I urval från Stockholms universitets publikationsdatabas

• 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

  Artikel

  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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• 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

  Artikel

  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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• Exposure to work-related violence and/or threats of violence as a predictor of certified sickness absence due to mental disorders: a prospective cohort study of 16,339 Swedish men and women in paid work

  2023. Maria Wijkander, Kristin Farrants, Linda Magnusson Hanson. International Archives of Occupational and Environmental Health 96 (2), 225-236

  Artikel

  Objectives The aim of this prospective cohort study was to investigate if exposure to work-related violence and/or threats of violence predict certified sickness absence due to mental disorders.

  Methods Information on work-related exposure to violence and/or threats of violence were derived from the biannual Swedish Longitudinal Occupational Survey of Health (SLOSH) study 2012-2016, including individuals in paid work across Sweden and from different occupations/sectors (n = 16,339). Certified sickness absence due to mental disorders were ascertained from register data from the Swedish Social Insurance Agency. Odds ratios of certified sickness absence due to mental disorders according to exposure to work-related violence were estimated using multiple logistic regression. Several potential confounding variables, such as demographic and socio-economic factors, age, sex, cohabitation, children living at home, socio-economic status, educational level, as well as other types of psychosocial work environmental factors, were adjusted for in the analyses.

  Results In the total study sample, 9% reported exposure to violence and/or threats of violence and the prevalence of sickness absence due to mental disorders was 5%. Exposure to work-related violence and/or threats of violence was associated prospectively with certified sickness absence due to mental disorders (odds ratio 1.46, 95% confidence interval 1.17-1.82, p < 0.01). Analysis of possible interaction showed no difference in association when comparing women to men and different age groups.

  Conclusions Exposure to work-related violence and/or threats of violence appear to increase the odds of certified sickness absence due to mental disorders. Preventive measures aiming to lower the risk of exposure is thus of great importance.

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• Feeling stressed and depressed? A three-wave follow-up study of the beneficial effects of voluntary work

  2023. Yannick Griep (et al.). International Journal of Clinical and Health Psychology 23 (3)

  Artikel

  While symptoms of stress are a major risk factor in the onset of depressive symptoms and major depression, a better understanding of intervening mechanisms in breaking down this positive association is urgently required. It is within this literature that we investigate (1) how symptoms of stress are associated with depressive symptoms and the onset of major depression, and (2) the buffering effect of hours spent on voluntary work on the stress-depression relationship. Using 3-wave longitudinal data, we estimated a direct and reverse auto-regressive path model. We found both cross-sectional and longitudinal support for the positive association between symptoms of stress and depressive symptoms. Next, we found that individuals who experienced more symptoms of stress at T1, T2, and T3 were 1.64 (95%CI [1.46;1.91]), 1.49 (95%CI [1.24;1.74]), and 1.40 (95%CI [1.21;1.60]) times more likely to be prescribed an anti-depression treatment at T3, respectively. Moreover, we found that the number of hours spent volunteering mitigated the (1) longitudinal-but not cross-sectional-stress-depression relationship, and (2) cross-sectional but not the longitudinal-association between symptoms of stress at T3 and the likelihood of being prescribed an anti-depression treatment. These results point toward the pivotal role of voluntary work in reducing the development of depressive symptoms and major depression in relation to the experience of symptoms of stress.

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• Gender-based harassment in Swedish workplaces and alcohol-related morbidity and mortality: A prospective cohort study

  2023. Katrina J. Blindow (et al.). Scandinavian Journal of Work, Environment and Health 49 (6), 395-404

  Artikel

  Objective The study investigated experiences of different types of work-related gender-based harassment (GBH), specifically sexual and gender harassment, as risk factors for alcohol-related morbidity and mortality (ARMM).

  Methods Information about experiences of (i) sexual harassment (SH-I) and (ii) gender harassment (GH-I) from inside the organization and (iii) sexual harassment from a person external to the organization (SH-E) were obtained from the Swedish Work Environment Survey 1995–2013, a biannual cross-sectional survey, administered to a representative sample of the Swedish working population. The survey responses from 86 033 individuals were connected to multiple registers containing information about alcohol-related diagnoses, treatment, or cause of death. Cox proportional hazard models were fitted to assess hazard ratios (HR) of incident ARMM during a mean follow-up of eight (SH-I and GH-I) and ten (SH-E) years.

  Results A higher prospective risk estimate of ARMM was found among participants who reported experiences of SH-E [HR 2.01, 95% confidence interval (CI) 1.61–2.52], GH-I (HR 1.33, CI 1.03–1.70), or SH-I (HR 2.37, CI 1.42–3.00). Additional analyses, distinguishing one-time from reoccurring harassment experiences, indicated a dose–response relationship for all three harassment types. Gender did not modify the associations. Under the assumption of causality, 9.3% (95% CI 5.4–13.1) of the risk of ARMM among Swedish women and 2.1% (95% CI 0.6–3.6) among Swedish men would be attributable to any of the three types of GBH included in this study.

  Conclusions Experiences of GBH in the work context may be a highly relevant factor in the etiology of ARMM.

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• Nature-related habits and their development and relation to mental health outcomes during the covid-19 pandemic: a population-based study in Sweden

  2023. Yannick Klein (et al.). International Journal of Behavioral Medicine, 136

  Konferens

  Background: Mental health disorders represent a major public health concern, and significantly contribute to the global burden of disease. The Covid-19 pandemic posed additional challenges for mental health. Spending time in natural environments has been linked to numerous health benefits.

  Purpose: Therefore, the present study investigated the role of different types of nature-related habits for symptoms of depression, anxiety, and loneliness, and their development during the pandemic 2019–2022, in Sweden. Further, we investigated whether nature habits could buffer negative effects of major life events on mental health outcomes (MHO).

  Method: Different types of nature-related habits, symptoms of depression, anxiety, loneliness, major life events, and control variables were assessed via self-report measures, in a sub-sample of respondents to the Swedish Occupational Survey of Health, in 2021 (n = 1 896), and 2022 (n = 1 579). Sequential linear regressions were conducted to analyze relationships between nature-related habits and MHO, while controlling for demographics, SES, relationship status, and pre-pandemic MHO.

  Results: Spending time in nature was consistently associated with fewer symptoms of depression, anxiety, and loneliness during the pandemic after adjusting for control variables. Especially spending time in forest and garden environments were associated with better mental health. Spending time in garden environments buffered effects of major life events on symptoms of depression and anxiety, but not loneliness. Increased nature habits during the pandemic related to improved MHO.

  Conclusions: Spending time in natural environments during the Covid-19 pandemic led to better MHO, with implications for urban development and public health promotion.

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• The role of residential greenspace qualities and it’s closeness for mental health and sleep outcomes: Results from longitudinal studies on nationwide population-based cohorts in Sweden with fine-grained assessments

  2023. Cecilia U. D. Stenfors (et al.). International Journal of Behavioral Medicine, 136

  Konferens

  Background: Mental health and sleeping problems are public health concerns associated with vast costs for society and individuals. Exposure and access to natural environments in terms of greenspace (vegetation) are associated with a range of benefits such as enhanced affect and cognition, and decreased stress. However, population-based studies investigating high-resolution, individual-level residential greenspace are yet lacking, as population-based studies have mainly assessed greenspace at the level of larger areas rather than the individual level. Furthermore, studies on residential greenspace and sleep are scarce.

  Objective & methods: Thus, in a set of large-scale population-based longitudinal studies, on nationwide cohorts in Sweden, objective high-resolution individual-level residential greenspace land cover assessments were made and the role of different greenspace qualities were investigated longitudinally for: 1) self-reported sleeping problems (n = 19 375), 2) objective prescription medication purchase in terms of a) insomnia medications and b) antidepressants (n = 99 036), while controlling for individual and neighbourhood confounders. Multilevel and generalized estimating equation models were conducted to estimate effects.

  Results: Results across studies showed that more residential greenspace primarily in the immediate residential surrounding (50 m and 100 m buffer zones around home) is associated with 1) less sleeping problems, and 2) lower risk of purchasing insomnia and antidepressant prescription medications. Furthermore, among physically active, greenspace further from home also associated with less sleeping problems.

  Conclusions: Results highlight the role of greenspace in the immediate residential surroundings for mental health and sleep outcomes, and the importance of integrating health-, environmental-, urban development- and greening policies, also mitigating climate change.

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• Workplace bullying, symptoms of anxiety and the interaction with leadership quality - a longitudinal study using dynamic panel models with fixed effects

  2023. Rebecka Holmgren (et al.). Scandinavian Journal of Work, Environment and Health 49 (1), 64-74

  Artikel

  Objectives: Workplace bullying has been suggested to increase symptoms of anxiety. A reverse relationship has also been proposed. However, so far only few earlier studies have investigated this topic and the reported associations might partly be explained by unmeasured individual characteristics. In this study, we aim to examine the temporality and directionality between workplace bullying and anxiety symptoms, taking time-invariant characteristics into account. Furthermore, we aim to examine whether leadership quality modifies these associations.

  Methods: We included 13 491 individuals from two nationwide cohort studies in Sweden and Denmark. Using cross-lagged structural equation models (SEM) and dynamic panel models with fixed effects, we examined contemporaneous and lagged associations between self-reported workplace bullying and anxiety. Cohort-specific results were estimated and combined using fixed-effect meta-analysis.

  Results: The cross-lagged SEM models supported contemporaneous and lagged relationships in both directions (from workplace bullying to symptoms of anxiety and vice versa). In contrast, only contemporaneous relationships remained statistically significant and of considerable magnitude in the dynamic panel models with fixed effects. Specifically, exposure to workplace bullying was related to a concurrent increase in anxiety symptoms (b=0.61, 95% confidence interval 0.32–0.90). No support of interaction with leadership quality was found.

  Conclusions: The results indicate that onset of workplace bullying is associated with an immediate or short-term increase in anxiety symptoms. This study provides novel insights regarding temporal aspects and causal inference of the bullying-anxiety relationship useful for managing psychological hazards and preventing mental illness at work.

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• How consistently does sleep quality improve at retirement? Prospective analyses with group-based trajectory models

  2022. Paraskevi Peristera (et al.). Journal of Sleep Research 31 (2)

  Artikel

  Growing evidence indicates that retiring from paid work is associated, at least in the short-term, with dramatic reductions in sleep difficulties and more restorative sleep. However, much is still not known, in particular how universal these improvements are, how long they last, and whether they relate to the work environment. A methodological challenge concerns how to model time when studying abrupt changes such as retirement. Using data from Swedish Longitudinal Occupational Survey of Health (n = 2,148), we studied difficulties falling asleep, difficulties maintaining sleep, premature awakening, restless sleep, a composite scale of these items, and non-restorative sleep. We compared polynomial and B-spline functions to model time in group-based trajectory modelling. We estimated variations in the individual development of sleep difficulties around retirement, relating these to the pre-retirement work environment. Reductions in sleep difficulties at retirement were sudden for all outcomes and were sustained for up to 11 years for non-restorative sleep, premature awakening, and restless sleep. Average patterns masked distinct patterns of change: groups of retirees experiencing greatest pre-retirement sleep difficulties benefitted most from retiring. Higher job demands, lower work time control, lower job control, and working full-time were work factors that accounted membership in these groups. Compared to polynomials, B-spline models more appropriately estimated time around retirement, providing trajectories that were closer to the observed shapes. The study highlights the need to exercise care in modelling time over a sudden transition because using polynomials can generate artefactual uplifts or omit abrupt changes entirely, findings that would have fallacious implications.

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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

  Artikel

  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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• Distance to sports facilities and low frequency of exercise and obesity: a cross-sectional study

  2022. Auriba Raza (et al.). BMC Public Health 22

  Artikel

  Background: Little research has investigated the associations between proximity to physical activity facilities and behavior-related health and the majority have focused on proximity from home address. We add to the literature by examining proximity of these facilities to work and home address and including a wide range of physical activity facilities. We assess the associations for proximity of physical activity facilities from home and work address with self-reported frequency of exercise and obesity.

  Methods: Our analytical sample of 7358 participants was from the 2018 wave of the Swedish Longitudinal Occupational Survey of Health. We used logistic binomial regression adjusting for age, sex, education, civil status, individual socioeconomic status, neighborhood socioeconomic status, number of children under 12 years of age, work strain, and chronic disease.

  Results: Longer distance from home to paid outdoor and paid indoor physical activity facilities was associated with low frequency of exercise (fully adjusted Relative Risk for both 1.01, 95% CI 1.01–1.02). Associations of any or free outdoor facility with low frequency of exercise were not robust. Findings also indicated associations between long distance from workplace to any and paid outdoor facility and low frequency of exercise. Results for obesity were in the similar direction, however, these were not statistically significant.

  Conclusion: Increased distance of paid outdoor and paid indoor physical activity facilities from home and of paid outdoor facilities from work was associated with low frequency of exercise. Longitudinal and larger studies are needed to confirm our findings, particularly regarding obesity.

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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

  Artikel

  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

  Artikel

  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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• Residential Greenspace Is Associated with Lower Levels of Depressive and Burnout Symptoms, and Higher Levels of Life Satisfaction: A Nationwide Population-Based Study in Sweden

  2022. Yannick Klein (et al.). International Journal of Environmental Research and Public Health 19 (9)

  Artikel

  Population-based studies of individual-level residential greenspace and mental health outcomes are still limited. Thus, the present study investigates greenspace–mental health associations—including depressive symptoms, burnout symptoms, and life satisfaction—in a population-based sample of adults, the Swedish Longitudinal Occupational Survey of Health, in 2016 (n = 14,641). High-resolution land cover of greenspace and green–blue-space was assessed at 50, 100, 300 and 500 m buffers around residential addresses. Higher residential greenspace and green–blue-space were associated with lower levels of depressive and burnout symptoms among non-working individuals and with higher life satisfaction in the whole study population, after controlling for age, sex, individual income, and neighborhood socioeconomics. The immediate residential-surrounding environment (50 m) consistently showed the strongest associations with the outcomes. Having a partner was associated with better mental health outcomes and with having more residential greenspace, and adjusting for this rendered greenspace–health associations mostly statistically non-significant. In conclusion, higher levels of greenspace and green–blue-space in the immediate residential-surrounding environment were associated with better mental health outcomes in the present study, which contributes additional nuances to prior studies. The importance of residential greenspace for public health, urban planning, and development is discussed.

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• Sexual and gender harassment and use of psychotropic medication among Swedish workers: a prospective cohort study

  2022. Katrina Julia Blindow (et al.). Occupational and Environmental Medicine 79 (8), 507-513

  Artikel

  OBJECTIVE: To estimate the prospective association between the exposure to three types of gender-based violence and harassment (GBVH) and psychotropic medication.

  METHODS: Information on three measures of workplace GBVH-sexual harassment (1) from superiors or colleagues, (2) from others (eg, clients) and (3) gender harassment from superiors or colleagues-were retrieved from the biannual Swedish Work Environment Survey 2007-2013 (N=23 449), a representative sample of working 16-64 years old registered in Sweden. The survey answers were merged with data on antidepressants, hypnotics/sedatives and anxiolytics from the Swedish Prescribed Drug Register. Cox proportional hazards analyses with days to purchase as time scale and first instance of medicine purchase as failure event were fitted, adjusted for demographic and workplace factors.

  RESULTS: Workers who reported exposure to gender harassment only (HR 1.2, 95% CI 1.07 to 1.36), to sexual but not gender harassment (HR 1.21, 95% CI 1.04 to 1.40), or to gender and sexual harassment (HR 1.31, 95% CI 1.08 to 1.60) had an excess risk of psychotropics use in comparison to workers who reported neither of the exposures in the past 12 months. We found no interaction between the exposures and gender in the association with psychotropics use.

  CONCLUSIONS: Exposure to sexual or gender harassment at the workplace may contribute to the development of mental disorders. 

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• Work stress and loss of years lived without chronic disease: an 18-year follow-up of 1.5 million employees in Denmark

  2022. Jeppe K. Sørensen (et al.). European Journal of Epidemiology 37 (4), 389-400

  Artikel

  We aimed to examine the association between exposure to work stress and chronic disease incidence and loss of chronic disease-free life years in the Danish workforce. The study population included 1,592,491 employees, aged 30–59 in 2000 and without prevalent chronic diseases. We assessed work stress as the combination of job strain and effort-reward imbalance using job exposure matrices. We used Cox regressions to estimate risk of incident hospital-diagnoses or death of chronic diseases (i.e., type 2 diabetes, coronary heart disease, stroke, cancer, asthma, chronic obstructive pulmonary disease, heart failure, and dementia) during 18 years of follow-up and calculated corresponding chronic disease-free life expectancy from age 30 to age 75. Individuals working in occupations with high prevalence of work stress had a higher risk of incident chronic disease compared to those in occupations with low prevalence of work stress (women: HR 1.04 (95% CI 1.02–1.05), men: HR 1.12 (95% CI 1.11–1.14)). The corresponding loss in chronic disease-free life expectancy was 0.25 (95% CI − 0.10 to 0.60) and 0.84 (95% CI 0.56–1.11) years in women and men, respectively. Additional adjustment for health behaviours attenuated these associations among men. We conclude that men working in high-stress occupations have a small loss of years lived without chronic disease compared to men working in low-stress occupations. This finding appeared to be partially attributable to harmful health behaviours. In women, high work stress indicated a very small and statistically non-significant loss of years lived without chronic disease.

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• Workplace bullying and risk of suicide and suicide attempts: A register-based prospective cohort study of 98 330 participants in Denmark

  2022. Paul Maurice Conway (et al.). Scandinavian Journal of Work, Environment and Health 48 (6), 425-434

  Artikel

  Objectives: The aim of this study was to analyze whether individuals reporting exposure to workplace bullying had a higher risk of suicidal behavior, including both suicide attempt and death by suicide, than those not reporting such exposure. Methods: Using a prospective cohort study design, we linked data from nine Danish questionnaire-based surveys (2004–2014) to national registers up to 31 December 2016. Exposure to workplace bullying was measured by a single item. Suicide attempts were identified in hospital registers and death by suicide in the Cause of Death Reg-ister. Among participants with no previous suicide attempts, we estimated hazard ratios (HR) and 95% confidence intervals (CI), adjusting for sex, age, marital status, socioeconomic status, and history of psychiatric morbidity. Results: The sample consisted of 98 330 participants (713 798 person-years), 63.6% were women, and the mean age was 44.5 years. Of these participants, 10 259 (10.4%) reported workplace bullying. During a mean follow-up of 7.3 years, we observed 184 cases of suicidal behavior, including 145 suicide attempts, 35 deaths by suicide and 4 cases that died by suicide after surviving a suicide attempt. The fully-adjusted HR for the association between workplace bullying and suicidal behavior was 1.65 (95% CI 1.06–2.58). The HR for suicide attempts and death by suicide were 1.65 (1.09–2.50) and 2.08 (0.82–5.27), respectively. Analyses stratified by sex showed a sta-tistically significant association between workplace bullying and suicidal behavior among men but not women. Conclusions: The results suggest that exposure to workplace bullying is associated with an elevated risk of suicidal behavior among men.

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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

  Artikel

  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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• The ICT demands index included in the Swedish Longitudinal Occupational Survey of Health (SLOSH)

  2021. M Stadin (et al.). Das Gesundheitswesen 83 (8/9), 674-675

  Artikel

  Purpose: Technostress operationalised as ICT demands is measured by the ICT demands index in the Swedish Longitudinal Occupational Survey of Health (SLOSH). This index is mainly based on findings in a qualitative Swedish study, published in 2003.

  Methods: The index consists of six items, accompanied by five response options rated on a Likert scale. The index is introduced by: ‘New technology and flexible working conditions have changed the working life of many people. Technology can be a great help but can also lead to new kinds of stress. Estimate the extent to which you are stressed by…’. Then follows the items, such as ‘…too many calls and emails’, ‘…demands to give immediate answers to emails and telephone calls that require a lot of work’ and ‘…computers and other digital device that fails to work properly’.

  Results: ICT demands have been observed to be correlated with the demands- and effort dimension in the demand control- and the effort-reward imbalance models, respectively. ICT demands have also been associated with cognitive complaints and suboptimal self-rated health, in cross-sectional- and prospective analyses. However, the ICT demands index in SLOSH have also some limitations. The index does not have a resource dimesion (such as ‘technostress inhibitors’ or ‘ICT resources’) and can thus not be considered a complete measure of technostress. Additionally, the ICT demands index only reflect a smaller part of technostress and does not reflect aspects such as insecurity and uncertainty related to ICT, lack of digital literacy, and ineffective communication. The items might also be somewhat outdated since new ICT demands might have occurred since 2003, such as ICT demands related to new types of digital communication and use of RPA and AI.

  Conclusions: It is warranted to use updated measures of technostress that reflects both ICT demands and resources

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• Commuting distance and behavior-related health

  2021. Auriba Raza (et al.). Preventive Medicine 150

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  Health benefits of active commuting and short commuting time are well-documented; however, limited evidence exists on the effects of commuting distance. We examined longitudinal associations between commuting distance and behavior-related health. Participants were from four survey waves of the Swedish Longitudinal Occupational Survey of Health (2012, 2014, 2016, and 2018). Analytical sample included 11,023 individuals and 21,769 observations. Random effects method used binomial logistic regression with generalized estimating equations. The outcomes were self-reported physical inactivity, overweight, smoking, problem drinking, and disturbed sleep. Models were adjusted for age, sex, occupational position, civil status, chronic disease, work strain, number of children under 12, and home/workplace neighborhood socioeconomic status. Using continuous measure, long commuting distance was associated with a higher odds of physical inactivity (OR 1.06; 95% CI, 1.04–1.09 per doubling of distance), overweight (OR 1.02; 95% CI, 1.00–1.04), and disturbed sleep (OR 1.03; 95% CI, 1.00–1.05) in fully adjusted models. Using categorized measure, individuals who commuted longer distance had a higher odds of physical inactivity compared to those with the shortest commute (3.1 km - <7.9 km vs. <3.1 km: OR 1.15; 95% CI, 1.04–1.28 and 7.9 km - <20 km vs. <3.1 km: OR 1.18; 95% CI, 1.06–1.32, fully adjusted model). Such dose-response associations were not observed for overweight or disturbed sleep. Our results suggest short commuting distance may be beneficial for behavior-related health.

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• Global, regional, and national burdens of ischemic heart disease and stroke attributable to exposure to long working hours for 194 countries, 2000-2016

  2021. Frank Pega (et al.). Environment International 154

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  Background: World Health Organization (WHO) and International Labour Organization (ILO) systematic reviews reported sufficient evidence for higher risks of ischemic heart disease and stroke amongst people working long hours (>= 55 hours/week), compared with people working standard hours (35-40 hours/week). This article presents WHO/ILO Joint Estimates of global, regional, and national exposure to long working hours, for 194 countries, and the attributable burdens of ischemic heart disease and stroke, for 183 countries, by sex and age, for 2000, 2010, and 2016.

  Methods and Findings: We calculated population-attributable fractions from estimates of the population exposed to long working hours and relative risks of exposure on the diseases from the systematic reviews. The exposed population was modelled using data from 2324 cross-sectional surveys and 1742 quarterly survey datasets. Attributable disease burdens were estimated by applying the population-attributable fractions to WHO's Global Health Estimates of total disease burdens.

  Results: In 2016, 488 million people (95% uncertainty range: 472-503 million), or 8.9% (8.6-9.1) of the global population, were exposed to working long hours (>= 55 hours/week). An estimated 745,194 deaths (705,786-784,601) and 23.3 million disability-adjusted life years (22.2-24.4) from ischemic heart disease and stroke combined were attributable to this exposure. The population-attributable fractions for deaths were 3.7% (3.4-4.0) for ischemic heart disease and 6.9% for stroke (6.4-7.5); for disability-adjusted life years they were 5.3% (4.9-5.6) for ischemic heart disease and 9.3% (8.7-9.9) for stroke.

  Conclusions: WHO and ILO estimate exposure to long working hours (>= 55 hours/week) is common and causes large attributable burdens of ischemic heart disease and stroke. Protecting and promoting occupational and workers' safety and health requires interventions to reduce hazardous long working hours.

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• Home and Workplace Neighborhood Socioeconomic Status and Behavior-related Health

  2021. Auriba Raza (et al.). Annals of Behavioral Medicine 55 (8), 779-790

  Artikel

  Background: The influence of individual and home neighborhood socioeconomic status (SES) on health-related behaviors have been widely studied, but the majority of these studies have neglected the possible impact of the workplace neighborhood SES.

  Objective: To examine within-individual associations between home and work place neighborhood SES and health-related behaviors in employed individuals.

  Methods: We used participants from the Swedish Longitudinal Occupational Survey of Health who responded to a minimum of two surveys between 2012 and 2018. Data included 12,932 individuals with a total of 35,332 observations. We used fixed-effects analysis with conditional logistic regression to examine within-individual associations of home, workplace, as well as time-weighted home and workplace neighborhood SES index, with self-reported obesity, physical activity, smoking, excessive alcohol consumption, sedentary lifestyle, and disturbed sleep.

  Results: After adjustment for covariates, participants were more likely to engage in risky alcohol consumption when they worked in a workplace that was located in the highest SES area compared to time when they worked in a workplace that was located in the lowest SES area (adjusted odds ratios 1.98; 95% confidence interval: 1.12 to 3.49). There was an indication of an increased risk of obesity when individuals worked in the highest compared to the time when they worked in the lowest neighborhood SES area (1.71; 1.02–2.87). No associations were observed for the other outcomes.

  Conclusion: These within-individual comparisons suggest that workplace neighborhood SES might have a role in health-related behaviors, particularly alcohol consumption.

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• Interrelationships between job demands, low back pain and depression

  2021. Julia K. Åhlin (et al.). Journal of Affective Disorders 282, 219-226

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  Background: Psychosocial work stressors may lead to low back pain (LBP) through depressive symptoms or to depression through LBP. Depressive symptoms or LBP may also modify these associations.

  Methods: We examined prospective interrelationships between job demands, LBP and depsive symptoms. We used comparable data from three consecutive biennial surveys in 2010-2016, from the Swedish Longitudinal Occupational Survey of Health (SLOSH) and the Work Environment and Health in Denmark (WEHD) cohorts, broadly representative of the working populations in Sweden and Denmark. We conducted multivariate counterfactual based mediation analyses allowing for four-way decomposition of the total effect of job demands, on incident LBP (N=2813, 2701) and incident major depression (N=3707, 5496). The four components estimated direct and indirect effects through mediation and/or interaction.

  Results: We observed no association between job demands and incident LBP four years later, but job demands was associated with later major depression (relative risks=1.88, 95% confidence interval=1.45-2.31 in SLOSH and 1.64, 1.18-2.11 in WEHD, adjusted for age, sex, panel (SLOSH data), education, cohabitation, physically strenuous work and chronic diseases. About 37% of the association was attributed to interaction between job demands and LBP in SLOSH. No interaction was found in WEHD. LBP partly mediated the relationship, by 14% in SLOSH and 2%, while statistically insignificant in WEHD.

  Limitations: Possible limitations include lack of comparable data on disabling low back pain, different scales for depressive symptoms, misclassification and residual confounding. Conclusions: This suggests mainly a direct effect of job demands on major depression, or through other pathways than LBP.

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• Long working hours and risk of 50 health conditions and mortality outcomes

  2021. Jenni Ervasti (et al.). The Lancet Regional Health 11

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  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.

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• Occupational class and employment sector differences in common mental disorders

  2021. Emma Björkenstam (et al.). European Journal of Public Health 31 (4), 809-815

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  Background Recent increases in common mental disorders (CMDs) among young adults are of great concern although studies of CMDs in young employees are sparse. This study investigated the independent and interacting effects of sector of employment, occupational class and CMDs. Additionally, associations between type of employment branch and CMDs within each sector were examined.

  Methods This population-based longitudinal cohort study included 665 138 employees, 19–29 years, residing in Sweden in 2009. Employment sector (i.e. private/public) and occupational class (non-manual/manual workers) were measured in 2009. Risk estimates of CMDs, measured as new prescription of antidepressants and/or psychiatric care with a diagnosis of CMDs, between 2010 and 2016, were calculated as hazard ratios (HRs) with 95% confidence intervals (CIs), using Cox multivariable regression analysis.

  Results Public sector employees (whereof 60% manual workers) had an elevated risk for CMDs compared to private sector employees [adjusted HR: 1.14 (95% CI 1.12–1.16)]. Within each sector, manual workers were at increased risk of CMDs compared to non-manual workers. There was an interaction between sector of employment and occupational class; manual workers in the public sector had the highest CMD risk [adjusted synergy index: 1.51 (95% CI 1.29–1.76)]. The most elevated risk for CMDs was observed in those employed in health and social services and the lowest risk among construction workers.

  Conclusion Sector of employment and occupational class play a role in CMDs in young employees. These findings should be taken into account in the attempts to reduce CMDs in the young working population.

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• Sickness absence due to common mental disorders in young employees in Sweden

  2021. Emma Björkenstam (et al.). Social Psychiatry and Psychiatric Epidemiology

  Artikel

  Background A large proportion of sickness absence (SA) in young adults is due to common mental disorders (CMDs). Still studies on CMD-related SA in young workers are lacking, especially studies for those employed in the private sector. The current study investigated the associations between sector of employment, occupational class and SA due to CMDs. In addition, associations between type of employment branch and SA due CMDs within each sector were examined.

  Methods This population-based longitudinal cohort study included 663,583 employees, 19-29 years, residing in Sweden in 2009. Employment sector (i.e., private/public) and occupational class (non-manual/manual workers) were measured in 2009. Risk estimates of SA due to CMDs, between 2010 and 2016, were calculated as Hazard Ratios (HR) with 95% confidence intervals (CI), using Cox regression analysis.

  Results Sector of employment was associated with SA due to CMDs, such that public sector workers had an elevated risk when compared with private sector employees (adjusted HR: 1.31 (95% CI 1.29-1.33). Moreover, manual workers had a slightly elevated risk for SA due to CMDs compared to non-manual workers. Within the private sector, in both manual and non-manual workers, those employed in education and health and social services evidenced the highest rates and risks of SA due to CMDs.

  Conclusion Sector of employment and occupational class play a role in SA due to CMDs in young employees. These findings should be considered when identifying high-risk groups for SA in the young working population.

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• Technostress operationalised as information and communication technology (ICT) demands among managers and other occupational groups

  2021. Magdalena Stadin (et al.). Computers in human behavior 114

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  Exposure to technostress operationalised as ICT demands is more prevalent in higher socioeconomic groups, but little is known about the exposure in different occupational groups considering industry and position. The aim of the present study was to explore the exposure to ICT demands in managers and other occupational groups. Cross-sectional self-reported data from the Swedish Longitudinal Occupational Survey of Health (SLOSH), collected in 2016 was used, including 13 572 respondents (1 241 'managers', 12 331 'non-managers'). ICT demands based on a six-item Likert scale were analysed as the main measure. 'Managers' (varying industries and positions) in comparison with 'non-managers', including nine occupational groups separated by industry and education level, showed the highest prevalence (74.7%) of ICT demands. 'Managers in health care, other community services and education' showed the highest odds ratio (OR) with 95% Confidence Intervals (CI) of ICT demands, in comparison with 'non-managers' (OR 4.64 [CI 3.26-6.61], and with 'all other managers' (OR 1.55 [CI 1.01-2.38]), after adjustment for sex, age, job strain, and social support. In conclusion, managers have increased odds of exposure to ICT demands, especially managers in health care, other community services and education. Targeted actions to improve the digitalised work environment among managers are warranted.

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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)

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  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 violence and health in human service industries

  2021. Anna Nyberg (et al.). Occupational and Environmental Medicine 78 (2), 69-81

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  Objectives To provide systematically evaluated evidence of prospective associations between exposure to physical, psychological and gender-based violence and health among healthcare, social care and education workers.

  Methods The guidelines on Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. Medline, Cinahl, Web of Science and PsycInfo were searched for population: human service workers; exposure: workplace violence; and study type:prospective or longitudinal in articles published 1990–August 2019. Quality assessment was performed based on a modified version of the Cochrane’s ‘Tool to Assess Risk of Bias in Cohort Studies’.

  Results After deduplication, 3566 studies remained, of which 132 articles were selected for full-text screening and 28 were included in the systematic review. A majority of the studies focused on healthcare personnel, were from the Nordic countries and were assessed to have medium quality. Nine of 11 associations between physical violence and poor mental health were statistically significant, and 3 of 4 associations between physical violence and sickness absence. Ten of 13 associations between psychological violence and poor mental health were statistically significant and 6 of 6 associations between psychological violence and sickness absence. The only study on gender-based violence and health reported a statistically non-significant association.

  Conclusion There is consistent evidence mainly in medium quality studies of prospective associations between psychological violence and poor mental health and sickness absence, and between physical violence and poor mental health in human service workers. More research using objective outcomes, improved exposure assessment and that focus on gender-based violence is needed.

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