Seasonal patterns of sickness absence due to diagnosed mental disorders: a nationwide 12-year register linkage study

AIMS

Although seasonality has been documented for mental disorders, it is unknown whether similar patterns can be observed in employee sickness absence from work due to a wide range of mental disorders with different severity level, and to what extent the rate of change in light exposure plays a role. To address these limitations, we used daily based sickness absence records to examine seasonal patterns in employee sickness absence due to mental disorders.

METHODS

We used nationwide diagnosis-specific psychiatric sickness absence claims data from 2006 to 2017 for adult individuals aged 16-67 (n = 636,543 sickness absence episodes) in Finland, a high-latitude country with a profound variation in daylength. The smoothed time-series of the ratio of observed and expected (O/E) daily counts of episodes were estimated, adjusted for variation in all-cause sickness absence rates during the year.

RESULTS

Unipolar depressive disorders peaked in October-November and dipped in July, with similar associations in all forms of depression. Also, anxiety and non-organic sleep disorders peaked in October-November. Anxiety disorders dipped in January-February and in July-August, while non-organic sleep disorders dipped in April-August. Manic episodes reached a peak from March to July and dipped in September-November and in January-February. Seasonality was not dependent on the severity of the depressive disorder.

CONCLUSIONS

These results suggest a seasonal variation in sickness absence due to common mental disorders and bipolar disorder, with high peaks in depressive, anxiety and sleep disorders towards the end of the year and a peak in manic episodes starting in spring. Rapid changes in light exposure may contribute to sickness absence due to bipolar disorder. The findings can help clinicians and workplaces prepare for seasonal variations in healthcare needs.

The relative importance of work-related psychosocial factors in physician burnout

Background

Identifying the most significant risk factors for physician burnout can help to define the priority areas for burnout prevention. However, not much is known about the relative importance of these risk factors.

Aims

This study was aimed to examine the relative importance of multiple work-related psychosocial factors in predicting burnout dimensions among physicians.

Methods

In a cross-sectional sample of 2423 Finnish physicians, dominance analysis was used to estimate the proportionate contribution of psychosocial factors to emotional exhaustion, depersonalization and reduced personal accomplishment. The psychosocial factors included job demands (time pressure, patient-related stress, lack of support, stress related to information systems, work–family conflict) and job resources (job control, team climate, organizational justice).

Results

Together, psychosocial factors explained 50% of the variance in emotional exhaustion, 24% in depersonalization and 11% in reduced professional efficacy. Time pressure was the most important predictor of emotional exhaustion (change in total variance explained ΔR² = 45%), and patient-related stress was the most important predictor of both depersonalization (ΔR² = 52%) and reduced professional accomplishment (ΔR² = 23%). Stress related to information systems was the least important predictor of the burnout dimensions (ΔR² = 1–2%).

Conclusions

Psychosocial factors in physicians’ work are differently associated with the dimensions of burnout. Among the factors, the most significant correlates of burnout are job demands in the form of time pressure and patient-related stress.

Final clinical practicum of nursing education and transition experience of new nurses

Background

Challenges in transitioning from a student to a registered nurse may contribute to new nurses high turnover rates. Final clinical practicum (FCP) before graduation is known for its importance in preparing students for the transition but little is known about the specific elements of FCPs essential for successful transition. We examined the associations between multiple FCP elements and transition experiences in new nurses and whether work characteristics modified these associations.

Methods

The data were collected in 2018 with electronic survey. The sample comprised 712 Finnish nurses graduated within the last two years. Linear regression analyses was used to examine the association of five FCP elements (Preparing for demands; Being part of team; Systematicness of FCP; Teacher involvement; Quality of supervision) with the transition experience that was measured with four scales demonstrating its emotional, physical, socio-developmental and intellectual domains. Work characteristics were defined based on demand-control -model and multiple potential confounders were considered.

Results

Several associations were found between the FCP elements and the four transition indicators (psychological distress, sleep problems, role conflict/ambiguity and perception of transition/educational preparation). Systematicness of FCP was, however, the only element associated with all the transition indicators, whereas quality of supervision was not associated with any. Multiple interactions were also detected between the FCP elements and job demands.

Conclusions

Our results suggest that FCP experiences reflect to new nurses’ first years of employment. Especially systematic planning and implementation of FCP, collegial work atmosphere and an opportunity for students to become an active member of the work community should be ensured for promoting a smoother transition from student to nurse. This could increase the chances to retain new nurses in the health care workforce.

Key messages

Well planned and implemented final clinical practicums with an opportunity to become an active member of professional team could help nursing students to obtain a smoother transition into nurses. The benefits of having a good final clinical practicum experience may be squandered if considerably high level of job demands (e.g. timepressure) is experienced in the first years of employment.

Mental disorders and long-term labour market outcomes: nationwide cohort study of 2 055 720 individuals

OBJECTIVE

To examine the associations between an onset of serious mental disorders before the age of 25 with subsequent employment, income and education outcomes.

METHODS

Nationwide cohort study including individuals (n = 2 055 720) living in Finland between 1988-2015, who were alive at the end of the year they turned 25. Mental disorder diagnosis between ages 15 and 25 was used as the exposure. The level of education, employment status, annual wage or self-employment earnings, and annual total income between ages 25 and 52 (measurement years 1988-2015) were used as the outcomes.

RESULTS

All serious mental disorders were associated with increased risk of not being employed and not having any secondary or higher education between ages 25 and 52. The earnings for individuals with serious mental disorders were considerably low, and the annual median total income remained rather stable between ages 25 and 52 for most of the mental disorder groups.

CONCLUSIONS

Serious mental disorders are associated with low employment rates and poor educational outcomes, leading to a substantial loss of total earnings over the life course.

Organizational fairness and psychological distress in hospital physicians

Aims: Prior research has reported high levels of stress for physicians, but determinants of this stress are poorly understood. We explored whether problems in decision-making procedures and treatment of employees, as expressed in the theory of organizational fairness, may contribute to psychological distress in hospital physicians. Methods: Structural equation modelling (LISREL) was based on survey responses from 251 male and 196 female physicians working in 11 public hospitals in Finland. Results: Low organizational fairness increased the risk of psychological distress in male physicians but not in female physicians. In the former group, the association between organizational fairness and psychological distress was partially mediated by decreased job control and increased workload. Conclusions: These findings suggest that broadening the view from the traditional psychosocial work characteristics to justice in management may assist in efforts to promote physicians' health and well-being.

Associations of temporal and energetic characteristics of behavior with depressive symptoms: A population-based longitudinal study within Strelau's Regulative Theory of Temperament

BACKGROUND

Individual dispositions have previously been associated with increased risk for depressive symptoms. The direction of the association has been found to be sometimes reciprocal. We examined whether temperament traits are associated with depressive symptoms and whether depressive symptoms contribute to changes in temperament.

METHODS

Participants (n=674-811) were from a population-based Young Finns Study. Temperament was assessed by a Finnish version of the Formal Characteristics of Behavior - Temperament Inventory. Depressive symptoms were assessed with modified BDI (mBDI) in 1997, 2001, 2007 and 2012, and BDI-II in 2012.

RESULTS

Higher perseveration and emotional reactivity were associated with higher level of depressive symptoms, and higher endurance was associated with lower level of depressive symptoms in 2007 and 2012. These associations were independent of several potential confounders and baseline depressive symptoms. The results of cross-lagged structural equation modeling showed that the associations between temperament and depressive symptoms were reciprocal: briskness, endurance and activity decreased the risk for depressive symptoms while depressive symptoms decreased the level of these characteristics. Perseveration, emotional reactivity and depressive symptoms reinforced each other over time.

LIMITATIONS

The depressive symptoms scales we used are not meant for measuring clinically diagnosed depression. The relationships between temperament traits and depressive symptoms were not strong enough to provide a clinical basis for guiding treatment.

CONCLUSIONS

Lower perseveration, lower emotional reactivity and higher endurance seem to be health protective temperament characteristics that reduce the risk for depressive symptoms. The reciprocal associations between temperament and depressive symptoms imply mutual health protective and health declining effects. Clinical relevance of the study is that enhancing positive loops and self-concept, and supporting individual stress management might be helpful in prevention of depressive symptoms.

Higher effort-reward imbalance and lower job control predict exit from the labour market at the age of 61 years or younger: evidence from the English Longitudinal Study of Ageing

BACKGROUND

We examined whether higher effort-reward imbalance (ERI) and lower job control are associated with exit from the labour market.

METHODS

There were 1263 participants aged 50-74 years from the English Longitudinal Study on Ageing with data on working status and work-related psychosocial factors at baseline (wave 2; 2004-2005), and working status at follow-up (wave 5; 2010-2011). Psychosocial factors at work were assessed using a short validated version of ERI and job control. An allostatic load index was formed using 13 biological parameters. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale. Exit from the labour market was defined as not working in the labour market when 61 years old or younger in 2010-2011.

RESULTS

Higher ERI OR=1.62 (95% CI 1.01 to 2.61, p=0.048) predicted exit from the labour market independent of age, sex, education, occupational class, allostatic load and depression. Job control OR=0.60 (95% CI 0.42 to 0.85, p=0.004) was associated with exit from the labour market independent of age, sex, education, occupation and depression. The association of higher effort OR=1.32 (95% CI 1.01 to 1.73, p=0.045) with exit from the labour market was independent of age, sex and depression but attenuated to non-significance when additionally controlling for socioeconomic measures. Reward was not related to exit from the labour market.

CONCLUSIONS

Stressful work conditions can be a risk for exiting the labour market before the age of 61 years. Neither socioeconomic position nor allostatic load and depressive symptoms seem to explain this association.

Treatment of depression in diagnosed diabetes: common cause or detection bias?

BACKGROUND

This study examined two competing hypotheses concerning the association between diabetes and treatment for depression: (1) the detection/ascertainment bias hypothesis suggesting that those with diabetes are more likely to be diagnosed with and treated for depression because of increased medical attention and (2) a hypothesis assuming that diabetes and depression share common underlying pathophysiological pathways.

METHOD

The study population included all persons aged 35-65 years in Finland with any record of type 2 diabetes in the national health and population registers from 1999 to 2002 and for whom register-based data on depression treatment (antidepressant medication use and hospitalizations for depression) were available at least 2 years before and after the diagnosis of diabetes (n = 18,217). Sociodemographic data were individually linked to the study population. Associations between diabetes diagnosis and time and indicators of depression care were assessed with population-averaged multilevel logistic models.

RESULTS

Within the year following diagnosis diabetes, there was a 5% increase in antidepressant medication use but not in hospitalization for depression. The longitudinal change in antidepressant use over time was less steep after the diabetes diagnosis, and hospitalization risk decreased after the diagnosis. These associations between diabetes diagnosis and depression treatment were not modified by the participant's socio-economic position (SEP).

CONCLUSIONS

These findings support the common cause hypothesis that treatment for diabetes is beneficial to the prevention of depression rather than the detection/ascertainment hypothesis that individuals with diabetes have higher rates of depression because they receive more medical attention in general.

On-call work and physicians' well-being: testing the potential mediators

BACKGROUND

On-call duties have been rated to be among the most stressful aspects of physicians' work. On-call work has been associated, for example, with medical errors, injuries and lower well-being. Thus, because it is not possible to remove on-call duties, measures to decrease the negative ramifications of on-call work are needed.

AIMS

To examine whether working on-call would predict psychological distress, job satisfaction and work ability in a 4-year follow-up and whether sleeping problems or work interference with family (WIF) would act as mechanisms in these associations.

METHODS

Questionnaires in 2006 and 2010 among physicians in Finland. The mediation analyses were conducted using methods suggested by Preacher and Hayes to examine direct and indirect effects with multiple mediators.

RESULTS

There were 1541 respondents (60% women) of whom 52% had on-call duties. Sleeping problems and WIF acted as mechanisms in the association of existence of on-call duties with high distress, low job satisfaction and low work ability. On-call work was associated with higher levels of sleeping problems and WIF, and the number of active on-call hours was associated with higher levels of WIF, but not with sleeping problems.

CONCLUSIONS

According to our results, one way to attenuate on-call work's negative ramifications is to make it easier for on-call physicians to connect work and family lives and develop work arrangements to promote better sleep and protected sleep time.

Internationally adopted children in Finland: parental evaluations of symptoms of reactive attachment disorder and learning difficulties - FINADO study

OBJECTIVE

This study investigated the association between psychological symptoms, such as features of reactive attachment disorder (RAD), and learning difficulties among international adoptees in Finland.

METHODS

The data for this study came from the FINnish ADOption (FINADO) study covering all internationally adopted children in Finland (n= 1450), with a response rate of 55.7%. The subsample consisted of 395 adopted children aged 9-15 (51.6% girls, 48.4% boys). Learning difficulties were evaluated by a screening questionnaire 'Five To Fifteen' and symptoms of RAD by FINADO RAD scale.

RESULTS

The parents estimated that one-third (33.4%) of the internationally adopted children had some, and 12.7% had severe learning difficulties, i.e. three and six times more than in normal population, respectively. RAD symptoms at the time of adoption were associated with learning difficulties at school age (OR 4.57, 95% CI 2.57-8.13).

CONCLUSIONS

Learning difficulties are common among internationally adopted children in Finland and symptoms of RAD are associated with a child's learning difficulties.

Environmental discomfort and musculoskeletal disorders

BACKGROUND

Musculoskeletal disorders (MSDs) are the most common occupational disease in Europe, with high prevalence among hospital workers. Both environmental and psychosocial work factors may impact significantly on the development and exacerbation of MSDs.

AIMS

To evaluate whether environmental factors at work are associated with MSDs in hospital workers and to investigate potential interactions between environmental and psychosocial risk factors in the workplace that are associated with MSDs.

METHODS

A cross-sectional investigation was performed using the Nordic questionnaire to assess MSDs, the IAQ/MM-040 indoor air questionnaire for environmental factors, the demand-control model for job strain and the Goldberg questionnaire for anxiety and depression. The association between environmental factors and MSDs was studied using logistic regression analysis. In addition, the interactions of environmental factors with strain, anxiety and depression for MSDs were examined.

RESULTS

Environmental complaints were associated with MSDs. The strongest associations were found between temperature complaints (OR 2.73), noise and light complaints (OR 2.22), other environmental complaints (OR 3.12) and upper limb disorders. A significant interaction between temperature complaints and strain for upper limb disorders (F = 9.52, P < 0.05) was found.

CONCLUSIONS

To prevent MSDs, a multi-level approach is needed, including environmental measures and interventions directed to both psychosocial and organizational factors.

[Influence of environmental discomfort on musculoskeletal disorders]

Musculoskeletal disorders (MSDs) are common among hospital workers. This cross-sectional study on 1744 hospital workers showed strong interaction between temperature complaints (OR 2.73), other environmental complaints (OR 3.12) and upper limbs disorders. A significant interaction between temperature and strain for upper limbs disorders (F = 9.52, p = 0.023) was also found. Environmental and psychosocial factors can interact increasing significantly the risk of MSDs.

Police job strain during routine activities and a major event

BACKGROUND

Special police forces are exposed to periods of intense work stress in ensuring public order.

AIMS

To explore the relationship between the work context (routine work or special event) of special force policemen and psychological measures of job strain (demand-control) and effort-reward imbalance.

METHODS

All policemen assigned to the G8 meeting in L'Aquila, Italy, in July 2009 were invited to complete a questionnaire while engaged in routine work in January 2009 (Time A) and in June 2009 (Time B), while preparing for the special event.

RESULTS

Participation rate in the questionnaire study was 292/294 (99%) members of the special police force. Measures of job strain (-0.39, P < 0.001) and effort-reward imbalance (-0.37, P < 0.001) decreased significantly from Time A to Time B. On average, demand decreased from 14.2 ± 1.9 to 12.6 ± 2.7 (P < 0.001), control increased from 11.8 ± 2.5 to 14.4 ± 3.4 (P < 0.001) and social support increased from 17.8 ± 2.9 to 19.0 ± 3.1 (P < 0.001). At the same time, effort decreased from 17.4 ± 3.2 to 11.8 ± 3.8 (P < 0.001), reward grew from 37.6 ± 5.5 to 45.5 ± 7.4 (P < 0.001) and overcommitment dropped from 7.1 ± 2.1 to 6.6 ± 1.7 (P < 0.001).

CONCLUSIONS

In special police forces, routine work may be significantly more stressful than a single critical event.

A prospective cohort study of deficient maternal nurturing attitudes predicting adulthood work stress independent of adulthood hostility and depressive symptoms

Stressful childhood environments arising from deficient nurturing attitudes are hypothesized to contribute to later stress vulnerability. We examined whether deficient nurturing attitudes predict adulthood work stress. Participants were 443 women and 380 men from the prospective Cardiovascular Risk in Young Finns Study. Work stress was assessed as job strain and effort-reward imbalance in 2001 when the participants were from 24 to 39 years old. Deficient maternal nurturance (intolerance and low emotional warmth) was assessed based on mothers' reports when the participants were at the age of 3-18 years and again at the age of 6-21 years. Linear regressions showed that deficient emotional warmth in childhood predicted lower adulthood job control and higher job strain. These associations were not explained by age, gender, socioeconomic circumstances, maternal mental problems or participant hostility, and depressive symptoms. Deficient nurturing attitudes in childhood might affect sensitivity to work stress and selection into stressful work conditions in adulthood. More attention should be paid to pre-employment factors in work stress research.

The association of cognitive performance with mental health and physical functioning strengthens with age: the Whitehall II cohort study

BACKGROUND

Cognitive performance has been associated with mental and physical health, but it is unknown whether the strength of these associations changes with ageing and with age-related social transitions, such as retirement. We examined whether cognitive performance predicted mental and physical health from midlife to early old age.

METHOD

Participants were 5414 men and 2278 women from the Whitehall II cohort study followed for 15 years between 1991 and 2006. The age range included over the follow-up was from 40 to 75 years. Mental health and physical functioning were measured six times using SF-36 subscales. Cognitive performance was assessed three times using five cognitive tests assessing verbal and numerical reasoning, verbal memory, and phonemic and semantic fluency. Socio-economic status (SES) and retirement were included as covariates.

RESULTS

High cognitive performance was associated with better mental health and physical functioning. Mental health differences associated with cognitive performance widened with age from 39 to 76 years of age, whereas physical functioning differences widened only between 39 and 60 years and not after 60 years of age. SES explained part of the widening differences in mental health and physical functioning before age 60. Cognitive performance was more strongly associated with mental health in retired than non-retired participants, which contributed to the widening differences after 60 years of age.

CONCLUSIONS

The strength of cognitive performance in predicting mental and physical health may increase from midlife to early old age, and these changes may be related to SES and age-related transitions, such as retirement.

Physical and cognitive function in midlife: reciprocal effects? A 5-year follow-up of the Whitehall II study

BACKGROUND

Cognitive and physical functions are closely linked in old age, but less is known about this association in midlife. Whether cognitive function predicts physical function and whether physical function predicts cognitive function were assessed in middle-aged men and women.

METHODS

Data were from Whitehall II, an ongoing large-scale, prospective occupational cohort study of employees from 20 London-based white-collar Civil Service departments. The participants, 3446 men and 1274 women aged 45-68 years at baseline (1995-1997), had complete data on cognitive performance and physical function at both baseline and follow-up (2002-2004). A composite cognitive score was compiled from the following tests: verbal memory, inductive reasoning (Alice Heim 4-I), verbal meaning (Mill Hill), phonemic and semantic fluency. Physical function was measured using the physical composite score of the short form (SF-36) scale. Average follow-up was 5.4 years.

RESULTS

Poor baseline cognitive performance predicted poor physical function at follow-up (beta = 0.08, p<0.001), while baseline physical function did not predict cognitive performance (beta = 0.01, p = 0.67). After full adjustment for sociodemographic, behavioural and biological risk factors, baseline cognitive performance (beta = 0.04 p = 0.009) remained predictive of physical function.

CONCLUSION

Despite previous work indicating that the association between physical and cognitive performance may be bidirectional, these findings suggest that, in middle age, the direction of the association is predominantly from poor cognition to poor physical function.

Association between passive jobs and low levels of leisure-time physical activity: the Whitehall II cohort study

BACKGROUND

There is mixed evidence on the association between psychosocial work exposures (ie, passive jobs) and physical activity, but previous studies did not take into account the effect of cumulative exposures nor did they examine different trajectories in exposure. We investigated whether exposure to passive jobs, measured three times over an average of 5 years, is associated with leisure-time physical activity (LTPA).

METHODS

Data were from working men (n = 4291) and women (n = 1794) aged 35-55 years who participated in the first three phases of the Whitehall II prospective cohort. Exposure to passive jobs was measured at each phase and LTPA at phases 1 and 3. Participants were categorised according to whether or not they worked in a passive job at each phase, leading to a scale ranging from 0 (non-passive job at all three phases) to 3 (passive job at all three phases). Poisson regression with robust variance estimates were used to assess the prevalence ratios of low LTPA.

RESULTS

An association was found in men between exposure to passive jobs over 5 years and low LTPA at follow-up, independently of other relevant risk factors. The prevalence ratio for low LTPA in men was 1.16 (95% CI 1.01 to 1.33) times greater for employees with three reports of passive job than for those who had never worked in passive jobs. No association was observed in women.

CONCLUSION

This study provides evidence that working in passive jobs may encourage a passive lifestyle in men.

Associations of C-reactive protein and interleukin-6 with cognitive symptoms of depression: 12-year follow-up of the Whitehall II study

BACKGROUND

A lack of longitudinal studies has made it difficult to establish the direction of associations between circulating concentrations of low-grade chronic inflammatory markers, such as C-reactive protein and interleukin-6, and cognitive symptoms of depression. The present study sought to assess whether C-reactive protein and interleukin-6 predict cognitive symptoms of depression or whether these symptoms predict inflammatory markers.

METHOD

In a prospective occupational cohort study of British white-collar civil servants (the Whitehall II study), serum C-reactive protein, interleukin-6 and cognitive symptoms of depression were measured at baseline in 1991-1993 and at follow-up in 2002-2004, an average follow-up of 11.8 years. Symptoms of depression were measured with four items describing cognitive symptoms of depression from the General Health Questionnaire. The number of participants varied between 3339 and 3070 (mean age 50 years, 30% women) depending on the analysis.

RESULTS

Baseline C-reactive protein (beta=0.046, p=0.004) and interleukin-6 (beta=0.046, p=0.005) predicted cognitive symptoms of depression at follow-up, while baseline symptoms of depression did not predict inflammatory markers at follow-up. After full adjustment for sociodemographic, behavioural and biological risk factors, health conditions, medication use and baseline cognitive systems of depression, baseline C-reactive protein (beta=0.038, p=0.036) and interleukin-6 (beta=0.041, p=0.018) remained predictive of cognitive symptoms of depression at follow-up.

CONCLUSIONS

These findings suggest that inflammation precedes depression at least with regard to the cognitive symptoms of depression.

Relationship between job strain and smoking cessation: the Finnish Public Sector Study

AIMS

To examine whether job strain (ie, excessive demands combined with low control) is related to smoking cessation.

METHODS

Prospective cohort study of 4928 Finnish employees who were baseline smokers. In addition to individual scores, coworker-assessed work unit level scores were calculated. A multilevel logistic regression analysis, with work units at the second level, was performed.

RESULTS

At follow-up, 21% of baseline smokers had quit smoking. After adjustment for sex, age, employer and marital status, elevated odds ratios (ORs) for smoking cessation were found for the lowest vs the highest quartile of work unit level job strain (OR 1.43, 95% CI 1.17 to 1.75) and for the highest vs the lowest quartile of work unit level job control (OR 1.61, 95% CI 1.31 to 1.96). After additional adjustment for health behaviours and trait anxiety, similar results were observed. Further adjustment for socioeconomic position slightly attenuated these associations, but an additional adjustment for individual strain/control had little effect on the results. The association between job strain and smoking cessation was slightly stronger in light than in moderate/heavy smokers. The results for individual job strain and job control were in the same direction as the work unit models, although these relationships became insignificant after adjustment for socioeconomic position. Job demands were not associated with smoking cessation.

CONCLUSIONS

Smoking cessation may be less likely in workplaces with high strain and low control. Policies and programs addressing employee job strain and control might also contribute to the effectiveness of smoking cessation interventions.

Sickness Absence Among Female Employees With Migraine and Co-Existing Conditions

This prospective cohort study examined the risk of sickness absence among 27 127 female public-sector employees by status of migraine and co-existing conditions. A baseline survey was used to assess chronic disorders and demographic factors. Information on sickness absence in the 3 years following the survey was obtained from employers' registers. Migraine was related to 5.4 extra sickness absence days per person-year, with the corresponding figures being 14.6 and 6.1 for depression and respiratory disorders, respectively. After adjusting for age, marital status, socioeconomic status and presence of depression or respiratory disorders, employees with migraine had a 1.21 (95± confidence interval 1.18, 1.24) times higher risk of self-certified sickness absence episodes (≤ 3 days) than did those without migraine. The corresponding excess risk for medically certified absence episodes (≤ 3 days) was 1.15 (1.12, 1.19). Among employees with depression or respiratory disorders, secondary migraine was associated with an increased risk of sickness absence episode of 1.15 to 1.23. These findings suggest that migraine is associated with increased risk of recorded sickness absence independent of depression and respiratory disorders.

Cumulative exposure to high-strain and active jobs as predictors of cognitive function: the Whitehall II study

OBJECTIVES

A high-strain job (a combination of high job demands and low job control) is expected to increase the risk of health problems, whereas an active job (high demands and high control) can be hypothesised to be associated with a greater capacity to learn. We tested associations between high-strain and active jobs and cognitive function in middle-aged men and women.

METHODS

Data on 4146 British civil servants (2989 men and 1157 women) aged 35-55 years at baseline came from the Whitehall II study. Cumulative exposure to both high-strain and active jobs was assessed at phases 1 (1985-1988), 2 (1989-1990) and 3 (1991-1993). Cognitive performance was assessed at phases 5 (1997-1999) and 7 (2003-2004) using the following tests: verbal memory, inductive reasoning (Alice Heim), verbal meaning (Mill Hill), phonemic and semantic fluency. Analyses were adjusted for age, sex and employment grade.

RESULTS

Longer exposure to high job strain and shorter exposure to active jobs were associated with lower scores in most of the cognitive performance tests. However, these associations disappeared on adjustment for employment grade. Phonemic fluency was an exception to this pattern. Associations between exposure to an active job and phonemic fluency at both follow-up phases were robust to adjustment for employment grade. However, there was no association between exposure to active jobs and change in phonemic fluency score between the follow-up phases after adjustment for employment grade.

CONCLUSIONS

In these data, associations between cumulative exposure to high-strain or active jobs and cognition are largely explained by socioeconomic position.

Job strain as a predictor of disability pension: the Finnish Public Sector Study

OBJECTIVE

To examine whether high job strain (a combination of high job demands and low job control) is a risk factor for disability pension.

SETTING

Ten municipalities and 21 hospitals in Finland.

DESIGN AND PARTICIPANTS

A prospective cohort study of 20 386 female and 4 764 male Finnish public sector employees aged 19-50 using data from two surveys (baseline in 2000-2 and follow-up in 2005) and employers' registers. In addition to self-reported job strain, we computed work unit-aggregated job strain for each participant (the average of scores of all workers of participant's work unit except the participant him/herself).

MAIN RESULTS

93 employees (0.4%) retired because of disability during the follow-up. In multilevel logistic regression analysis adjusted for demographic characteristics and health risk behaviour, odds for disability pension was 2.60 (95% CI 1.26 to 5.34) times higher for employees with high self-assessed job strain than for those with low self-assessed job strain at baseline. The corresponding OR for passive job versus low job strain was 2.82 (95% CI 1.34 to 5.96). Analysis of work unit-aggregated scores replicated the association for high job strain, OR 2.25 (95% CI 1.17 to 4.35), but not that for passive job. The association between work unit job strain and disability pension remained significant after further adjustment for prevalent diseases, psychological distress and perceived health status.

CONCLUSIONS

Job strain is associated with risk of subsequent disability pension. If causal, this association suggests that organisational interventions to reduce job strain may also reduce early exit from work.

When do social inequalities in C-reactive protein start? A life course perspective from conception to adulthood in the Cardiovascular Risk in Young Finns Study

BACKGROUND

It is unclear when in the life course do social inequalities in inflammation emerge. We examined whether the association between socioeconomic position (SEP) and C-reactive protein (CRP) is determined at conception, in childhood, adolescence or adulthood in 1484 participants from the population-based Cardiovascular Risk in Young Finns Study.

METHODS

Five variants of the CRP gene were used to investigate whether SEP differences in CRP levels are determined at conception. SEP and serum CRP were assessed in childhood (age 3-9), adolescence (age 12-18) and in adulthood (age 24-39). SEP was measured using parental education and occupational status in childhood and adolescence, and participants' own education and occupational status in adulthood. Participants with CRP > 10 mg/l were excluded.

RESULTS

All CRP gene variants were associated with circulating CRP concentrations in childhood, but there were no differences in the distribution of these variants by SEP. No strong evidence was found of associations between parental SEP and CRP. A graded association between higher SEP and lower CRP was observed in adulthood for education (P = 0.0005) but not for occupational status. Trajectories that led to high educational achievement both in the participants and their parents were associated with lower (P <or= 0.047) CRP levels in adulthood. Excluding participants with infectious diseases, pregnant or lactating women and women using oral contraceptives did not change the findings.

CONCLUSION

In this cohort, SEP differences in CRP concentrations seen in adulthood appear not to be determined at conception or evident in childhood or adolescence.

Work Stress and New-Onset Migraine in a Female Employee Population

This prospective cohort study examined whether work stress, as indicated by the job strain model and the effort-reward imbalance model, predicts new-onset migraine among 19 469 female employees with no history of migraine at study entry. A baseline survey between 2000 and 2002 assessed work stress and demographic factors. Self-reported newly diagnosed migraine was measured at follow-up between 2004 and 2005 and 1281 new cases of migraine were detected. In logistic regression analysis adjusted for age, socioeconomic position and depression at baseline, no association between job strain and migraine was found. In contrast, high effort-reward imbalance was associated with slightly increased risk of migraine at follow-up, odds ratio 1.23 (95± confidence interval 1.04, 1.45). The proportion of new migraine cases attributable to high effort-reward imbalance was 6.2±. If the observed association is causal, our findings suggest that high effort-reward imbalance might function as a modifiable risk factor for new-onset migraine.

Increased sickness absence in diabetic employees: what is the role of co-morbid conditions?

AIMS

Diabetes is thought to be associated with increased risk of sickness absence in working populations. We examined the contribution of co-morbidity to this association.

METHODS

Records of physician-certified sickness absence episodes (> 3 days) over a 1-year period were obtained from employers' records after a survey of chronic diseases and risk factors in 638 diabetic and 32 510 non-diabetic public sector employees in Finland (the Public Sector Study).

RESULTS

Diabetic employees had a 2.15-fold (95% confidence interval 1.92-2.40) age- and sex-adjusted excess risk of sickness absence compared with their colleagues with no chronic disease. In absolute terms, diabetes was related to 59 extra absence episodes per 100 person years. Of this excess risk, 55% was attributable to co-occurring non-cardiovascular diseases, such as depression, prolapsed intervertebral disc and bronchitis. The contribution of cardiovascular complications to the excess sickness absence was small (7%).

CONCLUSIONS

In this occupational cohort, the excess risk of sickness absence in diabetic employees was largely accounted for by non-cardiovascular co-morbidity. Intervening multiple chronic conditions may be important in programmes to reduce sickness absence in diabetic employees.

Serotonin receptor genes 5HT1A and 5HT2A modify the relation between childhood temperament and adulthood hostility

We examined a modifying role of 5HT1A and 5HT2A receptors in the relation between childhood difficult temperament and adulthood hostility in 729 subjects derived from a population-based sample. Subjects were 3-12 years when their childhood temperaments consisting of hyperactivity, low sociability and negative emotionality (i.e. the difficult temperament), were assessed by their mothers. Their adulthood hostility comprising anger, cynicism and paranoia, was measured twice, 17 and 21 years later. It was found that the 5HT1A and 5HT2A receptors were not related to childhood temperament or to adult hostility, but they modified the association between childhood hyperactivity and adult hostility in men. Male carriers of T/T genotype of 5HTR2A who were rated hyperactive by their mothers expressed a high level of hostility, especially that of cynicism, in adulthood. For men with other genetic variants, such an association was not seen. This finding was consistent across the two follow-ups 4 years apart. Further research is needed to clarify whether mother-related hyperactivity adequately describes the temperament of the child or is a reflection of mother's hostile child-rearing attitudes.

Increased absence due to sickness among employees with fibromyalgia

BACKGROUND

Little is known about the effect of fibromyalgia on absence due to sickness in working populations.

OBJECTIVE

To examine the risk of absence due to sickness among employees with fibromyalgia.

METHODS

A prospective cohort study with 1-year follow-up of recorded and certified absence due to sickness after a survey of chronic diseases among 34 100 Finnish public sector employees (27 360 women and 6740 men) aged 17-65 years at baseline in 2000-2.

RESULTS

20 224 days of absence due to sickness for the 644 employees with fibromyalgia and 454 816 days for others were documented. Of those with fibromyalgia, 67% had co-occurring chronic conditions such as osteoarthritis, rheumatoid arthritis, depression or other psychiatric disorders. Compared with employees with none of these chronic conditions, the hazard ratio (HR) adjusted for age, sex and occupational status was 1.85-fold (95% confidence interval (CI) 1.53 to 2.18) for people with fibromyalgia alone and 2.63-fold (95% CI 2.34 to 2.96) for employees with fibromyalgia with coexisting conditions. The excess rate of absence due to sickness was 61 episodes/100 person-years among people with fibromyalgia alone. Among employees with musculoskeletal and psychiatric disorders, secondary fibromyalgia was associated with a 1.4-1.5-fold increase in risk of absence.

CONCLUSION

Fibromyalgia is associated with a substantially increased risk of medically certified absence due to sickness that is not accounted for by coexisting osteoarthritis, rheumatoid arthritis or psychiatric disorders.

Sickness absence as a risk factor for job termination, unemployment, and disability pension among temporary and permanent employees

OBJECTIVES

This study examined sickness absence as a risk factor for job termination, unemployment, and disability pension among temporary and permanent workers.

METHODS

Prospective cohort study with data on employment contract and sickness absence in 1996, job termination by 1997, and employment status in 1997 and 2000 for 19,093 temporary and 41,530 permanent public sector employees.

RESULTS

For women aged 40 years or less and for women over 40, a high sickness absence increased the risk of job termination among temporary employees (OR 1.52 (95% CI 1.36 to 1.71) and OR 1.70 (95% CI 1.36 to 2.13) respectively). High absence was not associated with job termination among men in temporary employment. Among permanent employees, high sickness absence predicted job termination among older, but not among younger employees. Temporary employees with high sickness absence were at the highest risk of immediate unemployment and unemployment three years later. Among older permanent employees, high sickness absence was associated with subsequent work disability pension.

CONCLUSIONS

A high rate of sickness absenteeism increases the risk of job termination and unemployment among women in temporary public sector jobs. For permanent employees, secure employment provides protection against unemployment even in the case of high sickness absence.

Effort/reward imbalance and sedentary lifestyle: an observational study in a large occupational cohort

OBJECTIVES

To investigate the association between effort/reward imbalance (ERI) at work and sedentary lifestyle.

METHODS

Cross sectional data from the ongoing Finnish Public Sector Study related to 30,433 women and 7718 men aged 17-64 were used (n = 35,918 after exclusion of participants with missing values in covariates). From the responses to a questionnaire, an aggregated mean score for ERI in a work unit was assigned to each participant. The outcome was sedentary lifestyle defined as <2.00 metabolic equivalent task (MET) hours/day. Logistic regression with generalised estimating equations was used as an analysis method to include both individual and work unit level predictors in the models. Adjustments were made for age, marital status, occupational status, job contract, smoking, and heavy drinking.

RESULTS

Twenty five per cent of women and 27% of men had a sedentary lifestyle. High individual level ERI was associated with a higher likelihood of sedentary lifestyle both among women (odds ratio (OR) = 1.08, 95% CI 1.01 to 1.16) and men (OR = 1.17, 95% CI 1.02 to 1.33). These associations were not explained by relevant confounders and they were also independent of work unit level job strain measured as a ratio of job demands and control.

CONCLUSIONS

A mismatch between high occupational effort spent and low reward received in turn seems to be associated with an increased risk of sedentary lifestyle, although this association is relatively weak.

Organisational injustice and impaired cardiovascular regulation among female employees

OBJECTIVES

To examine the relation between perceived organisational justice and cardiovascular reactivity in women.

METHODS

The participants were 57 women working in long term care homes. Heart rate variability and systolic arterial pressure variability were used as markers of autonomic function. Organisational justice was measured using the scale of Moorman. Data on other risk factors were also collected.

RESULTS

Results from logistic regression models showed that the risk for increased low frequency band systolic arterial pressure variability was 3.8-5.8 times higher in employees with low justice than in employees with high justice. Low perceived justice was also related to an 80% excess risk of reduced high frequency heart rate variability compared to high perceived justice, but this association was not statistically significant.

CONCLUSIONS

These findings are consistent with the hypothesis that cardiac dysregulation is one stress mechanism through which a low perceived justice of decision making procedures and interpersonal treatment increases the risk of health problems in personnel.

Socioeconomic position in childhood and adult cardiovascular risk factors, vascular structure, and function: cardiovascular risk in young Finns study

OBJECTIVE

To examine the association of childhood socioeconomic position (SEP) with adult cardiovascular risk factors, vascular structure, and vascular function in a contemporary population of young adults.

DESIGN

Population based prospective cohort study with baseline assessment in 1980.

SETTING

Finland.

PARTICIPANTS

856 men and 1066 women whose childhood SEP was determined by parental occupational status (manual, lower non-manual, upper non-manual) at age 3-18 years.

MAIN OUTCOME MEASURES

Cardiovascular risk factors, carotid artery intima-media thickness, and brachial artery flow mediated vasodilatation, assessed at age 24-39 years.

RESULTS

After adjustment for age and adult SEP, systolic pressure was 2.3 mm Hg higher (p = 0.0002), high density lipoprotein (HDL) cholesterol 0.03 mmol/l lower (p = 0.02), and insulin resistance score (homeostasis model assessment index) 0.12 units greater (p = 0.05) among men; and systolic pressure was 1.3 mm Hg higher (p = 0.02), diastolic pressure 1.1 mm Hg higher (p = 0.01), and height 1.1 cm lower (p < 0.0001) among women for each step down the childhood SEP hierarchy. Lower childhood SEP was associated with a 20% increase in the odds of having a waist circumference > 102 cm in men and > 88 cm in women (overall p = 0.05). Childhood SEP was not associated with intima-media thickness, flow mediated vasodilatation, the metabolic syndrome, low density lipoprotein cholesterol, triglycerides, body mass index, alcohol consumption, or smoking.

CONCLUSIONS

Among adults under 40, low childhood SEP predicted higher blood pressure and central obesity and, among men, unfavourable HDL cholesterol and insulin resistance, independent of current SEP. No independent effects were found on adult vascular structure, vascular function, or health related behaviours at this life stage.

From insecure to secure employment: changes in work, health, health related behaviours, and sickness absence

AIMS

To determine whether change in employment status (from fixed term to permanent employment) is followed by changes in work, health, health related behaviours, and sickness absence.

METHODS

Prospective cohort study with four year follow up. Data from 4851 (710 male, 4141 female) hospital employees having a fixed term or permanent job contract on entry to the study were collected at baseline and follow up.

RESULTS

At baseline, compared to permanent employees, fixed term employees reported lower levels of workload, job security, and job satisfaction. They also reported greater work ability. All fixed term employees had a lower rate of medically certified sickness absence at baseline. Baseline rate ratios for those who remained fixed term were 0.64 (95% CI 0.55 to 0.75), and were 0.50 (95% CI 0.34 to 0.75) for those who later became permanent. Continuous fixed term employment was not associated with changes in the outcome measures. Change from fixed term to permanent employment was followed by an increase in job security, enduring job satisfaction, and increased medically certified sickness absence (compared to permanent workers rate ratio 0.96 (95% CI 0.80 to 1.16)). Other indicators of work, health, and health related behaviours remained unchanged.

CONCLUSION

Receiving a permanent job contract after fixed term employment is associated with favourable changes in job security and job satisfaction. The corresponding increase in sickness absence might be due to a reduction in presenteeism and the wearing off of health related selection.

Workplace bullying and the risk of cardiovascular disease and depression

AIMS

To examine exposure to workplace bullying as a risk factor for cardiovascular disease and depression in employees.

METHODS

Logistic regression models were related to prospective data from two surveys in a cohort of 5432 hospital employees (601 men and 4831 women), aged 18-63 years. Outcomes were new reports of doctor diagnosed cardiovascular disease and depression during the two year follow up among those who were free from these diseases at baseline.

RESULTS

The prevalence of bullying was 5% in the first survey and 6% in the second survey. Two per cent reported bullying experiences in both surveys, an indication of prolonged bullying. After adjustment for sex, age, and income, the odds ratio of incident cardiovascular disease for victims of prolonged bullying compared to non-bullied employees was 2.3 (95% CI 1.2 to 4.6). A further adjustment for overweight at baseline attenuated the odds ratio to 1.6 (95% CI 0.8 to 3.5). The association between prolonged bullying and incident depression was significant, even after these adjustments (odds ratio 4.2, 95% CI 2.0 to 8.6).

CONCLUSIONS

A strong association between workplace bullying and subsequent depression suggests that bullying is an aetiological factor for mental health problems. The victims of bullying also seem to be at greater risk of cardiovascular disease, but this risk may partly be attributable to overweight.

Association between organizational inequity and incidence of psychiatric disorders in female employees

BACKGROUND

Prior research on work-related factors in the aetiology of psychiatric disorders has been concentrated on job control, job demands and social support. To broaden the view to managerial procedures, we examined whether the extent to which employees are treated with equity in the workplace predicts their mental health. Organizational equity refers to decision-making procedures, which are consistently applied, open, correctable and include input from affected parties (procedural justice). It also refers to respectful and considerate treatment of individuals by supervisors (relational justice).

METHOD

A cohort of 1786 female hospital employees with no psychiatric disorder at baseline responded to a questionnaire on organizational equity. From the responses, both an individual score and a work unit mean score were assigned to each participant. The outcome was new reports of doctor-diagnosed psychiatric disorders during the 2-year follow-up. Odds ratios and 95% confidence intervals were corrected for clustering of the data.

RESULTS

After adjustment for age and salary, odds ratio of new psychiatric disorders for self-reported low procedural justice was 1.9 (95% CI 1.1 to 3.2). Corresponding odds ratio for low procedural justice, as assessed with work unit mean scores, was 1.7 (95% CI 1.5 to 2.0). These associations remained statistically significant after additional adjustment for mental distress at baseline and job control, job demands and social support. Relational justice did not predict psychiatric disorders.

CONCLUSION

Research on organizational equity provides new information about potential work-related determinants of mental health. Low procedural justice seems to be an independent risk factor for psychiatric disorders in female employees.

Organisational justice and health of employees: prospective cohort study

AIMS

To examine the association between components of organisational justice (that is, justice of decision making procedures and interpersonal treatment) and health of employees.

METHODS

The Poisson regression analyses of recorded all-cause sickness absences with medical certificate and the logistic regression analyses of minor psychiatric morbidity, as assessed by the General Health Questionnaire, and poor self rated health status were based on a cohort of 416 male and 3357 female employees working during 1998-2000 in 10 hospitals in Finland.

RESULTS

Low versus high justice of decision making procedures was associated with a 41% higher risk of sickness absence in men (rate ratio (RR) 1.4, 95% confidence interval (CI) 1.1 to 1.8), and a 12% higher risk in women (RR 1.1, 95% CI 1.0 to 1.2) after adjustment for baseline characteristics. The corresponding odds ratios (OR) for minor psychiatric morbidity were 1.6 (95% CI 1.0 to 2.6) in men and 1.4 (95% CI 1.2 to 1.7) in women, and for self rated health 1.4 in both sexes. In interpersonal treatment, low justice increased the risk of sickness absence (RR 1.3 (95% CI 1.0 to 1.6) and RR 1.2 (95% CI 1.2 to 1.3) in men and women respectively), and minor psychiatric morbidity (OR 1.2 in both sexes). These figures largely persisted after control for other risk factors (for example, job control, workload, social support, and hostility) and they were replicated in initially healthy subcohorts. No evidence was found to support the hypothesis that organisational justice would represent a consequence of health (reversed causality).

CONCLUSIONS

This is the first longitudinal study to show that the extent to which people are treated with justice in workplaces independently predicts their health.

Organizational fairness and psychological distress in hospital physicians

AIMS

Prior research has reported high levels of stress for physicians, but determinants of this stress are poorly understood. We explored whether problems in decision-making procedures and treatment of employees, as expressed in the theory of organizational fairness, may contribute to psychological distress in hospital physicians.

METHODS

Structural equation modelling (LISREL) was based on survey responses from 251 male and 196 female physicians working in 11 public hospitals in Finland.

RESULTS

Low organizational fairness increased the risk of psychological distress in male physicians but not in female physicians. In the former group, the association between organizational fairness and psychological distress was partially mediated by decreased job control and increased workload.

CONCLUSIONS

These findings suggest that broadening the view from the traditional psychosocial work characteristics to justice in management may assist in efforts to promote physicians' health and well-being.