Renée Bourbonnais

Job strain and evolution of mental health among nurses.

The objective of this 2nd phase of a 2-year study among female nurses was to provide further empirical validation of the demands-control and social support model. The association of job strain with psychological problems and the potential modifying role of social support at work were examined. A questionnaire was sent at the workplace to 1,741 nurses. The same associations were found between psychological demands, decision latitude, and a combination of the 2 with psychological distress and emotional exhaustion for current exposure and for cumulative exposure. Social support had a direct effect on these psychological symptoms but did not modify their association with job strain. Longitudinal and prospective data are needed to study the occurrence and persistence of health problems when exposure is maintained or retrieved.

Job strain, psychological distress, and burnout in nurses

The first phase of this longitudinal study consisted of a questionnaire completed by a cohort of 1,891 nurses (aged 23-65 years) from six acute care hospitals from the province of Québec. This study was set up to investigate the association between the psychosocial environment of work and mental health. After adjusting for confounding factors, a combination of high psychological demands and low decision latitude was associated with psychological distress and emotional exhaustion, one of the three dimensions of burnout. Social support at work, although associated with each of the mental health indicators, did not modify their association with job strain. The present study identified conditions of the work environment that are modifiable and provide the basis for interventions that focus beyond the modification of individual coping strategies.

Job strain and sickness absence among nurses in the province of Québec

BACKGROUND Using Karaseks job strain model, the objective of the study was to determine whether nurses exposed to job strain had a higher incidence of sick leave than nurses not exposed. METHODS The design was longitudinal. Data on sick leave were collected for 1,793 nurses for a 20-month period: short-term leaves and certified sick leaves. The Job Content Questionnaire was used to measure psychological demands, job decision latitude, and social support at work. RESULTS Short-term sick leaves were associated with job strain (incidence density ratio (IDR) = 1.20) and with low social support at work (IDR = 1.26). Certified sick leaves were also significantly associated with low social support at work (IDR = 1.27 for all diagnoses and IDR = 1.78 for mental health diagnoses). CONCLUSIONS Our results support the association between job strain and short-term sick leaves. The association with certified sick leaves is also significant for subgroups of nurses with specific job characteristics. Social support at work, although associated with all types of sick leaves measured, does not modify the association between job strain and absence.

Effectiveness of a participative intervention on psychosocial work factors to prevent mental health problems in a hospital setting

Objectives: To assess the effectiveness of a workplace intervention aimed at reducing adverse psychosocial work factors (psychological demands, decision latitude, social support, and effort-reward imbalance) and mental health problems among care providers. Methods: A quasi-experimental design with a control group was used. Pre-intervention (71% response rate), and one-year post-intervention measures (69% response rate) were collected by telephone interviews. Results: One year after the intervention, there was a reduction of several adverse psychosocial factors in the experimental group, whereas no such reduction was found in the control group. However, there was a significant deterioration of decision latitude and social support from supervisors in both experimental and control groups. There was also a significant reduction in sleeping problems and work related burnout in the experimental hospital, whereas only sleeping problems decreased in the control group while both client related and personal burnout increased in this hospital. The comparison between the experimental and control groups, after adjusting for pre-intervention measures, showed a significant difference in the means of all psychosocial factors except decision latitude. All other factors were better in the experimental group. Conclusion: Results suggest positive effects of the intervention, even though only 12 months have passed since the beginning of the intervention. Follow up at 36 months is necessary to evaluate whether observed effects are maintained over time. In light of these results, we believe that continuing the participative process in the experimental hospital will foster the achievement of a more important reduction of adverse psychosocial factors at work. It is expected that the intensity of the intervention will be directly related to its beneficial effects. Long term effects will however depend on the willingness of management and of staff to appropriate the process of identifying what contributes to adverse psychosocial factors at work and to adopt means to reduce them.

Long-term effects of an intervention on psychosocial work factors among healthcare professionals in a hospital setting

Objective This study assessed the long-term effects of a workplace intervention aimed at reducing adverse psychosocial work factors (psychological demands, decision latitude, social support and effort–reward imbalance) and mental health problems among health care professionals in an acute care hospital. Methods A quasi-experimental design with a control group was used. Pre-intervention (71% response rate) and 3-year post-intervention measures (60% response rate) were collected by telephone interviews with validated instruments. Results Three years after the intervention, all adverse psychosocial factors except one were reduced in the experimental group, and the improvement was statistically significant for 5/9 factors: psychological demands, effort–reward imbalance, quality of work, physical load and emotional demands. In addition, all health indicators improved and 2/5 significantly: work-related and personal burnout. In the control hospital, three work factors improved significantly but two deteriorated significantly: decision latitude and social support. All health problem deteriorated, although not significantly, in the control hospital. Moreover, 3 years after the intervention, the mean of all adverse factors except one (psychological demands) and all health indicators was significantly more favourable in the experimental than the control hospital, after adjusting for pre-intervention measures. Conclusion These results support the long-term effectiveness of the intervention. The reduction in many psychosocial factors in the experimental hospital may have clinical significance since most health indicators also improved in this hospital. These results support the whole process of the intervention given that significant improvements in psychosocial factors and health problems were observed in the experimental hospital but not in the control hospital.

Development and implementation of a participative intervention to improve the psychosocial work environment and mental health in an acute care hospital

Objectives: To describe the development and implementation phases of a participative intervention aimed at reducing four theory grounded and empirically supported adverse psychosocial work factors (high psychological demands, low decision latitude, low social support, and low reward), and their mental health effects. Methods: The intervention was realised among 500 care providers in an acute care hospital. A prior risk evaluation was performed, using a quantitative approach, to determine the prevalence of adverse psychosocial work factors and of psychological distress in the hospital compared to an appropriate reference population. In addition, a qualitative approach included observation in the care units, interviews with key informants, and collaborative work with an intervention team (IT) including all stakeholders. Results: The prior risk evaluation showed a high prevalence of adverse psychosocial factors and psychological distress among care providers compared to a representative sample of workers from the general population. Psychosocial variables at work associated with psychological distress in the prior risk evaluation were high psychological demands (prevalence ratio (PR) = 2.27), low social support from supervisors and co-workers (PR = 1.35), low reward (PR = 2.92), and effort-reward imbalance (PR = 2.65). These results showed the empirical relevance of an intervention on the four selected adverse psychosocial factors among care providers. Qualitative methods permitted the identification of 56 adverse conditions and of their solutions. Targets of intervention were related to team work and team spirit, staffing processes, work organisation, training, communication, and ergonomy. Conclusion: This study adds to the scarce literature describing the development and implementation of preventive intervention aimed at reducing psychosocial factors at work and their health effects. Even if adverse conditions in the psychosocial environment and solutions identified in this study may be specific to the healthcare sector, the intervention process used (participative problem solving) appears highly exportable to other work organisations.

The burden of wait for knee replacement surgery: effects on pain, function and health-related quality of life at the time of surgery

OBJECTIVE To examine the change in pain and function related to the knee scheduled for surgery, change in health-related quality of life (HRQoL) and change in contralateral knee pain during pre-surgery wait up until time of surgery. METHODS One hundred and fifty-three patients scheduled for knee replacement were recruited from three hospitals in Québec City, Canada, and followed until surgery. Pre-surgery wait, defined as the time between enrolment on the pre-surgery wait list and surgery, was considered in five categories (< or =3, >3-6, >6-9, >9-12 and >12 months). Pain and functional limitations were measured with the Western Ontario and McMaster Osteoarthritis Index (WOMAC) and HRQoL was measured with the medical outcomes study 36-item short form health survey. RESULTS Mean pre-surgery wait time was 183 (s.d. 121.9) days. Subjects having waited >9-12 months showed significant deterioration of the WOMAC pain (-9.9; 95% CI -19.2, -0.54) and function (-11.1; 95% CI -18.7, -3.4) scores. On the HRQoL SF-36 physical functioning scale, a significant deterioration was seen in subjects having waited >9-12 months (-11.3; 95% CI -18.4, -4.2) and >12 months (-7.1; 95% CI -12.9, -1.3). On the contralateral knee WOMAC pain score, a significant deterioration was observed in subjects having waited >6-9 months (-10.4; 95% CI -16.9, -3.9) and >12 months (-10.7; 95% CI -19.7, -1.7). CONCLUSION Pre-surgery wait time has a negative significant impact on pain, function and HRQoL at the time of surgery. The magnitude of deterioration seen in this study may be clinically important. The effects of this pre-surgery deterioration on post-surgery outcomes need to be investigated.

Job strain and psychotropic drug use among white-collar workers

The main objective of this study was to measure the association between simultaneous exposure to high psychological demand and low decision latitude at work and the use of psychotropic drugs among white-collar workers. A second objective was to determine whether social support at work modified this association. A cross-sectional study was performed that included 2786 workers from the public sector in the Greater Quebec City area. A self-administered questionnaire was used in order to evaluate psychological demand, decision latitude and social support at work. Psychotropic drug use was measured over a period of 2 days. The prevalence of psychotropic drug use among the participants was found to be 3.9%, even though 20.5% were exposed to job strain. The association between job strain and psychotropic drug use, after adjustment for social support at work, age, gender, education, family income, employment status, occupation, stressful life events, cigarette smoking, alcohol consumption and physical activity, w...

Effort-reward imbalance at work and recurrent coronary heart disease events: a 4-year prospective study of post-myocardial infarction patients.

Objective: Prospective studies have shown that effort-reward imbalance (ERI) at work is associated with the incidence of a first coronary heart disease (CHD) event. However, it is unknown whether ERI at work increases the risk of recurrent CHD events. The objective of this study was to determine whether ERI at work and its components (effort and reward) increase the risk of recurrent CHD in post-myocardial infarction (post-MI) workers. Methods: We carried out a prospective cohort study of 669 men and 69 women who returned to work after a first MI. ERI at work was assessed by telephone interview using validated scales of reward and psychological demands. The outcome was a composite of fatal CHD, nonfatal MI, and unstable angina. CHD risk factors were documented in medical files and by interview. The participants were followed up for a mean period of 4.0 years (1998-2005). Results: During the follow-up, 96 CHD events were documented. High ERI and low reward were associated with recurrent CHD (respective adjusted hazard ratios [HRs] = 1.75, 95% confidence interval [CI] = 0.99-3.08, and HR = 1.77, 95% CI = 1.16-2.71). There was a gender interaction showing stronger effects among women (respective adjusted HRs for high ERI and low reward: HR = 3.95, 95% CI = 0.93-16.79, and HR = 9.53, 95% CI = 1.15-78.68). Conclusions: Post-MI workers holding jobs that involved ERI or low reward had increased risk of recurrent CHD.BMI = body mass index; CHD = coronary heart disease; CI = confidence interval; ERI = effort-reward imbalance; HR = hazard ratio; MI = myocardial infarction.

Psychosocial work environment, interpersonal violence at work and psychotropic drug use among correctional officers

The aims of this study were to establish the prevalence of psychotropic drug use, measure the association between job strain, extrinsic efforts-rewards ratio, interpersonal violence and psychotropic drug use among officers working in correctional facilities in the province of Quebec in Canada. This study also examined if interpersonal violence at work is an intermediate factor in the causal chain between psychosocial risk factors at work and psychotropic drug use. A cross-sectional study was performed which included 1288 Quebec correctional officers. The participants answered a self-administered questionnaire in 2007 assessing psychological demands, decision latitude, extrinsic efforts, rewards, overcommitment, intimidation, psychological harassment, social support in the actual job, psychotropic drug use during the month preceding the questionnaire and sociodemographic variables. Binomial regressions were performed for the principal associations and a bootstrap analysis was performed in order to evaluate interpersonal violence as an intermediate factor between psychosocial risk factors at work and psychotropic drug use. The prevalence of psychotropic drug use among correctional officers was 14.7%. The prevalence ratios (PR) for the associations between job strain, extrinsic efforts-rewards ratio, social support from colleagues and supervisors, intimidation and psychological harassment adjusted for age and gender were respectively 1.4 (95% CI 0.9-2.2), 1.6 (95% CI 1.2-2.2), 1.7 (95% CI 1.3-2.3), 1.4 (95% CI 0.9-2.4) and 1.5 (95% CI 1.1-2.0). The value of the indirect effect evaluating psychological harassment as an intermediate factor was not statistically significant (value=0.0087, 95% CI -0.0033 to 0.0207). An imbalanced extrinsic efforts-rewards ratio, low social support from colleagues and supervisors and psychological harassment at work were separately associated with psychotropic drug use among correctional officers. Psychological harassment was not found to be an intermediate factor.