Persistent inequality: evolution of psychosocial exposures at work among the salaried population in Spain between 2005 and 2016.

PURPOSE: To assess the prevalence of poor mental health and of exposure to psychosocial risks among the working population in Spain in 2005, 2010 and 2016; to analyse the associations between workplace psychosocial exposures and mental health problems according to gender and occupation. METHODS: Three representative samples of the Spanish working population were analysed, in 2005 (n = 7,023), 2010 (n = 4,979), and 2016 (n = 1,807). Prevalence ratios between mental health and the five dimensions - job demands, job control, social support, employment insecurity and insecurity over working conditions-were estimated using multilevel mixed-effects Poisson regressions. All the analyses were separated by gender and occupation. RESULTS: In 2016, there were improvements in job control, job demands and social support, and deteriorations in employment insecurity and insecurity over working conditions. The risk of poor mental health among manual workers rose if they were exposed to high demands, low social support and high employment insecurity; among non-manual workers, the risk increased if they were exposed to high demands, low control, low social support and high insecurity over working conditions. There were no differences according to gender. CONCLUSION: The new findings shed light on the evolution of the working conditions and health of the wage-earning population in Spain over the last 11 years. The stratification by gender and occupational group is relevant, since it allows a detailed analysis of the social disparities in the associations between psychosocial risks and mental health. The most vulnerable groups can be identified and preventive measures developed at source.

Sickness presenteeism: Are we sure about what we are studying? A research based on a literature review and an empirical illustration.

BACKGROUND: There has been an increasing interest in studying sickness presenteeism (SP). An ever-increasing amount of scientific literature is published using this term, yet there appears to be considerable heterogeneity in how it is assessed, which could result in substantial differences in the definition and interpretation of the phenomenon really being studied. We aim to discuss what really is being studied, depending on how the phenomenon is operationalized, measured, and analyzed. METHODS: A study based on a literature review and an empirical illustration using data of the third Spanish Psychosocial Risks Survey (2016). RESULTS: Differences are observed based on the population in which SP is measured, the cut-off points used to define a worker as presenteeist, the reasons for an SP episode and even an analysis of the phenomenon treated as a count or as a dichotomous. CONCLUSIONS: Without being completely exclusive, it seems that restricting the population of analysis to only those workers who consider that they should not have gone to work due to their health, and/or establishing low cut-off points to define someone as presenteeist, would more clearly delimit the study of SP to the exercise of a right to sick leave. In contrast, working with the entire population or using high cut-off points appears to relate the study of SP more with health status and less with the exercise of rights. On the other hand, taking the reasons for SP into account would probably help to improve interpretation of the phenomenon.

Specific psychosocial exposures for workers' mental health: A population-based study.

BACKGROUND: In order to plan interventions it is important to obtain evidence on the relation between a health outcome and specific exposures. However, there are few studies that identify the effect of specific psychosocial work exposures on poor mental health. This is the aim of this study. METHODS: Population-based cross-sectional study in Catalonia. We estimated prevalence ratios (PR) of minor psychiatric disorder associated with several psychosocial work exposures. RESULTS: The items with highest PR were "Are there times when you need to be at work and at home at the same time?" (PR = 1.81), "Are you worried about a variation in your salary?" (PR = 1.77), "Is your work emotionally demanding?" (PR = 1.65) and "Are you worried about it being difficult for you to find another job if you became unemployed?" (PR = 1.51). CONCLUSIONS: This study could be useful in order to begin planning interventions on specific psychosocial exposures to protect mental health in the workplace.

Is the worsening of psychosocial exposures associated with mental health? Comparing two population-based cross-sectional studies in Spain, 2005-2010.

AIMS: To analyze whether associations between workplace psychosocial exposures and the mental health of the working population in Spain changed between 2005 and 2010. METHODS: Two representative samples of the Spanish working population have been analyzed, 2005 (n = 5073) and 2010 (n = 3544). RESULTS: In 2010 there was a significant association between poor mental health and exposure to high Demands, low Social Support and high Insecurity over working conditions, and exposure to high Insecurity over losing the job only for men. In 2005 there was a significant association with exposure to high Demands and low Social Support. CONCLUSION: Changes in the associations between psychosocial risks and mental health may be related to the socioeconomic context marked by the rise in unemployment and the destruction of jobs as a result of the 2008 economic crisis.

The changing patterns of psychosocial exposures at work in the south of Europe: Spain as a labor market laboratory.

AIMS: To examine the pattern of psychosocial risk exposures at work among wage-earners in Spain in 2005 and 2010, and to analyze changes in exposure inequalities by gender and job category. METHODS: Psychosocial exposures were compared using the COPSOQ-ISTAS21 method, based on two surveys representative of the Spanish wage-earning population (2005 and 2010). Statistical analysis was conducted using correspondence analysis. RESULTS: There was an increase in exposure to high Double Presence, low Social Support, high Work Pace, and high Insecurity about finding a job; and reduction in exposure to high Insecurity about losing a job, and to high Insecurity over worsening of employment conditions. A gender- and occupation-related gradient was maintained. CONCLUSION: Although this study analyzes wage-earner "survivors" after the outbreak of the current economic crisis, it shows a worsening of harmful exposures to some psychosocial risks. In a context of job destruction, concerns about worsening working conditions appear to be subordinate to insecurity about job loss.

The copenhagen psychosocial questionnaire II (COPSOQ II) in Spain--a tool for psychosocial risk assessment at the workplace.

AIMS: To describe the second version of the Spanish Copenhagen Psychosocial Questionnaire and to present evidence of its validity and reliability. METHODS: The original Danish long COPSOQ II questionnaire was adapted to the labor market, cultural, and linguistic setting of Spain and included in the 2010 Spanish Psychosocial Risks Survey. Analysis involved the assessment of psychometric characteristics and associations among psychosocial scales and health scales. Medium and short versions were derived from the long one. RESULTS: The long questionnaire was configured with 24 dimensions (92 items); medium-length questionnaire with 20 dimensions (69 items); and short questionnaire with 14 dimensions (28 items). All scales showed acceptable reliability and concordance between versions. Most associations among psychosocial scales and Mental Health, Stress, and Burnout scales were in the expected direction, except the scale of Influence, that showed some incongruent associations. CONCLUSION: Results support the validity and reliability of Spanish COPSOQ II questionnaires as tools for psychosocial risk assessment at the workplace, however, better scales should be developed specially for the dimension of Influence.

Psychosocial factor exposures in the workplace: differences between immigrants and Spaniards.

BACKGROUND: The purpose of this study was to analyse psychosocial factor exposures in the workplace for immigrant workers in Spain and identify differences in exposure at work between immigrants and Spaniards. METHODS: A multi-stage sample was taken by conglomerates (final sample size: 7555 workers). The information was obtained in 2004 and 2005 using a standardized questionnaire administered by interviewing participants in their homes. The analysis focused on eight psychosocial factors. For quantitative demands and insecurity, the exposure was defined according to the higher third, and for the others, the exposure was defined according to the lower third. The prevalence ratio (PR) and confidence interval (CI) for unfavourable psychosocial factor, both crude and adjusted, were calculated using log binomial models. RESULTS: Those with highest prevalence of unfavourable psychosocial factor were immigrant manual workers, particularly in low possibilities for development (PR=2.87; 95% CI 2.44-3.73), and immigrant women, particularly in low control over working times (PR=1.72; 95% CI 1.55-1.91). CONCLUSIONS: Immigrant workers with manual jobs and immigrant women are the groups most exposed to psychosocial factor. In efforts to prevent these exposures, these inequalities should be taken into account.

[Relationship between psychosocial risks exposure and health: a cohort study using the COPSOQ-Istas21]. / Relación entre exposición a riesgos psicosociales y salud: un estudio de cohorte mediante el COPSOQ-Istas21.

OBJECTIVE: To estimate the prospective relationships between exposure to psychosocial risks dimensions included in the COPSOQ-Istas21 and the deterioration of general and mental health and sleep problems among workers residing in Spain. METHOD: Cohort whose baseline corresponds to the 2016 Psychosocial Risks Survey with a new measurement after one year. RESULTS: Social capital and interpersonal relations and leadership dimensions, as well as work̶life conflict, were related to all health variables. Dimensions of work organization and job contents did it especially with the mental health, the quantitative demands with the general health and the emotional ones with the mental health. The dimensions related to job insecurity did not show relationships with health. CONCLUSIONS: The results obtained reinforce the role of the COPSOQ-Istas21 as a useful instrument for the evaluation and prevention of psychosocial risks at work.

Employment precariousness in Spain: prevalence, social distribution, and population-attributable risk percent of poor mental health.

As a consequence of labor market flexibilization, nonstandard employment has expanded and standard employment has declined. In many cases, these transformations are best described as an evolution toward precarious employment, which is considered a major determinant of health and health inequalities. Using the Employment Precariousness Scale (EPRES), this study aims to determine the prevalence of precarious employment in the waged and salaried workforce in Spain, to describe its distribution across social groups defined by occupational class, gender, age, and immigrant status, and to estimate the proportion of cases of poor mental health potentially attributable to employment precariousness. Data are from the Psychosocial Work Environment Survey conducted in 2004-5 on a representative sample of the Spanish workforce. Findings indicate a high prevalence of employment precariousness, affecting nearly 6.5 million workers, with almost 900,000 of them exposed to high precariousness. These estimates are higher than the proportion of fixed-term employment reported in regular statistical sources but may today be an underestimation, given the current economic crisis. Additionally, a significant proportion of cases of poor mental health are potentially attributable to employment precariousness. Both the proportion of cases of poor mental health attributable to and the prevalence of employment precariousness were highly unequally distributed across the study sample, indicating that this may be a significant contributor to social inequalities in mental health.

The Employment Precariousness Scale (EPRES): psychometric properties of a new tool for epidemiological studies among waged and salaried workers.

BACKGROUND: Despite the fact that labour market flexibility has resulted in an expansion of precarious employment in industrialised countries, to date there is limited empirical evidence concerning its health consequences. The Employment Precariousness Scale (EPRES) is a newly developed, theory-based, multidimensional questionnaire specifically devised for epidemiological studies among waged and salaried workers. OBJECTIVE: To assess the acceptability, reliability and construct validity of EPRES in a sample of waged and salaried workers in Spain. METHODS: A sample of 6968 temporary and permanent workers from a population-based survey carried out in 2004-2005 was analysed. The survey questionnaire was interviewer administered and included the six EPRES subscales, and measures of the psychosocial work environment (COPSOQ ISTAS21) and perceived general and mental health (SF-36). RESULTS: A high response rate to all EPRES items indicated good acceptability; Cronbach's alpha coefficients, over 0.70 for all subscales and the global score, demonstrated good internal consistency reliability; exploratory factor analysis using principal axis analysis and varimax rotation confirmed the six-subscale structure and the theoretical allocation of all items. Patterns across known groups and correlation coefficients with psychosocial work environment measures and perceived health demonstrated the expected relations, providing evidence of construct validity. CONCLUSIONS: Our results provide evidence in support of the psychometric properties of EPRES, which appears to be a promising tool for the measurement of employment precariousness in public health research.

Psychosocial risk exposures and labour management practices. An exploratory approach.

AIM: The purpose was to explore the relationship between psychosocial risk exposures and labour management practices (LMP), as indicators of work organization and pertinent features for primary preventive intervention. METHODS: Cross-sectional study of a representative sample of salaried working population in Spain (n = 7,612). Information was obtained in 2004-2005 using a standardized questionnaire administered through personal interviews at the household. Questions on working conditions were used to establish LMP indicators and the psychosocial exposures data were obtained on the basis of the Copenhagen Psychosocial Questionnaire (COPSOQ) I (ISTAS21). A multivariate description was performed through multiple correspondence analysis, and associations between LMPs and psychosocial exposures were assessed by ordinal logistic analysis adjusting for age and sex. RESULTS: Correspondence analysis showed a good-bad coherent pattern regarding both psychosocial dimension and LMPs, though several LMPs categories were placed in the centre. Among the 14 possible associations of each psychosocial scale with LMP variables, several scales showed significant associations with more than eight LMP variables. Most relevant results referred to the LMP variable ''Consultative and delegative participation in methods''. CONCLUSIONS: In line with previous research, psychosocial exposures were associated with LMP. LMP may constitute a step on a pathway from work organization to health. Our exploratory work suggested that good psychosocial exposures were related to participatory working methods, being hired with a permanent labour contract, not being made to feel easily replaceable, having superiors with non-authoritarian and non-aggressive manners, not being threatened with dismissal, upward functional mobility, being paid according to the number of working hours and occupation, working between 31 and 40 hours per week and in regular morning shifts. Hence, the more these features became part of LMP in the workplace, the better the psychosocial work environment would be.

Psychosocial work environment and its association with socioeconomic status. A comparison of Spain and Denmark.

AIMS: The purpose of this study was to describe psychosocial work environment inequalities among wage earners in Spain and Denmark. METHODS: Data came from the Spanish COPSOQ (ISTAS 21) and the Danish COPSOQ II surveys both performed in 2004-05 and based on national representative samples of employees with a 60% response rate. Study population was 3,359 Danish and 6,685 Spanish women and men. Only identical items from both surveys were included to construct 18 psychosocial scales. Socioeconomic status was categorized according to the European Socioeconomic Classification System. Analysis included ordinal logistic regression and multiple correspondence analysis after categorizing all scales. RESULTS: A relationship between socioeconomic status and psychosocial work environment in both Denmark and Spain was observed, with wider social inequalities in Spain for many scales, describing a strong interaction effect between socioeconomic status and country. CONCLUSIONS: Socioeconomic status is related to psychosocial work environment and some adverse psychosocial conditions tend to cluster in lower socioeconomic status groups in both Spain and Denmark. This effect could be modified by a country's characteristics, such as economic and labour market structures, normative regulations and industrial relations including work organization. Hence, preventive strategies to reduce social inequalities in working conditions should consider the combination of actions at the macro and micro levels.

A comparison between cognitive and affective job insecurities.

BACKGROUND: Cognitive and affective job insecurity are compared in six aspects related to employment: job loss, worsening of tasks, schedule, salary and workplace, and difficulties over finding an alternative job (also known as labor market insecurity). Methods: Cross-sectional study. Data comes from the third Spanish Psychosocial Risks Survey (2016) which is a representative sample of the Spanish salaried population. Results: Affective responses are more variable than cognitive ones resulting in a low degree of answer concordance (IC95% Kappa = 0.08-0.13 to 0.18-0.23). There is a significant percentage of workers (22.5-50.3%) highly concerned about their future despite perceiving low probabilities of experiencing the specific insecurity threat, except for the labor market insecurity question. Conclusion: The differences observed in the degree of insecurity between the affective and the cognitive forms confirm that they are measuring different components of the insecurity construct. These differences are partly due to the economic situation of their households.

Job insecurity, economic hardship, and sleep problems in a national sample of salaried workers in Spain.

OBJECTIVE: To check for associations between various types of job insecurity and self-reported sleeping problems. DESIGN: A population-based, cross-sectional study. SETTING: Spain, 2016. PARTICIPANTS: Salaried workers included in the third Psychosocial Risks Survey (n = 1807). MEASUREMENTS: We investigated the association between 6 subjective and 2 attributed indicators of job insecurity (exposure) with 5 sleep problem variables (difficulty falling sleep, difficulty sleeping through the night, waking up too early, sleeping restlessly, and a composite variable summing all the sleeping problems) using Poisson regression, and controlling for socioeconomic, occupational, and demographic factors. RESULTS: Anticipating a salary decrease or working at a company where staff restructuring had occurred in the preceding year were associated with sleeping problems. Having a temporary or informal employment contract and most domains of perceived job insecurity were not a significant factor in adjusted models. CONCLUSIONS: Recent or anticipated economic hardship within a worker's household was the main predictor of sleeping problems. More research is needed to elucidate the exact mechanisms through which the experience of aspects of downsizing might manifest in disruptions to employees' sleep. Sleep health should be an active part of all employee wellness programs.

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.

Cognitive and Affective Insecurity Related to Remaining Employed and Working Conditions: Their Associations With Mental and General Health.

OBJECTIVE: The present study aims to tackle in detail the associations of insecurity with mental and self-rated health by using cognitive and affective measures of insecurity that focus on different aspects such as job loss, difficulties in finding an alternative job, and worsening the working conditions. METHODS: Data come from a representative sample of the Spanish salaried working population (n = 1807) obtained by the 2016 Psychosocial Risks Survey. RESULTS: Cognitive measures yield stronger associations between job loss and labor market insecurity and health, whereas the association between insecurity over worsening job conditions and health is stronger when using affective measures, the associations with mental health being stronger in both cases than those involving self-rated health. CONCLUSION: Association with health varies, in strength and at times in direction, depending on how insecurity is measured and conceptualized.

Prevalence, associated factors and reasons for sickness presenteeism: a cross-sectional nationally representative study of salaried workers in Spain, 2016.

OBJECTIVES: The aim of this study was to estimate the prevalence of sickness presenteeism (SP), its associated factors and the reasons given for SP episodes, among the overall salaried population and excluding the 'healthy' workers. DESIGN: Population-based cross-sectional study. SETTING: Salaried population in Spain. PARTICIPANTS: Data were obtained from the third Spanish Psychosocial Risks Survey (2016), carried out between October and December 2016, n=1615. MAIN OUTCOME MEASURES: Self-reported episodes of SP and their reasons. RESULTS: 23.0% (95% CI 19.2 to 26.8) of the workers exhibit SP, whereas among those manifesting having had some health problem in the preceding year, the figure was 53.0% (95% CI 46.9 to 59.1). The factors associated with SP when we study all workers are age, seniority, salary structure, working more than 48 hours, the contribution of worker's wage to the total household income and downsizing; factors among the 'unhealthy' workers are working more than 48 hours and not having a contract. The most common reason for SP is 'did not want to burden my colleagues', 45.7% (95% CI 37.3 to 54.4), whereas 'I could not afford it for economic reasons' ranked third, 35.9% (29.4% to 42.9%), and 27.5% (21.3% to 34.6%) of the workers report 'worried about being laid off' as a reason for going to work despite being ill. CONCLUSIONS: The estimated frequency of SP in Spain is lower than certain other countries, such as the Scandinavian countries. The factors associated vary depending on the population analysed (all workers or excluding 'healthy' workers). The reason 'I was worried about being laid off' was much more common than the estimates for Sweden or Norway.

Measuring precarious employment in times of crisis: the revised Employment Precariousness Scale (EPRES) in Spain.

OBJECTIVE: This study examines the psychometric properties of the revised Employment Precariousness Scale (EPRES-2010) in a context of economic crisis and growing unemployment. METHODS: Data correspond to salaried workers with a contract (n=4,750) from the second Psychosocial Work Environment Survey (Spain, 2010). Analyses included acceptability, scale score distributions, Cronbach's alpha coefficient and exploratory factor analysis. RESULTS: Response rates were 80% or above, scores were widely distributed with reductions in floor effects for temporariness among permanent workers and for vulnerability. Cronbach's alpha coefficients were 0.70 or above; exploratory factor analysis confirmed the theoretical allocation of 21 out of 22 items. CONCLUSION: The revised version of the EPRES demonstrated good metric properties and improved sensitivity to worker vulnerability and employment instability among permanent workers. Furthermore, it was sensitive to increased levels of precariousness in some dimensions despite decreases in others, demonstrating responsiveness to the context of the economic crisis affecting the Spanish labour market.

[Health and safety professional roles and competencies to promote company-level integration of preventive actions. A Delphy study]. / Roles y competencias de los profesionales de la salud laboral para promover la integración de la prevención en la empresa. Un estudio Delphi.

OBJECTIVE: To describe the view of faculty who train health and safety professionals on the roles and competencies needed to promote the integration of preventive actions at the company level. METHODS: We used a Delphi method, in three rounds, on an intentional sample of experts, and asked them to rate the appropriateness, relevance and acceptability of 8 professional roles, on a scale of 1 to 9 points. We also asked them to formulate and rank order the corresponding competencies, in order of importance. RESULTS: Participant responses (n=76, 58% of the initially identified faculty) show a broad consensus when assessing professional roles (over 85% of participants rated two of these roles highly, with scores between 7 and 9) and general agreement on the three most important competencies in terms of knowledge, skills and attitudes to promote the integration of preventive actions. CONCLUSIONS: The experts participating in this study agreed that the main roles to be performed by health and safety professionals to promote prevention integration are as advisors and trainers. The competencies considered most important are knowledge about the company activity, its risks and the problems linked to the activity (to know), ability to work in multidisciplinary teams (to know how), and to perform professional duties ethically, with independence and impartiality (to know how to be).

OBJETIVO: Conocer el punto de vista de docentes que forman prevencionistas acerca de cuáles son los roles y competencias necesarios en los profesionales de la salud laboral para promover la integración de la prevención en la empresa. MÉTODO: Se utiliza la técnica Delphi en triple vuelta sobre una muestra intencional de expertos a los que se pidió que puntuaran en una escala de 1 a 9 la pertinencia, relevancia y aceptabilidad de un listado de ocho roles, y que enunciaran y ordenaran según su importancia las correspondientes competencias. RESULTADOS: Las respuestas obtenidas de los participantes (n=76, 58% de los docentes en el listado inicial) muestran amplio consenso en la valoración de los roles (más del 85% de los participantes coinciden en otorgar puntuaciones altas ­entre 7 y 9­ para dos de los ocho roles listados) así como un acuerdo generalizado sobre las tres competencias más importantes en relación con los conocimientos, habilidades y actitudes adecuadas para promover la integración de la prevención en la empresa. CONCLUSIONES: En opinión de los expertos participantes los principales roles que debe ejercer el profesional de salud laboral para promover la integración de la prevención son el de asesor y el de formador. Las competencias consideradas como más importantes son el conocimiento de la actividad de la empresa así como los riesgos y los problemas derivados de dicha actividad (saber), la capacidad de trabajar en equipos multidisciplinares (saber hacer), y el poseer ética profesional, independencia e imparcialidad (saber ser, estar).

Employment precariousness and poor mental health: evidence from Spain on a new social determinant of health.

BACKGROUND: Evidence on the health-damaging effects of precarious employment is limited by the use of one-dimensional approaches focused on employment instability. This study assesses the association between precarious employment and poor mental health using the multidimensional Employment Precariousness Scale. METHODS: Cross-sectional study of 5679 temporary and permanent workers from the population-based Psychosocial Factors Survey was carried out in 2004-2005 in Spain. Poor mental health was defined as SF-36 mental health scores below the 25th percentile of the Spanish reference for each respondent's sex and age. Prevalence proportion ratios (PPRs) of poor mental health across quintiles of employment precariousness (reference: 1st quintile) were calculated with log-binomial regressions, separately for women and men. RESULTS: Crude PPRs showed a gradient association with poor mental health and remained generally unchanged after adjustments for age, immigrant status, socioeconomic position, and previous unemployment. Fully adjusted PPRs for the 5th quintile were 2.54 (95% CI: 1.95-3.31) for women and 2.23 (95% CI: 1.86-2.68) for men. CONCLUSION: The study finds a gradient association between employment precariousness and poor mental health, which was somewhat stronger among women, suggesting an interaction with gender-related power asymmetries. Further research is needed to strengthen the epidemiological evidence base and to inform labour market policy-making.