IJmert Kant

Fatigue among working people: validity of a questionnaire measure

OBJECTIVES To evaluate the validity of the checklist individual strength questionnaire (CIS) in the working population. This 20 item self reported questionnaire has often been used in patients with chronic fatigue. To date, no research has focused on the validity of the CIS in occupational groups. METHODS To evaluate the discriminant validity the CIS was filled out by five groups of employees with expected differences in fatigue. The convergent validity was evaluated by comparing the results of the CIS with the results of three related measures: measured unidimensional fatigue, burnout, and need for recovery. RESULTS The CIS was able to discriminate between fatigued and non-fatigued employees in occupational groups. The expected agreement between the results of the CIS and related measures was confirmed. CONCLUSIONS The CIS seems to be an appropriate instrument for measuring fatigue in the working population.

Fatigue and psychological distress in the working population: Psychometrics, prevalence, and correlates

OBJECTIVE The purposes of this study were: (1) to explore the relationship between fatigue and psychological distress in the working population; (2) to examine associations with demographic and health factors; and (3) to determine the prevalence of fatigue and psychological distress. METHODS Data were taken from 12,095 employees. Fatigue was measured with the Checklist Individual Strength, and the General Health Questionnaire (GHQ) was used to measure psychological distress. RESULTS Fatigue was fairly well associated with psychological distress. A separation between fatigue items and GHQ items was shown. No clear, distinct pattern of associations was found for fatigue vs. psychological distress with respect to demographic factors. The prevalence was 22% for fatigue and 23% for psychological distress. Of the employees reporting fatigue, 43% had fatigue only, whereas 57% had fatigue and psychological distress. CONCLUSIONS The results indicate that fatigue and psychological distress are common in the working population. Although closely associated, there is some evidence suggesting that fatigue and psychological distress are different conditions, which can be measured independently.

Antecedents and Consequences of Work–family Conflict: A Prospective Cohort Study

Learning ObjectivesExplain the general nature of work-family conflict.Relate the prevalence and work-related correlates of work-family conflict as reported in the Maastricht Cohort study.Identify the work- and family-related antecedents of work-family conflict for male and female employees.Summarize the personal consequences of work-family conflict This study examined both risk factors for the onset of work–family conflict and consequences in terms of need for recovery and prolonged fatigue for men and women separately. Two-year follow-up data from the Maastricht Cohort Study on “Fatigue at Work” (n = 12,095) were used. At baseline, the prevalence of work–family conflict was 10.8% (9.0% in women; 11.1% in men), the cumulative incidence at 1 year follow-up was 5.1%. For men, several work-related demands, shift work, job insecurity, conflicts with coworkers or supervisor, having full responsibility for housekeeping, and having to care for a chronically ill child or other family member at home were risk factors for the onset of work–family conflict, whereas decision latitude and coworker and supervisor social support protected against work–family conflict. In women, physical demands, overtime work, commuting time to work, and having dependent children were risk factors for work–family conflict, whereas domestic help protected against work–family conflict at 1 year follow-up. Work–family conflict was further shown to be a strong risk factor for the onset of elevated need for recovery from work and fatigue.

Need for recovery from work: evaluating short-term effects of working hours, patterns and schedules

In this paper working hours, patterns and work schedules of employees were evaluated in terms of need for recovery from work. Self-administered questionnaire data from employees of the Maastricht Cohort Study on Fatigue at Work (n = 12,095) were used. Poisson regression analyses and multivariate logistic regression analyses revealed that higher working hours a day and working hours a week generally went together with more need for recovery from work. Overtime work was particularly associated with higher need for recovery from work in both genders. Both male and female three-shift or irregular shift workers had higher odds of elevated need for recovery compared to day workers. When additionally controlling for work-related factors, need for recovery levels among shift workers substantially lowered. This study clearly showed that working hours and schedules are associated with need for recovery from work, with different associations for men and women. Especially the associations between work schedules and need for recovery from work were very interrelated with other work-related factors. Future studies could further investigate the possibility that shift work might function as a proxy of other work-related factors that explain the different levels in need for recovery from work, or that job demands are perceived higher among shift workers and may therefore lead to more need for recovery from work.

DEPRESSED MOOD IN THE WORKING POPULATION: ASSOCIATIONS WITH WORK SCHEDULES AND WORKING HOURS

The impact of working time arrangements (WTA) on health has been studied extensively. Still, little is known about the interrelation between work schedules, working hours, and depressed mood. For work schedules, the underlying assumptions regarding depressed mood refer to a disturbance of social and biological rhythms, whereas for working hours, the assumptions relate to workload and work capacity. Conversely, depressed mood may urge an employee to adjust his/her work schedule and/or number of working hours/week (h/wk). The aim of this study was to assess the association between work schedule and working hours with depressed mood. Using baseline data from the Maastricht Cohort Study, depressed mood in day work was compared with depressed mood in different shiftwork schedules (n = 8843). Within day work, several categories of working h/wk were studied in association with depressed mood (n = 7217). The association between depressed mood and several aspects of overtime was assessed separately. Depressed mood was measured with a dichotomous item: “Did you feel down every day over the last two weeks?” Separate logistic regression analyses were conducted for men and women, with adjustments for potential confounders. The odds ratio (OR) for depressed mood was greater for men involved in shiftwork than for men only involved in day work (three-shift OR = 2.05 [95% confidence interval, CI 1.52–2.77]; five-shift OR = 1.34 [95% CI 1.00–1.80]; irregular-shift OR = 1.79 [95% CI 1.27–2.53]). In female employees, five-shift work was associated with a higher prevalence of depressed mood (OR = 5.96 [95% CI 2.83–12.56]). Regarding the number of working h/wk, men working <26 h/wk had a higher prevalence of depressed mood than men working 36–40 h/wk (OR = 2.73 [95% CI 1.35–5.52]). After conducting trend analyses, a significant decreasing trend was found in men, whereas an increasing trend was found in women working a high number of hours. Furthermore, a dose-response relationship was present in men regarding the number of overtime h/wk. This study showed that different work schedules and working hours are associated with depressed mood. Shiftwork was related to a higher prevalence of depressed mood than day work. The association was more pronounced for male employees. Regarding the number of working h/wk, male and female employees showed an opposite trend in depressed mood. Because of the possibility of a healthy worker effect and the possibility of a reciprocal relationship between WTA and depressed mood, the reported relation might be underestimated. This study has illustrated that occupational physicians, who deal with depressed mood among workers, should carefully consider the impact of WTA. (Author coorespondence: Karolien.Driesen@epid.unimaas.nl)

Differences in fatigue and psychological distress across occupations: results from the Maastricht Cohort study of fatigue at work

Differences in fatigue and psychological distress across occupations were examined among 8521 employees participating in the Maastricht Cohort Study of “Fatigue at Work.” Additional information on the perceived psychosocial work environment was incorporated. A total of 131 occupations, classified according to the Netherlands Standard Classification of Occupations 1992, were studied. Results showed that occupation as a proxy index of the “objective” work environment adds little explanatory information beyond perceived measures of the work environment. Although “occupation” seems to be an easy entree for intervention, focusing on occupation exclusively to prevent, or at least reduce, fatigue and psychological distress may be inadequate. Supplementary information about the perceived work environment of the job occupant is needed to develop preventive measures on the individual level. Further research, including a longitudinal analysis, is required to elucidate the complex relation between occupation, psychosocial risk factors, and fatigue and psychological distress.

Smoking among shift workers: More than a confounding factor.

In studies on the cardiovascular disease risk among shift workers, smoking is considered to be a confounding factor. In a study of 239 shift and 157 daytime workers, it was found that shift work was prospectively related to increased cigarette consumption, indicating that smoking might be in the causative pathway; however, the number of study subjects was too low to warrant sound conclusions. Therefore, data from the Maastricht Cohort study were used to investigate the longitudinal relation between smoking and shift work in a much larger population. In this study, a total of 12,140 employees were followed for two years by means of self‐administered questionnaires. The authors compared workers who normally worked during daytime hours only (74%) with those who worked other than day shifts (26%). Logistic regression analyses were performed, adjusting for demographic factors of age, gender, and educational level to evaluate the risk of starting to smoke (n=25) in the group of non‐smoking workers and the risk of quitting (n=318) in the group of smoking workers. Logistic regression analysis showed a significant association between shift work and taking up smoking during the two‐year follow‐up (odds ratio: 1.46, p=0.03). The risk to stop smoking was somewhat lower in shift workers (odds ratio: 0.91) but not statistically significant (p=0.5). To conclude, this study showed that, independent of educational level, shift workers are more prone to start smoking. This finding might have important implications for studies on the health effects of shift workers and for possible interventions aimed at the reduction of the excess health risk among shift workers.

Chronic bronchitis, cigarette smoking, and the subsequent onset of depression and anxiety: results from a prospective population-based cohort study.

Objective: The authors used data from a prospective, population-based cohort study to examine: (a) whether the presence of chronic bronchitis predicts the subsequent onset of depression or anxiety, and (b) if the incidence of depressed or anxious cases was different for smokers compared with nonsmokers. Materials and Methods: For studying the relation between chronic bronchitis and anxiety or depression, we used data from respectively 4468 and 4520 respondents. Results: The number of incident anxious (19.1%, n = 17) and depressed (14.0%, n = 13) cases was highest in employees with chronic bronchitis compared with employees without respiratory complaints (4.3%, n = 189 and 3.3%, n = 145, respectively). The presence of chronic bronchitis was associated with a significant increase in anxious and depressed cases (odds ratio (OR) for anxiety = 5.09, 95% confidence interval (CI) 2.91, 8.89; OR for depression = 4.38, 95% CI 2.35, 8.16). The incidence of anxiety as well as depression was strongest in the smokers group (OR for anxiety = 8.94, 95% CI 4.08, 19.59; OR for depression = 7.56, 95% CI 3.37, 16.96). Conclusions: This prospective study shows significantly higher levels of anxiety as well as depression in employees with chronic bronchitis. Results also seem to indicate that smoking cigarettes modifies this association, resulting in an increased risk of depression and anxiety in employees with chronic bronchitis who smoke. COPD = chronic obstructive pulmonary disease; HADS = Hospital Anxiety and Depression Scale; HADS-A = HADS anxiety subscale; HADS-D = HADS depression subscale.

The association between chronic diseases and fatigue in the working population

OBJECTIVE The aims of this study were to examine (a) whether employees with a chronic disease report more fatigue than employees without a chronic disease, (b) whether number or type of chronic disease is related to fatigue, and (c) whether differences in fatigue level in various types of chronic diseases are related to psychological distress. METHODS Data were taken from 12,137 employees. Fatigue was measured with the Checklist Individual Strength (CIS). RESULTS Employees with a chronic disease reported more fatigue (OR=2.9, 95% CI=2.7-3.2). Small differences were observed in the level of fatigue in various types of diseases. A strong linear association between the number of chronic diseases and fatigue was found. Psychological distress explained the higher level of fatigue in some chronic diseases (gastrointestinal diseases and migraine). CONCLUSIONS Fatigue is more common in employees with a chronic disease. A strong association between number of chronic diseases and fatigue exists. Fatigue in employees with a chronic disease can partly be explained by psychological distress. Some chronic diseases show a stronger association between psychological distress and fatigue.

Job mobility, its determinants, and its effects: longitudinal data from the Maastricht Cohort Study.

This prospective study of 12,140 employees examined the effects of work characteristics and situational, psychological, and health aspects on job mobility. Before job change, the mobility group reported significantly more conflicts with the supervisor, higher physical and emotional strain, higher degree of job insecurity, lower job satisfaction, and lower degree of commitment compared with employees who did not change jobs. After job change, the mobility group reported improved autonomy, task diversity, decreased occurrence of conflicts with the supervisor, decreased physical and emotional strain, and improved training possibilities and job security than before the change. Changing jobs had a positive effect on employees with respect to job perception and job satisfaction and led to reduced fatigue and need for recovery.