Mika Kivimäki

Workplace bullying and the risk of cardiovascular disease and depression

Aims: To examine exposure to workplace bullying as a risk factor for cardiovascular disease and depression in employees. Methods: Logistic regression models were related to prospective data from two surveys in a cohort of 5432 hospital employees (601 men and 4831 women), aged 18–63 years. Outcomes were new reports of doctor diagnosed cardiovascular disease and depression during the two year follow up among those who were free from these diseases at baseline. Results: The prevalence of bullying was 5% in the first survey and 6% in the second survey. Two per cent reported bullying experiences in both surveys, an indication of prolonged bullying. After adjustment for sex, age, and income, the odds ratio of incident cardiovascular disease for victims of prolonged bullying compared to non-bullied employees was 2.3 (95% CI 1.2 to 4.6). A further adjustment for overweight at baseline attenuated the odds ratio to 1.6 (95% CI 0.8 to 3.5). The association between prolonged bullying and incident depression was significant, even after these adjustments (odds ratio 4.2, 95% CI 2.0 to 8.6). Conclusions: A strong association between workplace bullying and subsequent depression suggests that bullying is an aetiological factor for mental health problems. The victims of bullying also seem to be at greater risk of cardiovascular disease, but this risk may partly be attributable to overweight.

Organisational justice and health of employees: prospective cohort study.

Aims: To examine the association between components of organisational justice (that is, justice of decision making procedures and interpersonal treatment) and health of employees. Methods: The Poisson regression analyses of recorded all-cause sickness absences with medical certificate and the logistic regression analyses of minor psychiatric morbidity, as assessed by the General Health Questionnaire, and poor self rated health status were based on a cohort of 416 male and 3357 female employees working during 1998–2000 in 10 hospitals in Finland. Results: Low versus high justice of decision making procedures was associated with a 41% higher risk of sickness absence in men (rate ratio (RR) 1.4, 95% confidence interval (CI) 1.1 to 1.8), and a 12% higher risk in women (RR 1.1, 95% CI 1.0 to 1.2) after adjustment for baseline characteristics. The corresponding odds ratios (OR) for minor psychiatric morbidity were 1.6 (95% CI 1.0 to 2.6) in men and 1.4 (95% CI 1.2 to 1.7) in women, and for self rated health 1.4 in both sexes. In interpersonal treatment, low justice increased the risk of sickness absence (RR 1.3 (95% CI 1.0 to 1.6) and RR 1.2 (95% CI 1.2 to 1.3) in men and women respectively), and minor psychiatric morbidity (OR 1.2 in both sexes). These figures largely persisted after control for other risk factors (for example, job control, workload, social support, and hostility) and they were replicated in initially healthy subcohorts. No evidence was found to support the hypothesis that organisational justice would represent a consequence of health (reversed causality). Conclusions: This is the first longitudinal study to show that the extent to which people are treated with justice in workplaces independently predicts their health.

From insecure to secure employment: changes in work, health, health related behaviours, and sickness absence

Aims: To determine whether change in employment status (from fixed term to permanent employment) is followed by changes in work, health, health related behaviours, and sickness absence. Methods: Prospective cohort study with four year follow up. Data from 4851 (710 male, 4141 female) hospital employees having a fixed term or permanent job contract on entry to the study were collected at baseline and follow up. Results: At baseline, compared to permanent employees, fixed term employees reported lower levels of workload, job security, and job satisfaction. They also reported greater work ability. All fixed term employees had a lower rate of medically certified sickness absence at baseline. Baseline rate ratios for those who remained fixed term were 0.64 (95% CI 0.55 to 0.75), and were 0.50 (95% CI 0.34 to 0.75) for those who later became permanent. Continuous fixed term employment was not associated with changes in the outcome measures. Change from fixed term to permanent employment was followed by an increase in job security, enduring job satisfaction, and increased medically certified sickness absence (compared to permanent workers rate ratio 0.96 (95% CI 0.80 to 1.16)). Other indicators of work, health, and health related behaviours remained unchanged. Conclusion: Receiving a permanent job contract after fixed term employment is associated with favourable changes in job security and job satisfaction. The corresponding increase in sickness absence might be due to a reduction in presenteeism and the wearing off of health related selection.

Sickness absence as a risk factor for job termination, unemployment, and disability pension among temporary and permanent employees

Objectives: This study examined sickness absence as a risk factor for job termination, unemployment, and disability pension among temporary and permanent workers. Methods: Prospective cohort study with data on employment contract and sickness absence in 1996, job termination by 1997, and employment status in 1997 and 2000 for 19 093 temporary and 41 530 permanent public sector employees. Results: For women aged 40 years or less and for women over 40, a high sickness absence increased the risk of job termination among temporary employees (OR 1.52 (95% CI 1.36 to 1.71) and OR 1.70 (95% CI 1.36 to 2.13) respectively). High absence was not associated with job termination among men in temporary employment. Among permanent employees, high sickness absence predicted job termination among older, but not among younger employees. Temporary employees with high sickness absence were at the highest risk of immediate unemployment and unemployment three years later. Among older permanent employees, high sickness absence was associated with subsequent work disability pension. Conclusions: A high rate of sickness absenteeism increases the risk of job termination and unemployment among women in temporary public sector jobs. For permanent employees, secure employment provides protection against unemployment even in the case of high sickness absence.

Examining Overweight and Obesity as Risk Factors for Common Mental Disorders Using Fat Mass and Obesity-Associated (FTO) Genotype-Instrumented Analysis The Whitehall II Study, 1985–2004

The Mendelian randomization approach exploits genetic variants to improve causal inference when using observational data. The authors examined the relation between long-term obesity and common mental disorders (CMD) by utilizing the known relation between fat mass and obesity-associated (FTO) genotype and body mass index (BMI; weight (kg)/height (m)(2)). Data collection in 2,981 men and 1,164 women (mean age at baseline = 44 years) from the Whitehall II Study (London, United Kingdom) included 4 repeated examinations of BMI and CMD over a 19-year follow-up period (1985-2004), plus an assessment of FTO polymorphism rs1421085. In men, there was an association of FTO genotype with all measures of adiposity (mean BMI, number of times obese, and, in nonobese persons, number of times overweight). FTO was also associated with CMD in men. This was independent of adiposity, thus potentially violating the exclusion restriction assumption. According to both conventional and FTO-instrumented regression analysis, measurement of obesity was associated with an increased occurrence of CMD. In the FTO-instrumented analysis only, higher BMI and overweight were also associated with CMD. In women, there was no link between FTO and adiposity. Mendelian randomization analyses supported the status of long-term obesity as a risk factor for CMD in men-a finding that should be interpreted cautiously because the function of the FTO gene is unknown.

Contribution of non-work and work-related risk factors to the association between income and mental disorders in a working population: the Health 2000 Study.

Objectives: To examine the contribution of non-work and work factors to the association between income and DSM-IV depressive and anxiety disorders in a working population. Methods: A representative sample of the Finnish working population aged 30–64 (1667 men, 1707 women) in 2000–2001 responded to a survey questionnaire on non-work factors (marital status, housing conditions, non-work social support, violence victimisation, smoking, physical symptoms), work factors (job demands, job control, social support at work, educational prospects, job insecurity) and household income. Somatic health was examined in a standard health examination. The 12-month prevalence of depressive and anxiety disorders was examined with the Composite International Diagnostic Interview. Results: The risk of having a depressive or anxiety disorder was 2.8 times higher in the low-income group than in the high-income group among men and 2.0 times higher among women. For men, non-work and work factors explained 20% and 31% of this association, respectively. For women, the corresponding figures were 65% and 23%. Conclusions: Low income is associated with frequent mental disorders among a working population. In particular, work factors among men and non-work factors among women contribute to the income differences in mental health.

Low Childhood IQ and Early Adult Mortality: The Role of Explanatory Factors in the 1958 British Birth Cohort

OBJECTIVE: To examine whether the association between childhood IQ and later mortality risk was explained by early developmental advantages or mediated by adult sociodemographic factors and health behaviors. PARTICIPANTS AND METHODS: Participants were 10 620 men and women from the 1958 British Birth Cohort Study whose IQ was assessed at the age of 11 years and who were followed up to age 46. Childhood covariates included birth weight, childhood height at 11 years of age, problem behaviors, fathers occupational class, parents interest in childs education, family size, and family difficulties. Adult risk factors were assessed at ages 23, 33, and 42 years, and they included education, occupational class, marital status, smoking, BMI, alcohol use, and psychosomatic symptoms. RESULTS: Between ages 23 and 46 years, 192 participants died. Higher childhood IQ was related to lower mortality risk (standardized odds ratio [OR]: 0.80 [95% confidence interval (CI): 0.69–0.93]) with no gender differences (OR: 0.81 [95% CI: 0.67–0.98] [men] and 0.79 [95% CI: 0.63–0.98] [women]). Adjusting for parents interest in childs education attenuated the IQ-mortality association by 15% to 20%, and adult education and psychosomatic symptoms both attenuated the association by 25%. Other covariates were less influential. CONCLUSIONS: In a cohort of British men and women, the most important explanatory factors for the lower mortality rate among individuals with high IQ were parental interest in childs education, high adult educational level, and low prevalence of psychosomatic symptoms. However, common sociodemographic risk factors and health behaviors may not be sufficient to explain the association between IQ and early mortality completely.

The role of extended weekends in sickness absenteeism

OBJECTIVES Employees are thought to lengthen their weekends by voluntary absenteeism, but the magnitude of such potentially reversible behaviour is not known. METHODS A follow up study based on employers registers on the dates of work contracts and absences in 27u2009541 permanent full time municipal employees in five towns during 1993–7. The absence rate on each weekday separately for all sick leaves and for 1 day sick leaves was determined. RESULTS 3.4% of the male employees and 5.0% of the female employees were on sick leave daily. The mean rate of sickness absence was lowest on Mondays, after which it increased towards Wednesday, and remained on the same level for the rest of the week. This pattern applied to both sexes, to each year of the follow up, and across towns, age groups, and income groups. For 1 day sick leaves, representing 4.5% of the total sickness absenteeism, the rates of sick leave for Mondays and Fridays were 1.4 and 1.9 times greater than those for other weekdays. However, these excess rates account for less than 1% of all days lost due to sickness absenteeism. Extended weekend absences were more common in men, in young employees, and in those in a low socioeconomic position, and they varied between towns. CONCLUSION Extended weekends seem to contribute only marginally to the days lost due to sickness absenteeism.

Selenium status and blood lipids: the cardiovascular risk in young finns study

Abstract.u2002 Stranges S, Tabák AG, Guallar E, Rayman MP, Akbaraly TN, Laclaustra M, Alfthan G, Mussalo‐Rauhamaa H, Viikari JSA, Raitakari OT, Kivimäki M (Health Sciences Research Institute, University of Warwick Medical School, Coventry; University College London, London, UK; Semmelweis University Faculty of Medicine, Budapest, Hungary; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; National Center for Cardiovascular Research (CNIC), Madrid, Spain; University of Surrey, UK; National Institute of Health and Medical Research (Inserm) U888. F‐34000 Montpellier, France; National Institute for Health and Welfare, Helsinki, Finland; Hjelt Institute, University of Helsinki, Helsinki; University of Turku and Turku University Hospital, Turku; University of Turku, Turku; Finnish Institute of Occupational Health and University of Helsinki, Helsinki, Finland). Selenium status and blood lipids: the cardiovascular risk in young finns study. J Intern Med 2011; 270: 469–477.

Influence of retirement on nonadherence to medication for hypertension and diabetes

Background: The extent to which common life transitions influence medication adherence among patients remains unknown. We examined whether retirement is associated with a change in adherence to medication in patients with hypertension or type 2 diabetes. Methods: Participants in the Finnish Public Sector study were linked to national registers. We included data for the years 1994–2011. We identified and followed 3468 adult patients with hypertension and 412 adult patients with type 2 diabetes for medication adherence for the 3 years before their retirement and the 4 years after their retirement (mean follow-up 6.8 yr). Our primary outcome was proportion of patients with poor adherence to medication, which we defined as less than 40% of days covered by treatment. We determined these proportions before and after retirement using data from filled prescriptions. Results: The preretirement prevalence of poor adherence to medication was 6% in men and women with hypertension, 2% in men with diabetes and 4% in women with diabetes. Among men, retirement was associated with an increased risk of poor adherence to both antihypertensive agents (odds ratio [OR] 1.32, 95% confidence interval [CI] 1.03–1.68) and antidiabetic drugs (OR 2.40, 95% CI 1.37–4.20). Among women, an increased risk of poor adherence was seen only for antihypertensive agents (OR 1.25, 95% CI 1.07–1.46). Similar results were apparent for alternative definitions of poor adherence. Our results did not differ across strata of age, socioeconomic status or comorbidity. Interpretation: We found a decline in adherence to medication after retirement among men and women with hypertension and men with type 2 diabetes. If these findings can be confirmed, we need randomized controlled trials to determine whether interventions to reduce poor adherence after retirement could improve clinical outcomes of treatments for hypertension and diabetes.