Transcript Psychosocial factors at work in the aetiology of mental disorders

Psychosocial factors at work in the
aetiology of mental disorders
Teija Honkonen
MD, Psychiatrist, FIOH
14.1.2004
Psychosocial factors at work and
mental disorders
• Mental disorders are common in the workforce
• Until recently there has been a dearth of research
on work-related factors as predictors of mental
disorders
Definition of mental disorder
According to DSM-IV, American Psychiatric Association
• Each of the mental disorders is conceptualized as a
clinically significant behavioral or psychological
syndrome or pattern that occurs in an individual
and that is associated with present distress or
disability or with a significantly increased risk of
suffering death, pain, disability or an important
loss of freedom
Psychosocial strain factors at work
may refer to
• Work characteristics
• Social relationships at work
• Organizational factors at work
Job strain models
• Job strain derives from (Karasek and Theorell 1990)
– high work demands
– low job control
– low levels of social support at work
• Job strain derives from (Siegrist 1996)
– effort-reward imbalance
Assessment of job strain
• Most of the assessment tools are questionnaires
• However, it is not easy to find out, to what extent
the worker's self-report reflects the characteristics
of the work and work environment, and to what
extent the worker's individual way to interpret his
or her work environment
Psychosocial work
characteristics and mental health
- Cross-sectional studies
• The association between psychosocial factors at
work and depressive symptoms or disorders has
been shown in several cross-sectional studies
Psychosocial work
characteristics and mental health
- Longitudinal studies
• The Whitehall II-study in England
• The GAZEL-study in France
• The "Work and Health in Finnish Hospital
Personnel" -study in Finland
The Whitehall II-study
• North et al.:
– Psychosocial work environment and sickness absence
among British civil servants: the Whitehal II study. Am J
Public Health 1996; 86: 332-40
• Stansfeld et al. :
– Work and psychiatric disorder in the Whitehall II Study. J
Psychosom Res 1997; 43: 73-81
• Stansfeld et al.:
– Work characteristics predict psychiatric disorder:
prospective results from the Whitehall II Study. Occup
Environ Med 1999; 56:302-7
The Whitehall II-study
• Prospective cohort study in London, UK
– nearly 7000 male and over 3000 female civil
servants
– age at baseline 35-55 years
• Phase 1: baseline study during 1985-1988
• Phase 2: follow-up in 1989
• Phase 3: follow-up in 1991-1993
Stansfeld et al. 1997
The Whitehall II-study
• Measurement of work characteristics
– work demands and decision latitude, social support at
work
– effort-reward imbalance
• Assessment of psychiatric disorder
– GHQ-30 (case: 5 or more)
• Assessment of negative affectivity and hostility
Stansfeld et al. 1999
The Whitehall II-study
- Risk factors of psychiatric symptoms
• High level of psychological demands
• Low level of decision latitude
• Low level of social support at work
• Effort-reward imbalance
Stansfeld et al. 1999
The Whitehall II-study
- Psychosocial work chracteristics and
sickness absence
• Low demands at work, low decision latitude of the
employee and low social support at work were in
connection with the amount of sickness absence,
particularly among male employees
North et al. 1996
The GAZEL-study
• Niedhammer et al.
– Psychosocial factors at work and subsequent
depressive symptoms in the Gazel cohort. Scand
J Work Environ Health 1998; 24(3):197-205.
• Paterniti et al.
– Psychosocial factors at work, personality traits
and depressive symptoms. Longitudinal results
from the GAZEL Study. Br J Psychiatry 2002;
181:111-7.
The GAZEL-study
• An ongoing longitudinal study including over
20 000 subjects working at the French National
Electricity and GAS Company
• The aim of the GAZEL Study was to investigate
the occupational risk factors of impaired physical
and mental health
• Since 1989 the cohort has been followed by means
of yearly self-administered questionnaires
The GAZEL-study
• This study attempted to establish whether
psychosocial factors at work are predictors of
depressive symptoms
• The present study included nearly 12 000 subjects
from the original GAZEL cohort
• The follow-up period was 1 year
Niedhammer et al. 1998
The GAZEL-study
• Data were obtained by the self-administered
questionnaire for
– psychosocial work characteristics in 1995
– depressive symptoms (CES-D-depression scale)
in 1996
Niedhammer et al. 1998
The GAZEL-study
- Predictors of subsequent depressive
symptoms
• High levels of psychological demands
• Low levels of decision latitude
• Low levels of social support at work
Niedhammer at al. 1998
The GAZEL-study
- Psychosocial factors at work and
sickness absence
• Low levels of decision latitude were associated
with more frequent and longer sickness absences
among men and women
• Low levels of social support at work increased the
numbers of spells and days of absence among men
only
Niedhammer et al.1998
The GAZEL-study
• To examine the relationship between psychosocial
factors at work and changes in depressive
symptoms
• The study included nearly 8000 men and 3000
women
• The follow up period was 3 years
Paterniti et al. 2002
The GAZEL-study
• Data were obtained by the self-administered
questionnaire for psychosocial work factors and
depressive symptoms (CES-D-depression scale)
• Personality traits (pattern A behaviour, low selfesteem, hostility) were taken into account
Paterniti et al. 2002
The GAZEL-study
- Psychosocial factors at work and
depressive symptoms
• In both genders, high job demands and low social
support at work were predictive of increased
depression scores
• In men, high decision latitude was predictive of a
decrease in the depression scores
• Adverse psychosocial work conditions are predictors of
depressive symptoms, independent of personality traits
Paterniti et al. 2002
"Work and Health in Finnish Hospital
Personnel" -study: Workplace bullying
• Kivimäki M, Elovainio M, Vahtera J.
– Workplace bullying and sickness absence in
hospital staff. Occup Environ Med 2000; 57:
656-660
• Kivimäki M, Virtanen M, Vartia M et al.
– Workplace bullying and the risk of
cardiovascular disease and depression. Occup
Environ Med 2003; 60: 779-83
Workplace bullying and depression
• At baseline the prevalence of workplace bullying
was 5%, and 6% after a follow up of 2 years
• At both phases workplace bullying was reported
by 2% of the employees (long-term workplace
bullying)
• The risk for depression was 4 fold after workplace
bullying lasting over 2
Kivimäki et al., 2003
Workplace bullying and sickness absence
in hospital staff
• Workplace bullying is associated with an increase
in the sickness absenteeism of the hospital staff
• The risk of medically certified sickness absence
was 26 % greater in the victims than among the
others.
Kivimäki et al. 2000
The "Work and Health in Finnish Hospital
Personnel" -study: Organizational justice
• Elovainio M, Kivimäki M, Vahtera J.
– Organizational justice: evidence of a new psychosocial
predictor of health. Am J Public Health 2002; 92: 105-8.
• Kivimäki M, Elovainio M, Vahtera J, et al.
– Organisational justice and health of employees:
prospective cohort study. Occup Environ Med 2003;
60:27-34.
• Kivimäki M, Elovainio M, Vahtera J, et al.
– Association between organizational inequity and
incidence of psychiatric disorders in female employees.
Psychol Med; 2003; 33: 319-26.
What is "Organizational justice"?
• The term "organizational justice" refers to the
extent to which employees are treated with justice
at their workplace
• A procedural component indicates
– whether decision making procedures include input from
affected parties, are consistently applied, suppress bias,
are accurate, are correctable, and are ethical
• A relational component refers to
– the polite and considerate treatment of individuals by
supervisors
Organizational justice and sickness
absences
• Low procedural and relational justice has been
associated with increased risk of sickness absence
and minor psychiatric morbidity in men and
women in a cross sectional (Elovainio ym. 2002)
and a longitudinal study (Kivimäki ym. 2003)
.
Organizational inequity and incidence of
psychiatric disorders
• A cohort of around 2000 female hospital employees with
no psychiatric disorder at baseline responded to a
questionnaire on organizational equity
• From the responses, both an individual score and work unit
mean score were assigned to each participant
• The outcome variable was new reports of doctor-diagnosed
psychiatric disorders during the 2-year follow-up.
Kivimäki et al. 2003
Organizational inequity and incidence of
psychiatric disorders
• Low procedural justice seems to be an independent risk
factor for psychiatric disorders in female employees
• Odds ratio of new psychiatric disorders for self-reported low
procedural justice was 1.9
• Odds ratio for low procedural justice, as assessed with work
unit mean scores, was 1.7
Kivimäki et al. 2003
Longitudinal studies of psychosocial work
characteristics and mental health
- Summary
• The results of the prospective longitudinal studies
indicate that negative work characteristics as well
as problems in social relationships at work and in
supervisory practices may increase risk of mental
disordes
Longitudinal studies
- Methodological limitations
• Work characteristics have been measured mostly
by self-reports
• No structured assessment methods have been used
for diagnosing mental disorders
• Personality factors have not been taken into
account comprehensively
Psychosocial work load and mental disorders
- Conclusions I
• The health risks at the group level: prevention of
health problems may be possible
• Intervention studies are needed in order to
evaluate whether it is possible to gain mental
health advantages by developing work and work
environment
Psychosocial work load and mental disorders
- Conclusions II
• The early recognition and treatment of mental
disorders, particularly depressive disorders, is
essential
• The support of the employees in ill health, is also
important