Niels Westergaard-Nielsen

Psychiatric illness and risk factors for suicide in Denmark.

BACKGROUNDnSeveral risk factors for suicide have been identified. We assessed the relative risks and population attributable risks of suicide associated with various socioeconomic factors and with previous mental illness that necessitated hospital admission. Our aim was to assist in the choice of potential strategies for preventing suicide in the general population.nnnMETHODSnWe did a population-based nested case-control study based on register data. Data were collected on a random 5% sample of the Danish population aged 16-78 years during a 15-year period (1980-94) and analysed with conditional logistic regression.nnnFINDINGSn811 cases of suicide were found and 79871 controls were chosen in this population. Unemployment, low income, being single, and a history of mental illness necessitating hospital admission were associated with increased risk of suicide. However, in the multivariate analysis, the strongest risk factor was mental illness necessitating hospital admission; risk of suicide was especially high during admission (relative risk 62.6 [95% CI 41.1-95.4]) and during the year after discharge (6.51 [5.03-8.44]). The effect of socioeconomic variables decreased after adjustment for history of mental illness. The population attributable risk associated with mental illness necessitating admission to hospital was 44.6% (43.6-45.5); the attributable risks associated with the other factors were 3.0% (1.4-6.6) for unemployment and 10.3% (6.13-16.9) for being single.nnnINTERPRETATIONnSuicide prevention aimed at patients who are admitted to hospital with mental disorders and improved detection and treatment of mental disorders in the general population may be the most efficient strategy to decrease risk of suicide. Reports of high relative risk and attributable risk associated with unemployment and other socioeconomic risk factors may be confounded and overestimated owing to the lack of adjustment for the association with mental disorders.

Age Structure of the Workforce and Firm Performance

In this contribution, we examine the interrelation between corporate age structures and firm performance. In particular, we address the issues, whether firms with young rather than older employees are successful and whether firms with homogeneous or heterogeneous workforces are doing well. Several theoretical approaches are discussed with respect to these questions and divergent hypotheses are derived. Using Danish linked employer-employee data, we find that both mean age and dispersion of age in firms are inversely u-shaped related to firm performance.

The Dispersion of Employees? Wage Increases and Firm Performance

Previous studies examining intra-firm wage dispersion and firm performance have focused on wage levels. The authors of this study argue that for purposes of comparing wage dispersions positive incentive effects with its adverse morale effects, the dispersion of wage increases is more revealing than the dispersion of wage levels. It is reasonable to expect greater dispersion of wage increases to be associated with higher monetary incentives, but also with increased perceptions of unfairness. The authors analysis of linked employer-employee data from Denmark for the years 1992–97 shows that the dispersion of wage growth within firms generally had a negative association with firm performance. The results are robust across industries and categories of firm size, but are mainly driven by white-collar rather than blue-collar workers.

Returns to tenure, firm‐specific human capital and worker heterogeneity

Workers with longer job tenure are paid more, on average, than those with shorter tenure. This paper re‐opens the debate about whether individual financial returns to tenure are due to firm‐specific human capital accumulation or sorting according to unobserved individual productivity heterogeneity. The paper constructs worker‐firm employment histories 1964‐1998 for all residents of Denmark and links this to wage and demographic information for all private sector workers 1980‐1998. All firm closures are observed, and following Kletzer we exploit these exogenous worker displacements from larger firms to distinguish between firm‐specific human capital and worker heterogeneity. Although the proportion of tenure returns due to firm‐specific human capital is smaller than that found in the USA, it has increased from 10 per cent in 1980 to 30 per cent in 1998 in Denmark. This change coincides with decentralisation of the wage bargaining process and may be explained by the increased freedom to write individual contracts.

Risk of suicide in relation to income level in people admitted to hospital with mental illness: nested case-control study.

# Risk of suicide in relation to income level in people admitted to hospital with mental illness: nested case-control study {#article-title-2}nnPeople at higher risk of suicide, such as those who are socially and economically disadvantaged, are also at high risk of being admitted to hospital with a mental illness.1 2 In some cases it seems that mental illness is a factor on the causal pathway between social position and suicide. 2 3 However, Mortensen and colleagues showed that the importance of socioeconomic variables as risk factors for suicide was reduced after adjustment was made for a history of mental illness.3 We present findings on 811 cases of suicide and 80 787 matched control subjects in a population based study which aimed to gain further insight into the association between social position and mental disorder.nnWe used the Danish medical registers on vital statistics to establish a random, 5%, population based sample of 811 people who had committed suicide between 1982 and 1994. Up to 1983, suicide was defined as ICD-8 codes E950-959; for 1994, ICD-10 codes X60-X84 were applied. Each person who had committed suicide was matched with approximately 100 people of the same sex and year of birth who were alive on the date of the suicide. Information on dates of hospital admission and discharge and details of diagnoses was drawn from the Danish psychiatric central register, which has monitored all psychiatric inpatient facilities since 1969. Socioeconomic data on case and control subjects from two years before the suicide were added from the longitudinal labour market register. Detailed description of the registers can be found in Mortensen et al.3nnThe main variables included were annual gross income (wages, pensions, unemployment and social security benefits, and interest), grouped into fourths, and hospital admission status in relation to mental illness. Hospital admission status was categorised as follows: never admitted, currently admitted or first discharge within the present or …

Personnel policy and profit.

Abstract There is a growing awareness of large differences in worker turnover and pay between firms. However, there is little knowledge about the effects of this on firm performance. This paper describes how personnel policies with respect to pay, tenure, and worker flows are related to economic performance of the firm. Here we follow the population of 7118 medium- to large-sized private sector Danish firms over the period 1992–1995. In an instrumental variables framework, we use changes in the personnel composition of different firms operating in the same local labour market to provide exogenous identifying personnel structure variation. It is found that personnel policy is strongly related to economic performance. At the margin, more hires are associated with lower profit, and more separations with higher profit. For the average firm, one new job, all else equal, is associated with 2680 euros (2000 prices) lower annual profit. Higher wage level and lower wage growth are associated with higher profit. A workforce that has less tenure, all else equal, is more profitable.

Global measure of satisfaction with psychosocial work conditions versus measures of specific aspects of psychosocial work conditions in explaining sickness absence.

BackgroundAttempts to identify particular aspects of psychosocial work conditions as predictors of sickness absence remain inconclusive. A global measure has previously been suggested to be an efficient way to measure psychosocial work conditions in questionnaires. This paper investigates whether satisfaction with specific aspects of psychosocial work conditions explains sickness absence beyond its association with a global measure of psychosocial work conditions.MethodsThe participants were 13,437 employees from 698 public service workplaces in Aarhus County, Denmark. 33 items from a questionnaire fell in groupings around six aspects of psychosocial work conditions: skill discretion, professionalism, management, decision authority, workload and cooperation. A global measure rating satisfaction with psychosocial work conditions on a scale from 0 to 10 was also included in the questionnaire. Individual ratings were aggregated to workplace scores. Analysis of variance and multiple linear regression was used to compare the average number of days of yearly sickness absence with different levels of satisfaction with six aspects of psychosocial work conditions. The covariates included were gender, age, occupation, size of workplace, contact to hospital, civil status and children below 13 living at home.ResultsDissatisfaction with each of the six aspects of psychosocial work conditions was associated with an increase in sickness absence. When all aspects were simultaneously included in the model, only skill discretion and professionalism were negatively associated with sickness absence. When a global measure of satisfaction with psychosocial work conditions was also included in the model none of the specific aspects showed a statistically significant association with sickness absence.ConclusionLow global satisfaction with psychosocial work conditions is associated with increased levels of sickness absence. Including specific aspects of psychosocial work conditions in the model does not provide further information regarding the nature of this association.

Job strain and ischemic heart disease: a prospective study using a new approach for exposure assessment.

Background: Prolonged psychosocial load at the workplace may increase the risk of ischemic heart disease (IHD), but the issue is still unsettled. We analyzed the association between psychosocial workload and risk of IHD using a new approach allocating measures of psychosocial load to individuals based on the average exposure level in minor work units. Methods: Cohort study of 18,258 Danish public service workers in 1106 work units; 79% were women; 108 subjects with history of cardiovascular disease were excluded from the follow-up. The outcome was hospitalization due to IHD (angina pectoris or myocardial infarction) during the period 2002 to end of 2007. Results: During 87,428 person-years at risk (mean follow-up = 4.82 years), 101 subjects were admitted to a hospital due to IHD. Neither job strain (synergy of job demands and job control) nor general job dissatisfaction were related to IHD risk. However, compared with others, subjects who were allocated to the low job control category, had an increased risk of IHD, Hazard Ratio (95% CI) = 2.0 (1.1 to 3.6). Conclusions: The findings presented do not lend support to the hypothesis that high job strain and job dissatisfaction are important determinants for IHD among Danish predominantly female public service workers.

Sickness absence and workplace levels of satisfaction with psychosocial work conditions at public service workplaces.

BACKGROUNDnThe objective of this study was to examine the impact of psychosocial work conditions on sickness absence while addressing methodological weaknesses in earlier studies.nnnMETHODSnThe participants were 13,437 employees from 698 public service workplace units in Aarhus County, Denmark. Satisfaction with psychosocial work conditions was rated on a scale from 0 (low) to 10 (high). Individual ratings were aggregated to workplace scores. Analysis of variance was used to compare the average number of days of yearly sickness absence in three groups with different levels of satisfaction with psychosocial work conditions.nnnRESULTSnSickness absence was 30.8% lower in the most satisfied group (11.7 days/year (CI 95%: 10.2; 13.1)) than in the least satisfied group (16.9 days/year (CI 95%: 15.3; 18.6)) adjusted for the covariates included.nnnCONCLUSIONSnSatisfaction with psychosocial work conditions has a strong and independent impact on sickness absence. Am. J. Ind. Med. 52:153-161, 2009. (c) 2008 Wiley-Liss, Inc.

Unemployment and Mental Disorders: Evidence from Danish Panel Data

This article addresses unemployment and related social factors as risk factors for impaired mental health. Departing from earlier studies of unemployment and mental health, we use first admissions to a psychiatric hospital or ward as our measure of mental illness. We construct the data by merging a longitudinal, representative sample of the Danish population aged 15-64 containing detailed annual information about labor market behaviour, incomes, and sick leaves during a 12-year period with a panel encompassing all cases of psychiatric illnesses and their diagnoses. We estimate conditional logistic regression models for case-control data with unemployment and other labor market statuses during the years preceding the first admission as the key explanatory variables. We find that experiences of long- and medium-term unemployment are followed by an increased probability of the individual being admitted for the first time to a psychiatric hospital. While the impact of previous unemployment experience does not differ between high and low unemployment regions, it differs across phases of the business cycle. This result implies that the eventual impact of a prolonged deep recession is likely to be smaller than expected from the experience from normal times.