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.

Occupation-specific risk estimates for suicide and non-fatal self-harm from a Swedish cohort of male construction workers followed 1987-2018.

OBJECTIVES: While suicidal behaviour has become less prevalent in non-manual workers in recent decades, rates have increased in manual workers. We aimed to identify occupations within the construction industry with excess risk of suicide and non-fatal self-harm. METHODS: This cohort of Swedish construction workers comprises 389 132 individuals examined 1971-1993 and followed 1987-2018 using national hospital and cause of death registers. More than 200 job titles were merged into 22 occupational groups. For 296 891 men alive in 1987 and active in the construction sector, survival was calculated from baseline to first event of non-fatal self-harm or suicide and censored for emigration, long-term unemployment, disability pension, retirement, death from other causes or end of follow-up. HRs with 95% CIs were obtained from multiple Cox proportional hazard regression. RESULTS: Overall, 1618 cases of suicide and 4774 events of non-fatal self-harm were registered. Self-harm before baseline was the single largest risk factor for suicide, HR 9.3 (95% CI 7.5 to 11.6). Compared with the overall mean, labourers and rock workers had excess risk for suicide, HR 1.4 (95% CI 1.1 to 1.7) and 1.5 (95% CI 1.0 to 2.3), respectively, while electricians, clerks and foremen had reduced risk. Labourers, concrete workers, sheet metal workers, painters, glaziers and the group 'other construction workers' were at increased risk for non-fatal self-harm. Almost all categories of manual workers were at increased risk for suicidal behaviour relative to clerks and foremen. CONCLUSIONS: Specific occupations within the construction sector were associated with excess risk for suicidal behaviour. Future studies should identify underlying risk factors to inform tailored interventions.

Does adolescent depression modify the association between psychosocial job stressors and mental health in emergent adulthood?

BACKGROUND: Job stressors can be particularly harmful to the mental health of disadvantaged groups through differential exposure, differential sensitivity to the effects of exposure, or both. In this paper, we assess the extent to which emergent adult workers with an adolescent history of high depression symptoms may be differentially sensitive to the effect of job stressors on mental health. METHODS: We conducted a secondary analysis of three waves of the Australian arm of the International Youth Development Study (n = 1262). We used multivariable linear regression to assess whether self-reported measures of high depression symptoms at one or two time points in adolescence (ages 11-16 years) modified the cross-sectional association between four self-reported job stressors (job demands, job control, job strain, and incivility at work) and psychological distress (Kessler-10 scores) in emergent adulthood (ages 23-27 years). RESULTS: For all four job stressors, there was a consistent pattern of approximately a doubling in the magnitude of association for participants with a history of high depression symptoms at two points in adolescence compared with those with no history of depression. However, results of effect modification analysisfor only job demands and job strain excluded chance as a potential explanation. CONCLUSIONS: Findings showed partial support for the hypothesis that a history of high depression symptoms in adolescence predicts stronger associations between job stressor exposures and psychological distress among those employed in emergent adulthood. The limitations of this secondary analysis suggest a need for purpose-designed studies to answer this important research question more definitively.

Workplace-related determinants of mental health in food and bar workers in Western, high-income countries: A systematic review.

BACKGROUND: This review synthesizes evidence from etiologic and intervention studies of workplace-related determinants of mental health in workers in food and bar workers in the hospitality industry in Western high-income countries. METHODS: Peer-reviewed literature published between January 2000 and August 2023 was gathered from five bibliographic databases. Any study design was eligible. Study quality was assessed using the Joanna Briggs Institute tools for appraisal. RESULTS: A narrative analysis was conducted for 26 included studies (total n = 15,069 participants) across Australia (3), Ireland (1), Norway (1), Spain (2), the United States (17) and the United Kingdom (2). Individual and task-related factors such as high emotional job demands and low job control were associated with high burnout and depression. Uncivil and hostile interpersonal interactions with customers, management, and colleagues were found to contribute to poor mental health outcomes, including depression, anxiety, and burnout. CONCLUSION: Findings from included studies highlight the impact of workplace culture, including management practices and workplace social support, on mental health. Organization-level interventions may therefore be most effective for addressing individual, interpersonal, and organizational determinants of mental health in food and bar occupations, particularly when implemented as part of broader organizational efforts to support health and wellbeing. Industry-wide policy changes may also be necessary to address structural concerns, including job and financial insecurity, job strain and access to benefits, such as secure sick leave and minimum contract hours.

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.

Mental health-related knowledge, attitudes and behaviours in a cross-sectional sample of australian university students: a comparison of domestic and international students.

BACKGROUND: There are growing concerns about the mental health of university students in Australia and internationally, with universities, governments and other stakeholders actively developing new policies and practices. Previous research suggests that many students experience poor mental health while at university, and that the risk may be heightened for international students. Mental health-related knowledge, attitudes and behaviours are modifiable determinants of mental health and thus suitable targets for intervention. This study assessed the mental health-related knowledge, stigmatising attitudes, helping behaviours, and self-reported experiences of mental health problems in the student population of a large multi-campus Australian university, and conducted a comparative assessment of international and domestic students. METHODS: Participants were 883 international and 2,852 domestic students (overall response rate 7.1%) who completed an anonymous voluntary online survey that was sent to all enrolled students in July 2019 (n = ~ 52,341). Various measures of mental health-related knowledge, attitudes and helping behaviours were assessed. A comparative analysis of international and domestic students was conducted, including adjustment for age and sex. RESULTS: Overall, there was evidence of improvements in mental health-related knowledge, attitudes and behaviours relative to previous studies, including higher depression recognition, intentions to seek help, and reported help-seeking behaviour. Comparative analysis indicated that international students scored predominantly lower on a range of indicators (e.g., depression recognition, awareness of evidence-based forms of help); however, differences were narrower difference between the two groups compared to what has been reported previously. Finally, some indicators were more favourable among international students, such as higher help-seeking intentions, and lower prevalence of self-reported mental health problems compared to domestic students. CONCLUSION: Though there were some important differences between domestic and international students in this study, differences were narrower than observed in previous studies. Study findings are informing the on-going implementation and refinement of this university's student mental health strategy, and may be used to inform evolving policy and practice in the university sector.

Effectiveness of the Australian MATES in Construction Suicide Prevention Program: a systematic review.

Suicide is a major public health issue globally. The World Health Organization has called for nations to create comprehensive national suicide prevention strategies including multisectoral collaboration, awareness raising, advocacy and capacity building. The workplace provides opportunity and structure for suicide prevention programs. However, many of these programs are poorly documented and evaluated. The MATES in Construction (MATES) program is a multimodal workplace-based suicide prevention program designed for and by the construction industry. This systematic review examined the available evidence for the effectiveness of the MATES program and is reported according to PRISMA guidelines. A literature search resulted in the inclusion of 12 peer-reviewed articles published between January 2010 and February 2023 containing primary data of evaluations of MATES. There was evidence of the effectiveness of the MATES program in improving mental health and suicide prevention literacy, helping intentions and reducing stigma. The results highlighted the importance of worker-to-worker peer approaches with workers consistently stating that supervisors were the least trusted resources for mental health and suicide concerns. Favourable results were found in relation to reduced suicide risk in the construction industry. The evidence base for MATES is limited in terms of causal inference with very few controlled evaluations and no experimental studies having been conducted to date. Improved understanding of how the program motivates volunteers, their experiences and research on the longer-term impacts of the program on the industry is required.

Exploring Australian university students' and staff members' perspectives on an animal-assisted intervention as a health promotion initiative on campus.

ISSUE ADDRESSED: The university campus environment is unique and complex, with students and staff members experiencing increasing levels of stress and anxiety over time. One intervention being used internationally to alleviate stress and anxiety is an Animal Assisted Intervention (AAI). This research aimed to explore Australian university students' and staff members' perspectives on an AAI prior to implementation. METHODS: This study used an explanatory mixed methods approach. Student participants were recruited through posts on a university's subject sites and via social media. University staff member participants were recruited through emails from managers or department newsletters. Data were collected through an online anonymous survey and subsequent semi-structured interviews. Quantitative data were analysed with SPSS and qualitative data were analysed via thematic analysis. RESULTS: Data included 344 survey responses and 45 semi-structured interviews. Survey responses indicated a large majority of participants believe an AAI could promote health on campus. This was due to the range of benefits participants felt an AAI could have on campus (such as reducing stress and anxiety, providing opportunities for a break from work or study, social benefits, and enhancing the university environment). In interviews, participants suggested an AAI could contribute towards a positive university environment and help promote other services on campus; provided it considers those not interested in participating. SO WHAT?: If implemented sustainably, an AAI has potential to contribute towards a positive university environment for both staff and students, by potentially reducing the high rates of stress and anxiety the university community are currently experiencing. An AAI could also help to raise awareness of other health services on campus, further contributing towards promoting positive mental health and wellbeing.

Systematic review of the effectiveness of health promotion interventions targeting obesity prevention in school-based staff.

School-based employee interventions can benefit the health of staff and have the potential to influence the health of school students through role-modelling. However, interventions within schools typically focus on students, with very few studies addressing obesity and related health behaviours among school staff. A systematic review of the peer-reviewed literature published between January 2000 and May 2020 was undertaken to synthesize the evidence on the impact that school-based obesity prevention programmes have on the staff they employ. Search terms were derived from four major topics: (i) school; (ii) staff; (iii) health promotion and (iv) obesity. Terms were adapted for six databases and three independent researchers screened results. Studies were included if they reported on the outcomes of body weight, dietary behaviours and/or physical activity. Of 3483 papers identified in the search, 13 studies met the inclusion criteria. All 13 studies included an intervention that focussed on improving nutrition, physical activity or both. All included studies demonstrated a positive outcome for either dietary intake, weight or body mass index or physical activity outcomes, however not all results were statistically significant. The included studies showed promising, although limited, impacts on employee health outcomes. This review demonstrated a lack of global focus and investment in interventions targeting school staff, particularly in contrast to the large amount of research on school-based health promotion initiatives focussed on students. There is a need for further research to understand effective interventions to promote health and prevent obesity in this large, diverse and influential workforce.

School-based health promotion interventions that focus on employees can benefit the health of staff and have the potential to also influence the health of school students through role-modelling. Most published intervention studies within schools have typically focussed on students, however, with very few studies addressing obesity and related health behaviours among school staff. This systematic review summarizes the evidence on the impact of school-based obesity prevention programmes on the outcomes of physical activity, weight or dietary practices of school staff. The search identified 13 relevant studies published since 2000. The findings of this review show that school staff focussed health promotion interventions can positively impact obesity-related outcomes. The small number of available studies, however, demonstrates a lack of research focus and investment in interventions targeting school staff and teachers' health. The majority of included studies used relatively weak study designs and included small numbers of schools and staff members. This is particularly contrasting to the large body of research on school-based health promotion initiatives focussed on students. There is a need for further research to understand effective interventions to promote health and prevent obesity in this large, diverse and influential workforce.

Psychosocial Work Factors of the Job Strain Model and All-Cause Mortality: The STRESSJEM Prospective Cohort Study.

OBJECTIVE: The objectives were to examine the prospective associations between psychosocial work factors of the job strain model and all-cause mortality in a national representative cohort of French employees using various measures of time-varying exposure. METHODS: The study was based on a sample of 798,547 men and 697,785 women for which data on job history from 1976 to 2002 were linked to mortality data from the national death registry. Psychosocial work factors from the validated job strain model questionnaire were imputed using a job-exposure matrix. Three time-varying measures of exposure were explored: current, cumulative, and recency-weighted cumulative exposure. Cox proportional hazards models were performed to study the associations between psychosocial work factors and mortality. RESULTS: Within the 1976-2002 period, 88,521 deaths occurred among men and 28,921 among women. Low decision latitude, low social support, job strain, isostrain, high strain, and passive job were found to be risk factors for mortality. The model using current exposure was the best relative-quality model. The associations of current exposure to job strain and mortality were found to have hazard ratios of 1.30 (95% confidence interval [CI] = 1.24-1.36) among men and 1.15 (95% CI = 1.06-1.25) among women. The population fractions of mortality attributable to job strain were 5.64% (95% CI = 4.56%-6.71%) among men and 4.13% (95% CI = 1.69%-6.71%) among women. CONCLUSIONS: This study supports the role of the psychosocial work factors of the job strain model on all-cause mortality. Preventive intervention to improve the psychosocial work environment may help to prevent mortality in working populations.

Psychosocial factors at work from the job strain model and preventable mortality in France: The STRESSJEM prospective study.

The study aimed to explore the prospective associations between psychosocial factors at work from the job strain model and preventable mortality, including smoking- and alcohol-related mortality as well as external causes of death. The study was based on prospective data and relied on a sample of 1,511,456 individuals for which data on job history, mortality and causes of death were linked over the 1976-2002 period. Exposures were the factors from the job strain model imputed through a job-exposure matrix. Various time-varying measures of exposure were used including current exposure and two measures of cumulative exposure. Preventable mortality was defined using the OECD/Eurostat list of preventable causes of death. The associations between exposures and outcomes were studied using Cox proportional hazards models. Effect modification by gender was also assessed. Over the study period, 57,264 preventable deaths occurred before the age of 75 years. Low decision latitude, low social support, job strain, iso-strain, passive job, and high strain were associated with preventable mortality, and associations of stronger magnitude were found for job strain and isostrain among men. Stronger associations were observed for alcohol-related mortality than for smoking-related mortality and external causes of death. The fractions of preventable mortality attributable to current exposure to job strain and isostrain were significant among men only (5.1% and 3.3%). Psychosocial factors at work from the job strain model may play a role on preventable mortality. Intensifying research and prevention towards the psychosocial work environment may be helpful to reduce risky health-related behaviours and related mortality.

Can an online mental health training programme improve physician supervisors' behaviour towards trainees?

BACKGROUND: Physician trainees have elevated rates of psychological distress, mental disorders and suicide. Physician supervisors can support the mental health needs of trainees. AIMS: To test the feasibility and acceptability of a tailored online mental health training programme and to ascertain the potential effectiveness of the programme to alter the confidence and behaviours of physician supervisors. METHODS: Thirty Australian hospital-based physicians who were supervising physician trainees participated in this quasi-experimental pre-post pilot study. All received the intervention that comprised 12 5-min modules to complete over a 3-week period. Baseline and post-intervention data were collected. The primary outcome evaluated participants' confidence to respond to trainees experiencing mental ill-health and promote a mentally healthy workplace. Secondary outcomes evaluated change in self-reported behaviour, mental health knowledge and stigmatising attitudes. Differences in mean scale scores for each outcome measure from baseline and post-intervention were compared using paired sample t-tests. RESULTS: Thirty physicians completed the baseline assessment and 23 (76.7%) completed all programme modules. Most participants found the programme engaging, interesting and useful. Post-intervention data, available for 25 (83.3%) participants, showed a significant increase in participants' knowledge of their role in supporting trainees under their supervision (P = 0.002), confidence to initiate conversations about mental health with staff (P < 0.001), and application of preventive and responsive supervisory behaviours to support the mental health needs of those they supervise (P < 0.001). CONCLUSIONS: This online mental health training programme for physician supervisors was feasible and associated with improved confidence and behaviour to support the mental health needs of trainees they supervised.

COVID-19 and suicide risk in the construction sector: preparing for a perfect storm.

AIMS: Worldwide, construction industries are considered to be key economic pillars of the societies they serve, and construction workers constitute a sizeable proportion of the global paid workforce. In many parts of the world, construction workers are at elevated risk of suicide. Here, we examine the extent to which construction workers may be differentially exposed to the economic effects of COVID-19. METHODS: A narrative review and synthesis of the literature was conducted. RESULTS: The economic and labour market shock resulting from the COVID-19 pandemic has led to a convergence of factors that may significantly exacerbate suicide risk among construction workers, particularly among those with lower skills. CONCLUSIONS: With important insights from previous financial crises, it is vital that governments, industry and workplaces act rapidly to mitigate suicide risk among vulnerable groups such as construction workers. Mental healthcare investment is needed, and must be complemented by prevention and control in the workplace and in the general community. Anticipating, preparing and acting to ameliorate this risk, particularly among low skilled construction workers, will save many livelihoods, as well as lives.

Gendered associations between household labour force participation and mental health using 17 waves of Australian cohort data.

PURPOSE: There is some evidence that employed women report more time pressure and work-life penalties than employed men and other women; however little is known about whether this exerts a mental health effect. This analysis examined associations between household labour force arrangements (household-employment configuration) and the mental health of men and women. METHODS: Seventeen waves of data from the Household Income and Labour Dynamics Survey (2001-2017) were used. Mental health was measured using the Mental Health Inventory (MHI-5). A six-category measure of household-employment configuration was derived: dual full-time employed, male-breadwinner, female-breadwinner, shared part-time employment (both part-time), male full-time/female part-time (modified male-breadwinner, MMBW), and female full-time/male part-time. Using fixed-effects regression methods, we examined the within-person effects of household-employment configuration on mental health after controlling for time-varying confounders. RESULTS: For men, being in the female-breadwinner configuration was associated with poorer mental health compared to being in the MMBW configuration (ß-1.98, 95% CI - 3.36, - 0.61). The mental health of women was poorer when in the male-breadwinner configuration, compared to when in the MMBW arrangement (ß-0.89, 95% CI - 1.56, - 0.22). CONCLUSION: These results suggest that the mental health of both men and women is poorer when not in the labour force, either as a man in the female-breadwinner arrangement, or as a woman in the male-breadwinner arrangement. These results are particularly noteworthy for women, because they pertain to a sizeable proportion of the population who are not in paid work, and highlight the need for policy reform to support women's labour force participation.

A cluster RCT to improve workplace mental health in a policing context: Findings of a mixed-methods implementation evaluation.

BACKGROUND: We conducted a cluster randomized trial of a workplace mental health intervention in an Australian police department. The intervention was co-designed and co-implemented with the police department. Intervention elements included tailored mental health literacy training for all members of participating police stations, and a leadership development and coaching program for station leaders. This study presents the results of a mixed-methods implementation evaluation of the trial. METHODS: Descriptive quantitative analyses characterized the extent of participation in intervention activities, complemented by a qualitative descriptive analysis of transcripts of 60 semistructured interviews with 53 persons and research team field notes. RESULTS: Participation rates in the multicomponent leadership development activities were highly variable, ranging from <10% to approximately 60% across stations. Approximately 50% of leaders and <50% of troops completed the mental health literacy training component of the intervention. Barriers to implementation included rostering challenges, high staff turnover and changes, competing work commitments, staff shortages, limited internal personnel resources to deliver the mental health literacy training, organizational cynicism, confidentiality concerns, and limited communication about the intervention by station command or station champions. Facilitators of participation were also identified, including perceived need for and benefits of the intervention, engagement at various levels, the research team's ability to create buy-in and manage stakeholder relationships, and the use of external, credible leadership development coaches. CONCLUSIONS: Implementation fell far short of expectations. The identified barriers and facilitators should be considered in the design and implementation of similar workplace mental health interventions.

Psychosocial work stressors and risk of mortality in Australia: analysis of data from the Household, Income and Labour Dynamics in Australia survey.

OBJECTIVE: To examine the association between exposures to psychosocial work stressors and mortality in a nationally representative Australian working population sample. METHODS: 18 000 participants from the Household, Income and Labour Dynamics in Australia survey with self-reported job demands, job control, job security and fair pay psychosocial work stressors exposures at baseline were followed for up to 15 waves. Cox proportional hazards regression models were used to examine the association between psychosocial work stressors and mortality. Models were serially adjusted for each subgroup of demographic, socioeconomic, health and behavioural risk factors. RESULTS: Low job control was associated with a 39% increase in the risk of all-cause mortality (HR 1.39; 95% CI 1.04 to 1.85), controlling for demographic, socioeconomic, health and behavioural factors. A decreased risk of mortality was observed for workers with exposure to high job demands (HR 0.76; 95% CI 0.60 to 0.96, adjusted for gender and calendar), but the risk was attenuated after serially adjusting for socioeconomic status, health (HR=0.84; 95% CI 0.65 to 1.08) and behavioural (HR=0.79; 95% CI 0.60 to 1.04) factors. There did not appear to be an association between exposure to job insecurity (HR 1.03; 95% CI 0.79 to 1.33) and mortality, or unfair pay and mortality (HR 1.04; 95% CI 0.80 to 1.34). CONCLUSIONS: Low job control may be associated with an increased risk of all-cause mortality. Policy and practice interventions that reduce the adverse impact of low job control in stressful work environments could be considered to improve health and decrease risk of mortality.

Are there differences in the return to work process for work-related psychological and musculoskeletal injuries? A longitudinal path analysis.

PURPOSE: To examine differences in the return to work (RTW) process for workers' compensation claimants with psychological injuries compared to those with musculoskeletal (MSK) injuries. METHODS: We collected data from 869 workers' compensation claimants in Victoria, Australia, at three time points over a 12-month period (21% with psychological injury claims). RTW was assessed through self-report. Potential mediators were identified at the personal, health-care provider, workplace and system levels. The relationships between injury type, mediating factors and RTW were assessed using path analysis, with adjustment for confounders through inverse probability weighting. RESULTS: We observed better RTW outcomes for claimants with MSK injuries (compared to those with psychological injuries) at T1 and T2, but not at T3. We also observed differences between psychological injuries and MSK injuries and all but two of the mediating factors examined. These differences, in particular related to supervisor response to injury, consultative RTW planning and offers of accommodation, as well as differences in mental health symptoms, explained approximately two-thirds of differences in RTW between injury types at T1. Differences in RTW at T2 were explained by mediating factors, and differences in RTW at T1. CONCLUSION: Claimants with work-related psychological injuries experience a variety of challenges in RTW compared to those with MSK injuries. While treating and preventing further exacerbation of psychological symptoms should remain an important part of the rehabilitation process, other modifiable factors, in particular supervisor response to injury and consultative RTW planning and modified duties, should be prioritised to reduce inequalities in RTW across injury types.

Do psychosocial job stressors influence mental health service use? Evidence from an Australian cohort.

OBJECTIVES: There is strong evidence of a relationship between psychosocial job stressors and mental health at the population level. There has been no longitudinal research on whether the experience of job stressors is also associated with greater mental health service use. We seek to fill this gap. METHODS: The Household Income Labour Dynamics in Australia survey cohort was used to assess the relationship between exposure to self-reported psychosocial job quality and reporting attendance at a mental health professional during the past 12 months. We adjusted for time-varying and time-invariant confounders. The study was conducted in 2009 and 2013. RESULTS: In the random effects logistic regression model, increasing exposure to psychosocial job stressors was associated with an increased odds of mental health service use after adjustment (one stressor: OR 1.26, 95% CI 1.01 to 1.56; two stressors: OR 1.33, 95% CI 1.02 to 1.73; three stressors: OR 1.82, 95% CI 1.28 to 2.57). However, once the between person effects were controlled in a fixed effects model, the within-person association between change in job stressors and change in mental health service use was estimated to be close to zero and not significant. CONCLUSIONS: More work is needed to understand the relationship between job stressors and service use. However, when taken with past findings on job stressors and mental health, these findings highlight the importance of considering policy and clinical practice responses to adverse working contexts.

Are there bidirectional relationships between psychosocial work characteristics and depressive symptoms? A fixed effects analysis of Swedish national panel survey data.

OBJECTIVES: Psychosocial work characteristics have been prospectively associated with depressive symptoms. However, methodological limitations have raised questions regarding causality. It is also unclear to what extent depressive symptoms affect the experience of the psychosocial work environment. We examined contemporaneous (measured simultaneously) and lagged bidirectional relationships between psychosocial work characteristics and depressive symptoms, simultaneously controlling for time-stable individual characteristics. METHODS: We included 3947 subjects in the Swedish Longitudinal Occupational Survey of Health (SLOSH), with self-reported job demands, control, social support, work efforts, rewards, procedural justice and depressive symptoms in four waves 2010-2016. We applied dynamic panel models with fixed effects, using structural equation modelling, adjusting for all time-stable individual characteristics such as personality and pre-employment factors. RESULTS: Higher levels of job demands, job demands in relation to control, work efforts and efforts in relation to rewards were contemporaneously associated with more depressive symptoms (standardised ß: 0.18-0.25, p<0.001), while higher levels of workplace social support, rewards at work and procedural justice were associated with less depressive symptoms (ß: -0.18, p<0.001,ß: -0.16, p<0.001 and ß: -0.09, p<0.01, respectively). In contrast, only work efforts predicted higher levels of depressive symptoms 2 years later (ß: 0.05, p<0.05). No other lagged associations were found in any direction. CONCLUSIONS: After controlling for all time-invariant confounding, our results suggest that psychosocial work characteristics predominantly affect depressive symptoms immediately or with only a short time lag. Furthermore, we found no evidence of reverse causation. This indicates short-term causal associations, although the temporal precedence of psychosocial work characteristics remains uncertain.

Multicohort study of change in job strain, poor mental health and incident cardiometabolic disease.

OBJECTIVES: Several recent large-scale studies have indicated a prospective association between job strain and coronary heart disease, stroke and diabetes. Job strain is also associated with poorer mental health, a risk factor for cardiometabolic disease. This study investigates the prospective relationships between change in job strain, poor mental health and cardiometabolic disease, and whether poor mental health is a potential mediator of the relationship between job strain and cardiometabolic disease. METHODS: We used data from five cohort studies from Australia, Finland, Sweden and UK, including 47 757 men and women. Data on job strain across two measurements 1-5 years apart (time 1 (T1)-time 2 (T2)) were used to define increase or decrease in job strain. Poor mental health (symptoms in the top 25% of the distribution of the scales) at T2 was considered a potential mediator in relation to incident cardiometabolic disease, including cardiovascular disease and diabetes, following T2 for a mean of 5-18 years. RESULTS: An increase in job strain was associated with poor mental health (HR 1.56, 95% CI 1.38 to 1.76), and a decrease in job strain was associated with lower risk in women (HR 0.70, 95% CI 0.60-0.84). However, no clear association was observed between poor mental health and incident cardiometabolic disease (HR 1.08, 95% CI 0.96-1.23), nor between increase (HR 1.01, 95% CI 0.90-1.14) and decrease (HR 1.08, 95% CI 0.96-1.22) in job strain and cardiometabolic disease. CONCLUSIONS: The results did not support that change in job strain is a risk factor for cardiometabolic disease and yielded no support for poor mental health as a mediator.