Psychosocial, psychiatric and work-related risk factors associated with suicide in Ireland: optimised methodological approach of a case-control psychological autopsy study.

BACKGROUND: Suicide has profound effects on families and communities, but is a statistically rare event. Psychological autopsies using a case-control design allow researchers to examine risk factors for suicide, using a variety of sources to detail the psychological and social characteristics of decedents and to compare them to controls. The Suicide Support and Information System Case Control study (SSIS-ACE) aimed to compare psychosocial, psychiatric and work-related risk factors across three groups of subjects: suicide decedents, patients presenting to hospital with a high-risk self-harm episode, and general practice controls. METHODS: The study design includes two inter-related studies; one main case-control study: comparing suicide cases to general practice (GP) controls, and one comparative study: comparing suicide cases to patients presenting with high-risk self-harm. Consecutive cases of suicide and probable suicide are identified through coroners' registration of deaths in the defined region (Cork City and County, Ireland) and are frequency-matched for age group and gender with GP patient controls recruited from the same GP practice as the deceased. Data sources for suicide cases include coroners' records, interviews with health care professionals and proxy informants; data sources for GP controls and for high-risk self-harm controls include interviews with control, with proxy informants and with health care professionals. Interviews are semi-structured and consist of quantitative and qualitative parts. The quantitative parts include a range of validated questionnaires addressing psychiatric, psychosocial and occupational factors. The study adopts several methodological innovations, including accessing multiple data sources for suicide cases and controls simultaneously, recruiting proxy informants to examine consistency across sources. CONCLUSIONS: The study allows for the investigation of consistency across different data sources and contributes to the methodological advancement of psychological autopsy research. The study will also inform clinical and public health practice. The comparison between suicide cases and controls will allow investigation of risk and protective factors for suicide more generally, while the comparison with high-risk self-harm patients will help to identify the factors associated specifically with a fatal outcome to a self-harm episode. A further enhancement is the particular focus on specific work-related risk factors for suicide.

Are Irish therapists at heightened risk for low back pain?

BACKGROUND: Within the international literature, no studies have been identified that compare prevalence rates of low back pain (LBP) in chartered physiotherapists, physical and athletic therapists and those in the national working population, making it unclear whether such therapists are an occupational group at high risk of developing LBP. AIMS: To establish the prevalence of LBP among therapists (both employed and self-employed) in Ireland, to compare the employment status-, gender- and age-specific LBP prevalence rates between therapists and the national working population and to estimate the adjusted odds of developing LBP among therapists relative to the national working population. METHODS: An analysis of data from the Health In Hand Intensive Tasks and Safety (HITS) study and the third national Survey on Lifestyle, Attitudes and Nutrition (SLÁN). The HITS study was a cross-sectional study investigating work-related musculoskeletal disorders in practising therapists. The SLÁN 2007 was a face-to-face interview study of adults. RESULTS: LBP prevalence in therapists was 49% with no significant difference by employment status. Therapists had a much higher prevalence compared with the national working population across all demographic strata, with therapists nearly five times more likely to suffer from LBP than the national working population after careful adjustment for differences in sociodemographic factors. CONCLUSIONS: Therapists in Ireland are an occupational group at high risk of developing LBP, warranting further research into their physical and psychosocial work-related risk factors.

Nutrition knowledge, diet quality and hypertension in a working population.

OBJECTIVE: To examine if employees with higher nutrition knowledge have better diet quality and lower prevalence of hypertension. METHOD: Cross-sectional baseline data were obtained from the complex workplace dietary intervention trial, the Food Choice at Work Study. Participants included 828 randomly selected employees (18-64 years) recruited from four multinational manufacturing workplaces in Ireland, 2013. A validated questionnaire assessed nutrition knowledge. Food Frequency Questionnaires (FFQ) measured diet quality from which a DASH (Dietary Approaches to Stop Hypertension) score was constructed. Standardised digital blood pressure monitors measured hypertension. RESULTS: Nutrition knowledge was positively associated with diet quality after adjustment for age, gender, health status, lifestyle and socio-demographic characteristics. The odds of having a high DASH score (better diet quality) were 6 times higher in the highest nutrition knowledge group compared to the lowest group (OR = 5.8, 95% CI 3.5 to 9.6). Employees in the highest nutrition knowledge group were 60% less likely to be hypertensive compared to the lowest group (OR = 0.4, 95% CI 0.2 to 0.87). However, multivariate analyses were not consistent with a mediation effect of the DASH score on the association between nutrition knowledge and blood pressure. CONCLUSION: Higher nutrition knowledge is associated with better diet quality and lower blood pressure but the inter-relationships between these variables are complex.

Post-traumatic stress and coping factors among search and recovery divers.

BACKGROUND: Irish search and recovery divers dive on a voluntary basis to recover missing persons. During these procedures, they encounter situations not typically part of ordinary human experience and might be expected to experience psychological effects as a result. AIMS: To investigate the association of post-traumatic stress disorder (PTSD) symptoms with previous experience of missing person recovery among divers, and to investigate the coping mechanisms used. METHODS: Self-administered questionnaires were distributed to all 206 active search divers in Ireland. A validated questionnaire, the Impact of Event Scale revised (IES-R), was used together with a coping questionnaire to compare the level of symptoms in divers with and without recovery experience, and to describe the main coping factors. RESULTS: One hundred and fifty-five questionnaires were returned, a response rate of 75%. Divers with prior missing person recovery experience scored lower on all three PTSD dimensions (avoidance, intrusion and hyper-arousal) with a significant difference for intrusion (P < 0.001). Coping mechanisms listed by the divers were search and recovery training, support from peers and search unit and sense of duty. CONCLUSIONS: The results do not support the hypothesis of an accumulation of traumatic experience in experienced divers but may indicate a survivor bias of the most resilient individuals, or a wearing off of vulnerability to traumatic events with experience.

The effectiveness of workplace dietary modification interventions: a systematic review.

OBJECTIVE: To evaluate the effectiveness of workplace dietary modification interventions alone or in combination with nutrition education on employees' dietary behaviour, health status, self-efficacy, perceived health, determinants of food choice, nutrition knowledge, co-worker support, job satisfaction, economic cost and food-purchasing patterns. METHOD: Data sources included PubMed, Medline, Embase, Psych Info., Web of Knowledge and Cochrane Library (November 2011). This review was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Studies were randomised controlled trials and controlled studies. Interventions were implemented for at least three months. Cochrane Collaboration's risk of bias tool measured potential biases. Heterogeneity precluded meta-analysis. Results were presented in a narrative summary. RESULTS: Six studies conducted in Brazil, the USA, Netherlands and Belgium met the inclusion criteria. Four studies reported small increases in fruit and vegetable consumption (≤half serving/day). These studies involved workplace dietary modifications and three incorporated nutrition education. Other outcomes reported included health status, co-worker support, job satisfaction, perceived health, self-efficacy and food-purchasing patterns. All studies had methodological limitations that weakened confidence in the results. CONCLUSION: Limited evidence suggests that workplace dietary modification interventions alone and in combination with nutrition education increase fruit and vegetable intakes. These interventions should be developed with recommended guidelines, workplace characteristics, long-term follow-up and objective outcomes for diet, health and cost.

Has your work worked you too hard? Physically demanding work and disability in a sample of the older Irish population.

BACKGROUND: There is a heightened need for the practitioner to be alert to the determinants of functional limitations and disabilities owing to the ageing workforce. AIM: This study investigated the association between work type and disability in older age in both the paid and the previously unexplored, unpaid worker (household labour). METHODS: Data on demographic factors, physical measurements, work history and functional status were collected on three hundred and fifty seven 57-80-year-olds. Past or present work was identified as either physically demanding or not. Functional limitations and activities of daily living (ADL) disabilities were assessed using validated scales. Logistic regression was used to examine the relationship between the dependent variables and work type (physically demanding work or not physically demanding work). RESULTS: Over half of the sample reported doing physically demanding work. 20% had complete function (n = 67), 65% (n = 223) functional limitations and 15% (n = 53) ADL disability. Physically demanding work was associated with functional limitations [OR 2.52 (1.41, 4.51), p = 0.01] and ADL disability [OR 2.10 (1.06, 4.17), p = 0.03] after adjustment for a measure of obesity and gender. When gender stratified, looking only at females, physically demanding work was associated with ADL disability [OR 2.79 (1.10, 7.07), p = 0.03] adjusted for a measure of obesity and household labour. CONCLUSIONS: Physically demanding work was related to functional limitations and ADL disability in older age. This is valuable information to inform practitioners in the treatment of older people with functional limitations and disabilities and in guiding interventions in the prevention of work related disability.

Age, job characteristics and coronary health.

BACKGROUND: Workplace demographics are changing in many European countries with a higher proportion of older workers in employment. Research has shown that there is an association between job strain and cardiovascular disease, but this relationship is unclear for the older worker. AIMS: To investigate the association between job strain and a coronary event comparing younger and older male workers. METHODS: Cases with a first-time coronary event were recruited from four coronary/intensive care units (1999-2001). Matched controls were recruited from the case's general practitioner surgery. Physical measurements were taken and self-administered questionnaires completed with questions on job characteristics, job demands and control. Unconditional logistic regression was carried out adjusting for classical cardiovascular risk factors. RESULTS: There were 227 cases and 277 matched controls. Age stratified analyses showed a clear difference between younger (<50 years) and older (≥50 years) workers with regard to the exposure of job strain (job demands and control) and the association between these factors and cardiovascular disease. Older workers who had a coronary event were four times as likely to have high job strain [OR = 4.09 (1.29-13.02)] and more likely to report low job control [OR = 0.83 (0.72-0.95)]. CONCLUSIONS: Job control emerged as a potential protective factor for heart disease and this evidence was stronger in the older male worker. Nevertheless, they were significantly more likely to have job strain. These results suggest that older workers may be more susceptible to job strain.

Perceived occupational stress in nurses working in Ireland.

BACKGROUND: Stress has been seen as a routine and accepted part of the health care worker's role. There is a lack of research on stress in nurses in Ireland. AIMS: To examine the levels of stress experienced by nurses working in an Irish teaching hospital and investigate differences in perceived stress levels by ward area and associations with work characteristics. METHODS: A cross-sectional study design was employed, with a two-stage cluster sampling process. Data collection was by means of a self-administered questionnaire, and nurses were investigated across 10 different wards using the Nursing Stress Scale and the Demand Control Support Scales. RESULTS: The response rate was 62%. Using outpatients as a reference ward, perceived stress levels were found to be significantly higher in the medical ward, accident and emergency, intensive care unit and paediatric wards (P < 0.05). There was no significant difference between the wards with regard to job strain; however, differences did occur with levels of support, the day unit and paediatric ward reporting the lowest level of supervisor support (P < 0.01). A significant association was seen between the wards and perceived stress even after adjustment (P < 0.05). CONCLUSIONS: The findings suggest that perceived stress does vary within different work areas in the same hospital. Work factors, such as demand and support, are important with regard to perceived stress. Job control was not found to play an important role.

Prevalence of smoking among bar workers prior to the Republic of Ireland smokefree workplace legislation.

BACKGROUND: This study establishes baseline prevalence of smoking and cigarette consumption among Cork bar workers prior to the Republic of Ireland's (ROI) smokefree workplace legislation and compares gender- and age-specific smoking rates and estimates the adjusted odds of being a smoker for Cork bar workers relative to the general population. METHODS: Cross-sectional random sample of bar workers in Cork city and cross-sectional random telephone survey of the general population were conducted prior to the smokefree legislation. RESULTS: Self reported smoking prevalence among Cork bar workers (n = 129) was 54% (58% using cotinine-validated measures), with particularly high rates in women (70%) and 18-28 years old (72%). Within the ROI (n = 1,240) sub-sample rates were substantially lower at 28%. Bar workers were twice as likely to be smokers as the general population sub-sample (OR = 2.15). CONCLUSIONS: Cork bar workers constitute an occupational group with an extremely high smoking prevalence.

Occupational stress factors and alcohol-related behavior in urban transit operators.

BACKGROUND: If alcohol consumption mitigates psychological and physiological aspects of the response to stressors, then alcohol consumption might be elevated for individuals exposed to high occupational stressors. Frequency of work stressors and reaction to those stressors were studied in relation to several alcohol-related outcomes. METHODS: During the period 1993-1995, 1979 transit operators underwent medical examinations for commercial driver's license renewal. Questionnaire and interview data concerning occupational stress factors and alcohol-related outcomes were available for 1386 (70.2%) of the operators. RESULTS: A positive association was found between the two job stressor-related measures and each of six alcohol-related outcomes. Of these 12 associations, ten were statistically significant. Individuals experiencing high self-reported frequency of job stressors and a higher perceived severity of those job stressors were more likely to drink and more likely to be heavy drinkers. They reported more consequences of alcohol consumption, reported increased consumption since beginning work as transit drivers, and were more likely to report drinking to deal with work stress. They also drank more, but this effect was not significant for either job stress measure. There was virtually no association between either stressor-related measure and alcohol dependency (CAGE). CONCLUSIONS: Together with other published findings, these results suggest increased alcohol-related outcomes in the presence of work stressors. This conclusion has potential implications for worksite health promotion and job design. Because our findings are cross-sectional, further research is needed to clarify the causal nature of the work stressor-alcohol association. Further research also is needed to clarify the role of individual differences and context.

Racial discrimination and alcohol-related behavior in urban transit operators: findings from the San Francisco Muni Health and Safety Study.

OBJECTIVE: A growing body of literature is documenting the health effects of racial discrimination. The authors investigated the association between racial discrimination and alcohol-related behavior in a sample of urban transit operators. METHODS: Using data from a 1993-1995 cross-sectional study of transit operators in San Francisco, California, the authors analyzed responses to two sets of questions about racial discrimination; the first set focused on reaction to unfair treatment and the second on arenas, or domains, of discrimination. Alcohol-related variables were: number of drinks per month, heavy drinking, alcohol dependence, and negative consequences of alcohol consumption. RESULTS: Operators who reported five or more domains of discrimination drank an average of 13.4 more drinks per month than those who reported no domains of discrimination (P = 0.01). Similarly, they were more likely to be heavy drinkers (adjusted odds ratio [OR] = 2.16; 95% confidence interval [CI] 1.14, 4.09) and dependent on alcohol (adjusted OR = 2.02; 95% CI 1.08, 3.79) than operators who reported no domains of discrimination. The number of domains in which operators reported having experienced discrimination was not related to sex, age, household income, job seniority, or marital status, but varied significantly by educational level and race/ethnicity. CONCLUSIONS: Data from a sample of urban transit operators showed an association between the number of domains of discrimination and some alcohol-related outcomes, but not others.

Workplace discrimination and alcohol consumption: findings from the San Francisco Muni Health and Safety Study.

OBJECTIVE: There is evidence of an association between occupational stress and alcohol consumption. This study investigates the association between workplace racial discrimination and alcohol consumption in a sample of urban transit operators. METHODS: During 1993-1995, after undergoing a medical exam, 1,542 transit operators completed an interview. Depending on the outcome, we used logistic or linear regression models to examine the cross-sectional relationship between discrimination experience and alcohol consumption. RESULTS: Operators who reported discrimination in at least one situation, out of a possible four, were more likely to have had negative life consequences as a result of drinking (adjusted OR = 1.97; 95% CI, 1.20-3.83) and were more likely to be classified as having an alcohol disorder (OR = 1.56 [0.96-2.54]), compared to those who reported no instances of workplace discrimination. Results adjusted simultaneously for age, sex, race/ethnicity, education, income, marital status, and seniority. There was no association between workplace discrimination and heavy drinking or drinks per month. CONCLUSIONS: Cross-sectional data from a sample of urban transit operators indicates an association between workplace racial discrimination and some measures of alcohol consumption.

Objective stress factors, accidents, and absenteeism in transit operators: a theoretical framework and empirical evidence.

The authors used observational job analysis as a conceptually based technique to measure stress factors unbiased by worker appraisal with 81 transit driving tasks on 27 transit lines. Stressor dimensions included work barriers that interfere with task performance due to poor technical-organizational design, time pressure, time binding (autonomy over time management), and monotonous conditions. Line-specific average stressor values were assigned to 308 transit operators who mainly worked the particular line. Logistic regression analyses showed associations for high work barriers and sickness absences (odds ratio [OR] = 3.8, p = .05). There were elevated risks for work accidents for high time pressure operators (OR = 4.0, p = .04) and for the medium time-binding group (OR = 3.3, p = .04) and significant (alpha = .20) unadjusted interaction terms for barriers and time pressure in predicting accidents and absences, and barriers and time binding in predicting absences. Findings suggest guaranteed rest breaks and flexible timing for accident prevention and removal of work barriers for reducing absenteeism.

Studies of health outcomes in transit operators: policy implications of the current scientific database.

Urban transit operators' medical symptoms and conditions exceed other occupational groups, resulting partly from working conditions. Medical outcomes among operators have an impact on the transit system, including on performance, work attendance, and medical costs. This is exacerbated by external economic and political pressures in which expected service often exceeds the system's capacity in a congested, chaotic urban environment. A vicious cycle of poor working environment, reduced health and well-being among operators, and lowered efficiency and increased costs often results. Operator-health policies focusing solely on individuals are not sufficient to address these problems. A broader approach is needed, acknowledging the relationship between health of the system and health of employees, including redesigning the interface between transit systems and the urban environment and organizational change within companies. This comprehensive approach recognizes the dynamic reciprocity among the transit operators, the transit system, and the larger community.

Physical workload and ergonomic factors associated with prevalence of back and neck pain in urban transit operators.

STUDY DESIGN: Back and neck pain was studied cross-sectionally in 1,449 urban transit drivers by linking medical data, self-reported ergonomic factors, and company records on job history. OBJECTIVES: The goal was to examine the relation between physical workload, ergonomic factors, and the prevalence of back and neck pain. SUMMARY OF BACKGROUND DATA: Researchers, to date, have not found an independent effect of ergonomic factors on back and neck pain while accounting for the effects of past and current physical workload. METHODS: Self-reported ergonomic factors, vehicle type, physical workload (measured as duration of driving), height, weight, age, and gender were analyzed in relation to back and neck pain, using multivariable logistic regression models. RESULTS: Physical workload showed a positive dose-response relation with back and neck pain after controlling for vehicle type, height, weight, age, and gender. The odds ratio for 10 years of driving was 3.43. Additional adjustment for ergonomic factors decreased this odds ratio to 2.55. Six out of seven ergonomic factors were significantly related to the prevalence of back and neck pain after adjustment for age, gender, height, weight, and physical workload. Problems with adjusting the seat had the largest effect (odds ratio = 3.52). Women had back and neck pain twice as frequently as men. CONCLUSION: The results support the hypothesis of a causal role of physical workload for the development of back and neck pain. Ergonomic factors partially mediated the risk of back and neck pain associated with driving, suggesting a potential for prevention of back and neck pain by ergonomic redesign of transit vehicles. Elevated risks for back and neck pain for female drivers were not explained by anthropometric and ergonomic factors.

Psychosocial job factors associated with back and neck pain in public transit operators.

OBJECTIVES: This cross-sectional study examined associations between psychosocial job factors and the prevalence of nondisabling back and neck pain in professional drivers after physical work load was taken into account. METHODS: A total of 1449 transit vehicle operators completed a medical examination and a questionnaire yielding information on demographic and anthropometric variables, health status, and physical and psychosocial job factors. Company records were used to supplement information on employment history. Physical work load was measured in life-time years and current weekly hours of professional driving. The relation of psychosocial factors with back or neck pain was analyzed by logistic regression models adjusted for past and current physical work load, vehicle type, age, gender, body height, and weight. RESULTS: The main result of this study was that both physical work load and psychosocial factors were simultaneously and independently associated with back or neck pain. Psychosocial factors associated with back or neck pain included extended uninterrupted driving driving periods, frequency of job problems, high psychosocial demands, high job dissatisfaction, and low supervisory support. An analysis of specific job problems is provided which may be useful in setting priorities for research and intervention efforts in this high risk occupation. CONCLUSION: The results provide support for the role of psychosocial job characteristics in the etiology of back or neck pain in occupational settings.

Hypertension and years of driving in transit vehicle operators.

In this study, data from transit vehicle operators of the San Francisco Municipal Railway (Muni), and a control group of individuals newly hired but not yet working as operators, were used to investigate prevalence of hypertension as a function of exposure to bus driving (years of driving), controlling for alcohol consumption and body mass index. Data were collected from transit vehicle operators in the course of their regular biennial examination during the period November 1983 to October 1985. Groups working as operators fewer than 10 years (n = 1137), from 10 to 20 years (n = 493), and more than 20 years (n = 196) were compared to each other and to a group of individuals with no prior exposure, but who were given a medical examination just before beginning their jobs as transit vehicle operators (n = 226). For hypertension (defined as systolic blood pressure > or = 140, or diastolic blood pressure > or = 90, or taking hypertension medication), the prevalence, adjusted for age, race, and gender, increased in a stepwise fashion from 28.8 percent in the group with no exposure to 38.9 percent in the group of drivers with more than 20 years on the job. A similar pattern was found for moderate to severe hypertension (systolic blood pressure > or = 160, or diastolic blood pressure > or = 95, or hypertension medication). These patterns were diminished, but not eliminated, when body mass index and alcohol consumption were considered. Higher rates of separation from employment for hypertensive operators suggested that the effect of years of employment may be underestimated by this cross-sectional comparison. Prolonged exposure to operating a transit vehicle may be associated with increased hypertension; increased alcohol consumption and body mass index with increased years of driving may account for at least some of the increased hypertension.

Objective measurement of occupational stress factors--an example with San Francisco urban transit operators.

Eighty-one observational work analyses were conducted to measure stressors independently of worker appraisal in the San Francisco transit system. On the basis of action regulation theory, stress factors were defined as hindrances for task performance due to poor work organization or technological design. Stressors included (a) work barriers, defined as obstacles that cause extra work or unsafe behavior; (b) time pressure; (c) monotonous conditions; and (d) time binding, defined as control over timing. Reliability, measured as interrater agreement, ranged between 80 and 97%, with kappas of .46-.70. Validity analyses were done with 71 transit operators who participated in the observations and 177 operators who were assigned mean line-specific observational stressor measures. High odds ratios (ORs) were found for barriers and psychosomatic complaints (OR = 3.8, p = .00), time pressure and relaxation time needed after work (OR = 3.1, p = .05), and barriers and smoking to cope (OR = 3.8, p = .02). Using observational data in conjunction with self-report data can reduce confounding and improve interpretability of stress and health studies.

Occupational and nonoccupational correlates of alcohol consumption in urban transit operators.

BACKGROUND: The influence of occupation and the worksite has emerged as an important area of study in research on alcohol consumption. Occupational and nonoccupational factors were studied in relation to alcohol consumption using data from a 1983-1985 cross-sectional study of transit operators. METHODS: A total of 1.853 operators underwent a medical examination for driver's license renewal (including information on age, ethnicity, gender, education). Of these operators, 1,448 completed a questionnaire about occupational (e.g., time of shift, job stressors) and nonoccupational (e.g., personality, life stressors) factors. From either the medical examination or the questionnaire, weekly alcohol consumption was available for 1,820 operators. Variables related to alcohol consumption in previous studies, or theoretically linked to consumption, were analyzed in relation to heavy ( > or = 15 drinks/week) and average weekly consumption. RESULTS: Heavy and average consumption were both related to several nonoccupational variables, including demographic (age, ethnicity, gender, marital status), personality (depression, anger expression), and life stress variables (i.e., life events). Heavy and average consumption were also related to several occupational variables, including job history (number of years driving, specific worksite) and job stressors. Neither measure was related to subjective job content (job demand, decision latitude). CONCLUSIONS: Variability in consumption by demographic factors among this population reflects that seen in society as a whole. However, occupational factors may influence consumption, since consumption was strongly related to (a) specific worksite and time of shift and (b) reported job stressors. Clarifying the exact influence of occupational and worksite factors on alcohol consumption will depend on the convergence of findings from different research designs (e.g., cross-sectional, longitudinal, ethnographic).