Nicole W. H. Jansen

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.

Need for recovery in the working population: Description and associations with fatigue and psychological distress

This study examined the concept of need for recovery, that is the need to recuperate from work-induced fatigue, experienced after a day of work. The study explored the relationship between need for recovery from work, prolonged fatigue, and psychological distress in the working population. A cross-sectional study was carried out. Data of the Maastricht Cohort Study on fatigue at work were used (n = 12,095). Some degree of need for recovery was found in nearly all employees. Need for recovery from work was associated with demographic, work-related, and health factors. Principal Components Analysis revealed obvious separation between need for recovery items and both fatigue items and psychological distress items, supporting the notion that need for recovery, fatigue, and psychological distress represent different underlying concepts. Although need for recovery, fatigue, and psychological distress were frequently comorbid, they also clearly occurred as separate entities.

Work–family conflict as a risk factor for sickness absence

Objectives: (1) To study both cross-sectional and prospective relationships between work–family conflict and sickness absence from work; (2) to explore the direction of the relationships between the different types of conflict (work–home interference and home–work interference) and sickness absence; and (3) to explore gender differences in the above relationships. Methods: Data from the Maastricht Cohort Study were used with six months of follow up (5072 men and 1015 women at T6). Work–family conflict was measured with the Survey Work–Home Interference Nijmegen (SWING). Sickness absence was assessed objectively through individual record linkage with the company registers on sickness absence. Results: In the cross-sectional analyses, high levels of work–family conflict, work–home interference, and home–work interference were all associated with a higher odds of being absent at the time of completing the questionnaire, after controlling for age and long term disease. Differences in average number of absent days between cases and non-cases of work–home interference were significant for men and most pronounced in women, where the average number of absent days over six months follow up was almost four days higher in women with high versus low–medium work–home interference. Conclusions: A clear relation between work–family conflict and sickness absence was shown. Additionally, the direction of work–family conflict was associated with a different sickness absence pattern. Sickness absence should be added to the list of adverse outcomes for employees struggling to combine their work and family life.

Prevalence of common infections among employees in different work schedules.

Learning ObjectivesDiscuss possible mechanisms through which the work schedule—particularly “shift work,” which includes nighttime work—might influence the risk of contracting common infections.Compare the demographic and behavioral features of day workers and shift workers.Contrast the prevalence of common infections in day and shift workers, adjusting for type of work. This study examined the prevalence of common infections among employees in different work schedules. Self-administered questionnaire data from the Maastricht Cohort Study on “Fatigue at Work” (n = 12,140) were used. Job title was used as a matching variable between day and shift workers to control for their different work environment. We used a multilevel analysis of a two-level structure, in which the individual employees (level 1) were nested within job titles (level 2), adjusted for demographics, longstanding disease, health behavior, work-related factors, fatigue and sleep quality. Results from the multilevel analyses showed that, compared to day work, shift work was associated with a higher risk for common infections, with the highest risk in three-shift workers. Compared to day work, shift work was further associated with differences in health, health behavior, sleep, fatigue and perceived job characteristics, factors that may influence the occurrence of infections and should be taken into account in future studies as well.

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)

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.

Prevention of long-term sickness absence and major depression in high-risk employees: a randomised controlled trial

Objectives To examine the efficacy of early intervention on the prevention of long-term sickness absence and major depression among employees at high risk of future sickness absence and with mild to severe depressive complaints. Methods Randomised controlled trial conducted among employees working in an office environment. 139 employees were identified both at high risk of future sickness absence and with mild to severe depressive complaints through screening. Subsequently, they were randomly assigned to the intervention group (n=69) or the control group (n=70). Objective sickness absence was analysed at 12 and 18 months of follow-up. Depressive complaints were assessed by the Beck Depression Inventory (BDI-II) at baseline, and at 6 and 12 months of follow-up. Results Intention-to-treat analyses showed a significant difference in total sickness absence duration between the intervention (27.5 calendar days (SD 44.7)) and control group (50.8 days (SD 75.8)) over 12 months of follow-up, a reduction of 46% (p=0.017). The intervention group showed a non-significantly lower proportion of long-term sickness absence spells compared with the control group (p=0.127). Statistically significant and clinically relevant differences in depressive complaints were found after both 6 months (p=0.001) and 12 months (p=0.005) of follow-up, in favour of the intervention group. Relative risk reductions (RRR) were 19.2% and 19.8% respectively. Sickness absence data were available for all participants over 18 months of follow-up. Questionnaire data were available for 99 (at 6 months) and 90 participants (at 12 months). No adverse events or side effects occurred. Conclusions Early intervention in employees with mild to severe depressive complaints and high risk of future long-term sickness absence proved to be effective in preventing/reducing both sickness absence and depressive complaints.

Depressive complaints as a predictor of sickness absence among the working population.

Objective: To study the relationship between depressive complaints and sickness absence in the working population. Methods: Data from a prospective epidemiological cohort (n = 3339) were used. Depressive complaints were measured with the Hospital Anxiety and Depression (HAD-D) Scale. Sickness absence was assessed objectively through individual record linkage with the company registers. Results: Higher levels of depressive complaints were associated with a shorter time to first sickness absence spell and a longer duration of sickness absence. In women with mild depressive complaints, the average number of sickness absence days over 10 months follow-up was 27.37 (SD = 64.73) days versus 11.01 (SD = 30.03) days (P < 0.001) in employees scoring within the reference range. In men this was 14.48 (SD = 38.73) days versus 7.67 (SD = 25.80) days (P < 0.001). Conclusions: Prevention of mild depressive complaints might be beneficial in preventing future sickness absence.

Changes in mental health as a predictor of changes in working time arrangements and occupational mobility : results from a prospective cohort study

OBJECTIVE The aim of this prospective study was to gain insight into a possible causal relationship between mental health and characteristics of the work situation. METHODS Using longitudinal data from the Maastricht Cohort Study, this study examines whether deterioration in mental health (prolonged fatigue, need for recovery, and psychological distress) results in a subsequent change in working time arrangements (assessed by means of logistic regression analysis) or occupational mobility (assessed by means of Cox regression analysis). RESULTS Compared to employees not experiencing a deterioration in mental health, employees who became a prolonged fatigue case were more likely to reduce their working hours (OR 2.49; 95% CI 1.42-4.35) and leave a shift work job (OR 3.44; 95% CI 1.42-8.38). Employees who became a need for recovery case were more likely to reduce their working hours (OR 2.83; 95% CI 1.53-5.26) or change jobs within the company (RR 1.31; 95% CI 1.07-1.61). Employees who became a psychological distress case were more likely to change jobs within the company (RR 1.38; 95% CI 1.16-1.65) or to change jobs from one employer to another (RR 1.45; 95% CI 1.03-2.03). CONCLUSION The results of this study provide evidence for a possible causal relationship between deterioration in mental health and subsequent change in working time arrangements or occupational mobility. These results suggest that workers adapt to the onset of a mental health problem by reducing their working hours, by leaving a shift work job, by changing jobs within the company, or by changing jobs from one employer to another.