Changes in mental health as a predictor of changes in working time arrangements and occupational mobility: results from a prospective cohort study.

OBJECTIVE: The aim of this prospective study was to gain insight into a possible causal relationship between mental health and characteristics of the work situation. METHODS: Using longitudinal data from the Maastricht Cohort Study, this study examines whether deterioration in mental health (prolonged fatigue, need for recovery, and psychological distress) results in a subsequent change in working time arrangements (assessed by means of logistic regression analysis) or occupational mobility (assessed by means of Cox regression analysis). RESULTS: Compared to employees not experiencing a deterioration in mental health, employees who became a prolonged fatigue case were more likely to reduce their working hours (OR 2.49; 95% CI 1.42-4.35) and leave a shift work job (OR 3.44; 95% CI 1.42-8.38). Employees who became a need for recovery case were more likely to reduce their working hours (OR 2.83; 95% CI 1.53-5.26) or change jobs within the company (RR 1.31; 95% CI 1.07-1.61). Employees who became a psychological distress case were more likely to change jobs within the company (RR 1.38; 95% CI 1.16-1.65) or to change jobs from one employer to another (RR 1.45; 95% CI 1.03-2.03). CONCLUSION: The results of this study provide evidence for a possible causal relationship between deterioration in mental health and subsequent change in working time arrangements or occupational mobility. These results suggest that workers adapt to the onset of a mental health problem by reducing their working hours, by leaving a shift work job, by changing jobs within the company, or by changing jobs from one employer to another.

Risk factors for interpersonal conflicts at work.

OBJECTIVES: The main goal of this study was to identify work-related risk factors for the onset of interpersonal conflicts at work. METHODS: Longitudinal data from the Maastricht Cohort Study on "fatigue at work" (N=9241) were used. After the respondents who reported an interpersonal conflict at baseline were excluded, logistic regression analyses were used to determine the role of several work-related risk factors at baseline in the onset of a conflict with coworkers or supervisors after 1 year of follow-up. RESULTS: Higher psychological job demands, higher levels of role ambiguity, the presence of physical demands, higher musculoskeletal demands, a poorer physical work environment, shift work, overtime, and higher levels of job insecurity significantly predicted the onset of both a coworker conflict and a supervisor conflict. Higher levels of coworker and supervisor social support, more autonomy concerning the terms of employment, good overall job satisfaction, monetary gratification, and esteem reward significantly protected against the onset of both a coworker conflict and a supervisor conflict. Higher levels of decision latitude and more career opportunities also significantly protected against the onset of a supervisor conflict. CONCLUSIONS: Several factors in the work environment were related to the onset of interpersonal conflicts at work. Given the rather serious consequences of interpersonal conflicts at work with respect to health and well-being, the observed risk factors can serve as a starting point for effective prevention and intervention strategies in the workplace.

The effects of integrated care on quality of work in nursing homes: a quasi-experiment.

BACKGROUND: In nursing homes there is a gradual move from traditional care to integrated care. Integrated care means a demand-oriented, small-scale, co-operated and coordinated provision of services by different caregivers. This integration has direct effect on the work of these separate disciplines. With the introduction of integrated care the quality of work of these caregivers should be assured or even be improved. OBJECTIVES: The purpose of this study was to examine the implementation of integrated care in the nursing home sector and its effects on the quality of work of the caregivers (work content, communication and co-operation and worker's outcomes). DESIGN: A non-equivalent pre-test/post-test control group design was used in this study. SETTINGS AND PARTICIPANTS: Two nursing homes in the Netherlands participated in the study. One nursing home provided the five experimental nursing wards and the other nursing home provided four control wards. METHOD: Data were selected by means of written questionnaires. RESULTS: The results showed that the intervention appeared to be only successful on the somatic wards. The caregivers of these wards were more able to create a home-like environment for their residents, to use a demand-oriented working method and to integrate the provision of care and services. Regarding the effects of the intervention on quality of work factors, the results included an increase of social support by the supervisor, an increase of the degree of collaboration and a decrease in job demands. No changes were found for the worker's outcomes such as job satisfaction. CONCLUSIONS: The intervention on the psycho-somatic wards was unsuccessful. Although the introduction of integrated care on the somatic wards was successful, the effects on quality of work were limited. Next to quantitative research, more qualitative in-depth research is needed to examine models of integrated care and their effects on the work of caregivers within health care organisations, with special attention for specific characteristics of different types of nursing home care (somatic vs. psycho-geriatric).

Mental health effects of changes in psychosocial work characteristics: a prospective cohort study.

OBJECTIVE: To explore a possible causal relationship between psychosocial work characteristics and mental health. METHODS: Using longitudinal data from the Maastricht Cohort Study on "Fatigue at Work" (n = 2332), the effects of changes in job demands and decision latitude on subsequent changes in need for recovery and prolonged fatigue were studied. RESULTS: Increasing job demands are a significant predictor of a subsequent increase in need for recovery (beta = 0.063) and prolonged fatigue (beta = 0.057). An increase in decision latitude predicted a subsequent decrease in need for recovery (beta = -0.078) and prolonged fatigue (beta = -0.063). After adjusting for changes in other work characteristics, the effects on changes in prolonged fatigue were no longer significant. CONCLUSION: These findings support a possible causal relationship between work characteristics and mental health and can be used for designing effective prevention and intervention strategies.