Psychosocial working conditions and depressive symptoms among Swedish employees.

PURPOSE: To investigate prospective associations between working conditions and depressive symptoms in Swedish men and women. METHODS: The study was based on SLOSH (N = 5,985), a follow-up of a representative sample of gainfully employed Swedes 16-64 years of age from the Swedish Work Environment Survey 2003. Work demands, decision authority, support and conflicts at work were measured in 2003. Depressive symptoms were recorded in 2006 by a short version of the depression subscale of the Symptom Checklist 90 (SCL-90). Linear regression analyses were performed. RESULTS: After adjusting for an indicator of previous depressive symptoms and covariates, conflicts with fellow workers in men were associated with depressive symptoms, whereas demands (men), support from fellow workers (women), and decision authority predicted lower scores. CONCLUSION: The study supports the theory that decision authority, support and conflicts at work are predictive of depressive symptoms in the general Swedish working population.

Workplace conflict resolution and the health of employees in the Swedish and Finnish units of an industrial company.

New patterns of working, the globalisation of production and the introduction of information technologies are changing the way we work. This new working environment has eliminated some risks whilst introducing others. The importance of the psychosocial working environment for the health of employees is now well documented, but the effects of managerial style have received relatively little attention. Yet management is an increasingly important aspect of companies' policies. In this paper, we examine the relationship between conflict management in the workplace and self-reported measures of stress, poor general health, exhaustion and sickness absence due to overstrain or fatigue. Our sample consists of non-supervisory employees (N = 9309) working in the Swedish and Finnish plants of a multinational forestry company who were surveyed in 2000. Bivariate analyses show that those who report that differences are resolved through discussion are least likely to report stress, poor general health, exhaustion or sickness absence. Those who report that authority is used or that no attempts are made to resolve differences have quite similar rates across all measures. Binary logistic regression analyses were performed for all health outcomes controlling for age, sex, occupational group, job complexity, job autonomy and support from superiors. Results show significantly lower likelihoods of reporting stress, poor general health, exhaustion or sickness absence amongst employees who report that differences of opinion are resolved through discussion compared to those who report that no attempts are made. No significant differences were found between those who reported that differences were resolved through use of authority and subjects in the 'no attempt' category. These results suggest that the workplace conflict resolution is important in the health of employees in addition to traditional psychosocial work environment risk factors.

Workplace expansion, long-term sickness absence, and hospital admission.

BACKGROUND: Downsizing has in previous studies, as well as in public debate, been associated with increased sickness absence. No studies have, however, looked at the long-term relation between workplace expansion and morbidity. METHODS: We investigated exposure to personnel change during 1991-96 in relation to long-term (90 days or longer) medically certified sickness absence and hospital admission for specified diagnoses during 1997-99 in 24?036 participants with a complete employment record in the biennial national Swedish Work Environment Surveys from 1989 to the end of 1999. FINDINGS: Accumulated exposure to large expansion (> or =18% per year) was related to an increased risk of long-term sickness absence (odds ratio 1.07 [95% CI 1.01-1.13], p=0.013) and hospital admission (1.09 [1.02-1.16], p=0.017). In this context, odds ratio signifies the change in odds for each additional year of exposure, varying from 0 to 6. Moderate expansion (> or =8% and <18% per year), was associated with a decreased risk of admission (0.91 [0.84-0.98], p=0.012). Moderate downsizing (> or =8% and <18% per year) was associated with an increased risk of sickness absence (1.07 [1.02-1.12], p=0.003). The strongest association between large expansion and sickness absence was in women in the public sector (1.18 [1.08-1.30], p=0.0002), corresponding to an odds ratio of 2.77 [1.62-4.74] between full exposure (all 6 years) and no exposure. INTERPRETATION: This study confirms earlier findings that downsizing is associated with health risks. It also shows that repeated exposure to rapid personnel expansion, possibly connected with centralisation of functions, statistically predicts long-term sickness absence and hospital admission. Although no conclusions about causal pathways can be drawn from our results, this exposure should be considered in future studies, policy making, and occupational health care practice.

Coping with critical life events and lack of control--the exertion of control.

Coping strategies in relation to unfair treatment or conflicts at work are discussed. 'Covert coping' has been assessed by means of a short questionnaire. Its relationship with cardiovascular risk and sick leave has been examined in an epidemiological study (WOLF) of working men and women in Stockholm. The findings indicate that in men 'covert coping' is associated with elevated cardiovascular risk and prospective long-term sick leave. In women such a coping strategy is related to current sick leave, but not to cardiovascular risk or long-term sick leave. Openness of coping strategies is also discussed in relation to bouts of anger preceding myocardial infarction. Another epidemiological study (SHEEP, ONSET) has shown that severe bouts of anger are reported significantly more often than expected during the hour preceding myocardial infarction. This was not the case in subjects who reported 'open coping patterns', however. Openness of coping strategies is partly determined by the working climate--the higher the decision latitude, the less 'covert' the coping strategies. The results support the idea that dialogue in the work place may be health promoting.

Psychosocial working conditions and cognitive complaints among Swedish employees.

BACKGROUND: Cognitive complaints involving problems with concentration, memory, decision-making and thinking are relatively common in the work force. The sensitivity of both subjective and objective cognitive functioning to common psychiatric conditions, stress levels and to cognitive load makes it plausible that psychosocial working conditions play a role in cognitive complaints. Thus, this study aimed to test the associations between psychosocial work factors and cognitive complaints in nationally representative samples of the Swedish work force. Cross-sectional (n = 9751) and prospective (n = 3644; two time points two years apart) sequential multiple regression analyses were run, adjusting for general confounders, depressive- and sleeping problems. Additional prospective analyses were run adjusting for baseline cognitive complaints. CROSS/SECTIONAL RESULTS: High quantitative demands, information and communication technology (ICT) demands, under qualification and conflicts were positively associated with cognitive complaints, while social support, good resources at work and over qualification were negatively associated with cognitive complaints in all models. Skill discretion and decision authority were weakly associated with cognitive complaints. Conflicts were more strongly associated with cognitive complaints in women than in men, after adjustment for general confounders. PROSPECTIVE RESULTS: Quantitative job demands, ICT demands and under qualification were positively associated with future cognitive complaints in all models, including when adjusted for baseline cognitive complaints. Decision authority was weakly positively associated with future cognitive complaints, only after adjustment for depressive- and sleeping problems respectively. Social support was negatively associated with future cognitive complaints after adjustment for general confounders and baseline cognitive complaints. Skill discretion and resources were negatively associated with future cognitive complaints after adjustment for general confounders. The associations between quantitative demands and future cognitive complaints were stronger in women. DISCUSSION/CONCLUSIONS: The findings indicate that psychosocial working conditions should be taken into account when considering cognitive complaints among employees.

Workplace bullying, working environment and health.

Improved work organisation could be of importance for decreased bullying in workplaces. Participants in the Swedish Longitudinal Occupational Survey of Health (SLOSH) responded to questions about work and workplace and whether they had been bullied during the past year in 2006. Those in worksites with at least five employees who did not report that they had been bullied in 2006 and without workplace change between 2006 and 2008 constituted the final sample (n=1,021 men and 1,182 women). Work characteristics and workplace factors in 2006 were used in multiple logistic regression as predictors of bullying in 2008. Separate analyses were performed for work characteristics and workplace factors respectively. Adjustments for demographic factors were made in all analyses. The question used for bullying was: "Are you exposed to personal persecution by means of vicious words or actions from your superiors or your workmates?" Such persecution any time during the past year was defined as bullying. For both genders organisational change and conflicting demands were identified as risk factors, and good decision authority as a protective factor. Dictatorial leadership, lack of procedural justice and attitude of expendability were male and lack of humanity a female risk factor for bullying.

Non-listening and self centered leadership--relationships to socioeconomic conditions and employee mental health.

BACKGROUND: The way in which leadership is experienced in different socioeconomic strata is of interest per se, as well as how it relates to employee mental health. METHODS: Three waves of SLOSH (Swedish Longitudinal Occupational Survey of Health, a questionnaire survey on a sample of the Swedish working population) were used, 2006, 2008 and 2010 (n = 5141). The leadership variables were: "Non-listening leadership" (one question: "Does your manager listen to you?"--four response categories), "Self centered leadership" (sum of three five-graded questions--"non-participating", "asocial" and "loner"). The socioeconomic factors were education and income. Emotional exhaustion and depressive symptoms were used as indicators of mental health. RESULTS: Non-listening leadership was associated with low income and low education whereas self-centered leadership showed a weaker relationship with education and no association at all with income. Both leadership variables were significantly associated with emotional exhaustion and depressive symptoms. "Self centered" as well as "non-listening" leadership in 2006 significantly predicted employee depressive symptoms in 2008 after adjustment for demographic variables. These predictions became non-significant when adjustment was made for job conditions (demands and decision latitude) in the "non-listening" leadership analyses, whereas predictions of depressive symptoms remained significant after these adjustments in the "self-centered leadership" analyses. CONCLUSIONS: Our results show that the leadership variables are associated with socioeconomic status and employee mental health. "Non-listening" scores were more sensitive to societal change and more strongly related to socioeconomic factors and job conditions than "self-centered" scores.

Conflicts at work--the relationship with workplace factors, work characteristics and self-rated health.

Few studies have considered the work environment in relation to workplace conflicts and those who have been published have included relatively few psychosocial work environment factors. Little research has been published on the consequences of workplace conflicts in terms of employee health. In this study, the statistical relationships between work and workplace characteristics on one hand and conflicts on the other hand are examined. In addition, the relationship between conflicts at work and self-rated health are described. The study population was derived from the Swedish Longitudinal Occupational Survey of Health (SLOSH) 2006; n=5,141. Among employees at workplaces with more than 20 employees (n=3,341), 1,126 (33.7%) responded that they had been involved in some type of conflict during the two years preceding the survey. Among the work and workplace characteristics studied, the following factors were independently associated with increased likelihood of ongoing conflicts: Conflicting demands, emotional demands, risk of transfer or dismissal, poor promotion prospects, high level of employee influence and good freedom of expression. Factors that decreased the likelihood of ongoing conflicts were: Good resources, good relations with management, good confidence in management, good procedural justice (fairness of decisions) and good social support. After adjustment for socioeconomic conditions the odds ratio for low self-rated health associated with ongoing conflict at work was 2.09 (1.60-2.74). The results provide a good starting point for intervention and prevention work.

Managerial leadership is associated with employee stress, health, and sickness absence independently of the demand-control-support model.

OBJECTIVES: Research on health effects of managerial leadership has only taken established work environment factors into account to a limited extent. We therefore investigated the associations between a measure of Attentive Managerial Leadership (AML), and perceived stress, age-relative self-rated health, and sickness absence due to overstrain/fatigue, adjusting for the dimensions of the Demand-Control-Support model. PARTICIPANTS: Blue- and white-collar workers from Finland, Germany and Sweden employed in a multi-national forest industry company (N=12,622). METHODS: Cross-sectional data on leadership and health from a company-wide survey analysed with logistic regression in different subgroups. RESULTS: AML was associated with perceived stress, age-relative self-rated health, and sickness absence due to overstrain/fatigue after controlling for the Demand-Control-Support model. Lack of AML was significantly associated with a high stress level in all subgroups (OR=1.68-2.67). Associations with age-relative self-rated health and sickness absence due to overstrain/fatigue were weaker, but still significant, and in the expected direction for several of the subgroups studied, suggesting an association between lack of AML and negative health consequences. CONCLUSION: The study indicates that managerial leadership is associated with employee stress, health, and sickness absence independently of the Demand-Control-Support model and should be considered in future studies of health consequences for employees, and in work environment interventions.

Demand, control and social climate as predictors of emotional exhaustion symptoms in working Swedish men and women.

AIMS: Most studies on burnout have been cross-sectional and focused on specific occupations. In the present study we prospectively investigated the association between demands, control, support and conflicts as well as downsizing and emotional exhaustion in men and women derived from a representative sample of the working population in Sweden. METHODS: The study comprised working men (1,511) and women (1,493), who participated in the Swedish Work Environment Survey (SWES) in 2003 and had no physical exhaustion and prior sick leave at baseline. These participants were followed up in 2006 as part of the Swedish Longitudinal Occupational Survey of Health (SLOSH). Demands, decision authority, support from fellow workers and superiors, conflicts with fellow workers and superiors, and downsizing were utilized as predictors and the Maslach Burnout Inventory subscale of emotional exhaustion as the outcome in multiple logistic regression analyses. RESULTS: High demands were a highly significant predictor of symptoms of emotional exhaustion (>/=75th percentile). Downsizing and lack of support from superiors were also independent predictors for men as well as lack of support from fellow workers and low decision authority for women. CONCLUSIONS: This study indicates that high demands, low decision authority, lack of support at work and downsizing could be important predictors of emotional exhaustion symptoms among working men and women.

The impact of moderate and major workplace expansion and downsizing on the psychosocial and physical work environment and income in Sweden.

AIMS: To describe the effect of organizational change (moderate and major expansion and downsizing) on psychosocial work characteristics, physical hazards, and income in a representative sample of larger workplaces in Sweden. METHODS: Annual changes in workforce size for the years 1991-1996 were derived from tax registry data. Work environment characteristics were measured in a sub-set of participants from the biennial Swedish Work Environment Surveys for 1991, 1993, and 1995. Income data were derived from national registries. RESULTS: Not all organizational change resulted in a poorer work environment. The number of beneficial outcomes associated with moderate downsizing and moderate expansion in the public sector outweighed the number of adverse outcomes. However, in the private sector the overall effect of moderate organizational change was a poorer work environment. Major downsizing was associated with a better psychosocial work environment for private-sector men and major expansion with a poorer environment for public-sector women and private-sector men. Otherwise, associations between major organizational change and the psychosocial work environment were mixed across sex and sector, although major organizational change was consistently associated with a greater risk of physical hazards. Low income was associated exclusively with organizational downsizing in the private sector. CONCLUSIONS: More research is needed to determine whether the work environment can explain observed associations between organizational change and health. Data limitations prevented the authors from examining this in the present study. Their findings indicate that future research on the work environment should pay more attention to physical hazards.

Dual source support and control at work in relation to poor health.

BACKGROUND AND AIM: Social support and decision authority in relation to health has been examined in extensive research. However, research on the role of different constellations of support sources is conspicuously lacking. The aim of the present study is to describe the health of employees in eight contrasting situations that differ with regard to support from superiors and from workmates and with regard to decision authority. Men and women were studied separately. STUDY SAMPLE AND METHODS: A large sample of Swedish employees (n = 53,371, after exclusion of supervisors) who participated in a national work environment survey was utilized. In addition prospective long-term sick leave data (60 days or more during the 12 months after questionnaire completion) were collected from the national insurance register. RESULTS: Employees who reported below median decision authority had higher prevalence of pains after work and general physical symptoms as well as a higher incidence of long-term sick leave than those with higher decision authority in all subgroups. Those with good support from both workmates and superiors had lower symptom prevalence and long-term sick leave incidence than those with poor support. The groups with either poor support from superiors or from workmates were in an intermediate category with regard to symptom prevalence. The group with good support from superiors but weak support from workmates, however, had as high long-term sick leave incidence as the group with poor support from both superiors and workmates. The patterns were similar for men and women. CONCLUSION: Long-term sick leave was related mainly to poor support from workmates. Prevalence of symptoms, on the other hand, was related to both sources of support and absence of both sources was associated with particularly high prevalence of physical symptoms. This illustrates that it is meaningful to separate the social support sources.

Bridges, pathways and valleys: labour market position and risk of hospitalization in a Swedish sample aged 55-63.

BACKGROUND: The combination of population ageing and increasingly early labour market exit (LME) throughout Europe has made older age a key issue in social policy and research. There is increasing awareness that older people are a heterogeneous group in which health inequalities persist. However, the effects of different types of LME on health have received relatively little attention. Existing studies reach different conclusions. This might be due to several reasons: different types of LME are rarely explored in conjuncture; studies often lack objective assessments of health and frequently rely on small populations. This paper aims to test the relative effects of different LME on the risk of hospitalization compared with those who remained in paid employment. METHODS: Using Government register data on pooled cross-section samples of Swedish workers aged 55-63 years (n=7,024) the authors have compared the likelihood of hospitalization for three types of LME - disability pension (fortidpension), unemployment, and early retirement - with those who continue working. RESULTS: Controlling for previous hospitalization, sex, age, social class, and health at work a significant increased risk of hospitalization was found following LME for the unemployed (OR=1.98). CONCLUSION: Early LME is a varied process with mixed effects on health, and hence is of possible importance for policy, which, therefore, requires more attention. Programmes to help older unemployed workers back into work will have positive health effects for individuals and reduce welfare costs of hospitalization.