Workplace bullying and risk of suicide and suicide attempts: A register-based prospective cohort study of 98 330 participants in Denmark.

OBJECTIVES: The aim of this study was to analyze whether individuals reporting exposure to workplace bullying had a higher risk of suicidal behavior, including both suicide attempt and death by suicide, than those not reporting such exposure. METHODS: Using a prospective cohort study design, we linked data from nine Danish questionnaire-based surveys (2004-2014) to national registers up to 31 December 2016. Exposure to workplace bullying was measured by a single item. Suicide attempts were identified in hospital registers and death by suicide in the Cause of Death Register. Among participants with no previous suicide attempts, we estimated hazard ratios (HR) and 95% confidence intervals (CI), adjusting for sex, age, marital status, socioeconomic status, and history of psychiatric morbidity. RESULTS: The sample consisted of 98 330 participants (713 798 person-years), 63.6% were women, and the mean age was 44.5 years. Of these participants, 10 259 (10.4%) reported workplace bullying. During a mean follow-up of 7.3 years, we observed 184 cases of suicidal behavior, including 145 suicide attempts, 35 deaths by suicide and 4 cases that died by suicide after surviving a suicide attempt. The fully-adjusted HR for the association between workplace bullying and suicidal behavior was 1.65 (95% CI 1.06-2.58). The HR for suicide attempts and death by suicide were 1.65 (1.09-2.50) and 2.08 (0.82-5.27), respectively. Analyses stratified by sex showed a statistically significant association between workplace bullying and suicidal behavior among men but not women. CONCLUSIONS: The results suggest that exposure to workplace bullying is associated with an elevated risk of suicidal behavior among men.

Depressive Symptoms Following Work-Related Violence and Threats and the Modifying Effect of Organizational Justice, Social Support, and Safety Perceptions.

Work-related threats and violence is a major occupational hazard and the consequences for victims may be a range of physical and psychological symptoms. The purpose of this study was to examine the associations between exposure to work-related violence and threats and subsequent risk for depression and to examine whether the associations were modified by social support, organizational justice and safety perceptions. Questionnaire data was collected in 2010, 2011 and in 2015. A total of 5,342 employees from special schools, psychiatric wards, eldercare and the Prison and Probation Services (PPS) participated in the first round in 2010. The analysis was performed by multivariate logistic regression. Staff exposed for work-related threats and violence had an increased risk for depression compared to non-exposed staff. The risk was highest for staff working in PPS. Compared to low levels, there were a tendency for high levels of social support, organizational justice and safety perception to attenuate the associations between work-related threats and violence and depression. However, none of the differences were statistically significant. Many employees working in human service sectors are exposed to work-related threats and violence which increases the risk for depression. The risk for depression following work-related threats and violence may be modified by social support, organizational justice and the perception of safety workplace. It is recommended that workplaces adopt an integrated organizational approach including both prevention of work-related threats and violence and intervention to modify the health consequences of work-related threats and violence.

Labour market affiliation among non-bullied colleagues at work units with reported bullying.

AIM: This study investigates if non-bullied employees in Work units (WUs) where bullying occur, are more prone to leave the WUs than employees in WUs with no bullying, and if the prevalence of workplace bullying had an impact on leaving the WUs. Leaving the workplace was defined by unemployment or change of workplace at follow-up. METHODS: We had data from 8326 Danish public health invited employees from 302 WUs. Of these 3036 responded to a questionnaire on working conditions and health in 2007. WUs were classified into three categories of WUs: (1) no bullying (0% bullied), (2) moderate prevalence of bullying (< 10% bullied), and (3) high prevalence of bullying (≥ 10% bullied). Bullied respondents were used to classify the WUs and excluded in the analyses. RESULTS: We found odds ratios (ORs) for unemployment 1 year later of 1.27 [95% CI 0.69-2.37] in WUs with moderate prevalence of bullying and 1.38 [95% CI 0.85-2.23] among employed in WUs with high prevalence of bullying, adjusted for size of WUs, age, sex, and job category. For turnover 1 year later the ORs were 1.27 [95% CI 0.78-2.15] and 1.46 [95% CI 0.99-2.15] in WUs with moderate and high prevalence of bullying, respectively. CONCLUSION: We did not find that non-bullied employees leave the WUs with moderate and high prevalence of bullying more than employees in WUs with no bullying behaviour 1 year later. Leaving the workplace tended to be higher among employees in WUs with high prevalence of bullying compared to no and moderate bullying.

The Demand-Control model and work-related threats and violence: Short- and long-term associations.

BACKGROUND: Work-related violence and threats are frequent in human service sectors. Although previous studies have identified several psycho-social work environmental risk factors for work-related violence and threats, the research domain still remains mainly descriptive and non-theoretical in nature. OBJECTIVE: Using the Job-Demands-Control model we analysed the relationship between the psycho-social work environment and work-related threats and violence. METHOD: Using a two-wave (2011 and 2015) longitudinal study of 2678 participants, we analysed the main and interactive effects of quantitative demands and job control on exposure to work-related violence and threats. RESULTS: High work demands and low job-control were associated with elevated risk of work-related threats in 2011 and in 2015. The associations of work demands and job control and work-related violence were mixed. There were not statistically significant interaction effects between high demands and low job control on neither work-related violence nor threats. CONCLUSION: In sectors where work-related threats and violence are likely to occur, risk prevention may also require improving the work conditions for employees, more specifically by reducing work-demands and increasing job control for instance by differentiating between important and less important work demands and by implementing self-autonomous work-teams may be a way to increase job control.

A longitudinal study of the possible escalation of aggressive behaviors - from bullying and conflicts to workplace violence. Is emotional exhaustion a mediator?

BACKGROUND: Aggression theories and cross-sectional studies imply an escalatory pattern of aggressive behaviors; however, this has not been investigated in a follow-up study. OBJECTIVE: To investigate whether bullying or conflicts are antecedents of threats and physical violence, and whether threats mediate the relationship between bullying or conflicts and violence. Lastly, it was explored whether associations could be explained through the effect of emotional exhaustion. METHODS: Survey data was collected from a follow-up sample of 3,584 employees from four human service sectors, namely psychiatry, special schools, eldercare, and the prison and probation services. The main analysis uses hierarchical logistic regression. RESULTS: The analyses showed that frequent /intense conflicts, not bullying, at baseline were significantly related to higher exposure rates of threats (OR = 4.98, CI = [3.19-7.76]) and violence (OR = 3.01, CI = [1.96-4.76]) at follow-up. Emotional exhaustion was not confirmed as a substantial mediator. However, the proportion mediated by threats was significant (70%) for the relationship between frequent /intense conflicts and violence. CONCLUSION: This study finds that aggressive workplace behaviors may indeed escalate, particularly within a similar victim-perpetrator relationship, such as between employees and clients. The study highlights the need for de-escalation techniques that transcend specific encounters, recognizing that aggressive behavior may escalate over time.

Employees exposed to work-related threats and violence in human services sectors: Are any employees members particularly exposed to violence and threats and what role do supervisors play?

BACKGROUND: The frequency of being exposed to work-related violence and threats is high in employees working in the human service sector. The question is whether certain employees are particularly exposed to violence and threats than others. OBJECTIVE: This study examined whether particular employees were especially exposed to work-related violence and threats due to personal characteristics, coping styles, attitudes or participating in violence prevention training. We also examined the role played by supervisors. METHODS: Questionnaire data were collected in 2010 and 2011. In all, 3584 employees from special schools, psychiatric wards, eldercare and the Prison and Probation Service participated. We used multivariate logistic regression analyses. RESULTS: We found persons high on the extroversion and introversion scales were associated with statistical significant increased risk for work-related threats. Furthermore, accepting attitudes concerning work-related violence were also statistical significant associated with increased the risk for both work-related threats and violence. Associations between coping styles and work-related threats and violence were very small and statistically non-significant and we found no effect of violence prevention training. The risk for work-related threats for persons high on the extroversion scale was decreased if supervisor violence prevention behaviour was high. Furthermore, if supervisor prevention behaviour was high, prevention training decreased the risk for work-related violence. However, these associations weren't statistically significant. CONCLUSION: The results stress that effective prevention requires involvement of both employees and supervisors.

Does leadership support buffer the effect of workplace bullying on the risk of disability pensioning? An analysis of register-based outcomes using pooled survey data from 24,538 employees.

PURPOSE: To investigate whether self-reported exposure to workplace bullying predicts the risk of disability pensioning among employees in two occupational groups-(1) employees working with clients or customers and (2) office workers and manual workers-and whether leadership support and occupational group moderates that association. METHODS: Survey data from 24,538 employees (112,889 person years) were fitted to a national register containing information on disability-pension payments. Using multi-adjusted Cox-regression analysis, observations were followed in the register to assess the risk of disability pensioning. The average follow-up time was 4.6 years (standard deviation [SD] = 1.5). RESULTS: Self-reported exposure to workplace bullying predicted an increased risk of disability pensioning (hazard ratio [HR] = 1.46; 95% confidence interval [CI]: 1.15-1.86). This association was moderated by leadership support: the association between workplace bullying and disability pensioning was significantly different for respondents who reported low leadership support (HR = 1.97; 95% CI: 1.38-2.80) compared to respondents who reported medium (HR = 1.03; 95% CI: 0.60-1.76) or high leadership support (HR = 1.08; 95% CI: 0.60-1.95). Further analyses showed similar associations between workplace bullying and the risk of disability pensioning among the two occupational groups. CONCLUSIONS: Self-reported workplace bullying increases the risk of disability pensioning, and this association is buffered by leadership support. Workplace bullying should be considered an important workplace stressor. This study indicates that workplaces may enhance worker retention by actively promoting measures to eliminate the occurrence of workplace bullying and to enhance leadership support.

Work-related threats and violence and post-traumatic symptoms in four high-risk occupations: short- and long-term symptoms.

OBJECTIVES: To examine the associations between exposure to work-related violence and threats and subsequent PTSD among males and females in four high-risk occupations in human service work. Furthermore, we examined the modifying effect of coping style and self-efficacy. METHODS: Questionnaire data were collected in 2011 and in 2015 from 2678 employees working in psychiatric wards, in the elder sector, in special schools and in the Prison and Probation Service (PPS). Exposure to work-related violence and threats was measured in 2011, while PTSD was measured in 2011 and 2015 by the Impact of Event Scale-Revised. To assess the associations, logistic regression was conducted, adjusted for bullying, sexual harassment, negative acts, conflicts at work, other private traumas and baseline PTSD. RESULTS: There was an association between work-related threats and PTSD in 2011 and 2015. Furthermore, there was an association between work-related violence and PTSD in 2011. The associations were strongest in the PPS. Male staff had a higher risk for PTSD. Neither coping style nor self-efficacy did modify the associations between exposure to work-related violence and threats and subsequent PTSD. CONCLUSION: The prevention of PTSD following work-related violence and threats should first of all be based on reducing the risk of work-related violence. In addition, supervisors should be trained to detect symptoms of PTSD after exposure to traumatic events.

Impact of workplace bullying on missed nursing care and quality of care in the eldercare sector.

PURPOSE: To analyze the long-term impact of bullying among healthcare providers (T1) on missed nursing care and quality of care 2 years later (T2) and to test the potential mediating effect of affective organizational commitment. METHODS: Survey data from healthcare providers in the eldercare sector in 2006 (T1) and 2008 (T2). At T1, 9212 employees participated in the survey and 5202 participated in both T1 and T2. Including only participants who were directly engaged in the provision of care yielded 4000 providers, who were employed in 268 workgroups at T1 and T2. Associations between exposure to bullying (predictor) and the two outcomes (missed nursing care and quality of care) were investigated using multi-level linear regression analysis. Included covariates were age, gender, job position, work place and tenure. RESULTS: We found a significant association between workplace bullying at T1 and missed nursing care at T2 but not for quality of care at T2. Affective organizational commitment did not mediate the association between bullying and the two outcomes. However, affective organizational commitment at T1 was associated with quality of care at T2. CONCLUSION: Exposure to bullying at work may cause the provider to miss nursing care for clients. To improve, care administrators should consider implementing bullying prevention strategies at three levels: organizational, work group and individual.

Leadership and post-traumatic stress disorder: are soldiers' perceptions of organizational justice during deployment protective?

Background: Soldiers' perception of leadership during military deployment has gained research attention as a potentially modifiable factor to buffer against the development of postdeployment post-traumatic stress disorder (PTSD). Within nonmilitary research, the organizational justice (OJ) framework, i.e. distributive justice, procedural justice (PJ) and interactional justice (IJ), has been found to relate to mental health outcomes. Aspects of OJ may, therefore, be protective against PTSD. Objectives: We examined the prospective relationship between aspects of OJ, namely the perceptions of PJ and IJ by subordinate soldiers without leadership obligations in relationship to immediate superiors and PTSD. Method: Participants were soldiers (n = 245) deployed to Helmand Province in Afghanistan in 2009. Logistic regression procedures were used. The primary analysis measured PTSD cases using the Structured Clinical Interview for DSM-IV-TR Axis-I Disorder (SCID) 2½ years after homecoming. PJ/IJ was measured during deployment with a 6-item composite measure ranging from 0 to 12. Supplementary primary analyses were performed with PJ/IJ measured before and immediately after deployment. A secondary PJ/IJ analysis also tested against four postdeployment measures with the Post-Traumatic Stress Disorder Checklist Civilian (PCL-C) dichotomized at screening symptom levels. Results: Higher levels of perceived PJ/IJ for soldiers without leadership obligations during deployment had a prospective relation (OR = 0.86, 95% CI = 0.75-0.98) with PTSD on the SCID 2½ years after homecoming after adjustment for factors including predeployment PTSD symptoms, trauma and combat exposure, and state affectivity. Similar results were found by measuring PJ/IJ before (OR = 0.83, 95% CI = 0.71-0.95) but not immediately after homecoming (OR = 0.97, 95% CI = 0.85-1.11). A relationship with PTSD symptoms at the screening level at the four measurements of PCL-C was found, but only when predeployment PTSD symptoms were not controlled for. Conclusions: These results suggest that PJ/IJ exercised by superiors in relation to military deployments may protect subordinate soldiers against the development of postdeployment PTSD.

Planteamiento: La percepción del liderazgo de los soldados durante un despliegue militar se ha ganado la atención de la investigación como factor potencialmente modificable para amortiguar el desarrollo del trastorno por estrés postraumático (TEPT) después de un despliegue militar. Dentro de la investigación no militar, se ha encontrado que el marco de justicia organizacional (JO) ­es decir, justicia distributiva, justicia procedimental (JP) y justicia interaccional (JI)­ está relacionado con resultados de salud mental. Algunos aspectos de la JO pueden, por lo tanto, proteger contra el TEPT.Objetivos: Examinamos la relación prospectiva entre los aspectos de la JO, es decir, las percepciones de JP y JI de los soldados subordinados sin obligaciones de liderazgo en relación a sus superiores inmediatos y al TEPT. Método: Los participantes fueron soldados (n = 245) desplegados en la provincia de Helmand en Afganistán en 2009. Se usaron procedimientos de regresión logística. El análisis principal midió los casos de TEPT mediante la Entrevista Clínica Estructurada para los trastorno del Eje I del DSM-IV-TR (SCID, por sus siglas en inglés) dos años y medio después del regreso a casa. Se midieron la JP y la JI durante el despliegue con una medida compuesta de seis elementos que van de 0 a 12. Se realizaron análisis primarios adicionales, midiendo la JP y la JI antes e inmediatamente después del despliegue. Un análisis secundario de la JP y la JI también se comparó con cuatro medidas posteriores al despliegue con la Lista de verificación del trastorno por estrés postraumático civil (PCL-C, por sus siglas en inglés) dicotomizada para los niveles de síntomas en la selección.Resultados: Niveles más altos de percepción de JP / JI en soldados sin obligaciones de liderazgo durante el despliegue tuvieron una relación prospectiva (OR = 0.86, 95% -IC = 0.75­0.98) con el TEPT en el SCID 2½ años después del regreso al hogar por factores que incluían síntomas de TEPT previos al despliegue, exposición al trauma y al combate, y afectividad de estado. Se encontraron resultados similares midiendo la JP y la JI antes (OR = 0,83; IC del 95% = 0,71­0,95) pero no inmediatamente después de la vuelta al hogar (OR = 0,97; IC del 95% = 0,85­1,11). Se encontró una relación con los síntomas de TEPT en el nivel de detección en las cuatro medidas del PCL-C, pero solo cuando no se controlaron los síntomas del TEPT antes del despliegue.Conclusiones: Estos resultados sugieren que la JP y la JI ejercidas por los superiores en relación con los despliegues militares puede proteger a los soldados subordinados de desarrollar un TEPT posterior al despliegue.

A cohort study on self-reported role stressors at work and poor sleep: does sense of coherence moderate or mediate the associations?

AIM: The aim of the present study was to examine the bidirectional associations between subjective role ambiguity and role conflicts at work, respectively, and self-reported sleep 2 years later. In addition, we also examine whether sense of coherence (SOC) moderate or mediate the association between role stressors and poor sleep and between poor sleep and role stressors. METHODS: We used questionnaire data collected in 2006 and 2008 from the Workplace Bullying and Harassment cohort. In 2006, 3363 responded to the questionnaire and in 2008 1671 responded. In total, 1569 participants responded in both 2006 and 2008 to the questions on role stressors (in terms of role ambiguity and role conflicts at work) and sleep problems in both 2006 and 2008. Sleep problems were assessed with the awakening index (AWI) and the disturbed sleep index (DSI). Moderation and mediation analyses of the association were estimated using structural equation modelling. RESULTS: We found a prospective association between role stressors and sleep problems [beta values were 0.07 (95% CI 0.03-0.11) and 0.05 (CI 0.01-0.10) for DSI and AWI, respectively] when adjusting for sleep problems at baseline, age, sex, and life style factors (i.e. alcohol, smoking, and leisure time physical activity). SOC moderated the association showing that participants with lower SOC scores who reported higher role ambiguity reported sleep problems to a higher extent than participants with high SOC scores. SOC also mediated the association between role stressors and sleep problems. We also found support for sleep problems at baseline and role stressors 2 years later [DSI 0.04 (CI 0.00-0.08) and 0.15 (CI 0.09-0.21)] for role ambiguity and role conflicts, respectively. Similar results were observed for AWI. CONCLUSION: Subjective role stressors were prospectively associated with sleep problems. Yet, sleep problems could also prospectively predict subjective role stressors (i.e. reverse causation). The analyses also showed that SOC may be regarded as both a mediating and a moderating factor of the association between subjective role conflicts and poor sleep. We found that SOC moderated the prospective association so participants with low SOC report more sleep problems with subjective role conflicts compared to participants with high SOC. Finally, we also found SOC mediated the prospective association between subjective role stressors and sleep problems and the reverse association.

Work-related threats and violence in human service sectors: The importance of the psycho-social work environment examined in a multilevel prospective study.

BACKGROUND: Threats and violence at work are major concerns for employees in many human service sectors. The prevention of work-related violence is a major challenge for employees and management. OBJECTIVE: The purpose of this study was to identify prospective associations between psycho-social work environment and work-related threats and violence in four high risk human service sectors. METHODS: Questionnaire data was collected from 3011 employees working at psychiatric wards, in the elder sector, in the Prison and Probation Service and at Special Schools. Associations between psycho-social work environment and work-related violence and threats were then studied using a one-year follow-up design and multilevel logistic regression analyses. RESULTS: The analyses showed that quantitative demands, high emotional demands, low level of influence over own work-situation, low predictability, low rewards at work, low role clarity, many role conflicts, many work-family conflicts and low organizational justice had statistically significant associations with high levels of work-related threats. Furthermore, high emotional demands, low predictability, low role clarity, many role conflicts, many work-family conflicts, low supervisor quality and low support from nearest supervisor had statistically significant associations with high levels of work-related violence. Finally, across the four sectors both similar and different associations between psycho-social work environment and work-related violence and threats were found. CONCLUSION: The results of the study underline the importance of including the psycho-social work environment as a supplement to existing violence prevention methods and interventions aimed at reducing work-related violence and threats.

Do frequent exposures to threats and violence at work affect later workforce participation?

PURPOSE: Threats and violence at work are common problems in the human service sector. It can result in physical and psychological health symptoms. The aim of this study was to examine the association between exposure to threats and violence and workforce participation in four human service sectors. METHODS: 5170 employees answered questionnaires about threats and violence in 2010 and were followed in a register for public transfer incomes for 3.5 years to identify episodes of sick leave, general workforce participation, and permanent health-related benefits. RESULTS: We found associations between exposures to threats and violence at work and workforce participation, though only a few specific types of threats and violence were associated on their own. Self-rated severity of both threatening and violent episodes was associated with overall low workforce participation, new sick leave episodes, and permanent health-related benefits. However, the latter was not statistically significant. The same pattern seems to be present in the relation between the total amount of exposure to threats and violence (threats score and violence score), respectively, and overall low workforce participation and new sick leave episodes. The threats score was also related to permanent health-related benefits. CONCLUSION: Exposure to threats and violence is associated with temporary and permanent health-related benefits as well as with low workforce participation in general, although some of the associations were not statistically significant.

Optimal Cut-Off Points for the Short-Negative Act Questionnaire and Their Association with Depressive Symptoms and Diagnosis of Depression.

Objectives: The behavioural experience method has been extensively used in the literature for the measurement of potential bullying behaviours at work. However, this approach presents limitations when used to classify respondents as targets or non-targets of workplace bullying. Therefore, the present study aimed to: (i) identify optimal cut-off points, reflecting a possible subjectively experienced exposure to occasional and frequent workplace bullying, for the 9-item Short Negative Act Questionnaire (S-NAQ), and (ii) examine the criterion validity of these cut-off points in relation to depressive symptoms and diagnosis of depression. Methods: The study was based on a sample of 4882 participants from the Danish MODENA cohort study (year 2011), which included both the S-NAQ (score range 9-45) and a one-item measure applying the self-labelling method with a definition to assess occasional and frequent workplace bullying. We employed receiver operating characteristic (ROC) curve analyses to derive the cut-off points for the S-NAQ. Based on these cut-off points, we created a new S-NAQ variable with three levels of exposure (i.e. 'not exposed', 'first threshold', and 'second threshold') and tested its criterion validity in relation to depressive symptoms (N = 4071) and diagnosis of depression (N = 4844). Results: The S-NAQ cut-off points obtained were ≥12 and ≥16 when using occasional and frequent bullying as reference standards, respectively. Both cut-off points showed high classification accuracy (area under the curve = 0.89 and 0.93) as well as good sensitivity (84.8% and 88.0%) and specificity (77.4% and 94.7%). In the adjusted linear regression analyses, both the first (B = 0.78, 95% confidence interval [CI] = 0.66-0.90) and the second threshold of exposure (B = 1.65, 95% CI = 1.44-1.86) were significantly associated with depressive symptoms. In the adjusted logistic regression analyses, both the first (odds ratio [OR] = 3.55, 95% CI = 1.98-6.38) and the second threshold of exposure (OR = 5.90, 95% CI = 2.93-11.88) were significantly associated with diagnosis of depression. Conclusions: The two cut-off points for the S-NAQ identified in this study showed a significant association with both depressive symptoms and diagnosis of depression. However, future prospective studies are needed to establish the predictive validity of the proposed cut-off points.

Effects of Violence Prevention Behavior on Exposure to Workplace Violence and Threats: A Follow-Up Study.

This longitudinal study investigates the relationship between prevention behaviors, that is, enacted violence prevention policies, and exposure to workplace violence and threats across four different high risk work sectors: psychiatry, special schools, eldercare, and the prison and probation services. Logistic regression analysis of a 1-year follow-up sample of 3.016 employees from these four sectors shows that prevention behaviors are significantly and negatively associated with self-reported exposure to workplace violence and threats-in the prison and probation services, eldercare, and in psychiatry, while no significant associations are found for special schools. The results therefore show clear sector differences with regard to the preventive effect of violence prevention behaviors. Furthermore, this multisector comparison suggests that prevention behaviors are more effective in relation to a moderate frequency of violence and threats, and that only top management prevention behavior can prevent very frequent incidents (odds ratio [ OR] = 0.58). This study contributes to the literature by use of a longitudinal design and acceptable response rates, while also simultaneously investigating several high risk sectors. The results imply that when managing workplace violence in high risk areas of human service work, there should be emphasis on the use of violence prevention behaviors from top management, supervisor, and among coworkers. However, type of sector and the frequency of workplace violence should be analyzed to evaluate the potential impact of prevention behaviors.

Does Workplace Bullying Affect Long-Term Sickness Absence Among Coworkers?

AIM: To examine if non-bullied employees at work units (WUs) with workplace bullying have more long-term sickness absence (LTSA) than employees in non-bullying WUs. METHODS: We included 7229 public health employees from 302 WUs and 3158 responders to a questionnaire on working conditions and health in 2007. WUs were classified into three categories of WUs; (1) no bullying (0% bullied); (2) moderate prevalence of bullying (less than 10% bullied); and (3) high prevalence of bullying (more than or equal to 10% bullied). LTSA (more than or equal to 30 consecutive days of sickness absence) during the following 2 years was obtained by linkage to the Danish register of sickness absence compensation benefits and social transfer payments. RESULTS: Non-bullied coworkers in WUs, where bullying was reported had 15% to 22% more LTSA compared with non-bullying WUs. CONCLUSION: Workplace bullying may be associated with LTSA in the entire WU.

The associations between workplace bullying, salivary cortisol, and long-term sickness absence: a longitudinal study.

BACKGROUND: Workplace stressors, such as bullying, are strongly related to subsequent long-term sickness absence, but little is known of the possible physiological mechanisms linking workplace stressors and sickness absence. The primary aim of this study was to investigate to what extent cortisol levels were associated with subsequent sickness absence and if cortisol mediated the association between workplace bullying and sickness absence. We additionally investigated possible bidirectional associations between bullying, cortisol, and long-term sickness absence. METHODS: Participants came from two Danish cohort studies, the "Psychosocial RIsk factors for Stress and MEntal disease" (PRISME) cohort and the "Workplace Bullying and Harassment" (WBH) cohort (n = 5418). Information about exposure to workplace bullying and morning and evening salivary cortisol was collected at three time points with approximately two years in between. After each data collection, all participants were followed for two years in registers, and cases with long-term sickness absence lasting 30 or more consecutive days were identified. The association between cortisol levels and subsequent sickness absence was assessed by logistic regression, while the extent to which the association between bullying and sickness absence was mediated by cortisol was quantified through natural direct and indirect effects. RESULTS: High evening cortisol was associated with a decreased risk of sickness absence (OR = 0.82, 95% CI = 0.68-0.99), but we did not find that high morning cortisol levels (OR = 0.98, 95% CI = 0.81-1.18) or high morning-to-evening slope (OR = 0.99, 95% CI = 0.82-1.18) were associated with subsequent sickness absence. We also tested for reverse causation and found that long-term sickness absence, but not salivary cortisol, was a strong risk factor for subsequent workplace bullying. There was no indication that cortisol mediated the association between workplace bullying and sickness absence. CONCLUSION: We found no straightforward and simple association between cortisol and long-term sickness absence. Furthermore, the association between workplace bullying and long-term sickness absence was not mediated by cortisol.

Social capital and workplace bullying.

BACKGROUND: Workplace bullying is a serious stressor with devastating short- and long-term consequences. The concept of organizational social capital may provide insights into the interactional and communicative dynamics of the bullying process and opportunities for prevention. OBJECTIVE: This study aimed to explore the association between organizational social capital and being a target or observer of workplace bullying. METHODS: Based on self-reported cross-sectional data from a large representative sample of the Danish working population (n = 10.037), logistic regression analyses were conducted to explore at the individual level the associations between vertical and horizontal organizational social capital with being a target or observer of workplace bullying. RESULTS: In the fully adjusted models, low organizational social capital (vertical and horizontal) was associated with significantly increased odds ratios of both self-labelled (vertical: OR = 3.25; CI = 2.34-4.51; horizontal: OR = 3.17; CI = 2.41-4.18) and observed workplace bullying (vertical: OR = 2.09; CI = 1.70-2.56; horizontal: OR = 1.60; CI = 1.35-1.89), when compared with high organizational social capital. CONCLUSIONS: This study supports that characteristics of the psychosocial work environment are of importance in the development of workplace bullying, and provides focus on the importance of self-reported organizational social capital.

The Role of Psychological Stress Reactions in the Longitudinal Relation Between Workplace Bullying and Turnover.

OBJECTIVES: To investigate the association between workplace bullying and change of job/unemployment, and to investigate whether psychological stress reactions constitute a potential pathway linking workplace bullying and change of job/unemployment. METHODS: We used questionnaire data on workplace bullying and psychological stress reactions and register data on change of job/unemployment. We applied a multiple pathway approach to estimate the proportion of the association between workplace bullying and subsequent change of job/unemployment that was potentially mediated by psychological stress reactions. RESULTS: Workplace bullying was associated with risk of change of job (odds ratio [OR] = 1.35; 95% confidence interval [CI]: 1.06-1.72; 24% potentially mediated by psychological stress reactions) and unemployment (OR = 4.90; 95% CI: 3.18-7.55; 19% potentially mediated by psychological stress reactions). CONCLUSION: Workplace bullying has important consequences for labor market outcomes. Psychological stress reactions may play a vital role in this process.

Burnout among Danish prison personnel: A question of quantitative and emotional demands.

Objectives The objective of this follow-up study was to investigate associations between individual, occupational and work environment factors and burnout among both uniformed and non-uniformed personnel working in the Danish Prison and Probation Service. Methods The participants (N = 4808) with client contact received a questionnaire in 2010 and again in 2011. In 2010, 2843 participants responded to the questionnaire (59.1%), and in 2011, 1741 responded to the questionnaire, yielding a response rate of 61.2% of the baseline population, and 36.2% of the invited population. Burnout and work characteristics were measured with validated scales from the Copenhagen Psychosocial Questionnaire, and data was analysed by logistic regression. Results Risk factors with the highest impact on burnout were work environmental factors: quantitative demands, emotional demands, involvement in and meaning of work. Role conflict, role clarity, social support and demands for hiding emotions had borderline significance. Besides cohabitation, there was no association between individual factors and burnout or between occupational characteristics and burnout. Moreover, there was no association between exposure to threats and violence and burnout. CONCLUSIONS: Efforts for preventing burnout ought to be concentrated on reducing the quantitative job-demands, on easing and improving staff-inmate relationships, but also on involvement in and meaning of work. Most work in prison is invisible and the overall goals are in conflict with each other. Management must provide solutions to problems of role conflict and support groups for social support. There is a risk of burnout among both uniformed personnel and non-uniformed personnel working in both open and closed facilities.