Gender differences in job strain, social support at work, and psychological distress

The Benefits and Challenges of Employment for Working Professionals Diagnosed with Mental Illness

The purpose of this study is to explore how professional employment impacts mental health among people with mental illness, and how having a mental illness impacts job performance, both positively and negatively. The research is based on in-depth interview data from 56 professionals diagnosed with mental illness, and the interview transcripts are analyzed in accordance with the flexible coding model of qualitative data analysis. We find that working conditions of professional jobs pose challenges to managing symptoms of mental illness, including the pressures of responsibility and exposure to secondary trauma. However, professional employment also provides benefits such as social connections and feeling accountable. Similarly, symptoms cause problems at work like having angry outbursts, yet experience with mental illness informs job performance such as by increasing empathy with others. We use these findings to recommend new directions for research and argue for inclusion of people with mental illness in the workplace.

Precarious Employment and Psychosocial Hazards: A Cross-Sectional Study in Stockholm County

Precarious employment (PE) has been linked to adverse health effects, possibly mediated through psychosocial hazards. The aim of this cross-sectional study is to explore if higher levels of PE are associated with psychosocial hazards (experiences of violence, sexual harassment, bullying, discrimination, high demands, and low control) and to explore gender differences in these patterns. The study is based on survey- and register data from a sample of 401 non-standard employees in Stockholm County (2016–2017). The level of PE (low/high) was assessed with the Swedish version of the employment precariousness scale (EPRES-Se) and analysed in relation to psychosocial hazards by means of generalized linear models, with the Poisson family and robust variances. After controlling for potential confounders (gender, age, country of birth, and education), the prevalence of suffering bullying (PR 1.07, 95% CI: 1.01–1.13) and discrimination (PR 1.52, 95% CI: 1.00–2.32) was higher among individuals with a high level of PE. Regarding the demand/control variables, a high level of PE was also associated with low control (PR 1.59, 95% CI: 1.30–1.96) and passive work (the combination of low demands and low control) (PR 1.60, 95% CI: 1.23–2.08). Our findings suggest that workers in PE are more likely to experience psychosocial hazards, and these experiences are more prevalent among women compared to men. Future longitudinal studies should look further into these associations and their implications for health and health inequalities.

Depression symptoms mediate the association between workplace stress and interleukin 6 in women, but not men: The Whitehall II study

Workplace stress and depression are positively related with inflammation, and each other. Low-grade inflammation and concurrent high levels of workplace stress or depression has been related with future morbidity. The potential pathway between constructs however, remains elusive. For the first time, this study explored the concurrent relationship between workplace stress, depressive symptomology and low-grade inflammation, and considered the role of gender in these relationships. Data from the Whitehall II cohort study (N ​= ​2528, M_age ​= ​57.01, 23.7% females) provided measures of workplace stress (job demand-control; JDC), depressive symptomology (Centre for Epidemiological Studies Depression scale; CES-D) and circulating inflammatory markers, interleukin-6 (IL-6) and C-reactive protein (CRP) collected on the same day from a single time point. Females had higher workplace stress, depressive symptoms and lower serum IL-6 concentrations. For males, higher workplace stress was associated with higher depressive symptoms. For females, higher depressive symptoms were related with elevated IL-6 levels, and both higher workplace stress and IL-6 levels were associated with higher depressive symptoms. Higher depressive symptoms were related with higher CRP levels in men only. Higher depressive symptoms statistically mediated the relationship between higher workplace stress and IL-6 levels in females only, b ​= ​0.016, CI [0.002, 0.039]. Females in this large cohort had higher levels of job strain, depression and lower IL-6 concentrations than males. In females, higher depressive symptoms were associated with higher serum IL-6 levels and workplace stress was not. Considered together, these findings suggest that low job control may be more apparent in females than males, but it is primarily negative affect that drives the positive relationship between work stress and serum IL-6 concentrations in females. Replicating the current design with a suitably proximal follow-up is required to determine if the associations identified are causal.

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Females had higher workplace stress, depressive symptoms and lower IL-6.

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Association between stress, depression and inflammation was stronger in women.

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Among females, depressive symptoms and not stress associated with serum IL-6. .

Socioeconomic Status, Mental Health, and Workplace Determinants among Working Adults in Hong Kong: A Latent Class Analysis

This study provides insights on mental health correlates and work stress patterns in a representative sample of working adults in Hong Kong using an intersectional perspective. Using data from a cross-sectional, population-based telephone survey of 1007 working adults in Hong Kong, latent class analysis was conducted to identify socioeconomic classes within the sample. Three latent classes were identified, and they differed significantly in all the SES variables. Results suggested mental health to be the lowest in Class 1, the lowest income group. The three classes did not differ from their perceived level of job demand and control in work-related stress. Predictably, the highest income group perceived the lowest level of effort-reward imbalance. The lowest paid class was also reported perceiving the lowest level of relational justice. Different barriers to mental health services were also identified. Finally, cultural implications associated with work stress patterns, research, and practice implications are discussed. This study provides an empirical foundation for future studies to investigate patterns of job stress and mental health needs in a diverse population of working adults, with a particular focus on addressing the intersectional profiles of working adults and their needs in mental health services.

Do working conditions contribute differently to gender gaps in self-rated health within different occupational classes? Evidence from the Swedish Level of Living Survey

Socioeconomic inequality in health among women is often referred to as smaller than health inequality among men. However, we know less about differences in health between men and women within the same socioeconomic groups. In this article the lack of attention to potential socioeconomic variation in gender health inequality is argued as unfortunate, as it can obscure how mechanisms, such as e.g. working conditions, affect gendered health within specific groups. Drawing on the nationally representative Swedish Level of Living survey (LNU), class/gender interactions as well as class-separate linear probability models are estimated to explore relationships between working conditions and health among men and women with the same occupational class positions. Results show that, although class is not a large explanatory factor for general gender differences in health, there are varying within-class differences between men and women in working conditions, that can contribute to the understanding of within-class gender differences in health. This highlights that, when targeting causes of gender health inequality, it is important to consider not only what class means for women as well as for men, but also what gender means within specific classes.

Descriptive study of workplace demand, control and bullying among migrant and Australian-born workers by gender: does workplace support make a difference?

OBJECTIVE

The objective of this study is to examine the relationship between bullying in migrants and Australians and types of workplace Iso-strain, by gender.

DESIGN AND SETTING

Two descriptive cross-sectional surveys of the Australian working population.

PARTICIPANTS

Australian-born workers of Caucasian ancestry (n=1051, participant response rate=87.3%) and workers born in New Zealand (n=566), India (n=633) and the Philippines (n=431) (participant response rate=79.5%).

PRIMARY AND SECONDARY OUTCOMES MEASURES

Using logistic regression, we examined whether self-reported assessment of various forms of bullying in the workplace was associated with Iso-strain (job with high demands and low control and without social support), gender and migrant status.

RESULTS

The prevalence of workplace bullying within the previous year was 14.5%. Sexual harassment, though rare (n=47, 1.8%), was reported by more women than men (83% vs 17%, χ²=19.3, p<0.0001) and more Australia or New Zealand born workers compared to India or the Philippines workers (75.5% vs 25.5%, χ²=4.6, p=0.032). Indian-born women had lower adjusted OR for being bullied and for being intimidated compared to other women. Independent of migrant status, Iso-strain (1), (low support from boss) and Iso-strain (2), (low support from colleagues) predicted being bullied. Women were more likely to be in an Iso-strain (1) job than men (18.7% vs 13.6%, p=0.013) and had twice the risk of being both verbally abused and intimidated compared to men (OR 9 vs OR 5.5, p<0.0001).

CONCLUSION

Workplace bullying was more likely for women than men. There were few differences between workers from different migrant groups. Iso-strain was the strongest predictor of workplace bullying. Workplaces should encourage supportive and collegiate work environments.

Well-Being: Its Relationship with Work-to-Family Conflict and Burnout among Males and Females

The present study aims to apply gender-specific analyses to examine how work-to-family conflict (WFC) and burnout are related to well-being among the workers in Taiwan. A cross-sectional research design was adopted. A questionnaire was distributed to obtain information pertaining to demographic characteristics, WFC, burnout, and well-being. In total, 4259 full-time workers in the manufacturing industry were recruited. Gender-specific statistical analyses were used. The results showed that no significant gender difference occurred on WFC; however, females had higher scores on burnout compared to males. In the correlation analyses, WFC as well as burnout were negatively associated with well-being in both genders. In the regression analyses when demographic factors were controlled, burnout explained larger variances of well-being in both genders compared with WFC. WFC made a smaller contribution to the models predicting well-being in males in contrast to females. Moreover, the significant association between WFC and well-being for males disappeared when burnout was taken into account. The conclusion reached was that to improve workers’ well-being, organizations should develop relevant policies to decrease the extent of burnout for different genders. The policies that the organization adopted should consider females’ needs beyond work-related burden. Moreover, merely decreasing the extent of WFC is insufficient to enhance males’ well-being.

Gender/Sex Differences in the Relationship between Psychosocial Work Exposures and Work and Life Stress

Objectives

Stress is an important factor affecting the health of working population. While work exposures are determinants of levels of work and life stress, we do not know whether similar or different exposures are related to stress levels for men and women. This study aimed to formally examine male/female differences in the relationships between psychosocial work exposures and work and life stress in a representative sample of Canadian labour market participants.

Methods

We used data from 2012 cycle of the Canadian Community Health Survey (CCHS), a representative population-based survey conducted by Statistics Canada. The sample was restricted to employed labour force participants working 15+ hours per week (N = 8328, 48% female). To examine the relationship between work exposures and work and life stress, we conducted path analyses. Psychosocial work exposures included social support, job insecurity, job control, and job strain. Differences between estimates for men and women were explored using multigroup analyses, constraining paths between male and female models to be equivalent and examining the impact on change in model fit.

Results

Male/female differences were observed in the relationships between supervisor support and work stress levels as well as between job control, job insecurity, job strain, and life stress levels. Higher levels of supervisor support at work were associated with lower work stress among women, but not among men. Low job control had a direct protective effect on life stress for men but not for women, while high job strain had a direct adverse effect on life stress among women but not among men. Higher job insecurity was more strongly associated with higher life stress among men compared with women. The relationship between work stress and life stress was similar among men and women.

Discussion

The findings of this study suggest that the relationships between psychosocial exposures and work and life stress differ for men and women. Our study also raised important questions about which work exposures are considered when assessing work stress, with level of job control not related to work stress but associated with levels of life stress among men.

Conclusion

Our study highlights the role of psychosocial work environment for both work and life stress and suggests differences in the importance of specific psychosocial work dimensions for feelings of stress among men and women, and for work stress versus life stress. Future study designs should ensure that measures are included to better disentangle the relative contribution of social and biological factors in explaining these differences among men and women.

Dissecting the effect of workplace exposures on workers' rating of psychological health and safety

Objectives

To validate the factor structure of the Copenhagen Psychosocial Questionnaire (COPSOQ) in a North American population and dissect the associations between psychosocial factors and workplace psychological health and safety.

Methods

Confirmatory factor analysis and multivariate linear regression were used to determine the associations between COPSOQ dimensions and a global rating of workplace psychological health and safety. Models were stratified by sex, gender roles, and age.

Results

The COPSOQ factor structure was verified among Canadian workers. Three factors were found to significantly contribute to the global rating of the psychological health and safety for all workers. Few differences were observed across sex, gender roles, and age.

Conclusions

This study identified dimensions of the psychosocial work environment that are strongly associated with the global rating of workplace psychological health and safety. Using a standardized questionnaire like the COPSOQ allows for comparisons over time, between different industries, and worker populations.

The association between exposure to psychosocial work factors and mental health in older employees, a 3-year follow-up study

Purpose

Unfavourable exposure to psychosocial work factors threatens older employees’ mental health, and their sustained employment. This study assesses whether an improved compared to stable unfavourable and stable favourable exposure to psychosocial work factors is associated with a change in mental health in older employees at 3-year follow-up.

Methods

The current study used data from the Study on Transitions in Employment, Ability and Motivation (STREAM), in workers aged 45–65 years (n = 5249). Two-year (2010–2012) exposure was assessed for psychological demands, autonomy, support, mental load, and distributive justice. Linear regression analyses were performed to compare improved exposure to unfavourable psychosocial work factors with stable unfavourable and stable favourable exposure and mental health at follow-up (2013), corrected for confounders. Analyses were stratified for age groups (45–54 and 55–65 years) and gender.

Results

In certain subgroups, stable unfavourable exposure to psychological demands, autonomy, support, and distributive justice was associated with a significantly lower mental health score than improved exposure. Stable favourable exposure to support was associated with a higher mental health score than improved support, whereas stable favourable exposure to autonomy was associated with a lower mental health score compared to improved exposure.

Conclusions

There is a longitudinal association between changes in exposure to psychosocial work factors and mental health. Improvement in unfavourable exposure to psychosocial work factors was associated with improved mental health. This is important information for organisations that consider deploying measures to improve the psychosocial work environment of older workers.

Electronic supplementary material

The online version of this article (doi:10.1007/s00420-017-1261-8) contains supplementary material, which is available to authorized users.

Domains of cognitive function in early old age: which ones are predicted by pre-retirement psychosocial work characteristics?

BACKGROUND

Psychosocial work characteristics may predict cognitive functioning after retirement. However, little research has explored specific cognitive domains associated with psychosocial work environments. Our study tested whether exposure to job demands, job control and their combination during working life predicted post-retirement performance on eight cognitive tests.

METHODS

We used data from French GAZEL cohort members who had undergone post-retirement cognitive testing (n=2149). Psychosocial job characteristics were measured on average for 4 years before retirement using Karasek's Job Content Questionnaire (job demands, job control and demand-control combinations). We tested associations between these exposures and post-retirement performance on tests for executive function, visual-motor speed, psychomotor speed, verbal memory, and verbal fluency using ordinary least squares regression.

RESULTS

Low job control during working life was negatively associated with executive function, psychomotor speed, phonemic fluency and semantic fluency after retirement (p's<0.05), even after adjustment for demographics, socioeconomic status, health and social behaviours and vascular risk factors. Both passive (low-demand, low-control) and high-strain (high-demand, low-control) jobs were associated with lower scores on phonemic and semantic fluency when compared to low-strain (low-demand, high-control) jobs.

CONCLUSIONS

Low job control, in combination with both high and low-job demands, is associated with post-retirement deficits in some, but not all, cognitive domains. In addition to work stress, associations between passive work and subsequent cognitive function may implicate lack of cognitive engagement at work as a risk factor for future cognitive difficulties.

Effects of Hospital Workers' Friendship Networks on Job Stress

BACKGROUND

This study attempted to identify the sources of job stress according to job position and investigate how friendship networks affect job stress.

METHODS

Questionnaires based on The Health Professions Stress Inventory (HPSI) developed by Wolfgang experienced by healthcare providers were collected from 420 nurses, doctors and radiological technologists in two general hospitals in Korea by a multistage cluster sampling method. Multiple regression analysis was used to examine the effects of friendship networks on job stress after controlling for other factors.

RESULTS

The severity of job stress differed according to level of job demands (p = .006); radiologic technologists experienced the least stress (45.4), nurses experienced moderate stress (52.4), and doctors experienced the most stress (53.6). Those with long-term friendships characterized by strong connections reported lower levels of stress than did those with weak ties to friends among nurses (1.3, p < .05) and radiological technologists (11.4, p < .01). The degree of cohesion among friends had a positive impact on the level of job stress experienced by nurses (8.2, p < .001) and radiological technologists (14.6, p < .1). Doctors who participated in workplace alumni meetings scored higher than those who did not. However, those who participated in alumni meetings outside the workplace showed the opposite tendency, scoring 9.4 (p < .05) lower than those who did not. The resources from their friendship network include both information and instrumental support. As most radiological technologists were male, their instrumental support positively affected their job stress (9.2, p < .05). Life information support was the primary positive contributor to control of nurses' (4.1, p < .05), radiological technologists' (8.0, p < .05) job stress.

CONCLUSION

The strength and density of such friendship networks were related to job stress. Life information support from their friendship network was the primary positive contributor to control of job stress.

Comparative study of major depressive symptoms among pregnant women by employment status

The objectives of our study were to compare the prevalence of major depressive symptoms between subgroups of pregnant women: working women, women who had stopped working, housewives and students; and to identify risk factors for major depressive symptoms during pregnancy. The CES-D scale (Center for Epidemiological Studies Depression scale) was used to measure major depressive symptoms (CES-D score ≥23) in 5337 pregnant women interviewed at 24–26 weeks of pregnancy. Multivariate logistic regression models were developed to identify risk factors associated with major depressive symptoms. Prevalence of major depressive symptoms was 11.9% (11.0–12.8%) for all pregnant women. Working women had the lowest proportion of major depressive symptoms [7.6% (6.6–8.7%); n = 2514] compared to housewives [19.1% (16.5–21.8%); n = 893], women who had stopped working [14.4% (12.7–16.1%); n = 1665], and students [14.3% (10.3–19.1%); n = 265]. After adjusting for major risk factors, the association between pregnant women’s employment status and major depressive symptoms remained significant for women who had stopped working (OR: 1.61; 95% CI 1.26 to 2.04) and for housewives (OR: 1.46; 95% CI 1.10 to 1.94), but not for students (OR: 1.37; 95% CI 0.87 to 2.16). In multivariate analyses, low education, low social support outside of work, having experienced acute stressful events, lack of money for basic needs, experiencing marital strain, having a chronic health problem, country of birth, and smoking were significantly associated with major depressive symptoms. Health professionals should consider the employment status of pregnant women when they evaluate risk profiles. Prevention, detection and intervention measures are needed to reduce the prevalence of prenatal depression.

Job stress across gender: the importance of emotional and intellectual demands and social support in women

This study aims to analyse whether any differences exist between the genders with respect to the effect of perceived Job Demands, Control and Support (JDCS model) on how individuals reach high levels of job stress. To do this, the perceived risk of suffering an illness or having an accident in the workplace is used as an outcome measure. The study is based on the First Survey on Working Conditions in Andalusia, which has a sample of 5,496 men and 2,779 women. We carry out a multi-sample analysis with structural equation models, controlling for age and sector. The results show that the generation of job stress has a different pattern in men and women. In the case of men, the results show that only one dimension of the job demands stressor is significant (quantitative demands), whose effect on job stress is weakened slightly by the direct effects of control and support. With women, in contrast, emotional and intellectual aspects (qualitative demands) are also statistically significant. Moreover, social support has a greater weakening effect on the levels of job stress in women than in men. These results suggest that applying the JDCS model in function of the gender will contribute to a greater understanding of how to reduce the levels of job stress in men and women, helping the design of more effective policies in this area.

Work and family demands: predictors of all-cause sickness absence in the GAZEL cohort

BACKGROUND

The aim of this study is to assess the impact of combined work and family demands on all-cause sickness absence and to examine variation in this relationship by occupational grade and gender.

METHODS

The study sample consists of 13,179 employees of Electricité de France-Gaz de France (EDF-GDF) who were members of the GAZEL occupational cohort in 1995. Combined work and family demands are assessed based on measures of job strain and number of dependants assessed at baseline (1995). Covariates include occupational grade and demographic, behavioural and social variables assessed at baseline. Ratios of sickness absence days to total person-days contributed by each employee were established from administrative data between baseline and the end of follow-up in 2003. Rate ratios across levels of work-family demands were then calculated. Effect modification by gender and grade of employment was tested.

RESULTS

In fully adjusted models, individuals with the highest work-family demands had a rate ratio of sickness absence of 1.78 (95% CI 1.47-2.14) compared with low-demand workers. This association was independent of occupational grade and did not vary with gender. Results were not attributable solely to psychiatric sickness absences.

CONCLUSION

High work-family demands at baseline predict long-term all-cause sickness absence across a socio-economically diverse occupational cohort.

Is social stress in the first half of life detrimental to later physical and mental health in both men and women?

This study examined gender differences in the associations between affection- and status-related stressors encountered in the first half of life and physical and mental health problems later on. Based on the theory of Social Production Functions (SPF) two hypotheses have been formulated, which were tested in a representative sample of 446 men and 514 women (aged 40–79). Main outcome measures were number of chronic somatic diseases and level of psychological distress. As expected, regression analyses showed no gender differences in the associations between affection-related stressors and physical and mental health problems later on. In contrast, but as also expected, status-related stressors encountered in the first half of life were associated with later physical and mental health for men only. It is concluded that the gender differences in the associations between earlier social stressors and later health problems may be more complex than the common assumption that men are only affected by status stress and women only by affection stress. This study contributes to the knowledge on gender differences concerning the link between social stress and health, and it indicates that social experiences encountered earlier in life are of importance for being healthy and happy in later life.

Inequalities in the psychological well-being of employed, single and partnered mothers: the role of psychosocial work quality and work-family conflict

Background

A large body of international research reveals that single mothers experience poorer mental health than their partnered counterparts, with socioeconomic disadvantage identified as an important contributory factor in understanding this health disparity. Much less research, however, has focused specifically on the psychological well-being of single mothers who are employed, despite their growing presence in the labor force. Of the research which has considered employment, the focus has been on employment status per se rather than on other important work-related factors which may impact psychological health, such as psychosocial work quality and work-family conflict. The aim of this study was to: (1) compare employed single mothers and employed partnered mothers on measures of psychological distress, psychosocial work quality and work-family conflict; and (2) explore the potential role of work-family conflict and psychosocial work quality as explanations for any observed differences in psychological distress based on partner status.

Method

Analysis of data obtained from a cross-sectional telephone survey of employed parents in a mid-sized Western Canadian city. Analyses were based on 674 employed mothers (438 partnered and 236 single), who were 25-50 years old, with at least one child in the household.

Results

Compared to employed single mothers, employed partnered mothers were older, had more education and reported fewer hours of paid work. Single mothers reported higher levels of psychological distress, financial hardship, work-family conflict and poor psychosocial work quality. Statistical adjustment for income adequacy, psychosocial work quality and work-family conflict each independently resulted in single motherhood no longer being associated with psychological distress.

Conclusions

While single employed mothers did experience higher levels of psychological distress than their partnered counterparts, differences between these groups of women in income adequacy, psychosocial work quality, and work-family conflict were found to explain this relationship. Future research employing a longitudinal design and subject to lower selection biases is required to tease out the interrelationship of these three life strains and to point to the most appropriate economic and social policies to support single mothers in the workforce.

Gender moderates the health-effects of job strain in managers

PURPOSE

To investigate cross-sectional associations between main, interactive and gender-dependent effects of the demand-control-support (DCS) model and subjective health in managers.

METHODS

Data of 424 German, Austrian and Swiss managers were collected at leadership seminars and through presentation of the study at meetings of staff managers and senior executives. Hierarchical regression models controlling for age, hierarchy and non-linear relationships were computed to assess associations between main, interactive and gender-dependent effects of the DCS dimensions (measures of job demands, job control, social support) and subjective health (measures of self rated health and psychosomatic complaints).

RESULTS

Social support was associated with both indicators of subjective health. Inconsistent results were obtained for the main effects of job demands and job control. Concerning the interaction effects of the model, a significant three-way interaction was observed: high job control and high social support seem to buffer the adverse health effects of high job demands. This interaction was moderated by gender. Female managers experience more psychosomatic complaints working in high demand, low control, low support settings than their male colleagues. While women seem to experience a higher buffering effect from social support than from job control, male managers may benefit equally from social support and job control.

CONCLUSIONS

In managers, gender moderates the health-related effects of the psychosocial work environment. The gender-dependent effects of the DCS model may play a crucial role in the understanding of female managers' adverse health perceptions. Increasing social support for female managers may help to overcome gender inequalities in management positions.

The demand-control-support model and health among women and men in similar occupations

The aim of the study was to investigate the main and the interaction effects of the demand-control-support (DCS) model on women's and men's health in a Swedish telecom company. According to the DCS model, work that is characterized by high demands, low decision latitude, and low support decreases health and well-being. Furthermore, control and support are assumed to interact in protecting against adverse health effects of stress. Earlier studies have failed to consider occupational status and gender simultaneously. Questionnaire data from 134 female and 145 male employees in similar occupations were collected. Correlational analysis supported the main effect hypotheses irrespective of gender. Hierarchical multiple regression analyses indicated that only demands predicted women's health, whereas both demands and lack of social support predicted men's health. However, no interaction effects were found for either women or men. Further studies should probe the relevance of the model while considering gender and occupational status.

[Validity of occupational stress and decision latitude on health in the National Population Health Survey of 1994-95]

Psychosocial environment at work is now considered a health determinant. The National Population Health Survey (NPHS) of 1994-95 is the first study in which psychological demands and decision latitude at work were measured in a random sample of the Canadian population. However, psychometric properties of the scales used in NPHS to measure these factors are not known. The objective of the present paper was to evaluate some validity parameters of the scales used in the NPHS by comparison to the original scales recommended by Karasek to measure these factors. Results of the current study support the validity of the decision latitude scale. However, validity of the psychological demand scale is more limited.