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.

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.

Education as a moderator of genetic risk for higher body mass index: prospective cohort study from childhood to adulthood.

OBJECTIVES: The life-course development of body mass index (BMI) may be driven by interactions between genes and obesity-inducing social environments. We examined whether lower parental or own education accentuates the genetic risk for higher BMI over the life course, and whether diet and physical activity account for the educational differences in genetic associations with BMI. SUBJECTS/METHODS: The study comprised 2441 participants (1319 women, 3-18 years at baseline) from the prospective, population-based Cardiovascular Risk in Young Finns Study. BMI (kg/m2) trajectories were calculated from 18 to 49 years, using data from six time points spanning 31 years. A polygenic risk score for BMI was calculated as a weighted sum of risk alleles in 97 single-nucleotide polymorphisms. Education was assessed via self-reports, measured prospectively from participants in adulthood and from parents when participants were children. Diet and physical activity were self-reported in adulthood. RESULTS: Mean BMI increased from 22.6 to 26.6 kg/m2 during the follow-up. In growth curve analyses, the genetic risk score was associated with faster BMI increase over time (b=0.02, (95% CI, 0.01-0.02, P<0.001)). The association between the genetic risk score and BMI was more pronounced among those with lower educational level in adulthood (b=-0.12 (95% CI, -0.23-0.01); P=0.036)). No interaction effect was observed between the genetic risk score and parental education (b=0.05 (95% CI, -0.09-0.18; P=0.51)). Diet and physical activity explained little of the interaction effect between the genetic risk score and adulthood education. CONCLUSIONS: In this prospective study, the association of a risk score of 97 genetic variants with BMI was stronger among those with low compared with high education. This suggests lower education in adulthood accentuates the risk of higher BMI in people at genetic risk.

Work stress, poor recovery and burnout in teachers.

BACKGROUND: Both work stress and poor recovery have been shown to contribute to the development of burnout. However, the role of recovery as a mediating mechanism that links work stress to burnout has not been sufficiently addressed in research. AIMS: To examine recovery as a mediator in the relationship between work stress and burnout among teachers. METHODS: A cross-sectional study of Finnish primary school teachers, in whom burnout was measured with the Maslach Burnout Inventory-General Survey and work stress was conceptualized using the effort-reward imbalance (ERI) model. Recovery was measured with the Recovery Experience Questionnaire and the Jenkins Sleep Problems Scale. Multiple linear regression analyses and bootstrap mediation analyses adjusted for age, gender and total working hours were performed. RESULTS: Among the 76 study subjects, high ERI was associated with burnout and its dimensions of exhaustion, cynicism and reduced professional efficacy. Poor recovery experiences, in terms of low relaxation during leisure time, partially mediated the relationship between ERI and reduced professional efficacy. Sleep problems, in the form of non-restorative sleep, partially mediated the relationship between ERI and both burnout and exhaustion. CONCLUSIONS: Supporting a balance between effort and reward at work may enhance leisure time recovery and improve sleep quality, as well as help to reduce burnout rates.

Is personality associated with cancer incidence and mortality? An individual-participant meta-analysis of 2156 incident cancer cases among 42,843 men and women.

BACKGROUND: The putative role of personality in cancer risk has been controversial, and the evidence remains inconclusive. METHODS: We pooled data from six prospective cohort studies (British Household Panel Survey; Health and Retirement Study; Household, Income, and Labour Dynamics in Australia; Midlife in the United Survey; Wisconsin Longitudinal Study Graduate; and Sibling samples) for an individual-participant meta-analysis to examine whether personality traits of the Five Factor Model (extraversion, neuroticism, agreeableness, conscientiousness, and openness to experience) were associated with the incidence of cancer and cancer mortality in 42,843 cancer-free men and women at baseline (mean age 52.2 years, 55.6% women). RESULTS: During an average follow-up of 5.4 years, there were 2156 incident cancer cases. In random-effects meta-analysis adjusted for age, sex, and race/ethnicity, none of the personality traits were associated with the incidence of all cancers or any of the six site-specific cancers included in the analysis (lung, colon, breast, prostate, skin, and leukaemia/lymphoma). In the three cohorts with cause-specific mortality data (421 cancer deaths among 21,835 participants), none of the personality traits were associated with cancer mortality. CONCLUSIONS: These data suggest that personality is not associated with increased risk of incident cancer or cancer-related mortality.

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.

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.

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.

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.

[Influence of environmental discomfort on musculoskeletal disorders]. / Influenza dei fattori ambientali sui disturbi muscoloscheletrici.

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.

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.

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.

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.

Workplace social capital and co-occurrence of lifestyle risk factors: the Finnish Public Sector Study.

OBJECTIVE: The aim of this prospective study was to examine the link between individual and ecological workplace social capital and the co-occurrence of adverse lifestyle risk factors such as smoking, heavy drinking, physical inactivity and overweight. METHODS: Data on 25 897 female and 5476 male public sector employees were analysed. Questionnaire surveys conducted in 2000-2002 (baseline) and 2004-2005 (follow-up) were used to assess workplace social capital, lifestyle risk factors and other characteristics. Multilevel multinomial logistic regression analysis was used to examine associations between individual and ecological social capital and the co-occurrence of lifestyle risk factors. RESULTS: In the cross-sectional analysis adjusted for age, sex, marital status and employer, low social capital at work at both the individual and ecological level was associated with at least a 1.3 times higher odds of having more than two lifestyle risk factors versus having no risk factors. Similar associations were found in the prospective setting. However, additional adjustment for the co-occurrence of risk factors and socioeconomic status at baseline attenuated the result to non-significant. CONCLUSION: Social capital at work seems to be associated with a lowered risk of co-occurrence of multiple lifestyle risk factors but does not clearly predict the future risk of this co-occurrence.

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.

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.

Mitigating on-call symptoms through organizational justice and job control: a cross-sectional study among Finnish anesthesiologists.

BACKGROUND: On-call duty has been shown to be associated with health problems among physicians. However, it cannot be abolished, as patient safety has to be assured. Thus, we need to find factors that could mitigate the negative health effects of on-call duty. METHODS: The cross-sectional questionnaire of the buffering effects of organizational justice, job control, and social support on on-call stress symptoms was sent to all working Finnish anesthesiologists (n=550). RESULTS: The response rate was 60% (n=328, 53% men). High organizational justice, job control, and social support were associated with a low number of symptoms while on call or the day after in crude analysis and when adjusted for age, gender, and place of work. Only the association between justice and symptoms was robust to additional adjustments for on-call burden and self-rated health. In the interaction analysis among those being on call at the hospital, we found that the higher the levels of job control or organizational justice, the lower the number of symptoms. CONCLUSIONS: Job control and organizational justice successfully mitigated stress symptoms among those who had on-call hospital duties. It would be worth enhancing decision-making procedures, interpersonal treatment, and job control routines when aiming to prevent on-call stress and related symptoms.

Suicidality among Finnish anaesthesiologists.

BACKGROUND: Suicide rates among physicians have constantly been reported to be higher than in the general population and anaesthesiologists appear to lead the suicide statistics among physicians. METHODS: A cross-sectional questionnaire study was sent to all working Finnish anaesthesiologists (n=550) investigating their suicidality (ideation and/or planning and/or attempt). The response rate was 60%. RESULTS: One in four had at some time seriously been thinking about suicide. Respondents with poor health (crude odds ratios 11.2 and 95% confidence interval 3.8-33.0), low social support (10.5, 4.0-27.9), and family problems (6.5, 3.4-12.5) had the highest risk of suicidality. The highest risks at work were conflicts with co-workers (4.1, 2.3-7.1) and superiors (2.1, 1.2-3.6), on-call-related stress symptoms (3.9, 1.9-8.3) and low organizational justice (1.9, 1.1-3.2). If a respondent had several risk factors, the risk of suicidality doubled with each cumulating factor. CONCLUSIONS: The reported level of suicidal ideation among Finnish anaesthesiologists is worth concern. It should be of utmost importance to screen the risk factors and recognize suicidal physicians in order to help them. Interpersonal relationships, decision-making procedures, and on-call-burden should be focused on when aiming to prevent suicidality among physicians.