Kirsi Ahola

The Job Demands-Resources model: A three-year cross-lagged study of burnout, depression, commitment, and work engagement

Abstract By using a full panel design in a representative sample of Finnish dentists (N=2555), the present study aimed to test longitudinally the motivational and health impairment processes as proposed in the Job Demands-Resources (JD-R) model. The second aim was to investigate whether home resources and home demands have an additional influence on both processes over time. The hypotheses were tested with cross-lagged analyses based on two waves over a three-year period. The results supported both the motivational process and the health impairment process. Job resources influenced future work engagement, which, in turn, predicted organizational commitment, whereas job demands predicted burnout over time, which, in turn, predicted future depression. In addition, job resources had a weak negative impact on burnout. Home demands and home resources did not influence the motivational or health impairment process over time. The results support the central role of work characteristics for health and well-being. By integrating both human thriving and ill-health in the same model, the JD-R model may help to bridge the gap between “negative” and “positive” psychology.

Burnout in the general population

BackgroundBurnout is a chronic stress syndrome which develops gradually as a consequence of prolonged stress situation. Socio-demographic factors related to job-related burnout have not been studied in the whole population. We investigated the relative differences in the level of burnout between groups based on various socio-demographic factors in the population-based Finnish sample.MethodsThe nationally representative sample comprised 3,424 employees aged 30–64 years. Burnout was assessed with the Maslach Burnout Inventory–General Survey. The socio-demographic factors of interest were gender, age, education, type of employment, work experience, socio-economic status (SES), working time, and marital status.ResultsOnly small differences in burnout were found between the different population groups. As a three-dimensional syndrome, burnout was associated with age. In contrast to what has been consistently reported so far, mostly among human service work and in non-representative studies, burnout seemed to increase somewhat with age. Among women, burnout was also related to education, SES, and work experience, and among men, to marital status.ConclusionsBurnout can evolve in all kinds of vocational groups. It seems that age does not generally protect against burnout. A low education level and low social status carry a possible risk of burnout for women, and being single, divorced, or widowed carry a possible risk of burnout for men.

Long working hours and symptoms of anxiety and depression: a 5-year follow-up of the Whitehall II study

BACKGROUND Although long working hours are common in working populations, little is known about the effect of long working hours on mental health. METHOD We examined the association between long working hours and the onset of depressive and anxiety symptoms in middle-aged employees. Participants were 2960 full-time employees aged 44 to 66 years (2248 men, 712 women) from the prospective Whitehall II cohort study of British civil servants. Working hours, anxiety and depressive symptoms, and covariates were measured at baseline (1997-1999) followed by two subsequent measurements of depressive and anxiety symptoms (2001 and 2002-2004). RESULTS In a prospective analysis of participants with no depressive (n=2549) or anxiety symptoms (n=2618) at baseline, Cox proportional hazard analysis adjusted for baseline covariates showed a 1.66-fold [95% confidence interval (CI) 1.06-2.61] risk of depressive symptoms and a 1.74-fold (95% CI 1.15-2.61) risk of anxiety symptoms among employees working more than 55 h/week compared with employees working 35-40 h/week. Sex-stratified analysis showed an excess risk of depression and anxiety associated with long working hours among women [hazard ratios (HRs) 2.67 (95% CI 1.07-6.68) and 2.84 (95% CI 1.27-6.34) respectively] but not men [1.30 (0.77-2.19) and 1.43 (0.89-2.30)]. CONCLUSIONS Working long hours is a risk factor for the development of depressive and anxiety symptoms in women.

Occupational burnout and medically certified sickness absence: A population-based study of Finnish employees

OBJECTIVE Occupational burnout is a common problem in working populations, but its association with sickness absence is poorly understood. The contribution of occupational burnout to medically certified sickness absence was examined in a population-based sample of employees. METHODS A representative sample of 3151 Finnish employees aged 30-60 years participated in a comprehensive health study in 2000-2001, including an assessment of physician-diagnosed physical illnesses and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders based on the Composite International Diagnostic Interview. Burnout was measured with the Maslach Burnout Inventory-General Survey. Sickness absences longer than 9 days in 2000-2001 were extracted from a register of the Social Insurance Institution of Finland. RESULTS The occurrence of medically certified sickness absence was more prevalent among employees with burnout than among those without burnout. After adjusting for sociodemographic factors and mental and physical disorders, the odds ratio of sickness absence for severe burnout was 6.9 [95% confidence interval (95% CI)=2.7-17.8] for men and 2.1 (95% CI=1.1-4.0) for women. Among employees with mental or physical disorders, severe burnout was associated with a 7.7-fold risk of sickness absence among men and with a 2.6-fold risk among women. The duration of absence was related to burnout among men with absences, for whom severe burnout accounted for 52 excess sickness absence days during the 2-year period after adjusting for sociodemographic factors, mental disorders, and physical illnesses. CONCLUSIONS Severe burnout is associated with a substantial excess risk of medically certified sickness absence among both men and women. This association is independent of prevalent mental disorders and physical illnesses.

Long working hours and alcohol use : systematic review and meta-analysis of published studies and unpublished individual participant data.

Objective To quantify the association between long working hours and alcohol use. Design Systematic review and meta-analysis of published studies and unpublished individual participant data. Data sources A systematic search of PubMed and Embase databases in April 2014 for published studies, supplemented with manual searches. Unpublished individual participant data were obtained from 27 additional studies. Review methods The search strategy was designed to retrieve cross sectional and prospective studies of the association between long working hours and alcohol use. Summary estimates were obtained with random effects meta-analysis. Sources of heterogeneity were examined with meta-regression. Results Cross sectional analysis was based on 61 studies representing 333 693 participants from 14 countries. Prospective analysis was based on 20 studies representing 100 602 participants from nine countries. The pooled maximum adjusted odds ratio for the association between long working hours and alcohol use was 1.11 (95% confidence interval 1.05 to 1.18) in the cross sectional analysis of published and unpublished data. Odds ratio of new onset risky alcohol use was 1.12 (1.04 to 1.20) in the analysis of prospective published and unpublished data. In the 18 studies with individual participant data it was possible to assess the European Union Working Time Directive, which recommends an upper limit of 48 hours a week. Odds ratios of new onset risky alcohol use for those working 49-54 hours and ≥55 hours a week were 1.13 (1.02 to 1.26; adjusted difference in incidence 0.8 percentage points) and 1.12 (1.01 to 1.25; adjusted difference in incidence 0.7 percentage points), respectively, compared with working standard 35-40 hours (incidence of new onset risky alcohol use 6.2%). There was no difference in these associations between men and women or by age or socioeconomic groups, geographical regions, sample type (population based v occupational cohort), prevalence of risky alcohol use in the cohort, or sample attrition rate. Conclusions Individuals whose working hours exceed standard recommendations are more likely to increase their alcohol use to levels that pose a health risk.

Contribution of burnout to the association between job strain and depression: the health 2000 study.

Objective: The objective of this study was to investigate the contribution of burnout to the association between job strain and depression. Methods: A representative sample of 3270 Finnish employees aged 30 to 64 years responded to the Maslach Burnout Inventory–General Survey and the Beck Depression Inventory and participated in the Composite International Diagnostic Interview. Results: High strain compared with low strain was associated with 7.4 (95% confidence interval [CI] = 5.6–9.7) times higher odds of burnout, 3.8 (95% CI = 2.8–5.1) times higher odds of depressive symptoms, and 1.7 (95% CI = 1.1–2.6) times higher odds of depressive disorders. The risk for depressive symptoms and for depressive disorders of high strain was reduced by 69% or more after adjusting for burnout. Conclusion: Burnout is strongly related to job strain and may in part mediate the association between job strain and depression.

Job Strain as a Risk Factor for Type 2 Diabetes : A Pooled Analysis of 124,808 Men and Women

OBJECTIVE The status of psychosocial stress at work as a risk factor for type 2 diabetes is unclear because existing evidence is based on small studies and is subject to confounding by lifestyle factors, such as obesity and physical inactivity. This collaborative study examined whether stress at work, defined as “job strain,” is associated with incident type 2 diabetes independent of lifestyle factors. RESEARCH DESIGN AND METHODS We extracted individual-level data for 124,808 diabetes-free adults from 13 European cohort studies participating in the IPD-Work Consortium. We measured job strain with baseline questionnaires. Incident type 2 diabetes at follow-up was ascertained using national health registers, clinical screening, and self-reports. We analyzed data for each study using Cox regression and pooled the study-specific estimates in fixed-effect meta-analyses. RESULTS There were 3,703 cases of incident diabetes during a mean follow-up of 10.3 years. After adjustment for age, sex, and socioeconomic status (SES), the hazard ratio (HR) for job strain compared with no job strain was 1.15 (95% CI 1.06–1.25) with no difference between men and women (1.19 [1.06–1.34] and 1.13 [1.00–1.28], respectively). In stratified analyses, job strain was associated with an increased risk of diabetes among those with healthy and unhealthy lifestyle habits. In a multivariable model adjusted for age, sex, SES, and lifestyle habits, the HR was 1.11 (1.00–1.23). CONCLUSIONS Findings from a large pan-European dataset suggest that job strain is a risk factor for type 2 diabetes in men and women independent of lifestyle factors.

Common mental disorders and subsequent work disability: A population-based Health 2000 Study

BACKGROUND Work disability due to common mental disorders has increased in Western countries during the past decade. The contribution of depressive, anxiety, and alcohol use disorders to all disability pensions at the population level is not known. METHODS Epidemiological health data from the Finnish Health 2000 Study, gathered in 2000-2001, was linked to the national register on disability pensions granted due to the ICD-10 diagnoses up to December 2007. Mental health at baseline was assessed using the Composite International Diagnostic Interview (CIDI). Sociodemographic, clinical, and work-related factors, health behaviors, and treatment setting were used as covariates in the logistic regression analyses among the 3164 participants aged 30-58 years. RESULTS Anxiety, depressive, and comorbid common mental disorders predicted disability pension when adjusted for sex and age. In the fully adjusted multivariate model, comorbid common mental disorders, as well as physical illnesses, age over 45 years, short education, high job strain, and previous long-term sickness absence predicted disability pension. LIMITATIONS The study population included persons aged 30 or over. Sub groups according to mental disorders were quite small which may have diminished statistical power in some sub groups. Baseline predictors were measured only once and the length of exposure could not be determined. The systems regarding financial compensation to employees differ between countries. CONCLUSIONS Comorbid mental disorders pose a high risk for disability pension. Other independent predictors of work disability include socio-demographic, clinical, work-related, and treatment factors, but not health behavior. More attention should be paid to work-related factors in order to prevent chronic work disability.

Occupational burnout as a predictor of disability pension: a population-based cohort study

Objectives: The aim of this study was to investigate whether burnout predicts new disability pension at population level during a follow-up of approximately 4 years. The diagnosis for which the disability pension was granted was also examined in relation to the level of burnout. Methods: We used a population-based cohort sample (n = 3125) of 30–60-year-old employees from an epidemiological health study, the Health 2000 Study, gathered during 2000–2001 in Finland. The data collection comprised an interview, a clinical health examination including a standardised mental health interview, and a questionnaire including the Maslach Burnout Inventory-General Survey. Disability pensions and their causes until December 2004 were extracted from national pension records. The association between burnout and new disability pension was analysed with logistic regression models adjusted for sociodemographic factors and health at baseline. Results: Altogether 113 persons were granted a new disability pension during the follow-up: 22% of those with severe burnout, 6% of those with mild burnout, and 2% of those with no burnout at baseline. After sociodemographic factors and health were adjusted for, each one-point increase in the overall burnout sum score was related to 49% increase in the odds for a future disability pension. A disability pension was most often granted on the basis of mental and behavioural disorders and diseases of the musculoskeletal system among those with burnout. After adjustments, exhaustion dimension among men and cynicism dimension among a combined group of men and women predicted new disability pensions. Conclusion: Burnout predicts permanent work disability and could therefore be used as a risk marker of chronic health-related work stress. To prevent early exit from work life, working conditions and employee burnout should be regularly assessed with the help of occupational health services.

Occupational burnout and chronic work disability: an eight-year cohort study on pensioning among Finnish forest industry workers.

BACKGROUND The objective was to explore if burnout, a syndrome from chronic work stress, predicts work disability during eight years among industrial employees. We investigated whether burnout would predict disability in initially healthy employees and all subgroups by the most common causes for disability. METHODS Of the participants in a company-wide survey (n=9705, 63%) performed in 1996, 8371 employees were identified and 7810 provided full information. The impact of burnout and its sub-dimensions, assessed with the Maslach Burnout Inventory-General Survey, on being granted register-based new disability pension till 2004 was analysed with Cox hazard regression and multinomial regression. The analyses were adjusted for socio-demographic factors, registered medication use, and self-reported chronic illness at baseline. RESULTS The hazard ratio (HR) for new disability pension was 3.8 (95% confidence interval CI 2.7-5.4) with severe burnout. The risk of severe burnout and severe exhaustion for work disability attenuated but remained significant after adjustments. The association between severe burnout and work disability was significant also in the subpopulation of employees without registered medication at baseline but not among employees healthy by self-report. Crude associations between burnout and all categories of cause-specific disability were significant. The exhaustion dimension predicted work disability due to mental and miscellaneous disorders after adjustments. LIMITATIONS A non-random one-branch sample was used. The final sample covered 50% of eligible employees. CONCLUSIONS In industrial work, burnout-related chronic work disability is general in nature. Burnout predicts work disability among healthy employees when health is assessed with registered use of medication but not when it is determined by self-report.