Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Gentiana Qirjako
- Department of Public Health, Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Hanna Reich
- German Depression Foundation, Leipzig, Germany
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Depression Research Centre of the German Depression Foundation, University Hospital, Goethe University, Frankfurt Am Main, Germany
| | - Sarita Sanches
- Phrenos Center of Expertise for Severe Mental Illness, Utrecht, The Netherlands
- Altrecht Mental Health Care, Utrecht, The Netherlands
| | - Monika Ditta Tóth
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Joseph Kilroy
- The Chartered Institute of Building, Dublin, Ireland
| | - Karen Michell
- Institution of Occupational Safety and Health, Leicester, UK
| | - Nicola Reavley
- School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, Centre for Mental Health, The University of Melbourne, Melbourne, Australia
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Chantal Van Audenhove
- Centre for Care Research and Consultancy, LUCAS, KU Leuven, Louvain, Belgium
- Academic Center for General Practice, KU Leuven, Louvain, Belgium
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Nikunlaakso R, Reuna K, Oksanen T, Laitinen J. Associations between accumulating job stressors, workplace social capital, and psychological distress on work-unit level: a cross-sectional study. BMC Public Health 2023; 23:1559. [PMID: 37587453 PMCID: PMC10428655 DOI: 10.1186/s12889-023-16506-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/10/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Psychosocial job stressor studies usually examine one exposure at a time and focus on individual workers. In this study we examined the accumulation of work stressors in work units and its association with psychological distress (PD) on work-unit level. We also investigated whether high workplace social capital modifies the effect. METHODS We examined survey responses from 813 Finnish health and social services (HSS) work units, comprising 9 502 employees, in a cross-sectional study design. The survey was conducted in 2021. We calculated odds ratios for the association between accumulating job stressors and PD. We also analyzed the interaction between work stressors and the effect modification of high workplace social capital. RESULTS We found that HSS work units with high percentage of employees having high job demands and low rewards (OR 7.2, 95% CI 3.7, 13.8) have an increased risk of higher PD in the work unit. We also found indication of high social capital possibly modifying the effect of job stressors on PD. The results suggest that accumulated job stressors are associated with PD on work unit level, with excess risk for PD compared to the stressors acting separately. CONCLUSIONS The results indicate that the effect of accumulating job stressors should be further studied on work-unit level. Participatory organizational-level and work-unit level interventions to tackle job stressors and to improve workplace social capital are warranted.
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Affiliation(s)
| | - Kaisa Reuna
- Finnish Institute of Occupational Health, 20520 Turku, Finland
| | - Tuula Oksanen
- University of Eastern Finland, 70210 Kuopio, Finland
| | - Jaana Laitinen
- Finnish Institute of Occupational Health, 90220 Oulu, Finland
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Berthelsen H, Owen M, Westerlund H. Does workplace social capital predict care quality through job satisfaction and stress at the clinic? A prospective study. BMC Public Health 2021; 21:1320. [PMID: 34225680 PMCID: PMC8259017 DOI: 10.1186/s12889-021-11320-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background Welfare societies like Sweden face challenges in balancing the budget while meeting the demand for good quality healthcare. The aim of this study was to analyse whether care quality, operationalized as survival of dental fillings, is predicted by workplace social capital and if this effect is direct or indirect (through stress and/or job satisfaction among staff at the clinic), controlling for patient demographics. Methods The prospective design includes A) work environment data from surveys of 75 general public dental clinics (aggregated data based on 872 individual ratings), and B) register-based survival of 9381dental fillings performed during a 3-month period around the time of the survey, and C) patient demographics (age, gender, income level and birth place). Using a multi-level discrete-time proportional hazard model, we tested whether clinic-level social capital, stress, and job satisfaction could predict tooth-level filling failure, controlling for patient demographics. One direct and two indirect pathways, moderated by filling tooth, location, and filling type, were tested. Results High workplace social capital reduced the risk of early failure of fillings in molar teeth, mediated by group-perceived job satisfaction (indirect path: OR = 0.93, p < .05, direct path from job satisfaction: OR = 0.89, p < .05). Contrary to expectations, we found no support for a direct effect from social capital on care quality or for the indirect pathway via stress at the clinic level. Conclusions Workplace social capital boosted the quality of dental fillings through increased levels of job satisfaction. In addition, staff at clinics with higher social capital reported less stress and higher levels of job satisfaction. These results indicate that promotion of social capital may improve both occupational health and care quality.
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Affiliation(s)
- Hanne Berthelsen
- Centre for Work Life and Evaluation Studies (CTA) & Faculty of Odontology, Malmö University, Malmö, Sweden.
| | - Mikaela Owen
- Centre for Workplace Excellence, University of South Australia, Adelaide, SA, Australia
| | - Hugo Westerlund
- Department of Psychology, The Stress Research Institute, Stockholm University, Stockholm, Sweden
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