Costs of presenteeism and absenteeism associated with psychological distress among male and female older workers: a cross-sectional study.

OBJECTIVE: We estimated, for women and men: 1) the associations between psychological distress and the prevalences of presenteeism and absenteeism, 2) average hours lost annually per person and 3) costs from the employers' economic perspective. METHODS: Participants were 1292 Canadian white-collar workers. Psychological distress, presenteeism and absenteeism were assessed with validated questionnaires. The average annual hours of productivity loss and related costs were estimated using generalized linear models with a negative binomial distribution and a log link. RESULTS: High psychological distress in women and men was associated with presenteeism costs ($6944 and $8432) and absenteeism costs ($2337 and $2796 per person). The association between psychological distress and annual hours lost to presenteeism was twice stronger for men than women. CONCLUSION: Productivity losses associated with psychological distress are high in women and men older workers.

Job strain and effort-reward imbalance as risk factors for type 2 diabetes mellitus: A systematic review and meta-analysis of prospective studies.

OBJECTIVES: This systematic review and meta-analysis aimed to synthesize the available data on prospective associations between work-related stressors and the risk of type 2 diabetes mellitus (T2DM) among adult workers, according to the demand-control-support (DCS) and the effort-reward imbalance (ERI) models. METHOD: We searched for prospective studies in PubMed, EMBASE, Web of Science, Scopus, CINHAL and PsychInfo. After screening and extraction, quality of evidence was assessed using the ROBINS-I tool adapted for observational studies. The effect estimates extracted for each cohort were synthesized using random effect models. RESULTS: We included 18 studies (reporting data on 25 cohorts) in meta-analyses for job strain, job demands, job control, social support at work and ERI. Workers exposed to job strain had a higher risk of developing T2DM when compared to unexposed workers [pooled rate ratio (RR) 1.16, 95% confidence interval (CI) 1.07-1.26]. This association was robust in several supplementary analyses. For exposed women relative to unexposed women, the RR was 1.35 (95% CI 1.12-1.64). The RR of workers exposed to ERI was 1.24 (95% CI 1.08-1.42) compared to unexposed workers. CONCLUSIONS: This is the first meta-analysis to find an effect of ERI on the onset of T2DM incidence. It also confirms that job strain increases the incidence of T2DM, especially among women.

Validation of case definitions of depression derived from administrative data against the CIDI-SF as reference standard: results from the PROspective Québec (PROQ) study.

BACKGROUND: Administrative data have several advantages over questionnaire and interview data to identify cases of depression: they are usually inexpensive, available for a long period of time and are less subject to recall bias and differential classification errors. However, the validity of administrative data in the correct identification of depression has not yet been studied in general populations. The present study aimed to 1) evaluate the sensitivity and specificity of administrative cases of depression using the validated Composite International Diagnostic Interview - Short Form (CIDI-SF) as reference standard and 2) compare the known-groups validity between administrative and CIDI-SF cases of depression. METHODS: The 5487 participants seen at the last wave (2015-2018) of the PROQ cohort had CIDI-SF questionnaire data linked to hospitalization and medical reimbursement data provided by the provincial universal healthcare provider and coded using the International Classification of Disease. We analyzed the sensitivity and specificity of several case definitions of depression from this administrative data. Their association with known predictors of depression was estimated using robust Poisson regression models. RESULTS: Administrative cases of depression showed high specificity (≥ 96%), low sensitivity (19-32%), and rather low agreement (Cohen's kappa of 0.21-0.25) compared with the CIDI-SF. These results were consistent over strata of sex, age and education level and with varying case definitions. In known-groups analysis, the administrative cases of depression were comparable to that of CIDI-SF cases (RR for sex: 1.80 vs 2.03 respectively, age: 1.53 vs 1.40, education: 1.52 vs 1.28, psychological distress: 2.21 vs 2.65). CONCLUSION: The results obtained in this large sample of a general population suggest that the dimensions of depression captured by administrative data and by the CIDI-SF are partially distinct. However, their known-groups validity in relation to risk factors for depression was similar to that of CIDI-SF cases. We suggest that neither of these data sources is superior to the other in the context of large epidemiological studies aiming to identify and quantify risk factors for depression.

Job strain and incident cardiovascular disease: the confounding and mediating effects of lifestyle habits. An overview of systematic reviews.

This overview of systematic reviews (SR) aims to determine how the potential confounding and/or mediating effects of lifestyle habits were taken into consideration in SR examining the job strain effect on cardiovascular disease (CVD) incidence. Thirteen SR were identified. Lifestyle habits were often considered as confounders (n = 8). Authors reported that the job strain and CVD association remained after adjusting for lifestyle habits (n = 6); discussed lifestyle habits as potential mediators (n = 8) and postulated a total effect underestimation due to over-adjustment (n = 4). None investigated the magnitude of this bias.The effect of job strain on CVD is independent of lifestyle habits, supporting its causal effect on CVD. Lifestyle habits are also potential mediators. The current practice of adjusting for lifestyle habits can therefore lead to an underestimation of the total effect. Research using meditation methods is needed.

Validity of participants' self-reported diagnosis for a work absence due to a mental health problem compared with physician-certified diagnosis for the same work absence among 709 Canadian workers.

OBJECTIVES: This study assesses the validity of a self-reported mental health problem (MHP) diagnosis as the reason for a work absence of 5 days or more compared with a physician-certified MHP diagnosis related to the same work absence. The potential modifying effect of absence duration on validity is also examined. METHODS: A total of 709 participants (1031 sickness absence episodes) were selected and interviewed. Total per cent agreement, Cohen's kappa, sensitivity and specificity values were calculated using the physician-certified MHP diagnosis related to a given work absence as the reference standard. Stratified analyses of total agreement, sensitivity and specificity values were also examined by duration of work absence (5-20 workdays,>20 workdays). RESULTS: Total agreement value for self-reported MHP was 90%. Cohen's kappa value was substantial (0.74). Sensitivity was 77% and specificity was 95%. Absences of more than 20 workdays had a better sensitivity than absences of shorter duration. A high specificity was observed for both short and longer absence episodes. CONCLUSION: This study showed high specificity and good sensitivity of self-reported MHP diagnosis compared with physician-certified MHP diagnosis for the same work absence. Absences of longer durations had a better sensitivity.

Differences between women and men in the relationship between psychosocial stressors at work and work absence due to mental health problem.

OBJECTIVES: Women have a higher incidence of mental health problems compared with men. Psychosocial stressors at work are associated with mental health problems. However, few prospective studies have examined the association between these stressors and objectively measured outcomes of mental health. Moreover, evidence regarding potential differences between women and men in this association is scarce and inconsistent. This study investigates whether psychosocial stressors at work are associated with the 7.5-year incidence of medically certified work absence due to a mental health problem, separately for women and men. METHODS: Data from a prospective cohort of white-collar workers in Canada (n=7138; 47.3% women) were used. We performed Cox regression models to examine the prospective association between self-reported psychosocial stressors at work (job strain model) at baseline and the 7.5-year HR of medically certified work absence of ≥5 days due to a mental health problem. RESULTS: During follow-up, 11.9% of participants had a certified work absence, with a twofold higher incidence among women. Women (HR 1.40, 95% CI 1.01 to 1.93) and men (HR 1.41, 95% CI 0.97 to 2.05) exposed to high strain (high demands and low control) had a higher incidence of work absence compared with those unexposed. Among women only, those exposed to an active job situation (high demands and high control) also had a higher risk (HR 1.82, 95% CI 1.29 to 2.56). CONCLUSIONS: Prevention efforts aimed at reducing psychosocial stressors at work could help lower the risk of work absence for both women and men. However, important differences between women and men need to be further studied in order to orient these efforts.

Psychosocial Stressors at Work and the Risk of Sickness Absence Due to a Diagnosed Mental Disorder: A Systematic Review and Meta-analysis.

Importance: Mental health problems are associated with considerable occupational, medical, social, and economic burdens. Psychosocial stressors at work have been associated with a higher risk of mental disorders, but the risk of sickness absence due to a diagnosed mental disorder, indicating a more severe condition, has never been investigated in a systematic review and meta-analysis. Objective: To synthesize the evidence of the association of psychosocial stressors at work with sickness absence due to a diagnosed mental disorder among adult workers. Data Sources: Seven electronic databases (MEDLINE, Embase, PsycInfo, Web of Science, CINAHL, Sociological Abstracts, and International Bibliography of the Social Sciences), 3 gray literature databases (Grey Literature Report, WHO-IRIS and Open Grey), and the reference lists of all eligible studies and reviews were searched in January 2017 and updated in February 2019. Study Selection: Only original prospective studies evaluating the association of at least 1 psychosocial stressor at work from the 3 most recognized theoretical models were eligible: the job demand-control-support model, including exposure to job strain (high psychological demands with low job control); effort-reward imbalance model; and organizational justice model. Study selection was performed in duplicate by blinded independent reviewers. Among the 28 467 citations screened, 23 studies were eligible for systematic review. Data Extraction and Synthesis: This meta-analysis followed the PRISMA and MOOSE guidelines. Data extraction and risk of bias evaluation, using the Risk of Bias in Nonrandomized Studies-Interventions tool, were performed in duplicate by blinded independent reviewers. Data were pooled using random-effect models. Main Outcomes and Measures: Sickness absence due to a mental disorder with a diagnosis obtained objectively. Results: A total of 13 studies representing 130 056 participants were included in the 6 meta-analyses. Workers exposed to low reward were associated with a higher risk of sickness absence due to a diagnosed mental disorder compared with nonexposed workers (pooled risk ratio [RR], 1.76 [95% CI, 1.49-2.08]), as were those exposed to effort-reward imbalance (pooled RR, 1.66 [95% CI, 1.37-2.00]), job strain (pooled RR, 1.47 [95% CI, 1.24-1.74]), low job control (pooled RR, 1.25 [95% CI, 1.02-1.53]), and high psychological demands (pooled RR, 1.23 [95% CI, 1.04-1.45]). Conclusions and Relevance: This meta-analysis found that workers exposed to psychosocial stressors at work were associated with a higher risk of sickness absence due to a mental disorder. A better understanding of the importance of these stressors could help physicians when evaluating their patients' mental health and work capacity.

Effect of psychosocial work factors on the risk of depression: a protocol of a systematic review and meta-analysis of prospective studies.

INTRODUCTION: Depression is a common and disabling health problem that contributes to an important social and economic burden, particularly among the working age population. The deleterious effect of psychosocial work factors on depression has been documented. However, the most recent systematic reviews had restrictive eligibility criteria and, since their publications, several original studies have been published. The proposed systematic review aims to update, evaluate and synthesise the effect of psychosocial work factors from three recognised theoretical models, the demand-control-support, effort-reward imbalance and organisational justice models, on the risk of depression among workers. METHOD AND ANALYSIS: A systematic literature search will be conducted in seven academic databases (Medline, Embase, CINAHL, Web of Science, PsycInfo, Sociological abstracts and IBSS) as well as three grey literature databases. The search strategy was first run on January 2017, updated in October 2017 and will be updated 6 months prior to submission for publication. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations, study selection will be carried out using a rigorous multistep screening process in duplicate by independent reviewers. Prospective studies evaluating the effect of at least one psychosocial work factor from the three theoretical models on depression or antidepressant medication use among working adults will be included. Extracted data will be used for evidence synthesis as well as to assess risk of bias and methodological quality. Meta-estimates will be provided after considering homogeneity and number of studies. ETHICS AND DISSEMINATION: This study will only draw from published studies and grey literature available in electronic databases; ethics approval is not required. The results of this review will be published in a peer review journal and presented at relevant conferences. Given that psychosocial work factors are frequent and modifiable, the results can help reduce the social and economic burden of depression and support public policy-makers to improve occupational health standards. PROSPERO REGISTRATION NUMBER: CRD42018107666.

Job strain and the prevalence of uncontrolled hypertension among white-collar workers.

To determine whether white-collar workers treated for hypertension who are exposed to psychosocial stressors at work have a higher prevalence of uncontrolled hypertension than unexposed workers, this study conducted three waves of data collection over a 5-year period (repeated cross-sectional design). The study sample was composed of 464 white-collar workers treated for hypertension. At each collection time, ambulatory blood pressure (ABP) was measured every 15 min during the workday. Uncontrolled hypertension was defined as a mean daytime systolic ABP ≥135 mmHg and/or diastolic ABP ≥85 mmHg for non-diabetic participants and systolic ABP ≥125 mmHg and/or diastolic ABP ≥75 mmHg for diabetic participants. Job strain was evaluated with Karasek's demand-latitude model using validated scales for psychological demands and decision latitude. Prevalence ratios (PR) and 95% confidence intervals (CI) were estimated using generalized estimating equations, adjusting for sociodemographic and lifestyle-related risk factors. Men with job strain (high demands and low latitude) and active jobs (high demands and high latitude) had a higher prevalence of uncontrolled hypertension (PR job strain = 1.46, 95% CI: 1.07-1.98 and PR active = 1.47, 95% CI: 1.12-1.94). When considered separately, high demands were associated with a higher prevalence of uncontrolled hypertension in both men (PR highest tertile = 1.60, 95% CI: 1.25-2.06) and women (PR highest tertile = 1.60, 95% CI: 1.03-2.47). Workers exposed to psychosocial stressors at work according to the demand-latitude model had a higher prevalence of uncontrolled hypertension. Reducing these frequent exposures could help to reduce the burden of uncontrolled hypertension.

A test for the correct specification of marginal structural models.

Marginal structural models (MSMs) allow estimating the causal effect of a time-varying exposure on an outcome in the presence of time-dependent confounding. The parameters of MSMs can be estimated utilizing an inverse probability of treatment weight estimator under certain assumptions. One of these assumptions is that the proposed causal model relating the outcome to exposure history is correctly specified. However, in practice, the true model is unknown. We propose a test that employs the observed data to attempt validating the assumption that the model is correctly specified. The performance of the proposed test is investigated with a simulation study. We illustrate our approach by estimating the effect of repeated exposure to psychosocial stressors at work on ambulatory blood pressure in a large cohort of white-collar workers in Québec City, Canada. Code examples in SAS and R are provided to facilitate the implementation of the test.

Evaluation of the Quebec Healthy Enterprise Standard: Effect on Adverse Physical and Psychosocial Work Factors and Work-Related Musculoskeletal Problems.

OBJECTIVE: The aim of this study was to evaluate the effect of the Quebec Healthy Enterprise Standard (QHES) on adverse physical and psychosocial work factors and work-related musculoskeletal problems (WMSP). METHODS: Workers of 10 organizations completed questionnaires before (n = 2849) and 2 to 3 years following (n = 2560) QHES implementation. Outcomes were assessed using validated instruments. RESULTS: Workers exposed to adverse physical and psychosocial work factors had a higher prevalence of WMSP. After interventions, the prevalences of one adverse physical and three adverse psychosocial work factors were lower among workers exposed to interventions. Among men exposed to physical and psychosocial interventions, the lower prevalence of neck WMSP is compatible with a beneficial intervention effect. Other results generally showed few effects on WMSP. CONCLUSION: Results suggest that QHES implementation lead to a decrease in some adverse physical and psychosocial work factors. Few effects were observed on WMSP.

Effect of psychosocial work factors on the risk of certified absences from work for a diagnosed mental health problem: a protocol of a systematic review and meta-analysis of prospective studies.

INTRODUCTION: Mental health problems (MHPs) are frequent and disabling and are the first or second leading cause of certified sickness absences from work in industrialised countries. They are generally long lasting and generate a considerable human and socioeconomic burden. The deleterious effect of adverse psychosocial work factors on MHP has been documented. However, the evidence regarding the effect of these factors on absences from work for an MHP has not been synthesised since 2007. The proposed systematic review aims to synthesise the effect of adverse psychosocial work factors from three validated theoretical models (the demand-control-support, effort-reward-imbalance and organisational justice models) on the risk of certified absences from work for diagnosed MHP among workers. METHOD AND ANALYSIS: A systematic search strategy will be conducted in seven databases: Medline, Embase, CINAHL, Web of Science, PsycInfo, Sociological abstracts and IBSS. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations, a multistep screening process by independent reviewers will lead to study selection. The search strategy was first run in 16 January 2017 and will be updated in October 2018. Only quantitative, prospective studies evaluating the effect of at least one psychosocial work factor from the validated theoretical models on certified absence from work for a diagnosed MHP will be considered for inclusion. Extracted data will be used for quantitative and qualitative evidence synthesis as well as to assess risk of bias and methodological quality. Meta-estimates will be provided for high-quality studies and by each psychosocial work factor, after considering homogeneity and number of studies. ETHICS AND DISSEMINATION: As this study will be based only on published studies, ethics approval is not required. Given that psychosocial works factors are frequent and modifiable, the results of this systematic review may provide evidence to support prevention strategies that can help to reduce the human social and economic burden associated with medically certified absences from work for an MHP. PROSPERO REGISTRATION NUMBER: CRD42018091632.

Evaluation of the Quebec Healthy Enterprise Standard: Effect on Adverse Psychosocial Work Factors and Psychological Distress.

Adverse psychosocial work factors are recognized as a significant source of psychological distress, resulting in a considerable socioeconomic burden. The impact of occupational health standards that aim to reduce these adverse work factors, such as the Quebec Healthy Enterprise Standard (QHES), is of great interest for public health. The aim of this study was to evaluate, for the first time, the effect of QHES interventions targeting adverse psychosocial work factors on the prevalence of these factors and of psychological distress among ten Quebec organizations. These outcomes were assessed by questionnaire using validated instruments before (T1, n = 2849) and 2-3 years following (T2, n = 2560) QHES implementation. Beneficial effects of interventions were observed for two adverse psychosocial work factors: low rewards (ratio of prevalence ratios (PRs) = 0.77, 95% CI = 0.66-0.91) and low social support at work (ratio of PRs = 0.89, 95% CI = 0.77-1.03). Moreover, beneficial effects of interventions were also observed on the prevalence of high psychological distress (ratio of PRs = 0.86, 95% CI = 0.75-0.998). Psychosocial interventions implemented in the context of this standard improved the psychosocial work environment and had beneficial effects on workers' mental health.