Investigating Associations Between Physical Activity and Presenteeism - A Scoping Review.

OBJECTIVE: The aim of this study is to scope the literature on what is currently known between physical activity and presenteeism. DATA SOURCE: A search strategy was conducting in six scientific databases. STUDY INCLUSION AND EXCLUSION CRITERIA: Studies written in English about the relation between physical activity and presenteeism were considered for inclusion. DATA EXTRACTION: Data on definitions and measurement of presenteeism and physical activity were extracted. DATA SYNTHESIS: The data is categorized according to the understanding of presenteeism of the studies to give a better idea of how this phenomenon is studied in relation to physical activity. RESULTS: After screening 9773 titles and abstracts and 269 full-text articles, 57 unique articles fulfilled our eligibility criteria. The majority of the articles were published since 2010 and originated predominantly in the United States. Most studies (70%) define presenteeism as lost productivity due to health problems, according to the American line of research, whereas 19% of the studies define it as "working while ill" which refers to the European line of research. The studies that reflected the American school of thought tends to report more results that supported their hypothesis (i.e., that more physical activity is associated with less presenteeism). CONCLUSION: This review has highlighted the homogeneity in how presenteeism is conceptualized and measured in studies included in our sample. Research on physical activity and presenteeism should be expanded across various disciplines in social sciences to respond to the needs that many researchers have expressed to promote healthier organizations.

Psychosocial Risks among Quebec Healthcare Workers during the COVID-19 Pandemic: A Social Media Analysis.

During the COVID-19 pandemic, healthcare workers (HCWs) were at high risk of exposure to the SARS-CoV-2 virus and to work-related psychosocial risks, such as high psychological demands, low social support at work and low recognition. Because these factors are known to be detrimental to health, their detection and mitigation was essential to protect the healthcare workforce during the pandemic, when this study was initiated. Therefore, using Facebook monitoring, this study aims to identify the psychosocial risk factors to which HCWs in Quebec, Canada reported being exposed at work during the first and second pandemic waves. In this study, HCWs mainly refer to nurses, respiratory therapists, beneficiary attendants and technicians (doctors, managers and heads of healthcare establishments were deemed to be less likely to have expressed work-related concerns on the social media platforms explored). A qualitative exploratory research based on passive analysis of Facebook pages from three different unions was conducted. For each Facebook page, automatic data extraction was followed by and completed through manual extraction. Posts and comments were submitted to undergo thematic content analysis allowing main coded themes to emerge based on known theoretical frameworks of the psychosocial work environment. In total, 3796 Facebook posts and comments were analyzed. HCWs reported a variety of psychosocial work exposures, the most recurrent of which were high workload (including high emotional demands), lack of recognition and perceived injustice, followed by low workplace social support and work-life conflicts. Social media monitoring was a useful approach for documenting the psychosocial work environment during the COVID-19 crisis and could be a useful means of identifying potential targets for preventive interventions in future sanitary crises or in a context of major reforms or restructuring.

The health-performance framework of presenteeism: A proof-of-concept study.

There is emerging research that considers presenteeism as a neutral behavior that has both positive and negative predictors and outcomes for individuals and organizations. This neutral perspective diverges from the traditional negative view of presenteeism and is aligned with the Health-Performance Framework of Presenteeism (HFPF) in which presenteeism is considered to be an adaptive behavior that aims to balance health limitations and performance demands. This proof-of-concept study aims to investigate the existence of different profiles of presentees based on their common health problems (mental and physical) and performance, and differences in attendance and job stressors among these subgroups. Latent profile analysis with 159 clerical employees and managers from the UK private sector supported the HPFP and revealed four profiles: those reporting a good health and high performance were labeled functional presentees (who represented 19% of the sample), those with poor health and low performance were the dysfunctional presentees (14%), those with relatively high performance but poor health were labeled overachieving presentees (22%), and those with average scores on both dimensions were the average Joe/Jane presentees (45%; a new profile based on this sample). There was no profile in the present sample that corresponded to therapeutic presenteeism, characterized by low performance but relatively good health. Although average Joe/Jane presentees were comparable to functional presentees in exposure to most job stressors, they reported poorer pay and benefits, and more health problems than the latter. Average Joe/Jane presentees reported the lowest number of days of presenteeism. No difference was found in absenteeism across profiles, highlighting difficulties in measuring presenteeism using a count-measure, since three profiles presented a similar number of days of presenteeism yet contrasted health-performance configurations. Dysfunctional presentees were systematically more exposed to job stressors compared to functional presentees. The results support the HPFP proposition for different subgroups of presentees who are influenced by their work environment. The study takes a person-centered approach, disentangle presenteeism from the total count of presenteeism days, offering implications for management and intervention practice. Presenteeism can have a bright side and be functional in certain contexts when the appropriate resources are available.

Psychological distress and post-traumatic growth in France during the COVID-19 pandemic: A mediation model of psychosocial safety climate as a determinant of work performance.

The psychosocial safety climate (PSC) reflects workers' perceptions of senior management's concern for mental health. Because the COVID-19 pandemic has exacerbated organizational issues, PSC could be a target for interventions attempting to preserve both the psychological health of employees and the economic health of companies. This study examines the direct and indirect relationships between PSC and work performance through two indicators of psychological health, psychological distress and post-traumatic growth, during a health crisis, i.e., prior to the second confinement in France. To this end, 2,004 participants from the French workforce completed a survey in October 2020. The results of mediation analyses indicate that PSC has a direct and positive influence on post-traumatic growth (PTG) and performance, as well as a direct negative influence on psychological distress. PSC also has an indirect positive influence on performance via psychological distress. Organizations that wish to jointly address mental health and performance at work would benefit from optimizing PSC.

Associations between psychosocial stressors at work and moral injury in frontline healthcare workers and leaders facing the COVID-19 pandemic in Quebec, Canada: A cross-sectional study.

Healthcare workers (HCWs) on the frontline of the COVID-19 pandemic exhibit a high prevalence of depression and psychological distress. Moral injury (MI) can lead to such mental health problems. MI occurs when perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations. Since the start of the pandemic, psychosocial stressors at work (PSWs) might have been exacerbated, which might in turn have led to an increased risk of MI in HCWs. However, research into the associations between PSWs and MI is lacking. Considering these stressors are frequent and most of them are modifiable occupational risk factors, they may constitute promising prevention targets. This study aims to evaluate the associations between a set of PSWs and MI in HCWs during the third wave of the COVID-19 pandemic in Quebec, Canada. Furthermore, our study aims to explore potential differences between urban and non-urban regions. The sample of this study consisted of 572 HCWs and leaders from the Quebec province. Prevalence ratios (PR) of MI and their 95% confidence intervals (CI) were modelled using robust Poisson regressions. Several covariates were considered, including age, sex, gender, socio-economic indicators, and lifestyle factors. Results indicated HCWs exposed to PSWs were 2.22-5.58 times more likely to experience MI. Low ethical culture had the strongest association (PR: 5.58, 95% CI: 1.34-23.27), followed by low reward (PR: 4.43, 95% CI: 2.14-9.16) and high emotional demands (PR: 4.32, 95% CI: 1.89-9.88). Identifying predictors of MI could contribute to the reduction of mental health problems and the implementation of targeted interventions in urban and non-urban areas.

Are Organizational Interventions Effective in Protecting Healthcare Worker Mental Health during Epidemics/Pandemics? A Systematic Literature Review.

It is unclear how to effectively protect healthcare workers' mental health during infectious disease epidemics. Targeting the occupational determinants of stress may hold more promise than individual stress management, which has received more focus. Through a systematic review of the 2000-2021 English- and French-language scientific literature, we evaluated the effectiveness of organizational and psychosocial work environment interventions to protect healthcare workers' mental health in an epidemic/pandemic context. Evidence from medium- and high-quality studies was synthesized using GRADE. Among 1604 unique search results, 41 studies were deemed relevant, yielding 34 low-quality and seven medium-quality studies. The latter reported on promising multi-component prevention programs that combined staffing adjustments, work shift arrangements, enhanced infection prevention and control, recognition of workers' efforts, psychological and/or logistic support during lockdowns (e.g., accommodation). Our confidence in the effectiveness of reviewed interventions is low to very low, however, owing to methodological limitations. We highlight gaps in the reporting of intervention process and context elements and discuss theory and implementation failure as possible explanations for results. We conclude by urging authors of future studies to include and document detailed risk assessments of the work environment, involve workers in solution design and implementation and consider how this process can be adapted during an emergency.

Predict, prevent and manage moral injuries in Canadian frontline healthcare workers and leaders facing the COVID-19 pandemic: Protocol of a mixed methods study.

Moral injuries can occur when perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations. The COVID-19 crisis highlighted the fact that psychosocial stressors at work, such as high emotional demands, are placing Canadian healthcare workers at risk of moral injuries. Evidence linking psychosocial stressors at work to moral injuries are needed to better predict, prevent and manage moral injuries, as these stressors are frequent and modifiable occupational risk factors. This protocol presents a study aiming to: 1) understand workplace events having the potential to either cause or reduce moral injuries, 2) predict the risk and severity of moral injuries using a disease prevention model, 3) identify biological signatures (biomarkers) associated with psychosocial stressors at work and moral injuries and 4) elaborate preliminary guidelines of organizational practices for frontline healthcare workers to reduce and manage moral injuries. This study is a mixed methods research with three components: qualitative, quantitative and biological. The data collection has been completed and because of the COVID-19 pandemic, it was adjusted to allow for gathering qualitative and quantitative data remotely. Frontline healthcare workers and leaders were included. Through focus groups and individual interviews, and an online questionnaire, events and psychosocial working conditions that may increase the risk of moral injuries will be documented. In addition, blood samples which were collected from a sub-sample of volunteer participants will measure an innovative set of biomarkers associated with vulnerability to stress and mental health. Data analyses are ongoing. We anticipate to identify workplace events that may trigger moral injuries. We expect that potential predictors of moral injury risk occurrence and severity will be identified from psychosocial stressors at work that can be improved by implementing organizational practices. We also expect to observe a different mental health state and biological inflammation signature across workers exposed compared to workers not exposed to psychosocial stressors at work. Based on these future findings, we intend to develop preliminary recommendations of organizational practices for managers. This research will contribute to expand our knowledge of the events in the workplace likely to generate or lessen the impact moral injuries, to build a model for predicting the risk of moral injuries at work, all in the specific context of the COVID-19 health crisis among healthcare workers.

The Role of Job Control and Job Demands in Becoming Physically Active during the COVID-19 Pandemic: A Three-Wave Longitudinal Study.

Organizational studies suggest that certain psychosocial working conditions are liable to foster positive health outcomes, such as engaging in leisure-time physical activities. However, the psychosocial factors contributing to this improvement remain unexplored, particularly in the workplace and in the context of the decline observed in the physical activity level of the population worldwide. The objective of the study was to examine whether exposure to different combinations of psychosocial working conditions during the COVID-19 pandemic predicts the probability of becoming physically active among Quebec workers. Job demands, job control, and physical activity were assessed three times during the first year of the pandemic via an online questionnaire among physically inactive workers (n = 440). Logistic regression analyses were conducted to examine the associations between various combinations of psychosocial risks and physical activity. A total of 117 participants became physically active during the study. After controlling for covariates, active jobs increased the odds of becoming physically active, compared to high-strain jobs (OR = 2.57 (95% CI 1.13 to 5.87)). Having a highly demanding job may not negatively impact physical activity if workers have enough job control to achieve the required tasks.

Teleworking While Sick: A Three-Wave Study of Psychosocial Safety Climate, Psychological Demands, and Presenteeism.

Introduction: The COVID-19 pandemic has led to a significant increase in the proportion of employees for whom teleworking became mandatory. Presenteeism, or the behavior of working while ill, has hardly been studied in the context of telework. The pandemic forced millions of workers to abruptly transition to working from home for a prolonged period of time, leaving employers often unaware of their health status or work capacity of the workers. This change also eroded the work experience itself, the workplace, and their protective impact on both individual health and work outcomes. This study focused on the longitudinal relationships among psychosocial safety climate (PSC), a lead indicator of workplace conditions, psychological demands, an indicator of quality of work, and presenteeism among a representative sample of teleworkers. PSC was expected to have an indirect impact on presenteeism with psychological demands as a mediator of this impact. Method: We collected the data from a representative sample of teleworkers in the first months (T1: April, T2: June, and T3: December 2020) of the pandemic using a three-wave online survey (n = 275). We tested a model of PSC as a determinant of presenteeism in teleworkers with psychological demands as a mediator. A cross-lagged panel model was estimated to test cross-sectional and longitudinal relationships. Findings: As expected, psychological demands increased over time. Contrary to expectations, the prevalence of presenteeism remained unchanged while PSC increased over time. The data fully supported the mediating effect of psychological demands such that a higher evaluation of PSC at T1 led to lower psychological demands at T2, which led to reduced presenteeism at T3. We also found a reciprocal relationship, with higher psychological demands at T2 leading to decreased evaluation of PSC at T3. These results show that the perception of teleworkers on their organization as giving a high priority to their psychological health is an important determinant of their work experience, ultimately influencing their decision to work while ill. The context of the pandemic has highlighted the importance of a positive workplace climate and working conditions for reducing the behaviors that can be harmful to health and productivity. Implications for theory and practice, beyond the pandemic, are discussed.

Revisiting presenteeism to broaden its conceptualization: A qualitative study.

BACKGROUND: Presenteeism is generally viewed as a symptom of organizational or individual dysfunction and is rarely considered as a behavioral response to positive triggering factors. Our study examines this issue in small enterprises (SEs), which are an unexplored environment in terms of presenteeism. OBJECTIVE: Through in-depth analysis, this study aims to understand the positive and negative factors that impact presenteeism in the context of small and medium enterprises (SMEs), with a particular focus on SEs. METHODS: We adopt a qualitative methodological approach in which we conducted 17 semi-structured interviews with employees and owner-managers of SEs with between 20 and 49 employees. RESULTS: Our thematic analysis shows that presenteeism can be explained by factors related to pressure to attend work, by individuals' constraints and commitment, by organizational and individual characteristics and by a congenial work environment. Presenteeism can also be a type of "therapy" which helps individuals to avoid focusing on being sick and enables them to stay active and avoid social isolation. CONCLUSIONS: Our study differs from earlier research by providing a more in-depth analysis of the positive and negative factors that trigger presenteeism. This article will help to expand the current theoretical knowledge about presenteeism and encourage a more holistic interpretation of the phenomenon.

Presenteeism in small and medium-sized enterprises: Determinants and impacts on health.

BACKGROUND: Small and medium sized enterprises are yet uncharted territory in terms of presenteeism. In addition, the Demand-Control-Support (DCS) and Siegrist's Effort-Reward Imbalance (ERI) models are proposed to predict stress-related health problems, but not for sickness behaviors such as presenteeism. OBJECTIVE: This study aims to examine the relationships between psychosocial risk factors, presenteeism, mental and physical health in the context of small and medium-sized enterprises (SMEs). This study also examines the moderating effect of company size on these associations. METHODS: To test the association between psychosocial risks, presenteeism, and health, only people working in small and medium-sized enterprises (SMEs) of between 2 and 199 employees were included in the sample, giving a total of 2,525 SME employees surveyed. To test the differences in exposure to psychosocial risk and presenteeism, and the moderating impact of size on the relationship between psychosocial risks, presenteeism, and health, we took the original sample (4608) of the EQCOTESST. RESULTS: The results confirm the associations between job demands, social support and effort-reward imbalance, and presenteeism. Also, the associations between presenteeism and health problems in SMEs' context. Multi-group analyses show that the business's size does not moderate the strength of the relationships between psychosocial risks, presenteeism and health. CONCLUSION: The current study highlights that SMEs are somehow protected from certain psychosocial constraints such as high job demands, and low social support, but are more exposed to others such as effort-reward imbalance.

Active meetings on stationary bicycle: An intervention to promote health at work without impairing performance.

Workers who experienced prolonged sitting have higher risk of mortality from all causes compared to non-sedentary workers. However, work can also be a health enhancement opportunity and it also can be designed to improve health and well-being. This research presents a novel intervention designed to reduce sedentary behavior in the workplace. Seven teams of employees (N = 30) conducted two meetings: one in a sitting position and one on a stationary bike. Repeated measures for heart rate, perceptions of stress, well-being, focus, attention and fatigue were collected before, during and after both meetings. Heart rate was significantly higher during active meeting. Results also indicated a significant effect of active meeting on stress. Well-being, focus and attention were similar during both meetings. Fatigue was perceived to be reduced in the hours following the active meeting. This suggests that active meetings can promote health without impairing performance which offers new perspectives for interventions.

Investigating associations between physical activity and presenteeism: a scoping review protocol.

INTRODUCTION: Considering that physical activity plays a key role in the health of workers, a growing number of researchers are studying its relationship with various workplace outcomes, such as presenteeism. Numerous scientists recognise the relevance of further studying this relationship in order to improve our understanding of it. However, studies about the association between physical activity and presenteeism show some discrepancy in the results obtained. Disparity in the way of measuring presenteeism makes it even more challenging to compare results. In addition, it remains difficult to determine the optimal frequency, intensity, duration and type of physical activity to increase the productivity benefits of physical activity. In light of these issues, clarification through a scoping review of the literature on the subject is warranted. METHOD AND ANALYSIS: A search strategy will be conducted in six scientific databases: MEDLINE, CINAHL, PsycINFO, ABI Inform Global, Web of Science and Business Source Premier. A screening process by two independent reviewers will lead to study selection. Quantitative and qualitative studies written in English about the relation between physical activity and presenteeism will be considered for inclusion. Data on the definition and measurement of presenteeism as well as the measurement of physical activity will be extracted. Additional data will be extracted to provide a descriptive overview of studies that have examined the relationship between presenteeism and physical activity. ETHICS AND DISSEMINATION: As this study will be based only on published studies, ethics approval is not required. Through the manner in which the included studies will be presented (categorised by their approach to presenteeism), this scoping review has the potential to improve our understanding of some of the inconsistencies observed in the literature. This review can also identify gaps in the existing evidence base and lead to new avenues of research.

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.

Psychosocial risks, burnout and intention to quit following the introduction of new software at work.

BACKGROUND: Despite a rich literature on association between psychosocial factors, the demand-control-support (DCS) model and burnout, there are few integrated frameworks encompassing the DCS model, burnout and intention to quit, particularly in a technological context. OBJECTIVE: This manuscript examines the relationships between psychosocial risks, the demand-control-support (DCS) model, burnout syndrome and intention to quit following the introduction of new software at work. METHODS: Data was collected from agents and advisors working at a Canadian university and using newstudy management software. An online questionnaire was sent via the university's internal mail. Finally, 112 people completed the online survey for a response rate of 60.9% . RESULTS: The results of structural equation modeling show that psychological demands, decision latitude and social support are associated with burnout. It is also clear that burnout, in particular depersonalization and emotional exhaustion, is positively associated with intention to quit. CONCLUSIONS: The few studies that raise the negative consequences of technology on quality of life in the workplace, and particularly on health, have not succeeded in establishing a direct link between a deterioration of health and the use of technology. This is due to the fact that there are few epidemiological studies on the direct consequences of the use of ITC on health.

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.

Taking Account of Gender Differences When Designing Interventions in Occupational Health? Lessons from a Study of the "Healthy Enterprise" Standard in Québec: Les différences de genre sont-elles prises en compte lors de la conception des interventions de prévention en santé au travail? Résultats d une étude sur la norme "Entreprises en Santé" dans les entreprises au Québec.

The literature shows substantial differences in occupational exposures between men and women, both between and within occupations, but remains very sparse on whether interventions are tailored to gender differences in the workplace. Our objective was to determine whether gender differences are taken into account when designing prevention interventions. This study is part of a project on the evaluation of interventions implemented in the framework of the "Healthy Enterprise" standard in Quebec organizations. Three sets of quantitative and qualitative data were collected in seven organizations and triangulated. Our results show that in the process of elaborating and implementing activities, the main objectives were to reach a maximum number of workers and meet the needs identified in a health and risk diagnosis. Activities were not tailored to the needs of specific subgroups of employees, such as gender or age. Not distinguishing men's and women's situations in this diagnosis may play a role in intervention design. Résumé La littérature montre des différences d'exposition au travail importantes entre les hommes et les femmes, y compris à catégories d'emploi identiques. Les études sur l'adaptation des interventions de prévention aux différences de genre dans les milieux de travail sont quasiment inexistantes dans la littérature. Notre objectif était de déterminer dans quelle mesure les différences de genre sont prises en compte lors de la conception des interventions de prévention. Cette étude fait partie d'un projet d'évaluation des interventions mises en œuvre dans le cadre de la norme «Entreprises en santéé au Québec. Trois séries de données quantitatives et qualitatives ont été collectées auprès de sept organisations et analysées par triangulation. Nos résultats montrent que lors du processus d'élaboration des activités, les principaux objectifs étaient d'atteindre un nombre maximal de travailleurs et de remplir les besoins identifiés dans le diagnostic des risques et de la santé des travailleurs. Le fait que la situation des hommes et des femmes n'ait pas été analysée séparément dans le diagnostic peut avoir joué un râle dans ce résultat. Les activités de prévention n'ont pas été conçues en tenant compte de sous-groupes de travailleurs en fonction du genre ou de l'âge.

Capturing the Active Ingredients of Multicomponent Participatory Organizational Stress Interventions Using an Adapted Study Design.

Adapted study designs use process evaluation to incorporate a measure of intervention exposure and create an artificial control and intervention groups. Taking into account exposure levels to interventions combines process and outcome evaluation and strengthens the design of the study when exposure levels cannot be controlled. This study includes longitudinal data (two assessments) with added process measures at time 2 gathered from three complex participatory intervention projects in Canada in a hospital and a university. Structural equation modelling was used to explore the specific working mechanisms of particular interventions on stress outcomes. Results showed that higher exposure to interventions aiming to modify tasks and working conditions reduced demands and improved social support, but not job control, which in turn, reduced psychological distress. Exposure to interventions aiming to improve relationships was not related to psychosocial risks. Most studies cannot explain how interventions produce their effects on outcomes, especially when there are multiple concurrent interventions delivered in several contexts. This study advances knowledge on process evaluation by using an adapted study design to capture the active ingredients of multicomponent interventions and suggesting some mechanisms by which the interventions produce their effects on stress outcomes. It provides an illustration of how to conduct process evaluation and relate exposure levels to observed outcomes. Copyright © 2016 John Wiley & Sons, Ltd.

The Psychosocial Work Environment, Employee Mental Health and Organizational Interventions: Improving Research and Practice by Taking a Multilevel Approach.

Although there have been several calls for incorporating multiple levels of analysis in employee health and well-being research, studies examining the interplay between individual, workgroup, organizational and broader societal factors in relation to employee mental health outcomes remain an exception rather than the norm. At the same time, organizational intervention research and practice also tends to be limited by a single-level focus, omitting potentially important influences at multiple levels of analysis. The aims of this conceptual paper are to help progress our understanding of work-related determinants of employee mental health by the following: (1) providing a rationale for routine multilevel assessment of the psychosocial work environment; (2) discussing how a multilevel perspective can improve related organizational interventions; and (3) highlighting key theoretical and methodological considerations relevant to these aims. We present five recommendations for future research, relating to using appropriate multilevel research designs, justifying group-level constructs, developing group-level measures, expanding investigations to the organizational level and developing multilevel approaches to intervention design, implementation and evaluation. Copyright © 2014 John Wiley & Sons, Ltd.