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Adamus C, Richter D, Sutor K, Zürcher SJ, Mötteli S. Preference for Competitive Employment in People with Mental Disorders: A Systematic Review and Meta-analysis of Proportions. J Occup Rehabil 2024:10.1007/s10926-024-10192-0. [PMID: 38662329 DOI: 10.1007/s10926-024-10192-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/24/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE The inclusion of people with mental disorders (MD) into competitive employment has become an important political and therapeutic goal. The present paper investigates meta-analytically to which extent people with MD who were unemployed or on sick leave due to MD prefer to work in a competitive job environment. METHODS For this systematic review and meta-analysis of proportions, we searched Medline, PsycInfo, Cinahl, Google Scholar, and reference lists for peer-reviewed publications from 1990 to Dec 2023, which provided data on the job preferences of people with MD. Two authors independently conducted full-text screening and quality assessments. Pooled proportions of job preferences were calculated with a random-effects meta-analysis of single proportions, and subgroup analyses were performed to examine characteristics associated with job preferences. RESULTS We included 30 studies with a total of 11,029 participants in the meta-analysis. The overall proportion of participants who expressed a preference for competitive employment was 0.61 (95%-CI: 0.53-0.68; I2 = 99%). The subgroup analyses showed different preference proportions between world regions where the studies were conducted (p < 0.01), publication years (p = 0.03), and support settings (p = 0.03). CONCLUSION Most people with MD want to work competitively. More efforts should be given to preventive approaches such as support for job retention. Interventions should be initiated at the beginning of the psychiatric treatment when the motivation to work is still high, and barriers are lower. TRAIL REGISTRATION The protocol is published in the Open Science registry at https://osf.io/7dj9r.
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Affiliation(s)
- Christine Adamus
- Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Bern, Switzerland.
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
- Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), 3098, Köniz, Switzerland.
| | - Dirk Richter
- Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Bern, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Kim Sutor
- Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Bern, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Simeon Joel Zürcher
- Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Bern, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sonja Mötteli
- Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Bern, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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LaMontagne AD, Too L, Witt K, Evans‐Whipp T, Owen PJ, Toumbourou JW. Does adolescent depression modify the association between psychosocial job stressors and mental health in emergent adulthood? Am J Ind Med 2024; 67:44-54. [PMID: 37924234 PMCID: PMC10952472 DOI: 10.1002/ajim.23547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Job stressors can be particularly harmful to the mental health of disadvantaged groups through differential exposure, differential sensitivity to the effects of exposure, or both. In this paper, we assess the extent to which emergent adult workers with an adolescent history of high depression symptoms may be differentially sensitive to the effect of job stressors on mental health. METHODS We conducted a secondary analysis of three waves of the Australian arm of the International Youth Development Study (n = 1262). We used multivariable linear regression to assess whether self-reported measures of high depression symptoms at one or two time points in adolescence (ages 11-16 years) modified the cross-sectional association between four self-reported job stressors (job demands, job control, job strain, and incivility at work) and psychological distress (Kessler-10 scores) in emergent adulthood (ages 23-27 years). RESULTS For all four job stressors, there was a consistent pattern of approximately a doubling in the magnitude of association for participants with a history of high depression symptoms at two points in adolescence compared with those with no history of depression. However, results of effect modification analysisfor only job demands and job strain excluded chance as a potential explanation. CONCLUSIONS Findings showed partial support for the hypothesis that a history of high depression symptoms in adolescence predicts stronger associations between job stressor exposures and psychological distress among those employed in emergent adulthood. The limitations of this secondary analysis suggest a need for purpose-designed studies to answer this important research question more definitively.
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Affiliation(s)
- Anthony D. LaMontagne
- Institute for Health TransformationDeakin UniversityGeelongVictoriaAustralia
- Melbourne School of Global & Population HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Lay‐San Too
- Melbourne School of Global & Population HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Katrina Witt
- Centre for Youth Mental HealthThe University of MelbourneMelbourneVictoriaAustralia
- OrygenParkvilleVictoriaAustralia
| | - Tracy Evans‐Whipp
- Australian Institute of Family StudiesSouthbankVictoriaAustralia
- Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia
| | - Patrick J. Owen
- Institute for Health TransformationDeakin UniversityGeelongVictoriaAustralia
| | - John W. Toumbourou
- Centre for Social and Early Emotional Development (SEED)Deakin UniversityGeelongVictoriaAustralia
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Zahiriharsini A, Gilbert-Ouimet M, Langlois L, Biron C, Pelletier J, Beaulieu M, Truchon M. Associations between psychosocial stressors at work and moral injury in frontline healthcare workers and leaders facing the COVID-19 pandemic in Quebec, Canada: A cross-sectional study. J Psychiatr Res 2022; 155:269-278. [PMID: 36162193 PMCID: PMC9477440 DOI: 10.1016/j.jpsychires.2022.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/30/2022] [Accepted: 09/12/2022] [Indexed: 11/11/2022]
Abstract
Healthcare workers (HCWs) on the frontline of the COVID-19 pandemic exhibit a high prevalence of depression and psychological distress. Moral injury (MI) can lead to such mental health problems. MI occurs when perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations. Since the start of the pandemic, psychosocial stressors at work (PSWs) might have been exacerbated, which might in turn have led to an increased risk of MI in HCWs. However, research into the associations between PSWs and MI is lacking. Considering these stressors are frequent and most of them are modifiable occupational risk factors, they may constitute promising prevention targets. This study aims to evaluate the associations between a set of PSWs and MI in HCWs during the third wave of the COVID-19 pandemic in Quebec, Canada. Furthermore, our study aims to explore potential differences between urban and non-urban regions. The sample of this study consisted of 572 HCWs and leaders from the Quebec province. Prevalence ratios (PR) of MI and their 95% confidence intervals (CI) were modelled using robust Poisson regressions. Several covariates were considered, including age, sex, gender, socio-economic indicators, and lifestyle factors. Results indicated HCWs exposed to PSWs were 2.22-5.58 times more likely to experience MI. Low ethical culture had the strongest association (PR: 5.58, 95% CI: 1.34-23.27), followed by low reward (PR: 4.43, 95% CI: 2.14-9.16) and high emotional demands (PR: 4.32, 95% CI: 1.89-9.88). Identifying predictors of MI could contribute to the reduction of mental health problems and the implementation of targeted interventions in urban and non-urban areas.
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Affiliation(s)
- Azita Zahiriharsini
- Department of Health Sciences, Université du Québec à Rimouski, Quebec, Canada; CHU de Québec-Laval University Research Center, Quebec, Canada; Réseau intersectoriel de recherche en santé de l'Université du Québec (RISUQ), Quebec, Canada.
| | - Mahée Gilbert-Ouimet
- Department of Health Sciences, Université du Québec à Rimouski, Quebec, Canada,CHU de Québec-Laval University Research Center, Quebec, Canada,Réseau intersectoriel de recherche en santé de l’Université du Québec (RISUQ), Quebec, Canada
| | - Lyse Langlois
- Faculty of Social Sciences, Department of Industrial Relations, Laval University, Quebec, Canada
| | - Caroline Biron
- Department of Management, Laval University, Quebec, Canada
| | - Jérôme Pelletier
- Department of Health Sciences, Université du Québec à Rimouski, Quebec, Canada
| | | | - Manon Truchon
- School of Psychology, Laval University, Quebec, Canada,Centre de recherche interdisciplinaire en réadaptation et intégration sociale (CIRRIS), Quebec, Canada
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Carazo S, Pelletier M, Talbot D, Jauvin N, De Serres G, Vézina M. Psychological Distress of Healthcare Workers in Québec (Canada) During the Second and the Third Pandemic Waves. J Occup Environ Med 2022; 64:495-503. [PMID: 35051960 PMCID: PMC9275796 DOI: 10.1097/jom.0000000000002487] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE We aimed to measure the prevalence of psychological distress among Quebec healthcare workers (HCWs) during the second and third pandemic waves and to assess the effect of psychosocial risk factors (PSRs) on work-related psychological distress among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected (cases) and non-infected (controls) HCWs. METHODS A self-administered survey was used to measure validated indicators of psychological distress (K6 scale) and PSR (questions based on Karasek and Siegrist models, value conflicts, and work-life balance). Adjusted robust Poisson models were used to estimate prevalence ratios. RESULTS Four thousand sixty eight cases and 4152 controls completed the survey. Prevalence of high work-related psychological distress was 42%; it was associated with PSRs (mainly work-life balance, value conflicts, and high psychological demands) but not with SARS-CoV-2 infection. CONCLUSION Primary prevention measures targeting PSRs are needed to reduce mental health risks of HCWs.
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Affiliation(s)
- Sara Carazo
- From the Centre Hospitalier Universitaire de Québec-Laval University Research Center (Dr Carazo, Dr Talbot, Dr Serres); Biological and Occupational Risks Unit, Quebec National Institute of Public Health (Dr Carazo, Dr Pelletier, Dr Jauvin, Dr Serres, Dr Vézina); Social and Preventive Medicine Department, Faculty of Medicine, Laval University (Dr Talbot, Dr Serres, Dr Vézina), Québec, Québec, Canada
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Amendola S, Hengartner MP, Ajdacic-Gross V, Angst J, Rössler W. Longitudinal reciprocal associations between depression, anxiety, and substance use disorders over three decades of life. J Affect Disord 2022; 302:315-323. [PMID: 35093414 DOI: 10.1016/j.jad.2022.01.101] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Studies exploring longitudinal reciprocal associations between depressive, anxiety, and substance use disorders (DD, AD and SUD, respectively) over long periods of time are mainly lacking. Therefore, the aim of the present study is to test longitudinal associations (i.e. temporal dynamics) between DD, AD and SUD from young adulthood to middle adulthood. METHODS A stratified community sample of 591 participants from the canton of Zurich, Switzerland, was interviewed with the Structured Psychopathological Interview and Rating of the Social Consequences of Psychological Disturbances for Epidemiology over seven interview waves from ages 20/21 to 49/50. Diagnostic and Statistical Manual of Mental Disorders criteria were used to evaluate the presence of DD, AD and SUD. We fitted an auto-regressive cross-lagged path analysis within a Bayesian structural equation model to test longitudinal associations. RESULTS Regarding autoregressive effects, AD (except during young adulthood) and SUD predicted themselves over the entire time period, while DD recurrently predicted itself not consistently over time. Regarding cross-lagged effects, DD predicted SUD at different time points, and vice versa. DD predicted subsequent AD in adulthood, whereas the reverse did not happen. Female gender was associated with DD and AD at all ages while male gender was associated with SUD only in young adulthood. CONCLUSIONS Reciprocal longitudinal associations were found between DD and SUD and DD usually preceded AD. Our results further confirm an increased risk of DD and AD in women and a higher risk of SUD in young men. Early treatment and broad psychosocial interventions should be provided in order to prevent chronicity and further maladjustment as well as interrupting the cycle of mutual reinforcement between DD and SUD.
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Affiliation(s)
- Simone Amendola
- Department of Dynamic and Clinical Psychology and Health Studies, Faculty of Medicine and Psychology, Sapienza - University of Rome, Rome, Italy.
| | | | - Vladeta Ajdacic-Gross
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Jules Angst
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland; Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Sao Paulo, Brazil; Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Germany
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Balint EM, Angerer P, Guendel H, Marten-Mittag B, Jarczok MN. Stress Management Intervention for Leaders Increases Nighttime SDANN: Results from a Randomized Controlled Trial. Int J Environ Res Public Health 2022; 19:3841. [PMID: 35409525 DOI: 10.3390/ijerph19073841] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 02/01/2023]
Abstract
Stress management interventions aim to reduce the disease risk that is heightened by work stress. Possible pathways of risk reduction include improvements in the autonomous nervous system, which is indexed by the measurement of heart rate variability (HRV). A randomized controlled trial on improving stress management skills at work was conducted to investigate the effects of intervention on HRV. A total of 174 lower management employees were randomized into either the waiting list control group (CG) or the intervention group (IG) receiving a 2-day stress management training program and another half-day booster after four and six months. In the trial, 24 h HRV was measured at baseline and after 12 months. Heart rate (HR), root mean square of successive differences (RMSSD), standard deviation of normal-to-normal intervals (SDNN), and standard deviation of the average of normal-to-normal intervals (SDANN) were calculated for 24 h and nighttime periods. Age-adjusted multilevel mixed effects linear regressions with unstructured covariance, time as a random coefficient, and time × group interaction with the according likelihood-ratio tests were calculated. The linear mixed-effect regression models showed neither group effects between IG and CG at baseline nor time effects between baseline and follow-up for SDANN (24 h), SDNN (24 h and nighttime), RMSSD (24 h and nighttime), and HR (24 h and nighttime). Nighttime SDANN significantly improved in the intervention group (z = 2.04, p = 0.041) compared to the control group. The objective stress axis measures (SDANN) showed successful stress reduction due to the training. Nighttime SDANN was strongly associated with minimum HR. Though the effects were small and only visible at night, it is highly remarkable that 3 days of intervention achieved a measurable effect considering that stress is only one of many factors that can influence HR and HRV.
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Langella F, Vanni D, Høgh M, Palsson TS, Christensen SWM, Bellosta-López P, Villafañe JH, Jensen PS, Silva PDB, Herrero P, Barletta P, Domenéch-García V, Berjano P. Development of the Prevent for Work Questionnaire (P4Wq) for the assessment of musculoskeletal risk factors in the workplace: part 2-pilot study for questionnaire development and validation. BMJ Open 2021; 11:e053988. [PMID: 34952882 PMCID: PMC9066351 DOI: 10.1136/bmjopen-2021-053988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The aim of this study was to develop a multifactorial, self-report questionnaire: Prevent for Work Questionnaire (P4Wq). The questionnaire is intended for screening for risk factors in work-related musculoskeletal disorders (WMSDs). DESIGN Data were collected from otherwise healthy workers employed in three service areas at a specialist hospital in Italy: healthcare, administration and ancillary services. SETTING AND PARTICIPANTS In all, 115 participants were enrolled (67% women; average age 41.5±9.94 years). The content of the tool for WMSDs was derived from three participation rounds of analysis involving a select group of experts who identified the questionnaire domains and items. Participants responded to 89 items in addition to the EuroQol 5 Dimensions Questionnaire (EQ-5D-5L), Fear-Avoidance Beliefs Questionnaire (FABq) and Oswestry Disability Index (ODI). The proportion of missing data and the distribution of responses were analysed for each item. Items with a discrimination index >0.40 and an interitem correlation <0.80 were retained. Factor analysis was performed using the VARIMAX rotation method, factor extraction, and identification, assignment of items to subscales, and assignment of scores to items. Internal consistency, reliability, construct validity and face validity were also assessed. RESULTS A total of 52 items were included in the factor analysis and four subscales identified: Physical Stress Subscore (six items); Mental Stress Subscore (six items); Job Satisfaction Subscore (four items) and Kinesiophobia/Catastrophizing Subscore (four items). The items in the final questionnaire version had a factor loading >0.7. The questionnaire consisted of 20 items with good internal consistency (Cronbach's alpha 0.81-0.91), reliability (weighted kappa coefficient 0.617-1.00), good construct validity (EQ-5D-5L, r=-0.549, p<0.001; ODI, r=0.549, p<0.001; FABq work, r=0.688, p<0.001) and satisfactory face validity (universal validity index 96.04%). CONCLUSION The P4Wq is a 20-item, multifactorial self-report risk assessment questionnaire. It may provide a useful tool for screening for WMSDs by specifically addressing back disorders. It investigates risks for individual workers and may inform educational programmes and preventive strategies tailored to a worker's needs. TRIAL REGISTRATION NUMBER NCT04192604.
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Affiliation(s)
| | | | - Morten Høgh
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | - Steffan Wittrup McPhee Christensen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark
| | - Pablo Bellosta-López
- Department of Physiotherapy, Faculty of Health Sciences, Universidad San Jorge, 50830 Villanueva de Gállego, Zaragoza, Spain
| | | | - Palle Schlott Jensen
- Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark
| | | | - Pablo Herrero
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Aragón, Spain
| | | | - Victor Domenéch-García
- Department of Physiotherapy, Faculty of Health Sciences, Universidad San Jorge, 50830 Villanueva de Gállego, Zaragoza, Spain
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Moe C, Brinchmann B, Rasmussen L, Brandseth OL, McDaid D, Killackey E, Rinaldi M, Borg M, Mykletun A. Implementing individual placement and support (IPS): the experiences of employment specialists in the early implementation phase of IPS in Northern Norway. The IPSNOR study. BMC Psychiatry 2021; 21:632. [PMID: 34930203 PMCID: PMC8690340 DOI: 10.1186/s12888-021-03644-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For decades there has been a continuous increase in the number of people receiving welfare benefits for being outside the work force due to mental illness. There is sufficient evidence for the efficacy of Individual Placement and Support (IPS) for gaining and maintaining competitive employment. Yet, IPS is still not implemented as routine practice in public community mental health services. Knowledge about implementation challenges as experienced by the practitioners is limited. This study seeks to explore the experiences of the front-line workers, known as employment specialists, in the early implementation phase. METHODS Qualitative data were collected through field notes and five focus group interviews. The study participants were 45 IPS employment specialists located at 14 different sites in Northern Norway. Transcripts and field notes were analysed by thematic analyses. RESULTS While employment specialists are key to the implementation process, implementing IPS requires more than creating and filling the role of the employment specialist. It requires adjustments in multiple organisations. The new employment specialist then is a pioneer of service development. Some employment specialists found this a difficult challenge, and one that did not correspond to their expectations going into this role. Others appreciated the pioneering role. IPS implementation also challenged the delegation of roles and responsibilities between sectors, and related legal frameworks related to confidentiality and access. The facilitating role of human relationships emphasised the importance of social support which is an important factor in a healthy work environment. Rural areas with long distances and close- knit societies may cause challenges for implementation. CONCLUSION The study provides increased understanding on what happens in the early implementation phase of IPS from the employment specialists' perspective. Results from this study can contribute to increased focus on job satisfaction, turnover and recruitment of employment specialists, factors which have previously been shown to influence the success of IPS. The greatest challenge for making "IPS efficacy in trials" become "IPS effectiveness in the real world" is implementation, and this study has highlighted some of the implementation issues.
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Affiliation(s)
- Cathrine Moe
- Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway. .,Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.
| | - Beate Brinchmann
- grid.420099.6Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway ,grid.10919.300000000122595234Department of Community Medicine, UiT – The Arctic University of Norway, Tromsø, Norway
| | - Line Rasmussen
- grid.420099.6Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway
| | - Oda Lekve Brandseth
- grid.420099.6Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway
| | - David McDaid
- grid.13063.370000 0001 0789 5319Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Eóin Killackey
- grid.488501.0Orygen, Melbourne, Australia ,grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Miles Rinaldi
- grid.439450.f0000 0001 0507 6811South West London and St George’s Mental Health NHS Trust, London, UK
| | - Marit Borg
- grid.420099.6Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway ,grid.463530.70000 0004 7417 509XUniversity of South-Eastern Norway, Drammen, Norway
| | - Arnstein Mykletun
- grid.420099.6Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway ,grid.10919.300000000122595234Department of Community Medicine, UiT – The Arctic University of Norway, Tromsø, Norway ,grid.412008.f0000 0000 9753 1393Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway ,grid.418193.60000 0001 1541 4204Division for Health Sciences, Norwegian Institute of Public Health, Oslo, Norway
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Manaf MRA, Shaharuddin MA, Nawi AM, Tauhid NM, Othman H, Rahman MRA, Yusoff HM, Safian N, Ng PY, Manaf ZA, Kadir NBA, Yanasegaran K, Basir SMA, Ramakrishnappa S, Ariff MI, Ganasegeran K. Perceived Symptoms of Depression, Anxiety and Stress amongst Staff in a Malaysian Public University: A Workers Survey. Int J Environ Res Public Health 2021; 18:11874. [PMID: 34831628 DOI: 10.3390/ijerph182211874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 11/17/2022]
Abstract
Mental health conditions are a major part of workers’ health that predisposes to poor self-motivation for sustaining productivity. This study was aimed to determine the prevalence of depression, anxiety, and stress among staff in a Malaysian public university and its associated factors. A cross-sectional study was conducted among 459 staff from the Universiti Kebangsaan Malaysia (UKM) between April and June 2019. A questionnaire that consisted of items on socio-demographic and socioeconomic characteristics, employment description, lifestyle risk behaviors, personal medical history, and symptoms of depression, anxiety, and stress was administered to participants. Descriptive and inferential statistics were conducted using SPSS version 22.0. The prevalence of perceived symptoms of depression, anxiety, and stress among the respondents was 28.7%, 50.1%, and 14.8%, respectively. Over one-quarter (26.5%) of the participants presented symptoms of two or more mental disorders. Women, those aged less than 40 years old, and non-academic professionals were more likely to exhibit depressive symptoms, while those with medical conditions that required hospitalizations sustained anxiety symptoms. Perceived stress was more likely to be prevalent among staff with secondary education or less and smokers. Proactive support for staff needs to be offered in sustaining their emotional well-being.
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Bergin AJ, Tucker MK, Jimmieson NL. Praise and recognition from supervisors buffers employee psychological strain: A two-sample investigation with tourism workers. Work 2021; 70:531-546. [PMID: 34657863 DOI: 10.3233/wor-213590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Focusing on employees with psychological strain, this research draws on Fredrickson's 'undoing hypothesis' to examine praise and recognition from one's supervisor as an organizational resource. OBJECTIVE A model is tested in which psychological strain is a mediator in the positive relationship between role demands and employees' intentions to take sick leave and seek medical advice, and positions supervisor praise and recognition as a buffer of psychological strain on such intentions. METHODS The model was tested using two Australian samples in the tourism sector, consisting of motel workers (n = 104) and museum workers (n = 168). RESULTS For museum workers, but not motel workers, there was a positive indirect effect of each role demand on sick leave intentions through psychological strain that weakened as a function of supervisor praise and recognition. The proposed moderated mediated model was supported for both samples in regards to intentions to seek medical advice. CONCLUSIONS This research contributes new evidence regarding the antecedents of employees' intentions to take sick leave and seek medical advice for work stress-related problems. It also contributes to the limited evidence regarding supervisor praise and recognition as a protective factor for employees exhibiting the symptoms of psychological strain.
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Affiliation(s)
- Adele J Bergin
- School of Management, Queensland University of Technology, Queensland, Australia
| | - Michelle K Tucker
- School of Management, Queensland University of Technology, Queensland, Australia
| | - Nerina L Jimmieson
- School of Management, Queensland University of Technology, Queensland, Australia
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Harvey SB, Epstein RM, Glozier N, Petrie K, Strudwick J, Gayed A, Dean K, Henderson M. Mental illness and suicide among physicians. Lancet 2021; 398:920-930. [PMID: 34481571 PMCID: PMC9618683 DOI: 10.1016/s0140-6736(21)01596-8] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 04/09/2021] [Accepted: 07/01/2021] [Indexed: 12/11/2022]
Abstract
The COVID-19 pandemic has heightened interest in how physician mental health can be protected and optimised, but uncertainty and misinformation remain about some key issues. In this Review, we discuss the current literature, which shows that despite what might be inferred during training, physicians are not immune to mental illness, with between a quarter and a third reporting increased symptoms of mental ill health. Physicians, particularly female physicians, are at an increased risk of suicide. An emerging consensus exists that some aspects of physician training, working conditions, and organisational support are unacceptable. Changes in medical training and health systems, and the additional strain of working through a pandemic, might have amplified these problems. A new evidence-informed framework for how individual and organisational interventions can be used in an integrated manner in medical schools, in health-care settings, and by professional colleagues is proposed. New initiatives are required at each of these levels, with an urgent need for organisational-level interventions, to better protect the mental health and wellbeing of physicians.
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Affiliation(s)
- Samuel B Harvey
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia.
| | - Ronald M Epstein
- Center for Communication and Disparities Research, Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Nicholas Glozier
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Katherine Petrie
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia; School of Psychiatry, UNSW Medicine, University of New South Wales, Kensington, NSW, Australia
| | - Jessica Strudwick
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
| | - Aimee Gayed
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
| | - Kimberlie Dean
- School of Psychiatry, UNSW Medicine, University of New South Wales, Kensington, NSW, Australia; Justice Health and Forensic Mental Health Network, Matraville, NSW, Australia
| | - Max Henderson
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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12
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Lahdenperä M, Virtanen M, Myllyntausta S, Pentti J, Vahtera J, Stenholm S. Psychological Distress During the Retirement Transition and the Role of Psychosocial Working Conditions and Social Living Environment. J Gerontol B Psychol Sci Soc Sci 2021; 77:135-148. [PMID: 34396418 PMCID: PMC8755891 DOI: 10.1093/geronb/gbab054] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Indexed: 11/23/2022] Open
Abstract
Objectives Mental health is determined by social, biological, and cultural factors and is sensitive to life transitions. We examine how psychosocial working conditions, social living environment, and cumulative risk factors are associated with mental health changes during the retirement transition. Method We use data from the Finnish Retirement and Aging study on public sector employees (n = 3,338) retiring between 2014 and 2019 in Finland. Psychological distress was measured with the General Health Questionnaire annually before and after retirement and psychosocial working conditions, social living environment, and accumulation of risk factors at the study wave prior to retirement. Results Psychological distress decreased during the retirement transition, but the magnitude of the change was dependent on the contexts individuals retire from. Psychological distress was higher among those from poorer psychosocial working conditions (high job demands, low decision authority, job strain), poorer social living environment (low neighborhood social cohesion, small social network), and more cumulative risk factors (work/social/both). During the retirement transition, greatest reductions in psychological distress were observed among those with poorer conditions (work: absolute and relative changes, p [Group × Time interactions] < .05; social living environment and cumulative risk factors: absolute changes, p [Group × Time interactions] < .05). Discussion Psychosocial work-related stressors lead to quick recovery during the retirement transition but the social and cumulative stressors have longer-term prevailing effects on psychological distress. More studies are urged incorporating exposures across multiple levels or contexts to clarify the determinants of mental health during the retirement transition and more generally at older ages.
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Affiliation(s)
- Mirkka Lahdenperä
- Department of Public Health, University of Turku and Turku University Hospital, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Finland
| | - Marianna Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Saana Myllyntausta
- Department of Public Health, University of Turku and Turku University Hospital, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Finland.,School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Jaana Pentti
- Department of Public Health, University of Turku and Turku University Hospital, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Finland.,Clinicum, Faculty of Medicine, University of Helsinki, Finland
| | - Jussi Vahtera
- Department of Public Health, University of Turku and Turku University Hospital, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Finland
| | - Sari Stenholm
- Department of Public Health, University of Turku and Turku University Hospital, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Finland
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13
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Leach LS, Dinh H, Cooklin A, Nicholson JM, Strazdins L. Australian parents' work-family conflict: accumulated effects on children's family environment and mental health. Soc Psychiatry Psychiatr Epidemiol 2021; 56:571-581. [PMID: 32813025 DOI: 10.1007/s00127-020-01944-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 08/07/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Many parents struggle to balance their work and family responsibilities. Yet, little research in the field of social psychiatry has explored the emergence of work-family conflict (WFC) as an important social determinant of mental health, particularly for children. The current study used longitudinal Australian population-based data to investigate the impact of parents' accumulated experiences of work-family conflict on children's mental health. Levels of parent psychological distress, marital satisfaction and parenting irritability were examined as potential explanatory factors within the family environment. METHODS The study used five waves of data from the Australian Longitudinal Study of Australian Children (LSAC), a representative community sample of Australian children and their parents. Analyses were restricted to coupled, employed mothers (1903) and fathers (1584) who reported their WFC levels in all five waves. Structural Equation Modelling (SEM) was used to examine the association between accumulated experiences of work-family conflict across all time-points (AWFC) and children's mental health at wave 5. Family environment factors were assessed as possible explanatory mediators. RESULTS There was a significant association between AWFC and children's mental health at wave 5. Parent psychological distress, marital satisfaction and parenting irritability were all found to significantly explain this association (accounting for 66% of the total effect). CONCLUSIONS Children whose parents have ongoing or accumulated difficulties managing their work and family responsibilities are more likely to have poorer mental health. This has important implications for family-friendly work arrangements and demonstrates the need to further understand the intergenerational impacts of parents' jobs on their children's psychological wellbeing.
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Affiliation(s)
- Liana S Leach
- National Centre for Epidemiology and Population Health (NCEPH), Research School of Population Health, The Australian National University, Building 62, Acton, 2601, Australia.
| | - Huong Dinh
- National Centre for Epidemiology and Population Health (NCEPH), Research School of Population Health, The Australian National University, Building 62, Acton, 2601, Australia
| | - Amanda Cooklin
- Judith Lumley Centre, La Trobe University, Bundoora, VIC, Australia
| | - Jan M Nicholson
- Judith Lumley Centre, La Trobe University, Bundoora, VIC, Australia
| | - Lyndall Strazdins
- National Centre for Epidemiology and Population Health (NCEPH), Research School of Population Health, The Australian National University, Building 62, Acton, 2601, Australia
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14
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Irizar P, Stevelink SAM, Pernet D, Gage SH, Greenberg N, Wessely S, Goodwin L, Fear NT. Probable post-traumatic stress disorder and harmful alcohol use among male members of the British Police Forces and the British Armed Forces: a comparative study. Eur J Psychotraumatol 2021; 12:1891734. [PMID: 33968324 PMCID: PMC8079084 DOI: 10.1080/20008198.2021.1891734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Background: British Armed Forces' and Police Forces' personnel are trained to operate in potentially traumatic conditions. Consequently, they may experience post-traumatic stress disorder (PTSD), which is often comorbid with harmful alcohol use. Objective: We aimed to assess the proportions, and associations, of probable PTSD and harmful alcohol use among a covariate-balanced sample of male military personnel and police employees. Methods: Proportions of probable PTSD, harmful alcohol use, and daily binge drinking, were explored using data from the police Airwave Health Monitoring Study (2007-2015) (N = 23,826) and the military Health and Wellbeing Cohort Study (phase 2: 2007-2009, phase 3: 2014-2016) (N = 7,399). Entropy balancing weights were applied to the larger police sample to make them comparable to the military sample on a range of pre-specified variables (i.e. year of data collection, age and education attainment). Multinomial and logistic regression analyses determined sample differences in outcome variables, and associated factors (stratified by sample). Results: Proportions of probable PTSD were similar in military personnel and police employees (3.67% vs 3.95%), although the large sample size made these borderline significant (Adjusted Odds Ratio (AOR): 0.84; 95% Confidence Intervals (CI): 0.72 to 0.99). Clear differences were found in harmful alcohol use among military personnel, compared to police employees (9.59% vs 2.87%; AOR: 2.79; 95% CI: 2.42 to 3.21). Current smoking, which was more prevalent in military personnel, was associated with harmful drinking and binge drinking in both samples but was associated with PTSD in military personnel only. Conclusions: It is generally assumed that both groups have high rates of PTSD from traumatic exposures, however, low proportions of PTSD were observed in both samples, possibly reflecting protective effects of unit cohesion or resilience. The higher level of harmful drinking in military personnel may relate to more prominent drinking cultures or unique operational experiences.
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Affiliation(s)
- Patricia Irizar
- Department of Psychology, Institute of Population Health, University of Liverpool, UK
| | - Sharon A M Stevelink
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - David Pernet
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Suzanne H Gage
- Department of Psychology, Institute of Population Health, University of Liverpool, UK
| | - Neil Greenberg
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Simon Wessely
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Laura Goodwin
- Department of Psychology, Institute of Population Health, University of Liverpool, UK
| | - Nicola T Fear
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,Academic Department of Military Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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15
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Almroth M, Hemmingsson T, Sörberg Wallin A, Kjellberg K, Burström B, Falkstedt D. Psychosocial working conditions and the risk of diagnosed depression: a Swedish register-based study. Psychol Med 2021; 52:1-9. [PMID: 33682646 PMCID: PMC9772906 DOI: 10.1017/s003329172100060x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/26/2021] [Accepted: 02/05/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND High job demands, low job control, and their combination (job strain) may increase workers' risk of depression. Previous research is limited by small populations, not controlling for previous depression, and relying on the same informant for reporting exposure and outcome. This study aims to examine the relationship between objectively measured workplace factors and the risk of developing clinical depression among the Swedish working population while controlling for previous psychiatric diagnoses and sociodemographic factors. METHODS Control, demands, and job strain were measured using the Swedish Job Exposure Matrix (JEM) measuring psychosocial workload linked to around 3 million individuals based on their occupational titles in 2005. Cox regression models were built to estimate associations between these factors and diagnoses of depression recorded in patient registers. RESULTS Lower job control was associated with an increased risk of developing depression (HR 1.43, 95% CI 1.39-1.48 and HR 1.27, 95% CI 1.24-1.30 for men and women with the lowest control, respectively), and this showed a dose-response relationship among men. Having high job demands was associated with a slight decrease in depression risk for men and women. High strain and passive jobs (both low control jobs) were associated with an increased risk of depression among men, and passive jobs were associated with an increased risk among women. CONCLUSION High job control appears important for reducing the risk of developing depression even when accounting for previous psychiatric diagnoses and sociodemographic factors. This is an important finding concerning strategies to improve occupational and in turn mental health.
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Affiliation(s)
- Melody Almroth
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Hemmingsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
| | - Alma Sörberg Wallin
- Department of Global Public health, Karolinska Institutet, Stockholm, Sweden
| | - Katarina Kjellberg
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Bo Burström
- Department of Global Public health, Karolinska Institutet, Stockholm, Sweden
| | - Daniel Falkstedt
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
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16
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Too LS, Leach L, Butterworth P. Cumulative impact of high job demands, low job control and high job insecurity on midlife depression and anxiety: a prospective cohort study of Australian employees. Occup Environ Med 2020; 78:oemed-2020-106840. [PMID: 33208409 DOI: 10.1136/oemed-2020-106840] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/09/2020] [Accepted: 10/14/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE There is a lack of evidence concerning the prospective effect of cumulative exposure to psychosocial job stressors over time on mental ill-health. This study aimed to assess whether cumulative exposure to poor quality jobs places employees at risk of future common mental disorder. METHODS Data were from the Personality and Total Health Through Life project (n=1279, age 40-46 at baseline). Data reported on the cumulative exposure to multiple indicators of poor psychosocial job quality over time (ie, a combination of low control, high demands and high insecurity) and future common mental disorder (ie, depressive and/or anxiety symptom scores above a validated threshold) 12 years later. Data were analysed using logistic regression models and controlled for potential confounders across the lifespan. RESULTS Cumulative exposure to poor-quality work (particularly more secure work) on multiple occasions elevated the risk of subsequent common mental disorder, independent of social, health, verbal intelligence and personality trait confounders (OR=1.30, 95% CI 1.06 to 1.59). CONCLUSIONS Our findings show that cumulative exposure to poor psychosocial job quality over time independently predicts future common mental disorder-supporting the need for workplace interventions to prevent repeated exposure of poor quality work.
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Affiliation(s)
- Lay San Too
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
- Centre for Research on Ageing, Health & Wellbeing, Research School of Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Liana Leach
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Peter Butterworth
- Centre for Research on Ageing, Health & Wellbeing, Research School of Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
- Melbourne Institute of Applied Economic and Social Research, The University of Melbourne, Parkville, Victoria, Australia
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17
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Jiang Y, Wu C, Hu T, Chen M, Liu W, Zhou Y, Chen Z, Xu X. Association for combined exposure to job strain, shift work on mental health among Chinese railway workers: a cross-sectional study. BMJ Open 2020; 10:e037544. [PMID: 33122313 PMCID: PMC7597467 DOI: 10.1136/bmjopen-2020-037544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess the effects of coexposure to job strain and shift work on mental health in railway workers. DESIGN Cross-sectional study. SETTING One Railway Bureau Group in China. PARTICIPANTS A total of 1270 front-line railway workers. OUTCOME MEASURES The Symptom Checklist-90-Revised questionnaire was used to measure general mental health. Job strain variables were derived from the Job Content Questionnaire. Based on the records of the work schedule 3 months prior to the survey, the following three shift types were identified: fixed day, fixed night and rotating night shifts. Risks associated with mental health were assessed by carrying out logistic regression analysis which was adjusted for age, job tenure, smoking and exercise. Additionally, a crossover analysis was employed for the combined effects. RESULTS High levels of job strain were linked to a higher risk of poor mental health (OR=1.53, 95% CI: 1.10 to 2.11). After adjusting for confounding factors, night shifts and rotating night shifts were significant risk factors for mental health (OR=2.21, 95% CI: 1.60 to 3.07; OR=2.36, 95% CI: 1.73 to 3.22). Compared with participants who experienced a low level of job strain and day shifts, those with a high level of job strain and who worked rotating shifts were at the highest risk of poor mental health (OR=4.68, 95% CI: 2.91 to 8.04), whereas the influence of a low level of job strain and rotating night shifts was not statistically significant. CONCLUSION Job strain and night shifts among workers were associated, both independently and in combination, with an increased risk of poor mental health. Our data suggest that job strain contributes to the risk of poor mental health by means of a combined effect with shift work.
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Affiliation(s)
- Yu Jiang
- Public Health, Fujian Medical University, Fuzhou, China
| | - Chuancheng Wu
- Public Health, Fujian Medical University, Fuzhou, China
| | - Tianqi Hu
- Public Health, Fujian Medical University, Fuzhou, China
| | - Meilong Chen
- Occupational Health, Fuzhou Railway Centers for Disease Control and Prevention, Fuzhou, China
| | - Wei Liu
- Public Health, Fujian Medical University, Fuzhou, China
| | - Yabing Zhou
- Humanities, Fujian Medical University, Fuzhou, China
| | - Zhibing Chen
- Public Health, Fujian Medical University, Fuzhou, China
| | - Xin Xu
- Public Health, Fujian Medical University, Fuzhou, China
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18
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Duchaine CS, Aubé K, Gilbert-Ouimet M, Vézina M, Ndjaboué R, Massamba V, Talbot D, Lavigne-Robichaud M, Trudel X, Pena-Gralle APB, Lesage A, Moore L, Milot A, Laurin D, Brisson C. Psychosocial Stressors at Work and the Risk of Sickness Absence Due to a Diagnosed Mental Disorder: A Systematic Review and Meta-analysis. JAMA Psychiatry 2020; 77:842-851. [PMID: 32236498 PMCID: PMC7113841 DOI: 10.1001/jamapsychiatry.2020.0322] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Mental health problems are associated with considerable occupational, medical, social, and economic burdens. Psychosocial stressors at work have been associated with a higher risk of mental disorders, but the risk of sickness absence due to a diagnosed mental disorder, indicating a more severe condition, has never been investigated in a systematic review and meta-analysis. OBJECTIVE To synthesize the evidence of the association of psychosocial stressors at work with sickness absence due to a diagnosed mental disorder among adult workers. DATA SOURCES Seven electronic databases (MEDLINE, Embase, PsycInfo, Web of Science, CINAHL, Sociological Abstracts, and International Bibliography of the Social Sciences), 3 gray literature databases (Grey Literature Report, WHO-IRIS and Open Grey), and the reference lists of all eligible studies and reviews were searched in January 2017 and updated in February 2019. STUDY SELECTION Only original prospective studies evaluating the association of at least 1 psychosocial stressor at work from the 3 most recognized theoretical models were eligible: the job demand-control-support model, including exposure to job strain (high psychological demands with low job control); effort-reward imbalance model; and organizational justice model. Study selection was performed in duplicate by blinded independent reviewers. Among the 28 467 citations screened, 23 studies were eligible for systematic review. DATA EXTRACTION AND SYNTHESIS This meta-analysis followed the PRISMA and MOOSE guidelines. Data extraction and risk of bias evaluation, using the Risk of Bias in Nonrandomized Studies-Interventions tool, were performed in duplicate by blinded independent reviewers. Data were pooled using random-effect models. MAIN OUTCOMES AND MEASURES Sickness absence due to a mental disorder with a diagnosis obtained objectively. RESULTS A total of 13 studies representing 130 056 participants were included in the 6 meta-analyses. Workers exposed to low reward were associated with a higher risk of sickness absence due to a diagnosed mental disorder compared with nonexposed workers (pooled risk ratio [RR], 1.76 [95% CI, 1.49-2.08]), as were those exposed to effort-reward imbalance (pooled RR, 1.66 [95% CI, 1.37-2.00]), job strain (pooled RR, 1.47 [95% CI, 1.24-1.74]), low job control (pooled RR, 1.25 [95% CI, 1.02-1.53]), and high psychological demands (pooled RR, 1.23 [95% CI, 1.04-1.45]). CONCLUSIONS AND RELEVANCE This meta-analysis found that workers exposed to psychosocial stressors at work were associated with a higher risk of sickness absence due to a mental disorder. A better understanding of the importance of these stressors could help physicians when evaluating their patients' mental health and work capacity.
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Affiliation(s)
- Caroline S. Duchaine
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada,Faculty of Medicine, Laval University, Quebec City, Québec, Canada,Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Quebec City, Québec, Canada
| | - Karine Aubé
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada
| | | | - Michel Vézina
- Institut national de santé publique du Québec, Quebec City, Québec, Canada
| | - Ruth Ndjaboué
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada,Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Quebec City, Québec, Canada
| | - Victoria Massamba
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada,Faculty of Medicine, Laval University, Quebec City, Québec, Canada
| | - Denis Talbot
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada,Faculty of Medicine, Laval University, Quebec City, Québec, Canada
| | - Mathilde Lavigne-Robichaud
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada,Faculty of Medicine, Laval University, Quebec City, Québec, Canada
| | - Xavier Trudel
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada,Faculty of Medicine, Laval University, Quebec City, Québec, Canada
| | - Ana-Paula Bruno Pena-Gralle
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada,Faculty of Medicine, Laval University, Quebec City, Québec, Canada
| | - Alain Lesage
- Department of Psychiatry, University of Montreal, Montreal, Québec, Canada
| | - Lynne Moore
- Faculty of Medicine, Laval University, Quebec City, Québec, Canada
| | - Alain Milot
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada,Faculty of Medicine, Laval University, Quebec City, Québec, Canada
| | - Danielle Laurin
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada,Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Quebec City, Québec, Canada,Faculty of Pharmacy, Laval University, Quebec City, Québec, Canada
| | - Chantal Brisson
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada,Faculty of Medicine, Laval University, Quebec City, Québec, Canada,Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Quebec City, Québec, Canada
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Hengartner MP. How effective are antidepressants for depression over the long term? A critical review of relapse prevention trials and the issue of withdrawal confounding. Ther Adv Psychopharmacol 2020; 10:2045125320921694. [PMID: 32435449 PMCID: PMC7225779 DOI: 10.1177/2045125320921694] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/27/2020] [Indexed: 12/20/2022] Open
Abstract
The aim of this article is to discuss the validity of relapse prevention trials and the issue of withdrawal confounding in these trials. Recommendations for long-term antidepressant treatment are based almost exclusively on discontinuation trials. In these relapse prevention trials, participants with remitted depression are randomised either to have the antidepressant abruptly discontinued and replaced by inert placebo or to continue active treatment. The drug-placebo difference in relapse rates at the end of the maintenance phase is then interpreted as a prophylactic drug effect. These trials consistently produce remarkable benefits for maintenance treatment. However, the internal validity of this trial protocol is compromised, as research has shown that abruptly stopping antidepressants can cause severe withdrawal reactions that lead to (or manifest as) depression relapses. That is, there is substantial withdrawal confounding in discontinuation trials, which renders their findings uninterpretable. It is not clear to what degree the drug-placebo separation in relapse prevention (discontinuation) trials is due to withdrawal reactions, but various estimations suggest that it is presumably the majority. A review of findings based on other methodologies, including real-world long-term effectiveness trials like STAR*D and various naturalistic cohort studies, do not indicate that antidepressants have considerable prophylactic effects. As absence of evidence does not imply evidence of absence, no definitive conclusions can be drawn from the literature. To enable a thorough risk-benefit evaluation, real-world effectiveness trials should not only focus on relapse prevention, but also assess antidepressants' long-term effects on social functioning and quality of life. Thus far, reliable long-term data on these outcome domains are lacking.
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Affiliation(s)
- Michael P. Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences (ZHAW), PO Box 707, Zurich, CH-8037, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
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20
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Svane-Petersen AC, Holm A, Burr H, Framke E, Melchior M, Rod NH, Sivertsen B, Stansfeld S, Sørensen JK, Virtanen M, Rugulies R, Madsen IEH. Psychosocial working conditions and depressive disorder: disentangling effects of job control from socioeconomic status using a life-course approach. Soc Psychiatry Psychiatr Epidemiol 2020; 55:217-228. [PMID: 31506742 DOI: 10.1007/s00127-019-01769-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/03/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Job control, the combination of skill discretion and decision authority, is considered a central component of the psychosocial working environment. This longitudinal study examines the relation between job control and risk of incident depressive disorder using a life-course approach. METHODS We analyze data from The Danish Work Life Course Cohort study, including all Danish individuals aged 15-30 who entered the Danish labor market during 1995-2009 and were free from depressive disorder at entry (955,573 individuals). We measured job control using a job exposure matrix. Depressive disorders were measured using information from nationwide registers of psychiatric in- and outpatient admissions. Using Cox regression models we estimated the prospective association between job control and risk of incident depressive disorders. Analyses accounted for a range of potential confounders prior to workforce entry including socioeconomic status in adolescence and parental psychiatric and somatic diagnoses prior to labor market entry, together with potential confounders in adulthood including income, education, and demographics. RESULTS Lower levels of past year job control were associated with a higher risk of depressive disorder after adjustment for all covariates (HR = 1.27, 95% CI 1.16-1.38). Results stratified by gender showed associations for both men (HR = 1.38, 95% CI 1.19-1.61) and women (HR = 1.19, 95% CI 1.08-1.32). CONCLUSIONS Our findings suggest that the level of job control at work affects the risk of clinically diagnosed depressive disorder, and that this association is not due to confounding by socioeconomic status.
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Affiliation(s)
| | - Anders Holm
- Department of Sociology, University of Western Ontario, London, Canada
| | - Hermann Burr
- Department of Work and Health, Federal Institute for Occupational Safety and Health, Berlin, Germany
| | - Elisabeth Framke
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Maria Melchior
- INSERM, Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | - Naja Hulvej Rod
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Børge Sivertsen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Department of Research and Innovation, Helse Fonna HF, Haugesund, Norway.,Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Stephen Stansfeld
- Centre for Psychiatry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Marianna Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Reiner Rugulies
- National Research Centre for the Working Environment, Copenhagen, Denmark.,Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Ida E H Madsen
- National Research Centre for the Working Environment, Copenhagen, Denmark.
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21
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Bergin AJ, Jimmieson NL. The importance of supervisor emotion recognition for praise and recognition for employees with psychological strain. Anxiety, Stress, & Coping 2020; 33:148-164. [DOI: 10.1080/10615806.2020.1716975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Adele J. Bergin
- School of Management, Queensland University of Technology, Brisbane, Australia
| | - Nerina L. Jimmieson
- School of Management, Queensland University of Technology, Brisbane, Australia
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Siegrist J, Wege N. Adverse Psychosocial Work Environments and Depression-A Narrative Review of Selected Theoretical Models. Front Psychiatry 2020; 11:66. [PMID: 32174849 PMCID: PMC7056901 DOI: 10.3389/fpsyt.2020.00066] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/27/2020] [Indexed: 11/29/2022] Open
Abstract
Far-reaching progress of treatment and prevention of depressive disorders is still limited, mainly due to the multifactorial determinants of these disorders and the restricted knowledge of their aetiology. Stressful socio-environmental conditions represent one of the multifactorial determinants, and in view of the centrality of work and employment for human well-being, research on health-adverse psychosocial work environments turned out to be a promising line of scientific inquiry. During the past three decades, respective research focused mainly on three theoretical models of adverse psychosocial work and their measurement in prospective epidemiologic studies, termed "demand-control," "effort-reward imbalance," and "organizational injustice." This report provides a review of current evidence on their associations with depression, based on several systematic reviews and updated by most recent publications. Moreover, it discusses the conceptual and methodological strengths and weaknesses of these associations. In summary, the results of more than 40 cohort studies from a variety of Western modern societies confirm that stressful work in terms of these models is associated with a moderately increased risk of subsequent onset of depression. While this knowledge is considered robust enough to instruct efforts of primary and secondary prevention, several methodological challenges still need to be resolved by future research.
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Affiliation(s)
- Johannes Siegrist
- Centre for Health and Society, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Natalia Wege
- Clinic for Psychiatry and Psychotherapy, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
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23
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Gayed A, Tan L, LaMontagne AD, Milner A, Deady M, Milligan-Saville JS, Madan I, Calvo RA, Christensen H, Mykletun A, Glozier N, Harvey SB. A comparison of face-to-face and online training in improving managers' confidence to support the mental health of workers. Internet Interv 2019; 18:100258. [PMID: 31890611 PMCID: PMC6926278 DOI: 10.1016/j.invent.2019.100258] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/13/2019] [Accepted: 07/04/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In recognition of the important role managers play in the well-being of the staff they supervise, many workplaces are implementing specialised training for leaders to help them better understand and support the mental health needs of their staff. This training can be delivered through face-to-face or online training sessions. Evaluation of such programs have found positive results for each format when compared to a control group, but to date, face-to-face and online manager mental health training have not been compared with one another. AIMS This study brings together results from two trials evaluating the same program content, each employing a different mode of content delivery. Both types of training aimed to change managers' confidence to better support the mental health needs of the staff they supervise. METHODS Utilising data derived from two previously conducted trials, mean change in manager confidence from baseline at both post-intervention and follow-up were examined for each method of content delivery. An identical way of measuring confidence was used in each study. RESULTS Managers' confidence improved from baseline with both methods of training. A greater change was observed with face-to-face training than for online, although both methods had sustained improvement over time. Analyses indicate that at follow-up, improvements in confidence were significant for both face-to-face (t 18 = 5.99; P < .001) and online training (t 39 = 3.85; P < .001). Analyses focused on managers who fully completed either type of training indicated very similar impacts for face-to-face and online training. CONCLUSIONS Both face-to-face and online delivery of manager mental health training can significantly improve managers' confidence in supporting the mental health needs of their staff. This change is sustained over various follow-up periods. However, lower retention rates common in online training reduce the relative effect of this method of delivery.
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Affiliation(s)
- Aimée Gayed
- School of Psychiatry, University of New South Wales, Sydney, Australia,Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, Australia,Corresponding author at: School of Psychiatry, University of New South Wales, Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia.
| | - Leona Tan
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Anthony D. LaMontagne
- Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia,School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Allison Milner
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Mark Deady
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | | | - Ira Madan
- Occupational Health Department, The Education Centre, Guy's and St Thomas' NHS Trust, London, UK,Department of Population Health Sciences, King's College London, London, UK
| | - Rafael A. Calvo
- Dyson School of Design Engineering, Imperial College London, London, UK,School of Electrical and Information Engineering, University of Sydney, Sydney, Australia
| | - Helen Christensen
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Arnstein Mykletun
- School of Psychiatry, University of New South Wales, Sydney, Australia,Department of Mental Health and Suicide, Norwegian Institute of Public Health, Oslo, Norway,Department of Community Medicine, University of Tromsø, Tromsø, Norway,Centre for Work and Mental Health, Nordland Hospital Trust, Bodø, Norway,Centre for Research and Education in Forensic Psychiatry and Psychology, Haukeland University Hospital, Bergen, Norway
| | - Nicholas Glozier
- Brain and Mind Centre & Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Samuel B. Harvey
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, Australia
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Kristman VL, Lowey J, Fraser L, Armstrong S, Sawula S. A multi-faceted community intervention is associated with knowledge and standards of workplace mental health: the Superior Mental Wellness @ Work study. BMC Public Health 2019; 19:638. [PMID: 31126273 PMCID: PMC6534893 DOI: 10.1186/s12889-019-6976-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/14/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Poor psychosocial work environments, such as those with low psychological support and high demands, can be harmful to the mental health of workers. In Canada, the National Standard for Psychological Health and Safety in the Workplace (the Standard) provides a comprehensive framework for organizations to identify hazards that may contribute to the psychological harm of employees. This study examines the association between a multi-faceted community intervention, the Superior Mental Wellness @ Work program designed to increase awareness of mental health and the National Standard, and outcomes assessing increased awareness and response to the Standard. These outcomes included the 1) prioritization of workplace mental health; 2) familiarity with the Standard; and 3) knowledge of mental health. METHODS A quasi-experimental design was used to assess the associations of interest. Surveys were sent to two random samples of employer representatives pre-and post-intervention. Intervention participants were also compared to non-participants at the post-intervention stage. T-tests and chi-square tests were used to compare differences between pre- and post-intervention outcomes and also between intervention participants and non-participants identified at the post-intervention survey. RESULTS The multi-faceted community intervention was associated with increased familiarity of the Standard, and increased knowledge of mental health challenges, mental health promotion, and existing resources at a community-level. When comparing those companies who participated in the intervention versus those who did not, participants were more likely to prioritize mental health in the workplace. Participants reported a greater need for support to address workplace mental health, poorer perceived mental health of employees, and greater stigma than non-participants. However, participants were more likely to be familiar with the Standard, have an action plan to implement the Standard, and be prepared to champion mental health in the workplace. Participants also had greater knowledge of workplace mental health in general compared to non-participants. CONCLUSIONS The multi-faceted community intervention, the Superior Mental Wellness @ Work project, was associated with increased familiarity of the Standard, and increased knowledge of mental health challenges, mental health promotion, and existing resources at a community-level. Such a multi-faceted intervention has the capacity to improve mental health literacy and awareness of the Standard.
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Affiliation(s)
- Vicki L. Kristman
- EPID@Work Research Institute, Lakehead University, Thunder Bay, Ontario Canada
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario Canada
- Division of Human Sciences, Northern Ontario School of Medicine, Thunder Bay, Ontario Canada
- Institute for Work & Health, Toronto, Ontario Canada
| | - Jessica Lowey
- EPID@Work Research Institute, Lakehead University, Thunder Bay, Ontario Canada
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario Canada
| | - Lynda Fraser
- Thunder Bay District Health Unit, Thunder Bay, Ontario Canada
| | - Susan Armstrong
- Thunder Bay District Health Unit, Thunder Bay, Ontario Canada
| | - Silva Sawula
- Thunder Bay District Health Unit, Thunder Bay, Ontario Canada
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25
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Fan JK, Mustard C, Smith PM. Psychosocial Work Conditions and Mental Health: Examining Differences Across Mental Illness and Well-Being Outcomes. Ann Work Expo Health 2019; 63:546-559. [DOI: 10.1093/annweh/wxz028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 03/01/2019] [Accepted: 05/02/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jonathan K Fan
- Institute for Work & Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Cameron Mustard
- Institute for Work & Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Peter M Smith
- Institute for Work & Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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26
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Oliveira AJ, Neto GAM, Barros OD, Pedreiro R, Murillo-Rodriguez E, de Leon ACP, Machado S. Association between physical fitness and psychological distress among Brazilian armed force personnel. Sport Sci Health 2019. [DOI: 10.1007/s11332-018-0503-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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