Weishan Chin

Suicidality 6 Years After Occupational Injury

OBJECTIVE Suicide attempts can result from traumatic events, including those caused by occupational injury. However, literature on the long-term prevalence rates of suicidality after occupational injury is relatively lacking. This study investigated the long-term prevalence of suicidality after occupational injury. METHODS Between February 1 and August 31, 2009, 4,403 workers in Taiwan sustained occupational injuries and were hospitalized for 3 days or longer. Surveys were conducted at 3 and 12 months after occupational injury, and 2,308 workers responded to either survey. They were invited to join the follow-up at 6 years after occupational injury, using the Brief Symptom Rating Scale (BSRS-5), Posttraumatic Symptom Checklist (PTSC), and 1 question on suicidal ideation. Workers with a high score on the BSRS-5 or PTSC were invited to participate in an in-depth psychiatric evaluation using the Chinese version of the Mini-International Neuropsychiatric Interview (MINI). RESULTS The estimated MINI-diagnosed suicidality rates at 3 months, 12 months, and 6 years after occupational injury were 5.4%, 4.8%, and 9.5%, respectively. Injured workers who reported that the injury majorly affected their physical appearance, experienced additional occupational injury requiring hospitalization for > 3 days, had unstable employment, and had lower income in the past 1 year than that before occupational injury had a higher risk of suicidal ideation. Injury majorly affecting the physical appearance, unstable employment, and lower income than that before occupational injury were the most crucial factors. These factors accounted for 12.7%, 13.2%, and 19.0% of suicidal ideation among the injured workers. CONCLUSIONS The suicidality rate increased at 6 years after occupational injury. The relevant factors for suicidal ideation were injury severity and work instability. Periodic monitoring of psychological and physical health and economic stability are warranted.

0430 Female workers suffered higher psychological symptoms after occupational injuries than male workers

Introduction This study aimed to examine the prevalence rates of psychological symptoms and risk factors between female and male workers at 12 months after their sustaining occupational injurie. Demographic and injury-related risk factors for psychological symptoms were evaluated. Methods Our study candidates were injured workers in Taiwan who were hospitalised for 3 days or longer and received hospitalisation benefits from the Labour Insurance program. A self-reported questionnaire including the Brief Symptom Rating Scale was sent to workers at 12 months after injury. Results A total of 1233 workers (response rate 28.0%) completed the questionnaire, including 356 women and 877 men. A higher percentage (30.1%) of women had elevated BSRS-5 score of 6 or higher than men (22.5%). The risk factors for elevated psychological symptom scores for female workers were lower education level (odds ratio, OR=1.8, 95% confidence interval, CI=1.1–3.0), main income contributor of the household (OR=1.8, CI=1.1–3.0), severely affected physical appearance due to injury (OR=2.8, CI=1.3–5.9), and having adverse life event after injury (OR=2.0, CI=1.1–3.6) after mutual adjustment. Whereas the risk factors for elevated psychological symptom scores for female workers were loss of consciousness after the injury (OR=2.0, CI=1.3–3.1), severely affected physical appearance due to injury (OR=3.7, CI=2.3–6.0), having adverse life event after injury (OR=2.5, CI=1.6–3.8), not return-to-work (OR=3.2, CI=2.0–5.1), and reduced salary as compared to that before injury (OR=2.4, CI=1.3–4.1). Conclusions After occupational injury, women suffered from higher rate of psychological symptoms. Risk factors were different between men and women who sustained occupational injuries.

0099 Psychological work environment and suicidal ideation among nurses in taiwan

Background Nurses are exposed to poor psychological work environment which in turn may cause poor mental health. Poor mental health is a risk factor for suicidal ideation. We intended to understand the association between psychosocial work environment and suicidal ideation among hospital nurses in Taiwan. Method A self-reported questionnaire including demographic data, psychological work environment, and the question of suicidal ideation was sent to our participants- female nurses working in hospitals. Multiple logistic regression and population attributable risks (PARs) were preformed to assess the effect of psychological work environment on reporting having suicidal ideation. Results A total of 2492 (72.6%) returned the questionnaires and were eligible for final analysis. The prevalence of reporting suicidal ideation was 18.3%. Higher risk of suicidal ideation was found associated with age between 36 and 40, educational level of Junior college or below, working for more than 60 hours per week, higher personal burnout, higher client-related burnout, and always felt stressed at job. Estimation of PAR showed that higher personal and client-related burnout, and always felt stressed at job were the most crucial factors and accounted for 12.2%, 9.3%, and 7.7% suicidal ideation among nurses. Conclusion A significant proportion of nurses developed suicidal ideations. Poor psychological work environment and long working hours were relevant factors for suicidal ideation. A good psychological work environment is warranted to dissuade nurses from developing suicidal ideations.

0167 Association between ambient temperature and occupational injury

Background Exposure to high temperature has been linked to adverse effects including cardiovascular and renal functions. It was also proposed to diminish human performance capacity and increase accident risk. However, the effects of high temperature on occupational injury have not been extensively studied. Objective The aim of this study was to determine the association between ambient temperature and occupational injury (OI) occurrence. Material and Methods OI information was extracted from the National Health Insurance Research Database (NHIRD). Daily ambient temperature and relative humidity (RH) were obtained from the Taiwan EPA air monitoring station. The day of first time OI outpatient/emergency visits during 2006–2011 was used as the event day. The same weekdays of the month were used as the referent day. Time-stratified case-crossover design and conditional logistic regression was used to investigate the relationship between ambient temperature and OI outpatient visits, adjusting for RH. Results There were 18 951 first time OI outpatient/emergency visits during 2006–2011. The odds ratio (OR) of OI outpatient visits associated with per interquartile range (7.7 degree centigrade) increase in ambient temperature of the same day (lag 0 day) was 1.15 (95% confidence interval, CI: 1.08–1.22). The ORs associated with lag1 (the day before visit day) to lag3 day was 1.13 (95% CI: 1.06–1.19), 1.11 (95% CI: 1.04–1.17), and 1.11 (95% CI: 1.02–1.14), respectively. Conclusion Exposure to higher ambient temperature was associated with increased risk of OI outpatient visits.

Workplace justice and intention to leave the nursing profession

Background: Poor psychosocial work environments are considered critical factors of nurses’ intention to leave their profession. Workplace injustice has been proven to increase the incidence of psychiatric morbidity among workers. However, few studies have directly investigated the effect of workplace justice on nurses’ intention to leave their profession and the population attributable risk among nurses. Objective: This study identified factors associated with workplace justice and nurses’ intention to leave the profession. Method: A cross-sectional survey was conducted using a self-administered structured questionnaire. Approximately 10% of all secondary referral centers in Taiwan were stratified and randomly sampled. Multiple logistic regression and population attributable risks were preformed to assess the effect of workplace justice on nurses’ intention to leave the nursing profession. Ethical considerations: This study was approved by the Research and Ethical Committee of National Taiwan University Hospital. Only nurses who consented to the study participated in the survey. Result: A total of 2268 nurses were recruited, of whom 1417 (62.5%) satisfactorily completed the questionnaire. The participants were classified and 342 (24.1%) of them were placed into the low workplace justice group. Nurses with low workplace justice had a higher intention of leaving the profession (adjusted odds ratio = 1.34, 95% confidence interval = 1.02–1.77). “Employees’ opinions are influential in hospital’s decision making” and “employees’ performance is evaluated fairly” were the most influential factors of the participants’ intention to quit. The adjusted population attributable risk was 3.7% for low workplace justice. Conclusion: This study has identified that workplace justice is a protective factor of nurses’ leaving their current profession. A fair performance appraisal system and increased autonomy at work are warranted to dissuade nurses from leaving the nursing profession.

0163 Job strain and burnout among nurses working in different healthcare setting

Objectives To assess job strain and burnout status among female nurses working in primary clinics, secondary referral hospitals, and public health units in Taiwan. Method Study participants included female nurses from (1) all primary clinics (PC) hiring more than two registered nurses; (2) a nation-wide representative sample of secondary referral hospitals (SRH), selected using stratified random sampling; and (3) all public health units (PHU) hiring more than two registered nurses. To candidate participants, a structured, self-administered questionnaire was disseminated, which included demographic information, work conditions, the Chinese Job Content Questionnaire, and the modified Chinese Copenhagen Burnout Inventory. Results A total of 6087 questionnaires were sent, and 4046 (66.5%) were satisfactorily completed. Compared with PC nurses, nurses working in SRHs and PHUs had higher job strain (adjusted odds ratio, aOR=1.7, 95% confidence interval, CI=1.3–2.1 for SRH; aOR=2.4, 95% CI=1.7–3.4 for PHU), personal burnout (aOR=2.6, 95% CI=1.8–3.6 for SRH; aOR=3.4, 95% CI=2.1–5.7 for PHU), work-related burnout (aOR=2.4, 95% CI=1.8–3.1 for SRH; aOR=3.0, 95% CI=2.0–4.5 for PHU), and client-related burnout (aOR=1.6, 95% CI=1.2–2.3 for SRH; aOR= 2.1, 95% CI=1.2–3.5 for PHU) while adjusted for significant variables. Conclusions We concluded that nurses worked in public health units and secondary referral hospitals had higher job strain and work-related burnout as compared to primary clinics. Further study should examine the stressors from these workplaces and follow up the health effects of high strain and burnout status.

0237 Psychosocial Impacts of a Contaminated Needlestick Injury or Blood and Body Fluid Exposure in Health Care Workers

Objectives This study aims to explore the psychosocial impacts of health care workers (HCW) who were exposed to a contaminated needlestick Injury (NSI) or blood and body fluid (BBF) at work. Method Personal interviews were performed using a phenomenological approach including in-depth interviews fort data collection, and expert meetings for data analysis. The trustworthiness of the study was examined using Lincoln and Guba (1985) principles. Results Seventeen health care workers participated in our study. There are five main themes generated, including (1) Emotional loading: shock and collapse, fear of being seroconverted to infectious diseases, worry about family members, and damage of the professional image. (2) Disappointment on the working environment: lack of manpower support, feel isolated and helpless. (3) Disapproving eyes: invasion of privacy, fear of being labelled. (4) Impact on life: feelings of life-threatening, prophylaxis of physical discomfort, impact on professional ambitions. (5) Self-adjustment: efforts to recover from the event. Conclusions A needlestick injury not only causes risk of infection, but has great psychosocial impact to the victims. Intervention should cover psychosocial support to the health care workers in addition to prophylaxis of infection.

218 The changing shift pattern and overtime affect nurses’ menstrual characteristics

Objective The aim of this study was to determine whether the frequency of changing work shift and overtime are associated with registered nurses’ menstrual characteristics. Method Female nursing staff aged 20–45 years and working at hospitals were invited to participate in the study. Menstrual characteristics and work shifts were recorded daily for 180 days. A multivariate logistic model was performed. Important confounders such as age, educational level, occupational category, regular excise habit, and major earner of family were adjusted. Result A total of 330 nurses and 1,437 menstrual cycles were collected and eligible for the final analysis. The adjusted odds ratio for shorter bleeding time (≦3 days) was associated with changing work shift (involved one night shift) more than 3 times between menstrual cycles were 2.2 (95% CI = 1.1–4.3). The adjusted odds ratios for longer menstrual cycle lengths (>40days) due to changing work shift (involved one night shift) more than 3 times between menstrual cycles were 4.7(95% CI = 3.1–7.1). The adjusted odds ratios for dysmenorrhea due to overtime more than 40 hours during 28 days before menstrual were 2.9 (95% CI = 1.6–5.2). Conclusion The high frequency of changing work shift (esp. from day shift change to night shift or from evening shift to night shift) and overtime (>40 hours/ 28days) may affect childbearing aged female nurses’ reproductive function.