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.

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.

Supporting employees with mental illness and reducing mental illness-related stigma in the workplace: an expert survey.

An expert survey was designed to support the development of a workplace-based multi-country intervention tackling depression, anxiety, and mental illness-related stigma in small- and medium-sized enterprises (SMEs). Academic experts and representatives of SME organisations, specific sector organisations, labour or advocacy groups, and occupational health organisations, were contacted across eight European countries and Australia. The survey comprised closed and open text questions to assess expert opinion about interventions for employees with mental health difficulties, interventions supporting their managers, and anti-stigma interventions. The survey was available in six languages. The online platform Qualtrics was used for data collection. Quantitative data was analysed through descriptive statistics and qualitative data was analysed through thematic analysis. Sixty-five of 146 experts responded, representing a 42% response rate. Results showed only 26.2% of experts agreed that employees could speak openly about mental health issues, and 81.5% of experts indicated a large or medium unmet need for support for employees with mental health issues. Psychoeducational materials, face-to-face workshops and interventions based on cognitive behavioural therapy were ranked most likely to be taken up by employees. Experts rated as most useful for managers' guidelines on how to act if an employee has mental health issues (67.7%). The greatest number of experts indicated workshops of people with lived experience of mental illness (80.0%) and awareness campaigns (78.5%) were most required to tackle stigma. Responses were consistent between experts from different countries and areas of expertise. Experts in this multinational survey assessed that interventions supporting mental health in the workplace and tackling stigma are greatly needed. A multicomponent intervention with a wide range of materials and tools is supported.

Developing a framework for evaluation: a Theory of Change for complex workplace mental health interventions.

BACKGROUND: There is a gap between the necessity of effective mental health interventions in the workplace and the availability of evidence-based information on how to evaluate them. The available evidence outlines that mental health interventions should follow integrated approaches combining multiple components related to different levels of change. However, there is a lack of robust studies on how to evaluate multicomponent workplace interventions which target a variety of outcomes at different levels taking into account the influence of different implementation contexts. METHOD: We use the MENTUPP project as a research context to develop a theory-driven approach to facilitate the evaluation of complex mental health interventions in occupational settings and to provide a comprehensive rationale of how these types of interventions are expected to achieve change. We used a participatory approach to develop a ToC involving a large number of the project team representing multiple academic backgrounds exploiting in tandem the knowledge from six systematic reviews and results from a survey among practitioners and academic experts in the field of mental health in SMEs. RESULTS: The ToC revealed four long-term outcomes that we assume MENTUPP can achieve in the workplace: 1) improved mental wellbeing and reduced burnout, 2) reduced mental illness, 3) reduced mental illness-related stigma, and 4) reduced productivity losses. They are assumed to be reached through six proximate and four intermediate outcomes according to a specific chronological order. The intervention consists of 23 components that were chosen based on specific rationales to achieve change on four levels (employee, team, leader, and organization). CONCLUSIONS: The ToC map provides a theory of how MENTUPP is expected to achieve its anticipated long-term outcomes through intermediate and proximate outcomes assessing alongside contextual factors which will facilitate the testing of hypotheses. Moreover, it allows for a structured approach to informing the future selection of outcomes and related evaluation measures in either subsequent iterations of complex interventions or other similarly structured programs. Hence, the resulting ToC can be employed by future research as an example for the development of a theoretical framework to evaluate complex mental health interventions in the workplace.

A cross-sectional national study of burnout and psychosocial work environment in vascular surgery in Denmark.

OBJECTIVE: Little is known about burnout among European vascular surgeons (VSs). In this study, the prevalence of burnout and its associated risk factors were investigated among all VSs and vascular surgeons in training (VSTs) in Denmark. METHODS: An anonymous electronic survey was distributed to all clinical active VSs and VSTs on January 1, 2020. Validated assessment tools were used to measure burnout and aspects of the psychosocial work environment. RESULTS: A total of 104 VSs and VSTs were invited to participate, and 82% (n = 85) completed the survey. The majority of the respondents were male (60%; n = 50) and VSs (67%; n = 61). Of the respondents, 82% (n = 70) reported either light (54%; n = 46), moderate (22%; n = 19), or severe (6%; n = 5) personal burnout. More than 50% (n = 47) reported work-related burnout, light (39%; n = 33), moderate (9%; n = 8), and severe (7%; n = 6), respectively, whereas 35% (n = 30) reported patient-related burnout, light (31%; n = 26), moderate (2%; n = 2), and severe (2%; n = 2), respectively. Respondents with more than four 24-hour on-call shifts per month had significantly higher work-related burnout scores, whereas respondents with home-living children and those aged 45 to 59 years showed significantly higher personal and patient-related burnout, respectively. There were strong associations between personal and work-related burnout and the psychosocial work environment, especially work organization and interpersonal relations, but not job demands. The prevalence of burnout was unevenly distributed across departments, with the most affected department having a burnout occurrence twice the least affected department. CONCLUSIONS: Based on a national survey conducted among all clinical active VSs and VSTs in Denmark, more than 80% (n = 70) suffered from burnout, of whom 28% (n = 24) suffered from moderate to severe personal burnout. The strong association with the psychosocial work environment, and the significant differences between departments, suggest that burnout is modifiable through changes in the work environment.

The association between pupils´ aggressive behaviour and burnout among Danish school teachers - the role of stress and social support at work.

BACKGROUND: Pupils´ aggressive behaviour towards teachers is a serious problem which is slowly gaining attention and has been found to be linked to burnout. However, prospective studies investigating the role of stress and social support from colleagues and supervisor are lacking. Therefore, the aims of the present study were 1. to investigate the association between pupils´ aggressive behaviour and burnout among Danish primary and lower secondary school teachers, 2. to investigate whether the association between pupils´ aggressive behaviour and burnout depends on the level and duration of stress, and 3. to investigate whether social support from colleagues or a supervisor at the work place has a mitigating effect on the association between pupils´ aggressive behaviour and burnout among teachers. METHODS: This study is a longitudinal study using data from 1198 teachers collected in two survey rounds at an interval of 1-year. Teacher-reported aggressive behaviour in pupils measured as harassment, threats, and violence towards teachers was collected at baseline. Burnout was measured at follow-up. The analyses were performed using multilevel logistic regression. RESULTS: Statistically significant associations between harassment, threats, or violence and burnout 1 year later were found (all ORs 1.6) after adjustment for potential confounders. After further adjustment for stress, the estimates attenuated to ORs between 1.4 and 1.5, and were also statistically significant. Pupils´ aggressive behaviour in combination with low support from colleagues increased the risk of burnout, whereas the risk of burnout increased among those experiencing pupils´ aggressive behaviour in combination with receiving high support from the supervisor. CONCLUSIONS: The results indicate associations between all three types of pupils´ aggressive behaviour and burnout among teachers in Danish primary and lower secondary schools. Stress explained only a minor part of the association between teachers' perceptions of pupils' aggressive behaviour and burnout in teachers, and the results regarding social support were conflicting. The results of this study emphasize the growing need for preventive initiatives directed towards pupils´ aggressive behaviour, and future research should focus on exploring in depth how to support and prevent burnout in teachers exposed to aggressive behaviour.

Improving the effectiveness of sickness benefit case management through a public-private partnership? A difference-in-difference analysis in eighteen Danish municipalities.

BACKGROUND: The aim of this study was to investigate whether a multidimensional public-private partnership intervention, focussing on improving the quality and efficiency of sickness benefit case management, reduced the sickness benefit duration and the duration until self-support. METHODS: We used a difference-in-difference (DID) design with six intervention municipalities and 12 matched control municipalities in Denmark. The study sample comprised 282,103 sickness benefit spells exceeding four weeks. The intervention group with 110,291 spells received the intervention, and the control group with 171,812 spells received ordinary sickness benefit case management. Using register data, we fitted Cox proportional hazard ratio models, estimating hazard ratios (HR) and confidence intervals (CI). RESULTS: We found no joint effect of the intervention on the sickness benefit duration (HR 1.02, CI 0.97-1.07) or the duration until self-support (HR 0.99, CI 0.96-1.02). The effect varied among the six municipalities, with sickness benefit HRs ranging from 0.96 (CI 0.93-1.00) to 1.13 (CI 1.08-1.18) and self-support HRs ranging from 0.91 (CI 0.82-1.00) to 1.11 (CI 1.06-1.17). CONCLUSIONS: Compared to receiving ordinary sickness benefit management the intervention had on average no effect on the sickness benefit duration or duration until self-support. However, the effect varied considerably among the six municipalities possibly due to differences in the implementation or the complexity of the intervention.

Effects of a randomized controlled intervention trial on return to work and health care utilization after long-term sickness absence.

BACKGROUND: The aim of the RCT study was to investigate if the effect of a multidisciplinary intervention on return to work (RTW) and health care utilization differed by participants' self-reported health status at baseline, defined by a) level of somatic symptoms, b) health anxiety and c) self-reported general health. METHODS: A total of 443 individuals were randomized to the intervention (n = 301) or the control group (n = 142) and responded to a questionnaire measuring health status at baseline. Participants were followed in registries measuring RTW and health care utilization. Relative risk (RR) and odds ratio (OR) were used as measures of associations. Results were adjusted for gender, age, educational level, work ability and previous sick leave. RESULTS: Among all responders we found no effect of the intervention on RTW. Among participants with low health anxiety, the one-year probability of RTW was lower in the intervention than in the control group (RR = 0.79 95 % CI 0.68-0.93), but for those with high health anxiety there was no difference between the groups (RR = 1.15 95 % CI 0.84-1.57). Neither general health nor somatic symptoms modified the effect of the intervention on RTW. The intervention had no effect on health care utilization. CONCLUSIONS: The multidisciplinary intervention did not facilitate RTW or decrease health care utilization compared to ordinary case management in subgroups with multiple somatic symptoms, health anxiety or low self-rated health. However, the intervention resulted in a reduced chance of RTW among participants with low health anxiety levels. TRIAL REGISTRATION: ISRCTN43004323 , and ISRCTN51445682.

Workplace social capital and risk of long-term sickness absence. Are associations modified by occupational grade?

BACKGROUND: Workplace social capital (WSC) is an emerging topic among both work environment professionals and researchers. We examined (i) whether high WSC protected against risk of long-term sickness absence (LTSA) in a random sample of the Danish workforce during a 1-year follow-up and (ii) whether the association of WSC with sickness absence was modified by occupational grade. METHODS: We measured WSC by self-report in a cohort of 3075 employees and linked responses to a national register of sickness absence. We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) of onset of LTSA (≥21 days), adjusted for covariates. We stratified analyses by occupational grade and examined if there was an interaction effect of WSC and occupational grade. RESULTS: A one standard deviation higher WSC score predicted a reduced risk of sickness absence after adjustment for sociodemographic variables, prevalent health problems and health behaviours (HR = 0.85, 95% CI = 0.74-0.99). The HR was attenuated and lost statistical significance after further adjustment for occupational grade (HR = 0.90, 95% CI = 0.78-1.04). When stratified by occupational grade, high WSC predicted a decreased risk of sickness absence among higher grade workers (HR = 0.61, 95% CI = 0.44-0.84) but not among lower grade workers (HR = 0.98, 95% CI = 0.83-1.15). The interaction effect of WSC and occupational grade was statistically significant (HR = 0.97, 95% CI = 0.95-0.99). CONCLUSION: High WSC might reduce risk of LTSA. However, the protective effect appears to be limited to workers of higher occupational grade.

Participatory organizational intervention for improved use of assistive devices for patient transfer: study protocol for a single-blinded cluster randomized controlled trial.

BACKGROUND: Epidemiological studies have shown that patient transfer is a risk factor for back pain, back injuries and long term sickness absence, whereas consistent use of assistive devices during patient transfer seems to be protective. While classical ergonomic interventions based on education and training in lifting and transferring techniques have not proven to be effective in preventing back pain, participatory ergonomics, that is meant to engage and motivate the involved parties while at the same time making the intervention maximally relevant, may represent a better solution. However, these findings are largely based on uncontrolled studies and thus lack to be confirmed by studies with better study designs. In this article, we present the design of a study which aims to evaluate the effect and process of a participatory organizational intervention for improved use of assistive devices. METHODS: The study was performed as a cluster randomized controlled trial. We recruited 27 departments (clusters) from five hospitals in Denmark to participate in the study. Prior to randomization, interviews, observations and questionnaire answers (baseline questionnaire) were collected to gain knowledge of barriers and potential solutions for better use of assistive devices. In April 2016, the 27 departments were randomly allocated using a random numbers table to a participatory intervention (14 clusters, 324 healthcare workers) or a control group (13 clusters, 318 healthcare workers). The participatory intervention will consist of workshops with leaders and selected healthcare workers of each department. Workshop participants will be asked to discuss the identified barriers, develop solutions for increasing the use of assistive devices and implement them in their department. Use of assistive devices (using digital counters -, primary outcome, and accelerometers and questionnaire - secondary outcome), perceived physical exertion during patient transfer, pain intensity in the lower back, occurrence of work-related back injuries during patient transfer, organizational readiness to change, knowledge on how to perform proper patient transfer, social capital and work ability (secondary outcomes) were assessed at baseline and will also be assessed at 1 year follow-up. Process evaluation will be based on qualitative and quantitative data to assess the implementation, the change process, and the impact of context aspects. DISCUSSION: The study will evaluate the effect and process of a participatory intervention on improving the use of assistive devices for patient transfer among hospital healthcare workers. By using cluster-randomization, as well as process- and effect evaluation based on objective measures we will contribute to the evidence base of a promising intervention approach. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT02708550 ). March, 2016.

Does rare use of assistive devices during patient handling increase the risk of low back pain? A prospective cohort study among female healthcare workers.

PURPOSE: To investigate whether rare use of assistive devices during patient handling increases the respective risk for infrequent and frequent low back pain (LBP) among female healthcare workers reporting to be free of LBP at baseline. METHOD: Female healthcare workers replied to questionnaires about use of assistive devices during patient handling activities (rarely, occasionally and often) and LBP in both 2005 and 2006. Among those reporting to be free of LBP (0 days the past 12 months) in 2005 (n = 1,478), the multi-adjusted odds ratio for developing infrequent LBP (1-30 days the past 12 months) and frequent LBP (>30 days the past 12 months) in 2006 depending on use of assistive devices was prospectively investigated. RESULTS: The multi-adjusted odds ratio for developing infrequent LBP was 1.21 (95 % CI 0.90-1.62) for those occasionally using assistive devices, and 1.78 (95 % CI 1.19-2.66) for those rarely using assistive devices, referencing healthcare workers often using assistive devices during patient handling (p < 0.01 for trend). No associations between use of assistive devices during patient handling and risk of frequent LBP were found. CONCLUSION: The study indicates that rare use of assistive devices can increase the risk for developing infrequent LBP in female healthcare workers reporting to be free from LBP at baseline.

A multisite randomized controlled trial on time to self-support among sickness absence beneficiaries. The Danish national return-to-work programme.

BACKGROUND: In 2010, the Danish Government launched the Danish national return-to-work (RTW) programme to reduce sickness absence and promote labour market attainment. Multidisciplinary teams delivered the RTW programme, which comprised a coordinated, tailored and multidisciplinary effort (CTM) for sickness absence beneficiaries at high risk for exclusion from the labour market. The aim of this article was to evaluate the effectiveness of the RTW programme on self-support. METHODS: Beneficiaries from three municipalities (denoted M1, M2 and M3) participated in a randomized controlled trial. We randomly assigned beneficiaries to CTM (M1: n = 598; M2: n = 459; M3: n = 331) or to ordinary sickness absence management (OSM) (M1: n = 393; M2: n = 324; M3: n = 95). We used the Cox proportional hazards model to estimate hazard ratios (HR) comparing rates of becoming self-supporting between beneficiaries receiving CTM and OSM. RESULTS: In M2, beneficiaries from employment receiving CTM became self-supporting faster compared with beneficiaries receiving OSM (HR = 1.32, 95% CI: 1.08-1.61). In M3, beneficiaries receiving CTM became self-supporting slower than beneficiaries receiving OSM (HR = 0.72, 95% CI: 0.54-0.95). In M1, we found no difference between the two groups (HR = 0.99, 95% CI: 0.84-1.17). CONCLUSION: The effect of the CTM programme on return to self-support differed substantially across the three participating municipalities. Thus, generalizing the study results to other Danish municipalities is not warranted. TRIAL REGISTRATION: ISRCTN43004323.

Exploring Environment-Intervention Fit: A Study of a Work Environment Intervention Program for the Care Sector.

Targeting occupational health and safety interventions to different groups of employees and sectors is important. The aim of this study was to explore the environment-intervention fit of a Danish psychosocial work environment intervention program for the residential and home care sector. Focus group interviews with employees and interviews with mangers were conducted at 12 selected workplaces and a questionnaire survey was conducted with managers at all 115 workplaces. The interventions enhanced the probability of employees experiencing more "good" work days, where they could make a difference to the lives of clients. The interventions may therefore be characterized as culturally compelling and having a good fit with the immediate work environment of employees. The interventions furthermore seemed to fit well with the wider organizational environment and with recent changes in the societal and economic context of workplaces. However, some workplaces had difficulties with involving all employees and adapting the interventions to the organization of work. The findings suggest that flexibility and a variety of strategies to involve all employees are important aspects, if interventions are to fit well with the care sector. The focus on employees' conceptualization of a "good" work day may be useful for intervention research in other sectors.

Joint ICOH-WOPS & APA-PFAW global roundtable perspectives: exploring national policy approaches for psychological health at work through the 'National Policy Index' lens.

Worker psychological health is a significant global imperative which requires national policy action and stakeholder engagement. While national policy is a critical lever for improving worker psychological health, some countries are more progressive than others in relation to policy development and/or implementation. At the Joint Congress of the International Commission on Occupational Health, Scientific Committee on Work Organization and Psychosocial Factors and the Asia Pacific Academy for Psychosocial Factors Work in Tokyo (September 2023), a Global Roundtable was designed to initiate international dialogue and knowledge exchange regarding relevant national policy approaches. The Global Roundtable involved experts from diverse regions alongside an engaged audience of congress attendees and facilitators. Qualitative data were analysed against the five components of the National Policy Index tool, comprising policy priority, specific laws, nation-wide initiatives, sector-oriented initiatives, national survey and/or studies. Analysis revealed that while work-related psychological health is a policy priority across many countries, at the same time, there are global gaps in both legislation specificity and active regulation across different countries. For future policy development across countries, it will be beneficial to continue and deepen international discourse and for countries to share their approaches with others.

Barriers and facilitators to implementing workplace interventions to promote mental health: qualitative evidence synthesis.

BACKGROUND: Despite growing interest in workplace mental health interventions, evidence of their effectiveness is mixed. Implementation science offers a valuable lens to investigate the factors influencing successful implementation. However, evidence synthesis is lacking, especially for small-to-medium-sized enterprises (SMEs) and for specific work sectors. The objectives of this review are to establish the scope of research with explicit analysis of implementation aspects of workplace mental health interventions and to identify barriers and facilitators to implementation in general and within SMEs and selected sectors. METHODS: A systematic scoping review and meta-synthesis of mixed methods process evaluation research from 11 databases, with the evaluation of methodological quality (MMAT) and confidence in findings (CERQual), was conducted. We selected information-rich studies and synthesised them using domains within the Nielsen and Randall implementation framework: context, intervention activities, implementation; and mental models. RESULTS: We included 43 studies published between 2009 and 2022, of which 22 were rated as information-rich to be analysed for barriers and facilitators. Most studies were conducted in healthcare. Facilitators reflecting 'high confidence' included: relevant and tailored content, continuous and pro-active leadership buy-in and support, internal or external change agents/champions, assistance from managers and peers, resources, and senior-level experience and awareness of mental health issues. Healthcare sector-specific facilitators included: easy accessibility with time provided, fostering relationships, clear communication, and perceptions of the intervention. Stigma and confidentiality issues were reported as barriers overall. Due to the small number of studies within SMEs reported findings did not reach 'high confidence'. A lack of studies in construction and Information and Communication Technology meant separate analyses were not possible. CONCLUSIONS: There is dependable evidence of key factors for the implementation of workplace mental health interventions which should be used to improve implementation. However, there is a lack of studies in SMEs and in a larger variety of sectors. SYSTEMATIC REVIEW REGISTRATION: Research Registry ( reviewregistry897 ).

Do self-reported psychosocial working conditions predict low back pain after adjustment for both physical work load and depressive symptoms? A prospective study among female eldercare workers.

OBJECTIVES: To investigate whether psychosocial working conditions predict the development of low back pain (LBP) in female eldercare workers while adjusting for physical workload and depressive symptoms. METHODS: We investigated risk for developing LBP for between 1 and 30 days in the past year and developing LBP for more than 30 days in the past year at follow-up in 1537 female eldercare workers with no LBP in the year before baseline. Data were analysed using logistic regression analysis adjusted for sociodemographic variables, health behaviours, physical workload and depressive symptoms at baseline. Follow-up ranged from 18 to 22 months. RESULTS: High emotional demands, high and medium role conflicts and low influence predicted risk for reporting LBP for between 1 and 30 days in the past year at follow-up after adjustment for sociodemographics, health behaviours and physical workload. All associations became statistically non-significant when adjusted for depressive symptoms. Low and medium influence at work and high emotional demands predicted risk of reporting LBP for more than 30 days in the past year at follow-up, after adjustment for sociodemographics, health behaviours and physical workload. For employees with low (OR 4.16; 95% CI 1.36 to 12.75) and medium (OR 3.93; 95% CI 1.37 to 11.22) influence, this risk remained statistically significant after adjustment for depressive symptoms. CONCLUSIONS: Most psychosocial working conditions in this study were no longer associated with risk of LBP after adjustment for depressive symptoms. However, low and medium influence at work predicted risk for LBP for more than 30 days after adjustment for both physical workload and depressive symptoms.

Risk for low back pain from different frequencies, load mass and trunk postures of lifting and carrying among female healthcare workers.

PURPOSE: To investigate the risk of developing non-chronic and chronic low back pain (LBP) from frequency, load mass and trunk postures of occupational lifting and carrying among female healthcare workers. METHODS: A total of 9,847 workers in eldercare answered a questionnaire about occupational lifting and carrying frequency (rarely, occasionally and frequently), load mass (low: 1-7 kg, moderate: 8-30 kg and heavy: >30 kg), trunk posture (upright or forward bent back), and days with LBP in 2005. The odds ratio (OR) for developing non-chronic (1-30 days the last 12 months) and chronic (>30 days the last 12 months) LBP reported in 2006 from these characteristics of occupational lifting and carrying was investigated with multi-adjusted logistic regressions among female healthcare workers without LBP in 2005 (n = 1,612). RESULTS: Frequently lifting and carrying low load mass with forward bent back doubled the risk for developing chronic LBP (OR: 2.14; 95 % CI: 1.02-4.50). Occasionally and frequently lifting or carrying of any load mass with upright back did not increase the risk for chronic LBP. Lifting and carrying did not increase the risk for non-chronic LBP. CONCLUSIONS: Preventive initiatives for LBP among healthcare workers ought to pay attention to frequent lifting and carrying of low load mass with forward bent back.

To what extent do single symptoms from a depression rating scale predict risk of long-term sickness absence among employees who are free of clinical depression?

PURPOSE: Depression rating scales have predicted long-term sickness absence (LTSA) in previous studies. With this study, we investigated to what extent single symptoms from a depression rating scale predicted LTSA among employees who were free of clinical depression. METHODS: We studied 6,670 female employees in the Danish eldercare sector. Frequency of 12 depressive symptoms over the last 2 weeks was assessed with the Major Depression Inventory. A symptom was considered as elevated if it was present at least "slightly more than half of the time." Data were linked to a national register on LTSA (≥3 weeks). We calculated hazard ratios (HR) from Cox's proportional hazard models to analyze whether a symptom predicted time to onset of LTSA during a 1-year follow-up. Analyses were adjusted for age, family status, health behaviors, occupational group, and previous LTSA. RESULTS: Of the 12 symptoms, three predicted LTSA after adjustment for covariates: "felt low in spirits and sad" (HR = 1.41, 95 % CI = 1.05-1.89), "felt lacking in energy and strength" (HR = 1.33, 95 % CI = 1.08-1.64), and "had trouble sleeping at night" (HR = 1.38, 95 % CI = 1.09-1.74). CONCLUSION: Among female eldercare workers free of clinical depression, feelings of low spirits and sadness, feelings of lack of energy and strength, and sleep disturbances predict risk of LTSA. Interventions that decrease the prevalence of these symptoms might contribute to a reduction in LTSA in this population.

Psychosocial work environment factors and weight change: a prospective study among Danish health care workers.

BACKGROUND: Lifestyle variables may serve as important intermediate factors between psychosocial work environment and health outcomes. Previous studies, focussing on work stress models have shown mixed and weak results in relation to weight change. This study aims to investigate psychosocial factors outside the classical work stress models as potential predictors of change in body mass index (BMI) in a population of health care workers. METHODS: A cohort study, with three years follow-up, was conducted among Danish health care workers (3982 women and 152 men). Logistic regression analyses examined change in BMI (more than +/- 2 kg/m(2)) as predicted by baseline psychosocial work factors (work pace, workload, quality of leadership, influence at work, meaning of work, predictability, commitment, role clarity, and role conflicts) and five covariates (age, cohabitation, physical work demands, type of work position and seniority). RESULTS: Among women, high role conflicts predicted weight gain, while high role clarity predicted both weight gain and weight loss. Living alone also predicted weight gain among women, while older age decreased the odds of weight gain. High leadership quality predicted weight loss among men. Associations were generally weak, with the exception of quality of leadership, age, and cohabitation. CONCLUSION: This study of a single occupational group suggested a few new risk factors for weight change outside the traditional work stress models.

Adverse psychosocial working conditions and risk of severe depressive symptoms. Do effects differ by occupational grade?

BACKGROUND: Depression is a major concern for public health. Both adverse working conditions and low socio-economic position are suspected to increase risk of depression. In a representative sample of the Danish workforce we investigated (i) whether adverse psychosocial working conditions, defined by the effort-reward imbalance (ERI) model, predicted onset of severe depressive symptoms after 5-year follow-up and (ii) whether the effect of ERI was differential across occupational grades. METHODS: A cohort of 2701 Danish employees filled in a questionnaire on work and health in 2000 and 2005. ERI was measured with four effort and seven reward items. Depressive symptoms were assessed with the five-item Mental Health Inventory. Participants scoring ≤ 52 points were defined as cases. We used logistic regression to investigate the association of ERI and occupational grade in 2000 with onset of severe depressive symptoms in 2005. Analyses were adjusted for socio-demographics, health behaviours, survey method, self-rated health, sleep disturbances and non-severe depressive symptoms at baseline. RESULTS: High ERI predicted onset of severe depressive symptoms at follow-up, after adjustment for co-variates and occupational grade (OR = 2.19, 95% CI = 1.12-4.25). Participants with high ERI and low occupational grade showed a considerably higher OR (2.43, 95% CI = 1.07-5.53) compared to participants with low/medium ERI and low grade (OR = 1.45, 95% CI = 0.72-2.92), high ERI and high grade (OR = 1.26, 95% CI = 0.59-2.70) and low/medium ERI and high grade (reference group). CONCLUSION: Adverse psychosocial working conditions predicted onset of severe depressive symptoms. The effect was stronger among employees of lower occupational grades compared to those of higher grades.