Paul Maurice Conway

Is sickness presenteeism a risk factor for depression? A Danish 2-year follow-up study.

Objective: To examine the prospective association between sickness presenteeism (SP), that is, working while ill, and the onset of depression. Methods: We carried out a two-wave (2006 to 2008) questionnaire-based study among 1271 employees from 60 Danish workplaces. Sickness presenteeism was assessed by asking participants to report the number of days that they went to work despite illness in the preceding year. Results: Multivariate logistic regression revealed that, after controlling for several health-related variables and other relevant confounders, reporting 8 or more days of SP was associated with an increased risk of depression among initially nondepressed participants (odds ratio, 2.45; 95% confidence interval, 1.06 to 5.64). No significant sex-related differences were observed in this relationship. Conclusion: Adding to previous evidence on the health effects of SP, this study suggests that working while ill may also be a significant risk factor for the development of depression.

Workplace bullying and sickness presenteeism: cross-sectional and prospective associations in a 2-year follow-up study

PurposeThe aim of this study was to investigate exposure to workplace bullying as a potential risk factor for sickness presenteeism (SP), i.e. working while ill.MethodsThis study is based on data collected through self-reported questionnaires in a 2-year prospective study on employees in Denmark. At baseline, 3363 employees (45.7xa0% response rate) answered to a questionnaire on their psychosocial work environment and health status. After 2xa0years, 1664 of the respondents also completed a follow-up questionnaire (49.5xa0% of the total baseline respondents). After excluding participants with missing values, the final samples were composed of 2865 and 1331 participants in the cross-sectional and prospective analyses, respectively.ResultsModified poisson regression analyses showed that frequent (i.e. daily or weekly) exposure to workplace bullying was associated with reporting 8 or more days of SP in the preceding year in both the cross-sectional and the prospective analysis, also when controlling for several confounders including health-related variables. However, the prospective relationship became non-significant after adjustment for baseline SP.ConclusionThis study provides indications of a significant relationship between exposure to frequent workplace bullying and SP, although causal connections could not be established. Methodological and theoretical considerations about study findings are provided, which could be of benefit to future studies examining the impact of being a target of workplace bullying on SP.

Negative Acts at Work as Potential Bullying Behavior and Depression: Examining the Direction of the Association in a 2-Year Follow-Up Study.

Objective: This study investigates the 2-year prospective association between exposure to negative acts at work and depression. Methods: A questionnaire study was carried out among 3363 employees and followed up 2 years later. Negative acts as potential bullying behavior were assessed by the Revised Negative Acts Questionnaire and depression by The Major Depression Inventory or Schedule for Clinical Assessment in Neuropsychiatry interviews. Logistic regression analyses tested potential associations between depression and negative acts. Results: Exposure to negative acts was associated with depression 2 years later; however, when adjusting for Sense of Coherence and depressive symptoms at baseline the association was no longer significant. Conversely, depression at baseline predicted self-reported exposure to negative acts at follow-up. Conclusions: Depression predicts exposure to negative acts at a 2-year follow-up, whereas negative acts do not predict depression after adjustment for Sense of Coherence and baseline depressive symptoms.

Confirmatory factor analysis of the Patient Assessment of Constipation-Symptoms (PAC-SYM) among patients with chronic constipation.

Background and aimPAC-SYM is widely adopted to asses constipation severity. However, it has been validated in a small sample, few items have been included based on expert opinion and not on empirical grounds, and its factor structure has never been replicated. We aimed at evaluating the psychometric properties of PAC-SYM in patients with chronic constipation.MethodsWe enrolled 2,203 outpatients with chronic constipation in two waves. We used wave I sample to test the psychometric properties of the PAC-SYM and wave II sample to cross-validate its factor structure, to assess criterion validity, responsiveness to clinical change, and its minimal clinically important difference.ResultsOnly a minority of patients reported any rectal tearing (38xa0%). Deletion of such item leads to a 11-item version (M:PAC-SYM). The remaining items in the rectal domain were moderately correlated with the stool domain. Exploratory factor analysis and confirmatory factor analysis revealed a bifactor structure with two subscales (stool and abdominal symptoms) and a general severity factor. The M:PAC-SYM demonstrated excellent reliability, moderate correlation with SF-12 and treatment satisfaction (rxa0=xa00.28–0.45), discrimination across Rome III criteria for functional constipation and abdominal pain, and responsiveness to clinical change (βxa0=xa0−0.49; ω2xa0=xa00.25). M:PAC-SYM minimal clinically important difference was 0.24.ConclusionOur analysis shows that the rectal domain may not represent a relevant cluster of symptoms for patients with chronic constipation. We developed a modified version of the PAC-SYM which might better represent symptom severity of most patients seeking care in gastroenterology referral centers.

Do Personal Dispositions Affect the Relationship Between Psychosocial Working Conditions and Workplace Bullying

There is scarce research on the interaction between psychosocial working conditions and being a target of workplace bullying with individual characteristics as a moderator. We therefore examined 3,363 employees from 60 Danish workplaces to test whether sense of coherence moderates the relationship between the job demand-control model and bullying. This work is exploratory in nature, as no previous study to assess this moderation was found. Hierarchical linear regressions showed that demand-control model was significantly associated with bullying. Sense of coherence displayed a significant though practically negligible moderating effect. This suggests that negative psychosocial working conditions are associated with bullying independently of personal characteristics, at least in terms of sense of coherence.

The role of poor sleep in the relation between workplace bullying/unwanted sexual attention and long-term sickness absence

PurposeWhile exposure to bullying and unwanted sexual attention was previously found to increase the risk of sickness absence, the underlying mechanisms are largely unknown. Poor sleep can be a consequence of stressful exposures and a cause of poor health, and poor sleep is also a determinant of insufficient recovery. Therefore, the present study investigated whether poor sleep mediates and/or moderates the association between bullying and unwanted sexual attention, on the one hand, and long-term sickness absence (LTSA), on the other hand.MethodsWe used questionnaire data from 7650 individuals contributing with 15,040 2-year observation periods. Workplace bullying, unwanted sexual attention, disturbed sleep, and difficulties awakening were measured at three time points, and participants were followed in registers to measure the occurrence of LTSA, defined as ≥30 consecutive days of sickness absence during the subsequent 2xa0years.ResultsThe odds of LTSA were significantly increased by workplace bullying (OR 1.77; 95xa0% CI 1.50–2.12) and unwanted sexual attention (OR 1.55; 95xa0% CI 1.06–2.29). Together, disturbed sleep and difficulties awakening mediated 12.8xa0% (95xa0% CI 8.1–19.8) of the association between bullying and long-term sickness absence, and 8.5xa0% (95xa0% CI −0.45 to 37.1) of the association between unwanted sexual attention and long-term sickness absence in the fully adjusted model. Neither disturbed sleep nor difficulties awakening moderated these associations.ConclusionAs expected, bullying and unwanted sexual attention were prospectively associated with long-term sickness absence. Only a small part of this association was mediated by poor sleep.

Predictive Validity of the Columbia-Suicide Severity Rating Scale for Short-Term Suicidal Behavior: A Danish Study of Adolescents at a High Risk of Suicide

Using the Columbia-Suicide Severity Rating Scale (C-SSRS), we examined the predictive and incremental predictive validity of past-month suicidal behavior and ideation for short-term suicidal behavior among adolescents at high risk of suicide. The study was conducted in 2014 on a sample of 85 adolescents (90.6% females) who participated at follow-up (85.9%) out of the 99 (49.7%) baseline respondents. All adolescents were recruited from a specialized suicide-prevention clinic in Denmark. Through multivariate logistic regression analyses, we examined whether baseline suicidal behavior predicted subsequent suicidal behavior (actual attempts and suicidal behavior of any type, including preparatory acts, aborted, interrupted and actual attempts; mean follow-up of 80.8 days, SD = 52.4). Furthermore, we examined whether suicidal ideation severity and intensity incrementally predicted suicidal behavior at follow-up over and above suicidal behavior at baseline. Actual suicide attempts at baseline strongly predicted suicide attempts at follow-up. Baseline suicidal ideation severity and intensity did not significantly predict future actual attempts over and above baseline attempts. The suicidal ideation intensity items deterrents and duration were significant predictors of subsequent actual attempts after adjustment for baseline suicide attempts and suicidal behavior of any type, respectively. Suicidal ideation severity and intensity, and the intensity items frequency, duration and deterrents, all significantly predicted any type of suicidal behavior at follow-up, also after adjusting for baseline suicidal behavior. The present study points to an incremental predictive validity of the C-SSRS suicidal ideation scales for short-term suicidal behavior of any type among high-risk adolescents.

Does perceived stress mediate the association between workplace bullying and long-term sickness absence?

Objective: To examine if perceived stress mediated the association between workplace bullying and subsequent long-term sickness absence. Methods: The PRISME cohort was established in 2007 and re-examined in 2009. Questionnaire data about workplace bullying and perceived stress were obtained from 4114 individuals. Participants were followed in registers on long-term sickness absence (≥30 consecutive days of sickness absence). Results: Workplace bullying was associated with subsequent sickness absence (odds ratio [OR]u200a=u200a2.05; 95% confidence interval [CI]: 1.57 to 2.65) and concurrent high perceived stress levels (ORu200a=u200a2.34; 95% CI: 1.86 to 2.96). A high perceived stress level was also associated with subsequent sickness absence (ORu200a=u200a1.33; 95% CI: 1.13 to 1.56). Perceived stress explained 13% (95% CI: 6 to 23%) of the total association between bullying and sickness absence. Conclusions: The association between workplace bullying and subsequent long-term sickness absence may be partially mediated by perceived stress.

Exposure to negative acts and risk of turnover: a study of a register-based outcome among employees in three occupational groups.

PurposeTo investigate whether self-reported exposure to negative acts in the workplace (bullying and threats of violence) predicted turnover in three occupational groups (human service and sales workers, office workers and manual workers).MethodsSurvey data on 2766 respondents were combined with data from a national labour force register to assess turnover. Mixed effects logistic regression analysis was used to examine the association between self-reported exposure to negative acts at baseline and risk of turnover after a 1-year follow-up.ResultsWe found no significant associations between exposure to negative acts (bullying and threats of violence) and risk of turnover. When participants were stratified by occupational group and analyses were adjusted for age, gender, tenure and psychosocial working conditions, we found that exposure to bullying predicted risk of turnover in office workers (OR 2.03, 95xa0% CI 1.05–3.90), but neither in human service and sales workers, nor in manual workers. The association in office workers lost statistical significance when additionally adjusted for depressive symptoms (OR 1.77, 95xa0% CI 0.90–3.49). However, in a sensitivity analysis in which we used a 2-year (instead of a 1-year) follow-up period the association between bullying and turnover remained statistically significantxa0in office workers even after adjusting for depressive symptoms (OR 2.10, 95xa0% CI 1.17–3.76). We found no statistically significant associations between threats of violence and risk of turnover in the stratified analyses.ConclusionExposure to bullying predicted risk of turnover among office workers but not among human service and sales workers and among manual workers. Threats of violence were not associated with turnover in any occupational group.

A cohort study on self-reported role stressors at work and poor sleep: does sense of coherence moderate or mediate the associations?

AimThe aim of the present study was to examine the bidirectional associations between subjective role ambiguity and role conflicts at work, respectively, and self-reported sleep 2xa0years later. In addition, we also examine whether sense of coherence (SOC) moderate or mediate the association between role stressors and poor sleep and between poor sleep and role stressors.MethodsWe used questionnaire data collected in 2006 and 2008 from the Workplace Bullying and Harassment cohort. In 2006, 3363 responded to the questionnaire and in 2008 1671 responded. In total, 1569 participants responded in both 2006 and 2008 to the questions on role stressors (in terms of role ambiguity and role conflicts at work) and sleep problems in both 2006 and 2008. Sleep problems were assessed with the awakening index (AWI) and the disturbed sleep index (DSI). Moderation and mediation analyses of the association were estimated using structural equation modelling.ResultsWe found a prospective association between role stressors and sleep problems [beta values were 0.07 (95% CI 0.03–0.11) and 0.05 (CI 0.01–0.10) for DSI and AWI, respectively] when adjusting for sleep problems at baseline, age, sex, and life style factors (i.e. alcohol, smoking, and leisure time physical activity). SOC moderated the association showing that participants with lower SOC scores who reported higher role ambiguity reported sleep problems to a higher extent than participants with high SOC scores. SOC also mediated the association between role stressors and sleep problems. We also found support for sleep problems at baseline and role stressors 2xa0years later [DSI 0.04 (CI 0.00–0.08) and 0.15 (CI 0.09–0.21)] for role ambiguity and role conflicts, respectively. Similar results were observed for AWI.ConclusionSubjective role stressors were prospectively associated with sleep problems. Yet, sleep problems could also prospectively predict subjective role stressors (i.e. reverse causation). The analyses also showed that SOC may be regarded as both a mediating and a moderating factor of the association between subjective role conflicts and poor sleep. We found that SOC moderated the prospective association so participants with low SOC report more sleep problems with subjective role conflicts compared to participants with high SOC. Finally, we also found SOC mediated the prospective association between subjective role stressors and sleep problems and the reverse association.