Rehabilitation of individuals on long-term sick leave due to sustained stress-related symptoms: a comparative follow-up study.

AIMS: Nature-assisted therapy for mental health problems receives increased attention. However, quantitative evaluations are rare. This study evaluates the effects of an all-outdoors vocational rehabilitation program for individuals on long-term sick leave due to sustained stress-related symptoms. METHODS: In a comparative pre-post intervention design the intervention group contained 48 participants from Mariendal Gardens (MG), while 45 participants at Stress- & Jobmanagement (SJ) formed the comparison group. At MG all activities took place outdoors, while activities at SJ were mainly indoors. Questionnaires were completed at baseline, 3- and 6-month follow-up. Outcomes included Perceived Stress Scale (PSS-10) and measures of sleep, mindfulness, self-efficacy, daily functioning, and work ability. Data were analyzed using mixed model repeated measures analysis of variance. RESULTS: At baseline the MG-group PSS-10 mean score was 25.15 points (SD=7.20), while the SJ-group mean score was 23.91 (SD=7.48). At 3-months the MG within-group score dropped 4.61 [2.71; 6.52] points (p<0.01), corresponding to at standardized mean difference (Cohen's d) of d=0.64 [0.38; 0.91], while the SJ within-group score dropped 4.16 [1.73; 6.59] points (p<0.01), corresponding to d=0.56 [0.23; 0.88]. The between-group mean difference was not significant (p=0.77). Similarly, results for sleep, mindfulness, self-efficacy, daily functioning, and work ability demonstrated significant within-group effects and minimal between-group differences. CONCLUSIONS: Both interventions demonstrated small to large pre-post effect sizes. Negligible differences were observed between the effects of the two interventions, indicating no added effect of the all-outdoors setting. Results should be interpreted with caution as unequal lost to follow-up rates threatens the comparability of changes in the two groups.

With long hours of work, might depression then lurk? A nationwide prospective follow-up study among Danish senior medical consultants.

OBJECTIVE: The aim of this study was to examine depression as a potential negative health effect of long work hours, anticipating an exposure-response relationship. METHOD: A nationwide prospective cohort study of 2790 Danish senior medical consultants was conducted (61.7% response rate). With the consent of Danish Data Protection Agency, data from a questionnaire survey was linked with data from a Medical Products Agency Register. Long work hours were defined based on a self-reported average of weekly work hours >40, while redemption of anti-depressive (AD) drug prescriptions defined depression. Proportional hazards Cox regression analyses were conducted adjusting for gender, age, marital status, medical specialty, decision authority at work, work social support, quantitative work demands, and AD drugs prescribed before baseline. RESULTS: Long weekly work hours did not increase the risk of redeeming AD drug prescriptions at all times during follow-up compared to the reference of 37-40 work hours [41-44 hours: hazard ratio (HR) 0.95, 95% confidence interval (95% CI) 0.5-1.8; 45-49 hours: HR 0.88, 95% CI 0.4-1.8; 50-54 hours: HR 0.83, 95% CI 0.3-2.1; 55-59 hours: HR 0.67, 95% CI 0.2-2.9; ≥ 60 hours: HR 0.48, 95% CI 0.1-3.7]. The same result emerged when work hours was applied in a continuous form (from 25-36 hours to 37-40 hours to 41-44 hours and so on) (HR 0.93, 95% CI 0.76-1.13) and when robust analyses were conducted (data not shown). CONCLUSIONS: This study does not support the anticipation that long work hours increase the risk of depression. If anything, long work hours vaguely appear to decrease the risk of redeeming AD drug prescriptions.

Psychosocial work environment and antidepressant medication: a prospective cohort study.

BACKGROUND: Adverse psychosocial work environments may lead to impaired mental health, but it is still a matter of conjecture if demonstrated associations are causal or biased. We aimed at verifying whether poor psychosocial working climate is related to increase of redeemed subscription of antidepressant medication. METHODS: Information on all antidepressant drugs (AD) purchased at pharmacies from 1995 through 2006 was obtained for a cohort of 21,129 Danish public service workers that participated in work climate surveys carried out during the period 2002-2005. Individual self-reports of psychosocial factors at work including satisfaction with the work climate and dimensions of the job strain model were obtained by self-administered questionnaires (response rate 77,2%). Each employee was assigned the average score value for all employees at his/her managerial work unit [1094 units with an average of 18 employees (range 3-120)]. The risk of first-time AD prescription during follow-up was examined according to level of satisfaction and psychosocial strain by Cox regression with adjustment for gender, age, marital status, occupational status and calendar year of the survey. RESULTS: The proportion of employees that received at least one prescription of ADs from 1995 through 2006 was 11.9% and prescriptions rose steadily from 1.50% in 1996 to the highest level 6.47% in 2006. ADs were prescribed more frequent among women, middle aged, employees with low occupational status and those living alone. None of the measured psychosocial work environment factors were consistently related to prescription of antidepressant drugs during the follow-up period. CONCLUSION: The study does not indicate that a poor psychosocial work environment among public service employees is related to prescription of antidepressant pharmaceuticals. These findings need cautious interpretation because of lacking individual exposure assessments.

Job strain and ischemic heart disease: a prospective study using a new approach for exposure assessment.

BACKGROUND: Prolonged psychosocial load at the workplace may increase the risk of ischemic heart disease (IHD), but the issue is still unsettled. We analyzed the association between psychosocial workload and risk of IHD using a new approach allocating measures of psychosocial load to individuals based on the average exposure level in minor work units. METHODS: Cohort study of 18,258 Danish public service workers in 1106 work units; 79% were women; 108 subjects with history of cardiovascular disease were excluded from the follow-up. The outcome was hospitalization due to IHD (angina pectoris or myocardial infarction) during the period 2002 to end of 2007. RESULTS: During 87,428 person-years at risk (mean follow-up = 4.82 years), 101 subjects were admitted to a hospital due to IHD. Neither job strain (synergy of job demands and job control) nor general job dissatisfaction were related to IHD risk. However, compared with others, subjects who were allocated to the low job control category, had an increased risk of IHD, Hazard Ratio (95% CI) = 2.0 (1.1 to 3.6). CONCLUSIONS: The findings presented do not lend support to the hypothesis that high job strain and job dissatisfaction are important determinants for IHD among Danish predominantly female public service workers.

Sickness absence and workplace levels of satisfaction with psychosocial work conditions at public service workplaces.

BACKGROUND: The objective of this study was to examine the impact of psychosocial work conditions on sickness absence while addressing methodological weaknesses in earlier studies. METHODS: The participants were 13,437 employees from 698 public service workplace units in Aarhus County, Denmark. Satisfaction with psychosocial work conditions was rated on a scale from 0 (low) to 10 (high). Individual ratings were aggregated to workplace scores. Analysis of variance was used to compare the average number of days of yearly sickness absence in three groups with different levels of satisfaction with psychosocial work conditions. RESULTS: Sickness absence was 30.8% lower in the most satisfied group (11.7 days/year (CI 95%: 10.2; 13.1)) than in the least satisfied group (16.9 days/year (CI 95%: 15.3; 18.6)) adjusted for the covariates included. CONCLUSIONS: Satisfaction with psychosocial work conditions has a strong and independent impact on sickness absence. Am. J. Ind. Med. 52:153-161, 2009. (c) 2008 Wiley-Liss, Inc.

Psychosocial working conditions and the risk of depression and anxiety disorders in the Danish workforce.

BACKGROUND: To examine the risk of depressive and anxiety disorders according to psychosocial working conditions in a large population-based sample. METHODS: Job Exposure Matrix was applied to assess psychosocial working conditions in a population-based nested case-control study of 14,166 psychiatric patients, diagnosed with depressive or anxiety disorders during 1995-1998 selected from The Danish Psychiatric Central Research Register, compared with 58,060 controls drawn from Statistics Denmark's Integrated Database for Labour Market Research. RESULTS: Low job control was associated with an increased risk of anxiety disorders in men (IRR 1.40, 95% CI 1.24-1.58). In women an elevated risk of depression was related to high emotional demands (IRR 1.39, 95%CI 1.22-1.58) and to working with people (IRR 1.15, 95% CI 1.01-1.30). In both sexes high demands were associated with a decreased risk of anxiety disorders. There was a weak association between job strain and anxiety disorders in men (IRR 1.13, 95%, CI 1.02-1.25) CONCLUSION: Psychosocial work exposures related to the risk of depressive and anxiety disorders differ as between the sexes. The pattern of risks is inconsistent. The results give rise to rethinking both study designs and possible causal links between work exposures and mental health.

Global measure of satisfaction with psychosocial work conditions versus measures of specific aspects of psychosocial work conditions in explaining sickness absence.

BACKGROUND: Attempts to identify particular aspects of psychosocial work conditions as predictors of sickness absence remain inconclusive. A global measure has previously been suggested to be an efficient way to measure psychosocial work conditions in questionnaires. This paper investigates whether satisfaction with specific aspects of psychosocial work conditions explains sickness absence beyond its association with a global measure of psychosocial work conditions. METHODS: The participants were 13,437 employees from 698 public service workplaces in Aarhus County, Denmark. 33 items from a questionnaire fell in groupings around six aspects of psychosocial work conditions: skill discretion, professionalism, management, decision authority, workload and cooperation. A global measure rating satisfaction with psychosocial work conditions on a scale from 0 to 10 was also included in the questionnaire. Individual ratings were aggregated to workplace scores. Analysis of variance and multiple linear regression was used to compare the average number of days of yearly sickness absence with different levels of satisfaction with six aspects of psychosocial work conditions. The covariates included were gender, age, occupation, size of workplace, contact to hospital, civil status and children below 13 living at home. RESULTS: Dissatisfaction with each of the six aspects of psychosocial work conditions was associated with an increase in sickness absence. When all aspects were simultaneously included in the model, only skill discretion and professionalism were negatively associated with sickness absence. When a global measure of satisfaction with psychosocial work conditions was also included in the model none of the specific aspects showed a statistically significant association with sickness absence. CONCLUSION: Low global satisfaction with psychosocial work conditions is associated with increased levels of sickness absence. Including specific aspects of psychosocial work conditions in the model does not provide further information regarding the nature of this association.

[The psychosocial work environment of junior physicians in Danish oncology departments. A questionnaire-based cross-sectional study]. / Psykisk arbejdsmiljø blandt yngre laeger på onkologiske afdelinger. Et spørgeskemabaseret tvaersnitsstudie.

INTRODUCTION: Employees in departments of oncology in Denmark are faced with the public's expectations of increased productivity and quality. Understaffing is a serious obstacle to the fulfillment of these expectations. In 2006, the psychosocial work environment was examined among junior physicians working in Danish departments of oncology. MATERIALS AND METHODS: The Department of Occupational Medicine at Aarhus University Hospital conducted a psychosocial work environment-questionnaire among 121 junior physicians employed at six departments of oncology in May 2006. Participation was voluntary and anonymous. RESULTS: The response rate was 87%. Meaningfulness and developing potentiality of employment as well as involvement in the workplace were rated higher by the junior physicians than by average Danish workers. However, as for quantitative and emotional work demands and the experience of influence and predictability at work, the assessment of the psychosocial work environment is significantly poorer. There is considerable inter-departmental variation. The junior physicians call for more staff, a higher prioritization of education, and an improved psychosocial work environment. CONCLUSION: Despite meaningfulness and developing potentiality of employment, the psychosocial work environment of junior physicians in Danish departments of oncology is perceived as significantly poorer than that of average Danish workers. This study provides a basis for developing strategies to improve working conditions and facilitate the recruitment and maintenance of junior physicians in clinical oncology.

Work related violence and threats and the risk of depression and stress disorders.

OBJECTIVE: To examine the risk of depression and stress related disorders as a function of occupational exposure to violence and threats. DESIGN: Population based nested case-control study. SETTING: All gainfully employed Danes. Cases and controls: 14 166 hospital inpatients and outpatients, aged 18-65, treated for affective or stress related disorders during 1995-1998 selected from The Danish Psychiatric Central Research Register and 58 060 controls matched for age, sex, and time, drawn from Statistics Denmark's Integrated Database for Labour Market Research. MAIN OUTCOME MEASURE: Clinical psychiatric diagnosis (WHO ICD-10) of affective (F30-39) or stress related (F40-48) disorders compared with controls by the occupation held the year before treatment. The occupation held the year before treatment was used as exposure proxy. RESULTS: Potential exposure to occupational violence is associated with significantly increased relative risks of both disorders in either sex (women: depression RR 1.45 CI 1.27 to 1.65, stress RR 1.32 CI 1.19 to 1.46; men: depression RR 1.48 CI 1.18 to 1.86, stress RR 1.55 CI 1.29 to 1.84). Work related threats are associated with increase in the risk of depression in women (RR 1.48 CI 1.23 to 1.79) and the risk of stress related disorders in men (RR 1.59 CI 1.32 to 1.91). Risks rose with increasing prevalence of violence and threats. The results remain significant and only slightly attenuated after controlling for extent of professional contact with people other than colleagues. CONCLUSIONS: Employment in occupations involving exposure to work related threats and violence is a risk factor for depression and stress related disorders in both sexes. These findings have implications for health and safety at work policies.

Occupational risk of affective and stress-related disorders in the Danish workforce.

OBJECTIVES: A population-based, nested, case-control study was carried out to quantify the risk of affective and stress-related disorders according to occupation in the entire Danish workforce. METHODS: All incident hospital patients and out-patients aged 18-65 years who received a first-time-ever diagnosis of an affective disorder (ICD-10, F 30-39) or stress-related condition (ICD-10, F 40-48) in Denmark from 1 January 1995 through 31 December 1998 were identified in the Danish Psychiatric Central Research Register (N=28 971). For each case, five randomly selected referents of the same age and gender were drawn from a 5% sample of the Danish population (N= 144 855). The occupation held 1 year before a person became a case was obtained from Denmark's Integrated Database for Labour Market Research. Occupation was classified according to the Danish version of the International Standard Classification of Occupations (ICD). Relative risks (RR) and 95% confidence intervals (95% CI) for 25 occupational categories with clerical staff as the reference were calculated using a conditional logistic regression adjusted for sociodemographic covariates. RESULTS: Eight occupations were associated with significantly elevated risks (RR range 1.20-1.58) among the women, while eight occupations were associated with a significantly reduced risk (RR range 0.50-0.76) among the men. The risks were highest for the teaching (RR 1.58) and health (RR 1.53) professions. Only social workers and professionals caring for mentally and physically disabled persons faced an elevated risk irrespective of gender (women RR 1.72, 95% CI 1.38-2.16; men RR 2.09, 95% CI 1.38-3-15). CONCLUSIONS: Major depression and stress-related psychiatric disorders are related to occupation. Risk profiles vary strongly according to gender.

Occupational disorders and return to work: a randomized controlled study.

OBJECTIVE: Goal setting and motivational factors are strongly associated with maintaining a job and return to work after sick leave, but research into the effects of interventions targeting these factors is limited. We conducted a randomized controlled study to examine the vocational effect of intervention focusing on motivation, goal setting and planning for return to work. DESIGN AND METHODS: Of 243 patients at risk of long-term sick leave or job dropout, 184 (76%) provided complete baseline information for the study. After randomization to an intervention group (n=92) and a reference group (n=92), occupational physicians examined the participants in accordance with standard guidelines. The intervention group received additional support from a social worker in order to enhance goal setting, motivation and planning for return to work. After 1 year 163 participants (89%) provided data on general health and employment status. The risk of not being gainfully employed was analysed by logistic regression analysis with adjustment for several covariates. RESULTS: The intervention did not increase the likelihood of gainful employment after 1 year or reduce the average number of days of sick leave. CONCLUSION: A low-cost counselling program addressing motivation, goal setting and planning for return to work did not improve vocational outcomes or reduce sick leave among patients with work-related disorders.