Onset of workplace sexual harassment and subsequent depressive symptoms and incident depressive disorder in the Danish workforce.

BACKGROUND: We studied onset of workplace sexual harassment and subsequent risk of depressive symptoms and depressive disorder. METHODS: We examined 9,981 individuals who participated in the Work Environment and Health in Denmark survey in 2012 and 2014 and 6,647 individuals who also participated in 2016, all unexposed to sexual harassment in 2012. Depressive symptoms and disorder were assessed with the Major Depression Inventory. Using linear regression, we estimated the associations between onset of sexual harassment in the 12 months preceding the 2014 survey and depressive symptoms in 2014 and 2016, respectively. Using logistic regression, we estimated risk of incident depressive disorder in 2014. RESULTS: Onset of sexual harassment was associated with elevated depressive symptoms in 2014, both for harassment by non-workplace personnel (e.g., patients, estimate (B): 1.61, 95% CI: 0.51-2.72, p = 0.004) and workplace personnel (e.g., supervisors, B: 3.85, 95% CI: 2.51-5.20, p < 0.001), after adjustment for depressive symptoms in 2012. Harassment by workplace personnel was further associated with elevated depressive symptoms in 2016 after adjustment for symptoms in 2012, but not after adjustment for symptoms in 2014. Harassment by workplace personnel was associated with incident depressive disorder in 2014 (odds ratio: 5.26, 95% CI: 2.68-10.31, p < 0.001). LIMITATIONS: Depressive symptoms and disorder were assessed with a validated self-administered rating scale but not a clinical diagnostic interview. Participants reporting harassment in 2014 had elevated depressive symptoms already in 2012 requiring future investigation. CONCLUSIONS: Exposure to sexual harassments at the workplace may be a contributing factor in the aetiology of depressive symptoms and disorder.

Workplace sexual harassment and depressive symptoms: a cross-sectional multilevel analysis comparing harassment from clients or customers to harassment from other employees amongst 7603 Danish employees from 1041 organizations.

BACKGROUND: Previous research has reported that sexual harassment can lead to reduced mental health. Few studies have focused on sexual harassment conducted by clients or customers, which might occur in person-related occupations such as eldercare work, social work or customer service work. This study examined the cross-sectional association between sexual harassment by clients or customers and depressive symptoms. We also examined if this association was different compared to sexual harassment conducted by a colleague, supervisor or subordinate. Further, we investigated if psychosocial workplace initiatives modified the association between sexual harassment by clients or customers and level of depressive symptoms. METHODS: We used data from the Work Environment and Health in Denmark cohort study (WEHD) and the Work Environment Activities in Danish Workplaces Study (WEADW) collected in 2012. WEHD is based on a random sample of employed individuals aged 18-64. In WEADW, organizational supervisors or employee representatives provided information on workplace characteristics. By combining WEHD and WEADW we included self-reported information on working conditions and health from 7603 employees and supervisors in 1041 organizations within 5 occupations. Data were analyzed using multilevel regression and analyses adjusted for gender, age, occupation and socioeconomic position. RESULTS: Exposure to workplace sexual harassment from clients or customers was statistically significantly associated with a higher level of depressive symptoms (2.05; 95% CI: 0.98-3.12) compared to no exposure. Employees harassed by colleagues, supervisors or subordinates had a higher mean level of depressive symptoms (2.45; 95% CI: 0.57-4.34) than employees harassed by clients or customers. We observed no statistically significant interactions between harassment from clients and customers and any of the examined psychosocial workplace initiatives (all p > 0.05). CONCLUSIONS: The association between sexual harassment and depressive symptoms differed for employees harassed by clients or customers and those harassed by colleagues, supervisors or subordinates. The results underline the importance of investigating sexual harassment from clients or customers and sexual harassment by colleagues, supervisors or subordinates as distinct types of harassment. We found no modification of the association between sexual harassment by clients or customers and depressive symptoms by any of the examined psychosocial workplace initiatives.

Sexual harassment in care work - Dilemmas and consequences: A qualitative investigation.

BACKGROUND: Care workers are often exposed to sexual harassment from patients. Research shows that such exposure may have detrimental effects on mental health of the care workers. Inappropriate sexual behaviour from patients is a particular challenge for formal and informal care workers alike. There is a scarceness of studies investigating the experience and the handling of sexual harassment from patients. OBJECTIVES: To investigate the experience and handling of sexual harassment from patients in care work. DESIGN: The study follows an explorative qualitative approach based on group interviews (n=19) with 39 care workers. SETTINGS: Ten workplaces participated in the study, including hospitals, nursing homes, community health centres, rehabilitations care centres, and psychiatric residential facilities. PARTICIPANTS: We conducted group interviews with care workers (employees), managers, shop stewards and/or safety representatives. The majority of the interviewees were trained nurses. RESULTS: The interviews revealed that sexual harassment is a complex and multifaceted phenomenon. The care workers often separated between intentional and unintentional behaviours initiated by cognitively impaired patients. Thus, they often refrain from using the term harassment, because it implies that the actions were intentional. However, the interviews revealed that, in practice, this separation was very difficult, and that sexual harassment often creates a range of dilemmas in the daily work. At the same time, sexual harassment is a taboo. The managers, shop stewards and safety representatives in this study were often not aware of the frequency and the impact of the episodes had on the care workers. The workplaces participating in this study, rarely had guidelines or policies for managing and/or preventing sexual harassment or inappropriate sexual behaviours, but often responded to episodes in an ad hoc and case-by-case manner. CONCLUSION: The term sexual harassment might not be appropriate in the context of care work, because many patients who display inappropriate behaviours are cognitively impaired. While the interviews revealed that there is no universally accepted term, it might be more prudent to avoid the term harassment and refer it to as sexual behaviours. Considering the demographic development with a rising number of elderly and the increase in various forms of dementia, the management of inappropriate sexual behaviour by patients will be even more pressing in the future. It is time to address the prevention of sexual harassment and the management of patients' sexuality as an explicit part of the professional organisational culture of care work.