The effect of improving psychosocial stressors on psychological distress: a quasi-experiment of Finnish health and social care workers.

AIMS: To examine how a positive change in one to three psychosocial stressors (job demands, job rewards, and workplace social capital) influenced psychological distress. METHODS: The analysis included 3605 Finnish health and social services workers who completed surveys in 2019, 2020 and 2021. A logistic regression model was used to estimate the propensity score of experiencing a positive change in one to three psychosocial stressors between 2019 and 2020. We balanced the baseline characteristics with propensity scoring. A generalised linear model with a binomial distribution and a log link function was used to compare the quasi-intervention and quasi-control groups for the risk of psychological distress in 2021. RESULTS: Among the total sample, neither improving a single stressor nor two or three stressors affected psychological distress. However, among employees younger than 50 years, improving two or three psychosocial stressors in 2019-2020 decreased the risk of moderate to severe psychological distress in 2021 by 41% (risk ratio 0.59, 95% confidence interval 0.36-0.96). Among employees aged 50 years or older, improving job rewards lowered the risk of mild to severe psychological distress by 23% (risk ratio 0.77, 95% confidence interval 0.62-0.96). CONCLUSIONS: The results of this quasi-experiment suggest that the positive effect of improving psychosocial stressors is stronger among younger than older workers. Future interventions should be customised for different ages and aim to improve accumulated work stressors and individual stress-coping skills.

Associations between accumulating job stressors, workplace social capital, and psychological distress on work-unit level: a cross-sectional study.

BACKGROUND: Psychosocial job stressor studies usually examine one exposure at a time and focus on individual workers. In this study we examined the accumulation of work stressors in work units and its association with psychological distress (PD) on work-unit level. We also investigated whether high workplace social capital modifies the effect. METHODS: We examined survey responses from 813 Finnish health and social services (HSS) work units, comprising 9 502 employees, in a cross-sectional study design. The survey was conducted in 2021. We calculated odds ratios for the association between accumulating job stressors and PD. We also analyzed the interaction between work stressors and the effect modification of high workplace social capital. RESULTS: We found that HSS work units with high percentage of employees having high job demands and low rewards (OR 7.2, 95% CI 3.7, 13.8) have an increased risk of higher PD in the work unit. We also found indication of high social capital possibly modifying the effect of job stressors on PD. The results suggest that accumulated job stressors are associated with PD on work unit level, with excess risk for PD compared to the stressors acting separately. CONCLUSIONS: The results indicate that the effect of accumulating job stressors should be further studied on work-unit level. Participatory organizational-level and work-unit level interventions to tackle job stressors and to improve workplace social capital are warranted.

Effectiveness of Workplace Interventions to Improve Health and Well-Being of Health and Social Service Workers: A Narrative Review of Randomised Controlled Trials.

Health and social service workers face high levels of workload and job stressors, which can affect their health and well-being. Therefore, it is important to evaluate the effectiveness of workplace interventions that aim to improve their mental and physical health outcomes. This review summarizes the findings of randomized controlled trials (RCTs) that examined the impact of different types of workplace interventions on various health indicators among health and social service workers. The review searched the PubMed database from its inception to December 2022 and included RCTs that reported on the effectiveness of organizational-level interventions and qualitative studies that explored barriers and facilitators to participation in such interventions. A total of 108 RCTs were included in the review, covering job burnout (N = 56 RCTs), happiness or job satisfaction (N = 35), sickness absence (N = 18), psychosocial work stressors (N = 14), well-being (N = 13), work ability (N = 12), job performance or work engagement (N = 12), perceived general health (N = 9), and occupational injuries (N = 3). The review found that several workplace interventions were effective in improving work ability, well-being, perceived general health, work performance, and job satisfaction and in reducing psychosocial stressors, burnout, and sickness absence among healthcare workers. However, the effects were generally modest and short-lived. Some of the common barriers to participation in workplace interventions among healthcare workers were inadequate staff, high workload, time pressures, work constraints, lack of manager support, scheduling health programs outside work hours, and lack of motivation. This review suggests that workplace interventions have small short-term positive effects on health and well-being of healthcare workers. Workplace interventions should be implemented as routine programs with free work hours to encourage participation or integrate intervention activities into daily work routines.

Association of poor perceived work ability and psychosocial work-related factors in health and social service worker age groups: a cross-sectional study.

OBJECTIVE: Previous work ability studies have primarily focused on old workers and physical health. This study investigated how poor perceived work ability (PPWA) is associated with work-related factors in different health and social service (HSS) worker age groups. DESIGN: Cross-sectional survey in 2020. SETTING: HSS employees (general HSS and eldercare) in nine Finnish public sector organisations. PARTICIPANTS: All employees who were employed in the organisation completed self-reported questionnaires. Of the original sample (N=24 459, response rate 67%), 22 528 gave consent for research use. PRIMARY AND SECONDARY OUTCOME MEASURES: Participants evaluated their psychosocial work environment and work ability. Lowest decile of work ability was categorised as poor. The association between psychosocial work-related factors and PPWA in different age-groups of HSS workers, adjusting for perceived health, was analysed with logistic regression. RESULTS: The proportion of PPWA was highest in shift workers, eldercare employees, practical nurses and registered nurses. Considerable variation between age groups exists in the work-related psychosocial factors associated with PPWA. Among young employees engaging leadership and working time and work task autonomy were statistically significant, whereas in middle-aged and old employees procedural justice and ethical strain were highlighted. The strength of the association with perceived health also differs in age groups (young: OR=3.77, 95% CI 3.30 to 4.30; middle-aged: OR=4.66, 95% CI 4.22 to 5.14; old: OR=6.16, 95% CI 5.20 to 7.18). CONCLUSIONS: Young employees would benefit from engaging leadership and mentoring, and from more working time and work task autonomy. As employees get older they would benefit more from job modification and from ethical and just organisation culture.

Interventions to reduce the risk of mental health problems in health and social care workplaces: A scoping review.

Work in the health and social care sector is stressful, and work-related stress increases the risk of depression, anxiety, burnout, and sleep disorders. Although interventions to reduce stress and burnout at workplaces have been developed and studied, most studies have lacked the effectiveness to improve the situation. Thus, more knowledge on interventions and analysis of their mechanisms is needed to reduce the risk of more adverse mental health problems (MHP). We conducted a scoping review to identify the relevant literature on individual and organizational interventions to improve mental health in health and social care workplaces. Data were gathered on target groups, intervention types and their effectiveness, and the outcomes of the interventions. We summarized this data thematically. The final review consisted of 76 studies. Mental health interventions primarily focused on health care workers rather than social care professionals. The interventions were mostly directed at individual workers, ignoring organizational-level interventions. They used a great variety of outcomes and questionnaires, and the questionnaires that measured the outcomes were used ambiguously. In most cases, the reported effectiveness of the studied interventions was incoherent, and many of the interventions had both statistically significant and non-significant effects. Evidence that interventions reduce the risk of work-related MHP is scarce. High-quality randomized controlled trials of interventions to promote mental health with more coherently formed outcomes are needed, especially on the organizational level. More interventions to improve social care professionals' mental health are also needed.

Association between work ability and work stressors: cross-sectional survey of elderly services and health and social care service employees.

BACKGROUND: Work in the health and social care services (HSS) is very stressful and sickness absences are high. Nevertheless, little is known about their work stressors and work ability. The first aim of this study is to describe the prevalence of different work stressors and their accumulation among eldercare workers compared to general HSS workers. Second aim is to analyze associations between different work stressors and work ability and thus provide information on factors that are important in enhancing work ability. METHODS: This cross-sectional survey examined HSS employees in Finland in 2020. The response rate was 67% (N = 22,502). Descriptive analyses were used to describe the control variables and the differences between the work stressors of general HSS and eldercare employees. After this, multinomial logistic regression analysis revealed the association between work stressors and work ability. RESULTS: Eldercare employees experienced more often moral distress than HSS employees in general, and this further lowers their work ability. Single work stressors--Karasek's strain, Siegrist's ERI, organizational injustice and moral distress--increased the odds of low work ability (OR range 1.4-2.5) in comparison to no work stressors. However, the association with single stressors was roughly one third of that with the accumulation of all four work stressors (OR = 6.8). Thus, the accumulation of several stressors was most harmful for work ability. CONCLUSIONS: This study provides novel information on the accumulation of work stressors in relation to work ability. The results suggest that in order to enhance work ability, HSS organizations should pay more attention to preventing several stressors from accumulating. Eldercare organizations in particular need to develop effective measures for lowering moral distress.

Synergistic Interaction between Job Stressors and Psychological Distress during the COVID-19 Pandemic: A Cross-Sectional Study.

Psychosocial job stressors increase the risk of mental health problems for the workers in health and social services (HSS). Although previous studies suggest that the accumulation of two or more stressors is detrimental to mental health, few studies have examined the synergistic interaction of accumulating job stressors. We examined survey responses from 9855 Finnish HSS workers in a cross-sectional study design from 2021. We conducted an interaction analysis of high job demands, low rewards and low workplace social capital on psychological distress, focusing on the relative excess risk due to interaction (RERI). Additionally, we analysed the interaction of job demands, low rewards and COVID-19 burden (extra workload and emotional load). Our analysis showed that the total RERI for the job stressors on psychological distress was considerable (6.27, 95% CI 3.14, 9.39). The total excess risk was caused by two-way interactions, especially between high demands and low rewards and by the three-way interaction of all stressors. The total RERI for job demands, low reward and COVID-19 burden (3.93, 95% CI 1.15, 6.72), however, was caused entirely by two-way interaction between high demands and low rewards. Mental health interventions tackling high demands, low rewards and low social capital are jointly needed.

Understanding Moral Distress among Eldercare Workers: A Scoping Review.

The aging of the population in Western countries will increase the use of social and health services in the future. Employees in eldercare are at risk for experiencing moral distress, which is associated with poor work ability. The causes and consequences of moral distress among eldercare workers remain undiscovered. This scoping review investigates the existing studies of causes and consequences of moral distress among eldercare workers. Additionally, it seeks evidence of interventions designed to mitigate moral distress in eldercare workers. Fourteen studies were included in the final review. Most of the included studies were qualitative, aiming to increase understanding of morally challenging situations in eldercare. We also found quantitative studies with cross-sectional designs and small sample sizes. Thus, no reliable evidence of causal effects between moral distress and worker wellbeing in eldercare was found. We found no interventions undertaken to resolve moral distress among eldercare workers, either. More research is needed on the causes and consequences of moral distress and on interventions to mitigate moral distress among eldercare workers. This is of utmost importance to increase the attractiveness of eldercare as a workplace and to improve eldercare workers' ability to work and sustain long working careers.