Working to the older age: assessing psychosocial resources in the working environment as decelerators of cardiometabolic disease development

FORTE-funded research project

The overall aim of this project is to examine the role of workplace psychosocial resources in the prevention of cardiometabolic diseases (CMD), with a particular focus on employees exhibiting pre-disease conditions.

The project consists of the following work packages (WPs):

WP1: Mapping psychosocial resources in the workplace

WP2: Workplace psychosocial resources as protective factors decelerating the transition from pre-disease conditions to clinical disease

WP3: Simulation of joint interventions targeting workplace resources and lifestyle factors among employees with and without pre-disease conditions

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Data and Methods

The project will utilize multicohort data from five major European occupational health cohorts, comprising over 120,000 participants with repeated measurements.

Pre-disease conditions include prediabetes, obesity, and gestational diabetes for type 2 diabetes (T2D); and obesity, hypertension, T2D, and a high cardiovascular risk profile (ASCVD risk score) for cardiovascular disease (CVD).

The project will refine existing analyses of psychosocial resource clusters in the workplace and identify organizational characteristics associated with limited or absent resources. Disease-free life-years will be estimated to assess the extent to which workplace resources can slow the transition from pre-disease to clinical disease, acknowledging that pre-disease conditions may be reversible.

Furthermore, using observational data, the project will simulate hypothetical interventions under a counterfactual framework, estimating risk ratios and risk differences for various intervention scenarios among employees with and without pre-disease conditions.

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Societal Relevance and Impact

As retirement ages rise, older workers increasingly face challenges related to managing pre-disease conditions of CMD, living with CMD, or premature exit from the workforce, all of which place significant burdens on individuals and public systems.

This project investigates how modifiable workplace psychosocial resources may influence the development of CMD among individuals with pre-disease conditions, thereby contributing to the understanding of these resources as potential protective factors for sustainable working lives.

The estimation of disease-free life-years, risk ratios, and risk differences will provide actionable insights to guide the development of preventive interventions and improve risk communication in both occupational health and public health contexts.

A selection from Stockholm University publication database

• Association of workplace violence and bullying with later suicide risk: a multicohort study and meta-analysis of published data

  2023. Linda Magnusson Hanson (et al.). The Lancet Public Health 8 (7), e494-E503

  Article

  Background Workplace offensive behaviours, such as violence and bullying, have been linked to psychological symptoms, but their potential impact on suicide risk remains unclear. We aimed to assess the association of workplace violence and bullying with the risk of death by suicide and suicide attempt in multiple cohort studies. Methods In this multicohort study, we used individual-participant data from three prospective studies: the Finnish Public Sector study, the Swedish Work Environment Survey, and the Work Environment and Health in Denmark study. Workplace violence and bullying were self-reported at baseline. Participants were followed up for suicide attempt and death using linkage to national health records. We additionally searched the literature for published prospective studies and pooled our effect estimates with those from published studies. Findings During 1 803 496 person-years at risk, we recorded 1103 suicide attempts or deaths in participants with data on workplace violence (n=205 048); the corresponding numbers for participants with data on workplace bullying (n=191 783) were 1144 suicide attempts or deaths in 1 960 796 person-years, which included data from one identified published study. Workplace violence was associated with an increased risk of suicide after basic adjustment for age, sex, educational level, and family situation (hazard ratio 1.34 [95% CI 1.15-1.56]) and full adjustment (additional adjustment for job demands, job control, and baseline health problems, 1.25 [1.08-1.47]). Where data on frequency were available, a stronger association was observed among people with frequent exposure to violence (1.75 [1.27-2.42]) than occasional violence (1.27 [1.04-1.56]). Workplace bullying was also associated with an increased suicide risk (1.32 [1.09-1.59]), but the association was attenuated after adjustment for baseline mental health problems (1.16 [0.96-1.41]). Interpretation Observational data from three Nordic countries suggest that workplace violence is associated with an increased suicide risk, highlighting the importance of effective prevention of violent behaviours at workplaces. Funding Swedish Research Council for Health, Working Life and Welfare, Academy of Finland, Finnish Work Environment Fund, and Danish Working Environment Research Fund.

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• Characteristics of Workplace Psychosocial Resources and Risk of Diabetes: A Prospective Cohort Study 

  2022. Tianwei Xu (et al.). Diabetes Care 45 (1), 59-66

  Article

  OBJECTIVE

  To examine whether characteristics of workplace psychosocial resources are associated with the risk of type 2 diabetes among employees.

  RESEARCH DESIGN AND METHODS

  Participants were 49,835 employees (77% women, aged 40–65 years, and diabetes free at baseline) from the Finnish Public Sector cohort study. Characteristics of horizontal (culture of collaboration and support from colleagues) and vertical (leadership quality and organizational procedural justice) psychosocial resources were self-reported. Incident type 2 diabetes (n = 2,148) was ascertained through linkage to electronic health records from national registers. We used latent class modeling to assess the clustering of resource characteristics. Cox proportional hazards models were used to examine the relationship between the identified clusters and risk of type 2 diabetes during 10.9 years of follow-up, adjusting for age, sex, marital status, educational level, type of employment contract, comorbidity, and diagnosed mental disorders.

  RESULTS

  We identified four patterns of workplace psychosocial resources: unfavorable, favorable vertical, favorable horizontal, and favorable vertical and horizontal. Compared with unfavorable, favorable vertical (hazard ratio 0.87 [95% CI 0.78; 0.97]), favorable horizontal (0.77 [0.67; 0.88]), and favorable vertical and horizontal (0.77 [0.68; 0.86]) resources were associated with a lower risk of type 2 diabetes, with the strongest associations seen in employees at age ≥55 years (Pinteraction = 0.03). These associations were robust to multivariable adjustments and were not explained by reverse causation.

  CONCLUSIONS

  A favorable culture of collaboration, support from colleagues, leadership quality, and organizational procedural justice are associated with a lower risk of employees developing type 2 diabetes than in those without such favorable workplace psychosocial resources.

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• Workplace psychosocial resources and risk of cardiovascular disease among employees: a multi-cohort study of 135 669 participants

  2022. Tianwei Xu (et al.). Scandinavian Journal of Work, Environment and Health 48 (8), 621-631

  Article

  Objective In terms of prevention, it is important to determine effects on cardiovascular disease (CVD) when some workplace psychosocial resources are high while others are low. The aim of the study was to assess the prospective relationship between clustering of workplace psychosocial resources and risk of CVD among employees.

  Methods We pooled data from three cohort studies of 135 669 employees (65% women, age 18–65 years and free of CVD) from Denmark, Finland and Sweden. Baseline horizontal resources (culture of collaboration and support from colleagues) and vertical resources (leadership quality and procedural justice) were measured using standard questionnaire items. Incident CVD, including coronary heart and cerebrovascular disease, was ascertained using linked electronic health records. We used latent class analysis to assess clustering (latent classes) of workplace psychosocial resources. Cox proportional hazard models were used to examine the association between these clusters and risk of CVD, adjusting for demographic and employment-related factors and pre-existing physical and mental disorders.

  Results We identified five clusters of workplace psychosocial resources from low on both vertical and horizontal resources (13%) to generally high resources (28%). High horizontal resources were combined with either intermediate [hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.74–0.95] or high (HR 0.88, 95% CI 0.78–1.00) vertical resources were associated with lower risks of CVD compared to those with generally low resources. The association was most prominent for cerebrovascular disease (eg, general high resources: HR 0.80, 95% CI 0.67–0.96).

  Conclusions Individuals with high levels of workplace psychosocial resources across horizontal and vertical dimensions have a lower risk of CVD, particularly cerebrovascular disease.

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• Organizational Justice and Long-term Metabolic Trajectories

  2022. Tibor V. Varga (et al.). Journal of Clinical Endocrinology and Metabolism 107 (2), 398-409

  Article

  Context: Organizational justice has been linked to lower risk of several chronic conditions among employees, but less is known about the long-term mechanisms underlying this risk reduction.

  Objective: To assess whether self-reported organizational justice is associated with individual and composite long-term metabolic trajectories.

  Design: Twenty-five-year follow-up of the Whitehall II prospective cohort study.

  Setting: Middle-aged public servants from the United Kingdom.

  Participants: Data on 8182 participants were used.

  Main Outcome Measures: Levels of 11 anthropometric, glycemic, lipid, and blood pressure biomarkers were measured at 5 timepoints (1991–2013). We used generalized estimating equations and group-based trajectory modeling to investigate the relationship between organizational justice and biomarker trajectories.

  Results: High vs low organizational justice were associated with lower waist (−1.7 cm) and hip (−1 cm) circumference, body mass index (−0.6 kg/m2), triglycerides (−1.07 mmol/L), and fasting insulin (−1.08 µIU/mL) trajectories. Two latent metabolic trajectory clusters were identified: a high- and a low-risk cluster. High organizational justice (vs low) were associated with belonging to the low-risk cluster (pooled odds ratio = 1.47). The low-risk cluster demonstrated lower baseline levels of most biomarkers and better glycemic control, whereas the high-risk cluster showed higher baseline levels of most biomarkers, glycemic deterioration, but also greater improvements in lipid levels over time.

  Conclusions: People with high organizational justice had more favorable long-term cardiometabolic biomarker patterns than those with low organizational justice, indicating a potential mechanism contributing to the lower risk of chronic diseases in the first group. Further intervention studies are warranted to determine whether improvement of organizational justice might improve long-term health.

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• The relationship between onset of workplace violence and onset of sleep disturbances in the Swedish working population

  2021. Meike Heming (et al.). Journal of Sleep Research 30 (5)

  Article

  The study investigated the association between onset of workplace violence and onset of sleep disturbances. We used self-reported data from the Swedish Longitudinal Occupational Survey of Health (SLOSH) collected in 2014, 2016, and 2018. A two-wave design was based on participants who had no exposure to workplace violence or sleep disturbances at baseline (n = 6,928). A three-wave design was based on participants who in addition were unexposed to sleep disturbances in the second wave (n = 6,150). Four items of the Karolinska Sleep Questionnaire were used to measure sleep disturbances and one question was used to measure the occurrence of workplace violence or threats of violence. Multivariate logistic regression analyses were performed. In the two-wave approach, onset of workplace violence was associated with onset of sleep disturbances after adjustment for sex, age, occupational position, education, and civil status (adjusted odds ratio 1.41, 95% confidence interval 1.02-1.96). The association was no longer statistically significant after further adjustment for night/evening work, demands, control, and social support at work. In the three-wave approach, results were only suggestive of an association between onset of workplace violence and subsequent onset of sleep disturbances after adjustment for sex, age, occupational position, education, and civil status. Onset of frequent exposure to workplace violence was associated with subsequent onset of sleep disturbances in the adjusted analyses, but these analyses were based on few individuals (13 exposed versus 5,907 unexposed). The results did not conclusively demonstrate that onset of workplace violence predicts development of sleep disturbances. Further research could elucidate the role of other working conditions.

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• Workplace discrimination as risk factor for long-term sickness absence

  2021. Alice Clark (et al.). PLOS ONE 16 (8)

  Article

  Workplace discrimination may affect the health of the exposed employees, but it is not known whether workplace discrimination is also associated with an increased risk of long-term sickness absence. The aim of this study was to examine the longitudinal associations of changes in and onset of workplace discrimination with the risk of long-term sickness absence. Data on workplace discrimination were obtained from 29,597 employees participating in survey waves 2004, 2006, 2008 and/or 2010 of the Finnish Public Sector Study. Four-year changes in long-term sickness absence (>= 10 days of medically certified absence with a mental or non-mental diagnosis) were assessed. This covered successive study waves in analyses of onset of workplace discrimination as well as fixed effect analyses of change in workplace discrimination (concurrent i.e. during the exposure year and 1-year lagged i.e. within one year following exposure), by using each employee as his/her own control. The risk of long-term sickness absence due to mental disorders was greater for employees with vs. without onset of workplace discrimination throughout the 4-year period, reaching a peak at the year when the onset of discrimination was reported (adjusted risk ratio 2.13; 95% confidence interval (CI) 1.80-2.52). The fixed effects analyses showed that workplace discrimination was associated with higher odds of concurrent, but not 1-year lagged, long-term sickness absence due to mental disorders (adjusted odds ratio 1.61; 95% CI 1.33-1.96 and adjusted odds ratio 1.02; 95% CI 0.83-1.25, respectively). Long-term sickness absence due to non-mental conditions was not associated with workplace discrimination. In conclusion, these findings suggest that workplace discrimination is associated with an elevated risk of long-term sickness absence due to mental disorders. Supporting an acute effect, the excess risk was confined to the year when workplace discrimination occurred.

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• Workplace Violence and Long-term Sickness Absence Assessment of the Potential Buffering Effect of Social Support in Two Occupational Cohort Studies

  2020. Sofie Have Hoffmann (et al.). Journal of Occupational and Environmental Medicine 62 (10), 830-838

  Article

  Objectives:

  We aimed to determine the effect of workplace violence on long-term sickness absence, and whether social support from supervisors and colleagues buffer this effect.

  Methods:

  Information on workplace violence and social support were derived from the Danish Work Environment Cohort Study in 2000, 2005, and 2010 and the Swedish Longitudinal Occupational Survey of Health in 2006 and 2008. Individual- and joint-effects on register-based long-term sickness absence were determined using logistic regression models for repeated measurements. Cohort-specific estimates were combined in random effect meta-analyses.

  Results:

  Workplace violence and low social support were independently associated with a higher risk of long-term sickness absence, and we did not find evidence of an interaction.

  Conclusion:

  Exposure to workplace violence is a risk factor for long-term sickness absence while social support is associated with a lower risk of long-term sickness absence.

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Show all publications by Tianwei Xu at Stockholm University