Hélène Sultan-Taïeb

Fractions of cardiovascular diseases, mental disorders, and musculoskeletal disorders attributable to job strain

ObjectivesThe aim of this study was to evaluate fractions of diseases attributable to job strain defined using Karasek’s model among the French working population for cardiovascular diseases (CVD), mental disorders, and musculoskeletal disorders (MSD).MethodsJob strain was defined as the combination of high psychological demands and low decision latitude. The prevalence of exposure (Pe) was estimated using the representative national sample of 24,486 employees of the French SUMER survey. Relative risks (RR) were estimated from a literature review (1990–2008) using the same inclusion criteria for the three health outcomes. Pe and RR estimates were used to calculate attributable fractions (AF).ResultsPe estimates were 19.6% for men, 28.2% for women, and 23.2% for men and women combined. The literature review led to a selection of 13 studies for CVD, 7 studies for mental disorders, and 11 studies for MSD. RR estimates were 0.63–2.45 for CVD (morbidity and mortality), 1.2–3.3 for mental disorders, and 0.94–2.3 for MSD. AF estimates for CVD morbidity were 4.9–21.5% for men, 0–15.9% for women, and 6.5–25.2% for men and women combined, for CVD mortality 7.9–21.5% for men, 2.5% for women, and 6.5–25.2% for men and women combined, for mental disorders 10.2–31.1% for men, 5.3–33.6% for women, and 6.5% for men and women combined, and for MSD 0–19.6% for men, 0–26.8% for women, and 3.4–19.9% for men and women combined.ConclusionThis study is the first one to provide fractions of diseases attributable to job strain for three health outcomes in France on the basis of a systematic review of the literature. These results could contribute to the estimation of the economic cost of diseases attributable to job strain.

The annual costs of cardiovascular diseases and mental disorders attributable to job strain in France

BackgroundWork stress has become a major occupational risk factor in industrialized countries and an important economic issue. The objective was to estimate the annual costs of coronary heart diseases (CHD) and mental disorders (MD) attributable to job strain exposure according to Karasek’s model in France for the year 2003 from a societal perspective.MethodsWe produced attributable fraction estimates which were applied to the number of cases (morbidity and mortality) and the costs of CHD and MD. Relative risk estimates came from a systematic literature review of prospective studies. We conducted meta-analyses based on this selection of studies. Prevalence of exposure to job strain came from the national SUMER survey conducted in France in 2003. Costs included direct medical costs and indirect costs: production losses due to sick leaves and premature deaths.ResultsBetween 8.8 and 10.2% of CHD morbidity was attributable to job strain, and between 9.4 and 11.2% of CHD mortality was attributable to this exposure for men. Between 15.2 and 19.8% of MD was attributable to job strain for men, and between 14.3 and 27.1% for women. As a whole, between 450 000 and 590 000 cases of diseases and 910–1130 deaths were attributable to job strain for men. From 730 000 to 1 380 000 cases of diseases and from 150 to 280 deaths were attributable to job strain for women. The total number of sick leave days amounted from 5 to 6.6 million days for men, and from 8.5 to 16 million days for women. The total costs of CHD and MD attributable to job strain exposure ranged from 1.8 to 3 billion euros for the year 2003 (0.12-0.19% GDP). Medical costs accounted for 11% of the total costs, value of life costs accounted for 13-15% and sick leave costs for 74-77%. The cost of CHD was estimated at 113–133 million euros and the cost of MD was between 1.7 - 2.8 billion euros in 2003.ConclusionThis study on the economic burden of diseases attributable to job strain in France provides relevant insights for policy-makers when defining public health priorities for prevention policies.

Psychosocial and organizational work environment of nurse managers and self-reported depressive symptoms: cross-sectional analysis from a cohort of nurse managers

ObjectivesThe association between depressive symptoms and psycho-organisational work environment has been established in the literature. Some studies have evaluated depressive symptoms in healthcare workers, but little research has been carried out among nurse managers. The aim of the study is to evaluate the depressive symptoms prevalence among nurse managers’ population and work environment factors.Material and MethodsA descriptive correlational research design was used. Data were collected from 296 nurse managers in five hospitals in the eastern area of France between 2007 and 2008. Health outcomes were evaluated by measuring depressive symptoms (CES-D scale), the exposure data by assessing psycho-organisational work environment with effort-reward imbalance-model of Siegrist. Multiple logistic regressions were used to describe the strength of the association between depressive symptoms and effort-reward imbalance adjusted for personal and occupational characteristics of the nurse managers.ResultsAmong the nurse managers, a third had depressive symptoms, and 18% presented an effort-reward imbalance (ratio: ≥ 1). A significant association was found between depressive symptoms and effort-reward imbalance (OR = 10.81, 95% CI: 5.1–23, p < 10−3), and with esteem as a reward (OR = 3.21, 95% CI: 1.6–6.3, p < 10−2).ConclusionIn view of the hierarchical situation of nurse managers and their primary roles in hospitals, it is necessary to take prevention measures to improve their work environment and health.

Are work organization interventions effective in preventing or reducing work-related musculoskeletal disorders? A systematic review of the literature

Objectives We sought to determine whether interventions that target work organization or the psychosocial work environment are effective in preventing or reducing work-related musculoskeletal disorders (WMSD) compared to usual work. Methods We systematically reviewed the 2000-2015 English- and French-language scientific literature, including studies evaluating the effectiveness of an organizational or psychosocial work intervention on incidence, prevalence or intensity of work-related musculoskeletal pain or disorders in the neck, shoulders, upper limbs and/or back or of work absence due to such problems, among non-sick-listed workers. We excluded rehabilitation and individual-level behavioral interventions and studies with >50% attrition. We analyzed medium- and high-quality studies and synthesized the evidence using the Grading of Recommendations Assessment, Development & Evaluation (GRADE) approach. An analysis of key workplace intervention elements supplemented the interpretation of results. Results We identified 884 articles; 28 met selection criteria, yielding 2 high-quality, 10 medium-quality and 16 low-quality studies. There was moderate evidence that supplementary breaks, compared to conventional break schedules, are effective in reducing symptom intensity in various body regions. Evidence was low-to-very-low quality for other interventions, primarily due to risk of bias related to study design, high attrition rates, co-interventions, and insensitive indicators. Most interventions lacked key intervention elements, such as work activity analysis and ergonomist guidance during implementation, but the relation of these elements to intervention effectiveness or ineffectiveness remains to be demonstrated. Conclusions Targeting work-rest cycles may reduce WMSD. Better quality studies are needed to allow definitive conclusions to be drawn on the effectiveness of other work organizational or psychosocial interventions to prevent or reduce WMSD.

Economic evaluations of ergonomic interventions preventing work-related musculoskeletal disorders: a systematic review of organizational-level interventions

BackgroundWork-related musculoskeletal disorders (WMSD) represent a major public health problem and economic burden to employers, workers and health insurance systems. This systematic review had two objectives: (1) to analyze the cost-benefit results of organizational-level ergonomic workplace-based interventions aimed at preventing WMSD, (2) to explore factors related to the implementation process of these interventions (obstacles and facilitating factors) in order to identify whether economic results may be due to a successful or unsuccessful implementation.MethodsSystematic review. Studies were searched in eight electronic databases and in reference lists of included studies. Companion papers were identified through backward and forward citation tracking. A quality assessment tool was developed following guidelines available in the literature. An integration of quantitative economic results and qualitative implementation data was conducted following an explanatory sequential design.ResultsOut of 189 records, nine studies met selection criteria and were included in our review. Out of nine included studies, grouped into four types of interventions, seven yielded positive economic results, one produced a negative result and one mixed results (negative cost-effectiveness and positive net benefit). However, the level of evidence was limited for the four types of interventions given the quality and the limited number of studies identified. Our review shows that among the nine included studies, negative and mixed economic results were observed when the dose delivered and received by participants was low, when the support from top and/or middle management was limited either due to limited participation of supervisors in training sessions or a lack of financial resources and when adequacy of intervention to workers’ needs was low. In studies where economic results were positive, implementation data showed strong support from supervisors and a high rate of employee participation.ConclusionStudies investigating the determinants of financial outcomes of prevention related to implementation process are very seldom. We recommend that in future research economic evaluation should include information on the implementation process in order to permit the interpretation of economic results and enhance the generalizability of results. This is also necessary for knowledge transfer and utilization of research results for prevention-oriented decision-making in occupational health and safety.

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.

A serial mediation model of workplace social support on work productivity: the role of self-stigma and job tenure self-efficacy in people with severe mental disorders

Abstract Purpose: Compared to groups with other disabilities, people with a severe mental illness face the greatest stigma and barriers to employment opportunities. This study contributes to the understanding of the relationship between workplace social support and work productivity in people with severe mental illness working in Social Enterprises by taking into account the mediating role of self-stigma and job tenure self-efficacy. Method: A total of 170 individuals with a severe mental disorder employed in a Social Enterprise filled out questionnaires assessing personal and work-related variables at Phase-1 (baseline) and Phase-2 (6-month follow-up). Process modeling was used to test for serial mediation. Results: In the Social Enterprise workplace, social support yields better perceptions of work productivity through lower levels of internalized stigma and higher confidence in facing job-related problems. When testing serial multiple mediations, the specific indirect effect of high workplace social support on work productivity through both low internalized stigma and high job tenure self-efficacy was significant with a point estimate of 1.01 (95% CI = 0.42, 2.28). Conclusions: Continued work in this area can provide guidance for organizations in the open labor market addressing the challenges posed by the work integration of people with severe mental illness. Implications for Rehabilitation: Work integration of people with severe mental disorders is difficult because of limited access to supportive and nondiscriminatory workplaces. Social enterprise represents an effective model for supporting people with severe mental disorders to integrate the labor market. In the social enterprise workplace, social support yields better perceptions of work productivity through lower levels of internalized stigma and higher confidence in facing job-related problems.

810 Healthy enterprise standard (hes) evaluation: impact on work-life balance and self-rated health

Introduction Work-life balance (WLB) refers to the harmonisation of one’s professional and personal roles. A growing body of research suggests that this conflict may be associated with various mental and physical health problems. An increasing number of organisations are implementing measures to promote WLB, but the effects of these on workers’ health are not well known. Implemented in 2008, the voluntary Healthy Enterprise Standard (HES) targets four intervention areas, including one to promote WLB. The objective of this study was to evaluate the impact of HES implementation on workers’ WLB and their self-rated health. Methods This was an intervention study with a before-after design derived from secondary data. Organisations adopted the standard of their own initiative and were responsible for implementing interventions. All active employees were solicited to participate before (T1, n=2849) and 24–38 months (T2, n=2560) following the standard’s implementation. At both time points, participants completed a questionnaire. WLB was measured using one item evaluating participants’ ability to maintain balance in their professional and personal responsibilities. Self-rated health was assessed using a validated self-report item. Exposure to the WLB intervention area was determined by qualitative analyses. Result The overall results show a deterioration of WLB for both women and men from T1 to T2. Of the two organisations that implemented specific interventions to promote WLB, only one implemented recognised interventions (flexible schedule and telecommute). In this organisation, a slight improvement in WLB was observed for men and especially for women. However, an increase in the prevalence of negative self-rated health was also observed in both sexes. Discussion These results suggest that workplace interventions implementing recognised and specific measures to promote workers’ WLB may be effective. The results of this study illustrate the importance of implementing concrete and recognised interventions in this field.

767 Healthy enterprise standard (hes) evaluation: analysing effects and cost-benefit results with a qualitative evaluation of implementation process

Introduction The Healthy Enterprise Standard (HES) is related to a certification program in Québec (Canada) and targets four areas: Lifestyle, Work-life balance, Workplace environment and Management practices. The aim of this study was to open the black box of intervention and analyse the implementation process in order to interpret effects of HES on health and workplace risk factors, and cost-benefit results from the employer’s perspective. Methods We used a before-after design for a two-case analysis with a mixed-method approach. In two organisations from different sectors, quantitative data were collected with a questionnaire among all active workers before the standard’s implementation (T1 organisation A=186, organisation B=1081) and 25–31 months after (T2 A=190, B=975). Psychosocial work factors (demand-control-support and effort-reward imbalance validated scales), psychological distress (validated Kessler-6), and work-related musculoskeletal problems (WMSP, 4 items from the Nordic Questionnaire) were measured as well as intervention exposure. Intervention costs data, presenteeism and absences data were collected. Qualitative data through interviews and focus groups in both organisations were recorded, transcribed and coded in order to perform thematic analysis a posteriori. Results The prevalence of psychosocial work factors (low social support, low reward) at T2 was lower amongst participants exposed to intervention in the Management practices area in both organisations. WMSP was lower for those exposed to the Workplace environment area in B. The average cost per worker per year was very similar for A and B whereas distribution of cost categories differed. The net benefit was highly positive in B and negative in A. Implementation analysis showed that each area of HES was associated to different types of facilitators and obstacles. Cyclical factors, communication and management involvement differed between A and B. Discussion These results show that the implementation process analysis provides interesting insights into understanding effect and cost-benefit results and improving OSH interventions.

880 Healthy enterprise standard (hes) evaluation: impact on adverse psychosocial work factors and psychological distress

Introduction Adverse psychosocial work factors are recognised as a significant source of psychological distress. The Healthy Enterprise Standard (HES) targets four intervention areas: Lifestyle, Work-life balance, Workplace environment and Management practices; this latter area referring to interventions aimed at improving the psychosocial work environment. The aim of this study was to evaluate the impact of implementing the HES on exposure to adverse psychosocial work factors and the prevalence of psychological distress among ten Quebec organisations. Methods This was an intervention study with a before-after design derived from secondary data. Organisations adopted the standard of their own initiative and were responsible for implementing interventions. All active employees were solicited to participate before (T1=2849) and 24–38 months (T2=2560) following the standard’s implementation. At both time points, participants completed a questionnaire. Psychosocial work factors were assessed with the validated demand-control-support and effort-reward imbalance models. Psychological distress was assessed with the validated K6. Intervention exposure was measured by questionnaire and complemented by qualitative analyses. Result The prevalence of low social support at work and high psychological distress decreased among all participants between T1 and T2. In organisations that were less exposed to interventions in the Management practices area, an increase in the prevalence of several adverse psychosocial work factors was observed while a decrease in the prevalence of these adverse factors was observed in organisations more exposed to Management practices interventions. Moreover, a more important decrease in high psychological distress was observed in organisations more exposed compared to those less exposed to interventions in this area. Discussion These results suggest that organisational psychosocial interventions implemented in the context of this standard may be effective in reducing both adverse psychosocial work factors as well as high psychological distress and may therefore be an effective means to improve the mental health of workers.