A selection from Stockholm University publication database

• Associations between COVID-19-related changes in the psychosocial work environment and mental health

  2023. Sandra Blomqvist (et al.). Scandinavian Journal of Public Health 51 (5), 664-672

  Article

  Background:

  Individuals' lives have been substantially affected by the COVID-19 pandemic. We aimed to describe changes in psychosocial work environment and mental health and to investigate associations between job insecurity and mental ill-health in relation to changes in other psychosocial work factors, loneliness and financial worries.

  Methods:

  A sub-sample of individuals from the eighth Swedish Longitudinal Occupational Survey of Health answered a web-based survey in early 2021 about current and pandemic-related changes in health, health behaviours, work and private life. We investigated participants working before the pandemic (N=1231) in relation to standardised measures on depression, anxiety and loneliness, together with psychosocial work factors, in descriptive and logistic regression analyses.

  Results:

  While 9% reached the clinical threshold for depression and 6% for anxiety, more than a third felt more worried, lonelier or in a low mood since the start of the pandemic. Two per cent had been dismissed from their jobs, but 16% experienced workplace downsizings. Conditioning on socio-demographic factors and prior mental-health problems, the 8% experiencing reduced job security during the pandemic had a higher risk of anxiety, but not of depression, compared to employees with unaltered or increased job security. Loneliness and other psychosocial work factors explained more of the association than objective measures of job insecurity and financial worries.

  Conclusions:

  Reduced job security during the COVID-19 pandemic seems to have increased the risk of anxiety among individuals with a strong labour market attachment, primarily via loneliness and other psychosocial work factors. This illustrates the potentially far-reaching effects of the pandemic on mental health in the working population.

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• It's giving me the blues: A fixed-effects and g-formula approach to understanding job insecurity, sleep disturbances, and major depression

  2022. Robin S. Högnäs (et al.). Social Science and Medicine 297

  Article

  Research suggests that work-related factors like job insecurity increases the risk of major depression (MD), although it is unclear whether the association is causal. Research further suggests that job insecurity increases sleep disturbances, which is also a risk factor for MD. Based on current knowledge, it is possible that job insecurity operates through sleep disturbances to affect MD, but this pathway has not been examined in the literature. The current study extends the literature by using two complementary, counterfactual approaches (i.e., random- and fixed-effects regression and a mediational g-formula) to examine whether job insecurity causes MD and whether sleep disturbances mediate the relationship. A methodological triangulation approach allowed us to adjust for unobserved and intermediate confounding, which has not been addressed in prior research. Findings suggest that the relationship between job insecurity and MD is primarily direct, that hypothetically intervening on job insecurity (in our g-formula) would reduce MD by approximately 10% at the population level, and this relationship operates via sleep disturbances to some degree. However, the indirect pathway had a high degree of uncertainty.

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• Perceived job insecurity and risk of suicide and suicide attempts: a study of men and women in the Swedish working population

  2022. Sandra Blomqvist (et al.). Scandinavian Journal of Work, Environment and Health 48 (4), 293-301

  Article

  Objective Whether perceived job insecurity increases the risk of suicidal behaviors is unclear. Improved understanding in this area could inform efforts to reduce suicide risk among those experiencing elevated job insecurity during the COVID-19 pandemic as well as post-pandemic. We aimed to investigate if perceived job insecurity predicted increased risk of suicide mortality and suicide attempts.

  Method Employees (N=65 571), representative of the Swedish working population who participated in the Swedish Work Environment Survey in 1991–2003, were followed up through 2016 in the National Inpatient and Death Registers. Suicide deaths and suicide attempts were defined according to International Classification of Diseases (ICD) 10 and ICD-8/9 codes of underlying cause of death and in-/outpatient care. Job insecurity and subsequent risk of suicide and suicide attempt were investigated with marginal structural Cox regression analyses and inverse probability of treatment weighting to control for confounding.

  Results Perceived job insecurity was associated with an elevated risk of suicide [hazard ratio (HR) 1.51, 95% confidence interval (CI) 1.03–2.20], but not with incident suicide attempts (HR 1.03, CI 0.86–1.24). Estimates remained similar after considering prevalent/previous poor mental health, other work factors, and when restricting the follow up time to ten years.

  Conclusion The study suggests that job insecurity is associated with an increased risk of suicide mortality. Concerns about elevated job insecurity and suicide levels in the wake of the current pandemic could thus be considered in strategies to reduce the population health impact job insecurity both during and following the COVID-19 pandemic.

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• The worries of working

  2022. Sandra Blomqvist.

  Thesis (Doc)

  While mental health problems according psychotropic drug purchases and sick leave spells for psychiatric disorders have increased in Sweden the past 15 years, this is not reflected in trends of psychiatric diagnoses or suicide mortality. In parallel, labor markets have undergone structural changes pressuring employers to increase their flexibility to ensure permanence. In consequence, this may introduce greater uncertainty about employment continuity and involuntary job transitions for the employees. While evidence suggest that employment uncertainty increases the risk of self-reported mental health problems, the relation to clinically pertinent mental health conditions remains unclear. Therefore, this thesis aimed to investigate if employment uncertainty and involuntary labor market transitions, was associated with common and with severe clinically defined mental health conditions.

  All four studies relied on national health registers for ascertainment of clinically defined mental health conditions. Studies I and II relied on information from registers to operationalize downsizings/workplace closures, while Study III and IV obtained information about cognitive and affective job insecurity from the Longitudinal Occupational Survey of Health and the Swedish Work Environment Survey, respectively.

  According to Study I, employees who left the downsizing organization for another or no job increased their purchases of psychotropic drugs prior to the downsizing more than unexposed employees, while their purchases decreased in connection to the exits. For employees staying in the organization, psychotropic drug purchases increased from 1 year before the downsizing to 4 years after, particularly in close proximity to the downsizing.

  Study II showed that older employees exposed to downsizing/workplace closure before permanently exiting into old age retirement, sickness absence/disability pension or unemployment exhibited a smaller or no decline in psychotropic drug purchases during the period before or close to their exit, compared to unexposed employees exiting the labor market.

  Study III showed that the association between perceived job insecurity and incidence psychotropic drug purchases of any kind, were particularly pronounced for affective job insecurity, while cognitive job insecurity only increased the incidence of antidepressant purchases.

  In Study IV, exposure to cognitive job insecurity was associated with an increased risk of suicide mortality, but not with suicide attempts.

  In conclusion, exposure to employment uncertainty may increase the risk of clinically defined mental health conditions, for employees leaving or staying in an organization. Negative mental health consequences were particularly apparent when individuals reported a worry about their future job situation. Furthermore, involuntary job transitions later in life when invoked by downsizings/workplace closures may limit opportunities of improved mental health around the exit. These labor market conditions are common and closely connected to the business cycle as to why they may continue to affect the mental health of employees. In accordance with goals and agendas ratified by the Swedish government to see to conditions that hinder, or promote, a sustainable working life for everyone, employment uncertainty is one dimension worth acknowledging.

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• Associations between cognitive and affective job insecurity and incident purchase of psychotropic drugs

  2020. Sandra Blomqvist (et al.). Journal of Affective Disorders 266, 215-222

  Article

  Background: Previous research suggests that job insecurity is associated with poor mental health, but research examining how different aspects of job insecurity relate to clinical measures of poor mental health are lacking. We aimed to investigate the association between cognitive and affective job insecurity and incident purchases of psychotropic drugs.

  Methods: We included 14,586 employees participating in the Swedish Longitudinal Occupational Survey of Health (SLOSH), who answered questions on cognitive and/or affective job insecurity in 2010, 2012 or 2014. Respondents were followed in the Swedish Prescribed Drug Register (2.5 years on average). We investigated the association between job insecurity and incident psychotropic drugs with marginal structural Cox models.

  Results: Affective job insecurity was associated with an increased risk of purchasing any psychotropic drugs (Hazard Ratio (HR) 1.40 (95% Confidence Interval (CI) 1.04–1.89)) while cognitive job insecurity was not (HR 1.15 (95% CI 0.92–1.43)). Cognitive and affective job insecurity were both associated with antidepressants, affective job insecurity with anxiolytics, but no association was found with sedatives. Women and younger workers seemed to have higher risk compared to men and older workers, but differences were not statistically significant.

  Limitations: Although job insecurity and psychotropic drugs were assessed through independent sources and several covariates were considered, unmeasured confounding cannot be ruled out.

  Conclusions: The findings support that affective job insecurity is a risk factor for psychotropic drug treatment, that it may be relevant to distinguish between different types of job insecurity, and to consider sex and age as moderating factors.

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• Labor market exit around retirement age in Sweden and trajectories of psychotropic drugs in a context of downsizing

  2020. Sandra Blomqvist (et al.). BMC Public Health 20 (1)

  Article

  Background A maintained psychological wellbeing is important in order to continue working longer and remain active into older age. However, little is known about impact of different organizational factors, such as downsizing, on the mental health of older workers exiting the labor market. The aim in this study was to investigate trajectories of purchases of psychotropic drugs in relation to labor market exit later in life in a context with and without downsizing. Method People living in Sweden, born 1941-1951, exiting paid work via unemployment, sickness absence/disability pension, or old-age pension were followed from 2005 to 2013 regarding purchases of psychotropic drugs. Individuals employed at a workplace closing down or downsizing with >= 18% between two subsequent years were compared to employees exiting from workplaces without downsizing or workplace closure. Generalized estimating equations was applied to derive trajectories of annual prevalence of purchased antidepressants, sedatives and anxiolytics from 4 years before to 4 years after a labour market exit. Results During the period around the exit, old-age retirees experiencing a downsizing/workplace closure did not decrease their purchases of sedatives (OR 1.01 95% CI 0.95-1.07) while the unexposed decreased their purchases during this period (OR 0.95 95% CI 0.92-0.98). Similar differences concerning sedatives and antidepressants between exposed and unexposed were seen for those exiting via sickness absence or disability pension. Furthermore, a significant difference in purchases of anxiolytics was observed between those exposed to downsizing (OR 1.10 95% CI 0.97-1.24) and the unexposed (OR 0.98 95% CI 0.91-1.06) exiting via old-age retirement during the time before the exit. Conclusion Downsizing or workplace closure, although weakly, was associated with higher prevalence of psychotropic drugs certain years around the labor market exit. The results support the idea that involuntary labor market exit in mature adulthood may negatively affect the development of mental health.

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• Downsizing and purchases of psychotropic drugs

  2018. Sandra Blomqvist (et al.). PLoS ONE 13 (8)

  Article

  Background The evidence is insufficient regarding the association between organizational downsizing and employee mental health. Our aim was to analyze trajectories of prescribed sedatives and anxiolytics with a sufficiently long follow-up time to capture anticipation, implementation and adaption to a downsizing event among stayers, changers and those who become unemployed compared to unexposed employees. Method Swedish residents aged 20-54 years in 2007, with stable employment between 2004 and 2007, were followed between 2005 and 2013 (n = 2,305,795). Employment at a workplace with staff reductions >= 18% between two subsequent years in 2007-2011 (n = 915,461) indicated exposure to, and timing of, downsizing. The unexposed (n = 1,390,334) were randomized into four corresponding sub-cohorts. With generalized estimating equations, we calculated the odds ratios (OR) of purchasing prescribed anxiolytics or sedatives within nine 12-month periods, from four years before to four years after downsizing. In order to investigate whether the groups changed their probability of purchases over time, odds ratios (OR) and their 95% confidence intervals (95% CI) were calculated contrasting the prevalence of purchases during the first and the last 12-month period within four time periods for each exposure group. Results The odds of purchasing anxiolytics increased more for stayers (OR 1.03, 95% CI 1.01-1.06) and unemployed (OR 1.08, 95% CI 1.03-1.14) compared to unexposed before downsizing, and purchases continued to increase after downsizing for stayers. Among those without previous sickness absence, stayers increased their purchases of anxiolytics from the year before the event up to four years after the event. Trajectories for sedatives were similar but less pronounced. Conclusion This study indicates that being exposed to downsizing is associated with increased use of sedatives and anxiolytics, especially before the event, if the employee stays in the organization or becomes unemployed.

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• Downsizing and purchases of psychotropic drugs

  Sandra Blomqvist (et al.).

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• Perceived job insecurity and risk of suicide and suicide attempts

  Sandra Blomqvist (et al.).

  Article

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