The overall fractions of coronary heart diseases and depression attributable to multiple dependent psychosocial work factors in Europe.

OBJECTIVES: The literature is nonexistent on the assessment of overall fractions of diseases attributable to multiple dependent psychosocial work factors. The objectives of the study were to calculate the overall fractions of coronary heart diseases (CHD) and depression attributable to multiple dependent psychosocial work factors in 35 European countries. METHODS: We used already published fractions of CHD and depression attributable to each of the following psychosocial work factors: job strain, effort-reward imbalance, job insecurity, long working hours, and workplace bullying. We took all exposures and their correlations into account to calculate overall attributable fractions. Wald tests were performed to test differences in these overall attributable fractions between genders and between countries. RESULTS: The overall fractions of CHD and depression attributable to all studied psychosocial work factors together were found to be 8.1% [95% CI: 2.0-13.9] and 26.3% [95% CI: 16.2-35.5] respectively in the 35 European countries. There was no difference between genders and between countries. CONCLUSION: Our study showed that the overall fractions attributable to all studied psychosocial work factors were substantial especially for depression. These overall attributable fractions may be particularly useful to evaluate the burden and costs attributable to psychosocial work factors, and also to inform policies makers at European level.

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 of the variation of the 12-month prevalence of exposure to workplace bullying across national French working population subgroups.

OBJECTIVES: The studies are lacking on the variation of the prevalence of exposure to workplace bullying according to subgroups of national working populations. The objectives were to assess the 12-month prevalence of bullying in the national French working population, to describe the reported reasons for bullying, and to study its variation according to various employment variables. METHODS: The study was based on the data of the 2013 national French working conditions survey. The study sample included 25,769 employees aged 15-65 working in the same job within the last 12 months. The 12-month prevalence of bullying was assessed using a 9-item questionnaire. Employment variables included: occupation, economic activity of the company, public/private sector, company size, permanent/temporary work contract, and full/part-time work. The analyses were performed using statistical methods for weighted survey data. RESULTS: The 12-month prevalence of bullying was 26.7% and 28.7% for men and women, respectively. The most prevalent forms of bullying were criticisms, exclusion, and deprivation of right of expression. The leading reasons for being bullied were related to occupation, age, and gender. The prevalence of bullying was higher among the younger employees, the employees working in medium/large companies (including the public sector), and among employees working full time. Though significant, the variations according to occupations and economic activities of the company were small. CONCLUSION: Workplace bullying appeared as a widespread phenomenon in France. More attention should be given to young employees and the employees working in medium/large companies. Preventive measures should also target the whole working population comprehensively.

Prospective associations of psychosocial work factors with sickness absence spells and duration: Results from the French national working conditions survey.

BACKGROUND: Some psychosocial work factors are associated with sickness absence, however little information is available on the associations of various psychosocial work factors and multiple exposures with sickness absence spells and duration, and gender differences. METHODS: Data were from the French working conditions survey conducted on a nationally representative sample of the working population. The study sample included 17,437 employees (7292 men, 10,145 women) followed from 2013 to 2016 and/or from 2016 to 2019. Occupational exposures (20 psychosocial work factors, 4 working time/hours factors, 4 physical work exposures) were measured at the beginning of each follow-up period. Hurdle and multinomial models were used to study the associations with the number of days and spells of sickness absence. RESULTS: Most of the psychosocial work factors predicted the risk of at least 1 day of sickness absence. Stronger associations were found among women than men for some factors. Psychosocial work factors were more likely to predict the number of spells than the number of days of sickness absence. Some physical work exposures predicted sickness absence spells and days, whereas shift work in women predicted the risk of at least 1 day of sickness absence. Dose-response associations were found between multiple psychosocial work exposures and sickness absence spells, and between multiple physical exposures and sickness absence spells and days. CONCLUSION: Comprehensive prevention policies oriented toward the whole psychosocial and physical work environment should be useful to reduce sickness absence among men and women.

Multiple psychosocial work exposures and well-being among employees: prospective associations from the French national Working Conditions Survey.

Aims: Working conditions, especially psychosocial work factors (PWFs), are thought to influence mental health outcomes among working populations, but there have been few studies on well-being per se. We assessed the prospective associations between a wide variety of occupational factors, including PWFs, multiple exposure to these factors, and well-being among employees in France. Methods: This study was based on a nationally representative sample of 15,776 employees, including 6595 men and 9181 women, followed up from 2013 to 2016. Psychological well-being was assessed using the WHO-5 Well-Being Index. Occupational factors included 20 PWFs, 4 factors related to working time/hours, and 4 physical work exposures. The associations of occupational exposures with poor well-being were estimated using weighted robust Poisson regression models in men and women separately. Results: Among the employees who rated their well-being as good in 2013, 10.3% of men and 16.8% of women had a poor well-being 3 years later. Most PWFs in 2013 were associated with poor well-being in 2016 among women, and half of them among men. An increase in the risk of poor well-being with the number of PWFs was found. Noise exposure was associated with poor well-being in women. Conclusions: The occupational factors associated with psychological well-being were mainly those related to the psychosocial work environment. A linear association was observed between the number of exposures to PWFs and well-being. Preventive policies focused on PWFs may be beneficial for well-being. More attention should be given to multiple exposures to these factors.

Prospective associations between psychosocial work factors and self-reported health: study of effect modification by gender, age, and occupation using the national French working conditions survey data.

BACKGROUND: Prospective studies exploring the effects of psychosocial work factors on self-reported health (SRH) are lacking, especially those studying effect modifications. The objectives were to examine the prospective associations of these factors, and multiple exposures to these factors, with SRH in a national representative sample, and effect modifications by gender, age, and occupation. METHODS: The prospective study relied on the three data collection waves (2013, 2016, and 2019) of the national French Working Conditions survey and was based on a sample of 15,971 employees, in good SRH at the beginning of the follow-up period. The occupational exposures were time-varying variables measured in 2013 and 2016, and included: 20 psychosocial work factors grouped into 5 broad domains, 4 exposures related to working time/hours and 4 physical-biomechanical-chemical exposures. The incidence of poor SRH three years later was the outcome. Discrete time Poisson regression models were performed using weighted data and with adjustment for gender, age, marital status, life events, and occupation. RESULTS: Almost all the studied psychosocial work factors were predictive of poor SRH. Some physical-biomechanical-chemical exposures were found to predict poor SRH. Only rare effect modifications were observed according to gender, age, and occupation. Dose-response associations between multiple exposures and the incidence of poor SRH were observed for 4 among 5 domains of psychosocial work factors. CONCLUSIONS: Our study underlined the effects of psychosocial work factors, as well as multiple exposure effects, on the incidence of poor SRH. However, most of these effects were the same across population groups related to gender, age, and occupation.

Update of the fractions of cardiovascular diseases and mental disorders attributable to psychosocial work factors in Europe.

OBJECTIVES: The objectives of this study were to provide the fractions of cardiovascular diseases and mental disorders attributable to five psychosocial work exposures, i.e. job strain, effort-reward imbalance, job insecurity, long working hours, and bullying in Europe (35 countries, including 28 European Union countries), for each one and all countries together, in 2015. METHODS: The prevalences of exposure were estimated using the sample of 35,571 employees from the 2015 European Working Conditions Survey (EWCS) for all countries together and each country separately. Relative risks (RR) were obtained via literature reviews and meta-analyses already published. The studied outcomes were: coronary/ischemic heart diseases (CHD), stroke, atrial fibrillation, peripheral artery disease, venous thromboembolism, and depression. Attributable fractions (AF) for each exposure and overall AFs for all exposures together were calculated. RESULTS: The AFs of depression were all significant: job strain (17%), job insecurity (9%), bullying (7%), and effort-reward imbalance (6%). Most of the AFs of cardiovascular diseases were significant and lower than 11%. Differences in AFs were observed between countries for depression and for long working hours. Differences between genders were found for long working hours, with higher AFs observed among men than among women for all outcomes. Overall AFs taking all exposures into account ranged between 17 and 35% for depression and between 5 and 11% for CHD. CONCLUSION: The overall burden of depression and cardiovascular diseases attributable to psychosocial work exposures was noticeable. As these exposures are modifiable, preventive policies may be useful to reduce the burden of disease associated with the psychosocial work environment.

Burden of cardiovascular diseases and depression attributable to psychosocial work exposures in 28 European countries.

BACKGROUND: This study aimed to estimate the annual burden of cardiovascular diseases and depression attributable to five psychosocial work exposures in 28 European Union countries (EU28) in 2015. METHODS: Based on available attributable fraction estimates, the study covered five exposures, job strain, effort-reward imbalance, job insecurity, long working hours and workplace bullying; and five outcomes, coronary/ischemic heart diseases (CHD), stroke, atrial fibrillation, peripheral artery disease and depression. We estimated the burden attributable to each exposure separately and all exposures together. We calculated Disability-Adjusted Life Years (DALY) rate per 100 000 workers in each country for each outcome attributable to each exposure and tested the differences between countries and between genders using the Wald test. RESULTS: The overall burden of CHD attributable to the five studied psychosocial work exposures together was estimated at 173 629 DALYs for men and 39 238 for women, 5092 deaths for men and 1098 for women in EU28 in 2015. The overall burden of depression was estimated at 528 549 DALYs for men and 344 151 for women (respectively 7862 and 1823 deaths). The three highest burdens in DALYs in EU28 in 2015 were found for depression attributable to job strain (546 502 DALYs), job insecurity (294 680 DALYs) and workplace bullying (276 337 DALYs). Significant differences between countries were observed for DALY rates per 100 000 workers. CONCLUSIONS: Such results are necessary as decision tools for decision-makers (governments, employers and trade unions) when defining public health priorities and work stress preventive strategies in Europe.

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.

Associations between multiple occupational exposures and sleep problems: Results from the national French Working Conditions survey.

Studies evaluating the effects of multiple occupational exposures on sleep are very rare. We assessed the associations between a wide range of occupational exposures and sleep problems and investigated the cumulative effects of these exposures on this outcome. We used data from the French 2016 Working Conditions survey conducted on a nationally representative sample of workers, including 20,430 employees aged 15-65 yr (8,579 men, 11,851 women). Sleep problems were defined by either sleep disturbances or sleep medication, almost daily or several times a week. Occupational exposures included 21 psychosocial work factors grouped into five dimensions, four factors related to working time/hours and four factors related to the physical work environment. Unadjusted and adjusted weighted robust Poisson regression analyses were performed. Almost all psychosocial work exposures were associated with sleep problems, whereas the only significant working time/hours factor associated with sleep problems was night work among women. Some gender differences in the exposure-outcome associations were found. The prevalence ratio of sleep problems increased with the number of exposures for most dimensions of psychosocial work factors. Physical work exposures were associated with sleep problems, and there was a linear association between the number of these occupational exposures and sleep problems in both genders, although the trend did not reach statistical significance among women. Workplace preventive strategies targeting the work environment comprehensively may be effective in improving sleep among working populations. More attention should be given to multiple exposures in the workplace.

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.

Associations of multiple occupational exposures with major depressive and generalized anxiety disorders: Findings from the French National Working Conditions Survey.

BACKGROUND: There have been numerous studies on the associations between psychosocial work factors and mental health, but very few of them explored the cumulative effects of these factors. The objectives were to study the associations between multiple occupational exposures and two common mental disorders, major depressive episode (MDE) and generalized anxiety disorder (GAD), among employees in France. METHODS: The data came from the 2016 French National Working Conditions Survey based on a representative sample of 20,430 employees (8579 men and 11,851 women) aged 15-65 years. MDE and GAD were assessed using the MINI (Mini International Neuropsychiatric Interview) standardized diagnostic interview. Occupational exposures included 21 psychosocial work factors grouped into five dimensions, four factors related to working time/hours, and four physical work exposures. Logistic regression modeling for weighted data was performed to evaluate the associations of occupational exposures with MDE and GAD in men and women separately. RESULTS: The prevalence of MDE and GAD was higher among women (8.6% and 8.7%, respectively) than among men (4.3% and 4.6%). Most psychosocial work factors were associated with MDE and/or GAD. A linear increase in the risk of MDE/GAD with the number of psychosocial work factors was found for each dimension, except workplace violence. The risk of MDE also increased linearly with multiple physical work exposures. CONCLUSIONS: Our results showed that a wide variety of occupational exposures were associated with clinical depression and anxiety, and that the risk of disease increased with multiple exposures to psychosocial and physical factors at work.

Psychosocial work exposures and suicide ideation: a study of multiple exposures using the French national working conditions survey.

BACKGROUND: Our study aimed to explore the associations between psychosocial work exposures, as well as other occupational exposures, and suicide ideation in the French national working population. An additional objective was to study the cumulative role of occupational exposures in this outcome. METHODS: The study was based on a nationally representative sample of the French working population of 20,430 employees, 8579 men and 11,851 women (2016 French national Working Conditions survey). Occupational exposures included 21 psychosocial work factors, 4 factors related to working time/hours and 4 factors related to the physical work environment. Suicide ideation within the last 12 months was the outcome. The associations between exposures and outcome were studied using weighted logistic regression models adjusted for covariates. RESULTS: The 12-month prevalence of suicide ideation was 5.2% among men and 5.7% among women. Among the occupational exposures, psychosocial work factors were found to be associated with suicide ideation: quantitative and cognitive demands, low influence and possibilities for development, low meaning at work, low sense of community, role conflict, job insecurity, temporary employment, changes at work, and internal violence. Some rare differences in these associations were observed between genders. Linear associations were observed between the number of psychosocial work exposures and suicide ideation. CONCLUSIONS: Psychosocial work factors were found to play a major role in suicide ideation, and their effects were cumulative on this outcome. More research on multiple and cumulative exposures and suicide ideation and more prevention towards the psychosocial work environment are needed.

Correction to: Fractions of cardiovascular diseases and mental disorders attributable to psychosocial work factors in 31 countries in Europe.

Whilst working on an update of our study published in 2014 (orginal article), we have discovered an error in the measure of effort-reward imbalance (ERI) in this study, leading to errors in Table 3 for (1) the prevalence of exposure to ERI, and (2) the fractions of cardiovascular diseases and mental disorders attributable to ERI, attributable fractions (AF) being calculated from exposure prevalence and relative risk.

Méthodologie de redressement des données nationales de l'enquête Évrest.

OBJECTIVES: The main objective was to describe the weighting methodology used for the national EVREST (Evolution and Relations in Health at Work) survey data. The secondary objectives were on the one hand to assess the extent of the differences between crude and weighted estimates, on the other hand to verify that the two-year gap in the availability of the reference data used does substantially not impact the estimates. METHODS: The study was based on data collected in 2013 and 2014 (N = 26,227). The weighting included 2 steps: 1) a first weighing to take into account the probability of participation of each employee; and 2) a calibration on margins to correct the potential distortions of the sample in comparison with the scope of the survey, the reference data used coming from the annual declarations of social data (DADS) of the years 2014 and 2012. The impact of the weighting method was studied using the differences between crude and weighted percentages for the 60 variables of the questionnaire. RESULTS: 90% of the differences between crude and weighted estimates were between - 2.0% and + 2.0% using the 2014 DADS, and 83% using the 2012 DADS. The most overestimated crude estimate concerned full-time work and the most underestimated was contact with the public. The impact of the two-year gap in the availability of the reference data used was weak. CONCLUSION: A weighting methodology for EVREST survey was define and implement, allowing results to be extrapolated to the scope of the survey.

Employment and occupational outcomes following adolescent-onset mental illness: analysis of a nationally representative French cohort.

BACKGROUND: There has been little work into the relative effects of adolescent-onset, as compared to lifetime, mental illness on employment, income and occupational outcomes in adulthood. METHODS: Using data from the Santé et Itinéraire Professionnel Survey, a nationally representative survey of 13 648 French working-age people to investigate prospective associations between self-reported mental illness and employment, income and occupational outcomes. We further investigated whether these outcomes would differ for those reporting an onset of mental illness prior to 18 years of age. RESULTS: Adolescent-onset mental illness was associated with poorer employment outcomes, significantly increased risk of employment in low-skilled occupations, as well as reduced monthly wage earnings. CONCLUSIONS: Results extend understandings of the risks of adolescent-onset mental illness on employment and occupational outcomes and suggest that vocational recovery services should take these factors into account when designing support services for adolescents with mental health problems, particularly for males.

Associations between occupational factors and self-rated health in the national Brazilian working population.

BACKGROUND: The literature remains seldom on the topic of self-rated health (SRH) among the national working populations of emerging countries. The objectives of the study were to examine the associations of occupational factors with SRH in a national representative sample of the working population in Brazil. METHODS: This study relied on a cross-sectional sample of 36,442 workers, 16,992 women and 19,450 men. SRH was the studied health outcome. Sixteen occupational factors related to four topics were studied: employment characteristics, working time/hours, psychosocial work factors and physical and chemical work exposures. The associations between occupational factors and SRH were studied using logistic regression models with adjustment for sociodemographic characteristics (age, ethnicity and marital status). The analyses were performed for each gender separately and using weights. RESULTS: The prevalence of poor SRH was 26.71%, this prevalence being higher among women (29.77%) than among men (24.23%). The following risk factors for poor SRH were found among men and women: working as a self-employed worker, clerk/service worker, manual worker, part-time (≤ 20 h/week), exposure to work stress, exposure to high physical activity and exposure to sun. The risk factors for poor SRH among women only were: working as a domestic worker and exposure to noise, and among men, working in the agriculture sector. CONCLUSIONS: Our study suggested that occupational factors related to both physical and psychosocial work environment may be associated with SRH in the working population in Brazil. Improving working conditions may be beneficial for health at work in Brazil.

[Weighting methodology for the national EVREST survey data]. / Méthodologie de redressement des données nationales de l'enquête Évrest.

OBJECTIVES: The main objective was to describe the weighting methodology used for the national EVREST (Evolution and Relations in Health at Work) survey data. The secondary objectives were on the one hand to assess the extent of the differences between crude and weighted estimates, on the other hand to verify that the two-year gap in the availability of the reference data used does substantially not impact the estimates. METHODS: The study was based on data collected in 2013 and 2014 (N = 26,227). The weighting included 2 steps: 1) a first weighing to take into account the probability of participation of each employee; and 2) a calibration on margins to correct the potential distortions of the sample in comparison with the scope of the survey, the reference data used coming from the annual declarations of social data (DADS) of the years 2014 and 2012. The impact of the weighting method was studied using the differences between crude and weighted percentages for the 60 variables of the questionnaire. RESULTS: 90% of the differences between crude and weighted estimates were between - 2.0% and + 2.0% using the 2014 DADS, and 83% using the 2012 DADS. The most overestimated crude estimate concerned full-time work and the most underestimated was contact with the public. The impact of the two-year gap in the availability of the reference data used was weak. CONCLUSION: A weighting methodology for EVREST survey was define and implement, allowing results to be extrapolated to the scope of the survey.

Psychosocial job stressors and suicidality: a meta-analysis and systematic review.

OBJECTIVES: Job stressors are known determinants of common mental disorders. Over the past 10 years, there has been evidence that job stressors may also be risk factors for suicidality. The current paper sought to examine this topic through the first comprehensive systematic review and meta-analysis of the literature to date. METHODS: We used a three-tier search strategy of seven electronic databases. Studies were included if they reported on a job stressor or job-related stress as an exposure and suicide ideation, self-harm, suicide attempt or suicide as an outcome. Two researchers independently screened articles. All extracted effect estimates were converted to log-transformed ORs. RESULTS: There were 22 studies that were included in meta-analysis. Overall, exposure to job stressors was associated with elevated risk of suicide ideation and behaviours. The OR for suicide ideation (14 studies) ranged from 1.45 (95% CI 1.01 to 2.08) for poor supervisor and colleague support to 1.91 (95% CI 1.22 to 2.99) for job insecurity. For suicide (six studies), exposure to lower supervisor and collegial support produced an OR of 1.16 (95% CI 0.98 to 1.38), while low job control resulted in an OR of 1.23 (95% CI 1.00 to 1.50). There were only two studies that examined suicide attempt, both of which suggested an adverse effect of exposure to job stressors. CONCLUSIONS: This study provides some evidence that job stressors may be related to suicidal outcomes. However, as most studies in the area were cross-sectional and observational in design, there is a need for longitudinal research to assess the robustness of observed associations.