Constanze LeineweberForskare, Docent
Jag arbetar sedan 2007 som forskare vid Stressforskningsinstitutet. Genom mitt arbete som data manager för den Svenska Longitudinella studien Om Sociala förhållanden, arbetsliv och Hälsa (SLOSH, se även www.slosh.se), som idag omfattar enkäts- och registerdata om omkring 40.000 personer, kommer jag i kontakt med många olika forskningsfält inom arbetsmiljö och epidemiologi. Mina egna forskningsintressen berör bl.a. samspelet mellan arbete och privatlivet, där jag har publicerat om samband mellan arbete-familj konflikt, kontroll över arbetstider, organisatorisk rättvisa och egenföretagares speciella situation. Jag är även intresserad av och forskar om arbetsmiljöns betydelse för sjukpension och sjukfrånvaro bland vårdpersonal. Nära relaterad till sjukfrånvaro är sjuknärvaro, ett fenomen som jag också har belyst i min forskning. Mycket av min forskning baseras på longitudinella data med upprepade mätningar och jag använder gärna mer avancerade statistiska modeller. Jag handleder studenter på kandidat- och mastersnivå inom ämnen psykologi och folkhälsovetenskap och är för närvarande handledare för tre doktorander. Sedan 2018 är jag associated editor för tidskriften BMC Public Health.
2001 legitimerad psykolog
2004 Med. dr. i psykosocial medicin
I urval från Stockholms universitets publikationsdatabas
Alterations in auditory brain stem response distinguish occasional and constant tinnitus
2022. Niklas K. Edvall (et al.). Journal of Clinical Investigation 132 (5)Artikel
BACKGROUND. The heterogeneity of tinnitus is thought to underlie the lack of objective diagnostic measures.
METHODS. Longitudinal data from 20,349 participants of the Swedish Longitudinal Occupational Survey of Health (SLOSH) cohort from 2008 to 2018 were used to understand the dynamics of transition between occasional and constant tinnitus. The second part of the study included electrophysiological data from 405 participants of the Swedish Tinnitus Outreach Project (STOP) cohort.
RESULTS. We determined that with increasing frequency of the occasional perception of self-reported tinnitus, the odds of reporting constant tinnitus after 2 years increases from 5.62 (95% CI, 4.83–6.55) for previous tinnitus (sometimes) to 29.74 (4.82–6.55) for previous tinnitus (often). When previous tinnitus was reported to be constant, the odds of reporting it as constant after 2 years rose to 603.02 (524.74–692.98), suggesting that once transitioned to constant tinnitus, the likelihood of tinnitus to persist was much greater. Auditory brain stem responses (ABRs) from subjects reporting nontinnitus (controls), occasional tinnitus, and constant tinnitus show that wave V latency increased in constant tinnitus when compared with occasional tinnitus or nontinnitus. The ABR from occasional tinnitus was indistinguishable from that of the nontinnitus controls.
CONCLUSIONS. Our results support the hypothesis that the transition from occasional to constant tinnitus is accompanied by neuronal changes in the midbrain leading to a persisting tinnitus, which is then less likely to remit.
Work changes and employee age, maladaptive coping expectations, and well-being
2022. Annelies E. M. Van Vianen (et al.). International Archives of Occupational and Environmental HealthArtikel
Purpose Older workers are expected to suffer more from work changes than younger ones, but empirical evidence is lacking. Negative responses to work changes may result rather from maladaptive coping expectations. This study examined possible age differences in job and life satisfaction, and sleep disturbances, after work changes (voluntary and involuntary job changes, reorganizations) and the moderating role of maladaptive coping expectations.
Methods Four biennial waves from the Swedish Longitudinal Occupational Survey of Health (SLOSH) including respondents who participated in all four waves (n = 3084). We used multilevel path analyses to estimate direct and moderated relationships between work changes and outcomes.
Results Involuntary job changes were associated with lower job and life satisfaction and more sleep disturbances. Reorganizations were only associated with lower job satisfaction. Older employees were more satisfied with their jobs and lives than younger employees and experienced more sleep disturbances. After involuntary job changes, older employees had similar (lower) levels of well-being as younger ones, but they reported more sleep disturbances when having experienced reorganizations. Maladaptive coping expectations were related to lower job and life satisfaction and more sleep disturbances. Employees with maladaptive coping expectations reported more sleep disturbances after involuntary job changes and reorganizations.
Conclusion Our results suggest that there are few age differences in well-being after work changes. Employee well-being seems to mostly depend on maladaptive coping expectations. Organizations aiming to prepare employees for job changes and reorganizations could focus their efforts on employees with maladaptive expectations rather than on older ones.
A Theoretical Development of the Gender Embodiment of Enrichment
2021. Emma Hagqvist, Anna Nyberg, Constanze Leineweber. Frontiers in Sociology 6Artikel
Enrichment is a phenomenon described as the synergistic and beneficial effects of participating in both work and private life. Far too few studies have acknowledged the role of gender in enrichment. By applying a gender theoretical approach, this article has two aims; first, we aim to study the role of gender in enrichment by examining the factorial structure of enrichment in men and women; secondly, we aim to study the relationship between enrichment and work and private life factors in an approximately representative sample of the Swedish working population. A multigroup confirmatory factor analysis with measurement in variance was performed and this resulted in a two-factor solution for enrichment for both men and women, representing the two directions of enrichment: work-to-life enrichment (WLE) and life-to-work enrichment (LWE). Factor loadings differ across genders, indicating that men and women construct and value items of enrichment differently. Next, linear mixed models were used to answer the second aim. Results show that gendered cultural norms in work and private life manifest in the relationship between factors in the work and home sphere and enrichment. Factors in work and private life with more or less masculine or feminine epithets relate differently to WLE and LWE for men and women. The main conclusion is that masculine and feminine norms are embodied in the values and experiences of enrichment and factors related to enrichment.
Association of rotating shift work schedules and the use of prescribed sleep medication
2021. Philip Tucker (et al.). Journal of Sleep Research 30 (6)Artikel
We examined whether working rotating shifts, with or without night work, is associated with the purchase of prescribed sleep medication, and whether the association is dependent on age. Data were obtained from a longitudinal cohort study of Finnish public sector employees who responded to questions on work schedule and background characteristics in 2000, 2004 and 2008. The data were linked to national register data on redeemed prescriptions of hypnotic and sedative medications, with up to 11 years of follow-up. Age stratified Cox proportional hazard regression models were computed to examine incident use of medication comparing two groups of rotating shift workers (those working shifts that included night shifts and those whose schedules did not include night shifts) with day workers who worked in a similar range of occupations. Shift work with night shifts was associated with increased use of sleep medication in all age groups, after adjustments for sex, occupational status, marital status, alcohol consumption, smoking and physical activity levels (hazard ratio [HR], [95% confidence interval, CI] 1.14 [1.01-1.28] for age group <= 39 years; 1.33 [1.19-1.48] for age group 40-49 years; 1.28 [1.13-1.44] for age group >= 50 years). Shift work without nights was associated with medication use in the two older age groups (HR [95% CI] 1.14 [1.01-1.29] and 1.17 [1.05-1.31] for age groups 40-49 years and >50 years, respectively). These findings suggest that circadian disruption and older age puts rotating shift workers, and especially those who work nights, at increased risk of developing clinically significant levels of sleep problems.
Comparing Depressive Symptoms, Emotional Exhaustion, and Sleep Disturbances in Self-Employed and Employed Workers
2021. Louise E. Bergman (et al.). Frontiers in Psychology 11Artikel
Studies investigating differences in mental health problems between self-employed and employed workers have provided contradictory results. Many of the studies utilized scales validated for employed workers, without collecting validity evidence for making comparisons with self-employed. The aim of this study was (1) to collect validity evidence for three different scales assessing depressive symptoms, emotional exhaustion, and sleep disturbances for employed workers, and combinators; and (2) to test if these groups differed. We first conducted approximate measurement invariance analysis and found that all scales were invariant at the scalar level. Self-employed workers had least mental health problems and employed workers had most, but differences were small. Though we found the scales invariant, we do not find them optimal for comparison of means. To be more precise in describing differences between groups, we recommend using clinical cut-offs or scales developed with the specific purpose of assessing mental health problems at work.
Comparing the acute effects of shiftwork on mothers and fathers
2021. Philip Tucker, Constanze Leineweber, Göran Kecklund. Occupational Medicine 71 (9), 414-421Artikel
Background: Shift work may impact women more negatively than men due to the increased burden of coping with demanding work schedules while also undertaking more of the domestic chores, including childcare.
Aims: To examine whether the combination of shift working and caring for children affects the sleep, fatigue and work–family conflict experienced by women more than it affects men.
Methods: Using data from a survey of the Swedish working population, mixed linear regression models examined work schedule (daywork, shift work with nights, shift work without nights), gender and presence of children <13 years at home as predictors of sleep insufficiency, sleep disturbance, fatigue and work–family conflict, over up to three successive measurement occasions. Adjustments were made for age, education, full/part-time working and baseline year.
Results: In fully adjusted models (N = 8938), shift work was associated with insufficient sleep (P < 0.01), disturbed sleep (P < 0.01), fatigue (P < 0.05) and work–family conflict (P < 0.001). Interactions in the analyses of sleep disturbance (P < 0.001) and work–family interference (P < 0.05) indicated that among participants with no children, females reported more disturbed sleep and more work–family conflict than their male counterparts, irrespective of schedule; while among participants with children, female dayworkers reported more disturbed sleep than their male counterparts, and females working shifts without nights reported more work–family interference.
Conclusions: Having young children did not exacerbate negative effects of shift work, in either men or women. This may reflect high levels of gender equality and childcare provision in Sweden.
Do good psychosocial working conditions prolong working lives?
2021. Johanna Stengård (et al.). European Journal of AgeingArtikel
Due to an ageing population, governments in European countries are striving to keep older workers longer in the workforce. Remarkably few studies have paid attention to the influence of psychosocial working conditions on timing of retirement for older workers in and beyond normative retirement age. The aim of the present study was to examine whether good psychosocial working conditions contribute to prolonged working lives among older workers (59 years and above). A particular question was whether such conditions increase in importance with age. Seven waves (2006-2018) of the Swedish Longitudinal Occupational Survey of Health (SLOSH) were used (N = 6000, observations = 10,632). Discrete-time event history analyses showed that higher levels of job resources (decision authority [OR 1.13, 95% CI 1.06-1.22], skill use [OR 1.17, 95% CI 1.07-1.29], learning opportunities [OR 1.22, 95% CI 1.13-1.31], social support [OR 1.29 (95% CI 1.16-1.42], work-time control [OR 1.07, 95% CI 1.01-1.13], and reward [OR 1.40, 95% CI 1.24-1.57])-but not lower levels of job demands (quantitative and emotional demands or effort)-were associated with working longer (continued work two years later). Also, low effort-reward imbalance (OR 0.84 [95% CI 0.73-0.96]) was associated with working longer. In addition, skill use, work-time control, reward, and low effort-reward imbalance increased in importance with age for continued work. These results suggest that providing older workers with control over their work tasks, giving opportunities for learning and using their skills, as well as rewarding and acknowledging their achievements, may keep them in the workforce longer. Especially, job resources may grow in importance with age.
Effort-Reward Imbalance at Work and Drug Misuse
2021. Jian Li (et al.). International Journal of Environmental Research and Public Health 18 (24)Artikel
With the rise of drug misuse among workers in recent years, preliminary research on potential risk factors in the workplace of single-type of drug misuse has been reported. This is the first study to examine cross-sectional associations of work stress, in terms of effort-reward imbalance, with multiple drug misuse (including any drug misuse, opioid misuse, sedatives misuse, cannabis misuse, and other drug misuse) during the past 12 months in a national sample of U.S. workers. Data of 2211 workers were derived from the nationally representative and population-based Midlife in the United States (MIDUS) study. Internal consistency reliability and factorial validity of a 17-item effort-reward imbalance measure were robust and satisfactory. After adjustment for relevant covariates, logistic regression analyses showed that workers experiencing effort-reward imbalance at work had significantly higher odds of any drug misuse (OR and 95% CI = 1.18 (1.03, 1.37)), especially opioid misuse (OR and 95% CI = 1.35 (1.07, 1.69)) and other drug misuse (OR and 95% CI = 1.36 (1.01, 1.83)). The findings suggest that a stressful work environment may act as a determinant of drug misuse, and further prospective evidence is needed.
Favorable Working Conditions Related to Health Behavior Among Nurses and Care Assistants in Sweden-A Population-Based Cohort Study
2021. Magnus Helgesson (et al.). Frontiers In Public Health 9Artikel
Objective: To analyze the associations between favorable physical and psychosocial work factors and health behavior among healthcare employees (nurses and care assistants) with health complaints.
Methods: The study was based on seven iterations (2001-2013) of a biennial Swedish work environment survey linked with data from public registers. In all, 7,180 healthcare employees, aged 16-64 years, who had reported health complaints, were included. Health behavior was operationalized through four combinations of sickness absence (SA) and sickness presence (SP): 'good health behavior' (Low SP/Low SA), 'recovery behavior' (Low SP/High SA), 'risk behavior' (High SP/Low SA), and 'poor health behavior' (High SP/High SA). Odds ratios (OR) were calculated by multinomial logistic regression with 95% confidence intervals (CI).
Results: After adjusting for socio-demographic factors, those who rarely worked in strenuous postures had an increased probability of having 'good health behavior' (OR range: nurses 1.72-2.02; care assistants 1.46-1.75). Those who rarely experienced high job demands had increased odds for having 'good health behavior' (OR: nurses 1.81; OR range: care assistants 1.67-2.13), while having good job control was found to be related to 'good health behavior' only among care assistants (OR range 1.30-1.68). In the full model, after also considering differences in health, none of the work environment indicators affected 'good health behavior' among nursing professionals. Among care assistants, rarely having heavy physical work and having low psychosocial demands remained significantly associated with 'good health behavior' (OR range: 1.24-1.58) and 'recovery behavior' (OR range: 1.33-1.70). No associations were found between favorable work environment factors and 'risk behavior' among the two groups of employees. However, positive assessments of the work situation were associated with 'good health behavior,' even after controlling for all confounders for both groups (OR range: 1.43-2.69).
Conclusions: 'Good health behavior' and 'recovery behavior' among care assistants were associated with favorable physical and psychosocial working conditions even when health was considered. This implies that reduced sickness presence and sickness absence among care assistants can be achieved through improved physical and psychosocial working conditions.
Health and motivation as mediators of the effects of job demands, job control, job support, and role conflicts at work and home on sickness presenteeism and absenteeism
2021. Gunnar Aronsson (et al.). International Archives of Occupational and Environmental Health 94 (3), 409-418Artikel
Purpose: The first objective was to contribute to a better understanding of the contrasting and paradoxical results in studies of work environment factors and sickness presence and sickness absence. A second objective was to examine if, and under what conditions, employees choose to replace sickness absence with sickness presence, i.e., so-called substitution.
Methods: The study utilizes a large body of cross-sectional questionnaire data (n = 130,161) gathered in Sweden from 2002 to 2007 in connection with a comprehensive health promotion initiative. Health and motivation were analyzed as mediators of the effects of five job factors, job control, job support, job demand, role conflict and “work to family conflict” on sickness presence and absence.
Results: The results concerning job demands indicate substitution in that increased job demands are associated with increased presenteeism and reduced absenteeism. The direct effect of higher job support was increased absenteeism, but via the health and motivation paths, the total effect of more social support was health-promoting and associated with a reduction in sickness absence and sickness presence. High job control emerged as the most pronounced health-promoting factor, reducing sickness presenteeism as well as absenteeism. More role conflicts and work-to-family conflicts were directly and indirectly associated with decreased health and increased absenteeism as well as presenteeism. earlier research.
Conclusion: The mediation analyzes shed light on some of the paradoxes in research on sickness presenteeism and sickness absenteeism, especially regarding job demands and job support. The substitution effect is important for workplace policy and occupational health practice.
Long working hours and risk of 50 health conditions and mortality outcomes
2021. Jenni Ervasti (et al.). The Lancet Regional Health 11Artikel
Background: Studies on the association between long working hours and health have captured only a narrow range of outcomes (mainly cardiometabolic diseases and depression) and no outcome-wide studies on this topic are available. To achieve wider scope of potential harm, we examined long working hours as a risk factor for a wide range of disease and mortality endpoints.
Methods: The data of this multicohort study were from two population cohorts from Finland (primary analysis, n=59 599) and nine cohorts (replication analysis, n=44 262) from Sweden, Denmark, and the UK, all part of the Individual-participant Meta-analysis in Working Populations (IPD-Work) consortium. Baseline-assessed long working hours (≥55 hours per week) were compared to standard working hours (35-40 h). Outcome measures with follow-up until age 65 years were 46 diseases that required hospital treatment or continuous pharmacotherapy, all-cause, and three cause-specific mortality endpoints, ascertained via linkage to national health and mortality registers.
Findings: 2747 (4·6%) participants in the primary cohorts and 3027 (6·8%) in the replication cohorts worked long hours. After adjustment for age, sex, and socioeconomic status, working long hours was associated with increased risk of cardiovascular death (hazard ratio 1·68; 95% confidence interval 1·08-2·61 in primary analysis and 1·52; 0·90-2·58 in replication analysis), infections (1·37; 1·13-1·67 and 1·45; 1·13-1·87), diabetes (1·18; 1·01-1·38 and 1·41; 0·98-2·02), injuries (1·22; 1·00-1·50 and 1·18; 0·98-1·18) and musculoskeletal disorders (1·15; 1·06-1·26 and 1·13; 1·00-1·27). Working long hours was not associated with all-cause mortality.
Interpretation: Follow-up of 50 health outcomes in four European countries suggests that working long hours is associated with an elevated risk of early cardiovascular death and hospital-treated infections before age 65. Associations, albeit weak, were also observed with diabetes, musculoskeletal disorders and injuries. In these data working long hours was not related to elevated overall mortality.
Reasons for presenteeism in different occupational branches in Sweden
2021. Staffan Marklund (et al.). International Archives of Occupational and Environmental Health 94, 1385-1395Artikel
Objective To compare the prevalence and reasons for presenteeism in occupations in three branches defined as employees handling people, handling things or handling symbols.
Method A cross-sectional population-based cohort study was conducted. The study group was drawn from a representative sample (n = 6230) aged 16-64, who had been interviewed in 2015 or in 2017 for the Swedish Work Environment Surveys (SWES). The odds ratios (ORs) stratified by occupational category for reasons of presenteeism, with 95% confidence intervals (CI), were estimated using binomial multiple logistic regression analysis.
Results The study showed that presenteeism was more common among employees handling people (74%), when compared to employees handling things (65%) or handling symbols (70%). The most common reason for presenteeism among employees handling people was I do not want to burden my colleagues, while Because nobody else can carry out my responsibilities was most common in the other two categories. After control for socio-demography, work environments and health, the differences in reasons mostly remained significant between the three occupational categories.
Conclusion The differences between occupational categories are important for prevalence and reasons for presenteeism. As presenteeism affects the future health of employees and the productivity of the work unit, attempts to reduce presenteeism may be important. Because the reasons vary between occupations, customized preventive measures should be applied in different occupational settings. Among employees handling people, covering up for absence in work team is relevant, while among employees handling symbols and handling things the corresponding focus could be on shared responsibilities for specific tasks.
Sickness Absence and Sickness Presence Among Health and Care Employees in Sweden-Health Complaints, Health Behavior, and Future Long-Term Sickness Absence
2021. Magnus Helgesson (et al.). Journal of Occupational and Environmental Medicine 63 (6), 514-520Artikel
Objective: To describe if health complaints relate to health behavior in terms of sickness absence (SA) and sickness presence (SP) and to examine how complaints and health behavior predicts the risk for future long-term sickness absence (LTSA).
Methods: Data originates from work environment surveys 2001 to 2013 and SA registers 2002 to 2016 of 1838 nurses, 7430 care assistants, and 40,515 individuals in all other occupations. Descriptive and regression analyses were conducted.
Results: Physical complaints and high SA in combination with high SP increased the risk of LTSA among nurses and care assistants. Nurses' high SP and care assistants' high SA elevated the LTSA risk.
Conclusions: Strategies to reduce the reasons behind physical health complaints among health care workers are warranted. SP among nurses and SA among care assistants should be considered in the organization of their job demands.
The changing nature of work - Job strain, job support and sickness absence among care workers and in other occupations in Sweden 1991-2013
2021. Gunnar Aronsson (et al.). SSM - Population Health 15Artikel
This study examined exposure changes in three psychosocial dimensions - job demands, job control, and social support - and the associations between these dimensions and sickness absence throughout the period 1991-2013. The analyses covered periods of economic ups and downs in Sweden and periods involving major fluctuations in sickness absence. Data on care workers (n = 16,179) and a comparison group of employees in other occupations (n = 82,070) were derived from the biennial Swedish Work Environment Survey and linked to register data on sickness absence. Eight exposure profiles, based on combinations of demands, control, and support, were formed. The proportion of individuals with work profiles involving high demands doubled among care workers (14%-29%) while increasing modestly in the comparison group (17%-21%) 1991-2013. The work profile that isolated high-strain (iso-strain), i.e., high demands, low control, and low social support, was more prevalent among care workers, from 4% in 1991 to 11% in 2013. Individuals with work profiles involving highdemand jobs had the highest number of days on sickness absence during the study period and those with the isostrain work profile had the highest increase in sickness absence, from 15 days per year during 1993-1994, to 42 days during 2000-2002. Employees with a passive work profile (low job demands and low job control) had the lowest rate and the lowest increase in sickness absence. Individuals with active work profiles, where high demands are supposed to be balanced by high job control, had a rather high increase in sickness days around 2000. A conclusion is that there is a long-term trend towards jobs with high demands. This trend is stronger among care workers than among other occupations. These levels of job demands seem to be at such a level that it is difficult to compensate for with higher job control and social support.
The mediating effect of exhaustion in the relationship between effort-reward imbalance and turnover intentions
2021. Constanze Leineweber (et al.). Journal of Occupational Health 63 (1)Artikel
Objectives: Earlier studies suggest that imbalance between effort and reward at work associates with exhaustion. Others have found that exhaustion increases turnover intentions; an important precursor of actual turnover that also associates with counterproductive work behaviors. Few, however, have studied the associations between effort-reward imbalance (ERI) and employees’ intentions to leave their current employment, and whether exhaustion is underpinning that relationship. Here, we investigate the mediating role of exhaustion in the effort-reward imbalance – turnover intentions relationship.
Methods: Data from three waves covering a time span of four years from the Swedish Longitudinal Occupational Survey of Health (SLOSH) were analysed using structural equation modeling. Cross-lagged mediation analyses were conducted to estimate if associations from ERI to subsequent turnover intentions were mediated by exhaustion. Other causal directions (direct and reversed direct effects, reversed mediation) were also examined.
Results: A direct path from ERI T1 to turnover intentions T2 was found, but not from ERI T2 to turnover intentions T3. Additionally, results showed that ERI at time points T1/T2 associated significantly with exhaustion two years later (T2/T3). Also, exhaustion at T1 showed a small but statistically significant direct association with turnover intentions at T2 (no association was found between exhaustion T2 and turnover intentions T3). A small, but statistically significant indirect effect from ERI to turnover intentions was found (estimate 0.005; 95% CI 0.002-0.010).
Conclusions: Providing a good balance between effort and reward for workers is essential to protect employee health and help retain employees in the organization.
Trajectories of Procedural and Interactional Justice as Predictors of Retirement among Swedish Workers
2021. Constanze Eib (et al.). International Journal of Environmental Research and Public Health 18 (12)Artikel
Organizational justice is an important aspect of the psychosocial work environment, but there is a lack of studies on whether justice perceptions also predict retirement decisions. The aim of this study is to examine trajectories of procedural and interactional justice perceptions prior to retirement of three groups of retirees while considering self-rated health and important demographics. Data from the Swedish Longitudinal Occupational Survey of Health (2006-2018, N = 3000) were used. Respondents were grouped into early retirement, normative retirement and late retirement. Latent growth curve models and multinomial logistic regressions were conducted to test whether trajectories of justice perceptions prior to retirement differed between retirement groups while controlling for self-rated health development and demographic variables. Late retirees had higher intercept levels of interactional justice and higher intercept levels of self-rated health prior to retirement, compared to early retirees. Late retirees also showed a slower decrease in procedural justice compared to early retirees. Only intercept levels of self-rated health differed between early retirees and normative retirees, such that early retirees had lower levels of self-rated health prior to retirement. Keeping employees in the workforce is a major challenge for any aging society. Organizational justice perceptions in the years prior to retirement seem particularly influential for delaying retirement.
You can't always get what you want
2021. Constanze Eib (et al.). International Journal of Human Resource ManagementArtikel
An intra-organizational change process involving all middle managers was studied in a public sector organization in Sweden over three time points, spanning two years in total. Using sensemaking and the person-environmental fit literature as well studies on promotion and demotion, hypotheses about the effects of managerial status loss and being offered a non-preferred role (non-preference) on change reactions (job satisfaction, turnover intentions, mental health) are made. Data from 140 middle managers was analyzed with path models, where two process factors (perceived organizational support during the change, procedural justice of the change) and two job characteristics (job demand, job control) were tested simultaneously as mediators. Results revealed that managerial status loss had negative effects on work attitudes but mental health was positively affected over time through decreased job demands. Non-preference had negative consequences for all outcome variables and these effects were mediated through lower procedural justice of the change, lower job control, and for some outcomes, lower perceived organizational support during the change. The results provide insight into how middle managers react to change, and suggest that process justice and job characteristics play an important part in shaping these reactions.