Acts of offensive behaviour and risk of disability pension in Danish female eldercare workers: prospective cohort with 11-year register follow-up.

OBJECTIVES: To investigate whether acts of offensive behaviour (threats, violence, workplace bullying and sexual harassment) in the workplace and type of perpetrator (internal or external to the workplace) of the offensive behaviours predicted risk of disability pension in Danish eldercare workers. METHODS: We merged survey responses from 8731 female eldercare workers with a national register on social transfer payments (Danish Register for Evaluation of Marginalisation (DREAM)), including all types of disability benefits. Using Cox proportional hazards models, we investigated the prospective association between self-reported exposures at baseline and the risk of receiving disability pension (any type of disability benefit payment) during 11 years of follow-up, while adjusting for potential confounders. RESULTS: Self-reported exposure to threats (hazard ratio (HR) 1.14; 95% confidence interval (CI) 1.00-1.32), violence (HR 1.16; 95% CI 1.00-1.35) and bullying (HR 1.44; 95% CI 1.22-1.71) predicted increased risk of disability pension during follow-up, when adjusted for age and educational attainment. When further adjusted for psychosocial working conditions only bullying remained a statistically significant (HR 1.39; 95% CI 1.16-1.67) predictor of disability pension. The results indicated no elevated risk for participants reporting sexual harassment. Moreover, we observed stronger associations between self-reported exposure to threats, violence and workplace bullying and risk of disability pension when the perpetrator was internal to the workplace (i.e. colleagues, managers and/or subordinates), than when the perpetrator was reported to be external to the workplace (i.e. service users, and/or relatives of service users). CONCLUSIONS: Results indicate that prevention of work-related exposure to threats, violence and workplace bullying may contribute to reduce involuntary early retirement in female eldercare workers.

Pain Control Beliefs Predict Premature Withdrawal From the Labor Market in Workers With Persistent Pain: Prospective Cohort Study With 11-Year Register Follow-up.

While a range of work-related psychosocial factors has been associated with various pain disorders and early retirement, less is known about pain cognitions and their influence on premature exit from the labor market. Therefore, as a primary objective, this study investigates associations between pain control beliefs and risk of disability pension among Danish eldercare workers. In 2005, 2257 female eldercare workers with low-back and/or neck/shoulder pain>90 days within the previous 12 months, replied to a survey and were followed for 11 years in a national register of social transfer payments. Using Cox regression, we estimated the risk of disability pension during follow-up from experiencing different levels of "pain control" and "pain influence," controlling for pain intensity and other relevant confounders. In the fully adjusted model for pain control with "high" as reference, hazard ratios of 1.30 (95% CI 1.03-1.64) and 2.09 (95% CI 1.45-3.01) are observed for "moderate" and "low," respectively, while the metric of pain influence shows hazard ratios of 1.43 (95% CI 1.11-1.87) and 2.10 (1.53-2.89), respectively. Pain control beliefs are associated with disability pension among eldercare workers with persistent pain. These results highlight the importance of evaluating not only bodily manifestations of pain, but also individual pain-related cognitions that may influence the experience of pain. PERSPECTIVE: This article addresses the complex experience of pain within an organizational context. We introduce the metrics of "pain control" and "pain influence" among workers with persistent pain, showing that the psychometric properties of these measures are prospectively associated with premature exit from the labor market.

Workplace bullying and risk of suicide and suicide attempts: A register-based prospective cohort study of 98 330 participants in Denmark.

OBJECTIVES: The aim of this study was to analyze whether individuals reporting exposure to workplace bullying had a higher risk of suicidal behavior, including both suicide attempt and death by suicide, than those not reporting such exposure. METHODS: Using a prospective cohort study design, we linked data from nine Danish questionnaire-based surveys (2004-2014) to national registers up to 31 December 2016. Exposure to workplace bullying was measured by a single item. Suicide attempts were identified in hospital registers and death by suicide in the Cause of Death Register. Among participants with no previous suicide attempts, we estimated hazard ratios (HR) and 95% confidence intervals (CI), adjusting for sex, age, marital status, socioeconomic status, and history of psychiatric morbidity. RESULTS: The sample consisted of 98 330 participants (713 798 person-years), 63.6% were women, and the mean age was 44.5 years. Of these participants, 10 259 (10.4%) reported workplace bullying. During a mean follow-up of 7.3 years, we observed 184 cases of suicidal behavior, including 145 suicide attempts, 35 deaths by suicide and 4 cases that died by suicide after surviving a suicide attempt. The fully-adjusted HR for the association between workplace bullying and suicidal behavior was 1.65 (95% CI 1.06-2.58). The HR for suicide attempts and death by suicide were 1.65 (1.09-2.50) and 2.08 (0.82-5.27), respectively. Analyses stratified by sex showed a statistically significant association between workplace bullying and suicidal behavior among men but not women. CONCLUSIONS: The results suggest that exposure to workplace bullying is associated with an elevated risk of suicidal behavior among men.

Combined ergonomic exposures and development of musculoskeletal pain in the general working population: A prospective cohort study.

OBJECTIVE: This study aimed to investigate the importance of combined ergonomic exposures at work for the development of musculoskeletal pain. METHODS: Through four rounds (2012-2018) of the Work Environment and Health in Denmark Study, 18 905 employees of the general working population replied to a baseline and 2-year follow-up questionnaire. First, a k-means cluster analysis of seven ergonomic factors (back bending, arm above shoulders, lifting etc., from 'never' to 'almost all the time') identified nine naturally occurring clusters. Second, using a weighted survey regression model controlling for age, gender, survey year, education, lifestyle, influence at work, and pain intensity at baseline, we estimated development of pain intensity (0-10) in the neck-shoulder and low-back in these clusters. The largest cluster served as reference to the other clusters and was characterized by low ergonomic exposures. RESULTS: Clusters characterized by multiple combined ergonomic exposures for a relatively high percentage of the working time showed the largest increase in neck-shoulder as well as low-back pain intensity from baseline to follow-up. However, clusters characterized by high exposure to a few specific ergonomic factors also increased pain significantly, eg, standing/walking combined with lifting/carrying or twisted/bent back for the majority of the working time increased low-back pain, whereas repetitive arm movements for the majority of the working time with or without standing/walking increased neck-shoulder pain. CONCLUSION: Combined occupational ergonomic exposures play an important role in the development of musculoskeletal pain. Workplace preventive approaches should consider this in risk assessments and organization of the work.

Contribution of income and job strain to the association between education and cardiovascular disease in 1.6 million Danish employees.

AIMS: We examined the extent to which associations between education and cardiovascular disease (CVD) morbidity and mortality are attributable to income and work stress. METHODS AND RESULTS: We included all employed Danish residents aged 30-59 years in 2000. Cardiovascular disease morbidity analyses included 1 638 270 individuals, free of cardiometabolic disease (CVD or diabetes). Mortality analyses included 41 944 individuals with cardiometabolic disease. We assessed education and income annually from population registers and work stress, defined as job strain, with a job-exposure matrix. Outcomes were ascertained until 2014 from health registers and risk was estimated using Cox regression. During 10 957 399 (men) and 10 776 516 person-years (women), we identified 51 585 and 24 075 incident CVD cases, respectively. For men with low education, risk of CVD was 1.62 [95% confidence interval (CI) 1.58-1.66] before and 1.46 (95% CI 1.42-1.50) after adjustment for income and job strain (25% reduction). In women, estimates were 1.66 (95% CI 1.61-1.72) and 1.53 (95% CI 1.47-1.58) (21% reduction). Of individuals with cardiometabolic disease, 1736 men (362 234 person-years) and 341 women (179 402 person-years) died from CVD. Education predicted CVD mortality in both sexes. Estimates were reduced with 54% (men) and 33% (women) after adjustment for income and job strain. CONCLUSION: Low education predicted incident CVD in initially healthy individuals and CVD mortality in individuals with prevalent cardiometabolic disease. In men with cardiometabolic disease, income and job strain explained half of the higher CVD mortality in the low education group. In healthy men and in women regardless of cardiometabolic disease, these factors explained 21-33% of the higher CVD morbidity and mortality.

Physical and Psychosocial Work Environmental Risk Factors for Back Injury among Healthcare Workers: Prospective Cohort Study.

The incidence of occupational back injury in the healthcare sector remains high despite decades of efforts to reduce such injuries. This prospective cohort study investigated the risk factors for back injury during patient transfer. Healthcare workers (n = 2080) from 314 departments at 17 hospitals in Denmark replied to repeated questionnaires sent every 14 days for one year. Using repeated-measures binomial logistic regression, controlling for education, work, lifestyle, and health, the odds for back injury (i.e., sudden onset episodes) were modeled. On the basis of 482 back injury events, a higher number of patient transfers was an important risk factor, with odds ratio (OR) 3.58 (95% confidence interval (CI) 2.51-5.10) for 1-4 transfers per day, OR 7.60 (5.14-11.22) for 5-8 transfers per day, and OR 8.03 (5.26-12.27) for 9 or more transfers per day (reference: less than 1 per day). The lack of necessary assistive devices was a common phenomenon during back injury events, with the top four lacking devices being sliding sheets (30%), intelligent beds (19%), walking aids (18%), and ceiling lifts (13%). For the psychosocial factors, poor collaboration between and support from colleagues increased the risk for back injury, with OR 3.16 (1.85-5.39). In conclusion, reducing the physical burden in terms of number of daily patient transfers, providing the necessary assistive devices, and cultivating good collaboration between colleagues are important factors in preventing occupational back injuries among healthcare workers.

Reasons for using workplace wellness services: Cross-sectional study among 6000 employees.

AIMS: While workplace wellness services are proactively established to improve well-being and reduce sickness absence, knowledge of reasons for using these services remains sparse. This study investigates which factors determine use of an in-house wellness service at a large organization (the Danish Police) with several departments in different geographical locations. METHODS: All potential users of the Wellness service ( n = 15,284) were invited to respond to a cross-sectional questionnaire. Of 6060 eligible respondents, 58% had used the service at least once (any use) and 17% had used the service at least three times (frequent users). Two items assessed the frequency of statements of justifications for using or not using the Wellness service. Associations between 32 demographic and psychosocial variables and use of the Wellness service were evaluated with unadjusted bivariate logistic regression analyses. RESULTS: The two primary justifications for using the Wellness service were: to get a blood pressure assessment (37%) and to rehabilitate injury (26%). The two most common justifications for not using the Wellness service were: no perceived need (44%) and already physically active (34%). Of the 32 demographical and psychosocial variables included, 28 were associated with any use and 24 with frequent use. CONCLUSIONS: Use of the Wellness service appears to be driven by a complex configuration of factors that resist easy translation into practical advice. Non-participation was accounted for in terms of both positive and negative barriers. Use of the service for purposes of primary prevention and health promotion was, relatively speaking, lagging behind.

Does employee participation in workplace health promotion depend on the working environment? A cross-sectional study of Danish workers.

OBJECTIVES: To investigate if participation in workplace health promotion (WHP) depends on the work environment. METHODS: Questionnaire data on participation in WHP activities (smoking cessation, healthy diet, exercise facilities, weekly exercise classes, contact with health professionals, health screenings) and the work environment (social support, fatiguing work, physical, quantitative and emotional demands, job control and WHP availability setting) were collected cross-sectionally in 2010 in a representative sample (n=10 605) of Danish workers. Binary regression analyses of the association between work environment characteristics and participation in WHP were conducted and adjusted for age, gender and industry. RESULTS: WHP offered during leisure time was associated with lower participation in all measured activities compared with when offered during working hours. Low social support and fatiguing work were associated with low participation in WHP. No associations with participation in WHPs were observed for physical work or quantitative demands, work pace or job strain. However, high physical demands/low job control and high emotional demands/low job control were associated with low participation. CONCLUSIONS: Lower participation in WHP was associated with programmes during leisure, low social support, very fatiguing work and high physical or emotional demands with low job control. This suggests that to obtain proper effect of health promotion in a workplace setting, a good work environment is essential.

Does workplace health promotion in Denmark reach relevant target groups?

The aim of the current study was to investigate whether Workplace Health Promotion (WHP) is available for workers with poor health status (overweight, musculoskeletal disorders, sickness absence and poor self-rated health) or health behaviour (smoking, poor diet and sedentarism) and whether they participate in WHP. In total, 9835 workers responded to questions regarding availability to 6 different types of WHP through The Danish Work Environment Cohort Study in 2010. Logistic regression analyses adjusted for age, gender and industry were performed to calculate odds ratios for availability and participation of WHP among groups with different health behaviours and health status. In general, poor health behaviours were associated with reduced availability of and participation in WHP. In contrast, poor health status was generally associated with higher availability of WHP and increased participation. However, poor self-rated health was associated with lower availability of several types of WHP and reduced participation. In general, workers with health challenges that are visible to others had WHP available, whereas workers with less visible health challenges had WHP less frequently available. Health challenges visible to others were associated with higher participation in WHP, whereas poor health behaviour and reduced self-rated health were associated with reduced participation in WHP programmes.

The relationship between self-efficacy and help evasion.

OBJECTIVE: To examine the relationship between self-efficacy and not wanting help to change health behaviors. METHOD: All employees in the Danish police department were invited to respond to an electronic questionnaire. All respondents expressing a desire to change health behaviors in relation to smoking (n = 845), alcohol (n = 684), eating (n = 4431), and physical activity (n = 5179) and who subsequently responded to questions on self-efficacy were included. RESULTS: Both the bivariate and multiple regression analyses showed that all four specific self-efficacy scores were positively related to reporting that one did not want help. CONCLUSION: A high belief in one's own ability to change lifestyle behaviors in relation to smoking, alcohol, eating, and physical activity may lead to avoidance of help offers in a workplace setting.

Help Preferences Among Employees Who Wish to Change Health Behaviors.

OBJECTIVE: To examine the help preferences of employees in the Danish police who had acknowledged that they wished to change health behaviors. In addition, we explored whether preferences varied with age, gender, chronic health concerns, positive expectations of good health, and past experiences of in-house health promotion services (i.e., wellness service). METHODS: Respondents to an electronic questionnaire who acknowledged wishing to change health behaviors in relation to smoking (n = 845), alcohol (n = 684), eating (n = 4,431), and physical activity (n = 5,179) were asked to choose up to three help alternatives on a predefined list. RESULTS: In descending order, smokers preferred help from nicotine gum, no help, and help and support from family and friends. Alcohol consumers preferred no help or help and support from family and friends or "other" forms. Employees who wanted to change eating habits preferred a free fruit bowl, free nutritional guidance, and healthy food at work. Employees who wanted to change physical activity patterns preferred exercise at work, offers of free exercise, and exercise in a social/collegial context. CONCLUSION: Wishing to change health behaviors is not always accompanied by perceiving a need for assistance. The no-help option was selected fairly frequently and mostly in relation to alcohol and smoking. A fruit bowl was the most preferred option for help, followed by exercise at work and free exercise. Help from traditional health services was ranked low, possibly reflecting that they are primarily viewed as a solution for stopping disease rather than promoting health.

Distribution of subjective health complaints, and their association with register based sickness absence in the Danish working population.

AIMS: To describe the distribution of subjective health complaints (SHCs) in a Danish working population and the associations between SHC and register based sickness absence. METHODS: The study entailed 2876 men and 3574 women aged 18-59 years that constituted the 2005 panel in the Danish Work Environment Cohort Study (DWECS). All had completed a subjective health complaints inventory and the Nordic Musculoskeletal Questionnaire (NMQ). Seven SHC/NMQ indices were constructed and merged with subsequently collected data on prolonged sickness absence periods (each period > 14 days) that was registered in the national Danish register on social transfer payments: the DREAM register. Ordinal logistic regression was used to model the cumulative odds for sickness absence as a function of strata. RESULTS: The majority of participants reported at least one SHC during a 30-day period (circa 89% of the men and 95% of the women). The reports of severe SHC, defined as recurring SHC within the 30-day period, were less common. About 55% of the men and 68% of the women reported at least one severe SHC during a 30-day period. The odds ratios of sickness absence increased with the number of SHC a participant acknowledged. The odds ratios were slightly reduced after adjusting for age, disease history and social class. CONCLUSIONS: The majority of the working population in Denmark report at least one SHC during a 30-day period. Roughly half of the population report having at least one recurrent (often to very often) SHC during the last 30-days (severe SHC). Reporting the presence of several SHCs increases the likelihood of having more prospectively registered periods of sickness absence above two weeks.

Why do people with suboptimal health avoid health promotion at work?

OBJECTIVES: To explore why people who have active work and who experience suboptimal health avoided using a multipurpose in-house health promotion service in the Danish police. METHODS: Data were first collected via an electronic survey (N=6060) and subsequently via 25 telephone interviews targeting nonusers who perceived their health to be suboptimal. RESULTS: Many nonusers with suboptimal health wished to change health behaviors, but did not use the service. Reasons were both individual (eg, laziness) and organizational (eg, delivery of the service). CONCLUSIONS: Although many reported barriers are more individual in nature, increased information and accessibility could serve to increase participation.

Impact of burnout and psychosocial work characteristics on future long-term sickness absence. Prospective results of the Danish PUMA Study among human service workers.

OBJECTIVES: The objective of this study was to examine if burnout and psychosocial factors predicted long-term sickness absence (>2 weeks) at work unit level. METHODS: Data were collected prospectively at 82-work units in human services (PUMA cohort, PUMA: Danish acronym for Burnout, Motivation and Job satisfaction) followed up during the proceeding 18 months regarding onset of long-term sickness absence. Questionnaire data regarding burnout and psychosocial factors were aggregated at work unit level. We used Poisson regression models with psychosocial factors and burnout as predictors of long-term sickness absence for more than 18 months based on data from a national absence register. RESULTS: Long-term sickness absence was predicted by psychosocial factors and by burnout at work unit level. CONCLUSION: To reduce sickness absence, organizations within human services should improve the psychosocial work environment, and equally important, the organizations should be attentive to employees with symptoms of burnout.

Predicting long-term sickness absence and early retirement pension from self-reported work ability.

OBJECTIVE: The aim of this paper is to examine the relationship between self-reported work ability and long-term term of sickness absence or early retirement from the labour market. METHODS: Data on work ability were retrieved from a representative cohort study of Danish wage earners and linked with a register of social payment transfers. In all, 4.743 individuals were followed from 2001 to 2005. Cox regression was used for the analyses. RESULTS: A one point decrease in perceived work ability, on a 10 point scale, was associated with an increased risk of long-term sickness absence (LTSA) of 15.1% (95% CI 12-19%, P < 0.0001) and an increased risk of early retirement from the labour market of 33% (95% CI 20-48%, P < 0.0001). CONCLUSIONS: Reports of reduced work ability were significantly associated with both an increased risk of onset of LTSA and early retirement from the labour market, after adjustment for socio-demographic characteristics and lifestyle variables.

Differences in sickness absence in Sweden and Denmark: the cross national HAKNAK study.

AIM: To investigate potential differences in sickness absence among public sector employees in Sweden and Denmark, and to what extent a difference was associated with age, gender, physical and psychosocial work environment exposures, lifestyle factors, self-rated health or work ability. METHODS: In 2000, two cross-sectional samples of 8562 public sector employees in Sweden and Denmark were surveyed. The study outcome, self-reported number of sick-leave days the year preceding interview, was dichotomized into 7 days or less, and more than 7 days. Chi square test was used to analyse distribution of dependent and independent variables in the two sub-cohorts. Stratified logistic regression analysis was performed to identify causes for absence within the two sub-cohorts, and logistic regression analysis was performed to study differences in sickness absence levels between the two sub-cohorts. RESULTS: More subjects from the Swedish study population reported more than 7 days of sickness absence. Factors associated with sickness absence were largely similar in the two countries. The difference in absence level between Sweden and Denmark was not associated with differences in age, gender, skill level, lifestyle, psychosocial or physical work environment, musculoskeletal symptoms or self-rated health, whereas work ability score decreased the difference in sickness absence level. CONCLUSION: The results could indicate an increased retention of employees with health problems in the Swedish labour market compared with the Danish labour market. A possible explanation for the differences in sickness absence ascertained in this study could be due to differences in the sickness insurance legislation.

Using administrative sickness absence data as a marker of future disability pension: the prospective DREAM study of Danish private sector employees.

OBJECTIVES: The aim of this study was to examine duration of sickness absence as a risk marker for future disability pension among all private sector employees in Denmark 1998-2004. METHODS: All private sector employees receiving sickness absence compensation from the municipality in 1998, a total of 225 056 persons (39.2% women 61.8% men, age range 18-65, mean age 37.2), were followed in a national register to determine granted disability pension during the period 1 January 2001 through 31 December 2004. The authors excluded pensions in 1999 and 2000 to determine the status of sickness absence duration as an early risk marker. RESULTS: 5694 persons (2.5%) received disability pension during follow-up, more men (53.4%) than women (46.6%). There was a strong graded association between increasing length of absence and increasing risk of future disability pension. Significant differences were found between the younger and older age strata: men below 40 experiencing more than 26 weeks of sickness absence had a 16-fold risk of disability pension. The corresponding figure for men 40 years or older was approximately 7. For women, the corresponding figures were 12.6 and 6.7 respectively. CONCLUSION: The findings suggest that administratively collected data on sickness absence compensation are an important predictor of disability pension among private sector employees. The use of information on sick leave may improve the effectiveness of early interventions by policy makers, case managing authorities, employers and physicians.

Does self-efficacy predict return-to-work after sickness absence? A prospective study among 930 employees with sickness absence for three weeks or more.

AIM: To compare levels of self-efficacy among the general working population and employees with sickness absence from work, and to examine if general self-efficacy measured before occurrence of sickness absence predicted subsequent onset of sickness absence and Return-to-Work. METHODS: The study follows a cohort of 5357 working employees and 106 long-term sickness absent employees in Denmark. They were interviewed in 2000 regarding self-efficacy and various co-variates, and followed for 78 weeks in a national sickness absence register. Cox regression analysis was performed in order to assess the effect of self-efficacy on Return-to-Work after sickness absence. RESULTS: General self-efficacy was significantly lower among those with sickness absence compared to the general working population. Self-efficacy showed no statistically significant association with later onset of sickness absence or with Return-to-Work. CONCLUSION: The results may suggest that lower self-efficacy among employees with sickness absence is a result of the sickness absence itself rather than a precursor of it. This indicates a need to investigate the potential change in self-efficacy in relation to the employee's change in labor market status; this will help to focus Return-to-Work interventions where planning has to be attentive towards the change in self-efficacy that can occur after onset of disease and sickness absence.

The fraction of long-term sickness absence attributable to work environmental factors: prospective results from the Danish Work Environment Cohort Study.

OBJECTIVE: To examine the fraction of long-term sickness absence periods attributable to physical and psychosocial work environmental risk factors. METHOD: A random population sample was followed for 18 months in a national register of social transfer payments. Mutually adjusted hazard ratios for onset of long-term sickness absence and aetiological fractions were computed. RESULTS: After mutual adjustment, no significant effect of psychosocial work environment factors remained. In men, 23% and 28% of long-term sickness absence were attributable to working mainly standing or squatting, and lifting or carrying loads, respectively. In women, 27% of long-term sickness absence was attributable to bending or twisting of the neck or back. CONCLUSIONS: Physical work environment exposures explained between 10% and 30% of long-term sickness absence. The potential for reducing long-term sickness absence is substantial.

The impact of health behaviour on long term sickness absence: results from DWECS/DREAM.

Long term sickness absence (LTSA) is a major public health problem. We examined the impact of four, potentially modifiable, health behaviours, such as smoking, alcohol consumption, leisure time physical activity, and the associated variable of body mass index on the risk of subsequent LTSA. This was done by following a representative population sample of 5,020 Danish employees aged 18-69 for 18 months in a national register on social transfer payments. Risk estimates for onset of LTSA and etiologic fractions were computed. In women, ex-smokers and heavy smokers had an increased risk of LTSA of 1.61 and 2.05 respectively after adjustment for age, family status, socio economic status, school education, physical and psychosocial work environment exposures and diagnosed disease. In men, effect estimates were smaller and only borderline significant in the fully-adjusted model. The etiologic fraction of smoking was 17.4% in men and 25.5% in women.