The contribution of the psychosocial work environment to sickness absence in human service workers: Results of a 3-year follow-up study

Abstract

We investigated to what extent psychosocial work characteristics predict sickness absence in a cohort of 890 human service professionals (84% women), followed-up for 3 years. We measured 16 different psychosocial work characteristics at baseline and analysed their associations with number of sickness absence days at follow-up using multivariate Poisson regression. In addition, we computed a psychosocial work environment index, summarizing eight psychosocial scales. Participants with exposure to violence and threats, high emotional demands, high demands for hiding emotions, low influence at work, low meaning of work, low quality of management, and role conflicts had an increased number of sickness absence days at follow-up, after adjustment for numerous confounders. Adjusting for sickness absence history caused little change in most effect estimates. Scoring in the most adverse quartile of the psychosocial work environment index was associated with a 71% increase in sickness absence days. Improving the psychosocial work environment index and eliminating exposure to violence and threats would have prevented 32% of all sickness absence days in the study population. In particular we found that exposure to violence was a strong predictor of absence. This study shows that a wide range of psychosocial work characteristics contribute to sickness absence in human service workers. Improving the psychosocial work environment might help to reduce sickness absence in this population.     

The effect of objective job demands on registered sickness absence spells; do personal,social and job-related resources act as moderators?

Abstract

This study applied Karaseks demand-control model, using sense of coherence (SOC), social support and job control as moderators of effects of job demands on ensuing sickness absence spells in a 3-year follow-up of 856 municipal employees. Among men the results supported the active learning hypothesis. Passive jobs predicted a high number of sickness absence spells and active jobs predicted a low number of spells. for short spells (1-3 days), the demand-control interaction, however, depended on SOC. In active jobs SOC was negatively associated with sickness absence spells; in passive jobs no such association was found. For long spells (3 days), the demand-control interaction depended on occupational level; active jobs were predictive of low absence spells among blue collar men. Among women, the results supported the strain hypothesis. The demand-control interaction, however, depended on household size. In small households, high-strain jobs predicted a high number of spells, while no increase in spells was found in active versus low-strain jobs. In larger households, the number of spells correlated positively with increasing demands even when control was good. The demand-control interaction, however, depended on SOC and spouse support. With strong SOC or spouse support, absence spells in active jobs remained on a relatively low level, otherwise active jobs led to a high number of spells. This suggests that SOC and spouse support may act as protective factors against female role conflicts associated with active jobs     

A systematic literature review of the relationship between work hours and sickness absence

The aim of this study was to determine the relationship between work hours and sickness absence: is a higher number of work hours associated with better or with adverse health? A systematic literature review was performed by searching Medline, PsychInfo, and Web of Science. All abstracts were screened to identify papers that empirically investigated the relationship between work hours and sickness absence in a working population. A total of 1072 papers were identified, and 70 papers were included in this review. A simple measure of the strength of effects was applied, and the findings are summarised in narrative form. Evidence supporting a relationship between sickness absence and working part-time or work hours as a continuous variable was inconclusive. These inconclusive findings might be due to heterogeneity in the operationalisation of key variables or to publication bias. Support for a negative relationship between long work hours and sickness absence was moderately strong. Possible explanations for this include the healthy worker selection effect, differences in job characteristics, and differences in job motivation. Empirical testing of these explanations, however, has been limited. Our findings indicate that employers should monitor employee health in times of high work pressure, even if sickness absence is low.     

Impact of the psychosocial work environment on registered absence from work: A two-year longitudinal study using the IPAW cohort

During the Intervention Project on Absence and Well-being (IPAW), a 5-year project conducted in Denmark, we investigated psychosocial work environment factors as independent predictors of the number of absence days per year. The present two-year longitudinal study used the IPAW cohort, but was not intended to study intervention effects, which will be reported later. Data were derived from baseline questionnaires and employers’ registers of absence for 1919 participants (1305 women, 614 men, mainly in low-skilled jobs) in different occupations from 52 workplaces. These workplaces included municipal care, municipal technical services and a large pharmaceutical company. Analyses were performed by Poisson regression accounting for over-dispersion. After controlling for age, family type, health behaviours and physical work environment variables, we found that high levels of decision authority predicted low absence rates in both women and men. We tested two new psychosocial constructs developed for this study: Predictability (relating to being informed on future events at work) and Meaning of Work (relating to how meaningful and useful the work is perceived to be). Higher Predictability was a significant predictor of lower absence rates in men. This study adds to the body of evidence that the psychosocial working environment influences absence and should therefore be considered to be an important target for intervention.     

Impact of the psychosocial work environment on registered absence from work: A two-year longitudinal study using the IPAW cohort

During the Intervention Project on Absence and Well-being (IPAW), a 5-year project conducted in Denmark, we investigated psychosocial work environment factors as independent predictors of the number of absence days per year. The present two-year longitudinal study used the IPAW cohort, but was not intended to study intervention effects, which will be reported later. Data were derived from baseline questionnaires and employers' registers of absence for 1919 participants (1305 women, 614 men, mainly in low-skilled jobs) in different occupations from 52 workplaces. These workplaces included municipal care, municipal technical services and a large pharmaceutical company. Analyses were performed by Poisson regression accounting for over-dispersion. After controlling for age, family type, health behaviours and physical work environment variables, we found that high levels of decision authority predicted low absence rates in both women and men. We tested two new psychosocial constructs developed for this study: Predictability (relating to being informed on future events at work) and Meaning of Work (relating to how meaningful and useful the work is perceived to be). Higher Predictability was a significant predictor of lower absence rates in men. This study adds to the body of evidence that the psychosocial working environment influences absence and should therefore be considered to be an important target for intervention.     

Determinants of the Annual Duration of Sickness Presenteeism: Empirical Evidence from European Data

Sickness presenteeism, i.e. going to work while sick, can cause substantial productivity losses. Focusing on work‐related characteristics, we investigate the determinants of the annual duration of sickness presenteeism using representative European cross‐sectional data. We find work autonomy, workload, tenure, and the work environment to be the quantitatively most relevant determinants of sickness presenteeism days. Work autonomy (control over one's work, being supervisor), workload (weekly working hours, time pressure), and tenure are positively related to the number of sickness presenteeism days. In contrast, a good work environment (good working conditions and social support) comes along with fewer presenteeism days.     

Psychosocial work environment and mental health among travelling salespeople

Travelling salespeople have a rather unusual working environment, with long periods of absence from their firm and a low level of social contacts with colleagues. Furthermore, they are exposed to high demands in their work, which may conflict with a normal family life. In this paper a cross-sectional study of psychosocial work environment and mental health of Danish travelling salespeople is described. A sample of 1,306 travelling salespeople filled in a questionnaire (response rate 68%). The results indicate that poor mental health is associated with a number of demand indicators: number of working hours per week, number of customers per week, non-day work, and a high level of perceived job demands. On the other hand, the number of hours spent with customers per week is positively associated with mental health. The authors did not find the expected associations between poor mental health and several factors such as number of hours away from firm, nights away from home, and a low degree of perceived support from colleagues and superiors. It is concluded that the main stressors of travelling salespeople are long working hours, many customers, non-day work and high perceived psychological demands in general.     

Psychosocial work environment and mental health among travelling salespeople

Travelling salespeople have a rather unusual working environment, with long periods of absence from their firm and a low level of social contacts with colleagues. Furthermore, they are exposed to high demands in their work, which may conflict with a normal family life. In this paper a cross-sectional study of psychosocial work environment and mental health of Danish travelling salespeople is described. A sample of 1,306 travelling salespeople filled in a questionnaire (response rate 68%). The results indicate that poor mental health is associated with a number of demand indicators: number of working hours per week, number of customers per week, non-day work, and a high level of perceived job demands. On the other hand, the number of hours spent with customers per week is positively associated with mental health. The authors did not find the expected associations between poor mental health and several factors such as number of hours away from firm, nights away from home, and a low degree of perceived support from colleagues and superiors. It is concluded that the main stressors of travelling salespeople are long working hours, many customers, non-day work and high perceived psychological demands in general.     

Risk factors for neck and back pain in a working population in Sweden

The relationship between lifestyle, ergonomie and psychosocial workplace factors and musculo-skeletal pain was examined in this cross-sectional study. A total of 22180 employees undergoing screening examinations at their occupational health-care service filled in a series of questionnaires concerning their health, lifestyle and working situation. Of these 31% reported having had neck pain and 18% had seen a health professional for such pain during the previous year. Similarly, 39% reported having had back pain and 16% had seen a professional during the year. Odds ratios were calculated to estimate the relative risk of the various exposure factors. Although not eating regularly and smoking increased the risk for both neck and back pain somewhat, not exercising and consuming alcohol did not increase the risk for these musculoskeletal pains. Lifting, monotonous work tasks, vibration and uncomfortable work postures were the most important ergonomie factors (odds ratios from 1.01 to 2.95). Sitting, however, did not increase the risk for either neck or back pain. A 'poor' psychosocial work environment, as compared to a 'good' one, increased the risk for both neck and back pain (odds ratios from 1.62 to 3.01). Work content and social support were of particular relevance. Finally, a combination of a 'poor' psychosocial work environment and exposure to one of the ergonomic variables produced the highest risk factors (odds ratios from 2.42 to 3.61). Although the conclusions that may be drawn are limited by the cross-sectional nature of this study, the results seem to underscore the complex aetiology of musculoskeletal pain and especially the importance of psychosocial variables. Prevention programmes should therefore be broad-based and include psychosocial as well as ergonomic measures.     

Childcare involvement, job characteristics, gender and work attitudes as predictors of emotional exhaustion and sickness absence

Reports in the literature vary regarding the existence of gender differences in relation to burnout and sickness absence. To investigate this, the present study was aimed at investigating the role of several gender-relevant variables, particularly childcare obligations, job characteristics, and work attitudes in emotional exhaustion and sickness absence in 404 male and female nurses in an institution for people with learning difficulties. Questionnaires were administered reflecting demographic and job characteristics, work and non-work attitudes, and emotional exhaustion (as measured by the Emotional Exhaustion Scale of the Maslach Burnout Inventory). Female nurses were expected to report higher levels of emotional exhaustion and to be absent through sickness more often than men. Also, childcare investment, job characteristics, and (non) work attitudes were expected—via emotional exhaustion—to predict gender differences in sickness absence. It was found that women did not have higher sickness absence rates, and although a gender difference appeared in emotional exhaustion it was in the opposite direction from that predicted. For both genders, emotional exhaustion had a significant positive effect on sickness absence, and especially childcare investment and number of work hours appeared to contribute to both outcomes. These results are of interest because, despite current stereotypes, sickness absence was not higher in women, and neither were women more at risk for emotional exhaustion. In particular, load—workload as well as care load—appeared to predict emotional exhaustion and thus sickness absence.     

Work and other factors influencing coronary health and sickness absence

Two major problems encountered in studies of the impact of work on health are the determination of which diseases and health states may be affected, and the separation of work from other factors affecting health. The greatest burden of ill-health may be due to the psychosocial work environment, rather than exposure to traditionally studied environmental agents. A common concern is with coronary heart disease (CHD). The author and his colleagues have been studying CHD, mental health and sickness absence, this last as a measure which combines social, psychological and physical functioning. Two longitudinal studies were conducted on civil servants, with the major aim of investigating the effect on health of occupational and other socioeconomic influences on white-collar workers. It was found that the lowest risk of CHD was in administrators, and the highest risk in the lower socioeconomic groups. Type A behaviour was higher in higher grades of worker. Lower-grade workers had less healthy lifestyle habits. It may not be possible to separate the effect of work from other influences on an individual, and it could be that the point of intervention should be not the individual but the environment.     

The Intervention Project on Absence and Well-being (IPAW): Design and results from the baseline of a 5-year study

This paper presents the background, design and baseline results of the Intervention Project on Absence and Well-being (IPAW). IPAW is a 5-year psychosocial work environment intervention study including 22 intervention and 30 control work-sites from three different types of work-site (a large pharmaceutical company, municipal technical services, and municipal nursing homes) in Copenhagen, Denmark. The baseline survey reported in this paper was conducted in 1996-97, and the cohort was followed until 2002. Interventions took place during 1996-98 at the organizational and interpersonal level and focused on psychological demands, social support, control, meaning of work, and predictability. The main end-points are self-rated health, perceived stress, absence from work, job satisfaction, and labour turnover. Analyses of the baseline data show good reliability of the psychosocial scales and a number of clear associations between psychosocial work environment factors and health indicators. The baseline data also demonstrate several discrepancies between the planned design of the study and the actual implementation of the project in practice.     

Relationships between bullying, psychosocial work environment and individual stress reactions

It is frequently assumed that a poor psychosocial working environment will create conditions that encourage bullying. However, few studies have examined this assumption while comparing work environment ratings of bullied and non-bullied employees who work in the same organization and/or department. The objectives of this study were therefore, first, to investigate relationships between bullying and other psychosocial work environment factors within a particular organizational setting and, second, to investigate if bullied employees reported higher levels of stress than non-bullied employees. A total of 186 blue-collar employees from a Danish manufacturing company participated in the study (response rate of 93%). Results showed significant differences in bullied and non-bullied employees' ratings of psychosocial factors such as job control, management style, role clarity, social climate, social contact and work centrality. In order to investigate assumptions that a poor psychosocial work environment creates conditions that encourage bullying, a number of analyses compared the company's manufacturing departments with either high, medium or low levels of bullying. Results showed significant departmental differences. Yet, when bullied employees were removed from the statistical analyses, with regard to the perceived psychosocial environment these same departments could be differentiated only on the basis of rated job demands and management style. The results therefore bring into question the assumption that a generally poor work environment contributes to bullying. None the less, they do suggest that management style may directly or indirectly have contributed to a higher level of bullying. Also, bullied employees reported significantly more symptoms of psychological stress and mental fatigue than non-bullied employees.     

Relationships between bullying,psychosocial work environment and individual stress reactions

It is frequently assumed that a poor psychosocial working environment will create conditions that encourage bullying. However, few studies have examined this assumption while comparing work environment ratings of bullied and non-bullied employees who work in the same organization and/or department. The objectives of this study were therefore, first, to investigate relationships between bullying and other psychosocial work environment factors within a particular organizational setting and, second, to investigate if bullied employees reported higher levels of stress than non-bullied employees. A total of 186 blue-collar employees from a Danish manufacturing company participated in the study (response rate of 93%). Results showed significant differences in bullied and non-bullied employees’ ratings of psychosocial factors such as job control, management style, role clarity, social climate, social contact and work centrality. In order to investigate assumptions that a poor psychosocial work environment creates conditions that encourage bullying, a number of analyses compared the company's manufacturing departments with either high, medium or low levels of bullying. Results showed significant departmental differences. Yet, when bullied employees were removed from the statistical analyses, with regard to the perceived psychosocial environment these same departments could be differentiated only on the basis of rated job demands and management style. The results therefore bring into question the assumption that a generally poor work environment contributes to bullying. None the less, they do suggest that management style may directly or indirectly have contributed to a higher level of bullying. Also, bullied employees reported significantly more symptoms of psychological stress and mental fatigue than non-bullied employees.     

Does change process healthiness reduce the negative effects of organizational change on the psychosocial work environment?

Abstract

This study aimed to investigate whether the detrimental effects of organizational change on the psychosocial work environment are reduced by the “healthiness” of change processes. This includes the management's awareness that the change may be experienced differently by various individuals and groups (diversity); availability of the manager during the process; the degree to which conflicts are resolved constructively; and the degree to which the new roles to be taken on are clarified. Two studies are presented. Using a randomized sample of the Norwegian working population (N = 2389), the first study showed that there were both direct and indirect positive relationships between organizational change and stress, with job demands (but not control and support) as a mediator. In the second study a healthy change process index (HCPI) was developed from dimensions of healthy change that had emerged in an earlier qualitative study. Using data from seven Norwegian enterprises undergoing change (N = 561), this study showed that the healthiness of the change process was related negatively to stress and positively to Control and Support, but not to Demands. Overall, these findings support the idea that a healthy process may not reduce the additional demands produced by organizational change. However, a healthy process may still be able to reduce the experience of stress and facilitate coping with stress and associated increased demands through enhancing the psychosocial work environment.     

Reciprocal relationships between psychosocial work characteristics and sleep problems: A two-wave study

Sleep problems are common and impair the health and productivity of employees. Work characteristics constitute one possible cause of sleep problems, and sleeping poorly might influence wellbeing and performance at work. This study examines the reciprocal associations between sleep problems and psychosocial work characteristics. The participants were 1744 full-time employed individuals (56% women; mean age 38 years in 2007) from the Young Finns study who responded to questionnaires on work characteristics (conceptualised by the demand–control model and effort–reward imbalance model) and sleep problems (Jenkins Sleep Scale) in 2007 and 2012. Cross-lagged structural equation models are used to examine the associations. The results show that low control and low rewards at baseline predicted sleep problems. Baseline sleep problems predicted higher effort, higher effort–reward imbalance, and lower reward. Sleep problems also predicted lower odds for belonging to the low (rather than high) job strain group and active jobs group. The association between work characteristics and sleep problems appears to be reciprocal, with a stressful work environment increasing sleep problems, and sleep problems influencing future work characteristics. The results emphasise the importance of interventions aimed at both enhancing sleep quality and reducing psychosocial risks at work.     

Psychosocial safety climate,psychosocial and physical factors in the aetiology of musculoskeletal disorder symptoms and workplace injury compensation claims

Causal agents for workers' compensation claims and physical injury have largely been identified as physical demands. We proposed an integrated theory of physical injury (i.e. musculoskeletal disorder symptoms [MSDs]) and workers' compensation claims, which combined psychosocial and physical mechanisms. A random, population-based sample of 1095 Australian workers completed a telephone interview on two occasions 12 months apart. As expected, the physical mechanism was confirmed; physical demands were related to MSDs, which in turn predicted workers' compensation claims. Further, a novel psychosocial mechanism was confirmed. Psychosocial safety climate (PSC; perceptions about the organisation's climate for psychological health) was a precursor to psychosocial risks (e.g. harassment, violence, bullying and work pressure). In turn, these psychosocial risks were related to emotional exhaustion, MSDs and then workers' compensation claims. Evidence was therefore provided for psychosocial-physical processes in explaining MSDs and workers' compensation for claims for physical injury. Occupational health and safety legislators and policy makers should be aware that, beyond physical demands, factors usually associated with risk for mental stress claims (e.g. harassment, bullying, and violence) may additionally manifest in physical health problems and workers' compensation injury claims. Focusing on modifying the PSC in an organisation, “the cause of the causes”, may be an effective injury prevention and intervention strategy.     

Exploring the Michigan model: The relationship of personality, managerial support and organizational structure with health outcomes in entrants to the healthcare environment

Few studies have examined the role of managerial support in the adaptation of entrants to healthcare. The purpose of this study was to identify the job characteristic and role-related variables that mediate the effects of managerial support and personality on the mental and physical health and sickness absence in two independent groups of new recruits to a healthcare organization. Entrants to a healthcare environment (student nurses) were surveyed 25 weeks after entry. Latent variables represented neuroticism, demand, control, role clarity and affective outcome variables in a simplified version of the Michigan model of work stress (House, 1981). This study used a two-stage approach to structural equation modelling, exploring hypothesized structural models on an initial data set (N=195) prior to confirmation on an independent replication data set (N=239) using multi-sample methods. Finally the confirmed model of choice was evaluated using the combined data (N=434). Emotional distress reported at 6 months was found to be associated with dispositional characteristics of the entrant and indirectly, via job satisfaction, with managerial support from academic and clinical sources. Managerial support from academic and clinical sources had an indirect influence on job satisfaction, but by differing mechanisms involving role clarity and control. The demands perceived by the entrants arose from neuroticism and were independent of any other variable. Emotional distress had its deleterious association with sickness absence via somatic health. This study details a series of mechanisms that will subsequently be tested longitudinally.     

The Violent Incident Form (VIF): A practical instrument for the registration of violent incidents in the health care workplace

The Violent Incident Form (VIF) is a practical instrument that has been developed for the registration of all types of threatening and violent behaviour directed toward staff in health care work environments. The instrument uses a broad definition of violence that encompasses verbal aggression and threats. A 1-page checklist, the VIF, summarizes key aspects of the violent incident, identifying the circumstances, perpetrator, event, and consequences. Results from a 15-week pilot study as well as a follow-up study of the instrument's test-retest reliability are presented. The VIF was then introduced at 47 health care workplaces and used for a period of 12 months. During this period, 684 incidents were recorded by 32 workplaces. Of these, only 147 incidents (21 %) were also filed as official work injury reports. The checklist is based on the principle that all kinds of violent events must be included if an accurate assessment of violence at the workplace is to be made. The VIF is not intended as a replacement for official work injury reports, but as a complement, focusing more specifically on the nature of the violent incident. It is presented here as a research tool for studying violence in today's health care environments. Further work is needed to assess the use of the VIF as a learning tool, and as a possible catalyst for the development of effective violence management programmes.     

Violence in the nursing profession: Occupational and lifestyle risk factors in Swedish nurses

In a national study of the work environment, physical, and mental well-being of more than 2600 Swedish nurses, 30% reported having experienced violence at work. Possible association between violence and a range of occupational, demographic, and lifestyle characteristics were studied. Stepwise multiple linear and logistic regressions were used to further examine risk factors for violence. Occupational factors with significant correlations to workplace violence were nursing discipline (type of ward or facility), years of work experience, supervisory responsibilities, night work, work dissatisfaction, work-related musculoskeletal injury, and frequency of patient handling. Demographic/lifestyle factors related to violence were age, gender, smoking, coffee consumption at work, and use of alcohol to relax after work. The best fit linear regression model explained 17% of the variance in violence, 13%, of the variance in threat of violence. The logistic regression model confirmed an increased risk of violence and threats in psychiatric and geriatric settings. However, much remains unexplained about the aetiology of violencc in health carc settings. This report provides the basis for a pilot intervention study currently in progress.