Johan Høy Jensen

Screening for cognitive dysfunction in unipolar depression: Validation and evaluation of objective and subjective tools

BACKGROUND Persistent cognitive dysfunction in unipolar depression (UD) contributes to socio-occupational impairment, but there are no feasible methods to screen for and monitor cognitive dysfunction in this patient group. The present study investigated the validity of two new instruments to screen for cognitive dysfunction in UD, and their associations with socio-occupational capacity. METHOD Participants (n=53) with UD in partial or full remission and healthy control persons (n=103) were assessed with two new screening instruments, the Danish translations of the Screen for Cognitive Impairment in Psychiatry (SCIP-D) and Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA) and with established neuropsychological and self-assessment measures. Depression symptoms and socio-occupational function were rated with the Hamilton Depression Rating Scale and Functional Assessment Short Test respectively. RESULTS The SCIP-D and COBRA were valid for detection of objective and subjective cognitive impairment, respectively. The three parallel SCIP-D forms were equivalent. A combined SCIP-D-COBRA measure showed high sensitivity and good specificity for objective cognitive impairment (91% and 70%, respectively). There was no correlation between subjective and objective measures of cognition. Subjective cognitive difficulties correlated more with socio-occupational impairment (r=0.7, p<0.01) than did objective cognitive difficulties, for which there was a weak correlation with the executive skills domain only (r =-0.3, p=0.05). LIMITATIONS A modest sample size. CONCLUSIONS The SCIP-D and COBRA are valid measures of objective and subjective cognitive impairment, respectively, and should ideally be implemented together in the screening for cognitive dysfunction in UD.

Discrete neurocognitive subgroups in fully or partially remitted bipolar disorder: Associations with functional abilities

BACKGROUND Neurocognitive impairment in remitted patients with bipolar disorder contributes to functional disabilities. However, the pattern and impact of these deficits are unclear. METHODS We pooled data from 193 fully or partially remitted patients with bipolar disorder and 110 healthy controls. Hierarchical cluster analysis was conducted to determine whether there are discrete neurocognitive subgroups in bipolar disorder. The pattern of the cognitive deficits and the characteristics of patients in these neurocognitive subgroups were examined with analyses of covariance and least significance difference pairwise comparison. RESULTS Three discrete neurocognitive subgroups were detected: one that was cognitively intact (46.1%), one that was selectively impaired with deficits in processing speed (32.6%), and one that was globally impaired across verbal learning, working memory, and executive skills (21.2%). The globally and selectively impaired subgroups were characterized by greater perceived stress and subjective cognitive complaints, poorer work and social adjustment, and reduced quality of life compared to patients who were cognitively intact. LIMITATIONS The study design was cross-sectional which limits inferences regarding the causality of the findings. CONCLUSION Globally and selectively impaired bipolar disorder patients displayed more functional disabilities than those who were cognitively intact. The present findings highlight a clinical need to systematically screen for cognitive dysfunction in remitted bipolar disorder and to target residual cognitive dysfunction in future treatment strategies.

Optimising screening for cognitive dysfunction in bipolar disorder: Validation and evaluation of objective and subjective tools.

INTRODUCTION Cognitive impairment is common in bipolar disorder and contributes to socio-occupational difficulties. The objective was to validate and evaluate instruments to screen for and monitor cognitive impairments, and improve the understanding of the association between cognitive measures and socio-occupational capacity. METHODS Patients with bipolar disorder in partial or full remission (n=84) and healthy controls (n=68) were assessed with the Screen for Cognitive Impairment in Psychiatry (SCIP), Cognitive Complaints in Bipolar Disorder Rating Scale (COBRA), and established neuropsychological tests and subjective rating scales. Socio-occupational function and affective symptoms were evaluated with the Functional Assessment Short Test, and the Hamilton Depression Rating Scale 17-items and Young Mania Rating Scale, respectively. Concurrent validity of the SCIP and COBRA were assessed by correlation with established objective and subjective cognitive measures, and decision validity was determined with Receiver-Operating-Characteristic analyses. Correlations and linear regression analyses were conducted to determine the associations between objective and subjective cognitive impairment, and socio-occupational difficulties. RESULTS The SCIP and COBRA correlated strongly with established objective and subjective cognitive measures, respectively. The SCIP yielded higher sensitivity and specificity for detection of cognitive dysfunction than the COBRA or a combined SCIP-COBRA measure. Correlations between objective and subjective cognitive impairment were weak but both were associated with socio-occupational difficulties. LIMITATIONS Influence of ageing was not investigated. CONCLUSIONS The SCIP and COBRA are valid for detection of objective and subjective cognitive impairment in bipolar disorder. Screening for cognitive dysfunction should be conducted with an objective measure like the SCIP.

Cohort Profile: The Well-being in HospitAL Employees (WHALE) study

Cohort Profile: The Well-being in HospitAL Employees (WHALE) study Ulla Arthur Hvidtfeldt, Jakob Bue Bjorner, Johan Høy Jensen, Nina Breinegaard, Peter Hasle, Jens Peter Ellekilde Bonde and Naja Hulvej Rod* Department of Public Health, University of Copenhagen, Copenhagen, Denmark, National Research Centre for the Working Environment, Copenhagen, Denmark, Quality Metric, Optum Patient Insights, Lincoln, RI, USA, Department of Occupational and Environmental Medicine, Frederiksberg and Bispebjerg Hospitals, Copenhagen, Denmark and Center for Industrial Production, Department of Business and Management, Aalborg University, Aalborg, Denmark

Longitudinal associations between organizational change, work-unit social capital, and employee exit from the work unit among public healthcare workers: a mediation analysis

Objectives Organizational changes are associated with higher rates of subsequent employee exit from the workplace, but the mediating role of social capital is unknown. We examined the associations between organizational changes and subsequent employee exit from the work unit and mediation through social capital. Methods Throughout 2013, 14 059 healthcare employees worked in the Capital Region of Denmark. Data on work-unit changes (yes/no) from July‒December 2013 were collected via a survey distributed to all managers (merger, split-up, relocation, change of management, employee layoff, budget cuts). Eight employee-reported items assessing social capital were aggregated into work-unit measures (quartiles: low-high). Data on employee exit from the work unit in 2014 were obtained from company registries. Results We found a somewhat higher rate of employee exit from the work unit after changes versus no changes [hazard ratio (HR) 1.10, 95% confidence interval (CI) 1.01-1.19] and an inverse dose‒response relationship between social capital and employee-exit rates (low versus high: HR 1.65, 95% CI 1.46-1.86). We also showed a higher risk of low social capital in work units exposed to changes [low versus high: odds ratio (OR) 2.04, 95% CI 1.86-2.23]. Accounting for potential mediation through social capital seemed slightly to reduce the association between changes and employee-exit rates (HR 1.07, 95% CI 0.98-1.16 versus HR 1.10). Conclusions Work-unit organizational changes prospectively predict lower work-unit social capital, and lower social capital is associated with higher employee-exit rates. Detection of weak indications of mediation through social capital, if any, were limited by inconsistent associations between changes and employee exit from the work unit.

Dual impact of organisational change on subsequent exit from work unit and sickness absence: a longitudinal study among public healthcare employees

Objectives We investigated work-unit exit, total and long-term sickness absence following organisational change among public healthcare employees. Methods The study population comprised employees from the Capital Region of Denmark (n=14 388). Data on reorganisation at the work-unit level (merger, demerger, relocation, change of management, employee layoff or budget cut) between July and December 2013 were obtained via surveys distributed to the managers of each work unit. Individual-level data on work-unit exit, total and long-term sickness absence (≥29 days) in 2014 were obtained from company registries. For exposure to any, each type or number of reorganisations (1, 2 or ≥3), the HRs and 95% CIs for subsequent work-unit exit were estimated by Cox regression, and the risk for total and long-term sickness absence were estimated by zero-inflated Poisson regression. Results Reorganisation was associated with subsequent work-unit exit (HR 1.10, 95% CI 1.01 to 1.19) in the year after reorganisation. This association was specifically important for exposure to ≥3 types of changes (HR 1.52, 95% CI 1.30 to 1.79), merger (HR 1.29, 95% CI 1.12 to 1.49), demerger (HR 1.41, 95% CI 1.16 to 1.71) or change of management (HR 1.24, 95% CI 1.11 to 1.38). Among the employees remaining in the work unit, reorganisation was also associated with more events of long-term sickness absence (OR 1.15, 95% CI 1.00 to 1.33), which was particularly important for merger (OR 1.31, 95% CI 1.00 to 1.72) and employee layoff (OR 1.31, 95% CI 1.08 to 1.59). Conclusions Specific types of reorganisation seem to have a dual impact on subsequent work-unit exit and sickness absence in the year after change.

Work-unit social capital and long-term sickness absence: a prospective cohort study of 32 053 hospital employees

Objective There is a lack of studies investigating social capital at the workplace level in small and relatively homogeneous work-units. The aim of the study was to investigate whether work-unit social capital predicts a lower risk of individual long-term sickness absence among Danish hospital employees followed prospectively for 1 year. Methods This study is based on the Well-being in HospitAL Employees cohort. The study sample consisted of 32 053 individuals nested within 2182 work-units in the Capital Region of Denmark. Work-unit social capital was measured with an eight-item scale covering elements of trust, justice and collaboration between employees and leaders. Social capital at the work-unit level was computed as the aggregated mean of individual-level social capital within each work-unit. Data on long-term sickness absence were retrieved from the employers’ payroll system and were operationalised as ≥29 consecutive days of sickness absence. We used a 12-point difference in social capital as the metric in our analyses and conducted two-level hierarchical logistic regression analysis. Adjustments were made for sex, age, seniority, occupational group and part-time work at the individual level, and work-unit size, the proportion of female employees and the proportion of part-time work at the work-unit level. Results The OR for long-term sickness absence associated with a 12-point higher work-unit social capital was 0.73 (95% CI 0.68 to 0.78). Further, we found an association between higher work-unit social capital and lower long-term sickness absence across quartiles of social capital: compared with the lowest quartile, the OR for long-term sickness absence in the highest quartile was 0.51 (95% CI 0.44 to 0.60). Conclusion Our study provides support for work-unit social capital being a protective factor for individual long-term sickness absence among hospital employees in the Capital Region of Denmark.

0332 The impact of organisational change on sickness absence: how much of the effects are mediated by workplace social capital?

Objective Organisational change may negatively affect employees’ health and social capital. This study examined the magnitude of mediated effects from organisational change through social capital on long-term sickness absence (LSA) among public hospital workers. Method In March 2014, 26.209 workers employed through January-December 2013 in the Capital Region of Denmark received a work-environment survey assessing social capital (84% responded). Social capital, measured using 8 self-reported items (collaboration, trust, and organisational justice) ranging 0-5/0-7 (low-high), was aggregated on work-unit level and categorised into quartiles. Organisational change (e.g., merger, layoff(s), and relocation) during July-December 2013 were recorded via surveys sent to all managers (58% responded). Monthly sickness-absence data of 2014 were obtained from regional salary registries (LSA:>28 days). Mediation was assessed using natural effects models nested on January-September 2014 and estimated the natural direct, indirect, and total effects from organisational change on LSA via social capital adjusting for age, gender, work-unit size, occupation, child- and health-proxies. Results Exposure to merger or layoff(s) yielded significant adverse direct effects (OR 1.33, 95% CI 1.12–1.58 and OR 1.15, 95% CI 1.01–1.30, respectively) and adverse indirect effects via social capital (OR 1.04, 95% CI 1.02–1.06 and OR 1.04, 95% CI 1.03–1.05, respectively) on LSA (total effects: OR 1.38, 95% CI 1.17–1.64 and OR 1.19, 95% CI 1.05–1.36, respectively). Surprisingly, exposure to relocation showed a protective direct effect (OR 0.73, 95% CI 0.58–0.91), but a significant adverse indirect effect (OR 1.01, 95% CI 1.00–1.03) on LSA (total effect: OR 0.74, 95% CI 0.52–0.92). Conclusion Social capital potentially mediates adverse effects from organisational change on LSA.

0448 Effects of organisational change on workplace social capital: a longitudinal study of hospital work units

Background Organisational change is associated with adverse health outcomes for employees. The association may be mediated by changes in the psychosocial work environment. Workplace social capital (WSC) is a recent construct, which has been shown predictive of health outcomes when studying the psychosocial work environment. Currently, there is no epidemiological evidence concerning the impact of organisational change on WSC. This study examines the impact of organisational change on WSC in public hospitals in Denmark. Method An open cohort-study of hospital employees in the Capital Region of Denmark provided longitudinal data on 1639 work units within 11 hospitals. WSC was assessed by employees during workplace evaluations in 2011 and 2014 (41.710 responses, 81% response rate). WSC was rated on 8 items using 5–7 point Likert-scales, and then transformed to a 0–100 scale. Exposure data were provided by work unit leaders, recollecting four types of organisational change from 2011 to 2014; mergers, layoffs, relocations and downsizing. A multilevel model was used to analyses the change of WSC-scores within each work unit. The model estimated the effect of organisational change and adjusted for changes in the size of the work unit and the vocation, age, gender and seniority of the employees. Preliminary results In work units exposed to one or more organisational changes in the three year period, WSC decreased by 1.5 points (95% CI: (−2.2; −0.7)). Mergers had the biggest impact, decreasing WSC by 1.9 points (95% CI: (−2.8; −1.0). Conclusion Organisational changes adversely impacted the workplace social capital, possibly mediating the effect on employee health.