Gender-based violence and harassment at work and health and occupational outcomes. A systematic review of prospective studies.

BACKGROUND: Many people experience forms of gender-based violence and harassment (GBVH) in the context of their work. This includes a wide range of experiences, from subtle expressions of hostility to physical assault, that can also be of a sexual nature (e.g., sexual harassment or assault). This systematic review aimed to summarize findings about the prospective associations of work-related GBVH with people's health and occupational situation. METHODS: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Scopus, Web of Science, MEDLINE and PsycINFO were searched for prospective studies in English from 1990 to May 24, 2023. Studies were included if they concerned a working population, exposure to any form of GBVH in the work context, and a health outcome or manifest occupational outcome. Quality was assessed with a modified version of the Cochrane 'Tool to Assess Risk of Bias in Cohort Studies', and studies assessed as low quality were excluded from the narrative synthesis. For the narrative synthesis, we grouped the results by similar exposures and outcomes and reported the strength and statistical significance of the associations. RESULTS: Of the 1 937 screened records, 29 studies were included in the narrative synthesis. Studies were mainly conducted in the USA and northern Europe and investigated exposure to sexual violence or harassment (SVH). Only two included studies investigated non-sexual kinds of GBVH. Consistently, studies showed associations of work-related SVH with poor mental health and there were indications of an association with hazardous substance use. There was no consistent evidence for an association of SVH with subsequent sickness absence, and there were too few studies concerning physical health and occupational outcomes to synthesize the results. CONCLUSIONS: There is consistent evidence of work-related SVH as a risk factor for subsequent poor mental health. There is no indication that the health consequences of SVH differ between women and men, although women are more often affected. There is a need for conceptual consistency, the consideration of non-sexual behaviors and prospective studies that test clear hypotheses about the temporal sequence of events.

Sexual and gender harassment and use of psychotropic medication among Swedish workers: a prospective cohort study.

OBJECTIVE: To estimate the prospective association between the exposure to three types of gender-based violence and harassment (GBVH) and psychotropic medication. METHODS: Information on three measures of workplace GBVH-sexual harassment (1) from superiors or colleagues, (2) from others (eg, clients) and (3) gender harassment from superiors or colleagues-were retrieved from the biannual Swedish Work Environment Survey 2007-2013 (N=23 449), a representative sample of working 16-64 years old registered in Sweden. The survey answers were merged with data on antidepressants, hypnotics/sedatives and anxiolytics from the Swedish Prescribed Drug Register. Cox proportional hazards analyses with days to purchase as time scale and first instance of medicine purchase as failure event were fitted, adjusted for demographic and workplace factors. RESULTS: Workers who reported exposure to gender harassment only (HR 1.2, 95% CI 1.07 to 1.36), to sexual but not gender harassment (HR 1.21, 95% CI 1.04 to 1.40), or to gender and sexual harassment (HR 1.31, 95% CI 1.08 to 1.60) had an excess risk of psychotropics use in comparison to workers who reported neither of the exposures in the past 12 months. We found no interaction between the exposures and gender in the association with psychotropics use. CONCLUSIONS: Exposure to sexual or gender harassment at the workplace may contribute to the development of mental disorders.

Gender-based harassment in Swedish workplaces and alcohol-related morbidity and mortality: A prospective cohort study.

OBJECTIVE: The study investigated experiences of different types of work-related gender-based harassment (GBH), specifically sexual and gender harassment, as risk factors for alcohol-related morbidity and mortality (ARMM). METHODS: Information about experiences of (i) sexual harassment (SH-I) and (ii) gender harassment (GH-I) from inside the organization and (iii) sexual harassment from a person external to the organization (SH-E) were obtained from the Swedish Work Environment Survey 1995-2013, a biannual cross-sectional survey, administered to a representative sample of the Swedish working population. The survey responses from 86 033 individuals were connected to multiple registers containing information about alcohol-related diagnoses, treatment, or cause of death. Cox proportional hazard models were fitted to assess hazard ratios (HR) of incident ARMM during a mean follow-up of eight (SH-I and GH-I) and ten (SH-E) years. RESULTS: A higher prospective risk estimate of ARMM was found among participants who reported experiences of SH-E [HR 2.01, 95% confidence interval (CI) 1.61-2.52], GH-I (HR 1.33, CI 1.03-1.70), or SH-I (HR 2.37, CI 1.42-3.00). Additional analyses, distinguishing one-time from reoccurring harassment experiences, indicated a dose-response relationship for all three harassment types. Gender did not modify the associations. Under the assumption of causality, 9.3% (95% CI 5.4-13.1) of the risk of ARMM among Swedish women and 2.1% (95% CI 0.6-3.6) among Swedish men would be attributable to any of the three types of GBH included in this study. CONCLUSIONS: Experiences of GBH in the work context may be a highly relevant factor in the etiology of ARMM.

Unequal access? Use of sickness absence benefits by precariously employed workers with common mental disorders: a register-based cohort study in Sweden.

OBJECTIVE: This study compares the use of sickness absence benefits (SABs) due to a common mental disorder (CMD) between precariously employed and non-precariously employed workers with CMDs. DESIGN: Register-based cohort study. PARTICIPANTS: The study included 78 215 Swedish workers aged 27-61 who experienced CMDs in 2017, indicated by a new treatment with selective serotonin reuptake inhibitors (SSRIs). Excluded were those who emigrated or immigrated, were self-employed, had an annual employment-based income <100 Swedish Krona, had >90 days of unemployment per year, had student status, had SABs due to CMDs during the exposure measurement (2016) and the two previous years, had an SSRI prescription 1 year or less before the start of the SSRI prescription in 2017, had packs of >100 pills of SSRI medication, had a disability pension before 2017, were not entitled to SABs due to CMDs in 2016, and had no information about the exposure. OUTCOME: The first incidence of SABs due to CMDs in 2017. RESULTS: The use of SABs due to a CMD was slightly lower among precariously employed workers compared with those in standard employment (adjusted OR [aOR] 0.92, 95% CI 0.81 to 1.05). Particularly, women with three consecutive years in precarious employment had reduced SABs use (aOR 0.48, 95% CI 0.26 to 0.89), while men in precarious employment showed weaker evidence of association. Those in standard employment with high income also showed a lower use of SABs (aOR 0.74, 95% CI 0.67 to 0.81). Low unionisation and both low and high-income levels were associated with lower use of SABs, particularly among women. CONCLUSIONS: The study indicates that workers with CMDs in precarious employment may use SABs to a lower extent. Accordingly, there is a need for (1) guaranteeing access to SABs for people in precarious employment and/or (2) reducing involuntary forms of presenteeism.

Sexual and gender harassment in Swedish workplaces: A prospective cohort study on implications for long-term sickness absence.

OBJECTIVES: This prospective cohort study aimed to investigate gender harassment and sexual harassment as risk factors for prospective long-term sickness absence (LTSA, ≥21 days). Furthermore, support from colleagues was investigated as a moderating factor of this association. METHODS: Information on gender harassment, sexual harassment and support by colleagues were derived from the biannual Swedish Work Environment Survey 1999-2013, a representative sample of the Swedish working population (N=64 297). Information on LTSA as well as demographic and workplace variables were added from register data. Relative rates of LTSA the year following the exposure were determined using modified Poisson regression. RESULTS: Monthly to daily exposure to gender harassment was a risk factor for prospective LTSA among women [rate ratio (RR) 1.04, 95% confidence interval (CI) 1.02-1.05] and men (RR 1.07, 95% CI 1.04-1.10). Monthly to daily exposure to sexual harassment was also a risk factor for LTSA among women (RR 1.05, 95% CI 1.01-1.10) and men (RR 1.07, 95% CI 1.02-1.13). Exposure to sexual or gender harassment once in the last 12 months was not associated with LTSA. There was no support for an interaction between either of the exposures and support from colleagues in relation to LTSA. CONCLUSIONS: Sexual harassment and gender harassment appear to contribute to a small excess risk for LTSA among women and men. For both kinds of offensive behaviors, the pervasiveness appears to be important for the outcome. The role of support by colleagues was inconclusive and needs further investigation.