Work as a social determinant of health in high-income countries: past, present, and future.

This paper, the first in a three-part Series on work and health, provides a narrative review of research into work as a social determinant of health over the past 25 years, the key emerging challenges in this field, and the implications of these challenges for future research. By use of a conceptual framework for work as a social determinant of health, we identified six emerging challenges: (1) the influence of technology on the nature of work in high-income countries, culminating in the sudden shift to telework during the COVID-19 pandemic; (2) the intersectionality of work with gender, sexual orientation, age, race, ethnicity, migrant status, and socioeconomic status as codeterminants of health disparities; (3) the arrival in many Organisation for Economic Co-operation and Development countries of large migrant labour workforces, who are often subject to adverse working conditions and social exclusion; (4) the development of precarious employment as a feature of many national labour markets; (5) the phenomenon of working long and irregular hours with potential health consequences; and (6) the looming threat of climate change's effects on work. We conclude that profound changes in the nature and availability of work over the past few decades have led to widespread new psychosocial and physical exposures that are associated with adverse health outcomes and contribute to increasing disparities in health. These new exposures at work will require novel and creative methods of data collection for monitoring of their potential health impacts to protect the workforce, and for new research into better means of occupational health promotion and protection. There is also an urgent need for a better integration of occupational health within public health, medicine, the life sciences, and the social sciences, with the work environment explicitly conceptualised as a major social determinant of health.

Work-related causes of mental health conditions and interventions for their improvement in workplaces.

Mental health problems and disorders are common among working people and are costly for the affected individuals, employers, and whole of society. This discussion paper provides an overview of the current state of knowledge on the relationship between work and mental health to inform research, policy, and practice. We synthesise available evidence, examining both the role of working conditions in the development of mental disorders, and what can be done to protect and promote mental health in the workplace. We show that exposure to some working conditions is associated with an increased risk of the onset of depressive disorders, the most studied mental disorders. The causality of the association, however, is still debated. Causal inference should be supported by more research with stronger linkage to theory, better exposure assessment, better understanding of biopsychosocial mechanisms, use of innovative analytical methods, a life-course perspective, and better understanding of the role of context, including the role of societal structures in the development of mental disorders. There is growing evidence for the effectiveness of interventions to protect and promote mental health and wellbeing in the workplace; however, there is a disproportionate focus on interventions directed towards individual workers and illnesses, compared with interventions for improving working conditions and enhancing mental health. Moreover, research on work and mental health is mainly done in high-income countries, and often does not address workers in lower socioeconomic positions. Flexible and innovative approaches tailored to local conditions are needed in implementation research on workplace mental health to complement experimental studies. Improvements in translating workplace mental health research to policy and practice, such as through workplace-oriented concrete guidance for interventions, and by national policies and programmes focusing on the people most in need, could capitalise on the growing interest in workplace mental health, possibly yielding important mental health gains in working populations.

Emotional demands at work and risk of disability pension: a nationwide cohort study in Denmark.

INTRODUCTION: Working in emotionally demanding jobs is associated with an increased risk of temporarily leaving the labour market due to long-term sickness absence. We tested whether employees working in emotionally demanding jobs are also at higher risk of permanently leaving the labour market due to disability pension compared with employees working in jobs that are not emotionally demanding. METHODS: We conducted a 10-year cohort study in the workforce in Denmark (n=1 670 825), aged 30-59 years at baseline, by linking job exposure matrices with nationwide registries on social transfer payments and covariates. Using Cox regression, we analysed the risk of disability pension in relation to emotional demands in the full population and sex stratified. Multivariable adjusted models included sex, age, cohabitation, migration background, household disposable income and other work environmental factors (physical workload, influence, possibilities for development and role conflicts). RESULTS: We identified 67 923 new cases of disability pension during 15 649 743 person-years of follow-up (mean follow-up: 9.4 years). We found an increasing risk of disability pension with higher levels of emotional demands, with HRs of 1.20, 1.23 and 1.73 for medium-low, medium-high and high emotional demands, respectively, compared with low emotional demands in the most adjusted model. There was an exposure-response association in women and a tendency towards an exposure-response association in men. DISCUSSION: In this nationwide cohort study, we found an increased risk of permanent exit from the labour market due to disability pension in women and men working in emotionally demanding jobs.

Workplace sexual and gender-based harassment in Denmark: a comparison of the self-labelling and behavioural list method.

AIM: Knowledge about the prevalence of sexual and gender-based harassment is hampered by disagreements about definitions and measurement methods. The two most common measurement methods are the self-labelling (a single question about exposure to sexual harassment) and the behavioural list method (an inventory of sexually harassing behaviours). The aim of this paper was to compare the self-labelling and the behavioural list methods for measuring sexual harassment and assess the association with depressive symptoms. METHODS: The study is based on a convenience sample of 1686 individuals employed in 29 workplaces in Denmark. Survey data were collected from November 2020 until June 2021 and there were 1000 participants with full data on key variables. We used a linear mixed-effects model to examine the relationship between sexual harassment and depressive symptoms. RESULTS: In total, 2.5% self-labelled as being sexually harassed, while 19.0% reported exposure to at least one type of sexual and gender-based harassment using the behavioural list method. Both groups reported higher levels of depressive symptoms compared with non-exposed employees. The most common types of behaviours were: that someone spoke derogatorily about women/men (11.6%); being belittled because of one's gender or sexuality (4.7%); and unwanted comments about one's body, clothes or lifestyle (4.5%). CONCLUSIONS: The behavioural list method yielded a higher prevalence of sexual and gender-based harassment compared with the self-labelling method. Self-labelling and reporting at least one type of sexual and gender-based harassment was associated with depressive symptoms.

The effects of different types of organisational workplace mental health interventions on mental health and wellbeing in healthcare workers: a systematic review.

OBJECTIVE: To determine if and which types of organisational interventions conducted in small and medium size enterprises (SMEs) in healthcare are effective on mental health and wellbeing. METHODS: Following PRISMA guidelines, we searched six scientific databases, assessed the methodological quality of eligible studies using QATQS and grouped them into six organisational intervention types for narrative synthesis. Only controlled studies with at least one follow-up were eligible. RESULTS: We identified 22 studies (23 articles) mainly conducted in hospitals with 16 studies rated of strong or moderate methodological quality. More than two thirds (68%) of the studies reported improvements in at least one primary outcome (mental wellbeing, burnout, stress, symptoms of depression or anxiety), most consistently in burnout with eleven out of thirteen studies. We found a strong level of evidence for the intervention type "Job and task modifications" and a moderate level of evidence for the types "Flexible work and scheduling" and "Changes in the physical work environment". For all other types, the level of evidence was insufficient. We found no studies conducted with an independent SME, however five studies with SMEs attached to a larger organisational structure. The effectiveness of workplace mental health interventions in these SMEs was mixed. CONCLUSION: Organisational interventions in healthcare workers can be effective in improving mental health, especially in reducing burnout. Intervention types where the change in the work environment constitutes the intervention had the highest level of evidence. More research is needed for SMEs and for healthcare workers other than hospital-based physicians and nurses.

Work-related suicide: Evolving understandings of etiology & intervention.

Previously published analyses of suicide case investigations suggest that work or working conditions contribute to 10%-13% of suicide deaths. Yet, the way in which work may increase suicide risk is an underdeveloped area of epidemiologic research. In this Commentary, we propose a definition of work-related suicide from an occupational health and safety perspective, and review the case investigation-based and epidemiologic evidence on work-related causes of suicide. We identified six broad categories of potential work-related causes of suicide, which are: (1) workplace chemical, physical, and psychosocial exposures; (2) exposure to trauma on the job; (3) access to means of suicide through work; (4) exposure to high-stigma work environments; (5) exposure to normative environments promoting extreme orientation to work; and (6) adverse experiences arising from work-related injury or illness. We summarise current evidence in a schema of potential work-related causes that can also be applied in workplace risk assessment and suicide case investigations. There are numerous implications of these findings for policy and practice. Various principle- and evidence-based workplace intervention strategies for suicide prevention exist, some of which have been shown to improve suicide-prevention literacy, reduce stigma, enhance helping behaviours, and in some instances maybe even reduce suicide rates. Prevailing practice in workplace suicide prevention, however, overly emphasises individual- and illness-directed interventions, with little attention directed to addressing the working conditions that may increase suicide risk. We conclude that a stronger emphasis on improving working conditions will be required for workplace suicide prevention to reach its full preventive potential.

Study design of National Surveillance of the Work Environment of Employees in Denmark (NASWEED): Prospective cohort with register follow-up.

AIM: The aim is to report the design and baseline data of the 'National Surveillance of the Work Environment of Employees in Denmark' study (NASWEED). METHODS: NASWEED consist of (a) bi-annual cross-sectional samples, based on probability samples of wage earners of the general working population in Denmark from 2021 onwards (surveillance), (b) a prospective cohort of all previous respondents every two years (epidemiology, questionnaire follow-up) and (c) longitudinal follow-up in Danish registers about work and health (epidemiology, register follow-up). Between February and May 2021, a stratified (38 occupational industries) probability sample of 63,391 Danish residents aged 15-69 years who were employed for at least 34 hours per month received an invitation to participate, of whom 30,099 (47.5%) completed the questionnaire, 897 (1.4%) partially completed the questionnaire and 32,395 (51.1%) did not respond. Baseline was completed in June 2021. NASWEED covers various topics about the work environment (psychosocial, ergonomic, chemical, biological, safety, accidents, working from home, etc), health behaviours and somatic and mental health-related conditions. Statistical analyses will mainly build on survey procedures with model-assisted weights to ensure that the sample will yield representative estimates of the general working population. DISCUSSION: NASWEED will monitor the development of the work environment and health in Denmark until 2030. The survey data will be included in epidemiological studies with repeated measurement of the work environment, health variables and covariates, and follow-ups in national registers to investigate the prospective association in the years and decades to come between the work environment and workers' health and labour market participation.

The linkage of depressive and anxiety disorders with the expected labor market affiliation (ELMA): a longitudinal multi-state study of Danish employees.

OBJECTIVE: Depressive and anxiety disorders are prevalent among employees in general. Still, knowledge regarding the contribution of these disorders to the dynamics of the labor market in terms of working time, sickness absence, and unemployment is scarce. We aim to quantify the linkage of depressive and anxiety disorders with labor market participation using the expected labor market affiliation method (ELMA), in a large sample of Danish employees. METHODS: We combined three survey waves on occupational health with six high-quality national registers in N = 43,148 Danish employees, of which the 2012 survey contributed 29,665 person years, the 2014 survey 33,043 person years, and the 2016 survey 35,375 person years. We used the new ELMA method to estimate the multi-state transition probabilities and 2-year expected time in work, sickness absence, and unemployment. Depressive and anxiety disorders were assessed by the Major Depression Inventory and the SCL-ANX4 scales, respectively. We adjusted for multiple variables by applying inverse probability weighting in groups of gender and age. RESULTS: Depressive and anxiety disorders among employees link to reduced labor market affiliation by significantly changed transitions probabilities between the labor markets states, viewed as reduced working time by 4-51 days (in two years), increased time in sickness absence by 6-44 days (in two years), and unemployment by 6-12 days (in two years) when compared to employees without depression or anxiety disorders. The results were most pronounced for women employees and for employees with both depression and anxiety disorders. CONCLUSIONS: The study reveals detailed insight into what extent depression and anxiety disorders influence the labor market affiliation, in terms of the complex interrelation between working time, sickness absence, and unemployment. The study emphasizes the importance of preventing and handling depressive and anxiety disorders among employees for strengthening work participation.

Ward-level leadership quality and prospective low-back pain of eldercare workers: do resident handlings mediate the association?

OBJECTIVE: We investigated the extent to which ward-level leadership quality was associated with prospective low-back pain among eldercare workers, and how this association was mediated by observed resident handlings. METHODS: 530 Danish eldercare workers, employed in 121 wards, distributed across 20 nursing homes were evaluated. At baseline, leadership quality was measured using the Copenhagen Psychosocial Questionnaire, and resident handlings [handlings per shift, handlings not using assistive devices, handlings done alone, interruptions to handlings, impediments to handlings] were assessed using observations. Frequency and intensity of low-back pain was assessed monthly during the following year. All variables were averaged for each ward. We used ordinary least squares regressions to examine direct effects of leadership on low-back pain and indirect effects through handlings, using PROCESS-macro for SPSS. RESULTS: After adjustments for low-back pain at baseline, type of ward, staff ratio (i.e., number of workers divided by number of residents) and proportion of devices not in place, leadership quality showed no effect on prospective low-back pain frequency (ß = 0.01 [- 0.05:0.07]) and a small beneficial effect on pain intensity (ß = - 0.02 [- 0.04:0.00]). Resident handlings did not mediate the association between leadership quality and frequency or intensity of low-back pain. CONCLUSIONS: Good leadership quality was associated with a small decrease in prospective low-back pain intensity, but resident handlings did not seem to play a mediating role, although better ward-level leadership quality contributed to fewer workplace-observed resident handlings without assistance. Potentially, organizational factors, such as type of ward and staff ratio, may have a greater influence on handlings and low-back pain than leadership quality per se among eldercare workers.

Outcome assessment of a complex mental health intervention in the workplace. Results from the MENTUPP pilot study.

OBJECTIVE: Multicomponent interventions are recommendable to achieve the greatest mental health benefits, but are difficult to evaluate due to their complexity. Defining long-term outcomes, arising from a Theory of Change (ToC) and testing them in a pilot phase, is a useful approach to plan a comprehensive and meaningful evaluation later on. This article reports on the pilot results of an outcome evaluation of a complex mental health intervention and examines whether appropriate evaluation measures and indicators have been selected ahead of a clustered randomised control trial (cRCT). METHODS: The MENTUPP pilot is an evidence-based intervention for Small and Medium Enterprises (SMEs) active in three work sectors and nine countries. Based on our ToC, we selected the MENTUPP long-term outcomes, which are reported in this article, are measured with seven validated scales assessing mental wellbeing, burnout, depression, anxiety, stigma towards depression and anxiety, absenteeism and presenteeism. The pilot MENTUPP intervention assessment took place at baseline and at 6 months follow-up. RESULTS: In total, 25 SMEs were recruited in the MENTUPP pilot and 346 participants completed the validated scales at baseline and 96 at follow-up. Three long-term outcomes significantly improved at follow-up (p < 0.05): mental wellbeing, symptoms of anxiety, and personal stigmatising attitudes towards depression and anxiety. CONCLUSIONS: The results of this outcome evaluation suggest that MENTUPP has the potential to strengthen employees' wellbeing and decrease anxiety symptoms and stigmatising attitudes. Additionally, this study demonstrates the utility of conducting pilot workplace interventions to assess whether appropriate measures and indicators have been selected. Based on the results, the intervention and the evaluation strategy have been optimised.

Exploring exposure to multiple psychosocial work factors: prospective associations with depression and sickness absence.

BACKGROUND: Most studies on the psychosocial working environment have focused on evaluating the isolated effect of individual psychosocial work factors or looked at effects through a lens of theories such as job strain or effort-reward imbalance. However, to fathom the intricate nature of workers' experience of occupational strain, there is a need to investigate the combined and cumulative effects of multiple exposures to psychosocial work factors on workers' health. METHODS: In this prospective cohort study, we created an additive index (range 0-4) on number of baseline exposures to quantitative demands, emotional demands, role conflicts, and workplace bullying. Via logistic regression and Cox regression, we estimated the association between the additive index of psychosocial work factors and depressive disorder and long-term sickness absence (LTSA). We assessed the onset of depressive disorder using the Major Depression Inventory at 6-month follow-up and the onset of LTSA using a national register during 12-month follow-up. RESULTS: For onset of depressive disorder, high exposure to any one [odds ratio (OR) 2.98], two (OR 3.14), three (OR 6.44) and all four (OR 9.62) adverse psychosocial work factors predicted a statistically significant increased risk. For onset of LTSA, high exposure to any one [hazard ratio (HR) 1.13], two (HR 1.67), three (HR 2.31) and all four (HR 4.04) psychosocial work factors predicted an increased risk. The two latter associations were statistically significant. Trend tests indicated an exposure-response relationship for both outcomes. CONCLUSIONS: Workers reporting exposure to multiple adverse psychosocial work factors had a higher risk of developing depressive disorder and LTSA.

Emotional demands and all-cause and diagnosis-specific long-term sickness absence: a prospective cohort study in Sweden.

BACKGROUND: High emotional demands at work require sustained emotional effort and are associated with adverse health outcomes. We tested whether individuals in occupations with high emotional demands, compared with low demands, had a higher future risk of all-cause long-term sickness absence (LTSA). We further explored whether the risk of LTSA associated with high emotional demands differed by LTSA diagnoses. METHODS: We conducted a prospective, nationwide cohort study on the association between emotional demands and LTSA (>30 days) in the workforce in Sweden (n = 3 905 685) during a 7-year follow-up. Using Cox regression, we analyzed sex-stratified risks of all-cause and diagnosis-specific LTSA due to common mental disorders (CMD), musculoskeletal disorders (MSD) and all other diagnoses. Multivariable adjusted models included age, birth country, education, living area, family situation and physical work demands. RESULTS: Working in emotionally demanding occupations was associated with a higher risk of all-cause LTSA in women [hazard ratio (HR) = 1.92, 95% confidence interval (CI): 1.88-1.96] and men (HR = 1.23, 95% CI: 1.21-1.25). In women, the higher risk was similar for LTSA due to CMD, MSD and all other diagnoses (HR of 1.82, 1.92 and 1.93, respectively). In men, risk of LTSA due to CMD was pronounced (HR = 2.01, 95% CI: 1.92-2.11), whereas risk of LTSA due to MSD and all other diagnoses was only slightly elevated (HR of 1.13, both outcomes). CONCLUSIONS: Workers in occupations with high emotional demands had a higher risk of all-cause LTSA. In women, risk of all-cause and diagnosis-specific LTSA were similar. In men, the risk was more pronounced for LTSA due to CMD.

Work stress and loss of years lived without chronic disease: an 18-year follow-up of 1.5 million employees in Denmark.

We aimed to examine the association between exposure to work stress and chronic disease incidence and loss of chronic disease-free life years in the Danish workforce. The study population included 1,592,491 employees, aged 30-59 in 2000 and without prevalent chronic diseases. We assessed work stress as the combination of job strain and effort-reward imbalance using job exposure matrices. We used Cox regressions to estimate risk of incident hospital-diagnoses or death of chronic diseases (i.e., type 2 diabetes, coronary heart disease, stroke, cancer, asthma, chronic obstructive pulmonary disease, heart failure, and dementia) during 18 years of follow-up and calculated corresponding chronic disease-free life expectancy from age 30 to age 75. Individuals working in occupations with high prevalence of work stress had a higher risk of incident chronic disease compared to those in occupations with low prevalence of work stress (women: HR 1.04 (95% CI 1.02-1.05), men: HR 1.12 (95% CI 1.11-1.14)). The corresponding loss in chronic disease-free life expectancy was 0.25 (95% CI - 0.10 to 0.60) and 0.84 (95% CI 0.56-1.11) years in women and men, respectively. Additional adjustment for health behaviours attenuated these associations among men. We conclude that men working in high-stress occupations have a small loss of years lived without chronic disease compared to men working in low-stress occupations. This finding appeared to be partially attributable to harmful health behaviours. In women, high work stress indicated a very small and statistically non-significant loss of years lived without chronic disease.

Work-unit measures of psychosocial job stressors and onset of bullying: a 2-year follow-up study.

OBJECTIVES: Numerous studies have examined the health consequences of workplace bullying, but little is known about workplace antecedents of workplace bullying. This study examines whether high psychological demands, low levels of justice at work, and low decision latitude increase the occurrence of being bullied or witnessing bullying. METHODS: In 2007, 4489 Danish public employees answered a questionnaire with follow-ups in 2009 (72%) and 2011 (73% of 2009 respondents). We examined the longitudinal association between exposure to job stressors in 2007 and 2009 and bullying in 2009 and 2011, respectively, on an individual and work-unit level. For each working condition (psychological demands, decision latitude, procedural and relational justice), we calculated a mean value. Odds ratios were calculated by logistic regression. RESULTS: Low levels of individual-level relational justice, compared to high levels, were associated with a higher risk of both witnessing episodes of bullying (OR 1.66, 95% CI 1.11-2.48) and perceiving oneself as a target of bullying (OR 2.21, 95% CI 1.17-4.16). Low levels of work-unit level relational justice were associated with a higher risk of witnessing bullying (OR 1.55, 95% CI 1.04-2.30) but not perceiving oneself as a target of bullying. The other workplace characteristics exhibited no or less consistent associations across the different analytical approaches. CONCLUSION: Low levels of relational justice prospectively predicted the occurrence of workplace bullying within a 2-year period for three out of four methodological approaches, suggesting that relational justice plays a role in the prevention of workplace bullying.

Pain management in eldercare employees - the role of managers in addressing musculoskeletal pain and pain-related sickness absence.

PURPOSE: Managers' knowledge and behaviors in addressing musculoskeletal pain and sickness absence is not well understood. We investigated the association between managers' knowledge and behaviours in relation to employees' pain and their future risk of musculoskeletal pain and associated sickness absence. METHODS: The prospective study included 535 eldercare employees, and 42 managers from 20 nursing homes. Managers' self-reported knowledge and behaviors in relation to employees' pain were grouped using Principal Components Analysis. Eldercare employees reported pain-related sickness absence, and number of days with musculoskeletal pain repeatedly over 1 year. We investigated associations using mixed-effects regression models. RESULTS: We identified four types of managers' knowledge and behaviors: 1) Pain-prevention (actions for prevention of employee pain), 2) Pain-management (actions to assist employees manage pain), 3) Pain-entitlements (communicating entitlements to employees with pain), and 4) Pain-accommodations (ability to facilitate workplace accommodations for employees with pain). The employees of managers with higher scores on knowledge of pain-entitlements reported fewer days of pain-related sickness absence (ß = -0.62; 95%CI [-1.14; -0.10]). The employees of managers with higher scores on pain-management were more likely to report low back pain (ß = 0.57; 95%CI [0.02; 1.11]). We found several key associations between the knowledge and behaviors measures and pain-related sickness absence (interactions). CONCLUSION: Managers' knowledge and behaviors in relation to employees' pain were associated with employees' future musculoskeletal pain and sickness absence. The relationships are complex, suggesting that a multifaceted approach is needed to ensure that managers are adequately informed on how to manage and accommodate employees with musculoskeletal pain to reduce sickness absence.

Associations between perceived quantitative work demands at different organisational levels and pain and sickness absence in eldercare workers: a multi-level longitudinal analysis.

PURPOSE: Eldercare work is characterised by high quantitative work demands and high occurrence of musculoskeletal pain and sickness absence. Our aim was to investigate the association between quantitative demands aggregated at the different organizational levels of eldercare and low back pain (LBP) and sickness absence due to pain among workers. METHODS: This study was conducted in 527 eldercare workers from 105 wards across 20 nursing homes in Denmark. We collected workers' perceived quantitative demands at baseline and workers' LBP and sickness absence repeatedly over the following year. We aggregated worker-level quantitative demands to the ward and nursing home-levels, and used mixed-effects regression models to investigate the associations between quantitative demands at different organizational levels and LBP and sickness absence over 1 year. RESULTS: Across all models, increased quantitative demands (0-100 scale) at the worker-level was associated with an increased likelihood (OR 1.02) and intensity of LBP (ß = 0.01). We did not identify any associations between quantitative demands at the ward-level and either of our outcomes. Across all models, increased quantitative demands at the nursing home-level was associated with increased days with sickness absence due to pain (ß = 0.03 to 0.06). CONCLUSION: In eldercare, workers' perceived quantitative demands are associated with the presence and intensity of LBP. Further, quantitative demands across the overall nursing home-level are associated with sickness absence due to pain among eldercare workers. These results are of relevance to developing organisational interventions targeting quantitative demands to reduce sickness absence in eldercare.

Impact of hypothetical improvements in the psychosocial work environment on sickness absence rates: a simulation study.

BACKGROUND: The association between psychosocial working environments and sickness absence is well-known. However, the potential for reducing sickness absences of different lengths through improvements in psychosocial work factors is not fully understood. We aim to quantify the potential for reducing short-, intermediate- and long-term sickness absence rates, respectively, through hypothetical improvements in several psychosocial work factors. METHODS: This longitudinal study includes 24 990 public hospital employees from the 2014 wave of the Well-being in Hospital Employees study. The 1-year sickness absence rate was divided into short- (1-3 days), intermediate- (4-28 days) and long-term (29 days or more) periods. We simulated hypothetical scenarios with improvements in 17 psychosocial work factors using the parametric g-formula and estimated resulting changes in sickness absence rate ratios (RRs) with 95% confidence intervals (95% CIs). RESULTS: Setting all 17 psychosocial work factors to their most desirable levels (vs. least desirable levels) was associated with an overall 54% lower rate of sickness absence (95% CI: 48-60%). Reducing bullying (no vs. yes RR: 0.86, 95% CI: 0.83-0.90) and perceived stress (low vs. high RR: 0.90, 95% CI: 0.87-0.92), and increasing skill discretion (high vs. low RR: 0.91, 95% CI: 0.89-0.94) held the largest potential for reducing the total sickness absence rate. Overall, associations were similar for short-, intermediate- and long-term sickness absence. CONCLUSIONS: The psychosocial working environment was strongly associated with sickness absence. Improving the working environment may have a great impact on short-, intermediate- and long-term sickness absence rates.

Leadership behaviours and health-related early exit from employment: a prospective cohort study of 55 364 employees.

BACKGROUND: Absence of certain leadership behaviours, such as lack of feedback, recognition and involvement in employee development, has been associated with long-term sickness absence. We tested the hypothesis that absence of eight specific behaviours predicts health-related early exit from employment, and investigated differential effects in subgroups to guide future preventive initiatives. METHODS: Using Cox-proportional hazard modelling, we examined the prospective association between absence of leadership behaviours and health-related early exit from employment in a sample of 55 364 employees during 4.3 years follow-up. Leadership behaviours were measured by employee ratings in national surveys from 2012 to 2016. Exit from employment included disability pension and related measures of health-related early exit, retrieved from a national registry. RESULTS: We identified 510 cases of health-related early exit from employment during follow-up. A high level of absence of leadership behaviours, was associated with an increased risk of exit from employment (hazard ratio: 1.57, 95% CI: 1.31; 1.89). Subgroup analyses showed that the association between absence of leadership behaviours and exit from employment was similar for women and men and across age groups. The association was stronger for employees with high level of education than for employees with medium/low education, and the association was not observed among employees with a prevalent depressive disorder. CONCLUSIONS: Absence of the eight leadership behaviours is a risk factor for health-related early exit from employment in the Danish workforce. More studies are needed to confirm the results.

High physical work demands have worse consequences for older workers: prospective study of long-term sickness absence among 69 117 employees.

OBJECTIVE: This study investigates the role of age for the prospective association between physical work demands and long-term sickness absence (LTSA). METHODS: We followed 69 117 employees of the general working population (Work Environment and Health in Denmark study 2012-2018), without LTSA during the past 52 weeks preceding initial interview, for up to 2 years in the Danish Register for Evaluation of Marginalisation. Self-reported physical work demands were based on a combined ergonomic index including seven different types of exposure during the working day. Using weighted Cox regression analyses controlling for years of age, gender, survey year, education, lifestyle, depressive symptoms and psychosocial work factors, we determined the interaction of age with physical work demands for the risk of LTSA. RESULTS: During follow-up, 8.4% of the participants developed LTSA. Age and physical work demands interacted (p<0.01). In the fully adjusted model, very high physical work demands were associated with LTSA with HRs of 1.18 (95% CI 0.93 to 1.50), 1.57 (95% CI 1.41 to 1.75) and 2.09 (95% CI 1.81 to 2.41) for 20, 40 and 60 years old (point estimates), respectively. Results remained robust in subgroup analyses including only skilled and unskilled workers and stratified for gender. CONCLUSION: The health consequences of high physical work demands increase with age. Workplaces should consider adapting physical work demands to the capacity of workers in different age groups.

Can leadership quality buffer the association between emotionally demanding work and risk of long-term sickness absence?

We examined whether the association between emotionally demanding work and risk of register-based long-term sickness absence (LTSA, ≥6 weeks) was buffered by high leadership quality among 25 416 Danish employees during 52-week follow-up. Emotional demands were measured at the job group level, whereas leadership quality was measured by workers rating their closest manager. Emotionally demanding work was associated with a higher risk of LTSA, regardless if leadership quality was high or low, with neither multiplicative nor additive interaction. We conclude that we found no evidence for high leadership quality buffering the effect of emotionally demanding work on risk of LTSA.