Susanna Toivanen

Beyond simple approaches to studying the association between work characteristics and absenteeism: Combining the DCS and ERI models

Abstract The Demand-Control-Support (DCS) and the Effort-Reward Imbalance (ERI) models assess different psychosocial factors. This study investigates whether a combination of these models increases their ability to predict sickness absence, as compared to results based on each model separately. A cross-sectional study with nursing personnel (N = 1307) in Brazil was performed. Regression analyses were conducted in three stages: analysis of each scale of the models and sickness absences; assessment of the independent association of each model with sickness absences; assessment of the associations of three combinations of models/scales with sickness absences: DC and social support (SS), ERI and overcommitment, and DC and ERI. As regards comparisons between the stress models, ERI was shown to be independently associated with short (up to 9 days) and long (10 days or more) spells of absenteeism. The same result held true for low social support. The combinations DC-ERI and DC-SS were better predictors for short spells than each model/scale separately, whereas for long spells, the combination DC-SS was the best predictor. ERI seems to be a good instrument for predicting absenteeism if used alone, whereas DC performed better when combined with ERI or SS. An improved risk estimation of sickness absences by combining information from the two models was observed.

Is the Impact of Job Control on Stroke Independent From Socioeconomic Status? A Large-Scale Study of the Swedish Working Population

Background and Purpose— The main purpose of this study was to test whether the impact of job control on stroke mortality is independent of socioeconomic factors. Methods— This was a register-based cohort study of nearly 3.5 million working people (25 to 64 years of age in the 1990 Swedish Census) with a 5-year follow-up for stroke mortality. Job control was aggregated to the data from a secondary data source (job exposure matrix). Gender-specific Poisson regressions were performed. Results— Compared with high job control occupations, low job control was significantly related to hemorrhagic (relative risk, 1.54; 95% CI, 1.10 to 2.17) and all-stroke mortality (relative risk, 1.50; 95% CI, 1.11 to 2.03) in women but not in men. The significance of job control in women was independent of all confounders included (marital status, education level, and occupational class). Class-specific analyses indicated a consistent effect of job control for most classes (significant for female lower nonmanuals). However, low job control did not increase the risk of stroke mortality in upper nonmanuals. Conclusions— Job control was significantly related to hemorrhagic and all-stroke mortality in women but not in men.

Exploring the interplay between work stress and socioeconomic position in relation to common health complaints: The role of interaction

BACKGROUND This study explored the interplay between work stress and socioeconomic position and investigated if the interaction of work stress and low socioeconomic position is associated with poorer health. METHODS A representative sample of the Swedish working population, including 2,613 employees (48.7% women) aged 19-64 years, was analyzed. The health outcomes were poor self-rated health, psychological distress, and musculoskeletal pain. Work stress was operationalized as job strain and effort-reward imbalance, and socioeconomic position as occupational class. Interaction analysis was based on departure from additivity as criterion, and a synergy index (SI) was applied, using odds ratios (ORs) from logistic regressions for women and men. RESULTS/CONCLUSIONS In fully adjusted models, work stress, and in a lesser extent also socioeconomic position, was associated with higher odds for the three health complaints. The prevalence of poorer health was highest among those individuals jointly exposed to high work stress and low occupational class, with ORs ranging from 1.94 to 6.77 (95%CI 1.01-18.65) for poor self-rated health, 2.42-8.44 (95%CI 1.28-27.06) for psychological distress and 1.93-3.93 (95%CI 1.11-6.78) for musculoskeletal pain. The joint influence of work stress and low socioeconomic position on health was additive rather than multiplicative.

Job Strain and Self-Reported Insomnia Symptoms among Nurses: What about the Influence of Emotional Demands and Social Support?

Job strain, derived from high psychological demands and low job control, is associated with insomnia, but information on the role of emotional demands and social support in this relationship is scarce. The aims of this study were (i) to test the association between job strain and self-reported insomnia symptoms, (ii) to evaluate the combination of emotional demands and job control regarding insomnia symptoms, and (iii) to analyze the influence of social support in these relationships. This cross-sectional study refers to a sample of nurses (N = 3,013 and N = 3,035 for Job Strain and Emotional demand-control model, resp.) working at public hospitals in Rio de Janeiro, Brazil. Data were collected through a self-report questionnaire. The prevalence of insomnia symptoms was 34.3%. Job strain was associated with increased odds for insomnia symptoms (OR: 2.20); the same result was observed with the combination of emotional demands and low job control (OR: 1.99). In both models, the inclusion of low social support combined with high demands and low job control led to increased odds for insomnia symptoms, compared to groups with high social support from coworkers and supervisors. Besides job strain, the study of emotional demands and social support are promising with regards to insomnia symptoms, particularly among nurses.

Job strain and unhealthy lifestyle: results from the baseline cohort study, Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

BackgroundUnhealthy lifestyle choices, such as smoking and sedentary behavior, are among the main modifiable risk factors for chronic non-communicable diseases. The workplace is regarded as an important site of potential health risks where preventive strategies can be effective. We investigated independent associations among psychosocial job strain, leisure-time physical inactivity, and smoking in public servants in the largest Brazilian adult cohort.MethodsWe conducted a cross-sectional analysis of baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)—a multicenter prospective cohort study of civil servants. Our analytical samples comprised 11,779 and 11,963 current workers for, respectively, analyses of job strain and leisure-time physical activity and analyses of job strain and smoking. Job strain was assessed using the Brazilian version of the Swedish Demand-Control-Support Questionnaire; physical activity was evaluated using a short form of the International Physical Activity Questionnaire. We also examined smoking status and number of cigarettes smoked per day. The association reported in this paper was assessed by means of multinomial and logistic regression, stratified by sex.ResultsAmong men, compared with low-strain activities (low demand and high control), job strain showed an association with physical inactivity (odds ratio [OR] = 1.34; 95% confidence interval [CI] = 1.09–1.64) or with the practice of physical activities of less than recommended duration (OR = 1.44; 95% CI = 1.15–1.82). Among women, greater likelihood of physical inactivity was identified among job-strain and passive-job groups (OR = 1.47; 95% CI = 1.22–1.77 and OR = 1.42; 95% CI = 1.20–1.67, respectively). Greater control at work was a protective factor for physical inactivity among both men and women. Social support at work was a protective factor for physical inactivity among women, as was smoking for both genders. We observed no association between demand or control dimensions and smoking.ConclusionsJob strain, job control, and social support were associated with physical activity. Social support at work was protective of smoking. Our results are comparable to those found in more developed countries; they provide additional evidence of an association between an adverse psychosocial work environment and health-related behaviors.

Social Determinants of Stroke as Related to Stress at Work among Working Women: A Literature Review

In adult life, many of the social determinants of health are connected to working life. Yet, our knowledge of the role of work-related factors for the risk of stroke is fairly limited. In contemporary occupational health research, the Demand-Control Model (DCM) is frequently used to measure work stress. Previous literature reviews of the association of work stress and cardiovascular disease (CVD) do not include stroke as a specific outcome. Results regarding work stress and the risk of CVD are less evident in working women. With the focus on working women, the purpose of the present paper was to review the current research into the DCM in relation to stroke and to scrutinize potential gender differences. A literature search was performed and eight studies from three countries were identified. Based on the reviewed studies, there is some evidence that high psychological demands, low job control, and job strain are associated with increased stroke risk in women as well as in men. Any major reduction in deaths and disability from stroke is likely to come from decreasing social inequalities in health, and reducing work stress has a potential to contribute to a reduced risk of stroke in working populations.

Mortality differences between self-employed and paid employees : a 5-year follow-up study of the working population in Sweden

Objectives Analyse mortality differences between self-employed and paid employees with a focus on industrial sector, educational level and gender using Swedish register data. Methods A cohort of the total working population (4 776 135 individuals; 7.2% self-employed; 18–100 years of age at baseline 2003) in Sweden with a 5-year follow-up (2004–2008) for all-cause and cause-specific mortality (57 743 deaths). Self-employed individuals were categorised as sole proprietors or limited liability company (LLC) owners according to their enterprises legal form. Cox proportional hazards models were applied to compare mortality rates between sole proprietors, LLC owners and paid employees, adjusted for sociodemographic confounders. Results Mortality from cardiovascular diseases was 16% lower and from suicide 26% lower among LLC owners than among paid employees, adjusted for confounders. Within the industrial category, all-cause mortality was 13–15% lower among sole proprietors and LLC owners compared with employees in manufacturing and mining (MM) as well as personal and cultural services (PCS), and 11–20% higher in sole proprietors in trade, transport and communication and the welfare industry (W). A significant three-way interaction indicated 17–23% lower all-cause mortality among male LLC owners in MM and female sole proprietors in PCS, and 50% higher mortality in female sole proprietors in W than in employees in the same industries. Conclusions Mortality differences between self-employed individuals and paid employees vary by the legal form of self-employment, across industries, and by gender. Differences in work environment exposures and working conditions, varying market competition across industries and gender segregation in the labour market are potential mechanisms underlying these findings.

Self-Employed Persons in Sweden - Mortality Differentials by Industrial Sector and Enterprise Legal Form : A Five-Year Follow-Up Study

OBJECTIVES This study investigated mortality differentials between self-employed persons in Sweden, considering industrial sector, enterprise characteristics and socio-demographic factors. METHODS Data on 321,274 self-employed persons were obtained from population registers in Sweden. Cox proportional hazards models were used to compare all-cause and cause-specific mortality rate ratios by industrial sector and enterprise legal form, adjusted for confounders. RESULTS All-cause mortality was 10-32% higher in self-employed persons in Manufacturing and Mining, Trade and Communication, and Not Specified and Other sectors than in Agriculture, Forestry, and Fishing. Mortality from cardiovascular disease was 23% higher in Trade and Communication, and from neoplasms 17-51% higher in Manufacturing and Mining, Not Specified, and Other. Mortality from suicide was 45-60% lower in Personal and Cultural Services, and in Not Specified. Mortality was 8-16% higher in sole proprietorship than limited partnership. CONCLUSIONS Further research of working conditions is warranted, considering industry and enterprise legal form.

Cross-cultural validity of the demand-control questionnaire: Swedish and Brazilian workers

OBJECTIVE To evaluate the cross-cultural validity of the Demand-Control Questionnaire, comparing the original Swedish questionnaire with the Brazilian version. METHODS We compared data from 362 Swedish and 399 Brazilian health workers. Confirmatory and exploratory factor analyses were performed to test structural validity, using the robust weighted least squares mean and variance-adjusted (WLSMV) estimator. Construct validity, using hypotheses testing, was evaluated through the inspection of the mean score distribution of the scale dimensions according to sociodemographic and social support at work variables. RESULTS The confirmatory and exploratory factor analyses supported the instrument in three dimensions (for Swedish and Brazilians): psychological demands, skill discretion and decision authority. The best-fit model was achieved by including an error correlation between work fast and work intensely (psychological demands) and removing the item repetitive work (skill discretion). Hypotheses testing showed that workers with university degree had higher scores on skill discretion and decision authority and those with high levels of Social Support at Work had lower scores on psychological demands and higher scores on decision authority. CONCLUSIONS The results supported the equivalent dimensional structures across the two culturally different work contexts. Skill discretion and decision authority formed two distinct dimensions and the item repetitive work should be removed.

Suicide among agricultural, forestry, and fishery workers: a systematic literature review and meta-analysis

Objectives This review aimed to quantify suicide risk among agricultural, forestry, and fishery workers and study potential variations of risk within this population. Methods We conducted a systematic literature review and meta-analysis from 1995 to 2016 using MEDLINE and following the PRISMA guidelines. A pooled effect size of suicide risk among the population of interest was calculated using meta-analysis. Subgroup analyses were conducted to investigate whether effect size differed according to population or study characteristics. Meta-regression was used to identify sources of heterogeneity. Results The systematic review identified 65 studies, of which 32 were included in the meta-analysis. Pooled effect size was 1.48 [95% confidence interval (CI) 1.30-1.68] representing an excess of suicide risk among the population of interest. Subgroup analysis showed that this effect size varied according to geographic area, with a higher effect size in Japan. The following study characteristics were found to contribute to the between-study variance: reference group, measure of effect size, and study design. Conclusions Our findings suggest an excess of suicide risk among agricultural, forestry, and fishery workers and demonstrated that this excess may be even higher for these groups in Japan. This review highlights the need for suicide prevention policies focusing on this specific population of workers. More research is also needed to better understand the underlying factors that may increase suicide risk in this population.