Open-door policy versus treatment-as-usual in urban psychiatric inpatient wards: a pragmatic, randomised controlled, non-inferiority trial in Norway.

BACKGROUND: Open-door policy is a recommended framework to reduce coercion in psychiatric wards. However, existing observational data might not fully capture potential increases in harm and use of coercion associated with open-door policies. In this first randomised controlled trial, we compared coercive practices in open-door policy and treatment-as-usual wards in an urban hospital setting. We hypothesised that the open-door policy would be non-inferior to treatment-as-usual on the proportion of patients exposed to coercive measures. METHODS: We conducted a pragmatic, randomised controlled, non-inferiority trial comparing two open-door policy wards and three treatment-as-usual acute psychiatric wards at Lovisenberg Diaconal Hospital in Oslo, Norway. An exemption from the consent requirements enabled inclusion and random allocation of all patients admitted to these wards using an open list (2:3 ratio) administrated by a team of ward nurses. The primary outcome was the proportion of patient stays with one or more coercive measures, including involuntary medication, isolation or seclusion, and physical and mechanical restraints. The non-inferiority margin was set to 15%. Primary and safety analyses were assessed using the intention-to-treat population. The trial is registered with ISRCTN registry and is complete, ISRCTN16876467. FINDINGS: Between Feb 10, 2021, and Feb 1, 2022, we randomly assigned 556 patients to either open-door policy wards (n=245; mean age 41·6 [SD 14·5] years; 119 [49%] male; 126 [51%] female; and 180 [73%] admitted to the ward involuntarily) or treatment-as-usual wards (n=311; mean age 41·6 [4·3] years; 172 [55%] male and 138 [45%] female; 233 [75%] admitted involuntarily). Data on race and ethnicity were not collected. The open-door policy was non-inferior to treatment-as-usual on all outcomes: the proportion of patient stays with exposure to coercion was 65 (26·5%) in open-door policy wards and 104 (33·4%) in treatment-as-usual wards (risk difference 6·9%; 95% CI -0·7 to 14·5), with a similar trend for specific measures of coercion. Reported incidents of violence against staff were 0·15 per patient stay in open-door policy wards and 0·18 in treatment-as-usual wards. There were no suicides during the randomised controlled trial period. INTERPRETATION: The open-door policy could be safely implemented without increased use of coercive measures. Our findings underscore the need for more reliable and relevant randomised trials to investigate how a complex intervention, such as open-door policy, can be efficiently implemented across health-care systems and contexts. FUNDING: South-Eastern Norway Regional Health Authority and The Research Council of Norway.

Workplace Bullying and Medically Certified Sickness Absence: Direction of Associations and the Moderating Role of Leader Behavior.

The aim of this study was to determine (1) associations between workplace bullying and subsequent risk and duration of medically certified sickness absence, (2) whether employees' perceptions of supportive, fair, and empowering leader behavior moderate the association between bullying and absence, and (3) whether prior sickness absence increases the risk of being a new victim of bullying. Altogether, 10,691 employees were recruited from 96 Norwegian organizations in the period 2004-2014. The study design was prospective with workplace bullying and leader behavior measured at baseline and then linked to official registry data on medically certified sickness absence for the year following the survey assessment. For analyses of reverse associations, exposure to bullying was reassessed in a follow-up survey after 24 months. The findings showed that workplace bullying was significantly associated with risk (risk ratio = 1.23; 95% CI = 1.13-1.34), but not duration (incidence rate ratio = 1.05; 95% CI = 0.89-1.25) of medically certified sickness absence after adjusting for age, gender, and supportive, fair, and empowering leader behavior. None of the indicators of leader behavior moderated the association between bullying and sickness absence (both risk and duration). Adjusting for baseline bullying, age, and gender, prior long-term sickness absence (>21 days) was associated with increased risk of being a new victim of bullying at follow-up (odds ratio = 1.86; 95% CI = 1.28-2.72). Effective interventions toward workplace bullying may be beneficial with regard to reducing sickness absence rates. Organizations should be aware that long-term sickness absence might be a social stigma as sick-listed employees have an increased risk of being bullied when they return to work.

Emotional dissonance and sickness absence: a prospective study of employees working with clients.

PURPOSE: (1) Determine the relationship between emotional dissonance and medically certified sickness absence among employees working with clients and (2) compare the impact of emotional dissonance on medically certified sickness absence with the impact of other psychological and social work factors. METHODS: A sample of 7758 employees was recruited from 96 Norwegian organizations in the period 2004 to 2014, all working with clients. The study design was prospective with emotional dissonance measured at baseline and then linked to official registry data of medically certified sickness absence for the year following the survey assessment. Quantitative demands, decision demands, role clarity, role conflict, control over work intensity, and decision control were included as additional work exposures. The impact of the study variables on the presence and duration of medically certified sickness absence was investigated with a negative binomial hurdle model. RESULTS: In the fully adjusted model, emotional dissonance and role conflict significantly predicted the presence of medically certified sickness absence. Control over work intensity and decision control were negatively related to presence of sickness absence. Only role conflict was a risk factor for the duration of sickness absence when all factors were analysed simultaneously. CONCLUSION: Emotional dissonance is a risk factor for the presence of medically certified sickness absence in client-driven work environments. Theoretical models of sickness absence, as well as interventions aiming to prevent sickness absence in such environments, should be aware of the effect emotional dissonance may have on employees.

Workplace bullying and sickness absence: a systematic review and meta-analysis of the research literature.

OBJECTIVE: The association between workplace bullying and sickness absence remains unclear. This paper presents a systematic review and meta-analysis of research on the association. METHOD: We conducted a systematic review and meta-analysis of published primary studies on workplace bullying and sickness absence. Studies based on prospective design or registry data on sickness absence were included. Cross-sectional studies with self-reported sickness absence were excluded. RESULTS: Seventeen primary studies were included in the review, sixteen originated from the Nordic countries and fifteen included registry data on sickness absence. All but one study found that exposure to workplace bullying was associated with increased risk of sickness absence. A meta-analysis of ten independent studies showed that exposure to bullying increased the risk of sickness absence (odds ratio 1.58, 95% CI 1.39-1.79). Five studies included variables that moderated the association between bullying and absenteeism. None of the studies included mediating variables. No studies examined sickness absence as a risk factor for later exposure to bullying. Following the GRADE guidelines, the evidence for an association between bullying and sickness absence is moderate. CONCLUSIONS: Workplace bullying is a risk factor for sickness absence, but the mechanisms to explain this relationship are not sufficiently described. It is unclear whether sickness absence predicts later exposure to bullying. While, the methodological quality of the reviewed studies was high, the knowledge base is small. There is a need for more research on how and when bullying is related to sickness absence and the possible bidirectional relationships involved.

The new workplace II: protocol for a prospective full-panel registry study of work factors, sickness absence, and exit from working life among Norwegian employees.

BACKGROUND: Previous studies on the effects of work factors on absence and disability retirement have only addressed a limited set of factors and little is known about the mechanisms that govern relationships between work exposures and sickness absence/disability retirement. The main aims of the present project are (1) to examine the impact of a comprehensive set of psychological, social, organizational, and mechanical work factors work factors on sickness absence and disability retirement, and (2) to identify moderating and mediating variables that determine how and when exposures at the workplace are related to sickness absence and disability retirement. METHODS: The study design is prospective and based on longitudinal survey data linked to registry data on sickness absence and disability. Altogether 14,501 respondents have given their permission to the linking of their survey questionnaire data to registry data. The project has been approved by the Regional Committees for Medical and Health Research Ethics and has permission from The Norwegian Data Protection Authority. The questionnaire instruments contain psychometrically validated items and inventories on demographic background factors, work exposures, individual dispositions and attitudes, somatic health, mental distress, well-being, lifestyle factors, and work ability. DISCUSSION: The findings will have relevance for, and benefit working life and the larger society in a number of ways. Firstly, it will lead to a more knowledge about which work factors that contribute to health, sickness absence, and participation in/exit from the labour force. Secondly, a better understanding of which mediators and moderators that modify and govern these relationships. Both are central to the development of laws and regulations and to any political decision on measures to tackle sickness absence and early retirement.

Modern health worries, subjective health complaints, health care utilization, and sick leave in the Norwegian working population.

BACKGROUND: Modern health worries (concerns about aspects of modern life affecting health) heve been associated with subjective health complaints and health care utilization. PURPOSE: The aim of this study was to investigate the association between modern health worries (MHW) and subjective health complaints (SHC), health care utilization, and sick leave related to such complaints in the Norwegian working population. METHODS: A sample of the Norwegian working population (N = 569) answered a questionnaire which included the Subjective Health Complaints Inventory and a Norwegian version of the Modern Health Worries Scale. RESULTS: Ninety-one percent of the participants reported at least one complaint in the past 30 days, and 96 % of the participants reported concerns for at least one of the items in the MHW scale. Women reported significantly more and more severe complaints compared to men and significantly more concern about aspects of modern life affecting health. Participants who reported a high level of MHW showed nearly twice the risk of reporting a high level of SHC (odds ratio (OR) = 1.83; 95 % confidence interval (CI) = 1.30-2.71; p = 0.001), and they showed twice the risk for self-certified sick leave related to SHC (OR = 2.04; 95 % CI = 1.01-3.92; p = 0.048). High levels of MHW showed no significant association with health care utilization or doctor-certified sick leave. CONCLUSIONS: Subjective health complaints and concerns about aspects of modern life affecting health are very common, even among healthy workers. Women have more complaints and more concerns compared to men. Within the health care system, it may be advantageous to pay close attention to the association between high levels of MHW and high levels of SHC.