Association between workplace bullying and common mental disorders in civil servants from a middle-income country

Workplace bullying (WB) is associated with Common mental disorders (CMD) in high-income countries, but there is a lack of evidence relating to this subject in low- and middle-income countries. Therefore, this study aimed to investigate the association between bullying and CMD in Brazil. A cross-sectional study with 907 judicial civil servants from Porto Alegre, southern Brazil, was carried out. WB was measured by the Negative Acts Questionnaire (NAQ-r) and CMD by the Self-Reporting Questionnaire (SRQ-20). Logistic regression was used to analyse data and test hypotheses. The overall prevalence of CMD was 32.8%, while the overall prevalence of bullying was 18.3%. WB was strongly associated with CMD, even after controlling for confounders. After adjustment for sociodemographic, personality and occupational confounders, weekly and daily exposures to negative acts increased 4.32 (95% CI: 2.00-9.33) and 6.80 (95% CI: 3.42-13.51) times the risk of CMD, respectively. Considering the operational definition, bullied workers had a 3.45 (95% CI: 2.26-5.25) higher risk of CMD. The results are consistent with studies from high-income countries. Different ways of categorising exposure to WB and testing association with CMD are suggested. Interventions to prevent bullying, focusing on work processes and psychosocial factors at work, could reduce the risk of mental health problems

Mental health and quality of life of workers from the socio-educational assistance foundation of Rio Grande do Sul

O trabalho nas Fundações de Atendimento Sócio-Educativo tem sido descrito como grande fonte de adoecimento psíquico. A natureza da atividade desses trabalhadores, em um contexto de condições laborais precárias, inclui, em muitas situações, o convívio cotidiano com violência, estresse e desgaste mental, entre outras condições adversas no trabalho às quais os servidores estão expostos. Este estudo objetivou investigar as associações entre a dimensão psicossocial do trabalho desses funcionários públicos com os sintomas de ansiedade, de depressão e com a qualidade de vida. Utilizou-se metodologia epidemiológica em uma pesquisa de corte transversal, com uma amostra de 214 trabalhadores da instituição, buscando descrever a exposição ao estresse ocupacional e analisando associações de variáveis do estresse com os desfechos (ansiedade, depressão, qualidade de vida). Evidenciaram-se altas prevalências e níveis de estresse, ansiedade, depressão e baixos escores de qualidade de vida em toda a amostra estudada. As casas de internação demonstraram piores resultados em todos os desfechos estudados. As altas demandas psicológicas, o baixo apoio social e o trabalho de alta exigência estiveram associados à ansiedade e depressão. Confirmou-se a hipótese de que um elevado estresse ocupacional está associado a piores escores da qualidade de vida nesses trabalhadores. A ansiedade e a depressão estiveram fortemente correlacionadas a piores escores na qualidade de vida. Diante dessa realidade, é urgente que a instituição desenvolva uma política permanente em saúde do trabalhador que intervenha nos processos de trabalho em todos os níveis da Fundação, com ênfase na organização do trabalho, de modo a prevenir desfechos de saúde mental e a promover uma melhora na qualidade de vida dos servidores.Working on Socio-Educational Assistance Foundation has been described as an important factor of development of mental disorders among employees of these institutions. Their job, in a context of poor working conditions, includes, in many situations, a daily exposure to violence, stress and mental strain, besides other adverse working conditions which labourers face on work. This study aimed to investigate associations between psychosocial factors at work and symptoms of anxiety, depression and quality of life of workers. We used epidemiological methodology in a cross-sectional study, with a sample of 214 workers, seeking to describe the exposure to occupational stress in the workplace and to analyse associations between these variables and outcomes (anxiety, depression, quality of life). Workers had high prevalence and high level of stress, anxiety, depression and had low scores of quality of life in the sample. Workers from juvenile detention centres showed worst results in all outcomes, compared to workers from the administrative centre. High psychological demands, low social support and high-strain job were associated with anxiety and depression. We confirmed the hypothesis that high occupational stress is associated to worse scores of quality of life of workers. Anxiety and depression were strongly correlated with lower scores on quality of life. Therefore developing a permanent policy on occupational health to intervene in the work processes at all levels of the Foundation is an urgent need. Interventions should focus on organizational factors, in order to prevent mental health outcomes and to improve quality of life in this group of civil servants

Workplace Bullying and its Role in Common Mental Disorders and Low Back Pain: a Study with Workers from the Federal Judiciary in Brazil

Introduction: The new models of work management have impacted occupational risks and workers health. In the Brazilian public service, this phenomenon is consolidated with state reform, which started in the 1990s. In this context, psychosocial risk at work, such as stress and bullying, increase, and negatively affect mental and physical health. It may lead to an increase in the occurrence of common mental disorders and musculoskeletal problems such as low back pain. Most studies which evaluate workplace bullying as a determinant of health are from high-income countries, being scarce in low- and middle-income countries. Besides, the mechanisms, confounders and mediators of the association between bullying, mental disorders and musculoskeletal complaints still need further clarification. Objectives: The first paper, a systematic review, aimed to analyse epidemiological studies that have addressed risk factors for workplace bullying, seeking to understand its mechanisms and determination; the other two articles evaluated the prevalence of common mental disorders and low back pain in civil servants of the Federal Judiciary in Porto Alegre, analysing the association between bullying and the health outcomes. Methods: The first paper of the thesis is a systematic review of risk factors for workplace bullying, with focus on epidemiological studies. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyzes) and MOOSE (Meta-Analyzes of Observational Studies in Epidemiology) guidelines were used to describe the selected articles, and the quality was evaluated by the Downs and Black checklist. The second part of the thesis consists of two papers related to a cross-sectional study, with data collected by a web survey between June and October 2018. The online questionnaire addressed demographic, socioeconomic, behavioural, and occupational factors, focusing on work organization, psychosocial factors at work and workplace bullying, as well as the health outcomes. The revised Negative Acts Questionnaire (NAQ-r) was used to assess workplace bullying, the Self- Report Questionnaire (SRQ-20) to measure common mental disorders, and the Nordic Questionnaire to evaluate low back pain. The association between workplace bullying and outcomes was analysed using logistic regression, controlling for confounders, according to a conceptual model. Odds ratios and their confidence intervals were estimated. The heterogeneity test, for categorical variables, and the linear trend test, for continuous or variables with a linear relationship, were used. Results: The Systematic Review comprised 51 papers that evaluated risk factors for bullying, identifying a strong association of occupational and psychosocial factors at work with bullying. Females were at higher risk of bullying in most studies, as well as several occupational factors. Leadership styles, work stress, and other psychosocial factors related to the work organization were strongly associated with bullying. The other two papers analysed 907 civil servants from the federal judiciary of the municipality of Porto Alegre, identifying a prevalence of 32.8% of Common Mental Disorder, 50.1% of lastweek Low Back Pain and 19.3% of Chronic Low Back Pain. The prevalence of bullying was 18.3%, which was strongly associated with goal-based management, occupational stress, and low psychosocial safety in the institution. Psychosocial factors at work were positively associated with common mental disorders and low back pain. Multivariate models showed a strong association of bullying at work with CMD and low back pain, even after adjustment for several confounders and covariates, including some mediators. Discussion: The systematic review showed that epidemiological studies on risk factors for workplace bullying support Leymann's theoretical model, emphasizing the role of work organization and management in determining harassment in workplaces, in contrast to individual factors such as personality. The results of the study with judiciary civil servants corroborated findings of research from high-income countries, showing a positive association of workplace bullying with mental health problems and musculoskeletal pain, and highlighting the role of bullying in both outcomes. The different ways used to categorize bullying, as well as the statistical models we used, with adjustment for several sociodemographic, behavioural and occupational confounders, should guide future analyses of these associations and may help to understand mechanisms that lead workers to health outcomes. The prevention of bullying and health problems such as mental disorders and low back pain demands changes in contextual factors of work organization and organizational culture.Sem bolsaIntrodução: Os novos modelos de gestão do trabalho têm impactado os riscos ocupacionais e a saúde de trabalhadores. No serviço público brasileiro, esse fenômeno se consolida com a Reforma do Estado, iniciada na década de 90. Nesse contexto, os riscos psicossociais do trabalho como o estresse e o assédio moral crescem, afetando negativamente a saúde mental e física, e podendo levar ao aumento da ocorrência de transtornos mentais comuns e problemas osteomusculares, como a dor lombar. A maioria dos estudos que avaliam o assédio moral como determinante da saúde provém de países de alta renda, sendo escassos em países de baixa e média renda. Além disso, os mecanismos, confundidores e mediadores da associação entre assédio moral, transtornos mentais e queixas osteomusculares ainda carecem de melhor elucidação. Objetivos: O artigo de revisão sistemática teve como objetivo analisar estudos epidemiológicos que tenham abordado fatores de risco para o assédio moral no trabalho, buscando compreender seus mecanismos e determinação; os outros dois artigos avaliaram a prevalência de transtornos mentais comuns e dor lombar em servidores públicos do Judiciário Federal do município de Porto Alegre, analisando a associação entre assédio moral e os dois desfechos de saúde. Métodos: O primeiro artigo desta tese é uma revisão sistemática sobre fatores de risco para o assédio moral no trabalho, em uma perspectiva epidemiológica. Utilizaram-se os guidelines PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) e MOOSE (Meta-analyses of Observational Studies in Epidemiology) para descrição dos artigos selecionados, que tiveram sua qualidade avaliada pelo Downs and Black checklist. A segunda parte da tese é composta por dois artigos oriundos de um estudo transversal, com coleta de dados por inquérito virtual entre junho e outubro de 2018. O questionário on-line abordou fatores demográficos, socioeconômicos, comportamentais e ocupacionais, enfocando a organização do trabalho, os aspectos psicossociais do trabalho e o assédio moral, além dos desfechos de saúde. Utilizaram-se o Questionário de Atos Negativos revisado (NAQ-r), para avaliação do assédio moral no trabalho, o Self-Report Questionnaire (SRQ-20) para mensuração dos transtornos mentais comuns e o Questionário Nórdico de Sintomas Osteomusculares para avaliação da dor lombar. A associação entre o assédio moral no trabalho e os desfechos de interesse foi avaliada através de regressão logística, com controle para fatores de confusão, seguindo um modelo conceitual. Estimaram-se as razões de odds e seus respectivos intervalos de confiança, examinando a significância através do teste de heterogeneidade ou, no caso de variáveis contínuas ou com relação linear, pelo teste de tendência linear. Resultados: A Revisão Sistemática abrangeu 51 artigos que avaliaram fatores de risco para o assédio moral, identificando forte associação de variáveis ocupacionais e fatores psicossociais do trabalho com o assédio moral. O sexo feminino esteve associado a um maior risco de assédio moral na maioria dos estudos, assim como diversos fatores ocupacionais. Estilos de liderança, estresse laboral e outros fatores psicossociais que remetem à organização do trabalho estiveram fortemente associados ao assédio moral. Os outros dois artigos analisaram 907 servidores públicos do judiciário federal do município de Porto Alegre, identificando prevalência de Transtorno Mental Comum de 32,8%, de Dor Lombar nos últimos 7 dias de 50,1% e de Dor Lombar Crônica de 19,3%. A prevalência de assédio moral foi de 18,3%, o qual esteve fortemente associado à gestão por metas, ao estresse ocupacional e à baixa segurança psicossocial na instituição. Fatores psicossociais do trabalho estiveram positivamente associados a transtornos mentais comuns e dor lombar. Os modelos multivariáveis demonstraram forte associação do assédio moral no trabalho com TMC e dor lombar, mesmo após controle para diversos fatores de confusão e covariáveis potencialmente mediadoras. Discussão: Por meio da revisão sistemática, evidenciou-se que os estudos epidemiológicos sobre fatores de risco para assédio moral dão suporte ao modelo teórico de Leymann, enfatizando o papel da organização e da gestão trabalho na determinação do assédio, em detrimento de outros fatores individuais como a personalidade. Os resultados do estudo com os servidores públicos do Judiciário Federal corroboraram achados de estudos de países de alta renda, no que tange à associação de assédio moral com os desfechos de saúde mental e dor osteomuscular, ressaltando o assédio moral como importante fator de risco para tais desfechos de saúde. As diferentes formas utilizadas para categorização do assédio moral, assim como os vários modelos estatísticos utilizados, com ajuste para diversos fatores de confusão, incluindo variáveis sociodemográficas, comportamentais e ocupacionais, orientam futuras análises dessas associações, podendo facilitar o entendimento dos mecanismos que levam os trabalhadores ao adoecimento. A prevenção do assédio moral e dos problemas de saúde como os transtornos mentais e a dor lombar demanda mudanças em fatores contextuais da organização do trabalho e da cultura das organizações

Occupational stress in workers from a socio-educational assistance foundation : prevalence and associated factors

Contexto: São raros os estudos sobre trabalho e saúde nas Fundações de Atendimento Socioeducativo (FASE). A literatura científica existente sobre o assunto indica que as atividades desenvolvidas nessas instituições podem ser fonte de estresse e adoecimento psíquico. Objetivos: Tendo em vista o importante papel do estresse em diversos desfechos de saúde, este estudo objetivou descrever a prevalência de estresse ocupacional e seus fatores associados em trabalhadores da Fundação de Atendimento Socioeducativo do Rio Grande do Sul (FASE-RS). Métodos: Estudo transversal com amostra de 211 trabalhadores. Utilizou-se a Job Stress Scale para a mensuração do estresse ocupacional por meio do modelo demanda-controle. Estatística descritiva, testes t de Student e χ2, regressão de Poisson e teste de Wald foram utilizados para a apresentação dos resultados, a análise das diferenças entre grupos e o controle de confundidores. Resultados: Os trabalhadores dos Centros de Atendimento Socioeducativo (CASE), que laboram diretamente com jovens em cumprimento de medida socioeducativa, apresentam 41,2% de prevalência de trabalho de alta exigência, enquanto nos profissionais da Sede Administrativa (SEDE) esse percentual é de 9,3%. Alta demanda psicológica esteve presente em 68,7% dos servidores dos CASE e em 34,9% dos trabalhadores da SEDE. Baixo controle sobre o trabalho e baixo apoio social estiveram presentes em 38 e 24,8% dos profissionais da SEDE e em 57,8 e 85,3% dos trabalhadores dos CASE, respectivamente. Violência, regime de trabalho, ter contato com jovens que cumprem medida socioeducativa e horas extras foram os fatores mais fortemente associados ao estresse. Conclusões: Existe alta exposição ao estresse ocupacional nessa população, o que demanda intervenções nos processos de trabalho para diminuir o risco de adoecimento.Background: Studies addressing work and health in socio-educational support foundations are rare. According to the available literature, the activities performed at such institutions might be a source of stress and mental illness. Objectives: Considering the relevant role of stress in several health outcomes, the present study sought to establish the prevalence of occupational stress and related factors among workers at Socio-educational Assistance Foundation of Rio Grande do Sul, Brazil (Fundação de Atendimento Socioeducativo do Rio Grande do Sul, FASE-RS). Methods: Cross-sectional study conducted with a sample comprising 211 employees, who responded the Job Stress Scale to assess occupational stress, based on the demand-control model. We used descriptive statistics, Student’s t test, the χ2 test, Poisson multiple regression and the Wald test to describe the sample data, compare between groups, analyze differences in prevalence and control confounders. Results: The prevalence of high job strain was 41.2% among the employees allocated to Socioeducational Assistance Centers (Centros de Atendimento Socioeducativo, CASE), who provide direct care to youths on probation, and 9.3% among the employees allocated to the Administration Section (Sede Administrativa, SEDE). The prevalence of high psychological demand was 68.7% and 34.9% among CASE and SEDE workers, respectively. The prevalence of low work control and low social support was 38% and 24.8% for SEDE employees and 57.8% and 85.3% among CASE workers, respectively. Violence, shift work, contact with youths on probation and overtime were the factors more strongly associated with stress. Conclusion: The analyzed population exhibits high exposure to occupational stress, which demands interventions in the work process to reduce the risk of illness among these workers

Occupational stress in workers from a socio-educational assistance foundation : prevalence and associated factors

Contexto: São raros os estudos sobre trabalho e saúde nas Fundações de Atendimento Socioeducativo (FASE). A literatura científica existente sobre o assunto indica que as atividades desenvolvidas nessas instituições podem ser fonte de estresse e adoecimento psíquico. Objetivos: Tendo em vista o importante papel do estresse em diversos desfechos de saúde, este estudo objetivou descrever a prevalência de estresse ocupacional e seus fatores associados em trabalhadores da Fundação de Atendimento Socioeducativo do Rio Grande do Sul (FASE-RS). Métodos: Estudo transversal com amostra de 211 trabalhadores. Utilizou-se a Job Stress Scale para a mensuração do estresse ocupacional por meio do modelo demanda-controle. Estatística descritiva, testes t de Student e χ2, regressão de Poisson e teste de Wald foram utilizados para a apresentação dos resultados, a análise das diferenças entre grupos e o controle de confundidores. Resultados: Os trabalhadores dos Centros de Atendimento Socioeducativo (CASE), que laboram diretamente com jovens em cumprimento de medida socioeducativa, apresentam 41,2% de prevalência de trabalho de alta exigência, enquanto nos profissionais da Sede Administrativa (SEDE) esse percentual é de 9,3%. Alta demanda psicológica esteve presente em 68,7% dos servidores dos CASE e em 34,9% dos trabalhadores da SEDE. Baixo controle sobre o trabalho e baixo apoio social estiveram presentes em 38 e 24,8% dos profissionais da SEDE e em 57,8 e 85,3% dos trabalhadores dos CASE, respectivamente. Violência, regime de trabalho, ter contato com jovens que cumprem medida socioeducativa e horas extras foram os fatores mais fortemente associados ao estresse. Conclusões: Existe alta exposição ao estresse ocupacional nessa população, o que demanda intervenções nos processos de trabalho para diminuir o risco de adoecimento.Background: Studies addressing work and health in socio-educational support foundations are rare. According to the available literature, the activities performed at such institutions might be a source of stress and mental illness. Objectives: Considering the relevant role of stress in several health outcomes, the present study sought to establish the prevalence of occupational stress and related factors among workers at Socio-educational Assistance Foundation of Rio Grande do Sul, Brazil (Fundação de Atendimento Socioeducativo do Rio Grande do Sul, FASE-RS). Methods: Cross-sectional study conducted with a sample comprising 211 employees, who responded the Job Stress Scale to assess occupational stress, based on the demand-control model. We used descriptive statistics, Student’s t test, the χ2 test, Poisson multiple regression and the Wald test to describe the sample data, compare between groups, analyze differences in prevalence and control confounders. Results: The prevalence of high job strain was 41.2% among the employees allocated to Socioeducational Assistance Centers (Centros de Atendimento Socioeducativo, CASE), who provide direct care to youths on probation, and 9.3% among the employees allocated to the Administration Section (Sede Administrativa, SEDE). The prevalence of high psychological demand was 68.7% and 34.9% among CASE and SEDE workers, respectively. The prevalence of low work control and low social support was 38% and 24.8% for SEDE employees and 57.8% and 85.3% among CASE workers, respectively. Violence, shift work, contact with youths on probation and overtime were the factors more strongly associated with stress. Conclusion: The analyzed population exhibits high exposure to occupational stress, which demands interventions in the work process to reduce the risk of illness among these workers

Residência médica e multiprofissional: demandas e recursos de preceptores na atenção primária à saúde

Primary Health Care (PHC) is the strategy advocated by the SUS to change the health care model, which implies the need to train more professionals in this area. Thus, there was greater space for Residency Programs, which advocate in-service training, with the preceptor responsible for direct supervision of practical activities carried out by residents. This research brings the main demands and resources of the work of preceptors of an Integrated Medical and Multiprofessional Residency Program, at PHC, from the perspective of the Job Demands and Resources (JDR) Model. The research is part of a master's thesis, with a qualitative approach and methodology of Convergent Care Research (CCR). For data collection, semi-structured interviews and convergent groups were carried out in a virtual format. Ten professionals from PHC, linked to the Residency Program, participated in the research. Demands were identified such as: excess of activities, lack of clarity in functions, devaluation, insecurity of rights, political conflicts, intensity of the preceptor and resident relationship, fragility in the relationship with the institution and as resources the investment in permanent education and political organization. The contributions of these professionals, in the interface between teaching and service, should be valued in the consolidation of health education.A Atenção Primária à Saúde (APS) é a estratégia preconizada pelo SUS para uma mudança do modelo de atenção à saúde, o que implica a necessidade de formar mais profissionais para essa área. Assim, há maior espaço para Programas de Residência que preconizam a formação em serviço, tendo um preceptor responsável pela supervisão direta das atividades práticas realizadas pelos residentes. Esta pesquisa traz as principais demandas e recursos do trabalho dos preceptores de um Programa Integrado de Residência Médica e Multiprofissional, na APS, sob a ótica do Modelo Job Demands and Resources (JDR). A pesquisa é recorte de dissertação de mestrado, com abordagem qualitativa e metodologia da Pesquisa Convergente Assistencial (PCA). Para a coleta de dados, foram realizadas, em formato virtual, entrevistas semiestruturadas e reuniões em formato de grupos convergentes. Participaram da pesquisa dez profissionais da APS vinculados ao Programa de Residência. Foram identificadas demandas relacionadas a excesso de atividades, falta de clareza nas funções, desvalorização, insegurança de direitos, conflitos políticos, intensidade da relação entre preceptor e residente, fragilidade da relação com a instituição, bem como a recursos, como o investimento em educação permanente e a organização política. As contribuições desses profissionais na interface entre ensino e serviço devem ser valorizadas na consolidação da formação em saúde

The Role of Workplace Bullying in Low Back Pain: A Study With Civil Servants From a Middle-Income Country.

This is a cross-sectional study that analysed the association between workplace bullying and LBP. The participants were 894 judicial civil servants from Porto Alegre, southern Brazil. Workplace Bullying was measured by the Negative Acts Questionnaire (NAQ-r) and Low Back Pain by the Nordic Questionnaire for Musculoskeletal Symptoms (NQMS). Logistic Regression was used to analyse data and test hypotheses. The prevalence of LBP in the last 7 days was 50.1%, while the overall prevalence of Chronic LBP was 19.3%. Some psychosocial factors at work were strongly associated with both outcomes. Workplace bullying was strongly associated with LBP, even after adjustment for several covariates. The odds of LBP in the last 7 days among bullied workers was 1.89 (95% CI: 1.31-2.71) times higher, compared to non-bullied. Workplace bullying was also associated with chronic LBP after adjustment for sociodemographic, behavioural and some occupational factors (OR = 1.60; 95% CI: 1.05-2.44). Psychosocial factors at work, and particularly workplace bullying, were strong risk factors for LBP, in contrast to most individual factors, and dose-response patterns were showed. Positive associations between bullying and LBP raise hypotheses on causation, and the role of psychosocial factors at work are discussed. Further longitudinal studies should address these hypotheses, investigating causal paths, mechanisms and possible mediation. PERSPECTIVES: As a psychosocial risk, workplace bullying may play a role in low back pain and can be focus of interventions to prevent LBP. Dose-response patterns on the association between workplace bullying and low back pain are discussed and hypotheses are raised. The paper addresses different ways of measuring and categorising bullying at work, in order to study the relationship between bullying and pain

First- and last-year medical students : is there a difference in the prevalence and intensity of anxiety and depressive symptoms?

Objective: Medical training is considered a significant stress factor. We sought to assess the prevalence and intensity of anxiety and depressive symptoms in medical students and compare samples of first-year and sixth-year students. Method: This was a cross-sectional study of first- and sixth-year medical students who attended classes regularly. The study instruments were a sociodemographic questionnaire, the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI). Results: A total of 232 students (110 first-year, 122 sixth-year) completed the questionnaires, for a response rate of 67.4%. Overall 50.4% of respondents were male (56.4% of first-year and 45.1% of sixth-year students). Anxiety symptoms were reported by 30.8% of first-year students and 9.4% of sixth-year students (p , 0.001). Female students were more affected by anxiety. There were no significant between-group differences in depressive symptoms. Conclusion: A higher prevalence of anxiety symptoms was found in first-year medical students as compared with sixth-year students. Strategies should be developed to help medical students, particularly female students, manage these symptoms at the beginning of their medical training