Does leadership support buffer the effect of workplace bullying on the risk of disability pensioning? An analysis of register-based outcomes using pooled survey data from 24,538 employees.

PURPOSE: To investigate whether self-reported exposure to workplace bullying predicts the risk of disability pensioning among employees in two occupational groups-(1) employees working with clients or customers and (2) office workers and manual workers-and whether leadership support and occupational group moderates that association. METHODS: Survey data from 24,538 employees (112,889 person years) were fitted to a national register containing information on disability-pension payments. Using multi-adjusted Cox-regression analysis, observations were followed in the register to assess the risk of disability pensioning. The average follow-up time was 4.6 years (standard deviation [SD] = 1.5). RESULTS: Self-reported exposure to workplace bullying predicted an increased risk of disability pensioning (hazard ratio [HR] = 1.46; 95% confidence interval [CI]: 1.15-1.86). This association was moderated by leadership support: the association between workplace bullying and disability pensioning was significantly different for respondents who reported low leadership support (HR = 1.97; 95% CI: 1.38-2.80) compared to respondents who reported medium (HR = 1.03; 95% CI: 0.60-1.76) or high leadership support (HR = 1.08; 95% CI: 0.60-1.95). Further analyses showed similar associations between workplace bullying and the risk of disability pensioning among the two occupational groups. CONCLUSIONS: Self-reported workplace bullying increases the risk of disability pensioning, and this association is buffered by leadership support. Workplace bullying should be considered an important workplace stressor. This study indicates that workplaces may enhance worker retention by actively promoting measures to eliminate the occurrence of workplace bullying and to enhance leadership support.

Ranking of psychosocial and traditional risk factors by importance for coronary heart disease: the Copenhagen City Heart Study.

AIMS: To rank psychosocial and traditional risk factors by importance for coronary heart disease. METHODS AND RESULTS: The Copenhagen City Heart Study is a prospective cardiovascular population study randomly selected in 1976. The third examination was carried out from 1991 to 1994, and 8882 men and women free of cardiovascular diseases were included in this study. Events were assessed until April 2013. Forward selection, population attributable fraction, and gradient boosting machine were used for determining ranks. The importance of vital exhaustion for risk prediction was investigated by C-statistics and net reclassification improvement. During the follow-up, 1731 non-fatal and fatal coronary events were registered. In men, the highest ranking risk factors for coronary heart disease were vital exhaustion [high vs. low; hazard ratio (HR) 2.36; 95% confidence interval (CI), 1.70-3.26; P < 0.001] and systolic blood pressure (≥160 mmHg or blood pressure medication vs. <120 mmHg; HR 2.07; 95% CI, 1.48-2.88; P < 0.001). In women, smoking was of highest importance (≥15 g tobacco/day vs. never smoker; HR 1.74; 95% CI, 1.43-2.11; P < 0.001), followed by vital exhaustion (high vs. low; HR 2.07; 95% CI, 1.61-2.68; P < 0.001). Vital exhaustion ranked first in women and fourth in men by population attributable fraction of 27.7% (95% CI, 18.6-36.7%; P < 0.001) and 21.1% (95% CI, 13.0-29.2%; P < 0.001), respectively. Finally, vital exhaustion significantly improved risk prediction. CONCLUSION: Vital exhaustion was one of the most important risk factors for coronary heart disease, our findings emphasize the importance of including psychosocial factors in risk prediction scores.

Relationships of organizational social capital with the presence of "gossip and slander," "quarrels and conflicts," sick leave, and poor work ability in nursing homes.

PURPOSE: This study aimed to explore the associations of organizational social capital (OSC) with the presence of "gossip and slander," the presence of "conflicts and quarrels," sick leave prevalence, and prevalence of poor work ability in frontline working personnel of nursing homes. METHODS: A total of 239 subjects (81 % participation), working in 11 different nursing homes, took part in a cross-sectional questionnaire study. Following end points were considered, they are as follows: prevalence of "gossip and slander," "conflicts and quarrels," sick leave, and poor work ability. Associations with OSC were explored at individual level (binomial log-linear regression analysis) and on group level (Kendall's tau correlation coefficients). RESULTS: Significant associations were found between OSC and "gossip and slander," sick leave, and poor work ability, both in the individual- and group-level analyses. The associations showed a higher significance level in the group-level analyses, with the strongest association found between mean OSC of the workplace and the prevalence of poor work ability at the workplace (τ = -0.722; p = 0.002). CONCLUSIONS: This study demonstrated significant associations of OSC with three end points that are relevant within the framework of well-being at work in nursing homes. The results are suggestive that OSC should be treated as a characteristic of the entire workplace, rather than as an individually experienced characteristic. The strikingly strong association between OSC and prevalence of poor work ability is suggestive for an important role of OSC within the context of maintaining work ability.

Self-reported workplace bullying and subsequent risk of diagnosed mental disorders and psychotropic drug prescriptions: A register-based prospective cohort study of 75,252 participants.

BACKGROUND: Evidence concerning workplace bullying as a risk factor for mental disorders is currently limited to depressive disorders and mainly based on non-clinical assessments. This study aims to examine the prospective association of self-reported workplace bullying with different types of register-based hospital-diagnosed mental disorders and redeemed psychotropic drug prescriptions. METHODS: Using a cohort study design, we examined a pooled dataset of 75,252 participants from 14 questionnaire-based surveys conducted between 2004 and 2014. In the questionnaires, workplace bullying was measured by a single item. The questionnaires were linked to Danish registers on hospital-diagnosed mental disorders and redeemed psychotropic drug prescriptions up to 2016. Data were analysed by multivariate Cox proportional hazard models, including only participants without a history of mental disorders or prescriptions since 1995. RESULTS: After adjustment for sex, age, marital and socio-economic status, workplace bullying was associated with an excess risk of any mental disorder (HR 1.37; 95 % CI: 1.17-1.59) as well as mood disorders and neurotic, stress-related, and somatoform disorders. In stratified analyses, this association were statistically significant only among women. Workplace bullying was also associated with any psychotropic drug prescription (fully-adjusted HR 1.43; 95 % CI: 1.35-1.53). This association was observed in both sexes and for all prescriptions, including anxiolytics, hypnotics and sedatives, antidepressants, and nootropics. LIMITATIONS: Firm conclusions about sex-related differences cannot be drawn. Residual confounding by unmeasured factors such as personality cannot be ruled out. CONCLUSIONS: Workplace bullying was associated with higher risks of diagnosed mental disorders among women and psychotropic drug prescriptions in both sexes.

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.

The development of the psychosocial work environment in Denmark from 1997 to 2005.

OBJECTIVE: The aim of the study was to elucidate the development of the psychosocial work environment in Denmark from 1997-2005. METHODS: The analyses were based on two national questionnaire surveys (N1=1062; N2=3517) of randomly selected employees who completed the Copenhagen Psychosocial Questionnaire. The psychosocial work environment was described by 19 scales and 6 single items. RESULTS: Quality of leadership and social support from supervisors were the only dimensions that saw improvements. The negative developments were: higher work pace, less influence (job control), less possibilities for development (skill discretion), lower level of meaning of work, more role conflicts, decreased role clarity, reduced sense of community, less social support from colleagues, increased conflicts at work, more threats of violence and more slander and gossip. CONCLUSIONS: The psychosocial work environment in Denmark has deteriorated during the period 1997-2005. This deterioration was seen not just among certain groups of employees but in all subgroups, incorporating gender, age and socioeconomic status. The negative development of a country's psychosocial work environment is worrying; as such, there is a strong need to change this negative trend.

The Third Version of the Copenhagen Psychosocial Questionnaire.

INTRODUCTION: A new third version of the Copenhagen Psychosocial Questionnaire (COPSOQ III) has been developed in response to trends in working life, theoretical concepts, and international experience. A key component of the COPSOQ III is a defined set of mandatory core items to be included in national short, middle, and long versions of the questionnaire. The aim of the present article is to present and test the reliability of the new international middle version of the COPSOQ III. METHODS: The questionnaire was tested among 23,361 employees during 2016-2017 in Canada, Spain, France, Germany, Sweden, and Turkey. A total of 26 dimensions (measured through scales or single items) of the middle version and two from the long version were tested. Psychometric properties of the dimensions were assessed regarding reliability (Cronbach α), ceiling and floor effects (fractions with extreme answers), and distinctiveness (correlations with other dimensions). RESULTS: Most international middle dimensions had satisfactory reliability in most countries, though some ceiling and floor effects were present. Dimensions with missing values were rare. Most dimensions had low to medium intercorrelations. CONCLUSIONS: The COPSOQ III offers reliable and distinct measures of a wide range of psychosocial dimensions of modern working life in different countries; although a few measures could be improved. Future testing should focus on validation of the COPSOQ items and dimensions using both qualitative and quantitative approaches. Such investigations would enhance the basis for recommendations using the COPSOQ III.

Perceived stress and cause-specific mortality among men and women: results from a prospective cohort study.

The authors assessed the effect of psychological stress on total and cause-specific mortality among men and women. In 1981-1983, the 12,128 Danish participants in the Copenhagen City Heart Study were asked two questions on stress intensity and frequency and were followed in a nationwide registry until 2004, with <0.1% loss to follow-up. Sex differences were found in the relations between stress and mortality (p = 0.02). After adjustments, men with high stress versus low stress had higher all-cause mortality (hazard ratio (HR) = 1.32, 95% confidence interval (CI): 1.15, 1.52). This finding was most pronounced for deaths due to respiratory diseases (high vs. low stress: HR = 1.79, 95% CI: 1.10, 2.91), external causes (HR = 3.07, 95% CI: 1.65, 5.71), and suicide (HR = 5.91, 95% CI: 2.47, 14.16). High stress was related to a 2.59 (95% CI: 1.20, 5.61) higher risk of ischemic heart disease mortality for younger, but not older, men. In general, the effects of stress were most pronounced among younger and healthier men. No associations were found between stress and mortality among women, except among younger women with high stress, who experienced lower cancer mortality (HR = 0.51, 95% CI: 0.28, 0.92). Future preventive strategies may be targeted toward stress as a risk factor for premature death among middle-aged, presumably healthy men.

Longitudinal associations of burnout with heart rate variability in patients following acute coronary syndrome: A one-year follow-up study.

OBJECTIVE: To investigate longitudinal associations of burnout with heart rate variability (HRV) in patients after their first events of acute coronary syndrome (ACS). METHODS: In total, two hundred eight patients participated in this one-year follow-up study. On the day before discharge, their personal burnout level was assessed by the Copenhagen Burnout Inventory. HRV signals were collected at four time points: the day before discharge, one month, six month and one year after discharge. HRV was measured by 24-hour ambulatory electrocardiography and analyzed in time and frequency domains. Generalized estimating equations were applied to analyze the associations of burnout at baseline with longitudinal tracking of HRV during follow-up in format of natural logarithmic transformation. RESULTS: After adjusting for relevant confounding factors, high burnout at baseline was significantly associated with low standard deviation of NN intervals (SDNN), a time domain measure of HRV (p < 0.05). Also, baseline burnout was inversely associated with five frequency domain measures, i.e., high frequency power (HF), low frequency power (LF), very low frequency power (VLF), and ultra low frequency power (ULF), and total power (TP) (all p < 0.05). CONCLUSION: Personal burnout is longitudinally associated with decreased HRV during one-year period among patients after first ACS.

Sociodemographic status, stress, and risk of prostate cancer. A prospective cohort study.

PURPOSE: The social gradient in prostate cancer incidence observed in several studies may be a result of differential access to prostate cancer screening. We aim to assess if socioeconomic status, stress, and marital status are associated with prostate cancer risk in a population with free access to health care. METHODS: The 5,496 men who participated in the Copenhagen City Heart Study were asked about their income, educational level, stress level, and marital status during 1981-1983. These men were prospectively followed up in the Danish Cancer Registry until the end of 2002 and fewer than 0.1 % were lost to follow-up. RESULTS: During follow-up, 157 men were diagnosed with prostate cancer. Neither high income (HR = 1.17, 95% confidence interval [CI]: 0.78-1.76) nor high education (HR = 1.22; 95% CI: 0.76-1.96) were associated with risk of prostate cancer. There were also no differences in prostate cancer risk according to stress (HR = 0.99; 95% CI: 0.90-1.09) or marital status. CONCLUSION: In a racially homogeneous population of Caucasians with free access to health care, we found no evidence of a relation between sociodemographic variables or stress and subsequent risk of prostate cancer.

Self-reported stress and risk of endometrial cancer: a prospective cohort study.

OBJECTIVES: To assess a possible relationship between perceived stress and first-time incidence of primary endometrial cancer. Psychological stress may affect the synthesis and metabolism of estrogens and thereby be related to risk of endometrial cancer. METHODS: The 6760 women participating in the Copenhagen City Heart Study were asked about their stress level at baseline from 1981 to 1983. These women were prospectively followed up in the Danish nationwide cancer registry until 2000 and <0.1% were lost to follow-up. Cox proportional hazard models were used to analyze data. RESULTS: During follow-up, 72 women were diagnosed with endometrial cancer. For each increase in stress level on a 7-point stress scale, there was a lower risk of primary endometrial cancer (hazard ratio (HR) = 0.88; 95% confidence interval (CI), 0.76-1.01). This inverse association was particularly strong in women who received hormone therapy (HR = 0.77; 95% CI, 0.61-0.96) and in normal-weight women (HR = 0.73; 95% CI, 0.58-0.91). CONCLUSIONS: Stress may affect gonadal synthesis of estrogens and alter the sensitivity of the uterus toward estrogen stimulation. These mechanisms may explain the lower risk of endometrial cancer observed among stressed women in this study. Despite these results, stress may still be a risk factor for a range of other diseases and should therefore not be considered a healthy response.

Analyzing sickness absence with statistical models for survival data.

OBJECTIVES: Sickness absence is the outcome in many epidemiologic studies and is often based on summary measures such as the number of sickness absences per year. In this study the use of modern statistical methods was examined by making better use of the available information. Since sickness absence data deal with events occurring over time, the use of statistical models for survival data has been reviewed, and the use of frailty models has been proposed for the analysis of such data. METHODS: Three methods for analyzing data on sickness absences were compared using a simulation study involving the following: (i) Poisson regression using a single outcome variable (number of sickness absences), (ii) analysis of time to first event using the Cox proportional hazards model, and (iii) frailty models, which are random effects proportional hazards models. Data from a study of the relation between the psychosocial work environment and sickness absence were used to illustrate the results. RESULTS: Standard methods were found to underestimate true effect sizes by approximately one-tenth [method i] and one-third [method ii] and to have lower statistical power than frailty models. CONCLUSIONS: An uncritical use of standard methods may underestimate the effect of work environment exposures or leave predictors of sickness absence undiscovered.

It is not just about occupation, but also about where you work.

OBJECTIVES: Dentistry is characterized by a meaningful but also stressful psychosocial working environment. Job satisfaction varies among staff working under different organizational forms. The aim of this study was to identify (i) to what extent crucial psychosocial work environment characteristics differ among occupations in general public dental clinics in Sweden, and (ii) how much of the variation within each occupation is attributable to the organizational level. METHODS: All staff (N=1782) employed in four public dental organizations received an email with personal log-in to an electronic questionnaire based on the Copenhagen Psychosocial Questionnaire. After two reminders, a response rate of 75% was obtained. Responses from 880 nonmanagerial dentists, dental hygienists and dental nurses working in general practices were included in our analyses. RESULTS: First, we compared the three dental occupations. We found that job demands, task resources (eg influence, possibilities for development and role clarity), strain symptoms and attitudes to work differed among occupations, dentists having the least favourable situation. Next, we compared the four organizations for each occupational group, separately. For dentists, a significant and relevant amount of variance (P<.05 and ICC >.05) was explained by the organizational level for 15 of 26 subscales, least pronounced for task resources. By contrast, for dental nurses and hygienists, the corresponding number was 2 subscales of 26. The psychosocial working environment of people working at the organization with the highest levels of strain indicators and the least positive work-related attitudes differed systematically from the organization with the most favourable profile, in particular regarding job demands and leadership aspects. CONCLUSION: In conclusion, the psychosocial working environment depended to a large degree on occupation and, for dentists in particular, also on their organizational affiliation. The findings suggest a potential for designing interventions at organizational level for improvements of the psychosocial working environment for dentists.

Multilevel analysis of individual and contextual factors as predictors of return to work.

OBJECTIVE: The objective of this study was to examine if individual and contextual levels of work environment factors predict return to work (RTW). METHODS: Baseline data from 52 workplaces was linked to a national absence register. Four hundred twenty-eight persons with more than 2 weeks of sickness absence during a 2-year period were identified. Follow up was 1 year to examine three RTW outcomes. Multilevel logistic and Poisson regression models were used. RESULTS: At the individual level, significant associations were found between one psychosocial and four physical factors and RTW within 4 weeks. Two physical factors predicted RTW within 1 year. Two psychosocial and two physical factors significantly prolonged duration of sickness absence. No significant contextual level risk factors were found. CONCLUSION: At the individual level, both the psychosocial and physical work environment factors are important independent predictors of RTW.

Psychosocial work environment predictors of short and long spells of registered sickness absence during a 2-year follow up.

OBJECTIVE: The objective of this study was to investigate the impact of psychosocial work environment factors on short and long absence spells. METHODS: Questionnaire data on work environment exposures and registered absence data during 2-year follow up were analyzed with Poisson regression for 1919 employees from the private and public sector. RESULTS: Short spells (1-10 working days) were predicted by low supervisor support, low predictability, and low meaning at work among men and high skill discretion among women. Long spells (>10 days) were predicted by low decision authority, low supervisor support, and low predictability among men and high psychologic demands and low decision authority among women. The variables predictability and meaning at work were developed for this study. CONCLUSION: Specific psychosocial work environment factors have both common and different effects on short and long absence spells. Effects also differ by gender.

Workplace levels of psychosocial factors as prospective predictors of registered sickness absence.

OBJECTIVE: We sought to investigate whether workplace levels of psychosocial work environment factors predict individual sickness absence. METHODS: Data were collected in a prospective study in 52 Danish workplaces in three organizations: municipal care, technical services, and a pharmaceutical company. Psychosocial factors were aggregated as workplace means. We used multilevel Poisson regression models with psychosocial factors as predictors and individual level sickness absence from absence registries as outcome. RESULTS: High workplace levels of decision authority predicted low sickness absence in the technical services (rate ratio = 0.66, 95% confidence interval = 0.51-0.86) and high workplace levels of skill discretion predicted low sickness absence in the pharmaceutical company (rate ratio = 0.74, 95% confidence interval = 0.62-0.88) after control for relevant confounders. Workplaces in municipal care did not differ with respect to the psychosocial factors. CONCLUSIONS: Psychosocial factors at the workplace level may be important predictors of sickness absence.

Psychosocial work characteristics as predictors for burnout: findings from 3-year follow up of the PUMA Study.

OBJECTIVE: The objective of this study was to investigate the impact of psychosocial work characteristics on burnout. METHODS: A total of 1772 participants in different human service sector organizations were eligible for the cross-sectional analyses (baseline) and 952 for the prospective analyses. We measured 14 psychosocial work characteristics and three types of burnout. Linear regression models were used for analyzing associations between psychosocial work characteristics at baseline and burnout at baseline and at 3 years of follow up. RESULTS: Low possibilities for development, high meaning of work, low predictability, high quality of leadership, low role clarity, and high role conflicts predicted burnout at 3 years of follow up after the psychosocial work characteristics were adjusted for each other, potential confounders, and burnout level at baseline. CONCLUSION: Psychosocial work characteristics were prospectively associated with burnout, suggesting that improving the psychosocial work environment may reduce future burnout in human service work.

The Copenhagen Psychosocial Questionnaire--a tool for the assessment and improvement of the psychosocial work environment.

OBJECTIVES: The aim of this article is to present the Copenhagen Psychosocial Questionnaire (COPSOQ), a questionnaire developed in three different lengths for assessing psychosocial factors at work, stress, and the well-being of employees and some personality factors. The purpose of the COPSOQ concept is to improve and facilitate research, as well as practical interventions at workplaces. METHODS: The development of the questionnaire was based on a survey of a representative sample of 1858 Danish employees aged 20-59 years. The response rate was 62%; 49% were women. Altogether 145 questions from some international and Danish questionnaires and 20 self-developed questions were tested with factor analyses, analyses of internal reliability, and analyses of response patterns. RESULTS: The analyses resulted in a long research version of the questionnaire with 141 questions and 30 dimensions, a medium-length version for work environment professionals with 95 questions and 26 dimensions, and a short version for workplaces with 44 questions and 8 dimensions. Most of the scales have good reliability, and there seems to be very little overlap between the scales. A novel feature of the COPSOQ is the development of five different scales on demands at work. CONCLUSIONS: The COPSOQ concept is a valid and reliable tool for workplace surveys, analytic research, interventions, and international comparisons. The questionnaire seems to be comprehensive and to include most of the relevant dimensions according to several important theories on psychosocial factors at work. The three versions facilitate communication between researchers, work environment professionals, and workplaces.

Antecedents and consequences of work-family conflict: a prospective cohort study.

This study examined both risk factors for the onset of work-family conflict and consequences in terms of need for recovery and prolonged fatigue for men and women separately. Two-year follow-up data from the Maastricht Cohort Study on "Fatigue at Work" (n = 12,095) were used. At baseline, the prevalence of work-family conflict was 10.8% (9.0% in women; 11.1% in men), the cumulative incidence at 1 year follow-up was 5.1%. For men, several work-related demands, shift work, job insecurity, conflicts with coworkers or supervisor, having full responsibility for housekeeping, and having to care for a chronically ill child or other family member at home were risk factors for the onset of work-family conflict, whereas decision latitude and coworker and supervisor social support protected against work-family conflict. In women, physical demands, overtime work, commuting time to work, and having dependent children were risk factors for work-family conflict, whereas domestic help protected against work-family conflict at 1 year follow-up. Work-family conflict was further shown to be a strong risk factor for the onset of elevated need for recovery from work and fatigue.

Trends in the Danish work environment in 1990-2000 and their associations with labor-force changes.

OBJECTIVES: The aims of this study were (i) to describe the trends in the work environment in 1990-2000 among employees in Denmark and (ii) to establish whether these trends were attributable to labor-force changes. METHODS: The split-panel design of the Danish Work Environment Cohort Study includes interviews with three cross-sections of 6067, 5454, and 5404 employees aged 18-59 years, each representative of the total Danish labor force in 1990, 1995 and 2000. In the cross-sections, the participation rate decreased over the period (90% in 1990, 80% in 1995, 76% in 2000). The relative differences in participation due to gender, age, and region did not change noticeably. RESULTS: Jobs with decreasing prevalence were clerks, cleaners, textile workers, and military personnel. Jobs with increasing prevalence were academics, computer professionals, and managers. Intense computer use, long workhours, and noise exposure increased. Job insecurity, part-time work, kneeling work posture, low job control, and skin contact with cleaning agents decreased. Labor-force changes fully explained the decline in low job control and skin contact to cleaning agents and half of the increase in long workhours, but not the other work environment changes. CONCLUSIONS: The work environment of Danish employees improved from 1990 to 2000, except for increases in long workhours and noise exposure. From a specific work environment intervention point of view, the development has been less encouraging because declines in low job control, as well as skin contact to cleaning agents, were explained by labor-force changes.