Changes in Emotional Vitality as a Predictor of Levels and Change in Allostatic Load: Longitudinal Results From the Whitehall II Cohort Study.

OBJECTIVE: Increasing evidence has shown an association between reduced psychological well-being and long-term morbidity. However, longitudinal studies addressing potential biobehavioral mechanisms, such as physiological function, are lacking. The aim of this study is to examine the association between changes in emotional vitality on levels and changes in allostatic load (AL), a measure of multisystem physiological dysregulation, as well as its composite risk markers. METHODS: Participants comprised 5919 British civil servants from phases 3, 5, and 7 of the Whitehall II study. Psychological well-being was operationalized as emotional vitality. AL was measured using nine biomarkers of the cardiovascular, metabolic, and immune system. Linear mixed-effect models were used to determine the association between changes in emotional vitality between phases 3 and 5 and subsequent levels and change in AL from phases 5 to 7. Generalized linear models were used to address the association between changes in emotional vitality and individual risk markers. RESULTS: Increase in emotional vitality was associated with a lower mean level of AL, whereas the AL slope was not markedly affected. Among the included risk markers, only interleukin-6 was weakly associated with changes in emotional vitality, with a 7% reduced risk of high levels of interleukin-6 per one-unit increase in emotional vitality. CONCLUSION: This study found that an increase in emotional vitality was associated with subsequent lower levels, but not rate of change, of AL over time. Further research is needed to address the relationship between trajectories of psychological well-being and physiological dysregulation.

Can work-unit social capital buffer the association between workplace violence and long-term sickness absence? A prospective cohort study of healthcare employees.

PURPOSE: To determine the prospective relation between workplace violence and the risk of long-term sickness absence (LTSA), and study if work-unit social capital could buffer this effect. As an explorative analysis, the association between work-unit social capital and workplace violence is also tested. METHODS: The study is based on the Well-being in HospitAL Employees (WHALE) cohort, including healthcare employees in Denmark. The study sample consisted of 30,044 employees nested within 2304 work-units. Exposure to workplace violence and threats of violence during the past 12 months was measured by self-report. Work-unit social capital was computed by aggregating the mean individual responses within work-units. LTSA was defined as one or more episodes of ≥ 29 consecutive sickness absence days initiated within 2 years following baseline. RESULTS: Employees experiencing workplace violence had a higher risk of LTSA (OR = 1.55; 95% CI 1.39-1.72), but there was no evidence in support of work-unit social capital buffering the effect of workplace violence on LTSA (RERI = 0.24; 95%CI: - 0.36 to 0.84; p = 0.12 for multiplicative interaction). High compared to low work-unit social capital was associated with a lower prevalence of workplace violence (OR = 0.47; 95% CI 0.36-0.61). CONCLUSION: There was a prospective association between workplace violence and LTSA, but work-unit social capital did not buffer this effect. Furthermore, the results revealed an inverse association between work-unit social capital and workplace violence. The findings indicate that  in order to effectively reduce LTSA, preventive interventions need to both prevent workplace violence and strengthen social capital.

Work-unit social capital and long-term sickness absence: a prospective cohort study of 32 053 hospital employees.

OBJECTIVE: There is a lack of studies investigating social capital at the workplace level in small and relatively homogeneous work-units. The aim of the study was to investigate whether work-unit social capital predicts a lower risk of individual long-term sickness absence among Danish hospital employees followed prospectively for 1 year. METHODS: This study is based on the Well-being in HospitAL Employees cohort. The study sample consisted of 32 053 individuals nested within 2182 work-units in the Capital Region of Denmark. Work-unit social capital was measured with an eight-item scale covering elements of trust, justice and collaboration between employees and leaders. Social capital at the work-unit level was computed as the aggregated mean of individual-level social capital within each work-unit. Data on long-term sickness absence were retrieved from the employers' payroll system and were operationalised as ≥29 consecutive days of sickness absence. We used a 12-point difference in social capital as the metric in our analyses and conducted two-level hierarchical logistic regression analysis. Adjustments were made for sex, age, seniority, occupational group and part-time work at the individual level, and work-unit size, the proportion of female employees and the proportion of part-time work at the work-unit level. RESULTS: The OR for long-term sickness absence associated with a 12-point higher work-unit social capital was 0.73 (95% CI 0.68 to 0.78). Further, we found an association between higher work-unit social capital and lower long-term sickness absence across quartiles of social capital: compared with the lowest quartile, the OR for long-term sickness absence in the highest quartile was 0.51 (95% CI 0.44 to 0.60). CONCLUSION: Our study provides support for work-unit social capital being a protective factor for individual long-term sickness absence among hospital employees in the Capital Region of Denmark.

Workplace Violence and Long-term Sickness Absence: Assessment of the Potential Buffering Effect of Social Support in Two Occupational Cohort Studies.

OBJECTIVES: We aimed to determine the effect of workplace violence on long-term sickness absence, and whether social support from supervisors and colleagues buffer this effect. METHODS: Information on workplace violence and social support were derived from the Danish Work Environment Cohort Study in 2000, 2005, and 2010 and the Swedish Longitudinal Occupational Survey of Health in 2006 and 2008. Individual- and joint-effects on register-based long-term sickness absence were determined using logistic regression models for repeated measurements. Cohort-specific estimates were combined in random effect meta-analyses. RESULTS: Workplace violence and low social support were independently associated with a higher risk of long-term sickness absence, and we did not find evidence of an interaction. CONCLUSION: Exposure to workplace violence is a risk factor for long-term sickness absence while social support is associated with a lower risk of long-term sickness absence.

Physical workload, long-term sickness absence, and the role of social capital. Multi-level analysis of a large occupation cohort.

Objectives This study determined the prospective relation between physical workload and long-term sickness absence (LTSA) and examined if work-unit social capital may buffer the effect of high physical workload on LTSA. Methods We included 28 925 participants from the Danish Well-being in HospitAL Employees (WHALE) cohort, and followed them for two years. Physical workload and social capital were self-reported and categorized into low, medium, and high. Physical workload was analyzed on the individual level, whereas social capital was analyzed on the work-unit level. LTSA data were obtained from the employers' payroll system. We performed two-level logistic regression analyses: joint-effect and stratified analyses adjusted for baseline covariates. Results High versus low physical workload was associated with a higher risk of LTSA [odds ratio (OR) 1.55, 95% confidence interval (CI) 1.40-1.72]. There was a multiplicative interaction (P=0.007) and a tendency of sub-additive interaction [relative excess risk due to interaction (RERI) -0.49, 95% CI -1.03-0.06] between physical workload and social capital. Doubly exposed employees had the highest risk of LTSA (OR 2.45; 95% CI 2.02-2.98), but this effect was smaller than expected from the sum of their main effects. Conclusions We found a prospective relation between physical workload and LTSA but no evidence of high social capital buffering the effect of high physical workload. High physical workload was a risk factor for LTSA at all levels of social capital and employees exposed to both exposures had the highest risk of LTSA. Interventions should aim at both improving social capital and reducing physical workload in order to efficiently prevent LTSA.

Informal caregiving and diurnal patterns of salivary cortisol: Results from the Whitehall II cohort study.

The objective was to investigate the relationship between various aspects of informal caregiving and diurnal patterns of salivary cortisol, with special attention to the moderating effect of sex and work status. The study population was composed of 3727 men and women from the British Whitehall II study. Salivary cortisol was measured six times during a weekday. Aspects of caregiving included the relationship of caregiver to recipient, weekly hours of caregiving, and length of caregiving. Diurnal cortisol profiles were assessed using the cortisol awakening response (CAR) and diurnal cortisol slopes. Results showed that men, but not women, providing informal care had a blunted CAR compared with non-caregivers (PInteraction = 0.03). Furthermore, we found a dose-response relationship showing that more weekly hours of informal care was associated with a more blunted CAR for men (Ptrend = 0.03). Also, the blunted CAR for men was especially pronounced in short-term caregivers and those in paid work. In women, the steepest cortisol slope was seen among those in paid work who provided informal care (PInteraction = 0.01). To conclude, we found different cortisol profiles in male and female informal caregivers. Male caregivers had a blunted CAR, which has previously been associated with chronic stress and burnout. Future research should investigate whether results are generalizable beyond UK citizens with a working history in the civil service.

Socioeconomic inequality in the use of prescription medications for smoking cessation among patients with COPD: a nationwide study.

Background: Bupropion and varenicline can substantially improve the chances of smoking cessation in patients with COPD, but are unsubsidized and relatively costly. We examined overall use and socioeconomic patterns of use among patients with COPD. Patients and methods: We identified 4,741 COPD patients reporting to be smokers at their first contact for COPD during 2008-2012 in the Danish register of COPD, which covers all pulmonary outpatient clinics in Denmark. Patients were followed for 6 months in the National Prescription Registry. Logistic regression analyses were used to calculate the ORs with corresponding 95% CI of redeeming a prescription for any of the smoking cessation medications in strata of baseline characteristics. Results: During 6 months from first consultation, only 5% redeemed a prescription for bupropion or varenicline. Younger age, female sex, higher education, and higher income were associated with an increased likelihood, while non-Danish ethnicity, living alone, and very severe COPD were associated with a lower likelihood of redeeming bupropion or varenicline. Conclusion: Despite their proven effectiveness, bupropion and varenicline are sparingly used among COPD patients followed in the hospital outpatient setting with the lowest use among the socioeconomically disadvantaged. This highlights a missed opportunity for intervention.

Psychosocial risk factors for the metabolic syndrome: A prospective cohort study.

BACKGROUND/OBJECTIVES: Metabolic deregulations and development of metabolic syndrome may be an important pathway underlying the relationship between stress and cardiovascular disease. We aim to estimate the effect of a comprehensive range of psychosocial factors on the risk of developing metabolic syndrome in men and women. METHODS: The study population consisted of 3621 men and women from the Copenhagen City Heart Study who were free of metabolic syndrome at baseline and reexamined after 10years. The data was analyzed by multivariable logistic regression models adjusted for age, education, income, menopausal status and life style factors. RESULTS: We found major life events in adult life (OR 1.48, 95% CI 0.93 to 2.36) and major life events at work (OR 2.75, 95% CI 1.38 to 5.50), lacking a confidant (OR 1.94, 95% CI 1.07 to 3.53) and dissatisfaction with social network (OR 1.53, 95% CI 1.11 to 2.11) to be risk factors for developing the metabolic syndrome in women, while vital exhaustion (OR 2.09, 95% CI 0.95 to 4.59) and intake of sleep medications (OR 2.54, 95% CI 0.92 to 5.96) may play a more important role in men. CONCLUSIONS: Experiencing major life events in work and adult life and/or dysfunctional social networks is a risk factor for metabolic syndrome in women, and stress reactions such as vital exhaustion and intake of sleep medications may play a more important role in the development of metabolic syndrome men.

Onset of Impaired Sleep and Cardiovascular Disease Risk Factors: A Longitudinal Study.

STUDY OBJECTIVES: Impaired sleep has been linked to increased risk of cardiovascular disease (CVD), but the underlying mechanisms are still unsettled. We sought to determine how onset of impaired sleep affects the risk of established physiological CVD risk factors (i.e., hypertension, diabetes, and dyslipidemia). METHODS: In a longitudinal cohort study with 3 survey waves (2000, 2004, 2008) from the Finnish Public Sector study we used repeated information on sleep duration and disturbances to determine onset of impaired sleep. Information on development of CVD risk factors, as indicated by initiation of medication for hypertension, diabetes, and dyslipidemia was derived from electronic medical records within 8 years of follow-up. Data on 45,647 participants was structured as two data-cycles to examine the effect of change in sleep (between two waves) on incident CVD events. We applied strict inclusion and exclusion criteria to determine temporality between changes in sleep and the outcomes. RESULTS: While we did not find consistent effects of onset of short or long sleep, we found onset of disturbed sleep to predict subsequent risk of hypertension (hazard ratio = 1.22, 95% CI: 1.04-1.44) and dyslipidemia (HR = 1.17, 95% CI: 1.07-1.29) in fully adjusted analyses. CONCLUSIONS: Results suggest that onset of sleep disturbances rather than short or long sleep mark an increase in physiological risk factors, which may partly explain the higher risk of CVD observed among impaired sleepers. COMMENTARY: A commentary on this paper appears in this issue on page 1629.

[Sleep impairment is a threat to good health].

Long-term sleep impairment is related to an increased risk of somatic health problems, e.g. overweight, Type 2 diabetes, cardiovascular disease and premature death. Avoidance of caffeine, alcohol, energy-rich or fatty foods and light from computer screens close to bedtime may counteract impaired sleep. A quiet, dark and well-tempered bedroom and physical activity during the day may have a positive impact on sleep. Impaired sleep may be related to stress and conditions at home or at work. Psychological sleep treatment is free of adverse side effects with effects comparable to effects of medical treatment.

Onset of impaired sleep as a predictor of change in health-related behaviours; analysing observational data as a series of non-randomized pseudo-trials.

BACKGROUND: Changes in health-related behaviour may be a key mechanism linking impaired sleep to poor health, but evidence on this is limited. In this study, we analysed observational data to determine whether onset of impaired sleep is followed by changes in health-related behaviours. METHODS: We used data from 37,508 adults from the longitudinal Finnish Public Sector Study. In analysis of 59 152 person-observations on duration and quality of sleep and health-related behaviours (alcohol consumption, smoking, physical activity and weight control), data were treated as a series of non-randomized pseudo-trials with strict predefined criteria for data inclusion and temporality. RESULTS: Smokers who experienced onset of short sleep were less likely to quit smoking than those with persistent normal sleep [odds ratio (OR) = 0.78, 95% confidence interval (CI): 0.64-0.97]. Onset of short sleep also predicted initiating high-risk alcohol consumption (OR = 1.17, 95% CI: 1.00-1.37). Onset of disturbed sleep was associated with changes in all assessed health-related behaviours: initiation of high-risk alcohol consumption (OR = 1.23, 95% CI: 1.05-1.45), quitting smoking (OR = 0.80, 95% CI: 0.63-1.00), becoming physically inactive (OR = 1.17, 95% CI: 1.06-1.30) and becoming overweight or obese (OR = 1.12, 95% CI: 1.01-1.23). CONCLUSIONS: Findings suggest that the onset of short or disturbed sleep are risk factors for adverse changes in health-related behaviours. These findings highlight potential pathways linking impaired sleep to the development of lifestyle-related morbidity and mortality.

Impaired sleep and allostatic load: cross-sectional results from the Danish Copenhagen Aging and Midlife Biobank.

OBJECTIVE: Understanding the mechanisms linking sleep impairment to morbidity and mortality is important for future prevention, but these mechanisms are far from elucidated. We aimed to determine the relation between impaired sleep, both in terms of duration and disturbed sleep, and allostatic load (AL), which is a measure of systemic wear and tear of multiple body systems, as well as with individual risk markers within the cardiac, metabolic, anthropometric, and immune system. METHODS: A cross-sectional population-based study of 5226 men and women from the Danish Copenhagen Aging and Midlife Biobank with comprehensive information on sleep duration, disturbed sleep, objective measures of an extensive range of biological risk markers, and physical conditions. RESULTS: Long sleep (mean difference 0.23; 95% confidence interval, 0.13, 0.32) and disturbed sleep (0.14; 0.06, 0.22) were associated with higher AL as well as with high-risk levels of risk markers from the anthropometric, metabolic, and immune system. Sub-analyses suggested that the association between disturbed sleep and AL might be explained by underlying disorders. Whereas there was no association between short sleep and AL, the combination of short and disturbed sleep was associated with higher AL (0.19; 0.08, 0.30) and high-risk levels of immune system markers. CONCLUSION: Our study suggests small but significant differences in the distribution of allostatic load, a pre-clinical indicator of disease risk and premature death, for people with impaired relative to normal sleep. Impaired sleep may be a risk factor for developing disease and be a risk marker for underlying illness or sleep disorders.