The burnout-depression conundrum: investigating construct-relevant multidimensionality across four countries and four patient samples.

This research seeks to contribute to the ongoing discussion about the distinctive nature of burnout and depression. In a first study, we relied on employee samples from four European countries (N = 5199; 51.27% women; Mage = 43.14). In a second study, we relied on a large sample of patients (N = 5791; 53.70% women; Mage = 39.54) who received a diagnosis of burnout, depressive episode, job strain, or adaptation disorder. Across all samples and subsamples, we relied on the bifactor exploratory structural equation modelling to achieve an optimal disaggregation of the variance shared across our measures of burnout and depression from the variance uniquely associated with each specific subscale included in these measures. Our results supported the value of this representation of participants' responses, as well as their invariance across samples. More precisely, our results revealed a strong underlying global factor representing participants' levels of psychological distress, as well as the presence of equally strong specific factors supporting the distinctive nature of burnout and depression. This means that, although both conditions share common ground (i.e. psychological distress), they are not redundant. Interestingly, our results also unexpectedly suggested that suicidal ideation might represent a distinctive core component of depression.

Spillover and crossover effects of exposure to work-related aggression and adversities: A dyadic diary study.

The past two decades have produced extensive evidence on the manifold and severe outcomes for victims of aggression exposure in the workplace. However, due to the dominating individual-centered approach, most findings miss a social network perspective. Consequently, knowledge of negative spillover to different life-domains or crossover to uninvolved individuals alongside a detailed understanding of the involved transmission processes remains scarce. By integrating social aggression theorizing, the present study investigated transmission routes (emphatic, behavioral) of experienced adversities and aggression at work toward perpetration of aggressive behavior and potential spillover and crossover effects into the private life domain in a diary study of 72 mixed dyads. Analyses of mediation based upon the Actor-Partner Interdependence Model revealed an association between the frequency of perpetrating aggressive behavior in the work context and a spillover into the private life domain via aggression-promoting internal states (emotions, cognitions, arousal). Based on the different patterns of mediation, it appears that adversities follow a mental transmission process, whereby experienced aggression displayed behavioral assimilation. In contrast, no crossover effects of exposure to adversities or aggression at work to a study partner at home could be detected. Practical and theoretical implications as well as limitations and ideas for future work are discussed.

Prospective effects of social support on self-actualization at work - The mediating role of basic psychological need fulfillment.

Self-actualization - an ethically meaningful, eudaimonic way of living - is achieved by self-determined activities and realizing one's highest potential. Therefore, personal growth and human fulfillment are considered central aspects. In accordance with self-determination theory this study aims to longitudinally investigate the mediating role of basic psychological need satisfaction - combined and separately - within the association between social support and indicators of self-actualization at work. 264 employees working in diverse economic sectors and occupations participated in the survey two times with a time lag of two months. Consistent with hypotheses the fulfillment of basic psychological needs in general as well as separately mediated the link between social support from different sources and self-actualization at work with one exception: Within the association between support from co-workers and indicators of self-actualization at work the need for relatedness did not have a significant mediating effect. Implications for future research and practice of promoting social support for personal development at the workplace are discussed.

Consequences of Exposure to Violence, Aggression, and Sexual Harassment in Private Security Work: A Mediation Model.

While exposure to violence and aggression is well known for its detrimental effects on employees' health as well as organizational outcomes, certain high-risk work domains have scarcely been researched. Thus, this study set out to determine negative consequences of work-related exposure to four forms of harmful behaviors in private security. In a sample of 487 German-speaking security guards, 23% had experienced outsider-initiated violence, 56% aggressive acts, 30% vicarious violent acts, and 3% were sexually harassed over the past 12 months. Additionally, 19% reported substantial to extreme worries about violence. By presenting an integrated model of negative consequences to outsider-initiated violent, aggressive as well as sexual harassing acts, we strived to extend previous research by showing that turnover intention (as an ultimate negative behavioral outcome) is only indirectly related to these experiences via worries about violence and psychosomatic complaints. Structural equation modeling provided support for the model and plausibility for a sequential "two-step" prediction of turnover intention. Further, we provided support that worries about violence are not solely triggered by directly experiencing physical violence but also vicarious violence, aggressive acts, and sexual harassment. Consistent with previous studies, worries about violence were identified as a central mediator in the transmission process from exposure to harmful behaviors at work to negative consequences, that is, psychosomatic complaints and turnover intention. Our findings have implications for the detailed understanding of consequences emerging from exposure to workplace violence and aggression as well as the development of effective prevention strategies especially in high-risk occupations such as private security.

Measurement Invariance of the Burnout Assessment Tool (BAT) Across Seven Cross-National Representative Samples.

The aim of this study was to investigate the measurement invariance of the Burnout Assessment Tool (BAT) across seven cross-national representative samples. In this study, burnout was modeled as a second-order factor in line with the conceptual definition as a syndrome. The combined sample consisted of 10,138 participants from countries in Europe and Japan. The data were treated as ordered categorical in nature and a series of models were tested to find evidence for invariance. Specifically, theta parameterization was used in conjunction with the weighted least squares (mean- and variance adjusted) estimation method. The results showed supportive evidence that BAT-assessed burnout was invariant across the samples, so that cross-country comparison would be justifiable. Comparison of effect sizes of the latent means between countries showed that Japan had a significantly higher score on overall burnout and all the first-order factors compared to the European countries. The European countries all scored similarly on overall burnout with no significant difference but for some minor differences in first-order factors between some of the European countries. All in all, the analyses of the data provided evidence that the BAT is invariant across the countries for meaningful comparisons of burnout scores.

Creating Positive Work Experiences Through Task Self-Redesign.

Complementing the traditional focus in work design on "top-down" organizational interventions, research into proactive work behavior suggests that "bottom-up" processes, based on the "micro-emancipatory" actions employees engage in, create more rewarding and meaningful work experiences. Based on current theorizing, this study tests a tripartite model of task self-redesign and positive work-related states of meaning, affective commitment, and work-home enrichment. The interactive effects of three modes of task influence are postulated: (a) the active use of existing potentials for task autonomy; (b) job crafting, as unauthorized and self-organized modifications of task features; (c) the individual renegotiation of tasks through idiosyncratic deals (i-deals) with superiors. Survey data from an occupationally heterogeneous convenience sample of N = 279 German-speaking employees were analyzed, using confirmatory factor analysis and moderated linear regression. The regression results confirmed that task i-deals consistently related to positive experiences, whereas autonomy only related to one, and task crafting had no significant main effect. A significant two-way interaction between i-deals and crafting was found only in relation to affective commitment. Supporting the suggested tripartite model, significant (synergistic) three-way interactions explained the additional variance in all three examined outcomes. These results offer some preliminary insights into the interplay of organizationally designed, individually crafted, and interpersonally negotiated work activities. Task autonomy, task-directed job crafting, and task i-deals appear to fulfill complementary roles in the self-directed creation of positive work experiences. Methodological limitations and further research needs are discussed.

Human resource management training of supervisors for improving health and well-being of employees.

BACKGROUND: Many workers suffer from work-related stress and are at increased risk of work-related cardiovascular, musculoskeletal, or mental disorders. In the European Union the prevalence of work-related stress was estimated at about 22%. There is consensus that stress, absenteeism, and well-being of employees can be influenced by leadership behaviour. Existing reviews predominantly included cross-sectional and non-experimental studies, which have limited informative value in deducing causal relationships between leadership interventions and health outcomes. OBJECTIVES: To assess the effect of four types of human resource management (HRM) training for supervisors on employees' psychomental stress, absenteeism, and well-being. We included training aimed at improving supervisor-employee interaction, either off-the-job or on-the-job training, and training aimed at improving supervisors' capability of designing the work environment, either off-the-job or on-the-job training. SEARCH METHODS: In May 2019 we searched CENTRAL, MEDLINE, four other databases, and most relevant trials registers (ICTRP, TroPHI, ClinicalTrials.gov). We did not impose any language restrictions on the searches. SELECTION CRITERIA: We included randomised controlled trials (RCT), cluster-randomised controlled trials (cRCT), and controlled before-after studies (CBA) with at least two intervention and control sites, which examined the effects of supervisor training on psychomental stress, absenteeism, and well-being of employees within natural settings of organisations by means of validated measures. DATA COLLECTION AND ANALYSIS: At least two authors independently screened abstracts and full texts, extracted data and assessed the risk of bias of included studies. We analysed study data from intervention and control groups with respect to different comparisons, outcomes, follow-up time, study designs, and intervention types. We pooled study results by use of standardised mean differences (SMD) with 95% confidence intervals when possible. We assessed the quality of evidence for each outcome using the GRADE approach. MAIN RESULTS: We included 25 studies of which 4 are awaiting assessment. The 21 studies that could be analysed were 1 RCT, 14 cRCTs and 6 CBAs with a total of at least 3479 employees in intervention and control groups. We judged 12 studies to have an unclear risk of bias and the remaining nine studies to have a high risk of bias. Sixteen studies focused on improving supervisor-employee interaction, whereas five studies aimed at improving the design of working environments by means of supervisor training.Training versus no interventionWe found very low-quality evidence that supervisor training does not reduce employees' stress levels (6 studies) or absenteeism (1 study) when compared to no intervention, regardless of intervention type or follow-up. We found inconsistent, very low-quality evidence that supervisor training aimed at employee interaction may (2 studies) or may not (7 studies) improve employees' well-being when compared to no intervention. Effects from two studies were not estimable due to missing data.Training versus placeboWe found moderate-quality evidence (2 studies) that supervisor training off the job aimed at employee interaction does not reduce employees' stress levels more than a placebo training at mid-term follow-up. We found low-quality evidence in one study that supervisor training on the job aimed at employee interaction does not reduce employees' absenteeism more than placebo training at long-term follow-up. Effects from one study were not estimable due to insufficient data.Training versus other trainingOne study compared the effects of supervisor training off the job aimed at employee interaction on employees' stress levels to training off the job aimed at working conditions at long-term follow-up but due to insufficient data, effects were not estimable. AUTHORS' CONCLUSIONS: Based on a small and heterogeneous sample of controlled intervention studies and in contrast to prevailing consensus that supervisor behaviour influences employees' health and well-being, we found inconsistent evidence that supervisor training may or may not improve employees' well-being when compared to no intervention. For all other types of interventions and outcomes, there was no evidence of a considerable effect. However, due to the very low- to moderate-quality of the evidence base, clear conclusions are currently unwarranted. Well-designed studies are needed to clarify effects of supervisor training on employees' stress, absenteeism, and well-being.

Say, What Is on Your Mind? Surgeons' Evaluations of Realism and Usability of a Virtual Reality Vertebroplasty Simulator.

BACKGROUND: Virtual reality (VR)-based simulations offer rich opportunities for surgical skill training and assessment of surgical novices and experts. A structured evaluation and validation process of such training and assessment tools is necessary for effective surgical learning environments. OBJECTIVE: To develop and apply a classification system of surgeon-reported experience during operation of a VR vertebroplasty simulator. METHODS: A group of orthopedic, trauma surgeons and neurosurgeons (n = 13) with various levels of expertise performed on a VR vertebroplasty simulator. We established a mixed-methods design using think-aloud protocols, senior surgical expert evaluations, performance metrics, and a post-simulation questionnaire. Verbal content was systematically analyzed using structured qualitative content analysis. We established a category system for classification of surgeons' verbal evaluations during the simulation. Furthermore, we evaluated intraoperative performance metrics and explored potential associations with surgeons' characteristics and simulator evaluation. RESULTS: Overall, 244 comments on realism and usability of the vertebroplasty simulator were collected. This included positive and negative remarks, questions, and specific suggestions for improvement. Further findings included surgeons' approval of the realism and usability of the simulator and the observation that the haptic feedback of the VR patient's anatomy requires further improvement. Surgeon-reported evaluations were not associated with performance decrements. DISCUSSION: This study is the first to apply think-aloud protocols for evaluation of a surgical VR-based simulator. A novel classification approach is introduced that can be used to classify surgeons' verbalized experiences during simulator use. Our lessons learned may be valuable for future research with similar methodological approach.

[Drawing up a Guideline for Handling Information and Communication Technology, Flexibility and Availability in Small and Medium Enterprises]. / Erstellung eines Handlungsleitfadens für einen gesundheitsförderlichen Umgang mit Informations- und Kommunikationstechnologien, Flexibilisierung und Erreichbarkeit in kleinen und mittleren Unternehmen.

BACKGROUND: Within the last decades the world of work has changed enormously. Due to new Information and Communication Technologies (ICT), working at any time from any place has become possible. Flexibility, availability and the dissolution of boundaries between work and private life are the possible results of this development. The spread of this development and possible consequences on the affected employee's health and wellbeing have been examined so far especially in big companies. Small and medium-sized enterprises (SME) are rarely subjects of scientific studies in this context. OBJECTIVE OF THIS PAPER: The aim of this work was to develop a guideline based on experiences and results of a study regarding flexibility in the business world (FlexA), as well as a systematic literature research. The target populations of this guideline are SMEs, focusing on integrating a health promoting way in dealing with ICT, flexibility and availability within the corporate culture. METHODS: In order to delineate the current state in of research in ICT-related work interventions, a systematic review in data bases e. g. PsycINFO, EconLit and Medline was carried out. The search strategy used the key words "work", "intervention", "ICT", "mental strain", "flexibility" and "availability". In addition, grey literature and findings from the FlexA study were used to formulate the current guideline. RESULTS: Based on the exclusion criteria, all studies from the systematic literature search were excluded after title and abstract screening. Within grey literature research, 4 relevant publications could be identified. The measures, developed during the corporate workshops of the FlexA study, e. g. the implementation of collective regulations in the company, were included in the guideline. CONCLUSION: Due to the ongoing development of ICT and flexibility in daily business life, it is getting more and more important to follow this progress. Executives and corporate management are responsible to actively shape this trend in a health-promoting way in their enterprises. The current guideline was made to support the corporate management in this task and it is an important instrument for a health-promoting use of ICT in daily business life taking in to consideration flexibility and availability.

Can a workplace leadership intervention reduce job insecurity and improve health? Results from a field study.

PURPOSE: To examine the effectiveness of an intervention in the workplace designed to reduce job insecurity among employees affected by organizational change. METHODS: Supervisors were randomly allocated to an intervention (IG) or waiting-list-control group (CG) and the intervention was administered over a period of 3 months, comprising six group sessions. N = 103 supervisors and their team members (mean age 41.80 ± 9.60 years, 60.19% male) provided data prior to (t0) and 3 months post-intervention (t1) by means of questionnaires and hair samples. Job insecurity (COPSOQ), mental health (HADS) and somatic health (GBB, hair cortisol concentration) were measured. RESULTS: Job insecurity was reduced to a marginally significant degree in the IG compared to the CG at t1 (B = - 5.78, p = .06, CI [- 11.73, 0.17]). Differential effects for supervisors and team members were not found. No effects on health could be observed overall in the IG, but supervisors in the IG reported a significant decrease in exhaustion tendency (B = - 0.92, p = 0.01, CI [- 1.64, - 0.20]) and a non-significant trend towards higher levels of anxiety (B = 2.98, p = 0.10, CI [- 0.57, 6.54]) compared to team members. CONCLUSIONS: This is the first study to provide some evidence for the effectiveness of an intervention that aimed at reducing job insecurity during organizational change. Health-related effects were observed in supervisors but not in team members. Further intervention studies are needed to add to the current knowledge base.

The Implications of Psychological Symptoms for Length of Sick Leave.

BACKGROUND: In this cross-sectional study, we aimed to determine the relation between sick leave duration, burnout symptoms, depression, anxiety, and somatization in a primary care setting. METHODS: Patients receiving a sickness certificate in one of 14 participating primary care practices were consecutively asked by their primary care physician to fill in a questionnaire comprising the Maslach Burnout Inventory-General Survey (MBI-GS) and the Patient Health Questionnaire (PHQ) containing the depression (PHQ-9), somatization (PHQ-15), and anxiety (GAD-7) scales. The main diagnosis on the sickness certificate was documented by the issuing physician. A quasi-Poisson regression analysis was performed to estimate the influence of burnout symptoms, depression, and anxiety on length of sick leave. RESULTS: 225 patients participated, 122 (54.2%) were female; the mean age was 39.5 years. Length of sick leave correlated with emotional exhaustion (p = 0.005), depersonalization (p = 0.013), depression (p = 0.006), anxiety (p = 0.023), and somatization (p = 0.001). However, regression analysis revealed that the only predictors for length of sick leave were anxiety (exp[0.081] = 1.084; p = 0.013), age (exp[0.017] = 1.017; p = 0.041) and education (exp[- 0.508] = 0.602; p = 0:029). The pseudo R2 of the model was 0.25. CONCLUSION: The impact of anxiety on burnout symptoms and sick leave days might have been underestimated so far. A holistic approach in patient centered communication should comprise the evaluation of psychosomatic comorbidity under consideration of the established concepts of depression and anxiety disorder to ensure adequate diagnostic and therapeutic management.

Dealing with Organizational Double Binds: Three-way Interactive Effects of Role Stressors and Coping on Worker Exhaustion.

Based on theory regarding the dynamics of organizational double binds, hypotheses were developed about interactive effects of role conflict, role ambiguity, and coping on psychological exhaustion. Hypotheses were tested in a sample of 948 civil servants employed by a government administration in Germany. The sample included 250 (26.4%) women (M age = 43.6 year, SD = 8.3) and average organizational tenure was 17.1 year (SD = 10.0). Moderated multiple regression supported the two hypothesized three-way interactions. Under conditions of high role conflict and high role ambiguity, exhaustion was lower in workers reporting high control coping than in workers reporting low control coping. Under conditions of high role conflict and high role ambiguity, worker exhaustion was more pronounced when support coping was high than when it was low. Problem-focused control coping seems crucial to maintain mental health in dealing with contradictory and unclear work role expectations. Emotion-focused support coping appears symptomatic of prolonged involvement in psychologically dysfunctional work situations that cannot otherwise be addressed. Implications are discussed in the context of growing awareness of the contradictory demands organizations impose on employees.

The associations of supervisor support and work overload with burnout and depression: a cross-sectional study in two nursing settings.

AIMS: To investigate the moderating effects of work overload and supervisor support on the emotional exhaustion-depressive state relationship. BACKGROUND: Burnout and depression are prevalent in human service professionals and have a detrimental impact on clients. Work overload and supervisor support are two key job demands and job resources, whose role and interplay for the development and maintenance of burnout and depression are not fully understood yet. DESIGN: Two consecutive cross-sectional surveys: survey 1 investigated 111 hospital nursing professionals and survey 2 examined 202 day care professionals. Data collection was completed in 2010. RESULTS: After controlling for general well-being and sociodemographic characteristics, nurses' emotional exhaustion was associated with increased depressive state in both samples. We found a meaningful three-way interaction: our results show consistently that the relationship between emotional exhaustion and depressive state was strongest for nurses with high work overload and low supervisor support. Additionally, nurses with low work overload and low supervisor support were also found to have stronger associations between emotional exhaustion and depressive state. CONCLUSION: The findings indicate that nurses' reported supervisor support exerts its buffering effect on the burnout-depression link differentially and serves as an important resource for nurses dealing with high self-reported work stress.

Workplace bullying and depressive symptoms: a prospective study among junior physicians in Germany.

OBJECTIVE: The relationship between workplace bullying and depression may be bi-directional. Furthermore, it has been suggested that the depressogenic effect of bullying may only become evident after reasonable periods of follow-up (i.e., >1 year). As prospective evidence remains sparse and inconsistent, we used data from a three-wave prospective study to disentangle this potentially bi-directional relationship. METHODS: In 2004, 621 junior hospital physicians participated in a survey and were followed-up 1.2 years and 2.8 years later. Prospective analyses were restricted to participants with complete data at all assessments (n=507 or 82%). To measure workplace bullying, a description of bullying at work was provided followed by an item inquiring whether the respondent felt she/he had been exposed. Depressive symptoms were assessed by the state scale of the German Spielberger's State-Trait Depression Scales. RESULTS: Multivariate linear regression suggested that workplace bullying at baseline predicted increased depressive symptoms both after 1 year (b=1.43, p=0.01) and after 3 years of follow-up (b=1.58, p=0.01). Multivariate Poisson regression models revealed that the depressive symptom z-score at baseline was associated with an increased risk of bullying at the 3-year follow-up (relative risk [RR]=1.49, 95% confidence interval [CI]=1.13-1.97). This association was less pronounced after 1 year of follow-up (RR=1.19, 95% CI=0.90-1.59). CONCLUSIONS: Our study suggests bi-directional associations between depressive symptoms and victimization from bullying at the workplace. Future prospective studies are needed to examine underlying biopsychosocial mechanisms.

The impact of training and working conditions on junior doctors' intention to leave clinical practice.

BACKGROUND: The shortage of physicians is an evolving problem throughout the world. In this study we aimed to identify to what extent junior doctors' training and working conditions determine their intention to leave clinical practice after residency training. METHODS: A prospective cohort study was conducted in 557 junior doctors undergoing residency training in German hospitals. Self-reported specialty training conditions, working conditions and intention to leave clinical practice were measured over three time points. Scales covering training conditions were assessed by structured residency training, professional support, and dealing with lack of knowledge; working conditions were evaluated by work overload, job autonomy and social support, based on the Demand-Control-Support model. Multivariate ordinal logistic regression analyses with random intercept for longitudinal data were applied to determine the odds ratio of having a higher level of intention to leave clinical practice. RESULTS: In the models that considered training and working conditions separately to predict intention to leave clinical practice we found significant baseline effects and change effects. After modelling training and working conditions simultaneously, we found evidence that the change effect of job autonomy (OR 0.77, p = .005) was associated with intention to leave clinical practice, whereas for the training conditions, only the baseline effects of structured residency training (OR 0.74, p = .017) and dealing with lack of knowledge (OR 0.74, p = .026) predicted intention to leave clinical practice. CONCLUSIONS: Junior doctors undergoing specialty training experience high workload in hospital practice and intense requirements in terms of specialty training. Our study indicates that simultaneously improving working conditions over time and establishing a high standard of specialty training conditions may prevent junior doctors from considering leaving clinical practice after residency training.

The effects of improving hospital physicians working conditions on patient care: a prospective, controlled intervention study.

BACKGROUND: Physicians, particularly in hospitals, suffer from adverse working conditions. There is a close link between physicians' psychosocial work environment and the quality of the work they deliver. Our study aimed to explore whether a participatory work-design intervention involving hospital physicians is effective in improving working conditions and quality of patient care. METHODS: A prospective, controlled intervention study was conducted in two surgical and two internal departments. Participants were 57 hospital physicians and 1581 inpatients. The intervention was a structured, participatory intervention based on continuous group meetings. Physicians actively analyzed problematic working conditions, developed solutions, and initiated their implementation. Physicians' working conditions and patients' perceived quality of care were outcome criteria. These variables were assessed by standardized questionnaires. Additional data on implementation status were gathered through interviews. RESULTS: Over the course of ten months, several work-related problems were identified, categorized, and ten solutions were implemented. Post-intervention, physicians in the intervention departments reported substantially less conflicting demands and enhanced quality of cooperation with patients' relatives, compared to control group physicians. Moreover, positive changes in enhanced colleague support could be attributed to the intervention. Regarding patient reports of care quality of care, patient ratings of physicians organization of care improved for physicians in the intervention group. Five interviews with involved physicians confirm the plausibility of obtained results, provide information on implementation status and sustainability of the solutions, and highlight process-related factors for re-design interventions to improve hospital physicians work. CONCLUSIONS: This study demonstrates that participatory work design for hospital physicians is a promising intervention for improving working conditions and promoting patient quality of care.

Changes in psychosocial work environment and depressive symptoms: a prospective study in junior physicians.

BACKGROUND: We examined the impact of changes in the psychosocial work environment on depressive symptoms in a sample of junior physicians, a high risk group for stress and mental disorders. METHODS: This is a three-wave prospective study in 417 junior physicians during their residency in German hospitals. The psychosocial work environment was measured by the Effort-Reward Imbalance (ERI) Questionnaire at Waves 1 and 2, and the depressive symptoms were assessed with the State-Trait Depression Scales at all three waves. Multivariate linear regression was applied for prospective associations between ERI across Waves 1 and 2, and baseline-adjusted depressive symptoms at Wave 3. RESULTS: Compared with the ERI scores at Wave 1, at Wave 2, and mean scores between the two waves, the baseline-adjusted ERI change scores between the two waves showed slightly better statistical power, predicting depressive symptoms at Wave 3 (ß = 0.78, 95% CI = 0.38-1.18 for increased ERI per SD, ß = 0.64, 95% CI = 0.22-1.06 for increased effort per SD, ß = -0.65, 95% CI = -1.06 to -0.24 for increased reward per SD, and ß = 0.68, 95% CI = 0.27-1.09 for increased overcommitment per SD). CONCLUSIONS: Negative changes in the psychosocial work environment, specifically increased ERI, are associated with depressive symptoms in German junior physicians. Reducing the non-reciprocity of working life, particularly improving reward at work, may have beneficial effects on prevention of mental health problems in the hospital workplace.

Selection, optimization, and compensation in nursing: exploration of job-specific strategies, scale development, and age-specific associations to work ability.

AIMS: (1) To explore 'successful ageing' strategies in terms of selection, optimization and compensation in nursing; (2) To develop a scale that measures these strategies in nursing; (3) To investigate the association between these strategies in nursing and work ability of nurses and the moderating effects of age on this relationship. BACKGROUND: Studies indicate impaired work ability of older nurses. Research is needed to examine if 'successful ageing' strategies can promote the work ability especially in older nurses. DESIGN: The investigation applied a mixed method design: Study (1) Semi-structured interviews were conducted to explore selection, optimization and compensation in nursing; (Study 2) A cross-sectional survey was used to test the association between selection, optimization and compensation in nursing and work ability. METHODS: Data were collected in 2010 and 2011. Study 1: 17 nurses ≥45 years were interviewed; Study 2: 438 nurses (21-63 years) participated. A selection, optimization and compensation-in-nursing-scale was applied that was developed on the basis of study 1. Work ability was measured with the Work Ability Index (Dimension 1). RESULTS: Study 1, the majority of reported ageing strategies were identified as selection, optimization and compensation in nursing. Study 2, selection, optimization, and compensation in nursing was positively related with work ability. The positive relationship was stronger for older nurses. CONCLUSION: Selection, optimization and compensation in nursing contributes positively to work ability, particularly in older nurses. This finding is relevant for the development of measures that promote work ability of nurses over the course of their professional careers.

Promoting work ability and well-being in hospital nursing: the interplay of age, job control, and successful ageing strategies.

Previous research shows that work ability of nurses decreases with age. In our study we therefore addressed the following questions: Do successful ageing strategies at work in terms of selection, optimization, and compensation (SOC) support the work ability of nurses? Does SOC mediate the relationship between job control (i.e., decision opportunities at work) and work ability? Does the mediation differ between age-groups? 438 nurses (Age Range 21-63 years) completed a questionnaire in the course of an employee survey. Results show that SOC is positively related with work ability. The positive effect of job control on work ability is significantly mediated by SOC. There are stronger mediating effects for elder nurses than for younger nurses. Results indicate that the interplay of job control and SOC at work helps to maintain the work ability of nurses in nursing care.

Depressive symptoms in junior doctors: a follow-up study on work-related determinants.

PURPOSE: The study investigates the long-term effects of accumulated working conditions on depressive symptoms in junior doctors. Drawing on the Job Demand-Control-Support model, this study aims to identify personal and job-related determinants for self-reported depression in junior doctors-a professional group that is vulnerable to depression. METHODS: We conducted a prospective cohort study with measures of work characteristics and depressive symptoms over three time-points among hospital doctors during postgraduate specialty training in Germany. Participants were 415 junior doctors with full-time contract (47.5% women; mean age, 30.5 years). The outcome was depressive symptoms assessed with the Spielberger State-Depression Scale. Odds ratios (OR) were computed to analyse the cumulative effect of initial depressive symptoms scores, demographic variables, and working characteristics across T1 and T2 on subsequent depressive symptoms at T3. RESULTS: The percentage of junior doctors reporting depressive symptoms scores above a critical value varied between 12.0% at T1, 10.4% at T2, and 13.3% at T3; N = 34 doctors (8.19%) were classified as incident cases during the observation period. Elevated depressive symptoms at T3 were positively predicted by depressive symptoms scores across T1 and T2 (OR: 1.37; 95% confidence interval: 1.25-1.50) and negatively by professional tenure (0.54; 0.31-0.96), free weekends (0.52; 0.28-0.97), and job autonomy (0.35; 0.18-0.65). CONCLUSIONS: After controlling for demographic and working time influences, findings suggest that junior doctors' perceived job autonomy is negatively associated with future depressive symptoms. Enhancing job control emerges as a promising strategy to lower the risk of depression during first years of professional practice.