Paulien M. Bongers

The relationships between work characteristics and mental health: Examining normal, reversed and reciprocal relationships in a 4-wave study

This longitudinal study examined the causal relationships between job demands, job control and supervisor support on the one hand and mental health on the other. Whereas we assumed that work characteristics affect mental health, we also examined reversed causal relationships (mental health influences work characteristics). Further, the topic of the appropriate time lag for testing causal relationships was addressed. Our hypotheses were tested in a 4-wave study among a heterogeneous sample of 668 Dutch employees using structural equation modelling. The results provide evidence for reciprocal causal relationships between the work characteristics and mental health, although the effects of work characteristics on well-being were causally predominant. The best model fit was found for a 1-year time lag. Compared to earlier—predominantly cross-sectional—results, the present study presents a stronger case for the effects of work characteristics on the development of strain. The results also emphasize the need for a dynamic view of the relationship between work and health; the one-directional viewpoint in many work stress models does not seem to fully capture the relations between work characteristics and well-being.

The relation between body mass index and musculoskeletal symptoms in the working population

BackgroundThe primary aim of this study was to investigate the association between BMI and musculoskeletal symptoms in interaction with physical workload. In addition, it was aimed to obtain insight into whether overweight and obesity are associated with an increase in occurrence of symptoms and/or decrease in recovery from symptoms.MethodsBased on a large working population sample (nu2009=u200944,793), using the data from The Netherlands Working Conditions Survey (NWCS), logistic regression analyses were carried out to investigate the association between BMI and musculoskeletal symptoms, with adjustment for potential confounders. Longitudinal data from the Netherlands Working Conditions Cohort Study (NWCCS) of 7,909 respondents was used for the second research aim (i.e., to investigate the transition in musculoskeletal symptoms).ResultsFor high BMI an increased 12-month prevalence of musculoskeletal symptoms was found (overweight: OR 1.13, 95% CI: 1.08-1.19 and obesity: OR 1.28, 95% CI: 1.19-1.39). The association was modified by physical workload, with a stronger association for employees with low physical workload than for those with high physical workload. Obesity was related to developing musculoskeletal symptoms (OR 1.37, 95% CI: 1.05-1.79) and inversely related to recovery from symptoms (OR 0.76, 95% CI: 0.59-0.97).ConclusionBMI was associated with musculoskeletal symptoms, in particular symptoms of the lower extremity. Furthermore, the association differed for employees with high or low physical workload. Compared to employees with normal weight, obese employees had higher risk for developing symptoms as well as less recovery from symptoms. This study supports the role of biomechanical factors for the relationship between BMI and symptoms in the lower extremity.

Factors associated with the ability and willingness to continue working until the age of 65 in construction workers

ObjectivesThe working population is aging and a shortage of workers is expected in the construction industry. As a consequence, it is considered necessary that construction workers extend their working life. The purpose of this study was to explore factors associated with construction workers’ ability and willingness to continue working until the age of 65.MethodsIn total, 5,610 construction workers that participated in the Netherlands Working Conditions Survey filled out questionnaires on demographics, work-related and health-related factors, and on the ability and willingness to continue working until the age of 65. Logistic regression analyses were applied.ResultsOlder workers were more often able, but less willing, to continue working until the age of 65. Frequently using force, lower supervisor support, lower skill discretion, and the occurrence of musculoskeletal complaints were associated with both a lower ability and willingness to continue working. In addition, dangerous work, occasionally using force, working in awkward postures, lack of job autonomy, and reporting emotional exhaustion were associated with a lower ability to continue working, whereas working overtime was associated with a higher ability. Furthermore, low social support from colleagues was associated with a higher willingness.ConclusionIn addition to physical job demands, psychosocial job characteristics play a significant role in both the ability and willingness to continue working until the age of 65 in construction workers. Moreover, preventing musculoskeletal complaints may support the ability and willingness to continue working, whereas preventing emotional exhaustion is relevant for the ability to continue working.

Pathways through which health influences early retirement: a qualitative study

BackgroundDue to the aeging of the population, there is a societal need for workers to prolong their working lives. In the Netherlands, many employees still leave the workforce before the official retirement age of 65. Previous quantitative research showed that poor self-perceived health is a risk factor of (non-disability) early retirement. However, little is known on how poor health may lead to early retirement, and why poor health leads to early retirement in some employees, but not in others. Therefore, the present qualitative study aims to identify in which ways health influences early retirement.MethodsFace-to-face semi-structured interviews were conducted with 30 employees (60–64xa0years) who retired before the official retirement age of 65. Participants were selected from the Study on Transitions in Employment, Ability and Motivation. The interviews were transcribed verbatim, a summary was made including a timeline, and the interviews were open coded.ResultsIn 15 of the 30 persons, health played a role in early retirement. Both poor and good health influenced early retirement. For poor health, four pathways were identified. First, employees felt unable to work at all due to health problems. Second, health problems resulted in a self-perceived (future) decline in the ability to work, and employees chose to retire early. Third, employees with health problems were afraid of a further decline in health, and chose to retire early. Fourth, employees with poor health retired early because they felt pushed out by their employer, although they themselves did not experience a reduced work ability. A good health influenced early retirement, since persons wanted to enjoy life while their health still allowed to do so. The financial opportunity to retire sometimes triggered the influence of poor health on early retirement, and often triggered the influence of good health. Employees and employers barely discussed opportunities to prolong working life.ConclusionsPoor and good health influence early retirement via several different pathways. To prolong working life, a dialogue between employers and employees and tailored work-related interventions may be helpful.

Effectiveness of an intervention at construction worksites on work engagement, social support, physical workload, and need for recovery: results from a cluster randomized controlled trial.

BackgroundTo prolong sustainable healthy working lives of construction workers, a worksite prevention program was developed which aimed to improve the health and work ability of construction workers. The aim of the current study was to investigate the effectiveness of this program on social support at work, work engagement, physical workload and need for recovery.MethodsFifteen departments from six construction companies participated in this cluster randomized controlled trial; 8 departments (n=171 workers) were randomized to an intervention group and 7 departments (n=122 workers) to a control group. The intervention consisted of two individual training sessions of a physical therapist to lower the physical workload, a Rest-Break tool to improve the balance between work and recovery, and two empowerment training sessions to increase the influence of the construction workers at the worksite. Data on work engagement, social support at work, physical workload, and need for recovery were collected at baseline, and at three, six and 12 months after the start of the intervention using questionnaires.ResultsNo differences between the intervention and control group were found for work engagement, social support at work, and need for recovery. At 6 months follow-up, the control group reported a small but statistically significant reduction of physical workload.ConclusionThe intervention neither improved social support nor work engagement, nor was it effective in reducing the physical workload and need for recovery among construction workers.Trial registrationNTR1278

The relative contribution of work exposure, leisure time exposure, and individual characteristics in the onset of arm-wrist-hand and neck-shoulder symptoms among office workers

PurposeTo identify the risk factors for the onset of arm–wrist–hand and neck–shoulder symptoms among office workers and to estimate the relative contribution of these risk factors by calculating Population Attributable Fractions (PAFs).MethodsA prospective cohort study was conducted among 1951 office workers with a follow-up duration of 2xa0years. Data on self-reported risk factors were collected at baseline and after 1xa0year of follow-up. Every 3xa0months, the occurrence of upper extremity symptoms was assessed using questionnaires. PAFs for individual risk factors were estimated based on Rate ratios (RRs) obtained from Poisson regression using Generalized Estimation Equations.ResultsPrevious disabling symptoms were identified as the most important risk factor for the onset of arm–wrist–hand and neck–shoulder symptoms. Modifiable risk factors for arm–wrist–hand symptoms with relatively large PAFs were: at least 4xa0h per day of self-reported computer use at work, high level of overcommitment, and low task variation and for neck-shoulder symptoms: supporting the arms during keyboard use and at least 4xa0h per day of self-reported mouse use at work. Compared to having 0 or 1 risk factor, the RR for arm–wrist–hand symptoms increased to 6.2 (95% CI 3.7–10.5) for having 5–7 potentially modifiable risk factors and for neck–shoulder symptoms to 3.0 (95% CI 2.1–4.4) for having 4 or 5 potentially modifiable risk factors.ConclusionPreventive interventions at the population level should be aimed at changing modifiable risk factors with large PAFs. At the individual level, preventive interventions should be aimed at changing multiple modifiable risk factors simultaneously.

Workstyle and overcommitment in relation to neck and upper limb symptoms

Few studies have examined the concepts of workstyle and overcommitment in relation to the occurrence of neck and upper limb symptoms. The aim of this study was to examine whether a high-risk workstyle is a mediator in the relation of work-related exposure (job demands and computer work) and overcommitment to neck and upper limb symptoms. The study participants comprised 3,855 office workers of a European institute. The Sobel test was applied to test the intermediate effects of 4 workstyle dimensions and of the total workstyle score. The results show that most mediated effects were statistically significant, meaning that the workstyle dimensions acted as a mediator in the relation between work-related exposure and symptoms as well as in the relation between overcommitment and symptoms. Given the results with the total workstyle score, 34% of the effect of prolonged computer work, 64% of the effect of job demands, and 84% of the effect of overcommitment was mediated by workstyle. However, due to possible bias in the assessment of workstyle factor and the crosssectional design of the study, the conclusions should be drawn with care.

Equal task, equal exposure? Are men and women with the same tasks equally exposed to awkward working postures?

The aim of the study was to determine whether men and woman with equal tasks perform these tasks in the same way. Video recordings of 37 male and 43 female workers in six task groups were observed, from which data regarding frequency and duration of exposure to awkward postures were derived. These data were also compared to self-reported exposures. The results showed that when level, duration and frequency of exposure were analysed at the same time, men and women had slightly different exposure patterns. However, these differences were not found when duration and frequency were analysed separately. From the questionnaires it appeared that men and women generally report similar exposures, but they seemed to over-report their exposure compared to the observed exposures. It is concluded that gender differences in exposure to awkward postures within the same task were small at most and cannot explain the female excess in musculoskeletal symptoms.

A worksite prevention program for construction workers: design of a randomized controlled trial

BackgroundA worksite prevention program was developed to promote the work ability of construction workers and thereby prolong a healthy working life. The objective of this paper is to present the design of a randomized controlled trial evaluating the effectiveness of that intervention program compared with usual care for construction workers.MethodsThe study is designed as a randomized controlled trial with a follow-up of one year. Employees eligible for this study are construction workers performing actual construction work. The worksite intervention will be compared with usual care. This intervention was developed by using the Intervention Mapping approach and consists of the following components: (1) two individual training sessions of a physical therapist to lower the physical workload, (2) a Rest-Break tool to improve the balance between work and recovery, and (3) two empowerment training sessions to increase the influence of the construction workers at the worksite. Outcome measures are assessed at baseline, 3, 6, and 12 months. The primary outcome measures of this study are work ability and health-related quality of life. Secondary outcome measures include need for recovery, musculoskeletal complaints, work engagement and self efficacy. Cost-effectiveness will be evaluated from the company perspective. Moreover, a process evaluation will be conducted.DiscussionThe feasibility of the intervention and the study has been enhanced by creating an intervention program that explicitly appeals to construction workers and will not interfere too much with the ongoing construction. The feasibility and effectiveness of this worksite prevention program will be investigated by means of an effect- and a process evaluation. If proven effective, this worksite prevention program can be implemented on a larger scale within the construction industry.Trial RegistrationNTR1278

Test-retest reliability and concurrent validity of a web-based questionnaire measuring workstation and individual correlates of work postures during computer work

INTRODUCTIONnErgonomic questionnaires are widely used in epidemiological field studies to study the association between workstation characteristics, work posture and musculoskeletal disorders among office workers. Findings have been inconsistent regarding the putative adverse effect of work postures. Underestimation of the true association might be present in studies due to misclassification of subjects to risk (i.e. exposed to non-neutral working postures) and no-risk categories (i.e. not exposed to non-neutral working postures) based on questionnaire responses. The objective of this study was to estimate the amount of misclassification resulting from the use of questionnaires.nnnMETHODSnTest-retest reliability and concurrent validity of a newly developed questionnaire was assessed. This questionnaire collects data on workstation characteristics and on individual characteristics during computer work (i.e. work postures, movements and habits). Pictures were added where possible to provide visual guidance. The study population consisted of 84 office workers of a research department. They filled out the questionnaire on the Internet twice, with an in-between period of 2 weeks. For a subgroup of workers (n=38), additional on-site observations and multiple manual goniometer measurements were performed.nnnRESULTSnPercentage agreement ranged between 71% and 100% for the test-retest analysis, between 31% and 100% for the comparison between questionnaire and on-site observation, and between 26% and 71% for the comparison between questionnaire and manual goniometer measurements. For 9 out of 12 tested items, the percentage agreement between questionnaire and manual goniometer measurements was below 50%.nnnCONCLUSIONSnThe questionnaire collects reliable data on workstation characteristics and some individual characteristics during computer work (i.e. work movements and habits), but does not seem to be useful to collect data on work postures during computer work in epidemiological field studies among office workers.